ABSTRACT
Background: In response to COVID-19, Quebec repurposed surgical care infrastructure and delayed many elective cancer surgeries. However, postponing cancer surgery is known to cause anxiety and distress. Methods: A qualitative study was conducted to understand patients experiences receiving surgical cancer treatment during the COVID-19 pandemic. Patients who underwent general surgery for cancer at the McGill University Health Centre between March 2020 and January 2021 were invited to one-to-one interviews. Patients were purposefully selected for maximum variation using quota sampling (i.e., targeting delay status, pandemic phase, cancer site, and clinical/ demographic characteristics) until interviews produced no new information (i.e., thematic saturation). Interviews were conducted using a semistructured guide, audio-recorded, transcribed verbatim, and analyzed independently by 2 researchers. Data were managed using MAXQDA2020 and analyzed according to inductive thematic analysis. Results: Interviews were conducted with 20 patients (mean age 64 yr;10 males;cancer sites: 8 breast, 4 skin, 4 hepato-pancreato-biliary, 2 colorectal, and 2 gastroesophageal). Surgery was delayed for 14 patients: 8 by the hospital, 4 by the patient, and 2 owing to a positive COVID-19 test. Thematic analysis revealed that patients considered their susceptibility to infection, hospital safety measures, and burden on health care resources when determining willingness to undergo surgery. Patients weighed these risks against the urgency of their health condition and recommendations of their provider. Changes to the hospital environment (e.g., COVID-19 preventative measures) and deviations from expected treatment (e.g., alternative treatments, remote consultations, rescheduled care) caused diverse psychological responses, ranging from increased satisfaction to severe distress. Patients employed coping strategies (e.g., reframing care interruptions, communicating with clinicians, information seeking) to mitigate distress. Conclusion: Changes in care during the pandemic elicited diverse psychological responses from patients undergoing cancer surgery. Patient coping was facilitated by open, consistent communication with clinicians, emphasizing the importance of patient-centred discussions regarding surgical delays within and beyond the pandemic.
ABSTRACT
BACKGROUND: Despite the significant role they play in the whole health care system, home care nurses are not paid the attention they deserve. Besides highlighting their significant role in the health care system, the COVID-19 pandemic also posed several challenges for home care nurses. OBJECTIVE: The purpose of this study is to explain the nurses' perception of the challenges of home care during the Covid-19 pandemic. METHODS: The present study was a qualitative study with a conventional content analysis approach conducted from November 2020 to September 2021. Participants included 16 home care nurses who were purposefully selected based on the eligibility criteria. After obtaining ethical authorization, the data were collected through semi-structured interviews. MAXQDA Version 10 software was used for data mangement. Data analysis was performed using the Granheim and Lundman five-step method. Guba and Lincoln criteria were utilized for trustworthiness. FINDINGS: The seven main categories obtained in this study included "the onset of a new chapter: from avoidance to relapse", "burnout", "vortex of moral distress", "social stigma", "difficulty in breaking the transmission chain", "care inhibitors related to the patient and family" and "support deficiency: the crisis of home care nursing agencies during the crisis". CONCLUSION: The results showed that nurses working in home care during the Covid-19 pandemic experienced several challenges in various fields. This study captured the nurses' perception of the challenges of home care during the Covid-19 pandemic, a period of unprecedented change and difficulty. These challenges included lack of support, psychological problems, and dealing with new experiences. Identifying these challenges can help improve the quality of home care nursing and planning in this area.