Older people with incurable cancer: Existential meaning-making from a life-span perspective

Strategies of coping with existential concerns in educationally active older adults

OBJECTIVES

Old age is the stage of life when people are the most vulnerable to existential experience. These concerns intensify in late adulthood when individuals become increasingly prone to reflection and inclined to evaluate their lives. The study aimed to explore how older people who are active learners dealt with their existential concerns.

METHOD

The study was based on the qualitative approach and grounded theory. The data collection methods were narrative interviews and semi-structured interviews. Eighteen interviews were conducted. The narrators were students of Universities of the Third Age.

RESULTS

An in-depth analysis of the collected empirical material revealed three themes that helped us understand how study participants differentiated their ways of dealing with self-perception of aging, effectiveness, and performing developmental tasks. This also allowed us to distinguish three main strategies educationally active older adults used to cope with existential concerns: repression, escape, and engagement.

CONCLUSION

The study's results indicate that confrontation or avoidance of existential problems can be perceived as a factor contributing to developing an older person's identity in two different ways. On the one hand, the readiness to face existential concerns leads to maturity in old age, a high level of social adaptation, supporting others, and, at the same time, focusing on oneself while ignoring existential concerns, which may contribute to held age identities that are younger than actual age.

Prayer and meditation practices in the early COVID-19 pandemic: A nationwide survey among Danish pregnant women. The COVIDPregDK study

BACKGROUND

The emergence of the COVID-19 pandemic and the derived changes in maternity care have created stress and anxiety among pregnant women in different parts of the world. In times of stress and crisis, spirituality, including spiritual and religious practices, may increase.

OBJECTIVE

To describe if the COVID-19 pandemic influenced pregnant women's considerations and practises of existential meaning-making and to investigate such considerations and practices during the early pandemic in a large nationwide sample.

METHODS

We used survey data from a nationwide cross-sectional study sent to all registered pregnant women in Denmark during April and May 2020. We used questions from four core items on prayer and meditation practices.

RESULTS

A total of 30,995 women were invited, of whom 16,380 participated (53%). Among respondents, we found that 44% considered themselves believers, 29% confirmed a specific form of prayer, and 18% confirmed a specific form of meditation. In addition, most respondents (88%) reported that the COVID-19 pandemic had not influenced their responses.

CONCLUSION

In a nationwide Danish cohort of pregnant women, existential meaning-making considerations and practices were not changed due to the COVID-19 pandemic. Nearly one in two study participants described themselves as believers, and many practised prayer and/or meditation.

A grounded theory of resilience experiences of women with gynecological cancer

PURPOSE

The present study aims to develop an explanatory framework to gain a deeper understanding of the resilience process in women diagnosed with gynecological cancers.

METHOD

Informed by Salutogenesis Model, a Straussian-grounded theory study was conducted. In-depth interviews were conducted with 20 women with gynecological cancer between January and August 2022. Data were analyzed using open, axial, selective coding, and constant comparative methods.

RESULTS

The core category encapsulated that most women defined resilience as having a dynamic process that could be promoted throughout the process. However, they expressed that they needed "individual resources for resilience" and "generated resources by the supportive interventions" to be resilient. They emphasized that these resources should make the process manageable, meaningful, and comprehensible to promote resilience. Furthermore, they defined in detail which components should be included in supportive interventions. They stated "some reflections of resilience on their cancer process" and "life gains from the process."

CONCLUSION

This study developed a grounded theory that provides a guideline for healthcare professionals on how women could be encouraged to have resilience and what is the importance of resilience on women's cancer process and their lives. Salutogenesis may help to understand the resilience process in women with gynecological cancer and provides direction for how healthcare professionals should shape their clinical interventions to promote the resilience process.

Contemporary occupational priorities at the end of life mapped against Model of Human Occupation constructs: A scoping review

INTRODUCTION

People with end-of-life care needs are seen in an increasingly diverse range of health and community settings. Opportunity for continued occupational participation is highly valued by people at the end of life. This scoping review sought to identify the priorities and preferences for participation at the end of life and to map findings using the model of human occupation.

