Transforming the Death Sentence: Elements of Hope in Women With Advanced Ovarian Cancer

Fear of recurrence in women with ovarian cancer: A qualitative evidence synthesis

PURPOSE

Approximately 80% of ovarian cancers recur after first-line treatments. Women with ovarian cancer (OC) are therefore particularly vulnerable to experiencing fear of cancer recurrence (FCR). This study aimed to synthesise experiences of fear of cancer recurrence among women living with ovarian cancer.

METHOD

A qualitative evidence synthesis (QES) was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. A systematic search of seven databases was undertaken to identify all available qualitative research exploring fear of cancer recurrence in women with OC. Thematic synthesis of extracted data from included studies was undertaken and managed in NVivo.

RESULTS

Twenty-two papers reporting on eighteen studies were included in the synthesis. Three main themes were developed (triggers, responses, and coping) and included ten subthemes. FCR was triggered by factors relating to awareness of prognosis, treatment, and negative communication. Women responded to FCR by performing body checking and protecting their families. FCR led to adverse effects on women's wellbeing as it exacerbated uncertainty about their future. Women attempted to cope with FCR through seeking support, regaining control, and redirecting negative thoughts and actions.

CONCLUSIONS

Women use a variety of approaches to manage their fear of recurrence. Further research on the most appropriate interventions for FCR tailored specifically to the needs of women with OC is needed.

"Hope at a crossroads" - Experiences of hope in intensive care patients: A qualitative study

BACKGROUND

Hope is closely connected to experiences of health and illness. In critical illness, the future may be uncertain regarding survival, recovery, and daily functioning. More knowledge is needed on how to support hope in patients in intensive care units and during the following rehabilitation period.

OBJECTIVES

The aim of this study was to explore hope and its impacting factors among critically ill patients in the intensive care unit.

METHODS

This was an exploratory study using semistructured interviews for data collection. Thirteen patients discharged from intensive care were interviewed while still in hospital. Data were analysed using thematic analysis. The consolidated criteria for reporting qualitative research were used for reporting this study.

FINDINGS

Three themes, consisting of 8 subthemes, were generated through the analysis. The first theme presented, 'Hope at the point of uncertainty', describes the perception of hope as a phenomenon in critical illness, while the last two, 'Nourishment for hope' and 'Barriers to hope', comprise possible promoting and constraining factors affecting hope during intensive care The overarching theme 'Hope at a crossroads' reflects the overall patient experience of hope in critical illness.

CONCLUSION

To maintain or regain hope, healthcare personnel working with critically ill patients should be aware of the importance of encouraging and acknowledging physical progress even when small. Furthermore, they should attend to patients' relational needs and facilitate their ability to interact as the persons they are, not only as patients.

Hope therapy in cancer patients: a systematic review

AIM

To identify the associated factors of hope therapy during treatment in cancer patients.

BACKGROUND

Hope is very important to cancer patients at all stages of the disease process. Several and different factors are associated with hope.

DESIGN

A systematic literature review of quantitative empirical studies on hope and quality of life in cancer patients.

DATA SOURCES

Search in MEDLINE, Psychinfo, and Cochrane (January 2010-December 2020).

REVIEW METHODS

A coherent search strategy was designed where MESH terms were combined with "free text" terms: hope (e.g., hope therapy, Herth Hope Index, quality of life) and cancer (e.g. neoplasm, tumor). Two authors independently screened all the studies and assessed their quality.

RESULTS

Twenty studies were included. The overall score of Herth Hope Index in cancer patients was 36.93, and the overall score of quality of life in cancer patients were 47.52. Also, the trend of quality of life and Herth Hope Index in cancer patients has been decreasing, from 2010 to 2020.

CONCLUSIONS

This systematic literature review of associated factors of hope in cancer patients receiving treatment shows that hope seems to be positively related mainly by intrinsic factors, such as perceived health, quality of life, and social support.

Communicating is analogous to caring: A systematic review and thematic synthesis of the patient-clinician communication experiences of individuals with ovarian cancer

OBJECTIVE

To systematically review and synthesize the patient-clinician communication experiences of individuals with ovarian cancer.

METHODS

The CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science databases were reviewed for articles that described (a) original qualitative or mixed methods research, (b) the experiences of individuals with ovarian cancer, and (c) findings related to patient-clinician communication. Relevant data were extracted from study results sections, then coded for descriptive and analytical themes in accordance with Thomas and Harden's approach to thematic synthesis. Data were coded by two authors and discrepancies were resolved through discussion.

RESULTS

Of 1,390 unique articles, 65 met criteria for inclusion. Four descriptive themes captured participants' experiences communicating with clinicians: respecting me, seeing me, supporting me, and advocating for myself. Findings were synthesized into three analytical themes: communication is analogous to caring, communication is essential to personalized care, and communication may mitigate or exacerbate the burden of illness.

