初めて病名告知を受けて治療に臨む壮年期がん患者の認知評価とその変化

Cognitive Appraisal of Patients with Cancer Following Telling about the Diagnosis

要　旨

　本研究の目的は，初めて病名告知を受けて治療に臨む壮年期がん患者が告知されたことをどのように認知評価し，それがどのように変化するのかを明らかにすることである．方法は，告知を受けた30歳から65歳までの壮年期がん患者13名を対象に面接を行った．その結果，がん患者の認知評価について【脅威的ながんによる衝撃】【運命的ながんとの直面】という2種類のがんについての心的表象が抽出された．【脅威的ながんによる衝撃】とがんの脅威に圧倒され，自己の存在が脅かされると捉えた者は，告知時に［がんに圧倒される］［がんであることが信じがたい］とがんである自分の状況を評価したが，時間の経過に従い［がんを直視できない］［がんにとらわれる］［自分の存在が不確か］と変化した．また，がんについての身近な人の良い体験や医師の良い情報により［自分の存在の確かめ］と自己存在の確かさを実感した肯定的な評価に変化した者も数人いた．【運命的ながんとの直面】とがんを親から引き継いだ宿命あるいは自然の摂理という運命的なものとして捉えた者は，［がんの宿命から逃れられない］［がんは宿命だ］［がんは身体の綻び］と評価していた．以上の結果から，告知前は患者が過去にどのようながんの体験をして告知に臨んでいるかを把握し，告知後はがんになったことをどのように捉えているのかを語る場をつくり，自分の病気について適切な認知を促す援助が必要であることが示唆された．

Abstract

　The purpose of this study was to identify changes in cognitive appraisal of significance disease made by cancer patients following telling about the diagnosis, and to collect information which would help reduced the psychological distress of patients when the diagnosis is told.

　The subjects were 13 patients with cancer whose the diagnosis was told for the first time and who gave informed consent to be involved in the study. Data were collected using a semi-structured interview.

　As a result, perceiving they had cancer resulted in their mental-representation of "shocked at the threat of having cancer" and "confronted with my pre-ordained cancer". Patients who described "shocked at the threat of having cancer" experienced the crisis and reported their mental state with such phrases as, "I am overwhelmed by cancer", "I am unbelievably having cancer", "I can't face with having cancer", "I am trapped by cancer", "I am uncertainty my own existence". Some of these patients later changed their report of mental state to "I can confirm my own existence" after hearing of the good experiences of other individuals who had had cancer, and obtaining favorable information from their physician. Patients who described "confronted with my pre-ordained cancer" used statements such as, "I can't escape from my fate" and "Cancer is my fate", "Cancer is a breakdown of my body". To help patients with cancer, it is essential for nurses to talk with the patients and assess the psycho-social condition of each patient so that the nurses can provide adequate information to the patients and help them think realistically about their disease.