Resilience process and its protective factors in long-term survivors after lung cancer surgery: a qualitative study

Resilience and vulnerability of post-ostomy patients with early-onset colorectal cancer from the perspective of social-ecological theory: a qualitative study

Background

The incidence rate of colorectal cancer (CRC) is rising among adults under the age of 50 (early-onset colorectal cancer, EOCRC). Post-ostomy dysfunction, along with negative perceptions due to incorrect public views and a decline in quality of life, has a significant impact on these individuals, their families, and social relationships.

Objective

By understanding the adaptation process of post-ostomy EOCRC(POEOCRC) patients, this study aims to provide information for developing targeted nursing interventions for this population.

Methods

Based on the social-ecological theory, semi-structured, in-depth interviews were conducted with 16 POEOCRC patients in China between May 2023 and January 2024.Colaizzi's method of phenomenology was employed for data analysis.

Results

This study found two aspects of adaptation experience in POEOCRC patients. For resilience, three themes emerged:(1) Micro-Positive individual psychological experiences, (2) Meso-Positive adjustment within the family and (3) Macro-Social resource integration and utilization. In terms of vulnerability, three themes were as follows:(1) Micro-Persistent negative experiences, (2) Meso-Family crisis caused by the ostomy and (3) Macro-Urgency and fragility of social support.

Conclusion

This study based on the social-ecological theory and highlights different dimensions of resilience and vulnerability experienced by POEOCRC patients. Early and targeted interventions to promote patients' coping skills and their ability to adapt to family and society.

Effect of an integrated narrative program (INP) on quality of life among patients with non-small cell lung cancer (NSCLC): An experimental trial

PURPOSE

To investigate the effectiveness of an integrated narrative program (INP) in enhancing the resilience, self-efficacy and quality of life of postoperative NSCLC patients.

METHODS

135 patients participated in this trial. 45 participants were recruited into the integrated narrative program group and received both the digital storytelling intervention and narrative therapy after a randomized controlled trial, while the control group (n = 45) received routine care and the intervention group (n = 45) underwent the digital storytelling intervention (DST). Questionnaires were administered to assess resilience, self-efficacy and quality of life at baseline (T0) (within 3 days before surgery), immediately after intervention (T1), one month post-intervention (T2), and three months post-intervention (T3). A linear mixed effects model was conducted via the intention-to-treat analysis.

RESULTS

During follow-up assessments, the INP group exhibited significantly greater increase in resilience, self-efficacy, and quality of life (all P < 0.001) compared to both DST group and control group, which were consistent with the sensitivity analysis results (all P < 0.001).

CONCLUSION

The INP was more effective than DST in improving the resilience, self-efficacy, and quality of life of postoperative NSCLC patients, and these benefits could persist for at least three months post-intervention. Due to the fact that the INP process is relatively complicated, so we recommend the use of web-based platforms for INP interventions in future clinical work.

The mediating role of perceived stress in the association between family resilience and psychological distress among gynecological cancer patients: a cross-sectional study

BACKGROUND

Gynecological cancer patients face various stressors and suffer from severe psychological distress. The activation of family resilience supports patients to overcome daily stressors, yet the relationship between family resilience and psychological distress is poorly understood. The purpose of this study is to investigate the degree of psychological distress in patients diagnosed with gynecological cancer, and whether perceived stress mediate the relationship between family resilience and psychological distress.

METHODS

A cross-sectional study was undertaken on 358 gynecological cancer patients in China from September 2021 to November 2022. The participants completed surveys that included the Chinese Version of the Family Resilience Assessment Scale, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale, the Distress Management Screening Measure, and socio-demographic questions. Using Pearson's correlation analysis to investigate the association between variables, and the bias corrected bootstrapping method was utilized to establish perceived stress as a mediator.

RESULTS

Chinese patients with gynecological cancer experienced a moderate psychological distress. In addition, psychological distress exhibited a negative correlation with family resilience and a positive correlation with perceived stress in gynecological cancer patients (both P < 0.01). Perceived stress partially mediated the correlation between family resilience and psychological distress (β=-0.182; 95% CI: -0.224 to -0.140; P < 0.001). The total indirect effect value was - 0.182, and the total effect value was - 3.060.

