Japanese

Title	血液がん患者へのアドバンス・ケア・プランニングの実態と看護師の実践知
Subtitle	原著
Authors	藤本実希1), 小林幹紘2), 坂口幸弘3)
Authors (kana)
Organization	1)Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, 2)武蔵野大学 看護学部, 3)関西学院大学 人間福祉学部
Journal	死の臨床
Volume	46
Number	1
Page	156-162
Year/Month	2024 / 6
Article	原著
Publisher	日本死の臨床研究会
Abstract	「抄録」 目的 : 血液がん患者へのアドバンス・ケア・プランニング(ACP)の実態と看護師の実践知を探索する. 方法 : 看護師へ半構造化インタビューを行い, 内容分析の手法を用いて分析した. 結果 : 合計10名の看護師へインタビューを行い, 分析を行った結果, 【患者の言動から価値観を探る難しさ】【患者への支援を一緒に考えられる医療チームづくり】【患者家族と医療従事者の代弁者となる共同意思決定支援】【患者家族の今に焦点を当てた話し合いの積み重ね】の大カテゴリーが抽出された. 最期まで続く積極的治療に伴う, 話し合う余裕のなさや, 病態理解の難しさから, ACPに満足に立ち入れない現状が報告された. 看護師はACPを行ううえで, 患者とのラポールを形成することや, 患者や家族, 医療従事者間の橋渡し役となり, 意見を擦り合わせること, 多職種チームで協働すること, 患者の今の価値観や選好に関する話し合いを積み重ねるなどの工夫を行っていた. 結論 : 血液がんの特徴に関連するアドバンス・ケア・プランニングの難しさが複数報告されたことから, 看護師の実践知をもとにその特徴に合わせた方策を検討することが重要である.
Practice	臨床医学：一般
Keywords	アドバンス・ケア・プランニング, 意思決定支援, 血液がん, 看護師, advance care planning, decision-making, haematologic malignancies, nurse

English

Title	Current state and nurses' practical knowledge on advance care planning for patients with hematologic malignancies in Japan : A qualitative interview
Subtitle
Authors	Miki Fujimoto1), Masahiro Kobayashi2), Yukihiro Sakaguchi3)
Authors (kana)
Organization	1)Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, 2)Faculty of Nursing, Musashino University, 3)School of Human Welfare Studies, Kwansei Gakuin University
Journal	The Japanese Journal of Clinical Research on Death and Dying
Volume	46
Number	1
Page	156-162
Year/Month	2024 / 6
Article	Original article
Publisher	The Japanese Association for Clinical Research on Death and Dying
Abstract	[Abstract] Aim: To explore the current state of nurses' practical knowledge on advance care planning (ACP) for patients with hematologic malignancies (HMs). Method: We conducted qualitative semi-structured interviews with nurses who are, or had been, working with patients with HMs. Data were analyzed using content analysis. Results: A total of 10 nurses were interviewed. Four major themes were extracted, "Difficulties in exploring patient's value through their behavior" ; "Building a multidisciplinary team that can cooperate while engaging the patient's decision-making" ; "Implementation of shared decision-making by bridging the gap between patients, families, and healthcare professionals" and "Continuous conversations focusing on the planning for current care". Lack of time due to continuous aggressive treatments and difficulties in understanding the pathology of HMs were identified as the main obstacles affecting ACP. The nurses reported the importance of building rapport with patients through daily care, bridging the gap between patients, their families, and healthcare professionals to find a middle ground, cooperation within a multidisciplinary team, and continuous conversations about current values and preferences. Conclusion: The difficulties in ACP are related to the unique characteristics of HMs. Therefore, a strategic approach for nurses based on these characteristics, and the nurses' practical knowledge, is needed.
Practice	Clinical medicine
Keywords	advance care planning, decision-making, haematologic malignancies, nurse

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