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Larsen MK, Schultz H, Mortensen MB, Birkelund R. Decision making in the oesophageal cancer trajectory a source of tension and edginess to patients and relatives: a qualitative study. Int J Qual Stud Health Well-being 2023; 18:2170018. [PMID: 36727528 PMCID: PMC9897738 DOI: 10.1080/17482631.2023.2170018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The curative oesophageal cancer continuum-diagnosis, treatment and survivorship represents different phases with its own challenges for the involved parties. The process of treatment decisions and interactions between patients with oesophageal cancer (EC), relatives and health professionals is vital yet not well described. The purpose of the study was to explore patients' and relatives' experiences with the process of decision-making through the EC illness and treatment trajectory. METHODS Longitudinal explorative design was employed based on ethnographic fieldwork in the form of participant observations inspired by the American anthropologist James Spradley. RESULTS Sixteen patients and 18 relatives were recruited for participant observations. In total, 184 hours of participant observations were conducted. The study showed that decision-making was filled with tension and edginess. Four themes were identified: 1) The encounter with the medical authority, 2) The need to see the big picture in the treatment trajectory, 3) A predetermined treatment decision, and 4) Meeting numerous different health professionals. CONCLUSION The EC trajectory and decision-making were filled with anxiety. Patients and relatives lacked an overview of the treatment pathway, leading to their role in decision-making often being governed by the medical authority. Timing information and continuity are vital factors in decision-making.
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Affiliation(s)
- Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark,CONTACT Malene Kaas Larsen Department of Surgery, Odense University Hospital, J.B. Winsløws Vej 4, Odense C5000, Denmark
| | - Helen Schultz
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Regner Birkelund
- Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark,Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
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Anderson R, Cooper M, Steffen EM. Cancer patients' experiences of moments of relational depth during psychological therapy: a qualitative study. J Psychosoc Oncol 2023; 41:704-720. [PMID: 36876598 DOI: 10.1080/07347332.2023.2184741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Research into psychological interventions for cancer patients has focused on the effectiveness of different treatment methods. Investigating common factors across treatments, such as qualities within the therapeutic relationship, has been neglected. This study explores cancer patients' experiences of moments of profound contact and engagement with their therapist, including any perceived impact. METHODS Semi-structured interviews were conducted with ten cancer patients. Eight participants reported having experienced moments of relational depth. Their transcripts were analyzed using thematic analysis. FINDINGS Five themes were identified: "Being physically and psychically vulnerable," "Being rescued from the waves," "Experiencing the calm after the storm," "More than a feeling," and "The therapist as 'a stranger and not a stranger'." CONCLUSION Both novice and experienced practitioners should be aware of the potential power of moments of relational depth for cancer patients: to normalize patients' increased vulnerability and emotionality, and to manage breaks and endings with relational sensitivity.
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Rha SY, Song SK, Lee J. Self-efficacy for coping with cancer and quality of life in advanced gastric cancer patients. Eur J Oncol Nurs 2022; 58:102120. [DOI: 10.1016/j.ejon.2022.102120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 12/09/2022]
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Taleghani F, Ehsani M, Farzi S, Farzi S, Adibi P, Moladoost A, Shahriari M, Tabakhan M. Nutritional challenges of gastric cancer patients from the perspectives of patients, family caregivers, and health professionals: a qualitative study. Support Care Cancer 2021; 29:3943-3950. [PMID: 33392766 DOI: 10.1007/s00520-020-05951-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to explore the perceptions of gastric cancer patients, their family caregivers, physicians, and nurses of nutritional challenges. METHODS Using a descriptive qualitative method, this study was conducted in 2019-2020. Twenty participants (6 patients, 6 family caregivers, 3 physicians, and 5 nurses) were selected through purposive sampling. Data was collected through in-depth semi-structured interviews and examined using qualitative content analysis. RESULTS Data analysis revealed three categories, each with two subcategories: eating, an unpleasant experience that contains "a feeling like hyperemesis gravidarum" and "childish food excuses"; flexibility while adhering to a proper diet, which consists of "dietary dos and don'ts" and "nutritional leniency"; and nutrition with distress that contains "patient's sense of being an extra burden" and "provision of nutrition with suffering in caregivers." CONCLUSION Because of the significant physical and psychological impact of nutritional problems on patients and their caregivers, the need to provide care and education to these patients and their families using a multidisciplinary team is becoming more important.
