Sustaining hope and life courage in patients undergoing ovarian cancer surgery - the impact of care

Non-curative surgical oncology: postoperative needs and preferences

OBJECTIVE

When intended curative cancer surgery is not completed, the postoperative transition to palliative care represents a prognostic landmark to patients and their families. In patients referred for highly specialised surgery for peritoneal metastases from the intestinal tract and ovaries, surgery is not performed in approximately 25%. Still, little is known of their postoperative needs and preferences.

METHODS

We performed 14 qualitative research interviews with 12 patients (four men and eight women, aged 41-85 years) undergoing surgery for peritoneal metastases; five of these were together with a relative. Five of the participants had ovarian, and seven had colorectal cancer (four men and seven women). The interviews followed a semistructured interview guide, were audio recorded, transcribed verbatim and analysed using meaning condensation.

RESULTS

Patients accepted the surgeon's decision of refraining from the intended surgery. During the postoperative period, when realising the prognostic consequences, their needs changed rapidly, in some cases from day to day, and gradually they developed a reoriented focus on their lives. The findings were framed by two themes dealing with 'Change in treatment strategy' and 'Physical and psychosocial aspects of not undergoing curative surgery'.

CONCLUSION

When curative cancer surgery is not completed as intended, patient-centred communication is essential for patients' psychosocial reorientation and quality of life. Further, to support their well-being and action competences, patients have a need for basic supportive care and physical restitution. Finally, high-quality postoperative palliative care needs to be coordinated, which requires staff training and reorganisation of pathways.

Relationship between supportive care needs with coronavirus anxiety and death anxiety of women with gynecologic cancer during the COVID-19 pandemic

AIM

The study aimed to determine the relationship between supportive care needs with coronavirus anxiety and death anxiety of women with gynecologic cancer during COVID-19.

METHODS

The population of the study was women with gynecologic cancer who received chemotherapy in a university hospital. The study sample was calculated using G*Power 3.1.9.4 analysis program and completed with 64 patients who agreed to participate and met the research criteria. The personal information form, supportive care needs survey-short form (SCNS-SF29^Tr ), coronavirus anxiety scale (CAS), and death anxiety scale (DAS) were used for data collection.

RESULTS

The participants' SCNS-SF29^Tr mean score was 105.7 ± 17.26, CAS mean score was 11.19 ± 3.96, and DAS mean score was 40.13 ± 15.5. There was a positive, very high-level correlation between the health system and information and psychological needs subscales of SCNS-SF29^Tr and CAS (r = 0.809, r = 0.878, respectively; p < 0.05). In addition, a high-level relationship was found between the daily life subscale of SCNS-SF29^Tr and CAS (r = 0.674; p < 0.001). A positive low-level relationship was determined between the health system and information, daily life, and psychological needs (except for the sexuality) subscales of SCNS-SF29^Tr and DAS (r = 0.357, r = 0.252, r = 0.353 respectively; p < 0.05).

CONCLUSION

Gynecologic cancer participants had unmet supportive care needs in all subscales except for the sexuality. The participants had higher supportive care needs, high-level coronavirus anxiety, and medium-level death anxiety. In addition, the participants' all supportive care needs have increased as their coronavirus anxiety levels have increased. The participants' supportive care needs have increased, except for sexuality, as their death anxiety levels have increased.

Reflections on the Complexity of Normalcy in Nursing and Health Care

Striving for normalcy plays an important role in patients' quality of life and illness experience. Normalcy is a powerful and complex idea, and the term can be used intentionally or unintentionally to various effects. We aimed to raise awareness of the complexity of this idea of normalcy and thus promote a more critically reflective understanding among nurses and other health professionals. By raising questions about how we use normalcy in our discourses and the potential impact that our professionally socialized interpretations of what constitutes normal might have on patient experience, we can encourage nurses and other health professionals to develop an intellectual curiosity about how the idea of normalcy works, and to be more critically reflective about how they integrate normalcy language into their practices and patient-centered communications. By unpacking the ideas that normal is always a good thing in the context of patient experience, and that normalizing can neutralize that which is bad in the health care world, we can qualify the language used and the metamessages conveyed for the ultimate benefit of patients.

