The experience of patients with cancer on narrative practice: A systematic review and meta-synthesis

Processing the trauma of gynaecological cancer through reading and writing: Women's experiences from digital storytelling after treatment

In this article we explore the potential significance of illness stories in cancer rehabilitation by describing gynaecological cancer survivors' experiences from both reading other women's illness stories as well as writing their own. Individual texts were written by fifty-nine women who had recently finished primary cancer treatment while participating in an e-intervention. These texts were analyzed, inspired by Braun and Clark's method of analysis. Our analysis led to two main themes; "Recognition - understanding oneself through others" and "Processing and adapting to a changed everyday life." We found that reading and writing about cancer can pave the way for the individual woman's recognition, normalization, belonging, and path to acceptance. However, this work can be painful as it can trigger memories of going through the cancer experience. Health personnel must be aware of both potentials and pitfalls and be sure to give the support needed.

Personal narratives to support learning about lung transplant for people with cystic fibrosis

OBJECTIVES

Cystic fibrosis (CF) causes progressive respiratory disease and premature death. Lung transplantation (LTx) is an important treatment consideration for people with CF (PwCF). Among PwCF, does preparedness for LTx and knowledge about LTx improve by reading personal narratives from CF LTx recipients ("CF Stories")?

METHODS

Adults with CF were recruited and presented with online CF Stories. Pre- and post-intervention questionnaires assessed LTx preparedness, knowledge, and decisional conflict. Deductive thematic analysis of study visits was conducted.

RESULTS

Twenty-five participants were included. Pre-intervention, 24 % (6/25) reported feeling "very prepared" to discuss LTx. Among the remaining 19, preparedness improved post-intervention for 74 % (n = 14, 95 % CI: 51-88 %), with 42 % (n = 8, 95 % CI: 23-64 %) transitioning to feeling "very prepared." Baseline transplant knowledge was high (100 % questions correct) among 48 % (12/25) of participants; among the remaining 13, 92 % (n = 12, 95 % CI: 67-99 %) scored 100 % post-intervention. Decisional conflict improved for 67 % of participants (16/24), with a mean individual Decisional Conflict Scale change of -9.4 (95 % CI: -2.8, -15.9; p = 0.01). Thematic analysis revealed that participants valued practical LTx insights and relatable stories, identifying key medical information for LTx discussions.

CONCLUSIONS

CF Stories improved knowledge and preparedness for LTx discussions.

PRACTICE IMPLICATIONS

Personal narratives could enhance preparedness for LTx discussions and decision-making for PwCF.

Exploring Narrative and Coping Strategies of Osteosarcoma Survivors in China: A Qualitative Study

BACKGROUND

The existing studies have pointed out that cancer survivorship experiences significantly contribute to a comprehensive understanding of cancer survivors and insights into oncological care development. However, little is known about the long-term survivorship experiences of osteosarcoma survivors within the Chinese context.

OBJECTIVE

This study aims to explore osteosarcoma survivorship and coping strategies to enrich our understanding of the unique challenges and psychological needs of this population.

METHODS

A qualitative narrative inquiry was used to provide a comprehensive understanding of survivors' illness narratives and coping strategies during osteosarcoma survivorship. Twelve osteosarcoma survivors were recruited using purposeful sampling. The data were collected through narrative inquiry interviews, which were audio-recorded and transcribed. A thematic narrative analysis is used to interpret the narrative inquiry data.

RESULTS

Three themes of illness narratives were identified, including "No one knows: chaos," "Rethinking: restitution," and "Restarting and retelling: quest." Coping strategies encompassed in the subthemes indicated the importance of archive efforts of osteosarcoma survivors in questing post-traumatic identity, values, and reconnecting to the community. Alternative narratives that emerged beyond the illness narrative framework highlighted contextual-specific insights.

CONCLUSION

This study demonstrates that a narrative approach provides an alternative perspective for exploring the cancer survivorship experience. The findings underscore the evolving nature of illness narratives, highlighting the long-term need for ongoing psychological support for osteosarcoma survivors. Moreover, the study highlighted a comprehensive understanding of osteosarcoma survivorship within the Chinese context. Specifically, it emphasizes (1) the rethinking of current medical discourse and psycho-oncology practice within the Chinese context and (2) the narrative empowerment of bone cancer survivors. These findings have significant implications for expanding exploration into the nuanced experiences and identification of barriers to the integration of medical and psychological support among Chinese cancer survivors.

Are digital psychological interventions for psychological distress and quality of life in cancer patients effective? A systematic review and network meta-analysis

BACKGROUND

Many cancer patients experience psychological distress and/or poor quality of life during or after their cancer treatment, yet they face multiple barriers to accessing psychological support. Digital psychological interventions represent a promising approach for addressing these barriers, however their comparative effectiveness remains uncertain.

