Encountering an alien world of disease and treatment. A qualitative study on oesophageal cancer patients’ experiences before start of treatment and the process of participation in treatment decisions
Abstract
Aim: The study explored oesophageal cancer (EC) patients’ experiences before the start of treatment and the process of participation in treatment decisions.
Background: EC is a serious and potentially lethal disease. Surgery and perioperative chemotherapy is the established treatment, which results in a treatment course of 6 to 8 months. No studies have explored how patients with EC experience the diagnosis, the time before the diagnosis and start of treatment and how they experience participating in treatment decisions.
Design: The study was a qualitative study employing a phenomenological-hermeneutic approach.
Methods: Sixteen patients with EC participated. Data collection was carried out using participant observations and semi-structured interviews. Data were analysed with inspiration from Ricœur’s theory of interpretation.
Results: The study showed that patients struggle to gain control of the new life situation and alternate between doubt and hope for the future. Maintaining everyday life activities is of importance and helps the patients deal with the diagnosis and forthcoming treatment. Patients acknowledged that the experts made decisions, yet they were aware that experts assessed their capability to access treatment. Patients experienced the time from diagnosis to the start of treatment as being in ‘no man’s land’.
Conclusions: EC patients encountered an alien world of disease and treatment and are struggling to gain control of their new life situation. Health professionals tend not to focus on patient expressions of everyday life and patients are not actively invited to participate in decisions.Keywords
Full Text:
PDFReferences
Bollschweiler, E., Plum, P., Monig, S.P. & Holscher, A.H. (2017). Current and future treatment options for esophageal cancer in the elderly. Expert Opinion on Pharmacotherapy 18 (10) 1001-1010.
Sjoquist, K.M., Burmeister, B.H., Smithers, B.M., Zalcberg, J.R., Simes, R.J., Barbour, A., Gebski, V. & Australasian Gastro-Intestinal Trials Group. (2011). Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. The Lancet Oncology 12 (7) 681-692.
Lewis, L., Marcu, A., Whitaker, K. & Maguire, R. (2018). Patient factors influencing symptom appraisal and subsequent adjustment to oesophageal cancer: A qualitative interview study. European Journal of Cancer Care 27 (1) doi: 10.1111/ecc.12745.
McCorry, N.K., Dempster, M., Clarke, C. & Doyle, R. (2009). Adjusting to life after esophagectomy: the experience of survivors and carers. Qualitative Health Research 19 (10) 1485-1494.
Andreassen, S., Randers, I., Ternulf Nyhlin, K. & Mattiasson, A.C. (2007). A meta-analysis of qualitative studies on living with oesophageal and clinically similar forms of cancer, seen from the perspective of patients and family members. International Journal of Qualitative Studies on Health and Well-being 2 (2) 114-127.
Danish Esophagus, Gastroesophageal Junction and Gastric Cancer Group (DECV). Annual Report 2016. Department of Epidemiology and Biostatistics, Regional Clinical Quality Development Program RKKP; 2016. Accessed: 23/4/2018. Available at: http://decv.gicancer.dk/Content/Files/Dokumenter/DECV_rapport2016_til%20regionerne.pdf.
Komatsu, H. & Yagasaki, K. (2014). The power of nursing: guiding patients through a journey of uncertainty. European Journal of Oncology Nursing 18 (4) 419-424.
Knobf, M.T. (2013). Being prepared: essential to self-care and quality of life for the person with cancer. Clinical Journal of Oncology Nursing 17 (3) 255-261.
Sainio, C., Lauri, S. & Eriksson, E. (2001). Cancer patients' views and experiences of participation in care and decision making. Nursing Ethics 8 (2) 97-113.
Lagergren, J., Smyth, E., Cunningham, D. & Lagergren, P. (2017). Oesophageal cancer. Lancet 390 (10110) 2383-2396.
Mansour, N.M., Groth, S.S. & Anandasabapathy, S. (2017). Esophageal Adenocarcinoma: Screening, Surveillance, and Management. Annual Review of Medicine 68, 213-227.
Ankem, K. (2006). Factors influencing information needs among cancer patients: A meta-analysis. Library & Information Science Research 28 (1) 7-23.
Miller, S.M. (1995). Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. Implications for cancer screening and management. Cancer 76 (2) 167-177.
Dieng, M., Trevena, L., Turner, R.M., Wadolowski, M. & McCaffery, K. (2013). What Australian women want and when they want it: cervical screening testing preferences, decision-making styles and information needs. Health Expectations 16 (2) 177-188.
Matsuyama, R.K., Kuhn, L.A., Molisani, A. & Wilson-Genderson, M.C. (2013). Cancer patients' information needs the first nine months after diagnosis. Patient Education and Counseling 90 (1) 96-102.
Thorsen, L., Gjerset, G.M., Loge, J.H., Kiserud, C.E., Skovlund, E., Fløtten, T. & Fosså, S.D. (2011). Cancer patients' needs for rehabilitation services. Acta Oncologica 50 (2) 212-222.
Fletcher, C., Flight, I., Chapman, J., Fennell, K. & Wilson, C. (2017). The information needs of adult cancer survivors across the cancer continuum: A scoping review. Patient Education and Counseling 100 (3) 383-410.
