Published papers

目的:本研究の目的は、産科医療に携わる多職種チームメンバーを対象としたシェアード・デシジョンメーキング(Shared Decision Making:以下SDM)教育プログラムの開発プロセスを記述すること、およびその一貫として本プログラムの適用を試み、受容性を検討し改善点を明らかにすることである。方法:本プログラムは、日本の産科医療におけるSDMの現状把握と既存の2つのSDM教育プログラムを比較検討した上で設計し、講義動画視聴と課題に取り組む個人学習(オンラインオンデマンド型)と、職場で共に働く多職種チームメンバーが合同で受講する集合学習(ロールプレイとディスカッション、オンラインライブ配信型)で構成した。2施設の産科医療に従事する多職種チームメンバーを対象に適用し、集合学習終了後に受容性や満足度を尋ねるアンケートを実施した。結果:13名がアンケートに回答し、本プログラムは概ねわかりやすく満足度が高いことが示されたが、3名は、所要時間が適切ではないと回答した。結論:本プログラムは、日本において様々な施設の産科医療に携わる多職種チームに普及できる可能性があるが、学習時間の短縮化を図り、さらに参加しやすい方法へ改善する必要がある。(著者抄録)

Background: Health literacy, or the ability to access, understand, appraise and apply health information, is central to individuals' health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe. Methods: A total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy. Results: Internal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill. Conclusions: This study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan. Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments.

Objective: We aimed to evaluate the effect of a decision aid (DA) with patient narratives on decisional conflict in surgery choice for Japanese women with early-stage breast cancer. Methods: Two hundred ten women with early-stage breast cancer were randomly assigned to an intervention or control group. Groups 1 and 2 received standard information and a DA, with or without patient narratives, and Group 3 received standard information (control) before surgery choice. At baseline, post-intervention (Time 2), and 1 month after surgery (Time 3), we evaluated decisional conflict as the primary outcome using a decisional conflict scale (DCS). Sidak corrections for multiple comparisons in analysis of covariate were used to compare Time 2 and Time 3 DCS mean scores between each pair of groups. Results: At Time 3, decisional conflict was significantly reduced for Group 1 vs control (P = 0.021, Cohen's d = 0.26) and Group 2 vs control (P = 0.008, Cohen's d = 0.40). Conclusion: The DAs with and without patient narratives are equivalently effective at reducing postoperative decisional conflict in Japanese women with early-stage breast cancer. Practice implications: The DAs with and without patient narratives can be used in clinical practice for women with early-stage breast cancer. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

新卒看護師に関する文献を整理し,新卒看護師にとって,どのような関わり方や教育のあり方がよいのかについて検討した.新卒看護師は慣れない場と業務内容の中で,自分の看護実践能力不足に向き合いながらも,患者やその家族の励まし,先輩看護師のあたたかい見守りとサポートにより,一歩一歩成長していた.又,先輩看護師がいかに,新卒看護師の個性を理解し,共に成長を喜ぶ姿勢で卒後教育に主体的に取り組むかが重要であった.更に,卒後教育においては,多くの施設が組織的に取り組みをして,その評価を行いながら,よりよい卒後教育のあり方を模索していた

聖路加看護大学看護実践開発研究センターではナースクリニックとして乳がん女性のためのサポートプログラムを開催している。プログラム参加者の提案をもとに、乳がん体験者と看護専門職との協働的パートナーシップにより新たなピアサポート活動を構築した。この提案は、仲間と出会う前に、乳がん体験により孤立感を感じ同じ体験を持つ人に誰にも言えない気持ちを話したいと感じた経験に基づくものであった。2008年10月より、研修プログラムを受講した先輩乳がん体験者ボランティアと看護専門職が協働し、悩みを持つ乳がん患者のためのピアサポート活動(「聖路加スマイルコミュニティ」)を開始した。月に2回の頻度で相談活動を行い2010年7月末日までに28名の乳がん患者(術前1名、術後27名)が利用した。利用者の平均年齢は49.82歳、利用時期は術後1年未満が最も多く16名であった。利用者の反応はおおむね良好であったが、今後は(1)活動を維持するための体制づくり、(2)運営体制の見直し、(3)ボランティアのスキルアップが求められている。(著者抄録)

