Involving family members in cancer care: focus group considerations of patients and oncological providers

Stress among allogeneic bone marrow transplantation patients

BMT (bone marrow transplantation) is acknowledged as one of the most stressful treatments in modern cancer care. When investigating the impact of BMT on patients it is crucial that the analytic method employed captures direct patient perceptions, allowing the patient to define the domains under investigation. In this study, a multivariate analytic method, concept mapping (CM), was used to identify perceived stressors among 109 allogeneic BMT recipients. CM employs multidimensional scaling and hierarchical cluster analyses to empirically identify the structure underlying the investigated conceptual domain. The analyses of the BMT stress data resulted in an eight-cluster solution. The stress clusters, ranked from the most severe to the least severe, were identified as: Change of life and impact of long-lasting treatment; Side-effects; Distress related to treatment outcome and physiological status; Family-related stress; Fear of death and depressive thoughts; Other concerns; Negative social support; and Stress related to lack of information and the medical staff. A number of stressors generated by the patients were quite novel, and identified important information likely to be useful in clinical settings as well as subsequent research with this high-risk population.

Clinical practice guidelines for the management of psychosocial distress at the end of life

After years of neglect, care at the end of life is receiving increasing attention and concern. It is then that the body is consumed by a progressive and mortal illness, and the person must cope not only with the bodily symptoms, but also with the existential crisis of the end of life and approaching death. As the body suffers, the mind is indeed “commanded … to suffer with the body,” as Shakespeare so well described. Thus, suffering near the end of life encompasses both the mind and the body. Providing optimal symptom relief and alleviation of suffering is the highest priority. However, evidence suggests that we continue to fall far short of this ideal (American Society of Clinical Oncology, 1996; Cassem, 1997; Cassel & Foley, 1999; Carver & Foley, 2000). Although pain management guidelines have been the most widely disseminated, we know that many patients continue to suffer not only from pain, but other troubling physical symptoms in their final days (American Nursing Association, 1991; Carr et al., 1994; American Pain Society, 1995; American Academy of Neurology, 1996; American Board of Internal Medicine, 1996; Ahmedzai, 1998). Despite clear advances in the identification and treatment of psychiatric disorders, we continue to underdiagnose and undertreat the debilitating symptoms of depression, anxiety, and delirium in the final stages of life (Carroll et al., 1993; Hirschfeld et al., 1997; Holland, 1997, 1998, 1999; Breitbart et al., 2000; Chochinov & Breitbart, 2000). And, beyond these physical and psychological symptoms, we fall even shorter of our goals of alleviating the spiritual, psychosocial, and existential suffering of the dying patient and family (Cherny & Portenoy, 1994; Cherny et al., 1996; Fitchett & Handzo, 1998; Karasu, 2000). And this is in spite of the ethical imperative “to comfort always” (Pellegrino, 2000).

Informal caregiving dynamics with a case study in blood and marrow transplantation

PURPOSE/OBJECTIVES

To develop a definition of informal caregiving dynamics through a selective literature review and explore the proposed definition in the context of blood and marrow transplantation using a case study.

DATA SOURCES

Published articles.

DATA SYNTHESIS

Informal caregiving dynamics are commitment, expectations, and negotiation that move a dyadic informal caregiving relationship along an illness trajectory.

CONCLUSIONS

The proposed definition of informal caregiving dynamics is useful in explaining how an informal caregiving dyadic relationship develops and is sustained.

IMPLICATIONS FOR NURSING

Understanding the dynamics underlying informal caregiving relationships enables nurses to intervene effectively to develop and sustain these vital relationships. Elements of the concept require further clarification. Research to validate the accuracy of the concept is needed.

End-of-life care in patients with lung cancer

Evidence-based practice guidelines for end-of-life care for patients with lung cancer have been previously available only from the British health-care system. Currently in this setting, there has been increasing concern in attaining control of the physical, psychological, social, and spiritual distress of the patient and family. This American College of Chest Physicians'-sponsored multidisciplinary panel has generated recommendations for improving quality of life after examining the English-language literature for answers to some of the most important questions in end-of-life care. Communication between the doctor, patient, and family is central to the active total care of patients with disease that is not responsive to curative treatment. The advance care directive, which has been slowly evolving and is presently limited in application and often circumstantially ineffective, better protects patient autonomy. The problem-solving capability of the hospital ethics committee has been poorly utilized, often due to a lack of understanding of its composition and function. Cost considerations and a sense of futility have confused caregivers as to the potentially important role of the critical care specialist in this scenario. Symptomatic and supportive care provided in a timely and consistent fashion in the hospice environment, which treats the patient and family at home, has been increasingly used, and at this time is the best model for end-of-life care in the United States.

Chemoprevention of breast cancer with selective estrogen receptor modulators: views from broadly diverse focus groups of women with elevated risk for breast cancer

Selective estrogen receptor modulators (SERMs) are anti-estrogens that selectively antagonize the proliferative effects of estrogens on breast cells, thereby inhibiting or reversing neoplastic progression to clinical breast cancer. The goal is to administer these agents to healthy women with an elevated risk for breast cancer. The study reported here assessed the knowledge and attitude of 26 broadly selected women with an elevated risk for breast cancer who participated in three focus groups (eight to ten per group) that discussed the use of SERMs, such as tamoxifen and raloxifen. Data were analyzed by cross-case procedure using variable-oriented strategies. Acceptance of breast cancer chemoprevention treatment with SERMs was found to be influenced by various factors, including a knowledge of breast cancer risk factors, the perception of personal risk for breast cancer, and the perception of barriers and benefits to receiving chemoprevention treatment. The issues involved in making the decision to accept treatment with SERMs are discussed. Most of the participants in the groups indicated they were unlikely to accept breast cancer chemoprevention treatment with SERMs.