Difficulties nurses face in clinical practice in supporting consensus decision-making by cancer patients and their families.

【目的】日々臨床で行われている患者・家族と医療者間の合意形成による意思決定支援における看護師の困難を明らかにし，その上で看護師が合意形成による意思決定支援に積極的に取り組めるようにしていくための今後の課題を検討した．【方法】がん診療連携拠点病院２病院に勤務する看護師12名を４グループに分け，フォーカスグループインタビューを実施し，質的帰納的に分析した．データ収集期間は2015年10月～2016年３月であった．【倫理的配慮】大分大学医学部倫理審査委員会（承認番号979）と大分県立病院研究倫理委員会（受付番号28-4）の承認を得た．【結果】がん患者と家族の意思決定支援を行う上で看護師が抱えている困難は，【家族の意向が重視され患者の主体的な意思決定が阻害される】【患者や家族の心情や意向を把握できず合意形成による意思決定支援に踏み出せない】【患者が主体的な意思決定をしたのかわからないまま治療が進むことに悩む】【終末期患者が家族や医療者との合意形成のないまま治療することが良い選択だったのか悩む】【BSCの状況での治療選択において医療者と患者・家族の合意を得ることが難しい】【患者・家族と医療者間のコミュニケーションが十分に図れず合意形成による意思決定支援が成り立たない】【看護ケアチームとして継続的に合意形成による意思決定支援ができない】【スキル不足で変化する患者の状況に合わせて合意形成による意思決定支援のプロセスが辿れない】の８カテゴリーであった．【考察】看護師は，がん患者の権利や意向が尊重されていない状況に疑問を感じたり悩んだりしているが，問題解決に向けてアプローチできない現状が見いだされた．がん医療における意思決定支援の質を向上させるためには，看護師自身が担う役割があることを認識し，実践を積み重ねて，患者や医師が看護師の役割を認知できることが重要であると考えられる．The purpose of this study was to clarify the difficulties nurses face in consensus decision support between patients/families and health care providers, and to examine the implications for education to enable nurses to actively engage in consensus decision support. Focus group interviews were conducted with 12 nurses working at two cancer treatment base hospitals. Respondents were divided into four groups and analyzed qualitatively and inductively. The difficulties nurses face in providing decision support to cancer patients and their families were classified into eight categories: ［Family intentions are emphasized and patient's independent decision-making is hindered］, ［Unable to grasp the feelings and intentions of the patient and family and unable to step forward to support decision-making through consensus building］, ［Distressed that treatment proceeds without knowing whether the patient has made an independent decision］, ［Wonder if it was a good choice for a terminally ill patient to be treated without consensus by family and healthcare providers］, ［Difficulty in obtaining agreement between healthcare providers and patients/families on treatment choices in BSC situations］, ［Communication between patients/family members and medical staff is not sufficient, and decision-making support through consensus building cannot be established］, ［As a nursing care team, we cannot continuously support decision-making through consensus building］, and ［Lack of skills makes it impossible to follow the process of decision support through consensus building in accordance with the changing patient's situation］. We found that nurses are concerned about situations in which the rights and intentions of cancer patients are not respected, but they are unable to approach patients to solve the problem. To improve the quality of decision-making support in cancer care, it is important for nurses to recognize that they themselves have a role to play, to accumulate practice, and to make patients and physicians aware of the role of nurses

Validity of the Short Nutritional Assessment Questionnaire for Japanese Patients with Cancer Undergoing Outpatient Chemotherapy

Purpose : To investigate the utility of the Short Nutritional Assessment Questionnaire (SNAQ) in the nutritional evaluation of patients with cancer undergoing outpatient chemotherapy. Methods :We included 229 patients with cancer who were undergoing outpatient chemotherapy between October 2015 and April 2016. The SNAQ and the revised SNAQ (addition of age and body mass index) were implemented, and their relationships with Controlling Nutritional Status (CONUT), an indicator of bionutritional assessment, were examined. Results : The cutoff value of the SNAQ score corresponding to moderate-to-severe undernourishment in CONUT values was 0.5, with a sensitivity of 87.5% and a specificity of 65.9%, and the corresponding values for the revised SNAQ score were 2.5, 91.7%, and 62.9%, respectively. This cutoff value and the corresponding positive prediction value for the revised SNAQ were superior to those of SNAQ. Binary logistic regression analysis with the revised SNAQ and sex as independent variables and the CONUT value as the dependent variable revealed that the higher the SNAQ score, the more likely it was that CONUT moderate-to-severe undernourishment would be identified (odds ratio, 1.48 ; , 1.34-1.96) . Conclusion : Nutritional evaluation with the revised SNAQ can predict moderateto- severe undernourishment according to CONUT in patients with cancer undergoing outpatient chemotherapy