Experiences of accessing and using breast cancer services in Vietnam: a descriptive qualitative study

OBJECTIVES

To understand, describe and analyse the experiences of women with breast cancer in Vietnam when accessing and using breast cancer services.

DESIGN

Descriptive qualitative study. Women were interviewed about their experiences from the first time they became aware of symptoms or changes to their body through treatment and post-treatment. This study is the first descriptive study on breast cancer in Vietnam from the perspective of women with a breast cancer diagnosis.

PARTICIPANTS

Women (n=13) who had completed or were still receiving treatment for breast cancer, purposively recruited from the north and south of Vietnam.

RESULTS

An analysis of the experiences of women with breast cancer in Vietnam revealed a lack of awareness and knowledge about breast cancer and symptoms. Family and social support were described as key factors influencing whether a woman accesses and uses breast cancer services. Cost of treatment and out-of-pocket expenditures limited access to services and resulted in significant financial challenges for women and their families.

CONCLUSIONS

Vietnam has made huge strides in improving cancer care, and is tackling a complex and expanding public health challenge, however, there are a number of areas requiring strengthening and future research. While Vietnam has successfully expanded social health insurance coverage, changes that increase the percentage of costs covered for specific treatments, such as chemotherapy or radiotherapy, could benefit women and their families.

Heideggerian hermeneutic phenomenology as method: modelling analysis through a meta-synthesis of articles on Being-towards-death

While the richness of Heideggerian philosophy is attractive as a healthcare research framework, its density means authors rarely utilise its fullest possibilities as an hermeneutic analytic structure. This article aims to clarify Heideggerian hermeneutic analysis by taking one discrete element of Heideggerian philosophy (Being-towards-death), and using it's clearly defined structure to conduct a meta-synthesis of Heideggerian phenomenological studies on the experience of living with a potentially life-limiting illness. The findings richly illustrate Heidegger's philosophy that there is either an inauthentic positioning towards death, or an authentic positioning towards death with a proposition that (1) death is certain; (2) death is indefinite; (3) death is non-relational; and (4) death is not-to-be-outstripped. None of the 29 included studies on the experience of a confrontation with death fully utilised this framework, despite claiming a grounding in Heideggerian thought. This demonstrates the value in modelling how Heideggerian existential structures can be used proactively as analytical 'hooks' for data in research claiming a basis in this philosophy and/or method. By modelling the potential application of an important Heideggerian philosophical construct to published qualitative data, this meta-synthesis has revealed new domains and more nuanced understandings of the temporal structure of Being-towards-death. Such an approach helps to more fully unveil the existential concerns of people at the core of interpretative phenomenological enquiry and may provide a blueprint to map either primary or synthesised data to other key ontological existentials.

HOW DO PATIENTS EXPERIENCE A KIDNEY BIOPSY?

BACKGROUND

Guidelines for care before, during and after a kidney biopsy vary nationally and internationally. A literature search has shown few studies about the care before, during and after a kidney biopsy and we found one study from the patients' perspective.

OBJECTIVES

The aim of the study is to gain knowledge about patients' experiences before, during and after a kidney biopsy.

METHODS

A qualitative study with a phenomenological and hermeneutic approach using 'observiews' of seven patients before, during and after a kidney biopsy. Data were analysed using Malterud's principles of systematic text condensation.

RESULTS

Three themes were found: The patients' basic needs, the patient's needs for information and the patients use humour as a coping strategy.

CONCLUSION AND APPLICATION TO PRACTICE

The patients' experiences were characterised by their need to fulfill self-care requirements, because they had to lie down for four to six hours after the biopsy procedure. There is a need to find evidence for the time the patient need to be bedbound to avoid bleeding complications. The patients' needs for information were different, which explains why information should be individualised. There is particular need for more information after discharge.

