➨8ᅇCSP-HORᖺ఍௒᪥㻌 䛚ヰ䛧䛩䜛䛣䛸
1. 䝺䝇䝫䞁䝇䝅䝣䝖䛸䛿PRO䛾ྛㄽ㻌 ᇶ♏

2. 䝺䝇䝫䞁䝇䝅䝣䝖䛾䝯䜹䝙䝈䝮䠉 䝺䝇䝫䞁䝇䝅䝣䝖䠉

3. 䝺䝇䝫䞁䝇䝅䝣䝖䛾᳨ฟᡭἲ4. 䝺䝇䝫䞁䝇䝅䝣䝖䛾␗䛺䜛どⅬᮾ໭኱Ꮫ་Ꮫ⣔◊✲⛉㞀ᐖ⛉Ꮫᑓᨷ⫥య୙⮬⏤Ꮫศ㔝5. 䝺䝇䝫䞁䝇䝅䝣䝖◊✲䞉ά⏝䛾ㄢ㢟㕥㬞䜘䛧䜏
2014ᖺ6᭶21᪥
㻌 Tohoku University Graduate School of Medicinen ౛䠖䜰䜴䝖䜹䝮ホ౯㻌 ἞⒪A㛤ጞ๓䛾䠄䜰䜴䝖䜹䝮䠅䛿20㼼5䛷䛒䛳䛯䛜䚸἞⒪ᚋ䛻䛿30㼼5Ⅼ䛷䛒䜚䚸䠄䜰䜴䝖䜹䝮䠅䛿᭷ព䛻ྥୖ䛧䛯䠄p<0.05䠅䚹

㻌 Tohoku University Graduate School of Medicine

n 1999䠖 Sprangers and SchwartzØ ་⒪ホ౯䛻䛚䛡䜛䛣䛾ၥ㢟䜢ึ䜑䛶ሗ࿌䚹Ø ᩍ⫱Ꮫศ㔝䛷౑䜟䜜䛶䛔䛯䛂䝺䝇䝫䞁䝇䝅䝣䝖䛃䛾ᴫᛕ䜢ᑟධØ ⌮ㄽ䝰䝕䝹䜢ᥦ♧䝺䝇䝫䞁䝇䝅䝣䝖䛸䛿ᐃ䛩䜛ᴫᛕ䛸ᑻᗘ䛜୍ᐃ䛷䛒䜛䠄ኚ໬䛧䛺䛔䠅䛣䛸䛜๓ᥦØ ⌧ᐇୡ⏺䛷䛿ኚ໬䛩䜛䞉䞉䞉Ø ┿䛾್䛜ୗ䛜䛳䛶䛔䛶䜒QOLᚓⅬ䛿ᕪ䛜䛺䛛䛳䛯䜚䚸┿䛾್䛜ኚ䜟䛳䛶䛔䛺䛟䛶䜒QOLᚓⅬ䛿㧗䛟䠄ప䛟䠅䛺䛳䛯䜚

QOL/PROᣦᶆ䛾ホ౯䛾㝿䛾೺ᗣ䛾ኚ໬䛻䜘䜚䚸PROᑻᗘ䛻ᅇ⟅䛩䜛㝿䛾ಶேෆ䛾ุ᩿ᇶ‽䛜ኚ໬䛩䜛䛣䛸ᐃ䝞䜲䜰䝇㻌 Tohoku University Graduate School of Medicine

㻌 Tohoku University Graduate School of Medicine䝺䝇䝫䞁䝇䝅䝣䝖䛾䠏ศ㢮䠍䠊ෆⓗᇶ‽䛾ኚ໬
Change in internal standards (recalibration)• ෆⓗᇶ‽䛾ኚ໬䠖
internal standards (recalibration)• ౯್䛾ኚ໬䠖value (reprioritization)

PRO
䝇䝁䜰

௒
厤
友叀
叐
䠛

• ព࿡䛾ኚ໬䠖
meaning (reconceptualization)

௒
厤
友叀
叐
䠛

᣺
叫㏉叄
叇
叠
召叉









๓

ᚋ௓ධor೺ᗣኚ໬

㻌 Tohoku University Graduate School of Medicine

㻌 Tohoku University Graduate School of Medicine䠎䠊౯್䛾ኚ໬䠄せ⣲䛾ඃඛ㡰఩䛾ኚ໬䠅䠏䠊ព࿡䛾ኚ໬䠄ᴫᛕ䛾෌ᵓᡂ䠅

Change in values (reprioritization)

Change in meaning (Reconceptualization)⢭⚄㠃௙஦ᐙ᪘ᐙ᪘೺ᗣ೺ᗣ⢭⚄㠃䞉㌟య㠃㌟య㠃ᶵ⬟㠃䠴௙஦䠴♫఍㠃㔜せᛶ㻌 Tohoku University Graduate School of Medicine

