緩和ケア病棟における家族を対象としたサポート・グループでの語りの様相

Narratives in Support Groups for Families of Patients in a Palliative Care Unit

要旨

　本研究は，緩和ケア病棟に入院中の患者の家族を対象とするサポート・グループ（以下，SG）を開催し，そこでの家族の語りの様相と語ることの意味について検討することを目的とした．研究方法は，家族を対象としたSGを緩和ケア病棟内で開催し，研究参加への同意を得られた場合にのみSGでの語りを録音し，研究データとした．データは，意味内容に着目して質的に分析した．分析の結果，家族の語りからは，【緩和ケア病棟への入院に至るまでの歩みと苦悩】【目に見えて衰えていく患者の様子】【死を感じながらも生と向き合う患者の心情】【患者の変化とともに揺れ動く家族の心情】【困難な状況に何とか応じようとする家族の姿勢】【患者に付き添うことによって得る気づきと直面する問題】【SGへの参加から家族が得たこと】の7つのカテゴリーが導き出され，刻々と変わっていく患者とともに揺れ動く家族の思いや経験の様相が明らかになった．SGへの参加は，語ることをとおして自らの経験を意味づけるきっかけを得たり，共感や励ましを受ける機会にもなっていた．緩和ケア病棟におけるSGは，同じような境遇にある者同士が語る機会・語る場を提供することにおいて意義があると示唆された．

Abstract

　The purpose of this study was to conduct support group meetings for family members of inpatients in a palliative care unit and to identify the characteristics and meanings of the family members' narratives. Support group meetings were conducted in the palliative care unit. With the participants' consent, the dialogue between participants was recorded and analyzed qualitatively in order to determine the meaning of the narratives.

　The following seven categories were extracted during the analysis:(a)The patient's and family's course and distress until admission to the palliative care unit,(b)The patient's condition is noticeably declining,(c)Awareness that the patient continues to live while facing death,(d)Feelings of family members who are upset by the change in the patient's condition,(e)The family members' attitudes toward dealing with difficult situations,(f)Realizations of family members who attend to the patient and are faced with problems, and(g)What the family gained from participating in support group meetings. According to these results, the family members had various feelings and experiences regarding patients whose conditions varied from hour to hour.

　Joining support group meetings allowed the families to give meaning to their own experiences by talking with others, and provided opportunities to give and receive sympathy and encouragement. These findings suggest that support group meetings in palliative care units are useful for providing opportunities to talk with other individuals who are in a similar situation.