Exchanging narratives-A qualitative study of peer support among surgical lung cancer patients

Exploring the symptoms and psychological experiences among lung cancer convalescence patients after radical lobectomy: A qualitative study

OBJECTIVE

This study aims to explore the symptom experiences and psychological feelings of lung cancer patients after radical lobectomy in China.

METHODS

A qualitative study was conducted using face-to-face semistructured interviews with lung cancer patients who had a radical lobectomy for treatment of their cancer during the convalescence period. Participants (n = 18) were recruited from a general hospital in China, and patients were selected using purposive sampling from September 2021 to February 2022. Interviews were recorded and transcribed verbatim, and Colaizzi's seven-step method of phenomenology was used. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was conducted to report the study.

RESULTS

Four themes were extracted from the interview data: physiological dimensions (fatigue, cough or sputum, chest tightness and shortness of breath, daily activities affected, sleep disturbance, lack of appetite); psychological dimensions (negative emotion, fear of cancer recurrence, learning to accept reality, strengthened faith and hope); family dimensions (heavy economic burden, perceived family care, improved health management behavior); and social dimensions (perceived support of medical staff, decreased sense of social value and self-identity, changes in social and working style).

CONCLUSION

Lung cancer patients are still troubled by many problems during the postoperative recovery period. Medical staff should design and implement effective evaluations and targeted interventions for patients' physical and mental health as soon as possible to improve patients' physical and mental health, as well as their quality of life.

"Please keep on beating"-Participation in a Creative Workshop Offers Unexpected Benefits to Women With Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TCM) or "broken heart syndrome" is a rare condition that is more common in women than men, particularly those who are postmenopausal. It mimics a myocardial infarction and psychological factors have been implicated in its etiology as well as being consequences of its presentation. As part of a public engagement project we brought together 8 women (of 12 invited) previously diagnosed with TCM to facilitate a discussion, through participation in a creative workshop-based process, about their illness experience, how they made sense of it, and the meaning it had for them in their lives, and to identify areas of unmet need. Through a range of creative activities we identified that participants had high levels of unmet need in terms of information and psychosocial support. All participants enjoyed the creative process and meeting other people with a diagnosis of TCM. The workshop overall was perceived as empowering. Exploring patient narratives during artist-facilitated workshops is one approach for providing the first steps to addressing unmet need, although the importance of ensuring psychological safety cannot be over-stated.

Following a standardised pathway: Healthcare professionals' perspectives on person-centred care within ERAS for patients with colorectal cancer

AIMS AND OBJECTIVES

To describe healthcare professionals' perceptions of person-centred care for patients with colorectal cancer, within the standardised care concept of Enhanced Recovery After Surgery.

BACKGROUND

International guidelines for colorectal surgery describe standardised perioperative care. Combining standardised care with person-centred care could be accomplished using the person-centred nursing framework for establishing and maintaining relationships with patients. Despite strong evidence for the standardised care concepts' medical benefits, studies concerning the practice of person-centred care from a nursing point of view are sparse.

DESIGN

A qualitative descriptive design was used.

METHODS

Four focus groups interviews were performed including 22 healthcare professionals with 1-29 years' experience of caring for patients with colorectal cancer. Data were analysed using qualitative conventional content analysis. The COREQ checklist for reporting qualitative research was used.

RESULTS

Three themes emerged in the analysis; Framework in the healthcare system, Facing differences in participation and Interacting with the person beyond the illness. Conditions for person-centred care were related to the interactions between patients and healthcare professionals, the structure of care were also considered relevant.

CONCLUSION

There is a discrepancy between what is considered important to do and what is done in clinical practice to create conditions for patient participation. Interacting with patients and creating an interprofessional environment are important conditions, the structure of care is also a fundamental key to promoting person-centred care. There is a need for further improvement in care of patients with colorectal cancer to achieve person-centredness within standardised care.

RELEVANCE TO CLINICAL PRACTICE

The findings provide valuable insights into what healthcare professionals consider to be important for achieving person-centred care. This knowledge can be useful in clinical practice and education programs.

PATIENT OR PUBLIC CONTRIBUTION

At the outset of the study, three patients were interviewed aimed at improving the conditions for the healthcare professionals' focus groups.

