地域の一般病院に通院する後期高齢がん患者の療養生活上の体験―複合的な外来看護支援モデルの構築に向けて

A Qualitative Study of Experiences Related to Medical Treatment and Life of Cancer Outpatients Aged 75 Years or Over in Local General Hospitals: Towards Developing a Compound Outpatient Nursing Support System

抄録

　本研究の目的は，地域の一般病院において後期高齢がん患者の療養を支援する複合的な外来看護支援モデルの構築に向け，後期高齢がん患者の療養生活上の体験を明らかにすることである．一般病院の外来に通う6人の患者を対象に半構造的インタビューを実施し，内容を質的帰納的に分析した．329のコードは30の小カテゴリー，14の中カテゴリーへ分類・統合され，最終的に【自分自身が安心・納得する治療を求める意思決定の繰り返し】【がんやその治療による症状と向き合う暮らし】【自宅に近いなじみの病院への信頼と安心感】【自分の身体の変化の自覚と変化への対応】【納得する人生の終い方への準備】【世話をしてくれる周囲の人々への感謝と気遣い】という6つの大カテゴリーに統合された．

　後期高齢がん患者は，診断直後はがんを患ったことに驚くが，医療者の意見や自身の治療体験を拠り所に納得する治療を受けることを繰り返し自ら決定していた．そして，無理なく通院でき顔なじみの医療スタッフがいる病院を信頼し，昔に比べれば体力が低下したものの自立した苦痛のない，いまの生活に満足し，自分が亡き後も家族が困らないよう納得する人生の終い方への準備をしていた．

　In Japan, the percentage of cancer patients aged 75 years or over is currently over 40 percent and is increasing. This study aims to clarify the experiences related to medical treatment and life of cancer outpatients aged 75 years or over in local general hospitals in order to develop a compound outpatient nursing support model.

　Six patients who visit local general hospitals were included as participants of this study. We conducted semi-structured interviews and analyzed the data qualitatively. Using the patients' interview transcripts, we codified the patients' own sentences relevant to the study by topic. From 329 original codes, we were able to consolidate the data into 30 sub-categories, which could be arranged into 14 larger categories, which we eventually integrated into six main categories as follows : repeat decision-making to seek treatments that are safe and satisfying, living with the symptoms of cancer and its treatment, trust and a sense of security for a familiar hospital, awareness of changes in his/her body and responses to changes, preparation for the end of life and gratitude and care for people who take care of them.

　This study found that older cancer outpatients were initially surprised by their diagnosis. Then, they had to decide whether to receive the treatment or not and chose the best course of their treatment repeatedly. They were more fragile now than before they developed cancer but grew more satisfied with their pain-free independent lives and desired to continue on living. They also prepared for the end of their lives to avoid burdening their families.