Abstract

The purpose of this research was to gain a better understanding of the factors that improve outcomes for cancer patients who receive outpatient chemotherapy, and provide appropriate suggestions for improving care. We performed semi-structured interviews with ten cancer patients who received outpatient chemotherapy. We then coded the data and conducted a factor-based comparative analysis. The results indicated that the following four factors improved outcomes in cancer patients after outpatient chemotherapy : “belief in living life,” “acknowledging the loss of function,” “creating one’s own circumstances,” and “discovering value in everyday life.”

“Belief in living life” appeared to be a driving force for the other three factors. In our study, patients were intensely involved in things they were capable of doing on their own and held a strong belief in living life. In order to move forward with the reality of having cancer and the effects of chemotherapy, patients created their own ideal circumstances and discovered values in everyday life by fostering a greater awareness of life and developing gratitude for everyday things. Patients approached their situation with eagerness. We believe that nurses can strengthen and accelerate a patient’s ability to move forward and adapt by supporting a patient's desire to live. This will help patients incorporate outpatient chemotherapy into their lives and continue to live a proactive life while in therapy.

Abstract

The aims of this study were to elucidate the sorts of difficulties experienced by patients with breast cancer during the process of selecting their initial treatment, and to identify nursing interventions to support patients’ decision-making. The participants in this study were 21 women diagnosed with stage Ⅰ or Ⅱ breast cancer who were offered options as to their initial treatment by their treating physicians. Data were collected through semi-structured interviews and participant observations, and were evaluated using qualitative induction analysis.

We identified 8 categories of difficulty, comprising “inability to properly understand and create a mental image of my condition”, “difficulty making decisions in an uncertain situation based on generalisations”, “hesitation and holding back in discussing things with doctors and nurses”, “not wanting to be a burden to the family, and can’t expect support from them”, “too anxious and worried about everything”, “inability to think clearly due to feelings of distress and unfairness”, “troubled by mood swings under the influence of too much information and other people”, and “feeling overwhelmed by the weight of responsibility in making life and death decisions”. The core problem for these patients with breast cancer was their inability to think clearly when they were asked to make a decision in spite of their unstable emotional state. Difficulty in identifying the basis for their decision-making, difficulty obtaining support from their families and medical service providers, and the weight of responsibility in making life and death decisions, were factors that further destabilised their emotional states.

Abstract

This study aimed to implement and improve the effectiveness of an outpatient nursing support program developed by the authors (2003) to facilitate postoperative rehabilitation of gastrointestinal cancer patients and their family members. Subjects were adult patients who underwent surgery for gastrointestinal cancer after being informed that they had cancer and who regularly received post-operative outpatient treatment, and their family members. During a two-month period, the previously developed nursing support program was conducted by the first author who is a nurse. Responses regarding the support program were collected as descriptive data through participant observation and semi-structured interviews. The protocol of this research was approved in advance by the ethics committees of the participating facilities. Data were analyzed by qualitative and inductive methods and any description of “changes observed in the subjects” and “nursing support” observed to have elicited such changes were extracted. Data obtained from 20 sets of patients and family members about changes observed in the subjects were sorted into 14 categories of 4 different meaning groups including “balanced self-esteem” and “ability to look after one’s own health”. The data also indicated that the nursing support could be sorted into 9 categories of 3 different meaning groups including “helping patients to open their minds” and “inducing inner power”. Consequently, 4 specific nursing support practices were identified that should be the focus of an effective outpatient nursing support program that facilitates the post-operative rehabilitation of gastrointestinal cancer patients and their family members. These included “facilitating acceptance of changes in physical and psychosocial status following surgery for gastrointestinal cancer and inducing self-affirmation to sustain energy to live with the disease”. The improved support practices include “sharing emotions and life experiences and recognizing efforts for rehabilitation”.