同種造血幹細胞移植を施行した若年成人がんサバイバーの移行プロセス

Transition Process in Young adult Cancer Survivors who received Allogeneic Hematopoietic Stem Cell Transplantation

要　旨

　目的：同種造血幹細胞移植を施行し，退院後外来フォローとなる若年成人がんサバイバーの移行プロセスを明らかにすることとした．

　方法：同種造血幹細胞移植を20歳代に施行し，退院後長期的にフォローアップをしている20〜40歳未満の5名を対象とした．半構成的面接を行い，transitions theory の概念枠組みに基づき質的帰納的に分析した．

　結果：同種造血幹細胞移植施行後の若年成人がんサバイバーの移行プロセスのタイプは，健康／疾病であり，移植が変化を引き金とし複数の移行が順次起こり，反応パターンに至るまで相互に関連していた．移植を施行した若年成人がんサバイバーの移行プロセスの特徴は，【新たなライフイベントに取り組む】なかで【思い描いていた人生どおりに歩めない葛藤】をいだきながらも【自分の目標に向かって進む】ものであった．心理的側面では，【ポジティブな移植経験の受け止め】と【ネガティブな移植経験の受け止め】の相反する《意味》があり，心理面のコントロールに苦悩していることが明らかとなった．

　考察：移植を施行した若年成人がんサバイバーの移行プロセスは，自らの力で《エンゲイジメント》しようと苦戦し《熟達》に向かうものであり，移行のプロセス全体を支援する必要がある．

　Objective: This study aimed to elucidate the transition process of young adult cancer survivors who underwent allogeneic hematopoietic stem cell transplantation and were subsequently followed-up with as outpatients after discharge.

　Method: The study involved five participants, aged between 20 to 40, who underwent allogeneic hematopoietic stem cell transplantation in their 20s and were followed-up with long-term after discharge. Semi-structured interviews were conducted, and the data were analyzed qualitatively and inductively, using the conceptual framework of transitions theory.

　Results: The type of transition process experienced by young adult cancer survivors following allogeneic hematopoietic stem cell transplantation was a health/disease transition. Transplantation initiated changes that led to multiple, sequential transitions, which were interrelated down to the response pattern. The characteristics of young adult survivors who underwent transplantation were marked by “progressing toward their goals” while simultaneously “dealing with new life events” and “feeling conflicted about not being able to live the life they had envisioned”. Psychologically, there were conflicting meanings of “acceptance of the positive aspects of the transplant experience” and “acceptance of the negative aspects of the transplant experience”, and the participants evidently struggled to regulate their psychological state.

　Discussion: The transition process for young adult cancer survivors who have undergone transplantation involves a struggle to achieve engagement and progress toward mastery. Therefore, it is essential for care providers to support survivors throughout the entire transition process.