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Kalloger SE, Ho C, Mitton C, Regier DA. Mapping the experiences of people with advanced cancer across multiple cancer types-a scoping review. J Cancer Surviv 2024; 18:318-324. [PMID: 36180762 DOI: 10.1007/s11764-022-01263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Through the introduction of tumor agnostic therapies, people with metastatic cancer and their treating physicians are facing new treatment choices that have differing side effect and efficacy profiles from conventional chemotherapy. OBJECTIVE The present study undertakes a scoping review of research into the experiences of people with advanced or metastatic cancer across various solid tumor types with the goal of developing a tumor-agnostic conceptual model. DESIGN Automated queries on three internet search engines were performed to identify qualitative interview studies that focused on people with metastatic cancer. No limits were imposed for dates nor location of studies. RESULTS Of the 173 hits generated from the searches, 25 peer-reviewed papers were selected for the review with dates that ranged from 2007 to 2022. All papers originated from the USA, Europe, Australia, or Japan. Three major themes emerged that formed the basis for the tumor-agnostic conceptual model: symptoms, loss of autonomy, and adaptation/coping. CONCLUSIONS The explication of the interplay between the physical and emotional symptoms experienced by those with advanced and metastatic cancer using a multi-tumor approach provides the potential to make generalizations about the needs of this population. An opportunity exists to potentially address these needs through matching patient needs and preferences with the characteristics of novel therapeutics. IMPLICATIONS FOR CANCER SURVIVORS In the era of tumor agnostic therapies, the elicitation of patient preferences across the spectrum of anatomical origins has the potential to enhance shared decision making in the setting of metastatic disease.
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Affiliation(s)
- Steve E Kalloger
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
- Cancer Control Research, BC Cancer, Vancouver, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
| | - Cheryl Ho
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Dean A Regier
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Cancer Control Research, BC Cancer, Vancouver, Canada
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Ramezanzade Tabriz E, Ramezani M, Heydari A, Aledavood SA, Jamali J. Development and psychometric properties of Health-Promoting Lifestyle Scale in Colorectal Cancer Survivors (HPLS-CRCS): a mixed-method study. BMC Cancer 2023; 23:931. [PMID: 37789256 PMCID: PMC10546727 DOI: 10.1186/s12885-023-11436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Detecting a health-promoting lifestyle in colorectal cancer (CRC) survivors is of paramount importance to manage disease complications, prevent their recurrence, and enhance survival; however, no specialized tool has yet been provided to measure the lifestyle of these patients. Accordingly, this study aimed to develop and determine the psychometric properties of the Health-Promoting Lifestyle Scale in CRC Survivors (HPLS-CRCS). METHODS This study was a mixed study with an exploratory sequential design in two phases. Concept analysis was performed in the first phase according to Schwartz-Barcott and Kim's (2000) hybrid model to explain the concept, identify dimensions, and generate items. In the second phase, psychometrics including validity (face, content, and construct) and reliability (internal consistency and stability) were determined. Responsiveness, interpretability, ease of use, item weighting, and scale scoring were also determined. RESULTS After explaining the concept, an initial scale encompassing 211 items was developed, content and item analyses were conducted, and the items decreased to 89 items after the face validity assessment. For construct validity, confirmatory factor analysis (CFA) was conducted with a sample size of 500 survivors, and convergent validity was performed for the Persian version of the Health-Promoting Lifestyle Profile II (HPLP-II). Accordingly, 80 items were classified into six factors: activity and rest, spiritual growth, health responsibility, nutrition, interpersonal relationships, and psychological management, with RMSEA = 0.055, χ2/df = 2.484, and χ2 = 6816.516. The reliability of the scale was confirmed, Cronbach's alpha was between 0.865 and 0.928, and the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal important change (MIC), and the smallest detectable change (SDC) were 0.896, 3.36, 13.86, and 19.87, respectively. CONCLUSION The HPLS-CRCS consists of 80 items in six dimensions and is a valid and reliable scale for evaluating the health-promoting lifestyle in CRC survivors. Using this scale to evaluate the healthy lifestyle in these survivors can lead healthcare providers to detect deficiencies and plan the lifestyle of CRC survivors during the post-treatment period.
