炎症性腸疾患患者の生物学的治療選択に関する意思決定プロセス

Decision-making Process about Biologic Therapy by Patients with Inflammatory Bowel Disease

要旨

目的：炎症性腸疾患患者の生物学的治療選択に関する意思決定プロセスを明らかにする．

方法：Grounded theory approachを用いて，寛解期にある炎症性腸疾患患者20名に半構造化面接を行い，継続比較分析を行った．

結果：分析の結果，炎症性腸疾患患者の生物学的治療選択に関する意思決定プロセスとして【症状軽減を狙った賭けに出るか否か】というコアカテゴリーが抽出された．これは《症状による生活への支障》，《治療の選択・決定に臨む姿勢》，《情報・経験の模索》，《天秤にかける》，《決断》という5つの段階から構成された．《天秤にかける》段階で患者は，『病状の重大性』，『普通の生活への希求』と，『副作用・効果減弱への恐怖』，『後戻りできない』，『最後の切り札』とを比較衡量し，《決断》に至っていた．

結論：患者が生物学的治療に伴う利害にどのように重きを置くかによって，治療選択の決断が異なることが明らかになった．

Purpose: This study aimed to explore the decision-making process in patients with inflammatory bowel disease who were considering biologic therapy.

Methods: This descriptive study used a grounded theory approach, involving semistructured interviews and continuous comparative analysis, to study decision making. The study subjects were 20 adult patients with inflammatory bowel disease that was in remission.

Results: During the data analysis, one core theme (“should I take the risk to reduce my symptoms?”) emerged as the central problem in patients considering biologic therapy. This was resolved through a process consisting of five stages: 1) experiencing disruption of daily life by symptoms, 2) selecting who decides treatment to receive, 3) searching for information, 4) weighing the risks against the benefits, and 5) making the decision. When weighing the risks against benefits, common considerations were “seriousness of the symptoms,” “desire for a normal life,” “fear of the side effects,” “cannot go back to a condition before receiving the treatment,” and “treatment as the last remaining option.” The decision is based on this evaluation.

Conclusions: The results suggest that when making decisions regarding biologic therapy, patients are influenced by their evaluation of the risks and benefits of the treatment.