子どものハイリスク治療受け入れに向けた親の関わり―造血幹細胞移植事例を通して

Parental Negotiation to Child's Assent Related High-Risk Treatment

要旨

　ハイリスク治療における子どもの権利の尊重や治療参加への促しは重要であるが，子どもの認知能力の限界とともに親の関わりが問題となる．そこで造血幹細胞移植の意思決定への子どもの参加を巡る親の関わりの要素と過程を探求する目的で，これから移植を受ける子どもの親を対象に質的帰納的なプロスペクティブスタディを実施した．

　その結果，親は「移植への親の踏み切り」に基づき，子どもの治療受け入れの必要性を考え，「子どもの意思決定に対する親の見解」を見出し，「治療受け入れに向けた子どもへの働きかけ―子どもの受け入れへの促し，受け入れの確かめ」を繰り返していた．この過程に「子どもの見極め―これまでの姿，子どもの理解と決断，促しへの子どもの反応の予測」と「親の振り返り―移植の受けとめ，親としての役割意識，親の対応力の予想」が影響していた．これらは『子どものハイリスク治療受け入れに向けた親の関わり』を意味していた．

Abstract

　In high-risk treatment, although it is important to respect children's rights and to promote their involvement in treatment, cognitive ability in children and the influence of parental management should be questioned. To clarify the elements and processes of parental management which may correlate to children's participation in decision making in treatment, we conducted a prospective study using a qualitative inductive method. The subjects of this study were parents with children undergoing hematopoiesis stem cell transplantation.

　The results showed the followings：Parents based their actions on “parental determination to transplantation”and must get child's assent to treatment. So parents emerge from “opinion on the child's decision making”and led to the cyclical process of “approach to the child's assent related treatment”that is to say, “encouraging the child to accept treatment”, “confirmation of the acceptance”. This process influence “evaluation of the child”-“earlier characteristics of the child”, “the child's grasp and decision”, “prospect of the child's response to encouragement”, and “parental retrospection”-“emotional turmoil of transplantation”,“awareness of the parental role”, “expected parental ability to confront”. This process implied “parental negotiations to induce the child's assent of treatment”.