研究報告 肺がん患者の治療過程において bad news を伝えられた配偶者の心理的ストレス反応 病期における差異とその影響要因 * 1 2 1 2 要旨 目的 bad news 3 3 方法 bad news 3 結果 44 2/3 3 結論 Key words bad news はじめに 1 2 3 co-sufferers 4 bad news 5 bad news 2014 7 18 2015 4 13 連絡先 849 8501 5 1 1 Phone Fax 0952 34 2548 E mail 11624010@edu.cc.saga-u.ac.jp 54 29 1 2015
6 7 8 9 10 11 12 仮説 1 bad news 2 3 用語の定義 1 bad news 13 2 3 4 5 bad news 研究方法 対象者 2010 22 5 10 bad news 4 44 調査方法 2 3 調査項目 14 ) 心理的ストレス反応測定尺度 Stress Response Scale-18 SRS-18 3 18 2 3 3 bad news 2 3 bad news 4 4 29 1 2015 55
Total p n=44 n=17 n=15 n=12 10 22.7 6 35.3 1 6.7 3 25.0 0.152 c 34 77.3 11 64.7 14 93.3 9 75.0 0.076 SD 67.9 10.6 67.5 10.4 63.5 10.2 74.0 9.2 0.036 b 0.335 0.013 a 16 36.4 5 29.4 7 46.7 4 33.3 0.580 c 28 63.6 12 70.6 8 53.3 8 66.7 19 43.2 5 29.4 10 66.7 4 33.3 0.076 c 25 56.8 12 70.6 5 33.3 8 66.7 17 38.6 10 58.8 4 26.7 3 25.0 0.092 c 27 61.4 7 41.2 11 73.3 9 75.0 18 40.9 7 41.2 6 40.0 5 41.7 0.996 c 26 59.1 9 58.8 9 60.0 7 58.3 23 52.3 10 58.8 7 46.7 6 50.0 0.776 c 21 47.7 7 41.2 8 53.3 6 50.0 28 63.6 8 47.1 11 73.3 9 75.0 0.192 c 16 36.4 9 52.9 4 26.7 3 25.0 37 84.1 13 76.5 13 86.7 11 91.7 0.515 c 7 15.9 4 23.5 2 13.3 1 8.3 a Mann-Whitey U b Kruskal-Wallis c Pearson 2 0 54 3 0 18 15 QOL 16 17 18 bad news 1 6 8 19 20 0.915 QMI Quality Marriage Index 22 23 6 1 2 3 4 4 6 6 24 0.957 SPSS16.0J for Windows 56 29 1 2015
n 44 n 17 n 15 n 12 p 20.9 13.0 0 48 24.0 12.5 7 48 17.7 13.4 0 42 20.5 13.3 3 46 0.32 9.3 4.7 0 18 10.6 4.1 4 18 7.9 5.2 0 16 9.3 4.9 2 17 0.32 6.0 4.6 0 17 6.7 4.0 3 17 5.0 4.7 0 14 6.1 5.4 0 16 0.51 5.6 4.8 0 16 6.7 5.4 0 16 4.7 4.2 0 13 5.2 4.5 1 14 0.66 19.8 4.8 6 24 18.3 4.0 6 23 SRS-18 Kruskal-Wallis 20.3 5.2 6 24 19.4 4.6 6 24 0.15 n 44 n 17 n 15 n 12 0.259 0.523** 0.326* 0.600* 0.594* 0.651** 0.507 0.319 0.341* 0.561** 0.336* 0.634** 0.710** 0.559* 0.508 0.100 0.008 0.449** 0.210 0.359 0.510* 0.563* 0.423 0.670* 0.352* 0.497** 0.356* 0.592* 0.491* 0.763** 0.650** 0.174 Spearman *p 0.05 **p 0.01 Mann-Whitney U Kruskal- Wallis Spearman p 0.05 44 20.9 13.0 3 29 1 2015 57
病期別の心理的ストレス反応と各変数間の相関 ( 表 ) 44 考察 心理的ストレス反応 20.9 13.0 bad news 24 17.7 20.5 4 8 21 20 32 12 67 6 3 8 9 12 10.6 9.3 25 7.9 3 7 bad news 2 6 6 11 6.7 4.7 5.2 58 29 1 2015
心理的ストレス反応と夫婦関係満足度 19.8 23 18.3 24 18.3 Cindy 25 26 bad news 病期別の心理的ストレス反応に影響を及ぼす要因 44 27 24 Ezekiel 28 29 29 1 2015 59
研究の限界と今後の課題 44 3 結語 1 2 3 文献 1 3 52 58, 2008 2 1995 33 47 3 Cancer Help Net CHN 1 26 32 2006 4 2007, 64 5 7 496 495 2004 6 1 1 10 2009 7 3 4 13 2009 8 41 47 2003 9 777 785 2000 10 1 65 75 2002 11 E 3 2006, 192 12 3 79 99 2006 13 Breaking Bad News 10 2 130 135, 3 217 224 1998 14 SRS 18, 22 29 1997 15 SRS 18 Stress Response Scale 18 2007, 7 9 16 QOL 2 43 55 2007 17 4 1 10 2002 18 1 15 22 2011 19 / / / / 2013, 9 20 Miller K. The Concept of Crisis: Current Status and Mental Health Implications. Hum Organ., 195 201 1968 21 