Hoping to reach a safe haven - Swedish families' lived experience when a family member is diagnosed with breast cancer

Exploring patients' opportunities for participation in meetings with a contact nurse, prior to cancer treatment - An interview study

PURPOSE

In Swedish cancer care, Contact Nurses (CNs), have a role to enhance the patients' opportunities for participation through improved communication and information. The aim of this study was to explore how patients describe their opportunities for participation during the first encounter with the CN, prior to starting the cancer treatment.

METHODS

Semi-structured interviews with 14 patients with cancer, planned for curative treatment, were performed. Purposeful sampling, based on estimated high or low activation level measured with PAM-13®, as well as gender and age, were used. The interviews were analysed, using a qualitative inductive approach.

RESULTS

The overarching theme "Dealing with an entirely new life situation" encompass three categories; "Establish relationships", "Gaining understanding of the illness" and "Taking part in treatment planning". The relationships with the CNs as well as the understanding of what was being planned, was considered important. Having the opportunity to communicate essential matters and the adaption of the information, was also found to be of great importance. The perceived possibilities to participate in the planning of treatment and care varied, with some patients describing the plan to be predetermined, while others had a more accommodating experience.

CONCLUSION

The result highlights the importance for CNs of establishing relationships with their patients. It also points out the importance of the patients understanding of their situation. These insights emphasize the need for CNs to prioritize empathic communication, the need to adapt information to the patient's preunderstanding and to actively involve patients in their care planning, enhancing overall patient satisfaction and outcomes.

The complexity of needs and roles of family members during breast cancer rehabilitation: a qualitative study

BACKGROUND

Family members play a crucial role in supporting women with breast cancer during their recovery. In the complex situation of being an informal caregiver, their own health and ability to support the patient needs to be acknowledged. The aim was to explore the experiences, needs and roles of family members throughout the rehabilitation process of women with breast cancer.

METHODS

A qualitative study was conducted, involving semi-structured individual telephone interviews with 20 purposefully selected family members of women with breast cancer (13 men aged 24-79 years, 7 women aged 19-76 years). Data analysis utilized conventional content analysis and used "casing" as the analysis technique. The study is part of the ReScreen randomized controlled trial and all participants gave informed consent.

RESULTS

The interviews revealed significant variation among family members, leading to the emergence of different typologies based on their reactions and specific preconditions. These typologies included: 1) The case of the assertive and confident team leader, 2) The case of the frustrated but persistent guardian, 3) The case of the reassured bystander, and 4) The case of the neglected outsider. While not mutually exclusive, the cases demonstrated clear similarities and differences in whether individuals felt secure or insecure in the rehabilitation process and their level of involvement in this process. Some described feelings of being involved and active in the process while others experienced not being involved and described feelings of abandonment. However, regardless of their role, family members reported that their own health was seldom considered by healthcare professionals.

CONCLUSIONS

This study sheds light on the concept of "we-disease," where the role of a family member is interrelated with factors such as their health literacy, supporting role, level of involvement, relationship, and identity during the patient's rehabilitation process. This highlights significant divergence in whether family members perceive the rehabilitation process as a collaborative effort or an individual challenge. These perceptions greatly impact their own well-being and ability to support women with breast cancer, underscoring the importance of recognizing family members as informal caregivers and offering tailored support from healthcare professionals when needed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03434717. Registered February 15, 2018.

Health Information Needs of Breast Cancer Survivors: An Umbrella Review

Purpose

The aim of this umbrella review was to identify the main information needs of breast cancer survivors. Since several reviews have already been done on this topic, conducting an umbrella review not only combines their results but also gives a comprehensive picture and informative summary of breast cancer survivors' needs.

Method

The search was performed in PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane, and Google Scholar from inception to the end of March 2024. This review was conducted according to the JBI methodology for umbrella reviews, and the report was based on Rutten's category for information needs of patients with cancer. After removing duplicate and irrelevant articles, 14 systematic reviews were included in the analysis. The JBI checklist was used for evaluating the quality of eligible articles.

Results

The information needs were classified into 11 main categories and 86 subcategories. As a result of this umbrella review, one category was added to Rutten's 10 categories. Also, treatment information needs were introduced as the main identified category. Information on supportive care needs ranked second, and body image/sexuality information needs ranked third with a slight difference.

Conclusion

The information needs outlined in the present study can serve as a general model to help clinical decision makers and policymakers in order to better understand the needs of the group and meet the information needs of the population. Implications for Cancer Survivors. These recommendations can promote and develop targeted interventions to reduce the psychosocial consequences of breast cancer survivors and increase their quality of life.