METHODS

A search strategy informed by the research question was developed in collaboration with a research librarian. Data sources used were Ovid Medline(R), CINAHL, Ovid Emcare, Scopus, Web of Science and PsychInfo. Studies that focused on clinician perspectives, clinical care, grief and loss, did not clearly identify end-stage diseases, <18 years and written in languages other than English were excluded.

FINDINGS

Forty-four studies were included with a total of 1,070 study participants. Inductively developed themes were mapped against the model of human occupation constructs of volition (personal causation, values, interests), habituation (habits of occupational performance and routine), performance capacity and the lived body within the physical, social and occupational environment. The majority of findings sat within the construct of volition, particularly around sense of personal capacity, self-efficacy and values. At the end of life, people prioritise ongoing engagement in valued occupations even if participation is effortful. As disease progresses, opportunity to exert influence and control over this participation and engagement increases in importance. Personal causation plays an important role in the experience of occupational participation at this time.

CONCLUSION

This review provides important insights into the occupational priorities of people at the end of life and the importance of supporting agency and volition at this time. The model of human occupation and its client-centred focus offer a framework for a more robust examination of ways to enhance volitional capacity and enable occupational participation for people at the end of life.

Online follow-up with a mobile device improves incurable cancer patients' coping - A qualitative study

PURPOSE

To examine patients' experiences regarding the impact of support given by a mobile application on their ability to cope with incurable cancer.

METHOD

The qualitative research data of semi-structured, face-to-face interviews with 20 adult patients suffering from incurable cancer during disease-controlling chemotherapy or palliative care were analysed with inductive content analysis.

RESULTS

The majority of the interviewees viewed the mobile application as helpful for monitoring relevant symptoms and coping with the disease. The patients' sense of security was increased by their ability to contact the clinic at all times. As a communication channel, the mobile application was seen as more convenient than the telephone, and it provided a sense of freedom for the patients as contacting the clinic was not tied to time or place. The patients also experienced as well increased involvement with their own care and had a sense of staying abreast with their treatment. A minority of the interviewees reported that there was a certain disease-centredness in using the mobile application.

CONCLUSIONS

The present study extends the knowledge of patients using a mobile application as a part of their cancer care and assesses of the acceptance of using this application to provide supportive care. The patients reported that they were better able to cope with the disease when using the mobile application, although some described it as being too disease centred. Overall, this study indicates that the patients' sense of security and freedom increased when using the mobile application.

Psychological resilience among palliative patients with advanced cancer: A systematic review of definitions and associated factors

OBJECTIVE

The palliative journey can be emotionally stressful for both patients with advanced cancer and their families. Psychological resilience is crucial in aiding with patients' adaptation and post-traumatic growth. The aim of this systematic review was to critically examine the definitions of psychological resilience and its associated factors in palliative patients with advanced cancer.

METHODS

Four databases were systematically searched from inception to August 2020. Both qualitative and quantitative studies that examined factors associated with psychological resilience in a sample of patients with advanced cancer undergoing palliative care were included.

RESULTS

A total of 15 studies met the criteria, of which 10 were qualitative and five were quantitative. Nine studies included a definition of psychological resilience, from which five common themes of buffering, adaptation, resources, recovery, and growth were derived. The quantitative studies found association between resilience and hope, independence, social support, fatigue, emotional distress, and coping strategies. The qualitative studies reported additional sources of resilience such as spirituality, social support, prior experience dealing with illness and life adversity, meaning-making, reconciling with life's finiteness, acceptance of illness, control, determination, positive attitude, dignity, engagement with palliative care and quality of life being supported by palliative care.

CONCLUSIONS

More research is needed for developing an overarching definition of psychological resilience in palliative advanced cancer patients that acknowledges and appreciates the contextual sensitivity of this concept among different cultural groups. Further studies are also needed to examine a holistic range of bio-psycho-socio-spiritual factors associated with psychological resilience among these patients and their families.

Loss of homeland: a qualitative study of the changes in perception of relocated Sichuan earthquake survivors with posttraumatic stress disorder

BACKGROUND

This research aims to explore the life experiences of relocated earthquake survivors with PTSD and develop a conceptual framework for understanding their life experiences.

METHOD

Interviews were conducted with twenty-three participants. The participant selection, data collection and analysis were based on grounded theory methodology. A theoretical model called "loss of homeland" was developed.

