通院患者のがん疼痛セルフマネジメントを促進する看護介入プログラムの臨床的有用性の評価

Evaluation of the Clinical Utility of a Nursing Intervention Program to Promote Cancer Pain Self-management for Outpatients

要旨

　目的：通院患者のがん疼痛セルフマネジメントを促進する看護介入プログラムを臨床適用し有用性を評価した．

　方法：通院患者10名に本プログラムを用いた対面式個別介入を実施し，介入前後の疼痛強度，日常生活への支障，QOL，自己効力感，不安・抑うつを比較した．

　結果：対象者は平均年齢59.9歳（SD 8.3）であった．介入前後で効果量が大きかったのは不安（r = .63）と抑うつ（r = .67）で有意に低下した（p < .05）．有意差はないが効果量が中程度であった最も強い痛み（r = .36），平均の痛み（r = .33），日常生活への支障合計（r = .31）は介入後に低下し，鎮痛治療への満足感（r = .36）は介入後に上昇した．

　結論：患者の不安・抑うつが有意に改善し，疼痛強度と日常生活への支障合計，鎮痛治療への満足感において効果量が中程度であったことから，本プログラムは臨床的に有用であると示唆された．

　Purpose: This study aimed to evaluate the clinical utility of a nursing intervention program to promote cancer pain self-management for outpatients by adapting the program for clinical practice.

　Methods: This study used a single-group, pre-post intervention comparative research design. In the study, a face-to-face individual intervention using the program was conducted three times for 10 outpatients with cancer pain. A self-administered questionnaire survey was conducted, and the scores of pain intensity, interference with daily life, quality of life, self-Efficacy, anxiety and depression were compared and analyzed before and after the intervention.

　Results: The mean participant age was 59.9 (SD 8.3) years. The items that had a large effect size comparing those before and after the intervention were anxiety (r = .63) and depression (r = .67), which decreased significantly (p < .05). The items that were not significantly different but had a medium effect size were the most severe pain (r = .36), average pain (r = .33), and total interference with daily life (r = .31), which both decreased after the intervention. The satisfaction with the analgesic treatment (r = .36) increased after the intervention.

　Conclusion: Patient anxiety and depression decreased significantly, and pain intensity, interference with daily life and satisfaction with analgesic treatment had a medium positive effect size. Overall, this program was suggested to have clinical utility.