婦人科がん術後患者の生活支援に係る倫理的課題：退院後電話相談の内容からの考察

Ethical issues related to the life support of postoperative gynecological cancers: Consideration from the contents of the post-discharge telephone consultation

　本研究目的は、退院後の患者を対象にセルフマネジメント（以下、SM）向上のための電話相談を実施し、その相談内容から婦人科がん患者の生活を支える看護実践について倫理的課題の視点から考察することである。婦人科がん術後はリンパ浮腫発症のリスクが高く、SMは不可欠であるが、入院中の限られた時間でのSMの習得は難しい。20歳代〜70歳代婦人科がん術後女性患者55名に対して半構造的質問紙を用い、術後6ヶ月間、月1回電話相談を行い質的帰納的に分析した。相談内容は一般的術後相談、個人的相談、助言要請に大別された。退院後の患者は生活する上で適切な情報が獲得できていないこと、女性特有疾患の性的問題等が含まれることによる医療者介入の困難性、患者の医療者に対する遠慮により、医療者が患者ニーズを把握できないこと等の倫理的課題が抽出された。これらの倫理的課題を解決する方策の一つとして、外来での患者相談体制の構築が必要である。

　The aim of this study is to examine the contents of telephone consultation for the post-discharged patients with postoperative gynecological cancers from the ethical point of view. From this doing, we could learn nursing practices with life support for cancer patients. Lymphedemas are the most serious risks for such patients and it is critical to prevent the onset by self-management (SM). However, learning the methods of SM is difficult considering the short period of hospitalization. To improve on this we conducted telephone consultations with 55 female homecare patients, aged between 20 and to above 70 years of age, to assist and improve the SM skills. The telephone consultations with each participant took place once a month for six months with semi-structured questionnaires. A narrative analysis of the consultations was performed for a qualitative approach. As a result, the narratives were classified into three categories: 1) general post-operation issues, 2) private matters, and 3) requests for advice. For the private matters, some are related to issues of sexuality. For 1) and 3), post-operation and advice requests, the most serious concerns are issues of reinforcement of support for the discharged patients. It is necessary to be aware of patients with gynecological cancers as having specific ethical issues and their wishes to have access to an ethically sensitive support arrangement.