㻌 Tohoku University Graduate School of Medicine䝺䝇䝫䞁䝇䝅䝣䝖䛾䝯䜹䝙䝈䝮䝺䝇䝫䞁䝇䝅䝣䝖䛾᳨ฟᡭἲ䛾Ⓨᒎ

Sprangers and Schwartz (1999)ಶ䚻䛻ᑜ䛽䜛᪉ἲ๓ᥦ

1. ᣺䜚㏉䜚ホ౯ retrospective rating (Then test)
2. ಶู໬䛥䜜䛯ホ౯ individualized methods (SEIQOL䛺䛹)䞉♫఍⤫ィᏛⓗせᅉ䞉ᛶ᱁䞉ᮇᚅ䞉䝇䝢䝸䝏䝱䝹䛺≉ᛶ䝕䞊䝍䛻ᑜ䛽䜛᪉ἲ䠖⤫ィⓗᡭἲ䝺䝇䝫䞁䝇䝅䝣䝖ゐ፹䝯䜹䝙䝈䝮䞉䝁䞊䝢䞁䜾䞉♫఍ⓗẚ㍑䞉䝋䞊䝅䝱䝹䝃䝫䞊䝖䞉┠ᶆ䛾෌ᵓ⠏䞉ᮇᚅ䛾䝸䝣䝺䞊䝭䞁䜾୺ほⓗQOL௨ୗ䛾ኚ໬䞉ෆⓗᇶ‽䞉౯್䞉ᴫᛕ໬

1. ᵓ㐀᪉⛬ᘧ䝰䝕䝸䞁䜾(SEM)
2. ₯ᅾ㌶㐨ゎᯒ(latent trajectory analysis)
3. ศ㢮ᅇᖐᮌゎᯒ(classification and regression treeanalysis)
4. 㡯┠཯ᛂ⌮ㄽ(Item response theory)
Barclay-Goddard R, et al. 2009䜘䜚ᢤ⢋㻌 Tohoku University Graduate School of Medicine

Then test䠄᣺䜚㏉䜚ホ౯䠅㻌ಶู໬䛥䜜䛯ホ౯䠖㻌 SEIQOL

Posttest

PretestThentest

ほPRO䝇䝁䜰௒厤友叀叐䠛㻌 Tohoku University Graduate School of Medicine௒厤友叀叐䠛厤叏叉厯厤友叀叐䠛䛥䜜䛯ኚ໬䝺䝇䝫䞁䝇䝅䝣䝖䝺䝇䝫䞁䝇䝅䝣䝖ㄪᩚᚋ䛾ኚ໬䕿 ᐇ᪋䛧䜔䛩䛔㽢 ゎ㔘䛜ᅔ㞴䞉ᛮ䛔䛰䛧䝞䜲䜰䝇䞉♫఍ⓗᮃ䜎䛧䛥๓ᚋ

SEIQOL: The Schedule for the Evaluationof Individual Quality of Life௓ධor೺ᗣኚ໬
㻌 Tohoku University Graduate School of Medicineᵓ㐀᪉⛬ᘧ䝰䝕䝸䞁䜾䠄SEM䠅䛻䜘䜛᳨ฟ䕿 ಶ䚻ே䛾ᕪ␗䜔౯್ほ䜢ᑛ㔜㽢 ホ౯䛻᫬㛫䛜䛛䛛䜛ㄪᰝ⮬య䛾௓ධຠᯝ䛜኱䛝䛔ᚓ䜙䜜䛯ᚓⅬ䛜௚䛾ಶே䛸ྠ➼䛻ᢅ䛘䜛䛛䛹䛖䛛䛜୙᫂㻌 Tohoku University Graduate School of Medicine䝺䝇䝫䞁䝇䝅䝣䝖䛾␗䛺䜛どⅬnᐃ䝞䜲䜰䝇Ø⮫ᗋヨ㦂䛾ホ౯䜢㐣኱ホ౯䚸䜎䛯䛿㐣ᑠホ౯

௒
厤
友 厤
叀 叏
叐 叉䠛 厯䠛௒厤友叀叐䠛๓㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 㻌 ᚋnᚰ⌮ⓗ㐺ᛂØ೺ᗣ㞀ᐖ䛜䛒䛳䛶䜒䚸ே䛾ឤ䛨᪉䜢Ⰻ䛔≧ែ䛻ಖ䛴䛯䜑䛾䝩䝯䜸䝇䝍䝅䝇䝥䝻䝉䝇㻌 Tohoku University Graduate School of Medicine

