進行膵がん患者とその家族の療養体験の変容—看護師とのパートナーシップの過程における相互行為に焦点を当てて

Transforming Experiences of Advanced Pancreatic Cancer Patients and Their Families, Focusing on Interactions in the Process of Partnership with a Nurse

要旨

　本研究の目的は，進行膵がん患者・家族と看護師とのパートナーシップの過程における相互行為がどのように行われたのか，その特徴を明らかにし，それらによって成し遂げられる彼らの療養体験の変容を明らかにすることであった．

　デザインは事例研究で，大学病院で切除不能化学療法を受ける膵がん患者3名・その家族各1〜3名計5名を倫理委員会で承認された方法で募集した．拡張する意識としての健康理論（HEC）に基づく研究プロトコールを参考に，「患者・家族の対人関係を示した図（関係図）」を取り入れ，対話を中心とした「パートナーシップの過程」を事前に定めた．先に患者，次に家族を含めた対話を計6回（約2カ月）予定してパートナーシップの過程を辿った．

　データ収集・分析は，①全対話を録音・エスノメソドロジー的相互行為分析（EM），②看護師記載のジャーナルを基にその場面を振り返り，発話場面の感情，思考，気づきを分析，③全事例の共通点分析，を行った．

　その結果，①進行膵がん患者とその家族の療養体験は，5〜6回の対話を経て段階的に変容した．②療養生活における家族関係の変化が対話を重ねるごとに表出され，最終的にはその変化を受け止め，意味づけて家族としての療養生活の方向性を見出すという体験変容であった．③相互行為の特徴には，看護師の意図していた行為と対話参加者で創り出した行為があった．

　The purposes of this research are: to examine what were the specific characteristics of the interactions that occurred between advanced pancreatic cancer patients (and their families) and a researcher-nurse in the process of partnership, and to clarify how the experiences of the patients and their families were transformed by those interactions through which the partnership was achieved.

　Research design is case studies. Three patients with pancreatic cancer who underwent unresectable chemotherapy at a university hospital and their family members (1 to 3) were recruited by the method approved by the ethics committee. With reference to the research protocol based on “Health as Expanding Consciousness (HEC)” “a figure showing interpersonal relationships among family members” and “a partnership process” were created, focusing on dialogue. Following the partnership process, a total of 6 dialogical conversations were held, first with the patients, and then with their family members within two months.

　Data collection and analysis methods are: ①audio-recording, transcribing and analyzing all the dialogues, using ethnomethodological interaction analysis (EM); ②examining the recorded dialogues by reflecting on the emotions, thoughts and consciousness of the researcher-nurse, based on her journal, and ③analyzing and identifying common characteristics．

　The findings of this research are: ①advanced pancreatic cancer patients and their families experienced gradual transformations in the process of their dialogues with the researcher-nurse; ②the transformations that the patients experienced were that they increasingly came to express their felt transformations in their relations with their family, and ultimately to accept those transformations and their fates by trying to make meaningful sense of their experiences and thus to find their own directions of how to live their limited life as a family; ③while some actions were implemented deliberately by the nurse, other actions were created collaboratively by all the participants through the continuous dialogues.