Examination of a nursing support ACP model for assisting patients with malignant brain tumor to be themselves until the end of life

2021 Fiscal Year Final Research Report

• Project/Area Number: 20K23223
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Multi-year Fund
• Review Section: 0908:Society medicine, nursing, and related fields
• Research Institution: Kyoto University
• Principal Investigator: CHIKADA AI 京都大学, 医学研究科, 助教 (10883647)
• Project Period (FY): 2020-09-11 – 2022-03-31
• Keywords: アドバンス・ケア・プランニング / 原発性悪性脳腫瘍 / 意思決定支援 / 多職種連携

Outline of Final Research Achievements

A systematic review of the Japanese ACP literature clarified the definition of ACP based on Japanese cultural values and norms and what ACP implementation could be recommended.
In addition, a semi-structured interview was conducted with 21 health care professionals (physicians, nurses, rehabilitation therapists, pharmacist, and MSWs) who support decision-making in patients with primary malignant brain tumors to explore the best practice and challenges of implementation of ACP in daily clinical practice. From the narratives of the participants, we obtained important insights into clinical practice strategies that each experts use to elicit patients' values, goals, and preferences, and into the challenges of ACP practice, such as the difficulty of approaching patients who have difficulty communicating at an early stage, and the difficulty of interdisciplinary team collaboration approach.

Free Research Field

看護学

Academic Significance and Societal Importance of the Research Achievements

本邦では厚生労働省が2018年に人生の最終段階における医療・ケアの決定プロセスに関す
るガイドラインを改訂したが、ACPの具体的支援内容は提示されていない。さらに、他の疾患の経過と大きく異なる原発性悪性脳腫瘍患者や家族に、医療者がどのようにACPを導入し、実践するべきか、十分な知見が得られていない。本研究課題において、原発性悪性脳腫瘍患者の医療やケアに携わる医療専門職が実践するACPの実態・課題を可視化し、日本の文化的価値観や規範に基づいた原発性悪性脳腫瘍患者にふさわしいACP支援策を検討したことは、今後臨床で実装可能な看護師主導の多職種連携型ACP支援モデルを開発する上で重要な手がかりとなる。