Michinobu Ryoko, Yamamoto Masaki, Hori Tsukasa, Mikami Takahiro, Igarashi Keita, Iesato Kotoe, Takebayashi Akira, Tsugawa Takeshi, Kawasaki Yukihiko, Tsutsumi Hiroyuki
Center for Medical Education, Sapporo Medical University, Sapporo, Japan.
Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan.
Pediatr Int. 2022 Jan;64(1):e14700. doi: 10.1111/ped.14700. Epub 2021 Nov 12.
The survival rate of children with cancer has increased substantially in recent years. Shared decision making (i.e., the ability of children with cancer to express their will and share it with medical personnel) has become a particularly important issue. The nature and developmental processes of children's decision making in hospital should be understood. There is, however, a lack of research in this area.
From January 2016 to March 2018, we conducted a longitudinal qualitative observational study, within the context of medical anthropology, in a hospital pediatric ward in Japan. We investigated the nature and development of decision making among seven children aged 5-12 years with hematologic cancers. We recorded their everyday behaviors, interactions, narratives, and events in the ward. The recording was conducted systematically and it was analyzed thematically using both variable-oriented and process-oriented modes to assess causal relationships between phenomena.
The thematic analysis identified three thematic scenes in which children developed their will regarding cancer treatment: (1) adjusting to hospital life; (2) forming friendships with other children; and (3) communicating with medical personnel. Sharing information, building trusting relationships, and sharing treatment goals with medical personnel were identified as forms of children's participation in medical decision making. Through cultivated friendships, children's peer groups were sources of resilience and strength in overcoming difficulties in hospital life.
The development of children's decision making in a pediatric oncology ward was based on various rich human relationships. Such relationships should be promoted to improve shared decision making substantially.
近年来，癌症患儿的生存率大幅提高。共同决策（即癌症患儿表达自己意愿并与医务人员分享的能力）已成为一个尤为重要的问题。应当了解儿童在医院进行决策的性质和发展过程。然而，这一领域缺乏相关研究。
2016年1月至2018年3月，我们在日本一家医院的儿科病房内，在医学人类学背景下开展了一项纵向定性观察研究。我们调查了7名5 - 12岁血液系统癌症患儿决策的性质和发展情况。我们记录了他们在病房里的日常行为、互动、叙述和事件。记录是系统进行的，并使用变量导向和过程导向模式进行主题分析，以评估现象之间的因果关系。
主题分析确定了儿童形成癌症治疗意愿的三个主题场景：（1）适应医院生活；（2）与其他儿童建立友谊；（3）与医务人员沟通。与医务人员分享信息、建立信任关系以及分享治疗目标被确定为儿童参与医疗决策的形式。通过建立的友谊，儿童的同龄群体成为他们在克服医院生活困难时恢复力和力量的来源。
儿科肿瘤病房中儿童决策的发展基于各种丰富的人际关系。应促进此类关系，以大幅改善共同决策。
