慢性心不全患者のアドバンスケアプランニングの概念分析

A Concept Analysis of Advanced Care Planning for Chronic Heart Failure Patients

要旨

　目的：慢性心不全患者のアドバンスケアプランニングの定義を明らかにする．

　方法：49文献を対象にRodgersの方法を用いて概念分析を行った．

　結果：8つの属性：共有と議論が必要な医療とケアに関する情報，その人を知る，エンドオブライフ（EoL）を見通す，決めるプロセスの推進，シームレスなケアのための体制構築，パートナーシップ，対話，継続的・反復的なプロセス，7つの先行要件：社会的背景，文化的背景，医療従事者の背景，個別の判断による意向確認のタイミング，心不全に対する認識のズレ，心不全の病態と治療・ケアの不確実性，終末期ケアの不足，5つの帰結：患者・家族の満足度の向上，患者・家族の全人的苦痛の緩和，患者の内的変化，その人らしい人生の実現，医療的アウトカムの向上が抽出された．

　結論：本概念を「慢性心不全特有の病いのプロセスのなかで先を見通し，対話を通してその人らしさを探究し，自律した意思決定と望む生き方を実現するための継続的・反復的プロセス」と定義した．

　Purpose: The purpose of this study was to analyze the concept of advanced care planning for patients with chronic heart failure.

　Method: The analysis was conducted on 49 reports using the Rodgers' evolutionary concept analysis.

　Results: The following eight categories were extracted as attributes of advanced care planning: information that needs to be shared and discussed, exploring of humanity, foresee the end-of-life, promoting decision-making process, construction of system for seamless care, partnership, dialogue, and continuous and repetitive process. In addition, seven antecedents were extracted: social background, cultural background, background of medical personnel, timing of confirmation of intention by individual judgment, gap of heart failure perception, uncertainty of medical condition, treatment and care of heart failure, and lack of end-of-life care. Finally, five considerations were extracted: improvement of patient and family satisfaction, relief of total human suffering of patients and families, internal change of patient, realization of that patients' way of life, and medical outcomes improvement.

　Conclusion: Advanced care planning for chronic heart failure patients is defined as a process whereby, in preparation for the decline of the patients decision-making ability, patients, families and healthcare professional dialogue as they explore the patients' humanity while looking at the disease processes specific to chronic heart failure, and continuously and repeatedly work together for the realization of the patients' autonomous intentions and desired way of life.