増島 麻里子

INTRODUCTION: Advances in treatment have transformed cancer from a fatal to a chronic illness. This requires healthcare professionals, particularly nurses, to have advanced knowledge and collaborative skills. However, challenges persist in implementing patient-centered care in the context of evolving treatment complexity. OBJECTIVES: This study aimed to clarify nurses' support practices in providing cancer pharmacotherapy at a university hospital in Japan and compare these practices based on nurses' years of experience. METHODS: A questionnaire survey was conducted from February to April 2023 among 430 nurses involved in provision of cancer pharmacotherapy at a Japanese university hospital. Nurses were asked about the types of support they provided during care for patients undergoing cancer pharmacotherapy. Nurses' cancer pharmacotherapy support practices were extracted using factor analysis, and differences in support scores by years of experience were examined. RESULTS: Responses were received from 184 nurses (42.8% response rate). Three support factors were identified: "Providing patient-centered cancer pharmacotherapy," "Management of continued cancer pharmacotherapy treatment," and "Assessment of and response to physical symptoms." Scores for "Providing patient-centered cancer pharmacotherapy" were significantly lower than those for the other two factors (p < .001). The group with ≥10 years of nursing experience had statistically significantly lower practice scores than those with 4-9 years of experience. CONCLUSIONS: Enhancing nursing education and interprofessional collaboration are crucial to overcome barriers to patient-centered cancer care. Continuous learning opportunities are essential to adapt to evolving cancer treatment protocols and ensure delivery of patient-centered care, particularly for experienced nurses.

本論文は,エンドオブライフ期にある患者の浮腫/リンパ浮腫治療やケアを導くエビデンスを見出すことを目指し,関連文献の体系的マッピングレビューを行った.医中誌Web,PubMed等の文献データベース等から抽出した文献336件において,2008-2019年に発刊された対象文献11件を特定した.主な治療やケア内容は,複合的治療や利尿剤投与等,アウトカム指標は四肢状態や機能,QOL等であったが,評価指標は統一されていないことが明示された.(著者抄録)

目的:集中治療室(以下,ICU)で終末期患者の尊厳を重視する看護師の実践知を明示すること.方法:看護師経験5年以上・ICU経験3年以上の看護師8名に,質問紙調査・半構造化面接を行い,質的帰納的に分析した.結果:実践知として【終末期患者自身から情報が得られにくい状況を悟り,知識・経験・獲得した多様な情報を結びつけ,患者の価値観を支援に反映する】,【様々な制約により,共に過ごす時間・空間が不足している終末期患者と家族の状況を察知し,両者の心理的・物理的距離が離れないよう創意工夫する】,【終末期患者と家族への支援の意味を捉え,集中治療領域の終末期看護を探求し続ける】等の5つのカテゴリーを明示した.結論:救命が第一義であり患者の尊厳がまもられにくいICUで終末期患者を支援した看護師の実践知は,患者のその人らしさ・看護支援での患者の存在のありようを大切にする看護師の姿を反映していた.(著者抄録)

BACKGROUND: Many patients with cancer experience challenges when they return to work (RTW) following cancer diagnosis and treatment. Psycho-educational support is important to facilitate the RTW process. OBJECTIVE: This scoping review examined published reports on psycho-educational support for patients with cancer who RTW. METHODS: We followed the preferred reported items for systematic reviews and meta-analyses statement and the framework of Arksey and O’Malley. We searched the Cochrane Central Register of Controlled Trials database, PubMed, CINAHL (EBSCO), and ICHUSHI and performed manual searches. RESULTS: We retrieved 1,586 articles and retained 48 for analysis (published January 2000 to December 2020). Physicians, occupational physicians, nurses, social workers, and psychologists provide considerable support in hospitals. Delivery modes included individual, face-to-face, and workbook. Psychological support included emotional, stress coping, counseling, and knowledge. Educational support included information or advice provision, communication skills, problem discussion, and work planning. Employment status was typically the primary outcome. We included 50 measurement scales across quality of life, cognitive functioning and illness, self-efficacy, psychological distress, and fatigue. CONCLUSION: This review elucidated psycho-educational support for patients with cancer who RTW, and measurement tools for related effects. Based on the characteristics of the psycho-educational support revealed in this study, future studies should examine the development, intervention, and implementation of support programs for patients’ RTW.

本研究は,青年期後期にある子における親のがん罹患経験の実態,及びがんと共に生きる親と暮らす上で医療者に求める支援を明らかにすることを目的に,大学生に無記名自記式質問紙調査を実施し,18から22歳の男女570名(回収率85.0%,有効回答率95.0%)のデータを分析した。質問紙は,個人属性,親のがん罹患経験の内容,医療者に求める支援に関する項目で構成し,IBM SPSS Statistics 25.0を用いた記述統計量の算出とNVivoを用いた自由記載の内容分析を行った。分析の結果,対象者570名のうち45.3%が祖父母を含む身近な人のがん罹患経験があり,10.4%がその人との同居経験があった。実際に親のがん罹患経験があったのは対象者の4.4%であり,その半数以上が病気の親のために自分に何ができるか分らないという思いを常に抱え,全員が蚊帳の外に置かれていると感じていた。医療者に求める支援では,対象者は親のがん罹患経験を振り返る,または親のがん罹患を想定して回答し,親のがんや治療に関する情報のほか,身体症状の出現時や急変時の対応,がんと共に生きる親を支える具体的な方法に関する情報ニーズが高かった。対象者の90%以上が,問題解決につながる等の理由で「親のがん罹患に伴って生じた悩み等を医療者に直接会って相談できる場」を求めていた。これより,青年期後期にある子は,がんと共に生きる親との暮らしのなかで,親が置かれている状況を正しく把握し,自分にできることを模索するための支援を希求すると考えられた。(著者抄録)