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Author: Aki Morita, Psy.D.

Advance Care Planning at End of Life in the United States and Japan (Japanese Medical Management Institute) August 25, 2019 Tokyo, Japan

Advance Care Planning at End of Life in the United States and Japan (Japanese Medical Management Institute) August 25, 2019 Tokyo, Japan

日本医療経営研究所主催の総合診断能力養成塾にお招きいただきました。

様々なご専門のお医者様にお集まりいただき、日本と米国の意思決定支援事情についてお話ししました。こうした少人数の学びの場に伺うのは、お一人お一人の顔を見ながらご意見やご感想などを伺うことができるので、こちらが学ぶものも多くとても贅沢な時間を過ごさせていただきました。

In Tokyo I addressed group of medical doctors of various specializations and disciplines to review the topic of Advance Care Planning (ACP) at end-of-life as it is approached in the United States and Japan. It was an afternoon filled with compassionate, interactive discussion and learning. Since the topic of end-of-life care is rarely addressed in the medical educational protocols in either country, these doctors were especially interested in how this conversation can be approached with humanity and compassionate awareness.

Comparative Advance Care Planning (ACP) Between the United States and Japan (Shige Prefecture University Lecture and Workshop) August 22, 2019 Hikone, Japan

Comparative Advance Care Planning (ACP) Between the United States and Japan (Shige Prefecture University Lecture and Workshop) August 22, 2019 Hikone, Japan

滋賀県立大学は彦根城に近い、穏やかな町の中にキャンパスがあります。駅からバスでキャンパスに向かうのも観光めぐり気分でした。たくさんの方々にお集まりいただき、米国と日本のエンドオブライフの意思決定支援についてお話しさせていただきました。その後のワークショップでは大学院生の方々中心に参加いただき、実際にロールプライなどを使ってACPを導入する会話を練習しました。時間が足りず急ぎ足で駆け抜けたのが残念でしたが、みなさん様々な気づきを持たれたようでした。

 

Shiga Prefecture University is located near the historic Hikone castle. It is a beautiful bus ride from Hikone station through picturesque Jokamachi, a quiet castle town. Shige University faculty members, community nurses, and graduate students attended a workshop that discussed ACP practice in the United States as compared to Japan. In addition to my presentation there was also a role play exercise which allowed participants to experience what it might be like to have ACP conversation with one of their patients. They were also required to experience the conversation from the patients’ point of view and how to approach these difficult but necessary conversations.

Grief Care for Nurses (Osaka Prefecture University) August 21, 2019 Osaka, Japan

Grief Care for Nurses (Osaka Prefecture University) August 21, 2019 Osaka, Japan

大阪府立大学からお招きを受け医療関係者・看護大学院生の方々向けにグリーフケアについての講義とワークショップをする機会をいただきました。グリーフケアという言葉は医療の場ではまだ馴染みがありませんが、大切な人が重篤な病気になるということは、患者ご本人、そのご家族、医療提供者までもが失うものに対するグリーフを体験しているといっても過言ではありません。ロールプレイなども交え、グリーフについての理解を深め、看護師としてのスキルアップを目指しました。みなさん熱心に取り組まれ、いい質問も飛び交い、有意義な1日となりました。

This lecture was sponsored by Osaka Prefecture University and focused on the topic of grief care for community nurses and graduate nursing students. Most medical professionals in Japan as well as the United States are not trained in “grief care” and how grief can affect them as well as their patients and families. By the end of the day, all of the participants enjoyed an active learning process and acquired skills that could be translated into their workplace routines. It was a pleasure working with such an enthusiastic and empathetic group of nurses!

Advanced Grief Care Training for Complicated Grief (Sponsored by the Portland Institute for Loss and Transition) June 17 -21, 2019 Portland, Oregon

Advanced Grief Care Training for Complicated Grief (Sponsored by the Portland Institute for Loss and Transition) June 17 -21, 2019 Portland, Oregon

Portland Institute Summer Institute

6月17日から21日までポートランドインスティチュート主催のワークショップがオレゴン州ポートランドで開催され、グリーフケアにおいては第一人者であるロバート・ニーマイヤー教授をはじめとし、エド・ライニアソン教授、ロリー・バーク教授、ダーシー・ハリス教授などがそれぞれの研究や臨床事例などを発表しました。約80名の参加者は米国のみならず、ヨーロッパやアジアからも集まり、複雑性悲嘆、医療従事者のためのセルフケア、子供の悲嘆、終末期のケアにおける倫理、など幅の広いトピックが紹介されました。