Development and Validation of the Spiritual Care Needs Inventory for Acute Care Hospital Patients in Taiwan

Spiritual care is increasingly being recognized as an integral aspect of nursing practice. The aim of this study was to develop a new instrument, Spiritual Care Needs Inventory (SCNI), for measuring spiritual care needs in acute care hospital patients with different religious beliefs. The 21-item instrument was completed by 1,351 adult acute care patients recruited from a medical center in Taiwan. Principal components analysis of the SCNI revealed two components, (a) meaning and hope and (b) caring and respect, which together accounted for 66.2% of the total variance. The internal consistency measures for the two components were 0.96 and 0.91, respectively. Furthermore, younger age, female sex, Christian religion, and regularly attending religious activities had significantly higher mean total scores in both components. The SCNI was found to be a simple instrument with excellent internal consistency for measuring the spiritual care needs in acute care hospital patients.

A comunicação médico-paciente na percepção de mulheres com nódulo mamário e indicação de biópsia

Objetivos: compreender como a comunicação com mastologistas é percebida e interpretada no diagnóstico de nódulo mamário com indicação de biópsia. Métodos: estudo qualitativo, com abordagem hermenêutica e crítica, efetuado em serviço de referência, em Recife, PE. Foram realizadas entrevistas semiestruturada com 16 mulheres entre 35-63 anos de idade. Formaram-se dois grupos de mulheres (Grupo 1 com e Grupo 2 sem hipótese diagnóstica de câncer). Resultados: nenhuma mulher relatou interesse do médico por sua percepção da doença. A relação com mastologistas foi satisfatória para o Grupo 1, sobretudo, pela sinceridade e atitude solidária ao facilitar o acesso a consultas e exames. No Grupo2 predominou a percepção de falta de reciprocidade. A comunicação médico-paciente sucedeu, principalmente, enquanto era necessária ao profissional, para apreender demandas reconhecidas cientificamente e fornecer informações, sendo mais demorada e esclarecedora com o Grupo 1. A banalização do nódulo benigno pelo médico resultou numa enorme insatisfação das mulheres do Grupo 2 quanto às informações obtidas, em particular, na definição do diagnóstico e conduta. Em geral, desconsiderou-se direito da paciente de opinar sobre suas conveniências. Conclusões: a comunicação médico-paciente teve caráter informativo e paternalista, com maior atenção dedicada às mulheres com suspeita de câncer. Nenhuma delas, ainda quando muito insatisfeitas, visaram de fato um projeto terapêutico individual. Dialogar é tarefa difícil para médicos e pacientes.

Patient fears of tumor cell dissemination secondary to surgical interventions-part II

Patient fears are an ever-present factor of patient care, and addressing those fears is a responsibility of the healthcare provider. One such fear may be of tumor cell dissemination secondary to surgical interventions. Preparing for such discussions will allow the healthcare provider to speak with authority on the topic of tumor dissemination secondary to breast biopsy or surgery, even in a situation where a patient has underlying fears.

"The support I need": women's experiences of social support after having received breast cancer diagnosis and awaiting surgery

BACKGROUND

Social support is associated with a better adjustment to breast cancer, whereas inadequate social support increases psychological distress. However, the period between diagnosis and surgery is particularly stressful, and few studies have addressed the significance of social support in this period.

OBJECTIVE

The purpose of this study was to describe women's individual experiences of social support after having received a breast cancer diagnosis and awaiting surgery.

METHODS

A qualitative descriptive design was used. Individual semistructured interviews were conducted the day before surgery with 21 women aged 41 to 73 years with newly diagnosed breast cancer at a Norwegian university hospital.

RESULTS

Methods of qualitative meaning condensation analysis revealed 5 themes: available support, information and advice, care, having confidants, and balancing distance and closeness. Knowing that both family and healthcare professionals were available and caring gave a sense of security. Social support gave strength, although too much could be experienced as difficult and frightening. The women needed a balance between distance from and closeness to their social network. Both professional information and someone professional with whom to talk personally were essential.

CONCLUSIONS

Social support is an important resource for women with breast cancer but can be a double-edged sword as the network's offered support can sometimes be a burden.

