Abstract

Purposes: To clarify elements related to promoting cooperation between peer counselors and healthcare pro viders in cancer care based on peer counselorsʼ experiences and feelings and to explore strategies for promoting such cooperation. Method: We conducted semi-structured interviews with six peer counselors who were members of the NPO cancer patients support organization in Japan and who were in charge of peer counseling at a cancer consultation support center. We then qualitatively and inductively analyzed their responses. Results: There were three strategies that promoted cooperation between peer counselors and healthcare pro viders in cancer care: “formation of a membership system in medical care teams,” “improvement of peer counsel ing mindsets and skills,” and “enhancement of counseling environment and services.” Discussion: As a result of examining the association of each category, forming membership systems in medi cal care teams and improving peer counseling mindsets were considered core strategies for promoting coopera tion. These two categories influenced each other because demonstrating a peer counseling mindset accelerated peer counselors presence in the medical care team and allowed them to play an important part. It was also shown that the need to improve infrastructure of the counseling environment and services is a fundamental strategy for promoting cooperation. Conclusion: Useful strategies for promoting cooperation between peer counselors and healthcare providers in cancer care are required to maintain an adequate environment for the peer counselors to work, to better under stand aspects that lead to the ambivalence of peer counselors, and to improve the motivation of peer counselors.

Abstract

This study aimed to identify stress and coping of nurses caring for cancer patients with dementia who are hospitalized in the hospice and Palliative Care Unit (PCU). Semi-structured interviews were conducted involving 12 nurses with experience in providing care for cancer patients with dementia in the PCU. The obtained data was analyzed using an ethnographic approach. From the results, 12 categories were extracted, and the following types of stress and coping issues were identified: 1. The nurses had experienced stress over the care of cancer patients with dementia, and felt 〈difficulties when standard nursing care plans couldnʼt be applied〉. To cope with the stress, they 〈had developed and practiced various types of care based on their clinical experiences〉. 2. Their coping methods were based on 〈focusing on relieving pain and providing patients with a peace of mind〉. 3. Finding ways to cope resulted in the nurses feeling as follows: 〈if we donʼt give up, it is possible to offer appropriate palliative care based on the traits of dementia〉. On the other hand, some nurses 〈had failed to achieve effective care and medication despite their efforts〉, and so such nurses 〈had chosen to shift the focus of care from patients to families in end-of-life care〉. Irrespective of this, 〈families were satisfied with the end-of-life care and created trusting relationships with the nurses〉. In order to reduce the stress of nurses caring for patients with dementia, it is important for them to acquire knowledge of delirium or behavioral and psychological symptoms of dementia to help them achieve effective care, and establish a system to promote cooperation with other healthcare professionals working outside hospitals.

Abstract

The purpose of this study was to clarify the psychological stress caused by numbness during colorectal cancer chemotherapy and methods for addressing the stress, and then to explore methods to help patients continue their treatment while maintaining their QOL. The subjects were 16 patients who had received ≥ 10 doses of oxaliplatin at a total dosage of ≥ 850 mg/m ² , and who agreed to participate in this study. A semi-structural interview using an interview guide was conducted and qualitative inductive analysis was performed. Based on the results, the psychological stress could be classified into three categories: “anxiety and a helpless feeling related to un-selfcontrollable numbness,” “aversion or sadness towards the numbness constraining their behavior,” and “a sense of alienation due to numbness.” The methods for addressing the stresses were classified into two categories: “To convince them to accept the numbness by changing their understanding of numbness,” and “To explore a method to address the numbness while enlisting othersʼ cooperation.” The findings suggested that the nursing staff must obtain details of the patientʼs psychological stress associated with the numbness and devise a method to address the stress both objectively and subjectively, detect anxiety and/or depression early, and determine the feasibility of continuing treatment subjectively.

