通院しながら免疫療法を受けている腎がん患者のセルフケアの探究

Self Care Figured Out by Renal Cell Carcinoma Patients Undergoing Immunotherapy in Outpatient Settings

要旨

　本研究は，通院しながら免疫療法を受けている腎がん患者がどのようなセルフケアを行っているのか，そして，どのような状況でセルフケアを必要とするのかを明らかにすることが目的である．セルフケアは，このような時期のがん患者が生命，健康，および安寧を維持するために実行している行為とその考えとした．研究方法は，通院しながら免疫療法を受け始めて1年以内の告知された腎がん患者に，半構成的質問紙を用いて1時間ほどの面接を2〜4週間ごとに3回行った．データ分析は，逐語録から通院しながら免疫療法を受けている腎がん患者が実施しているセルフケアを，それを必要とする状況とともに抽出した．セルフケアとセルフケアを必要とする状況は，意味を損なわないように簡単な文章にし，共通したものをカテゴリー化した．その結果，セルフケアの必要な状況として，壮年期にある5名の対象者は，病状や限られた治療法によって，免疫療法の必要性を感じて治療を受け始めていた．対象者は，高額な治療で，効果がなかなか実感できず，また，治療による不快な症状を体験していた．セルフケア（【　】で記載）は，次の5つが抽出された．対象者は，【治癒の不確かな病気とともに生きるための感情調整】をしながら，【社会的役割を続ける】ことと，【効果の不確かな治療を続ける】こととのバランスをとっていた．また，これらを続けるために治療による【苦痛な症状を軽減する】ことと，【体調を整える】ことをしていた．どんなに努力しても病気になる前の自分らしい生活には戻れないと「見究めた」対象者は，【苦痛な症状を軽減する】以外で，自分では変えられない状況の捉え方を変える感情調整的な対処を行いながら自分らしい生活を再構築していた．これらのセルフケアは，生活するために対象者が探究した知恵であると考える．

Abstract

　The purpose of this research is to identify behavior and ideas of self-care by renal cell carcinoma patients undergoing immunotherapy in outpatient settings. In this research, each of five renal cell carcinoma patients who had started immunotherapy within one year was interviewed three times. Data were collected using a semi-structured interview method guided by Orem's Self Care Theory and other self-care researches for cancer patients. Self-care was defined as behavior and ideas with which patients maintain their life, health, and wellness by themselves. Self-care data were collected with selfcare requirements for the patients. The verbatim record of the interviews with the patients was analyzed to pick out and name behavior and ideas of self-care and self-care requirements from each patient. A similar categorization of self-care and self-care requirements was obtained from each patient.

　The patients, all in their 50s, diagnosed with renal cell carcinoma, recognized the need to start immunotherapy, considering their condition and the limited treatments available for them. The expensive treatments they had had turned out to be not effective, and they became uncertain and apprehensive about the cure of their cancer. They experienced flu like symptoms and fatigue as side effects and felt weak both physically and mentally. They need to take time for outpatient treatment and to continue assuming their role at home and at work. The following five characteristics of self-care for the patients, specified in brackets［ ］, were identified: the patients were trying to keep balance between ［ continuing to assume their social roles］ and [continuing to undergo their treatment with its effectiveness uncertain], as they try to［ adjust and control their negative emotions to live with illness of which cure is uncertain］. They also［ controlled discomfort of side effects］ and［ maintained their physical condition］ enough to continue assuming their social roles and undergoing their treatment. I found the following in this study: patients realize that they cannot escape from the fact that they have cancer; therefore they have made a decision to reconstruct their life with a new found perspective in four characteristic areas of self-care except for the area of［controlling the discomfort of side effects］