Emotions and social relationships for breast and gynecologic patients: a qualitative study of coping with recurrence

What is the direction of the association between social support and coping in cancer patients? A systematic review

The aims of this systematic review were (a) to analyze recent studies about the association between social support and coping strategies in cancer patients after an established diagnosis; (b) to evaluate the direction of this association; and (c) to highlight any differences among different cancer types. Seven databases were searched for studies reporting the association between coping and social support for cancer patients in the last 51 years. Most of the 52 included studies highlighted the association between coping and social support, regardless of the source. Our findings supported a bidirectional association. No significant differences were found among the different types of cancer. In conclusion, our results sustain the importance of knowledge in studying this association to identify social limits and resources for the well-being of oncological patients. This knowledge could lead to the creation of holistic protocols to prevent poor adjustment to cancer.

A survey of hospice day services in the United Kingdom & Republic of Ireland : how did hospices offer social support to palliative care patients, pre-pandemic?

INTRODUCTION

Social support is described by patients and other stakeholders to be a valuable component of palliative day care. Less is known about the range of hospice services that have been used in practice that facilitate social support. An online survey aimed to gain an overview of all hospice day services that facilitated social support for adults outside of their own homes.

METHODS

An online survey was distributed via email to people involved in managing hospice day services. Questions were asked on hospice characteristics, including staff and volunteer roles. Respondents were asked to identify services they felt offered social support to patients. Data collection took place between August 2017 and May 2018.

RESULTS

Responses were received from 103 hospices in the UK and ROI (response rate 49.5%). Results provide an overview of hospice day and outpatient services that offer social support to patients. These are: multi-component interventions, activity groups, formal support groups, befriending, and informal social activities. Multi-component interventions, such as palliative day care, were the most commonly reported. Their stated aims tend to focus on clinical aspects, but many survey respondents considered these multicomponent interventions to be the 'most social' service at their hospice. The survey also identified a huge variety of activity groups, as well as formal therapeutic support groups. Informal 'social-only' activities were present, but less common. Over a third of all the services were described as 'drop in'. Most responding hospices did not routinely use patient reported outcome measures in their 'most social' services.

CONCLUSIONS

The survey documents hospice activity in facilitating social support to be diverse and evolving. At the time of data collection, many hospices offered multiple different services by which a patient might obtain social support outside of their own home and in the presence of other patients.

Dilemma: Disclosure Experience Among Young Female Breast Cancer Survivors in China

Purpose: Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods: Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results: From the analysis of the interviews of the 31 participants, three main themes were identified: (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including: to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion. Conclusions: For young women diagnosed with breast cancer in China, it is a very complicated matter whether they choose to disclose their diagnosis to others. While disclosure can bring many benefits, it is important to look at the reasons why these women are concealing their diagnosis.

Suffering experiences of people with cancer undergoing chemotherapy: A meta-ethnographic study

This meta-ethnography had the objectives of identifying, evaluating, and summarizing the findings of qualitative studies regarding the suffering experiences of people undergoing chemotherapy, as well as developing an explanatory conceptual structure regarding what affects these experiences. A systematic literature review was carried out, covering the past 10 years, in the following databases: CINAHL, Embase, Medline, LILACS and Scopus. By using meta-ethnographic synthesis methods, the following themes were found: the pain of loss; evaluating, measuring, and neutralizing the threat; and social contours of suffering. The experience of living with cancer and undergoing chemotherapy was synthesized into a theoretical-explanatory model with a structure that resembles barbed-wire loops. The model expresses people's suffering experiences as marked by the feeling of loss, restraint of emotions, and resilience. While transcendent movements broke the cycle of suffering, resilience emerged as a learning experience that made patients more resistant to the pain of loss. The results indicated a complex and diverse set of factors that influence suffering, which confirmed that experiences are individual, comprehensive, and continuously reinterpreted.

Socioeconomic impact of breast cancer on young women in Ghana: A qualitative study

Aim

This study was undertaken to discover the socioeconomic impact of breast cancer on young women in Ghana.

Methods

A qualitative exploratory and descriptive design was used to recruit 12 young women from the University of Ghana hospital, 37 Military hospital and Ridge hospital. Individual interviews were conducted face to face and data transcribed verbatim and analysed using content analysis.

Results

Three themes emerged: perceptions and beliefs; economic concerns; and secrecy. Participants perceived that breast cancer was a test of faith, a spiritual disease that is contagious and disgraceful. Mostly, participants stopped work to cater for themselves, and as a result, they encountered financial challenges. Their challenges were compounded with conscious efforts to keep diagnosis secret to avoid being stigmatized.

Conclusion

Young women living with breast cancer need support physically, economically and socially from healthcare providers, their families and the society at large.

Information Access and Use by Patients With Cancer and Their Friends and Family: Development of a Grounded Theory

Background

Information has been identified as a commonly unmet supportive care need for those living with cancer (ie, patients and their friends and family). The information needed to help individuals plan their lives around the consequences of cancer, such as the receipt of health care, is an example of an important informational need. A suitable theory to guide the development of interventions designed to meet this informational need has not been identified by the authors.

