維持血液透析見合わせにおける高齢者の思いに添った意思決定支援

Decision-making Support to Respect the Thoughts of Older Adults in Relation to Withdrawing Maintenance Hemodialysis

要旨

　目的：維持血液透析見合わせにおける高齢者の思いに添った意思決定支援の内容を明らかにする．

　方法：透析看護認定看護師13名に半構造化面接を行い，修正版グラウンデッド・セオリー・アプローチを用いて分析した．

　結果：透析看護認定看護師は【透析治療や予後に関わる高齢者の価値観や固有の状況の把握】をし，【高齢者の価値観や固有の状況に応じた透析治療や予後に関する情報提供】をする必要があると語った．【維持血液透析見合わせの選択に関わる高齢者と家族の受け止め方の把握】により，見合わせを選択した後も【維持血液透析見合わせの撤回も見据えた継続的な支援】を行い，【高齢者の意思に基づいた選択を行うための支援】と【多職種連携に基づく高齢者にとっての最善の策の検討】が重要であると明らかになった．

　結論：これらの支援は高齢者の思いの揺れに添って，繰り返し継続して実施する必要性を示した．

　Purpose: The purpose of this study is to clarify the contents of decision-making support aimed to respect the thoughts of older adults in relation to withdrawing maintenance hemodialysis.

　Methods: Semi-structured interviews were conducted targeting 13 Certified nurses in dialysis nursing, and analysis was conducted using a Modified Grounded Theory Approach.

　Result: According to the certified dialysis nurses, it is necessary to “understand each specific situation of older adults as well as how they view dialysis treatment and prognosis” and to “provide information on dialysis treatment and prognosis in line with each specific situation and views of older adults.” It also became clear that, even after a patient has opted to withdraw treatment, it is important to provide “continuous support with future reversal of the decision to withdraw maintenance hemodialysis in mind” by “understanding how the older adult and his/her family view the decision to withdraw maintenance hemodialysis,” and it is important to provide “support in making a decision that is based on the desires of older adults” as well as “examination of optimal measures for older adults based on interprofessional collaboration.”

　Conclusion: Results suggested that it is necessary to repeatedly conduct these types of support in accordance with the fluctuating moods of older adults.