患者による乳房切除術か乳房温存術かの選択に影響を及ぼす要因に関する研究

Factors Influencing Patients' Decisions for Choice of Mastectomy or Breast-conserving Surgery

要　旨

　本研究は，乳がん患者の術式選択に影響を及ぼす要因を明らかにし，乳がん患者のよりよい術式選択への看護支援を検討することを目的とした．乳がんのⅠまたはⅡ期と診断され，医師から術式選択を任された患者18名を対象として，半構成的面接調査と参加観察を実施し，得られたデータを分析した．

　その結果，乳房温存術に傾く要因は，入院前後を通して「温存可能な状況」「治療成績」「乳房に対する価値観」が多く，乳房切除術に傾く要因は，入院前後を通した「乳房温存術の欠点」「がんの不確かさ」，入院後にみられる「入院後の周囲の勧めや体験」が多かった．これらの要因は，『がんの不確かさ』『治療方法の変化と治療成績に関すること』『乳房温存術の適応に関すること』『術式の利点・欠点に関すること』『周囲の人の勧めや体験』『あいまいな情報』『個人特性』の7つにまとめられた．

　以上の結果より，乳がん患者の術式選択を促進するための看護支援として，①段階をおった情報提供により患者の理解を助ける，②術後の予期的悲嘆に対する情緒的支援，③乳房に対する価値観・人生観の明確化への支援が示唆された．

Abstract

　The purpose of this study was to identify the factors influencing patients' decisions for choice of surgery for women with early breast cancer, and to suggest nursing interventions to support the patients' decision-making. The participants of the study were 18 women who were offered a choice between breast-conserving surgery and mastectomy. The data were collected using a semi-structured interview and participant observation, so as to clarify the feelings and ideas of these subjects concerning the treatment options offered. We used qualitative data analyses.

　As a result, out of 19 factors, "high possibility of breast-conserving surgery", "results of breast cancer treatment", and "feeling of their dear breast" were recognized as main factors to incline toward breast-conserving surgery, while "risk of the breast-conserving surgery", "uncertainties of cancer", and "impact of those around one during hospitalization" were found as main factors for mastectomy. These factors were classified into seven categories of : 1) uncertainties of cancer, 2) trend and results in treatment of breast cancer, 3) criterion of breast-conserving surgery, 4) benefits and risks of mastectomy or breast-conserving surgery, 5) , impact of people's experience and suggestions 6) ambiguous information, and 7) patient's personal background.

　The findings indicated that the following nursing interventions might facilitate the decision-making process, as follows : provision of gradual and correct information to assist patient's understandings, supporting the impact of the risk of each option and breast loss, and supporting to make patients clear on values of the breast and views of life.