食道切除再建術後がん患者が受けた退院後の食の再獲得を支える他者からの援助

The Assistance Provided by Others to Support the Recovery of Eating Habits for Cancer Patients Discharged From Hospital Following Esophageal Reconstructive Surgery

要　旨

　目的：食道切除再建術後がん患者が受けた退院後の食の再獲得を支える他者からの援助を明らかにする．

　方法：研究参加者：食道切除再建術を受け，退院後2カ月から1年程度の術後補助療法を受けていない外来通院がん患者7名．調査方法：半構成的質問紙による面接法と記録調査法．分析方法：逐語録から退院後の食の再獲得を支える他者からの援助について語られている部分を抽出し，意味内容の類似したものを集めてカテゴリー化した．

　結果：食道切除再建術後がん患者が受けた退院後の食の再獲得を支える他者からの援助は，《食べる気持ちを整える援助》《楽しく食事ができる援助》《自分に合わせて自由に食事ができるよう配慮してくれる援助》《食に伴う苦痛症状への対処を支える援助》《効率的な食事摂取を促す援助》《食習慣の変更を促す援助》《新たな気づきを与える援助》の7つの上位カテゴリーが抽出された．

　考察：食道切除再建術後がん患者が受けた退院後の食の再獲得を支える他者からの援助は，食への気持ちを向上させる援助，食の楽しみや自律性を保つ援助，食に伴う苦痛を軽減する援助，新たな食習慣を得る援助，自己認識の拡大を促す援助であった．食道切除再建術後がん患者の新たな食の確立のためには，食べる前の患者の気持ちに配慮した情緒的支援，患者の対処に対する他者への教育的支援，患者自身が客観的に自己を捉えることを促す援助などの必要性が示唆された．

　The objective of this study was to learn about the assistance provided by others to support the recovery of eating habits for cancer patients discharged from hospital following esophageal reconstructive surgery.

　Seven outpatients who did not undergo postoperative adjuvant therapy in the period from 2 months to about 1 year after undergoing esophageal reconstructive surgery participated in the study. The study method consisted of reviews of patient records and interviews using a semi-structured questionnaire. Analysis consisted of extracting the parts of the transcripts pertaining to the assistance that patients received from others to help them regain their eating habits after discharge, and categorizing semantically similar content.

　The following seven top-level categories of help were extracted: ①in regaining appetite, ②in making eating a pleasant experience, ③in enabling the patient to eat freely according to his own needs, ④in promoting ways to deal with pain that accompanies eating, ⑤in promoting efficient food intake, ⑥in promoting changes in eating habits, and ⑦in obtaining new awareness.

　Assistance from others in the recovery of eating habits by cancer patients who have been discharged from the hospital following esophageal reconstructive surgery included helping the patient feel better about eating, helping to make eating a pleasant and autonomous experience for the patient, helping to reduce the amount of pain involved in eating, helping the patient obtain new eating habits, and helping to increase the patient's self-awareness. The study suggested that to establish new eating habits for patients who have undergone esophageal reconstructive surgery, they must be provided with emotional support with consideration for their feelings about eating before they eat, that educational support with regards to how to deal with the patient must be provided to those supporting them, and that the patients need help in being encouraged to objectively be aware of their sense of self on their own.