血液透析患者の自己管理行動と血液透析導入期の腎代替療法選択におけるshared decision making （SDM）との関連

Relationship between Shared Decision Making (SDM) and Self-management Behavior of Hemodialysis Patients in the Selection of Renal Replacement Therapy when Introducing Hemodialysis

要旨

　目的：血液透析患者の腎代替療法選択におけるSDMと自己管理行動との関連を検討する．

　方法：血液透析患者61名に無記名自記式質問紙調査を行い，個人属性，血液透析自己管理行動尺度，SDM-C-patient尺度，療養行動の動機づけ尺度，慢性疾患患者の健康行動に対するセルフエフィカシー尺度を尋ねた．自己管理行動への関係モデルを構築し，共分散構造分析を実施した．

　結果：食事制限と水分制限の遵守は，SDMの直接効果と，疾患に対する対処行動の積極性を介した間接効果が確認された．治療法の管理と合併症の予防は，SDMから疾患に対する対処行動の積極性を介した間接効果と，SDMから自律的動機づけを介した間接効果が確認された．身体と心理社会生活の調整は，SDMから疾患に対する対処行動の積極性を介した間接効果が確認された．

　結論：血液透析患者の自己管理行動には，腎代替療法選択におけるSDMが影響していた．

　Objective: This study examined the relationship between SDM: shared decision making and selfmanagement behavior in the selection of renal replacement therapy when introducing hemodialysis.

　Methods: We conducted a survey by sending self-administered questionnaires to 61 hemodialysis patients. The survey items included personal attributes, the hemodialysis self-management behavior scale, the SDM-C-patient, the motivation scale for medical treatment behavior, and the self-efficacy scale for health behavior of patients with chronic diseases. We constructed a relational model of self-management behavior and SDM, self-efficacy, and motivation, based on the conceptual framework and the results of the univariate analysis, and conducted covariance structure analysis.

　Results: SDM had direct effects on compliance with dietary restrictions and water restrictions and indirect effects through positive coping behavior against disease. Regarding the management of therapy and prevention of complications, SDM had indirect effects through positive coping behavior against disease and autonomous motivation. Regarding the adjustment of physical and psychosocial living, SDM had indirect effects through positive coping behavior against disease.

　Conclusion: Self-management behavior of hemodialysis patients was influenced by SDM in the selection of renal replacement therapy.