高齢な終末期がん患者と家族の在宅における療養体験

The Experiences During Treatment at Home of Elderly Cancer Patients in the End-of-life and of Family Caregivers

要旨

　本研究の目的は、高齢な終末期がん患者と家族の在宅における療養体験を明らかにし、より適切な在宅療養支援について示唆を得ることである。高齢な終末期がん患者と家族を1組とする9組を対象に、参加観察法と半構成的面接法を用いてデータを収集し、質的帰納的に分析した。

　分析の結果、以下のようなカテゴリーにまとめられた。患者は【症状改善と行動拡大への希望】をもち、家族は【状態改善と患者の願い成就への希望】をもって、一貫して患者と家族は可能性にかける気持ちをもち続けた。患者は【現実との折り合い】をつけながら【自分が生きた証】を確認した。家族は【共に苦悩】しつつ、【体験と家族協調性に基づいて介護】していた。また、穏やかな最期を迎えた患者には【自他認知の拡大】による【最期まで生きる充実感】がみられ、最期を見取った家族には【自他認知の拡大】による【最期を看取る充実感】が認められた。

　患者と家族の希望を支えることが必要であり、また、家族に対してその歴史と協調性を洞察しつつケアすることの重要性が示唆された。

Abstract

　The purpose of this study was to clarify the experiences during treatment at home of elderly cancer patients in the end-of-life and the family caregivers, and to get the suggestions for supporting home care adequately. The participants were nine-set elderly cancer patients in the end-of-life and family caregivers. Data were collected through semi-structured interviews and participant observations, and analyzed by inductive coding.

　The following results were obtained. The patients had "hopes for improvement of symptoms and enlargement of actions of daily life", and family caregivers had "hopes for improvement of patient's conditions and the accomplishment of patient's wishes". The patients and the family caregivers continued having a feeling to bet on possibility consistently. The patients confirmed "the proof in which they lived", making "a compromise with reality". The family caregivers "suffered with their patients", and "took care of their patients based on experiences and family cooperativeness". "A life substantiality feeling" by "expansion of oneself-and-others cognition" was seen by the patient who saw the quiet last moment. Moreover, the family caregiver who tended the last moment gained "a substantiality feeling of end-of-life care" by "expansion of oneself-and-others cognition".

　It is required to support the hope of a patient and a family, and the importance of being cared discerning the history and cooperativeness to a family was suggested.