The family with cancer. Nursing interventions throughout the course of living with cancer

“But isn't it depressing?” The Vitality of Palliative Care

A common question about palliative care from those unfamiliar with the work is, “But isn't it depressing?” This view distances palliative care workers from the general public and reflects a deeply held belief that matters associated with death and dying are negative. Published definitions fall short of capturing a full understanding of the work, making it difficult to communicate the meaning of palliative care. This qualitative study examined the experiences of six long-term palliative care workers. Palliative care was described as “a way of living” and, throughout the descriptions, the concept of “vitality” emerged as the core meaning of palliative care. In the current economic environment, where there is competition for health care funding, more wide-spread agreement about the meaning of palliative care is important if informed decisions are to be made about allocation of resources.

Validation of the Korean Version of the McMaster Quality of Life Scale in Terminal Cancer Patients

The purpose of this study was to develop and validate a Korean version of McMaster Quality of Life Scale (K-MQLS) suitable for evaluating clinical hospice and palliative care. The McMaster Quality of Life Scale (MQLS) is a brief and comprehensive scale that is used to assess cancer patients receiving palliative care due to poor physical condition. To further develop the K-MQLS, we followed rigorous international translation steps and performed validity, reliability, and sensitivity analyses. The results of our study show that the K-MQLS is an efficient tool in terms of its validity, reliability, and sensitivity for the measurement of the health-related quality of life during the palliative phase. This developed tool could be used in research or clinical settings to assess health-related quality of life in Korean palliative care patients.

My Love is Hurting: The Meaning Spouses Attribute to Their Loved Ones’ Pain during Palliative Care

The purpose of this qualitative study was to develop our knowledge of the pain experiences of family members by addressing the meaning of cancer pain to the spouse of a patient receiving palliative care. In particular, this study explored factors associated with the meanings the spouses ascribe to the experience of pain during palliative care and whether the meanings the patients attributed to pain were similar to the meanings held by the spouse. Two different states emerged, the “in-pain state” and the “out of pain state”. The spouses described feelings of helplessness, fear, and unfairness when witnessing their loved one in pain. Once the pain had been controlled, spouses described feelings of peace and relaxation, and felt this meant that the couple could return to their old routines because their spouse was still alive. It was discovered that the meanings placed on the cancer pain differed for the spouse and the patient, with the spouse focusing on future consequences. Implications and suggestions for nursing practice and future research are proposed.

Significance of Psychological Stress Response and Health-related Quality of Life in Spouses of Cancer Patients When Given Bad News

Objective:

This study illuminates the degree of psychological stress response experienced by spouses of cancer patients when given bad news at three different times (notification of the name of the disease, notification of recurrence, and notification of terminality) as well as the factors that influence the response and the health status of the spouse as measured by health-related quality of life (QOL).

Methods:

A total of 203 individuals (57 men and 146 women) who had received the three types of news were surveyed using a self-report questionnaire on psychological stress response, marital satisfaction, and health-related QOL scales.

Results:

The degree of the psychological stress response was the highest for notification of terminality, followed by notification of the name of the disease, and notification of recurrence. The influencing factors varied depending on the notification period. Although no significant difference was observed for health-related QOL among the three notification types, significant differences were observed for certain items when compared with national standard values.

Conclusions:

When a notification of terminality, which produced the highest psychological stress response, is given, providing care that considers health-related QOL is necessary not only for patients but also for their spouses.

A Study on the Relationship among Family Support, Stress and Quality of Life on according to the Phases of Illness in Breast Cancer Patients

PURPOSE

The purpose of this study was to investigate the relationship among family support, stress and quality of life according to the phases of illness in breast cancer patients.

METHODS

A descriptive correlational study was employed with 121 breast cancer patients. The data was collected by using self reported questionnaire. Self reported data was collected by using the Family support scale, Perceived Stress Scale (PSS), and EORTC QLQ-BR23. Phases of illness consisted 1st phase, 2nd phase, 3rd phase.