SIGNIFICANCE OF RESULTS

Patient-clinician communication is a process by which individuals with ovarian cancer may engage in self-advocacy and appraise the extent to which they are seen, respected, and supported by clinicians. Strategies to enhance patient-clinician communication in the ovarian cancer care setting may promote patient perceptions of patient-centered care.

Openness and topic avoidance in interpersonal communication about ovarian cancer: An uncertainty management perspective

This study examined openness and topic avoidance in interpersonal communication about ovarian cancer. Guided by the uncertainty management theory, the researchers analyzed qualitative data from 28 ovarian cancer patients/survivors and found openness and topic avoidance to be complex communication behaviors which are connected to patients/survivors’ uncertainty. Participants appraised uncertainty about disease prognosis and effectiveness of treatments as a threat; thus, they avoided topics such as treatment side effects and fears about death and disease recurrence to manage such uncertainty. Furthermore, findings showed that communication about ovarian cancer is layered with degrees of openness and avoidance relative to respective audiences and changing illness trajectories. Overall, the findings indicate connections between interpersonal communication about ovarian cancer and uncertainty management practices, suggesting that intervention efforts should help cancer patients/survivors and relational others practice sensitivity when discussing topics such as death and dying.

The Effect of Religious Coping on Hope Level of Cancer Patients Receiving Chemotherapy

Religious coping and hope are among factors that affect the disease, treatment compliance, psychological health and quality of life of cancer patients. The aim of this study was to determine the level of hope and religious coping styles of cancer patients, and to determine the relationship between religious coping and hope. The study was carried out descriptively and cross-sectionally with 133 patients receiving chemotherapy in an oncology center. In the study, the level of hope and positive religious coping of the patients were high and their level of negative religious coping was low. It was determined that there was a positive relationship between positive religious coping style and hope levels of patients, and positive religious coping style was a significant predictor of hope level. While patients are dealing with cancer diagnosis and treatment, it is recommended that health care professionals primarily focus on providing these patients a service with a holistic care approach and developing their hope with practices that will strengthen their positive religious coping styles.

Effects of a nursing care program based on the theory of human caring on women diagnosed with gynecologic cancer: a pilot study from Turkey

PURPOSE/OBJECTIVES

This pilot study aimed to determine the effects of a nursing care program based on the Theory of Human Caring (THC) on chemotherapy symptoms, hope, and meaning in life in women diagnosed with gynecologic cancer.

DESIGN/METHODS

This pilot study was conducted in a single-blinded, randomized controlled trial on 52 women diagnosed with gynecologic cancer in Turkey. In the present study, the experimental group was given a nursing care program based on the THC alongside routine nursing care for five sessions, while the control group received solely routine nursing care. Data were collected using the Chemotherapy Symptom Assessment Scale, the Herth Hope Scale, and the Life Attitude Profile.

FINDINGS

There was a statistically significant decrease in the frequency, severity, and degree of discomfort of some chemotherapy symptoms in the experimental group. In addition, the mean scores of hope and meaning in life were significantly higher in the study group compared to the control group.

CONCLUSIONS/IMPLICATIONS

This study revealed that a nursing care program based on the Theory of Human Caring might be of benefit for decreasing the frequency, intensity, and discomfort level of some chemotherapy symptoms, and also for improving the level of hope and meaning in life in women diagnosed with gynecologic cancer.

Hope in end-of-life cancer patients: A cross-sectional analysis

Objective

Hope promotes oncology patients’ adaptability to their illness, regardless of the stage of cancer. This study aimed to determine the prevalence of hope in a sample of end-of-life patients and to investigate the possible relationships between hope and a set of clinical and psychosocial measures.

Method

Three hundred and fifty end-of-life oncology patients, with a presumed life expectancy of 4 months or less and a Karnofsky Performance Status (KPS) of 50 or lower, were administered the Italian validated versions of a set of rating scales during their first consultation with a psychologist. This included the Herth Hope Index (HHI), Patient Dignity Inventory (PDI), Demoralization Scale (DS), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy (FACIT-Sp), and the Visual Analogue Scale for pain (VAS).

Results

On average, the sample scored between moderate and high on the HHI and the average level of spirituality was high. However, most patients had clinically relevant anxious and depressive symptomatology and high levels of demoralization. Other than the pain scale, the total HHI score significantly correlated with the total scores of all rating scales and their subscales, as well as with the measure of personal religious practice. The “Meaning” FACIT-Sp subscale was found to be the main predictor of hope.

