Changes in cancer patients’ personal goals in the first 6 months after diagnosis: the role of illness variables

Using value-focused thinking to elicit oncologic inpatients' life and treatment objectives: a qualitative interview study

OBJECTIVE

Value-focused thinking (VFT) is a decision-making method that places the qualitative elicitation of decisionmakers' objectives at the beginning of the decision-making process. A potential healthcare application of VFT is to elicit patients' objectives to better understand what matters to them. Only then can treatments be tailored accordingly. This is particularly important for patients with life-threatening diseases such as cancer. Thus, this interview study used VFT to elicit the life and treatment objectives of non-terminal oncologic inpatients.

METHODS

Fifteen cancer inpatients (median age 66 years) were sampled in a German university hospital in September 2019. The participants completed questionnaires, the data of which were used to semi-structure the subsequent interviews. Data were analysed using inductive category formation to identify objectives in the transcribed interviews.

RESULTS

Sixteen objectives in five life domains (optimising physical wellbeing, optimising mental wellbeing, optimising personal life, optimising family life and optimising financial life) were identified.

CONCLUSION

Comparison of the findings with previous research indicated that VFT is a reliable approach to elicit patients' objectives. The identified objectives could increase understanding of the outcomes that cancer inpatients care about.

A general theory of rehabilitation: Rehabilitation catalyses and assists adaptation to illness

BACKGROUND

There is no general theory of rehabilitation, only definitions and descriptions, with the biopsychosocial model of illness as a structure.

OBJECTIVE

To develop a general theory of rehabilitation that explains how healthcare rehabilitation changes outcomes and to evaluate its validity.

NEED

A general rehabilitation theory would help research, improve services, increase understanding, modify resource allocation and explain some anomalies, such as how rehabilitation helps when no natural recovery occurs.

BUILDING BLOCKS

People adapt to change throughout their lives. Illness is a change, and people adapt to their illness. Adaptation's purpose is to maintain an equilibrium in a person's life. The balanced components are related to Maslow's five needs: basic, safety, affiliation, status and self-fulfilment. The general theory of behaviour suggests that a person's behaviours change to maintain balance, regulated by a central homeostatic mechanism.

THE THEORY

Rehabilitation aids adaptation to changes associated with illness through accurate diagnosis and formulation, catalysing adaptation, optimising the environment and assisting the person in making necessary changes by safely practising activities and teaching self-management.

IMPLICATIONS

The theory makes the person the central active agent, emphasises the importance of the environment in facilitating adaptation, explains why all conditions may benefit, including progressive and static conditions, suggests that health can be equated to someone maintaining their equilibrium and explains why a small dose may be very effective.

CONCLUSION

The general theory of rehabilitation emphasises the catalytic effects of rehabilitation in facilitating and guiding adaptation and suggests areas for research and improvement.

Goal adjustment by people living with long-term conditions: A scoping review of literature published from January 2007 to June 2018

Long-term health conditions can limit achievement of personal goals. We aimed to map and synthesize definitions of goal adjustment, theoretical underpinnings, associations with recovery and supportive interventions for adults with long-term conditions. We searched multiple databases (January 2007-June 2018) and identified peer-reviewed research relating to goal adjustment. Data were charted, mapped and synthesized using content analysis and descriptive summaries. Two stakeholder consultations informed the review. Ninety-one articles were included. A range of long-term conditions were represented including cancer (22%), stroke (12%) and mixed neurological conditions (8%). Goal adjustment was one available option when faced with unattainable goals; other options were goal disengagement and goal re-engagement. Most studies were quantitative (58%), reporting mainly positive associations between goal adjustment, disengagement, reengagement and recovery. The Dual Process Model, Goal Adjustment Model and Self-Regulation Theory were most cited underpinning models/theory. Five interventions were identified; only one (self-system therapy) was evaluated in a randomized controlled trial. Our review provides original and significant insights into goal adjustment definitions, theoretical underpinnings and association with recovery. Effective interventions to support goal adjustment, disengagement and reengagement are lacking. This research-practice gap warrants attention to ensure people with long-term conditions are optimally supported when facing unattainable goals.

