外来外照射療法開始前のがん患者が必要とする情報と患者の内的世界─患者のセルフケアを促進する治療開始前の看護支援の検討

The Inner World of Cancer Patients and Information That They Need Before the Start of Outpatient External Beam Radiotherapy : Nursing Care for Cancer Patients Before Starting Radiotherapy to Promote Their Self-care

要旨

　研究目的は，外来外照射療法適用決定後治療開始前のがん患者が必要とする情報の詳細と患者の内的世界とを明らかにし，外来外照射療法を受けるがん患者のセルフケアを促進する治療開始前の看護支援への示唆を得ることである．外来外照射療法開始前のがん患者21名に半構造化面接を実施し，Krippendorffの内容分析の手法を用いて分析した結果，がん患者が必要とする情報の詳細は，有害事象の種類および出現時期・部位・程度，治療がもたらす生活上の制約，原爆との相違点，抗腫瘍効果に関する客観的指標，治療にかかる費用，受けた人の体験談など，12大表題に類型化された．また，患者の内的世界は，病状の悪化や死の意識がもたらす脅威の知覚，がんの不確かさへの憂慮，ほかに選択肢はないという覚悟，長期間を要する治療であることに由来する困惑など，16大表題に類型化された．外来外照射療法開始前の看護支援への示唆として，がん患者が必要とする情報の12の大表題に関する内容を治療開始前に提供することで，患者が外来外照射療法をコントロールできる感覚を獲得できるようにする，集学的治療を体験した患者に過去に受けた治療に対する不満がある場合には治療開始前に解消する援助を行う，など計4つが得られた．

Abstract

　The purpose of this study was to elucidate the inner world of cancer patients, the information that they need and suggestions for nursing care to promote their self care before the start of outpatient external beam radiotherapy. Data were collected using semi-structured interviews with 21 cancer patients before outpatient external beam radiotherapy started, and were analyzed using the method of content analysis by Krippendorff. Information which cancer patients need was classified into 12 themes: "type, appearance time, region and grade of adverse events", "restrictions on life which outpatient external beam radiotherapy brings about", "difference from atomic bomb effects", "objective indicators about anticancer efficacy", "expense concerning outpatient external beam radiotherapy", "the experiences of people who received external beam radiotherapy", etc. The inner world of patients was classified using 16 themes: "threat awareness brought about by aggravation of the disease condition and consciousness of death", "anxiety over the uncertainty of cancer", "preparedness for there being no other choices", "embarrassment originating in the fact of medical treatment which requires a long period of time", etc. Suggestions are given for nursing care of cancer patients before the start of outpatient external beam radiotherapy, such as ＜prior to the start of treatment providing information about the 12 themes so that cancer patients can feel a sense of personal control over outpatient external beam radiotherapy＞, ＜when patients who underwent multidisciplinary treatment in the past have dissatisfaction about previous treatment, nurses can help to reduce patient dissatisfaction before new medical treatment is started＞.