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Wilson DM, Cohen J, Eliason C, Deliens L, Macleod R, Hewitt JA, Houttekier D. Is the bereavement grief intensity of survivors linked with their perception of death quality? Int J Palliat Nurs 2019; 25:398-405. [DOI: 10.12968/ijpn.2019.25.8.398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Some people experience exceptionally severe bereavement grief, and this level of post-death grief could potentially be the result of a low quality dying process. Aims: A pilot study was conducted to determine if a relationship exists between perceived death quality and bereavement grief intensity. Methods: A questionnaire was developed and posted online for data on bereavement grief intensity, perceived death quality, and decedent and bereaved person characteristics. Data from 151 Canadian volunteers were analysed using bi-variate and multiple linear regression tests. Findings: Half had high levels of grief, and over half rated the death as more bad than good. Perceived death quality and post-death grief intensity were close to being negatively correlated. Conclusion: These findings indicate research is needed to explore possible connections between bereavement grief and the survivor's perceptions of whether a good or bad death took place. In the meantime, it is important for palliative care nurses to think of the quality of the dying process as being potentially very impactful on the people who will be left to grieve that death.
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Affiliation(s)
- Donna M Wilson
- Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Joachim Cohen
- Professor, End-of-life Care Research Group, Vrije University Brussels and Ghent University, Belgium
| | - Cecilia Eliason
- Lecturer, School of Nursing and Midwifery, University of Ghana
| | - Luc Deliens
- Head, End-of-life Care Research Group, Vrije University Brussels and Ghent University
| | - Rod Macleod
- Palliative Care Professor, HammondCare and Conjoint Professor in Palliative Care, University of Sydney, Australia
| | | | - Dirk Houttekier
- End-of-life Care Research Group, Vrije University Brussels and Ghent University
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2
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Wise M, Marchand L. Living Fully in the shadow of Mortal Time: Psychosocial Assets in Advanced Cancer. J Palliat Care 2018. [DOI: 10.1177/082585971302900203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This study aimed to characterize the strategies and psychosocial conditions that influence how resilient people live in the face of advanced cancer. Methods: Grounded theory interviews and a survey of 10 resilient people with advanced cancer were collected and analyzed. Findings: Personal assets — including positive relationships, purpose in life, faith, and mastery — contributed to living fully in mortal time. Strategies included embracing paradox, reframing time, deepening connections, and aligning actions with priorities. Open-ended interviews yielded rich illness and life stories; many participants requested a copy of the transcript. Conclusion: Resilient people use a range of strategies to thrive in the face of advanced cancer.
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Affiliation(s)
- Meg Wise
- Center for Health Enhancement Systems Studies, and Sonderegger Research Center, School of Pharmacy, University of Wisconsin – Madison, 777 Highland Avenue, Madison, WI 53705-2222
| | - Lucille Marchand
- Department of Family Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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3
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Global analysis of advanced/metastatic breast cancer: Decade report (2005-2015). Breast 2018; 39:131-138. [PMID: 29679849 DOI: 10.1016/j.breast.2018.03.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 02/05/2023] Open
Abstract
Approximately 0.5 million people worldwide die from metastatic breast cancer (mBC) every year. This manuscript provides an overview on the status of mBC in several regions of the world, highlighting the gaps in care, resources, and support available for patients with mBC. Primary research was conducted in 2015 and 2016, comprising four global qualitative and quantitative surveys of approximately 15,000 individuals in 34 countries. Secondary research was conducted using literature reviews of peer-reviewed publications, patient survey reports, and media or online articles. There have been modest improvements in mBC outcomes over the past decade. Patients are not provided with adequate information about mBC. There is a need for open discussion with patients and caregivers about realistic goals; however, physicians are not trained in communicating with patients about their disease. Maintaining patients' quality of life is a crucial goal; however, this has not improved, and in some cases, may have declined in the past decade. Public awareness and understanding of mBC is limited, with damaging consequences for patients and caregivers. Issues affecting employment remain relevant to patients with mBC and their caregivers. Globally, mBC is associated with a substantial economic burden. Relationships with caregivers are crucial to patients with mBC, and caregiver support needs are often overlooked. A strong and united global effort among healthcare professionals, including clinicians, oncologists, pharmaceutical manufacturers, payers, and policy makers, and with advocates, families, and patients, is necessary to improve the outcome and quality of life for patients with mBC.