IMPLICATIONS FOR PRACTICE

Healthcare professionals could call each patient, encourage the patients to call if they want, and, if preferred, offer face-to-face consultations for women with breast cancer awaiting surgery. This contact should be a supportive, informative, and confidential available resource.

Incidence of distress and associated factors in women undergoing breast diagnostic evaluation

The purpose of this study was to identify the incidence of distress and factors associated with distress in women undergoing breast diagnostic evaluations. A total of 128 women undergoing a breast biopsy at three hospitals completed a set of nine standardized instruments. The presence of distress was identified with 14% having symptoms above the cutoff point for clinical anxiety. In multiple regression analyses, trait anxiety alone explained 71% of the State-Trait Anxiety Inventory State score. A model with trait anxiety, satisfaction with health care, meaning in life, and friend support accounted for 66% of the Hospital Anxiety and Depression Scale score for depression. It appears that when faced with a potential cancer diagnosis, distress levels are based on personality and self-evaluation of whether one has the resources to adapt to life with cancer. Distress screening protocols need to be routinely included in diagnostic radiology appointments. Nurses should implement interventions focusing on providing information, facilitating communication, and offering psychosocial support.

Review of patients' experiences with fungating wounds and associated quality of life

OBJECTIVE

To investigate the evidence exploring the experiences of patients with fungating wounds and associated quality of life, and to subsequently provide recommendations to how these implications may be addressed in practice.

METHOD

Using a systematic approach, a comprehensive literature search was conducted to investigate the most appropriate and relevant evidence regarding the experiences of patients with fungating wounds.

RESULTS

Studies unveiled the enormity of the unrelenting, unique and devastating consequences that these wounds have on an individual’s life and that every domain of their life is negatively affected.

CONCLUSION

These findings must galvanise nurses to become aware of the extent of the devastation experienced and aspects of life affected by these wounds. The issues raised have multifaceted and challenging implications for practice; however, all aspects need to be addressed and satisfied in an attempt to improve the quality of life of individuals with fungating wounds.

Anaesthesia type, gender and anxiety

The number of patients treated by elective day-case surgery in the UK is growing. Patient preoperative anxiety can be considerable, although the opportunity to help to reduce fears is minimal. Day surgery patients (n = 674) were surveyed and 82% were found to be anxious. General anaesthesia patients were more anxious than local anaesthesia patients and females more anxious than males. The results indicate that general anaesthesia patients may require more preoperative information, and gender differences associated with waiting may need to be given greater consideration.

Experiences of non-navigated women undergoing breast diagnostic evaluation

During the diagnostic period, women need appropriate, timely information regarding tests and procedures. Nurse navigator programs were developed to combat the negative effects on survival that are caused by delays in the diagnosis of breast cancer and lack of support from the healthcare team. Nurse navigators decreased barriers to care, increased patient satisfaction, and lowered anxiety in women undergoing diagnostic evaluation. However, although patient navigation programs have become a presence in oncology centers, those programs and the accompanying support are not offered at every facility that provides components of diagnostic evaluation. Therefore, the purpose of the current study was to explore the experiences of women who underwent a breast diagnostic evaluation without any accompanying navigation services.

The lived spiritual experiences of patients transitioning through major outpatient surgery

Dramatic changes in outpatient surgery have occurred in recent years, but the basic care needs of surgical patients remain constant. Most outpatients face the same spiritual and coping issues that inpatients do, but outpatient surgery requires that patients cope with the surgery at an accelerated pace. This phenomenological study describes the meanings of the lived spiritual experiences of patients transitioning through major outpatient surgery. Analysis of interviews with participants resulted in four distinct themes: a point in time, holy other, vulnerability in the OR, and appraisals of uncertainty. Ways that health care providers can provide holistic case include developing an understanding of the patient's overall experience, understanding the patient's goals, and supporting the patient's own coping mechanisms and resources. Additional research should be conducted to explore interventions related to patients' spiritual well-being in outpatient settings.

