緩和ケア英語：必須語彙とフレーズ

"breakthrough pain"

A sudden, temporary flare of pain that occurs despite the patient already taking around-the-clock pain medication

"The nurse administered a rescue dose of opioid to address the patient's breakthrough pain episode."

"titration"

The process of gradually adjusting the dose of a medication until the desired therapeutic effect is achieved

"Careful opioid titration over three days brought the patient's pain scores down from eight to two."

"refractory symptom"

A symptom that cannot be adequately controlled despite aggressive efforts to identify and treat its cause

"When dyspnoea became a refractory symptom, the team considered palliative sedation as a last resort."

"nociceptive pain"

Pain caused by actual or threatened damage to body tissue, typically described as aching or throbbing

"The oncologist explained that the patient's bone metastases were producing nociceptive pain requiring a different analgesic approach."

"neuropathic pain"

Pain arising from damage or disease affecting the somatosensory nervous system, often described as burning, shooting, or electric

"A low-dose tricyclic antidepressant was added to the regimen for the neuropathic pain caused by spinal cord compression."

"cachexia"

A complex metabolic syndrome associated with underlying illness characterised by severe weight loss, muscle wasting, and fatigue

"The palliative care dietitian developed a nutritional support plan to slow the progression of cancer-related cachexia."

"dyspnoea"

The subjective experience of breathing discomfort; breathlessness that is distressing to the patient

"Low-dose oral morphine was prescribed to relieve the dyspnoea that worsened on minimal exertion."

"opioid rotation"

Switching a patient from one opioid to another to improve the balance between pain relief and adverse effects

"Persistent opioid-induced nausea prompted the team to initiate opioid rotation from morphine to hydromorphone."

"goals of care conversation"

A structured discussion with a patient and family to clarify what outcomes matter most and align treatment accordingly

"The palliative care physician facilitated a goals of care conversation after the oncologist reported disease progression."

"prognosis disclosure"

The process of communicating a patient's expected disease course or life expectancy in a sensitive and honest manner

"Training in prognosis disclosure helped nurses respond compassionately when families asked how long the patient had left."

"breaking bad news"

The communication of information that negatively and seriously affects a patient's or family's view of the future

"The SPIKES protocol is widely used as a structured framework for breaking bad news in oncology and palliative settings."

"truthful uncertainty"

An honest acknowledgment that prognosis cannot be predicted precisely, while still conveying the overall trajectory

"The consultant practised truthful uncertainty by saying, "I cannot tell you exactly how long, but I expect weeks rather than months.""

"collusion"

An agreement between family members and clinicians to withhold information about diagnosis or prognosis from the patient

"The team explored the family's fears before gently challenging the collusion that had kept the patient unaware of her diagnosis."

"surrogate decision-maker"

A person legally or ethically authorised to make healthcare decisions on behalf of a patient who lacks capacity

"Because the patient had lost capacity, the surrogate decision-maker guided the team's treatment choices."

"informed refusal"

A competent patient's deliberate decision to decline a recommended medical intervention after receiving full information

"The documentation of informed refusal ensured that the patient's wish to forgo chemotherapy was legally and ethically recorded."

"active listening"

A communication technique that involves fully concentrating, understanding, responding, and remembering what the patient says

"The palliative nurse used active listening—nodding, reflecting, and pausing—to allow the patient to express her deepest fears."

"advance directive"

A legal document in which a person states their wishes about medical treatment in the event they can no longer make decisions

"The social worker helped the patient complete an advance directive specifying that she did not want mechanical ventilation."

"do not resuscitate (DNR)"

A medical order instructing healthcare providers not to perform cardiopulmonary resuscitation if the patient's heart or breathing stops

"After a family meeting, a do not resuscitate order was placed in the patient's chart to reflect his stated wishes."

"lasting power of attorney"

A legal arrangement in which a person (the donor) gives another person (the attorney) the right to make decisions on their behalf

"The patient registered a lasting power of attorney for health and welfare while she still had mental capacity."

"mental capacity"

The ability to understand, retain, and weigh information to make a specific decision and communicate that decision

"A formal mental capacity assessment was conducted before the patient signed his advance directive."

"preferred place of care"

The location—home, hospice, care home, or hospital—where a patient wishes to receive their end-of-life care

"Recording the preferred place of care early allowed the community team to arrange appropriate home-based support."

"emergency care plan"

A portable document summarising a patient's diagnosis, agreed care decisions, and escalation preferences for use by any treating clinician

"The paramedics followed the emergency care plan and did not attempt resuscitation, in line with the patient's wishes."

"anticipatory prescribing"

The practice of prescribing medications in advance so they are available at home for symptom control in the last days of life

"Anticipatory prescribing of subcutaneous morphine and midazolam enabled the district nurse to manage the patient's agitation at home."

"POLST (Physician Orders for Life-Sustaining Treatment)"

A standardised medical order set that translates a patient's wishes into actionable clinical instructions for life-sustaining treatments

"The POLST form was signed by the physician and travelled with the patient to ensure consistent care at every facility."

