手術療法を受ける乳がん患者の術式選択のプロセスに関する研究

The Process of Decision-making Regarding Surgical Treatment by Breast Cancer Patients

要旨

　本研究は，乳がん患者の術式選択のプロセスを明らかにし，手術を受ける乳がん患者のよりよい術式選択に対する看護援助への示唆を得ることを目的とした．乳がんのⅠまたはⅡ期と診断され，医師から術式選択を任された患者18名を対象として，術式に対する気持ちや考えに関する半構成的面接調査と参加観察を実施し，質的帰納的に分析した．

　その結果，乳がん患者の術式選択は，希望貫徹型，段階的納得型，動揺型，振り回され型の4タイプに分類された．この4タイプを包括する乳がん患者の術式選択のプロセスは，初期の反応，当初の術式への疑問，希望する術式への思い，術式選択の葛藤，術式決定の5局面で構成されていたことが明らかになった．

　乳がん患者の術式選択を促進するための看護支援として，早期からの情報提供と修正，人生観と乳房に対する価値観の明確化への支援，困難な術式選択の道のりへの支援が示唆された．

Abstract

　The purpose of this study was to investigate the decision-making process regarding surgical treatment in patients with early breast cancer, and to suggest nursing interventions to facilitate this process. The participants of the study were 18 women who were offered a choice between breastconserving surgery and mastectomy. The data were collected using a semi-structured interview and participant observation, so as to clarify the feelings and ideas of these subjects concerning the treatment options offered. We used qualitative data analyses.

　As a result, four types of processes were identified; carrying her hope through-type, gradual consent-type, agitation-type and confusion-type. Each of these types of processes was structured into five phases: initial reaction, question against initial reaction, idea about undergoing surgical treatment, decision conflict, and final selection of the type of surgery.

　The findings indicated that the following nursing interventions might facilitate the decisionmaking process, as follows: early provision of correct information regarding each option, clarifying each subject's values of the breast and views of life, and emotional support to facilitate the difficult decision-making process.