RESULTS

The score of family supporting, stress and quality of life showed a statically differences according to the phase of illness. Family supporting and stress had negative relation in the first, second and third phase. Family supporting and quality of life in function area had positive relation in the first, second phase. There was no relation between family supporting and quality of life in symptom area. Stress, quality of life in symptom area and quality of life in function area had correlation in the first, third phase.

CONCLUSION

This study suggest that the new nursing implementation should be considered according to the phase of illness in order to improve the family supporting and quality of life and reduce the stress in breast cancer patients through this study results.

The family and nurse in partnership: Providing day-to-day care for rural cancer patients

OBJECTIVE

To explore demands made on family members in managing symptoms and providing for the day-to-day care of relatives with cancer in rural New South Wales and how specialist palliative care nurses support these family members.

DESIGN

Cross sectional qualitative study.

SETTING

Seven health centres across rural New South Wales that cover a broad geographical area and reflect the diversity in economic conditions, population density and distance from three major urban centres in New South Wales.

SUBJECTS

The study involved two groups of participants. The first group consisted of one or more members of families of oncology patients who were accessed through health workers at the seven centres. Nineteen family members from 17 families were interviewed. The second group comprised 10 nursing staff working as specialist palliative care nurses across the same geographical area as the families.

MAIN OUTCOME MEASURES

Physical care and symptom management were the two main areas of interest.

RESULTS

The rural experience of caring for palliative care patients was challenging, with support nurses needing to take into consideration all aspects of the patients' and families' living environments.

CONCLUSION

There is a need for equipment and basic resources to be readily available to practitioners, funding for ongoing education and 24-h care.

A survey of pediatric oncology nurses' perceptions of parent educational needs

Educating parents of children with cancer is a primary nursing responsibility in pediatric oncology. A survey using Delphi techniques was conducted with nurses attending a Children's Oncology Group Nursing Workshop to identify priority educational topics from pediatric oncology nurses' perspective. In round 1 of the survey, nurses were asked to identify 5 priority educational topics and 5 topics they spend the most time teaching parents. Twenty-four educational categories were identified by 199 nurses, and responses were sorted by category and frequencies tabulated. Information about treatment was the most frequently cited priority. Bone marrow suppression (BMS) was the second most important priority and was the topic nurses spent most time in teaching. Round 2 of the survey was sent via e-mail to 132 consenting participants from round 1. Nurses were asked to rate the importance of the categories from round 1 (presented in random order) during 4 time periods (diagnosis, initial treatment, maintenance, and off therapy). Nurses reported different teaching priorities across the continuum of treatment. Of note, teaching about end-of-life issues and alternative therapy were ranked as low in importance across all time points. These findings can be used to inform educational programs and materials development for parents of children with cancer.

Information needs and the related variables of Japanese family caregivers of terminally ill cancer patients

The present study examined the information needs of family caregivers of terminally ill cancer patients. Data were obtained by a structured interview from 66 Japanese caregivers of cancer patients institutionalized in a palliative care unit. Needs for disease-related information (the disease, treatment and prognosis) and care-related information (the care for the patient and family members) were investigated, and demographic and situational characteristics related to individual information needs were assessed. More than 60% of family caregivers wanted disease-related information, and approximately half of these wanted patient and family care-related information. These information needs had significant correlations with the family caregiver's age and with such patient-dependent situational variables as time since diagnosis, care site before enrolling in a palliative care unit, and presence or absence of other family caregivers. The results may help health care professionals to better inform terminally ill cancer patients and their family caregivers.

Family Beliefs Regarding the Nutritional Care of a Terminally Ill Relative: A Qualitative Study

OBJECTIVE

To develop a conceptual model of family caregiver beliefs and behavior related to nutritional care of the terminally ill by examining the perspectives of family members, patients, and health care providers.

DESIGN

Qualitative study using in-depth, open-ended, face to face interviews, participant observation, and content analysis.