CONCLUSIONS

The findings indicate that higher family resilience and lower perceived stress can reduce psychological distress in gynecological cancer patients, and family resilience also tends to reduce perceived stress in cancer patients. Clinical staff and psychologist should consciously cultivate patients' family resilience to reduce psychological distress. Meanwhile, identifying potential mediators between family resilience and psychological distress are able to promote the development and assessment of interventions in the future.

Journey towards resiliency: A systematic review and meta-synthesis of cancer patients' experiences

PURPOSE

This systematic review and meta-synthesis seeks to explore cancer patients' journey towards resiliency. The secondary aim of this review is to identify unique resilience protective factors among cancer patients.

METHODS

A thorough search was conducted in eight electronic databases and the grey literature for published or unpublished qualitative and mixed methods studies. Studies that explored resilience among cancer patients were included. The studies were appraised using the Critical Appraisal Skill Programme Checklist. The overall certainty of evidence was further evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation's Confidence in Evidence from Reviews of Qualitative Research. Themes identified were synthesized using Sandelowski and Barroso's meta-synthesis method.

RESULTS

A total of 34 studies comprising 987 cancer patients were included in this review. Three themes and nine subthemes were generated from the meta-synthesis. The themes were: (1) Confronting the cancer diagnosis, (2) personal adaptations to cancer, and (3) drawing strength from others. The findings highlighted how individuals overcame cancer adversities through resilience, which is influenced by various factors, including life experiences, social-cultural stigmas, spirituality, social support networks, coping strategies, motivation, acceptance of illness, positive mindset, and engagement with healthcare facilities.

CONCLUSIONS

This review highlights the role of resilience in a cancer patient's journey. It emphasizes on the importance of building resilience in both cancer patients and survivors to effectively overcome the challenges of their cancer diagnosis. These insights are essential for developing interventions that promote resilience and improve existing psychosocial oncology services. Future research should focus on longitudinal studies to better understand how resilience evolves and pinpoint factors that can further influence one's resilience.

Effect of digital storytelling intervention on resilience, self-efficacy and quality of life among patients with non-small cell lung cancer (NSCLC): A randomized controlled trial

OBJECTIVE

To verify and compare whether the digital stories could effectively improve the resilience, self-efficacy and quality of life of postoperative NSCLC patients.

MATERIALS AND METHODS

A total of 90 participants at baseline were randomly assigned to two groups, 45 patients per group. The intervention group received the digital storytelling intervention which includes 4 videos on different topics: positive psychological quality, cultivating healthy living habits, establishing good social support, and insisting on scientific exercise, whereas the control group received only routine care. The resilience, self-efficacy, and quality of life were assessed at baseline (T0) (within 3 days before surgery), immediately after intervention (T1), one month after intervention (T2), and three months after intervention (T3). A linear mixed effects model was used to test the effects of the digital storytelling interventions on resilience, self-efficacy, and quality of life.

RESULTS

The intervention group reported significantly greater improvements in resilience, self-efficacy, and quality of life (all P < 0.001) at follow-ups than the control group after controlling for age, gender, and education level as covariates. Moreover, the sensitivity analysis results are consistent with the per-protocol, that overall time × group interactions effects were significantly different in resilience, self-efficacy, and quality of life (all P < 0.001).

CONCLUSION

The digital storytelling intervention based on lung cancer survivors' experience can effectively improve resilience, self-efficacy and quality of life in postoperative lung cancer patients. More comprehensive researches are needed to evaluate the longer-term impacts of the DST and its feasibility for those with more advanced cancer.

Disparities in lung cancer short- and long-term outcomes after surgery: Analysis from the national cancer database

INTRODUCTION

Social determinants of health are particularly important in lung cancer epidemiology. Previous studies have primarily associated social determinants with long-term outcomes, such as survival, but fail to include short-term outcomes after surgery. The National Cancer Database (NCDB) was used to draw associations between social factors of patients with lung cancer and short-term post-surgical outcomes, while comparing them to prognostic factors, including stage at diagnosis and survival.

METHODS

The 2004-17 NCDB was queried for patients with primary epithelial tumor, squamous cell carcinoma, or adenocarcinoma of the lung treated with curative intent. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were utilized.

RESULTS

On logistic regression modeling, male gender, low income, lacking insurance, and facility in the central United States were associated with poor short-term outcomes (<0.05). Increased age, White race, and Black race were associated with increased length of hospital stay and mortality, but negatively correlated with readmission rates (<0.05). Medicare and Medicaid were associated with increased length of stay and mortality, respectively (<0.05). Similar patterns were observed for higher stage at diagnosis (<0.05). Hazard ratios were elevated with increased age, male gender, White race, lacking insurance, Medicaid, and facility in the central United States (<0.05).

