化学放射線療法を受ける肺がん患者が捉える体力と体力を維持するための取り組み

The Meaning of Strength and Strategy in Keeping up Strength in Patients Receiving Chemoradiotherapy for Lung Cancer

要旨

　本研究の目的は，化学放射線療法を受ける肺がん患者が，治療を継続するうえで必要とする体力と，体力を維持するための取り組みについて具体的に明らかにし，治療完遂に向けた支援を考察することである．対象者は6名で，各2回の半構成的面接法にて体力に関するデータを収集し，質的帰納的方法で分析した．

　その結果，患者が捉える体力は，【がんに向き合うために不可欠なもの】【自分の体への信頼から生まれる】【心のありようを反映する】【恒常性を保つ指標】【目的に応じた行動を可能にする】の5のコアカテゴリーに集約された．また体力を維持するための取り組みとして【体力を維持することへの強い意思を持つ】【ある程度の体力低下を受容する】【治療中の不安や葛藤と付き合う】【生死に対峙し，自分の人生を俯瞰する】【食事量を維持する】【生活リズムを調整する】【活動量を調整する】【東洋医学を取り入れる】【重要他者とのつながりやサポートを大事にする】の9のコアカテゴリーが得られた．患者は，進行肺がんという厳しい生命予後に向き合う中，本治療を完遂するためにこれまでの人生で培ったあらゆる力を体力という言葉に集約していた．また【体力を維持することへの強い意思を持つ】のように，具体的行動だけでなく体力への向き合い方も模索していた．看護師は，体力が患者にとって身体能力以上の意味を持つことを理解し，心身両面から支援することが重要である．

　The purpose of this study was to identify the meaning of strength and strategy in keeping up strength in advanced lung cancer patients receiving chemoradiotherapy (CRT), and to consider proper support for them to complete treatment. We conducted semi-structured interviews with 6 locally advanced lung cancer patients twice during treatment. A qualitative design was chosen for this study and date was interpreted using content analysis techniques.

　In this study, the meaning of strength was integrated into 5 major categories. The 5 major categories were：“facing the cancer”, “knowing and trusting your bodily strength”, “strength being affected by emotions”, “indicators for preventing homeostasis”, “permit activities according to purpose”. Details of individual strategies to maintain strength were integrated into 9 major categories. The 9 major categories were：“having a strong will to keep up strength”, “accepting strength reduction to a certain degree”, “management with anxiety and worry”, “confronting life and death, and reviewing one's own life”, “receiving enough nutrition”, “adjusting the rhythm of living for a 24-hour day cycle” “controlling activities”, “adjusting to oriental medicine”, “placing value on human relationships and support”. Advanced lung cancer patients were forced to face poor prognosis. CRT was the only way to cure their advanced lung cancer, so they put forth all energy to complete their treatment and expressed their energy using the word “strength”. “Having a strong will to keep up strength” was most important for the patients, and they found their own ways to keep their strength.

　As has been discussed, strength did not only imply physical ability for patients receiving CRT. Strength is a complex, subjective concept. To support these patients, nurses must pay attention to their symptoms, physical condition and psychological response.