Experiences and perspectives of suffering in cancer: A qualitative systematic review

Death preparedness interventions for patients with advanced cancer: A systematic review

Objective

This study aims to synthesize and critically evaluate the current evidence on interventions aimed at enhancing death preparedness among patients with advanced cancer.

Methods

A comprehensive search of PubMed, Embase, Cochrane Library, CINAHL, ProQuest, and Web of Science was conducted to identify relevant studies. The review followed Systematic Review and Meta-Analysis Preferred Reporting Items (PRISMA) guidelines, with a structured assessment of study quality and intervention outcomes.

Results

Nine studies involving a total of 876 patients with advanced cancer met the inclusion criteria. Interventions demonstrated significant improvements in overall death preparedness, with additional benefits observed in psychological well-being and functional status. Most interventions incorporated death education, psychological support, and meaning-centered psychotherapy.

Conclusions

Interventions appear to be effective in enhancing death preparedness among patients with advanced cancer. Future research should focus on refining intervention components, clearly defining outcome measures, and aligning strategies with individualized patient needs and goals.

Systematic review registration

PROSPERO CRD420250652562.

Modulating Gut Microbiota with Dietary Components: A Novel Strategy for Cancer-Depression Comorbidity Management

BACKGROUND

Gut microbiota play a critical role in mediating the bidirectional association between cancer and depression. Emerging evidence indicates that adjusting the dietary component intake can significantly alter gut microbiota composition, thereby influencing the host's metabolism and immune function. Changes in gut microbiota and their metabolites may represent key factors in preventing cancer-depression comorbidity.

METHODS

English publications were searched in databases including the Web of Science, Scopus, and PubMed using a series of keywords: "cancer", "depression", "gut microbiota", "dietary components", and related terms, individually or in combination. The search focused on preclinical and clinical studies describing the regulatory effects of dietary component interventions.

RESULTS

This narrative review summarizes the associations among gut microbiota, cancer, and depression, and synthesizes current evidence on the modulatory effects and mechanisms of specific dietary component interventions, including dietary patterns, probiotics, prebiotics, and diet-derived phytochemicals, on gut microbiota. On the one hand, these interventions inhibit abnormal proliferation signals in the tumor microenvironment and enhance anticancer immune responses; on the other hand, they modulate neurotransmitter homeostasis, suppress neuroinflammation, and improve mood behaviors through the gut-brain axis interactions mediated by microbial metabolites.

CONCLUSIONS

The complex associations among cancer, depression, and gut microbiota require further clarification. Modulating gut microbiota composition through dietary components represents a novel therapeutic strategy for improving cancer-depression comorbidity. Regulated gut microbiota enhance immune homeostasis and intestinal barrier function, while their metabolites bidirectionally modulate one another via systemic circulation and the gut-brain axis, thereby improving both the tumor microenvironment and depressive-like behaviors in cancer patients while reducing the adverse effects of cancer.

The Lived Experience of Nurses in Conserving the Dignity of Patients With Life-Limiting Illnesses

To explore the experiences of nurses in maintaining the dignity of patients with life-limiting illnesses. A phenomenological study was conducted with 15 purposively selected nurses who provide care for patients with life-limiting illnesses. Colaizzi's naturalistic phenomenological approach was utilized to analyze the data. The study followed the COREQ guidelines for qualitative research reporting. Three themes emerged: (1) Establishing a therapeutic environment, (2) Respecting the humanity of patients, and (3) Strengthening the spirituality of patients. Building trust, providing compassionate care, and motivating patients are integral to establishing a therapeutic environment. Nurses emphasized enhancing patients' spirituality by encouraging religious rituals and supporting positive interpretations of illness from religious perspectives. Creating a therapeutic environment is fundamental to dignified care. In addition, humanized care and spirituality are critical components of providing dignified care. These findings have implications for nursing practice, education, and policy, highlighting the need to integrate dignity into nursing care through humanized and spiritual/religious support.

Understanding siblings' grief: a scoping review focused on death by cancer

PURPOSE

This study aimed to examine the existing literature on the grief experienced by siblings of cancer patients who have died, focusing on adaptation processes, emotional impact, and support needs of this population during and after the illness.