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Affiliation(s)
- Fariba Taleghani
- Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Ehsani
- Nursing Care Research Center, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Farzi
- Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Saba Farzi
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Gastroenterology and Hepatology Department of Internal Medicine, School of Medicine, Integrative Functional Gastroenterology Research Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Moladoost
- Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Mohsen Shahriari
- Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Tabakhan
- Omid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Larsen MK, Birkelund R, Mortensen MB, Schultz H. Undertaking responsibility and a new role as a relative: a qualitative focus group interview study. Scand J Caring Sci 2020; 35:952-961. [PMID: 33089551 DOI: 10.1111/scs.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Being a relative of a patient with oesophageal cancer can evoke strong emotions and uncertainty about the future. As a consequence of the treatment course for oesophageal cancer and an increase in outpatient treatment, relatives are becoming increasingly responsible for patients' physical and emotional care. There is a lack of research exploring relatives' experiences with illness, treatment and decision-making. AIMS AND OBJECTIVES To explore relatives' experiences with illness, treatment of the patient and decision-making in the context of oesophageal cancer. DESIGN A qualitative explorative design was chosen. METHODS We conducted two focus group interviews with 11 relatives. The analysis was based on Ricoeur's theory of interpretation. RESULTS Throughout illness and treatment, relatives faced the fear of loss, leading to distress and anxiety. Relatives were simultaneously taking responsibility and asserting a new role during treatment as they regarded treatment as a joint affair. Regarding decision-making, relatives positioned themselves on the sidelines, awaiting the authority of the patients and healthcare professionals to give them space for participation. CONCLUSION Relatives of patients with oesophageal cancer undergoing treatment are suppressing their anxiety and doubt about the future. As they are undertaking responsibility during treatment, they are claiming control in new areas, which leads to changing roles within the family. However, they do not feel empowered in decision-making because they recognise patients' decision-making authority. This study highlights the complexity of balancing patients' authority with acknowledgement of relatives' role as active collaborators.
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Affiliation(s)
- Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Regner Birkelund
- Lillebaelt Hospital - University Hospital of Southern Denmark & Institute of Regional Health Research, Vejle, Denmark.,University of Southern Denmark, Odense M, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Helen Schultz
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
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Haste A, Lambert M, Sharp L, Thomson R, Sowden S. Patient experiences of the urgent cancer referral pathway-Can the NHS do better? Semi-structured interviews with patients with upper gastrointestinal cancer. Health Expect 2020; 23:1512-1522. [PMID: 32989907 PMCID: PMC7752202 DOI: 10.1111/hex.13136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Timeliness is viewed as a key feature of health‐care quality. Internationally, this is challenging. In England, cancer waiting time targets are currently not being met. For example, between 2015 and 2018 only 71% of patients with upper gastrointestinal (UGI) cancer started treatment within the recommended 62 days of referral. Objective We explored patients’ experiences to identify areas for service improvement. Design Semi‐structured interviews were conducted. Setting and participants Twenty patients who were referred through the urgent (two‐week) GP referral route and were within six months of receiving first treatment were recruited. Data analysis Data from the interviews were analysed thematically. Results Four themes were developed: organization of care; diagnosis; support; and views and expectations of the NHS. Patients described cross‐cutting issues such as complex and varied pathways and uncertainty about what would happen next. They felt daunted by the intensity and speed of investigations. They were presented with a recommended course of action rather than options and had little involvement in decision making. They were grateful for care, reluctant to complain and resigned to the status quo. Discussion and conclusions In order to meet patient needs, the NHS needs to improve communication and streamline pathways. Future cancer pathways also need to be designed to support shared decision making, be truly person‐centred and informed by patient experience.