PARTICIPANTS

A total of 47 participants from 4 groups: hospitalized palliative patients with cancer (n = 13), family members of hospitalized palliative patients with cancer (n = 13), health care providers on a palliative care unit (n = 11), and bereaved family members who had previously experienced the death of a relative on a palliative care unit.

OUTCOME MEASURES

Participant views on nutritional care in the terminal phases of illness.

RESULTS

There is marked variability in the ways family members respond to a dying cachectic anorexic relative. The overarching theme of "doing what's best" captures this variability and integrates the major categories into the key analytic model emerging from this study.

CONCLUSION

We have developed a conceptual model of family beliefs regarding the nutritional care of a hospitalized terminally ill relative. The model has implications for education, practice, and research regarding nutritional care in the palliative care setting.

Stress and coping strategies of patients with cancer. A Korean study

Cancer is a potential life-threatening illness that engenders considerable psychologic distress, requiring persistent coping for the treatment procedures. In this cross-sectional descriptive study stress levels and coping strategies of 257 cancer patients residing in South Korea are addressed. Lazarus and Folkman's theory of stress and coping was used as the theoretical framework. The data were collected from November 1999 to March 2000 by face-to-face interviews. Study participants were primarily male (62.6%) and married (91.4%). Cancer of the gastrointestinal system was the most prevalent type of cancer (31.3%). Women and the patients in the third-stage of cancer showed higher stress but less coping than other groups. Stress was negatively correlated with both problem-focused coping and emotion-focused coping. Korean patients with cancer used emotion-focused coping strategies more than problem-focused coping strategies.

Information needs and the related characteristics of Japanese family caregivers of newly diagnosed patients with cancer

In Japan, family caregivers of newly diagnosed patients with cancer usually receive information on the patient from healthcare professionals before patients are told the truth. Efforts to provide suitable information to these caregivers may be crucial to improving the quality of life in patients as well as in family caregivers. A descriptive correlational study explored and assessed the informational needs of family caregivers of newly diagnosed patients with cancer. Data were obtained by a semistructured interview with a questionnaire administered to 66 caregivers. Information needs were assessed on disease, treatment, prognosis, and patient and family care. In addition, the demographic and situational characteristics related to individual information needs were investigated by logistic regression analyses. More than 70% of caregivers wanted the disease-related information and about one third of those wanted the care-related information for the patient and family. The disease-related information needs had significant correlations only with the demographic variables. The care-related information needs were correlated both with the demographic variables and with the situational variables such as the presence of pain in the patient and the presence of other family caregivers. Our results may help healthcare professionals to plan the appropriate provision of information to newly diagnosed patients with cancer and their family caregivers.

Clinical support for families in the palliative care phase of hematologic or oncologic illness

This article focuses on families' needs for support and care when the patient is receiving palliative care. Health care professionals providing care to patients with hematologic or oncologic illnesses are coming to understand that care for the family must begin at the time of patient's diagnosis and treatment. Families who do not receive adequate information and support in the early phases of the patient's treatment have greater needs, less trust and confidence in the health care system, and cope more poorly in the later stages than families who have been informed and supported throughout the course of the illness. This article documents the needs of families in the palliative phase of a patient's hematologic or oncologic illness and provides empirically based recommendations for assessment and care of the family unit.

Prognostication in advance cancer: nurses' perceptions of the dying process

PURPOSE/OBJECTIVES

To determine how experienced nurses describe the dying process of patients with advanced cancer.

SAMPLE/SETTING

Fifteen nurses, experienced in the care of patients with advanced cancer, employed by a midsize midwestern hospice or academic inpatient oncology unit.

METHODS

Individual interviews using structured and semi-structured questions. Responses were content-analyzed using Krippendorff's techniques.

MAIN RESEARCH VARIABLE

Dying process in cancer.

FINDINGS

Nurses view the dying process as a weeks-to-months-long, multidimensional process that encompasses physical, psychosocial, and spiritual/existential domains. Impending death is recognized and monitored. Common clinical signs include declining interest in life, increased weakness, somnolence, and changes in respiratory, circulatory, and cognitive status.

