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

Making meaning of everyday life in the context of lung cancer treatment-a qualitative study of outpatients' perspectives

BACKGROUND

The increasing survival after a lung cancer diagnosis implies that patients live longer with the disease, which means that symptoms and side effects of the treatment become part of everyday life.

AIM

The study explored how older adults make meaning of everyday life when undergoing treatment for their lung cancer.

MATERIAL AND METHODS

A qualitative study using semi-structured interviews was conducted with 12 older adults with lung cancer undergoing various treatments. The analysis followed Giorgi's phenomenologic five-step method.

RESULTS

The analysis revealed three partly overlapping themes: meeting the health care system, losing identity, and struggling for meaning in everyday life. The patients appreciate clear and coherent communication at the oncology clinic. They had different needs for support from organised support groups, friends, communities, or relatives to make meaning of everyday life.

CONCLUSION

Creating meaning in everyday life is essential despite the disease and the treatments' side effects. Interpersonal relationships create meaningfulness in everyday life through a salutogenic perspective that makes everyday life comprehensible and manageable.

SIGNIFICANCE

The patients need an everyday life perspective on the disease and the side effects, which a salutogenic approach in the encounter with the health care system could support.

Experiential Avoidance in Advanced Cancer: a Mixed-Methods Systematic Review

BACKGROUND

People with advanced cancer experience psychological distress due to physical symptoms, functional decline, and a limited prognosis. Difficult thoughts, feelings, and emotions may exacerbate distress and lead to avoidance of these experiences which is sometimes referred to as experiential avoidance (EA). Advanced cancer patients may be more likely to engage in EA especially when no obvious solutions to their problems exist. This study aims to examine the terms used to describe EA, the processes that might indicate EA, associations between EA and psychological distress, and to understand why individuals might engage in EA.

METHODS

A mixed-methods review. Literature search of Medline, Embase, Psych INFO, and CINAHL 1980-October 2019.

INCLUSION

adults ≥ 18 years; advanced cancer not amenable to cure.

EXCLUSION

no measures of EA or psychological distress. Risk of bias and study quality assessed. Evidence of statistical techniques collected. Themes coded, grouped, and developed based on meaning.

RESULTS

Nineteen studies identified, 13 quantitative studies and 6 qualitative. The quantitative of which 6 compared early-stage cancers with advanced cancers and examined subscales of EA alongside mood, quality of life, and psychological distress. EA covers a range or terms of which 'avoidant coping' is the commonest. EA is manifest as cognitive, behavioural, and emotional avoidance. A thematic synthesis suggests the function of EA is to protect people from distress, and from confronting or expressing difficult emotions by avoiding communication about cancer, controlling negative information, and maintaining normality and hope and optimism.

CONCLUSIONS

EA may be beneficial in the short term to alleviate distress, but in the longer term, it can impair function and limit engagement in life. Greater clinical awareness of the complexity of EA behaviours is needed. Clinicians and researchers should define EA precisely and be aware of the function it may serve in the short and longer term. Future research studies may consider using specific measures of EA as a primary outcome, to assess the impact of psychological interventions such as ACT.

Understanding illness experiences of patients with primary sclerosing cholangitis: a qualitative analysis within the SOMA.LIV study

BACKGROUND

Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease with a largely unpredictable course. Due to limited treatment options, individuals may for many years suffer from distressing symptoms and the emotional burden of an uncertain future. The need to shift from cure to care of PSC has spurred an interest into patients' health-related quality of life. Qualitative research in this context remains scarce. Hence, this study aimed to enrich the clinical understanding about the lived experience of PSC through a qualitative approach.

METHODS

A total of 20 patients with PSC were recruited at a specialist centre for autoimmune liver disease in Germany and engaged in semi-structured telephone-based interviews between March and June 2022. Verbatim transcripts were interpreted using inductive thematic analysis.

