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"Who can I ring? Where can I go?" Living with advanced cancer whilst navigating the health system: a qualitative study. Support Care Cancer 2022; 30:6817-6826. [PMID: 35536328 PMCID: PMC9213291 DOI: 10.1007/s00520-022-07107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/29/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND People with advanced cancer often experience greater physical and psychosocial morbidity compared to those with early disease. Limited research has focused on their experiences within the Australian health system. The aim of this study was to explore the lived experiences of adults receiving care for advanced cancer. METHODS A qualitative design with a descriptive phenomenological approach was used to explore the lived experiences of people with advanced cancer following their diagnosis. Twenty-three people living with an advanced solid malignancy receiving care were referred by their oncologists to take part in an interview conducted at their home, the hospital, or over the phone. RESULTS Three key themes emerged relating to participants' experiences of living with advanced cancer: (1) living with a life-limiting diagnosis and uncertainty, (2) living with symptom burden and side effects, and (3) living within the health system, with two subthemes, the patient-clinician relationship, and care coordination. Participant relationships with their health professionals were particularly important and had a defining impact on whether patient experiences living with cancer were positive or negative. CONCLUSION People with advanced cancer experienced broad variation in their experiences navigating the health system, and their relationships with clinicians and other health professionals were important factors affecting their perceptions of their experiences. Attention to the coordination of care for people with advanced cancer is necessary to improve their experiences and improve symptom control and the management of their psychosocial burden.
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Lippiett KA, Richardson A, Myall M, Cummings A, May CR. Patients and informal caregivers' experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research. BMJ Open 2019; 9:e020515. [PMID: 30813114 PMCID: PMC6377510 DOI: 10.1136/bmjopen-2017-020515] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify, characterise and explain common and specific features of the experience of treatment burden in relation to patients living with lung cancer or chronic obstructive pulmonary disease (COPD) and their informal caregivers. DESIGN Systematic review and interpretative synthesis of primary qualitative studies. Papers were analysed using constant comparison and directed qualitative content analysis. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science searched from January 2006 to December 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Primary qualitative studies in English where participants were patients with lung cancer or COPD and/or their informal caregivers, aged >18 years that contain descriptions of experiences of interacting with health or social care in Europe, North America and Australia. RESULTS We identified 127 articles with 1769 patients and 491 informal caregivers. Patients, informal caregivers and healthcare professionals (HCPs) acknowledged lung cancer's existential threat. Managing treatment workload was a priority in this condition, characterised by a short illness trajectory. Treatment workload was generally well supported by an immediacy of access to healthcare systems and a clear treatment pathway. Conversely, patients, informal caregivers and HCPs typically did not recognise or understand COPD. Treatment workload was balanced with the demands of everyday life throughout a characteristically long illness trajectory. Consequently, treatment workload was complicated by difficulties of access to, and navigation of, healthcare systems, and a fragmented treatment pathway. In both conditions, patients' capacity to manage workload was enhanced by the support of family and friends, peers and HCPs and diminished by illness/smoking-related stigma and social isolation. CONCLUSION This interpretative synthesis has affirmed significant differences in treatment workload between lung cancer and COPD. It has demonstrated the importance of the capacity patients have to manage their workload in both conditions. This suggests a workload which exceeds capacity may be a primary driver of treatment burden. PROSPERO REGISTRATION NUMBER CRD42016048191.