Psychological experiences of family caregivers of patients with breast cancer: Protocol for a meta-synthesis

AIM

The number of breast cancer patients is increasing, but there are insufficient sources of information for their family caregivers. The purpose of this systematic review was to elaborate the psychologically realistic experiences and corresponding needs of family members of patients with breast cancer in the course of their experience in the disease which may provide them with effective, targeted intervention strategies to improve their quality of life.

DESIGN

Protocol for a meta-synthesis.

METHODS

We will search the Chinese databases (i.e., China National Knowledge Infrastructure, VIP Database and Wanfang Database) and the English databases (i.e., PubMed, Embase, Web of Science, the Cochrane Library, CINAHL and PsycINFO). Qualitative studies from the above databases, studying the psychological experiences of family members of patients with breast cancer, will be searched comprehensively. The quality of the study will be evaluated by two reviewers independently using the Joanna Briggs Institute (JBI) critical appraisal tools for qualitative study, and any disagreements will be discussed and judged by the third reviewer. Data will be extracted using JBI standardized data extraction tool. Then, the literature will be compared and analysed, and the raw results summarized using the JBI meta-aggregation tool. The reliability and credibility of the overall quality of the included studies will be assessed by using the JBI ConQual approach.

RESULTS

N/A. No Patient or Public Contribution.

PROSPERO REGISTRATION NUMBER

REDACTED.

Assessing the Expression of Emotions in Breast Cancer Survivors during the Time of Recovery: Perspective from Focus Groups

Breast cancer has major public health implications, as it is the most frequent malignant tumor and the leading cause of cancer death in women. Survivors have many needs, including strategies to cope with the associated distress. We explore whether focus groups are useful for nurses to obtain information about the emotional state of breast cancer women, and develop strategies for coping with the stress that this disease entails. A qualitative study was carried out, involving 25 focus groups with 83 women treated for breast cancer, recruited from the local Breast Cancer Association (ALMOM). Four open-ended questions were employed, and 60-min discussions were carried out. They were transcribed, analyzed, coded, and the themes identified. Four major themes emerged, including "complex emotional evolution", "emotional isolation", "lack of information" and "inability to give advice". Women admitted that this disease had been a stressful factor for them, causing emotional (anxiety, irritability, anger or guilt) and cognitive disorders (confusion, lack of concentration, forgetfulness). The use of focus groups in breast cancer survivors allows nurses to evaluate the expression of emotions in these women, and collect and share information about their feelings, thoughts and experiences, so that survivors can cope more easily with the stress related to their illness.

Personal and Contextual Factors to the Successful Implementation of a Family Nursing Approach in Oncology Care

The aim of this study was to explore nurses' attitudes and beliefs about the importance of families in nursing care, as well as the barriers and facilitators within the clinical context that influence the implementation offamily nursing in an in-patient oncology service. A cross-sectional study design, incorporating quantitative and qualitative measurements, was used with a sample of nurses in Spain from an oncology service (N = 39). In general, oncology nurses reported positive attitudes and beliefs about the importance of family in nursing care. However, they did not effectively involve the family in their daily clinical practice. This was due to the nurses' lack of clinical skills and competence to work with families as well as contextual factors such as the lack of time and workload that acted as barriers to the implementation of family-oriented care. This study identified areas of improvement that are needed to promote the effective and sustainable implementation of family nursing knowledge in clinical practice settings.

Autosacrificio femenino durante el padecimiento del cáncer de mama

Resumen: Explorar los patrones del comportamiento socialmente construido y basados en el género asociado con el autosacrificio de mujeres jóvenes durante el padecimiento del cáncer de mama. Estudio cualitativo descriptivo realizado en la ciudad de Neiva, Departamento del Huila (Colombia) durante el 2018. Participaron 15 mujeres diagnosticadas a los 45 años o antes. La información se recolectó a través de un grupo de discusión y diez entrevistas semiestructuradas, y los datos se trataron mediante el análisis temático. Tres temas emergieron: “Ante todo, cuidar de sus hijos(as) y su familia”, “Ocultar el dolor físico y emocional” y “No ser una carga para su familia”. A pesar de la enfermedad, las mujeres deben continuar cumpliendo los roles socialmente establecidos para el género femenino, priorizando las necesidades de los demás y haciéndose cargo de las propias.

'Bad news consultations' with oncology nurses: Impact on perceived stress and patient experience

PURPOSE

'Bad News Consultations' (BNC), conducted by nurses who are specialists in cancer, have been institutionally implemented in all French anti-cancer centres, to support the patient facing announcement-related stress. This study aimed to 1/describe the impact of the BNC on the patient's perceived stress and 2/determine the patient's benefits from the BNC.

