The importance of relationships in the experience of cancer: a re-working of the policy ideal of the whole-systems approach

Long-distance caregiving at the end of life: a protocol for an exploratory qualitative study in Germany

Background

Of the approximately 4.7 million people in Germany caring for a relative, many live at a geographical distance from their loved one. The provision of remote care to a terminally ill patient is associated with specific challenges and burdens. In the German context, research is lacking on the specific experiences and needs of caregivers in end-of-life situations who are geographically distanced from their relative. Thus, the overarching goal of the proposed study is to detail the specifics of long-distance caregiving at the end of life in Germany, determining the role played by physical distance in shaping end-of-life caregiving and identifying the needs of long-distance caregivers in this situation.

Methods

The exploratory qualitative study will be guided by an inductive logic, drawing on one-time semi-structured interviews. To uncover the multiplicity of caregiving experiences, long-distance caregivers of both patients receiving early palliative care and patients at a very advanced stage of disease will be included. The study will be divided into five phases: (1) preparation and pretest, (2) data collection and primary analysis, (3) data analysis and interpretation, (4) advisory board workshop and (5) conclusions and recommendations.

Discussion

The study will aim at generating valuable insight regarding the experiences and needs of family caregivers of end-of-life patients. This is particularly relevant, given that families are becoming increasingly geographically dispersed. As this trend continues, it will challenge traditional models of family care and shed light on novel caregiving issues that will need to be addressed through social and health policy.

Trial registration

The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00024164; date of registration: January 25, 2021), and is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00967-8.

Family involvement in advance care planning for people living with advanced cancer: A systematic mixed-methods review

BACKGROUND

Advance care planning is important for people with advanced cancer. Family involvement in advance care planning may be instrumental to achieving goal-concordant care since they frequently become surrogate decision-makers.

AIM

To examine components, contexts, effects and linkages with intended outcomes of involving family members in advance care planning.

DESIGN

A mixed-methods systematic review, in which quantitative and qualitative data were extracted and synthesised using thematic synthesis leading to a logic model. Prospectively registered on PROSPERO (CRD42020208143).

DATA SOURCES

Primary quantitative and qualitative research regarding family-involved advance care planning for people with advanced cancer were identified using Medline, Embase, PsycINFO and CINAHL from inception to September 2020. Quality appraisal was performed with 'QualSyst'.

RESULTS

Fourteen articles were included. The synthesis identified perceptions of individuals and family members concerning family involvement in advance care planning and presents components for family-integrated advance care planning intervention. The logic model includes (i) addressing family members' concerns and emotions and (ii) facilitating communication between individuals and family members which are distinctive when healthcare professionals engage with individuals as well as family members.

CONCLUSIONS

This review provides a comprehensive understanding of family involvement in advance care planning and could inform its assessment and implementation in clinical practice. The number of included articles was limited. Therefore future research must focus on family integration and exploration of stakeholders' perceptions to identify additional components and linkages between them within family-integrated advance care planning.

Reproductive concerns and fear of cancer recurrence: a qualitative study of women's experiences of the perinatal period after cancer

Background

Young female cancer survivors are at a disproportionate risk of suffering significant psychological distress following treatment, particularly fears of cancer recurrence (FCR). While previous research has established the robust relationship between FCR and family matters (e.g., family planning and motherhood), there is a paucity of information about how a history of cancer affects women’s psychological functioning throughout the perinatal period. The present investigation sought to better understand women’s experiences of pregnancy and the postpartum period following cancer treatment through a qualitative analysis.

Methods

Ten women participated in a semi-structured, one-on-one interview either over telephone or video conferencing (Zoom). Women were recruited from Sunnybrook Health Sciences Centre in Toronto, as well as through online cancer support platforms, and social media sites. Participants all had a past cancer diagnosis; no active disease; were 45-years of age or younger; currently in the perinatal period; and spoke English fluently. The study employed a grounded theory analysis by which verbatim interview data were analysed using a constant comparison method until data saturation was reached.

Results

The qualitative analysis yielded I’m So Happy, But Also Terrified, as the core category, indicative of the duality of emotional experience that characterized the perinatal period for these women. Additionally, four higher-order categories emerged revealing how women go through a process of grief related to potential fertility loss; conditional joy during and after pregnancy due to the lingering weight of cancer; frustration with a lack of resources regarding perinatal health after cancer; and hope as they enter into motherhood.

Conclusion

These results suggest that women in the perinatal period with a history of cancer may be at an increased risk for psychological distress and require additional fertility and reproductive resources both during and after cancer treatment. This research is an important step in further understanding women’s experiences of pregnancy after cancer and may help to inform future research and healthcare practices, in addition to improving perinatal care after cancer.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04208-3.

Health professionals' perceptions of colorectal cancer patients' treatment burden and their supportive work to ameliorate the burden - a qualitative study

BACKGROUND

Support is pivotal for patients in managing colorectal cancer treatment, as they might be overwhelmed by the burden of treatment. There is scarce knowledge regarding health professionals' perceptions of colorectal cancer patients' burdens and supportive needs. The study aims to describe health professionals' perspectives on treatment burden among patients receiving curative surgical treatment for colorectal cancer during the hospital stay and how they support patients to ameliorate the burden.

