Patients' experiences of a mindfulness intervention for adults with advanced cancer: a qualitative analysis.

PURPOSE: People with advanced cancer often experience significant emotional turmoil that accompanies their diagnosis and cancer-related treatments. Therefore, psychological interventions become relevant to address these impacts; however, there is a lack of research into the psychological support needs of those with advanced cancer (those not yet in palliative or end-of-life stages). In this context, we developed a mindfulness-based intervention, Coping with Cancer Mindfully (CCM), to provide psychological and emotional support to adults with advanced cancer. This article reports on qualitative interviews from a mixed method study of the CCM intervention exploring its utility and the extent it provides psychological support to this population in a pre-post-intervention design. METHODS: Adults with advanced cancer (stage III or IV) were recruited via cancer-related services in Christchurch, New Zealand. Thematic analysis was used to analyse the semi-structured interviews. RESULTS: Twenty participants were interviewed. Thematic analysis showed that at baseline, participants were experiencing distress but few had been offered psychological support; they reported feeling vulnerable and battling their cancers, and were seeking help. Post-intervention interviews reported that most participants' perspectives had shifted, from a state of vulnerability to one of self-encouragement, increased optimism, and taking new actions regarding their situations. The CCM intervention was identified as a readily available and positive tool of support. CONCLUSIONS: Our findings suggest that those with advanced cancer should be offered options of psychological support at any stage post-diagnosis. At such an intense period in their lives, people with advanced cancer are likely to benefit from tailored psychological interventions. The CCM intervention with its focus on acceptance, meaning in life, and mindful coping has been shown to be acceptable to participants and as a supportive tool.

Coping with cancer mindfully: A feasibility study of a mindfulness intervention focused on acceptance and meaning in life for adults with advanced cancer.

PURPOSE: The psychological needs of those with advanced cancer have been relatively neglected and many cannot attend treatment for logistic reasons. This study evaluated the feasibility of recruitment and delivery strategies and gathered preliminary data regarding efficacy of the "Coping with Cancer Mindfully" intervention. This is a mindfulness-based intervention designed to improve patients' coping by accepting their situation, increasing their focus on meaning in life and learning to cope with cancer mindfully. METHODS: This is a single arm pre-post-intervention design. Adults with advanced cancer were recruited from oncology services providers in Christchurch, New Zealand. The intervention was a 1:1 delivery of a 4-week course of pre-recorded mindfulness sessions. Feasibility was assessed by attaining recruitment targets and treatment retention. MEASURES: evaluated participants' levels of mindful coping skills (Mindful Coping Scale), acceptance stance (Acceptance and Action Questionnaire - II) and meaning in their lives (Meaning in Life Questionnaire). Descriptive statistics, paired t-tests and Cohen's d effect sizes were used. RESULTS: Twenty of 30 eligible participants consented. All participants completed the four-week course, and 19/20 completed post-treatment questionnaires, demonstrating feasibility. Pre-post effect sizes were moderate-large for change in acceptance, large for mindful coping skills and the presence of meaning in life. Pre-post change in search for meaning in life was not statistically significant. CONCLUSIONS: This study presented preliminary promising results regarding efficacy of the intervention in promoting positive changes in acceptance, meaning in life and mindful coping skills. The low-burden and flexible home-based delivery aspects of the intervention contributed to full retention.

Effective Surgical Teams: An Integrative Literature Review.

It is imperative to understand the factors that contribute to effective surgical teams. The aim of this integrative review was to evaluate the aids and barriers for perioperative teams in functioning effectively, preventing adverse events, and fostering a culture of safety. The literature search was undertaken of 15 databases, which resulted in 70 articles being included. It was found perioperative teamwork was not widely understood. Findings indicated barriers to effective surgical teams comprised of confusion in tasks and responsibilities, existing hierarchies and prevailing misconceptions and understanding among team members. Although numerous quality initiatives exist, the introduction of protocols and checklists, team effectiveness in the perioperative setting is still insufficient and challenges in establishing effective surgical teams continue. Further research is recommended to obtain a comprehensive perception of environmental influences and barriers surgical teams encounter in the delivery of safe quality care.