関東および関西の都市部に在住する乳幼児から中学生までの子育て期の女性で、乳がんの既往がない者とサポートグループや患者会に参加している乳がん体験者を対象に、フォーカス・グループ・インタビューを用いて調査を行った。子育て期の対象者は関東1グループ5人、関西2グループ10人の3グループ計15人(平均年齢40.3歳)であった。乳がん体験者は14人(平均年齢52.6歳)で、サポートグループ参加者が10人、患者会参加者が4人であった。インタビューの録音データをもとに逐語録を作成し、コード化、カテゴリー化を行った。分析の結果、子育て期の女性、乳がん体験者双方から乳がん検診の受診を促進する要点として共通して、「受診しやすい検診システム」「意識への働きかけ」が挙げられた。検診受診あるいは検診継続を可能とする要因として、子育て期の女性の分析からは4カテゴリーが生成され、乳がん体験者の分析からは3カテゴリーが生成された。

新卒看護師が,先輩看護師のどのような関わりをサポートと認識しているのかを,23名の新卒看護師への半構成的面接により検討した.その結果,新卒看護師は先輩看護師から「<出来るようになる>ための関わり」及び先輩看護師との「(聞ける)(言える)(話せる)関係」によって「やる気の高まり」「自己肯定感」といったエネルギーの注入を感じたり,逆に「やる気の低下」「自己否定感」といった「エネルギーの喪失」を感じていることがわかった.新卒看護師にエネルギーが注入される関わりをするためには,先輩看護師のアセスメント能力,コミュニケーション能力などが必要であることが示唆された

本報告の目的は,21世紀COEプログラム事業の一環として継続的に実施している国際駅伝シンポジウムのうち,2005年10月に開催された第4回「私たちが選ぶ時代に向けて:患者中心の乳がんチーム医療」の企画・実施過程および評価を報告し,それらを通じてみえてきたPeople-Centered Careを生成するうえでの重要な要素について提示し,今後の課題を検討することである.方法は,シンポジウムの企画,実施,評価の全過程で記述した議事録や講演・討議内容,参加者のアンケート内容を資料とし,質的データは内容分析を,量的データは記述統計を行った.シンポジウムは,乳がん体験者と共に構成や内容,方法を検討し企画した.プログラムは, 1)参加者の医療ニーズを共に知ることをめざしたクイズ, 2)米国のチーム医療から学びをうる講演, 3)共にめざす乳がんチーム医療について広い視点から討議することをめざしたシンポジウム, 4)参加者と共に音とことばのメッセージを分かちあう詩の朗読と音楽演奏,そして 5)ピンクリボンにちなんだシンボルキルトの作成で構成された.その結果,参加者のニーズとテーマの合致性,シンポジウム成果の政策提言,有用性などシンポジウムの評価は全体的に高かった.そして,シンポジウムを通して,患者と医療者が互いに学び,歩み寄り,協働して医療に取り組む姿勢が重要であるといった,新しいチーム医療の方向性やあり方が示された(著者抄録)