CONCLUSION

Many social factors previously associated with poor prognosis after lung cancer diagnosis are also associated with poor short-term outcomes after surgery. This study implies that healthcare providers treating lung cancer should proceed with care while aware that patients with the discussed social factors are predisposed to complicated recoveries.

Resilience process in individuals with colorectal cancer: a qualitative study

PURPOSE

Resilience is a positive outcome in giving individuals strength to adapt to cancer and have better various aspects of health-related quality of life. However, research focusing on resilience in relation to colorectal cancer (CRC) is limited. Therefore, the aim of this study was to explore the process of resilience in individuals with CRC.

METHOD

Sixteen individuals diagnosed with stage Ι to III CRC within the last five years were recruited from a CRC surgical outpatient department in a medical center in Northern Taiwan. Semi-structured interviews were used to explore the resilience process of living with CRC. Recorded interviews were transcribed verbatim and were analyzed using modified grounded theory.

FINDINGS

Resilience is a dynamic three-phase process, including impact of CRC, adaptation or maladaptation following CRC, and growth from CRC experience. Resilience strategies (i.e., attitude adjustment, developing personal strategies to conquer CRC and side effects, setting new goals in life, and viewing death as a normal process), avoidance behaviors, and passive waiting strategy were shown across the resilience process.

CONCLUSIONS

All individuals showed negative impacts during CRC diagnosis and treatments, but some individuals used the resilience strategies in helping to promote positive adjustment and redirect to develop their resilience process. Furthermore, resilient and maladaptive individuals may change the situation depending on which strategies are used and on the progression of CRC because resilience is dynamic. Oncology clinicians should help individuals use resilience strategies to smoothly go through the resilience process.

An Analysis and Evaluation of Kumpfer's Resilience Framework

Kumpfer's resilience framework (KRF) was initially developed from evidence on resilience and its predictors among at-risk youth. This framework has been expanded to guide resilience research in diverse populations facing a variety of stressors. However, KRF's strengths and weaknesses have not been evaluated since its publication. Guided by Walker and Avant's method, an analysis of KRF was conducted drawn from 41 publications. A revised KRF diagram was proposed on the basis of the analysis to improve clarity, consistency, logical structure, and parsimony in the diagram of KRF. Overall, KRF provides a useful, generalizable, and testable theoretical framework for future resilience research.

Passing through end-of-life suffering: Possible or not? Results from a qualitative inquiry

The objective of this study was to understand the factors associated with "passing through suffering" in terminal illness. We interviewed 19 adults diagnosed with terminal disease in palliative stage. Interviews were analyzed using thematic analysis. Four axes of understanding were generated. In the first, participants discussed the will to "feel alive" despite the disease. The second, the process of acceptance, is based on lucidity and on letting go. The third highlights the importance of relationships with others. The fourth axis describes the consequences of this passage through suffering. This study highlights a phenomenon of adapting to suffering.

Health-related quality of life in patients with neuroendocrine neoplasms: a two-wave longitudinal study

PURPOSE

Scientific knowledge on health-related quality of life (HRQoL) in patients with neuroendocrine neoplasm (NEN) is still limited and longitudinal assessment of HRQoL over the time in NEN patients are scarce. The current study aimed to assess the role of clinical severity and heterogeneity of NEN, as well as resilience, in the HRQoL of NEN patients over the course of a year.

METHODS

39 consecutive NEN patients (25 men and 14 women) aged from 29 to 73 years participated in a longitudinal Italian multicentric study. The main outcome measure concerned the severity and heterogeneity of NEN, HRQoL, and resilience.

RESULTS

Over the course of a year, higher levels of the global health (GH) were associated to the absence of distant metastases, while the presence of metastases with higher levels of fatigue, diarrhea, and financial difficulties. Higher levels of resilience are still associated with better GH and lower levels of fatigue, diarrhea, and financial difficulties, but no longer with constipation. Furthermore, patients with gastroenteropancreatic NEN still have higher scores on constipation, but not on GH, fatigue, diarrhea, and financial difficulties. Patients with hereditary NEN continue to have greater GH than those with a sporadic NEN and lower fatigue, diarrhea, and financial difficulties.

