Tapestry: a retreat program of support for persons living with cancer

Oncology Couples' Retreats: A Focus on Relationships Between Patients and Their Caregivers

A cancer diagnosis not only affects multiple aspects of a patient's life, but can also have a significant impact on the caregiver, who is often the spouse as well. Beginning in 2012, the Johns Hopkins Gastrointestinal Oncology group has organized a couples' retreat program to help address the concerns of oncology patients as well as their caregivers in a safe and closed environment. These retreats are disease-site specific and include 10 to 12 couples with metastatic or locally advanced pancreatic or colorectal cancer. The program includes a multidisciplinary approach over 3 days and includes meals, activities, and lodging. Couples are encouraged to engage with each other as well as other couples enduring a similar journey in an effort to help them relate and express concerns and questions they may have. Sessions include topics by medical professions such as treatments and symptom management as well as sessions by additional professionals to address other practical needs related to the diagnosis, such as finances and advance directives. These retreats have shown that both patients and caregivers appreciate the opportunity to discuss their feelings with others and subsequently feel less uncertainty about their future. They have also been beneficial to the health-care professionals participating to gain knowledge on which activities as a whole are important to these populations. Data are extremely limited for programs such as these, but we are hopeful they will continue to help support these populations of oncology patients and their caregivers through a very difficult portion of their lives.

Feasibility of a psychosocial rehabilitation intervention to enhance the involvement of relatives in cancer rehabilitation: pilot study for a randomized controlled trial

BACKGROUND

Cancer often affects the quality of life and well-being of patients as well as their relatives. Previous studies have suggested that relatives should be involved in psychosocial rehabilitation to address the needs for an interpersonal relationship with others in the disease trajectory. We developed an innovative rehabilitation program to be offered to the patient and a relative as a pair.

OBJECTIVE

The aim of the present pilot study was to examine the feasibility of the intervention in a randomized controlled trial (RCT) and to evaluate the impact on quality of life.

METHODS

The study was designed as an RCT comparing the new multimodal psychosocial rehabilitation with the usual services. The intervention comprised three 'supportive talks' and a residential rehabilitation course. From March 2010 to March 2011, participation was offered at the time of diagnosis to patients with lung or gynecological cancer from two departments at Odense University Hospital in Denmark. Questionnaires were used to estimate changes in quality of life (EORTC-QLQ-C30 on global health status) and well-being (WHO-Five Well-Being Index) at baseline and after 2 and 12 months. Information on the participants' views about the rehabilitation intervention was obtained from assessment charts and qualitative interviews.

RESULTS

A total of 209 patients were assessed for eligibility, but only 42 pairs were randomized to the study. The 2-month follow-up was completed by 34 patients and 32 relatives, and 19 patients and 21 relatives completed the 12-month follow-up. A higher dropout rate at the 12-month follow-up was reported in the intervention group compared with controls. Quality of life and well-being increased for patients and relatives in both the intervention and the control group, and no clinically significant difference was observed between the intervention and the control group. Pairs reported that the time of inclusion was inconvenient and that rehabilitation ought to meet their changing needs.

CONCLUSIONS

The pilot study showed that it may be difficult to conduct an RCT of a psychosocial rehabilitation intervention for pairs, and difficulties with inclusion and drop out have to be addressed. Interventions need to be carefully developed and tested before evaluating an effect in a large-scale study.

The ritualization of rehabilitation

There is widespread and increasing political interest in devising plans to support people who have or have had cancer to recover and recommence 'normal' lives. Educating cancer patients for this purpose is a central element in cancer rehabilitation in both Europe and the United States. One of the challenges in intervention research pertaining to rehabilitation is how to measure and explain the effects of a particular rehabilitation program. The social processes of particular programs are often a 'closed box' and not taken into consideration methodologically or analytically. In this article, we unpack and explicate the 'closed box' of a particular cancer rehabilitation program in Denmark by drawing on approaches from the study of ritual. By analyzing rehabilitation as a ritual and as ritualization, we identify and conceptualize some of the transformative activities involved in cancer rehabilitation. We highlight the significance of the ritual site, its aesthetics, its exaggerations, and the social and temporal organization of the program.