METHODS

This study has a descriptive and explorative qualitative design, using semi-structured interviews with nine health professionals recruited from a gastrointestinal-surgery ward at a university hospital in Norway. Data were analysed by using systematic text condensation.

RESULTS

Data analysis identified the themes "capturing patients' burdens of colorectal cancer treatment" and "health professionals' support to ameliorate the burden". Patients with colorectal cancer had to face burdens related to a challenging emotional situation, treatment complications and side effects, and an extensive need for information. A trusting patient-carer relationship was therefore perceived as the essence of health professionals' support. Health professionals focused their support on safeguarding patients, motivating patients to self-manage, and involving family and peers as supporters. Patients' journey characteristics and illness severity challenged health professionals' supportive work.

CONCLUSION

Support from health professionals includes providing patients emotional support and relevant treatment-related information and motivating patients for early post-surgical mobilisation. Health professionals should be aware of identifying colorectal cancer patients' information needs according to the specific treatment stages, which may ameliorate the burden of colorectal cancer treatment and enable patients to self-manage.

Lung cancer and family-centered concerns

BACKGROUND

Genetic and environmental interactions predispose certain groups to lung cancer, including families. Families or caregiving units experience the disease interdependently. We have previously evaluated the concerns and preferences of patients in addressing the lung cancer experience and cancer risks in their families. This qualitative study evaluates the concerns and preferences of family members and caregivers of patients with lung cancer in the lung cancer experience and familial cancer risks.

METHODS

We held focus groups to discuss the format and timing of addressing these preferences and concerns. Qualitative data generated was analyzed using a grounded theory approach.

RESULTS

Five focus groups totaling 19 participants were conducted. Seven themes were identified: (1) journey to lung cancer diagnosis has core dimensions for patient and family, (2) importance of communication between patients, families, and providers, (3) challenges for caregivers and family, (4) mixed perceptions of lung cancer causation among relatives, (5) discussion of cancer risk with relatives has complex dynamics, (6) impact of diagnosis on family health behaviors and screening, (7) role of genetic counseling.

CONCLUSIONS

Family members of patients with lung cancer are interested in discussing risk factors, prevention, and diagnoses and also would like access to other supportive services do learn about and cope with some of the stresses and barriers they experience in the family lung cancer journey. The diagnosis represents a potential teachable moment with the opportunity to reduce the risk of LC development or improve early detection in LC patient's family members.

Psychometric validation of the French version of the Supportive Care Needs Survey for Partners and Caregivers of cancer patients

The objective of this study was to assess the psychometric properties of the French version of the Supportive Care Needs Survey for Partners and Caregivers (SCNS-P&C-F). The SCNS-P&C-F, the Hospital Anxiety and Depression Scale (HADS) and the CareGiver Oncology Quality of Life questionnaire (CarGOQoL) were completed by 327 caregivers at the baseline. The SCNS-P&C-F was completed a second time by 121 participants within 30 days. Four factors were retained with a good explanation of variance (82.65%) and acceptable internal consistencies (α: 0.70 to 0.94): 1) Health Care Service and Information Needs, 2) Emotional and Psychological Needs, 3) Work and Social Security Needs and 4) Communication and Family Support Needs. Overall, convergent and divergent validities were confirmed. The caregiver's gender, age, professional status and level of anxiety and depression, as well as the type of relationship with the patient and cancer, showed an effect on some caregivers' unmet supportive care needs. Lastly, the test-retest reliability was acceptable (> 0.70), except for the communication and family support dimension. The scale is appropriate for clinical and research use (e.g. good reliability and validity).

The cancer may come back: experiencing and managing worries of relapse in a North Norwegian village after treatment. Anthropol Med 2018;26:296-310. [PMID: 29913070 DOI: 10.1080/13648470.2017.1391172]

Little is known about how people living in the aftermath of cancer treatment experience and manage worries about possible signs of cancer relapse, not as an individual enterprise but as socially embedded management. One-year ethnographic fieldwork was conducted in a coastal village of under 3000 inhabitants in northern Norway. Ten villagers who had undergone cancer treatment from six months to five years earlier were the main informants. During fieldwork, the first author conducted qualitative, semi-structured monthly interviews with them, and participated in their everyday activities and relationships, including families, friends and co-villagers. In this article, we contemplate human emotions as arising in contexts of transactions, capable of creating social realities. By including this perspective, we highlight how people who recover from cancer construct and experience worry about possible relapse in relation to close family members, friends and co-villagers in the socially closely-knit and relatively isolated village. These emotional experiences emerge through relationships with others have communicative characteristics and take place in interaction with the social environment of their village. While informants attempt to protect family members by avoiding sharing worries with them, they express the need to share their worries within friendships. However, they experience both comfort and challenges in managing their worries in relation to acquaintances in the village. Overall, the study enhances understanding of the social embeddedness of emotions in everyday life, by revealing how worries of relapse of cancer configure and relate to various social contexts.

