1
|
Saracíbar-Razquin M, Zaragoza-Salcedo A, Martín-Martín J, Cobo-Sanchez JL, Pérez-García S, Simón-Ricart A, Ara-Lucea P, Jimeno-San Martín L, Ducay-Eguillor M, De La Torre-Lomas N, Pérez-Herreros J, Olano-Lizarraga M. Development of a scale to gain insight into the experience of living with chronic heart failure: The UNAV-Experience of Living with Chronic Heart Failure Scale. An Sist Sanit Navar 2024; 47:e1071. [PMID: 38626132 PMCID: PMC11095135 DOI: 10.23938/assn.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND To date, there are no tools for the nursing staff to gain systematic insight on the experience lived by patients with chronic heart failure. The objective of this study was to develop a scale for this purpose. METHODS The study was conducted between January 2018 and December 2020 in three Spanish hospitals. The process described by DeVellis was used for the development of the scale. The items were built based on a phenomenological study and a systematic review of the literature. Next, feedback from a panel of experts was obtained, the scale was administered to a sample of patients with chronic heart failure, and a cognitive interview and an observational study were conducted to create the final version of the scale. RESULTS The first version of the scale had in seven domains and 76 items. After its evaluation by a panel of experts, it was reduced to a second version with six domains and 55 items. Following the administration of Version 2 to 17 patients (58.8% male, mean age 59.53, 70.6% classified as NYHA functional class II), five items were modified and two eliminated. Thus, the third version of the UNAV-CHF Experience Scale was composed of six domains and 53 items. CONCLUSIONS This study presents the development of the UNAV-experience of living with chronic heart failure scale. It is an original and novel instrument that allows systematically explore this experience. A larger-scale study is necessary to confirm the validity of our scale.
Collapse
Affiliation(s)
| | - Amparo Zaragoza-Salcedo
- Universidad de Navarra. School of Nursing. Department of Adult Nursing Care. Pamplona. Spain.
| | - Jesús Martín-Martín
- Universidad de Navarra. School of Nursing. Department of Adult Nursing Care. Pamplona. Spain.
| | | | | | - Aurora Simón-Ricart
- Clínica Universidad de Navarra. Cardiology Department. Pamplona. Spain. https://ror.org/03phm3r45.
| | - Pilar Ara-Lucea
- Clínica Universidad de Navarra. Cardiology Department. Pamplona. Spain. https://ror.org/03phm3r45.
| | | | | | - Noelia De La Torre-Lomas
- University Hospital 12 de Octubre. Cardiology Department. Madrid. Spain. https://ror.org/00qyh5r35.
| | - Jesica Pérez-Herreros
- Hospital Universitario Marqués de Valdecilla. Advanced Heart Failure and Heart Transplant Unit. Santander. Spain. https://ror.org/01w4yqf75.
| | - Maddi Olano-Lizarraga
- Universidad de Navarra. School of Nursing. Department of Adult Nursing Care. Pamplona. Spain.
| |
Collapse
|
2
|
Franklin M, Lewis S, Townsend J, Warren M, Boyle F, Smith AL. Making the unbearable, bearable: Qualitative examination of patient, family and nurses' perspectives on the role and value of specialist metastatic breast care nurses. Eur J Oncol Nurs 2024; 69:102523. [PMID: 38342058 DOI: 10.1016/j.ejon.2024.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE To examine the role and value of specialist metastatic breast care nurses in Australia from the perspective of metastatic breast care nurses, patients, and family members. Metastatic breast cancer (mBC) is treatable yet incurable, with distinct supportive care needs, yet many of these needs are unmet. METHOD Diverse sampling methods were used to recruit 10 people with mBC, 5 family members and 10 metastatic breast care nurses. Semi-structured interviews were conducted online or by telephone during August-December 2020, and analysed thematically. RESULTS The role of the specialist nurse was strongly valued within and across participant groups, with close alignment regarding what was highly valued. Three themes were identified. First, nurses played a vital role in giving voice and visibility to patients with mBC in a healthcare system in which they often felt invisible. Second, nurses combined their clinical and psychosocial skills with a sense of authentic engagement to create a safe space for those with mBC to discuss their feelings, experiences, and topics, especially those that were unlikely to be discussed in their other social and clinical interactions. Finally, nurses supported patients in living as well as possible while managing symptoms, ongoing treatment, and attendant psychosocial impacts of an incurable and life-limiting condition. CONCLUSIONS This study underscores the central importance of metastatic breast care nurses in enhancing patient well-being, bridging gaps in care, and offering much-needed support. By addressing patients' emotional, clinical, and social needs, these specialist nurses contribute to a more holistic and compassionate approach to managing mBC.
Collapse
Affiliation(s)
- Marika Franklin
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | - Sophie Lewis
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia
| | | | | | - Fran Boyle
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Australia; The Mater Hospital, North Sydney, Australia
| | - Andrea L Smith
- The Daffodil Centre, University of Sydney, a Joint Venture with Cancer Council NSW, Australia.
| |
Collapse
|
3
|
Lewis S, Newton G, Kenny K, Boyle F. The incurable self: Negotiating social bonds and dis/connection with metastatic breast cancer. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:295-314. [PMID: 37610256 DOI: 10.1111/1467-9566.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
As the culture of silence that once surrounded cancer has gradually given way to greater public awareness, normative visions of what cancer survivorship should entail have proliferated. These visions emphasise positivity and perseverance in pursuit of cure. While these visions provide comfort to many, for people with metastatic cancer, the emphasis on cure can undermine their sense of belonging to the broader collective of people living with cancer. Drawing on semi-structured interviews with 38 Australian women living with metastatic breast cancer, we explore how incurable cancer inflects understandings of self and transforms interpersonal relationships. Extending ideas around biosociality and belonging, we explore the tenuousness of social bonds, revealing how (in)visibility, (in)authenticity and (in)validation circulate within the daily lives of women with metastatic breast cancer. We conceptualise accounts according to four social bonds: (1) threatened bonds where a relationship is strained by misunderstanding, (2) severed bonds where a relationship is ruptured due to misunderstanding, (3) attuned bonds whereby a relationship is based on shared identification and (4) flexible social bonds when a relationship is based on mutual understanding. More broadly, we illustrate the persistence of normative visions of cancer survivorship and their enduring effects on those whom such visions exclude.
