腎代替療法選択支援における共同意思決定（shared decision making：SDM）の実態と関連要因—職種別の解析

Shared Decision Making in Renal Replacement Therapy Choice: Current Practices and Associated Factors by Profession

要旨

　目的：腎代替療法選択支援におけるSDMの実態と関連要因を医師・看護師の職種別に明らかにする．

　方法：医師250名，看護師299名を対象に，SDM，腎代替療法知識，コミュニケーション・スキル，共感力，社会人基礎力を調査した．SDMを従属変数とした重回帰分析を行った．

　結果：有効回答は医師103名，看護師122名であった．90％以上の医師・看護師がSDMを認知し，医師72.8％，看護師56.6％が，SDM実践への障壁を感じていた．医師のSDMには，性別，経験年数，SDMの障壁，【気持ちの想像】，【アクション】，看護師のSDMには，SDMの認知と【自己主張】が関連していた．

　結論：質の高いSDM実践には，医師は，SDM障壁の除去，相手への想像力および主体性をもち周囲に働きかける実行力の育成，看護師は，SDMの認知向上，柔軟かつ論理的に主張する能力の育成といった教育支援が必要である．

　Objective: To investigate the current implementation of shared decision making (SDM) when helping patients choose renal replacement therapies, including related factors, broken down by physicians and nurses.

　Methods: An online questionnaire was distributed to 250 physicians and 299 nurses. It assessed SDM practices, familiarity with renal replacement options, communication skills, empathy, and essential competencies for working adults. We conducted multiple regression analyses, using SDM scores as the dependent variables and all other measures as independent variables.

　Results: Valid responses were obtained from 103 physicians and 122 nurses. Over 90% of physicians and nurses were aware of SDM, and 72.8% of physicians and 56.6% of nurses perceived barriers to SDM practice. Among physicians, factors linked to SDM included sex, years of experience, perceived obstacles to SDM, [imagining feelings], and [actions]. In nurses, associations were found with familiarity with SDM and [self-assertion].

　Conclusion: Enhancing SDM in clinical settings calls for targeted training. Physicians would benefit from efforts to overcome SDM hurdles, build skills in empathizing with patients' viewpoints and emotions, and cultivate their drive to rally team support and push through tough scenarios to meet objectives. Nurses, meanwhile, need opportunities to raising awareness of SDM and hone their ability to present reasoned arguments in an adaptable, persuasive manner that resonates with others.