化学療法を受けるがん患者の効果的なセルフケア行動を促進する要素の分析

Analysis of Factors Promoting Effective Self-care Behavior in Patients Undergoing Chemotherapy for Cancer

要　旨

　本研究は，化学療法を受ける患者のセルフケアを促進するための動機となる要素，実際の行動などについて探求することを目的とした．対象は患者10名と看護師9名であり，患者のセルフケア行動の動機となった要因，セルフケア行動，セルフケアの結果を内容分析した．看護師の調査は患者のデータの信頼性を高めるために行った．

　化学療法を受けるがん患者のセルフケア行動を促進する動機となる要素は，【有効な情報の獲得】【他者強化】【自己強化】【隠し事がされていない状況】【信頼できる対象がある】【家族と同じ方向を向いているという確かさ】【自分の状況を評価する】【自分で体験し自信がある】【苦痛が緩和・予防できると認識している】が抽出された．セルフケア行動は，【副作用の予防・対処】【生活の調整】【体力をつける】【気分転換】【感情の表出】【医療器具が取り扱える】【仕事の調整】【家族と相談】【必要な情報を探索する】【医療者に必要な情報を提供する】が抽出された．セルフケア行動の結果は，化学療法を受けたがん患者は【意思決定できる】【治療の継続】【コントロール感を得る】【不安の緩和】【苦痛の緩和】が抽出された．

　以上，セルフケア行動の動機となる要素は，情報の獲得とともに，強化したり，苦痛が緩和される等が抽出された．化学療法を受けるがん患者のセルフケア促進のためには，不安の緩和，闘病意欲向上などのがん告知され侵襲的な治療を受けている患者のニーズにあった関わりが求められる．

Abstract

　The purpose of this study was to search for motivating factors to promote self-care and actual behavior in patients undergoing chemotherapy.

　The subjects were 10 patients and 9 nurses. We performed a content analysis of the motivating factors of self-care behavior in patients, self-care behavior, and the outcome of self-care.

　We extracted the following factors that promoted motivation for self-care in patients undergoing chemotherapy for cancer : acquisition of effective information, reinforcement from others, self-reinforcement, not having the situation hidden, having someone to trust, assurance that everyone in the family was working in the same direction, positive self-evaluation of one's situation, confidence based on one's experiences, and awareness that pain can be prevented or alleviated.

　We extracted the following factors for self-care behavior : prevention and treatment of side-effects, adjustments in daily life, gaining strength, change of mood, expression of emotions, ability to handle medical devices, adjustments in work, talking with one's family, searching for needed information, and providing medical personnel with the necessary information.

　We extracted the following factors for self-care behavior in patients who underwent chemotherapy for cancer : ability to make decisions, continuation of treatment, gaining a sense of control, easing of anxiety and easing of pain.

　Among the factors we extracted that are the motivation for self-care behavior were reinforcement and the alleviation of pain, along with acquisition of information.

　A relationship that meets the emotional needs of the patient after he or she is informed of the disease is desirable in order to promote self-care in patients undergoing chemotherapy for cancer.