緩和ケア病棟におけるがん患者の抑うつを早期発見するためのアセスメントに関する基礎的研究

Basic Survey on Early Detection of Depression in Cancer Patients by Palliative Care Unit Nurses

要旨

　目　的：がん患者の抑うつに関する看護の現状を把握し，看護の課題を検討した．

　方　法：研究倫理審査委員会の許可を得て実施した．全国で同意が得られた80病院の緩和ケア病棟看護師435名に郵送法で調査した．調査項目は国内外の文献検討に基づき作成し，抑うつの客観的観察項目と主観的質問項目とそれに関連すると考えるコミュニケーションスキル，Aguileraの危機の問題解決モデルの枠組みである決定要因，看護師・緩和ケア経験年数などとした．

　結　果：分析対象は250名で30〜40歳代が70％以上，看護師・緩和ケア経験平均年数はそれぞれ16.6年（SD±7.5），5.1年（SD±2.8）であった．客観的観察項目を“ いつもする”“ 時々する”合わせて75％以上あった項目は35項目中32項目，主観的質問項目は37項目中10項目，コミュニケーションスキルは22項目中19項目であった．決定要因は“いつもする”が75％以上あった項目は38項目中20項目であった．客観的観察項目と主観的質問項目を因子分析し，抽出した各因子を目的変数に，コミュニケーションスキルの平均点，看護職・緩和ケア経験年数を説明変数に重回帰分析を行った結果，コミュニケーションスキルと有意に相関があった（β＝0.247〜0.414，p＜0.001）．

　考　察：がん患者の抑うつに関して，患者の主観的な気持ちを聴くためのコミュニケーションスキルを向上し，意図的に客観的な観察ができるツールが必要であると考える．

　Objective：The purpose of this study was to investigate the current situation of nursing care regarding depression in cancer patients, and to address issues related to nursing care.

　Methods：The study was approved by the ethics board of the affiliated university. Data were collected by mail. We sent a questionnaire survey of 435 palliative care unit nurses in Japan. The questionnaire comprised the following：objective items related to depression (35 items)；subjective items related to depression (37 items)；communication skill (22 items)；balancing factors such as realistic perception of the event, adequate situation support, and adequate coping mechanisms (total 38 items)；years of nursing experience；years of palliative care practice, etc.

　Results：Valid responses were obtained from 250 nurses (57.5％).

　1) More than 70％ of the nurses were aged 30〜49. Their average number of years of nursing experience was 16.6 (SD±7.5), and their average number of years of palliative care experience was 5.1 (SD±2.8).

　2) More than 75％ of respondents answered “always” and “sometimes” to 32/35 objective items related to depression and 10/37 subjective items related to depression.

　3) More than 75％ of respondents answered “always” and “sometimes” to 19/22 items regarding communication skill and “always” to 20/38 items regarding balancing factors.

　4) Multiple regression analysis indicated that objective and subjective items related to depression were significantly associated with communication skill (β＝0.247〜0.414, p＜0.001).

　Conclusion：These findings indicate that improvement of communication skills for listening to patients' subjective views based on observation and sufficient objective observation are required for early detection of depression in cancer patients.