Collapse
Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, The University of Sydney, New South Wales, Sydney, Australia
| | - Giselle Newton
- Digital Cultures and Societies, University of Queensland, Queensland, Brisbane, Australia
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, New South Wales, Sydney, Australia
| | - Frances Boyle
- Mater Hospital, North Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Lyons-Rahilly T, Meskell P, Carey E, Meade E, O’ Sullivan D, Coffey A. Exploring the experiences of women living with metastatic breast cancer [MBC]: A systematic review of qualitative evidence. PLoS One 2024; 19:e0296384. [PMID: 38181009 PMCID: PMC10769043 DOI: 10.1371/journal.pone.0296384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Metastatic breast cancer [MBC] is the leading cause of cancer death in women globally with no cure. Women diagnosed with MBC endure a catastrophic upheaval to multiple aspects of their life and a radically transformed future landscape. Evidence suggests that the provision of care for women living with metastatic breast cancer is inadequate, socially isolating and stigmatising. To date, this topic has received little research attention. To increase understanding of the experiences of women living with MBC, a synthesis of current evidence is required. This paper presents a review of qualitative evidence on women's experiences of MBC. METHODS A qualitative evidence synthesis [QES] was conducted to synthesise primary qualitative research on the experiences of women living with MBC. Searches were performed of electronic databases Medline, Medline Ovid, PsycINFO, Psych articles, PubMED, CINAHL Complete, Scopus and grey literature databases. The methodological quality of the included studies was appraised using a modified version of the Critical Appraisal Skills Programme [CASP]. Title, abstract, and full-text screening were undertaken. A 'best fit' framework approach using the ARC [Adversity, Restoration, Compatibility] framework was used to guide data extraction and synthesis. Confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation, Confidence in the Evidence from Reviews of Qualitative research [GRADE-CERQual]. RESULTS 28 papers from 21 research studies containing 478 women's experiences of living with MBC were deemed suitable for inclusion in this qualitative evidence synthesis. Findings are presented in a new conceptual framework RAAW [adapted from ARC] for women living with MBC under themes: Reality, Adversity, Adjustment and Wellbeing. Findings revealed that a diagnosis of MBC impacted every aspect of women's lives; this is different to a diagnosis of early breast cancer. An overarching theme of lack of support extended across various facets of their lives. A lack of psychological, emotional, and psychosocial support was evident, with a critical finding that models of care were not fit for purpose. Deficits included a lack of information, knowledge, inclusion in shared decision-making and MDT support, specifically the need for palliative care/oncology support access. Some women living with MBC wanted to be identified as having a chronic illness not a life-limiting illness. Culture and socioeconomic standing influenced the availability of various types of support. The impact of treatment and symptoms had an adverse effect on women's quality of life and affected their ability to adjust. CONCLUSION This review synthesised the qualitative literature on the experiences of women living with MBC. The ARC framework used in the synthesis was adapted to develop a revised conceptual framework titled RAAW to represent the evidence from this review on experiences for women living with MBC; Reality & Adversity: A diagnosis of MBC; Adjustment: Living with MBC; Wellbeing: Awareness, meaning, engagement [RAAW; MBC].
Collapse
Affiliation(s)
- Trína Lyons-Rahilly
- Department of Nursing & Health Care Sciences, Munster Technological University, Tralee, Kerry, Ireland
| | - Pauline Meskell
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Eileen Carey
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| | - Elizabeth Meade
- Oncology Department, HSE Dublin Mid Leinster, Midlands Regional Hospital, Tullamore, Co. Offaly, Ireland
| | - Donal O’ Sullivan
- MTU Kerry Library, Munster Technological University, Tralee, Co Kerry, Ireland
| | - Alice Coffey
- Department of Nursing & Midwifery, University of Limerick, Limerick, Ireland
| |
Collapse
|
5
|
Tollow P, Ogden J, McCabe CS, Harcourt D. Physical appearance and well-being in adults with incurable cancer: a thematic analysis. BMJ Support Palliat Care 2023; 13:e163-e169. [PMID: 33246936 DOI: 10.1136/bmjspcare-2020-002632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/16/2020] [Accepted: 11/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Existing research has established the importance of appearance concerns for individuals with cancer and identified appearance as an important factor in dying with dignity. No research, however, has explored in depth the role of appearance in the experiences of individuals who have incurable cancer. This research aims to explore patients' experiences and perspectives in relation to the role of appearance issues in adults with incurable cancer. METHODS Semi-structured interviews were conducted with 24 adults with incurable cancer (20 women, 4 men; mean age 54.5, SD 11.32). RESULTS Thematic analysis generated three themes: 'Identity: Embodying Cancer', 'Communication: Wearing your illness' and 'Support: Holistic Care'. Appearance was felt to be an important element of identity, which was often dominated by cancer, leading to feelings of separation from the participant's previous self. Appearance changes also influenced the way in which individuals communicated with their external world, forcing discussion of their diagnosis, and increasing focus on their cancer, with participants having to manage the emotional impact of this on loved ones, as well as the impact on their legacy. Finally, participants highlighted the positive impact of appearance-related support in their well-being and identified peer connections and refocusing on the self as key elements of such support. CONCLUSIONS Appearance changes play an important role in the experiences of individuals with incurable cancer with regards to both identity and communication and challenged participants' ability to maintain normalcy. Further psychosocial support relating to appearance concerns was considered necessary to promote dignity and provide truly holistic patient care.
Collapse
Affiliation(s)
- Philippa Tollow
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, UK
| | - Candida S McCabe
- Dorothy House Hospice, Winsley, UK
- University of the West of England, Bristol, UK
- Florence Nightingale Foundation, London, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
| |
Collapse
|
6
|
Esquives BSN, Walsh EA, Penedo FJ, Thomas JL, Horner FS, Torzewski JB, Gradishar W, Victorson D, Moreno PI. Coping strategies and psychosocial resources among women living with metastatic breast cancer: A qualitative study. J Psychosoc Oncol 2023; 42:381-397. [PMID: 37698184 PMCID: PMC10927610 DOI: 10.1080/07347332.2023.2254754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Objective: Despite more women living with metastatic breast cancer (MBC), this population is underrepresented in cancer survivorship research. Few studies have assessed how women with MBC cope with their cancer experience. This qualitative study describes the coping strategies and psychosocial resources utilized by women living with MBC.Methods: Twenty-two women with MBC participated in four focus groups. Transcripts were analyzed using a general inductive approach. Codes derived from participants' responses were subsequently condensed into themes.Results: We identified 12 coping strategies and psychosocial resources and grouped them into five themes: Behavioral Coping Strategies (i.e. stress management, active coping and planning); Cognitive Coping Strategies and Psychological Resources (i.e. cognitive reappraisal, optimism, mindfulness, positive thinking, and religious coping); Existential Approach-Oriented Coping (i.e. acceptance, values-based living, and identity integration); Avoidance (i.e. avoidant coping); and Interpersonal Resources and Seeking Social Support (i.e. social support).Conclusions: Women living with MBC utilize several engagement and disengagement coping strategies, as well as intrapersonal and interpersonal resources. This study provides useful perspectives of women living with MBC that may inform the development of psychosocial interventions. Further research is needed to assess coping strategies and psychosocial resources across different subgroups of MBC patients and determine their impact on cancer outcomes.
Collapse
Affiliation(s)
| | | | - Frank J. Penedo
- Department of Psychology, University of Miami
- Department of Medicine, University of Miami Miller School of Medicine
| | - Jessica L. Thomas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | | | - Joanna B. Torzewski
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - William Gradishar
- Department of Medicine, Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Patricia I. Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| |
Collapse
|
7
|
Keane D, Phillips G, Mitchell N, Connolly RM, Hegarty J. Improving quality of life and symptom experience in patients with metastatic breast cancer: A systematic review of supportive care interventions. Psychooncology 2023; 32:1192-1207. [PMID: 37434307 DOI: 10.1002/pon.6183] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE The prognosis for individuals with metastatic breast cancer (MBC) has improved in recent decades. This expanding cohort has unique psychological and psychosocial needs, yet targeted supportive care interventions are underdeveloped. This systematic review seeks to summarise the available evidence on the effectiveness of supportive care interventions in improving quality of life and symptom experience of individuals living with MBC so that services can be developed to address the unmet needs of this cohort in future. METHODS Academic Search Complete, CINAHL, ERIC, Medline and SocINDEX were searched for publications investigating the effect of supportive care interventions specifically targeted at addressing the quality of life or symptom experience of individuals living with MBC. Three reviewers independently screened and selected studies. Quality appraisal and assessed risk of bias were carried out. RESULTS The search yielded 1972 citations. Thirteen studies met the inclusion criteria. Interventions included psychological (n = 3), end of life discussion and preparation (n = 2), physical activity (n = 4), lifestyle (n = 2), and medication self-management support (n = 2). Three studies reported significant improvement in quality of life, two of which reported improved symptom experience in at least one symptom. Three further physical activity interventions showed improvement in at least one of the symptoms investigated. CONCLUSION Studies reporting a statistically significant effect on quality of life and improved symptom experience were extremely heterogenous. We can tentatively suggest that multimodal and frequently administered interventions are effective, with physical activity interventions positively impacting on symptom experience, however further research is required.
