Sense of coherence and acceptance of the disease in patients with lung cancer during palliative chemotherapy

Consideration of sense of coherence in a structured communication approach with stage IV lung cancer patients and their informal caregivers: a qualitative interview study

Objective

Salutogenetic aspects are valuable for consideration in patient-centred care of advanced oncological diseases with a limited life expectancy. The Milestone Communication Approach (MCA), involving physician-nurse tandems, addresses specific challenges and needs over the disease trajectory of patients with stage IV lung cancer and their informal caregivers. This study aims to explore patients’ and informal caregivers’ salutogenetic experiences with the MCA concept.

Methods

This qualitative study used face-to-face semi-structured interviews with patients and informal caregivers. All generated data were audio-recorded, pseudonymised and transcribed verbatim. Data were structured using Qualitative Content Analysis. The material was coded deductively into themes related to the components of sense of coherence (Aaron Antonovsky) and emerging sub-themes. All data was managed and organised in MAXQDA.

Results

In 25 interviews, sense of coherence was referred to with all three components: “Comprehensibility” was supported by information conveyed suitably for the patients; “meaningfulness” was addressed as accepting the situation; and “manageability” led to advance care planning the patients were comfortable with. Patients and informal caregivers experienced the interprofessional tandem as an added value for patient care.

Conclusions

Participants appreciate the MCA in its support for coping with a life-limiting disease. Considering salutogenetic aspects facilitates prognostic awareness and advance care planning. Nevertheless, individual needs of patients and informal caregivers require an individualised application of the MCA.

Sense of Coherence and Health-Related Quality of Life in Patients With Brain Metastases

With improvements in treatments for primary tumor and brain metastases (BM), the life expectancy of patients with advanced cancers is increasing; thus, helping patients with BM maintain quality of life is becoming increasingly important. Sense of coherence (SOC) has been found to be closely related to health-related quality of life (HRQoL) in patients with chronic diseases, however, this relationship has not been validated in patients with BM. This study first examined the relationship between SOC and HRQoL in patients with BM, and further identified factors associated with SOC in these patients. Patients with BM reported lower scores for most of the functioning subscales and for the general rating of quality of life, and higher scores for most of the symptom subscales, compared with a normative sample. SOC was significantly correlated with most aspects of HRQoL in patients with BM. Further, SOC in the patients was associated with awareness of the disease, possession of religious belief, and type of primary cancer. These results validate the close relationship between SOC and HRQoL in patients with BM, and indicate that SOC is associated with awareness of illness and religious belief.

The patient's readiness to accept the changes in life after the radical lung cancer surgery

Introduction

Lung cancer holds the first position as the number of deaths among both the genders and, even if oncological efficient, is related to lasting psychological effects, which may significantly influence further functioning of a patient's professional and social life. The researches objective was to find the level of acceptance of lung cancer and to determine what is the patient's readiness to accept the changes in life after the surgery.

Material and methods

In total, 135 patients suffering from lung cancer were enrolled. To evaluate the readiness to accept the changes in life after the surgery the authors' questionnaire was used and to evaluate of level of acceptance of illness the standardized the Acceptance of Illness Scale (AIS) was used.

Results

The awareness of the treatment consequences is high among the patients scheduled for surgery. The acceptance of lung cancer is high (mean = 32.23; SD = 7.53). The level of disease acceptance depends on the evaluation of own health - both currently (it is higher among the patients who consider their health as good) and compared to the previous year (it is higher among the patients who evaluate it as the same or better than a year ago) (p < 0.05). The willingness to accept the life changes depends on a gender, age, marital status, education, employment and health orientation (p < 0.05).

Conclusions

Regardless of the achievements of the recent years in the lung cancer treatment, it remains the biggest oncologic challenge worldwide. Only multidisciplinary actions including prevention and psychological support may contribute to much more efficient treatment.