症状マネジメントにおけるIASMの有効性の検討—がん性疼痛の症状マネジメントにおける比較から

Examination of Effectiveness of IASM in Symptom Management: By the comparison in symptom management and non-symptom management among cancer pain

はじめに

　症状マネジメントの考え方は医療者主体によるものから患者が主体となるものへとパラダイムの転換が求められている。なぜならば，症状は非常に主観的な体験であり，症状とともに生活していくのは患者自身であることからすると，従来の医療者主体の症状マネジメントは非効果的といえるからである。1997年に患者を主体とした症状マネジメントモデルが日本に紹介され（UCSF症状マネジメント教員グループ，1997），症状の体験や患者のセルフケアに焦点を当てた患者主体の症状マネジメントが注目されるようになった。

　そこで，本研究では，がん患者が最も頻繁に訴える症状である痛みを持つ患者に対し，患者を主体とした症状マネジメントの統合的アプローチ（An Integrated Approach to Symptom Management：以下，IASM）を枠組みとして看護を提供し，患者のセルフケア能力をいかした症状マネジメントを行なうことで，症状の軽減やQuality of life（以下，QOL）の向上に寄与できるかどうか，モデルの有効性を検討することを目的とした。

　The purpose of this research was to verify the effectiveness of the model of nursing intervention with IASM for cancer patient's experiences of pain, comparing the non-intervention group who were given the usual pain care and the intervention group. The samples consisted of ten persons in the non-intervention group, and seven in the intervention group. A semi-experiment was undertaken through the comparative study of both of quantitative and qualitative data.

　Both group's symptom management was measured by 1) Faces Scale (FS) [pain]; 2) Eastern Cooperative Oncology Group Performance Status (PS) [functioning]; 3) Functional Living Index Cancer (FLIC) [QOL]; 4) self-care was assessed using the self-care analyzing method (Uchinuno et al. 1999).

　The result of the analysis showed a difference between the non-intervention group and the intervention group's symptom states, the state of QOL, and self-care ability. It was suggested that intervenion was able to improve the patient's self care ability, and the pain decreased as a result. In addition even though, level of QOL of both intervention group and non-intervention group are decreased, level of the intervention group's QOL decreases less than non-intervention group. However, intervention did not show an effect on the state of the function.

　The nursing intervention of IASM is thought to be a contribution to the improvement of the symptom. This results from improving the expression ability of the patient's symptom.

　These results prove that IASM is effective to clinical symptom management.