就労世代のがん患者のがん罹患後から離職に至るまでの体験の過程

Process Experience by Cancer Patients Who are Unemployed after Cancer Diagnosis

要旨

　研究の目的は，がん罹患後に離職した就労世代のがん患者のがん罹患後から離職に至るまでの体験の過程を明らかにし，就労世代のがん患者への看護支援を検討することである．がん罹患後に離職した患者8名を対象に，記録調査，非参与観察，面接調査よりデータ収集を行い，Sandelowski Mによる質的記述的分析の手法を参考に分析した．

　その結果，就労世代のがん患者の体験は，【がん治療によるつらい身体症状をかかえながらでも働き続けたい】【がん治療による身体の変化に直面し，対処できずに苦悩する】【仕事について相談したいが相談できる相手を見出せない】【離職後も治療を続けながら生活していけるか不安に思う】【がん罹患や身体症状が仕事に支障をきたし，辞めざるをえない状況に立たされる】【周囲の人の発言から仕事の進退について決断する】など10のカテゴリーに集約された．また，カテゴリー間の関係性を時系列で示すと，がん罹患から離職に至るまでには，〔がん治療と仕事の両立を願い葛藤する時期〕〔がん治療と仕事の両立が困難な現実に直面する時期〕〔離職を決断する時期〕という3つの体験の過程をたどることが明らかとなった．

　就労世代のがん患者への看護支援は，就労に関する意思決定を支えること，就業継続に向けて苦痛症状を緩和すること，患者の置かれた状況に合わせた情報提供，経済的問題に関する専門家との連携が必要であると考えた．

　This study aimed to clarify the process experience by cancer patients who are unemployed after a cancer diagnosis, and to investigate the appropriate nursing support for them. Data were collected by assessing medical records, nonparticipant observation, and face-to-face interviews with ten working-age cancer patients who were unemployed after their diagnosis; qualitative and descriptive analyses were carried out by Sandelowski's method.

　The result was that the types of experience were categorized as follows: “hoping to continue working despite the physical symptoms due to cancer treatment”; “facing cancer treatment's physical changes, and am distressed that I cannot deal with them”; “would like to consult about work, but cannot find anyone with whom to do that”; “worried about the economic situation after unemployment”; and “decided whether to continue working based on the opinion of family and colleagues.” It was clear that if the relationships between these categories show a temporal sequence, the following three processes occur from cancer diagnosis until unemployment: (i) phase with cancer treatment and working; (ii) phase with difficulties combining cancer treatment and work; and (iii) phase of deciding to quit work.

　Nursing support for working-age cancer patients must include the following: (i) supporting patients' own decision-making about work to enable them to make their own decisions; (ii) supporting to alleviate distress; (iii) providing information appropriate to patients' own situations and statuses; and (iv) liaison with specialists about financial issues.