外来化学療法を受ける消化器がん術後患者の症状体験，セルフマネジメント力，自己効力感，QOLの実態および関連

Actual Condition Correlated with Experience, Self-Management, Self-Efficacy and Quality of Life : Findings from Postoperative Gastroenterological Cancer Patients Receiving Outpatient Chemotherapy

要旨

　本研究の目的は，外来化学療法を受ける消化器がん術後患者の具体的な症状体験，セルフマネジメント力，自己効力感，QOLの実態および関連について明らかにすることである．そして，外来化学療法を行う消化器がん術後患者の自己効力感，QOLを高める看護への示唆を得ることである．患者のセルフマネジメント力を調査するために質問紙を作成した．

　調査は，外来化学療法を受ける消化器がん術後患者61名を対象に聞き取り調査した．対象者の平均年齢は65.6±10.8歳．大腸がん38名（62.3％），胃がん23名（37.7％）であった．対象者のうち43名（70.5％）に症状体験ありと回答があった．外来化学療法を行う消化器がん術後患者の実態は，栄養状態の変化や排泄の変化を生じている者が多く，無症状を示すperformance status 0の患者においては心理社会的変化を生じている割合が多かった．また，セルフマネジメント力では，行動の成果を評価する力を習得している患者の割合が低かった．症状体験がある患者には，セルフマネジメント力と自己効力感（r＝0.338）に有意な正の相関が認められた．

　症状体験がある患者においてセルフマネジメント力向上が自己効力感につながることが明らかとなり，セルフマネジメント力を向上させる介入の必要性と介入指標として本研究で作成したセルフマネジメント力調査項目が活用できることが示唆された．

　The present study aimed to measure and clarify correlations between specific experiences, self-management, self-efficacy and quality of life (QOL) in order to suggest nursing interventions to increase self-efficacy and QOL among post-operative gastroenterological cancer patients receiving outpatient chemotherapy.

　The survey was conducted by interviewing 61 gastroenterological cancer patients (mean age, 65.6±10.8 years) receiving outpatient chemotherapy following surgery for colon cancer (n＝38, 62.3％) or stomach cancer (n＝23, 37.7％). A total of 43 patients (70.5％) reported subjective symptoms. Many patients reported changes in nutritional state and excretion, and psychosocial changes were experienced by a large proportion of patients, including asymptomatic, Performance Status 0 patients. With regard to self-management ability, only a small proportion of patients had acquired the ability to assess behavioral outcomes. Furthermore, a significant positive correlation was observed between self-management ability and self-efficacy among patients with subjective symptoms (r＝.338).

　The present findings indicate the need for nursing involvement to enable patients to appropriately assess the outcome of their own behavior. The self-management ability survey items developed during the present study can be used as an intervention index during such nursing intervention.