Communicating is analogous to caring: A systematic review and thematic synthesis of the patient-clinician communication experiences of individuals with ovarian cancer

OBJECTIVE

To systematically review and synthesize the patient-clinician communication experiences of individuals with ovarian cancer.

METHODS

The CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science databases were reviewed for articles that described (a) original qualitative or mixed methods research, (b) the experiences of individuals with ovarian cancer, and (c) findings related to patient-clinician communication. Relevant data were extracted from study results sections, then coded for descriptive and analytical themes in accordance with Thomas and Harden's approach to thematic synthesis. Data were coded by two authors and discrepancies were resolved through discussion.

RESULTS

Of 1,390 unique articles, 65 met criteria for inclusion. Four descriptive themes captured participants' experiences communicating with clinicians: respecting me, seeing me, supporting me, and advocating for myself. Findings were synthesized into three analytical themes: communication is analogous to caring, communication is essential to personalized care, and communication may mitigate or exacerbate the burden of illness.

SIGNIFICANCE OF RESULTS

Patient-clinician communication is a process by which individuals with ovarian cancer may engage in self-advocacy and appraise the extent to which they are seen, respected, and supported by clinicians. Strategies to enhance patient-clinician communication in the ovarian cancer care setting may promote patient perceptions of patient-centered care.

Patient involvement in Greenland hospital-care: A qualitative study of the patient perspective

This article deals with drivers for and barriers to patient involvement in Greenland hospital-care, from the patients' perspective.Data were generated in 2019, via semi-structured research interviews and field observations. At the National Hospital in Nuuk, participants were purposively included to ensure variation regarding diagnosis, age, sex, socio-demographics, and place of residence. A number of 11 patients participated in individual interviews. Concurrently, observations of bed-side care situations and interactions between health professionals and patients were conducted, and informal conversations were held with eight patients. Findings were analysed using Malterud's systematic text condensation, and constituted the following themes: "Patient characteristics"; "Interaction with staff members"; and "Personal experiences and prerequisites for information and care".One of the main findings was that personal expectations, confidence in the quality of hospital-care, language skills, conditions around family support, and taboos concerning not being able to take care of oneself, impacted patients' opportunities for involvement.It is concluded that patient involvement cannot be accomplished by simply focusing on patients' health competencies. To ensure that hospital-care is provided in partnership with patients and families, it is equally important that health professionals develop new skills, and that the healthcare system is re-organised towards a more patient- oriented approach.

Postoperative mobilisation as an indicator for the quality of surgical nursing care

BACKGROUND

Postoperative mobilisation is an important part of fundamental care. Increased mobilisation has positive effect on recovery, but immobilisation is still a challenge in postoperative care.

AIMS

To report how the establishment of a national nursing database was used to measure postoperative mobilisation in patients undergoing surgery for ovarian cancer.

METHODS

'Mobilisation' was defined as at least 3 hours out of bed on postoperative day 1, with the goal set at achieving this in 60% of patients. Data entry was performed by clinical nurses on 4400 patients with ovarian cancer.

FINDINGS

46.7% of patients met the goal for mobilisation on the first postoperative day, but variations in duration and type of mobilisation were observed. Of those mobilised, 51.8% had been walking in the hallway.

CONCLUSIONS

A national nursing database creates opportunities to optimise fundamental care. By comparing nursing data with oncological, surgical and pathology data it became possible to study mobilisation in relation to cancer stage, comorbidity, treatment and extent of surgery.

'Well, if I don't show up and go through with the fertility treatment, I won't have a baby'; Patient involvement in clinical practice: Option or condition?