RESULTS

An overarching concept of 'a wave-like experience' was formulated to illustrate the dual and shifting nature of living with PSC. Reflecting upon this central idea, three major themes were generated to address important aspects of participants' illness experiences: 'Invisible presence' focused on perceptions of suffering from a seemingly hidden illness that periodically reveals itself through specific trigger events. 'Embracing the threat' captured the psycho-emotional response shift to this chronic disease from a predominantly negative to a coping-oriented pattern with regular setbacks. 'Between control and constraints' uncovered restrictions that PSC enforces onto patients' lives and their desire for controllability.

CONCLUSIONS

The present study provides an in-depth look at the fluctuating tensions arising from a life with PSC. Insights on perceived invisibility, disease-related triggers of emotional distress and the complexity behind self-management highlight opportunities for enhanced clinical support of this patient group.

Contemporaneous symptom networks of multidimensional symptom experiences in cancer survivors: A network analysis

BACKGROUND

Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have explored the symptom networks of multidimensional symptom experiences in cancer survivors. The objectives of this study were to generate symptom networks of multidimensional symptom experiences in cancer survivors and explore the centrality indices and density in these symptom networks METHODS: Data from 1065 cancer survivors were obtained from the Shanghai CANcer Survivor (SCANS) Report. The MD Anderson Symptom Inventory was used to assess the prevalence and severity of 13 cancer-related symptoms. We constructed contemporaneous networks with all 13 symptoms after controlling for covariates.

RESULTS

Distress (r_s  = 9.18, r_c  = 0.06), sadness (r_s  = 9.05, r_c  = 0.06), and lack of appetite (r_s  = 9.04, r_c  = 0.06) had the largest values for strength and closeness. The density of the "less than 5 years" network was significantly different from that of the "5-10 years" and "over 10 years" networks (p < 0.001). We found that while fatigue was the most severe symptom in cancer survivorship, the centrality of fatigue was lower than that of the majority of other symptoms.

CONCLUSION

Our study demonstrates the need for the assessment of centrality indices and network density as an essential component of cancer care, especially for survivors with <5 years of survivorship. Future studies are warranted to develop dynamic symptom networks and trajectories of centrality indices in longitudinal data to explore causality among symptoms and markers of interventions.

Development and feasibility of culturally sensitive family-oriented dignity therapy for Chinese patients with lung cancer undergoing chemotherapy

Objective

It is well-documented in the literature that dignity therapy is feasible and effectively improves the end-of-life experience of the terminally ill. In a similar vein, this study aimed to develop and investigate the feasibility of evidence-based and culturally sensitive family-oriented dignity therapy for Chinese patients with lung cancer undergoing chemotherapy.

Methods

Three phases of the Medical Research Council framework were adopted to guide the development of the novel dignity therapy intervention. It was preliminarily designed based on a qualitative study and a systematic review, Erikson's eighth stage of psychosocial development, and the dignity model. The feasibility and acceptability of the intervention were examined in a pilot randomized controlled trial with 12 recruited dyads of patients and family caregivers.

Results

The intervention consists of three face-to-face sessions that facilitate participants’ reminiscences and promote their communication. Recruitment and response rates for the feasibility study of the intervention were 92.3% and 75%, respectively. Both patients and family caregivers reported that the intervention alleviated their psychological distress and improved communication.

Conclusions

The Medical Research Council framework serves as a useful scientific basis for modifying dignity therapy with a culturally sensitive approach. The results of the feasibility study suggest that the family-oriented dignity therapy intervention is feasible, acceptable and has the potential to enhance the effects of dignity therapy.

•

This study devised a stepwise procedure for developing a culturally sensitive family-oriented dignity therapy intervention.

•

The family-oriented dignity therapy intervention is feasible and acceptable for Chinese patients with lung cancer .

•

The family-oriented dignity therapy has the potential toalleviate patients' dignity-related and psychological distress.

Home Coping Strategies for Fatigue Used by Patients With Lung Cancer Receiving Chemotherapy in Rural China: A Qualitative Study

BACKGROUND

Cancer-related fatigue, a distressing symptom, is frequently reported by patients with lung cancer as increasing in severity with the number of rounds of chemotherapy. Yet, patients and healthcare providers are challenged to control this fatigue. Thus, healthcare providers must have interventions to effectively enhance coping engagement in patients with lung cancer.