Using intervention mapping to design a self-management programme for older people with chronic conditions.

Self-management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community-based programme that combines a transdiagnostic approach to self-management with mindfulness to enhance psychological coping for older people with long-term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence-based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes.

Factors influencing women's decisions about having the pertussis-containing vaccine during pregnancy.

INTRODUCTION New Zealand experienced a major epidemic of pertussis from September 2011 to January 2014. In response to this epidemic, a pertussis-containing tetanus, diphtheria and acellular pertussis (Tdap) vaccine was funded for pregnant women of 28-38 weeks' gestation. AIM To investigate the factors influencing women's decisions regarding having the Tdap vaccine during pregnancy. METHODS A retrospective, self-reported postal survey of early postpartum women in Canterbury that assessed participant knowledge, beliefs, attitudes and influencing factors about the Tdap vaccine was conducted from June to October 2013. RESULTS Of the 1883 surveys distributed, 596 women completed the survey. The main factors influencing women's decisions to accept the Tdap vaccine during pregnancy were: the desire to protect their baby, a health professional's recommendation, the threat of pertussis in the community and the fact that the vaccine was administered at no cost. Conversely, for women who did not receive the Tdap vaccine, the main factors that influenced their decisions were: they did not know the vaccine was available, fear of side-effects and doubt regarding vaccine effectiveness. CONCLUSION A clear health professional recommendation for maternal Tdap immunisation was a significant factor influencing pregnant women and would most likely improve the uptake of the vaccine.

The acceptability and potential benefits of mindfulness-based interventions in improving psychological well-being for adults with advanced cancer: A systematic review.

OBJECTIVE: In spite of supportive care for people affected by cancer being well recognized as a priority for research, there is little solid evidence of the effectiveness of psychological interventions using mindfulness for those with advanced cancer. This systematic review aims to describe, evaluate and synthesize the acceptability and potential benefits of mindfulness-based interventions (MBIs) for the psychological well-being of people with advanced cancers. METHODS: Eight databases were searched and terms related to advanced stages of cancer and mindfulness were combined systematically to identify relevant published literature. Inclusion criteria were studies with adults only and all types of cancer at stages III and IV. There was considerable variety in the MBI treatment packages including in the extent and centrality of mindfulness in the interventions. RESULTS: Of 312 identified studies, only 8 included MBIs for people with advanced cancer rather than their families or carers. Results from these studies suggests that MBIs are acceptable and beneficial to the advanced cancer population, improving quality of life, use of mindfulness skills, acceptance of their cancer situation and reduction in depression and anxiety. Some adaptations were recommended however regarding delivery, simplified briefer MBIs, abbreviated session time, flexibility concerning locality of treatment and a minimized questionnaire burden for this group. CONCLUSIONS: MBI packages reviewed in this study had evidence of acceptability and of effectiveness, indicating potential benefit for this population. Individualized, including home-based interventions may be optimal to allow critically ill patients to participate in treatment. In future, MBIs adapted to the needs of various advanced cancer patients are recommended to address the gap in the field and improve health care.

Clinical effectiveness of transdiagnostic health management interventions for older people with multimorbidity: a quantitative systematic review.