Predictors of Patient and Partner Satisfaction Following Radical Prostatectomy

INTRODUCTION

The diagnosis and treatment of prostate cancer adversely affects the physical and emotional well-being of patients and partners and has been associated with sexual dysfunction in patients and their intimate partners.

AIM

To identify predictors of sexual satisfaction in prostate cancer survivors and their partners based on a review of the current literature.

METHODS

We performed a comprehensive review of the PubMed database from January 2000 to May 2017 focused on the (i) prevalence of patient and partner sexual dysfunction related to radical prostatectomy, (ii) differences in patient and partner perspectives of sexual function and dysfunction, and (iii) predictors of patient and partner sexual satisfaction after radical prostatectomy.

MAIN OUTCOME MEASURES

Patient- and partner-reported sexual satisfaction.

RESULTS

There is a paucity of published data examining sexual satisfaction in prostate cancer survivors and their partners. Patients and partners can have different expectations of sexual outcomes after radical prostatectomy and different attitudes toward the relative importance of recovery of sexual function after surgery. Available data suggest that patients' and partners' mental and physical health and the quality of communication between them are important contributors to their sexual satisfaction. Patient-perceived partner support also is associated with better patient-reported erectile function and greater relationship satisfaction.

CONCLUSION

Mental health, physical health, quality of interpersonal communication, and patient-perceived partner support appear to be the most important predictors of sexual satisfaction for patients and partners in the post-prostatectomy period. There is a definite need for further research on this topic to develop interventions to improve sexual function and quality of life for prostate cancer survivors and their intimate partners. Guercio C, Mehta A. Predictors of Patient and Partner Satisfaction Following Radical Prostatectomy. Sex Med Rev 2018;6:295-301.

Dealing with cancer: a meta-synthesis of patients' and relatives' experiences of participating in psychosocial interventions

The aim was to synthesise patients' and relatives' experiences of participating in a psychosocial intervention related to having cancer. The study was a meta-synthesis inspired by Noblit & Hare's 'meta-ethnography' approach. We systematically searched six databases and included 33 studies in the meta-synthesis. Inclusion criteria were qualitative studies with relevance to the synthesis topic. The meta-synthesis conceptualised the way in which participants develop their way of living with cancer, and the role psychosocial interventions play in helping them to live through the illness. Five themes symbolising the participants' core experiences were identified: (1) Emotional relief and a sense of well-being, (2) normalisation of experiences and a sense of control, (3) shared experience and a sense of community, (4) a safe place and (5) transformation and adaptability. The findings indicated that psychosocial interventions were used to try to deal with the changes in the human conditions caused by cancer. Sharing their experiences and forming social relationships helped the participants adapt to cancer. An existential perspective may provide a nuanced understanding of patients' and relatives' experiences of participating in psychosocial interventions.

Regenerative medicine: Stroke survivor and carer views and motivations towards a proposed stem cell clinical trial using placebo neurosurgery

BACKGROUND

Few studies explore stroke survivor views and motivations towards stem cell therapy (SCT). This qualitative study explores the views and motivations of both stroke survivors and their partners/carers towards a proposed 2-arm Phase III Randomised Controlled Trial (RCT) comparing intracerebral insertion of stem cells with placebo neurosurgery in stroke survivors with disability.

OBJECTIVE

To explore views and motivations towards a proposed 2-arm stem cell trial and identify factors that may impede and enhance participation.

DESIGN

This study adopts a naturalistic design to explore the complexity of this field, employing a participatory action-research approach comprising a specialized Conversation (World) Café form of focus group. Data were collected via 5 Conversation Cafés with stroke survivors (age 40-75) and partners/carers between June and October 2016. Of 66 participants, 53 (31 male, 22 female) were stroke survivors and 13 (6 female, 7 male) were partners/carers. Qualitative data were analysed using a thematic approach.

DISCUSSION AND CONCLUSION

Stroke survivor views and motivations reflect anticipation of the personal and future benefits of regenerative medicine. Partners/carers sought to balance the value of stroke survivor hope with carrying the weight of hope as carer, a conflict burden adding to known caregiver burden. All participants expressed the need for during and post-trial psychological support. This study provides a rare opportunity to explore the prospective views and motivations of stroke survivors and their partners/carers towards a proposed Phase III 2-arm RCT. This adds weight to qualitative evidence exploring capacity, consent, decision making, perceptions of treatment risk and supports required for clinical trial participation.

Diagnosis as the First Critical Point in the Treatment Trajectory: An Exploration of Operable Lung Cancer Patients' Lived Experiences

BACKGROUND

Significant advances have been made in the surgical treatment of lung cancer while patient experiences with diagnosis, treatment, and rehabilitation remain only sparsely researched.

OBJECTIVE

The objective of this study was to investigate how the diagnosis affects the daily lives of patients with operable lung cancer in order to identify their needs for care interventions from the point of diagnosis to hospitalization.

METHODS

We investigated patients' lived experiences from a longitudinal perspective at 4 critical time points during the treatment trajectory; we present here the findings from the first time point, diagnosis. Data were collected through interviews conducted 7 to 10 days following diagnosis of lung cancer. Data from 19 patients are included, and the analysis is based on Ricoeur's interpretation theory. The study framework is inspired by Schutz's phenomenological sociology.

