2012 Volume 26 Issue 1 Pages 22-31
Abstract
The aims of the present study were to clarify post-operative lifestyle restructuring by patients receiving adjuvant therapy during the post-esophagectomy recovery process and to obtain practical nursing suggestions. Subjects comprised 22 outpatients who had completed post-operative adjuvant therapy and who had been discharged from hospital for at least 6 months following esophagectomy for esophageal cancer. Semi-structured interviews were conducted during outpatient visits and data were analyzed using the modified grounded theory approach.
Results revealed that the process of post-operative lifestyle restructuring by patients receiving adjuvant therapy during post-esophagectomy recovery could be explained by the core categories of ‘narrowing of sphere of daily life’ and ‘accepting narrowing of sphere of daily life and acquiring a personalized way of life in exchange for being alive’. This process began with the subcategory “realization of unlikelihood of returning to original state” caused by “considerably greater pain than expected and damaged eating and swallowing behavior”. Although some patients perceived this realization as “loss of eating ability is only to be expected”, others had mixed feelings of “self-questioning regarding the meaning of undergoing esophageal surgery” and “inability to decide whether this was something that could happen to anyone” but were satisfied by “comparing food-related symptoms with other patients”. Both of these patients groups talked at this stage about “exchange for being alive” and while facing “difficulty living life as before” they continually attempted “to increase their food intake through trial and error” with the feeling of “pressure to recover from surrounding expectations”.
However, these attempts were protracted compared to post-operative adjuvant therapy and this caused “anxiety regarding economic hardship caused by loss of employment” and “narrowing of functional range”. However, through recalling their talk of “exchange for being alive” and objectively viewing their physical status, patients developed “realization of recovery over time” and “expectations of recovery accompanying increase in food intake capacity”. They acquired a new set of values comprising “changing lifestyle to date” and “living a health-based lifestyle”, and by “searching for a personalized way of life while trying to adapt”, they ultimately achieved lifestyle restructuring. Post-operative “fear of metastasis, relapse and cancer onset at a different location” constantly constituted a core part of the patient’s mental state.
