永久的消化管ストーマを造設したがん患者の就労に関わる体験—ストーマ造設前から就労再開前後における時期別の体験

Employment Experiences of Patients with Cancer who Underwent a Permanent Gastrointestinal Stoma: experiences in each period of time from before stoma creation to before and after the resumption of employment

要旨

　本研究の目的は，永久的消化管ストーマを造設するがん患者の就労に関わる体験をストーマ造設前から就労再開後までの時期ごとに明らかにし，それぞれの時期に適した就労に関わる看護支援方法を検討することである．

　対象者からのインタビューを質的記述的に分析し，ストーマ造設前，就労再開前，就労再開後の各時期のコード，サブカテゴリ—，カテゴリーを抽出した．

　永久的消化管ストーマを造設するがん患者の就労に関わる体験について，ストーマ造設前は【がんやストーマへのイメージや価値観で就労継続を判断する】など5カテゴリー，就労再開前は，【現状から就労再開を判断する】，【がん治療やストーマが就労に及ぼす影響を想像できず不安になる】など7カテゴリー，就労再開後は【便漏れや便臭への懸念で就労中常に不安や緊張感がある】など7カテゴリーが得られた．また，全期間で仕事関係者へ迷惑をかけないよう配慮しながらがん治療を行う体験，その時々で仕事関係者へ自身のがんやストーマについて伝える体験，仕事関係者などから就労再開に関して支援を受ける体験が得られた．

　このことから永久的消化管ストーマを造設する就労中のがん患者に対し，就労再開前はがん治療やストーマが就労に及ぼす影響をイメージできるような情報提供支援，就労再開前は就労中のがん治療の副作用やストーマ管理のセルフケア確立の支援，就労再開後は就労中の便漏れや便臭に対する不安や緊張感を軽減する支援などが必要と考える．

　This study aimed to identify the experiences of patients with cancer with permanent gastrointestinal stomas regarding their employment in each period of time from before stoma creation to after the resumption of employment and examine the nursing support for their employment for each time period.

　Interviews with 11 subjects were analyzed qualitatively and descriptively to extract the codes, subcategories, and categories for before the stoma creation and before and after resumption of employment.

　Regarding the work-related experiences of patients with cancer with permanent gastrointestinal stomas, five categories were identified for before stoma creation, which included "judged whether to continue working based on the image and values of the cancer and stoma." For before resumption of employment, there were seven categories, including "judged whether to resume work based on the current situation," and "unable to imagine how the cancer treatment and stoma would affect employment and anxiety." For after the resumption of employment, seven categories were obtained, which included "constant anxiety and tension at work due to concerns regarding fecal leakage and odor." In addition, the respondents underwent cancer treatment while taking care not to inconvenience those involved at their work during the entire treatment period. Further, they communicated about their cancer and stoma to those involved at work from time to time and received support regarding their resumption of work.

　Based on these findings, we believe that working patients with cancer with permanent gastrointestinal stomas require support for providing information on their cancer treatment and the impact of the stomas on employment before stoma creation. In addition, support should also be provided for establishing self-care measures for the side effects of their cancer treatment and stoma management at work before resumption, and for reducing anxiety and tension regarding fecal leakage and odor after resumption.