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Affiliation(s)
- Elahe Ramezanzade Tabriz
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monir Ramezani
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- School of Nursing and Midwifery, Mashhad University of Medical Sciences, Ebne Sina St, PO Box 9137913199, Mashhad, Iran.
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Jamshid Jamali
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Patel RK, Rahman S, Schwantes IR, Bartlett A, Eil R, Farsad K, Fowler K, Goodyear SM, Hansen L, Kardosh A, Nabavizadeh N, Rocha FG, Tsikitis VL, Wong MH, Mayo SC. Updated Management of Colorectal Cancer Liver Metastases: Scientific Advances Driving Modern Therapeutic Innovations. Cell Mol Gastroenterol Hepatol 2023; 16:881-894. [PMID: 37678799 PMCID: PMC10598050 DOI: 10.1016/j.jcmgh.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
Colorectal cancer is the second leading cause of cancer-related deaths in the United States and accounts for an estimated 1 million deaths annually worldwide. The liver is the most common site of metastatic spread from colorectal cancer, significantly driving both morbidity and mortality. Although remarkable advances have been made in recent years in the management for patients with colorectal cancer liver metastases, significant challenges remain in early detection, prevention of progression and recurrence, and in the development of more effective therapeutics. In 2017, our group held a multidisciplinary state-of-the-science symposium to discuss the rapidly evolving clinical and scientific advances in the field of colorectal liver metastases, including novel early detection and prognostic liquid biomarkers, identification of high-risk cohorts, advances in tumor-immune therapy, and different regional and systemic therapeutic strategies. Since that time, there have been scientific discoveries translating into therapeutic innovations addressing the current management challenges. These innovations are currently reshaping the treatment paradigms and spurring further scientific discovery. Herein, we present an updated discussion of both the scientific and clinical advances and future directions in the management of colorectal liver metastases, including adoptive T-cell therapies, novel blood-based biomarkers, and the role of the tumor microbiome. In addition, we provide a comprehensive overview detailing the role of modern multidisciplinary clinical approaches used in the management of patients with colorectal liver metastases, including considerations toward specific molecular tumor profiles identified on next generation sequencing, as well as quality of life implications for these innovative treatments.
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Affiliation(s)
- Ranish K Patel
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Shahrose Rahman
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Issac R Schwantes
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Alexandra Bartlett
- Division of Surgical Oncology, Department of Surgery, OHSU, Portland, Oregon
| | - Robert Eil
- Division of Surgical Oncology, Department of Surgery, OHSU, Portland, Oregon; The Knight Cancer Institute, OHSU, Portland, Oregon
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, OHSU, Portland, Oregon
| | - Kathryn Fowler
- Department of Surgery, Oregon Health & Science University (OHSU), Portland, Oregon
| | - Shaun M Goodyear
- The Knight Cancer Institute, OHSU, Portland, Oregon; Division of Hematology and Oncology, School of Medicine, OHSU, Portland, Oregon
| | - Lissi Hansen
- The Knight Cancer Institute, OHSU, Portland, Oregon; School of Nursing, OHSU, Portland, Oregon
| | - Adel Kardosh
- The Knight Cancer Institute, OHSU, Portland, Oregon; Division of Hematology and Oncology, School of Medicine, OHSU, Portland, Oregon
| | - Nima Nabavizadeh
- The Knight Cancer Institute, OHSU, Portland, Oregon; Department of Radiation Medicine, OHSU, Portland, Oregon
| | - Flavio G Rocha
- Division of Surgical Oncology, Department of Surgery, OHSU, Portland, Oregon; The Knight Cancer Institute, OHSU, Portland, Oregon
| | - V Liana Tsikitis
- The Knight Cancer Institute, OHSU, Portland, Oregon; Division of Gastrointestinal Surgery, Department of Surgery, OHSU, Portland, Oregon
| | - Melissa H Wong
- The Knight Cancer Institute, OHSU, Portland, Oregon; Department of Cell, Developmental and Cancer Biology, OHSU, Portland, Oregon
| | - Skye C Mayo
- Division of Surgical Oncology, Department of Surgery, OHSU, Portland, Oregon; The Knight Cancer Institute, OHSU, Portland, Oregon.