This Inaugural Summer Institute sponsored by the Portland Institute for Loss and Transition was held June 17-21 in Portland, Oregon. Featured speakers included the noted expert in the field of complicated grief, Dr. Robert Neimeyer, as well as a distinguished panel of co-presenters including Dr. Ed Rynearson, Dr. Laurie Burke and Dr. Darcy Harris. Nearly eighty participants from across the United States, Europe and Asia attended thought provoking lectures and workshops such as Complicated Spiritual Grief, Healing the Healer Workshop, Child and Adolescent Bereavement, Loss Epicenters in Life, Ethical Imperative to Discuss End-of-Life, and many others related to grief, spiritual care, restorative retelling and attachment-informed interventions.

ADEC (Association for Death Education and Counseling) Annual Conference ~ April 11-13, 2019 in Atlanta, Georgia (USA).

ADEC (Association for Death Education and Counseling) Annual Conference ~ April 11-13, 2019 in Atlanta, Georgia (USA).

4月11日から13日まで米国ジョージア州アトランタ市にてAssociation for Death Education and Counseling (ADEC)の年次学会があり、ACP(人生会議)の重要性について、ホスピスでの事例と共に発表してきました。さまざまな理由で最期は病院で蘇生を望んでいた患者がカウンセリングを通じて、自分の中の、消化されていなかった過去の悲嘆と向き合い、家族との絆を深めたことで、最終的に本来望んでいた”蘇生はせず、自然の摂理にまかせて家で家族に囲まれて死ぬ”ということを叶えることができた例です。意思決定ではただ決めたことを記録しておくだけではなく、決定に至るまでの過程にどう寄り添うかということが大切であり、他のACP研究や、グリープ理論、家族への介入法などに焦点を当てて、発表しました。いい質問やコメントを頂き、さらにディスカッションが膨らみ、充実したプレゼンテーションとなりました。

 

I presented “Whole Person Approach to EOL Discussion: What is Most Important to You?”. I shared a case which represented a patient’s ambivalence in making end of life decisions. Through counseling, she worked through her multiple losses in her life, resolved family conflicts and reconnected with her sons. At the end, the patient and family engaged in a meaningful meeting and expressed affection and gratitude. It was the goal of the patient to make sure that her sons will continue family traditions together. End of life discussion is a key element in increasing QOL and QOD of patients and their families in the area of emotional and spiritual care.

March 13 – 16, 2019 “Who is in Control? Cultural and Institutional Barriers to EOL Decisions in Japan and the United States.” (7th Annual International Advance Care Planning Conference (ACP-I)) (Rotterdam, The Netherlands)

March 13 – 16, 2019 “Who is in Control? Cultural and Institutional Barriers to EOL Decisions in Japan and the United States.” (7th Annual International Advance Care Planning Conference (ACP-I)) (Rotterdam, The Netherlands)

  

第7回ACP―I(国際アドバンスケアプランニング)学会にて日本と米国における終末期の意思決定の課題について、文化、医療制度の観点から発表しました。日本・米国共に高度な医学の恩恵を受けていつつも、終末期のケアの質ということに関しては、様々な課題を抱えています。日本ではACPを記入している人が8.1%しかおらず、終末期においてもどのようなケアを希望しているのかという会話が医療現場で交わされていないというのが現実です。今後市民活動や医療従事者に対する情報の提供、研修のあり方を課題として挙げました。

Dr. Morita addressed an international body of physicians, scholars and researchers on how the healthcare systems in America and Japan manage or fail to manage adequately patients’ end-of-life issues. Her presentation identified an array of cross-cultural factors that may interject themselves into a patient’s end-of-life care and how those factors can impede and at times, even prevent, the patient from achieving their desired quality of end-of-life care. The interplay of cultural versus institutional factors in the vastly different American and Japanese societies oftentimes results in a terminal patient’s wishes going unheard or unacknowledged. Thus, Dr. Morita provided a framework for recognizing the importance of EOL discussions and how that conversation is an essential part of providing quality care to the dying patient.

