血液がんの治療の一つである同種造血幹細胞移植治療（以下，移植）は，患者にとって唯一の治癒を目指した治療であるが，想像以上の副作用に苦しむ可能性の高い治療でもある．成功率20～30% 程度と説明された不安，前処置の副作用，生着前・後の感染症状，GVHD 症状，退院に向けての社会的負担などの苦痛が測り知れなく出現する．主治医は患者の生命維持に精一杯であり，看護師は大量の点滴や身体ケアに精一杯であり，移植患者の苦痛への対応が困難な状況に陥りやすい．そこで，2018年10月から緩和ケアチームが移植患者全例に介入することとした．移植治療のインフォームドコンセント時に緩和ケアチームの専従看護師が立ち会い，主治医から移植治療中の苦痛に対して緩和ケアチームが介入していくことを説明し開始した．これまでに，４症例の移植患者に介入できており，主に心理的対応と栄養士の早期対応が実現できた．しかし，主治医との連携は，良好なものから連携不良とさまざまであり，今後も検討していく必要性があると考えられた．移植患者の苦痛への早期対応が，患者，家族そして主治医と看護師を含めた医療者との三位一体の緩和ケアが可能となり，成果が期待される． Allogeneic hematopoietic stem-cell transplantation (hereinafter referred to as transplantation) is one of the treatments for blood cancer. Although it is the only treatment that may cure cancer, it is highly likely to cause excruciating side effects. Patients undergoing transplantation face difficulties beyond their imagination such as anxiety upon learning that the success rate is approximately 20-30%, side effects from preliminary treatment, infection symptoms before and after engraftment, GVHD symptoms, and social burden while preparing for discharge. Such patients’ doctors and nurses find it difficult to deal with their and distress. While the doctors are fully engaged in maintaining patients’ lives, nurses are similarly engaged in performing a large amount of drip infusions and maintaining their personal hygiene. Owing to this situation, in October 2018, a palliative care team began interventions for all patients who undergo transplantation. At the beginning of the intervention, a dedicated nurse from the palliative care team attends an informed consent session for transplantation treatment. The doctor explains to the patient that the palliative care team will perform an intervention for him or her in order to alleviate pain and distress during the transplantation treatment. To date, the team has performed interventions for four patients who underwent transplantation. The main achievements were psychological support and early-stage interventions by a dietitian. However, collaborating with the doctors of patients is not always successful. Thus, this practice requires further research in the future. Dealing with the pain and distress of a patient who undergoes transplantation at an early stage makes it possible for the patient, his or her family, and healthcare providers-including doctors and nurses-to collaborate with each other in palliative care. It is believed that such collaborative practices will lead to favorable outcomes
