乳がん患者の受診遅延の概念分析

Delay of Help Seeking Behavior for Symptomatic Breast Cancer Patients: A Concept Analysis

要旨

目的：乳がん患者の受診遅延の概念分析を行い，受診遅延の定義を明確にすることを目的とする．

方法：Rogersの概念分析法を用いた．データ収集にはPubMed，MEDLINE，CINAHL，医学中央雑誌のデータベースを使用し，検索用語は「breast cancer」「help seeking behavior」「delay」，ならびに「乳がん」「受診遅延」とした．さらに，患者の語りのデータベースDIPEX Japanを加え，計30件を分析対象とした．

結果：概念の属性として「時間」「意思決定プロセス」の2カテゴリー，先行要件として「個人因子」「医療環境」「社会文化」の3カテゴリー，帰結として「生存率の低下」「治療に伴う医療者・患者への負担」の2カテゴリーを抽出した．分析の結果，乳がん患者の受診遅延を「主観的時間を含む受診に至るまでの意思決定プロセスにおいて客観的時間が延長した結果，治療に伴う医療者・患者負担や生存率等に悪影響を及ぼす現象」と定義した．

結論：乳がん患者の受診遅延の定義は，医療者のみならず患者の視点を含めた看護援助の構築に有用である．

Purpose: The purpose is to clarify the concept “delay of help seeking behavior” for breast cancer patients with the concept analysis strategy proposed by Rogers (2000).

Method: Four databases (PubMed, MEDLINE, CINAHL, Ichushi Web) were used. Search terms were “breast cancer”, “help seeking behavior”, “delay”. DIPEX Japan was added to our data analysis. As a result of the research, thirty resources were chosen and used for this analysis.

Results: Two attributes of the concept “delay of help seeking behavior” were identified; 1) time, 2) decision making process. Three antecedents were identified; 1) individual factor, 2) medical environment, 3) social culture. Two consequences were identified; 1) reduction of the survival rate, 2) load of medical staffs and patients in medical treatment. From the study, the delay of help seeking behavior of breast cancer patient is defined as the phenomena which have negative influences on the load of medical staffs and patients in medical treatment and survival due to the extension of the objective time during the decision-making process for help-seeking include subjective time.

Conclusion: The definition of “delay of help seeking behavior in breast cancer patients” is useful for construction of effective nursing care which compresences medical professionals and patients point of view.