PURPOSE

The aims of this study were to explore how patients with lung cancer in a rural area of China undergoing chemotherapy cope with the fatigue at home and to summarize their strategies.

METHODS

A descriptive qualitative research approach was used, and data were collected using semistructured interviews. Sixteen patients with lung cancer with chemotherapy-related fatigue living in rural communities were recruited from a large, tertiary teaching hospital in Huzhou in eastern China. The transcripts of the interviews were analyzed using content analysis.

RESULTS

Coping strategies for cancer-related fatigue were delineated into the three themes of (a) psychological adjustment, (b) efforts to change lifestyles and act as a Chinese health practitioner, and (c) relying on social support.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The participants in this study provided information on a variety of approaches to reducing/alleviating cancer-related fatigue that were influenced by Chinese culture. Healthcare providers and patients may work together in clinical settings to identify appropriate, effective coping solutions and then to incorporate these into the regular care regimen to help patients transition between hospital and home.

Psychometric and Linguistic Evaluation of a Coping Scale for Breast Cancer Survivors in Taiwan

BACKGROUND

Coping strategies are essential in dealing with threatening situations or difficulties for better psychological adjustments and quality of life. A short-form modified Ways of Coping Questionnaire (MWCQ) would be useful to quickly assess the coping strategies used by breast cancer survivors.

OBJECTIVES

The aim of this study was to evaluate the psychometric properties of a Chinese version of a brief version of the MWCQ in breast cancer survivors.

METHODS

A methodological, cross-sectional design was used in this study. The study has internal consistency reliability, face/content, construct, and convergent/divergent validity. Factor analysis and confirmatory factor analysis were used to examine the psychometric properties of the MWCQ-brief in a convenience sample of 207 women with breast cancer from 2 general hospitals in Taiwan.

RESULTS

From the initial 35-item coping scale, factor analysis results supported a 24-item questionnaire, and the following 4 factors were extracted: effective coping, optimistic coping, unpractical coping, and escape coping. Confirmatory factor analysis results revealed an 18-item questionnaire with 3 factors extracted: active coping, avoidance coping, and minimizing the situation.

CONCLUSIONS

The 24- and 18-item MWCQ-brief versions demonstrate fair psychometric properties to measure adaptability among women with breast cancer in Taiwan. This scale is simple but contains 4 or 3 concepts for coping that can be appropriately used to assess underlying states of adaptation in women with breast cancer.

IMPLICATIONS FOR PRACTICE

The MWCQ-brief is a valid and reliable tool to understand the adaptability states of female breast cancer survivors by exploring reactions to the disease. Healthcare professionals can provide appropriate psychosocial interventions based on assessment results.

Suffering experiences of people with cancer undergoing chemotherapy: A meta-ethnographic study

This meta-ethnography had the objectives of identifying, evaluating, and summarizing the findings of qualitative studies regarding the suffering experiences of people undergoing chemotherapy, as well as developing an explanatory conceptual structure regarding what affects these experiences. A systematic literature review was carried out, covering the past 10 years, in the following databases: CINAHL, Embase, Medline, LILACS and Scopus. By using meta-ethnographic synthesis methods, the following themes were found: the pain of loss; evaluating, measuring, and neutralizing the threat; and social contours of suffering. The experience of living with cancer and undergoing chemotherapy was synthesized into a theoretical-explanatory model with a structure that resembles barbed-wire loops. The model expresses people's suffering experiences as marked by the feeling of loss, restraint of emotions, and resilience. While transcendent movements broke the cycle of suffering, resilience emerged as a learning experience that made patients more resistant to the pain of loss. The results indicated a complex and diverse set of factors that influence suffering, which confirmed that experiences are individual, comprehensive, and continuously reinterpreted.

Psychological Distress Among Patients With Advanced Cancer: A Conceptual Analysis

BACKGROUND

Psychological distress is a common problem that occurs in advanced cancer patients; however, the concept has not been sufficiently specified or clearly described.