METHODS

Nine databases were searched for randomized controlled trials (RCTs) from inception to July 2024. The primary outcomes were psychological distress and quality of life, and the secondary outcomes were measures of depression, anxiety, insomnia, fatigue, and fear of cancer recurrence in this study.

RESULTS

One hundred and thirty-six RCTs with 23,154 participants were identified. Of these interventions, three types-digitally-delivered cognitive behavioral therapy (CBT), health education, and virtual reality therapy (VRT)-demonstrated significant reductions in psychological distress compared to non-active controls. Digital CBT, narrative interventions, and VRT significantly improved quality of life compared to non-active controls. For depression, both digital CBT and VRT were superior to the non-active control group. Regarding anxiety, CBT, psychoeducation, and VRT outperformed the non-active control group. In terms of fatigue, CBT, psychoeducation, VRT, and multi-component interventions all showed enhanced efficacy compared to the non-active control group. However, only CBT exhibited significantly superior effectiveness in alleviating insomnia compared to non-active controls. Similarly, only mindfulness-based interventions significantly reduced fear of cancer recurrence compared to the non-active control condition.

CONCLUSIONS

Our results suggest that digital CBT and VRT are highly promising options for reducing psychological distress and enhancing the quality of life among cancer patients; further high-quality randomized controlled trials involving diverse populations are essential to validate these findings.

The effect of narrative nursing on improving the negative emotions and quality of life of patients with moderate to severe cancer pain

OBJECTIVE

This study aimed to explore the effect of narrative nursing on improving the negative emotions, sleep quality, and quality of life of patients with moderate to severe cancer pain.

METHODS

A total of 80 patients with moderate to severe cancer pain who had been hospitalized in the lymphoma oncology department in our hospital from March 2019 to September 2021 were selected as the study subjects and randomly divided into the conventional nursing and narrative nursing groups, with 40 cases in each group. A conventional nursing intervention was conducted for one group, and narrative nursing was provided for the second group in addition to the conventional nursing. The anxiety and depression, sleep quality, quality of life, and satisfaction with pain management of the patients in the two groups were compared before and after the intervention.

RESULTS

In the narrative nursing group, the self-rating anxiety scale and self-rating depression scale scores were significantly lower than those in the conventional nursing group after the intervention (P < 0.05). The scores for sleep quality, sleep duration, sleep efficiency, and daytime dysfunction and the total Pittsburgh Sleep Quality Index scores were significantly lower in the narrative nursing group compared with the conventional care group (P < 0.05). The scores for the physical function, living ability, social adaptation, and psychological status items in the Quality of Life Questionnaire Core 30 were significantly higher in the narrative nursing group than in the conventional care group (P < 0.05). The patients' satisfaction with pain management was higher in the narrative nursing group than in the conventional care group (P < 0.05).

CONCLUSION

Narrative nursing can alleviate the negative emotions of anxiety and depression in patients with moderate to severe cancer pain and improve their sleep quality, quality of life, and pain management satisfaction.

Evaluation of outcomes of psychological interventions in terminally ill family caregivers: a brief overview

Background

Family caregivers play a crucial role in supporting patients with incurable diseases, but often experience significant stress and anxiety. This study aimed to investigate the impact of psychological interventions on family caregivers, with a focus on reducing the burden of care, improving mental health and quality of life, and promoting family communication.

Method

This study conducted a brief overview of quantitative and qualitative research on assessing the impact of psychological interventions on family caregivers. A comprehensive literature search was conducted in PUBMED, SCOPUS, EMBASE, SCIENCE DIRECT and WEB OF SCIENCE to identify relevant papers, resulting in 20 articles being included. The included studies focused on evaluating the outcomes of psychological interventions on family caregivers.

Result

Ultimately, 20 relevant articles were retrieved from a pool of 500 articles, focusing on the evaluation of the primary outcomes of psychological interventions on family caregivers. The review of 20 articles revealed that interventions such as expressive writing and reminiscence therapy had a positive and significant impact on reducing the burden of care and fostering a positive care environment. Additionally, these interventions were found to be effective in improving self-esteem, family communication, and overall wellbeing.

Conclusion

The study emphasizes the need for further research to confirm the benefits of these interventions and their role in promoting family resilience. These findings highlight the potential of psychological interventions in alleviating the challenges faced by family caregivers of patients with incurable diseases.