Negative pressure wound therapy: a study on patient perspectives

AIM

to explore patients' lived experience of using negative pressure wound therapy (NPWT).

METHOD

A phenomenological approach based on Heideggerian philosophy was undertaken. The study population consisted of 6 participants who had used NPWT for a minimum of 4 weeks. Semi-structured interviews were transcribed verbatim and investigated for themes using interpretative phenomenological analysis.

RESULTS

Three superordinate themes were identified: altered sense of self, new culture of technology and leading a restricted life. Themes associated with an altered sense of self and leading a restricted life were in keeping with other wound care studies. Identification of barriers such as managing technical difficulties, practicalities of daily living, and improved understanding of NPWT for both patient and practitioner, can foster hope and reduce anxiety.

CONCLUSIONS

Recommendations include holistic assessment of patient suitability for NPWT, education for patients and health professionals on NPWT, use of lighter, quieter devices, and the inclusion of a technology domain in future health-related quality of life studies on NPWT.

Influence of gender and anaesthesia type on day surgery anxiety

AIM

  To investigate the possible influence of gender and anaesthesia type on anxiety prior to day surgery.

BACKGROUND

  Elective surgery undertaken on a day, short stay or 'day of surgery' basis is growing and much emphasis also placed on 'enhanced recovery' for in-patient surgery. During such brief episodes preoperative apprehension can be considerable but the opportunity to help reduce anxiety is minimal and formal plans uncommon.

METHOD

  As part of a larger study, a questionnaire was distributed to 1606 patients undergoing day surgery, with anaesthesia (2005-2007). Participants were requested to return the questionnaire by mail 24-48 hours following surgery, with 674 returned. Data were analysed using descriptive statistics and multivariate analysis of variance.

RESULTS

  Of the total patients 82·4% experienced anxiety on the day of surgery with the wait, anaesthesia and possible pain being common anxiety-provoking aspects. The majority preferred to receive information between 1-4 weeks in advance and participants experiencing general anaesthesia required information at a statistically significantly earlier stage. General anaesthesia patients were statistically significantly more anxious than local anaesthesia patients and desired more information. Female patients were statistically significantly more anxious, anxiety commenced earlier and they preferred to wait with a relative/friend or talk with other patients.

CONCLUSIONS

  Anxiety was experienced by the majority of participants but was more prevalent amongst general anaesthesia and female patients. For general anaesthesia patients, a comprehensive level of information may be required a number of weeks prior to surgery and gender differences associated with the preoperative wait may require greater consideration.

Being in suspense: women's experiences awaiting breast cancer surgery

AIM

This article is a report of a qualitative study of women's experiences after having received a breast cancer diagnosis and awaiting primary surgery.

BACKGROUND

Breast cancer is experienced as an important stressor and a major challenge. How women appraise the diagnosis affects their postsurgery adaptation. Although studies have documented the presurgery period as stressful, in-depth understanding of women's experiences while awaiting surgery studied during this stressful period is still needed.

METHOD

Twenty-one women with newly diagnosed breast cancer were interviewed individually the day before surgery at a Norwegian university hospital, between February 2006 and February 2007. Interviews were analysed using the qualitative meaning condensation method.

FINDINGS

Feeling healthy, but having to adapt to disease, waiting, uncertainty, having to tell and existential awareness were themes identified. Having to wait was experienced as frightening, painful, long and difficult - but also necessary. Some expressed apprehension because they could not do anything about their situation. Others emphasized that it was good to have some time between diagnosis and surgery to become personally prepared and spend time with loved ones. Informing others about the diagnosis was a great burden for most of them. Social networks could both give and crave support.

CONCLUSION

Healthcare professionals need to be sensitive to the individual experiences of women awaiting breast cancer surgery to give support to ease their situation. Setting the date for surgery will alleviate anxiety. Follow-up studies about the potential impact of presurgery experiences on later experiences of living with breast cancer and intervention studies are needed.