㻌 Tohoku University Graduate School of Medicineᚰ⌮ⓗ㐺ᛂ䛾┤᥋ ᐃ䛾౛Nottingham Adjustment Scale (NAS)䝜䝑䝔䜱䞁䜺䝮㐺ᛂᑻᗘ
nどぬ㞀ᐖ䛾䜈ᚰ⌮ⓗ㐺ᛂ䜢 ᐃnDodds A, et al (1991), 㕥㬞䜙(2001)nᚰ⌮ⓗ㐺ᛂ䜢」ᩘ䛾ㄆ▱ⓗኚᩘ䛜㧗䛔≧ែ䛸ᐃ⩏Lancet 2008; 372: 246–55

㻌 Tohoku University Graduate School of Medicine୙Ᏻ䜔䛖䛴䛜䛺䛟䚸⮬ศ䜢኱஦䛺Ꮡᅾ䛸ㄆ㆑䛧䛶䛔䛶䚸⮬ศ䛻䛿ᚲせ䛺䛣䛸䜢䛩䜛ຊ䛜䛒䜛䛸ឤ䛨䛶䛚䜚䚸⮬ศ䛾㞀ᐖ䜢ཷ䛡ධ䜜䚸௚䛾㞀ᐖ⪅䛻䜒⫯ᐃⓗ䛺ែᗘ䜢ᣢ䛱䚸䛥䜙䛻䚸䝸䝝䝡䝸䝔䞊䝅䝵䞁䜢㐍䜑䜛䛾䛿⮬ศ⮬㌟䛷
䛒䜛䛸ㄆ㆑䛧䛶䛔䜛≧ែ㻌 Tohoku University Graduate School of Medicine

NAS䛾㉁ၥ㡯┠౛䠄᪥ᮏㄒ∧䠅ᐃኚᩘ㡯┠ᩘ㡯┠౛୙Ᏻ㻙䛖䛴㻢㻌᭱㏆䚸ඖẼ䛜䛺䛟ⴠ䛱㎸䜣䛷䛔䜛䛸ឤ䛨䛶䛔䜛⮬ᑛឤ᝟㻠㻌᫬䛚䜚䚸⮬ศ䛿඲䛟䝎䝯䛰䛸ᛮ䛖㻌どぬ㞀ᐖ⪅䜈䛾ែᗘ㻠㻌䝻䞊䜹䝇䜸䝤䝁䞁䝖䝻䞊䝹㻟㻌ᚰ⌮ⓗ㐺ᛂ䛸♫఍ཧຍ䛾㛵㐃䝰䝕䝹⮬ᑛឤ᝟㻚㻢㻠㻚㻢㻥ෆⓗ㻌⮬ᕫ౯್㻌⾜ື䛾㻌⤫ᚚឤ㻌

どぬ㞀ᐖ⪅䛿䚸⮬ศ䛻‶㊊䛧䛶䛔䛺䛔ே䛜ከ䛔㻌୙Ᏻ㻌䛖䛴㻌ཷ㻌 ᐜែ㻌 ᗘ㻚㻣㻝㻚㻠㻥㻚㻤㻤㞀ᐖ䛾㻌ㄆᐜ㻌㻚㻤㻞㻚㻝㻡㻚㻡㻞㻚㻢㻥䛣䜜䛛䜙䜘䛟䛺䜛䛛䛹䛖䛛䛿䚸⮬ศ䛾ຊ䛷䛹䛖䛻䛛䛷䛝䜛䜒䛾䛷䛿䛺䛔ᖺ㻌 ᩘ⮬ᕫ㻌ຠຊឤ㻌㞀ᐖ䛾ཷᐜ⮬ᕫຠຊឤ㻢㻌㻠㻌㻚㻠㻤どぬ㞀ᐖ䛷䛒䛳䛶䜒䚸ே⏕䛻䛿䛔䜝䛔䜝䛺ྍ⬟ᛶ䛜䛒䜛㻌䢗䡬䡲䡹䡱䢈䢚㻌䡶䢙䢀䢗䡬䢕㻌♫఍ཧຍ
㻚㻞㻡

ど㻌 ຊ
㻚㻤㻠

㻚㻢㻝㻚㻥㻟᪥ᖖᙺ๭㻌 ᪥ᖖᙺ๭㻌㌟య⢭⚄⚾䛿≀஦䛻ኻᩋ䛩䜜䜀䛩䜛䜋䛹୍⏕ᠱ࿨ྲྀ䜚⤌䜐♫఍ⓗ㻌ᶵ⬟㻌Suzukamo et al. 2001㻳㻲㻵㻩㻚㻥㻡㻠
㻌 Tohoku University Graduate School of Medicine

