The development of the 'Cancer Home-Life Intervention': An occupational therapy-based intervention programme for people with advanced cancer living at home

Making meaning of everyday life in the context of lung cancer treatment-a qualitative study of outpatients' perspectives

BACKGROUND

The increasing survival after a lung cancer diagnosis implies that patients live longer with the disease, which means that symptoms and side effects of the treatment become part of everyday life.

AIM

The study explored how older adults make meaning of everyday life when undergoing treatment for their lung cancer.

MATERIAL AND METHODS

A qualitative study using semi-structured interviews was conducted with 12 older adults with lung cancer undergoing various treatments. The analysis followed Giorgi's phenomenologic five-step method.

RESULTS

The analysis revealed three partly overlapping themes: meeting the health care system, losing identity, and struggling for meaning in everyday life. The patients appreciate clear and coherent communication at the oncology clinic. They had different needs for support from organised support groups, friends, communities, or relatives to make meaning of everyday life.

CONCLUSION

Creating meaning in everyday life is essential despite the disease and the treatments' side effects. Interpersonal relationships create meaningfulness in everyday life through a salutogenic perspective that makes everyday life comprehensible and manageable.

SIGNIFICANCE

The patients need an everyday life perspective on the disease and the side effects, which a salutogenic approach in the encounter with the health care system could support.

A resource-oriented intervention addressing balance in everyday activities and quality of life in people with advanced cancer: protocol for a feasibility study

Background

People with advanced cancer need to balance their resources and energy in order to experience enjoyment and quality of life in the time they have left. A resource-oriented intervention is developed targeting these aspects. The present protocol presents a feasibility study of this resource-oriented intervention in people with advanced cancer.

Methods

A feasibility study with a repeated-measurement design without a control group will be conducted at the research clinic of REHPA, the Danish Knowledge Center for Rehabilitation and Palliative Care. Data will be gathered at baseline, during and after a 5-day residential stay, after 6 weeks, during a 2-day follow-up stay and after 12 weeks. In total, 20–25 home-living adults (≥ 18 years) with advanced cancer reporting needs in everyday life will be recruited. The intervention consists of workshops and engagement in physical and creative everyday activities provided by a multidisciplinary team.

Outcome measures are quality of life, physical function and fatigue, which will be assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire Core-30. Balance in everyday activities will be assessed using the Occupational Balance Questionnaire.

Feasibility data will also be collected regarding (1) fidelity, (2) adherence, (3) dose and (4) reach and mechanisms of impact. For exploration of mechanism of impact, participant observations and focus group interviews will be used.

Discussion

This study presents a new approach in rehabilitation and palliative care aimed at supporting people with advanced cancer; instead of identification of problems, the present resource-oriented palliative rehabilitation intervention will target people’s resources, enhancing balance in everyday activities and underpinning enjoyment and quality of life. The results from the feasibility study can inform ways in which to support the everyday life of people with advanced cancer and thus have potential to improve their quality of life. The long-term perspectives are to evaluate the intervention in terms of effect, process and cost-effectiveness. This will provide evidence to adjust the content of rehabilitation and palliative care for this group of people.

Trial registration

NCT04772690

Name of the registry: Balance, Activity and Quality of Life (BAL)

Date of registry: February 26, 2021

Occupations creating joy for people living with advanced cancer: A qualitative descriptive study

Introduction

For people living with advanced cancer, the possibilities for experiences of joy are seriously influenced by the consequences of the illness. Due to the limited expected lifetime, the need to support such experiences that may entail joy and contribute to quality of life are of importance. Research shows that people with advanced cancer experience quality of life through occupations they are able to perform and enjoy. The aim of this study was to describe which occupations contribute to joy for people living with advanced cancer and explore how they reflect upon these occupations during an occupational therapy intervention.

Methods

In total, 111 people with advanced cancer from the intervention group in a randomised controlled trial participated in the present study. Thirty-six of these participants were interviewed, and for 10 participants, this was combined with participant observations. A directed and a conventional content analysis were applied.

Results

148 occupations contributing to joy were categorised into self-care, leisure and productivity. Most occupations were placed into leisure (89%). Participants had three distinct approaches to occupations contributing to joy: Finding solutions to maintain occupations contributing to joy; having an all or nothing approach; and hoping to resume occupations contributing to joy.

Conclusion

This study found a wide range of occupations contributing to joy and shows the importance of focusing on enabling leisure occupations for people living with advanced cancer. The wide range of occupations as well as participants’ approaches to occupations may be useful to inform future interventions to enable enjoyment for people living with advanced cancer.