An outline of palliative care services in the UK : Structure, process and outcome

摘要

英国における緩和ケアの現状について,各種統計資料を用い,ケアの質を規定する構造,過程,帰結の3つの側面から報告する.構造においては,サービス提供施設・組織の規模やサービス内容が多様であること,過程においては,在宅緩和ケア,入院緩和ケア,デイ緩和ケア,病院の緩和支援サービスなど各サービスがネットワークを構成して,きめ細かいサービスを提供していること,などが日本と比べ大きく異なる点であった.帰結においては,緩和ケアサービス全体で看取る患者数は,英国の年間死亡数580千人の約1 /10,がんによる死亡数154千人の約1 /3に達していた.また,がん患者は全疾患と比べ,希望する場所(自宅,入院緩和ケア施設)で18%多く死亡しており,逆に希望しない場所(病院,介護施設,他)での死亡は18%少なかった.がん患者に見られるこの18%のシフトは,自宅や入院緩和ケア施設で,末期がん患者を主な対象として提供されている緩和ケアサービスの効果と考えられる. The purpose of this report is to introduce an outline of palliative care services in the UK through their structure, process and outcome according to related statistics. There are a large number of facilities and organizations providing palliative care, and the content of services offered varies widely. There is a complex network of home palliative care, day palliative care, inpatient unit palliative care and supportive care for patients in hospitals. In both structure and process therefore, the UK differs considerably from Japan. The outcome of UK palliative care services is that terminal care is provided for about one tenth of all deaths (rate 580,000) per year, and about one third of all cancer deaths (rate 154,000) per year in the UK. The number of cancer patients who were able to choose their preferred place of death was18% higher than the figure for all patients, which is considered as one of the outcomes of palliative care services.