初めて化学療法を受ける就労がん患者の役割遂行上の困難と対処

Difficulties in Managing Work Roles by Working Cancer Patients Receiving First Chemotherapy

要旨

　本研究の目的は，初めて化学療法を受ける就労がん患者が抱える役割遂行上の困難と対処を明らかにすることである．初めて化学療法を受ける14名の就労がん患者を対象に，半構成質問紙を用いた面接を，初回治療開始時，初回治療開始後1・2・3カ月の時期に行った．分析は，困難と対処の部分を抽出し意味内容の類似性からカテゴリー化した．

　初回治療時の困難は，〈体力的に役割をこなしていけるのか心配〉〈病気や治療が役割に及ぼす影響がわからない〉などの7カテゴリーだった．新たに抽出された困難は，1カ月後は〈役割を継続したくてもできない〉〈他者との関係に悩む〉などの6カテゴリー，2カ月後は〈役割と治療の両立が難しい〉などの3カテゴリー，3カ月後は〈他者との関係がつらい〉だった．治療開始時の対処は，｛深く考えない｝｛他者を活用する｝などの11カテゴリー，新たに抽出された対処は，1カ月後は｛気持ちの支えをもって治療に取り組む｝などの5カテゴリー，2カ月後は｛できる範囲で役割を担う｝などの3カテゴリー，3カ月後は｛意思をアサーティブに伝える｝などの2カテゴリーだった．

　初めて化学療法を受ける就労がん患者は，体力的な不安を抱えながら他者との関係に悩み，病気や治療の影響がわからないという不確かさの中で，体調をコントロールし周囲のサポートを活用しながら気持ちの上でも前向きに努力していることがわかった．患者が社会的役割と病者役割を両立させながら主体的に治療に取り組むためには，先の見通しをもちながら副作用のセルフケアが行えるようにし，周囲の人とアサーティブに関われるよう支援することが必要である．

Abstract

　The purpose of this study was to elucidate the difficulties encountered in the performance and management of duties by 14 working cancer patients receiving first chemotherapy. Data were collected using semi-structured questionnaires to interview at the start of chemotherapy, and after the 1st, 2nd, and 3rd month. Collected data were analyzed to extract responses concerning difficulties and management, further categorizing them according to similarities in semantic content.

　There were 7 categories of difficulties encountered at the commencement of chemotherapy, e.g., "I am worried whether I will be physically able to perform my duties", "I do not know what impact the illness and chemotherapy will have on my duties". Regarding newly revealed difficulties, there were 6 categories identified after the 1st month, e.g., "Although I want to continue performing my duties, I am unable to", "I do not know how to relate to other people". Three categories were revealed after the 2nd month, e.g., "performing my duties and receiving chemotherapy simultaneously is difficult", "I have difficulty in coping with side effects", and 1 identified after the 3rd month, e.g., "it is difficult to relate to others". For management difficulties, 11 categories were revealed at the commencement of the chemotherapy, e.g., "do not think too much", "involve others". Regarding newly identified categories, there were 5 categories after the 1st month, e.g., "remain positive when receiving chemotherapy", 3 categories after the 2nd month, e.g., "I try to discharge my duties as much as I can", and 2 categories after the 3rd month, e.g., "express my intentions in an assertive manner".

　It was demonstrated that working cancer patients attempted to make positive efforts, both physically as well as psychologically, by monitoring their physical condition and making use of support provided by other people; this in spite of being concerned about their physical strength, having difficulties in interacting with others, as well as being uncertain about possible implications of the illness and chemotherapy. For patients to be proactive in receiving chemotherapy by combining their social roles with those of patients, it is necessary for them to have certain foresight and deal with side effects of self care, thereby enabling them to interact with other people in a positive and assertive manner.