OBJECTIVE

To develop succinct understanding of psychological distress among advanced cancer patients.

METHODS

A literature search was conducted using the CINAHL, PubMed, and MEDLINE databases from 1988 to 2018. The analysis used the 8 steps of concept analysis developed by Walker and Avant. The final articles selected focused on definitions, predictors, determinant factors, and measurements of psychological distress in advanced cancer.

RESULTS

Analysis identified that psychological distress in terms of advanced cancer has 5 defining attributes: (1) anxiety, (2) depression, (3) death anxiety, (4) demoralization, and (5) a perceived inability to cope effectively. The primary antecedent is treatment complexity. The consequences are acceptance and living in the present positively, lower performance status, poor quality of life, suicide, and hastened death.

CONCLUSIONS

This concept analysis clarifies the meaning of the concept and differentiates the concept of psychological distress from other emotional symptoms that advanced cancer patients commonly experience. It provides clarity in meaning by examining various ways the concept is used in the area of nursing.

IMPLICATIONS FOR PRACTICE

The identified attributes of psychological distress play vital roles in nursing assessments and should be used as guidance for nurses to provide appropriate nursing care for advanced cancer patients. Interventions should address antecedents and consequences of the concept and consider individuals as persons with unique characteristics.

Heavy shackles: The experience of symptom distress and coping behaviors of Chinese patients with chronic obstructive pulmonary disease

People with chronic obstructive pulmonary disease exhibit various symptoms, some of which can negatively affect their daily lives. Thus, they may adopt coping behaviors to improve their condition. This qualitative descriptive study investigated symptom distress and coping behaviors among 19 Chinese patients with chronic obstructive pulmonary disease using individual, semi-structured, face-to-face interviews. We identified the following three themes for the patients' symptom distress: distressing symptoms, inescapable imprisonment, and no choice other than being a burden to the family. The various coping behaviors of the patients were categorized into the following three themes: struggle during the medical treatment process, careful maintenance of daily life, and coping with negative emotions. Although all patients experienced physical and psychological distress, they displayed a strong desire to improve their lives and health. By recognizing the patients' symptom distress and coping behaviors, tailored interventions could be developed to improve the quality of their lives.

Coping Strategy Influences Quality of Life in Patients With Advanced Lung Cancer by Mediating Mood

INTRODUCTION

Patients with advanced lung cancer experience high physical symptom burden with substantial psychological distress. Depressive and anxiety symptoms are common and associated with worse quality of life (QoL). Early palliative care (EPC) addresses the complex supportive care needs improving QoL and mood. The mechanisms of EPC are uncertain. We examined whether and how coping strategy, a primary component of EPC, influenced QoL in these patients.

MATERIALS AND METHODS

We conducted a multicenter cross-sectional study of patients with advanced lung cancer. A total of 125 patients completed assessments of QoL (QLQ-C15-PAL), depressive and anxiety symptoms (HADS), and coping (brief COPE questionnaire). The data were analyzed by descriptive statistics. To determine whether and how coping strategy influences QoL, correlations and logistic regressions were performed.

RESULTS

Positive reframing correlates significantly with global QoL (r = 0.25, P < .01), emotional well-being (r = 0.33, P < .01), pain (r = -0.30, P < .01), fatigue (r = -0.22, P < .01), loss of appetite (r = -0.22, P < .01) and nausea (r = -0.24, P < .01). Self-blame correlates significantly with worse emotional well-being (r = -0.19, P < .05) and insomnia (r = 0.19, P < .05). Using a 4-step logistic regression model, it was found that anxiety and depressive symptoms fully mediated the relationship between positive reframing and QoL.

CONCLUSIONS

Patients with advanced lung cancer using positive reframing as coping strategy, experience higher QoL. The mechanism behind it seems that positive reframing goes along with less anxiety and depressive symptoms leading to a better QoL. Self-blame leads to more insomnia and worse emotional well-being. Providing skills to cope effectively could impact QoL in these patients.

