骨盤内臓全摘術後に直腸がん患者が生活を再構築していくプロセス

The Process of Life Reconstruction in Rectal Cancer Patients after Total Pelvic Exenteration

要旨

　本研究の目的は，骨盤内臓全摘術後に直腸がん患者が生活を再構築していくプロセスについて明らかにすることである．対象は，過去5年以内に骨盤内臓全摘術を受け，現在外来通院している直腸がん患者8名である．データ収集は半構成的面接を行い，質的帰納的に分析を行った．なお，本研究は研究実施施設の倫理審査で承認を得た．

　対象者は［骨盤内臓全摘術後に遭遇する困難］を経験し，［骨盤内臓全摘術後の生活を再構築するための対処］を行っていた．困難と対処を繰り返す中で，対象者は［自己に対する肯定感覚の形成］を行い，［生きている意味の充足感］を得ていた．また，［ありたい自分を目指す欲求］が対処の獲得を促進し，［骨盤内臓全摘術後の患者を支える周囲からのサポート状況］が生活再構築のプロセス全体に影響することが明らかになった．

　骨盤内臓全摘術後に直腸がん患者が生活を再構築していくプロセスの中心となっていたのは，［自己に対する肯定感覚の形成］であり，これは対処の成功によって促進された．サポートの欠如と対処の失敗は肯定感覚の形成のつまずきを引き起こしていた．

　［自己に対する肯定感覚の形成］を促すことが，患者が骨盤内臓全摘術後の生活を再構築し，生活に充実を感じるために最も重要であった．

Abstract

　The purpose of this study was to clarify the process for rectal cancer patients to rebuild their lives following total pelvic exenteration. The subjects in this study were 8 rectal cancer patients who had undergone total pelvic exenteration within the past 5 years, and who currently return for outpatients follow-up visits. The study data was collected by semi-structured interviews, and were analyzed by a qualitative and inductive method. This study was approved by the clinical ethics committee of the concerned hospital.

　Subjects experienced "problems encountered following total pelvic exenteration", and pursued "coping behavior to rebuild their lives following total pelvic exenteration". In the course of dealing with these problems repeatedly, the subjects experienced a "development of a sense of self-affirmation", and obtained "a sense of satisfaction with the meaning of life". In addition, it was clarified that the "need to pursue being happy with themselves" promoted the acquisition of coping behavior, and the "support situation provided by a supportive environment to the patients following total pelvic exenteration" affected the whole process of life reconstruction.

　The core thing of the process that rectal cancer patients rebuilding their lives after total pelvic exenteration was their "development of a sense of self-affirmation", which was promoted by the success of such coping behavior. Deficiencies in these coping behavior and the lack of a supportive environment caused failures in the "development of a sense of self-affirmation".

　In conclusion, it was found that encouraging the "development of a sense of self-affirmation" was the most important factor in rebuilding patients' lives following total pelvic exenteration, and in feeling satisfaction in their lives.