外来化学療法を受ける転移・再発乳がん患者に生じる複数の症状の主観的体験と対処に関する質的研究

Qualitative Research of the Subjective Experience and Coping with Multiple Symptoms of Outpatients with Metastatic and Recurrent Breast Cancer Receiving Chemotherapy

要旨

目的：外来化学療法中の転移・再発乳がん患者に生じる複数の症状の主観的体験と対処の実態を明らかにする．

方法：転移・再発乳がん患者20名に半構造化面接を実施し，質的帰納的に分析した．

結果：対象者は【幾重にも重なった症状で日常生活が滞る感覚に苛まれる】【自分で症状をコントロールできずにもどかしい】【この先も化学療法を継続できるのか危ぶまれる】という体験のなか，【複数の症状とうまく付き合う術を探る】【各症状の出現パターンから今後の見通しを立てる】【傷んだ身体への更なるダメージを避ける】という対処の実態が導かれた．

結論：外来看護は，複数の症状による患者の生活への支障を網羅的に捉え，テーラーメイドなケアの提案が必要である．それには転移再発という不確実な状況下で培われた患者の経験値に着目した介入が有効と考える．今後は，患者の生活に支障を与えるトリガーとなるコア症状の特定とアセスメントツールの開発が必要である．

Purpose: To clarify the subjective experience and coping with multiple symptoms of outpatients with metastatic and recurrent breast cancer receiving chemotherapy.

Methods: Twenty outpatients with metastatic and recurrent breast cancer receiving chemotherapy participated in semi-structured interviews. We used an inductive approach to qualitatively analyze the responses.

Results: Responses regarding subjective experience could be grouped into three categories: “I feel that daily life routine is interrupted due to overlapping of multiple symptoms,” “I feel irritated that I have no control over my symptoms,” and “I fear whether I can continue chemotherapy.” Responses regarding coping with multiple symptoms could also be grouped into three categories: “I explore skills to control multiple symptoms better,” “I am aware of the changes my body is going through and foresee the future,” and “I want to avoid further damage to my weakened body.”

Conclusion: It is necessary for nursing care to capture patients' difficulties in daily life caused by multiple and variable symptoms. Moreover, nursing professionals should pay close attention to patients who are dealing with the uncertainties regarding metastatic recurrence in order to provide effective personalize care. Future research is warranted to identify core symptoms and to develop assessment tools to detect them.