肺がん患者の治療過程において「bad news」を伝えられた配偶者の心理的ストレス反応—病期における差異とその影響要因

The Spouse's Reaction to Mental Stress When “Bad News” was Given in the Course of a Lung Cancer Patient's Treatment: Timings of Disclosure and Other Affecting Factors

要旨

　目的：肺がんの治療過程の中で，配偶者に医師から「bad news」が伝えられる時期を大きく3つの病期（診断告知の時期・再発の時期・積極的な治療終了の時期）に分け，各病期での配偶者の心理的ストレス反応の程度およびそれに影響を及ぼしている要因を明らかにし，3つの病期に応じた適切な看護援助について考察する．

　方法：「bad news」が伝えられる3つの病期にある肺がん患者の配偶者に対して，心理的ストレス反応，夫婦関係満足度を含む自記式質問紙を用いて調査を行った．

　結果：肺がん患者の配偶者（44名）の約2/3は自分の健康問題を抱えていた．その心理的ストレス反応は最初の「診断告知の時期」に高い傾向にあったが，病期別の有意差は認められなかった．配偶者の心理的ストレス反応に影響する要因としては，「夫婦関係満足度」「健康の状態」「経済的不安」「家族構成」が主なものであり，3つの病期によってこれらの影響要因は異なっていた．

　結論：看護者は，肺がん患者の配偶者の心理的ストレス反応を緩和するために，病期によって要因が異なることを考慮して援助することが大切である．

　Purpose : In the course of lung cancer treatment, the doctor at some point must disclose “bad news” to the spouse of a married patient. In this research the stress reaction of the spouse was analyzed at three points in time: When cancer was diagnosed and announced; When recurrence of the cancer was found; and when positive medical treatment was to end. To offer the best possible nursing assistance, how badly the spouse was affected by the news was determined. Factors that may have affected the mental reaction that he/she displayed were also examined.

　Methods : Data was collected after disclosures of “bad news” and from the self-account questionnaires which the spouse had filled in. The items therein contained his/her mental stress reaction and the degree of satisfaction in their marital relationship.

　Results : Of a total of 44 spouses who took part in the study, about two-thirds of them had their own health problems. Although their mental stress reaction showed a more negative tendency at the initial diagnosis of cancer than the subsequent disclosures, there was no significant difference between the timing of bad news. “Degree of marital satisfaction”, “state of spouse's own health”, “financial uncertainty” and “family make-up” were the main factors that influenced a spouse's mental stress reaction. As to how these factors affected his/her mental status changed somewhat depending on the phase of the cancer.

　Conclusion : Nurse is lung cancer patient's spouse will help alleviate for the mental stress. It is to nursing in consideration of the factors varies depending on the stage is important.