本稿は,聖路加看護大学21世紀COEプログラム事業の一環として実施した「国際駅伝シンポジウム:知恵と勇気を分かちあう〜社会の中で支えあう女性たち〜」の報告と,シンポジストの経験してきた活動の共通性をPeople-Centered Careの構成概念に比較して考察することを目的とする.本国際駅伝シンポジウムは,「市民主導型の健康生成をめざす看護形成拠点」を機軸に,「Women-Centered Care」と「すべての人々への健康へ貢献できる国際コラボレーション実践モデル開発」の2つのプロジェクトが中心となって行われた.今回,女性が生きるうえで直面する難しい問題,予期せぬアクシデント,その困難に出会う中で,共に支えあい,知恵と経験を生かし,社会の中で女性に勇気を与える役割を担ってきた4人のシンポジストから話題提供をしていただいた.助産師としてミャンマー連邦農村部で母子保健の向上をめざす女性グループの育成活動を行ってきた小黒氏.流産・死産・新生児死を体験された方のセルフ・ヘルプ・グループの運営者として,子どもを失うという悲しみを分かちあい,支えあうための支援活動を展開されてきた石井氏.異文化である日本での結婚・出産・子育ての経験を生かし,同じように悩みをもつ在日外国人女性を支えるためのNPOを立ち上げ活動する長南氏.そして国際看護・家族看護を専門とし,中央アジアで女性たちのキャパシティ・ビルディングにかかわってきたパーフィット氏.以上の方々からその経験を紹介していただいた.シンポジストの語った経験は,それぞれのコミュニティにおける立場やその特徴により多様であったが,共通していたのは,活動を通して経験される女性たちのエンパワーメントであった.各シンポジストの活動においては,市民と医療職という二極分化でなく,なだらかな連合帯としての構造が示唆された.これまでのCOE活動から得られたPeople-Centered Careの要素,「おもいやり」「生きてきた経験からの学び」「わかりあう言葉」「役立つ健康情報の生成」「異なる視線でのつながり」「意思決定」を,再び支持し確認できた(著者抄録)

AbstractPurpose: The purpose of this study was to determine whether an educational program aimed at promoting breast awareness for early detection of breast cancer would encourage changes in behaviors and beliefs regarding breast cancer， breast self-examination, and mammography screening. Methods: We compared subjectsʼ behaviors and beliefs regarding breast self-examination and mammography screening before and after intervention, without a control group. Forty⊖two women, aged over 20 years and with no breast cancer history, consented to enroll in the study. They participated in an educational program conducted by ourselves and breast cancer survivors. Study outcomes consisted of the rates of performing regular breast self-examination and having mammography screening, and scores from Championʼs Health Belief Model Scale for Japanese （CHBMS-J）． Results: The mean participant age was 50.6 （SD=11.5） years; 59.5％ had an occupation, and 16.7％ had breast disease. One year after the intervention, the percentage of women who were performing regular breast self-examinations had risen significantly to 54.8％ from 21.4％（χ 2 =9.389, p＝0.002, effect size w=0.602）；the percentage who had undergone mammography screenings had also risen significantly, to 47.6％ from 23.8％ （χ2 =8.100, p=0.004, effect size w＝0.569）．CHBMS-J scores for self-efficacy in breast self-examinations raised significantly at 1 and 6 months, and 1 year, after intervention （F=34.080, p＜0.001, effect size f=0.586）．More than 90％ of participants stated that they were satisfied with the program and found it useful and valuable. Conclusion: The program successfully enhanced self-efficacy in breast self-examination and motivation to undergo breast self-examination and mammography screening, thus raising rates of performance of breast self-examination and attendance for mammography screening.

乳癌患者が術式決定に参加できるよう支援し、決定プロセスを共有するシェアド・ディシジョン・メイキング(SDM)を実践することは、患者中心の医療において重要である。以下について概説した。1)3つの意思決定モデルとその歴史的推移、2)SDMとは何か、3)SDMにおける意思決定支援ツールとしてのディシジョンエイドの役割と効果、4)ディシジョンエイドに必要な要素、5)乳房再建を含む乳癌術式決定におけるディシジョンエイド、として述べた。

© 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the effects of decision coaching when used to provide non-directive support to help people prepare to make decisions related to their health care.