CONCLUSIONS

Active (or acute) dying processes are recognized and monitored by nurses; the complexities and patterns of the phenomenon remain unarticulated.

IMPLICATIONS FOR NURSING

Future research could explore both empirical and contextual aspects of acute dying processes. Nurses are in a position to develop useful knowledge about acute dying processes in cancer.

Men's experiences of their partner's primary and recurrent breast cancer

The reaction and support from the partner of the woman with breast cancer is viewed by health professionals as an important factor in her adjustment to disease. However, there is little theory and research that focuses on the individual concerns and experiences of the man living with a woman who has breast cancer. Literature concerning the experience of breast cancer recurrence for both the partner and the patient is particularly sparse. The aim of this literature review is to explore the experiences of male partners of women with breast cancer. The role of the male partner supporting the woman with breast cancer, and the potential concerns he may have, will be explored. It will also focus on the partners' experience of living with a woman with primary breast cancer. Finally, the partners' experience of living with a woman with a recurrence of metastatic breast cancer will be considered. Relevant literature is reviewed and critiqued to place current knowledge in context, including identifying areas for further research.

Preferences for participation in treatment decision making and information needs of parents of children with cancer: a pilot study

This study was performed to obtain information on parents of children with cancer: (a) what role parents preferred to assume in treatment decision making (TDM); (b) parents' priority information needs; (c) if a relationship existed between TDM preferences and information needs; and (d) if sociodemographic, disease and treatment variables predicted TDM preferences or information needs. A cross-sectional survey was conducted with a convenience sample of 58 parents who had a child less than 13 years of age diagnosed with cancer in the previous year. Instruments included a Sociodemographic, Disease, and Treatment Questionnaire; the Control Preferences Scale for Pediatrics, and an Information Needs Questionnaire. The results showed that parents had systematic preferences about TDM, preferring collaborative followed by passive and active roles. Nine priorities in information needs (highest to lowest) were found: (a) treatments and tests, (b) cure, (c) caring for my child, (d) emotional impact, (e) side effects, (f) physical impact, (g) disease, (h) coping with painful procedures, and (i) impact on the family. Sociodemographic, disease and treatment variables were not predictive of preferences for TDM or information needs. Concrete informational needs take precedence over issues of emotional or family impact or pain. A low Kendall's coefficient (0.07) indicated that parents as a group do not have uniform information needs. Information giving must be individualized.

How do cancer patients who die at home differ from those who die elsewhere?

Our objective was to investigate how cancer patients who die at home differ from those who do not. A postbereavement survey of 229 people who registered the death of a random sample of cancer deaths in an inner London health authority was conducted. It was found that a fifth of patients (21%) died in their own home. Overall, 38% were reported to have expressed a preference for place of death, 73% of whom wanted to die at home. Only 58% achieved this. Having special equipment and stating a preference for place of death was associated with an increased likelihood of dying at home; using social and health services for social care was associated with a decreased likelihood of so doing. It was concluded that, as in previous studies, most patients who expressed a preference wanted a home death, but nearly half did not achieve this. Recognition of a preference for home death, providing the motivation to 'stick it out' at home, and adequate community support to provide the practical means to fulfil the preference, appear to be crucial in the achievement of a home death for all who desire it.

Spouses' view during their partners' illness and treatment

Nine spouses of people who had suffered from acute leukemia or highly malignant lymphoma were interviewed about their everyday life experiences throughout their partner's illness and treatment, and concerning their view of the professional care provided. The transcribed texts were subjected to phenomenological-hermeneutic analysis. The spouses felt they were in a situation of overall severe crisis (i.e., experiencing feelings of distress, restrictions, and limited or lack of support). The analysis revealed three family types: the couple acting as a unit, the couple acting independently on equal terms, and the couple acting separately with the spouse in a subordinate position. The spouses' evaluation of the entire experience varied according to the family type and the spouses' personal resources, which influenced the availability and utilization of their social network as well as the support of health-care staff. Contentment was related to the couple acting as a unit or the couple acting independently on equal terms and taking control over the situation, actively asking for support and requiring the staff to meet their needs. Discontentment was related to subordination of the spouse to the partner or to health-care staff, and failure of the couple to obtain support between them or from others. Empowering the spouses may mean helping them develop their skills, providing them with opportunities and authority, and assisting them in gaining access to resources based on knowledge of the family type, the consent of the partner, and the spouse's freedom to make choices. This may well lead to increased efficiency and have positive effects for the patient, for the spouse, and for them both as a couple.