Evaluation of centers for information and support combining formal and informal care for patients with cancer: a systematic review of the literature

PURPOSE

Clear information and supportive care are necessary for patients with cancer to effectively manage their condition. Traditionally, healthcare professionals offer information and support via the so-called formal care route. In addition, research has found favorable effects of informal care provided by volunteer programs and informal "walk-in support centers." Less research has been done on initiatives that combine formal and complementary informal supportive care for patients with cancer. This systematic literature study aimed to discover (1) which types of initiatives are described in the literature, (2) what type of care they offer, and (3). how they are evaluated in terms of outcome measures.

METHODS

We performed a systematic literature search of MEDLINE, Embase, PsycINFO, and CINAHL. Studies were included if the collaboration between one type of formal care together with one type of informal care was explicitly mentioned in the article. The search was not restricted to a specific cancer type.

RESULTS

A total of 4869 records were retrieved and 18 studies were included. In most studies, the care provided consisted of emotional support for, and/or providing information to, patients and their families. Initiatives were evaluated with interviews and questionnaires. Patients with cancer reported that they were satisfied with the care offered, including information, social and emotional support, help with activities of daily living, and family-related issues. Volunteers reported that visits they made were experienced positive and rewarding and the volunteers were confident about their contribution to general healthcare. Some negative experiences were reported by volunteers, e.g., interference of their own cancer diagnosis with volunteer work. The importance of proper training was stressed.

CONCLUSIONS

Initiatives combining formal and informal supportive care hold the potential of added value in terms of providing emotional support for, and providing information to, patients with cancer. Support and specific training for volunteers can be viewed as success factors in the involvement of volunteers in formal care practices.

Learning from the experience of peer support facilitators and study nurses in diabetes peer support: A qualitative study

OBJECTIVES

We report on the experiences of peer support facilitators and study nurses who participated in a large trial of peer support for type 2 diabetes. The support was led by volunteer peer support facilitators, who were trained in overcoming barriers to diabetes care, motivational interviewing, listening skills and setting up and running group support sessions. There is currently a distinct lack of qualitative evidence on what works in peer support.

METHODS

The peer support facilitators and study nurses completed open-answer questionnaire items on what worked well and less well, problems encountered and how they were resolved, group dynamics and suggestions for improvement. We also collected data from end-of-study meetings. Inductive thematic analysis was used to allow the emergent themes to be strongly based in the data.Findings: We find that process factors, peer support facilitator and peer characteristics, their relationships with each other and group dynamics are all fundamental for effective peer support. Sustaining and ending support also emerged as a key theme.

DISCUSSION

Given the increasing interest in peer support, these findings will be useful to those interested in running groups in the future. Training programmes should help peer support facilitators develop confidence whilst emphasising that peer support ideally entails an equal, democratic dynamic. More attention is needed on to how to end groups appropriately.

Transforming the experience of illness into action - Patient and spouses experiences of involvement in a patient and family advisory council

OBJECTIVE

The objective was to explore patients' and spouses' perception and attitudes towards participating in a patient and family advisory council.

METHODS

A qualitative study with interviews conducted within a phenomenological-hermeneutical frame, inspired by Ricoeur were conducted with current and former participants (patients and/or spouses) of a patient and family advisory council in Denmark.

RESULTS

In total, 16 participants were interviewed (12 former patients/four spouses) with a mean age of 68 (range 49-79) and 44 % women. After the analysis, perceptions and attitudes towards participating in a patient advisory council emerged in four themes; "Payback", "A personal invitation", "A safe and equal atmosphere", and "Sharing, caring, and healing".

CONCLUSION

Participants of an advisory council express a need for "paying it back" to the health care system. When being part of the advisory council, the participants expressed feeling a genuine engagement and interest from the health-care professionals - leading to a feeling of being equal and taken seriously. The advisory council increased the process of recovery by sharing narratives with peers.

PRACTICAL VALUE

Experiences of being part of an advisory council lead to an understanding of "why" former patients and spouses participate. This knowledge can help others to recruit members.

Patient experiences with videoconferencing as social contact and in follow-up from oncology nurses in primary health care

Patients with various forms of cancer often have unmet psychosocial support needs. By interpretative phenomenological approach, this study aimed to acquire a deeper understanding of home-living patients with cancer’s experience and meaning from videoconferencing in oncological nursing follow-up in primary healthcare and contact with networks. Six patients from rural Norway participated. Three themes emerged: (1) From skepticism to videoconferencing-enthusiasm; (2) Oncology nurses ensured tablet mastery and delivered close follow-up; and (3) Oncology nurses helped ensure general social support using videoconferencing. Oncology follow-up care in rural areas using videoconferencing may enhance care availability and provision of psychosocial support meeting patients’ needs.

