生殖年齢にある女性乳がん患者の妊孕性温存に関する意思決定過程

Decision Making Process on Fertility Preservation in Female Breast Cancer Patients of Reproductive Age

要　旨

　本研究の目的は，生殖年齢にある女性乳がん患者の妊孕性温存に関する意思決定過程を明らかにし，必要な看護実践への示唆を得ることである．

　がん罹患歴のない初発女性乳がん患者で，薬物療法開始前の妊孕性温存に関する意思決定時に生殖年齢にあり，最初の治療として手術療法を受け，薬物療法開始後は6カ月以上10年以下にあり，面接時に転移や再発がない外来通院中の患者30名に半構造化面接を実施し，修正版グラウンデッド・セオリー・アプローチの手法を用いて分析した．その結果，生殖年齢にある女性乳がん患者の妊孕性温存に関する意思決定過程は，『まだ決めなくてよかった 産む・産まないのいずれかを期日までに選びとる』『私の人生の地図を描き変え始める』の2つをコアカテゴリとする過程として説明でき，【他者の力を借りる】が全過程の進行を支えていた．また，『まだ決めなくてよかった 産む･産まないのいずれかを期日までに選びとる』過程は，4パターンの過程から成っていた．

　意思決定支援として，妊孕性温存に関して提供された情報の受け止め方を把握し，それに続く温存する・しないことを選択決定するまでの過程のパターンを予測し，その過程に内包される体験に応じた個別的支援，迷い・混乱などの多様な感情の表出を促す支援，医師と連携した診断時の情報提供，温存しない場合における継続的な支援，挙児希望へと気持ちが変化した時の支援が示唆された.

　The purpose of this study was to clarify the process through which female breast cancer patients of reproductive age make decisions regarding fertility preservation, and to obtain suggestions for nursing practice.

　Semi-structured interviews were conducted with 30 female outpatients with primary breast cancer who had no previous history of cancer, were of reproductive age at the time of decision-making, underwent surgery as their first treatment, had been on cancer-drug treatment for between 6 months and 10 years (if they have started it), and had no metastasis or recurrence at the time of the interviews. A modified grounded theory approach was used for the analysis. Decision-making was thus broken down into a process with two core categories: “Choose the option of give birth or not that you did not need to decide yet by a time limit” and “I am beginning to redraw the map of my life”. The progress of the whole process was supported by “getting help from others”. In addition, the process of “Choose the option of give birth or not that you did not need to decide yet by a time limit” consisted of four patterns.

　The following approaches were suggested to support patient decision-making: understanding how patients perceived the information provided about fertility preservation; predicting the pattern of the process leading up to the decision on whether or not to preserve fertility; providing individualized support according to patients' experiences in that process; encouraging patients to express their various emotions such as ambivalence and confusion; providing information at the time of diagnosis in collaboration with physicians; providing continuous support when fertility is not preserved; and providing support when patients change their mind and wish to have a child.