1．超長期透析患者の抱える苦痛の形成過程

Process of suffering development recognized by ultralong-term dialysis patients

　透析歴30年以上の超長期透析患者の事例は，日本以外での報告はなく，患者の生活に対する理解は十分でない．目的は，日本の超長期透析患者が生活上認識する苦痛の形成過程を明らかにし，生活支援を検討することである．超長期透析患者を対象に，修正版グラウンデッド・セオリー・アプローチを用いた質的研究を行った．その結果，13人の対象から，30の概念，9のサブカテゴリ，3つの【カテゴリ】が抽出された．【下り坂の生活】のなかで生じる［選ばれた者の負う脅威］は，超長期透析患者に特有である．【下り坂の生活】は，医療者とのかみ合わなさと身内への気兼ねによる【深まる孤独】によって促進される．一方，患者は生き抜いた実感を【最後の砦】とし，【下り坂の生活】を抑制する．支援として，医療者や身内との関係調整の必要性が示唆された．

　There have been no reports of patients on dialysis for more than 30 years, in countries other than Japan. And the lives of such patients have not been sufficiently understood. Purpose: This study aims to clarify the process of suffering development experienced by ultralong-term dialysis patients in Japan. Methods: Data obtained from semi-structured interviews of 13 patients were analyzed using the modified grounded theory approach. Results/Discussion: Data extracted included 30 concepts, 9 subcategories, and 3 [categories]. [The menace that the chosen ones are bearing] occurs in the [increasingly impaired life] that is specific for ultralong-term dialysis patients. In particular, the patients bear the brunt of progressively impaired life, which is worsened by their [deepening solitude] due to disagreements with health professionals and hesitation to talk to relatives. On the other hand, patients control their [increasingly impaired lives] by confidently realizing their being alive as their [last stronghold]. It was suggested that an effective support measure to coordinate interactions with health professionals and relatives is required.