繰り返し化学療法を受ける婦人科がん患者の配偶者の対処

Spouses of Patients with Gynecologic Cancer Who Repeatedly Receive Chemotherapy: Their Coping Strategies

要　旨

　本研究の目的は，繰り返し化学療法を受ける婦人科がん患者の配偶者が体験する対処のプロセスを明らかにすることである．2クール以上の化学療法を受けている子宮がん，卵巣がん患者の配偶者10名を対象に半構成的面接を行い，得られたデータを修正版グラウンデッド・セオリー・アプローチの手法を用いて分析した．

　その結果，24の概念が生成され，6つのカテゴリーに集約された．配偶者は，妻の気持ちに添いたくても異性である自分には難しく，【妻の苦しみを前に自分の気持ちを抑え込む】ようにしながら，妻を支え続けていた．ファーストラインの化学療法時は【先を見通す術を探す】ことをしながら，【自分ひとりで妻を守る】ように尽力するが，次第に【共倒れしない術を模索する】ようになっていた．セカンドラインの化学療法時には【妻の治療継続を支える】一方で，治療が不可能になる日が近いことも認識し，【治療の限界を意識しながら夫婦で生きていく】ことが明らかになった．

　看護師は，治療の時期や男性ゆえに生じる困難を理解し，ともに解決する姿勢を示すとともに，配偶者の努力を承認するといった情緒的支援の重要性が示唆された．

　This study aims to elucidate the challenges facing spouses of patients with gynecologic cancer who repeatedly receive chemotherapy, as well as their coping process. We conducted semi-structured interviews with 10 spouses of patients with uterine or ovarian cancer who received 2 or more courses of chemotherapy.

　Through an analysis employing the Modified Grounded Theory Approach, we identified 24 concepts classified under 6 categories as below. Although spouses were willing to offer emotional support to their wives, this proved challenging due to gender differences. Thus, spouses “repressed their feelings as they witnessed their wives suffer” while they continued supporting their wives. During first-line chemotherapy, spouses “sought ways to anticipate the future” and strived to “care for their wives on their own”. Eventually, however, they began “seeking ways to avoid mutual exhaustion”. During second-line chemotherapy, although spouses “supported their wives' continuation of treatment”, they also acknowledged that the treatment may become ineffective in the near future and “lived on as couple while being conscious of the limits of therapy”. These results illustrate the need for nurses to understand the difficulties that arise because of treatment timing and gender differences, as well as to demonstrate the willingness to work together for a solution. In addition, these results highlight the importance of emotional support such as affirming the spouse's efforts.