The experience of patients with cancer who develop venous thromboembolism: an exploratory study.

PURPOSE/OBJECTIVES: To better understand the experience of venous thromboembolism (VTE) from the points of view of patients with cancer during various stages of the cancer experience. RESEARCH APPROACH: Qualitative, descriptive. SETTING: Various inpatient and outpatient units of a large urban university-affiliated hospital in Montreal, Quebec, Canada. PARTICIPANTS: Purposive sample of 10 participants who were anticipating, had recently undergone, or were currently undergoing cancer treatment and who had received a VTE diagnosis within the past year. METHODOLOGIC APPROACH: Semistructured interviews were transcribed verbatim. Thematic analysis of data revealed themes contributing to understanding the lived experience of VTE during cancer care. MAIN RESEARCH VARIABLES: The experience of patients with cancer who develop VTE. FINDINGS: Patients' initial reaction to VTE included VTE as a life-threat, past experience with VTE, and VTE as the "cherry on the sundae" in light of other cancer-related health issues. Patients' coping with VTE also included three themes: VTE being overshadowed by unresolved cancer-related concerns, VTE as a setback in cancer care, and attitudes about VTE treatment. CONCLUSIONS: This study contributes new insight into the experience of patients with cancer who develop VTE. The most salient finding was that patients having no prior VTE knowledge experienced VTE as more challenging. Future studies comparing experiences with VTE across the various stages of cancer care are needed. INTERPRETATION: Study findings suggest that patient education about VTE would be useful for the initial reaction and subsequent coping phases of VTE, thus representing an important target area for nursing intervention.

Response phases in methadone treatment for chronic nonmalignant pain.

Although studies on the beliefs of persons with chronic nonmalignant pain (CNMP) are still scarce, methadone is increasingly prescribed for the treatment of CNMP. This qualitative case study uses semistructured interviews to explore the beliefs of 11 patients with CNMP and the challenges they faced coming to terms with and integrating methadone treatment into their lives. The study identifies a two-phase process of acceptance and integration. In the first phase, during acceptance of the prescribed methadone treatment, initial beliefs were mostly determined by the societal stigma that "methadone is for junkies." Different influencing factors such as knowledge about methadone for pain management, family support, and trust in physicians changed behavior in a positive way. In the second phase, patients dealt with the degree of disclosure about their treatment. Full disclosers have no problem in telling others that they were being treated with methadone, whereas partial disclosers were more selective. They were confronted with various barriers: negative encounters with family, friends, and the public; past addict experiences; safety issues; and obstacles within the health care system. As a result of these challenges, their beliefs were summarized as: "others think I'm an addict," and "methadone can harm me and/or my family."This study highlights the important role nurses have in the education of patients on the use of methadone in pain management, and in assisting patients with CNMP to gain confidence and a greater sense of control to cope with the challenging issues related to disclosing information.