METHOD

This monocentric study, cross-sectional evaluation, used a mixed method, both quantitative and qualitative. During 8 months, 336 eligible participants who underwent a BNC were recruited by nurses. Perceived stress was self-assessed with a validated Visual Analogic Scale (VAS), at the beginning and at the end of the BNC. Stress resilience was self-assessed once using the CD-RISC2. Qualitative experiences were explored after the BNC, using a 25-item questionnaire. Multivariate analyses were conducted on perceived stress measures (on the VAS) to test mixed-effects models, including initial predispositions (e.g., stress resilience) and organisational constraints (e.g, interval between the medical consultation and the BNC).

RESULTS

Analyses on the perceived stress measures revealed a significant and negative effect of Time (B = -1.91; p < .001), Gender (B = 0.72; p = .03), and Resilience score (B = -0.43; p < .001), without any significant effect of the other incorporated random effects (i.e., Type of cancer/treatment) nor fixed effects (i.e., Age, Organisational constraints). Patients mostly reported having received necessary information, having their addressed emotions with empathetic responses and respect, perceived benefits in the healthcare pathway, and heard of some supportive cares.

CONCLUSION

Perceived stress was reduced after BNCs. According to the patients, the BNCs allowed a better patient-centered communication and a better care pathway.

The meaning of being a visiting child of a seriously ill parent receiving care at the ICU

PURPOSE

Children's visits to the ICU are still restricted, and more focus on the child's own needs and experiences are needed. The aim of this study is to illustrate the meaning of being a visiting child of a seriously ill parent receiving care at the ICU.

METHOD

A qualitative descriptive design was used, with open-ended interviews with seven children (6-18 years) performed and analysed using a phenomenological research approach.

FINDINGS

Being a visiting child of a seriously ill parent receiving care at the ICU is described as a life situation taking place in an unfamiliar environment, characterized by a heartfelt, genuine desire to be there, in an interdependence entailing offering a loved one the help they need while at the same time being seen in a compassionate way and being able to share, revealing a sudden awakening of an inner truth of reality and a sense of a healing wisdom of understanding.

CONCLUSIONS

The children felt good when they visited their ill parent, but at the same time not fully involved, and desired a more compassionate, caring approach by the nurses. Improvements are needed in how to approach visiting children in a more individual and caring way.

Models of support to family members during the trajectory of cancer: A scoping review

AIMS AND OBJECTIVES

To map the existing literature on support models provided to family members during the cancer trajectory.

BACKGROUND

Cancer diagnosis, treatment and survivorship have a profound influence on the surrounding family members. This scoping review is part of the development of a support model for family members of persons diagnosed with colorectal cancer.

DESIGN

The method was guided by the Arksey and O'Malley framework, described in the Joanna Briggs Institute guidelines, and the reporting is compliant with PRISMA-ScR Checklist. Searches were conducted in PubMed, CINAHL and PsycINFO from November 2019-February 2020 with no limitation in publication year or study design. Complementing searches were conducted in reference lists and for grey literature, followed by an additional search in September 2020. Inclusion criteria were primary research about support provided by health care, to family members, during cancer, of an adult person, in Swedish or English, of moderate or high methodological quality. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. Data were extracted using a charting form.

RESULT

A total of 32 studies were included in the review describing 39 support models.

CONCLUSION

The mapping of the existing literature resulted in the identification of three themes of support models: psychoeducation, caregiver training and psychological support. In addition, that future research should target a specific diagnosis and trajectory phase as well as include family members and intervention providers in model development.

RELEVANCE FOR CLINICAL PRACTICE

Knowledge from the literature on both the needs of the family members and existing support models should be incorporated with the prerequisites of clinical practice. Clinical practice should also be complemented with structured assessments of family members' needs conducted regularly.

The Usefulness of Brief Family Health Conversations Offered to Families Following the Diagnosis of Breast Cancer

Currently, there are few studies which examine targeted family-focused support when a family member is diagnosed with breast cancer. Thus, the aim of this study was to explore families' experiences of participating in a family nursing intervention identified as Brief Family Health Conversations (BFamHC) following the diagnosis of breast cancer. Semi-structured family interviews were conducted with nine families (including 29 family members) 2 weeks following the family-focused intervention of three sessions of BFamHC. Thematic analysis was used to analyze the data. Families reported the BFamHC as positive and as a unique kind of family health conversation, one that afforded them the opportunity to communicate and share their experiences as a family group. A family conversation, even one as time-limited as BFamHC, offered a sense of relational sharing and togetherness, thus preventing feelings of isolation and vulnerability. Therapeutic family-focused conversations, such as BFamHC, hold promise as a useful family nursing intervention following the diagnosis of breast cancer.

The experiences of family caregivers living with breast cancer patients in low-and middle-income countries: a systematic review

INTRODUCTION

Caregivers of women with breast cancer in low-and-middle-income countries experience significant physical and economic burdens. The review aimed to map the evidence of studies that had reported on the experiences of family caregivers of women diagnosed with breast cancer.

