化学放射線療法を受ける頭頸部がん患者が捉える口腔粘膜炎に伴う疼痛への看護支援

Nursing Support for Oral Mucositis Perceived by Patients with Head and Neck Cancer undergoing Chemoradiation Therapy

要旨

　本研究の目的は，化学放射線療法を受ける頭頸部がん患者が，口腔粘膜炎の疼痛に対する看護支援に対して，どのように捉えているのかを明らかにすることである．化学放射線療法を受ける頭頸部がん患者5名に，30Gy照射後と治療終了後に半構成的面接を行い，疼痛緩和への看護支援をどのように捉えていたかについて，Krippendorffの内容分析を用いて質的帰納的に分析を行った．

　1回目の面接では，患者は【増強する疼痛へ備えるための事前説明】と【疼痛を増強させないための看護師主導の疼痛緩和】を受け，【患者として実施すべき疼痛管理への理解】をもち，疼痛管理を継続していたが【看護支援を受けても難しい疼痛緩和】と捉えていた．2回目の面接では治療後半の時期について語ってもらったところ，引き続き【強い疼痛に対する看護師主導の疼痛緩和】が提供され，【目的をもち患者ができる範囲でケアを行うという認識】をもち疼痛管理を継続していたが，【看護支援を受けても難しい疼痛緩和】に直面し，【個別的な看護支援の不足】を捉えていた．

　治療開始時から継続して看護師による口腔内や疼痛の観察が行われ，疼痛の増強に伴い鎮痛剤の調整が行われていたことから，対象者らは看護師主導の疼痛緩和が提供されていると捉えていた．これらは，麻薬性鎮痛剤の導入には効果的であったが，治療後半から増強する疼痛への緩和は難しい状況であった．そのため，看護師には患者の疼痛体験に寄り添い，より個別的で具体的な看護支援が求められていた．

　The purpose of this study is to determine how patients receiving chemoradiation to treat head and neck cancer perceive nursing support for pain relief related to oral mucositis. A semi-structured interview was conducted with five patients with head and neck cancer after 30 Gy irradiation and at the end of chemoradiation therapy. Their perception of nursing support for pain relief was qualitatively and inductively analyzed using Krippendorff's content analysis.

　In the first interview, subjects were provided with “briefing beforehand to prepare for pain increase” and “pain relief led by nurses intended to not increase pain”. Subjects were continuing pain control by themselves with an “understanding of pain management to be performed as a patient”, while they recognized pain associated with oral mucositis as “pain difficult to control even when supported by nurses”. Subjects were asked to talk about the latter treatment period in the second interview. During that period, the “nurse led pain relief for strong pain” was still ongoing and pain control was also being continued by patients with a “recognition that care will be carried out to the extent that patients can handle”. However, having been faced with “pain difficult to control even when supported by nurses”, subjects recognized a “lack of individualized nursing support”.

　Subjects were aware that the pain relief being provided was nurse-driven as a consequence of nursing that had been continued by nurses since the beginning of treatment, namely, observational assessment of the oral cavity and pain, and analgesic adjustment to address pain increase. These were effective for introducing narcotic analgesics, although it was difficult for nurses to relieve severe pain from the latter treatment period. Therefore, nurses were expected to sympathize with the patient's experience of pain and offer more individualized, specific support in nursing.