RESULTS

The findings are presented as themes that summarize and express the ways in which a diagnosis affects patients' daily lives: the cancer diagnosis comes as a shock, it changes everyday awareness; it presents the patient with an unfamiliar body, disturbs social relationships, forces the patient to face a new life situation, and demands one-on-one supportive care.

CONCLUSIONS

Diagnosis is the first critical point for patients with operable lung cancer and disrupts their daily life. Patients need psychosocial support during the period from diagnosis to surgical intervention and patient-tailored one-on-one information.

IMPLICATIONS FOR PRACTICE

This article contributes to the knowledge base of support needs of lung cancer patients. Interventions aimed at supportive care during the period between diagnosis and surgical intervention should be researched.

Involvement of patients with lung and gynecological cancer and their relatives in psychosocial cancer rehabilitation: a narrative review

INTRODUCTION

Getting cancer is stressful for most patients and their relatives, and research has shown that psychosocial support is needed. Still, cancer care fails to appropriately address psychosocial problems associated with cancer. Research on this topic is often seen from the perspective of either the patient or the relative, even though it is suggested that psychosocial support is beneficial for the patient and the relative as a pair. Furthermore, research on the need for psychosocial support rarely involves patients with gynecological and lung cancer and their relatives, even though they often suffer from isolation and stigmatization. The aim of this review was therefore to summarize knowledge about psychosocial support with regard to individual needs, involvement of significant others, and providers of psychosocial support focusing on this specific population.

METHOD

A narrative review procedure was chosen. This method is a specific kind of review, which summarizes, explains, and interprets evidence on a selected topic. The review process was structured according to typical scholarly articles with attention to the search and review process.

RESULTS

A total of 16 studies were included in the review. The studies were divided into two main categories: (1) studies focusing on needs for psychosocial support; and (2) studies focusing on interventions. The needs studies were analyzed, and three themes emerged: the needs of the patient and the significant other across the cancer trajectory; the needs of the significant other as a carer; and needs and ongoing and tailored support. The intervention studies were directed toward the patient and the relative, the patient, or the relative. Five interventions comprising various forms of support that were purely supportive and were carried out by healthcare professionals were identified.

CONCLUSION

There were overlaps between the needs of the patient and the relative, but there were also distinctive characteristics of the needs in the two groups. The needs varied during the cancer trajectory, and we therefore recommend that support be offered continuously. It was also evident that the relatives should be involved in the patients' care and that the involvement was beneficial for both the patient and the relative.

Purposeful Agency in Support Seeking During Cancer Treatment From a Person-Centered Perspective

People diagnosed with early-stage breast cancer (ESBC) manifest high supportive needs. eHealth supportive programs successfully satisfy those needs, but the process of generating supportive outcomes is less understood. We conducted this study to explore patients' efforts to satisfy their supportive needs throughout the treatment course, not limited to but particularly considering their use of the Internet. Guided by interpretive description, 19 women undergoing treatment for ESBC participated in two phases of focus group meetings. Our results disclose women as self-driven resourceful agents, a perspective that underlay the process of reaching out as women appraised their need for support and intentionally engaged their supportive resources. Our findings convey a need to shift the paradigm of professionals' provision of support in scheduled appointments toward achieving a continuous reciprocal care partnership. This is especially significant for the development of eHealth supportive programs, which assist in the enhancement of the health care accessibility.

Regaining familiarity with own body after treatment for operable lung cancer - a qualitative longitudinal exploration

Little is known about the experiences of operable lung cancer patients during treatment in a clinical setting based on fast-track surgery. The study aimed to explore (1) the embodied meaning of illness in patients with operable lung cancer during treatment to 4 months after surgery and (2) patterns of change over time that may affect the patients' daily lives. Twenty patients referred for lung cancer surgery were interviewed three times, corresponding to potential critical transition points following surgery: hospitalisation; hospital-to-home transition; and resumption of daily life activities. Data collection, analysis and interpretation followed a phenomenological hermeneutical approach inspired by Ricoeur and the theoretical framework was grounded in Merleau-Ponty's phenomenology of perception. The findings reveal the process patients went through in regaining familiarity with their own body after lung cancer treatment. Through the post-operative trajectory the patients' resumption of daily activities involved adjusting to a new awareness of everyday life, physical restrictions and their perception of themselves. The findings are expressed in four sub-themes: (1) perceptions of embodied alterations; (2) transformation of embodied structures in the transition from hospital to home was unexpectedly challenging; (3) embodied perceptions of the intersubjective world; and (4) transforming embodied disruptions into bodily awareness. Patients experienced a smooth treatment trajectory regarding physical consequences of illness and treatment which might be due to the fast-track surgery. Clinicians should be aware of patients' experiences of illness to facilitate patient reconstitution of own identity.

Conceptualising psychological distress in families in palliative care: Findings from a systematic review

BACKGROUND

Adult palliative care patients and their family members experience significant psychological distress and morbidity. Psychosocial interventions adopting a systemic approach may provide a cogent model to improve the psychosocial care of families in palliative care. To facilitate design of these interventions, the construct of psychological distress in families in palliative care should be empirically derived.

