Spouses' view during their partners' illness and treatment

Cuidando de Pacientes que Faleceram por Câncer de Mama: A Experiência dos Familiares

A assistência a pacientes com câncer avançado tem se constituído num desafio para os serviços de saúde e para os familiares. Assim, conhecer a experiência de familiares em relação a assistência domiciliar prestada a parentes que faleceram por câncer de mama constitui-se no principal objetivo deste estudo. Para tanto, foi solicitado, por carta, o consentimento para concessão de uma entrevista a familiares de 77 pacientes que haviam falecido por câncer de mama, em 1996, em quatro distritos do município de São Paulo. Foi-lhes informado, previamente, os objetivos da pesquisa e assegurado que as informações coletadas seriam tratadas de maneira sigilosa, preservando a identificação individual dos participantes. Obteve-se resposta positiva de familiares de 14 pacientes. O resultado da análise das entrevistas mostra que, de maneira geral, a experiência foi percebida como difícil e sofrida, devido à sensação de impotência perante a doença, falta de ter com quem compartilhar sentimentos e responsabilidades, e sobrecarga física e emocional. Constatou-se que o período de incapacidade total das pacientes variou de 15 dias a um ano, e as pessoas que assumiram seu cuidado foram, principalmente, as filhas e as irmãs. Destacaram, ainda, a necessidade de contar com suporte profissional, tanto para os aspectos técnicos do cuidado como para os psicossociais envolvidos na situação.

Serious illness conversations in patients with multiple myeloma and their family caregivers-A qualitative interview study

OBJECTIVE

Patients treated for multiple myeloma often suffer from anxiety and depression related to concerns about the future. This indicates a need for improvement of communication between patients and healthcare professionals within haematology. The aim of this study was to explore how patients with multiple myeloma and their caregivers experience serious illness conversation focusing on illness understanding, concerns, values, and wishes for the future.

METHODS

Phenomenological, semi-structured dyad interviews were carried out in patients with multiple myeloma (n = 12) and their caregivers (n = 11) 2-20 days after participation in one serious illness conversation. interpretive phenomenological analysis was used for analysing data.

RESULTS

Three themes emerged (1) transforming patient-caregiver communication, (2) redeeming communication, and (3) equality in communication in an unequal relation. Furthermore, time allocated for the conversation and preparatory materials for the conversations highly influenced outcome.

CONCLUSION

The findings suggest that serious illness conversation can help patients and family caregivers managing living life with multiple myeloma by increasing dyadic communication and strengthen their use of existential language together with healthcare professionals. This study highlights the benefits of preparing patients and caregivers prior to the conversation and cancer care systems should strive to allocate ample time for serious illness conversations.

Psychosocial Factors Related to the Correspondence of Recipient and Provider Perceptions of Social Support among Patients Diagnosed with or at Risk for Malignant Melanoma

This study examined considered perceptions of social support and factors contributing to increased support among 18 patients diagnosed with or at risk for malignant melanoma and their partners. Partner support, perceived stress, emotional approach coping and partner empathy were evaluated. Results showed lack of correspondence between patient and partner reports of support. Greater correspondence between reports was associated with increased patient emotional approach coping. Partners reported increased empathy following the patients’ diagnoses and more perceived stress than patients. Patients indicated greater use of emotional approach coping than their partners. Male partners reported engaging in less emotional expression than female partners. Interventions might incorporate partner participation to resolve misperceptions of support and to foster factors that promote increased support.

Support Efforts for Caregivers of Chronically Ill Persons

An increasing number of people today live with chronic diseases that affect their quality of life and that of their families. Health professionals confirm this finding based on their clinical interventions targeting families of chronically ill patients. The aim of this study was to describe and evaluate these interventions. A systematic literature review was conducted, including previous reviews and controlled studies from 1997 to 2007 of interventions targeting caregivers of adults with stroke, diabetes, cardiovascular disease, and cancer.Ten out of the 32 studies included found the interventions to have no effect, whereas effects were found in the other 22 studies in one or more areas, including burden, knowledge level, mastering skills, and satisfaction. The literature review concludes that the impact of these interventions is neither unique nor significant. The defined concepts of the randomized clinical studies appear problematic when implemented and underscore the importance of strict requirements on future randomized, controlled designs.

Psychological adjustment among partners of women at high risk of developing breast/ovarian cancer

PURPOSE

The aim of the current research was to characterize psychological adjustment among partners of women at high risk of developing breast/ovarian cancer and to explore the relationship between women's and partners' adjustment.

METHODS

A study of 95 unaffected at-risk women and 95 partners was carried out using mailed, self-administered questionnaires with validated measures of psychological outcome.

RESULTS

Elevated levels of distress were noted in up to 10% of partners. High monitoring coping style and greater perceived breast cancer risk for their wife were associated with higher distress levels for partners. However, communicating openly with their wife and the occurrence of a recent cancer-related event in the woman's family were related to lower distress for partners. Partners' cancer-specific distress was positively related to their wives' distress.

