Abstract

Along with the growing incidence of cancer, an increasing number of patients seek treatment in stage I, which is an early stage of the disease. The five-year survival rate for patients with stage I stomach or uterine cancer is more than 90%, demonstrating that many of these patients live the rest of their lives as cancer survivors. However, only a few studies have focused on the early stage of cancer. The objective of this study was to examine the process of disease acceptance in cancer survivors with stomach cancer who underwent surgery in stage I. Semi-structured interviews were conducted with 27 cancer survivors who underwent surgery within 5 years prior to the study. The collected data were analyzed using a modified grounded theory approach. The process of disease acceptance in stomach cancer survivors who underwent surgery in stage I included “facing a limited life as a result of being diagnosed with cancer”, “becoming aware of the fortunate recovery of life”, and “living his/her recovered life”. For this unidirectional change, “regaining daily living activities previously lost due to cancer diagnosis and surgery” and “receiving benefits from early treatment” by “recovering normality” were essential. In nursing support, therefore, it may be effective to indicate practical approaches to recover lost activities and normality. Further, the patient's need to access information on cancer, which was frequently observed in this study, suggests the need for provision of practical information, such as experiences of peers who were treated in the same hospital, made available long-term through accessible sources.

Abstract

The primary aim of this study was to identify the components of influence on physicians and nurses participating in clinical ethics case conferences using the four quadrants approach described by Jonsen et al. The second aim was to determine how physicians and nurses feel about clinical ethics, through qualitative interviews. From March 2006, we scheduled a weekly conference in the Hematology Ward. Three physicians and ten nurses were recruited from the ward for semi-structured interviews. Content analysis was applied to their answers；14 categories were extracted and classified into the following 4 core categories as the components of influence on nurses: (1) self-growth, (2) awareness of the primary nurse, (3) awareness of the importance of the team approach and (4) sense of accomplishment. Alternatively, 8 categories were extracted and classified into the following 4 core categories as the components of influence on physicians: (1) self-growth, (2) awareness of the importance of the team approach, (3) understanding nurses’ professional development, and (4) increase in motivation of the medical care team. We then presented 6 categories as clinical ethics issues considered by physicians and nurses: (1) patient distrust of nurses and physicians, and nurse and physician distrust and negative response to patients, (2) anxiety and hesitation due to many serious decisions, (3) immature ability to address problems, (4) dilemma of treatment strategy, (5) weaknesses in communication between physicians and nurses, and (6) physicians’ limited opportunities to think about the psychological aspects of the patient. Through the conference using the four quadrants approach, nurses were able to understand patients from many perspectives including disease status, medical indications, patient preferences, patient quality of life, and contextual features. Physicians recognized that the professional development of individual nurses created an atmosphere change for the entire ward. The conference is an opportunity for the nurses to share their perceptions with physicians, which benefits the team approach. The conference is useful for physicians and nurses to discuss resolving clinical ethics issues and understanding detailed information about patients as individuals.

Abstract

This study aimed to clarify physical and psychological suffering during the medical care process of females with breast cancer, and build a structural model. We conducted semi-structured interviews with 7 females during or after breast cancer treatment, and performed qualitative inductive analysis.

Concerning suffering experienced by the females during the medical care process, the first consultation was performed in a state of “focused therapy”, and the females “became aware of their life”, and experienced “pain caused by the waiting period for treatment”. Until admission, they constantly “hated cancer”, repeatedly “predicted the outcome” and “were controlled by emotions”, and lived while being aware of death. From admission until surgery, “strong conflict” continued even after they decided to undergo treatment. After surgery, while developing “adverse physical and psychological reactions”, they had “a feeling of inconsistency with no way to resolve this” and felt “self-alienation in medical care”. Negative feelings toward additional treatment were expressed as “veiled emotion”. Since treatment had priority over life, they had “a feeling of being weak” despite their “self-alienation”. Concerning additional treatment, they sometimes “not have treatment due to uncontrollable matters” in their life. In radiotherapy, they “fought against a latent fear” of X-ray exposure, but made “efforts toward continuation and maintenance”. In chemotherapy, while they experienced “related side effects”, they “behaved normally in daily life” but were “affected by the necessity of continuing treatment”. In endocrine therapy, while “physical symptoms develop as a result of abnormal hormone suppression” , women “maintained their fight against the disease” with “an objective view of treatment”. In regular examinations, they made efforts while “feeling responsible for their body” despite “physical and psychological exhaustion”. Their fight against the disease was maintained by “receiving supportive information from females with the same experience”, but “awareness of the disease” markedly increased during every examination.

This suggests that breast cancer patients are strongly affected by treatment not only during treatment, but also the entire medical care process, which markedly affects their gender roles.

Abstract

The purpose of this study was to clarify visiting and hospital nurses’ evaluations of prognostic items for patients with terminal lung, stomach, and colorectal cancer.

Nurses with more than 5 years of clinical experience responded to an original questionnaire survey about prognostic items. Data were collected from twenty-seven visiting nurses and seventeen hospital nurses.

Prognostic items that were recognized as appropriate by both visiting and hospital nurses included： “dyspnea during rest” in patients with lung cancer； “ascites” in patients with stomach cancer and “oliguria/anuria” in patients with colorectal cancer as the ten-day prognosis. “Drowsiness” and “oliguria/anuria” in patients with terminal lung, stomach, and colorectal cancer were related to the three-day prognosis. Among the items that were not recognized as appropriate by both visiting and hospital nurses was “pressure ulcer”, which was related to both the ten-day and three-day prognosis in patients with lung, stomach, and colorectal cancer.

The items that were recognized as appropriate only by visiting nurses included： “decreased talking” in patients with lung cancer； “bed bound” in patients with stomach cancer, and “dysphagia” in patients with colorectal cancer, which was related to the ten-day prognosis, and “coma” in patients with lung cancer, “strong pulse” in patients with stomach cancer, and “arrhythmia” in patients with colorectal cancer, which was related to the three-day prognosis.

Only the items that both visiting and hospital nurses recognized as appropriate were considered to have validity because these items were related to invasive cancer and reduced physical function. The differences in evaluations between visiting and hospital nurses might be related to variations in the availability of medical devices and medicine in homes and hospitals. To offer seamless care, it is needed for visiting and hospital nurses to consider their differences in determining the items and to share information about the patients.

Abstract

This study aimed to clarify how patients go through cancer clinical trials and to identify nursing interventions to support cancer patients. This study investigated seven advanced cancer patients who participated for the first time in phase 1 or 2 of clinical trials of anticancer drugs. Semi-structured interviews were used to collect data on the experiences of participants from trial recruitment to trial completion. These data were analyzed using the phenomenological methods of A. Giorgi. The 29 themes that emerged from the analysis according to the clinical trial process were divided into two periods. The first period is “Patients’ experience of trial recruitment up to decision-making.” During this period, participants faced the fear of death if they were not participating in a cancer clinical trail, by experiencing the impact of cancer diagnosis and disease progression. The second period is “Patients’ experience in the cancer clinical trial from the beginning to the end.” In this period, the fear of death spurred participants to continue the trial as a duty even though the burden of the clinical trial caught them in a dilemma. Moreover, participants were frustrated and perplexed when the trial was suddenly stopped unexpectedly. The results suggest the need for nurses to be aware of the fear that makes advanced cancer patients vulnerable and the need to reduce their burden in order to continue a clinical trial. The results also show the importance of nurses providing support for cancer patients regardless of the outcome of clinical trials.