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Affiliation(s)
- Anna Haste
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Mark Lambert
- Public Health England, North East Centre, Newcastle, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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7
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Larsen MK, Birkelund R, Mortensen MB, Schultz H. Being a relative on the sideline to the patient with oesophageal cancer: a qualitative study across the treatment course. Scand J Caring Sci 2020; 35:277-286. [PMID: 32271481 DOI: 10.1111/scs.12845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/19/2020] [Accepted: 03/11/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Being a relative of patients with oesophageal cancer or cancer in the oesophageal junction is stressful, as the healthcare system often overlooks concerns about the future as well as the roles and needs of relatives. There is a lack of research addressing relatives' experiences, roles and needs for participation in decisions. AIMS AND OBJECTIVES To explore relatives' experiences before the start of treatment and their subsequent roles and needs for participation in treatment decisions. DESIGN A qualitative approach based on a phenomenological - hermeneutical methodology was used. METHODS Data consisted of participant observations and semi-structured interviews with 19 relatives of patients with oesophageal cancer. We analysed data with inspiration from Ricœur's theory of interpretation. RESULTS The relatives were fellow sufferers, experiencing uncertainties and fear for the future with the patients, but they were simultaneously a challenged anchor during a difficult time, actively involved in handling the diagnosis and the everyday life. The relatives were positioned on the sideline both by the professionals and by themselves; they took a passive and subordinate part in decisions. CONCLUSION Relatives are central to cancer care and treatment. Adequate and timely information is imperative for relatives as well for patients in order to facilitate shared decision-making. We advocate for a new approach to relatives in order to prepare the relatives for their roles and support their individual needs but also to acknowledge relatives' knowledge about everyday life from the relatives' perspective.
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Affiliation(s)
- Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Regner Birkelund
- Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Helen Schultz
- Department of Surgery, Odense University Hospital, Odense C, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
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8
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Sandén U, Nilsson F, Thulesius H, Hägglund M, Harrysson L. Cancer, a relational disease exploring the needs of relatives to cancer patients. Int J Qual Stud Health Well-being 2020; 14:1622354. [PMID: 31122166 PMCID: PMC6534208 DOI: 10.1080/17482631.2019.1622354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: In this qualitative interview study we investigated the experiences of family members to cancer patients. Our objective was to explore and to differentiate their needs from the needs of cancer patients. Methods: Five focus groups and six individual narrative interviews with 17 family members to cancer patients in Sweden were conducted and compared with 19 cancer patient interviews. Our analysis was inspired by classic grounded theory. Results: Family members to cancer patients expressed own morbidity connected to high stress levels and difficulties in recognizing own stress due to ongoing comparisons with the cancer patient. Family members were trapped in a momentary terror-like situation where they became their sick relative’s safety net. A percieved inability to improve their loved one’s well being contributed to a feeling of guilt. The longing for it all to end was encumbered with shame since the end included possible death. Conclusions: By recognizing cancer as a disease striking both body and relationships, family members are given precedence over their own struggles, differentiated from the patient’s experiences. We define differences in needs between cancer patients and family members. Family members to cancer patients may be supported in developing balancing strategies towards less stress, increased safety and moments of contentment.
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Affiliation(s)
- Ulrika Sandén
- a Department of Design sciences , Lund University , Lund , Sweden
| | - Fredrik Nilsson
- a Department of Design sciences , Lund University , Lund , Sweden
| | - Hans Thulesius
- b Research and Development Kronoberg and Linnaeus University , Växjö , Sweden
| | - Maria Hägglund
- c Department of Women's and Children's Health , Uppsala University and Uppsala University Hospital , Uppsala , Sweden
| | - Lars Harrysson
- d School of Social Work , Lund University , Helsingborg , Sweden
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9
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Graham-Wisener L, Hanna J, Collins L, Dempster M. Psychological adjustment in patients post-curative treatment for oesophageal cancer: a longitudinal interview study. Psychol Health 2019; 34:901-921. [PMID: 30939933 DOI: 10.1080/08870446.2019.1579910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Oesophageal cancer is an increasingly prevalent disease with a demanding post-curative treatment recovery period and sustained longer-term effects. Although post-curative treatment is a key transitionary period, the process of psychological adjustment for the individual is under-researched which limits the evidence base to inform supportive care. The aim of this study was to understand the process of adjustment for oesophageal cancer patients post-curative treatment, in particular the beliefs participants hold regarding their condition and how these are appraised against their experience. Design: Serial interviews were undertaken with six oesophageal cancer patients who have recently completed curative treatment, at baseline and at 6-month follow-up using interpretative phenomenological analysis. Results: The findings demonstrate an effortful process of adjustment, including recognising and accepting a changed self, fostering control beliefs over the course of the illness and physical sequelae, searching for meaning, developing illness coherence and moving away from self-blame. Conclusions: This study is the first to utilise a longitudinal qualitative design in oesophageal cancer, and provides an understanding of post-treatment adjustment over time for this clinical population through which to inform clinical practice and service development.