Collapse
Affiliation(s)
- Danielle Keane
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Grace Phillips
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | | | - Roisin M Connolly
- Cancer Research @UCC, College of Medicine & Health, University College Cork, Cork, Ireland
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
8
|
Fallowfield L, Starkings R, Palmieri C, Tait A, Stephen L, May S, Habibi R, Russ S, Shilling V, Jenkins V. Living with metastatic breast cancer (LIMBER): experiences, quality of life, gaps in information, care and support of patients in the UK. Support Care Cancer 2023; 31:459. [PMID: 37432501 PMCID: PMC10335945 DOI: 10.1007/s00520-023-07928-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE To determine the experiences, information, support needs and quality of life of women in the UK living with metastatic breast cancer (MBC) to provide content for educational materials. METHODS An online survey, hosted for 3 months on a UK MBC charity website, comprised sections covering issues such as communication about MBC treatment and management, helpful and less helpful things that healthcare professionals, family and friends did or said and completion of the Patient Roles and Responsibilities Scale (PRRS). RESULTS A total of 143 patients participated; 48/143(33%) presented de novo; 54/143(38%) had been living with MBC > 2 years. PRRS analysis revealed that MBC imposed a serious impact upon most respondents' own caring abilities and social lives. A majority 98/139 (71%) wished they had known more about MBC before their diagnosis; 63/134(47%) indicated that they still did not fully understand their illness; merely 78/139(56%) had access to a specialist nurse and only 69/135(51%) had been offered any additional support. Respondents reported little consideration given to their lifestyle/culture during consultations and inconsistent information, support services, continuity of care or access to clinical trials. They commented upon things health care professionals/friends and family did or said that were useful and cited other behaviours that were especially unhelpful. CONCLUSIONS MBC exerted a deleterious impact upon patients' activities of daily living which were exacerbated in part by significant gaps in support, communication and information. IMPLICATIONS FOR CANCER SURVIVORS LIMBER results are informing the content of educational materials currently being developed for patients' formal and informal carers.
Collapse
Affiliation(s)
- L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK.
| | - R Starkings
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - C Palmieri
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Department of Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, UK
| | - A Tait
- Make2ndsCount, Edinburgh, UK
| | | | - S May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - R Habibi
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - S Russ
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - V Shilling
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - V Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| |
Collapse
|
9
|
Iseki C. The process of reaching psychological adjustment among adult women diagnosed with metastatic breast cancer and receiving cancer pharmacotherapy. Asia Pac J Oncol Nurs 2023; 10:100184. [PMID: 36844250 PMCID: PMC9944287 DOI: 10.1016/j.apjon.2023.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
Objective This study clarified the process by which adult women diagnosed with metastatic breast cancer (MBC) and undergoing cancer pharmacotherapy reach psychological adjustment. Methods A semistructured interview was conducted with adult women who had received their MBC diagnosis. The data collected were analyzed using Kinoshita's modified grounded theory approach. Results A total of 21 women with an average age of 50 years participated in the study. Seven categories and 21 concepts were generated through the analysis. Upon being diagnosed with MBC by a doctor, the participants felt the "threat of death" and "conflict with painful cancer pharmacotherapy." Thereafter, they received "encouragement from strong supporters," consolidated their "resolve to save their life," and began cancer pharmacotherapy. During the therapy, they made "efforts to internalize MBC" to overcome the distress arising from the "struggle to internalize MBC," and this led to the "expansion of self-awareness." Conclusions Despite finding themselves in harsh circumstances, the participants remained focused on the big picture and realized that cancer had changed their values and outlook on life, leading to psychological growth. It is important for nurses to provide systematic and continuous support from the time of MBC diagnosis.
Collapse
Affiliation(s)
- Chihiro Iseki
- Osaka Medical and Pharmaceutical University Graduate School of Nursing, Takatsuki-shi, Osaka, Japan.,Hyogo Prefectural Nishinomiya Hospital, Nishinomiya-shi, Hyogo, Japan
| |
Collapse
|
10
|
Striving towards normality in an unpredictable situation. A qualitative interview study of how persons newly diagnosed with incurable oesophageal and gastric cancer manage everyday life. Eur J Oncol Nurs 2023; 63:102302. [PMID: 36893571 DOI: 10.1016/j.ejon.2023.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE Getting an incurable oesophageal or gastric cancer diagnosis is a major stressful life event associated with severe physical, psychosocial and existential challenges. To provide timely and efficient support, based on patients' experiences, the aim of the study was to explore how patients newly diagnosed with incurable oesophageal and gastric cancer manage everyday life. METHOD Semi-structured interviews were conducted with 12 patients 1-3 months after being diagnosed with incurable oesophageal or gastric cancer. Four participants were interviewed twice, which resulted in 16 interviews. Data were analysed with qualitative content analysis. RESULTS An overall theme, "Striving towards normality in an unpredictable situation", with three related themes - "Trying to comprehend the disease", "Dealing with the consequences of illness" and "Re-evaluating what is important in everyday life" - and seven sub-themes were identified. The participants described an unexpected and unpredictable situation, in which they strived to maintain their normal life. Amidst struggling to manage problems related to eating, fatigue and an incurable diagnosis the participants talked about the importance of focusing on the positive and normal aspects of life. CONCLUSIONS The findings in this study point to the importance of supporting patients' confidence and skills, particularly with regard to managing eating, so that they can hold on to their normal life as much as possible. The findings further point to the possible benefit of integrating an early palliative care approach and could provide guidance for nurses and other professionals on how to support patients post diagnosis.
Collapse
|
11
|
Alfieri S, Brunelli C, Capri G, Caraceni A, Bianchi GV, Borreani C. A Qualitative Study on the Needs of Women with Metastatic Breast Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1322-1331. [PMID: 33486712 DOI: 10.1007/s13187-020-01954-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
Few studies have investigated the needs of patients with metastatic breast cancer (MBC), and none have been conducted in Italy. Three categories of needs have been identified from the literature: information, support, and practical resources. The present study aims to achieve an in-depth understanding of the patients' needs related to the MBC care pathway. In-depth interviews were conducted and analyzed by thematic analysis. The participants were 9 women with MBC (age range 36-74) who were enrolled at the Fondazione IRCCS Istituto Nazionalde dei tumori, in Milan. The analysis enabled us to identify four themes (which reflect the needs of the participants), each divided into numerous sub-themes: (1) the need for clinical recognition, (2) the need for more attention from healthcare professionals, (3) the need for more and better services to be available at the hospital, (4) the need for specific public health policies. Since the metastatic phase of breast cancer seems to elicit additional, specific needs and multi-level management, changes in attitudes and multidisciplinary practices should be tested in order to ascertain how these needs can be met.
Collapse
Affiliation(s)
- Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy.
| | - Giuseppe Capri
- Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Giulia V Bianchi
- Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
12
|
Guo YQ, Ju QM, You M, Yusuf A, Wu Y, Soon LK. A Qualitative Study on Coping Strategies of Chinese Women With Metastatic Breast Cancer Undergoing Chemotherapy. Front Psychol 2022; 13:841963. [PMID: 35369261 PMCID: PMC8970282 DOI: 10.3389/fpsyg.2022.841963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesWomen who underwent chemotherapy (CT) for metastatic breast cancer (MBC) used both adaptive and maladaptive coping strategies but had low implementation levels. The present study explores the qualitative experience of coping strategies for women with MBC undergoing CT in Beijing.MethodsA hermeneutic phenomenological approach was employed on twenty Chinese MBC women undergoing CT. These interviews were transcribed verbatim, coded using thematic analysis, and analyzed using NVivo 11.ResultsThree themes are highlighted: Maintaining hope; Spiritual growth, and Self-perceived support resources.ConclusionThe present study results have led to a greater understanding of the tremendous impact of CT on MBC women’s lives. This research provides insight into the scope of maintaining hope. Spiritual growth and self-perceived support resources were crucial factors to coping strategies among MBC women to improve their quality of life.Clinical RelevanceBy attaining the adaptive coping strategies and further understanding about Chinese MBC women, health care professionals are encouraged to appraise MBC women’s specific problems and adopt effective interventions to improve MBC women’s psychosocial wellbeing.
