がん患者への看護師のアドバンスケアプランニング

Advance Care Planning of Nurses to Cancer Patients

要　旨

　本研究の目的は，がん患者に関わっている看護師が，最期まで患者が自分らしい人生を歩むことができるようにアドバンスケアプランニング（以下：ACP）としてどのような看護支援を行っているのかを明らかにすることである．看護師12名に，半構成的面接を行い，質的帰納的に分析した．

　分析の結果，がん患者への看護師のACPとして，『患者の価値観の尊重』『意思決定支援のアプローチ』『終末期のことに関する取り決め』『継続的な取り組み』の4局面が抽出された．

　看護師は，日頃のコミュニケーションの中で患者の価値観を理解しながら，患者の今後の気がかりへ関わり，多職種連携によるチームアプローチ，社会資源の調整，家族ケアなどの意思決定支援のアプローチを行っていた．そして終末期の医療やケア，療養場所，代理意思決定者の取り決めを支援していた．また，ACPは1度で完結することなく，プロセスの中で繰り返し行われており，継続的に関わることの大切さが示唆された．

　The purpose of this study is to investigate what type of nursing support are provided as a part of advanced care planning (ACP) so that patients can live with autonomy and dignity until their deaths. A semi-structured interview was conducted with 12 nurses, and the data was analyzed qualitatively and inductively.

　The following four aspects were extracted on nursing support in ACP with cancer patients: Respect for the values of patients, Assistance with decision-making, Arrangement for end of life care, and Ongoing support. While understanding patients' values through daily communication, nurses were involved in addressing patients' future concerns and providing decision-making support through multiple types of approaches, including multidisciplinary team collaboration, coordination of social resources and family care.

　The areas of decision-making assistance revolved around end of life care, places to live while receiving treatment and care, and arrangements of surrogate decision makers. Additionally, ACP was carried out throughout the care process instead of being completed it once a plan was made, which suggests the importance of nurses' continuous involvement in the ACP proces.