がん患者と家族成員のパートナーシップとQOLとの関連およびパートナーシップの影響要因

Correlation of the Quality of Life with the Partnership between Cancer Patients and Their Primary Family Caregiver, and Influencing Factors on the Partnership

要旨

　【目的】がん患者と家族成員のパートナーシップとQOLとの関連，パートナーシップに及ぼす影響要因を明らかにする．

　【方法】通院または短期入院のがん患者と家族成員28組（56名）に対し構造化面接を行った．調査項目は，患者と家族成員両者に特性，WHOQOL26，家族コミュニケーション尺度，患者にMental Adjustment to Cancer scale，家族成員にCaregiver Qualityof Life Index-Cancerを用い，パートナーシップの指標は患者と家族成員の「肯定的コミュニケーション得点の和」とした．分析はPearsonの積率相関係数と重回帰分析（p＜0.05）で行った．

　【結果】分析対象者は25組（50名），患者は全員化学療法を受けていた．分析の結果，パートナーシップは患者のQOL（r＝0.504，p＜0.05），家族成員のQOL（r＝0.615，p＜0.01）と関連し，患者のQOLと家族成員のQOLは関連（r＝0.626，p＜0.001）することが明らかとなった．パートナーシップに及ぼす影響要因は「患者の悲観」「家族成員の心理的負担感」「患者の否定的コミュニケーション」「家族成員の否定的コミュニケーション」「家族成員のサポートの有無」であった．

　【考察】がん患者と家族成員のパートナーシップとQOLとの関連を明らかにすることで，家族をシステムとして捉える看護実践の重要性を示した．パートナーシップを促進するためには，患者の悲観，家族成員の心理的負担感に対する「ありのままを受け止める支持的共感的介入」と「コミュニケーションをつなぐ洞察力」を磨き，「家族成員のサポート体制の構築」が必要である．

Abstract

　Aim: The aim of this study was to investigate the correlation between the quality of life of cancer patients and their partnership with their primary family caregiver, as well as the effects on their partnership.

　Method: The subjects were 28 pairs(56 people)of both in- and outpatients and their families who received a "structured interview."

　The assessment was carried out using character, WHOQOL26 and the Family Communication Scale for both the patients and their families; Mental Adjustment to Cancer Scale for the patients; and Caregiver Quality of Life Index-Cancer for the families.

　The criterion was the sum of the positive communication points, and the analysis was based on the Pearson product-moment correlation coefficient, and multiple regression analysis(p＜0.05).

　Result: The data analysis was done on 25 pairs of patient and primary caregiver(50 people), and all of the patients had been receiving chemotherapy. The analysis revealed that partnership has a positive correlation with the patient's QOL(r=0.504, p＜0.05)and the family's QOL(r=0.615, p＜ 0.01), which indicates there is a correlation between patient's QOL and family's QOL.

　The impact factors on partnership were "the patient is pessimistic", "the primary family caregiver's burden", "the patient's negative communication", "the primary family caregiver's negative communication" and "the primary family caregiver's support".

　Discussion: This study on the correlation between QOL for cancer patients and their primary family caregiver shows a great need for practical nursing, in which the patient and their family are considered as a system. The result also revealed that in order to encourage and build patient partnership with the primary caregiver, it is important for nurses to thoroughly understand the character of the patient's family, which can influence partnership.

　It is also important to give a helping hand to alleviate "patient's pessimism" and "family's burden".

　Nursing assistance plays an important role to mediate and establish communication between patients and their family and a support system for primary family caregivers should be established.