Patient-reported care domains that enhance the experience of "being known" in an ambulatory cancer care centre

Purpose

This study explored patients' perceptions of "being known" in an ambulatory chemotherapy unit.

Methods

Using a qualitative descriptive design, 10 participants with various cancer diagnoses were recruited from a large cancer centre in Montreal, Quebec. Audiotaped individual interviews were transcribed verbatim. Textual data were coded and analyzed thematically.

Findings

Participants spoke of their need to have the staff approach them as individuals first and then as persons with cancer. They further underscored the importance of: (1) feeling truly welcome in the cancer care environment, (2) being provided with person- and situation-responsive care, and (3) considering occupational and social roles that go beyond the "sick role". Mutual patient-nurse disclosure also contributed to perceptions of a personalized care approach.

Implications for nursing

In addition to key elements construed as crucial for enhancing perceptions of being known, future studies should further document how the interplay among demographic, physical/psychological, and cultural factors affect these perceptions.

Impact of hemodialysis on left and right ventricular Doppler diastolic filling indices

Hemodialysis is associated with acute reduction in intravascular volume. To assess the impact of volume reduction on left and right ventricular diastolic filling indexes obtained by Doppler echocardiography, 24 patients on chronic hemodialysis were consecutively studied before, during, and immediately after one hemodialysis session. Twenty four normal sex and age-matched volunteers served as a control group. Study patients had abnormal diastolic indexes when compared to controls. At 2 hours of dialysis (mid dialysis) there was a significant decrease in peak early mitral flow velocity (E), no change in peak atrial filling velocity (A), and a reduction in the E/A ratio. The deceleration time of the mitral E wave also was prolonged compared to baseline. Similar findings were observed with respect to right ventricular filling indices. These changes occurred during the first 2 hours of dialysis and remained unaltered at end dialysis. When patients were subdivided according to weight loss, only the group that lost 1 or more kilograms had significant changes in the Doppler parameters of the left and right ventricle, as well as reduction of the left ventricular dimensions. These findings suggest that preload reduction is the main mechanism that accounts for acute changes in Doppler diastolic indices observed during hemodialysis.

Group participation and survival among patients with end-stage renal disease

All 126 End-Stage Renal Disease (ESRD) patients who entered dialysis between 1971 and 1981 at the Harlem Hospital Center, New York City, were separated into those who had participated in a patient support group and those who had not done so. Patients who engaged in the group activities survived considerably longer than non-participants. Family history of renal disease, psychiatric illness, blood urea nitrogen (BUN), and creatinine were also related to survival, but, education, religion, marital status, and age were not. When 13 psychosocial and physiological covariates were controlled for in a Cox proportional hazard analysis, the group participation effect remained substantial.