口唇裂・口蓋裂児の母親の次子妊娠に関する医療職者の意識調査  [in Japanese] Attitude of Health-care Staff Toward Mothers of Children with Cleft Lip/Palate Who are Pregnant with Their Second Child  [in Japanese]

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Author(s)

    • 中新 美保子 NAKANII Mihoko
    • 川崎医療福祉大学医療福祉学部保健看護学科 Department of Nursing, Faculty of Medical Welfare, Kawasaki University of Medical Welfare
    • 三村 邦子 MIMURA Kuniko
    • 川崎医療福祉大学医療技術学部感覚矯正学科 Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare
    • 山内 泰子 YAMANOUCHI Yasuko
    • 川崎医療福祉大学医療福祉学部医療福祉学科 Department of Social Work, Faculty of Health and Welfare, Kawasaki University of Medical Welfare
    • 松田 美鈴 MATUDA Mishuzu
    • 川崎医療福祉大学医療福祉学部保健看護学科 Department of Nursing, Faculty of Medical Welfare, Kawasaki University of Medical Welfare
    • 稲川 喜一 INAGAWA Kiichi
    • 川崎医科大学医学部形成外科・美容外科 Department of Plastic and Reconstructive Surgery, Kawasaki Medical School
    • 篠山 美香 SHINOYAMA Mika
    • 川崎医科大学医学部形成外科・美容外科 Department of Plastic and Reconstructive Surgery, Kawasaki Medical School
    • 山本 真弓 YAMAMOTO Mayumi
    • 川崎医科大学医学部形成外科・美容外科 Department of Plastic and Reconstructive Surgery, Kawasaki Medical School
    • 森口 隆彦 MORIGUCHI Takahiko
    • 川崎医療福祉大学医療技術学部感覚矯正学科 Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare

Abstract

口唇裂・口蓋裂児の母親が遺伝に関することに不安を抱き,次子妊娠に対する戸惑いを感じることは少なくない。本調査は,口唇裂・口蓋裂の治療に携わる医療職者の次子妊娠に関する情報提供の実態を把握することを目的に,2008年9月~11月に無記名自記式調査票を日本口蓋裂学会員に郵送,回答を得た768人(回収率35.6%,有効回答率99.7%)を対象とし,以下の結果を得た。<br>1.対象者の職種は,矯正歯科医が57.4%と最も多く,口腔外科医,形成外科医,歯科医,言語聴覚士,耳鼻咽喉科医,その他(看護師・臨床心理士)の順であった。<br>2.次子妊娠に関する相談を「受けた」と回答したのは309人(40.2%),その時実施した支援(複数回答)は,「話を聞いた」,「再発率について話をした」,「遺伝カウンセリングの紹介」,「家族会の紹介」,「気にしないように告げた」等であった。その場面で「困った」と回答したのは49人,困った理由は,再発率の知識不足,具体的支援ができない,専門職(カウンセラー)がいない,心理的不安を増大させる,どこまで話してよいか疑問等の記述があった。<br>3.次子妊娠に関わる事柄を医療職者側から「説明した」と回答したのは140人(18.2%),その職種は,矯正歯科医,口腔外科医,形成外科医で占められ,ほぼ同じ割合であった。説明時期は初回受診時が最も多かった。<br>4.現在連携している職種としては,「認定遺伝カウンセラー」と回答したのは15人,「臨床遺伝専門医」は49人,今後連携したい職種としては,それぞれ,175人,154人であった。<br>今後は母親のニーズと照らし合わせながら,チーム医療への遺伝専門職の参加を求め,必要時施設外連携も視野に入れながら,具体的情報提供とその後の支援のあり方を検討する必要がある。

It is common for mothers of children with cleft lip/palate to feel anxious about heredity and uneasy during pregnancy with their second child. This survey was conducted to clarify how health-care staff involved in the treatment of cleft lip/palate provide information on the second pregnancy. In the survey, a self-administered questionnaire was sent to health-care staff by mail between September and November 2008 and 768 replies were obtained (recovery rate, 35.6%; valid response rate, 99.7%), with the following results:<br>1. Orthodontists were the most common, accounting for 57.4% of the staff, followed by oral surgeons, plastic surgeons, dentists, speech pathologists, otolaryngologists, and others (nurses and clinical psychologists).<br>2. The number of staff who "have been consulted about a second pregnancy" was 309 (40.2%). The support (multiple answers) conducted at that time was as follows: "listening to mothers", "talking about the recurrence rate", "referring to genetic counselors", "referring to family support groups", and "advising not to worry". Forty-nine staff "were at a loss how to proceed", the reasons for which included: gaps in knowledge of the recurrence rate, impossibility of providing support, lack of professional staff (counselors), increasing psychological anxiety, and wondering to what extent they could explain things.<br>3. The number of staff who "explained matters concerning the second pregnancy from their own perspective" was 140 (18.2%), comprising orthodontic, oral, and plastic surgeons. The rates of the above three types of surgeon were similar. Regarding the time to explain, the time taken for the first consultation was the most consistent.<br>4. Other professional staff currently coordinating with were "genetic counselors" in only 15 respondents and "clinical medical geneticists" in only 49. Other professional staff wishing to coordinate with in the future were "genetic counselors" in 175 respondents and "clinical medical geneticists" in 154.<br> In the future, it is necessary to ask genetic professionals to join health-care teams to accommodate mothers' needs, and to discuss how to actually provide information and support, considering off-site coordination when appropriate.

Journal

  • Journal of Japanese Cleft Palate Association

    Journal of Japanese Cleft Palate Association 35(3), 207-216, 2010-10-25

    Japanese Cleft Palate Association

References:  17

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