AIM: The aim of this study was to evaluate the clinical effectiveness (improvement in health status and/or functioning and use of health services) of transdiagnostic health management interventions for people aged 65 years and older. BACKGROUND: The care of older people with multimorbidity is of increasing concern for nurses. A transdiagnostic approach to health management interventions (promote self-management or lifestyle) may be apposite for providing older people with the skills to manage symptoms that may or may not be disease-specific. DESIGN: Quantitative systematic review. REVIEW METHODS: Cochrane methods using Cochrane's Effective Practice and Organization of Care Methods (EPOC) for assessing risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for assessing the weight of evidence. DATA SOURCES: Medline, CINAHL, PubMed and PsycINFO 1999-2014. RESULTS: Twelve studies were included in the review (n = 10,393). All 12 studies provided results for health outcomes (health status and functioning) and six provided results for health outcomes and health service utilization. Ten studies reported statistically significant improvements in health outcomes but of these studies only two were of low risk of bias. Three studies identified some statistically significant reductions in health service utilization. The weight of evidence for the health management interventions included in the review, were low/moderate for improvements in health status and low for improvements in health service utilization. CONCLUSION: While there is some very preliminary evidence suggesting that structured transdiagnostic health management interventions may be clinically effective for older people with multimorbidity the effect sizes are small and the quality of this evidence is generally low.

The Experience of Fatigue Across Long-Term Conditions: A Qualitative Meta-Synthesis.

CONTEXT: Fatigue is a common and debilitating symptom associated with many long-term conditions and is reported to cause significant levels of distress for those individuals. There is a substantial body of literature related to the nature of fatigue; however, this has not been drawn together and compared across conditions. OBJECTIVES: The aim of this review was to synthesize data on the nature of fatigue across long-term conditions. METHODS: The review was designed as a qualitative meta-synthesis and followed the Joanna Briggs Institute guidelines for synthesizing qualitative research. The following databases were searched for the period January 1980 to January 2016, Ovid (Medline, Embase, CINAHL, and PsycINFO) and manual searching from the reference lists from articles identified by electronic search. Fifty-seven studies were included in the review, and findings related to the nature of fatigue were extracted and findings meta-synthesized. RESULTS: The perceived nature of fatigue across long-term conditions was encompassed in one synthesis; the fatigue experience is without precedent, with four categories: a different fatigue to any experienced before, the intensity of fatigue is overwhelming, the trajectory of fatigue, and impact on sleep and sleep disturbance. Just over half of the participants in the included studies were diagnosed with cancer. Patterns in the experience of fatigue by condition were found for cancer-related fatigue and post-stroke fatigue where data were able to be synthesized. CONCLUSION: Although similarities in the nature of the fatigue experienced were found across conditions, differences were also evident and could be mapped for cancer-related fatigue and post-stroke fatigue. Further qualitative research on the experience of fatigue across a wide range of chronic conditions would further contribute to understanding similarities and differences across conditions and inform both research and practice in relation to assessment and management.

Mindfulness-based stress reduction for long-term physical conditions: A systematic review.

OBJECTIVE: To identify whether mindfulness-based stress reduction is effective in improving physical health outcomes for long-term physical conditions. METHOD: A systematic review of the literature (retrieved from MEDLINE, PubMed and PsycINFO). RESULTS: Fifteen studies were included in the review. None of the studies assessed as having a low risk of bias demonstrated significant improvements in physical health status although there was some emerging evidence that mindfulness-based stress reduction may be useful in pain conditions. There was some preliminary evidence that it may also be effective in improving primary insomnia and irritable bowel syndrome. Small to moderate effect sizes were also found for asthma, pain, tinnitus, fibromyalgia and somatization disorders. CONCLUSION: Although there is some preliminary support for the use of mindfulness-based stress reduction in physical health conditions, further research is required before it could be considered an effective intervention for improving physical health outcomes.

Learning to live well with chronic fatigue: the personal perspective.

BACKGROUND: Persistent fatigue is recognized as an integral and significantly disabling aspect of the experience of living with a long-term health condition. Acute medical care models have limited applicability when seeking to provide health care to meet the needs of those living with chronic fatigue. AIMS: This article is a report of a study that sought to understand how people can live well in spite of the presence of chronic fatigue. METHODS: A thematic analysis was conducted on 43 narratives provided by people living with chronic fatigue during 2007 as part of an internet-based study. FINDINGS: This report focuses on the two themes that appeared of most relevance to participants: managing energy and redefining self. Two particular approaches to energy management were noted. In the first, the focus is upon moderating and avoiding excess to manage energy. In the second approach, the body was conceptualized as a machine so that energy becomes a limited resource to be managed. Work to redefine the sense of self appeared to be focused upon the desire to seek normality, to see oneself as rational and come to terms with change. CONCLUSION: People can and do find ways to live well with chronic fatigue. Understanding how the person with chronic fatigue has come to conceptualize his/her experiences will be a more fruitful starting point than providing recipes for successful living if nurses are to work effectively with this group of people.

