治療中止と同時に療養の場を選択する進行がん患者とその家族へのがん看護専門看護師による相談支援の実際

Actual consultation support by oncology certified nurse specialist for advanced cancer patients and their families when choosing a place for end of life after discontinuing treatment

要旨

　目的：がん相談支援センターのがん看護専門看護師が行う，治療中止と同時に療養の場を選択する進行がん患者とその家族への相談支援の実際を明らかにすることである．

　方法：専門看護師経験年数が5年以上，かつ，相談支援経験年数が1年以上のがん看護専門看護師10名を対象とした半構造化面接を行い，データを質的に分析した．

　結果：がん看護専門看護師による相談支援の実際は，【がん治療中止に対する患者と家族の複雑な思いや本心を推察する】【病態やADLから今後起こりうる症状と残り時間を予測する】【患者・家族に合わせて現状への理解を助ける】【患者を取り巻く関係者の相違を埋める】【思いを受けとめ，情報提供よりも心理的安寧を優先させる】【患者の生き方や力を尊重し，これからの過ごし方について意向を確認する】【患者・家族への相談支援の効果とチーム医療の最大限の機能の発揮を常に考慮して，方略を立てる】【がん看護専門看護師としての信念や倫理的価値観を基盤とし，患者・家族への支援につなげる】であった．

　考察および結論：がん看護専門看護師は，がん患者が予後に直面することを助け，残り時間を予測しつつ，今後の過ごし方への意思決定支援を行っていた．患者と家族の最善なQOLを根幹とし，患者の納得感とともに残りの人生を歩む支援として，患者の意思決定を尊重した最終的な療養支援体制の調整が示唆された．

　Purpose: To clarify the actual consultation support provided by oncology certified nurse specialists at cancer counseling support centers to advanced cancer patients and their families when choosing the place of end of life care at the time of treatment discontinuation.

　Method: Semi-structured interviews were conducted with 10 specialist cancer nurses with more than five years of experience as specialist nurses and more than one year of consultation support experience, and the data were qualitatively analyzed.

　Results: The actual consultation support provided by specialist cancer nurses consisted of the following: Inferring the complex nature of and true feelings of patients and their families regarding the discontinuation of cancer treatment; predicting possible future symptoms and time remaining from pathological conditions and ADL; helping patients and their families understand the current situation; bridging perception divides between the people involved with the patient; accepting feelings and prioritizing psychological well-being over providing information; respecting the patient's way of life and strength, and confirming their intentions about how to spend the time available to them; formulating strategies while considering the effects of consultation support for patients and families and the maximum functionality of team medical care; and supporting patients and families based on the beliefs and ethical values of a specialist cancer nurse.

　Discussion and Conclusions: Specialist cancer nurses helped cancer patients face their prognosis and make decisions about how to spend the time available to them while predicting their remaining time. Based on the best possible QOL of the patient and family, it was suggested that the final medical treatment support system should be adjusted in a way which respects the patient's decision-making from the projected time remaining as a means of support for the patient to live their remaining days with a sense of conviction.