外来で術後補助化学療法を受けている成人期乳がん患者の就労継続のプロセス

The Process of Continuing to Work for Adult Breast Cancer Patients Receiving Outpatient Postoperative Adjuvant Chemotherapy

要　旨

　本研究の目的は外来で術後補助化学療法を受けている成人期乳がん患者の就労継続のプロセスを明らかにし，就労継続に対する看護実践の示唆を得ることである．外来で術後補助化学療法を受けながら就労継続した成人期乳がん患者13名を対象に半構造化面接を行い，M-GTA を用いて分析した．その結果，治療決定後は〈仕事は辞められない〉〈治療をしながら仕事を続けてみよう〉という【就労継続の意思決定】を行い，これは〈経験者の示唆による就労継続の可能性の知覚〉に影響された．治療開始後は，〈抗がん剤の副作用への苦慮と就労継続意欲の減退〉と〈がんとの闘いに負けずに仕事を続けていきたい〉思いの間で【就労継続への葛藤】が生じ，葛藤を感じながらも患者自身で【副作用に対する身体的・心理的自己調整】を行っていた．また全期間を通して【就労継続を支える存在の自覚】があり，この思いが常に患者を支えていた．副作用の増減にともない【就労継続への葛藤】が続くなかで就労によって得られる価値を見出し，治療決定から〈仕事は生きがい〉である思いを根底にもち就労を継続していた．看護実践としては，治療決定時は治療と就労の両立経験者の情報提供，治療中は就労継続意欲の減退に対する医療者からの支持的支援，職場へコミュニケーションを通した働き方を交渉するための支援，職場からの配慮に対する謝恩を行動で示すための支援が示唆された．

　This study aims to reveal the process of continuing to work for adult breast cancer patients receiving outpatient postoperative adjuvant chemotherapy and obtain hints for nursing practice regarding work continuation. Semi-structured interviews were conducted with 13 adult breast cancer patients who continued work while receiving outpatient chemotherapy; the results were analyzed using M-GTA. Consequently, after deciding to receive treatment, patients made “the decision to continue working”, thinking they “cannot stop working” and want to “try continuing work while being treated”, which was supported by the “perception of possibilities for continuing work through suggestions from people with experience”. After treatment commenced, a “conflict regarding continuing work” arose between “concerns about side effects from anticancer drugs and decline in the desire to continue work” and the “desire to keep working, and not give in to the battle with cancer”. Amid this conflict, the patients themselves engaged in “physical and psychological self-regulation concerning side effects”, while maintaining the idea that they “can become their normal selves only when working”. Moreover, during treatment, “awareness of those who support the continuation of work” continually sustained the patients. While the “conflict regarding continuing work” continued with the increase or decrease in side effects, patients found value that could be obtained through work, in that “working is living,” and from the decision to receive treatment until it ended, they looked forward to the end of treatment with the idea that “work is the purpose of life”. As nursing support, it is necessary to provide information on people with working experience who had the same disease at the commencement of treatment, support for side effects and the decline in the desire to continue work during treatment, support for negotiating work styles through communication in the workplace, and support for showing gratitude for consideration from the workplace through actions.