Patients and Cancer

This paper explores different peer-reviewed articles that attempts to shed some light on the phenomenon of the lived experience of patients with cancer; supporting the fact that individuality is a huge factor in the care of cancer patients. Manu types of cancers exist and patients should be treated as individuals versus as a disease or diagnosis. As oncology nurses we accumulate knowledge on a daily basis that may be revised in practice. Therefore, it becomes our innate duty to visit the literature and gain the understanding and evidence that will help us in improving our practice of nursing.

The articles, however, vary in the type of cancer with different treatment modalities and the collection methods but have the commonality of all participants being diagnosed with Cancer. The findings showed that patients have many unmet psychosocial and emotional needs among others but exercise hope when family support is present. These shortcomings or gaps in knowledge can alter how care is received and administered. We as nurses, have a lot of work to do in assisting patients feel more individualized with the diagnosis of Cancer.

Each day in practice we meet new patients and see old ones and we may see them smile or get sad or display other emotions but as nurses do not take enough time to find out what our patients face and how they handle their diagnoses of cancer. As nurses we get so wrapped up in our daily tasks. Cancer is an experience that can threaten not only the end of one’s life, but also touch all aspects of the person’s existence, making it significant to them and if it is significant to them then it should also be the same to us.

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Cancer also imposes so many burdens on patients, families and the society at large. So large that it is labeled the silent killer and will overtake disease as top killer by the end of 2010 (foxnews. com). I chose this topic because I realize the gap in knowledge and communication between what happens to patients between diagnoses, treatment and discharge, up to the time they return for follow -up cycles to the time they may hear that the cancer has either metastasis or have been cured (in remission).

Just knowing that your life will change is significant enough. We, as nurses are first line in the patient care area. The Doctor walks in and tells the patient that they have cancer and then walk out and the nurse is faced with the aftermath, the questions and the emotions that follow. The nurse is also the one that administers the chemotherapy and various radiation treatments and again is faced with questions and emotions. At discharge the nurse again becomes the one that is faced with questions and emotions.

It may not be possible to answer all the questions and for the ones that we are not sure of, we can refer or ask the doctor to explain but having the knowledge of what it may be like for these cancer patients can help with how we approach these questions and the treatment options. Having this knowledge can help in terms of support, teaching, prevention and alleviation of suffering, enabling us to give more culturally congruent care. Literature Review In Arber et al. s (2008) article on the lived experience of patients with pleural mesothelioma it was found that these patients had many unmet psychosocial and emotional needs and that there was a lack of information provided to patients . A feeling of isolation was also reported. All patients and care givers experienced frustration due to the physical experience (Arber et al. , 2008). It was showed that these patients wanted to tell their stories and wanted people to listen. The methodology was phenomenology which was appropriate for the study with unstructured interview questions allowing for participants to speak their mind and their experiences.

As nurses sometimes we are unsure of what to say for fear of saying the wrong thing. There was also evidence of loss of intimacy with partners. Macmillan Cancer support (2006) states that four out of ten couples where one partner has cancer report sexual problems (Arber et al. , 2008). The study was done only on patients with mesothelioma and was very small making it hard to generalize to other cancer areas. The patients and families were only from a specialist palliative community center assuming that these patients had incurable mesothelioma.

Benzein et al. , (2005) studied cancer in palliative care in home care and made hope the center of the study. The findings showed that the participants used hope to live as normally as possible. The meaning of the experience of hope seemed to be a will to live for a while longer (Benzein et al. , 2005). The structural analysis revealed the hope of being cured, a hope of living as normally as possible, a presence of confirmative relationships and reconciliation with life and death.

The commonality between this article and Arber et al. , 2008 is that these cancers were incurable, however in this article the study group was a mix of males and females ages 54-83 with a median age of 65. The previous article failed to reveal the ages of the participants, making it difficult to impact practice. The other difference is that the latter was done in the patient’s own homes while the study on patients with mesothelioma was done in a different setting that may influence the outcome.

Being surrounded by loved ones in the home setting would allow the patient to feel more human, than being in a hospital setting where they are just another patient and loved ones may not be able to visit at lib, which in the end has a negative impact on recovery. Demir et al. , (2008) in their quest to understand the experience of breast cancer survivors that underwent biopsies used a phenomenological approach to reveal three themes that were evident among participants, namely, the need for information, fear and spiritual needs.

