胎児異常の診断を受けた女性とそのパートナーの支援に関する文献レビュー

Support for Women and Their Partners after Receiving a Diagnosis for Fetal Abnormality: A Literature Review

要旨

目的：胎児異常の診断を受けた女性とそのパートナーの支援に関する文献を整理し，支援の方向性と今後の研究課題について示唆を得る．

方法：PubMed, Web of Science, 医学中央雑誌を用いて“fetal abnormality（胎児異常）”“women（女性）”“partner（パートナー）”“nursing（看護）”をキーワードに2003年1月から2013年12月の期間に発表された文献を検索．胎児異常を診断された女性の体験や心理に関する研究とパートナーの体験を含む26文献（国内文献10件・海外文献16件）を分析対象とした．

結果：妊娠期の女性に焦点を当てた研究がほとんどであった．女性とパートナーの心理特性では，診断時における悲嘆，不安，ショック，などの心理的反応に性別の違いはなく，夫婦間での一致の頻度は高かった．また，夫婦ともにネガティブな感情だけでなく，希望などのポジティブな感情もみられた．医療者には，胎児異常の診断時から正確な情報提供を行うことや共感的で継続的な支援が求められていた．

結論：日本の研究は海外に比べ集積が少ない現状にあり，日本の社会文化的背景のなかでの検討が必要である．今後は，ケアシステム構築のため，パートナーも含めたケアニーズやケアの質評価に関する検討が必要である．女性とそのパートナーの支援を行う看護者への教育プログラムの必要性が示唆された．

Purpose: Construction of a support system is a crucial issue for women and their partners who receive a diagnosis for fetal abnormality. We sought to identify the current issues and the direction of future studies by reviewing the Japanese and international literature.

Methods: PubMed, Web of Science, and Ichushi Web were searched using the key terms “fetal abnormality,” “women,” “partner,” and “nursing,” to find Japanese and international articles from January, 2003 to December, 2013. We performed a systematic literature review. After title and abstract screening, study quality was assessed.

Results: Most studies addressed women's issues that occur during pregnancy. Twenty-six articles in domestic and international journals were reviewed for this study. Women and their partners experienced the psychological conditions of sadness, anxiety, and shock after receiving a diagnosis of fetal abnormality. No gender differences were found, and intra-couple congruence was frequent. Moreover, not only negative feelings but also positive feelings, such as hope, were experienced. In addition, health professionals need to provide accurate information and empathic support from the time of disclosure for fetal abnormality.

Conclusion: Based on the results of this literature review, future studies should examine the care needs of women and their partners as well as assess the quality of care they receive in order to construct care systems. There is a smaller body of knowledge about women and their partners who received a diagnosis for fetal abnormality in Japan than in other countries. Therefore, education programs for nurses who provide support to women and their partners should be developed.