METHODS

The current scoping review follows the PRISMA-ScR guidelines. Peer-reviewed articles that explored the experiences of sibling grief due to oncological death were included. The search was conducted on twelve databases in July 2023. Thirty-four studies were included.

RESULTS

Findings evidenced a lack of sample representativity. Moreover, coping with grief depends on several facilitating and hindering factors. Quality of the sibling bond, passage of time, recreational activities, social support, healthcare professionals' communication during illness and after death, and cultural practices are among the most common facilitating factors. Conversely, isolation, inadequate social support, and a lack of information about illness and death may hinder grief coping. Intervention studies play a key role in assessing social support and helping individuals construct meaning around death and loss. Recommendations for a better approach to managing grief in siblings are reported.

CONCLUSION

The topic studied could benefit from further research as no study includes samples from low- and middle-income countries. A better understanding of how the sibling bond affects grief and coping is needed to tailor interventions for these populations. A cohesive response from healthcare professionals, community-based support, and school-based support is needed to accompany the family and the bereaved sibling during illness and after the patient's death.

Talking About Suffering in the Intensive Care Unit

BACKGROUND

Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients' families.

METHODS

We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from 2012-2017 to look at how the term "suffering" and its variants were used. A coding guide was developed by consensus-oriented discussion by four members of the research team. Two coders independently evaluated each transcript. We followed an inductive approach to data analysis in reviewing transcripts; findings were iteratively discussed among study authors until consensus on key themes was reached.

RESULTS

Of 146 available transcripts, 34 (23%) contained the word "suffer" or "suffering" at least once, with 58 distinct uses. Clinicians contributed 62% of first uses. Among uses describing the suffering of persons, 57% (n = 24) were related to a decision, but only 42% (n = 10) of decision-relevant uses accompanied a proposal to limit treatment, and only half of treatment-limiting uses (n = 5) were initiated by clinicians. The target terms had a variety of implicit meanings, including poor prognosis, reduced functioning, pain, discomfort, low quality of life, and emotional distress. Suffering was frequently attributed to persons who were unconscious.

CONCLUSIONS

Our results did not support the claim that the term "suffering" and its variants are used primarily by clinicians to justify limiting treatment, and the terms were not commonly used in our sample when decisions were requested. Still, when these terms were used, they were often used in a decision-relevant fashion.

The impact of malignancy on death anxiety and psychological well-being in middle-aged and older patients undergoing abdominal surgery: a quasi-experimental study

BACKGROUND

Malignancy is a critical factor affecting death anxiety and psychological well-being. This study examined the impact of malignancy on death anxiety and psychological well-being in middle-aged and older adult patients undergoing abdominal surgery and projected it along with sociodemographic profiles.

METHODS

This study is quasi-experimental in design. It was conducted with patients undergoing abdominal surgery at a university hospital due to suspected malignancy. A total of 93 patients participated in the study: 57 patients diagnosed with malignancy were included in the experimental group, while 36 patients without a malignancy diagnosis were included in the control group. Data were collected using a questionnaire developed by the researchers based on the literature, the 'Turkish Death Anxiety Scale', and the 'Psychological Well-being Scale'. The analyses revealed that the data were normally distributed, and parametric tests were used to analyze differences between demographic variables and groups. Cohen's d and r values were examined to assess the effect size in the tests.

RESULTS

The study found a significant difference in death anxiety between the experimental and control groups (P < 0.05), with higher mean scores in the experimental group. Malignancy had a large effect on death anxiety (d = 1.42). Additionally, the control group had significantly higher mean psychological well-being scores compared to the experimental group (P < 0.05).

CONCLUSIONS

The study found that malignancy significantly affects death anxiety and psychological well-being. Increased death anxiety in patients with malignancy was associated with reduced psychological well-being. Thus, assessing death anxiety and providing targeted nursing care are essential for supporting the psychological well-being of these patients.

A Model of Death Preparedness in Patients With Advanced Cancer: A Grounded Theory Study

BACKGROUND

Death preparedness in patients with advanced cancer is an important prerequisite for improving the quality of death. However, there are insufficient studies on death preparedness in patients with advanced cancer, and the level of death preparedness needs to be further improved.

AIM

To develop a model of death preparedness in patients with advanced cancer.