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TAŞ İ. Spiritual Well-being as a Mediator between Internet Addiction and Alienation. Spiritual Psychology and Counseling 2022. [DOI: 10.37898/spiritualpc.1171408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of the negative effects of internet addiction on individuals’ personal and social life is alienation. Spiritual well-being affects both internet addiction and the level of alienation. The present study investigated the mediator effect of spiritual well-being in the relationship between internet addiction and alienation. The study was conducted with 320 college students : 183 (57.2%) female and 137 (42.8%) male. The ages of participants ranged from 19 to 35, and the mean age was 20.74. Data were collected using a personal information form, an internet addiction scale, an alienation scale and a spiritual well-being scale. The analyses showed that internet addiction, alienation and spiritual well-being were correlated. Internet addiction significantly predicted alienation and spiritual well-being. Spiritual well-being significantly predicted alienation. It was found that spiritual well-being partially mediated (indirect effect = .1525) the relationship between internet addiction and alienation. These results showed that spiritual well-being can be an important variable in preventing alienation.
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Affiliation(s)
- İbrahim TAŞ
- SAKARYA ÜNİVERSİTESİ, FEN-EDEBİYAT FAKÜLTESİ, PSİKOLOJİ BÖLÜMÜ, GELİŞİM PSİKOLOJİSİ ANABİLİM DALI
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Ata G, Kılıç D. Correlation of spiritual well-being with hope and depression in oncology patients: The case of Turkey. Perspect Psychiatr Care 2022; 58:1460-1466. [PMID: 34541686 DOI: 10.1111/ppc.12950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was conducted to determine the correlation between spiritual well-being and hope and depression in oncology patients. DESIGN AND METHODS The sample of the study consisted of 210 cancer patients. For data collection, a Patient Information Form, the FACIT-Sp-12 Scale, the Beck Hopelessness Scale, and the Beck Depression Inventory were used. FINDINGS The patients had mean scores of 32.02 ± 5.14 for spiritual well-being, 4.15 ± 4.17 for hopelessness, and 16.05 ± 8.29 for depression. A negative relationship was determined between spiritual well-being and hopelessness and depression, and a positive and significant relationship was found between depression and hopelessness. PRACTICE IMPLICATIONS Oncology patients should be given psychosocial care that supports their spiritual well-being and hope, and depression symptoms should be well known and given importance.
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Affiliation(s)
- Gülnaz Ata
- Department of Public Health Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
| | - Dilek Kılıç
- Department of Public Health Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
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Correa Júnior AJS, Sonobe HM, Teles AADS, Neves WFDS, Santana MED. Experiences, dietary behavior and cultural characteristics of people with colorectal neoplasms. Rev Bras Enferm 2021; 74:e20200092. [PMID: 33787782 DOI: 10.1590/0034-7167-2020-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/15/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to interpret the socio-cultural, religious, and spiritual aspects of the experience of people who have colorectal cancer and were submitted to surgical treatment with ostomy. METHODS ethnographic study under the perspective of the Sociology of Health, in the comprehensive aspect, in a surgical unit of an oncologic hospital of the state of Pará, Brazil. Eighteen deponents participated, eleven patients, and seven caregivers, between December 2018 and March 2019. Data were obtained with non-participant observation, field diary records, and semi-structured interviews with subsequent inductive content analysis. RESULTS religious attachment and socio-cultural aspects of the illness were interpreted, emphasizing the social fact of the Immediate Dream, emotional shock, modern totemism, toxic food as taboo, and medicalization in the sphere of common sense and biomedical system. FINAL CONSIDERATIONS microsocial and macrosocial factors of the participants' experiences contribute to the qualification of oncologic assistance in the public system, assuming the need for specialized interprofessional assistance.
