心不全患者のアドバンス・ケア・プランニングの概念分析

Concept Analysis of Advance Care Planning for Patients with Heart Failure

要旨

　目的：心不全患者のアドバンス・ケア・プランニングの概念を明らかにすることである．

　方法：Rodgers（2000）の概念分析の手法を用いた．

　結果：分析の結果，7つの属性【希望を持ちながら最悪の事態への備え】【その人の価値の探求】【疾患管理を見据えた生活の編み直し】【病みの軌跡に関する認識を合わせること】【納得したケアゴールに向けた対話】【段階的で継続的な取り組み】【患者の意思をつむいでいくこと】，4つの先行要件，4つの帰結が明らかになった．

　結論：本概念は「患者が家族・医療者とともに価値を探求し，疾患管理のための生活の編み直しをしながら，最悪の事態への備えとして，病みの軌跡に関する認識を合わせることや，納得したケアゴールに向けた対話を繰り返し，患者の意思をつむいでいくプロセス」と定義した．本概念は心不全の臨床経過の特徴を反映し，慢性疾患のセルフマネジメントの要素を含むことが示唆された．

　Objective: To clarify the concept of advance care planning (ACP) for patients with heart failure.

　Method: The concept analysis method described by Rodgers (2000).

　Results: The following seven attributes were identified: “hoping for the best but preparing for the worst,” “exploration of personal values,” “life restructuring from the perspective of disease management,” “sharing recognition of the patient's illness trajectory,” “dialogue toward satisfactory care goals,” “step-by-step and continuous efforts,” and “sharing patient hopes.” In addition, four antecedents and four consequences were identified.

　Conclusion: ACP in patients with heart failure was defined as a process to prepare for the worst, share recognition of the illness's trajectory, conduct dialogues toward satisfactory care goals, and share patient hopes, while exploring personal values and restructuring life from the perspective of disease management together with family and medical staff.

　These findings suggested that the concepts of ACP for patients with heart failure reflected the clinical course of the disease, and that self-management of chronic disease was included in the attributes.