Tincture of Time: The Evolution of Goals in Adolescents and Young Adults with Cancer

Purpose: A diagnosis of cancer often derails an individual's goals. The purpose of this mixed-methods analysis was to describe the evolution of adolescent and young adult (AYA)-reported goals in the year after a diagnosis of new or advanced cancer. Methods: As part of the Promoting Resilience in Stress Management (PRISM) phase 2 randomized controlled trial, AYAs with cancer (ages 12-25 years) were asked at baseline, 6 months, and 12 months: "Please give an example of a goal you hope to accomplish over the next month/year." We used content analysis to categorize goals as follows: life milestones, physical health, mental/emotional health, cancer specific, and hobbies/interests. We summarized goal categories at each time point: for the entire cohort, by baseline diagnosis status (new vs. advanced cancer), treatment status (on-therapy vs. off-therapy), and baseline health-related quality of life (high vs. low). Results: Eighty-six participants completed the study and were included in the analysis (control: n = 41, PRISM: n = 45); 69 reported their goals at 6 months, and 54 at 12 months. Participants submitted a total of 169 goals at baseline, 148 at 6 months, and 126 at 12 months. At baseline, cancer-specific goals were most common for the short-term (35%), whereas milestone goals were most common for the long-term (46%). At 6 months, milestone goals were most common in both short- (38%) and long-term (51%) categories. A similar pattern was seen at 12 months. Conclusion: AYAs' goals change over the first year of their cancer experience, with a shift in short-term goals from cancer-specific goals at baseline to milestone goals at later time points. ClinicalTrials.gov (NCT02340884).

Cancer patient perspectives on survivorship goals from the Smart Patients online community

BACKGROUND

Cancer impacts individuals' life goals. Recent cancer care guidelines recommend discussing life goals as part of patient-provider communication. The goal of this study was to understand patients' attitudes toward goal sharing with their cancer care providers.

PATIENTS AND METHODS

Semi-structured questionnaires were conducted via email with cancer patients and survivors (n = 39) on an online social network called Smart Patients. Participants answered open-ended questions about their life goals. They then completed a survey regarding their attitudes toward goal sharing with healthcare providers. The study team used an integrated inductive-deductive qualitative analysis to identify conceptual themes.

RESULTS

Participants listed goals related to improving physical activity, control, enjoyment/leisure, and inner strength while reducing pain, anxiety, fear of recurrence, and uncertainty. Most of these goals were life goals rather than goals specifically related to medical care. Across all goals, there was a focus on returning to normality. Our findings show that 87% of participants expect their cancer specialist to discuss their treatment preferences and goals regularly with them. However, participants were reluctant to share their goals with their providers. Respondents felt that their providers did not have an interest in their life goals or time to address them in addition to their medical treatment.

CONCLUSION

Even though cancer patient-provider communication guidelines advocate for discussions around life goals, participants in this study expressed reluctance to share life goals with providers. Further efforts to align expectations of patients and providers may facilitate adherence to cancer communication guidelines about life goals.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors should be aware that discussing life goals is part of recommended communication with their cancer care teams.

Living With an Intestinal Stoma: A Qualitative Systematic Review

The main aim of this article is to explore the experiences and life situations of people living with intestinal stomas. Previous studies indicated the need to investigate the concerns of ostomy patients and how these concerns can affect their quality of life and their approaches to the comprehensive conceptualization of the bodily changes. A qualitative systematic review and metasynthesis design was carried out by using the main scientific databases. Original articles from 2002 to 2015 were selected based on their qualitative methodology. Methodological quality was evaluated using the Critical Appraisal Skills Program. The findings were synthesized using the metasynthesis procedure of Sandelowski. The final number of articles included was 95 and 1,982 participants. Regarding the metasummary, the data generated 191 thematic statements that were organized into eight categories. The findings support an explanatory model of the experience of people with ostomy based on three aspects: Acceptance, Adaptation, and Autonomy.

Goal disturbance in early-stage breast cancer survivors

PURPOSE

Cancer-related goal disturbance can influence long-term outcomes in cancer patients and survivors; however, few studies have examined the factors that contribute to goal disturbance in early survivorship.

DESIGN

The current study examined the relationships between demographic variables, cancer- and treatment-related factors, and behavioral and psychological symptoms (i.e., fatigue, pain, cognitive complaints, depressive symptoms, and anxiety) and goal disturbance in breast cancer survivors 1 year after treatment completion.