AIM

To ascertain how psychological distress is conceptualised in families receiving palliative care.

DESIGN

A systematic review of the literature; this was followed by a thematic analysis and narrative synthesis.

DATA SOURCES

Using pre-defined search terms, four electronic databases (MEDLINE, CINAHL, PsycINFO and Behavioural Sciences collections) were searched with no date restrictions imposed. Pre-determined inclusion and exclusion criteria were then applied.

RESULTS

A total of 32 papers were included in the review. Two findings emerged from data synthesis. First, distress is conceptualised as a multi-dimensional construct but little consensus exists as to how to capture and measure distress. Second, distress in the families within these studies can be conceptualised using a tiered approach, moving from individual non-interactive depictions of distress through gradations of interaction to convey a systemic account of distress within the family system. Thus, distress shifts from a unitary to a systemic construct.

CONCLUSION

Currently, there is a paucity of research examining distress informed by family systems theories. This review proposes that distress in families in palliative care can be conceptualised and illustrated within a tiered model of distress. Further research is merited to advance current explanatory frameworks and theoretical models of distress.

A longitudinal exploration of 'Four Critical Moments' during treatment trajectory in patients with operable lung cancer and the feasibility of an exercise intervention: a research protocol

AIM

This article described a research protocol for a study exploring the lived experiences of patients with operable lung cancer in daily life at 'Four Critical Moments' during the disease and treatment trajectory.

BACKGROUND

Patients with lung cancer may experience complex problems during the disease and treatment trajectory, and studies conclude this population to be at higher risk in developing emotional distress than other cancer populations. It is required to explore the supportive needs of patients with lung cancer through the treatment trajectory.

DESIGN

A longitudinal design with a method of multiple data collection. The study is performed at four time points 'Four Critical Moments'.

METHODS

The study contained three samples. Sample I and sample II explored the expected four critical moments for patients with operable lung cancer within the first 4 months following diagnosis and surgery. Sample III explored the patients' participation and the feasibility of an exercise intervention targeting patients with operable lung cancer. For all three samples, interviews will be performed: (1) 5 days following diagnosis; (2) the day after surgery; (3) 7 weeks; and (4) 4 months following surgery. Data from questionnaires for all three samples will be collected at baseline and 4 months following surgery.

DISCUSSION

The study will add new perspectives on the lived experiences of patients with lung cancer along the treatment trajectory based on empirical and theoretical findings for both the general lung cancer population and patients participating in an exercise intervention. This will provide a basis for optimizing and developing interventions for patients with lung cancer starting in the surgical context.

Patient experiences at diagnosis and psychological well-being in prostate cancer: A Finnish national survey

PURPOSE

Most cases of prostate cancer are diagnosed at an early stage, and men live for many years after diagnosis. Thus, their well-being and quality of life are of great importance. This study investigated patient experiences and psychological well-being in a Finnish national sample of prostate cancer patients who received various types of treatment.

METHOD

In a national sample (50%) of prostate cancer patients diagnosed in Finland in 2004, information was collected on the patients' experiences at diagnosis and choice of treatment (e.g. treatment selection, patient satisfaction with care and information, psychological reactions). In 2009, participants were asked about their experiences, and psychological well-being (psychological symptoms, satisfaction with life) was measured. In total, 1239 completed questionnaires (73%) were accepted for the study. Differences between treatments and predictors of psychological well-being were investigated using descriptive statistics and regression analysis.

RESULTS

Half of the respondents were satisfied with the care and information they received about the cancer and side effects of treatment. Experiences and psychological well-being were most positive among patients who received brachytherapy and poorest among patients who received hormonal therapy. Patients who underwent prostatectomy or brachytherapy were most likely to have been involved in treatment selection. Negative experiences, such as learning of the diagnosis in an impersonal way and dissatisfaction with the information and care received, were predictive of poorer well-being.

CONCLUSIONS

Unmet supportive care and informational needs were common. Experiences and well-being varied between treatments. Patients tended to prefer prostatectomy and brachytherapy. Unmet needs, which would probably be reduced by improvements in care, appear to have a long-lasting impact on patients' psychological well-being.

Pathways to care: how superdiversity shapes the need for navigational assistance

The recently developed sociological concept of superdiversity provides a potentially interesting and useful way of developing an understanding of life in contemporary Europe. Here we report on research based on individual narratives about access to health care, as described by a range of people from very different sociocultural backgrounds in four European countries. This article notes the frequent appearance in first-person narratives of the need for navigational assistance in the form of knowledge, cultural competence and orientation that facilitate the identification and use of pathways to health care. Our dataset of 24 semi-structured interviews suggests that, in the context of needing health care, the feeling of being a 'stranger in a strange land' is common in people from a wide range of backgrounds. In social settings characterised by transnationalism and cultural heterogeneity, it is important to understand the need for navigational assistance, particularly at times of uncertainty, in the design and delivery of health services. The relationship between the inhabitants of contemporary Europe and the healthcare systems available in the places where they live is dominated by both complexity and contingency - and this is the cultural field in which navigation operates.