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4
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Wanat M, Boulton M, Watson E. Patients' experience with cancer recurrence: a meta-ethnography. Psychooncology 2015. [PMID: 26224137 DOI: 10.1002/pon.3908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Recurrence is a difficult stage in the cancer journey as it brings to the fore the life-threatening nature of the illness. This meta-ethnography examines and synthesises the findings of qualitative research regarding patients' experience of cancer recurrence. METHODS A systematic search of the qualitative studies published between January 1994 to April 2014 was undertaken. Seventeen relevant papers were identified, and a meta-ethnography was conducted. RESULTS Six third-order concepts were developed to capture patients' experiences: experiencing emotional turmoil following diagnosis, which described the emotional impact of diagnosis and the influence of previous experiences on how the news were received; experiencing otherness, encompassing changed relationships; seeking support in the health care system, describing the extent of information needs and the importance of the relationship with health care professionals; adjusting to a new prognosis and uncertain future, highlighting the changes associated with uncertainty; finding strategies to deal with recurrence, describing ways of maintaining emotional well-being and regaining a sense of control over cancer; and facing mortality, describing the difficulties in facing death-related concerns and associated consequences. CONCLUSIONS This meta-ethnography clarifies the fundamental aspects of patients' experience of recurrence. It suggests that health care professionals can promote a positive experience of care and help lessen the psychosocial impact of recurrence by providing information in an approachable way and being sensitive to their changing needs. It also points to the importance of supporting patients in adopting strategies to regain a sense of control and to address their potential mortality and its impact on loved ones.
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Affiliation(s)
- Marta Wanat
- Clinical Health Care Department, Oxford Brookes University, Jack Straws Lane, Oxford, UK
| | - Mary Boulton
- Clinical Health Care Department, Oxford Brookes University, Jack Straws Lane, Oxford, UK
| | - Eila Watson
- Clinical Health Care Department, Oxford Brookes University, Jack Straws Lane, Oxford, UK
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5
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Willis K, Lewis S, Ng F, Wilson L. The experience of living with metastatic breast cancer--a review of the literature. Health Care Women Int 2014; 36:514-42. [PMID: 24579717 DOI: 10.1080/07399332.2014.896364] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Women's experiences with metastatic breast cancer have received little research attention. We reviewed published articles (1984-2013) reporting research examining women's experiences of metastatic breast cancer (n = 33). Findings from quantitative studies were categorized into three broad areas: adverse consequences, satisfaction with health care providers, and strategies for living. Themes identified from qualitative findings include living as a social outsider; importance of hope; health and quality of life; positive experiences; experiences at end of life; and strategies for living. More research is needed to explore experiences of subgroups to appropriately respond to women's diverse care needs.
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Affiliation(s)
- Karen Willis
- a Faculty of Health Sciences , University of Sydney , Sydney , New South Wales , Australia
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6
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Abstract
Canadian population mortality data reveal a significantly reduced proportion of deaths occurring in hospitals after 1994. Hospital deaths peaked at 80.5% in 1994, after a longstanding hospitalization-of-death trend in Canada. A decline in hospital-based death and dying has also occurred in some other countries. As the place of death can have multiple significant direct and indirect impacts on dying individuals, their families, and health services utilization and costs, it is important to understand factors for an out-of-hospital shift. An integrative review of Canadian print literature from 1995 was undertaken to identify these factors, with three themes emerging: (1) changes in health care and health system reforms after 1994 reduced both the availability and desirability of hospital-based care, (2) sociodemographic developments including aging of the population, increased multiculturalism, and diversity in accepted end-of-life care practices shifted place preferences, and (3) advances in palliative and end-of-life care, including a palliative care expansion out of hospital, supported nonhospital death, and dying processes. The period following 1994 was thus a time of major transformation during which the place of death and dying underwent important changes that supported and promoted a transition from hospital-based end-of-life care.
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Mosher CE, Johnson C, Dickler M, Norton L, Massie MJ, DuHamel K. Living with metastatic breast cancer: a qualitative analysis of physical, psychological, and social sequelae. Breast J 2013; 19:285-92. [PMID: 23528206 DOI: 10.1111/tbj.12107] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Women with metastatic breast cancer face a wide range of medical, practical, and emotional challenges that impact their quality of life. Research to date, however, has not focused on the quality-of-life concerns of metastatic breast cancer patients with significant distress. The present study examined a range of concerns among distressed metastatic breast cancer patients, including physical and emotional distress, social functioning, and existential issues. Forty-four distressed women with metastatic breast cancer wrote their deepest thoughts and feelings regarding their illness. These essays were thematically analyzed for effects of the illness on quality of life. Three themes were identified in patients' essays. First, metastatic breast cancer and its treatment may result in a number of quality-of-life concerns, including physical symptom burden, emotional distress, body image disturbance, and disrupted daily activities. Second, social constraints on disclosure of cancer-related concerns may exacerbate patients' distress. Third, many women experience a heightened awareness of life's brevity and search for meaning in their cancer experience. Results highlight a range of quality-of-life concerns following a metastatic breast cancer diagnosis and suggest that addressing social constraints on cancer-related disclosure and the search for meaning may improve patients' psychological adjustment.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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8
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Ohnsorge K, Keller HRG, Widdershoven GAM, Rehmann-Sutter C. ‘Ambivalence’ at the end of life. Nurs Ethics 2012; 19:629-41. [DOI: 10.1177/0969733011436206] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Health-care professionals in end-of-life care are frequently confronted with patients who seem to be ‘ambivalent’ about treatment decisions, especially if they express a wish to die. This article investigates this phenomenon by analysing two case stories based on narrative interviews with two patients and their caregivers. First, we argue that a respectful approach to patients requires acknowledging that coexistence of opposing wishes can be part of authentic, multi-layered experiences and moral understandings at the end of life. Second, caregivers need to understand when contradictory statements point to tensions in a patient’s moral experience that require support. Third, caregivers should be careful not to negatively label or even pathologize seemingly contradictory patient statements.