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Affiliation(s)
- Kate Alice Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
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Kyte K, Ekstedt M, Rustoen T, Oksholm T. Longing to get back on track: Patients' experiences and supportive care needs after lung cancer surgery. J Clin Nurs 2019; 28:1546-1554. [PMID: 30589147 DOI: 10.1111/jocn.14751] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 12/13/2022]
Abstract
AIMS AND OBJECTIVES This study aims to describe surgically treated lung cancer patients' experiences of coming home after discharge from hospital to expand the knowledge about their supportive care needs. BACKGROUND Existing research reports that patients suffer from a high symptom burden after lung cancer surgery. Such burden has negative impacts on their physical, emotional and social wellbeing. Few studies have explored the surgically treated patients' supportive care needs after being discharged from hospital. DESIGN This study used a qualitative descriptive design, following the EQUATOR guidelines (COREQ). METHODS The information about 14 patients' experiences was collected from semi-structured interviews. The interviews were conducted in their homes within three weeks after their discharge from hospital. The data were analysed using qualitative content analysis. RESULTS The main theme of the study, "Longing to get back on track with their lives", consisted of four categories: "Burdened with problems related to postoperative symptoms and treatment", "Struggling for the needed support", "A pendulum between being in need of support and being independent", and "Striving to adapt to a new way of life". The participants experienced many problems related to postoperative symptoms and treatment. Information and support from healthcare professionals were deficient. Life was characterised by striving to be independent and adapting to a new lifestyle. CONCLUSIONS The findings demonstrate the supportive care needs of surgically treated lung cancer patients. Nurses and other healthcare professionals could offer more individualised support during the first few weeks after the patients' discharge by including them and their caregivers in the discharge planning. RELEVANCE TO CLINICAL PRACTICE Knowledge of patients' perspectives and experiences of everyday life at home after lung cancer surgery can provide hospital nurses with a better understanding of what is important for such patients beyond hospitalisation. This knowledge should be included in discharge planning.
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Affiliation(s)
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Sweden.,Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Tone Rustoen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Raque-Bogdan TL, Lamphere B, Kostiuk M, Gissen M, Beranek M. Unpacking the layers: a meta-ethnography of cancer survivors' loneliness. J Cancer Surviv 2018; 13:21-33. [PMID: 30414079 DOI: 10.1007/s11764-018-0724-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/20/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the empirical qualitative literature on cancer survivor's experiences with loneliness to inform assessments and interventions for improving cancer survivors' social well-being. METHODS A rigorous systematic review of qualitative studies published in five databases between 1993 and 2016 was conducted. Three coders reviewed 285 titles and abstracts and, after applying a critical review process, 20 manuscripts were synthesized using meta-ethnography. RESULTS The synthesis of the 20 studies provided a framework for understanding survivors' layers of loneliness at the level of the individual, their social support system, the healthcare system, and society. Internally, survivors described loneliness resulting from feelings of inauthenticity, of being alone in their cancer experience, and of lack of control. In their social networks, survivors attributed loneliness to others' avoidance, misperceptions of cancer, and others' failure to recognize the effects of cancer after active treatment. Unmet needs after treatment contributed to feelings of loneliness within the healthcare system. Further, societal stigma around cancer and pressures to experience growth after cancer created another layer of loneliness. The results suggest the need to move beyond an individual level perspective in assessing and treating loneliness in cancer survivors. CONCLUSIONS This meta-ethnography presents an integrated framework of loneliness in cancer survivors as a multi-layered experience. Implications for Cancer Survivors Conceptualizing loneliness from a systemic perspective adds missing pieces to the loneliness puzzle by encouraging assessment and intervention at interacting levels of functioning; considering how individuals respond to and are affected by their social systems can deepen our understanding of cancer survivorship.
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Affiliation(s)
- Trisha L Raque-Bogdan
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA.
| | - Brooke Lamphere
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA
| | - Marisa Kostiuk
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA
| | - Maura Gissen
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA
| | - Megan Beranek
- Department of Counseling Psychology, Morgridge College of Education, University of Denver, 1999 E. Evans Avenue, Denver, CO, USA
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Ball H, Moore S, Leary A. A systematic literature review comparing the psychological care needs of patients with mesothelioma and advanced lung cancer. Eur J Oncol Nurs 2016; 25:62-67. [DOI: 10.1016/j.ejon.2016.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 01/10/2023]
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Patients' experiences of care and support at home after a family member's participation in an intervention during palliative care. Palliat Support Care 2016; 15:305-312. [PMID: 27748224 DOI: 10.1017/s1478951516000729] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patients who receive palliative home care are in need of support from family members, who take on great responsibility related to caregiving but who often feel unprepared for this task. Increasing numbers of interventions aimed at supporting family members in palliative care have been described and evaluated. It is not known whether and how these interventions actually affect the care or support provided to a patient, even though it has been suggested that family members would be likely to provide better care and support and thus allow for positive experiences for patients. However, this has not been studied from the perspective of the patients themselves. The objective of our study was to explore patients' experiences of care and support at home after family members' participation in a psychoeducational intervention during palliative care. METHOD Our study took a qualitative approach, and interviews were conducted with 11 patients whose family members had participated in a psychoeducational intervention during palliative home care. The interviews were analyzed employing interpretive description. RESULTS Patients' experiences were represented by three themes: "safe at home," "facilitated and more honest communication," and "feeling like a unit of care." Patients felt that their needs were better met and that family members became more confident at home without risking their own health. Patients felt relieved when family members were given the opportunity to talk and reflect with others and hoped that the intervention would contribute to more honest communications between themselves and their family members. Further, it was of great importance to patients that family members receive attention from and be confirmed and supported by healthcare professionals. SIGNIFICANCE OF RESULTS Our findings show how an intervention targeted at family members during palliative home care also benefits the patients.
