終末期がん患者が認知する穏やかさ

Calmness Recognized by Cancer Patients at the End of Life

要　旨

　本研究の目的は，終末期がん患者がどのように穏やかさを捉え，穏やかさがどのような時にもたらされ，どのように穏やかさを維持しているかを明らかにし，終末期がん患者が認知する穏やかさを構成する要素を見出すことである．在宅緩和ケアを受けながら在宅療養，または緩和ケア病棟に入院中の終末期がん患者10名を研究参加者とし，半構造化面接法を用いて質的記述的研究を実施した．

　分析の結果，終末期がん患者の穏やかさを構成する要素として，『穏やかさを求める患者の状況』『穏やかさの基盤となる環境』『穏やかさと認知する体験』『穏やかさによる認知の変化』『穏やかさを揺さぶる状況』『穏やかさを保つ対処』の6つのカテゴリーが抽出された．

　終末期がん患者が穏やかさを認知する過程には，まず『穏やかさを求める患者の状況』があり，『穏やかさの基盤となる環境』の中で療養生活を送り，『穏やかさと認知する体験』をすることで，患者は穏やかさを認知していた．終末期がん患者は，日々のささやかな体験や緩和ケアを受け続けられる環境の中でニードが満たされることで穏やかさを認知できていたと考える．終末期に穏やかさを認知できる意義は，癒しになるだけでなく，『穏やかさによる認知の変化』によって，患者が自分の人生を肯定的に捉え直すことができ，苦痛を抱えながらも最期までその人らしい人生を生ききる可能性を高めることといえる．

　The aims of this study are to clarify how end-of-life cancer patients recognize their own calmness of mind, when they achieve it, how they maintain it. A qualitative descriptive study was conducted using semi-structured interviews. The participants were ten end-of-life cancer patients undergoing either palliative home care or in-hospital palliative care at palliative care units.

　As a result of analysis, we extracted the following six categories of calmness of mind in cancer end-of-life patients: “conditions of a patient seeking calmness of mind” “an environment that forms a foundation for calmness of mind,” “experiences that a patient recognizes to be calmness of mind,” “changes in recognition due to calmness of mind,” “conditions that shake calmness of mind,” and “coping to maintain calmness of mind.”

　The process through which a cancer patient recognizes calmness for the end of life includes “conditions of a patient seeking calmness of mind.” Patients feel calm in accepting their medical treatments when “an environment that forms a foundation for calmness of mind” and when they have “experiences that a patient recognizes to be calmness of mind.” It is considered that end-of-life cancer patients were able to recognize calmness of mind because they had a modest experience in daily life and their needs were met in an environment where they are able to continue to receive palliative care. The significance of being able to recognize calmness of mind at the end of life is not only in the healing effect, but also in positively reconsidering their life through “changes in recognition due to calmness of mind,” and raising the possibility that they can live their own life until the end despite experiencing pain.