Abstract

This study developed a scale that measures concern of cancer patients undergoing chemotherapy, then investigated the reliability and validity of this new scale. First, a questionnaire consisting of 30 items was developed. For each item, there were four possible answers that had been chosen based on the literature and our previous qualitative study. Subjects were 206（males 83, females 123, average age 57.3 ± 10.7 years）cancer patients who were undergoing chemotherapy at two hospitals. After excluding statistically inappropriate items from the study, factor analysis was performed by principal factor analysis and Varian rotation. The study protocol was approved by the institutional review boards at both hospitals.

Four factors with 15 items were finally obtained : Self―existence, disease progress, reorganization of daily life and social and economic concerns. The 15 items were defined as the Cancer―chemotherapy Concerns Rating Scale（CCRS）．The cumulative contribution percentage after extracting these factors was 48.6％. The reliability of CCRS was investigated by Cronbach’s alpha and Spearman―Brown’s coefficient. These were 0.88 and 0.89 respectively. The validity of CCRS was investigated through content validity, concurrent validity and discriminate validity. Concurrent validity was confirmed by STAI（r＝0.42, p＜0.001）and Stress Responses Scale―18（r＝0.634, p＜0.001），and discriminate validity was found between high and low stressed subjects.

The above findings indicate that the CCRS is sufficiently reliable and valid for practical use.

Abstract

The purpose of this study was to conduct support group meetings for family members of inpatients in a palliative care unit and to identify the characteristics and meanings of the family members’ narratives. Support group meetings were conducted in the palliative care unit. With the participants’ consent, the dialogue between participants was recorded and analyzed qualitatively in order to determine the meaning of the narratives.

The following seven categories were extracted during the analysis: (a) The patient’s and family’s course and distress until admission to the palliative care unit, (b) The patient’s condition is noticeably declining, (c) Awareness that the patient continues to live while facing death, (d) Feelings of family members who are upset by the change in the patient’s condition, (e) The family members’ attitudes toward dealing with difficult situations, (f) Realizations of family members who attend to the patient and are faced with problems, and (g) What the family gained from participating in support group meetings. According to these results, the family members had various feelings and experiences regarding patients whose conditions varied from hour to hour.

Joining support group meetings allowed the families to give meaning to their own experiences by talking with others, and provided opportunities to give and receive sympathy and encouragement. These findings suggest that support group meetings in palliative care units are useful for providing opportunities to talk with other individuals who are in a similar situation.

Abstract

Prostate cancer is detected earlier with the spread of prostate specific antigen（PSA）screening test. Some of the patients with early stage localized prostate cancer choose regular checks of PSA : watchful waiting, instead of active treatment. The purpose of this study is to investigate men’s experience living with untreated prostate cancer and to suggest nursing care.

13 men were interviewed using a semi-structured interview about their own meanings of living with untreated prostate cancer. The data were analyzed qualitatively referring to phenomenological approach inspired by Colaizzi.

As a result, we identified 6 essentials of experience living with untreated prostate cancer ―“View of the diagnosis”, “Understanding the choice of treatment at present”, “Uncertainty of the future and feelings tossed by PSA”, “Attitude coping with the disease for himself”, “Trust and feelings regarding his physician”, and “Feelings toward people surrounding him”. Then, we created the “Figure of men’s experience living with untreated prostate cancer” based on these 6 essentials.

We can see the direction to provide care suitable for each man, when we know how he understands these 6 essentials. We need to know how they understand the diagnosis told by their physicians, what disturbs them, and how they cope with the uncertainty. Then we can provide the information to increase the understanding of each man. We need to adjust the relationships between the men and the physicians, and the men and people surrounding them if they feel lonely because of their relationships or the gaps in understanding. Of course, we need to understand their solitude and anxiety. Nurses need to watch over reticent men and adjust the resources they need. Then nurses could become one of their resources.

Abstract

The purpose of this study is to make clear the emotional reaction process concerning treatment continuance for digestive cancer patients who had experienced metastasis or exacerbation of cancer during chemotherapy and to examine their nursing support.