Significance of results

Since hope represents a core need and a tool for patients dealing with their illness, it is essential to implement stage-specific and realistic hope-facilitating interventions and support patients in their search for meaning, which promotes spiritual well-being and appears relevant in fostering hope.

Life experiences and disease trajectories in women coexisting with ovarian cancer

OBJECTIVE

This study investigated the lived experiences of ovarian cancer survivors amid the disease trajectory and psychosocial adaptation.

MATERIALS AND METHODS

Twenty-one women, all of whom were ovarian cancer survivors, were recruited from medical centers in Taiwan. In-depth, face-to-face, semi-structured interviews were conducted and transcribed verbatim from audio recordings. The sample size was determined by information saturation during data collection. The steps of data process and analysis were performed using Giorgi's phenomenology.

RESULTS

Three themes and 12 subthemes were extracted: (1) a depressed state, as if facing a fierce enemy: being sentenced to a death penalty like facing an insurmountable challenge; contradictory information and helplessness; turnaround for treatment decision; and facing stigmatization from society; (2) shadow of cancer recurrence: side-effects of cancer treatment; falling into desperation and frustration; worrying about cancer recurrence; and continuing to fight cancer; (3) a change of mindset to move forward: experiencing changes in outlook on life; activating the self-healing process; coexisting with cancer and treating it as a chronic disease; and experiencing physical and mental purification and enhancement.

CONCLUSION

The conventional models caring for patients with ovarian cancer are based on disease and unable to meet their needs because the lengthy rehabilitation journey. Therefore, medical personnel should emphasize patients' medical autonomy and combine professional care and social resources to help patients developing adjustment strategies and establishing support systems in timely manner for body, mind, and soul of these patients.

Experiences and health care preferences of women with ovarian cancer during the diagnosis phase

OBJECTIVE

An ovarian cancer diagnosis presents physical and psychological challenges. Usually identified at an advanced stage, the disease involves invasive treatment and has a high mortality rate. The diagnosis phase is generally a time of heightened distress. Accordingly, the aim of this qualitative study was to explore the health care experiences and preferences of women with ovarian cancer during this phase, and identify opportunities to enhance women's experiences and outcomes.

METHODS

Thirty-four women diagnosed with ovarian cancer were recruited from across Australia (median age = 60.5 years, range = 31-74 years). Semistructured interviews explored participants' experience of health care services and preferences during the diagnosis phase. Thematic analysis of interview transcripts followed.

RESULTS

Five themes were identified including "navigating uncertainty" which summarized women's general experiences throughout the diagnosis phase and provided a context for concomitant health care preferences. Four other themes highlighted significant areas where health care may be better aligned with women's preferences. These included "responsiveness in health care," "relational communication," "person-centered information," and "preparation for living beyond cancer treatment."

CONCLUSIONS

Responsive and prompt health care services that employ relational communication, provide patient-centered information, and prepare women for survivorship could improve the health care experiences of women diagnosed with ovarian cancer.

"A peculiar time in my life": making sense of illness and recovery with gynaecological cancer

PURPOSE

Worldwide there are nearly 1.1 million new cases of gynaecological cancer annually. In England, uterine, ovarian and cervical cancers comprize the third most common type of new cancer in women. Research with gynaecological cancer patients within 6 months of diagnosis is rare, as is data collection that is roughly contemporaneous with treatment. Our aim was to explore the experiences of women who were, at study entry, within 6 weeks of surgery or were undergoing chemotherapy or radiotherapy.

METHODS

An interpretative phenomenological analysis (IPA) of data from 16 women in five focus groups was conducted in the UK, exploring women's experiences of being diagnosed with and treated for gynaecological cancer.

RESULTS

Participants conceptualized their experiences temporally, from the shock of diagnosis, through their cancer treatment, to thinking about recovery. They tried to make sense of diagnosis, even with treatment being complete. In the context of the Self-Regulation Model, these women were struggling to interpret a changing and multi-faceted illness identity, and attempting to return to pre-illness levels of health.

CONCLUSIONS

This study adds to this under-studied time period in cancer survivorship. The results suggest that survivors' goals may change from returning to pre-illness status to reformulating goals as survival time increases.

Impact of Recurrence of Ovarian Cancer on Quality of Life and Outlook for the Future

OBJECTIVE

Ovarian cancer recurs in most patients, with a 5-year survival rate less than 30%. Quality of life is an increasingly important issue in patients with cancer, but there are limited data in women with recurrent ovarian cancer in this regard.

MATERIALS AND METHODS

We used an ad hoc questionnaire to compare changes in health perceptions, burden of disease, and expectations for the future quality of life in women with and without recurrence of ovarian cancer. A total of 173 women were included, 116 with relapse and 57 without, undergoing follow-up in a routine clinical setting.