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To carry on as before: A meta-synthesis of qualitative studies in lung cancer. Lung Cancer 2016; 99:88-93. [PMID: 27565920 DOI: 10.1016/j.lungcan.2016.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 11/22/2022]
Abstract
As a complement to quantitative studies, qualitative studies give us a better understanding of how persons affected by lung cancer live their everyday lives and how they deal with the obvious strain of having lung cancer. Because qualitative studies are based on only a few participants in specific contexts, the purpose of the present study is to synthesize knowledge from these qualitative studies to get a more general picture of the everyday lives of patients with lung cancer. A search on PubMed, CINAHL, Medline and PsychInfo yielded 383 hits. After exclusion we found 16 studies that focused on how these patients lived, reflected, and dealt with their new life situation. These studies comprised 393 interviews with 283 patients with primary lung cancer, and the findings from these studies were synthesized into a core process with subcategories. The overarching process was that the patients were eager "to carry on as before". They wanted to resume their former everyday life, and their views on their relationships with their bodies and side effects of treatments, their families, the health care staff, and with dying and death were very much related to how these could assist the core process. The synthesis presented here suggests that health care in consultations with patients with lung cancer should defer to the importance of the patient's core idea that life carries on despite the fact that it will probably soon come to an end.
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García-Rueda N, Carvajal Valcárcel A, Saracíbar-Razquin M, Arantzamendi Solabarrieta M. The experience of living with advanced-stage cancer: a thematic synthesis of the literature. Eur J Cancer Care (Engl) 2016; 25:551-69. [DOI: 10.1111/ecc.12523] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- N. García-Rueda
- Department of Adult Nursing; Faculty of Nursing; University of Navarra; Pamplona Navarra Spain
- IdiSNA.; Instituto de Investigación Sanitaria de Navarra; Pamplona Navarra Spain
| | - A. Carvajal Valcárcel
- Department of Adult Nursing; Faculty of Nursing; University of Navarra; Pamplona Navarra Spain
- IdiSNA.; Instituto de Investigación Sanitaria de Navarra; Pamplona Navarra Spain
- Clínica Universidad de Navarra; Pamplona Navarra Spain
| | - M. Saracíbar-Razquin
- Department of Adult Nursing; Faculty of Nursing; University of Navarra; Pamplona Navarra Spain
- IdiSNA.; Instituto de Investigación Sanitaria de Navarra; Pamplona Navarra Spain
| | - M. Arantzamendi Solabarrieta
- Department of Adult Nursing; Faculty of Nursing; University of Navarra; Pamplona Navarra Spain
- IdiSNA.; Instituto de Investigación Sanitaria de Navarra; Pamplona Navarra Spain
- ATLANTES Research Program: Human Dignity; Advanced Illness and Palliative Care. Institute for Culture and Society; University of Navarra; Pamplona Navarra Spain
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Refsgaard B, Frederiksen K. Illness-related emotional experiences of patients living with incurable lung cancer: a qualitative metasynthesis. Cancer Nurs 2014; 36:221-8. [PMID: 23051865 DOI: 10.1097/ncc.0b013e318268f983] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Living with incurable lung cancer often drastically changes the patients' lives physically, socially, psychologically, and spiritually. The emotional experiences of patients with incurable lung cancer have been studied with a qualitative approach, but the findings are yet to be synthesized. OBJECTIVE The objective of this study was to synthesize interpreted knowledge on the illness-related emotional experiences of patients with incurable lung cancer. METHODS A qualitative metasynthesis was carried out to integrate the findings from 10 qualitative studies conducted between 1995 and 2011. The studies were critically appraised according to the method defined by Sandelowski and Barroso, and the findings were extracted, edited, and abstracted. The concept "loss" was imported as a method to synthesize the findings. RESULTS Eight themes of emotional experiences emerged: "guilt, blame, shame, and stigmatization," "hope and despair," "loneliness," "changing in self-image and self-worth," "uselessness and dependency," "uncertainty and worries," "anxiety and fear," and "loss." The loss experiences were categorized as unrecognized and clear losses. CONCLUSION This study supports that patients with incurable lung cancer undergo illness-related emotions that can be identified as losses. Further studies are required to determine the best way for nurses to implement emotional care. IMPLICATIONS FOR PRACTICE Nurses play an important role in the acknowledgement of unrecognized and clear losses while caring for patients with incurable lung cancer.