Narrative therapy to relieve stigma in oral cancer patients: A randomized controlled trial

AIMS AND OBJECTIVES

This study aimed to evaluate the efficacy of narrative therapy in relieving stigma in oral cancer patients who underwent major surgical treatment.

BACKGROUND

Health-related stigma compromises mental health and life quality in people with physical or mental abnormalities. Narrative therapy has been implemented to overcome stigma among populations in a diversity of disease states. However, the effectiveness of narrative therapy in relieving stigma among patients with oral cancer is not known.

DESIGN

This study was a randomized controlled trial, in which 100 oral cancer patients were selected and randomly assigned to the 'narrative therapy' group, who received narrative therapy treatment in addition to standard care, and the 'control' group, who was provided standard care only.

METHODS

This research combined measurement of several questionnaires to evaluate stigma. Analysis of variance and paired t tests were employed for data analysis.

RESULTS

Findings in this study demonstrated that narrative therapy treatment effectively relieved oral cancer patients' sense of shame, reducing overall stigma and significantly improving self-esteem and social relationships.

CONCLUSIONS

Narrative therapy was demonstrated to be a promising therapeutic intervention for stigma relief in oral cancer patients.

SUMMARY STATEMENT

What is already known about this topic? Stigma is common among oral cancer patients, especially those who undergo major surgical resection. Psychological intervention is highly recommended in addition to postsurgical care. Narrative therapy might help relieve stigma among oral cancer patients. What this paper adds? Conventional postsurgical care did not improve oral cancer patients' psychological situation. A 7-week intervention of narrative therapy treatment significantly reduced stigma and enhanced sense of self-worth and social support among oral cancer patients. The implications of this paper: Narrative therapy can be clinically accepted as a therapeutic approach to assist oral cancer patients with stigma after major surgery. Tailored approaches, including patient-customized methods, should be encouraged in conducting narrative therapy.

The marked body - a qualitative study on survivors embodied experiences of a COVID-19 illness trajectory

Background

Research on COVID‐19 has reported data on epidemiology and pathophysiology but less about what it means to be a person living through this illness. Research involving the patients’ perspectives may help to improve healthcare professionals' understanding of ways to support patients.

Aims

To gain in‐depth understanding of the meaning of a COVID‐19 illness trajectory from the patients’ perspective.

Methods

Fifteen participants who had undergone an illness trajectory due to confirmed COVID‐19 infection participated in individual qualitative interviews. Data collection, analysis and interpretation were inspired by Ricoeur’s philosophy and Merleau‐Ponty’s phenomenology of perception and embodiment has been applied as a theoretical frame.

Findings

Being infected with coronavirus is expressed as an experience in which the participants oscillate between relief, security, imprisonment and raw fear. A predominant focus on the physical dimensions of the diseased body was found in the encounters between patient and healthcare system, and distance may furthermore be a consequence of use of protective equipment. Stigma and fear of infection were also expressed. After COVID‐19, an overwhelming feeling of a door opening to freedom is perceived. However, the body is marked, and bears witness to decay from this insidious and frightening virus. The responsibility for assessing their bodily symptoms is placed with the individual patients themselves, who feel lonely and fearful and this keeps them indoors.

Conclusions

During a COVID‐19 illness, trajectory concerns about the unknown course of this disease are highlighted. Isolation is confrontational; however, a companionship between patients might emerge. The study shed light on an unavoidable gap between the patients and healthcare professionals due to the use protective equipment. After COVID‐19, the body is labelled as something others fear and become a symbol of awe and alienation for others.

A radical change: A qualitative study of patients' experiences of eating and daily living through the first year after oesophageal resection

PURPOSE

The purpose of this study is to explore the lived experiences of patients in terms of eating and consequences in everyday life in the first year after oesophageal cancer surgery.

METHODS

Thirteen patients participated in qualitative interviews one year after surgery for oesophageal cancer. Descriptions capturing the meaning of the lived experiences of patients were then derived from subsequent analysis and interpretation of the interviews. A phenomenological hermeneutical approach comprised the epistemological stance, and theoretical perspectives were drawn from Schutz' theory of everyday life.

