終末期がん患者の希望に関する研究

Hope of End-stage Cancer Patients

要　旨

　本研究の目的は，終末期がん患者が抱く希望，および希望が変化する状況を明らかにし，終末期がん患者が生きる力となるような希望を抱くための看護介入のあり方を検討することである．7名の終末期がん患者を対象に，希望に関する内容について，参加観察法，面接法によって調査し，質的分析を行い，以下を明らかにした．

　終末期がん患者は，ほぼ全経過において複数の希望を表出しており，表出された希望は時間の推移と共に希望の内容や，成り行きに関わる認知や感情，行動が変化していた．終末期がん患者の抱く希望は最終的に，「思いのままに生きる」「家族とのつながりの中で生きる」「他者とつながっている」などの12の希望にまとめられた．さらに，得られた希望に含まれる意味内容から，1）自由で自立した自己，2）家族愛，3）社会的自己，4）生きざま，5）安寧，6）回復意欲，7）元の自分，8）自己の存在，9）他力志向，10）信仰心，11）生かされる自己，の11の希望の本質が抽出された．

　希望の本質は，終末期がん患者にとって生きる力となる希望の源であると考える．終末期がん患者が最期まで生きる力となるような希望を抱くための看護目標とは，患者が希望の本質を保持し希望を芽生えさせることができるような環境を整えること，希望のプロセスに関わり患者の希望を支え育むような働きかけをすることである．

Abstract

　The purpose of this study was to clarify hope expressed by end-stage cancer patients and the state of changes in their hope over time, and to find out nursing interventions that could encourage those patients to have hope as a source of power to live. Details of hope were studied in seven end-stage cancer patients by the participant observation method and interview, and the following results were obtained through qualitative analysis.

　The patients expressed multiple hope in almost the entire study period, and contents of the expressed hope as well as cognition, emotion, and behaviors associated with the hope altered over time. Hope expressed by the end-stage cancer patients was finally summarized into 12 items, including "living as he or she wishes", "living in a good relationship with family members", and "connectedness with other individuals". More, the followingll items were extracted, as the true nature of hope, from the import and substance contained in their hope : 1) maintenance of self independence and freedom, 2) love of family, 3) social self, 4) a way of life, 5) peacefulness, 6) a desire to cure, 7) previous self, 8) existence of self, 9) a tendency toward reliance upon others, 10) religious faith, and 11) self to be lived.

　True nature of hope is thought to be the source of power to live in end-stage cancer patients. Nursing interventions that encourage these patients to have hope as a source of power to live until the last day of life should be aimed at creating an environment that makes the patients build up hope by retaining the true nature of hope, and at supporting and fostering their hope through active involvement in the process of building up the hope.