"existential distress"

Profound suffering related to questions of meaning, purpose, identity, and the significance of one's life in the face of death

"The chaplain and psychologist co-facilitated sessions to address the patient's existential distress following his terminal diagnosis."

"dignity therapy"

A brief psychotherapeutic intervention that invites patients to discuss what has been most meaningful in their lives for a recorded legacy document

"Dignity therapy gave the elderly patient an opportunity to share life stories that were then read aloud at her bedside by family."

"spiritual care"

Support that addresses a patient's search for meaning, transcendence, and connection, regardless of religious affiliation

"The palliative care team included a spiritual care coordinator to ensure all patients' non-physical needs were met."

"anticipatory grief"

The experience of grief before an expected death, occurring in both the patient and their family or carers

"The counsellor ran a support group specifically for family members experiencing anticipatory grief."

"psychosocial assessment"

A systematic evaluation of a patient's emotional, social, cultural, and practical needs alongside their physical symptoms

"A comprehensive psychosocial assessment revealed that financial stress was compounding the patient's anxiety."

"demoralization syndrome"

A cluster of symptoms including hopelessness, loss of meaning, and inability to cope, distinct from clinical depression

"The patient's persistent sense of futility was recognised as demoralization syndrome and addressed through meaning-centred therapy."

"family meeting"

A structured clinical encounter that brings together the patient, family members, and the care team to share information and align on care goals

"A family meeting was convened to discuss the shift from curative to comfort-focused care and address conflicting opinions."

"legacy work"

Activities that help patients create a tangible record—letters, videos, artwork—of their values and memories for those they will leave behind

"Legacy work in the form of recorded voice messages brought the patient peace and gave her grandchildren a lasting connection."

"recognition of dying"

The clinical and ethical process of acknowledging that a patient has entered the terminal phase of their illness

"Recognition of dying prompted the team to discontinue futile interventions and focus entirely on comfort."

"death rattle"

A rattling or gurgling sound caused by the movement of air past secretions in the throat of a patient who is too weak to cough

"The nurse reassured the distressed family that the death rattle indicated unconsciousness rather than distress in the patient."

"Cheyne-Stokes respiration"

An abnormal pattern of breathing characterised by alternating periods of deep breathing and apnoea, common in the dying process

"The doctor explained that Cheyne-Stokes respiration was a normal sign that death was likely within hours."

"terminal agitation"

A state of restlessness, confusion, and distress that can occur in the final hours or days of life, requiring prompt management

"Low-dose midazolam was administered subcutaneously to manage the patient's terminal agitation."

"palliative sedation"

The use of sedating drugs to reduce consciousness in a terminally ill patient suffering from refractory symptoms, as a last resort

"After ethical review, the team initiated palliative sedation to relieve uncontrollable pain in the patient's final 48 hours."

"comfort care"

A care approach focused entirely on maximising quality of life and alleviating suffering, with no goal of curative treatment

"The family agreed to transition to comfort care, meaning all blood draws and IV fluids were discontinued."

"mottling"

A purplish, blotchy discolouration of the skin caused by reduced circulation, typically seen in the hours or days before death

"The nurse noted mottling on the patient's knees and calves, indicating that death was imminent."

"pronouncing death"

The formal medical act of confirming that a person has died, followed by documentation of the time and circumstances

"The junior doctor was guided through the clinical and legal steps of pronouncing death during her palliative care rotation."

"complicated grief"

An intense, prolonged form of grief that interferes significantly with daily functioning and does not follow a typical trajectory

"The widower was referred to a grief therapist after screening indicated complicated grief six months after his wife's death."

"bereavement care"

Support provided to family members and significant others after the death of a patient, to facilitate healthy grieving

"The hospice offered bereavement care including a phone call at one month and group sessions at three and twelve months."

"condolence"

An expression of sympathy offered to someone who has experienced a death or loss

"The palliative care team sent a written condolence card to the family within a week of the patient's death."

"dual process model"

A theory of coping with bereavement that alternates between loss-orientation (focusing on grief) and restoration-orientation (focusing on life changes)

"The counsellor explained the dual process model to help the bereaved daughter understand her fluctuating emotions."

"continuing bonds"

A model of grief that recognises maintaining an ongoing inner relationship with the deceased as a healthy coping strategy

"Rather than urging the widow to "let go," the therapist encouraged continuing bonds through photo albums and letters."

"bereavement risk assessment"

A structured evaluation of factors that may increase a family member's vulnerability to poor grief outcomes

"A bereavement risk assessment identified the patient's teenage son as needing additional support after the death."

"memorial service"

A ceremony held to honour and remember a person who has died, often separate from the funeral

"The hospice hosted an annual memorial service to give bereaved families a communal space to remember their loved ones."

"disenfranchised grief"

Grief over a loss that is not openly acknowledged, publicly mourned, or socially supported

"The nursing staff member's disenfranchised grief after losing a long-term patient was addressed through a structured staff debriefing."