Informed Consent for Patients with Lung Cancer and the Role of Nurses

がん医療の化学療法において，1990年から実施されているGCP（医薬品の臨床試験の実施に関する基準）の普及に伴いインフォームド・コンセント（以下ICと略す）が医療者間には勿論，一般の人々にも広く認識されるようになってきた． そこで，平成7年4月から平成10年10月の間に患者本人の承諾書に基づいて病名が告知され，ICを経て化学療法を受けた肺がん患者110名（男性94名，女性16名）のカルテ類（医師の診療カルテ，看護カルテ，看護記録など）から，ICの実態について調査を行った．合わせて，チーム医療の重要性について看護婦の認識を深める意味から，看護婦（22名）を対象に"ICおける看護婦の役割について "の調査を実施した． 調査の結果，ICの実態は，医師の説明時間は30分以内が全体の83．3％であった．医師の説明によって，化学療法を受けることに同意した人の内，納得した人は74．5％，仕方ないとした人は14．5％であった．化学療法を受けることの決定は，本人の自発的意思による41．8％，主治医に一任する46．4％，という結果であり，治療は"医者にお任せ"という傾向が強かった．"ICにおける看護婦の役割について"の調査では，ICの場に同席した看護婦自身の認知的葛藤体験を通して，看護婦が患者・家族と医師間の調整役として，また，精神的支援者としての役割の重要性を認識していた．In chemotherapy for cancer, the need to oftain informed consent (IC) for various medical procedures has come to be increasingly recognized by the general public as well as by those involved in medicine due to the spread of the Good Clinical Practice established in 1990. We investigated the state of IC according to the records, including the patient charts written up by physicians and nurses, of 110 patients (94 males and 16 females) with lung cancer who received chemotherapy in whom the diagnosis had been disclosed based on the patients' personal consent between April 1995 and October 1998. From the viewpoint of team medical care, the role of the nurses in IC was studied in a group of 22 nurses. Concerning IC, the explanation by the physician was 30 minutes or less in 83.3％ of the patients. Most of the patients (74.5％) agreed to undergo chemotherapy after the physician's explanation, while 14.5％ accepted it as unavoidable. Decisions regarding treatment were left up to the patients in 41.8％ of the cases but were left up to the physicians in 46.4％, thus indicating a tendency to relyon experts concerning treatment. Regarding the nurses' role in IC, when present during the physicians explanation they acted as coordinators between the patients or their families and physicians while also providing valuable psychological support