経カテーテル的大動脈弁植え込み術を受けた後期高齢者の手術決断に至る意思決定プロセス

Process of Decision-Making Leading to Surgical Decision among Older Adults Aged ≧75 Years Undergone Transcatheter Aortic Valve Implantation

抄録

目的：経カテーテル的大動脈弁植え込み術（TAVI）を受けた後期高齢者の手術決断に至る意思決定プロセスを明らかにし，意思決定支援における看護の示唆を得ること．

研究方法：TAVIを受けた75歳以上の男女12人に半構造化面接を実施し，M-GTAを用いて分析した．

結果：意思決定プロセスの中核には，《望む逝（生）き方》《TAVIを受ける利益の合理的理解》《他者との関係性のなかでの生の見いだし》の3要素からなる【人生における価値観と治療の意味との照合】がとらえられた．また，診断時の【不安・恐怖心の体験】や，【自分の思いだけでは決められない】も意思決定に影響を与えており，後期高齢者の発達課題や死生観，老年的超越性，情報処理の傾向，医師や家族との相互作用等の特徴が明らかとなった．

結論：看護支援としては，診断初期からかかわり，後期高齢者の感情や理解を支えながら意思形成・意思表明を支援するとともに，意思実現に向けて医療機関内外の多職種と連携した包括的な支援体制を構築することが重要である．

Purpose: This study explored the decision-making process leading to surgical decision among older adults aged ≧75 years who have undergone transcatheter aortic valve implantation (TAVI) and determined implications for nursing support in making such decisions.

Methods: Semi-structured interviews were conducted with 12 men and women ≧75 years old who had undergone TAVI. The data were analyzed using a Modified Grounded Theory Approach (M-GTA).

Results: The core category of the decision-making process was identified as the “Alignment of Personal Life Values and the Meaning of Treatment,” which comprised three main elements: “Desired Way of Living and Dying,” “Rational Understanding of the Benefits of TAVI,” and“Discovering the Meaning of Life Through Relationships with Others.”In addition, “personally experienced feelings of anxiety and fear at the time of the diagnosis”, as well as “Inability to Decide Based Solely on One's Own Feelings,” were found to influence decision-making. The findings also revealed characteristics specific to older adults aged ≧75 years, such as developmental challenges in later life, views on life and death, gerotranscendence, information-processing tendencies, and interactions with physicians and family members.

Conclusion: In nursing support, it is important to be involved from the early stage of the diagnosis to support the emotions and understanding of older adults aged ≧75 years, to assist in the formation and expression of their intentions, and to establish a comprehensive support system in collaboration with multidisciplinary teams both inside and outside the medical institution to help realize their decisions.