初発乳がん患者の不確かさの認知と適応，QOLとの関係—共分散構造分析による検討

The Relationships among Perceived Uncertainty, Adaptation and QOL of Newly Diagnosed Breast Cancer Patients: A Covariance Structure Analysis

要　旨

　目的：初発乳がん患者が認知する不確かさと適応，QOLとの関係を共分散構造分析により明らかにすることを目的とした．

　方法：初発乳がん患者147名を対象に質問紙調査を実施した．不確かさは「療養の場を問わず使用できる病気の不確かさ尺度：UUIS」，適応はPOMS-TMD，QOLはQLICVで測定した．Mishelの不確かさ認知モデルを参考に，先行要因の影響を受けて認知された不確かさが，適応とQOLに影響を及ぼすことを示すモデルを作成し，共分散構造分析で検討した．

　結果：対象者は全員が女性，平均年齢は52.6（SD = 9.9）歳であった．選択されたモデルは，先行要因（痛み，医師･看護師に相談の程度，教育年数）の影響を受けて認知された不確かさが，適応とQOLに影響を及ぼすとともに，不確かさは適応を介してQOLに影響を及ぼすことを示していた（GFI = .967，AGFI = .924，CFI = .968，RMSEA = .066）．

　看護実践への示唆：乳がんは再発，転移のリスクを否定できない疾患であることから，患者の不確かさは生涯続くと言われている．選択されたモデルは，不確かさが適応を妨げ，QOLを低下させるが，看護師の支援は不確かさを軽減させることを示している．

　乳がん患者が不確かさを管理し，QOLを維持するうえで，看護師の継続的支援が不可欠である．

　Objective: This study aims to clarify the relationships among perceived uncertainty, adaptation and QOL of newly diagnosed breast cancer patients using covariance structure analysis.

　Methods: A questionnaire survey was conducted among 147 breast cancer patients. Patients' perceived uncertainty was assessed using the Universal Uncertainty in Illness Scale (UUIS), and their adaptation and QOL were evaluated using POMS-TMD and QLI-CV respectively. A model was made with reference to Mishel's model of perceived uncertainty in illness.

　In this model, the uncertainty perceived by a patient under the influence of antecedent factors affects her adaptation and QOL. The model was analyzed using covariance structure analysis.

　Results: All respondents were female, and their average age was 52.6 years (SD=9.9). The model selected in this study indicated that uncertainty affected by certain antecedent factors (e.g., pain, number of years of schooling, availability of consultation with a doctor or a nurse) directly influenced adaptation and QOL. In addition, uncertainty affected by antecedent factors affected QOL via adaptation. (GFI= .967, AGFI= .924, CFI= .968, RMSEA= .066).

　Implications for practice: Discussion: Because the risks of recurrence and metastasis cannot be eliminated for breast cancer patients, their uncertainty is said to persist for life. The model showed that patients' perceived uncertainty prevented them from adapting to their circumstances, resulting in a decline in QOL.

　It was also suggested that nurses' support helped to reduce perceived uncertainty. Continual support by nurses is essential for breast cancer patients to control their perceived uncertainty and to maintain their QOL.