Outcome of supportive talks in a hospital setting: insights from cancer patients and their relatives

BACKGROUND

In psychosocial cancer rehabilitation, relatives are often central to patients' experiences and management of their cancer disease, and they need to be actively involved in rehabilitation. To address this need we developed a psychosocial rehabilitation intervention. As part of the intervention, lung or gynecological cancer patients and a relative as a pair were offered three supportive talks initiated on the date of admission and completed within 2 months.

OBJECTIVE

The objective of this study was to qualitatively assess the outcome of supportive talks from the pairs' perspectives and to provide a nuanced understanding of psychosocial support offered to pairs in a hospital setting in Denmark.

METHODS

Using a qualitative approach, we conducted semi-structured interviews with pairs receiving supportive talks and pairs receiving usual care. The interviews focused on the pairs' experiences of psychosocial supportive talks in a hospital setting. A constant comparative analysis was applied to identify themes related to the ways the pairs experienced the talks.

RESULTS

The analysis revealed two main themes: 'appreciation of the supportive talks' and 'the influence of the hospital setting'. The majority of pairs valued the focus on relationship and interpersonal communication, although they appreciated various aspects of the talks. The hospital setting provided valuable resources (trained nurses and medical expertise), but existing clinical routines challenged the implementation of the supportive talks.

CONCLUSIONS

The supportive talks were appreciated as psychosocial support in line with the objective, or as information on cancer treatment and routine care. The implementation of a new rehabilitation practice was challenged by the influence of the hospital setting.

Illness perceptions in relation to experiences of contemporary cancer care settings among colorectal cancer survivors and their partners

Illness is constituted by subjective experiences of symptoms and their psychosocial consequences. Illness perceptions concern people's lay beliefs about understandings and interpretation of a disease and expectations as to disease outcome. Our knowledge about illness perceptions and coping in relation to the cancer care context among persons with colorectal cancer (CRC) and their partners is incomplete. The aim of the present study was to explore illness perceptions in relation to contemporary cancer care settings among CRC survivors and partners. The present research focused on illness rather than disease, implying that personal experiences are central to the methodology. The grounded theory method used is that presented by Kathy Charmaz. The present results explore illness perceptions in the early recovery phase after being diagnosed and treated for cancer in a contemporary cancer care setting. The core category outlook on the cancer diagnosis when quickly informed, treated, and discharged illustrates the illness perceptions of survivors and partners as well as the environment in which they were found. The cancer care environment is presented in the conceptual category experiencing contemporary cancer care settings. Receiving treatment quickly and without waiting was a positive experience for both partners and survivors; however partners experienced the information as massive and as causing concern. The period after discharge was being marked by uncertainty and loneliness, and partners tended to experience non-continuity in care as more problematic than the survivor did. The results showed different illness perceptions and a mismatch between illness perceptions among survivors and partners, presented in the conceptual category outlook on the cancer diagnosis. One illness perception, here presented among partners, focused on seeing the cancer diagnosis as a permanent life-changing event. The other illness perception, here presented among survivors, concentrated on leaving the cancer diagnosis behind and moving forward. The importance of illness perceptions among survivors, and the differences in illness perceptions between survivors and partners, should be recognized by healthcare professionals to achieve the goals of person-centered contemporary cancer care.

Perioperative rehabilitation in operation for lung cancer (PROLUCA) - rationale and design

BACKGROUND

The purpose of the PROLUCA study is to investigate the efficacy of preoperative and early postoperative rehabilitation in a non-hospital setting in patients with operable lung cancer with special focus on exercise.

METHODS

Using a 2 x 2 factorial design with continuous effect endpoint (Maximal Oxygen Uptake (VO2peak)), 380 patients with non-small cell lung cancer (NSCLC) stage I-IIIa referred for surgical resection will be randomly assigned to one of four groups: (1) preoperative and early postoperative rehabilitation (starting two weeks after surgery); (2) preoperative and late postoperative rehabilitation (starting six weeks after surgery); (3) early postoperative rehabilitation alone; (4) today's standard care which is postoperative rehabilitation initiated six weeks after surgery. The preoperative rehabilitation program consists of an individually designed, 30-minute home-based exercise program performed daily. The postoperative rehabilitation program consists of a supervised group exercise program comprising cardiovascular and resistance training two-hour weekly for 12 weeks combined with individual counseling. The primary study endpoint is VO2peak and secondary endpoints include: Six-minute walk distance (6MWD), one-repetition-maximum (1RM), pulmonary function, patient-reported outcomes (PROs) on health-related quality of life (HRQoL), symptoms and side effects of the cancer disease and the treatment of the disease, anxiety, depression, wellbeing, lifestyle, hospitalization time, sick leave, work status, postoperative complications (up to 30 days after surgery) and survival. Endpoints will be assessed at baseline, the day before surgery, pre-intervention, post-intervention, six months after surgery and one year after surgery.

DISCUSSION

The results of the PROLUCA study may potentially contribute to the identification of the optimal perioperative rehabilitation for operable lung cancer patients focusing on exercise initiated immediately after diagnosis and rehabilitation shortly after surgery.

