末期がんサバイバーの「生ききる」の実現に向けた訪問看護師の意思決定支援プロセス

Decision-Making Support Process of Visiting Nurses Help Terminal Cancer Survivors "Live a Fulfilling Life"

要旨

　目的：末期がんサバイバーの「生ききる」の実現に向けた訪問看護師の意思決定支援プロセスを明らかにする．

　方法：訪問看護経験3年以上，在宅でのがん終末期ケアかつ看取り経験を有する看護師17名に半構造化面接を実施し，修正版グラウンデッド・セオリー・アプローチの手法で分析した．

　結果：意思決定支援プロセスは，「暮らしの日常・非日常の実現」「がん治療への未練に付き合う」「人生の締めくくりに向けた伴走」により構成される「共にいのち・人生に向き合う」支援が核となっていた．これは「現実的決断への仲立ち」「症状緩和に徹する」支援により促進され，「看護師主導の体制整備」が基盤にあることで成立していた．

　結論：本意思決定支援プロセスは，残りの人生を主体的にデザインすることやGood deathを実現し，末期がんサバイバーがわずかであっても希望を持ち続け，「生ききる」ことを可能にする．

　Objective: To clarify the decision-making support process of visiting nurses to help terminal cancer survivors "live a fulfilling life".

　Methods: Semi-structured interviews were conducted with 17 nurses, who had worked as a visiting nurse for 3 years or longer and had experience in providing home care and end-of-life care for patients with terminal care needs. We analyzed the data using the modified grounded theory approach.

　Results: The decision-making support process was focused on ＜facing life together＞, including ＜realizing the ordinary and extraordinary aspects of daily life＞, ＜going alone with patients who are still attached to cancer treatment＞, and ＜helping patients prepare for the end of life＞. These approaches were facilitated by ＜promoting realistic decisions＞ and ＜focusing on symptom relief＞, and based on ＜establishing a nurse-led system＞.

　Conclusion: The decision-making support process helps terminal cancer survivors maintain hope, even if it is only a little, and "live a fulfilling life" by actively designing the rest of their lives, and achieving a "good death".