Collapse
Affiliation(s)
- Yi-Qiang Guo
- School of Nursing, Capital Medical University, Beijing, China
| | | | - Miaoning You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Azlina Yusuf
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
- *Correspondence: Ying Wu,
| | - Lean Keng Soon
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| |
Collapse
|
13
|
Plage S, Kirby E. Reconfiguring time: optimisation and authenticity in accounts of people surviving with advanced cancer. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:96-111. [PMID: 33886429 DOI: 10.1080/14461242.2021.1918016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Increasingly, people live longer with advanced cancer, despite having no prospect of full recovery. Ongoing survival is owed to early detection and effective disease management, yet experienced as highly precarious. In this article we explore how cancer chronicity brings into effect a pre-occupation with time, what time is to people with advanced cancer, and what socio-cultural norms inflect everyday practices. We analyse 20 interviews conducted in Queensland, Australia with 11 participants with advanced cancer, to trace the intersections of what time means, what people do with time, and what time feels like. Drawing on scholarship on the moralities around ill health, we discuss how awareness of time emerges in cancer chronicity and raises moral questions on how to live well. Here, imperatives of optimisation (urging people with advanced cancer to make the most of limited time) intersect with imperatives of authenticity (marked by emphasis on how to live one's own best life). These dynamics reveal expressions of living with advanced cancer in morally viable ways. Such ontological processes have implications for the lived experience of people with advanced cancer, their families and oncological care.
Collapse
Affiliation(s)
- Stefanie Plage
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Children and Families over the Life Course (Life Course Centre), The University of Queensland, Brisbane, Australia
| | - Emma Kirby
- Centre for Social Research in Health (CSRH), The University of New South Wales, Sydney, Australia
| |
Collapse
|
14
|
Kirby E, Kenny K, Broom A, Lwin Z. Chronicity in/and cancer: a qualitative interview study of health professionals, patients, and family carers. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2035319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, Australia
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
15
|
Lindén L. Running out of time: The case of patient advocacy for ovarian cancer patients' access to PARP inhibitors. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:2141-2155. [PMID: 34636047 DOI: 10.1111/1467-9566.13385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
This article analyses patient advocacy for ovarian cancer patients' access to a group of new targeted cancer treatments, so-called poly (adenosine diphosphate ribose) polymerase (PARP) inhibitors. Ovarian cancer is often detected in its advanced stages and has relatively poor survival rates. Based on ethnographic fieldwork with the Gynae Cancer Group, a Swedish patients' group, this article examines ovarian cancer patient advocates' engagement with biomedicine as a rarely considered topic in the social sciences. Adopting a modified version of the science and technology studies perspective on evidence-based activism, I analyse how ovarian cancer patient advocates engage in the 'epistemic activities' of framing, producing and mobilising 'credentialed' and 'experiential' knowledge. I show how patient advocates, alone and together with professionals and the media, engage in epistemic activities to 'act upon' ovarian cancer patients' anticipated limited time and poor prognosis: patient advocates mobilise around PARP inhibitors as offering hope, access to these drugs as an urgent matter and ovarian cancer care as unequal. The article contributes to the sociological literature on novel cancer treatments and patient advocacy through its ethnographic tracing of cancer advocacy tropes and knowledge practices, centred on the temporal figure of 'the patient running out of time'.
Collapse
Affiliation(s)
- Lisa Lindén
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
16
|
Guité-Verret A, Vachon M. The incurable metastatic breast cancer experience through metaphors: the fight and the unveiling. Int J Qual Stud Health Well-being 2021; 16:1971597. [PMID: 34455941 PMCID: PMC8409930 DOI: 10.1080/17482631.2021.1971597] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: War metaphors are omnipresent in public and medical discourse on cancer . If some studies suggest that cancer patients may view their experiences as afight, few studies focus on the metaphors that patients create from their subjective experiences. The aim was to better understand the experience of four women with incurabale metastatic breast cancer from the metaphors they used in personal cancer blogs.Methods: An interpretive phenomenological analysis (IPA) was used to analyze these women's experience and metaphors of cancer.Results: Two metaphors carried the meaning of metastatic breast cancer experience: the fight and the unveiling. The results show that the war metaphor had a unique meaning for the bloggers who lived with incurable breast cancer: they revealed the difficulty of fighting cancer and eventually collapsing in battle, although a renewed look at life had developed in parallel to their struggle. The bloggers thus tried to lift the veil on this complex experience.Conclusion: The results highlight the need for women with metastatic breast cancer to be able to tell and share their experience in a supportive context and to reinvest the war metaphor in order to express themselves in a more authentic way.
Collapse
Affiliation(s)
- Alexandra Guité-Verret
- Psychology Department, Université Du Québec À Montréal, Montréal, Canada.,Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Montreal, Canada.,Réseau Québécois De Recherche En Soins Palliatifs Et De Fin De Vie (Rqspal), Quebec, Canada
| | - Melanie Vachon
- Psychology Department, Université Du Québec À Montréal, Montréal, Canada.,Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Montreal, Canada.,Réseau Québécois De Recherche En Soins Palliatifs Et De Fin De Vie (Rqspal), Quebec, Canada
| |
Collapse
|
17
|
Abstract
Drawing from interviews with women with metastatic breast cancer in the UK and France, in this article I analyze uncertainties linked to this condition. In particular, I show how the impossibility of foreseeing the evolution of the condition, also as an indirect consequence of medical innovation, initiates an irreparable disruption of life after diagnosis. I further show how the lives of the patients are not only limited by the illness, but also by the difficulty of finding a place in society. I argue that such experiences are best understood through the concept of the crisis of the presence.
Collapse
Affiliation(s)
- Cinzia Greco
- Wellcome Trust Research Fellow, Centre for the History of Science, Technology and Medicine, University of Manchester, Manchester, UK
| |
Collapse
|
18
|
The social meanings of choice in living-with advanced breast cancer. Soc Sci Med 2021; 280:114047. [PMID: 34090104 DOI: 10.1016/j.socscimed.2021.114047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/06/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022]
Abstract
Individual choice is valorised as a core social value; yet the necessity and desirability of making choices takes on new significance for people living with incurable cancer who are required to make often difficult decisions about treatment, care and family life, amidst considerable vulnerability and precariousness. There has been comparatively little exploration of how choice is negotiated and made meaningful under the spectre of incurability and a contracted future. In this paper, drawing on multiple qualitative interviews with 38 women with metastatic breast cancer, we explore how they experience and give meaning to choice in relation to their health (and beyond) in their daily lives. Our analysis highlights that while exercising choice was sometimes a concealed or silent pursuit, choice was always a socially negotiated and temporally unfolding process, nested within relational and interpersonal dynamics. Choices were also often constrained, even foreclosed, due to situational and relational dynamics. Yet even in the absence of choice, the idea of choice-as-control was discursively embraced by women. We argue that greater attention is needed to the affective, temporal and economic dimensions of choice, and how treatment decisions are asymmetrically structured when considered within the normative context of cancer.
