緩和ケア病棟入院中の終末期がん患者と家族員の連帯感—家族員に焦点を当てて

Feeling of Solidarity between Terminal Cancer Patients and Their Family Members in Palliative Care Units

要　旨

　本研究の目的は，緩和ケア病棟入院中の終末期にあるがん患者と家族員の連帯感はどのようなものであるかを明らかにすることである．

　２県内の緩和ケア病棟に入院中の終末期がん患者をおもに介護する家族員10名に半構成的面接法を用いて，データ収集を行い，質的・帰納的に分析を行った．結果より，緩和ケア病棟入院中の終末期がん患者と家族員の連帯感の要素として，【揺るぎない信頼】【内からこみ上げる志気】【拭い去れない自責の念】【ふたりで抱く最期の希望】の４つが明らかとなった．

　家族員が認識する終末期がん患者と家族員の連帯感は，互いをかけがえのない大切な存在として想い合うふたりの間にある【揺るぎない信頼】を基盤として，家族員が介護を行う中で抱く【拭い去れない自責の念】を【内からこみ上げる志気】に向けることによって，自身を鼓舞し，【ふたりで抱く最期の希望】に向かってまとまろうとすることで高まる情緒的な結びつきの感情であると考えられた．連帯感に働きかける支援として，ふたりで過ごす時間や場を提供することやふたりが語り合う機会をつくること，ふたりが互いのために行っている援助行動を継続できるように支援し，それに対して肯定的なフィードバックをすること，家族員の自責の念を強めないようにすること，そして，ふたりの希望の実現を助けることの重要性が示唆された．

　The purpose of the present study is to elucidate the feeling of solidarity between patients with terminal phase cancer and their family members as perceived by family members. Data was collected using semi-structured interviews of 10 family members who were the primary care givers of hospitalized patients with terminal cancer in the palliative care wards of two prefectures. The data obtained was qualitatively analyzed by an inductive approach. As a result, we found four elements regarding a sense of solidarity between patients and their family members, as perceived by the family members. The four elements included: ‘unwavering trust’, ‘a rise in determination’, ‘undispellable remorse’, and ‘the dying wishes held by a patient and the family member’.

　We describe the feeling of solidarity between patients and their family members as a basis of ‘unwavering trust’ that arises from the recognition of an irreplaceable band with each other. Though the family members feel ‘undispellable remorse’, they encourage themselves by changing their remorse to ‘a rise in determination’. Moreover they build up stronger bonds by trying to realize ‘the dying wishes held by a patient and the family member’. For nursing support, the following suggestions were obtained, namely, to encourage them to spend time and talk with the patients and their families, to support patients and family members in maintaining their aid actions for each other and make sure they are given positive feedback, to alleviate the remorse of the family members, and to realize the wishes of the a patient and the family member.