Abstract

Background：Hand-foot syndrome（HFS）adversely affects quality of life. There are many factors to consider regarding the management of HFS and patientsʼ daily life. However, self-management of HFS is not fully understood. Aim：To explore how breast cancer patients treated with capecitabine prevent or manage HFS. Methods：Twenty one recurrent or advanced breast cancer patients who were treated with capecitabine were enrolled in this study. Data was collected by semi-structured interviews based on the interview guidelines. All interviews were recorded and transcribed verbatim, and analyzed using qualitative data analysis. Results：Breast cancer patientsʼ management of HFS was described as “Achieving a good balance between continuing the treatment and maintaining quality of life”. This included five categories:（1）“Risk perception for damage caused by HFS”,（2）“Awareness of skin alterations”,（3）“Efforts to care for skin alterations”,（4）“Prospects related to continuance of self care”, and（5）“Accommodating the differences between actual health status and treatment goals”. These five categories were identified as a cyclical pr.（5）“Accommodating the differences between actual health status and treatment goals” means reconsidering life priorities, alterating treatment goals, and searching for meaning related to experiences of treatment. The participants pursue the act of “Achieving a good balance between continuing the treatment and maintaining quality of life” while considering how HFS affects their own life. Conclusion: Healthcare providers must not only provide knowledge but also help patients make inportant life decisions related to treatment. Then, we can send them down the correct path towards self-management.

Abstract

Objectives：To identify the experiences of medication adherence of patients with recurrent or metastatic breast cancer. Methods：Qualitative descriptive study. Participants：Four female outpatients with recurrent or metastatic breast cancer receiving oral chemotherapy at a university hospital in Tokyo. Data collection：We conducted longitudinal semi-structured interviews （3-4 times） in a private room at an outpatient clinic. Questions included, “How do you manage your current oral chemotherapy?” and, “What is the significance of oral chemotherapy for you?” Results：The following themes emerged from the reported experiences of the four participants：“An imbalance between the threat of death and daily living”（ participant A）; “Inner conflict between the value of maintaining a normal life and when to withdraw from treatment”（ participant B）; “Inner conflict over significance of uncomfortable medication”（ participant C）; and “Reminding oneself to continue medication for survival” （participant D）. Patients gave the oral anticancer drugs meaning as a “savior” or “means for survival” and adhered to medication when the threat of death or anxiety increased. However, when the threat of death was relieved, when they were concerned about physical harm, or when increased feelings of avoiding taking medicine occurred, they repeatedly skipped medication either unintentionally or intentionally. Conclusions：Patients with recurrent or metastatic breast cancer experienced ambivalent feelings about oral chemotherapy between positive emotions：recognition of gratitude and expectation of treatment; and negative emotions：recognition of physical harm and uncertain treatment effects. In addition, patients created a meaning for the treatment through repeated self-reflection of their life and values. These values regarding oral chemotherapy affected their medication behavior, such as skipping medication unintentionally, intentionally or adhering to medication. In conclusion, other provisions in addition to medication adherence support are required. Support based on understanding the meanings of patient behavior and/or suppressed emotions is vital.

Abstract

Purposes: Various treatment strategies are available for prostate cancer. Therefore, patients often have anxiety and emotional conflicts at the time of treatment selection. This study was aimed at identifying the decisionmaking process of patients who chose carbon ion radiotherapy and to examine the need for nursing support. Methods: The study was conducted in 14 patients who started receiving carbon ion radiotherapy treatment for prostate cancer during the past 1 year. Data were analyzed using the modified grounded theory approach. Results: During this process, the patients were at first shocked by the diagnosis of cancer, but were then ready to acquire information on the treatment options available for prostate cancer. Thereafter, they were able to identify the value of treatments based on their beliefs, and were convinced that carbon ion radiotherapy was the optimal treatment. Conclusions: The characteristics of this decision-making process were that once they made up their minds, the decision of the patients remained unchanged, and they had made the decision with their post-treatment life in mind. It is important to support patients not only by caring for their physical needs, but also by understanding their mental state, so that they can make choices by keeping in mind their social life after treatment.