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Affiliation(s)
- Birgit Refsgaard
- Department of Respiratory Diseases, Aarhus University Hospital, Denmark.
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10
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Thon Aamodt IM, Lie I, Hellesø R. Nurses' perspectives on the discharge of cancer patients with palliative care needs from a gastroenterology ward. Int J Palliat Nurs 2013; 19:396-402. [PMID: 23970296 DOI: 10.12968/ijpn.2013.19.8.396] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND People with cancer usually like to spend as much time as possible at home rather than in the hospital. Nurses have a pivotal role when patients are discharged to a unit in hospital or from hospital to the community health-care system. AIM To explore how frontline surgical nurses assess patients with gastrointestinal cancer receiving palliative care and the implications of their assessment and competency for the patients' discharge destinations. METHODS A descriptive exploratory approach was used involving focus group interviews with a purposive sample of ten nurses from an inpatient gastroenterology surgical ward at a university hospital in Norway. Transcriptions of the interviews were analysed using Kvale and Brinkman's thematic approach. RESULTS Two overall themes emerged that had implications for the nurses' recommendations for optimal patient follow-up care after discharge: 'the complexity of and fluctuations in the patients' health status' and 'considering the competency of the nurses at the discharge destinations'. CONCLUSIONS This study illustrates surgical nurses' perspectives on the discharge destinations of cancer patients receiving palliative care. The findings have implications for initiatives aimed at providing more home-based palliative care.
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Affiliation(s)
- Ina Marie Thon Aamodt
- Assistant Professor, Lovisenberg Diaconal University College, Lovisenberg gata 15b, 0456 Oslo, Norway
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Maguire R, Papadopoulou C, Kotronoulas G, Simpson MF, McPhelim J, Irvine L. A systematic review of supportive care needs of people living with lung cancer. Eur J Oncol Nurs 2013; 17:449-64. [PMID: 23246484 DOI: 10.1016/j.ejon.2012.10.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/23/2012] [Accepted: 10/30/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Roma Maguire
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
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Andersson T, Falk K, Bjerså K, Forsberg A. Health Is Belonging: Lived Experiences during Recovery after Pancreaticoduodenectomy. ISRN NURSING 2012; 2012:602323. [PMID: 23304548 PMCID: PMC3529488 DOI: 10.5402/2012/602323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/06/2012] [Indexed: 01/05/2023]
Abstract
The aim of this study was to explore the lived experience of the symptoms, health, and illness reported by patients recovering after pancreaticoduodenectomy ad modum Whipple due to pancreatic or periampullary cancer. Thirteen patients with pancreatic or periampullary cancer who underwent pancreaticoduodenectomy ad modum Whipple between 2006 and 2008 were interviewed during postoperative recovery. Data were analysed using the phenomenological-hermeneutic method. The structural analysis of patient experiences revealed that recovery after pancreaticoduodenectomy was described as recapturing everyday life, being healthy, and looking to the future. Participants experienced symptoms but did not dwell on them, instead they stated that their general health was good. They strived to regain their former precancer selves and be a part of as well as contribute to the social context. Overall, the participants' view of the future was positive, and improvement in their health generated further confidence and encouragement. This study suggests that persons recovering from pancreaticoduodenectomy ad modum Whipple due to a pancreatic or periampullary tumour experience health despite postoperative symptoms. They manage their symptoms by means of different strategies and express a positive view of the future. Nurses working with such patients should adopt a person-centred approach focusing on patient perspectives, participation, and possibilities.
