仕事や子どもの世話役割を担う家族員が自宅で終末期がん療養者を看取るプロセス

The Process by Which Family Members Care for End-of-Life Cancer Patients at Home While Working or Taking Care of Children

要　旨

　目的：国民の多くはがんで余命が限られた時に自宅で過ごしたいと望むが，実際の自宅死亡率は1割程度に過ぎない．その要因の一つとして，仕事や子どもの世話と介護の両立による介護者の負担がある．本研究の目的は，主介護者が仕事や子どもの世話と介護の役割を両立しながら，終末期がん療養者を自宅で看取るまでのプロセスを明らかにし，看護支援を検討することである．

　方法：仕事や子どもの世話役割を担いながらがん療養者を自宅で看取った主介護者で，研究の同意が得られた15名を対象に半構造的面接を行った．分析焦点者に照らし3名を除外し12名を分析対象とした．得られたデータは修正版グラウンデッド・セオリー・アプローチを用い，質的記述的に分析した．

　結果：本プロセスは，対象者が自宅看取りの決意をし，今までと変わらない暮らしの中での介護を行うところから始まる．療養者の状態悪化を契機に自宅看取りの決意が揺らぐものの，自宅で過ごす療養者の姿や思いから自宅で看取ることを再決意し，自宅での看取りに至っていた．

　考察：看護支援として，状態が安定し介護の必要性が低い時期には，病状に合わせた病状予測の説明や，状態悪化後の仕事や子どもの世話の調整が必要である．また，状態悪化後は両立しているが故の苦悩と奮起する心の鬩ぎ合いに対し，ありのままの心の状態を受け入れる姿勢を示すと共に，根本にあるニーズを見極める視点が必要とされる．

　Purpose: Many people with a cancer-induced limited life expectancy choose to spend the remainder of their lives at home. Despite this, home mortality only accounts for about 10% of deaths among cancer patients. One factor is the burden on caregivers who must balance childcare and work. Thus, this study seeks to clarify the process by which primary caregivers take care of end-of-life cancer patients at home while also balancing work or childcare, as well as to examine nursing support.

　Methods: Semi-structured interviews were conducted with 15 consenting primary caregivers who took care of cancer patients at home while working or caring for children. Given the focus of the analysis, three people were excluded; the remaining 12 participants were eligible for data collection. The participants' data were analyzed qualitatively and descriptively using a modified grounded theory approach.

　Results: The process began when the subject decided to provide end-of-life care at home and nurse the patient while maintaining the same lifestyle as before. Although this decision faltered when the patient's condition deteriorated, the caregiver reaffirmed their decision and continued to care for the patient at home because of the appearance and the thoughts of the patient.

　Discussion: In terms of nursing support, when the patient's condition is stable (with little need for nursing care), it is necessary to prepare via an explanation of the prognosis and the condition of the patient, or by adjusting work or childcare after deterioration of the patient's condition. Furthermore, in response to the spiritual conflict—between distress due to balancing work/childcare and nursing care and a renewed commitment following the deterioration of the patient's condition—there is a need to display an attitude that is accepting of the patient's state of mind and to identify their underlying needs.