初期治療を選択する乳がん患者が経験する困難

Difficulties Experienced by Breast Cancer Patients in Selecting Their Initial Treatment

要旨

　本研究は，乳がん患者が初期治療選択を行う過程で経験している困難を明らかにし，乳がん患者のよりよい初期治療選択への看護支援に資することを目的とした．乳がんのⅠ期またはⅡ期と診断された患者のうち，医師より初期治療の選択肢を提示され，その選択を任された21名を対象として，半構成的面接調査と参加観察を実施し，質的帰納的に分析した．

　その結果，乳がん患者が初期治療選択を行う過程で経験する困難として，【自分の状況を正確に把握しイメージできない】【不確かな状況や一般論では判断しにくい】【医療者に対する遠慮やためらいで相談しにくい】【家族に気を使いサポートは期待できない】【何もかもが気になり不安で仕方ない】【辛さや理不尽な感情で一杯になり冷静に考えられない】【情報の多さや周囲の影響で揺れ動く感情に戸惑う】【命と自己決定責任の重みに圧倒される】の8つのカテゴリーが明らかになった．さらに，乳がん患者の意思決定における困難さの関係は，精神的に不安定な状況で冷静に考えられないが中核となり，判断のよりどころとなるものが不確かである，家族や医療者からのサポートが受けにくい，命と自己決定責任の重みに圧倒されるが精神的な不安定な状況を助長する要因ととらえられた．

Abstract

　The aims of this study were to elucidate the sorts of difficulties experienced by patients with breast cancer during the process of selecting their initial treatment, and to identify nursing interventions to support patients' decision.making. The participants in this study were 21 women diagnosed with stageⅠorⅡbreast cancer who were offered options as to their initial treatment by their treating physicians. Data were collected through semi.structured interviews and participant observations, and were evaluated using qualitative induction analysis.

　We identified 8 categories of difficulty, comprising "inability to properly understand and create a mental image of my condition", "difficulty making decisions in an uncertain situation based on generalisations", "hesitation and holding back in discussing things with doctors and nurses", "not wanting to be a burden to the family, and can't expect support from them", "too anxious and worried about everything", "inability to think clearly due to feelings of distress and unfairness", "troubled by mood swings under the influence of too much information and other people", and "feeling overwhelmed by the weight of responsibility in making life and death decisions". The core problem for these patients with breast cancer was their inability to think clearly when they were asked to make a decision in spite of their unstable emotional state. Difficulty in identifying the basis for their decision.making, difficulty obtaining support from their families and medical service providers, and the weight of responsibility in making life and death decisions, were factors that further destabilised their emotional states.