CONCLUSION

Among partners with elevated levels of distress, the ability to provide effective support to the at-risk women and participate appropriately in their decision making may be compromised. These partners are likely to benefit from targeted clinical interventions designed to reduce their distress levels. The findings emphasize the importance of considering partners of at-risk women in service provision and highlight the need for partners to obtain information and support specifically tailored to their needs.

Information to the relatives of people with ostomies: is it satisfactory and adequate?

PURPOSE

The aim of this study was to evaluate how relatives of patients with an ostomy rated the various aspects of care, how they perceived the quality of the care provided, and how they ranked their involvement in the care. Patients' satisfaction was also sought, particularly their perception of relatives' involvement.

DESIGN

Descriptive cross-sectional.

SETTINGS AND SUBJECTS

The study comprised a colostomy group (32 pairs) and an ileostomy group (28 pairs). All patients attended a stoma outpatient clinic.

METHODS

Quality of care was assessed using the identity-oriented dimension of the validated questionnaire Qualityof Care from the Patient's Perspective. Questionnaires were mailed to patients and their relatives.

RESULTS

Relatives and patients in both study groups considered most topics covered by the questionnaire to be important. Half of the patients with an ileostomy and their relatives and approximately 30% of those in the colostomy group were dissatisfied with the information they received, however. Moreover, a greater proportion (41-89%) of the patients were unhappy with the opportunities they were offered to participate in the decision-making process. Patients with an ileostomy and their relatives tended to be more dissatisfied with the quality of care than the colostomy group, but the difference was not statistically significant.

CONCLUSION

The topics covered by the questionnaire were considered important to both patients and their relatives. Information and counseling offered by the ET nurses and the colorectal surgeons were judged to be unsatisfactory, indicating the need for frequently assessing and improving general standards of quality of care.

Patient-reported family distress among long-term cancer survivors

Two quality of life studies at the University of Nebraska Medical Center and 3 similar studies in the nursing literature were compared regarding family distress to illness scores as reported by long-term cancer survivors. All studies were cross-sectional mail surveys and used City of Hope National Medical Center questionnaires. Participants represented a broad range of survivorship in terms of diagnosis and length of survival (range of means 3Y8 years). Single-item scores were compared among participants regarding the item "How distressing has your illness been for your family?" Significant levels of patient-reported family distress to illness were reported in all 5 studies. Patient survivors may have been able to recall past levels of significant family distress despite prolonged survival or they may have reported significant ongoing family distress as a result of their disease and treatment. Longitudinal assessment of patients' and families' quality of life is essential throughout survivorship. Future studies should identify and compare the types distress experienced by patient survivors and families over time and also measure the intensity of their distress. Interventions designed to meet their individual and collective needs, thereby decreasing their distress, are needed to improve quality of life for survivors and families.

Evidence on Spouse Responses to Illness as a Guide to Understanding and Studying Spouse Responses to Living Organ Donation

Although living kidney donors receive praise from friends and coworkers for their selflessness, recent studies report that members of the immediate family may not be as supportive. Reports of conflict surrounding living organ donation include divorce between the donor and the donor's spouse. The purpose of this review of the literature is to (1) discuss the spousal role when confronted with a partner's illness, (2) explore the current research describing the spouses of patients with heart disease and cancer, various transplant recipients, and living organ donors, and (3) identify the need for future research to explore the experiences and needs of the spouses of living kidney donors. Because the attitudes of donor family members, especially spouses, may affect the decision to donate and the satisfaction with recovery from donation surgery, it is critical to know how the spouses of living kidney donors view kidney donation. This knowledge may be instrumental in promoting family harmony and donor recovery and wellness.

Living after radical prostatectomy for localized prostate cancer: a qualitative analysis of patient narratives

The purpose of this study was to illuminate the experience of living after radical prostatectomy (RP) for localized prostate cancer (LPC). Ten men were interviewed after RP. The interview text was qualitatively analyzed using the content analysis. The men suffered from worry, anxiety, and distress, and longed for life as they had lived it before the diagnosis. Changes in bodily functions after RP include urine incontinence (UI) and/or erectile dysfunction (ED) making the patient feel like a changed man with a lost sex life, with changes in his intimate relations with his wife, and with lowered self-esteem. Most men choose to cope on their own. Coping strategies in our study population included finding new areas of interest and a new focus in the present. In the present study, living after RP meant striving to gain control over, and become reconciled with, the new life situation as a changed man living with an altered self.

