経口がん薬物療法を受ける高齢がん患者の服薬自己管理に対する訪問看護師のケア：質的研究

Home-visit nursing care for the self-administration of medication of older adult cancer patients receiving oral chemotherapy: A qualitative study

要旨

　目的：在宅で経口がん薬物療法を受ける高齢がん患者に対して，訪問看護師がどのように服薬自己管理に関するケアを行っているかを明らかにする．

　方法：在宅で経口がん薬物療法を受ける高齢がん患者への看護の経験がある訪問看護師14名を対象に，半構造化面接とテーマ分析による質的記述的研究を行った．

　結果：在宅で経口がん薬物療法を受ける高齢がん患者に対するケアとして【二義的な目的としての服薬支援】【患者にとっての治療の意味を探求】【限界のなかでの最善】という3つのテーマが導かれた．

　結論：訪問看護師は，高齢がん患者との関係構築を最優先し，患者の自律の尊重や自宅での生活が成り立つことを重視し，服薬管理は二義的なことととらえて支援していた．また，訪問看護師は，高齢がん患者の治療適用に葛藤を抱きながらも，患者の根底にある意向を模索し，治療の意味を探求する姿勢を保っていた．患者の生活に服薬を織り込み，リスクに備えたネットワークを築きながらも，患者を擁護するために自ら行動を起こすことで，限界のなかでも最善を尽くそうとしていた．

　Purpose: To explore how home-visit nurses support the administration of medication in older adult cancer patients undergoing oral chemotherapy.

　Methods: Qualitative and descriptive research was conducted using semi-structured interviews with 14 home-visit nurses who had experience in providing home nursing care to older adult cancer patients undergoing oral chemotherapy in their own homes. A thematic analysis was used to analyze the interview data.

　Results: Three themes were identified in this study: medication assistance as a secondary purpose, exploring the meaning of treatment for patients, and doing the best within set limits.

　Conclusions: Home-visit nurses prioritized relationship-building with older adult cancer patients, emphasized respect for the patients' autonomy and maintaining their lives at home, and gave support for medication administration, which was regarded as a secondary matter. Additionally, home-visit nurses maintained their stance of searching for the underlying intentions of the patients and exploring the meaning of treatment for patients, even while facing conflicts with applying treatment for older adult cancer patients. They tried their best within set limits by incorporating medication into the patients' lives, building a network for risk, and taking action to defend the patients.