西岡 英菜

目的：同種造血幹細胞移植を施行し，退院後外来フォローとなる若年成人がんサバイバーの移行プロセスを明らかにすることとした． 方法：同種造血幹細胞移植を20歳代に施行し，退院後長期的にフォローアップをしている20～40歳未満の5名を対象とした．半構成的面接を行い，transitions theoryの概念枠組みに基づき質的帰納的に分析した． 結果：同種造血幹細胞移植施行後の若年成人がんサバイバーの移行プロセスのタイプは，健康／疾病であり，移植が変化を引き金とし複数の移行が順次起こり，反応パターンに至るまで相互に関連していた．移植を施行した若年成人がんサバイバーの移行プロセスの特徴は，【新たなライフイベントに取り組む】なかで【思い描いていた人生どおりに歩めない葛藤】をいだきながらも【自分の目標に向かって進む】ものであった．心理的側面では，【ポジティブな移植経験の受け止め】と【ネガティブな移植経験の受け止め】の相反する《意味》があり，心理面のコントロールに苦悩していることが明らかとなった． 考察：移植を施行した若年成人がんサバイバーの移行プロセスは，自らの力で《エンゲイジメント》しようと苦戦し《熟達》に向かうものであり，移行のプロセス全体を支援する必要がある．

OBJECTIVES: This study was performed to examine the content of decision-making support and patient responses, as documented in the nursing records of individuals with cancer. These patients had received outpatient treatment at hospitals that met government requirements for providing specialized cancer care. METHODS: Nursing records from the electronic medical record system (in the subjective, objective, assessment, and plan [SOAP] format), along with data from interviews, were extracted for patients receiving outpatient care at the Department of Internal Medicine and Palliative Care and the Department of Breast Oncology. Data analysis involved simple tabulation and text mining, utilizing KH Coder version 3.beta.07d. RESULTS: The study included 42 patients from palliative care internal medicine and 60 from breast oncology, with mean ages of 70.5 ± 12.2 and 55.8 ± 12.2 years, respectively. Decisions most frequently regarded palliative care unit admission (25 cases) and genetic testing (24 cases). The assessment category covered keywords including (1) "pain," "treatment," "future," "recuperation," and "home," as terms related to palliative care and internal medicine, as well as (2) "treatment," "relief," and "genetics" as terms related to breast oncology. The plan category incorporated keywords such as (1) "treatment," "relaxation," and "visit" and (2) "explanation," "confirmation," and "conveyance." CONCLUSIONS: Nurses appear crucial in evaluating patients' symptoms and treatment paths during the decision-making support process, helping them make informed choices about future treatments, care settings, and genetic testing. However, when patients cannot make a decision solely based on the information provided, clinicians must address complex psychological concepts such as disease progression and the potential genetic impact on their children. Further detailed observational studies of nurses' responses to patients' psychological reactions are warranted.