子宮頸部前がん病変と診断された女性の受診経過における体験

Experience of Women Diagnosed with a Pre-cancerous Cervical Lesion during the Consultation Period

要旨

　本研究は，子宮頸部前がん病変と診断された女性の受診経過における体験を明らかにし，子宮頸部前がん病変と診断された女性の継続した受診を支える看護支援を検討することを目的とした．高度異形成または子宮頸がんの最終診断がついた女性10名を対象に，参加観察，面接調査，記録調査よりデータ収集を行った．得られたデータを“前がん病変の診断から手術適応の診断”“手術適応の診断から最終診断”の2つの時期に分類し，時期ごとに質的分析を行った．

　その結果，子宮頸部前がん病変と診断された女性の受診経過における体験は，【前がん病変という曖昧な状態に戸惑う】【子宮頸がんへの進行を阻止するための手段を講じる】【見通しを立て安心感を得るために情報を求める】【安寧を脅かす情報に動揺する】【他者との関係に疑念を抱き孤立する】【励みとなる他者の存在が支えとなる】【最終診断の結果を受け止める】という，7のコアカテゴリーに集約された．“前がん病変の診断から手術適応の診断”の時期は前がん病変の事実を受容していくことが，“手術適応の診断から最終診断”の時期は治療を終え安心感を得る一方で，新たな脅威に立ち向かうことが示された．

　子宮頸部前がん病変と診断された女性の継続した受診を支える看護支援は，前がん病変の診断やウイルス感染の事実と向き合い，受け入れられるようにすること，妊孕性や術後の性生活について夫やパートナーと話し合い，生活を再構築できるように促すことが必要であると考えられた．

　This study aimed to clarify the experiences of women diagnosed with a pre-cancerous cervical lesion during the consultation period and to investigate the nursing support given to these women who were receiving ongoing consultations. Data were collected via participant observation, interviews, and records surveys from 10 participants who had a high-grade dysplasia or final diagnosis of cervical cancer. The data were classified into two time periods: from diagnosis of the pre-cancerous lesion to surgical diagnosis, and from surgical diagnosis to final diagnosis. A qualitative analysis was carried out on each period.

　As a result, the experiences of women diagnosed with a pre-cancerous cervical lesion during the consultation period was classified into seven core categories: feeling confused while in the ambiguous state of having a precancerous lesion, taking measures to prevent the progression to cervical cancer, asking for information to establish expectations and obtain a sense of ease, feeling upset upon receiving information that threatens one's wellbeing, feeling doubtful and isolated in relationships with others, the supportive presence of others serving as encouragement, and accepting the result of the final diagnosis. The period from the diagnosis of a pre-cancerous lesion to surgical diagnosis involved accepting the reality of the pre-cancerous lesion; however, the period from surgical diagnosis to final diagnosis encompassed obtaining peace of mind after receiving treatment while being confronted with a new threat.

　Nursing support during the consultation period for women diagnosed with a pre-cancerous cervical lesion is important for helping them to accept and face the reality of the diagnosis of a pre-cancerous lesion or viral infection, to help them discuss their fertility and postoperative sexual life with their husband or partner, and to ensure that they have the ability to rebuild their lives.