初発乳がん患者が罹患に伴う情報を小学生の子どもに伝える決断のプロセス

Process of Decision to Be Adopted by Patients with Newly Diagnosed Breast Cancer to Tell Their Elementary School Children About the Illness

要旨

　本研究の目的は，初発乳がん患者が告知を受けてから小学生の子どもに罹患に伴う情報を伝えることを決断するまでのプロセスを可視化し，子どもに伝える時の看護支援の在り方を検討することである．小学生の子どもを持つ初発乳がん患者14名に半構造化面接を行い，修正版グラウンデッド・セオリー・アプローチを用いて質的帰納的分析を行った．伝える決断のプロセスは，がん患者ががん診断による衝撃を受けながらも，子どもの唯一無二の母親であるという意識のもと，母親役割を遂行するために子どもに罹患に伴う情報を伝えることに至る体験であり，母親役割の強化・停滞要因が影響していた．子育ての経験を活かした，これまで通りのコミュニケーションスタイルをとることで，子どもに情報を伝えることを可能にしていた．患者が母親役割を果たす強化要因を早期に把握し，強化要因を強化する支援が必要である．また，母親の存在意義を認め，子どもが持つがんのイメージを理解し，自信をもって子どもに罹患に伴う情報を伝えるための看護システム構築の必要が示唆された．

　The aim of this study was to visualize the decision-making process of patients with newly diagnosed breast cancer, from cancer diagnosis to the time that they tell their elementary school children about their illness, and to discuss the state of nursing support when telling their children about their disease. A semi-structured interview was conducted with 14 patients with newly diagnosed breast cancer who had children in elementary school. A qualitative inductive analysis was performed using a modified grounded theory approach. The process of telling one's child is an experience that involves the patient's role and responsibilities as a mother, with the perception that they are the only mother that their children have, along with still being in shock themselves by the cancer diagnosis. This process is affected by factors that encourage or deter them from playing a maternal role. Maintaining the usual communication pattern by taking advantage of their experience in raising children allowed them to convey the information to their children. It is necessary to provide support, in order to identify early on the factors that would encourage them to play a maternal role and also to reinforce encouraging factors. In addition, the results suggested a need to establish a nursing care system to allow the patients to recognize the significance of being a mother, to understand their children's perception of cancer, and to tell their children about the disease with confidence.