CONCLUSION

These findings showed that the effects of severity and clinical heterogeneity of the NEN on HRQoL may change over time. This evidence should lead clinicians to monitor the HRQoL of NEN patients throughout the course of the disease and psychologists to implement evidence-based resilience interventions.

Self-efficacy and positive coping mediate the relationship between social support and resilience in patients undergoing lung cancer treatment: A cross-sectional study

Background

The prognosis of patients undergoing lung cancer treatment might be influenced by mental health status. Resilience is one of the important predictors to reflect the mental health status. It has been shown that patients with higher levels of social support, self-care self-efficacy, and positive coping have greater resilience. This study aimed to determine the mediating role of self-efficacy and positive coping in the relationship between social support and psychological resilience in patients with lung cancer.

Method

This is a cross-sectional study that was conducted in in the oncology departments and thoracic surgical wards of four tertiary hospitals in Hunan Province, China, between November 2016 and November 2017. Three hundred and three patients who were undergoing treatment for lung cancer volunteered their participation in the study. Participants completed questionnaires, including the Chinese version of the Perceived Social Support Seale Scale, the Chinese version of Strategies Used by People to Promote Health Scale, and the Chinese version of the Connor-Davidson Resilience Scale.

Results

Mediation analysis indicated that self-care self-efficacy and social support partially mediate the effect of social support on resilience. Direct paths from social support to self-efficacy, self-efficacy to positive coping, positive coping to psychological resilience, self-efficacy to psychological resilience, and social support to psychological resilience were significant (p &lt; 0.001). The indirect paths from social support to self-efficacy and self-efficacy to psychological resilience were also significant. The chain mediation from social support to self-efficacy, self-efficacy to positive coping, and positive coping to resilience were significant.

Conclusion

Self-efficacy and positive coping play an important role in the relationship between social support and resilience in patients receiving cancer treatment. Social support not only directly influenced psychological resilience but also indirectly influenced psychological resilience through self-efficacy and positive coping.

Postoperative Symptom Burden in Patients Undergoing Lung Cancer Surgery

CONTEXT

Previous studies on quality of life (QOL) after lung cancer surgery have identified a long duration of symptoms postoperatively. We first performed a systematic review of QOL in patients undergoing surgery for lung cancer. A subgroup analysis was conducted focusing on symptom burden and its relationship with QOL.

OBJECTIVE

To perform a qualitative review of articles addressing symptom burden in patients undergoing surgical resection for lung cancer.

METHODS

The parent systematic review utilized search terms for symptoms, functional status, and well-being as well as instruments commonly used to evaluate global QOL and symptom experiences after lung cancer surgery. The articles examining symptom burden (n = 54) were analyzed through thematic analysis of their findings and graded according to the Oxford Centre for Evidence-based Medicine rating scale.

RESULTS

The publication rate of studies assessing symptom burden in patients undergoing surgery for lung cancer have increased over time. The level of evidence quality was 2 or 3 for 14 articles (cohort study or case control) and level of 4 in the remaining 40 articles (case series). The most common QOL instruments used were the Short Form 36 and 12, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, and the Hospital Anxiety and Depression Score. Thematic analysis revealed several key findings: 1) lung cancer surgery patients have a high symptom burden both before and after surgery; 2) pain, dyspnea, cough, fatigue, depression, and anxiety are the most commonly studied symptoms; 3) the presence of symptoms prior to surgery is an important risk factor for higher acuity of symptoms and persistence after surgery; and 4) symptom burden is a predictor of postoperative QOL.

CONCLUSION

Lung cancer patients undergoing surgery carry a high symptom burden which impacts their QOL. Measurement approaches use myriad and heterogenous instruments. More research is needed to standardize symptom burden measurement and management, with the goal to improve patient experience and overall outcomes.

Application Effect and Prognosis of High-Quality Nursing in the Whole Process of Nursing in Lung Cancer Surgery

Objective

To explore the application effect and prognostic benefits of whole-course high-quality nursing in lung cancer patients after surgery.

Methods

Sixty patients with lung cancer who underwent surgical treatment in the Department of Respiratory Medicine from April 2020 to July 2021 were recruited and assigned to receive either conventional nursing (control group) or whole-course high-quality nursing (intervention group) using the random number table method, with 30 cases in each group. Outcome measures included self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, nursing compliance, patient satisfaction, complications, and patient prognosis.

