同種造血幹細胞移植を受けたがん患者の退院後の転倒予防行動と影響を与える諸条件

Fall-Prevention Behaviors and Factors Influencing Them Post Discharge: Study on Cancer Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

要　旨

　目的：同種造血幹細胞移植（以下，移植）を受けたがん患者の退院後の転倒予防行動や，転倒予防行動に影響を与える諸条件を明らかにすることである．

　方法：造血器腫瘍に対して移植を行った患者5名を対象に半構造化面接を行い，保健行動シーソーモデルに基づき質的記述的に分析した．

　結果：移植患者の転倒予防行動を促進する動機として【治療後の身体脆弱性の自覚】【転倒に対する危機感の自覚】【参考にできる過去の経験がある】【副次的効果への期待】【社会的役割における目標がある】などの7カテゴリーが抽出された．一方で，転倒予防行動を阻害する動機として，【治療による影響でできない】【転倒予防行動への関心が低い】【社会的支援の不足】などの5カテゴリーが抽出された．対象者によって，意思決定における主体性や他者からの支援の受け入れが異なっていた．社会的支援として，医療者，家族，友人・知人からの支援や公的制度の利用を認めた．これらの影響を受けて，移植患者が退院後に行っていた転倒予防行動は，【症状への対処】【移動動作時の注意】【日常生活の調整】【身体機能回復のための運動】であった．

　結論：看護師は，患者が身体脆弱性を感じる場面に出合った際にはタイミングを逃さず支援を行い，転倒予防行動の効果を伝えることや，過去の経験を参考にしながら，患者のもつ目標に沿った具体的方法を検討し，継続的に支援する重要性が示唆された．

　Purpose: This study aims to clarify fall-prevention behaviors and the conditions that influence such behaviors among cancer patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) after their discharge from the hospital.

　Methods: Semi-structured interviews were conducted with five patients who underwent allo-HSCT for hematologic malignancy, and a qualitative descriptive analysis was conducted based on the seesaw model for health behavior.

　Results: Patients undergoing allo-HSCT cited several motives for following fall-prevention behavior, which could be classified into seven categories: awareness of their physical vulnerability after treatment, wary of the dangers of falling, reference to past experience of falling, awareness about the secondary effects of falling, awareness of their responsibilities in society, and two other categories. On the contrary, not following or being unable to follow fall-prevention behaviors was classified into five categories: inability to do so due to the effects of treatment, lack of interest in fall-prevention behaviors, lack of social support, and two other categories. The subjects differed in their independence in decision-making and acceptance of support from others. As social support, support from medical personnel, family, friends, and acquaintances, and use of public systems were recognized. Influenced by these factors, fall-prevention actions to be taken by patients after discharge from the hospital were classified into four categories: coping with symptoms, being careful when moving, adjusting to daily life activities, and exercising to restore physical function.

　Conclusions: This study suggests the importance of nurses providing timely support to patients, when they encounter situations in which patients feel vulnerable, by communicating to them the benefits of following fall-prevention behaviors, referring to their past experiences, proposing specific methods in accordance with patients' goals, and offering constant support toward fall prevention.