がん疼痛のある進行肺がん患者の情動体験

Emotional Experiences of Patients with Advanced Lung Cancer Suffering from Cancer Pain

要旨

　研究目的は，がん疼痛のある進行肺がん患者の情動体験を明らかにすることである．がん疼痛のある進行肺がん患者12名を対象に，参加観察と半構成的面接を行い，質的統合法（KJ法）で分析した．がん疼痛のある進行肺がん患者の情動体験は，【悲観的意識の自己調整と周囲の支援によって心身の回復が得られる実感】【痛みの緩和がもたらす安心感とがんからの解放】【麻薬性鎮痛薬への懸念ゆえの自助努力と痛み増強時の最終手段としての受け止め】【完治できなくとも現状維持するための療養への取り組み】【心の拠り所や信仰，新たな生きる意味を糧とした療養への取り組み】【がんと死の経過を想定した予測的対応による死の恐怖が和らぐ実感】の6つに統合され，回復意欲に基づいた自律的存在として社会の中で生きるための取り組みであり，死期に向けた予測的対応へと帰結するものであることが示された．がん疼痛のある患者への看護実践のあり方として，心身の回復への期待感を高め回復意欲を促すこと，自律的存在として社会で生きることを支えることが必要であると考える．

　This study aimed to clarify emotional experiences of patients with advanced lung cancer suffering from cancer pain (N=12). We conducted participant observation and semi-structured interviews. Furthermore, we analyzed results using the Qualitative Synthesis Method (KJ Method). Emotional experiences of participants were integrated into six categories：a feeling of recovery of body and mind due to self-regulation of pessimistic thoughts and surrounding support；a sense of security and release from cancer brought by pain relief；accepting self-help efforts stemming from anxiety over opioid analgesics as an ultimate solution when pain increases；commitment to medical treatment to maintain current condition even though the cancer cannot be completely cured；commitment to medical treatment as a cornerstone for improved mind, religion, and a new way of life；and moderate fear of death based on the predictive response that assumes the progress of cancer leading to death. We found that emotional experiences of patients suffering from cancer pain relate to the struggle to live in society as autonomous existence inspired by their wills to recover, and their experiences will turn into preparation for their predicted death. We consider that it is necessary for nurses to enhance these patients' expectations of physical and mental recovery, encourage their desire to recover, and support each of them in living in society as autonomous existence.