Oxaliplatinによる末梢神経障害「しびれ」を経験する大腸がん患者の精神的ストレス内容と対処

Details and Care of Psychological Stress in Colorectal Cancer Patients with Oxaliplatin-Related “Numbness” as a Peripheral Nerve DisorderOxaliplatin

要旨

　本研究の目的はしびれによる精神的ストレス内容と対処を明らかにし，効果的な支援方法を検討することである．Oxaliplatin総投与回数10回以上，総投与量850mg/m²以上で，研究に同意した16名を対象とした．インタビューガイドを用いた半構造的面接調査を行い，質的帰納的分析を行った．しびれによる精神的ストレスの内容3カテゴリーは【自分ではどうにもできないしびれに対し不安や無力感を抱く】【行動の制限を強いるしびれに恐怖やつらさを感じる】【しびれにより他者との距離を感じる】にまとめられた．また，精神的ストレスへの対処は【しびれについての認知を変えることでしびれを納得し受け止める】，【しびれに対する対処行動を模索することで自分なりの解決策を得る】の2カテゴリーであった．看護師はしびれによる精神的ストレス内容とその対処についてアセスメントし，しびれの影響で不安やうつに進展していないか治療継続性を客観的に判断する必要性が示唆された．

　The purpose of this study was to clarify the psychological stress caused by numbness during colorectal cancer chemotherapy and methods for addressing the stress, and then to explore methods to help patients continue their treatment while maintaining their QOL. The subjects were 16 patients who had received ≥ 10 doses of oxaliplatin at a total dosage of ≥ 850mg/m², and who agreed to participate in this study. A semi-structural interview using an interview guide was conducted and qualitative inductive analysis was performed. Based on the results, the psychological stress could be classified into three categories: “anxiety and a helpless feeling related to un-selfcontrollable numbness,” “aversion or sadness towards the numbness constraining their behavior,” and “a sense of alienation due to numbness.” The methods for addressing the stresses were classified into two categories: “To convince them to accept the numbness by changing their understanding of numbness,” and “To explore a method to address the numbness while enlisting others' cooperation.” The findings suggested that the nursing staff must obtain details of the patient's psychological stress associated with the numbness and devise a method to address the stress both objectively and subjectively, detect anxiety and/or depression early, and determine the feasibility of continuing treatment subjectively.