RESULTS

Substantial differences were seen in self-assessed health status between women with and without recurrence; 33.6% and 82.4% of women with and without recurrence rated their health as good to excellent, respectively. More patients with recurrence of disease reported limitations in moderate activity than those without. Furthermore, 79.0% of women without recurrence reported that pain did not affect or only slightly affected daily activities, compared with 28.2% with recurrence. Most women with recurrence (59.5%) reported that they were able to do less than they wanted to because of their emotional status compared with only 15.8% of women without recurrence. In addition, 66.4% of women with recurrence referred that they had problems concentrating at work and home versus 26.3% of women without recurrence.

CONCLUSIONS

From this survey, it is clear that relapse of disease has a negative psychological and physical impact, highlighting the importance of time without recurrence and the need for effective treatment in the long term.

Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study

PURPOSE

Limited research has focused on women with lung cancer (LC) although they are recognized as the most vulnerable to psychological distress. This study explored in-depth the psychological distress experienced by women with incurable LC and analyzed the coping strategies with which they manage that distress.

METHODS

A qualitative methodology with in-depth interviews was employed for 34 women with advanced or recurrent LC. An inductive data-driven thematic analysis was applied to analyze transcripts.

RESULTS

Psychological distress was an iterative process for the women. Four themes were identified: shock regarding the diagnosis, distress regarding cancer treatment and its side effects, the facing of a recurrent or progressive disease, and persistent struggle with the life-limiting disease. Various coping strategies applied by the women to manage psychological distress were grouped into four themes: relying upon social support, focusing on positive thoughts, avoidance-based strategies, and religious faith and acceptance.

CONCLUSIONS

Women with incurable LC experienced substantial iterative psychological distress throughout the illness, regardless of length of illness at time of interview. They applied multiple forms of coping. The findings enrich the limited existing literature on this understudied population and provide direction for the future development of interventions to improve their psychological well-being.

Post-traumatic Stress Disorder in patients with ovarian cancer

Ovarian cancer (OC) is one of the deadliest malignancies. The impact of this diagnosis is, therefore, highly traumatic, and affected women are prone to significant distress during the whole course of the disease. The present paper is aimed to review extant literature about the relationship between OC and Post-traumatic Stress Disorder (PTSD).

When to Consider Risk-Reducing Mastectomy in BRCA1/BRCA2 Mutation Carriers with Advanced Stage Ovarian Cancer: a Case Study Illustrating the Genetic Counseling Challenges

Germline mutations in BRCA1/BRCA2 significantly increase the risk of breast and ovarian cancer in women. This case report describes a BRCA1 germline mutation identified in a woman with stage IV epithelial ovarian cancer and the provision of genetic counseling about BRCA1-associated breast cancer risk in the three years following diagnosis. The report centers on the patient’s enquiry about risk-reducing breast surgery. We focus on the challenges for health professionals and patients in understanding and balancing the risks and benefits of major prophylactic surgery in the context of a potentially life-limiting cancer diagnosis. Breast cancer risk management in BRCA1/BRCA2 carriers with advanced ovarian cancer is an under-explored area of genetic counseling research. This article includes a case report, a review of the relevant literature and considers some implications for practice.

Fear of cancer recurrence: A study of the experience of survivors of ovarian cancer

PURPOSE

The purpose of this study is to better understand fear of cancer (FCR) through the experience of ovarian and fallopian tube cancer survivors.

METHODS

This study used a descriptive qualitative design. Twelve participants in remission from ovarian or fallopian tube cancer were recruited. Researchers conducted face-to-face, semi-structured interviews and the content, transcribed verbatim, underwent content analysis.

RESULTS

FCR has been identified as a significant concern for women in remission from ovarian cancer. Four themes emerged from the participants' FCR experience: (a) uncertainty surrounding recurrence; (b) varied beliefs and sources of worry; (c) perceived risk of recurrence; (d) management of FCR.

IMPLICATIONS

Survivorship support can be optimized by nurses by screening for FCR, offering psychosocial support for women at risk for FCR, teaching and reinforcing adaptive coping strategies.

Ovarian cancer outcomes: Predictors of early death

OBJECTIVE

To describe the outcomes and mortality in advanced ovarian cancer patients in a population-based cohort in the 90 days after diagnosis.

METHODS

Using the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified a cohort of women with stage III/IV epithelial ovarian cancer diagnosed between 1995 and 2007. A χ(2) test was used to assess demographic and clinical factors. Kaplan-Meier curves and Cox proportional hazards models were used to assess factors associated with variation in survival.

