がん患者の意思決定プロセスを支援する共有型看護相談モデルの開発

Development of Nursing Shared-Structured Decision-Making Model to Support Cancer Patients

要旨

目的：がん患者の意思決定プロセスを支援する共有型看護相談モデル（NSSDM）の有効性を明らかにすることである．

方法：対照群のがん患者は通常のサポートを受け，介入群のがん患者はNSSDMを用いた意思決定サポートを受けた．介入効果の判定は，不安尺度（STAI）と葛藤尺度（DCS）を用いて測定した．

結果：研究に参加したがん患者は，対照群28名，介入群26名であった．STAIは面談前と面談後に有意な改善は認められなかった．DCSは下位尺度の較差において「情報」が有意に悪化（p＝0.02）し，「価値の明確さ」は有意に改善（p＝0.031）したが，価値の明確さは面談前に介入群の得点が有意に高かった．

結論：NSSDMは価値の不明瞭さを低下させるという効果の可能性が示唆されたが，今後さらなる検討が必要である．一方，患者の中に新たな情報が増えることによりそれに対する葛藤が生まれる可能性もあることが示唆された．

Purpose: This study was conducted to confirm the effects of a nursing shared-structured decision-making model (NSSDM) for cancer patients who need to make care-related decisions.

Methods: While the control group mainly received information about their condition, the intervention group received decision-making support based on the nursing shared-structured decision-making model. Anxiety and conflict were measured using the Japanese version of the State-Trait Anxiety Inventory-Form (STAI) and the Decisional Conflict Scale (DCS), respectively.

Results: This trial consisted of 28 control and 26 intervention group patients. STAI subscale scores was no significant difference between before and after the interview. DCS subscale scores, “information” was significantly worse (p=0.02), and “Clarity of value” was significantly improved (p=0.031), however, “Clarity of value” was significantly higher in the intervention group score before interview.

Conclusions: Decision-making support based on the nursing shared-structured decision-making model was possibility of effective in clarifying personal values, but it is necessary to further promote research in the future. On the other hand, when increasing the new information into the patient, it was suggested that there is a possibility of conflict occurs for the information in the patient.