RATIONALE, AIMS, AND OBJECTIVES

Worldwide, the concept of patient involvement has a growing impact on health care. Involvement in care represents a benefit to many patients, but while being involved is inevitable for the patient, we assume that getting involved is not in all cases obtainable. On this background, we aimed to investigate patients' perceptions and experiences concerning their treatment and care in a clinical fertility treatment setting, and discuss how these may influence their possibilities for involvement in care.

METHOD

Based on findings from focus-group interviews with women undergoing fertility treatment, we have dealt with two aspects that impact the patients' possibilities for getting involved in their care: Imbalanced power relations in clinical settings, and patients' experiences of their physical vulnerability. Framed by phenomenological-hermeneutic text interpretation theory key condensations were analysed and critically discussed.

RESULTS

We found that (a) to the individual patient it did not represent a free choice to seek and undergo treatment; (b) patients experienced substantial dependency, vulnerability, and anxiety during their clinical pathway.

CONCLUSION

We conclude that it is essential to integrate also the influence of the clinical setting and the bodily aspects of care in the understanding of patient involvement in clinical practice.

Hope, Sociodemographic and Clinical Characteristics as Predictors of Stigma-Related Negative Discrimination Experiences of Patients With Primary Malignant Brain Tumor

ABSTRACT

BACKGROUND: A brain tumor can cause specific dysfunctions including psychosocial problems, and neurological, cognitive, mental, personality, behavioral, body image, and self-concept changes. Hope is reported in previous studies as an important and protective factor during the difficult duration of the disease. The purpose of this study is to examine hope and related factors as predictors of the stigma-induced negative discrimination experience of patients with primary malignant brain tumor. METHODS: The relational research method was used. The study was conducted in neurosurgery and oncology clinics and outpatient clinics of a university hospital in Southeastern Turkey between July 2018 and March 2020. The research data were collected using an information form, the Discrimination and Stigma Scale, and the Dispositional Hope Scale. The research sample consisted of 124 patients with primary malignant brain tumor. The data were analyzed by stepwise multiple linear regression analysis. RESULTS: The average age of the patients with primary malignant brain tumor was 46.64 (±12.00) years. Of all the patients, 61.3% were male, and 25% received radiotherapy. When the negative discrimination experience of patients with primary malignant brain tumor was examined, age (β = -0.244, P = .004), total dispositional hope (β = -0.225, P = .009), and currently receiving radiotherapy (β = 0.169, P = .048) were determined to be significant predictors. CONCLUSION: This study demonstrates the importance of hope, age, and treatment type in the negative discrimination experience of patients with primary malignant brain tumor. Initiatives taking hope into account should be planned by nurses and healthcare professionals to reduce patients' experience of negative discrimination.

Effects of a nursing care program based on the theory of human caring on women diagnosed with gynecologic cancer: a pilot study from Turkey

PURPOSE/OBJECTIVES

This pilot study aimed to determine the effects of a nursing care program based on the Theory of Human Caring (THC) on chemotherapy symptoms, hope, and meaning in life in women diagnosed with gynecologic cancer.

DESIGN/METHODS

This pilot study was conducted in a single-blinded, randomized controlled trial on 52 women diagnosed with gynecologic cancer in Turkey. In the present study, the experimental group was given a nursing care program based on the THC alongside routine nursing care for five sessions, while the control group received solely routine nursing care. Data were collected using the Chemotherapy Symptom Assessment Scale, the Herth Hope Scale, and the Life Attitude Profile.

FINDINGS

There was a statistically significant decrease in the frequency, severity, and degree of discomfort of some chemotherapy symptoms in the experimental group. In addition, the mean scores of hope and meaning in life were significantly higher in the study group compared to the control group.

CONCLUSIONS/IMPLICATIONS

This study revealed that a nursing care program based on the Theory of Human Caring might be of benefit for decreasing the frequency, intensity, and discomfort level of some chemotherapy symptoms, and also for improving the level of hope and meaning in life in women diagnosed with gynecologic cancer.

Research roundup

Synopses of a selection of recently published research articles of relevance to palliative care.