RESULTS

Of the 9491 patients with stage III/IV ovarian cancer identified from the SEER/Medicare system, 4131 (43.6%) patients died in the first year after diagnosis. Of these, 2472 (26.0%) patients died in the first 90 days after diagnosis. Over the study period, the number of patients who died in the first 90 days after diagnosis slightly increased (p=0.053). Older age (>75 years of age), increased comorbidity, stage IV disease, lack of a visit with a gynecologic oncologist, and surgery were associated with an increase in 90-day mortality. Chemotherapy was associated with a reduction in 90-day mortality.

CONCLUSIONS

Approximately 25% of patients with advanced ovarian cancer in our study period died within 90 days of diagnosis, and more than 40% died within the first year of diagnosis. In addition, a substantial proportion of patients did not receive any treatment. Further research into the characteristics of these patients should be performed to elucidate clinical areas for intervention to either prevent these poor outcomes or allocate appropriate resources to patients with extremely poor prognoses.

A systematic review of ovarian cancer and fear of recurrence

OBJECTIVE

To assess demographic, medical, and psychological factors that are associated with fear of recurrence (FCR) in ovarian cancer patients.

METHOD

We searched PubMed, EMBASE, Cochrane, CINAHL, and PsycINFO. For PubMed, a search using Medical Subject Headings (MeSH) was run, as well as a text-word search from 1990 to July of 2014. The search terms used consisted of ovarian terms, fear terms, and recurrence/progression themes. Title and abstract reviews were conducted by two independent reviewers to determine eligibility, and discrepancies were decided by a third reviewer. Full-text reviews of potentially eligible articles were conducted by the review team, which met regularly to ensure the reliability of eligibility ratings across all articles.

RESULTS

A total of 15 articles met our inclusion criteria. Nine were quantitative studies that utilized a cross-sectional design, and the other six included three qualitative studies, two small intervention studies, and one study that utilized content analysis to explore written correspondence among ovarian cancer patients. FCR was reported as a significant concern for both older and younger women at both early and advanced stages. Women were distressed about recurrence at various times during their treatment and posttreatment. FCR was noted to be prevalent around cancer follow-up examinations. Many women reported not receiving adequate support for recurrence. FCR was also shown to be linked in some way to hopelessness, faith/spirituality, and posttraumatic stress disorder (PTSD). FCR was also linked to patients' anxiety about death and dying and uncertainty about the future of their medical health.

SIGNIFICANCE OF RESULTS

This review demonstrates that FCR is prevalent in the ovarian cancer population. Moreover, cancer recurrence fears are not adequately assessed or treated. More information is needed on the factors that may be related to women's fears about recurrence of ovarian cancer. In addition, a validated measure of FCR among ovarian cancer patients as well as a treatment intervention are needed.

Beyond survivorship? A discursive analysis of how people with pancreatic cancer negotiate identity transitions in their health

We explored how people negotiate, and respond to, identity transitions following a diagnosis of pancreatic cancer. Interviews with 19 people with pancreatic cancer were analysed using thematic discourse analysis. While discursively negotiating two transitions, 'moving from healthy to ill' and 'moving from active treatment to end-of-life care', participants positioned themselves as 'in control', 'optimistic' and managing their health and illness. In the absence of other discourses or models of life post-cancer, many people draw on the promise of survival. Moving away from 'survivorship' may assist people with advanced cancer to make sense of their lives in a short timeframe.

Inner conflict in patients receiving oral anticancer agents: a qualitative study

OBJECTIVES

To explore the experiences of patients receiving oral anticancer agents.

DESIGN

A qualitative study using semistructured interviews with a grounded theory approach.

SETTING

A university hospital in Japan.

PARTICIPANTS

14 patients with gastric cancer who managed their cancer with oral anticancer agents.

RESULTS

Patients with cancer experienced inner conflict between rational belief and emotional resistance to taking medication due to confrontation with cancer, doubt regarding efficacy and concerns over potential harm attached to use of the agent. Although they perceived themselves as being adherent to medication, they reported partial non-adherent behaviours. The patients reassessed their lives through the experience of inner conflict and, ultimately, they recognised their role in medication therapy.

CONCLUSIONS

Patients with cancer experienced inner conflict, in which considerable emotional resistance to taking their medication affected their occasional non-adherent behaviours. In patient-centred care, it is imperative that healthcare providers understand patients' inner conflict and inconsistency between their subjective view and behaviour to support patient adherence.

Hopelessness and complementary therapy use in patients with ovarian cancer

BACKGROUND

Hopelessness negatively affects ovarian cancer patients' quality of life (QOL). Research validating the effects of complementary and alternative medicine (CAM) use on QOL and hope is scarce, even though QOL and hope are reasons that patients cite for using CAM therapy. Clinicians need effective, evidence-based interventions to improve QOL and reduce hopelessness.

