遊離組織移植による再建術を伴う頭頸部がん拡大根治術を受けた患者の家族の思い

Thoughts of Families of Patients Undergoing Extended Radical Surgery for Cancer of the Head and Neck Followed by Reconstruction Using Free-Tissue Transfer

要旨

　本研究の目的は，遊離組織移植による再建術を伴う頭頸部がん拡大根治術を受ける患者の家族の思いを明らかにすることである．コミュニケーション能力の低下，顔貌の変化などに付随する問題が，他のあらゆるがん患者と比較して最も強調される頭頸部がん患者の術後急性期に，患者の側にいた家族を対象とした．その家族から手術にともなって感じた思いについて半構造化面接を行い，KJ法を用いて内容分析を行った．

　面接で得られた内容をまとめ，ラベルづけを行った結果，45コードが抽出された．そのコードから，［平静］［安心］［喜び］［感謝］［達成感］の5つのサブカテゴリーがポジティブに，［恐怖］［つらい］［可哀想］［困惑］［不安］［後悔］［ねぎらってほしい］の7つのサブカテゴリーがネガティブにカテゴリー化された．

　今回の研究から，患者の側にいる家族は普段言葉には出さないさまざまな思いを抱えながらも，命をかけて治療に臨む患者を多大な努力と気持ちのコントロールを行いながら支えていることが判明した．それらを踏まえ，今後も関わっていく患者・家族両者の思いに向き合い，支援していく助けとしたい．

　The purpose of this study is to clarify the thoughts of families of patients undergoing extended radical surgery for cancer of the head and neck followed by reconstruction using free-tissue transfer. The close families of the head and neck cancer patients in postoperative acute phase, who face more problems associated with deterioration in communication competence and change of facial appearance compared to other cancer patients. Semistructured interviews were conducted to collect the thoughts of the family dealing with surgery, which were analyzed using KJ method. The results from the interviews were labeled and coded. Consequently, five subcategories; “Peace”, “Relief”, “Joy”, “Gratitude” and “Sense of accomplishment” were summarized in positive thoughts. Similarly, seven subcategories; “Fear”, “Sadness”, “Sympathy”, “Confusion”, “Anxiety” and “Desire for empathy” in negative thoughts. From this study, it was found that the close families have many feelings they usually do not express, and they support the patients going through the high risk treatment with great efforts and self-control. The information gained in this study could be used to further develop appropriate help and support for both patients and their families.