在宅がん患者の看取りにおける家族の対処の過程

Home-based Family Caregivers' Processes for Coping up with Cancer Patients at the End of Their Lives

要旨

　目的：在宅がん患者の看取りにおける家族の対処の過程を明らかにする．

　方法：がん患者の看取り期に訪問看護を利用した20名の家族を対象に，家族の対処の過程について半構造化面接を行った．分析は複線径路・等至性モデルを用いた．看取りの過程を一連の径路に示し，家族の対処とそれに影響した要因を検討した．

　結果：対処の過程は2つに大別され，その差異は，患者が臥床がちになるなどの看取り期の変化の時期に生じた．患者の変化を捉え，昼夜を問わず患者のそばにいるなどの対処をとった家族は，心身の不調をきたしながらも，「自分ができるだけのことを一生懸命やれた」という認識に至った．一方，患者の死を予期せず自分の生活を優先するなどした家族は，「患者との死別や死の状況は受け入れがたい」という認識に至った．

　結論：家族が心身の健康を保ちながら，看取り期の患者の変化に対処できる，介護への適度な距離を保つ必要性が示唆された．

　Objective: To clarify home-based family caregivers' processes for coping up with cancer patients who are at the end of their lives.

　Method: Semi-structured interviews regarding the coping processes were conducted on 20 family caregivers who, along with visiting nurses, cared for cancer patients who were at the end of their lives. The trajectory equifinality model (TEM) was used for analysis.

　Results: Family caregivers who noticed physical changes in the cancer patients at the end of their lives and coped with the need to be with them day and night reported the following: “I did everything I could”; however, some of them suffered mental and physical disorders during care and after bereavement.” Conversely, family caregivers who prioritized their daily living over physical changes in the cancer patients felt that: “I could not accept the fact of death and the end-of-life situation.”

　Conclusion: Home-based family caregivers of cancer patients suggested that it is necessary to help the patients in keeping sufficient distance because it can maintain their physical and mental health and they can cope with physical changes occurring in these patients.