重粒子線治療を選択した前立腺がん患者の治療選択における意思決定プロセス

Decision-making Process for Treatment Selection in Prostate Cancer Patients Who Chose Carbon Ion Radiotherapy

要旨

　目的：前立腺がんにはさまざまな治療方法があることで，治療の選択時に悩みや葛藤が生じることが予測される．また，他のがんに比べて長期生存が望めることから，治療後の尿失禁に悩まされることなく暮らしたいなど，自分に合った治療を選択したいと願う患者は少なくない．本研究の目的は，重粒子線治療を選択した患者の意思決定プロセスを明らかにし，看護支援を検討することである．

　方法：対象者は，前立腺がんに対して重粒子線治療を受け，治療終了後1年以内の患者14名である．データ収集は半構造化面接を行い，修正版グラウンデッド・セオリー・アプローチ（M-GTA）を用いて質的帰納的に分析した．

　結果：本プロセスは，対象者ががん告知による衝撃を受けながらも病気を受け止め，前立腺がん治療に関する情報を獲得していた．その後，自己のゆずれない考えのもと，治療の価値を見出し気持ちが傾き，重粒子線治療が最適な治療だと確信し，治療の決定へと至っていた．

　考察：プロセスの特徴は，重粒子線治療と一度決めたら揺らがない意思決定であり，自己の価値観と照らし合わせ，治療後の生活を見据えた意思決定であった．看護支援としては，獲得した情報から自己の価値観に基づいた意思決定が行えているか見極め，治療後の身体的な側面だけでなく仕事や趣味など社会的な側面など，生活全体を捉えた選択ができるよう患者の気持ちに寄り添い支えていくことが重要である．

　Purposes: Various treatment strategies are available for prostate cancer. Therefore, patients often have anxiety and emotional conflicts at the time of treatment selection. This study was aimed at identifying the decisionmaking process of patients who chose carbon ion radiotherapy and to examine the need for nursing support.

　Methods: The study was conducted in 14 patients who started receiving carbon ion radiotherapy treatment for prostate cancer during the past 1 year. Data were analyzed using the modified grounded theory approach.

　Results: During this process, the patients were at first shocked by the diagnosis of cancer, but were then ready to acquire information on the treatment options available for prostate cancer. Thereafter, they were able to identify the value of treatments based on their beliefs, and were convinced that carbon ion radiotherapy was the optimal treatment.

　Conclusions: The characteristics of this decision-making process were that once they made up their minds, the decision of the patients remained unchanged, and they had made the decision with their post-treatment life in mind. It is important to support patients not only by caring for their physical needs, but also by understanding their mental state, so that they can make choices by keeping in mind their social life after treatment.