METHODS

A qualitative approach with grounded theory was used. Data were collected between February 2024 and July 2024 in the oncology wards of the two general hospitals in Wuhan. We recruited 12 patients, 11 family members, 16 nurses and 4 doctors for semistructured interviews. Data analysis included open coding, axial coding and selective coding. The study is reported using the COREQ checklist.

RESULTS

Death preparedness in patients with advanced cancer is a spiralling process whose core components include death awareness, emotional response, hospice programme and reflexive care, and multiple personal, interpersonal and social factors influence it.

CONCLUSION

A model of death preparedness in advanced cancer patients was constructed through rooted theory, revealing its formation and change process. This model deepens the understanding of death preparedness and helps healthcare providers identify patients' preparedness status in advance to provide more targeted support and care. This personalised care enhances patients' quality of life and reduces the psychological burden on them and their families, achieving more comprehensive and humanised end-of-life care.

IMPACT

To better understand patients' death preparedness, healthcare providers should focus on patients' cognitive, emotional, behavioural and social needs in the process of death preparation from a multifactorial perspective, and provide targeted support and assistance. No Patient or Public Contributions were included in this paper.

The meaning-making process in the re-entry phase: A qualitative focus group study with patients treated for breast cancer or melanoma

PURPOSE

After completion of curative cancer treatment patients enter the re-entry phase, which is characterized by the task to pick up life again. While having to resume their former roles, patients experience the loss of normality and face existential concerns. A sense of meaning and purpose may help in dealing with changes in life and existential concerns. The aim of this study is to gain insight in the meaning-making process of patients treated for breast cancer or melanoma in the re-entry phase in order to develop an intervention to support picking up life after a long treatment process including systemic treatment.

METHODS

We conducted six focus groups with 16 patients (11 breast cancer and five melanoma) to explore their experiences, challenges, and sources of meaning during the re-entry phase. The re-entry phase was defined as the point from completion of surgical and systemic treatment (except for hormonal therapy) up to 18 months in remission. A thematic content analysis was performed by two researchers.

RESULTS

We identified four themes pertaining to patients' use of sources of meaning in the meaning-making process: (1) use of existing, helpful sources; (2) distress due to impacted sources; (3) search for new sources; and (4) use of adapted or new sources. When patients drew upon existing sources of meaning that had been impacted by cancer and the aftermath of treatment, they experienced distress. This could instigate a search resulting in adapted, strengthened, or new sources of meaning.

CONCLUSIONS

Meaning-making in the re-entry phase is a versatile process involving the use of existing sources of meaning, and a search for, or use of new, strengthened, or adapted sources of meaning. An intervention increasing patients' awareness of their sources of meaning might strengthen the meaning-making process of patients treated for breast cancer or melanoma.

Acute, long-term or non-vincristine-induced peripheral neuropathy among non-Hodgkin lymphoma survivors: Symptoms, daily activities, functional status, and quality of life

PURPOSE

This study aimed to explore the incidence and severity of vincristine-induced peripheral neuropathy (VIPN) in non-Hodgkin lymphoma (NHL) survivors (primary aim) and its impact on daily life by comparing common cancer symptoms, functional status, and quality of life (QoL) among survivors with acute, long-term, and non-VIPN (secondary aim).

METHODS

This cross-sectional study examined 144 NHL survivors. Standardized questionnaires were used to assess common cancer symptoms, functional status, and QoL with the European Organization for the Research and Treatment of Cancer - Quality of Life Questionnaire (EORTC-QLQ-C30). VIPN (Chemotherapy-Induced Peripheral Neuropathy) status was classified using EORTC-QLQ-CIPN20. A self-designed interference scale was developed to determine the impact of the VIPN on daily activities. The Kruskal-Wallis test and Spearman rank correlation were used in this study.

RESULTS

Among the survivors of acute and long-term VIPN, the highest incidences and most severe symptoms were found for hand numbness and foot cramps. A significant moderate correlation was found between disturbances in daily activities and acute or long-term VIPN, including gait changes, going up or down the stairs, and imbalance-related falls. Acute and long-term VIPN survivors showed worse symptoms (fatigue, insomnia, and constipation) and lower QoL than non-VIPN survivors did. In acute VIPN, social function was significantly affected, whereas in long-term VIPN, emotional and cognitive functions were affected.