Results

Patients receiving whole-course high-quality nursing showed significantly lower SAS and SDS scores versus those given conventional nursing (P < 0.05). Whole-course high-quality nursing resulted in higher patient compliance versus conventional nursing (P < 0.05). Patients in the intervention group were more satisfied with the nursing compared with those in the control group (P < 0.05). Whole-course high-quality nursing resulted in a lower incidence of complications, postoperative recurrence, and mortality versus conventional nursing (P < 0.05).

Conclusion

Whole-course high-quality nursing alleviates the negative emotions of patients after lung cancer surgery, enhances patient compliance and satisfaction, and reduces the incidence of postoperative relapse and complications, which demonstrates great potential for clinical promotion.

Resilience is associated with frailty and older age in hospitalised patients

Background

Little is known about resilience in an internal medicine setting. We aimed to assess the relationship between resilience and frailty and other clinical and sociodemographic characteristics in a cohort of prospectively enrolled hospitalised patients.

Methods

In 2017–2019, we consecutively enrolled patients in our internal medicine wards. We selected all patients who filled in the 25-item Connor-Davidson resilience scale (CD-RISC). Mean resilience was evaluated according to baseline demographic (i.e., age, sex, marital and socioeconomic status) and clinical (i.e., Cumulative Illness Rating Scale [CIRS], Edmonton Frail Scale [EFS], Barthel index, Short Blessed test, length of stay [LOS]) data. A multivariable analysis for assessing factors affecting resilience was fitted.

Results

Overall, 143 patients (median age 69 years, interquartile range 52–79, 74 females) were included. Resilience was significantly lower in frail (p = 0.010), elderly (p = 0.021), dependent (p = 0.032), and more clinically (p = 0.028) and cognitively compromised patients (p = 0.028), and in those with a low educational status (p = 0.032). No relation between resilience and LOS was noticed (p = 0.597). Frail patients were significantly older (p < 0.001), had a greater disease burden as measured by CIRS comorbidity (p < 0.001) and severity indexes (p < 0.001), were more dependent (p < 0.001), more cognitively impaired (p < 0.001), and displayed a lower educational level (p = 0.011) compared to non-frail patients. At multivariable analysis, frailty (p = 0.022) and dependency (p = 0.031; according to the Barthel index) were associated with lower resilience in the age groups 18–64 and ≥ 65 years, respectively.

Conclusions

Low resilience was associated with frailty and dependency with an age-dependent fashion. Studies assessing the impact of this finding on important health outcomes are needed.

Trial registration

Clinical Complexity in Internal Medicine Wards. San MAtteo Complexity Study (SMAC); NCT03439410. Registered 01/11/2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03251-9.

"For Years I lived in a Cage. Now the Cage Is Open and I Am Just Learning to Fly." Perspectives of Cancer Survivors on Psychological Resilience

BACKGROUND

Transitioning from treatment to survivorship engenders several challenges that cancer survivors must learn to manage. These challenges are commonly associated with struggling to manage reentry into postcancer life. Thus, balance is restored after cancer, and postcancer experiences should be considered along with all previous life experiences. This balancing process surrounding cancer causes some cancer survivors' life to deteriorate, whereas other cancer survivors begin a psychological resilience process.

OBJECTIVE

The aim of this study was to investigate the way that psychological resilience is experienced by cancer survivors.

METHODS

The present descriptive qualitative design study was conducted from August 2019 through January 2020. A total of 12 cancer survivors were sampled from the follow-up clinics of a hospital. Data were collected through semistructured, pilot-tested, face-to-face interviews using an interview guide.

RESULTS

Three main themes were clarified based on the descriptive analysis of the data on cancer survivors' experiences: "fight vs lose," "balancing uncertainties," and "learned to fly." The results demonstrate the importance and influence of psychological resilience in the overall cancer experience.

CONCLUSION

This study provides insight into the subjective psychological resilience process of cancer survivors. Nurses may use this knowledge in fostering effective strategies enabling cancer survivors to develop psychological resilience.

IMPLICATIONS FOR PRACTICE

The results offer a promising resource for nurses to assess and address the risk and protective factors of cancer survivors to identify unique needs and to provide individualized care. In this context, nurses can develop novel approaches and interventions for cancer survivors in accordance with Kumpfer's resilience framework.