Objective

The aim of this study is to generate a grounded theory capable of guiding the development of interventions designed to assist those living with cancer in meeting their informational needs.

Methods

Classic grounded theory was used to analyze data collected through digitally recorded one-on-one audio interviews with 31 patients with cancer and 29 friends and family members. These interviews focused on how the participants had accessed and used information to plan their lives and what barriers they faced in obtaining and using this information.

Results

The theory that emerged consisted of 4 variables: personal projects, cancer as a source of disruption to personal projects, information as the process of accessing and interpreting cancer-related data (CRD) to inform action, and CRD quality as defined by accessibility, credibility, applicability, and framing. CRD quality as a moderator of personal project disruption by cancer is the core concept of this theory.

Conclusions

Informational resources providing accessible, credible, applicable, and positively framed CRD are likely key to meeting the information needs of those affected by cancer. Web-based informational resources delivering high-quality CRD focused on assisting individuals living with cancer in maintaining and planning their personal projects are predicted to improve quality of life. Research is needed to develop and integrate resources informed by this theoretical framework into clinical practice.

Psychological and physical effects of breast cancer diagnosis and treatment on young Ghanaian women: a qualitative study

BACKGROUND

Young women diagnosed with breast cancer face challenges that interfere with their entire life with psychological and physical effects.

METHOD

We employed a qualitative exploratory descriptive design, and recruited twelve participants through purposive and snowball sampling methods to conduct 12 face to face individual interviews. A reputable review board in Ghana; Noguchi Memorial Institute for Medical Research, gave ethical clearance for data collection. Data were transcribed verbatim and analysed using thematic content analysis.

RESULTS

Three themes emerged from the data; physical effects of breast cancer, effects of treatment on body image, and emotional effects of breast cancer diagnosis and treatment. The negative effects of treatment incapacitated most of the women and limited their activities of daily living. Some experienced severe bodily weakness and stayed indoors for days. Most participants felt they looked unattractive because they have had a mastectomy done, and used pieces of rags and handkerchiefs as breast prostheses. Those who had hair loss through chemotherapy used different kinds of wigs to cover their baldness. Almost all the participants cried, felt depressed, and became emotionally unstable when they were told their diagnosis. Some denied their diagnoses and displaced their anger on healthcare personnel. A few of them felt they had brought disgrace to their families because breast cancer is perceived, a disgraceful disease.

CONCLUSION

Young women diagnosed with breast cancer require psychological interventions and physical support from healthcare personnel and their families.

Validation of the HPV Impact Profile in Portuguese women with human papilloma virus

Objective: Human papilloma virus (HPV) is the world's most common causative agent in sexually transmitted viral infections; thus requiring clinical guidance, before and after treatment, to promote better quality of life in women diagnosed with HPV. The HPV Impact Profile (HIP) is a comprehensive instrument used to assess the psychosocial impact of HPV and related interventions in a wide range of domains. The main purpose of this study was to validate the HIP in Portuguese women, so that it can be used in this population, both in research and in clinical settings. Methods: A sample of 178 Portuguese women infected with HPV were assessed with the following instruments: Index of Sexual Satisfaction, Hospital Anxiety and Depression Scale and HPV Impact Profile. Results: The results of the confirmatory factor analysis showed some changes to the original model, which resulted in an adapted version with six domains, compared to the seven domains of the original model. The final model showed a good fit to the data. All Cronbach's alphas were higher than 0.79 indicating a high level of internal consistency of the subscales. As in the original HIP questionnaire, the exception was sexual impact, with a lower, but acceptable, Cronbach's alpha. Convergent and discriminant validities of the instrument were also assessed. Conclusions: The Portuguese version of the HIP presents good psychometric properties, allowing its use in clinical trials as well as in clinical practice in order to evaluate quality of life in women with HPV.

A qualitative exploration of the fear of recurrence among Taiwanese breast cancer survivors

OBJECTIVE

Fear of cancer recurrence (FCR) is the most commonly reported problem and unmet need among breast cancer survivors. The aim of this qualitative study was to explore the experience of recurrence fears among Taiwanese breast cancer survivors.

METHODS

Three focus groups were included in this study. A purposive sampling technique was used to recruit 11 recurrence-free women at least 20 years of age from southern Taiwan who were diagnosed with breast cancer within the previous 2 years. Data were analysed and interpreted using content analysis.

RESULTS

Three themes reflecting the experience of FCR were extracted from the transcript analyses: "Trapped in insecurity," "Suffering in silence," and "Pretending as if nothing happened." Participants endured a complex set of circumstances akin to silently walking the survival tightrope. Breast cancer survivors were still insecure and suffering, rather than celebrating survival, after the completion of treatment. Fear of cancer recurrence silently dominated their lives.

CONCLUSIONS

An avoidance mindset and an unspoken FCR leave survivors insecure, resulting in a silent survival journey. These difficult thoughts and feelings that may impact the reconstruction of post-cancer life should be acknowledged. The development of appropriate survivorship care programs and emotional resilience regarding recurrence is needed for Taiwanese breast cancer survivors.