The study also suggests that results may be different considering different emotional investments in their breasts, sociocultural factors and age. The study was a very small group of twenty with the interviews being held in an unused room outside the clinic before the patients postoperative visits. Having the interviews on postoperative days may further aggravate feelings of fear that could invalidate the study. When compared to the study done by Perreault et al. , (2005) similarities were evident as participants exhibited fear and uncertainty. This study studied women with breast cancer and examined their experiences.

Both studies used the interpretative phenomenological approach to gain insights. What this study included that would help with validity that Demir et al. , (2008) did not include was the staging. The staging of the cancer can have a great impact on the emotions and fear and response to experience. This sample size was only six person who lowered the reliability and generalizability. Lacey, (2005), researched breast cancer and support aides revealed that participants were identified as being too overwhelmed and stressed to make decisions about their care.

They trusted their physicians to make the appropriate choices and appreciated and welcomed the support of family members. They also expressed hope. These same sentiments were echoed somewhat in Demir et al. , (2008) and Perreault et al. , (2005). All 3 studies involved breast cancer and the study method was the same and even though the same size and ages may have varied, it may prove to offer some insight as to what these women face adding to the validity. All 3 papers also suggest that more research may be necessary to facilitate the different decision- making and emotional abilities. The definite commonality expressed and assumed mong all these articles so far is the need for information especially at different stages. Molen, (2000) study sought to identify the different information needed for people with cancer. Adequate, appropriate and timely information can be a key element for many people in managing the experience of cancer. Different themes emerged from the research. There was a deficit in information regarding self-identity, body image, and family, social and work relationships. A cancer diagnoses impacts all areas of an individual’s life, and life management information is equally as important as medical information. Molen, 2000). Cancer was viewed as an intrusion and illness engendered feelings of vulnerability that impacted on their normal coping mechanisms. This research had six participants all with different types of cancer with ages ranging from 45 to 65. The end results showed feelings and questions received on a daily basis but the sample size was so small and the age range was so limited that may lessen the reliability. However, further research may be needed to identify the different ages when information becomes such a deciding factor or the processing of information since all the participants were older.

Similarly, information needs proved to be a big part of the equation as evidenced in another research study done by Molen (2005). However the type of information, the amount and to what depth varied considerably between individuals proving that information needs are unlikely to remain static and consequently, will change throughout the cancer experience. The literature highlights the importance of information giving, however; many problems are encountered with its provision. People with cancer frequently express dissatisfaction with the information given to them and experience difficulty in retaining and processing information.

The cancer experience invariably begins before the point of diagnoses and information needs clearly change over time. (Molen 2005) Jones et al. , (2006) in researching the lived experience showed similarity with the Molen, (2000) themes that emerged from the different stories including changing concepts of self, the significant of relationships, being different from the past and temporality. These patients were bone marrow transplant candidates who were experiencing a mountain of emotions that they believed were affecting them negatively.

From their stories it was clear that all participants underwent many physical and emotional changes. Taking it to a different level Meenaghan et al. , (2010) researched elderly patients and their lived experience and concluded that all participants experienced fear and shock at diagnoses but also experienced hope despite their age. With good support from family and friends participants exhibited hope and revealed that they learned to cope with the diagnoses and its treatments. As expressed in Perreault et al. (2005), the same fear and uncertainty was revealed and the same method of data collection and interview was used. Walker et al. , (2009) attempted to understand the lived experience of cancer patients undergoing photodynamic therapy. Analysis of the data yielded six themes, the impact on day –to- day life, existential meaning, the physical effects of treatment, and the kaleidoscope of emotions, information gap and family burden. This article summarizes all the feelings expressed by all the previously reviewed articles.

If not all a least one of the articles expressed the same feelings which leads nurses to believe that these are the expected emotions, fears and expressions that can be experienced and that we all should be mindful of the factors that to suffering and the nursing interventions that can be used to address these multiple dimensions of suffering. All these studies used the phenomenological approach which is appropriate and if not the interpretative design the descriptive. Sample sizes and ages vary but the information and end results remained the same or close to the same throughout this literature review.

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