Collapse
|
19
|
Wright JD, Kroenke CH, Kwan ML, Kushi LH. "I Had to Make Them Feel at Ease": Narrative Accounts of How Women With Breast Cancer Navigate Social Support. QUALITATIVE HEALTH RESEARCH 2021; 31:1056-1068. [PMID: 33645335 PMCID: PMC8376224 DOI: 10.1177/1049732321989999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Social scientific studies of social support predominantly focus on the positive associations between social support and emotional well-being. The negative aspects of social support have received much less attention. We conducted semi-structured interviews of women with breast cancer (n = 47) to examine the emotional strain associated with social support and how recipients navigate it in ways that protect themselves and their relationships. Based on our analysis of narratives of women's lived experiences of breast cancer, we found that social support can be perceived negatively and associated with experiences of emotional strain. Interviewees engaged in strategies of avoidance, information control, and cognitive reframing to minimize emotional strain. We applied the concept of emotion work to understand the complexity of emotional strain in this context. The findings highlight the difficulties of social support from a recipient's perspective and emphasize the importance of perception and agency in navigating this experience.
Collapse
Affiliation(s)
| | | | - Marilyn L Kwan
- Kaiser Permanente Northern California, Oakland, California, USA
| | | |
Collapse
|
20
|
Abstract
BACKGROUND Advanced cancer in young parents (PWAC) can increase dying concerns, the fluctuating thoughts, or feelings, conscious, or unconscious, about an approaching death by a person facing a terminal illness or a family member coping with the impending death of a loved one. However, limited research has been conducted to identify dying concerns in an ill parent as the research has focused on older adults. OBJECTIVE Our goal was to identify dying concerns that PWAC are expressing and to understand how these concerns affect measurable outcomes. METHOD CINHAL, MEDLINE, PsychARTICLES, PsycINFO, Social Work Abstracts, Health Source: Nursing/Academic Edition, and Psychology and Behavioral Sciences Collection were searched. Articles included were samples of PWAC, peer-reviewed, and published within the last 10 years. Elderly or pediatric populations, PWAC with adult children, and early-stage cancer were excluded. The initial search resulted in 1,526 articles, 18 were identified as potentially relevant. Fourteen articles were identified and reviewed. RESULTS PWAC expressed concerns for their children (n = 11), concerns for their co-parent (n = 4), and personal concerns (n = 11). Additionally, PWAC have decreased quality of life, have significant emotional and psychological distress, and have increased family dysfunction in relation to their concerns. Samples limit the generalizability of the findings. Majority of the articles consisted of White, upper, middle-class (n = 8) women (n = 7) diagnosed with breast cancer (n = 11) within nuclear families (n = 11). SIGNIFICANCE OF RESULTS Dying concerns are described in the literature from a fairly narrow sample of PWAC. Future research should focus on recruiting participants from diverse backgrounds, genders, diagnosis types, and non-nuclear families. Identifying concerns for the co-parent would also add to the understanding of dying concerns.
Collapse
|
21
|
Weber R, Ehrenthal JC, Brock-Midding E, Halbach S, Würstlein R, Kowalski C, Ernstmann N. Defense Mechanisms and Repressive Coping Among Male Breast Cancer Patients. Front Psychiatry 2021; 12:718076. [PMID: 34955906 PMCID: PMC8703166 DOI: 10.3389/fpsyt.2021.718076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: The concept of defense mechanisms has undergone extensive revision and expansion since Freud first described these processes. Initially formulated as an unconscious repression of unpleasant memories, with further development focusing on the role of defense mechanisms in the regulation of internal conflicts, the concept shifted and evolved to incorporate the adaptation to external demands, including intrapsychic and interpersonal handling of burden of illness. In addition to defense mechanisms, coping provides another perspective on human adjustment to difficult life events. While there is substantial research on both coping and defense mechanisms in various psychiatric and somatic diseases, including cancer, little is known about defensive regulation, coping, and their interaction in male breast cancer patients. Methods: The present study is part of the N-Male project conducted between 2016 and 2018 in Germany (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care). Semi-standardized interviews with 27 male breast cancer patients were analyzed with regard to defense mechanisms. In addition, fear of progression and repressive coping was assessed by self-report. Results: There was considerable variety in levels of defensive functioning as well as repressive coping in our sample. We found no difference in overall levels of defensive functioning between men with vs. without repressive coping. However, patients with repressive coping demonstrated a decopupled association between fear of progression and defensive functioning as compared to patients without repressive coping. Discussion: The study provides the first evidence of disease processing in male breast cancer patients Knowledge of patients' defense patterns and repressive coping seems promising for better planning targeted intervention strategies.
Collapse
Affiliation(s)
- Rainer Weber
- Department of Psychosomatic and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Johannes C Ehrenthal
- Department of Psychology, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Evamarie Brock-Midding
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), Bonn, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics (Comprehensive Cancer Center Munich), University Hospital of Munich (Ludwig Maximilian University), Munich, Germany
| | | | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), Bonn, Germany
| |
Collapse
|
22
|
Shands ME, Lewis FM. Parents With Advanced Cancer: Worries About Their Children's Unspoken Concerns. Am J Hosp Palliat Care 2020; 38:920-926. [PMID: 33107327 DOI: 10.1177/1049909120969120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Parents with advanced cancer struggle initiating conversations with their children about the cancer. When parents do not have the tools to talk with their children, they silently watch their children attempt to navigate their illness but can only wonder but not know what their children are thinking. The objective of the current study is to describe, from parents living with advanced cancer, the worries and concerns parents wonder their child holds, but has not spoken, about the parent's cancer. METHODS Twenty-seven parents with incurable cancer enrolled in a 5 session telephone intervention pilot study during which they were asked, "What questions do you have about what your child is thinking or feeling about the cancer?" Data were transcribed and inductively coded using content analysis methods adapted from grounded theory. RESULTS Analysis yielded 14 categories of parent concerns organized into 6 larger conceptual domains: Being Concerned and Scared about My Cancer; Worrying about Me; Changing How We Talk and Live Day-to-Day; Not Knowing What Will Happen; Having Unanswered Questions about My Cancer; and Understanding My Disease Is Terminal. CONCLUSIONS Study results add to our understanding of the magnitude of the emotional burden parents with advanced cancer carry as they struggle to balance their diagnosis and treatment and their life as parents.
Collapse
|
23
|
Constructing Recovery Narratives: Experiences and Expectations Following Spinal Cord Injury. Rehabil Nurs 2020; 45:254-262. [PMID: 32865946 DOI: 10.1097/rnj.0000000000000202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to explore how married individuals construct narratives following spinal cord injury (SCI). DESIGN Prospective qualitative study. METHODS Eighteen married people with SCI were recruited during inpatient hospitalization. In-depth interviews were conducted at approximately 1, 4, and 7 months post-SCI. Interviews were analyzed using thematic analysis. FINDINGS Participants constructed three primary narrative types (optimistic, anxious, and stability) about their trajectories following SCI, focusing on their expectations about recovery and their past and current experiences with their spouse, peers, and health professionals. These narrative types are the foundation for understanding how people make sense of the rehabilitation experience in relation to others. CONCLUSIONS Findings provide an initial understanding of how expectations of life with SCI as well as social interactions in the healthcare setting influence experiences of injury and recovery. CLINICAL RELEVANCE Findings can inform future interventions during SCI rehabilitation to ease transitions and decrease anxiety following SCI.
