Research projects

In this study, we developed and evaluated the acceptability of a web-based educational program on the systematic development and use of decision aids (DA) for healthcare professionals in oncology. Based on a needs assessment of healthcare professionals and information about existing educational programs, we designed a web-based educational program available to healthcare professionals not only in oncology but also in a variety of specialties. We conducted an acceptability study. A total of 4o participants completed the post-program acceptability survey. 90% of the participants were satisfied with the program. In addition, 90% of the participants indicated that they would like to use DA and 60% of the participants indicated that they would like to develop DA. Our findings suggest that this web-based educational program could improve learners' intentions to develop and use DA.

本研究は、がん患者の主体的な意思決定参加を促すSDMが組織内に定着し、患者の意思決定の質を組織レベルで向上することを目指し、①がん医療におけるSDMの障壁となる要因と促進要因を明らかにすること、② ①の結果を踏まえ、障壁となる要因を取り除き、促進要因を強化するための実装モデルを構築すること、③ ②で構築した実装モデルに対するがん医療に携わる医療者による受容性と有用性の認識の程度、および実装モデルの改善点にはどのようなものがあるかを明らかにすること、を目的とする。

本研究の目的は健康を決める力ヘルスリテラシー(HL)の根幹をなす、判断・意思決定が困難な日本人並びにその支援者の看護職に、HLの前提となる意思決定のスキルを学習するツール開発である。国際比較研究では日本人はEUやアジアよりHLが低く、死亡率の低下が鈍化し、慢性疾患の管理も悪く、喫煙率や自殺率は高く、警鐘が鳴らされている。しかし日本人は学校教育や生涯教育において、意思決定できることが幸せであること、その基本的な方法として選択肢を探し、それぞれの長所と短所を比較し自分の価値観に合ったものを選ぶことを学習する機会がない。これは意思決定を支援する看護職でも同様で、共にそれらを学び合うことを可能にする。

Objective: To clarify the reality of shared decision-making (SDM) in obstetrics and to evaluate SDM educational programs for healthcare professionals. Methods: (1) Web-based survey and interviews on SDM, and (2) evaluation of the program. Results: (1) Fifty-three healthcare professionals responded to the web survey (February 2021). The older they were and the more years of experience they had, the more they practiced SDM. 7 interviewees revealed problems and responses to SDM that support decision-making for both the expectant mother and the fetus, as well as situations requiring IP-SDM and responses. (2) The educational program (in October of the same year) was attended by 13 participants from two facilities. The "individual study" received high formative evaluations and the "group study" was conducted as planned, suggesting its feasibility of the program in clinical practice.

People are faced with difficult decisions have single “best”choice in healthcare. These types of decisions are considered to be “preference-sensitive”because there is insufficient evidence about outcomes or there is a need to trade off known benefits and harms. Patient decision aids are evidence based tools that can be supportive in shared decision -making. This study aimed to develop an educational program on evidence-based patient decision aids to support shared decision- making for healthcare providers in Japan. The educational program was developed based on a literature review and evaluation of six available patient decision aids for the Japanese.

本研究は、乳がん死亡率の上昇をくい止めるために乳がん検診率及び意識の向上をめざし、乳がん体験者と協働して子を持つ母親及び助産師のための乳がん予防啓発プログラムを開発・実施し、その効果を明らかにした。同意の得られた子をもつ母親47人を対象に、 1)乳がんに関する知識提供、 2)乳がん体験者による語り、 3)小グループの乳房セルフチェック実施練習の70分で構成したプログラムを実施した。その結果、乳がん検診・自己検診に関する知識、態度、行動は、介入前に比べ介入後は有意に改善し、プログラムの有効性が示された。また、乳房ケアに携わっている助産師215人を対象に、3時間のプログラムを適用したプログラム群61人、テキスト群72人、対照群82人の3時間において、乳がん検診・自己検診に関する知識、態度、行動、教育活動を介入前後で比較分析した。その結果、プログラム群とテキスト群は知識が有意に上昇し学習効果がみられたが、態度や行動の変化はみられなかった。

The objectives of this study were to develop an "e-learning system for peer-supporters for facilitating accurate and trustful communication." Research methods : We assessed the impact and feasibility of the e-leaning system in patients with breast cancer. Results : The "e-learning system for peer supporters" improved the relationship and developed competency for open discussion on cancer experience, resulting in positive coping with anxiety and improving emotional well-being.

Purposes: This study was conducted to: 1) survey the current situations and existing problems in the practice of the multidisciplinary approach to cancer care; 2) develop a model for the multidisciplinary approach to cancer care that can promote the strengths of cancer treatment system and ensure the provision of patient-focused and effective care; and 3) apply the developed model to the clinical setting and evaluate whether it improve the quality of life and levels of satisfaction with healthcare among women with breast cancer. Method: As the fundamental study, a survey using the questionnaire was conducted among healthcare providers and women with breast cancer at 457 institutions authorized by the Japanese Breast Cancer Society. Based on the results, a “patient-healthcare provider information sharing" multidisciplinary approach to cancer care was developed, and an intervention study was conducted with a quasi-experimental design, in order to evaluate the effects of developed care approach. Results and Discussion: A “patient-healthcare provider information-sharing" multidisciplinary approach to cancer care was developed, with the aim of increasing the function of healthcare teams to provide human resources and opportunities to share the information of evidence-based treatment and care issues and patients' narrative information about their own lives and ways of living as well as their needs, thereby helping them fully promote their self-care abilities. Specifically, a system to provide care was developed with an emphasis placed on: 1) the assignment of resource nurses in charge of strengthening collaboration between healthcare providers and patients, 2) information systems to share patient needs and issues among the treatment team and efficient conferences that utilize them, and 3) a booklet on self-care to navigate patients. This care approach was applied to breast cancer women who were receiving neoadjuvant chemotherapy. The results suggested an increased awareness of among healthcare providers (p<0.01). Also the proportion of patients of who reported dysgeusia were significantly lower in experimental group than in control group (p<0.05).

本研究の目的は、先進国で広く利用が進んできている患者中心の意思決定を支援するツールであるディシジョンエイド(decision aid)において、エビデンスが不十分で長所(利益)と短所(リスク)の不確実性が高い場合に、自分の価値観を中心に決める必要がある「複雑な意思決定」を、よりシンプルで、親しみやすく、わかりやすくするために必要な要件を探り、ディシジョンエイドのチェックリストを作成することである。ディシジョンエイドにおいて、日本人の半分が、確率情報の比較及び選択が困難な可能性があり、価値観の明確化を可能にする方法に関するエビデンスもない。わかりやすい方法を当事者への調査から明らかにする。

This study documented the establishment of an online breast cancer support group with medical professionals and six experienced breast cancer survivors. A focus group using a semi-structured guide provided data that was transcribed verbatim, and analyzed qualitatively to clarify patient's needs and issues about peer support via Internet. Second, a bibliographic survey provided clarification regarding issues about online breast cancer support groups. Next, existing web-based support groups were analyzed. Based on these investigations, Hope Tomorrow, the web system for breast cancer patients, was developed. Active use of this site should increase the community's store of knowledge, both factual and narrative. The next step will be the sophistication of the site contents and usability, the formulation of evaluation indicators and the examination of effectiveness.