広汎子宮全摘術を受けた患者が変化したと捉えた自己概念

Changes in Self-concept by Patients After Radical Hysterectomy

要旨

　本研究の目的は，広汎子宮全摘術を受けた患者のがん罹患前の自己概念と手術後に患者が変化したと捉えた自己概念を明らかにすることである．広汎子宮全摘術を受け外来通院中の女性患者7名を対象に，半構成的面接により得られたデータを質的内容分析した．がん罹患前の自己概念は『健康な自分』，『生きたいように生きる自分』，『女性として生きる自分』，『自分の役割を全うする自分』の4つの上位カテゴリーに，手術後に変化したと捉えた自己概念は｛自分を苦しく思う自分｝，｛新たな生き方を得た自分｝，｛女性性を意識する自分｝，｛人とのかかわりの中で生きる自分｝の4つの上位カテゴリーに分類された．広汎子宮全摘術を受けた患者が変化したと捉えた自己概念が意味するものは，がん罹患前の自分の喪失，新たな自分の獲得，女性性に対する意識の変化と考えられた．

　がん罹患前の自分の喪失には身体コントロール感の障害による体に対する信頼感の低下，新たな自分の獲得には苦しい体験の中で自己認識が拡大することが関係していたと考えられた．女性性に対する意識の変化には周囲からの評価が影響していたと考えられた．以上から広汎子宮全摘術を受けた患者が自己を肯定的に捉えられるためには，身体コントロール感の再獲得や自己認識の拡大，患者が自分を女性と実感できるかかわりへの援助が必要と考えられる．

Abstract

　The purpose of this study is to clarify changes in the self.concept of patients who underwent radical hysterectomy, comparing before they were affected by cancer and after the operation. Semi.structured interviews were conducted with seven female patients who underwent radical hysterectomy and were receiving outpatient treatment, and qualitative content analysis was carried out on the data obtained. The patient's self.concept prior to being affected by cancer was classified into four upper categories: "a healthy self", "a self who lives as she wishes", "a self who lives as a female", and "a self who fulfills her roles". The self.concept after operation was classified into four upper categories: "a self who feels painful about herself", "a self who acquired a new way of living", "a self who is aware of her femininity", and "a self who lives in relationships with other people". Changes in self.concept by patients after the operation meant loss of self before being affected by cancer, acquisition of a new self, and changes in awareness of femininity.

　Loss of self from before being affected by cancer was considered to relate to a decrease in reliance on the body due to disability of the sense of physical control, and acquisition of a new self was considered to relate to expansion of self.recognition through painful experiences. Changes in awareness of femininity seemed to have been influenced by evaluation from other people. Based on the above, in order for a patient who underwent radical hysterectomy to see herself in a positive manner, assistance in reacquisition of the sense of physical control, expansion of self.recognition and involvement to allow a patient to feel her femininity seems to be necessary.