Counseling and Spiritual Assistance to Chemotherapy Patients: A Reflection in the Light of Jean Watson's Theory

Abstract Aim: To reflect on the use of spiritual interventions and methods of psychological, theological and psychotherapeutic counseling applicable to nursing. Method: Theoretical reflection article, used to identify approximations and distances of counseling methods and spiritual interventions with Jean Watson's Theory of Human Care. Results: The critical analysis of methods of psychological, theological and psychotherapeutic counseling indicates approximations with the Theory of Human Care, promoting the improvement of spiritual interventions directed to patients in chemotherapy. Conclusion: From Jean Watson's Theory emerged a creative, original and unique advice in nursing. Implications for practice: Understanding counseling methods and spiritual interventions are important tools for the practice of oncological nursing, as well as enhancing the resources available to integrate spirituality and health.

Concomitant psychiatric symptoms and impaired quality of life in women with cervical cancer: a critical review

Our aim was to summarize the current relevant literature on concomitant psychiatric symptoms with a focus on anxiety/depression in a population with gynecologic cancer; to identify the predictors, associated factors, and prevention strategies of psychiatric disorders; to examine psychiatric disorders in a population with recurrent gynecologic cancer; and to describe the limitations of the literature and future research areas. Little is known about attending psychiatric disorders in patients with gynecologic and other malignant diseases like cervical or breast cancer. However, patients suffering from other types of gynecologic cancer (eg, genital/cervical cancer) may also have an increased risk of psychiatric symptoms. In this review, we identify the potential information deficits in this field. A two-rater independent literature search was conducted using the PubMed/Google Scholar search engines to systematically evaluate the literature on the research objectives, followed by a critical reflection on the results. Of the 77 screened studies, 15 met the criteria for inclusion in this review. Patients with gynecologic malignancies, especially cervical cancer, had a very high prevalence of psychiatric symptoms including depression (33%-52%). Additionally, the risk groups facing higher rates of concomitant reduced quality of life and increased psychiatric symptoms such as depression were identified. Specifically, low socioeconomic status, sexual inactivity, absence of a partner, and physical symptoms were correlated with an increased risk. Patients suffering from recurrent gynecologic cancer should receive particular attention because of their significantly increased risk of depressive symptoms. Screening programs are needed to detect psychiatric symptoms in cervical cancer patients and the associated high-risk groups. Regular screening should be implemented, and psychosocial care should be provided during follow-up.

Living with Metastatic Breast Cancer

Although prevalence estimates are imprecise, growing numbers of women in the United States are living longer with metastatic breast cancer, attributable at least in part to the availability of effective targeted therapies. Women living with metastatic disease are understudied, however, and substantial heterogeneity exists in both the clinical characteristics of metastatic tumors and the physical and psychological experience of patients living with the disease. Survivorship issues are complex for patients who are living with metastatic disease over extended periods of time, from years to decades. Newly diagnosed patients with stage IV disease are confronting cancer for the first time, while others have metastatic disease as a result of breast cancer recurrence. Many patients are able to live for years on stable medical regimens, and yet others live with a moving target of aggressive disease with arduous treatments and uneven response. The psychological common denominator is the experience of profound life threat and the accompanying uncertainty, for both the affected woman and her loved ones. Maintaining life balance in the face of metastatic disease, as well as managing pain, fatigue, and other physical and psychological symptoms are major challenges. Increasingly, the clinical approach to metastatic disease reflects the consensus that palliative and supportive care are essential from the point of diagnosis. To remedy the paucity of systematic research on women living with metastatic breast cancer for extended periods, we offer directions for research to understand the experience of metastatic breast cancer and to provide evidence-based inter-professional care.

Test of mindfulness and hope components in a psychological intervention for women with cancer recurrence

OBJECTIVE

Psychological interventions can attenuate distress and enhance coping for those with an initial diagnosis of cancer, but there are few intervention options for individuals with cancer recurrence. To address this gap, we developed and tested a novel treatment combining Mindfulness, Hope Therapy, and biobehavioral components.

METHOD

An uncontrolled, repeated measures design was used. Women (N = 32) with recurrent breast or gynecologic cancers were provided 20 treatment sessions in individual (n = 12) or group (n = 20) formats. On average, participants were middle aged (M = 58) and Caucasian (81%). Independent variables (i.e., hope and mindfulness) and psychological outcomes (i.e., depression, negative mood, worry, and symptoms of generalized anxiety disorder) were assessed pre-treatment and 2, 4, and 7 months later. Session-by-session therapy process (positive and negative affect, quality-of-life) and mechanism (use of intervention-specific skills) measures were also included.

RESULTS

Distress, anxiety, and negative affect decreased, whereas positive affect and mental-health-related quality-of-life increased over the course of treatment, as demonstrated in mixed-effects models with the intent-to-treat sample. Both hope and mindfulness increased, and use of mindfulness skills was related to decreased anxiety.

CONCLUSIONS

This treatment was feasible to deliver and was acceptable to patients. The trial serves as preliminary evidence for a multi-component intervention tailored to treat difficulties specific to recurrent cancer. The blending of the components was novel as well as theoretically and practically consistent. A gap in the literature is addressed, providing directions for testing interventions designed for patients coping with the continuing stressors and challenges of cancer recurrence.