終末期がん患者の家族の不安への対処を支える要因

Support Factors of Coping with Anxiety in Families of Patients with Terminal Cancer

要旨

　本稿は，終末期がん患者の家族の長期的経過の中での不安への対処を支える要因を明らかにすることを目的とし，余命についての説明を受けた家族8名を対象に，半構造的面接法によりデータ収集を行い，質的・帰納的に分析を行った．結果，余命についての説明直後の家族は【将来が予測できない不安】と【現実的な問題への不安】を持ち，【受け入れられない気持ちを安定させる努力】と【患者の延命の為の必死な努力】を行い不安の軽減を図っていた．しかし厳しい現実への直面時期において【将来の具体的な問題への不安】と【余命の過ごし方への不安】が出現し，【看病を継続できるように自分を保つ努力】と【患者のQOLを保つ努力】を行っていた．これらを支える要因として【信頼でき家族への配慮がある医療者の存在】【気持ちを理解し協力してくれる他者の存在】【患者との絆】【自分自身の時間がもて気分転換が出来ること】【看病経験による自信】【将来の見通し】が明らかになった．

Abstract

　To clarify the support factors of coping with anxiety in families of terminal cancer patients during the long-term progression of the disease, this study involved the conducting of semistructured interviews with 8 family members who had been told of the life expectancy of cancer patients in their families, and analyzed data from the interviews in a qualitative and inductive manner. The results revealed that, immediately after the explanation of life expectancy, the families had［anxieties over the unpredictableness of the future］and［worries about real issues］, and attempted to reduce them by making［efforts to mentally stabilize themselves in the face of not being able to accept the situation］and［desperate efforts to keep the patient alive］. However, as they confronted the reality of the situation, they developed［concerns over specific problems in the future］and［worries about how the patient should live the rest of his/her life］, and tried to make［efforts to maintain themselves so as to continue to nurse the patient］and［efforts to promote the patient's QOL］. As factors supporting these responses, the［presence of reliable healthcare professionals considerate of the family］,［presence of others who understood their thinking and were willing to cooperate with them］,［family bond with the patient］,［availability of private time and recreation］,［self-confidence from the nursing experience］, and［future prospects］were identified.