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Affiliation(s)
- Lisa Graham-Wisener
- a School of Psychology, Queen's University Belfast , Belfast , Northern Ireland
| | - Julie Hanna
- b Belfast Health and Social Care Trust , Belfast City Hospital , Belfast , Northern Ireland
| | - Louise Collins
- b Belfast Health and Social Care Trust , Belfast City Hospital , Belfast , Northern Ireland
| | - Martin Dempster
- a School of Psychology, Queen's University Belfast , Belfast , Northern Ireland
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Cowley A, Evans C, Bath-Hextall F, Cooper J. Patient, nursing and medical staff experiences and perceptions of the care of people with palliative esophagogastric cancer: a systematic review of the qualitative evidence. ACTA ACUST UNITED AC 2018; 14:134-166. [PMID: 27846123 DOI: 10.11124/jbisrir-2016-003168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Esophagogastric cancer is the fifth most common malignancy and its incidence is increasing. The disease progresses quickly and five-year survival rates are poor. Treatment with palliative intent is provided for the majority of patients but there remains a lack of empirical evidence on the most effective service models to support esophagogastric cancer patients. OBJECTIVES The overall objective of this systematic review was to synthesize the best available evidence on the experiences and perceptions of patients and health professionals with regard to the care of people diagnosed with palliative esophagogastric cancer. INCLUSION CRITERIA TYPES OF PARTICIPANTS The review considered studies that included patients diagnosed with palliative esophagogastric cancer and any health professionals involved in the delivery of palliative care to this patient group in a hospital, home or community setting. PHENOMENA OF INTEREST The review considered studies that investigated the experiences and perceptions of people diagnosed with palliative esophagogastric cancer and staff working with these people. CONTEXT Studies that were carried out in any setting, including in-patient and outpatient areas, specialist cancer and non-specialist palliative care services and those were any patient were in receipt or had experiences of palliative care services were considered. All types of health practitioners delivering palliative care to esophagogastric cancer patients were considered. TYPES OF STUDIES Studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, feminist research and narrative approaches were considered. Mixed methods studies were considered in the review only if qualitative findings were reported separately. SEARCH STRATEGY A three-step search strategy was utilized. A total 11 databases were searched for studies from 2000 onward, followed by hand searching of reference lists. METHODOLOGICAL QUALITY Methodological quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool (JBI-QARI). DATA EXTRACTION Qualitative findings were extracted using the JBI-QARI data extraction Instrument. DATA SYNTHESIS Qualitative research findings were pooled using a pragmatic meta-aggregative approach. RESULTS The review included two publications. There were 46 findings which were aggregated into four categories and one overall synthesized finding: "In addition to support for physical needs, patients need support that takes into account changing life situations to achieve the best quality of life." CONCLUSIONS The review shows that patients value services and support that addresses their complex, fluctuating and highly individual needs. No evidence was uncovered regarding how these services should be designed and delivered.
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Affiliation(s)
- Alison Cowley
- 1Nottingham University Hospitals NHS Trust, Nottingham, UK 2School of Health Sciences, University of Nottingham 3The Nottingham Centre for Evidence-based Healthcare: a Joanna Briggs Institute Centre of Excellence, Nottingham, UK
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11
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Lewis L, Marcu A, Whitaker K, Maguire R. Patient factors influencing symptom appraisal and subsequent adjustment to oesophageal cancer: A qualitative interview study. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28857296 DOI: 10.1111/ecc.12745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 02/06/2023]
Abstract
Oesophageal cancer (EC) is characterised by vague symptoms and is often diagnosed at an advanced stage, leading to poor outcomes. Therefore, we aimed to investigate whether there might be any patient factors contributing to delay in EC diagnosis, and focused on the symptom appraisal and help-seeking strategies of people diagnosed with EC in the UK. Semi-structured interviews were conducted with 14 patients aged >18 years with localised EC at point of diagnosis. Purposive sampling was used to include patients from 1 to 9 months post-diagnosis. Analysis of the interviews identified three main themes: Interpreting symptoms, Triggers to seeking help and Making sense of an unfamiliar cancer. Findings suggested that participants normalised symptoms or used previous health experiences as a means to interpret their symptoms. The majority of participants were not alarmed by their symptoms, mainly because they had very little knowledge of EC specific symptoms. Lack of knowledge also influenced participants' sense-making of their diagnosis. The findings highlight that the process of symptom appraisal in EC is likely to be inaccurate, which may hinder early presentation and thus diagnosis. Public health campaigns communicating EC specific symptoms, however, could shorten the appraisal period and lead to earlier diagnosis.