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Lim CYS, Laidsaar-Powell RC, Young JM, Kao SCH, Zhang Y, Butow P. Colorectal cancer survivorship: A systematic review and thematic synthesis of qualitative research. Eur J Cancer Care (Engl) 2021; 30:e13421. [PMID: 33733545 DOI: 10.1111/ecc.13421] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/06/2020] [Accepted: 01/15/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION With rapid changes in treatments for colorectal cancer (CRC), qualitative research into CRC survivorship requires greater synthesis. This paper aims to fill this gap through a systematic review (PROSPERO CRD42019131576) and thematic synthesis of the qualitative literature on survivorship experiences across early-stage and advanced CRC survivors. METHODS CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched for qualitative CRC survivorship papers. Titles, abstracts and full texts were screened. Included articles (n = 81) underwent data extraction, CASP qualitative bias ratings and thematic synthesis. RESULTS Bowel dysfunction caused functional limitations and negative quality of life (QoL), while stomas posed threats to body image and confidence. Physical symptoms hindered return to work, increasing financial burdens. Survivors' unmet needs included information regarding symptom expectations and management, and ongoing support throughout recovery. Advanced and early-stage survivors shared similar experiences. Advanced survivors struggled with fear of cancer recurrence/progression and feelings of powerlessness. Functional limitations, financial impacts and sexuality in advanced survivors were underexplored areas. CONCLUSION CRC and its treatments impact survivors' QoL in all areas. A coordinated supportive care response is required to address survivors' unmet needs. Future qualitative studies should explore advanced CRC subpopulations, treatment-specific impacts on QoL and long-term (>5 years) impacts on CRC survivors.
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Affiliation(s)
- Chloe Yi Shing Lim
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah Clare Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Jane M Young
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,RPA Institute of Academic Surgery (IAS) and Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney, NSW, Australia
| | - Steven Chuan-Hao Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Yuehan Zhang
- National Centre for Epidemiology and Population Health, Australian National University Research School of Population Health, Canberra, ACT, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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Lau J, Khoo AMG, Ho AHY, Tan KK. Psychological resilience among palliative patients with advanced cancer: A systematic review of definitions and associated factors. Psychooncology 2021; 30:1029-1040. [PMID: 33728728 DOI: 10.1002/pon.5666] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The palliative journey can be emotionally stressful for both patients with advanced cancer and their families. Psychological resilience is crucial in aiding with patients' adaptation and post-traumatic growth. The aim of this systematic review was to critically examine the definitions of psychological resilience and its associated factors in palliative patients with advanced cancer. METHODS Four databases were systematically searched from inception to August 2020. Both qualitative and quantitative studies that examined factors associated with psychological resilience in a sample of patients with advanced cancer undergoing palliative care were included. RESULTS A total of 15 studies met the criteria, of which 10 were qualitative and five were quantitative. Nine studies included a definition of psychological resilience, from which five common themes of buffering, adaptation, resources, recovery, and growth were derived. The quantitative studies found association between resilience and hope, independence, social support, fatigue, emotional distress, and coping strategies. The qualitative studies reported additional sources of resilience such as spirituality, social support, prior experience dealing with illness and life adversity, meaning-making, reconciling with life's finiteness, acceptance of illness, control, determination, positive attitude, dignity, engagement with palliative care and quality of life being supported by palliative care. CONCLUSIONS More research is needed for developing an overarching definition of psychological resilience in palliative advanced cancer patients that acknowledges and appreciates the contextual sensitivity of this concept among different cultural groups. Further studies are also needed to examine a holistic range of bio-psycho-socio-spiritual factors associated with psychological resilience among these patients and their families.
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Affiliation(s)
- Jerrald Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Andy Hau-Yan Ho
- School of Social Sciences, Nanyang Technological University, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Arenas-Massa Á, Nocetti-de la Barra A, Fraile-Ducviq CG. Espiritualidad en el contexto de cuidados paliativos oncológicos dirigidos a personas mayores. pers bioet 2020. [DOI: 10.5294/pebi.2020.24.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
La última década ha estudiado la faceta “espiritualidad” en el contexto de cuidados paliativos oncológicos en personas mayores desde perspectivas cuantitativas, cualitativas y mixtas. El estudio busca develar –en este contexto– el significado de espiritualidad. Se revisa literatura indexada en buscador PubMed vía Medline entre los años 2009 y 2019, con acceso on line, a texto completo, en forma anónima, en idiomas inglés-español y, análogamente, con búsqueda manual en la Revista Medicina Paliativa. Los resultados arrojan 50 artículos de pertinencia temática y cuatro categorías. Se concluye que existen desafíos relacionados con el significado de espiritualidad y calidad de vida, formación y perspectivas de invetigación.
