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Development of a national health policy logic model to accelerate the integration of oncology and palliative care: A nationwide Delphi survey in Japan

Uneno, Yu 京都大学 DOI:10.14989/doctor.k24285

2022.11.24

概要

Cancer is the world’s leading cause of death, accounting for approximately 10.0 ...【研究の背景】緩和ケアは、患者とその家族の苦痛を和らげ、生活の質を向上させるこ白とを目 的とする。国民に質の高い緩和ケアを提供するには、国の健康政策の充実が必要 不 白可欠である。しかし、国内における調査では、質の高い緩和ケアが国民に行き届いている白とはいえない現状が報告されている。また、国のがん緩和ケア政策とそのアウトカム、評 白価指標との関係について、これまで十分に検討されていない。近年、政策立案・評価の手白法として、ロジックモデの活用が注目されている。ロジックモデルは、施策が直接的に影白響を与える初期アウトカムから中間アウトカム・最終アウトカムまでを結びつけること白で、政策の立案・ 評価に資する論 理 的構造を明らかにする。しかし、国際的にも国のがん白緩和ケア政策に関するロジックモデルの開発は、これまでに行われていない。

【研究の目的】国が推進する「がんと診断された時からの緩和ケア」のロジックモデルを開発し、それに基づいて実施すべき施策を明らかにすること。

【研究方法】本研究は、下記①-③の手順で行われた。①ロジックモデルのアウトカム白と評価指標を、医療政策の専門家のガイダンスの元、研 究チームで提案し、ロジックモデ白ルの各構成概念が、相互に排他的で包括的になるよう整理した。ロジックモデルは、研 究 白者らの合議で「がん治療病 院でのケア提供」 、「地域連携」、 「 緩和ケアに関する社会的 白認 識 」の3つのドメインに分類された。②ロジックモデルの初期アウトカムに有効に機能 白するがん緩和ケア施策を立案した。その際、厚生労働省におけるがん対策など公的な業務白に従事した経験のある内部専門家パネルを招聘し、研究チームと合同で、立案作業を遂行 白した。③医療従事 者 、がん罹患経 験 者 、経営コンサルタント、新聞 記 者 等の有識 者から構白成される外部専門家パネルを招聘し、デルファイ法に則り、②で立案された施策について白の合意形成を行った。5件法のLikert Scale( 1=絶対に除外すべきである、2=除外したほ白うがよい、3=どちらとも言えない、4=含めたほうがよい、5=絶対に含めるべきである)で白回答を求め、1)5件法のLikert Scaleで平均が4以上かつ2)80%以上のパネルメンバーが白4あるいは5と評価した場合、を合意到達基準と事前に定義した。施策の優先度は、1- 10 白のNumerical Rating Scaleで評価された。

【結果】45の施策 草案が提案され、それらは国における検討スキーム等を考慮し、「が白ん対策推進基本計 画 ( BP) 」 「がん診 療 連携拠点病 院 等の指定要件( RD) 」 「 財政支援白( FS)」「その他( Others)」の4つに分類された。これらの施策案は64人の外部専門 白家パネルによって独立して評価され、1-3回目のデルファイ調査の回答率は96.9〜 98.4% 白であった。最終 的に、47の施策案が合意に到達した。BP、RD、FS、Othersはそれぞれ、 白17、11、12、7の施策案で構成され、優先度の最高点が8.85点最低点が6.34点であった。

【考察】本研究は、国のがん緩和ケア政策におけるロジックモデルを開発し、ロジック白モデルを効果的に機能させるための施策を明らかにした。医療現場でのケア提供に直接か白かわる施策や医療者教育施策は優先度が高く、ピアサポートやテクノロジー活用に関する白施策は低く評価された。

【結論】国民への質の高いがん緩和ケアの提供に寄与し得る、国のがん緩和ケア政策にお白けるロジックモデルを開発した。今後、本モデルの活用及び、実際の政策立案・評価にお白ける有用性の検証が望まれる。

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