Reform and community care: has de-institutionalisation delivered for people with intellectual disability?

Reform and community care: has de-institutionalisation delivered for people with intellectual disability? In this paper we provide a post structural analysis of the theoretical shifts informing changes to service delivery over the past 150 years in relation to people with intellectual disability. We utilise the New Zealand experience of reform as it reflected global knowledge at any given period. Firstly, we address the historical modes of treatment and care, with reference to the eugenics movement, the concepts informing 'Prisons of protection' and moral treatment. Secondly the paper traces reforms commencing in the 1960s where changes from institutional care to community care were informed by humanistic ideals, a key driver being the concept of normalisation. Theorists offered competing discourses that formed the bases of arguments for the status quo whilst resistant voices advocated change. Covering such significant changes leads us to assess the state of de-institutionalisation' as it stands today and how it may be perceived in the future. We assert that Foucault's genealogical approach provides analytic tools to uncover the dynamics of changing attitudes and approaches to service delivery. In applying a Foucauldian lens to the trajectory of reforms concerning institutionalisation to de-institutionalisation we question whether a form of re-institutionalisation may be occurring.

Negotiating competing discourses: the decision to take menopausal hormone therapy following surgical menopause.

The aim of this study was to examine women's reports of negotiation and decision-making regarding use of menopausal hormone therapy after hysterectomy. Women who have experienced surgical menopause have more intense menopausal symptoms than women who have natural menopause and are often prescribed menopausal hormone therapy. Over the past decade acceptance of use of menopausal hormone therapy has been challenged by publications indicating its associated risks. Foucauldian discourse analysis was used to examine the discourses influencing women's experiences of early menopause precipitated by surgery and their decision-making regarding the use of menopausal hormone therapy. The project investigated via semi-structured interviews the perceptions and experiences of 30 New Zealand women aged 45-65 years who had undergone surgical menopause. The predominant discourses within which the participants' descriptions of their experience were embedded were: (a) new public health, (b) medical, and (c) lay moral judgment. Their health keeping/management practices were influenced by moral imperatives for quality of life, managing risk, and taking care of oneself. The use of menopausal hormone therapy for surgical menopause provides an example of the infiltration of public health discourse into lay judgments and influenced people to identify potential lifestyle problems and direct them to medicine and pharmacology as moral imperatives; and how women resist these discourses in various/particular ways.

The replacement of the replacement in menopause: hormone therapy, controversies, truth and risk.

A Foucauldian discourse analysis is employed to identify how our current understandings of menopause are culturally and historically determined by medical discourse. The polarity of the normal and the abnormal (pathological) became the crux of medical deliberation, where deviation from norms becomes the reason for intervention. Through manifold relations of power and the 'struggle of knowledges' medicine derives social authority, influencing social orthodoxies thus normalising menopausal women via discursive constructs. The course of nature in ageing women has been re-categorised as unnatural. In using the case of hormone therapy (HT) and the emergence of bio-identical or natural hormones, while deconstructing the premises used in marketing both types of hormone therapy, the tenuousness of scientific claims about these hormones is revealed. Discourses on bio-identical hormones (BHT) display a reliance on seemingly opposing naturalist and scientific arguments. Menopause, having been constructed as a deficiency disease, required initially chemical hormone replacement and now bio-identical hormones replacing the mainstream medical solution. The idea of the postmenopausal state as diseased is perpetuated as the basis to suggest therapies to women. This paper suggests that although therapeutic in a few cases, hormone preparations are in fact potentially dangerous lifestyle drugs.