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Haufe M, Leget C, Potma M, Teunissen S. How can existential or spiritual strengths be fostered in palliative care? An interpretative synthesis of recent literature. BMJ Support Palliat Care 2020:bmjspcare-2020-002379. [PMID: 32928785 DOI: 10.1136/bmjspcare-2020-002379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/21/2020] [Accepted: 08/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients receiving palliative care may benefit greatly when their existential or spiritual strengths are fostered. To date however, there has not been a comprehensive literature review of patient and care professional approaches that are available. AIMS To describe and synthesise existential or spiritual strength-based approaches within the context of palliative care. METHODS Literature search of 2436 articles between January 1999 and March 2019 in Scopus, Web of Science, CINAHL and PsycINFO. Articles were included if they deal with a palliative care situation, focus on the patient, specific existential/spiritual strength, discernible strength approach and an analysis of the workings of that approach. The interpretative synthesis consisted of a thematic analysis of the included articles and an integration of themes. RESULTS In the 14 included articles, 5 different strengths were found to be fostered by 16 approaches: (1) Meaning was fostered by: maintaining normalcy, experiencing sanctuaries, reassessing importance and reconstructing positive self; (2) Connection by: opening up, giving/receiving care and envisioning continuation; (3) Agency by: maintaining control, refocusing goals and continuous adaptation; (4) Hope through: setting special targets, imagining alternate outcomes, building a collection and extending wishes; (5) Faith through: living the tradition and relating to a benevolent force. Strengths and approaches are visualised in an overarching analytical framework: 'the Propeller'. CONCLUSIONS The constructed Propeller framework can be used to become aware of, apply and further develop approaches to foster existential or spiritual strengths among patients receiving palliative care.
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Affiliation(s)
- Marc Haufe
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Carlo Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Marieke Potma
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Department of General Practice, Center of Expertise Palliative Care Utrecht, Julius Center for Healthcare Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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Rohde G, Söderhamn U, Vistad I. Reflections on communication of disease prognosis and life expectancy by patients with colorectal cancer undergoing palliative care: a qualitative study. BMJ Open 2019; 9:e023463. [PMID: 30850402 PMCID: PMC6429716 DOI: 10.1136/bmjopen-2018-023463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Patients with colorectal cancer undergoing palliative treatment receive extensive treatment-related information throughout their disease trajectory. We aimed to explore the experiences of patients with incurable colorectal cancer while in palliative care and their reflections on the information provided by physicians and nurses. Our main focus was the patients' thoughts about how information about disease status and life expectancy was communicated, from the first time that they were informed about the incurable nature of their disease through to postsurgery palliative treatment. SETTINGS Patients with colorectal cancer receiving palliative chemotherapy. RESEARCH DESIGN We used a qualitative approach, and the data were analysed by qualitative content analysis. PARTICIPANTS 20 patients (34-75 years of age) were included in the study; 12 received first-line chemotherapy and 8 received second-line chemotherapy. Eleven patients were treated by oncologists, and nine were treated by junior physicians. RESULTS Data-driven empirical analysis identified three themes: (1) inadequate information during the initial phase of the disease trajectory; (2) hope and information further into the disease trajectory and (3) personal, professional and organisational factors that influenced information and communication throughout the disease trajectory. CONCLUSION The participants' experience of being told for the first time that they had an incurable disease was perceived as inadequate, while postsurgery palliative chemotherapy, physicians and nurses offered hope. The participants preferred customised information about their treatment and likely future prospects and physicians and nurses who took a holistic and compassionate approach focusing on their lifeworld. To be a sensitive, holistic and compassionate physician or nurse requires knowledge and confidence. To achieve this requires training and guidance at universities and in hospitals.