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9
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Gaertner J, Wuerstlein R, Klein U, Scheicht D, Frechen S, Wolf J, Hellmich M, Mallmann P, Harbeck N, Voltz R. Integrating Palliative Medicine into Comprehensive Breast Cancer Therapy - a Pilot Project. ACTA ACUST UNITED AC 2011; 6:215-220. [PMID: 21779227 DOI: 10.1159/000328162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND: To comply with the World Health Organization (WHO) recommendations, our institution's administrative directives were adopted to advocate the provision of palliative care (PC) early in the disease trajectory of breast cancer (BC). To assess the outcome of this recommendation, this study evaluated the effects of this approach. METHODS: A retrospective systematic chart analysis of a 2-year period was performed. The first PC consultation of patients was analyzed according to (a) physical condition, (b) symptom burden of the patients, and (c) reasons for PC consultation. RESULTS: Many patients were already in a reduced physical state and experienced burdening symptoms when first counselled by PC. After a 1-year experience with PC consultations, the number of burdening symptoms identified at first PC consultation decreased and senologists increasingly requested PC support also for non-somatic issues. CONCLUSIONS: A development towards a better understanding of PC competencies after a 1-year initiation period could be demonstrated, but BC patients continued to be in late stages of the disease at the time of first PC contact. Disease-specific guidelines may facilitate and optimize the integration of PC into breast cancer therapy.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Medicine, University Hospital, Cologne, Cologne, Germany
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10
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Wentlandt K, Burman D, Swami N, Hales S, Rydall A, Rodin G, Lo C, Zimmermann C. Preparation for the end of life in patients with advanced cancer and association with communication with professional caregivers. Psychooncology 2011; 21:868-76. [DOI: 10.1002/pon.1995] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 04/09/2011] [Accepted: 04/13/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Kirsten Wentlandt
- Department of Psychosocial Oncology and Palliative Care; Princess Margaret Hospital, University Health Network; Toronto Canada
| | - Debika Burman
- Department of Psychosocial Oncology and Palliative Care; Princess Margaret Hospital, University Health Network; Toronto Canada
- Campbell Family Cancer Research Institute, Ontario Cancer Institute; Princess Margaret Hospital, University Health Network; Toronto Canada
| | - Nadia Swami
- Department of Psychosocial Oncology and Palliative Care; Princess Margaret Hospital, University Health Network; Toronto Canada
- Campbell Family Cancer Research Institute, Ontario Cancer Institute; Princess Margaret Hospital, University Health Network; Toronto Canada
| | - Sarah Hales
- Department of Psychosocial Oncology and Palliative Care; Princess Margaret Hospital, University Health Network; Toronto Canada
- Department of Psychiatry; University of Toronto; Toronto Canada
| | - Anne Rydall
- Department of Psychosocial Oncology and Palliative Care; Princess Margaret Hospital, University Health Network; Toronto Canada
- Campbell Family Cancer Research Institute, Ontario Cancer Institute; Princess Margaret Hospital, University Health Network; Toronto Canada
| | - Gary Rodin
- Department of Psychosocial Oncology and Palliative Care; Princess Margaret Hospital, University Health Network; Toronto Canada
- Campbell Family Cancer Research Institute, Ontario Cancer Institute; Princess Margaret Hospital, University Health Network; Toronto Canada
- Department of Psychiatry; University of Toronto; Toronto Canada
| | - Christopher Lo
- Department of Psychosocial Oncology and Palliative Care; Princess Margaret Hospital, University Health Network; Toronto Canada
- Department of Psychiatry; University of Toronto; Toronto Canada
| | - Camilla Zimmermann
- Department of Psychosocial Oncology and Palliative Care; Princess Margaret Hospital, University Health Network; Toronto Canada
- Campbell Family Cancer Research Institute, Ontario Cancer Institute; Princess Margaret Hospital, University Health Network; Toronto Canada
- Department of Psychiatry; University of Toronto; Toronto Canada
- Division of Medical Oncology and Haematology, Department of Medicine; University of Toronto; Toronto Canada
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Gómez CEP, Sánchez LVG, Enríquez JI. Experiencias de vida en mujeres con cáncer de mama en quimioterapia*. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s0034-7450(14)60105-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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