Malmstrom, M., Ivarsson, B., Johansson, J. & Klefsgard, R. (2013). Long-term experiences after oesophagectomy/gastrectomy for cancer--a focus group study. International Journal of Nursing Studies 50 (1) 44-52.
Ginex, P., Thom, B., Jingeleski, M., Vincent, A., Plourde, G., Rizk, N., Rusch, V.W. & Bains, M. (2013). Patterns of symptoms following surgery for esophageal cancer. Oncology Nursing Forum 40 (3) E101-E107.
Graham, L. & Wikman, A. (2016). Toward improved survivorship: supportive care needs of esophageal cancer patients, a literature review. Diseases of the Esophagus 29 (8) 1081-1089.
McNair, A.G.K., MacKichan, F., Donovan, J.L., Brookes, S.T., Avery, K.N.L., Griffin, S.M., Crosby, T. & Blazeby, J.M. (20126). What surgeons tell patients and what patients want to know before major cancer surgery: a qualitative study. BMC Cancer 16, 258.
Andreassen, S., Randers, I., Naslund, E., Stockeld, D. & Mattiasson, A.C. (2007). Information needs following a diagnosis of oesophageal cancer; self-perceived information needs of patients and family members compared with the perceptions of healthcare professionals: a pilot study. European Journal of Cancer Care 16 (3) 277-285.
Kitson, A., Marshall, A., Bassett, K. & Zeitz, K. (2013). What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing 69 (1) 4-15.
Thorgård, K. (2012). Patient involvement between expert knowledge and everyday experiences. Nordisk Sygeplejeforskning 2 (2) 96-108.
Cartmell, R. & Coles, A. (2000). Informed choice in cancer pain: empowering the patient. British Journal of Community Nursing 5 (11) 560, 562-564.
Coulter, A. (2011). Engaging patients in healthcare, p. 192. London: Open University Press.
Spradley, J.P. (2006). Participant observation. New print. edn, p.195. New York: Wadsworth.
Emerson, R. (2011). Writing Ethnographic Fieldnotes. Second edn. Chicago: The University of Chicago Press.
Kvale, S. & Brinkmann, S. (2014). Interviews: learning the craft of qualitative research interviewing. 3rd edn, xviii, p. 405. Thousand Oaks, CA: Sage Publications.
Ricoeur, P. (1976). Interpretation Theory. Discourse and the Surplus of Meaning. Fort Worth, Texas: TCU Press.
Ricoeur, P. (1984). Time and narrative. Chicago: The University of Chicago Press.
Dreyer, P.S. & Pedersen, B.D. (2010). Distanciation [sic] in Ricoeur's theory of interpretation: narrations in a study of life experiences of living with chronic illness and home mechanical ventilation. Nordic Nursing Research / Tidsskrift for Sygeplejeforskning 26 (2-3) 60-68.
Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J. & Neville, A.J. (2014). The use of triangulation in qualitative research. Oncology Nursing Forum 41 (5) 545-547.
Pedersen, B.D. (1999). Sygeplejepraksis. Sprog & Erkendelse (Nursing practice. Language and cognition) [PhD Thesis]. Aarhus, Denmark: University of Aarhus, Denmark.
World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Journal of the American Medical Association 310 (20) 2191-2194.
Frank, A.W. (2013). The wounded storyteller: body, illness, and ethics. 2 edn., xxvi, p. 253. Chicago & London: The University of Chicago Press.
Mol, A. (2008). The logic of care health and the problem of patient choice, p. 129. London & New York: Routledge Taylor & Francis Group.
Levinson, W., Lesser, C.S. & Epstein, R.M. (2010). Developing physician communication skills for patient-centered care. Health Affairs (Millwood) 29 (7) 1310-1318.
Andreassen, S., Randers, I., Naslund, E., Stockeld, D. & Mattiasson, A.C. (2006). Patients' experiences of living with oesophageal cancer. Journal of Clinical Nursing 15 (6) 685-695.
Malmstrom, M., Klefsgard, R., Johansson, J. & Ivarsson, B. (2013). Patients' experiences of supportive care from a long-term perspective after oesophageal cancer surgery - a focus group study. European Journal of Oncology Nursing 17 (6) 856-862.
Berglund, M., Westin, L., Svanstrom, R. & Sundler, A.J. (2012). Suffering caused by care--patients' experiences from hospital settings. International Journal of Qualitative Studies on Health and Well-being 7, 1-9.
Cahill, J. (1996). Patient participation: a concept analysis. Journal of Advanced Nursing 24 (3) 561-571.
Sahlsten, M.J., Larsson, I.E., Sjostrom, B. & Plos, K.A. (2008). An analysis of the concept of patient participation. Nursing Forum 43 (1) 2-11.
Simony, C., Specht, K., Andersen, I.C., Johansen, K.K., Nielsen, C. & Agerskov, H. (2018). A Ricoeur-Inspired Approach to Interpret Participant Observations and Interviews. Global Qualitative Nursing Research 5, 2333393618807395.
Malterud, K. (2001). Qualitative research: standards, challenges, and guidelines. Lancet 358 (9280) 483-488.
DOI: http://dx.doi.org/10.5750/ejpch.v7i3.1760
Refbacks
- There are currently no refbacks.