OBJECTIVE

The objectives of this study were to examine factors influencing hopelessness in patients with newly diagnosed disease, long-term survivors, and patients experiencing ovarian cancer recurrence and to examine the effects of CAM on hopelessness in the same population.

METHODS

Surveys of ovarian cancer patients (N = 219) undergoing treatment at a comprehensive cancer center in the United States were analyzed. Descriptive, correlation, and multivariate analyses described variables and demonstrated the effects of sociodemographics, disease state, psychological distress, QOL, CAM use, and faith on hopelessness.

RESULTS

Patients ages 65 years or older (-0.95, P = .03), with strong faith (-0.28, P = .00), and good QOL (0.11, P = .00) directly reduced hopelessness scores (mean, 3.37). Massage therapy substantially reduced hopelessness scores (-1.07, P = .02); holding age constant, employed patients were twice as likely to use massage (odds ratio, 2.09; P = .04). Patients who had newly diagnosed and recurrent ovarian cancer were more hopeless because of greater distress from symptoms and adverse effects of treatment.

CONCLUSION

Patients who used massage therapy were significantly less hopeless, as were those with strong faith and well-controlled disease symptoms and treatment for adverse effects.

IMPLICATIONS FOR PRACTICE

Support of spiritual needs and symptom management are important interventions to prevent and/or reduce hopelessness, especially for patients with newly diagnosed and recurrent ovarian cancer. Further research testing the positive effect of massage interventions on hopelessness is needed.

Hope pictured in drawings by women newly diagnosed with gynecologic cancer

BACKGROUND

In mysterious ways, hope makes life meaningful even in chaotic and uncontrolled situations. When a woman is newly diagnosed with gynecologic cancer, hope is ineffable and needs exploring. Drawings help express ineffable phenomena.

OBJECTIVE

The aim of the study was to explore how women newly diagnosed with gynecologic cancer express the meaning of hope in drawings.

METHOD

Participants were 15 women who on the same day had received the diagnosis of gynecologic cancer. They were between 24 and 87 years (median, 52 years) with a variety of gynecologic cancer diagnoses. Data from 15 drawings and postdrawing interviews with the women were analyzed using visual and hermeneutic phenomenology.

RESULTS

Three themes emerged: hope as a spirit to move on, hope as energy through nature, and hope as a communion with families.

CONCLUSION

Hope as pictured in drawings often appears through metaphors and incorporates internal, external, and relational aspects. With other words, inner willpower, experiences in open nature, and closeness to loved ones contribute to hope when newly diagnosed with gynecologic cancer.

IMPLICATION FOR PRACTICE

The use of drawings in clinical situations might give cancer nurses new perceptions of hope and other phenomena. Patients might feel threat and despair when diagnosed with cancer; they need gentle truth about reality, and they long for being together with loved ones. Nurses are in a unique position to enable hope in this situation through listening and active engagement. Drawing might be a tool in understanding the hope. Drawings picture where words come short.

Hope, quality of life, and benefit from treatment in women having chemotherapy for platinum-resistant/refractory recurrent ovarian cancer: the gynecologic cancer intergroup symptom benefit study

Chemotherapy for platinum-resistant/refractory ovarian cancer is motivated by the hope of benefit. We sought to determine the relationships between: (a) trait hope, expectation of symptom benefit from chemotherapy, and anxiety and depression; (b) hope and perceived efficacy of chemotherapy; and (c) unfulfilled hope (where expectations for benefit are not fulfilled) and depression. Methods. Adult patients enrolled within stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study were included. Patient. Reported outcomes were collected from 126 women with predominantly platinum-resistant ovarian cancer at baseline, prior to the first four treatment cycles (12-16 weeks), and four weeks after completing chemotherapy or at disease progression, whichever came first. Associations were assessed with Spearman rank correlation coefficient (r) and odds ratio. Results. Trait hope and expectation of symptom benefit from chemotherapy were weakly correlated with each other (r = 0.25). Trait hope, but not expectation of symptom benefit, was negatively correlated with anxiety (r = -0.43) and depression (r = -0.50). The smaller the discrepancy between perceived and expected symptom benefit, the less likely the patient was to have scores indicative of depression (odds ratio: 0.68; 95% confidence interval: 0.49-0.96; p = .026). Conclusion. Trait hope and expectation of symptom benefit from chemotherapy appear to be distinct and independent of the aspects of quality of life and scores for depression. Hope did not appear to affect perceived efficacy of chemotherapy in alleviating symptoms, but women whose expectation of symptom benefit from chemotherapy was not fulfilled were more likely to have scores indicative of depression. It may be preferable to encourage hope toward achievable goals rather than toward benefits from chemotherapy.