The Primary Sclerosing Cholangitis (PSC) Wellbeing Study: Understanding psychological distress in those living with PSC and those who support them

INTRODUCTION

The impact of living with Primary Sclerosing Cholangitis (PSC) on psychological wellbeing is not well-known. A recent scoping review by the authors found that both depression and anxiety frequently featured in the accounts of those living with the illness. However, less clear were the factors that led to such psychological distress, the impact that the illness had on families and how to best support those living or supporting someone living with the illness. In light of this, the aim of this study was to explore how the illness impacted the lives of both those diagnosed with the illness and those supporting them.

METHOD AND RESULTS

This study adopted a phenomenological approach to understand the subjective experiences of individual participants. A total of 30 individuals took part in Asynchronous Virtual Focus Groups hosted on a Virtual Learning Environment for a four-week period. Chronological narratives of individuals' lived experiences from diagnosis to post-transplant are presented below. These narratives centred upon individuals' and families' experiences of receiving a diagnosis, and adjusting to life post-diagnosis, particularly in regard to their relationships with health professionals and other family members, and in preparing for the possibility of transplant.

DISCUSSION

The present article provides an in-depth look at how PSC can impact psychological wellbeing, how psychological distress arises and includes advice tailored to individuals, families and health professionals on how to best support each other.

Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer

Advanced cancer, with its considerable physical symptoms and psychosocial burdens, represents an existential threat and major stressor to patients and their caregivers. In response to such stress, patients and their caregivers use a variety of strategies to manage the disease and related symptoms, such as problem-focused, emotion-focused, meaning-focused, and spiritual/religious coping. The use of such coping strategies is associated with multiple outcomes, including quality of life, symptoms of depression and anxiety, illness understanding, and end-of-life care. Accumulating data demonstrate that early palliative care, integrated with oncology care, not only improves these key outcomes but also enhances coping in patients with advanced cancer. In addition, trials of home-based palliative care interventions have shown promise for improving the ways that patients and family caregivers cope together and manage problems as a dyad. In this article, we describe the nature and correlates of coping in this population, highlight the role of palliative care to promote effective coping strategies in patients and caregivers, and review evidence supporting the beneficial effects of palliative care on patient coping as well as the mechanisms by which improved coping is associated with better outcomes. We conclude with a discussion of the limitations of the state of science, future directions, and best practices on the basis of available evidence.

American Indian women cancer survivors' coping with depressive symptoms

OBJECTIVE

Depressive symptoms have been identified as a primary predictor of quality of life among cancer patients. Depression and cancer are co-occurring and disproportionately elevated for American Indian and Alaska Native (AI/AN) women. The purpose of this article is to examine American Indian (AI) women cancer survivors' coping mechanisms for depressive symptoms.

RESEARCH APPROACH

The methodology included a qualitative descriptive approach with conventional content analysis to examine the coping strategies of AI women cancer survivors associated with depressive symptoms. The interview guide was semi-structured and developed in collaboration with a community advisory board (CAB). Data-derived qualitative analysis was used to generate codes inductively from the data.

PARTICIPANTS

A sample of 43 AI women cancer survivors (n = 14 cervical cancer, n = 14 breast cancer, and n = 15 other cancers) from the Northern Plains region, in the state of South Dakota were interviewed. Data were collected from June 2014 to February 2015. Methodological approach: Qualitative content analysis was used for data analysis, which allowed themes to emerge inductively from the data. Analysis revealed 430 preliminary codes. After de-briefing, validation, and discussion among coauthors, these were then sorted into 67 codes. Member checks with all available participants were conducted to minimize misinterpretation.

FINDINGS

A total of 26 participants (62%) indicated they had feelings of depression since their cancer diagnosis. Women coped with depressive feelings by (a) participating in faith traditions; (b) seeking creative and positive outlets; (c) martialing family and social support; and (d) keeping busy with other life activities.

INTERPRETATION

AI women experienced depressive symptoms following a cancer diagnosis and used a variety of positive coping mechanisms to create personal meaning. Implications for Psychosocial Providers or Policy: AI women may need unique support following a cancer diagnosis, and interventions should incorporate AI beliefs and traditions, such as storytelling and talking with family and community members.