子どもを得ず不妊治療を終結する女性の意思決定プロセス—複線径路・等至性モデル（TEM）による分析

Decision-making Process of Women who Discontinue Fertility Treatment after Unsuccessful Attempts: an Analysis with the Trajectory Equifinality Model

要旨

目的：不妊治療を受療した女性が子どもを得ず治療終結を意思決定する過程の多様な径路と，多様な径路を辿る影響要因を明らかにし，その特徴から終結期の看護支援を見出す．

方法：子どもを得ず不妊治療を終結した女性15名に面接調査を行った．分析手法は，複線径路・等至性モデル（TEM）を用いた．

結果：終結過程は，治療を周囲に伝えるか否かの選択，治療継続か否かの葛藤，相談するか否かの選択，本当に治療をやめてよいかの葛藤などの分岐を経ながらそれぞれの径路で終結に向かっていた．周囲の期待・年齢の焦り，諦めきれない思いなどが治療継続を選択させ，夫や親の承認，医療者の対応，限界の自覚，産まれる子どものリスクと命の有限性の実感が，終結の意思決定に影響していた．

結論：治療継続・終結への思いと影響要因を把握し，適切な情報提供と相談の機会を確保し，本人と重要他者が納得し選択できるように支援することが重要である．

Objective: To illustrate the diverse decision-making pathways followed by women who decide to discontinue fertility treatment and the factors affecting their decision, in order to find ways to support such women at the time of treatment termination.

Method: Fifteen women who had discontinued fertility treatment after unsuccessful attempts were interviewed, and the results were analyzed using the Trajectory Equifinality Model.

Results: The decision-making process was found to involve the following divergences before leading to the discontinuation of fertility treatment: a decision on whether to tell people that they are undergoing a treatment, conflict over whether to continue with the treatment, a decision on whether to seek counseling, and conflict over whether they are certain about discontinuing the treatment. Factors such as the anticipation of other people, the sense of urgency because of their age, and the difficulty to let go of their desire prompted the women to continue with the treatment. In contrast, factors such as acceptance by their husband and parents; care given by health professionals; and realization of their limits, the possible risk to their future child, and the finite nature of life persuaded the women to discontinue with the treatment.

Conclusion: Understanding the patients' feelings toward continuation or discontinuation of treatment as well as the factors affecting their decision, providing appropriate information, and ensuring opportunities for counseling are required in order for patients and their significant others to make a wholehearted decision.