Data was collected from 10 participants through participant observation and semi-structured interviews, which were analyzed by qualitative inductive analysis.

As a result, 4 phases were found in the emotional reaction process. Phase 1: “Beginning chemotherapy under both hope and hesitation”, Phase 2: “Continuance of chemotherapy as the balance between life and side effects is weighed”, Phase 3: “Emotional disorder due to cancer deterioration”, and Phase 4: “Readjusting oneself to face cancer itself”. In the series of emotional reactions, 4 types of reactions were clear: “emotionally expressive type”, “emotion-controlling type”, “experience-mediated emotion adaptational type”, and “dilemma type”.

In the emotional reaction process of digestive cancer patients who experienced metastasis or exacerbation during chemotherapy, each patient gave a different meaning in “chemotherapy continuance”, in spite of the fact that all patients decided to continue treatment upon all phases. Also, it has been observed that independence of patients in decision making differed depending on the patient’s introspection and external environment.

As for nursing support concerning patient decisions on treatment accompanying cancer progression, it is important that the roles of nurses in a medical team be established and that patients and their family could receive guidance from the point of initial treatment presentation so that patients suffering from the uncertainty of the future could receive guidance at the right moment.

Abstract

This qualitative study investigates how family caregivers come to terms with having a terminally ill member. Coming to terms was defined as coping. The concept of coming to terms involved several themes, including facing the inevitability of death, conflicts, and conflict resolution. The subjects were 19 family caregivers in a palliative care and general hospital care setting. A semi-structured taped interview and observations were used to collect data, and the Content Analysis Method by Krippendorff was used to analyze data. Ways of coming to terms were “focusing on the evidence to accept the existing situation” “finding positives” “finding ways of avoiding trouble” “sharing the burden” “finding approaches to solving disagreements” “accepting resignation” and “changing one’s way of giving care”. Ways of coming to terms were used to resolve conflicts. The researcher suggests that these ways of coming to terms have three functions: to accept the dying process and one’s own caregiving behavior, to protect oneself from burden, and to try to keep giving care.

Abstract

The purpose of this study was to identify the illness course experienced by patients with hematopoietic malignancy who have undergone hematopoietic stem cell transplantation, during the period from the onset to the post-transplantation, and to find ideas for recommended nursing care for the patients. We had semi-structured interviews with 8 such patients within 5-year survival, and the data was analyzed using the life history research method.

The illness courses experienced and narrated by the participants had the following 7 phases:（1）They see their symptoms lightly,（2）They suspect themselves to be seriously ill,（3）They are shocked and confused knowing they have an incurable disease, and fear death,（4）They hope for life and face up to their diseases,（5）They continue to receive treatment to live even though their physical and mental/emotional condition deteriorates through repeated treatment,（6）They start to fear death again because of increasing physical and mental/emotional suffering from hematopoietic stem cell transplantation,（7）They construct new lives fearing the recurrence of the disease and eventual death. Accordingly we were able to integrate the mental/emotional process of the patients from the illness onset up to the post-transplantation, which had been previously been regarded, separately.

From our result, it is possible to anticipate to some extent the mental/emotional phases which patients with hematopoietic malignancy have gone and will go through, and this enables the practice of appropriate and timely nursing care for them.

Abstract

The purpose of this study is to describe and interpret the experiences of self-integration in outpatients with recurrent breast cancer, and identify the meaning of their experiences. Non―structural interviews were conducted with four patients. The data were analyzed using qualitative and descriptive methods based on phenomenology to explore the implications of their subjective experiences. Two major themes emerged from the analysis : to accept the reality and live in the present ; and to live by one’s own values through the relationship with others. According to the Heidegger hermeneutical approach, it is rooted in temporality : the original unity of the future, the past and the present. It implies accepting painful reality, seeking for being oneself and new possibilities and living fully in the present moment. It also indicates being oneself in the open relationship with reliable others, and living at one’s own will. Even in harsh reality, achieving one’s potential would bring a better future. The results suggest that the patients direct themselves toward self-integration through these experiences. Thus, the existence of the significant others and talking to them are vital.