Abstract

The present study was undertaken to investigate how patients diagnosed with HCV-induced liver cirrhosis or cancer face and deal with their illness. The study used semi-structured interviews of 12 patients with HCV-induced liver cirrhosis or cancer who had been told the true nature of their illness. The data were analyzed using a grounded-theory approach.

During the interview, the patients reviewed their experience with their disease. Many reported that they had come to terms with the strong wish to survive（which they had begun to be aware of after their first recognition of their diagnosis with a potentially life-threatening illness）by attaining the view that they had already lived good and full lives. The patients described the course of changes of their views about life. While their condition went through repeated cycles of recurrence, commencement of treatment and success in treatment, their feelings or perceptions about life swung like a pendulum. The central balance state was characterized as : “I have to accept the advance of this illness”. The two polar feeling states were expressed as : “My life will continue to be saved by this treatment” and “Death is inevitable and I am destined to die”.

The coming to terms with the strong desire to survive in the face of their first recognition they were possibly facing death can probably be explained by successful integration of memories surveying the courses of their lives. However, the feeling : “My life will continue to be saved by this treatment” persisted until the terminal stage, and this probably kept the patient from completely accepting death even though he/she was striving to accept it. Because, after the patients became aware they were facing death, their goal became achieving an extended life through treatment, their feelings about clinging to life continued to swing like a pendulum.

Abstract

The aim of this study was to develop and evaluate a psychoeducational nursing intervention program to help patients diagnosed to have breast cancer overcome the crisis, positively face the disease and its treatment, and improve their QOL through their own.

The subjects were those who consented to enrollment in the study among patients aged 65 years or below diagnosed to have breast cancer and scheduled to undergo surgery for the first time. The program consisted of : 1）promoting appropriate understanding of the disease and its treatment, 2）supporting their physical condition, 3）supporting their psychological state, and 4）fulfilling the needs for learning about the disease and treatment. This program was conducted in 4 sessions individually to each patient for about 2 months between 1 week after disclosure of the diagnosis and 1 month after discharge（intervention group ; 20 patients）. Data were also collected from a group to which the program was not conducted（control group ; 20 patients）and the control group firstly were collected data. Each patient was evaluated before, immediately after and 1 month after intervention using the Japanese version of POMS, Japanese version of MAC, and a QOL questionnaire. The data were analyzed by two-way analysis of variance with repeated measurements in the two groups and by stratification of the subjects according to the disease stage and surgical procedure to evaluate the effect of the program.

The intervention group showed better improvements in the mood state, mental adjustment to cancer, and QOL than the control group until 1 month after intervention, but the differences between the two groups were not significant. In stages Ⅱ-Ⅳ, depression-dejection（p＝0.022）, fighting spirit（p＝0.03）, and hopelessness / helplessness（p＝0.077）were significantly better in the intervention group than in the control group until 1 month after intervention.

The results of this study suggested that the program produces significant improvement in the mood state and mental adjustment to cancer in stages Ⅱ-Ⅳ of patients with breast cancer.

Abstract

The purpose of this study was to identify the process of expanding consciousness of elderly patients with cancer in a patient-researcher caring partnership based on Margaret Newman’s theory of health. Research and practice were bridged in a qualitative, longitudinal approach. The participants consisted of six elderly patients（65-80 years old） who were suffering from cancer and who had experience in receiving cancer treatments after diagnosis. The participants had at least three meetings with a researcher to talk about meaningful relationship and events in their lives and to facilitate better understandings between them and the researcher.

The pattern of the participants revealed ‘priority to others’, ‘lack of expression of one’s own feelings’, and ‘live up to one’s principles’. A transformation occurred in the process of the caring partnership when participants realized their own patterns and knew that the more they tried to continue this way of life, the more they would be suffered. Once fully realizing this, they immediately became cognizant of their true feelings. The realities of their lives became more acceptable and pleasing by gaining a new sense of values and beliefs. This phenomenon was also similar in the participant who accomplished transformation through death.

It is suggested that the caring partnership within Newman’s theory can be benefit to elderly patients with cancer who are facing predicaments and struggling in their decreased self-esteem due to aging and cancer.