緩和ケア病棟入院中の終末期がん患者の家族が在宅療養移行に向き合うプロセス

Transition Process of Family Members of Terminal Cancer Patients Moving from the Palliative Care Unit to Home Care

要旨

　本研究の目的は，緩和ケア病棟入院中の終末期がん患者の家族が，在宅療養移行に向き合うプロセスを明らかにし，緩和ケア病棟から在宅療養移行に向けた家族への看護支援の示唆を得ることである．

　緩和ケア病棟から在宅療養移行した終末期がん患者の遺族15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分析した．

　分析の結果，緩和ケア病棟入院中の終末期がん患者の家族は，入院時には〈自宅に連れて帰れるか分からない思い〉などさまざまな思いを抱えていたが，いずれの家族も患者の命の期限を意識しながら限られた時間の中で思いを巡らし，〈入院継続と在宅療養を天秤にかけ在宅療養に傾く思い〉を経て〈「今しかない時宜」と在宅療養移行を決意〉していた．その後在宅療養移行日までの短期間において，《医療者のリードによるめまぐるしい在宅療養準備への取り組み》をする中で《在宅でも医療介護専門職者による継続支援が得られる安心感》を得て〈在宅療養に対して少しずつ前向きになる〉ことを経ながら在宅療養移行に至っていた．在宅療養移行を意識した時から《終末期がん患者を在宅で看ることへの不安》を抱きながらも，根底にある〈患者本人の“家に帰りたい願望”を叶えたい思い〉を基盤に〈いつでもこの場所に戻ってこられる安心感〉に支えられながら在宅療養移行に進んでいた．

　以上を踏まえ，早期から不安に寄り添い，緩和ケア病棟への再入院の機会を保障し，医療者がリードする在宅療養移行準備の支援の必要性が示唆された．

　In this study, we sought to demonstrate the process that family members of terminally-ill cancer patients go through when patients transition from the Palliative Care Unit (PCU) to home care in order to gain insights into how nurses can support these family members.

　We conducted semi-structured interviews of 15 bereaved family members of terminal cancer patients transitioning from the PCU to home care, and analyzed their responses using the Modified Grounded Theory Approach (M-GTA).

　The results of our M-GTA analysis indicated that the family members experienced various feelings when the patient was admitted to the PCU, such as “not knowing whether they would be able to take them home again.” However, all respondents contemplated the transition amidst an impending time limit while realizing that the patient's life expectancy was limited, and developed a “strong inclination towards caring for the patient at home after comparing continued hospitalization with home care,” before eventually “deciding on the transition to home care based on a ‘now or never’ attitude.” In the brief period of transition from hospital to home care, family members had “peace of mind that continued support from healthcare professionals can be obtained even at home” amidst the “hectic efforts to prepare the home care environment led by medical professionals,” and made the transition while “gradually becoming more positive about home care.” Although family members admitted to feeling “anxious about caring for the terminal cancer patient at home” from the time they started considering the transition, their underlying “desire to grant the terminal cancer patient's wish to ‘return home’” formed the basis for proceeding with the transition while feeling a “sense of security about being able to return to this place at any time.”

　The study findings suggest that nurses should support preparations led by medical professionals to transition the terminally-ill cancer patient to home care by attempting to address the anxiety of family members early on, and by ensuring that the patient has the opportunity to be readmitted to the PCU if necessary.