Manabu Nii

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.

Introduction: The purpose of this study was to clarify the relationship between the available service information on small-scale multifunctional in-home nursing care (KANTAKI) and its operational status via text mining. Methods: We obtained nationwide textual information on KANTAKI from the Nursing Care Service Information Disclosure System and the Ministry of Health, Labour, and Welfare, and analyzed the characteristics of the word usage using KH Coder. The number of users and employees and the implementation of services were compared among the facilities that used terms relating to medical dependency and end-of-life care, which are KANTAKI characteristics, and with other facilities. Results: The facilities that used terms relating to medical dependency and end-of-life care showed significantly more users requiring nursing care level 5 and more full-time nursing staff than those not using such terms. Moreover, regarding service provision, the rate of procedures was significantly higher in 11 of 12 items, except for stoma. Conclusion: The facilities that use terms relating to medical dependency and end-of-life care in their information have more users and provide a greater variety of services. In the future, educational support is required to enable facility managers to understand the services and translate them into their work.

【目的】本研究では,2型糖尿病が強く疑われる人とそうでない人の生活習慣の比較を行うことを目的とした。【方法】A市において2008年度から2019年度までに国民健康保険の健康診査を受診した30歳以上の男女のうち,解析項目に欠損がある人,既に生活習慣改善に取り組んでいる人を除く10,401名を解析対象とした。糖尿病が強く疑われる人を「HbA1c(NGSP値)が6.5%以上かつ/または血糖値を下げる薬の服薬ありの人」と定義し,χ2検定を用いて糖尿病の疑いの有無の2群間で生活習慣の比較を行った。その後,糖尿病が強く疑われる/それ以外を従属変数,各生活習慣項目を独立変数,性別と年齢で調整した二項ロジスティック回帰分析を行った。解析は65歳未満と以上で行った。【結果】二項ロジスティック回帰分析の結果,65歳未満の対象者においては,日常生活において歩行または同等の身体活動を1日1時間以上実施していない人,他の人と比較して食べる速度が速い人,就寝前の2時間以内に夕食をとることが週に3回以上ある人は,そうでない人と比較して糖尿病が強く疑われる人のオッズ比がそれぞれ1.69倍(95%信頼区間:1.22-2.32),1.31倍(1.01-1.72),1.52倍(1.12-2.07)であった。一方,お酒を時々あるいは毎日飲み,かつ1日当たり1～2合飲む人では,ほとんど飲まない・飲まない人と比較して糖尿病が強く疑われる人のオッズ比が0.65倍(0.46-0.92)であった。65歳以上の対象者では,日常生活において歩行または同等の身体活動を1日1時間以上実施していない人,ほぼ同じ年齢の同性と比較して歩く速度が速くない人,他の人と比較して食べる速度が速い人は,そうでない人と比較して糖尿病が強く疑われる人のオッズ比がそれぞれ1.41倍(1.18-1.70),1.21倍(1.01-1.45),1.29倍(1.09-1.53)であった。【結論】本研究より,糖尿病予防のためには65歳未満,65歳以上の人に共通して身体活動を行うこと,早食いをしないことが重要であり,加えて65歳未満の人では就寝前2時間以内の夕食摂取に注意すべきことが示唆された。(著者抄録)