RESULTS

Patient descriptions of their experiences with food, eating and everyday life in the first year after oesophageal cancer surgery fell into four themes: Adjusting to a different anatomy - food and eating as a dominant and difficult activity; changed body - food and eating as an underlying shadow; feeling different - social consequences of changed eating; a nutritional jungle - guidance and support in an uncertain time.

CONCLUSION

The physical and social consequences of oesophageal cancer resection upend everyday structures, requiring patients to adopt a new, conscious and reflexive approach to food and eating as a social activity. Continuous support from healthcare professionals and patient-to-patient interaction can help redefine everyday life.

Resilience process and its protective factors in long-term survivors after lung cancer surgery: a qualitative study

BACKGROUND

Resilience was correlated with psychological outcomes and quality of life in lung cancer patients. But the resilience process and its protective factors remained uncertain.

PURPOSE

To investigate and analyze resilience process and its protective factors in long-term survivors after lung cancer surgery.

METHODS

This qualitative study included 19 patients who had survived at least 5 years after lung cancer surgery. Colaizzi's method of phenomenology was used for data analysis.

RESULTS

Analysis of this study was divided into the resilience process and protective factors. The resilience process was summarized into three stages, including initial stress, adaptation to disease, and personal growth. Five themes were regarded contributing to their own resilience in this process, including excellent psychological qualities, good social support, regular lifestyle and exercise, participating in social activities, and Chinese medicine.

CONCLUSION

This study showed the dynamic process of resilience and its protective factors in long-term survivors after lung cancer surgery. Future studies could identify average length of time of each stage and how patients transfer between stages during resilience process. Besides, interventions could be carried out to educate patients diagnosed with cancer about normal stages of change in body and resilience through time and strategies on adaptation and adjustment of lung cancer.

The experience of patients with cancer on narrative practice: A systematic review and meta-synthesis

BACKGROUND

In recent years, narrative practice has been applied in clinical settings to address the relational and psychological concerns that occur in tandem with physical illness. It is an emerging strategy to treat patients as individuals with their own stories, rather than purely based on symptoms.

OBJECTIVE

To synthesize the experience of patients with cancer using narrative practice.

METHODS

Following a systematic search strategy, a literature search was conducted to identify qualitative studies on the experience of patients with cancer using narrative practice. Nine databases were searched up to April 2018, which included six English databases and three Chinese databases. A meta-synthesis was conducted to synthesize the findings of the included studies.

MAIN RESULTS

Seven studies out of 2894 studies were included in this review. Patients with cancer had different preferences on narrative practices. In terms of the impacts of narrative practice on patients with cancer, six themes were identified, which included '(a) reducing the gap between patients and clinicians; (b) healing effect; (c) social connection; (d) facilitating self-reflection, self-recognition and self-realization; (e) risk of negative impacts; and (f) Patients' preference on different approaches of narrative practice'.

CONCLUSIONS

Patients with cancer experienced positive effects regarding narrative practice. Although some patients may experience negative effects, narrative practice is a humanized way to provide care for patients with cancer in the clinical settings.

Connecting one's own illness story to the illness experiences of others on a website-An evaluation study using the think aloud method

OBJECTIVE

It is well described how telling one's illness story can help to cope with illness, but little is known about the processes of reception of other people's stories. This study aimed to analyse patients' reception processes of other patients' experiences while using a website (www.krankheitserfahrungen.de - DIPEx Germany).

METHODS

A text analysis of think aloud transcripts was conducted, using data from a usability study of the website krankheitserfahrungen.de. Twenty patients with the same conditions as presented on the website (chronic pain, diabetes type 2, inflammatory bowel disease, epilepsy) were assigned to the study, asked to use the website and concurrently to think aloud. The sessions were audio recorded, transcribed and analysed using grounded theory methodology.

RESULTS

Study participants started to talk about their own illness experiences while using the website. They constantly compared their experiences with those they read about. Participants' verbalised experiences were categorised according to three underlying themes: significant emotions, unresolved problems, and inevitability and acceptance.

CONCLUSION

Reception of a variety of illness experiences presented online led patients to consider their own challenges in coping with their illness.

PRACTICE IMPLICATIONS

Providing other patients' experiences in information and education materials helps patients to deal with their own illness.

Food and heart-the nutritional jungle: Patients' experiences of dietary habits and nutritional counselling after coronary artery bypass grafting

AIMS AND OBJECTIVES

The aim of the study was to examine patients' experience of dietary habits and nutritional counselling in the early period during hospitalisation after coronary artery bypass surgery (CABG).