Collapse
|
24
|
Dönmez ÇF, Johnston B. Living in the moment for people approaching the end of life: A concept analysis. Int J Nurs Stud 2020; 108:103584. [PMID: 32450405 DOI: 10.1016/j.ijnurstu.2020.103584] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/26/2020] [Accepted: 03/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND 'Living in the moment' is an essential part of dignity-conserving practice in end-of-life care settings. Although living in the moment is important for care at the end of life, from the perspective of both the person and their family, there is no clear conceptual understanding of what it represents. OBJECTIVE To explore the concept of 'living in the moment' in the context of dignity-conserving care at the end of life. DESIGN A concept analysis. DATA SOURCES The databases of Medline, CinAHL, PubMed, Web of Science, PsycINFO, SocINDEX and Cochrane were searched for studies published between 1941 and 2019, and searches of dictionaries and grey literature, as well as hand-searching were conducted, to yield qualitative, mixed methods and systematic reviews published in English, related to the term 'living in the moment'. METHOD The methods of Walker and Avant were used to identify antecedents, attributes and consequences of the concept of 'living in the moment'. RESULTS The literature review generated a total of 37 papers for this concept analysis. The attributes identified were (1) simple pleasure, (2) prioritising relationships, (3) living each day to the fullest, (4) maintaining normality, and (5) not worrying about the future. The antecedents were (1) awareness of dying, (2) living with life-threatening illness, (3) positive individual growth, and (4) living with an uncertain future. The consequences were (1) a good quality of life, (2) preserving dignity, and (3) coping with the uncertainty of life. CONCLUSIONS A universal definition and conceptual model of the main concept, including theoretical relationships between its antecedents, attributes and consequences, was developed. The definition and proposed conceptual model can allow instruments to be developed that measure the effects, existence or attributes of the concept, and identify a theoretical model, and can also lead to new perspectives and strategies for implementation by nurses to improve dignified person-centred care at the end of life.
Collapse
Affiliation(s)
- Çiğdem Fulya Dönmez
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; School of Heath Sciences, Department of Nursing, Istanbul Arel University, Istanbul, Turkey.
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; Florence Nightingale Foundation Clinical Professor of Nursing, School of Medicine, Dentistry & Nursing, and NHS Greater Glasgow and Clyde, College of Medical, Veterinary & Life Sciences, University of Glasgow, 57-61 Oakfield Avenue, Glasgow G12 8LL, Scotland, UK.
| |
Collapse
|
25
|
Wigginton B, Thomson ZO, Sandler CX, Reeves MM. Reflexive Intervention Development: Using Qualitative Research to Inform the Development of an Intervention for Women With Metastatic Breast Cancer. QUALITATIVE HEALTH RESEARCH 2020; 30:666-678. [PMID: 31744371 DOI: 10.1177/1049732319884901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is growing consensus around the limited attention given to documenting the process of intervention development, specifically the role of qualitative research. In this article, we seek to describe a missing piece of this process: how qualitative research, and related methodologies and theories, informs intervention development. We use our research as a case study of "reflexive intervention development." We begin by describing our interview study, consisting of 23 in-depth interviews with women diagnosed with metastatic breast cancer, and go on to detail our methodological framework and research team. We then explain how this interview study directly informed our development of the intervention materials, allowing us to attend carefully to language and its potential implications for women. We conclude by inviting researchers to reflect on the knowledge production process that is inherent in intervention development to consider not only their role in this process but also the role of qualitative research.
Collapse
Affiliation(s)
| | - Zoe O Thomson
- The University of Queensland, Brisbane, Queensland, Australia
| | - Carolina X Sandler
- The University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Marina M Reeves
- The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
26
|
Ginter AC. "The day you lose your hope is the day you start to die": Quality of life measured by young women with metastatic breast cancer. J Psychosoc Oncol 2020; 38:418-434. [PMID: 32067600 DOI: 10.1080/07347332.2020.1715523] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose/Objectives: The number of young women with metastatic breast cancer (MBC) is growing in the United States. The intersection of age and cancer stage presents unique challenges for this population. However, there is little extant research on the concerns and perspectives of young women with MBC. The purpose of this study is to understand how young women describe their lived experiences following their diagnoses of MBC.Design: A cross-sectional qualitative study with a life course theoretical framework was employed.Sample/Participants: Purposive sampling yielded nine participants who took part in semi-structured interviews. Phenomenology informed understanding of the lived experience of young women with MBC.Findings: The findings describe how young women with MBC measure quality of life, via themes of facing off-time diagnoses, strategizing disclosure, relying on mindfulness and spirituality, contemplating the future, and differentiating surviving from truly living.Conclusion: The notion of short-term or long-term decision-making is clouded by a metastatic prognosis.Implications for Psychosocial Providers: These findings present new information about the needs of young women with MBC, with potentially transferable implications for young adults with other forms of metastatic cancer.
Collapse
Affiliation(s)
- Amanda C Ginter
- Department of Family Studies and Community Development, Towson University, Towson, MD, USA
| |
Collapse
|
27
|
van Dongen SI, de Nooijer K, Cramm JM, Francke AL, Oldenmenger WH, Korfage IJ, Witkamp FE, Stoevelaar R, van der Heide A, Rietjens JA. Self-management of patients with advanced cancer: A systematic review of experiences and attitudes. Palliat Med 2020; 34:160-178. [PMID: 32009565 PMCID: PMC7433395 DOI: 10.1177/0269216319883976] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention. AIM To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management. DESIGN A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting. DATA SOURCES MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019). RESULTS Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient-professional partnerships (three articles). CONCLUSION Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.
Collapse
Affiliation(s)
- Sophie I van Dongen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kim de Nooijer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jane M Cramm
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Amsterdam Public Health (APH) Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Wendy H Oldenmenger
- Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frederika E Witkamp
- Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Rik Stoevelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
28
|
Olano-Lizarraga M, Martín-Martín J, Oroviogoicoechea C, Saracíbar-Razquin M. Unexplored Aspects of the Meaning of Living with Chronic Heart Failure: A Phenomenological Study within the Framework of the Model of Interpersonal Relationship between the Nurse and the Person/Family Cared for. Clin Nurs Res 2020; 30:171-182. [PMID: 31896283 DOI: 10.1177/1054773819898825] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The complicated situation experienced by chronic heart failure (CHF) patients affects their entire well-being but clinical practice continues to fail to adequately respond to their demands. The aim of this study was to understand the meaning of living with CHF from the patient's perspective. A hermeneutic phenomenological study was conducted according to Van Manen's phenomenology of practice method. Individual conversational interviews were held with 20 outpatients with CHF. Six main themes emerged from the analysis: (1) Living with CHF involves a profound change in the person; (2) The person living with CHF has to accept their situation; (3) The person with CHF needs to feel that their life is normal and demonstrate it to others; (4) The person with CHF needs to have hope; (5) Having CHF makes the person continuously aware of the possibility of dying; (6) The person with CHF feels that it negatively influences their close environment.
Collapse
Affiliation(s)
- Maddi Olano-Lizarraga
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jesús Martín-Martín
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Cristina Oroviogoicoechea
- Innovation for a Person-Centred Care Research Group, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Area of Nursing Research, Training and Development, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maribel Saracíbar-Razquin
- Department of Nursing Care for Adult Patients, School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| |
Collapse
|
29
|
Yee J, Davis GM, Hackett D, Beith JM, Wilcken N, Currow D, Emery J, Phillips J, Martin A, Hui R, Harrison M, Segelov E, Kilbreath SL. Physical Activity for Symptom Management in Women With Metastatic Breast Cancer: A Randomized Feasibility Trial on Physical Activity and Breast Metastases. J Pain Symptom Manage 2019; 58:929-939. [PMID: 31374368 DOI: 10.1016/j.jpainsymman.2019.07.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022]
Abstract
CONTEXT Physical activity for women with early-stage breast cancer is well recognized for managing cancer-related symptoms and improving quality of life. While typically excluded from interventions, women with metastatic breast cancer may also benefit from physical activity. OBJECTIVE To 1) determine the safety and feasibility of a physical activity program for women with metastatic breast cancer and 2) explore the efficacy of the program. METHODS Fourteen women with metastatic breast cancer were randomized to either a control group or an 8-week home-based physical activity intervention comprising twice weekly supervised resistance training and an unsupervized walking program. RESULTS The recruitment rate was 93%. Adherence to the resistance and walking components of the program was 100% and 25%, respectively. No adverse events were reported. When mean change scores from baseline to postintervention were compared, trends in favor of the exercise group over the control group were observed for the Functional Assessment of Chronic Illness Therapy-Fatigue score (+5.6 ± 3.2 vs. -1.8 ± 3.9, respectively), VO2max (+1.6 ml/kg/minute ±1.8 mL/kg/minute vs. -0.2 mL/kg/minute ±0.1 mL/kg/minute, respectively) and six-minute walk test (+40 m ± 23 m vs. -46 m ± 56 m, respectively). CONCLUSION A partially supervised home-based physical activity program for women with metastatic breast cancer is feasible and safe. The dose of the resistance training component was well tolerated and achievable in this population. In contrast, adherence and compliance to the walking program were poor. Preliminary data suggest a physical activity program, comprising predominantly resistance training, may lead to improvements in physical capacity and may help women to live well with their disease.