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Affiliation(s)
- Liane Lewis
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Afrodita Marcu
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Katriina Whitaker
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Roma Maguire
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
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12
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Metta E, Bailey A, Kessy F, Geubbels E, Haisma H. Illness experiences of diabetes in the context of malaria in settings experiencing double burden of disease in southeastern Tanzania. PLoS One 2017; 12:e0178394. [PMID: 28542578 PMCID: PMC5444834 DOI: 10.1371/journal.pone.0178394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 05/12/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tanzania is doubly burdened with both non-communicable and infectious diseases, but information on how Tanzanians experience the co-existence of these conditions is limited. Using Kleinman's eight prompting questions the study synthesizes explanatory models from patients to describe common illness experiences of diabetes in a rural setting where malaria is the predominant health threat. METHODS We conducted 17 focus group discussions with adult members of the general community, diabetes patients, neighbours and relatives of diabetes patients to gain insight into shared experiences. To gain in-depth understanding of the individual illness experiences, we conducted 41 in-depth interviews with malaria or diabetes patients and family members of diabetes patients. The analysis followed grounded theory principles and the illness experiences were derived from the emerging themes. RESULTS The illness experiences showed that malaria and diabetes are both perceived to be severe and fatal conditions, but over the years people have learned to live with malaria and the condition is relatively manageable compared with diabetes. In contrast, diabetes was perceived as a relatively new disease, with serious life-long consequences. Uncertainty, fear of those consequences, and the increased risk for severe malaria and other illnesses impacted diabetes patients and their families' illness experiences. Unpredictable ailments and loss of consciousness, memory, libido, and functional incapability were common problems reported by diabetes patients. These problems had an effect on their psychological and emotional health and limited their social life. Direct and indirect costs of illness pushed individuals and their families further into poverty and were more pronounced for diabetes patients. CONCLUSION The illness experiences revealed both malaria and diabetes as distressing conditions, however, diabetes showed a higher level of stress because of its chronicity. Strategies for supporting social, emotional, and psychological well-being that build on the patient accounts are likely to improve illness experiences and quality of life for the chronically ill patient.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Ajay Bailey
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | | | | | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
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13
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Hellstadius Y, Lagergren J, Zylstra J, Gossage J, Davies A, Hultman CM, Lagergren P, Wikman A. Prevalence and predictors of anxiety and depression among esophageal cancer patients prior to surgery. Dis Esophagus 2016; 29:1128-1134. [PMID: 26542282 DOI: 10.1111/dote.12437] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aims to establish the prevalence and predictors of anxiety and depression among esophageal cancer patients, post-diagnosis but prior to curatively intended surgery. This was a cross-sectional study using data from a hospital-based prospective cohort study, carried out at St Thomas' Hospital, London. Potential predictor variables were retrieved from medical charts and self-report questionnaires. Anxiety and depression were measured prior to esophageal cancer surgery, using the Hospital Anxiety and Depression Scale. Prevalence of anxiety and depression was calculated using the established cutoff (scores ≥8 on each subscale) indicating cases of 'possible-probable' anxiety or depression, and multivariable logistic regression analyses were performed to examine predictors of emotional distress. Among the 106 included patients, 36 (34%) scored above the cutoff (≥8) for anxiety and 24 (23%) for depression. Women were more likely to report anxiety than men (odds ratio 4.04, 95% confidence interval 1.45-11.16), and patients reporting limitations in their activity status had more than five times greater odds of reporting depression (odds ratio 6.07, 95% confidence interval 1.53-24.10). A substantial proportion of esophageal cancer patients report anxiety and/or depression prior to surgery, particularly women and those with limited activity status, which highlights a need for qualified emotional support.
