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Japanese women's reasons for accompaniment status to Hereditary Breast and Ovarian Cancer-focused genetic counseling

Matsukawa, Manami 京都大学 DOI:10.14989/doctor.k23759

2022.03.23

概要

【背景】遺伝カウンセリング(以下、GC)における「来談者(クライエント;以下、CL)に合った」情報提供・サポートとは、提供した情報をCLが正確に理解するだけでなく、置かれた状況にCLが適応・変化していくこと、血縁者の健康管理に繋げることを助けることをも含む。遺伝性乳癌卵巣癌症候群(Hereditary Breast and Ovarian Cancer:以下、HBOC) は、頻度・浸透率の高い遺伝性腫瘍の一つである。結婚、出産などライフイベントの多い若年で発症すること、遺伝学的検査結果が、術式、薬剤選択、リスク低減卵管卵巣摘出術(以下、RRSO)等に繋がることが特徴である。単身で来談するCLも血縁者と来談するCLもいる中で、それぞれのCLの心理社会的背景に合った情報提供とサポートのあり方が求められている。

【目的】GC初回来談時の同伴者の有無に関する決定要因を明らかにする。

【方法】質問票および半構造化式個別面接を用いた質的研究。2016.9-2017.4に、HBOC当事者会(以下、当事者会)の理事長を起点としたスノーボールサンプリング、及び合目的サンプリングを実施した。紙またはweb質問票にて回答を得た後、インタビュー参加同意者には、質問票回答内容に沿って、後日電話または対面で1時間のインタビューを行った。録音したインタビューの逐語録を作成し、同伴者と「一緒に行く要因」「一緒に行かない要因」についてテーマ分析を行った。分析の信憑性、確実性を高めるため、共同研究者とトライアンギュレーションした。

【結果】32名から質問票の回答を得た。うちインタビュー参加者は19名であり、全員女性、37-65歳(中央値46歳)、15名が当事者会会員、初回GCは0-9年前(中央値2.5年前)、18名が遺伝学的検査(自費)受検済、11名がRRSO経験者であった。電話インタビューが15名、時間は42-227分(中央値62分)であった。「一緒に行く要因」8カテゴリー、「一緒に行かない要因」9カテゴリーが抽出された。各カテゴリーは対を成す形となり、最終的に(1)自身の能力・性格,(2)意思決定のスタイル,(3)自身/家族の習慣・都合,(4)家族への想い・葛藤,(5)医療者の助言の5つのテーマが生成された。

【考察】対象者はRRSO経験者、当事者会会員が大半を占めたことから、情報収集や治療に積極的なHBOC当事者が参加したと考えられる。インタビューの結果から、同伴者有無の決定要因は、CL自身とその家族の性格、習慣、心理社会的背景を反映していることが示唆された。GCに誰と一緒に行くか否かを決定する過程は、CLのGCへの期待度や血縁者への想いの表れとも言える。また同伴者(血縁者)は、GCの内容が自身の健康管理に直接繋がることもあること、家族間コミュニケーションのキーパーソンにもなり得ることから、同伴者の有無は家族の健康管理にとっても重要であることが示唆された。

【限界】同伴者有無に理由があるCLのみ参加した可能性がある。BRCA1/2保険適用前のデータであり必ずしも日本の現況を反映していない。遺伝学的検査、サーベイランスに対する国内外の状況が異なるため、本結果を遺伝性乳癌卵巣癌症候群が疑われGCに来談した人の結果として一般化できない。

【結語】本研究は初めてCLを対象に、同伴者の有無について決定要因を探索した質的研究である。CLが考える同伴者の役割は多様であり、同伴者は将来のCLになり得ることにも配慮した事前の案内が重要である。同伴者有無の理由を理解することが、CL中心のGCの一助となると考えられる。

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