ゲノム医療を受けるがん患者の受診動機づけ要因と結果の受容

Motivations for Receiving Genomic Medicine and Acceptance of the Results in Patients With Cancer

要旨

　目的：ゲノム医療を受けるがん患者の動機づけと結果の受容を明らかにする．

　方法：がんゲノム外来を受診した193名を対象に，遺伝子パネル検査の結果，受診の動機づけ，結果の受容について後方視野的に解析した．

　結果：検査を受けた39.3％にdruggable変異が提示され，8.9％が治療到達し，8.1％に二次的所見が判明した．動機づけとして，がん治療の探求，家族のがんリスクへの関心，最善を尽くす闘病スタイル，がんへの不安，医師の勧め，がんの原因の探求の6項目があった．説明を受けた患者の71.2％が受容し，28.7％が悲観したが理解した．

　結論：治療到達できなくとも，事前にゲノム医療の限界を説明することと，患者の最善を尽くす闘病スタイルが，結果の受容を促進すると考えられた．患者の経過や価値観に応じ，チームで協働し説明することが，治療到達率が低い中で患者の満足度を高める可能性がある．

　Purpose: The aime of the study is to elucidate the motivations for receiving genomic medicine and acceptance of the results in patients with cancer.

　Methods: We retrospectively analyzed the results of gene panel testing, motivation for undergoing the testing, and acceptance of the results in 193 outpatients who visited the Cancer Genomic Medicine Department at our institution.

　Results: Druggable mutations were found in 39.3% of the patients, treatment based on genomic findings was given in 8.9%, and secondary genomic findings were found in 8.1%. The following six motivations were extracted: exploring cancer therapies, concern about cancer risk in family members, determination to fight the disease, anxiety about cancer, doctor's recommendation, and exploring the causes of cancer. After receiving an explanation, 71.2% of the patients accepted the results, while 28.7% felt pessimistic but understood the results.

　Conclusions: Providing an explanation about the limits of genomic medicine in advance as well as patients' determination to fight the disease appeared to promote acceptance of the results even if patients did not receive treatment based on genomic findings. Taking into account the disease course and the patient's values, cooperation and providing explanations to patients as a team may enhance the patient's satisfaction even if only a small proportion of patients receive treatment based on genomic findings.