進行がん患者が病気の情報を未成年の子どもに伝えることに関する意思決定過程

Decision-Making Process in Advanced Cancer Patients Regarding Communicating Information About Their Disease to Their Minor Children

要　旨

　本研究の目的は，進行がん患者が病気の情報を未成年の子どもに伝えることに関する意思決定過程を明らかにし，必要な看護実践への示唆を得ることである．進行がん診断時に6歳〜18歳未満の子どもをもち，面接までの年数が15年以内にあり，医師より根治的治療の対象とはならないと伝えられ，延命や症状緩和目的の治療中あるいは経過観察中の患者20名に半構造化面接を実施し，修正版グラウンデッド・セオリー・アプローチの手法を用いて分析した．その結果，進行がん患者が病気の情報を未成年の子どもに伝えることに関する意思決定過程は，①『自己の価値観に基づき，「伝える」「伝えない」を選択する』，②『伝える時・人・方法を熟考したうえで伝える』，および③『死について伝えるべきか答えが出ない』の3 つをコアカテゴリとする過程であり，【自身の決断を信頼できる人に確認する】が②の進行を支えている．意思決定支援として，看護師は，患者から伝える・伝えないの選択に至った思いを引き出し，進行がん患者が辿ると予測される3 つのコアカテゴリから成る意思決定過程を支える継続的支援，伝えるタイミングの尊重・支持，死を伝えることの困難さに関する患者の語りと看護師の傾聴により，患者が自分の意識を再構成し，死を伝えるべきかどうするか自らが答えを出していける支援が示唆された．

　Our purpose was to clarify the decision-making process in advanced cancer patients regarding communicating information about their disease to their minor children, and to obtain suggestions for nursing practice.

　Semi-structured interviews were conducted with 20 patients diagnosed with advanced cancer who had children aged 6 to under 18 years old at the time of diagnosis of advanced cancer, were told by their doctors that they were not eligible for curative treatment, and were undergoing treatment or watchful waiting to prolong life or relieve symptoms, and in whom the period between diagnosis of advanced cancer and the interview was 15 years or less. The modified grounded theory approach was used.

　The decision-making process in advanced cancer patients regarding communicating information about their disease to their children is divided into three core categories: (1)“choosing whether or not to communicate information about their disease to their children based on their own values,” (2)“communicating after thinking about when, from whom, and in what way to communicate,” and (3)“being unable to decide whether or not to communicate about death.” “Checking with a trusted person if they made a good decision” supports the process of (2).

　The following approaches by nurses were suggested to support patients' decision-making: listening to advanced cancer patients’ thoughts and feelings that led to their decision of whether or not to communicate their disease information to their minor children; providing continued support for the decision-making process, which consists of the three core categories predicted to be followed by patients; respecting and supporting the patients’ timing of communicating the information about their disease to their children; and facilitating the patients’ narratives about difficulties of communicating about death and listening to them carefully so that they can reconstruct their own narrative and come to their own conclusions about whether or not to communicate about their death to their children.