Abstract

The objective of the present study was to develop a means of evaluating the “coping ability” of liver cancer patients continuing to fight the disease. A 90─item draft questionnaire was developed, based on the conceptual framework of Orem’s theory, and data were collected from semi─structured interviews of 21 liver cancer patients. The face validity of the draft questionnaire was first investigated in a survey of 15 liver cancer patients, and the number of items was reduced to 46. Next, the construct validity and internal consistency of the modified questionnaire were evaluated in a survey of 92 liver cancer patients. After examining factor loadings obtained from factor analysis, we developed the final draft, which comprised 25 items classified into 4 subscales : “recovery behavior”, “feelings about support”, “expectations of medical treatment”, and “motivation and faith”. Cronbach’s α coefficient was 0.89 for the entire questionnaire, and between 0.68 and 0.85 for each subscale, indicating internal consistency. Based on these findings, the reliability and validity of the questionnaire were confirmed to be acceptable. Coping ability tended to be also affected by age and the number of facilities visited, so the questionnaire will be further refined according to the results of the present study.

Abstract

We wanted to identify the particular difficulties in resuming meals experienced by patients who had undergone esophagectomy and reconstruction with 3―field lymph node dissection for esophageal cancer, from the early postoperative period, until shortly after discharge from hospital, and to examine the nursing care required to support the process. The subjects were 9 patients who had undergone right―thoracotomy thoraco―abdominal esophagectomy and thoracic wall anterior gastric reconstruction for cancer of the thoracic esophagus, and in whom oral feeding had been started. Data were collected by interview and observations, and were evaluated by qualitative induction analysis. We identified 9 categories of difficulty, including “It takes a great effort just to get ready to eat”, “Swallowing, digestion, and absorption are all hard”, “It is impossible to predict, prevent, or cope with unpleasant symptoms”, “Unpleasant symptoms affect activities of daily living”, and “Unable to eat even though wanting to”. The 4 components of difficulty in resuming meals were :（1）attitude towards meals,（2）development of unpleasant symptoms and difficulty predicting them,（3）interference with quality of life, and（4）loss of the pleasure associated with meals. These findings suggested that nursing care to encourage resumption of meals needs to be based on symptom assessments, individual meal design, and helping patients find new pleasures and a creative life.

Abstract

The purpose of this study was to assess the experiences of esophageal cancer patients undergoing both esophagectomy and laryngectomy, and to identify the appropriate nursing intervention for these patients.

A semi―structured questionnaire was designed to gather the following data : disease information, and therapy received from the attending physician prior to surgery ; patient feelings when told of the necessity for laryngectomy ; factors that influenced the decision to undergo surgery ; feelings postoperatively due to loss of voice; difficulties related to activities of daily living other than loss of voice ; and lifestyle modifications made to cope with limitations due to surgery. Each patient was interviewed using open―ended questions, guided by the questionnaire. Verbal language was the main mode of communication during the interviews. Because the subjects had undergone laryngectomies, we confirmed the contents of interviews through writing and gesture.

Content analysis of the interviews was used to define the following seven major categories related to the experiences of esophageal cancer patients: “have burdensome symptoms related to respiration, sensation or eating” ; “have difficulty accepting that they can not resume their previous lifestyle” ; “become angry and frustrated when unable to communicate verbally” ; “feel self-hatred for troubling other people and living with a surgically altered body part” ; “have a continued fear of cancer and death” ; “can not calmly accept the surgically constructed tracheal stoma” ; and, “individually modify each activity of daily living based on the experiences of other patients in the same situation”.