外出訓練が治療開始の意思につながった，緩和ケア病棟入院中のがん患者の1例

Report of a Patient with Cancer Being Admitted to Palliative Care Ward whose Rehabilitation Training outside the Hospital Led to the Intention to Start Treatment

はじめに

　がん患者は，がんと診断され治療を進めていく過程でさまざまな喪失を経験するといわれる．また，心理的なストレスも多く，「身体的」な苦痛だけではなく「精神的」「社会的」「スピリチュアル」の苦痛も生じ，それら4つの要素を合わせて「トータルペイン」といわれる¹⁾．がん患者へのリハビリテーション治療では，身体機能のみならず，精神的なアプローチも重要である．それを行うにあたっては，患者の希望を聴取し，その気持ちに寄り添うことでリハビリテーション治療の目的や方法もみえてくる．

　今回，脳転移で発見された肺がん症例のリハビリテーション治療を経験した．突然の運動麻痺や脳転移や肺がんの告知と向き合うこととなり，最初本人は積極的な検査や治療を拒否していた．しかし，リハビリテーション治療を行う中で出てきた希望を叶えるために，外出訓練を行い，その後の前向きな気持ちにつながったと考えたので報告する．

Abstract

Rehabilitation therapy is important for patients with cancer, especially for those with terminal stage cancer who have physical malfunction and psychological distress. By setting goals according to patients' wishes, rehabilitation therapy may positively affect physical activity. In this study, we reported the implementation of rehabilitation training outside the hospital as a rehabilitation treatment. A 64-year-old man was diagnosed as having multiple brain metastases from lung cancer. The patient was admitted to the palliative care ward without active treatment according to his wish and was referred to the rehabilitation department. The patient had mild right hemiplegia at the time of initial examination and therefore required assistance for walking and eating. On the 51st day of the intervention, he requested to visit the ramen restaurant of his friend, which recently opened. Going out independently to the restaurant served as his practical training for improving his quality of life (QOL). This outing further expanded his activities of daily living, which made him motivated to treat his cancer. On the 71st day of intervention, he was discharged from the hospital and underwent outpatient examination. Therefore, the role of treatment in palliative care is to achieve the highest possible QOL. In this case, providing options according to the patients' wishes, such as outing, is believed to be effective in cancer treatment