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Affiliation(s)
- Thomas Andersson
- Department of Surgery, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, 40530 Gothenburg, Sweden
| | - Kristofer Bjerså
- Department of Surgery, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Anna Forsberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 22100 Lund, Sweden
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Ellis J, Lloyd Williams M, Wagland R, Bailey C, Molassiotis A. Coping with and factors impacting upon the experience of lung cancer in patients and primary carers. Eur J Cancer Care (Engl) 2012; 22:97-106. [PMID: 22978743 DOI: 10.1111/ecc.12003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is a paucity of research exploring patients' and their informal carers' experience of coping with and factors impacting on the lung cancer experience. This study aims to explore how patients and their informal carers cope with a diagnosis of lung cancer and describe the key factors that mediate distress in this population in order that they may be better supported in the future. This was a qualitative study employing semi-structured interviews and framework analysis to elicit the experience of 37 patients with lung cancer and 23 primary carers regarding their coping with and factors influencing patient/carer distress. The findings illustrate that participants used both emotional- and problem-focused coping strategies, including accepting the reality of lung cancer, adopting a positive attitude/fighting spirit, denial, avoidance and distraction and information seeking. Maintaining normality was also important. Key factors that mediate the lung cancer experience were also identified including hope, social network, prior experience of cancer and other chronic illnesses, the competing coping strategies of patients and their primary carers, the unpredictable nature of patients' behaviour, changing symptomatology, the perceived attitudes of health professionals and the impact of perceived delays in diagnosis. This study provides important insights into how patients with lung cancer and their primary carers might be better supported.
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Affiliation(s)
- J Ellis
- Academic Palliative and Supportive Care Studies Group, Division of Health Service Research, University of Liverpool, Liverpool, UK.
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Hansen L, Press N, Rosenkranz SJ, Baggs JG, Kendall J, Kerber A, Williamson A, Chesnutt MS. Life-sustaining treatment decisions in the ICU for patients with ESLD: a prospective investigation. Res Nurs Health 2012; 35:518-32. [PMID: 22581585 DOI: 10.1002/nur.21488] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2012] [Indexed: 12/13/2022]
Abstract
We conducted a prospective study in the ICU of life-sustaining treatment and comfort care decisions over time in patients with end-stage liver disease (ESLD) from the perspectives of patients, family members, and healthcare professionals. Six patients with ESLD, 19 family members, and 122 professionals participated. The overarching theme describing the decision-making process was "on the train." Four sub-themes positioned patients and family members as passengers with limited control, unable to fully understand the decision-making process. Findings suggest that including patients and family members in non-immediate life-saving decisions and verifying early on their understanding may help to improve the decision-making process.