BACKGROUND

Undergoing CABG, patients have two different nutritional needs, extra proteins and calories for the first period after surgery and a heart-healthy diet when the recovery period is over. These needs can be difficult to manage for the patients.

DESIGN

Qualitative study.

METHODS

Interviews were conducted and analysed within a phenomenological-hermeneutic frame inspired by the French philosopher Paul Ricoeur. Patients undergoing CABG were interviewed 4-5 days after surgery at Odense University Hospital from March to May, 2017. The study adhered to the COREQ guidelines.

RESULTS

In total, 15 patients were interviewed (mean age 65 years, 87% men). After analysing the interviews following themes emerged, "Different needs-the nutritional jungle", "Food and heart-the lacking attention," and "The force of habits-being under the influence from spouses on dietary habits".

CONCLUSION

The interviewed patients had no or only a little knowledge about how to eat after heart surgery. In general, they experienced a lack of attention to nutritional counselling by the nursing staff during hospitalisation. Furthermore, the health behaviour of men seems to be different from women's, and therefore, interventions aiming at optimising men's health might be prioritised. Finally, spouses have a great influence on eating habits, why they should be involved in nutritional counselling.

RELEVANCE TO CLINICAL PRACTICE

This study provides important and relevant knowledge about patients' lacking knowledge about nutrition. When planning nutritional measures, whether it is promoting healing after heart surgery or preventing progression of arteriosclerosis, the study contributes with suggestions as to which factors should be considered in this process-men's health behaviour and spouses' influence on dietary habits in the household.

Proposed Criteria for Systematic Evaluation of Qualitative Oncology Research

Oncology has made significant advances in standardizing how clinical research is conducted and reported. The advancement of such research that improves oncology practice requires an expansion of not only our research questions but also the research methods we deploy to address them. In particular, there is increasing recognition of the value of qualitative research methods to develop more comprehensive understandings of phenomena of interest and to describe and explain underlying motivations and potential causes of specific outcomes. However, qualitative researchers in oncology have lacked guidance to produce and evaluate methodologically rigorous qualitative publications. In this review, we highlight characteristics of high-quality, methodologically rigorous reports of qualitative research, provide criteria for readers and reviewers to appraise such publications critically, and proffer guidance for preparing publications for submission to Journal of Oncology Practice. Namely, the quality of qualitative research in oncology practice is best assessed according to key domains that include fitness of purpose, theoretical framework, methodological rigor, ethical concerns, analytic comprehensives, and the dissemination/application of findings. In particular, determinations of rigor in qualitative research in oncology practice should consider definitions of the appropriateness of qualitative methods for the research objectives against the setting of current literature, use of an appropriate theoretical framework, inclusion of a rigorous and innovative measurement plan, application of appropriate analytic techniques, and clear explanation and dissemination of the research findings.

Public involvement in designing a study on patient-witnessed cardiopulmonary resuscitation in hospital

The aim of this paper is to report the findings of the consultation rounds with former patients and health care professionals to inform the design of a qualitative study. We aimed to understand stakeholders' views regarding the relevance of a proposed study looking at the impact of patients witnessing cardiopulmonary resuscitation on other patients in hospital, the appropriateness of the proposed methodology and ethical aspects. We conducted an online survey (n = 22) and telephone interviews (n = 4) with former patients linked to the British Heart Foundation charity and a focus group (n = 15) with hospital health care professionals involved in cardiopulmonary resuscitation activities. Data were analysed using thematic analysis. The consultation rounds provided valuable advice on three major themes: conceptual aspects, methodological aspects and practical suggestions. The conceptual aspects were related to the relevance of the proposed study, the emotional impact for participating patients and how the social interaction among patients could influence the witnessing experience. Methodological advice included recruitment strategies and data collection methods such as the use of individual and focus group interviews, the timeframe of interviews with patients and the topics of the interview guides. In the third theme, practical suggestions were provided, such as strategies to advertise the study, improving the public's and participants' engagement throughout the study process and disseminating the findings. Overall, the study proposed in this consultation was considered relevant and worthy by patients and health care professionals to raise awareness and generate new evidence on an unconsidered aspect of cardiopulmonary resuscitation and of patients' hospital experience. These stakeholders' consultation rounds constituted a valuable exercise to design high-quality research based on a shared vision among researchers, service users and clinicians. They also provided pragmatic advice to inform critical care practice to support patients witnessing cardiopulmonary resuscitation in hospital.