CONCLUSION

Numbness and cramps should be addressed in survivors of acute and long-term VIPN. Preventing falls is recommended for NHL survivors with VIPN, and psychological support is suggested for long-term VIPN survivors.

'I Had It. I Don't Think I Have It…But I Do Feel It Will Come Back Somewhere': A Qualitative Investigation of the Experience of People With Non-Muscle Invasive Bladder Cancer

Very little is known about the impact of living with non-muscle invasive bladder cancer (NMIBC). NMIBC patients' experiences of their illness-in terms of their perceptions, coping strategies and psychological wellbeing-were explored. This study describes an interpretative phenomenological analysis (IPA) of individuals' accounts of living with NMIBC while on routine surveillance for cancer recurrence. Ten individuals took part in face-to-face semi-structured interviews. Three superordinate themes were derived from the data. The first theme, Being Diagnosed and Treated for NMIBC, concerned the observation that participants considered the physical implications, timeline and practicalities of their illness of primary importance and focused less on its psychological aspects. The second theme, Grappling with the Illness, outlined the impact of the doctor-patient relationship. The final theme, 'I don't treat it as a problem. I treat it as an issue', delineated how participants managed difficult emotions in the context of the illness. Findings from this study demonstrated that participants generally found effective ways to cope with their illness and experience of ongoing surveillance, though delay of emotional responses was common. Clinical implications for healthcare professionals are outlined including the importance of high-quality communication with the urology team.

Psychological and spiritual interventions to enhance meaning in adults diagnosed with cancer: a systematic review with meta-analysis and meta-regression

OBJECTIVE

To summarize the evidence on the effectiveness that psychological and/or spiritual interventions may have to change the levels of meaning, measured with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), in adults diagnosed with cancer.

METHODS

Systematic review with meta-analysis and meta-regression. CINAHL (via EBSCOhost), Embase, PubMed, PsycINFO (via ProQuest), and the Cochrane Library were searched from inception to 21st October 2022. Manual searches were conducted. Only randomized clinical trials (RCTs) were included. The risk of bias was assessed with the Cochrane Risk of Bias tool 2. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to judge the certainty of the evidence.

RESULTS

Eight RCTs were included (N = 1682). Although some individual studies showed positive effects to enhance meaning using mindfulness or dignity therapy, the overall and individual meta-analyses showed a lack of effect of psychological and spiritual interventions in comparison to comparator interventions (MD (95%CI) = -0.19 (-0.45 to 0.06), p = 0.11, Tau2 = 0.0015, I2 = 2%). Publication bias was undetected (Egger's test = 0.35). Furthermore, no RCTs were judged to have a low risk of bias and the overall certainty of the evidence was judged as low. Meta-regression and subgroups meta-analyses also found possible sources of heterogeneity such as some cancer characteristics, the educational stage, or the religious affiliation.

CONCLUSIONS

Despite some RCTs may show promising results following mindfulness or dignity therapy, no effects were observed in the meta-analysis. Moreover, important methodological and clinical concerns precluded us to make sound clinical recommendations with the available evidence. OPEN SCIENCE FRAMEWORK DOI REGISTRATION: https://doi.org/10.17605/OSF.IO/4YMTK .

Post-traumatic growth among childhood cancer survivors: A qualitative meta-synthesis

PURPOSE

To conduct a meta-synthesis of qualitative studies on the post-traumatic growth experiences of childhood cancer survivors.

METHOD

Various databases, including PubMed, Cochrane Library, Web of Science, EMBASE, PsycInfo, ProQuest, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (CSTJ), and China Biology Medicine (CBM) were used to retrieve qualitative studies on childhood cancer survivors who experienced post-traumatic growth.

RESULTS

Eight papers were included in this study, and similar fragments were combined to form eight categories, which were further combined into four synthesized findings: adjustment of cognitive system, enhancement of personal strength, improving relationships with others, resetting of life goals.

CONCLUSIONS

Post-traumatic growth was observed in some childhood cancer survivors. The potential resources and positive forces contributing to this growth are of great significance in the fight against cancer, in tapping into individual and social resources to help survivors grow, and in improving their survival rates and quality of life. It also provides a new perspective for healthcare providers regarding the relevant psychological interventions.