乳房切除術と乳房温存術を受ける患者の術前・術後のストレス・コーピングとその比較

Pre-and Postoperative Stress Coping : Comparison of Patient Treated by Mastectomy or Breast Conserving Therapy

要　旨

　本研究は乳房切除術と乳房温存術を受ける患者の術前・術後のストレス・コーピングを明らかにした上で，両術式間のストレス・コーピングの類似点と相違点を明らかにすることを目的とした．

　対象者は外来で病名告知を受け，入院してきた乳房切除術患者8名と乳房温存術患者16名の計24名であり，面接法と参加観察法で得られたデータを分析した．

分析の結果，以下の知見が得られた．

　1．術前・術後ストレスを両者で比較した結果，両者ともにがん告知後に『気持を整理することの困難・不安』を体験していた．そして，乳房切除術患者の方には，『親戚・近所』『乳房喪失』の不安が多くみられた．また，乳房温存術患者の方には，放射線などの治療に関する『退院後の治療の不安』術式選択時に相談できないとの『医療者への不満』が多くみられた．

　2．術前・術後のコーピングを両者で比較した結果，乳房切除術患者の方には，乳房を切除することに対して『違う視点から見つめ直す』『あきらめる』『現実から回避する』方略が多くみられた．また，乳房温存術患者の方には，『情報を検索する』『具体的な解決策を考える』『自分を励ます』方略が多くみられた．

Abstract

　The purpose of this study was...to describe the stress-coping and make clear the different and the same point in stress-coping before and after the patients who have or had an operation on mastectomy or breast conserving. The subjects were 24 patients (8 patients who need or needed an operation on mastectomy and 16 patients who need or needed an operation on breast conserving) who were informed that they had gotten breast cancer. Interview and participant observation methods were used to collect the deat. In consequence, I got the following results.

　1. After I compared the stress which mastectomy have and breast conserving have I found that both patients experienced "The difficulty or anxiety getting out of the confusion" after they were informed. Most of the patients who had mastectomy went through "anxiety how do relatives and neighbors think about it" and "grief or anxiety about the loss of the breast. "Most of the patients who had breast conserving went through the anxiety for the treatment like X-ray, "anxiety about the treatment after they left hospital" and "discontent with doctors and nurses." This means they couldn't consult doctors or nurses on the operation.

　2. After I compared the coping which mastectomy have and breast conserving have I found that most of the patients who had mastectomy experienced coping-method about lossing their breast like "rethinking from a different point of view", "abandoning" and "escaping from reality." And most of the patients who had breast conserving experienced coping-method like "looking for information", "thinking of solution concretely" and "bracing themselves."