アドバンス・ケア・プランニング Advance Care …

1 9 1 ( ) 2 70% Silveira MJ, NEJM 2011 3 Advance care planning (ACP) ACP 4 (ACP: Advance care planning ) ACP Sudore RL et al.

2 J Pain Symptom Manage. 2017 5 1 ACP ACP ACP Sudore RL et al. J Pain Symptom Manage. 2017 6 ACP Sudore RL et al. J Pain Symptom Manage. 2017 7 ACP ACP ACP 8 ACP - Nursing home 4 5 Mukamel DB, Med care 2013 AD Nursing home 61 Bischoff KE, JAGS 2013 Sudore RL, J Health Commun 2010 Wittink MN, Arch Int Med 2008 9 Heyland DK, JAMA Intern Med 2013 1 Camhi SL, Clit care Med 2009 Evangelista LS, J Palliat Med 2012 Anderson WG, J Gen Int Med.

3 2011 10 ACP ACP ACP AD ACP 1 EOL QOD 11 ACP UK ACP OR ACP OR ACP Tripken JL. Am J Hosp Palliat care . 2016 Musa I, Seymour J. Age Ageing. 2015 Morrison RS. Arch Intern Med. 2004 12 ACP 13 14 70% Silveira MJ, NEJM 2011 15 The SUPPORT study 9000 AD ICU DNR AD JAMA.

4 1995 Nov 22-29;274(20):1591-8. 16 AD AD 17 AD ACP 18 19 ( ) 20 NSCLC stageIV QOL 9%vs50% Primary Temel J NEJM 2010 21 ( ) ( Yoong J.)

5 JAMA Intern Med. 2013;173(4):283-90. 22 ESAS MSAS 3-6 Good Working lists for PC. Smith TJ, et al. JCO2012 23 ACP EOL Gold Standard Framework Advance care planning first for quality end-of-life care 24 25 ACP 26 ACP 27 25-50 2-14 ACP Miovic M, Cancer 2007. 70-80 Weeks JC, NEJM 2012 28 29 ACP - Degenholtz, Ann Intern Med.

6 2004 Morrison, J Am Geriatr Soc. 2005 Teno J. JAGS 2007 ACP Detering K, BMJ 2010 30 35% ACP Jones L, Palliat Support care 2011 31 ACP Auriemma CL. JAMA Intern Med. 2014;174(7):1085-92. ACP 32 ( ) 33 34 Goldilocks phenomenon Billngs JA, JAMA Intern Med. 2014 35 ACP Johnson S Psycho Oncology 2015 36 1 2 Lynn. Rand Health 2003: 37 Lynn.

7 Rand Health 2003: 38 Lynn. Rand Health 2003: 39 SPICT 40 1 Small N. Palliat Med 2010;24:740-741 Hamano J. Oncologist 2015. 41 SPICT 42 SPICT PS 50% 3-6 5-10 BMI 43 44 45 ACP 10 7-10 10 7-10 1 3 PD Hui D.

8 Lancet Oncol. 2016 46 ACP Hancock K, Palliat Med. 2007. Dow LA, J Clin Oncol 2010. 47 ACP 48 ACP Johnson S Psycho Oncology 2015 49 50 ACP CST ACP Bernacki R JAMA Intern Med. 2014 51 52 Modified from Respecting Choices, Sudora R, Ann Int Med 2010.

9 53 .. 54 .. 55 .. Hope for the best, Prepare for the worst. Back AL Arch Int Med 2007 56 ACP QOL ACP 57 POLST Physicians order of Life-Sustaining Treatment) 58 POLST ACP 59 POLST POLST 1 60 61 9 17 10 9 10 14 10 22 11 4,5 11 19 11 23 12 10 12 16 12 24 1 14 1 25.

10 26 62 E-FIELD 8-12 ACP 63 E-FIELD ACP 64 6 4 71 121 103 0%10%20%30%40%50%60%70%80%90%100% 314 305 95 10 65 29 12 66 29 ACP 67 68 Modified from Sudora R, Ann Int Med 2010.