非小細胞肺がんで病期Ⅲ期以上と診断され初回治療（化学療法・放射線治療）を受ける患者に対する心理的な看護介入の効果

The Effects of Psychological Nursing Intervention for Patients Undergoing Initial Chemotherapy and/or Radiotherapy for Advanced Non-small Cell Lung Cancer

要旨

　【目　的】初回治療を受ける非小細胞肺がん患者に対して心理的な看護介入を行い，その効果を検討した．

　【方　法】病期Ⅲ期以上の男性患者を対象とし，年齢と病期を用いて参加者を層別化し2群に割り当てた．介入群には，緩和ケア認定看護師が認知的支援，情緒的支援を行った．効果判定には，認知的評価尺度，Mental Adjustment to Cancer Scale（Mac scale），European Organization for Research and Treatment of Cancer quality of life questionnaire（QLQ-C30）を用いた．

　【結　果】介入群はⅢ期3名/Ⅳ期5名で，対照群はⅢ期4名/Ⅳ期6名であった．対照群では，1カ月後の「脅威性の評価」「予期的不安」の平均値は上昇し，介入群では低下し（変化量，p＜0.05），効果量は0.64，0.63であった．QLQ-C30では「role functioning」に異なる変化を認め（p＜0.05），介入群で改善し，その効果量は0.59 であった．

　【結　論】心理的な看護介入が，患者の状況に対する評価を変化させ，対処や取り組みを促進し，QOLの改善に寄与する可能性が示唆された．

　Objective：The present study aimed to investigate the effects of psychological nursing intervention for patients undergoing initial non-small cell lung cancer treatment.

　Methods：A total of 18 men with stage III or IV non-small cell lung cancer were assigned to either the control or intervention group by stratified randomization using age and cancer stage. The intervention group received cognitive and emotional support from a certified palliative care nurse. The effects of intervention were measured using a cognitive appraisal scale, the mental adjustment to cancer scale, and the 30-item cancer quality of life questionnaire (QLQ-C30).

　Results：The control group (n=10) comprised four stage III and six stage IV patients while the intervention group (n=8) comprised three stage III and five stage IV patients. While mean scores for “threat” and “anxious preoccupation” 1 month after the start of treatment increased in the control group, scores decreased in the intervention group (effect size per category, 0.62 and 0.64, respectively; both p＜0.05). Various items in “role functioning” observed on the QLQ-C30 improved in the intervention group (effect size, 0.59：p＜0.05).

　Conclusion：The present findings suggest that psychological nursing intervention alters non-small cell lung cancer patients' appraisals of their situation and is effective for promoting illness acceptance and treatment initiatives.