Evaluation of the needs and concerns of partners of women at high risk of developing breast/ovarian cancer

This exploratory study investigates the experience of partners of women at high risk of developing breast/ovarian cancer and reports on the partners' views concerning their relationship, communication, future planning, children and childbearing, involvement in decision-making regarding screening and prophylactic measures, and information and support needs. In-depth interviews were conducted with 15 partners. Of these, seven were partners of women who were BRCA1/2 mutation carriers, five were partners of women with unknown mutation status, and three were partners of women who were non-carriers. None of the women had a previous diagnosis of breast or ovarian cancer. Partners of carriers and women with unknown mutation status were found to be more distressed than partners of non-carriers, with partners of mutation carriers reporting the most difficulties. Factors associated with better adjustment and coping for partners included dealing with this situation as a team with their wife, greater involvement in decision-making, satisfaction with their supportive roles and being optimistic. Decision-making difficulties in relation to prophylactic measures, concerns about their children possibly being at increased cancer risk, as well as the need to receive information directly from health professionals and the wish to meet other partners were also discussed.

The experiences of close relatives living with a person with serious chronic illness

Living with serious chronic illness has a directly threatening effect on the life course of healthy relatives. The aim of this study was to elucidate the meaning of close relatives' experiences of living with a person with serious, chronic illness. Using a narrative approach, the authors interviewed 13 spouses and 1 daughter about the meaning of their experiences. They used a phenomenological hermeneutic method to interpret the interview text. The structural analysis revealed three major themes: A Shrinking Life, Forced to Take Responsibility, and Struggling to Keep Going. Close relatives in this study seemed to be living lives characterized by a reduced sense of individual freedom and an increased sense of responsibility for the care of the ill person. It means struggling to obtain the strength to manage their duty and an inner sense of community and of solidarity. The authors interpret the findings in the light of the works of philosophers who have described ethical demands and natural love between people.

Lived Experience of Survivors of Leukemia or Malignant Lymphoma

Individuals (n = 18) in remission from acute leukemia or highly malignant lymphoma were asked to narrate their lived experience of falling ill, of being under treatment, and life following this event. The transcribed texts were analyzed from a phenomenological-hermeneutic perspective, expanded by their medical and social history as related in interviews. The analysis revealed 3 themes: (I) Believed in life, fought for it and came through stronger; (II) Life went on, adapted and found a balance in the new life; (III) Life was over, felt out of control and lost belief in life. Participants in the first 2 groups viewed their quality of life as improved and stated that the struggle had been meaningful and that the experience had made them grow, as a person, related to the experience of gaining new insight or strength. The third group of survivors viewed their quality of life as worse. They found no meaning in their experience and evaluated the situation with bitterness. Thus the core of living through having acute leukemia or highly malignant lymphoma seemed to be to find meaning with it and the profound crisis it meant to them. To help people retell their experiences may be one way of processing this life-threatening disease and treatment and may be one way to developing a sense of meaning and to regain balance in life.

Spousesʼ Perceptions of and Reactions to Living With a Partner Who has Undergone Surgery for Rectal Cancer Resulting in a Stoma

The aim of this study was to illuminate spouses' perceptions of living with a partner who had been diagnosed with rectal cancer followed by surgery resulting in a stoma. The focus group interview was chosen as method of data collection. Two focus group interviews consisting of 2 meetings each were conducted. A qualitative content analysis was used. Five themes emerged: difficulties of being involved; living with uncertainty; learning to live in a new way; the altered body; and the search for explanations. There were feelings of anxiety about the partner's serious condition and the possible spread of the cancer. After the rehabilitation period, the stoma influenced the spouses' lives in many ways but they coped with the problems together with their partners and helped them adapt to their changed circumstances. This study indicates that the spouses were very much involved in caring for the patient suffering from rectal cancer by protecting them and showing empathy. However, the dependence on the stoma affected and restricted their family and social life.

Men's experiences and their resources from cancer diagnosis to recovery

This study describes the experiences and resources of male cancer patients in Finland during the trajectory of their illness. A semi-structured interview schedule was used to collect data on falling ill with cancer, on periods of treatment (surgery, chemotherapy, radiation therapy), and on convalescence. The participants (n=8), aged 42-64 (mean=53) were interviewed in a clinic setting in connection with a check-up visit. The interviews were tape-recorded and transcribed for qualitative content analysis. The male cancer patients described their experiences through the illness trajectory in terms of suspicions, their encounter with cancer, and the cancer becoming a reality. During treatment, men described their experiences in terms of changes in body image, individual illness experiences, and new social roles. Men's experiences during the convalescence period included physical restoration, anxiety following treatment regimes, reflection, and social roles at transition. The results also indicated that men did not consider their status as a chronic one, but rather as a passing and relatively short stage in their life. Both intra- and extrapersonal resources were described: the former included body image and capacity, self-understanding, social situation, and psychological resources; and the latter wives, children, colleagues, health-care personnel, fellow patients, health-care interventions and society. Extrapersonal resources included informational, emotional, and evaluative support, as well as concrete help.