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Affiliation(s)
- Gudrun Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Ulrika Söderhamn
- Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Centre for Caring Research–Southern Norway, Grimstad, Norway
| | - Ingvild Vistad
- Department of Obstetric and Gynaecology, Sorlandet Hospital Kristiansand, Kristiansand, Norway
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Maiko S, Johns SA, Helft PR, Slaven JE, Cottingham AH, Torke AM. Spiritual Experiences of Adults With Advanced Cancer in Outpatient Clinical Settings. J Pain Symptom Manage 2019; 57:576-586.e1. [PMID: 30528539 PMCID: PMC6382574 DOI: 10.1016/j.jpainsymman.2018.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
CONTEXT Adults who have advanced cancer experience distress, and many use religion and spirituality to cope. Research on the spiritual experiences of patients with advanced cancer will help guide the provision of high-quality spiritual care. OBJECTIVES To qualitatively describe advanced cancer patients' spiritual experiences of illness. METHODS We conducted semistructured qualitative interviews at a single cancer center with 21 patients with stage IV solid malignancies who had a prognosis of less than 12 months, as estimated by each patient's medical oncologist. Five investigators conducted a thematic analysis of the transcribed interviews. RESULTS We found 31 patients who were eligible for enrollment, and 21 (67.7%) participated in interviews to thematic saturation. Using a thematic-analysis approach, five major themes emerged. Relationships with family and friends was the most important theme among all 21 patients irrespective of their religious or spiritual identity. Relationship with God and faith community was frequently identified by those who considered themselves spiritually religious. Cancer often led to reflection about the meaning of life and the nature of existential suffering. Patients addressed the extent to which identity was changed or maintained through the cancer experience, and some expressed acceptance as a way of coping with illness. CONCLUSIONS Spiritual care for dying cancer patients should always include the exploration of relationships with family and friends, as well as God and faith community for some patients. Relationships with family, friends, and God can be a source of strength for many. Making meaning, addressing identity concerns, supporting acceptance as a resource for coping with illness, and acknowledging existential suffering will often arise for these patients.
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Affiliation(s)
- Saneta Maiko
- Indiana University Health, The Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, Indianapolis, Indiana, USA; The John Templeton Transforming Chaplaincy Research Fellow and Affiliate Research Scientist, Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, Indiana, USA.
| | - Shelley A Johns
- Indiana University School of Medicine, Regenstrief Institute, Indianapolis, Indiana, USA; Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana, USA; Research in Palliative and End-of-Life Communication and Training (RESPECT) Center, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Paul R Helft
- Indiana University Cancer Center, Charles Warren Fairbanks Center for Medical Ethics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ann H Cottingham
- Regenstrief Institute, Inc, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexia M Torke
- The Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
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Abstract
BACKGROUND Colon and/or rectum cancer (CRC) patients use various strategies to cope with their condition, and these can vary between age groups. OBJECTIVES The aims of this study were to investigate differences between psychosocial/spiritual variables and coping strategies in CRC patients of different age groups (younger vs older) and to identify the predictors of coping for both age groups. METHODS A cross-sectional descriptive study was conducted at 3 outpatient clinics in Korea. The Hospital Anxiety and Depression Scale, Social Support Scale, and Self-Transcendence Scale were used to measure psychosocial and spiritual variables; the Mini-Mental Adjustment to Cancer Scale was used to assess cancer-specific coping strategies. RESULTS Both younger and older patients who were psychologically distressed used more maladaptive coping. Individuals who received less social support from healthcare providers used more maladaptive coping strategies. For younger patients, self-transcendence was the only significant predictor of both adaptive and maladaptive coping strategies; for older patients, Hospital Anxiety and Depression Scale score was the only significant predictor of maladaptive coping. CONCLUSION Differences in psychological distress, social support, and self-transcendence due to age are important protective or risk factors for the use of coping strategies among CRC patients. IMPLICATIONS FOR PRACTICE Considering our findings, we encourage healthcare professionals to be aware of patients' coping strategies and take them into account when planning age-specific interventions related to coping, before hospital discharge.
