病棟看護師におけるがん患者の治療法の意思決定支援と影響要因に関する検討

Support from Cancer-Ward Nurses for Cancer Patients Making Treatment-Related Decisions and Factors Affecting Execution

要旨

　目的：がん患者の治療法の意思決定に対する看護師の支援の実態とその影響要因を明らかにすることを目的とした．

　方法：2008年7月～9月に自記式質問紙調査を行った．「医師による治療法の説明に関わる看護援助」の項目と「看護師による情報提供」の項目について因子分析を行い，看護師の属性や病院分類による因子得点の差をt検定および一元配置の分散分析を用いて分析した．すべての分析はSPSSver15.0を使用し，有意水準を5％とした．

　結果：有効回答数は666名（71.6％）であった．因子分析の結果，「医師による治療法の説明に関わる看護援助」では4因子が抽出され，そのうち「説明内容の理解と精神的援助」は比較的良好に実施されていたが，「説明の場の調整」は十分に行われていなかった．「看護師による情報提供」では2因子が抽出され，「治療関連」の情報提供は良好に実施されていたが，「生活関連」の情報提供は十分に行われていなかった．因子得点は，いずれも卒業後の意思決定に関する学習や指導の有無により有意な差が認められた．

　結論：がん患者の治療法の意思決定支援を向上させるためには，医療機関で経験を積んだ後の自主的な学習だけでなく，がん看護に精通している先輩や上司の指導があることが有用であることが示唆された．

Abstract

　The purpose of this study was to survey the level of support offered by the nursing staff to cancer patients making treatment-related decisions and the factors affecting the execution of such support. We surveyed 930 nurses from general hospitals or cancer centers in Japan. The nurses responded to questions concerning the level of support offered for 20 items of nursing help related to the explanation of the treatment method by the doctor and 10 items of information provided by the nursing staff. A factorial analysis revealed that for the items concerning nursing help related to the explanation of the treatment method by the doctor, “Understanding and psychological support for the contents of the explanation” was excellently executed, but “Adjustments for the place in which the doctor's explanation was received by the patient” was inadequate. Moreover, “Information about treatment” was excellently provided, but “Information about Life” was insufficient. The factor scores were significantly correlated with the nurses' ongoing studies, participation in training associations, and guidance from senior nurses regarding the support of treatment-related decision making after the nurses had graduated from nurses' training school（university or junior college etc.）. This result indicates that not only ongoing studies after acquiring experience at a medical institution, but also the guidance of senior nurses who are well versed in cancer nursing might be useful for improving the support of cancer patients making treatment-related decisions.