{"id":1506,"date":"2018-05-23T10:54:33","date_gmt":"2018-05-23T01:54:33","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=1506"},"modified":"2018-05-23T11:11:30","modified_gmt":"2018-05-23T02:11:30","slug":"%e7%97%85%e9%99%a2%e3%81%ab%e3%81%8a%e3%81%91%e3%82%8b%e7%b5%82%e6%9c%ab%e6%9c%9f%e6%82%a3%e8%80%85%e3%81%ae%e6%b2%bb%e7%99%82%e7%9b%ae%e6%a8%99%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e6%84%8f%e5%bf%97","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=1506","title":{"rendered":"\u75c5\u9662\u306b\u304a\u3051\u308b\u7d42\u672b\u671f\u60a3\u8005\u306e\u6cbb\u7642\u76ee\u6a19\u306b\u5bfe\u3059\u308b\u610f\u5fd7\u6c7a\u5b9a\u306e\u969c\u58c1\u56e0\u5b50\u306b\u3064\u3044\u3066"},"content":{"rendered":"<p>\uff0d\u6587\u732e\u540d\uff0d<br \/>\nBarriers to Goals of Care Discussions With Seriously ill Hospitalized Patients and Their Families A Multicenter Survey of Clinicians<br \/>\nohn J. You, MD, MSc1,2; James Downar, MDCM, MHSc3,4; Robert A. Fowler, MDCM, Epi5,6; et al<br \/>\nJAMA Intern Med. 2015;175(4):549-556. doi:10.1001\/jamainternmed.2014.7732<\/p>\n<p>\uff0dIntroduction\uff0d<br \/>\n\u7d42\u672b\u671f\u306e\u5165\u9662\u60a3\u8005\u306b\u5bfe\u3057\u3066\u3001\u30b1\u30a2\u306e\u76ee\u6a19\u306b\u5bfe\u3059\u308b\u30b3\u30df\u30e5\u30cb\u30b1\u30fc\u30b7\u30e7\u30f3\u3068\u610f\u5fd7\u6c7a\u5b9a\u304cEOL(end of life)\u306e\u30b1\u30a2\u306e\u8cea\u3092\u5411\u4e0a\u3055\u305b\u308b\u512a\u5148\u4e8b\u9805\u3067\u3042\u308b\u3002EOL\u306e\u30b1\u30a2\u306e\u8cea\u3092\u6539\u5584\u3059\u308b\u305f\u3081\u306b\u306f\u65e2\u5b58\u306e\u969c\u58c1\u3092\u53d6\u308a\u9664\u304f\u5fc5\u8981\u304c\u3042\u308b\u3002\u305f\u3060\u3001\u4eca\u307e\u3067\u3053\u308c\u3089\u306b\u5bfe\u3059\u308b\u75c5\u68df\u306e\u81e8\u5e8a\u5bb6\u306e\u898b\u89e3\u3092\u660e\u3089\u304b\u306b\u3057\u305f\u8ad6\u6587\u306f\u306a\u304b\u3063\u305f\u3002\u76ee\u7684\u3068\u3057\u3066\u306f\u75c5\u9662\u81e8\u5e8a\u5bb6\u306e\u89b3\u70b9\u304b\u30891\u7d42\u672b\u671f\u60a3\u8005\u3068\u305d\u306e\u5bb6\u65cf\u3068\u306e\u30b1\u30a2\u306e\u76ee\u6a19\u3092\u963b\u5bb3\u3059\u308b\u56e0\u5b50\u306b\u3064\u3044\u3066\u30012\u81e8\u5e8a\u5bb6\u304c\u3053\u306e\u30d7\u30ed\u30bb\u30b9\u306b\u5f93\u4e8b\u3059\u308b\u610f\u6b32\u3068\u53d7\u3051\u5165\u308c\u306b\u3064\u3044\u3066\u8abf\u67fb\u3059\u308b\u3053\u3068\u3067\u3042\u308b\u3002<\/p>\n<p>\uff0dMethod\uff0d<br \/>\n\u30ab\u30ca\u30c0\u306e5\u3064\u306e\u5dde\u306e\u6559\u80b2\u65bd\u8a2d\u3067\u3042\u308b13\u306e\u75c5\u9662\u3067\u52e4\u52d9\u3057\u3066\u3044\u308b\u5185\u79d1\u30b9\u30bf\u30c3\u30d5\u3001\u5185\u79d1\u30ec\u30b8\u30c7\u30f3\u30c8\u3001\u770b\u8b77\u5e2b\u3092\u5bfe\u8c61\u3068\u3057\u3001\u533b\u5e2b\u3001\u770b\u8b77\u5e2b\u3067\u500b\u5225\u6027\u3092\u6301\u3064\u30a2\u30f3\u30b1\u30fc\u30c8\u30923\u6bb5\u968e\u3067\u4f5c\u6210\u3057\u305f\u3002\u30a2\u30f3\u30b1\u30fc\u30c8\u306e\u5185\u5bb9\u306b\u95a2\u3057\u3066\u306f\u3001\u6700\u521d\u306e\u30bb\u30af\u30b7\u30e7\u30f3\u306f\u81e8\u5e8a\u554f\u984c(Box)\u3092\u8aad\u3093\u3067\u3082\u3089\u3044\u3001\u305d\u306e\u4e2d\u3067\u60a3\u8005\u3068\u610f\u5fd7\u6c7a\u5b9a\u3092\u8b70\u8ad6\u3059\u308b\u4e0a\u3067\u306e21\u306e\u969c\u58c1(\u5bb6\u65cf\u3001\u60a3\u8005\u56e0\u5b50\u306b\u95a2\u308f\u308b\u3082\u306e\u304c10\u500b\u3001\u81e8\u5e8a\u533b\u306e\u8981\u56e0\u304c4\u3064\u3001\u30b7\u30b9\u30c6\u30e0\u306b\u95a2\u3059\u308b\u8981\u56e0\u304c7\u3064)\u306e\u91cd\u8981\u6027\u306b\u3064\u3044\u3066\u3001\u4e3b\u8981\u30a2\u30a6\u30c8\u30ab\u30e0\u3068\u3057\u30667\u70b9\u30b9\u30b1\u30fc\u30eb(1\u91cd\u8981\u3067\u306a\u30447\u975e\u5e38\u306b\u91cd\u8981)\u3067\u8a55\u4fa1\u3059\u308b\u3088\u3046\u306b\u56de\u7b54\u3002<br 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\/>\n\u89e3\u7b54\u306b\u95a2\u3057\u3066\u306f\u30b9\u30bf\u30c3\u30d5\u533b\u5e2b\u3001\u30ec\u30b8\u30c7\u30f3\u30c8\u3001\u770b\u8b77\u5e2b\u306b\u5206\u3051\u3066\u8a18\u8f09\u3002\u30ab\u30c6\u30b4\u30ea\u5909\u6570\u306f\u30ab\u30a6\u30f3\u30c8\u3068\u30d1\u30fc\u30bb\u30f3\u30c6\u30fc\u30b8\u3001\u9023\u7d9a\u5909\u6570\u306f\u5e73\u5747\u3068\u6a19\u6e96\u504f\u5dee\u3067\u8a18\u8f09\u3002\u5e73\u5747\u3068\u969c\u58c1\u306b\u304a\u3051\u308b95\uff05\u4fe1\u983c\u533a\u9593\u304c\u5168\u8a66\u9a13\u30b5\u30f3\u30d7\u30eb\u3067\u5831\u544a\u3002\u5c02\u9580\u79d1\u3067\u306e\u5404\u969c\u58c1\u306b\u5bfe\u3059\u308b\u91cd\u8981\u5ea6\u306e\u9055\u3044\u3082\u8a55\u4fa1\u3057\u305f\u3002<\/p>\n<p><a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90541.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90541-1024x561.png\" alt=\"\uff2a\uff2320180523\u5b89\u90541\" width=\"640\" height=\"351\" class=\"alignleft size-large wp-image-1513\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90541-1024x561.png 1024w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90541-300x164.png 300w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90541.png 1876w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/a><\/p>\n<p><a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90542.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90542-1024x448.png\" alt=\"\uff2a\uff2320180523\u5b89\u90542\" width=\"640\" height=\"280\" class=\"alignleft size-large wp-image-1514\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90542-1024x448.png 1024w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90542-300x131.png 300w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90542.png 1379w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/a><\/p>\n<p><a href=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90543.