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Affiliation(s)
- Y Hellstadius
- Surgical Care Science, Karolinska Institutet, Stockholm, Sweden
| | - J Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.,Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Zylstra
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.,Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Gossage
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.,Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Davies
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.,Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C M Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - P Lagergren
- Surgical Care Science, Karolinska Institutet, Stockholm, Sweden.,Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
| | - A Wikman
- Surgical Care Science, Karolinska Institutet, Stockholm, Sweden.,Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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14
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Malmström M, Klefsgard R, Ivarsson B, Roman M, Johansson J. Quality of life measurements as an indicator for timing of support after oesophagectomy for cancer: a prospective study. BMC Health Serv Res 2015; 15:96. [PMID: 25890232 PMCID: PMC4409990 DOI: 10.1186/s12913-015-0747-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 02/17/2015] [Indexed: 11/12/2022] Open
Abstract
Background Oesophagectomy is a major procedure with known side effects and reduced postoperative quality of life (QOL). It has been shown that support of patients in their new life situation is often lacking. Knowledge about how QOL changes over time is fundamental for addressing patient needs and for determining the optimal timing of supportive care. The aim of this study was to identify QOL changes over time as well as factors that may impact patient QOL during the first year after oesophagectomy for cancer. Methods Patients operated on for adenocarcinoma or squamous cell cancer of the oesophagus were included in this study. Seventy-nine patients completed the European Organisation for Research and Treatment of Cancer QOL questionnaires (QLQ-C30 and QLQ-OES18) before and 2, 4, 6, 9, and 12 months after surgery. A general linear model with repeated measurement analysis of variance was used for statistical testing. Results There was a significant QOL nadir at 2 months compared to 12 months after surgery (QLQ-C30 function scales p < 0.001, symptom scales p < 0.001, QLQ-OES18 scales p < 0.001). Treatment with proton-pump inhibitors was associated with enhanced QOL according to QLQ-C30 symptom scales (p = 0.003) and OES-18 scales (p = 0.015), but age, gender and American Society of Anaesthesiologists classification did not significantly impact QOL. Conclusions Patient QOL is severely hampered the first year after oesophagectomy for cancer, with a nadir at 2 months after surgery. Treatment with proton-pump inhibitors improved patient responses to symptom scales. Evidence of severely affected QOL after surgery indicates that these patients need support at an early stage after surgery. These results can be used by healthcare professionals to develop a postoperative supportive-care programme that is timed and better optimised to meet patient needs. Trial registration: EudraCT database 2009-009997-28.
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Affiliation(s)
- Marlene Malmström
- Clinical Sciences, Lund University, Lund, Sweden. .,Department of surgery, Skane University Hospital, Lund, Sweden.
| | | | - Bodil Ivarsson
- Clinical Sciences, Lund University, Lund, Sweden. .,Department of cardio-thoracic surgery, Skane University Hospital, Lund, Sweden.
| | - Maria Roman
- Department of surgery, Skane University Hospital, Lund, Sweden.
| | - Jan Johansson
- Clinical Sciences, Lund University, Lund, Sweden. .,Department of surgery, Skane University Hospital, Lund, Sweden.
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Malmström M, Ivarsson B, Johansson J, Klefsgård R. Long-term experiences after oesophagectomy/gastrectomy for cancer—A focus group study. Int J Nurs Stud 2013; 50:44-52. [DOI: 10.1016/j.ijnurstu.2012.08.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 07/23/2012] [Accepted: 08/13/2012] [Indexed: 11/24/2022]
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16
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Hit by waves-living with local advanced or localized prostate cancer treated with endocrine therapy or under active surveillance. Cancer Nurs 2011; 33:382-9. [PMID: 20562621 DOI: 10.1097/ncc.0b013e3181d1c8ea] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies of living with prostate cancer have shown that the illness and the treatment cause physical as well as psychosocial problems. OBJECTIVE The aim of this study was to illuminate men's experiences living with localized or local advanced prostate cancer when curative treatment such as surgery or radiation therapy is not an option at the time of diagnosis. METHODS The study was conducted via qualitative interviews, using a phenomenological hermeneutic approach. Ten men treated with endocrine therapy or under active surveillance were interviewed. RESULTS Being diagnosed with prostate cancer was described as a shock, with different aspects of the illness revealed gradually. The limited amount of time available for meeting with health care providers contributed to patients' feelings of being left alone with difficulty getting information and help. Sexual and urinary problems were perceived as a threat to their manhood. The spouses provided the closest everyday support. CONCLUSION The life situation of these patients can be understood as living in a "state of readiness," expecting something to happen regarding their illness, and not always knowing where to get help. IMPLICATIONS FOR PRACTICE The results confirm existing knowledge of patient's experiences in living with prostate cancer regarding the initial shock perceived by the patients, the bodily alterations, and the important role of their spouses. Nurses, as well as general practitioners, must play a more active role in follow-up to ensure that the men and their spouses receive better help and support.
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Folke S, Paulsson G, Fridlund B, Söderfeldt B. The subjective meaning of xerostomia—an aggravating misery. Int J Qual Stud Health Well-being 2009. [DOI: 10.3109/17482620903189476] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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