TRIAL REGISTRATION

NCT01893580.

Sleep patterns and sleep-impairing factors of persons providing informal care for people with cancer: a critical review of the literature

BACKGROUND

Sleep is increasingly recognized as an area of functioning that may be greatly affected in persons who are practically and emotionally involved in the care of patients with cancer. Clinician awareness is required to ensure that effective care for informal caregivers with sleep problems is provided.

OBJECTIVE

A 2-fold critical review of the published literature was conducted, which aimed at summarizing and critically analyzing evidence regarding sleep patterns of informal caregivers of adults with cancer and contributing factors to sleep-wake disturbances.

METHODS

Using a wide range of key terms and synonyms, 3 electronic databases (MEDLINE, CINAHL, EMBASE) were systematically searched for the period between January 1990 and July 2011.

RESULTS

Based on prespecified selection criteria, 44 articles were pooled to provide evidence on sleep-impairing factors in the context of informal caregiving, 17 of which specifically addressed sleep patterns of caregivers of people with cancer.

CONCLUSIONS

At least 4 of 10 caregivers may report at least 1 sleep problem. Short sleep duration, nocturnal awakenings, wakefulness after sleep onset, and daytime dysfunction seem to be the areas most affected irrespective of stage or type of disease, yet circadian activity remains understudied. In addition, despite a wide spectrum of potential sleep-impairing factors, underlying causal pathways are yet to be explored.

IMPLICATIONS FOR PRACTICE

More longitudinal, mixed-methods, and comparison studies are warranted to explore caregiver sleep disorders in relation to the gravity of the caregiving situation in the context of diverse types of cancer and disease severity.

The role of interpersonal relationships in men's attendance in primary care: qualitative findings in a cohort of men with prostate cancer

OBJECTIVES

Men's response to ill health is framed as a "battleground" for the enactment of masculinities. With an increase in diagnoses of men's cancers, there is a need to better understand the features which influence timely access to diagnostic services. This study explored the ways in which men account for the timing of their diagnosis of prostate cancer.

METHODS

Thirty semi-structured interviews were conducted with men and, where possible, their partner. Data were analyzed with reference to framework analysis.

RESULTS

Relationships, including spousal, familial, and friendships, appear pivotal in informing men's help-seeking behaviors. Friends and partners were often critical in facilitating access to primary care. Following their own diagnosis, this virtuous cycle of encouragement led many men to encourage others to seek medical attention for prostate tests.

CONCLUSIONS

Interpersonal relationships are a missing dimension in models of delay. We need to know more about how to use relationships, in addition to traditional routes, to harness health promotion messages. Interpersonal relationship, including partners and social networks, may be powerful conduits and may prove effective mechanisms to identify and access men most at risk of prostate cancer.

Impact of prostate cancer on sexual relationships: a longitudinal perspective on intimate partners' experiences

INTRODUCTION

In this prospective study of localized prostate cancer patients and their partners, we analyzed how partner issues evolve over time, focusing on satisfaction with care, influence of cancer treatment, and its impact on relationship with patient, cancer worry, and personal activities.

AIMS

Our study aims were twofold: (i) to determine whether the impact of treatment on patients and partners moderate over time and (ii) if receiving surgery (i.e., radical prostatectomy) influences partner issues more than other treatments.

METHODS

Patients newly diagnosed with localized prostate cancer and their female partners were recruited from three states to complete surveys by mail at three time points over 12 months.

MAIN OUTCOME MEASURES

The four primary outcomes assessed in the partner analysis included satisfaction with treatment, cancer worry, and the influence of cancer and its treatment on their relationship (both general relationship and sexual relationship).

RESULTS

This analysis included 88 patient-partner pairs. At 6 months, partners reported that cancer had a negative impact on their sexual relationship (39%--somewhat negative and 12%--very negative). At 12 months, this proportion increased substantially (42%--somewhat negative and 29%--very negative). Partners were significantly more likely to report that their sexual relationship was worse when the patient reported having surgery (P = 0.0045, odds ratio = 9.8025, 95% confidence interval 2.076-46.296). A minority of partners reported significant negative impacts in other areas involving their personal activities (16% at 6 months and 25% at 12 months) or work life (6% at 6 months, which increased to 12% at 12 months).

CONCLUSION

From partners' perspectives, prostate cancer therapy has negative impact on sexual relationships and appears to worsen over time.

The Influence of Family Ties on Men’s Prostate Cancer Screening, Biopsy, and Treatment Decisions

Extensive research has focused on understanding family dynamics of men with prostate cancer. However, little qualitative work has examined the role of family ties on men’s prostate cancer decisions across the spectrum of screening, diagnosis, and treatment. Using data from a larger study, we qualitatively explored the influence of family ties on men’s prostate cancer decisions. Semistructured interviews were conducted with men ages ≥50 ( N = 64), and data were analyzed using a grounded theory approach and a series of immersion/crystallization cycles. Three major themes of spousal/family member influence were identified: (a) spousal/family member alliance marked by open communication and shared decision making, (b) men who actively opposed spouse/family member pressure and made final decisions themselves, and (c) men who yielded to spouse/family member pressure. Our findings provide insights into men’s relational dynamics that are important to consider for the shared decision-making process across the prostate cancer spectrum.

