子どもを持つ乳がん患者が術後外来化学療法を受ける際の母親としての困難とその対処

Difficulties and Related Coping Skills for Mothers with Breast Cancer Who are Undergoing Adjuvant Chemotherapy

要　旨

　本研究の目的は，18歳以下の子どもを持つ乳がん患者が，術後外来化学療法を受ける際の母親としての困難とその対処を明らかにすることである．子どもを持つ乳がん患者で外来化学療法を受けた14名に，半構造化面接にて母親としての困難とその対処についてデータを収集し，質的帰納的に分析を行った．

　その結果，母親としての困難は【子どもの発達段階に応じた成長発達への関わり】をもつことや，【外出が制限されることによる子どもの成長の見守り】【形成してきた母親像の維持】で，子どもに関しては【子どもとの相互作用による信頼関係の維持】【子どもの生活のサポート】の5カテゴリーが得られた．母親としての困難への対処として，化学療法による副作用が出現する状況で【子どもの生活に影響を与えないための副作用症状に合わせたセルフマネジメント】【子どもの生活に影響を与えないために代替可能なことへのサポート調整】を行い，子どもに対しては母親として【子どもの思いを察して関わる】こと，また【代替不可能なことは無理してでも行う】ことなどであった．子どもを持つ母親の困難は，副作用症状によって生活のサポート・発達段階に応じた関わりや見守りが困難になり，セルフマネジメントとサポート調整を駆使した対処をしていた．また，代替不可能なことは無理をして対処しており，少しでも無理をすることがないように看護支援を検討してくことが重要である．

　This study aimed to clarify difficulties of mothers who are breast cancer patients and are undergoing outpatient chemotherapy, and skills for coping with those difficulties. We conducted semi-structured interviews with 14 mothers with breast cancer who were receiving such chemotherapy. We then examined the results using qualitative content analysis techniques. We recognized five categories of these women's difficulties as mothers: commitment to growth and development and taking care of their children in accordance with the children's developmental stage, watching over their children's growth despite personally having limited ability to leave the home, maintaining the image of being a mother, maintaining relationships with their children, and supporting their children's lives. In the mothers' dealing with their difficulties, six identified categories were: practicing self-management to deal with side effects, adjusting one's role by using surrounding support to give their children continuity, involvement in anticipating their children's thinking, encouraging self-reliance in their children, identifying what one is not capable of, and entrusting things to people around them.

　The present study's findings detail the difficulties of a mother's role with relation to the chemotherapy side effects. These women attempted to cope with their situations by using alternative methods such as self-management of side effects and adjusting how they provided support, to the extent possible. It is important to understand each mother's difficulties based on self-management practices and create a reassuring environment that provides adequate nursing support.