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The purpose of this study was to investigate decision-making on the return to social life in postoperative cancer patients early after discharge and to determine the most suitable nursing care. A qualitative study incorporating a decision-making process model for return to social life was conducted at two surgical outpatient clinics in two major hospitals in urban areas. Subjects were fifteen consenting adult patients diagnosed with non-terminal cancer who had undergone surgery. Postoperative chemotherapy was scheduled to last more than one year. Data were collected through semi-structured interviews to obtain patient characteristics, patients' ideas about the return to social life, and difficulties with rehabilitation during postoperative therapy. The result of qualitative and inductive analyses showed that the patients reexamined disease acceptance as well as gains and losses, and they made decisions about returning to social life and their way of living. Four characteristics were found: face death and reevaluate her/his way of living, support by a strong belief and hope for a cure, lead life as before, worry about disease progression. The various ways of living showed patients lifestyle differences. The most important roles for nurses in assisting cancer patients' in making decisions about their return to social life include encouraging them to express their emotions while in the process of discovering the meaning of cancer surgery and helping them accept the losses and appreciate gains., 本研究の目的は,がん手術後成人患者の社会復帰における意思決定を明らかにし,退院後早期の看護援助のあり方を検討することである。調査の場は,都市部の中核病院の外科外来2カ所であり,対象は,病名を告知されて手術を受け,継続治療が1年以上の予定で開始され,本研究に同意した成人がん患者15名であった。がん手術後の社会復帰に対する考え及び思い,退院後の治療継続と社会復帰上の困難について,半構成面接調査を実施した。社会復帰の意思決定過程モデルを概念枠組みとしてケース分析した結果,以下を得た。患者は,病気の受けとめを再吟味し,損失(loss)と利益(gain)を吟味,社会復帰への意思とこれからの生き方を決めていた。社会復帰の意思決定の仕方は,""死を覚悟し,生き方を見直す"",""がん治癒への強い信念と希望に支えられている"",""淡々とやり過ごす"",""疾患・経過へのこだわり""の4つにまとめられ,生き方の特徴は,死を覚悟して生きる,治癒を目指して生きる,人生の1つの出来事として生きる,迷いながら生きる,の4つが認められた。退院後早期の重要な看護援助は,がん罹患の受けとめ方を理解し感情や状況を共有する,がん手術に伴う損失(Loss)と利益(Gain)の表出を促し利益(Gain)を価値付けられるように援助する,がん術後患者の生き方及び生活の仕方をアセスメントし社会復帰への意思決定を支えることである。

The purpose of this study was to investigate decision-making on the return to social life in postoperative cancer patients early after discharge and to determine the most suitable nursing care. A qualitative study incorporating a decision-making process model for return to social life was conducted at two surgical outpatient clinics in two major hospitals in urban areas. Subjects were fifteen consenting adult patients diagnosed with non-terminal cancer who had undergone surgery. Postoperative chemotherapy was scheduled to last more than one year. Data were collected through semi-structured interviews to obtain patient characteristics, patients' ideas about the return to social life, and difficulties with rehabilitation during postoperative therapy. The result of qualitative and inductive analyses showed that the patients reexamined disease acceptance as well as gains and losses, and they made decisions about returning to social life and their way of living. Four characteristics were found: face death and reevaluate her/his way of living, support by a strong belief and hope for a cure, lead life as before, worry about disease progression. The various ways of living showed patients lifestyle differences. The most important roles for nurses in assisting cancer patients' in making decisions about their return to social life include encouraging them to express their emotions while in the process of discovering the meaning of cancer surgery and helping them accept the losses and appreciate gains., 本研究の目的は,がん手術後成人患者の社会復帰における意思決定を明らかにし,退院後早期の看護援助のあり方を検討することである。調査の場は,都市部の中核病院の外科外来2カ所であり,対象は,病名を告知されて手術を受け,継続治療が1年以上の予定で開始され,本研究に同意した成人がん患者15名であった。がん手術後の社会復帰に対する考え及び思い,退院後の治療継続と社会復帰上の困難について,半構成面接調査を実施した。社会復帰の意思決定過程モデルを概念枠組みとしてケース分析した結果,以下を得た。患者は,病気の受けとめを再吟味し,損失(loss)と利益(gain)を吟味,社会復帰への意思とこれからの生き方を決めていた。社会復帰の意思決定の仕方は,""死を覚悟し,生き方を見直す"",""がん治癒への強い信念と希望に支えられている"",""淡々とやり過ごす"",""疾患・経過へのこだわり""の4つにまとめられ,生き方の特徴は,死を覚悟して生きる,治癒を目指して生きる,人生の1つの出来事として生きる,迷いながら生きる,の4つが認められた。退院後早期の重要な看護援助は,がん罹患の受けとめ方を理解し感情や状況を共有する,がん手術に伴う損失(Loss)と利益(Gain)の表出を促し利益(Gain)を価値付けられるように援助する,がん術後患者の生き方及び生活の仕方をアセスメントし社会復帰への意思決定を支えることである。