METHODS

Women diagnosed with early-stage breast cancer (n = 171) completed assessments following primary treatment (i.e., surgery, radiation, and chemotherapy) and again 6 months and 1 year later. We focused on the 1-year post-treatment assessment when participants were asked if they had experienced a cancer-related goal disturbance.

FINDINGS

Approximately, 27% of women reported a cancer-related goal disturbance. Analyses indicated that both receipt of chemotherapy and behavioral and psychological symptoms-analyzed as a composite score and individually-were associated with a higher probability of reporting a goal disturbance.

CONCLUSIONS

Chemotherapy and behavioral and psychological symptoms were unique correlates of goal disturbance, suggesting that the impact of chemotherapy extends beyond its influence on persistent symptoms.

IMPLICATIONS

Elucidating factors that inhibit the pursuit of meaningful activities in early survivorship is critically important to understanding the long-term psychosocial impacts of cancer diagnosis and treatment.

Reducing discrepancies of personal goals in the context of cancer: A longitudinal study on the relation with well-being, psychological characteristics, and goal progress

OBJECTIVES

To (1) examine whether reducing discrepancies between goal importance and goal attainability is an adaptive predictor of well-being, (2) investigate intrusion, awareness, optimism, and pessimism as determinants of reducing discrepancies between goal importance and goal attainability, and (3) explore how goal progress is involved in reducing discrepancies between goal importance and goal attainability during two major periods after a colorectal cancer diagnosis.

DESIGN

Prospective design.

METHODS

Newly diagnosed colorectal cancer patients (n = 120) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) post-diagnosis. Data were analysed using multiple regressions.

RESULTS

Results showed that (1) reducing discrepancies enhances well-being, (2) optimism and pessimism are predictors of reducing discrepancies during the treatment period but not during the follow-up period, while intrusion and awareness do not predict reducing discrepancies in either period, and (3) goal progress is a predictor of reducing discrepancies during the follow-up period, but no evidence for a moderating or mediating role of goal progress in the relation between psychological characteristics and reducing discrepancies was found.

CONCLUSIONS

Reducing discrepancies between goal importance and goal attainability could benefit colorectal cancer patients' well-being. Optimism, pessimism, and goal progress appear to influence cancer patients' ability to reduce discrepancies. Providing assistance in improving goal progress to those who are less optimistic and highly pessimistic may be a suitable training for cancer patients to prevent deterioration in well-being. Statement of contribution What is already known on this subject? More discrepancy between goal importance and goal attainability is associated with lower levels of well-being. People are able to change evaluations of importance and attainability, but it is unknown whether this positively impacts well-being. Underlying causes of differences in the extent to which discrepancies between goal importance and goal attainability are reduced are unknown. What does this study add? This is the first study to show that reducing discrepancies between goal importance and goal attainability is beneficial for well-being. This is the first study to show that optimism and pessimism are determinants of reducing discrepancies between goal importance and goal attainability. Goal progress might be an effective target for interventions that aim to facilitate one's ability to reduce discrepancies between goal importance and goal attainability.

Long-term effects of goal disturbance and adjustment on well-being in cancer patients

PURPOSE

To investigate the impact of personal goal disturbance after cancer diagnosis on well-being over time, and a possible moderating role of goal adjustment tendencies and actual goal adjustment strategies.

METHODS

Participants (n = 186) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) after being diagnosed with colorectal cancer. Participants were asked to freely mention three to ten personal goals. Goal disturbance was assessed by the patients' ratings of the amount of hindrance experienced in goal achievement. Goal adjustment tendencies were assessed using the Goal Disengagement and Re-engagement Scale and actual goal adjustment (i.e. goal flexibility) by the number of goal adjustment strategies used. Outcome measures were overall quality of life and emotional functioning, assessed with the cancer-specific EORTC QLQ-C30.

RESULTS

Hierarchical regression analyses showed that goal disturbance predicted well-being over both the treatment and the follow-up period. Additionally, the negative effect of goal disturbance on well-being was less for patients who scored higher on goal disengagement and not significant for patients who were more flexible in their use of actual goal adjustment strategies.

CONCLUSIONS

The present study is the first to test the theoretical assumption that goal adjustment is beneficial after goal disturbance. Whereas these findings need to be confirmed in future research, the possibly beneficial role of goal disengagement and actual goal adjustment strategies can be used for psychological interventions.