婦人科がんサバイバーの就労に影響を及ぼす要因

Factors Affecting Employment of Gynecological Cancer Survivors

要旨

　本研究の目的は，婦人科がんサバイバーの就労継続上の困難，離職に影響を及ぼす要因，就労継続に影響を及ぼす要因を明らかにし，就労支援への示唆を得ることである．対象者は婦人科がん診断時に就労しており，調査時も就労している者20名，診断時に就労していたが，調査時に離職していた者6名を対象に半構造化面接を行い，Krippendorffの内容分析法を用いた．

　分析の結果，婦人科がんサバイバーの就労継続上の困難として，【治療の有害事象・後遺症による就労への支障】【セルフマネジメントに対する困難感】【見通しがつかないことへの不安】【自己イメージ・女性性の変化にともなう辛さ】【医療者・医療機関による就労支援の欠如】などが抽出された．離職に影響を及ぼす要因は，【職場における就労支援体制の欠如】【再発への懸念】【精神疾患の発症】などであった．一方，就労継続に影響を及ぼす要因は，【治療の有害事象・後遺症に関する情報探求】【治療の有害事象・後遺症に対するセルフマネジメント】【職場での病名・治療計画開示】などの対処に加え，【病状に対する理解・配慮が得られる就労環境】【高い就労意欲】【医療者による就労支援】などの支えであった．婦人科がんサバイバーの就労継続には，診断時から生活と治療の場で継続的に関わることができる看護師が主体となり，多職種連携による包括的な就労支援の重要性が示唆された．

　This study aimed to examine the challenges faced at work by survivors of gynecological cancer and the factors determining their decision to continue or end their employment. The participants were 26 survivors who had been working when they were initially diagnosed with gynecological cancer. Of these, 20 participants continued employment, while six had ended employment at the time of the study. Semi-structured interviews were conducted for data collection, and Krippendorff's content analysis method was used to analyze the data.

　The results suggested that the challenges for continued employment among survivors of gynecological cancer were “obstacles due to adverse events and the after-effects of treatment”, “difficulty of self-management”, “anxiety about uncertain prospects”, “psychological damage due to changes in self-image and femininity”, and “lack of employment status support by medical staff/institutions”. Furthermore, the factors determining end of employment were “lack of employee support in the workplace”, “anxiety about recurrence”, and “onset of mental illness”. Similarly, the factors determining continuity of employment were “searching for information on adverse events and the after-effects of treatment”, “self-management for adverse events and the after-effects of treatment”, and “disclosure of disease and treatment plans in the workplace”, in addition to the support received through “workplace environments with resources for medical conditions”, “high motivation to work”, and “employment status support by medical staff”. Comprehensive employment support through multi-professional collaboration is necessary for the continued employment of survivors of gynecological cancer. This collaboration should happen primarily with nurses due to their constant involvement in the patients' life and treatment from the initial diagnosis.