ハイリスク治療計画への意思決定における子どもの参加への親の関わりの過程―造血幹細胞移植事例を通して

The Parental Intervening Process to Children's Participation in Decision Making Concerning a High Risk Treatment Plan：In Case of Hematopoiesis Stem Cell Transplantation

要旨

　ハイリスク治療としての造血幹細胞移植の意思決定への子どもの参加は，子どもの権利の尊重と治療への協力の必要性から重要である．しかし子どもの認知能力の限界とその選択権が親にあるために実現は困難となっている．そこで本研究はその実現に深く関与している親の，ハイリスク治療計画の意思決定への子どもの参加に対する関わりの過程を明らかにすることを目的として，過去2年以内に造血幹細胞移植を受けた14人の小児患者の親を対象に半構成的面接を行い，その内容を質的に分析した．

　その結果，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過程は，親の決意に基づいて行われる「参加への働きかけ─“親の思いの伝達”“誘い込む”“承諾への誘導”“任せる”」から，「結果の確かめ─“納得の確かめ”“受け入れの確かめ”」を経ていた．これらの過程を看護職が理解し支援することは親の対応力を高め，子どもの治療への協力を促すことにつながる．

Abstract

　Concerning hematopoietic stem cell transplantation as a high-risk treatment, children's participation in decision making is important to respect their rights and obtain their cooperation in treatment. It is, however, difficult to achieve such cooperative relationships, because children's cogni-tive abilities are inadequate and parents have options for their children's participation.

　The purpose of this study is to clarify processes that parents, who were deeply involved with the accomplishment of such cooperation, intervened to children.

　Thus, in this research, we conducted semi-structured interviews with parents of 14 pediatric cases of hematopoietic stem cell transplantation performed within the past 2 years, and data were analyzed qualitatively.

　The processes of parents' interventions in decision making by children regarding hematopoiet-ic stem cell transplantation began with invitation to participation on the basis of parents' decisions, that is,“approach to participation-”conveyance of parents' wish”, “inviting”,“guidance to consent”and“trust””, and reached to verification of the results, namely “confirmation for participation-”confirmation for assent”and“confirmation for acceptation””.

　To enhance the coping abilities of parents and to gain children's cooperation, nurses are required to understand and support such processes.