RESULTS

Loss of homeland was the most important condition that influenced the relocated participants' self-identity, social connections, and meaning system. These aspects were categorized into existential changes, lost connections, and changes in identity. Post-disaster relocation threatens individuals' sense of meaning, integrity of self, and sense of belonging, affects every aspect of everyday life and shatters their inner and outer harmony.

CONCLUSIONS

Further research guided by this theoretical model is needed to inform post-disaster mental health services and relocation policy. Mental health professionals and policy makers can make more informed decisions in terms of disaster relocation policy and manage post-disaster psychological disturbances by focusing on both places and people.

Do cancer patients use the term resilience? A systematic review of qualitative studies

PURPOSE

Resilience is a dynamic process of positive adaptation to adversity, including cancer. While the term is used frequently by researchers, controversy exists over its conceptualisation and little is known if and how cancer patients use the term resilience. We examined qualitative studies exploring cancer patient experiences/perceptions of resilience to understand: (a) definitions of resilience as identified by patients and researchers and (b) the themes relating to attributes of resilience as identified by patients.

METHODS

Four electronic databases (MEDLINE, PsycINFO, SCOPUS, and CINAHL) were searched from database inception to November 2017, identifying qualitative studies of adult cancer patients/survivors which included resilience and cancer in the title, abstract, or medical subject headings. Articles were excluded if resilience was not a theme or outcome or was discussed primarily in the context of non-individuals. Thematic analysis was used to code studies and generate analytical themes, and a single author identified definitions of resilience within the studies.

RESULTS

Five hundred and seventy-three non-duplicate citations were screened, resulting in 65 citations screened for full-text review. Of these, 33 were excluded, leaving 32 studies. Four thematic categories emerged; coping strategies, social support, spirituality, and growth, within which 79 individual themes were identified. Eight researcher definitions and no patient definitions of resilience were identified.

CONCLUSION

This review found no cancer patient definitions of resilience and that cancer patients are seldom quoted using the term resilience directly, instead identifying coping strategies, social support, growth, and spirituality as attributes associated with resilience.

Effectiveness of palliative care interventions offering social support to people with life-limiting illness-A systematic review

Individuals managing the challenges of life-limiting illness require adequate social support to maintain quality of life. Qualitative research reports that patients value highly the social support obtained in palliative care interventions such as day care and group therapies. This systematic review aims to summarise existing quantitative evidence on palliative care interventions that facilitate social support. Research literature was systematically searched using electronic databases and key journals. Searches returned a total of 6,247 unique titles of which sixteen were eligible for inclusion. Interventions include group therapies, group practical interventions and palliative day care. Outcome measures and study designs were heterogeneous. Only one study used a validated outcome measure of social support. Benefits were influenced by participant characteristics such as baseline distress. Partial economic evaluation was attempted by two studies. Methodological challenges include attrition and use of outcome measures that were insensitive to change. Statistically significant results were reported in psychological and physical domains. Evidence is limited due to methodological issues and a scarcity of quantitative research, particularly regarding long-term benefits and cost-effectiveness. Interventions may be more beneficial to some groups than others.

Evidence on selection, optimization, and compensation strategies to optimize aging with multiple chronic conditions: A literature review

The self-regulation strategies of selection, optimization, and compensation (SOC) can be effective in optimizing aging with multiple chronic conditions (MCC). Nineteen articles on the use and effects of SOC among older adults with chronic conditions were reviewed. The studies' quality, evaluated by the Mixed Methods Appraisal Tool, ranged from medium to high (Mean = 0.90, SD = 0.10). SOC were found to improve the symptom experience for older adults, resulting in better health outcomes such as increased daily living activities, subjective well-being, life success, fewer falls/sick days, and use of medication for pain control. For those with MCC, higher degree of disabilities, serious health events, and negative self-perceived aging undermined the relationships between SOC and long-term physical functioning, self-rated health, and life satisfaction. Aging can be optimized by identifying and improving older individuals' coping using SOC. Future studies should utilize better MCC measures for comorbidity and chronic disabling symptoms to investigate the influence of SOC on MCC-associated health outcomes.