初発乳がん患者がとらえる学童期の子どもへの告知にともなう体験

Primary Breast Cancer Patients' Experiences Related to Explanations of the Disease to Their School-age Children

要旨

　目的：初発乳がん患者がとらえる学童期の子どもへの告知にともなう体験を明らかにし，母親の子どもへの告知に関する看護実践の示唆を得る．

　方法：初期治療中の母親13名に半構造化面接を行いKrippendorffの内容分析を用いて分析した．

　結果：がんの母親の子どもへの告知にともなう体験は【母親として告知と向き合い続ける苦悩】【告知における子どもの理解力と精神的負担の熟慮】【告知を通した子どもの精神的成長と母子関係発展の実感】など，7大カテゴリとなった．

　考察：母親は確定診断時に限らず，自身のがんと子どもへの告知に対する二重の苦悩を繰り返すとともに，学童期のことばの概念を視点にがんに対する理解度を判断し伝達方法・内容を熟慮していた．告知後，母親は子どもとの相互行為を通し，精神的動揺の一方，心身ともに母親を支えようとする子どもの反応をとらえていた．告知は，子どもの精神的成長とともに母子の信頼関係に影響をもたらすものと考える．

　このように，告知を通し母子ともにがん治療を歩むなかで，療養の支えとなる子どもの精神的成長とともに母子関係の発展を実感し，母親の闘病を支える原動力となることが示唆された．がんの母親の子どもへの告知における看護実践には，初回受診時より母子の存在を意識し，母子相互行為のなかで繰り返される告知への苦悩を具体的にとらえた継続的支援が必要である．また子どもへの告知に向けて，ことばの概念化を視点に，伝え方の情報提供と相談支援が重要である．

　Objective: We aimed to clarify primary breast cancer patients' experiences in explaining the disease to their school-age children to improve the quality of nursing practice in this area.

　Methods: Semi-structured interviews were conducted with 13 mothers with primary breast cancer receiving initial treatment, and the obtained data were analyzed using Krippendorff's content analysis.

　Results: Primary breast cancer patients' experiences related to explanations of the disease to their children were summarized into 7 categories, including 【experiencing distress due to the necessity of continuously providing such explanations as a mother】, 【considering the child's ability to understand and psychological burden】, and 【realizing the child's mental growth and the development of a favorable mother-child relationship through explanations】.

　Discussion: While repeatedly facing distress due to the development of cancer and burden of explaining the disease to their children, the patients judged the children's levels of understanding from the perspective of language conceptualization during the elementary school period and carefully examined how and what to explain to them. After explanation, the patients simultaneously perceived the children's emotional upset, which was expressed through mother-child interactions, and desire to mentally and physically support their mothers, demonstrating that explanation of the disease leads to both the mental growth of children and the development of trust-based mother-child relationships.

　This suggested that by explaining the disease, patients realize the mental growth of their children, who begin to cope with cancer treatment together with them and become their driving force for cancer treatment after explanations, further promoting a favorable mother-child relationship. Based on this study, nursing practice for mothers with cancer should focus on mother-child relationships from initial consultations and continuously support patients to practically reduce the distress they repeatedly face due to the burden of explaining the disease to their children. Information provision, consultation, and support for appropriate explanations from the perspective of language conceptualization may also be important.