Sleep and sleep-wake disturbances in care recipient-caregiver dyads in the context of a chronic illness: a critical review of the literature

CONTEXT

Alterations in sleep-wake patterns of care recipients and their informal caregivers are common in the context of a chronic illness. Given the current notion that sleep may be regulated within and affected by close human relationships, concurrent and interrelated sleep problems may be present in care recipient-caregiver dyads.

OBJECTIVES

To critically analyze evidence regarding concurrent sleep patterns or changes in care recipient-caregiver dyads in the context of a chronic illness and address methodological and research gaps.

METHODS

Using a wide range of key terms and synonyms, three electronic databases (Medline, CINAHL, and Embase) were systematically searched for the period between January 1990 and July 2011.

RESULTS

Ten studies met prespecified selection criteria and were included for analysis. Study quality was fair to good on average. Seven studies were conducted in the context of dementia or Parkinson's disease, two in the context of cancer, and one study included a group of community elders with mixed related comorbidities and their informal caregivers. Bidirectional associations in the sleep of care recipient-caregiver dyads seem to exist. Concurrent and comparable nocturnal sleep disruptions also may be evident. Yet, inconsistencies in the methods implemented, and the samples included, as well as uncertainty regarding factors coaffecting sleep, still preclude safe conclusions to be drawn on.

CONCLUSION

The dyadic investigation of sleep is a promising approach to the development of truly effective interventions to improve sleep quality of care recipients and their caregivers. Nevertheless, more systematic, longitudinal dyadic research is warranted to augment our understanding of co-occurrence and over time changes of sleep problems in care recipient-caregiver dyads, as well as to clarify covariates/factors that appear to contribute to these problems within the dyad and across time and context of illness.

Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study

Background

While the evidence-base concerning the economic impact of cancer for patients and their families/carers has grown in recent years, there is little known about how emotional responses to cancer influence this economic impact. We investigated the economic costs of cancer in the context of patients’ emotions and how these both shaped the patient and family burden.

Methods

Health professionals from six hospitals invited patients diagnosed with colorectal cancer (ICD10 C18-C20) within the previous year to take part in the study. Semi-structured face-to-face interviews were conducted with patients and, where available, a family member. Interviews covered medical and non-medical costs incurred as a result of cancer and the impact of these on the lives of the patient and their family. Interviews were audio-recorded. Recordings were transcribed verbatim and these data were analysed qualitatively using thematic content analysis.

Results

Twenty-two patients with colorectal cancer (17 colon and 5 rectal; 14 women and 8 men) were interviewed; 6 were accompanied by a family member. Important cancer-related financial outlays included: travel and parking associated with hospital appointments; costs of procedures; increased household bills; and new clothing. Cancer impacted on employed individuals’ ability to work and depressed their income. The opportunity cost of informal care for carers/family members, especially immediately post-diagnosis, was a strong theme. All patients spoke of the emotional burden of colorectal cancer and described how this burden could lead to further costs for themselves and their families by limiting work and hindering their ability to efficiently manage their expenses. Some patients also spoke of how economic and emotional burdens could interact with each other. Support from employers, family/carers and the state/health services and patients’ own attitudes influenced this inter-relationship.

Conclusions

The economic impact of colorectal cancer on patients and their families is complex. This study suggests that the economic costs and the emotional impact of cancer are often related and can exacerbate each other, but that various factors can meditate this inter-relationship.

Informal caregiving in Hematopoietic Blood and Marrow Transplant patients

PURPOSE

Hematopoietic cell transplant patients are among the most vulnerable and acutely ill cancer populations (Bevans et al., 2008). The responsibility of caring for the daily physical and psychosocial needs of these patients after transplant is placed mostly on family caregivers (Williams, 2007). The purpose of this descriptive correlational research study was to describe caregiving experiences of 56 caregivers of HCT patients 3-12 months following transplant. METHODS & SAMPLE: Patients and caregivers were recruited from two west coast regional transplant programs in the United States. Variables studied were: relationship quality, rewards of caregiving, predictability, role strain, patient function, caregiving activities, and caregiver quality of life (QOL).

KEY RESULTS

Results indicated that all areas of role strain are significantly negatively correlated with caregiver's QOL. Predictability was negatively associated with problem solving and emotional strain indicating that as the level of predictability of the situation decreases, caregiver strain and problem solving increase. Predictability was positively correlated to caregiver QOL indicating that as the situation is more predictable caregiver QOL increases. Emotional strain, problem-solving strain, and usual care strain were significantly positively related, indicating that emotional strain and problem-solving strain increased together. As usual care strain increased, so did problem-solving strain and emotional strain.

CONCLUSIONS

Suggestions for interventions include assessing and responding to caregiver issues such as emotional strain, problem-solving strain, usual care strain, unpredictability, and QOL. Examples of caregiver-focused interventions include providing timely appropriate information about these caregiver concerns including elements that make the caregiving situation predictable, and incorporating best practices for preventing and minimizing caregiver emotional strain.