Care of women with breast cancer on a surgical ward: nurses' opinions of the need for support for women, relatives and themselves

BACKGROUND

In Sweden women with newly diagnosed breast cancer are admitted to surgical wards in order to undergo surgery and receive postoperative care. On these wards, nursing staff take care of women both with newly diagnosed breast cancer and those with cancer in advanced stages. Nurses have to meet the varying needs of patients and their relatives.

AIM

To describe nurses' opinions of the need for care and support for women and their relatives in connection with surgery for breast cancer, as well as their own need for support on a surgical ward.

METHODS

Thirty-one nurses from a surgical ward participated in semi-structured interviews. The interviews were tape-recorded and transcribed verbatim. Thereafter a step-by-step, qualitative content analysis was carried out.

RESULTS

The nurses described the need to talk and receive information as being the most important among women and their relatives, as well as among themselves. Only a few nurses mentioned the need for physical care among the women. Contact with relatives was described as being almost nonexistent. There was a discrepancy between what nurses described as important needs and how these needs were provided for.

CONCLUSION

This study shows that what the nurses described as being the most important needs, and the way how these needs were provided for, was more often seen from a theoretical point of view with few examples of self-experienced situations in the daily care. Needs among women and their relatives seemed to be not fully known to nurses and therefore, possibly, were not met. Nurses themselves had a pronounced need for support, which was sometimes unsatisfactorily met.

In the shadow of risk. How men cope with a partner's gynaecological cancer

This paper discusses a qualitative, grounded theory study of partners' perspectives on gynaecological cancer that compared their experience of illness with that of the cancer patient. The study investigated, through unstructured interviews, gender differences in attitude to, and communication about, serious illness, with particular reference to coping and risk management. The results illuminate issues surrounding the sharing of a cancer diagnosis, offering an insight into the care processes that enhance or impede partner involvement. The paper discusses issues beyond immediate treatment, and explores the recovery process as both patient and partner experience it. The implications of the findings and the development of clinical practice are subsequently highlighted.

Discrepancies between attainment and importance of life values and anxiety and depression in gastrointestinal cancer patients and their spouses

Patients' satisfaction with life, viewed in terms of the discrepancy between the perceived attainment and subjective importance of various life values, is a less often studied phenomenon for understanding the psychological adaptation in cancer patients. The main aim of the present study is to investigate the relation between the degree of attainment and importance of life values on the one hand, and anxiety and depression, on the other. A consecutive series of 85 newly diagnosed patients with gastrointestinal (GI) cancers, 52 potentially cured and 33 with an advanced disease, and 26 spouses to the patients with an advanced disease participated. The patients and spouses of non-cured patients filled out questionnaires twice, close to the diagnosis and after 1 (non-cured patients) or 3 months. Overall, large discrepancies between the perceived attainment and importance of life values were associated with high anxiety and depression. For the patients (both cured and non-cured), the discrepancies decreased for several life values over time, as did anxiety and depression. For the spouses of the non-cured patients, there was no decrease either for life value discrepancies or for anxiety/depression. This suggests that patients, in contrast to their spouses, strive to achieve small discrepancies between the perceived attainment and importance of life values, as part of their adjustment to serious diseases, e.g. cancer.

The impact of supportive telephone call intervention on grief after the death of a family member

This study describes the impact of a supportive telephone call on grief 4 months after the death of a family member. The study design involved a quasi-experimental intervention group (n = 70) and a control group (n = 155). The intervention was a supportive telephone call after the death of a family member. Grief reactions were measured with the Hogan Grief Reactions Checklist. Results were completed by content analysis of family members' experiences of the intervention. Chi-square and t tests were used to compare the associations with demographic data, and logistic regression analysis was used to compare the responses. The results pointed to differences in despair and personal growth between the groups. The participants experienced the supportive telephone call positively for the most part. Negative experiences were associated with promises to call in which the call never reached the participant. Grieving family members' positive experiences of the call indicate that there is a need for individual support after the death, given by nurses of the wards in which the deceased received care.

Thoughts and feelings of in-patients with advanced terminal cancer: implications for terminal care improvement

The purpose of this study was to clarify how terminally ill patients think and feel while hospitalized, thereby providing some insight into improving the quality of terminal care. The subjects of the study were eight terminally ill patients with cancer. The researchers obtained the patients' consent and their doctors' permission prior to conducting the interviews. Individual, semi-structured interviews were conducted. The patients' thoughts and feelings were extracted and then categorized according to particular themes. As a result, we came up with four major categories: maintaining pain control, living an ordinary life, hoping for improvement of physical condition, and having family nearby. The desire to live life to its fullest given their situation, as well as to maintain a hopeful attitude about their future proved very important. The presence of family also played a crucial role. These factors must be taken into consideration in achieving better care for terminally ill patients.