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Selman LE, Brighton LJ, Sinclair S, Karvinen I, Egan R, Speck P, Powell RA, Deskur-Smielecka E, Glajchen M, Adler S, Puchalski C, Hunter J, Gikaara N, Hope J. Patients' and caregivers' needs, experiences, preferences and research priorities in spiritual care: A focus group study across nine countries. Palliat Med 2018; 32:216-230. [PMID: 29020846 PMCID: PMC5758929 DOI: 10.1177/0269216317734954] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Spiritual distress is prevalent in advanced disease, but often neglected, resulting in unnecessary suffering. Evidence to inform spiritual care practices in palliative care is limited. AIM To explore spiritual care needs, experiences, preferences and research priorities in an international sample of patients with life-limiting disease and family caregivers. DESIGN Focus group study. SETTING/PARTICIPANTS Separate patient and caregiver focus groups were conducted at 11 sites in South Africa, Kenya, South Korea, the United States, Canada, the United Kingdom, Belgium, Finland and Poland. Discussions were transcribed, translated into English and analysed thematically. RESULTS A total of 74 patients participated: median age 62 years; 53 had cancer; 48 were women. In total, 71 caregivers participated: median age 61 years; 56 were women. Two-thirds of participants were Christian. Five themes are described: patients' and caregivers' spiritual concerns, understanding of spirituality and its role in illness, views and experiences of spiritual care, preferences regarding spiritual care, and research priorities. Participants reported wide-ranging spiritual concerns spanning existential, psychological, religious and social domains. Spirituality supported coping, but could also result in framing illness as punishment. Participants emphasised the need for staff competence in spiritual care. Spiritual care was reportedly lacking, primarily due to staff members' de-prioritisation and lack of time. Patients' research priorities included understanding the qualities of human connectedness and fostering these skills in staff. Caregivers' priorities included staff training, assessment, studying impact, and caregiver's spiritual care needs. CONCLUSION To meet patient and caregiver preferences, healthcare providers should be able to address their spiritual concerns. Findings should inform patient- and caregiver-centred spiritual care provision, education and research.
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Affiliation(s)
- Lucy Ellen Selman
- 1 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lisa Jane Brighton
- 2 Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Shane Sinclair
- 3 Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Ikali Karvinen
- 4 Global Health Programme, Diaconia University of Applied Sciences, Helsinki, Finland
| | - Richard Egan
- 5 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Peter Speck
- 2 Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | | | - Ewa Deskur-Smielecka
- 7 Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Myra Glajchen
- 8 Director of Medical Education, MJHS Institute for Innovation in Palliative Care, New York, NY, USA
| | - Shelly Adler
- 9 Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christina Puchalski
- 10 The George Washington University's Institute for Spirituality & Health (GWish), School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Joy Hunter
- 11 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nancy Gikaara
- 12 Independent Consultant in Palliative Care Research, Kenya
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Kisvetrová H, Vévodová Š, Školoudík D. Comfort-Supporting Nursing Activities for End-of-Life Patients in an Institutionalized Environment. J Nurs Scholarsh 2017; 50:126-133. [PMID: 28869697 DOI: 10.1111/jnu.12341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Comfort promotion plays a significant role in end-of-life patient care. The objective of this study was to determine the utilization rate of comfort supporting nursing activities in end-of-life patients in an institutionalized environment in the Czech Republic in relation to the age of the registered nurses (RNs), length of work experience, education level, and type of workplace. DESIGN A cross-sectional, descriptive study was designed. A questionnaire with Likert scales included 31 activities of dying care and spiritual support interventions. The sample comprised 907 RNs working in 49 institutions in nine regions of the Czech Republic. The Kruskal-Wallis test, Mann-Whitney U post-hoc test with Bonferroni correction of significance, Spearman's correlation analysis, and logical regression model were used for statistical evaluation. FINDINGS The least frequently implemented activity by RNs was "Show the patient's willingness to discuss death" and the most frequent activity was "Threat to the patient's dignity and respect." The highest utilization rate of nursing activities was reported in the physical dimension, while the lowest utilization rate of nursing activities was in the social dimension set. Significant predictors for the high utilization rate of physical dimension set activities were hospice care departments, long-term care facilities (LTCFs), and the age of RNs. Hospice departments were also a predictor of high utilization rate of activities in the psychological, spiritual, and social dimension set activities. CONCLUSIONS With the exception of hospice departments, RNs used activities encouraging psychological, spiritual, and social comfort for end-of-life patients less frequently than the physical dimension. CLINICAL RELEVANCE RNs in hospitals and LTCFs focus insufficiently on the spiritual and psychosocial comfort of end-of-life patients. This study is of particular significance to educators who prepare the next generation of nurses.
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Affiliation(s)
- Helena Kisvetrová
- Phi Gamma, Associate Professor, The Centre for Research and Science, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
| | - Šárka Vévodová
- Head of Department of Humanities and Social Sciences, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
| | - David Školoudík
- Professor, Vice-Dean, and Director of The Centre for Research and Science, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
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