METHODS

A systematic literature search was conducted in CINAHL, PubMed, PsycINFO, Scopus, and Web of Science databases using a combination of key search terms and medical subject heading terms such as "family caregiver," "breast cancer," "home care," "low-and-middle-income countries," "experience," "effect," and "coping mechanism." A total of 1781 articles were retrieved and screened. Nineteen studies addressing caregiving experiences were included in the final review based on the inclusion and exclusion criteria.

RESULTS

The systematic review yielded 19 studies that focused on caregivers' motivation, needs of caregivers, intervention for caregivers, and consequences of caregiving. The most significant correlates of the quality of life among caregivers were disease severity, functional status of patients, and family income. The challenges encountered by caregivers were mostly psychosocial.

CONCLUSIONS

Caregivers play a crucial role in the management of women with breast cancer. However, they are faced with increasing challenges in their caregiving roles. Understanding the nature and extent of the burden experienced by family caregivers in developing countries will facilitate the development of appropriate interventions that can help improve caregivers' quality of life. Gaps in recent studies were identified, and suggestions for future research were also addressed in this review.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019118391.

Caregiving motivations and experiences among family caregivers of patients living with advanced breast cancer in Ghana

INTRODUCTION

Significant number of women present with advanced-stage breast cancer in Ghana. These women usually depend on family caregivers for their multi-dimensional needs. Yet, there are gaps in research about what motivates family caregivers to assume the caring role and their experiences with caregiving within the Ghanaian context.

AIM

To explore and describe the caregiving motivations and experiences among family caregivers of patients living with advanced breast cancer.

METHODS

In-depth, semi-structured qualitative interviews were conducted with 15 family caregivers who were providing unpaid care for women living with advanced breast cancer. Colaizzi's thematic analysis was used to analyze the data.

RESULTS

Family relationship normally prescribed the caregiving role among family caregivers. Due to the lack of home-based palliative services in Ghana, findings suggest that family caregivers are the main managers of advanced breast cancer-related symptoms in the home. These findings are discussed under three major themes: (i) motivation for assuming the caregiving role; (ii) meeting self-care and psychosocial needs of the patient; and (iii) symptom management and monitoring.

CONCLUSION

Socio-cultural values influence the role of family caregivers in Ghana. This presents opportunities for health professionals and relevant stakeholders to develop a culturally-appropriate intervention to support informal caregivers in their home-based care for women living with advanced breast cancer in Ghana.

Long-term treatment for emotional distress in women with breast cancer

PURPOSE

Breast cancer patients have many needs, including strategies to cope with the associated distress, during and after cancer treatment. Establishing and implementing adequate social and emotional support for these women, to reduce the detrimental effects of stress resulting from their treatment and disease, is the need of the hour. This study aims to assess how women, diagnosed and treated for breast cancer, combat emotional stress using mechanisms of coping and control and emotional defense, as well as to identify potential groups among them, with different long-term patterns and needs.

METHODS

98 patients belonging to a local breast cancer support association (ALMOM), were enrolled in this study. A questionnaire specifically designed for them was administered, and its internal consistency and reliability assessed. A hierarchical clustering was employed to classify the women. The questionnaire focused on four sections, including personal feelings, coping strategies, environmental influences and maladaptive coping.

RESULTS

An adequate internal reliability was obtained with Cronbach's α near or greater than 0.60. Personal feelings were significant and clearly correlated with coping strategies and maladaptive coping. Three groups of women with different patterns of emotional characteristics and needs were identified: positivist, unsafe, and hopeless women, with different long-term emotional needs to be satisfied.

CONCLUSIONS

Psychological therapeutic interventions should be maintained in many breast cancer patients over time, even after treatment completion, in order to consolidate adaptive and sustainable responses.

Professionals’ involvement of relatives – only good intentions?

Purpose

The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice.

Design/methodology/approach

Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals.

Findings

Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all.

Originality/value

The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.

The effects of perceived stress on hope in women with breast cancer and the role of psychological hardiness

OBJECTIVE

Diagnosis and treatment of breast cancer are psychologically stressful events, and hope and hardiness have been found to be important constructs for women with breast cancer. Therefore, this research sought to examine the relationships of perceived stress and hardiness with hope, and the buffering role of hardiness in the link between perceived stress and hope among Iranian women with breast cancer.

METHODS

Two hundred and twenty Iranian women with breast cancer from three hospitals completed online measures evaluating perceived stress, hardiness, and hope.

RESULTS

Using structural equation modelling, perceived stress was found to be negatively related to hope. Additionally, there was a positive relationship between hardiness and hope. The findings indicate that hardiness is a buffer in the link between perceived stress and hope for women with breast cancer.

CONCLUSIONS

These findings demonstrate the importance of hardiness in reducing the effects of perceived stress on hope and have clinical implications for health professionals.