Association between hope and burden reported by family caregivers of patients with advanced cancer

PURPOSE

The aim of this study, in a sample of family caregivers (FCs) of patients with advanced cancer, was to describe the level of FC burden using the Caregiver Reaction Assessment (CRA). In addition, the effects of select FC and patient characteristics on each of the CRA subscales were evaluated.

METHODS

FCs and patients (n = 112) completed a demographic questionnaire, and Herth Hope Index, and the Hospital Anxiety and Depression Scale. FCs completed the CRA. Data were analyzed using multiple linear regression analyses.

RESULTS

For three of the five CRA subscales (i.e., "impact on finances", "impact on daily schedule", and "impact on health"), the mean scores were comparable to a Norwegian sample of FCs caring for patients in the late palliative phase. The variance in each of the CRA subscales was explained by different factors. Total explained variance ranged from 5.5% ("lack of family support") to 31.8% ("impact on daily schedule"). FC characteristics, such as being female and lower educational level, distress regarding the patient's pain, anxiety, depression, and level of hope, as well as the patients' number of comorbidities, depression, and hope contributed to an increase in various domains of FC burden. FCs' level of hope was a significant predictor for three of the CRA subscales (i.e., "self-esteem", "lack of family support", and "impact on health").

CONCLUSIONS

Findings suggest that FCs' and patients' level of hope are important determinants of caregiver burden and that FCs with lower levels of hope represent a high-risk group for higher levels of caregiver burden.

The lived experience of ovarian cancer: a phenomenological approach

PURPOSE

To describe the lived experience of women diagnosed with ovarian cancer using individual interviews.

DATA SOURCES

Eleven women who had been diagnosed with ovarian cancer within the past five years were interviewed with open-ended guiding questions. The narrative responses were analyzed for constitutive patterns and relational themes according to Diekelmann and Allen's hermeneutic phenomenological process.

CONCLUSIONS

This phenomenological study gave voice to the women's experience with ovarian cancer. The following six constitutive patterns and associated themes emerged: (a) The Revelation, (b) Jeopardy, (c) On the Lookout, (d) Becoming Normal, and (e) Living Every Moment.

IMPLICATIONS FOR PRACTICE

An understanding of the common experiences and shared meanings of women with ovarian cancer may contribute to earlier diagnosis and improved quality of life. The women identified symptoms that should generate concern when reported to providers, potentially leading to diagnostic testing. The experiences may also serve to inform the development of interventions aimed at meeting the needs of women diagnosed with ovarian cancer.

Dignity and deferral narratives as strategies in facilitated technology-based support groups for people with advanced cancer

This paper examines the value of facilitated telephone and online support groups for palliative care. Telephone interviews were conducted with twenty people living with advanced cancer who had participated in either a telephone or online support group facilitated by the Cancer Council Victoria, Melbourne, Australia. Two dominant participant narratives emerged: a focus on dying with dignity or an interest in deferring discussion of death and dying to focus on the present. Despite the different approaches, participants found the technology-based support groups to be accessible and safe environments in which to discuss difficult topics in privacy. Technology-based strategies provide opportunities for health professionals to provide social and emotional care to more people by moving beyond individualised care and facilitate peer-to-peer support at the end of life, especially to those with specific needs. Such options are feasible for palliative care services to set up and acceptable to a group of clients, especially for younger clients or those socially or geographically isolated.

Factors affecting hope in a sample of fatigued breast cancer outpatients

OBJECTIVE

The aims of this study of women with breast cancer were: to describe the levels of hope and compare hope scores for these patients with a sample from the general Norwegian population; to describe the relationship between hope and fatigue; and finally to evaluate the effect of demographic and clinical characteristics and fatigue on hope.

METHOD

A total of 160 Norwegian outpatients with cancer and fatigue (>2.5 on a 0-10 scale) completed the Herth Hope Index (HHI), Fatigue Questionnaire (FQ), and Self-administered Comorbidity Questionnaire (SCQ).

RESULTS

The mean age of the women was 55.3 years (SD = 9.4), 81% lived with someone, and 67% were employed. The most common comorbidities were back pain (42%), osteoarthritis (26%), and headache (19%). The fatigued breast cancer patients reported significantly higher total hope scores than the general Norwegian population (p < .0001). The difference was largest in the individual item "I can see a light in the tunnel," to which the cancer sample reported the highest scores, but they also felt more "scared about the future." Total hope score was negatively correlated with total fatigue (TF), mental fatigue (MF), and chronic fatigue (CF), but not with physical fatigue (PF). Demographic and clinical characteristics were not significantly related to hope, except that patients who were married or living with someone showed significantly higher total hope scores.