㻌 Tohoku University Graduate School of Medicine䝺䝇䝫䞁䝇䝅䝣䝖䛾ព࿡䠄௓ㆤண㜵䝁䝭䝳䝙䜿䞊䝅䝵䞁௓ධ◊✲㻌 Suzukamo, 2009䠅䝺䝇䝫䞁䝇䝅䝣䝖䛾䝫䝆䝔䜱䝤䛺ഃ㠃฼⏝⪅䛛䜙䛾ホ౯<㻌 0→㻌 ព㆑ኚ໬⩌㻌 䕔㻌㻌㻌㻌㻌㻌㻌Then䠉◊ಟ๓Then吊吶吼吢合呎‶后㊊吾ᗘ呉p < 0.05

㻝㻡

Thenಖ
೺
ᖌ吊吶吼
吢
合呎
后吾呉
ຊ⮬ᕫホ౯㻠㻜㻟㻥㻟㻤㻟㻣㻟㻢㻟㻡㻟㻠㻟㻟㻟㻞㻟㻝㻟㻜

p < 0.10

㻌 >= 0㻌 non→㻌 ↓ኚ໬⩌㻌 㻌 䕔⥲ྜ‶㊊ᗘ㻝㻠㻝㻟
㻝㻞㻝㻝nSpirituality䠄䝇䝢䝸䝏䝳䜰䝸䝔䜱䠅nMeaning䠄ព࿡䠅
nGratitude䠄ឤㅰ䠅
nHope䠄ᕼᮃ䠅
nCompassion䠄ᛮ䛔䜔䜚䠅
nForgiveness䠄ᐶᐜ䠅nMindfulness䠄䝬䜲䞁䝗䝣䝹䝛䝇䠅Park CL: ISOQOL2013

㻝㻜◊ಟ๓㻌 㻌 㻌 ◊ಟᚋ
N=119

N=101

㻌 Tohoku University Graduate School of Medicine

㻌 Tohoku University Graduate School of Medicine䝺䝇䝫䞁䝇䝅䝣䝖◊✲䛾ㄢ㢟
(Barclay-Goddard R, et al. 2009)1. ⏝ㄒ䛸⌮ㄽ䝰䝕䝹䛻㛵䛩䜛䝁䞁䝉䞁䝃䝇2. 䝺䝇䝫䞁䝇䝅䝣䝖䛾⮫ᗋୖ䛾㔜せᛶ䛾✲᫂
3. ⮫ᗋⓗ䛻㔜せ䛺஺⤡ᅉᏊ䛸䛧䛶䛾䝺䝇䝫䞁䝇䝅䝣䝖䛾 ᐃ᪉ἲ䛸ㄪᩚ᪉ἲ䛾☜❧Ø◊✲䝕䝄䜲䞁ᡭἲ䚸⤫ィⓗᡭἲ䚸RSㄪᩚ῭䜏ኚ໬㔞4. 䝺䝇䝫䞁䝇䝅䝣䝖䛜἞⒪䛾ᑐ㇟䛷䛒䜛ሙྜ䛾἞⒪ᡭἲ
5. 䝺䝇䝫䞁䝇䝅䝣䝖⌮ㄽ䜢⌧ᐇ䛻ά⏝䛩䜛䛯䜑䛾ᡭἲ䛾☜❧㻌 Tohoku University Graduate School of Medicine䝃䝬䝸䞊
1. 䝺䝇䝫䞁䝇䝅䝣䝖䛸䛿೺ᗣኚ໬䛻䜘䜚䚸PROᑻᗘ䛻ᅇ⟅䛩䜛㝿䛾ಶேෆ䛾ุ᩿ᇶ‽䛜ኚ໬䛩䜛䛣䛸䠄QOL◊✲䛾ホ౯䝞䜲䜰䝇䛸䛧䛶Ⓩሙ䠅

2. 䝞䜲䜰䝇䛾ㄪᩚ䛾ᚲせᛶ᳨ฟ᪉ἲ䛾㛤Ⓨ䠄Then test→ಶูⓗᡭἲ䚸⤫ィⓗᡭἲ䠅䛥䜙䛻ㄪᩚᡭἲ䛾㛤Ⓨ䛜ồ䜑䜙䜜䜛

3. 䝺䝇䝫䞁䝇䝅䝣䝖䛾䝩䝯䜸䝇䝍䝅䝇䛸䛧䛶䛾ഃ㠃䝞䜲䜰䝇䛸䛧䛶䛾䜏䛸䜙䛘䜛䜉䛝䛷䛿䛺䛛䜝䛖㛤Ⓨ䛥䜜䛯ᡭἲ䛾✚ᴟⓗά⏝䠄䝩䝯䜸䝇䝍䝅䝇䚸ᚰ⌮ⓗ㐺ᛂ䚸䝇䝖䝺䝇ᑐฎ䛻䜘䜛ኚᐜ䚸ㄆ▱䛾ኚᐜ䚸䝫䝆䝔䜱䝤ᚰ⌮Ꮫ䠅㻌 Tohoku University Graduate School of Medicine