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90543-992x1024.png\" alt=\"\uff2a\uff2320180523\u5b89\u90543\" width=\"640\" height=\"661\" class=\"alignleft size-large wp-image-1515\" srcset=\"https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90543-992x1024.png 992w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90543-291x300.png 291w, https:\/\/www.hcfm.jp\/journal\/wp-content\/uploads\/2018\/05\/\uff2a\uff2320180523\u5b89\u90543.png 1379w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/a><\/p>\n<p>\uff0dResults\uff0d<br \/>\n2012\u5e749\u6708\u304b\u30892013\u5e743\u6708\u306e\u671f\u9593\u3067\u30011617\u4eba\u306e\u5bfe\u8c61\u8005\u306e\u3046\u30611256\u4eba\u304c\u30a2\u30f3\u30b1\u30fc\u30c8\u8abf\u67fb\u3092\u53d7\u3051\u89e3\u7b54\u3057\u305f\u3002\u5168\u4f53\u306e\u56de\u7b54\u7387\u306f77.7\uff05\uff08646\u4eba\u306e\u770b\u8b77\u5e2b\u306e\u3046\u3061512\u4eba[79.3\uff05]\u3001634\u4eba\u306e\u3046\u3061484\u4eba[76.3\uff05]\u3001337\u4eba\u306e\u30b9\u30bf\u30c3\u30d5\u533b\u5e2b[ 77.2\uff05]\uff09\u3002<br \/>\nFigure1\u306f\u3059\u3079\u3066\u306e\u53c2\u52a0\u8005\u306b\u3088\u308b\u30b1\u30a2\u306e\u76ee\u6a19\u3092\u6c7a\u3081\u308b\u969b\u306e\u969c\u58c1\u3068\u611f\u3058\u308b\u3082\u306e\u306e\u91cd\u8981\u6027\u3067\u3059\u3002<br \/>\n\u969c\u58c1\u306e\u91cd\u8981\u6027\u306e\u9806\u4f4d\u4ed8\u3051\u306f3\u30b0\u30eb\u30fc\u30d7\u3068\u3082\u306b\u540c\u69d8\u3067\u3042\u308a\u3001\u5bb6\u65cf\u3001\u60a3\u8005\u306b\u95a2\u9023\u3057\u305f\u56e0\u5b50\u304c\u6700\u5927\u306e\u969c\u58c1\u3068\u306a\u3063\u3066\u3044\u308b\u3068\u306e\u7b54\u3048\u3067\u3042\u3063\u305f\u3002<br \/>\n(\u5bb6\u65cf\u3001\u60a3\u8005\u304c\u77ed\u3044\u4e88\u5f8c\u3092\u53d7\u3051\u5165\u308c\u3089\u308c\u306a\u3044\u3001\u6cbb\u7642\u306e\u9650\u754c\u3084\u5408\u4f75\u75c7\u306e\u7406\u89e3\u304c\u96e3\u3057\u3044\u3001\u5bb6\u65cf\u9593\u306e\u5408\u610f\u306e\u6b20\u5982\u3001\u672c\u4eba\u306e\u610f\u5fd7\u6c7a\u5b9a\u80fd\u529b<br \/>\n\u306e\u6b20\u5982)\u3002\u81e8\u5e8a\u5bb6\u306f\u81ea\u5206\u9054\u306e\u30b9\u30ad\u30eb\u4e0d\u8db3\u3001\u8981\u56e0\u306f\u3042\u307e\u308a\u91cd\u8981\u3067\u306f\u306a\u3044\u3068\u8003\u3048\u3066\u3044\u305f\u3002\u307e\u305f\u3001\u969c\u58c1\u306e\u9806\u4f4d\u306f\u985e\u4f3c\u3057\u3066\u3044\u305f\u304c\u5404\u91cd\u8981\u5ea6\u306f\u770b\u8b77\u5e2b\u304c\u6700\u3082\u9ad8\u304b\u3063\u305f\u3002<br \/>\nFigure2\u306f\u610f\u5fd7\u6c7a\u5b9a\u306e\u76ee\u6a19\u3092\u9054\u6210\u3059\u308b\u610f\u6b32\u3068\u652f\u6301\u306b\u3064\u3044\u3066\u8a18\u8f09\u3055\u308c\u3066\u3044\u308b\u3002\u30b9\u30bf\u30c3\u30d5\u533b\u5e2b\u304c\u6700\u3082\u610f\u6b32\u7684\u3067\u3042\u308a\u3001\u6b21\u306f\u30ec\u30b8\u30c7\u30f3\u30c8\u3067\u3042\u3063\u305f\u3002<br \/>\n\u770b\u8b77\u5e2b\u306f\u76ee\u6a19\u9054\u6210\u306e\u610f\u6b32\u3001\u8077\u5834\u74b0\u5883\u306e\u30b5\u30dd\u30fc\u30c8\u3068\u3082\u306b\u9ad8\u304f\u306f\u306a\u304b\u3063\u305f\u3002<br \/>\nFigure3\u306f\u30b3\u30df\u30e5\u30cb\u30b1\u30fc\u30b7\u30e7\u30f3\u3068\u610f\u5fd7\u6c7a\u5b9a\u306b\u304a\u3051\u308b\u69d8\u3005\u306a\u5c02\u9580\u8077\u3068\u306e\u95a2\u308f\u308a\u306e\u91cd\u8981\u6027\u306b\u3064\u3044\u3066\u8a18\u8f09\u3055\u308c\u3066\u3044\u308b\u3002<br \/>\n\u30b9\u30bf\u30c3\u30d5\u533b\u5e2b\u3068\u30ec\u30b8\u30c7\u30f3\u30c8\u306f\u610f\u5fd7\u6c7a\u5b9a\u306b\u975e\u5e38\u306b\u91cd\u8981\u3067\u3042\u308b\u3068\u8a55\u4fa1\u3055\u308c\u305f\u3001\u4e00\u65b9\u3067\u30b9\u30bf\u30c3\u30d5\u533b\u5e2b\u3001\u30ec\u30b8\u30c7\u30f3\u30c8\u306f\u770b\u8b77\u5e2b\u3068\u6bd4\u8f03\u3057\u3066\u3001\u770b\u8b77\u5e2b\u3001\uff33\uff37\u3001\u4ed6\u306e\u533b\u7642\u30b9\u30bf\u30c3\u30d5\u304c\u610f\u5fd7\u6c7a\u5b9a\u306b\u95a2\u308f\u308b\u3053\u3068\u306f\u3042\u307e\u308a\u91cd\u8981\u3067\u306f\u306a\u3044\u3068\u8a55\u4fa1\u3057\u3066\u3044\u305f\u3002<\/p>\n<p>\u3010\u958b\u50ac\u65e5\u30112018\u5e745\u670823\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\uff0d\u6587\u732e\u540d\uff0d Barriers to Goals of Care Discussions With Seriously ill Hospitalized Patients and Their Families A Mult &hellip; <a href=\"https:\/\/www.hcfm.jp\/journal\/?p=1506\" class=\"more-link\">\u7d9a\u304d\u3092\u8aad\u3080 <span class=\"screen-reader-text\">\u75c5\u9662\u306b\u304a\u3051\u308b\u7d42\u672b\u671f\u60a3\u8005\u306e\u6cbb\u7642\u76ee\u6a19\u306b\u5bfe\u3059\u308b\u610f\u5fd7\u6c7a\u5b9a\u306e\u969c\u58c1\u56e0\u5b50\u306b\u3064\u3044\u3066<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12],"tags":[],"class_list":["post-1506","post","type-post","status-publish","format-standard","hentry","category-12"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1506","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1506"}],"version-history":[{"count":4,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1506\/revisions"}],"predecessor-version":[{"id":1516,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1506\/revisions\/1516"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1506"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1506"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1506"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}