Blood cell transplantation: its impact on one family

OBJECTIVES

To share a story about being the wife of a cancer survivor who had a blood cell transplantation (BCT).

DATA SOURCES

Personal experience, and published articles related to the impact of cancer on the family.

CONCLUSIONS

Cancer affects not only the patient but the entire family unit. Yet, family members are a forgotten population. With advances in cancer treatment, survivorship has increased resulting in caregiving demands that can last for years. The lack of research related to the impact of BCT on family members must be addressed.

IMPLICATIONS FOR NURSING PRACTICE

There are many ways that nurses can provide holistic care to family members who have a loved one going through a BCT. Physical, psychological, social, and spiritual aspects of care can make a tremendous impact on the lives of patients and family members.

The needs of parents of pediatric oncology patients during the palliative care phase

The death of a child is considered one of the greatest stresses a parent can experience. It has been suggested that death from childhood malignancies is more stressful for parents than death due to other chronic diseases. The purpose of this qualitative study is to identify parents' perceptions of their needs while their child was dying of cancer. Twelve parents of eight children, who died of various types of cancer 1 to 3 years ago, were interviewed by the primary investigator. These children died either in hospital or at home. Interviews were tape recorded, transcribed and analyzed by the investigators. Three needs were identified: (1) The need to have the child recognized as special while retaining as much normality within the child's and family's lives as possible; (2) The need for caring and connectedness with health care professionals; and (3) The need to retain responsibility of parenting their dying child. Findings suggest that parental needs are similar regardless of where the death occurred. Implications for nursing practice and areas for further research were identified.

Childhood cancer--a family crisis 2: coping with diagnosis

A diagnosis of cancer in a child requires families to mobilize their coping strategies in response to an extremely stressful life event. In the second article of this two-part series, the nature of coping, the strategies employed, and the factors that influence the family's choice of strategy are examined. The findings indicate that personality traits may constitute internal factors that affect the coping response, while concurrently stressful events and chronic uncertainty may be considered external influences on the family's ability to cope with a diagnosis of cancer in a child. In the first article of this series, the nature, purpose and functioning of the family were explored in an attempt to explain the impact of a childhood cancer diagnosis on the family. Overall, family reaction appears to be directed by several factors: communication and information; stage and prognosis, and as attitude to the nature of the disease itself.

Childhood cancer--a family crisis 1: the impact of diagnosis

There have been substantial improvements in both treatment and survival of childhood cancer in recent decades. However, the diagnosis of cancer in a child still poses a threat to the whole family unit. In this article, the first of a two-part series, the nature, purpose and functioning of the family are explored to suggest how families may perceive a cancer diagnosis in a child. Review of the literature indicates that the level of threat correlates with indicators such as overall family reaction, information and communication, position within the disease continuum, prognosis and the presence of metastatic disease.

Social networks, social support and coping with serious illness: the family connection

Selected social support and family research is reviewed to highlight potential problems in social support exchange as patients and families collectively cope with illness and disability. Results indicate that family support is a primary source of patient support and that the impact of illness on families is substantial, underscoring their need for support. Results also indicate that there are numerous opportunities for problematic supportive exchange within families. The case is made that future studies of social support are needed to answer a series of questions about social support process within families coping with serious illness.

