外来がん化学療法患者における自己効力感の関連要因

Related Factors of Self-Efficacy in Cancer Outpatients Receiving Chemotherapy

要旨

　本研究の目的は，外来で化学療法を受ける患者を支援するために，外来がん化学療法患者の自己効力感に関連する要因を明らかにすることである．地域がん診療連携拠点病院の外来で化学療法を受ける169名のがん患者に対し，患者背景・療養ニーズ・生活のしやすさに関する質問票（身体症状・つらさの寒暖計・全般的QOL）・進行がん患者のための自己効力感尺度で構成した質問紙調査を行った．分析の結果，以下の関連要因が明らかになった．患者背景のうち，40歳未満，非就労状態，1人暮らし，PS1以上，無趣味，相談相手がいない，医療者に相談しにくい，以上のいずれかの背景をもつ患者で，自己効力感得点が有意に低く，これらの背景に注目して重点的に介入していく必要性が示された．療養ニーズでは，副作用や症状悪化，外出や食事，相談についての援助を求める患者で自己効力感得点が有意に低く，これらのニーズを充足することが自己効力感の改善につながると推測された．身体症状のうち，不眠・食欲不振・呼吸困難・倦怠感の重篤度が自己効力感得点に影響を及ぼしており，自己効力感を高める具体的な看護支援として，これら，がん患者に高頻度で生じる症状の緩和やセルフケアの向上に対する支援の確立の必要性が改めて示された．さらに，自己効力感得点は，がん患者の気持ちのつらさや全般的QOLに影響を与えており，自己効力感を高める看護は，がん患者の包括的な支援になり得るものであり，外来で化学療法を受けるがん患者にとって必要不可欠であることが示唆された．

Abstract

　The purpose of this study was to identify by a survey questionnaire the factors related to selfefficacy in cancer outpatients receiving chemotherapy, and to discuss the appropriate nursing care for them.

　The sample consisted of 169 cancer outpatients receiving chemotherapy at a chemotherapy center. The questionnaire covered the patient's background, patient needs in terms of home care, a Screening Questionnaire(physical symptoms, a Severity Distress Thermometer, overall quality of life)and a Self-Efficacy Scale for Advanced Cancer(SEAC).

　As the result of analyses, factors related to self-efficacy in cancer outpatients were clarified. First, the SEAC score was significantly lower among patients with the following backgrounds: under 40 years old, jobless, solitary life, performance status 1 or more, no hobby, no adviser, and difficulty in consulting doctors or nurses. These results suggest that such outpatients need selective support.

　Second, the SEAC score was significantly lower in patients with the following needs: managing adverse effects / physical symptoms, going out / eating, and consulting. These results suggest that self-efficacy is enhanced by satisfying these needs.

　Third, the severity of the following physical symptoms significantly affected the SEAC score: insomnia, inappetence, dyspnea, and fatigue. These symptoms are frequent and distressing for cancer patients. So a nursing system to improve symptom management and self-caring behavior should be established.

　Finally, the SEAC score significantly affected the levels of overall quality of life and psychological distress. Nursing care that provides comprehensive support for outpatients enhances self-efficacy and is essential for cancer outpatients.