造血器腫瘍患者の初期治療期における主観的体験と自己決定の質的分析

The Subjective Experiences of Patients with Hematological Malignancies in Primary Care Period and Their Decision Making

要旨

　本研究の目的は，造血器腫瘍患者の初期治療期における主観的体験と，それらに対する自己決定内容を明らかにすることであった．発病から1年以上経過した7名の患者に半構造的面接を実施し，記述データを質的帰納的に分析した．

　その結果，患者は【生きていることの価値の捉え直し】【日常生活の価値の捉え直し】【感情体験の深化】【身体機能コントロール感の喪失】という主観的体験をしていた．これらの主観的体験は，【生活上の自己決定】により療養生活を安定させる取り組みを行うことによって，捉え方が否定的なものから肯定的なものへ変化していた．また，それに伴い【治療上の自己決定】も徐々に受動的なものから主体的なものへと変化していた．以上から看護者が患者の【生活上の自己決定】の支援を行うことは，療養生活の安定化とともに，主体的な【治療上の自己決定】が行えるようになるための支援に繋がることが示唆された．

Abstract

　The purpose of the study is to clarify the subjective experiences of patients with hematological malignancies during recuperation of over one year and their decision making processes used with these phenomena. Semi-structured interviews were conducted on 7 participants, and a qualitative and inductive approach was employed to analyze the descriptive data.

　The results showed that, during the course of recuperation, patients experienced: “the recognition of being alive value,” “the recognition of everyday life value,” and “the enhancement of emotional experience,” “the loss of control of bodily functions.” In the early stages of the medical treatment, patients responded to these experiences negatively. Accordingly, they maintained stability through “decision-making activities of daily life” under the medical treatment. These decision-makings made to act independently to “decision-making of therapeutic activities” in a stepwise manner. Finally they responded to these experiences positively. These findings suggest that nurses would need to support patients in their “decision-making activities of daily life” for stability under the medical treatment and “decision-making of therapeutic activities” independently.