がん治療後のリンパ浮腫をもつ患者における複合的治療のアドヒアランスの概念分析

Concept Analysis of Adherence for Complex Decongestive Therapy in Patients with Lymphedema Caused by Cancer Treatment

要旨

目的：がん治療後のリンパ浮腫患者における複合的治療のアドヒアランスの概念分析を行う

方法：WalkerとAvantの手法で，医学領域，看護学領域，理学療法学領域，心理学領域の4領域から文献検索し50論文を抽出した．

結果：属性に【精神的に安定している状態】【リンパ浮腫や複合的治療についての理解】【主体性】【実施方法やスキルの工夫】【複合的治療の実行・評価】【リンパ浮腫を自己管理できるという自己効力感】【医療者からの学習の促し】【医療者とのパートナーシップ】，先行要件に【慢性的な苦痛症状】【長期管理の必要性】【複合的治療の自己管理を余儀なくされる】，帰結に【リンパ浮腫の症状】や【QOL】の改善が抽出された．

結論：概念を「精神的に安定した状態でリンパ浮腫や複合的治療について理解し，主体的に複合的治療のスキルを工夫して実行することであり，患者の自己効力感が影響する．これらは医療者からの学習の促しと，患者と医療者との間に築かれたパートナーシップを通して実現される」と定義した．

Objective: The purpose of this concept analysis was to define patients' adherence for complex decongestive therapy in relation to lymphedema caused by cancer treatment.

Method: With using the framework outlined by Walker and Avant, articles were searched by the databases of internet engines related to 4fields and 50 articles were analyzed.

Result: The defining attributes consisted of “Mental stability,” “understanding the lymphedema and complex decongestive therapy” “spontaneity”, “devise the management skills” “practice and assess the complex decongestive therapy” and “self-efficacy to manage by themselves”, “educational approach from medical professionals” and “Partnerships with medical professionals” were also extracted. Recognized antecedents were “suffering symptoms” associated with lymphedema and, “long-term management”. In addition, factors such as the “forced to self-management of complex decongestive therapy” was extracted. The consequences were improvement of lymphedema and the patient's quality of life.

Conclusion: According to the concept analysis in this study, adherence for complex decongestive therapy in patients with lymphedema caused by cancer treatment was defined “As managing the symptom by using customized skills spontaneously based on understanding the lymphedema and the treatment with mental stability, patient carry out the treatment with self-efficacy. It is established by education and partnership with medical professionals.”