2001, 149 152 22 Norton R. Measuring marital quality : A critical look at the dependentvariable. J Marriage Family., 141 151 1983 23 1 15 30 1996 24 SMI Health Locus of Control 1 143 151 2006 25 Cindy L, Carmack Taylor Ph D, Hoda Badr Ph D, et al. Lung Cancer Patients and Their Spouses: Psychological and relationship Functioning Within 1 Month of Treatment Initiation. Ann Behav Med., 129 140 2008 26 QOL 3 14 21 2012 27 1 52 57 2011 28 Ezekiel J, Emanuel MD PhD, Diane L, et al. Understanding economic and other burdens of terminal illness: The experience of patients and their caregivers. Ann Intern Med., 451 459 2000 291 18 25 2011 60 29 1 2015
Abstract The Spouse s Reaction to Mental Stress When Bad News was Given in the Course of a Lung Cancer Patient s Treatment Timings of Disclosure and Other Affecting Factors by Toyoko Kugimoto 1, Akemi Koga 2 from 1 Saga University Graduate School of Medical Science Doctoral Course 2 Institute of Nursing, Faculty of Medicine, Saga University : In the course of lung cancer treatment, the doctor at some point must disclose bad news to the spouse of a married patient. In this research the stress reaction of the spouse was analyzed at three points in time: When cancer was diagnosed and announced; When recurrence of the cancer was found; and when positive medical treatment was to end. To offer the best possible nursing assistance, how badly the spouse was affected by the news was determined. Factors that may have affected the mental reaction that he/she displayed were also examined. : Data was collected after disclosures of bad news and from the self-account questionnaires which the spouse had filled in. The items therein contained his/her mental stress reaction and the degree of satisfaction in their marital relationship. : Of a total of 44 spouses who took part in the study, about two-thirds of them had their own health problems. Although their mental stress reaction showed a more negative tendency at the initial diagnosis of cancer than the subsequent disclosures, there was no significant difference between the timing of bad news. Degree of marital satisfaction, state of spouse s own health, financial uncertainty and family make-up were the main factors that influenced a spouse s mental stress reaction. As to how these factors affected his/her mental status changed somewhat depending on the phase of the cancer. : Nurse is lung cancer patient s spouse will help alleviate for the mental stress. It is to nursing in consideration of the factors varies depending on the stage is important. Key words lung cancer, spouse, mental stress, bad news Address reprint requests to : Toyoko Kugimoto. Saga University Graduate School of Medical Science Doctoral Course 5 1 1 Nabeshima, Saga shi, 849 8501, Japan Phone Fax 0952 34 2548 E mail 11624010@edu.cc.saga-u.ac.jp 29 1 2015 61