SIGNIFICANCE OF RESULTS

The higher levels of hope in breast cancer patients compared with the general Norwegian population may reflect a response shift in patients after getting a cancer diagnosis. The fact that a significant relationship was found between total hope scores and living arrangements may indicate that hope is easier to establish when patients have someone to relate to or receive support from. Hope and total fatigue were significantly, but weakly correlated.

Advanced cancer: a mind-body-spirit approach to life and living

OBJECTIVES

To present the nursing theory of Modeling and Role Modeling as a holistic theoretical basis for identifying needs, planning and implementing care and services, and measuring and enhancing outcomes of programs and interventions to meet the needs of people living with advanced cancer.

DATA SOURCES

Published books and journal articles, web resources, newspapers and current events magazines, and trade publications.

CONCLUSION

The growing number of people living with advanced cancer has numerous unique, multi-dimensional, and interrelated needs that are underexplored, generally unmet, and require a holistic approach to be adequately addressed.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses in clinical practice and research settings must be informed, aware of and prepared to assess and intervene to address the needs of the rapidly emerging subpopulation of cancer survivors. Using a holistic nursing theory promotes our understanding of human responses to illness and provides a way to holistically approach health, wellness, and healing among people living with advanced cancer.

Information and communication needs of individuals living with advanced cancer

OBJECTIVES

To identify the informational needs of individuals living with advanced cancer, offer guidance to reliable and timely informational resources, and suggest ways in which communication among patients, family members, and health care providers can be optimized.

DATA SOURCE

Published articles and research studies.

CONCLUSION

Information and communication needs are problematic and common for people living with advanced cancer as they are frequently unable to find useful information. Health care professionals may lack effective communication skills that are suited to meet these patients' needs.

IMPLICATIONS FOR NURSING PRACTICE

Nursing practice can be significantly strengthened by an awareness of the information needs of this population, and the skills to communicate more effectively with people living with advanced cancer and their families.

Hope as experienced in women newly diagnosed with gynaecological cancer

AIM

This article presents findings from a hermeneutic-phenomenological study with the aim to investigate the meaning of the lived experience of hope in women newly diagnosed with gynaecological cancer.

METHOD

Fifteen women were interviewed the day they were receiving the diagnosis at a gynaecological department of a Danish university hospital. The women, aged 24-87 (median 52 yrs), were diagnosed with ovarian, endometrial, cervical and vulvar cancer.

RESULTS

Hope was found to be connected to both diagnosis, cure, family life and life itself and closely tied to hopelessness. The newly received cancer diagnosis made the women oscillate between hope and hopelessness, between positive expectations of getting cured and frightening feelings of the disease taking over. Five major interrelated themes of hope were identified: hope of being cured, cared for and getting back to normal, hope as being active and feeling well, hope as an internal power to maintain integration, hope as significant relationships and hope as fighting against hopelessness. Thus, hope was woven together with hopelessness in a mysterious way; it took command through inner strength and courage based on a trust in being cured and of being in relationship with significant others.

CONCLUSION

The findings of the close relationship between the shades of hope and hopelessness support the need for nurses to continue to practice hope-inspiring nursing. Nurses need to understand the complexity of hope and its close connection to hopelessness when newly diagnosed with a threatening disease as cancer; and the findings might help nurses assist patients in fighting hopelessness.

The relationship between hope and pain in a sample of hospitalized oncology patients

Objective:

The aims of this study were to describe hope in a sample of hospitalized oncology patients in pain and to determine if various demographic, clinical, and pain characteristics were related to hope. In addition, the individual item and total Herth Hope Index (HHI) scores for these oncology inpatients with pain were compared with those from the general Norwegian population.

Method:

Oncology inpatients in pain (n = 225) were recruited from the Norwegian Radium Hospital. The research instruments included the HHI, the Brief Pain Inventory (BPI), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Data were analyzed using descriptive statistics, Pearson's correlations, and one-samplettests.

Results:

Total HHI scores in oncology inpatients with pain were comparable to a similar sample in Taiwan. The Norwegian oncology inpatients reported significantly higher total HHI scores than the general Norwegian population. The largest difference was on the item “I feel scared about my future.” No relationships were found between total HHI scores and any of the pain intensity scores. Significant relationships were found between total HHI scores and the more psychosocial interference items on BPI and sleep.

Significance of results:

The higher levels of hope in the oncology inpatients with pain compared with the general Norwegian population may reflect a “response shift” in the patients' evaluation of hope. Although the difference is relatively small, it may represent a clinically meaningful difference. The fact that significant relationships were found between HHI scores and the more psychosocial interference scores on BPI suggest that hope may be more related to psychosocial effects on pain than on its physical effects.