Collapse
Affiliation(s)
- Jasmine Yee
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Glen M Davis
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Daniel Hackett
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
| | - Jane M Beith
- The Chris O'Brien Lifehouse, Camperdown, Australia
| | - Nicholas Wilcken
- Crown Princess Mary Cancer Centre, Westmead Hospital, The University of Sydney, Lidcombe, Australia
| | - David Currow
- Faculty of Health Sciences, Flinders University, Daw Park, Australia
| | - Jon Emery
- General Practice and Primary Care Academic Centre, University of Melbourne, Parkville, Australia; General Practice, University of Western Australia, Crawley, Australia
| | - Jane Phillips
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Andrew Martin
- Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Rina Hui
- Crown Princess Mary Cancer Centre, Westmead Hospital, The University of Sydney, Lidcombe, Australia
| | | | - Eva Segelov
- Monash Health and Monash University, Melbourne, Australia
| | - Sharon L Kilbreath
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.
| |
Collapse
|
30
|
Olano-Lizarraga M, Zaragoza-Salcedo A, Martín-Martín J, Saracíbar-Razquin M. Redefining a 'new normality': A hermeneutic phenomenological study of the experiences of patients with chronic heart failure. J Adv Nurs 2019; 76:275-286. [PMID: 31642086 DOI: 10.1111/jan.14237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022]
Abstract
AIM To explore the perception of normality in life experienced by patients with chronic heart failure. DESIGN A hermeneutic phenomenological study was conducted. METHODS Individual conversational interviews were held with 20 outpatients with chronic heart failure between March 2014-July 2015. Van Manen's phenomenology of practice method was used for data analysis. RESULTS From the analysis, four main themes emerged: (a) Accepting my new situation; (b) Experiencing satisfaction with life; (c) Continuing with my family, social and work roles; and (d) Hiding my illness from others. CONCLUSIONS The present study makes a novel contribution to understanding the importance of the perception of normality in the lives of patients with chronic heart failure. It was found that patients need to incorporate this health experience into their lives and reach a 'new normal', thus achieving well-being. Several factors were identified that can help promote this perception in their lives; therefore, nursing interventions should be designed to help develop scenarios encouraging this normalization process. IMPACT Although the implications of having a sense of normality or experiencing 'normalization' of the illness process in life have been studied in other chronic patient populations, no studies to date have examined how patients with chronic heart failure experience this phenomenon in their lives. For the first time, the results of this research prove that the perception of normality is a key aspect in the experience of living with chronic heart failure.
Collapse
Affiliation(s)
- Maddi Olano-Lizarraga
- School of Nursing, Department of Nursing Care for Adult Patients, Campus Universitario, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Amparo Zaragoza-Salcedo
- School of Nursing, Department of Nursing Care for Adult Patients, Campus Universitario, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jesús Martín-Martín
- School of Nursing, Department of Nursing Care for Adult Patients, Campus Universitario, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Maribel Saracíbar-Razquin
- School of Nursing, Department of Nursing Care for Adult Patients, Campus Universitario, Universidad de Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| |
Collapse
|
31
|
Nguyen TS, Bauer M, Maass N, Kaduszkiewicz H. Living with Male Breast Cancer: A Qualitative Study of Men's Experiences and Care Needs. Breast Care (Basel) 2019; 15:6-12. [PMID: 32231492 DOI: 10.1159/000501542] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
Background Male breast cancer (MBC) is rare, and most previous studies limited their focus on clinical aspects of the disease. Psychosocial implications and care needs of MBC patients are poorly understood. Objectives The aim of this study is to explore the experiences of men living with breast cancer and to identify supportive care needs. Methods Eighteen men were interviewed using qualitative, semi-structured telephone interviews. Qualitative content analysis was used to analyze the data. Results The majority of men did not have negative feelings about having a "women's disease," although some felt that stigmatization threatened their masculinity. Male sex was perceived as hindering access to adequate care. Patients identified key barriers including (1) a lack of awareness and experience of treating males among health professionals; (2) treatment and available information were based on evidence for females; and (3) lacking support services. Conclusion To improve MBC care, it is important to raise awareness of the disease and to adapt treatment strategies, patient information, and support services to meet the needs of men.
Collapse
Affiliation(s)
- Truc Sophia Nguyen
- Institute of General Practice, Faculty of Medicine, Christian Albrecht University Kiel, Kiel, Germany.,Institute of General Practice, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | | | - Nicolai Maass
- Clinic for Gynaecology and Obstetrics, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Faculty of Medicine, Christian Albrecht University Kiel, Kiel, Germany
| |
Collapse
|
32
|
|
33
|
Saunders B, Bartlam B, Artus M, Konstantinou K. Biographical suspension and liminality of Self in accounts of severe sciatica. Soc Sci Med 2018; 218:28-36. [DOI: 10.1016/j.socscimed.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
|
34
|
“I Have Both Lost and Gained.” Norwegian Survivors’ Experiences of Coping 9 Years After Primary Breast Cancer Surgery. Cancer Nurs 2018; 43:E30-E37. [DOI: 10.1097/ncc.0000000000000656] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Budhwani S, Wodchis WP, Zimmermann C, Moineddin R, Howell D. Self-management, self-management support needs and interventions in advanced cancer: a scoping review. BMJ Support Palliat Care 2018; 9:12-25. [PMID: 30121581 DOI: 10.1136/bmjspcare-2018-001529] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/29/2018] [Accepted: 07/11/2018] [Indexed: 12/25/2022]
Abstract
Patients with advanced cancer can experience illness trajectories similar to other progressive chronic disease conditions where undertaking self-management (SM) and provision of self-management support (SMS) becomes important. The main objectives of this study were to map the literature of SM strategies and SMS needs of patients with advanced cancer and to describe SMS interventions tested in this patient population. A scoping review of all literature published between 2002 and 2016 was conducted. A total of 11 094 articles were generated for screening from MEDLINE, Embase, PsychINFO, CINAHL and Cochrane Library databases. A final 55 articles were extracted for inclusion in the review. Included studies identified a wide variety of SM behaviours used by patients with advanced cancer including controlling and coping with the physical components of the disease and facilitating emotional and psychosocial adjustments to a life-limiting illness. Studies also described a wide range of SMS needs, SMS interventions and their effectiveness in this patient population. Findings suggest that SMS interventions addressing SMS needs should be based on a sound understanding of the core skills required for effective SM and theoretical and conceptual frameworks. Future research should examine how a patient-oriented SMS approach can be incorporated into existing models of care delivery and the effects of SMS on quality of life and health system utilisation in this population.