Estimating length of survival in end-stage cancer: a review of the literature

Accurately estimating survival times in patients with end-stage cancer is on ongoing challenge for palliative care clinicians. Psychosocial as well as physiological factors have been thought to influence the length of the terminal phase of illness, but conclusive findings remain elusive. This review examines the studies that have addressed the issue using observable, measurable criteria associated with physiological, clinical status. Improving the ability to estimate accurately a patient's length of survival may improve patient/family quality of life and assist in the efficient, appropriate use of resources. Additional research in this and other palliative care issues will need to be better funded and organized if progress is to be made.

The information and learning needs of the caregiving family of the adult patient with cancer

The need for information by the caregiving family of an adult patient with cancer has been identified by research. This paper is a literature review of the information and learning needs of caregiving relatives. By meeting these needs the health care professional is able to help support the family, and therefore the patient, with the difficult adjustment to the diagnosis and through the subsequent course of the disease. The health care professional facilitates the individual caregivers' coping mechanisms and the benefits can be seen in the caregiving outcome for both the family and the patient. Information needs vary from individual to individual and are dynamic throughout the cancer experience. This paper describes the role of the nurse in this area, and encourages the nurse to act as a resource person for the caregiver by the appropriate delivery of information and by ensuring that the information given to the family by other health care professionals is understood and fulfils their needs.

What are the educational needs of prospective family caregivers of newly disabled adults?

What are the needs of family caregivers of newly disabled adults? Research to date has focused on the needs of family members of patients in critical care units and of family members who have been in the caregiver role at home for some time. No studies could be found on the perceptions of individuals facing the decision to assume the family caregiver role for a newly disabled adult anticipating discharge from a physical rehabilitation or medical-surgical nursing unit. Watson's philosophy of science and caring provided the theoretical basis for this study. The Elaine Matthis Educational Wants of Family Caregivers of Disabled Adults Questionnaire was used to assess the perceptions of prospective family caregivers visiting newly disabled adults in an urban medical center. The results of this research are offered to help nurses understand the feelings of uncertainty about the new and unexpected role that family caregivers face and to help nurses meet the needs of families preparing to take disabled adult relatives home.

The experience of cancer

The illness career of the person with cancer has been characterized as a 'living-dying' experience in which, faced with the intolerable incompatibility of life and death, the individual and his or her family attempt to maintain control and 'normalize' everyday activity. Unfortunately, in their everyday struggles, families in North America appear to face social isolation from existing community services and networks that might assist them. Perhaps because the illness is so heavily medicalized and stigmatized, most persons with cancer and their families do not participate in them. A minority benefit from self-help organizations such as Cancer Society groups and survivor coalitions. The palliative care and hospice/home care movements provide an alternative to dying in the acute-care hospital, again, for a minority. Half of those with cancer survive more than 5 years; for these persons, the ordeal has just begun. Survivors must cope with physical disabilities due to surgery and the side effects of other treatments, the psychological traumas of fear of recurrence and social stigma, and the disappointment of a considerably reduced range of future possibilities for career and development. The fact that their relationships with others are negatively affected is well documented, particularly with intimate relationships. In a sense, a person never really 'gets over' cancer: it is a sword of Damocles that continues to hang over the individual and his or her family for the rest of the person's life.(ABSTRACT TRUNCATED AT 250 WORDS)

Long distance related stressors and coping behaviors in parents of children with cancer

This descriptive comparative study addresses long distance related stress and coping behaviors of 53 parents of children with cancer. The purpose of the study was to determine the differences in the stress and coping behaviors of parents living 100 miles from the tertiary treatment center compared with those who live less than 100 miles from the center. The theoretical framework used was Lazarus' theory on stress and coping. The study participants were from several Pediatric Oncology Group member institutions. The parents completed Hymovich's Parent Perception Inventory and a demographic data sheet. Parametric (one-tailed t-test) and nonparametric (Mann-Whitney and chi-squared tests) were included in the statistical analysis. The results showed significant differences in demographic data, concerns, beliefs/feelings, and coping. Implications for the pediatric oncology treatment team include specific interventions that will improve the quality of care for the children/parents who live a long distance from the tertiary treatment center.