BACKGROUND: As the advent of genomic technology accelerates personalized medicine and complex care, multidisciplinary care is essential for management of breast cancer. OBJECTIVES: To assess whether healthcare delivery systems are related to patients' perceptions of care in breast cancer treatment institutions. METHODS: We conducted a cross-sectional nationwide study of breast cancer treatment institutions approved by the Japanese Breast Cancer Society in Japan. From 128 of the 457 institutions, 1,206 patients were included in the analysis. Each patient completed a questionnaire regarding perceptions of care that consisted of a multidisciplinary care subscale and a patient-centered care subscale. RESULTS: Multiple regression analysis revealed that the multidisciplinary care subscale was significantly related to implementation of patient-based medical record system that was paper-based (p<0.05). The results of the secondary analysis showed a significant relationship between the interdepartmental medical record system and the patient's perception of multidisciplinary care (p<0.05) and patient-centered care (p<0.05). When a multidisciplinary case conference took place regularly or multidisciplinary viewpoints were incorporated into the conference records, the conference had a significantly higher correlation with both subscales (p<0.001). CONCLUSIONS: Integrated patient-based information and regular multidisciplinary case conferences that include records of viewpoints from different professionals improve patients' perceptions of comprehensive breast cancer care.

Introduction: After the World Health Assembly approved the WHA 45.5 in 1992, which addressed the nursing shortage by refocusing nurses and midwives to meet community health needs, community demands for educated nurses and the needs of higher nursing education in developing countries increased. However, in developing countries that suffering from multiple resource deficiencies, such as Kenya, the strategic direction of higher education in nursing was unclear. Therefore, in Kenya, a major university school of nursing initiated a collaborative study with a well-established Japanese nursing college to determine the service-providers' perspective about upgrading the Master's community nursing curriculum. Purpose: The aim of the study was to describe the Kenyan stakeholders' perspective and the expected roles and abilities of Master's graduates in community nursing. Methods: This qualitative, cross-sectional study used convenience sampling to obtain 21 participants. The content analysis of the data was based on 19 semistructured interviews. Results: Sixteen categories and 42 subcategories were derived from the five key questions that related to the expectations of the Master's program. The Master's graduates were expected to acquire knowledge and skills relating to administration, management, epidemiology, research, and education. The participants recognized that epidemiology, important for preventive care, was minimal among the current community health nurses. Also, Master's graduates must be prepared to manage health programs. Conclusion: The stakeholders expected that Master's graduates would become leaders in community health nursing, with a broad range of knowledge and skills, most notably in the areas of management and administration, epidemiology, and research. Those abilities should be reflected in the curriculum content.

Women with a BRCA pathogenic variant are required to manage the risk of breast and ovarian cancer. Decision-making of the optimal strategy (e.g., prophylactic surgery, chemoprevention, or surveillance) is very complex and difficult due to uncertain effects and impact. This study aimed to develop a decision aid for women with a BRCA pathogenic variant and evaluate its acceptability. The International Patient Decision Aids Standards were used as a guide for an evidence-based development process. We created a prototype using the Ottawa Decision Support framework. During its development, we conducted required assessment from six experts. Once completed, its acceptability was assessed via semi-structured interviews, which included open-ended feedback, with 27 women with a BRCA pathogenic variant. All the participants felt the decision aid would have been helpful during their consultation and recommended it for future patients. However, many participants indicated the need for further information regarding the various symptoms after risk-reducing salpingo-oophorectomy and the cost of each medical strategy. Acceptability of the decision aid was high. Furthermore, based on the evaluation, it was further revised to meet the needs.

Purpose: This study aims to investigate the impact of a Science Café (SC) dealing with medical topics on participants’ patient activation (PA), a concept that refers to patients’ involvement in managing their own health, working with their healthcare providers, and maintaining their health. Material and Methods: Semi-structured interviews were conducted with patients who had participated in a medical SC (n = 10) to identify the medical SC-associated factors that influenced PA. Through a questionnaire of medical SC participants (n = 23), the impact on PA and correlations with relevant psychological measures were quantitatively assessed. Results: The interviews revealed three factors: “Experience & acceptance of chronic conditions”, “Features of medical SC” and “Changes as a result of participation.” The questionnaire results showed a positive correlation between PA and resilience and a negative correlation with decision regret. Conclusions: Participation in a medical SC by people with illnesses can improve PA by improving knowledge and skills for self-management and increasing self-awareness of illness in a supportive environment. The study highlights the potential benefits of using medical SC as a strategy for healthcare providers to improve PA and health outcomes.