Collapse
Affiliation(s)
- Suman Budhwani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,Health System Performance Research Network, University of Toronto, Toronto, ON, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,Health System Performance Research Network, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
36
|
Guérin A, Goldschmidt D, Small T, Gagnon-Sanschagrin P, Romdhani H, Gauthier G, Kelkar S, Wu EQ, Niravath P, Dalal AA. Monitoring of Hematologic, Cardiac, and Hepatic Function in Post-Menopausal Women with HR+/HER2- Metastatic Breast Cancer. Adv Ther 2018; 35:1251-1264. [PMID: 29946797 DOI: 10.1007/s12325-018-0740-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In the treatment of metastatic breast cancer (mBC), regular monitoring is key in helping physicians to make informed clinical decisions, managing treatment side effects, and maintaining patients' quality of life. Therefore, we investigated the monitoring frequency in post-menopausal women with HR+/HER2- mBC stratified by first-line regimen. METHODS Treatment monitoring was assessed using two complementary data sources: a medical chart review (chart review analysis) and a commercial claims database (claims analysis). Women with post-menopausal HR+/HER2- mBC who initiated first-line therapy for mBC were selected and classified under three cohorts, based on treatment received: cyclin-dependent kinase 4/6 (CDK4/6) inhibitor (i.e., palbociclib-the only CDK4/6 approved at the time of the study), endocrine therapy (ET), and chemotherapy. Frequency of monitoring [complete blood count (CBC), electrocardiogram (EKG), and liver function test (LFT)] and laboratory abnormalities detected during the first line of therapy were analyzed. RESULTS In the chart review analysis, 64 US oncologists abstracted medical information on 401 eligible patients, including 210 CDK4/6 users, 121 ET users, 51 chemotherapy users; 19 patients used other regimens. All patients had ≥ 1 CBC; between 8.3% (ET users) and 39.5% (CDK4/6 users) had ≥ 1 EKG; and over 98% of patients had ≥ 1 LFT across all three cohorts. Among monitored patients, 64.6% had a CBC abnormality, with anemia (39.9%), leukopenia (27.4%), and neutropenia (26.7%) being the most common. Abnormal EKG readings were detected in 8.4, 0.0%, and 7.7% of CDK4/6, ET, and chemotherapy users, respectively. LFT abnormalities were detected in 14.1-26.0% of CDK4/6 and chemotherapy users, respectively. Similar frequency of monitoring was observed in the claims analysis, with the exception of EKG monitoring, for which the proportion of patients tested was higher. CONCLUSION Post-menopausal women with HR+/HER2- mBC receiving first-line therapy with CDK4/6, ET, or chemotherapy were regularly monitored regardless of the first-line regimen received. FUNDING Novartis Pharmaceuticals Corporation.
Collapse
Affiliation(s)
- Annie Guérin
- Analysis Group, Inc., 1000 De La Gauchetière West, Suite 1200, Montreal, QC, H3B 4W5, Canada.
| | - Debbie Goldschmidt
- Analysis Group, Inc., 10 Rockefeller Plaza, 15th floor, New York, NY, 10020, USA
| | - Tania Small
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, 07936, NJ, USA
| | | | - Hela Romdhani
- Analysis Group, Inc., 1000 De La Gauchetière West, Suite 1200, Montreal, QC, H3B 4W5, Canada
| | - Genevieve Gauthier
- Analysis Group, Inc., 1000 De La Gauchetière West, Suite 1200, Montreal, QC, H3B 4W5, Canada
| | - Sneha Kelkar
- Analysis Group, Inc., 10 Rockefeller Plaza, 15th floor, New York, NY, 10020, USA
| | - Eric Q Wu
- Analysis Group, Inc., 111 Huntington Ave, 14th floor, Boston, MA, 02199, USA
| | - Polly Niravath
- Houston Methodist Hospital, 6445 Main St, Houston, 77030, TX, USA
| | - Anand A Dalal
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, 07936, NJ, USA
| |
Collapse
|
37
|
Williamson TJ, Love SM, Clague DeHart JN, Jorge-Miller A, Eshraghi L, Cooper Ortner H, Stanton AL. Metastatic Breast Cancer Collateral Damage Project (MBCCD): Scale development and preliminary results of the Survey of Health, Impact, Needs, and Experiences (SHINE). Breast Cancer Res Treat 2018; 171:75-84. [PMID: 29767345 DOI: 10.1007/s10549-018-4823-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Until recently, people with metastatic breast cancer (MBC) had a very poor prognosis. New treatment approaches have prolonged the time that people with MBC live, but their quality of life has received less attention. Consequently, the needs and concerns across financial, vocational, psychological, social, and physical domains in MBC patients are poorly understood-particularly regarding the collateral damage or longer-term, life-altering impacts of MBC and its treatments. This study's aims were to characterize MBC-related collateral damage, identify groups most likely to experience collateral damage, and examine its associations with psychological health, illness management, and health behaviors. METHODS Participants (N = 515) with MBC were recruited from Dr. Susan Love Research Foundation's Army of Women® and other advocacy organizations. Participants completed questionnaires of MBC-related collateral damage, depressive symptoms, anxiety, self-efficacy for managing oncologic treatments and physical symptoms, sleep, and physical activity. RESULTS Eight domains of MBC-related collateral damage, as well as MBC-related benefit finding, were reliably characterized. Concerns about mortality/uncertainty were most prominent. Participants also endorsed high levels of benefit finding. Participants younger than 50 years, with limited financial resources, or with children under 18 at home reported the most collateral damage. Collateral damage was associated significantly with compromised psychological health, lower illness management efficacy, and poorer health behaviors, beyond sociodemographic and medical characteristics. CONCLUSIONS Subgroups of MBC patients report long-term, life-altering consequences of MBC and its treatments, which relate to important health outcomes. Clinical implications and recommendations are discussed.
Collapse
Affiliation(s)
- Timothy J Williamson
- Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Susan M Love
- Dr. Susan Love Research Foundation, Encino, CA, USA
| | - Jessica N Clague DeHart
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Alexandra Jorge-Miller
- Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | | | | | - Annette L Stanton
- Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA. .,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA. .,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA. .,Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, USA.
| |
Collapse
|
38
|
Vehling S, Gerstorf D, Schulz-Kindermann F, Oechsle K, Philipp R, Scheffold K, Härter M, Mehnert A, Lo C. The daily dynamics of loss orientation and life engagement in advanced cancer: A pilot study to characterise patterns of adaptation at the end of life. Eur J Cancer Care (Engl) 2018; 27:e12842. [DOI: 10.1111/ecc.12842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S. Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Palliative Care Unit; Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - D. Gerstorf
- Department of Psychology; Humboldt University Berlin; Berlin Germany
| | - F. Schulz-Kindermann
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Oechsle
- Palliative Care Unit; Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - R. Philipp
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Scheffold
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Härter
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - A. Mehnert
- Department of Medical Psychology and Sociology; University Medical Center Leipzig; Leipzig Germany
| | - C. Lo
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Department of Psychiatry; University of Toronto; Toronto ON Canada
- Department of Psychology; University of Guelph-Humber; Toronto ON Canada
| |
Collapse
|
39
|
Saunders B. 'It seems like you're going around in circles': recurrent biographical disruption constructed through the past, present and anticipated future in the narratives of young adults with inflammatory bowel disease. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:726-740. [PMID: 28425115 DOI: 10.1111/1467-9566.12561] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Biographical disruption and related concepts continue to be widely drawn upon in explaining how individuals experience chronic illness. Through in-depth examination of the narrative experiences of two young adults with inflammatory bowel disease (IBD), this article aims to contribute to the continuing theoretical elaboration of biographical disruption, and in turn offer new insights into how young adults experience this condition. The cases are analysed from an interaction-based, constructionist perspective, through which it is argued that the relapse-remission nature of IBD can give rise to a particular form of recurrent biographical disruption, constructed in narrative through a complex configuration of past, present and anticipated future experiences. The two young adults are found to give different meaning to this recurrent disruption in terms of its significance and consequences - whilst Samuel represents an ongoing cycle of profound disruption and biographical reinstatement, Edith normalises the cycle of disruption and its role in her ongoing biography. Therefore, moving beyond the notion of 'normal illness' observed in previous research literature, the concept of 'normal recurrent disruption' is proposed. Finally, it is argued that this recurrent biographical disruption may be experienced particularly severely in young adulthood owing to the unique pressures and expectations of this lifestage.
Collapse
|