HCV由来肝硬変・肝がん患者が語る病みの経験

The Ill Experience through the Story Telling of Patients with HCV-Caused Liver Cirrhosis or Cancer

要旨

　本研究の目的は，HCV由来肝硬変・肝がん患者の病みの経験を明らかにすることである．研究方法は病名告知されたHCV由来肝硬変・肝がん患者を参加者に半構成的面接を行い，グラウンデッド・セオリー・アプローチによって分析した．研究参加者は12名であった．

　HCV由来肝硬変・肝がん患者の病みの経験とは，最初に死を意識したときから始まり，患者の生の確かさは再発の告知や治療の成功の体験のたびに［進行してしまう病気を認めるしかないという思い］を中心に［治療によって繰り返し継ぎ足されていく命］と［死は仕方のないこととあきらめようと思う］の間を終末期になっても振り子のように揺れ動いた行路を中核として語られた．

　患者は最初に死を意識したとき，それ以前の自分の経験を振り返り，［病気があっても，自分なりに生きることができた］と意味づけることで，最初に死を意識したとき以後の生の確かさを求める思いを抑えていた．

　［病気があっても，自分なりに生きることができた］は人生の統合を意味し，患者は死を受け入れようとしながらも終末期でも死の受容に至らないと考えられた．これは，最初に死を意識した以後は命を継ぎ足すことそのものが病みの経験の意味となっているためと考えられた．

Abstract

　The present study was undertaken to investigate how patients diagnosed with HCV - induced liver cirrhosis or cancer face and deal with their illness. The study used semi - structured interviews of 12 patients with HCV - induced liver cirrhosis or cancer who had been told the true nature of their illness. The data were analyzed using a grounded - theory approach.

　During the interview, the patients reviewed their experience with their disease. Many reported that they had come to terms with the strong wish to survive(which they had begun to be aware of after their first recognition of their diagnosis with a potentially life - threatening illness)by attaining the view that they had already lived good and full lives. The patients described the course of changes of their views about life. While their condition went through repeated cycles of recurrence, commencement of treatment and success in treatment, their feelings or perceptions about life swung like a pendulum. The central balance state was characterized as :"I have to accept the advance of this illness". The two polar feeling states were expressed as :"My life will continue to be saved by this treatment"and"Death is inevitable and I am destined to die".

　The coming to terms with the strong desire to survive in the face of their first recognition they were possibly facing death can probably be explained by successful integration of memories surveying the courses of their lives. However, the feeling :"My life will continue to be saved by this treatment"persisted until the terminal stage, and this probably kept the patient from completely accepting death even though he/she was striving to accept it. Because, after the patients became aware they were facing death, their goal became achieving an extended life through treatment, their feelings about clinging to life continued to swing like a pendulum.