新居 学

BACKGROUND/AIM: Patients diagnosed with cancer are expected to choose one or more treatment modalities after receiving corresponding explanations of the options. When making these choices, patients consider the effects of treatment and aspects related to their quality of life. These concerns can cause confusion and conflict owing to the complicated information provided by medical caregivers. The objective of the study was to identify perceptions of cancer treatment in patients with cancer and the decision-making factors affecting their treatment choices. PATIENTS AND METHODS: In this observational (cross-sectional) study, an online questionnaire survey was administered to 194 Japanese cancer patients with treatment experience. Patient information, perceptions of explanations provided by healthcare professionals, treatment views, and reasons for treatment decisions were subjected to a simple tabulation. Content and factor analysis was conducted to determine important treatment selection elements. RESULTS: Regarding treatment perception, 60.3% of respondents (n=117) considered treatment a financial and family burden, 47.4% (n=92) had concerns about physical pain, and 40.2% (n=78) were worried about increased stress. Regarding decision-making quality, 95.9% determined their preferred treatment within one week, 49.0% reported difficulties in making their decisions, and 83.0% chose their treatment themselves. Major decisive factors were prolonging life, opinions of medical staff, and accepting treatment risks (68.0%, 68.6%, and 60.3% of patients, respectively). The main attitudes toward treatment were anxiety, expectations of benefit, and expectations of support and care. CONCLUSION: SDM should enable patients to visualize the changes that their bodies will experience and include discussions on prognosis. Psychological care should be prioritized to alleviate anxiety and improve readiness for decision-making; attention should be paid to the extent and timing of information provision.

目的：看護小規模多機能型居宅介護（看多機）に特徴的なサービス情報の発信と運営状況との関係を明らかにする． 方法：介護サービス情報公開システムに公表された全国の看多機のテキスト情報を厚生労働省から入手し，KH Coderを用いて語の使われ方の特徴を分析した．看多機に特徴的である医療依存度や看取りに関する語を使用していた事業所とそれ以外に分け，利用者数や従業員数，サービスの実施状況を比較した． 結果：医療依存度や看取りに関する語を使用していた事業所は，使用していない事業所よりも要介護5の利用者数，看護職員の常勤人数が有意に多く，処置の実施率も人工肛門の1項目を除く，12項目で有意に高かった． 結論：医療依存度や看取りに関する語を発信していた事業所は，より多くの利用者を確保し多様なサービスを展開していることが示唆された．今後は事業所管理者が看多機サービスの理解を深め，運営に反映できるような支援が求められる．