サイコオンコロジー—国内初の遺族ケアガイドライン

Psycho-Oncology: An Overview of Clinical Practice Guidelines for the Care of Psychologically Distressed Bereaved Families Who Have Lost a Family Member to Physical Illness, Including Cancer

サイコオンコロジーとは，「がん」と「こころ」の関係を扱う学問領域であるが，この度，がん関連2学会が合同で遺族ケアガイドラインを作成した。遺族ケアについては，国際的にも考え方に差異が大きいため，総論としての解説を充実させた。臨床疑問としては，臨床的関与が必要な精神心理的苦痛に対して，非薬物療法を行うことは推奨される一方，薬物療法ではうつ病（薬物療法が推奨される）と複雑性悲嘆（薬物療法は推奨されない）では推奨の方向が異なることに留意したい。

Abstract

Psycho-oncology is an interdisciplinary field encompassing physical, psychological, social, and behavioral aspects of the cancer experience for both patients and caregivers. The Japanese Psycho-Oncology Society and the Japanese Association of Supportive Care in Cancer developed evidence-based clinical practice guidelines for the care of psychologically distressed bereaved families who have lost members to physical illness including cancer. Because of the wide variation in international attitudes toward bereavement care, we have enhanced the descriptions in the general comment section. Two clinical questions were set and a systematic literature review was conducted by the guideline development group. The level of evidence and the strength of the recommendations were graded, and the modified Delphi method was used to validate the recommendation statements. Recommendations were as follows: nonpharmacologic interventions were indicated for severe psychological distress (depression and grief), and antidepressants were indicated for depression; however, psychotropic medications, including antidepressants, were not recommended for “complicated” grief. These guidelines facilitate the provision of appropriate care for distressed bereaved families and identify areas in need of further research.