外来の診断・治療方針決定時期に支援を開始したがん患者の不安の変化—がん患者指導管理料2におけるSTAS-Jの分析

Study on How Cancer Patients' Anxieties Shift along with Nursing Supports Starting During the Periods When Their Diagnoses and Therapeutic Plans Are Decided: Assessment on STAS-J Score in the “Cancer Patient Personal Counseling 2”

要　旨

　研究目的は，外来の診断・治療方針決定時期にがん患者指導管理料2を算定し支援を開始した患者の不安の変化を明らかにすることである．

　対象は診断・治療方針決定時期に支援を開始し，支援開始時・支援中・支援終了時にSTAS-J（以下SJ）を評価した患者である．後方視的に，①患者属性データ②患者と家族の状況③SJの点数④SJの点数変化の影響要因を診療記録から取得した．

　分析はSJの全項目を単純集計し，「患者の不安」の支援開始時と終了時の点数変化に対して，Wilcoxonの符号順位和検定およびFisherのexact検定（有意水準5％）を用い検定を行った．また，SJの変化を視覚化し影響要因を質的に分析した．

　対象は62名（男11：女51）で，平均年齢は55.9歳（31-76）だった．SJが低下したものは85.5％で，支援開始時と終了時の点数に有意差があった（p値＜0.001）．患者の属性間で有意差はなかった．SJの変化には4つのパターンが観察され，点数が1度も上がらずに下がるパターンが64.5％にみられ，治療の意思決定ができることや治療の開始が点数の低下に多くつながっていた．

　診断・治療方針決定時期は，病状や治療に関する不安が多く，家族の不安もみられるため，患者と家族の不安に対する支援と治療の意思決定支援を確実に行う必要性が明らかになった．また，不安の状況を見極め，早期に専門職種の支援を調整する必要性が示唆された．

　The purpose of this study is to clarify how cancer patients' anxieties shift along with nursing supports, which start being provided when the “Cancer Patient Personal Counseling 2” fees are determined and their diagnoses and therapeutic plans as outpatients are decided. The research objects are cancer patients who started receiving nursing supports when their diagnoses and therapeutic plans were decided. Their STAS-J scores were assessed when the supports started, while they were being provided, and when they ended. The patients' data, the status and the situation of them and their families, their STAS-J scores and the scores reflecting their “anxiety shifts” with the influencing factors were gained retrospectively from their medical records. Their overall STAS-J scores were tallied first, and the score changes showing their “anxiety shifts” from when their nursing supports started to when they ended were evaluated based on the Wilcoxon signed-rank test and the Fisher's exact test (with the significance level 5%). Also, the STAS-J score changes were visualized in a line chart for the quality assessment of the influencing factors. Sixty-two patients participated, including 11 men and 51 women with an average age of 55.9 (31-76). Lowering of the anxieties was identified among 85.5% of them, with significant differences in their STAS-J scores between when the nursing supports started and ended (p<0.001). There were no significant differences per attributions of the patients. Four types were identified among the changes, including the lowering-only type identified in 64.5%, which confirmed the assumption that being able to decide on their own treatments and starting taking them could be the lowering factors. During the periods when diagnoses and therapeutic plans were decided, many patients and families showed anxieties. It proved the needs for supporting them especially at the time of their decision-making, for identifying their anxieties, and for arranging early inter-professional supports.