2016 研究助成 Research Grant Program  /  (B)個人研究助成  
(Grant Number)
(Project Title)
Dilemmas for Medical Professionals in Determining the Course of Care for Oldest-Old Patients: Reconsidering "cure-oriented" values in the realm of medicine
島田 千穂
Chiho Shimada
Human Care Research Team, Tokyo Metropolitan Institute of Gerontology
(Grant Amount)
企画書・概要 (Abstract of Project Proposal)


    Recent advances in medical technology have increasingly complicated the way of determining the course of care for oldest-old adults in acute-care settings. On the one hand, development of less invasive techniques has made it difficult to justify withholding medical treatment for these adults simply on the grounds of their frailty and vulnerability. On the other hand, it is open to question whether these techniques can extend the lives of oldest-old patients while maintaining their quality of life. Accordingly, physicians and health care professionals are likely to face a formidable dilemma in their search for the optimal acute-phase treatment for oldest-old adults. 
    My aim in this project is to introduce a new scheme for determining the treatments for oldest-old patients in an acute stage. To this end, I organize a series of conferences in which physicians, nurses, and other health care professionals as well as specialists in the field of medical ethics participate and discuss ethical dilemmas that these professionals can and do experience in attempts to choose an appropriate treatment for oldest-old patients. On the basis of potential approaches to these solutions that are identified and evaluated in the conferences, I seek to propose guideposts along which to provide acute-phase treatments for oldest-old adults. I will also examine whether these guideposts are relevant and applicable to actual clinical practices in acute-care settings. 
    Findings from this project will serve as an empirical foundation to develop a new value in health care decisions that are needed in super-aging society. In the realm of medicine, attention has been focused on elimination of diseases in the pursuit of longevity, which has increased the volume of medical care provided for older patients. Through intensive, ethical examinations on the implications of providing highly sophisticated treatments for oldest-old patients, this project will help to reconsider such predominant, "cure-oriented" values in the delivery of health care.

実施報告書・概要 (Summary of Final Report)








Japan faces the fastest societal aging in the world. Patients have the right to receive medical treatment regardless of how old they are, however not every treatment helps to improve patients’ quality of life. Even though physicians know that providing medical treatment can be harmful for patients under some conditions, family members sometimes require that these patients receive treatment, which causes dilemma to medical staff working in acute hospitals. The purpose of this research project is to clarify situations under which medical staff experience such dilemma in the struggle for appropriate treatment for older patients.
Fifty-three physicians and 358 nurses working at 5 acute hospitals participated in our survey. They first read a fictional story of older patients with different conditions and circumstances. For each patient, they then answered the type of treatment they considered appropriate and what treatment was likely to be provided in hospitals where they worked. The results show that both physicians and nurses tended to choose more aggressive treatment as likely to be provided in their hospitals compared with the type of treatment they considered as appropriate. The gap between likely and appropriate treatment was wider in the case of the fictional situation where the patient’s and family member’s wishes differed.
Based on the results of survey, 2 group interviews were conducted. One physician and 4 nurses working at acute hospitals participated in each group. They discussed that there are several obstacles to achieving appropriate decision making for patients based on their wishes. First, patients do not tell their wish clearly although medical staff wants to know it. Some patients cannot communicate their wish because of deteriorating cognitive functions. Second, they want to know what lies behind patients’ wish, which helps medical staff to make a medical decision for these patients. Third, some patients seem to feel pain in receiving treatment. It is difficult to judge whether to continue the treatment or not. Fourth, they want to decide patient’s treatment based not only on patients’ conditions but on their families’ circumstances, which is as important. Fifth, they seek to collaborate with community physicians and care providers when making a decision because only limited information can be obtained at acute hospitals. However, they do not necessarily have a network with medical and care service providers in communities. Lastly, they have difficulty identifying the optimal timing to cease aggressive treatment and shift patients to a palliative care setting. They want more chances to talk with patients in order to understand their thoughts and values concerning how they wish to live their life, which cannot always be done because of time constraints.
As a result of this project, I created a booklet for patients and their families who worry about a medical decision that they may or do have to make. This booklet might help patients and their families to think about what it is like to live while receiving medical treatment until the end, which they may experience in the future.

ホームページへのリンク ◆トヨタ財団WEBサイト内関連記事