診断から初回治療導入期における肺がん患者の不確かさの管理

Management of Uncertainty by Patients with Lung Cancer between Diagnosis and Treatment

要旨

　目的：本研究は，進行肺がんの診断から初回治療導入の期間に患者がどのように不確かさを管理しているのか明らかにする質的研究である．

　方法：研究協力者15名に半構造化面接を行い，質的記述的研究手法を用いて分析をした．結果：コアカテゴリーとして《死ぬかもしれない自己の先行きが混迷する中で，生きる道筋を見出す》が抽出された．これは，【死が迫っているかもしれない肺がんの治療の先行きが読めない】【自己が存在していく基盤が揺れ動く】という不確かさに対して【死を遠ざけて，まだ生きられると挑戦をする】【がんとつき合いながら生きる甲斐を見出していく】という生きることへ専心していく管理と捉えられた．結論：進行肺がんと診断された患者の不確かさの管理は，命を長く延ばす取り組みと生きる意味を見出す取り組みの2つを包含していた．これは，死ぬかもしれないという不確かさの中で，周りの環境を活用しながら自己の力を駆使した生きることへの挑戦であり，進行肺がん患者の不確かさの管理の特徴であると言える．

　Aim: A qualitative study was performed to clarify the methods patients employed to manage uncertainty in the period between diagnosis of advanced lung cancer and initiation of treatment.

　Methods: Fifteen patients participated in semi-structured interviews to obtain information. Analysis of the interviews was done by employing a qualitative descriptive study.

　Results: The core category for managing uncertainty was identified as 《finding a way to live despite bewilderment at the prospect of dying.》 In the period between diagnosis and the initiation of treatment, patients experienced uncertainty due to their 〈inability to predict the future and fear that treatment for lung cancer may bring death closer〉 and 〈having the foundations of existence shaken.〉 They responded by engaging in survival-related activities through 〈gaining distance from death and accepting the challenge of living〉 and by 〈searching for the meaning of living while dealing with cancer.〉

　Conclusions: In patients diagnosed with advanced lung cancer, managing uncertainty involved attempts to prolong survival and to find meaning in living. In the period between diagnosis and the start of treatment, these patients attempted to manage uncertainty through trying to live to the fullest extent possible by making use of the surrounding environment despite uncertainty about the risk of dying.