外来がん薬物療法を継続する終末期がん患者の家族の体験

Experiences of the Families of Outpatients with End-stage Cancer who Received Anticancer Medication Therapy

要　旨

　本研究の目的は，外来でがん薬物療法を継続する終末期がん患者の家族の体験を明らかにし，がん患者とともに生活する家族を支援するために必要な看護への示唆を得ることである．対象者8名に，半構造化面接調査を行い，得られたデータを質的帰納的に分析した．その結果，外来でがん薬物療法を継続する終末期がん患者の家族の体験として，1）がん薬物療法の効果に懸ける強い思い，2）終末期がん患者の心身に注意を払いながら，患者の病状の改善を目指す家族の取り組み，3）終末期がん患者の療養選択の不確かさとがんの進行の懸念，4）終末期がん患者の療養を支えるための生活の調整と負担，5）延命への期待と近い将来患者に死が訪れる現実との葛藤，6）終末期がん患者とその家族が互いに支え合いながら得た経験の肯定の6つのテーマが明示された．結果より，外来がん薬物療法を継続する終末期がん患者の家族に対するおもな看護支援として，1．終末期がん患者にがん薬物療法を継続しながら少しでも長く生き続けて欲しい家族の思いを理解し，限りある時間のなかで家族ができることを患者に尽くしたと思えるように促す，2．外来でがん薬物療法中の家族の待ち時間を有効利用し，家族が容易に医療者に相談できる環境をつくる，3．家族の心身の健康の維持を促す，4．がん薬物療法を継続しながらも患者の死が現実味を帯びて葛藤する家族の思いを汲み取り心持ちを支えることが重要 であると考えた．

　We aimed to investigate the experiences of family members of outpatients with end-stage cancer who are receiving anticancer medication therapy. In addition, we aimed to obtain suggestions for improving nursing support, which is necessary to assist family members of patients with cancer.

　Eight family members of patients who underwent outpatient medication therapy participated in semi-structured interviews. A qualitative content analysis approach was used to analyze the data.

　Based on the interviews, six categories of family experiences were recognized, which are as follows: (1) having great expectations of the efficacy of anticancer medication therapy, (2) prioritizing the patient's mental and physical well-being to improve the patient's condition, (3) having concerns regarding the progression of cancer and uncertainty about the choice of treatment and location, (4) adjusting their lifestyle to support the patient, (5) having conflicts between expectations of a prolonged life and the reality of death occurring in the near future, and (6) gaining positive thoughts and experiences during times when the patient and their family supported each other.

　Four types of nursing support were identified, which are as follows: (1) understanding the emotional state of families who want the outpatient receiving anticancer medication therapy to live for as long as possible and encouraging the families to believe they have done what they could despite the time constraints, (2) effectively utilizing the waiting time of families during outpatient medication therapy and creating an environment where families can conveniently consult the medical personnel, (3) maintaining the mental and physical well-being of the family, and (4) ensuring the patient's view of death is realistic and encouraging the family members' desire to provide emotional support while continuing anticancer medication therapy.