がんの終末期で症状緩和をうける患者の家族のストレス・コーピング―一般病棟と緩和ケア病棟の比較

Stress・Coping of the Family Members of End-stage Cancer Patients Receiving Palliative Care in the Hospital: Comparison between General Units and Palliative Care Units

要旨

　本研究は，がんの終末期で症状緩和のためのケアを受ける患者にかかわる家族のストレス・コーピングにはどのようなものがあるのか，また一般病棟の家族と緩和ケア病棟の家族とでは，どのような相違があるのかを明らかにすることを目的とした。

　医師より患者の病名・予後について知らされており，患者の身の回りの世話などを行う家族員35名を対象とし，面接法と参加観察を行い，得られた質的データを分析した。

　その結果，以下の知見が得られた。一般病棟の家族と緩和ケア病棟の家族の体験している困難・心配などは共通の要素を持ちながら内容において，①患者の苦痛，②今後の患者の病状，③患者の症状緩和，④患者の死期が近いこと，⑤患者の近い死に対する受けとめ，⑥患者の役割不遂行という6項目での相違と，①面会(付き添い)での困難，②病名告知・予後という2項目での類似が見られた。体験に対するコーピングは，内容において問題志向的タイプより感情志向的タイプにより多くの相違が見られた。

Abstract

　The purpose of this study was to describe the stress・coping of the family members of end-stage cancer patients receiving palliative care in the hospital, and to know the difference in their stress ・ coping between general units and palliative care units. The subjects were 35 family members who were informed of the patients' diagnosis and their limited life expectancy by the doctor and were taking care of the patients. Interview and participant observation techniques were used to collect the data.

　The following results were obtained. Though there were common difficulties or worries about patient care experienced by the family members in general units and palliative care units, some differences were also revealed. The differences were 1. pain of the patients, 2. patients' future condition of the disease, 3. palliation for the patients, 4. the patients' death in immediate future, 5. acceptance of the patients' death, 6. nonfulfillment of the role of the patients. The similarities were 1. difficulties in meeting with (or taking care of) the patients, 2. disclosure of diagnosis and limited life expectancy. There were much more diffrences in coping with their experiences in feeling-oriented subjects than in problem-oriented subjects between general and palliative care units.