The Encounter of Two Worlds: Divided Narratives of Decision-Making on Cancer Treatment Between Physicians and Patients

INTRODUCTION

Divided narratives pose long-standing difficulties in physician and patient communication. In decision-making on cancer treatment, divided narratives between physicians and patients hinder mutual understanding and agreement over the illness and its treatment. For effective decision-making on treatments, it is necessary to investigate the similarities and differences in these divided narratives.

METHODS

This study adopted a qualitative research design of narrative inquiry to examine the data, which included interviews with 32 cancer patients and 16 paired physicians in two hospitals in China. Data analysis was conducted using grounded theory to generate findings.

RESULTS

Both physicians and patients were concerned about goals and obstacles to their decision-making on cancer treatment. Four common aspects of goal setting were identified from the divided narratives: decision pools, treatment goals, identity practice and preferred identity. Four common obstacles were identified: pains and trust, communication gap, financial issues and complex family. However, the meanings attached to these eight aspects differed between physicians and patients.

CONCLUSION

Cancer treatment decision-making is an encounter of the scientific world and lifeworld. A divided narrative approach can identify the similarities and differences in the decision-making on cancer treatment between physicians and patients. Physicians generally adopt a rational decision-making approach, whereas patients generally adopt a relational decision-making approach. Despite the common concerns in their goals and obstacles, physicians and patients differed in their contextualized interpretations, which demonstrates the physicians' and the patients' pursuit of preferred identities in decision-making. The results of this study provide a new perspective to treatment decision-making, emphasizing the importance of narrative integration in reaching mutual agreement.

PATIENT AND PUBLIC CONTRIBUTION

The findings were shared with 15 cancer patients and caregivers for feedback and advice in June 2024. This study was also presented at the international conferences of COMET (International and Interdisciplinary Conference on Communication, Medicine, and Ethics) and ICCH (International Conference on Communication in Healthcare) 2023 for continuous feedback and comments.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Cancer survival stories: Perception, creation, and potential use case

BACKGROUND

Cancer patients often search for information about their health conditions online. Cancer patient narratives have established themselves as a way of providing information and education but also as an effective approach to improving coping with the disease.

OBJECTIVE

We investigated how people affected by cancer perceive cancer patient narratives and whether such stories can potentially improve coping during their own cancer journeys. Additionally, we reflected on whether our co-creative citizen science approach can contribute to gaining knowledge about cancer survival stories and providing peer support.

DESIGN, SETTING AND STAKEHOLDERS

We applied a co-creative citizen science approach by using quantitative and qualitative research methods with stakeholders (i.e., cancer patients, their relatives, friends and health professionals).

MAIN OUTCOME MEASURES

Understandability and perceived benefits of cancer survival stories, coping, emotional reactions to the stories and helpful characteristics of the stories.

RESULTS

Cancer survival stories were considered intelligible and beneficial, and they potentially support positive emotions and coping in people affected by cancer. Together with the stakeholders, we identified four main characteristics that evoked positive emotions and that were considered especially helpful: (1) positive attitudes towards life, (2) encouraging cancer journeys, (3) individual coping strategies for everyday challenges and (4) openly shared vulnerabilities.

CONCLUSIONS

Cancer survival stories potentially support positive emotions and coping in people affected by cancer. A citizen science approach is suitable for identifying relevant characteristics of cancer survival stories and may become a helpful educational peer support resource for people coping with cancer.

PATIENT OR PUBLIC CONTRIBUTIONS

We adopted a co-creative citizen science approach, wherein citizens and researchers were equally involved throughout the entire project.

The experience of patients with cancer on narrative practice: A systematic review and meta-synthesis

BACKGROUND

In recent years, narrative practice has been applied in clinical settings to address the relational and psychological concerns that occur in tandem with physical illness. It is an emerging strategy to treat patients as individuals with their own stories, rather than purely based on symptoms.

OBJECTIVE

To synthesize the experience of patients with cancer using narrative practice.

METHODS

Following a systematic search strategy, a literature search was conducted to identify qualitative studies on the experience of patients with cancer using narrative practice. Nine databases were searched up to April 2018, which included six English databases and three Chinese databases. A meta-synthesis was conducted to synthesize the findings of the included studies.

MAIN RESULTS

Seven studies out of 2894 studies were included in this review. Patients with cancer had different preferences on narrative practices. In terms of the impacts of narrative practice on patients with cancer, six themes were identified, which included '(a) reducing the gap between patients and clinicians; (b) healing effect; (c) social connection; (d) facilitating self-reflection, self-recognition and self-realization; (e) risk of negative impacts; and (f) Patients' preference on different approaches of narrative practice'.

CONCLUSIONS

Patients with cancer experienced positive effects regarding narrative practice. Although some patients may experience negative effects, narrative practice is a humanized way to provide care for patients with cancer in the clinical settings.