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Affiliation(s)
- Lissi Hansen
- Oregon Health & Science University, Portland, OR 97239-2941, USA
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Horne G, Seymour J, Payne S. Maintaining integrity in the face of death: a grounded theory to explain the perspectives of people affected by lung cancer about the expression of wishes for end of life care. Int J Nurs Stud 2011; 49:718-26. [PMID: 22209426 DOI: 10.1016/j.ijnurstu.2011.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 10/16/2011] [Accepted: 12/08/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND An emphasis on patient choice in health and social care underpins a growing interest in advance care planning. Few studies have explored the views and experiences of people with advanced lung cancer about discussing their wishes or preferences for end of life care. Evidence suggests that some people may want nurses and other health professionals to initiate discussions about the future. However, there is a lack of evidence about what priority patients facing death give to their preferences and wishes, and how these shape their views about end of life. OBJECTIVES To explore the views and experiences of people affected by lung cancer about discussing preferences and wishes for end of life care and treatment. DESIGN A qualitative study using semi-structured interviews and constant comparative method of analysis to develop a grounded theory. SETTINGS One multi-cultural city and one post-industrial town in northern England, UK. Data were collected between 2006 and 2008. PARTICIPANTS Interviews took place with 25 patients with lung cancer and 19 family members. METHOD Qualitative constructivist grounded theory study. RESULTS The study found that preferences and wishes for future care and treatment were not the main concern of people with cancer; rather, any concerns for the future were about the social aspects of death. A theory 'maintaining integrity in the face of death' is proposed. This theory purports that patients with advanced lung cancer and their families focus on acting and talking as 'normal' to help them balance living in the present whilst facing death. Participants talked about their experiences of facing death whilst striving to live in the present. Planning for one's own dying and eventual death was not something that people with lung cancer reported having discussed, except when, out of concern for their families, practical arrangements needed to be made following death. CONCLUSION The study suggests that people facing the end of their life primarily focus on living in the present. The findings suggest that nurses need to develop ways of helping people prepare for the 'social' rather than just the physical or 'medicalised' aspects of death.
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Dale MJ, Johnston B. An exploration of the concerns of patients with inoperable lung cancer. Int J Palliat Nurs 2011; 17:285-90. [PMID: 21727886 DOI: 10.12968/ijpn.2011.17.6.285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Appraisal of the literature suggests that patients with lung cancer report more unmet supportive care needs and greater psychological distress than patients with other cancers. This study aimed to explore the concerns of patients with inoperable lung cancer and to interpret those concerns to inform specialist palliative care nursing practice. A descriptive qualitative study was undertaken using semi-structured interviews with six participants on a single site. Three main themes were identified: steadfastly living life, family support and separation, and trust in professionals. The latter is crucial for enabling patients to express their concerns, which in turn allows support to be directed appropriately and from a patient-centred perspective.
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Affiliation(s)
- Moira J Dale
- Community Dumfries and Galloway Royal Infirmary, Bankend Road, Dumfries, Scotland.
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Lobchuk MM, McPherson CJ, McClement SE, Cheang M. A comparison of patient and family caregiver prospective control over lung cancer. J Adv Nurs 2011; 68:1122-33. [PMID: 21883407 DOI: 10.1111/j.1365-2648.2011.05819.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This paper is a report of our secondary analysis of patient and family caregiver prospective control in lung cancer. BACKGROUND Control beliefs underlie self-care in sickness and health. Self-care often involves 'shared' activities between the afflicted individual and caregiving family and friends. However, depending on how control is perceived, conflicts can occur in decision-making thus jeopardizing optimal self-care. We need to comprehend how control beliefs compare between patients and caregivers and how their control beliefs are linked with dealing with serious illness. METHODS Based on questionnaire data collected in our larger study between September 2005 and February 2009, we conducted exploratory comparative analyses of 304 patients' and caregivers' control beliefs in managing lung cancer. Eight 5-point response items captured prospective control. Exploratory factor analysis with promax rotation was conducted to compare dyadic perceptions on the dimensionality of prospective control. We also conducted exploratory correlations between control beliefs and smoking cessation, attributional reactions, caregiver helping and symptom reports. RESULTS Principal component analysis identified the same factors for patients and caregivers: factor 1, Fate control and factor 2, Team control. Patient and caregiver 'Fate' and 'Team' control sub-scales were respectively associated with hope, caregiver helping and patient smoking cessation. CONCLUSION Clinicians need to support, adapt or develop a philosophy of cancer care that is inclusive of partnerships, drawing on beliefs of patients and caregivers that controlling lung cancer is a team effort which in turn is tentatively linked to patient smoking cessation, positive emotions and caregiver helping.
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Experiences of living with a deteriorating body in late palliative phases of cancer. Curr Opin Support Palliat Care 2010; 4:153-7. [DOI: 10.1097/spc.0b013e32833b4f37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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