 

August 25, 2018 “Team Approach in End of Life Care in the United States” Ochanomizu Total Pain Conference (Tokyo, Japan)

August 25, 2018 “Team Approach in End of Life Care in the United States” Ochanomizu Total Pain Conference (Tokyo, Japan)

第5回トータルペイン緩和研究会のお茶の水緩和ケアカンファレンスにご招待いただき「日本と違う!?終末期をチームで支える米国ホスピスケア」というタイトルで米国の ホスピス事情そしてホスピスハワイの取り組みについてお話させていただきました。米国では終末期における身体的な苦痛のみではなく、精神的、社会的、スピリチュアルな 苦痛の緩和にチームで関わります。医師や看護師の方を始め、300名を超える方々にお 集まりいただきました。

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Dr. Morita appeared as the keynote speaker at the annual Ochanomizu Total Pain Conference co-sponsored by Hisamitsu Corporation and Grief Care Institute of Sofia University hosted at the Juntendo University Graduate School of Medicine campus. Dr. Morita’s lecture and slideshow addressed the topic: “Team Approach in End of Life Care in the United States.”  Three hundred (300) physicians, nurses, hospital administrators, psychologists and other healthcare providers attended the conference to learn how western medicine increasingly adopts a cross-discipline approach when treating terminally ill patients. This treatment strategy emphasizes the need to treat more than the patient’s physical pain. It requires healthcare professionals to embrace the emotional, psychological and even spiritual needs of terminally ill patients and their loved ones.

 

August 23, 2018 “Family Care in Hospice in the United States” Honpa Hongwanji Tsumura Betsuin (Osaka, Japan)

August 23, 2018 “Family Care in Hospice in the United States” Honpa Hongwanji Tsumura Betsuin (Osaka, Japan)

 

本願寺津村別院にて病床にある方の側でスピリチュアルケアをされるビハーラ僧の方と充実した時間を過ごさせていただきました。米国のホスピスでのご家族へのサポートについてお話させていただき、Q&Aでは現場でご家族に寄り添われている方々の貴重な体験談などを伺いました。本願寺はハワイでも色々とお付き合いがあり、今回はそのご縁でお邪魔することになりました。

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Dr. Morita was invited to speak to a very special order of monks at the Honpa Hongwanji Tsumura Betsuin. Dr. Morita’s lecture and slideshow discussed how the American system deals with “Family Care in Hospice in the United States.” This order of Vihara monks was especially interested in this topic as they often found themselves having to address patients at the end-of-life and families whose loved ones have recently departed.

August 18, 2018 “Team Approach in End of Life Care in the United States” Fukuoka College of Medical Health and Sports (Fukuoka, Japan)

August 18, 2018 “Team Approach in End of Life Care in the United States” Fukuoka College of Medical Health and Sports (Fukuoka, Japan)

地域でご活躍の看護師の方々対象に、米国での終末期におけるチームアプローチについてお話させていただいた後、「2つの聴く力」体験型ワークショップに参加いただきました。自分自身のグリーフについて考えるアクティビティでは、グリーフが自分の仕事に与える影響などを考えるいい機会となったという意見をたくさんの方からいただきました。福岡医健の先生方にもご参加いただき、有意義な1日となりました。

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Dr. Morita addressed nursing professors and nurses on the topic of how to provide a more unified physical and emotional strategy in treating patients who are facing end-of-life issues. Dr. Morita’s presentation entitled “Team Approach in End of Life Care in the United State” focused on how western healthcare providers are increasingly incorporating a cross-discipline strategy when dealing with terminally ill patients and their families. Western medicine oftentimes includes the treating physician, case managers, social workers, chaplains and grief counselors in a “team approach” to manage the physical, emotional and psychological impediments that prevent the patient from experiencing what end-of-life literature refers to as a “good death.”

November 20, 2017 “Grief Care for Families” Tokyo Bay Urayasu Ichikawa Medical Center (Tokyo, Japan)

November 20, 2017 “Grief Care for Families” Tokyo Bay Urayasu Ichikawa Medical Center (Tokyo, Japan)

東京ベイ・浦安市川医療センターにお邪魔し、ホスピスにおける家族ケアというタイトルでホスピスハワイ での取り組みについてご紹介しました。ホスピスでは患者の方が入所の段階から必要に応じてグリーフカウンセラーが介入し、患者の方やご家族のケアにあたります。そして死後は13ヶ月に渡って遺族へのケアを提供します。こういった専門家によるグリーフサポートが日本の緩和ケア・ホスピスケアにも早く定着する日が来ますように。

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Dr. Morita presented a lecture on “Grief Care for Families” to physicians, nurses and pharmacists at the Tokyo Bay Urayasu Ichikawa Medical Center in Tokyo, Japan. Dr. Morita discussed the need for healthcare providers to address issues related to grief in order to treat the “entire” patient. Dr. Morita emphasized that the issue of grief is one confronted not only by patients facing their own end-of-life issues but also the family members and loved ones of the dying patient. This team approach to end-of-life issues is largely absent in the Japanese healthcare system even though it is widely accepted in western medicine and institutions.