Contributions of a retreat weekend to the healing and coping of cancer patients' relatives

Relatives play a key role in the daily support and care of cancer patients. This role, however, can negatively affect relatives physically, psychologically, emotionally, and spiritually, challenging their health and well-being. Consequently, this could inhibit relatives' abilities to continue in their roles as caregivers. Although various studies have examined different interventions for the relatives of cancer patients, no formal research has been published on the role that retreat weekends play in their cancer journeys. In this qualitative study we used semistructured interviews to explore the experiences of 8 relatives who attended a "Skills for Healing Retreat Weekend" in Ontario, Canada. The findings indicate that the retreat, in bringing people together to partake in discussions and activities, fostered a sense of community among the participants. The retreat also had enduring effects, contributing to relatives' ongoing processes of healing as well as providing them with strategies for coping in their roles as caregivers.

Recruitment and retention of palliative cancer patients and their partners participating in a longitudinal evaluation of a psychosocial retreat program

OBJECTIVE

The negative impact of a palliative cancer diagnosis on the quality of life of patients and their partners is well documented. Unfortunately, research on interventions to improve psychological and spiritual well-being of these couples has been considered impractical because of the deleterious influence of disease progression on participation. This study evaluated the feasibility of offering the Tapestry Retreat, an intensive psychosocial intervention for palliative care patients and their partners.

METHODS

Participants in the Tapestry Retreat included 15 patients with advanced breast, prostate, or colon cancer and their partners (n = 30). Also included was a natural history group consisting of 20 patients and their partners (n = 40). All couples completed questionnaires related to quality of life, distress, marital satisfaction, and existential concerns at baseline, after the retreat or 1 month after baseline, and then again at 3, 6, 9, and 12 months.

RESULTS

Patients in the Tapestry group were significantly more likely to be women who had received prior psychological support and were less comfortable with their finances. Partners attending the Tapestry retreat were also more likely to have received prior psychological support.

SIGNIFICANCE OF RESULTS

Despite issues with recruitment and retention, retreat participation was considered feasible. Recommendations for future research are discussed.

Perceived Need for Spiritual and Religious Treatment Options in Chronically Ill Individuals

The objective of the study was to examine the desire for spiritual and religious treatment options in chronically ill adults. Email interview data ( N = 12) generated themes for religion, spirituality, and desired treatments. The resultant questionnaire data ( N = 83) analysed the popularity of treatments. Thirty-five wide-ranging spiritual and religious treatment options were identified for use in the questionnaire; 47 per cent of the sample was interested in spiritual or religious treatments. There is a need for spiritual and religious treatment options, and translation of treatments into practice would assist coping for many people.

Tapestry: a retreat program of support for persons living with cancer

PURPOSE

In an effort to mitigate the negative psychological sequelae of a cancer diagnosis and cancer treatment, efforts have been made to explore a variety of psychosocial issues and interventions. This article describes the provision and preliminary evaluation of a novel psychosocial service delivery, a residential "retreat" program called Tapestry, which is run under the aegis of the established cancer care community in Alberta, Canada.

OVERVIEW

Retreat programs offer a novel way to provide psychosocial support for those persons who are living with cancer. The retreats are unique in the provision of a respite and the opportunity to address the isolation and other existential issues arising from a cancer diagnosis. The program described in this article has provided such a service six times per year since 1998. The intervention is described, and preliminary evaluation data are presented.

CLINICAL IMPLICATIONS

Cancer care has begun to move beyond a solely biomedical paradigm toward a more holistic ethos in service delivery and research orientation. While the face value of and demand for such programming continues to grow, few residential psychosocial programs are offered under the auspices of conventional cancer care centers, and little work has been done to examine the nature and possible efficacy of retreat programs as a valid forum for psychosocial service delivery.