症状出現からがん発見までにおける術前消化器がん患者のヘルス・リテラシーの発揮

Health Literacy in Pre-operative Gastrointestinal Cancer Patients Who Utilized Their Health Literacy, Starting from Initial Detection of Symptoms to Cancer Diagnosis

要旨

　目的：消化器がん患者がヘルス・リテラシーを発揮している現象として，自覚症状出現時からがんの発見に至るまでの医療・健康情報の入手や活用のプロセスをとらえ，その構造を明らかにする．

　方法：研究協力者10名に対して，術前に参加観察と半構成的面接を行い，グラウンデッド・セオリー・アプローチで分析した．

　結果：《自己診察》という中心概念が抽出された．症状を自覚した患者は，今までの経験・知識，新たな情報によって病因を予測し，病院の受診あるいは経過観察を経て，がんの発見に至った．一方，自覚症状のない患者は，検診や定期受診によってがんの発見に至った．

　結論：消化器がん患者は，自覚症状という身体からの情報提供に，今までの経験・知識と新たに収集した情報などを参考にして病気の予測をする《自己診察》を行っていた．そして病因の予測と受診行動の決定の後，がんの診断に至っていた．今までの経験・知識を使用する能力は，情報を蓄積し活用するという新しいヘルス・リテラシーの能力の1つであると考えられた．

Abstract

　Purpose：The purpose of this study is to investigate the mechanics and processes by which gastrointestinal cancer （GIC） patients utilized their health literacy awareness, starting from initial detection of symptoms to cancer diagnosis.

　Method：Participant observation and semi-structured interview data from 10 pre-operative GIC patients were analyzed using the grounded theory approach.

　Result：Core category is “self-examination.” Results indicated that GIC patients detected the symptoms and hypothesized the cause of disease by managing the prior medical experiential knowledge and new medical information they collected. The patients were diagnosed with GIC after they consulted with a gastrointestinal （GI） doctor, a non-GI doctor or followup without further consultation. However, patients with no symptoms were diagnosed with GIC after they had access to a family doctor or had a regular medical examination.

　Conclusion：Pre-operative GIC patients examined themselves based on prior medical experiential knowledge, new medical information, and opinions of other people from the initial onset of symptoms. These observations explained the need for patients to be able to obtain new medical information. The observations suggested that providing appropriate medical information was essential for health literacy in pre-operative GIC patients. Furthermore, patients predicted the cause of symptoms and then decided to consult a doctor. Therefore, recognizing the symptoms might be a trigger for pre-operative GIC patients to search for and handle new medical information, prior medical experience and knowledge. GIC patients' health literacy might be initiated by symptoms.