Patients' illness narratives-From being healthy to living with incurable cancer: Encounters with doctors through the disease trajectory.

BACKGROUND: Narrative medicine emphasizes how stories can increase the understanding of patients' experiences and give important insights into how patients interpret and strive to make meaning in the situation they find themselves in. AIM: The aim of this study was to gain insight into the illness narratives of cancer patients, from the day they suspected that something was wrong until living with incurable cancer. METHODS AND RESULTS: Six men and seven women, aged 47 to 79 years, diagnosed with metastatic cancer and undergoing chemotherapy with life-prolonging intent in an oncology outpatient clinic, were asked to tell their illness stories as freely as possible, without guiding questions. Stories were tape recorded, transcribed, and analyzed by a thematic narrative analysis. Encounters with doctors through the disease trajectory were highlighted by all narrators. Several informants described poor communication and consequences in the form of "doctors delay" and substandard psychosocial care. Continuity in follow-up and the physician's ability or inability to break bad news and adapt information to the patient's wishes and preferences were particularly emphasized. CONCLUSION: A key finding was the importance of the doctor's role throughout the whole trajectory. A good doctor-patient relationship was characterized by continuity of care in follow-up, and trust acquired over time, based on the physician's thorough medical knowledge combined with sensitive communication and empathy.

Understanding cancer patients' reflections on good nursing care in light of Antonovsky's theory.

PURPOSE: Data from an empirical study about cancer patients' perception of good caring are analysed in the light of Antonovsky's theory. The aim was to reflect on whether and how health personnel by giving good care, can function as vital resources at cancer patients disposal in activating their General Resistance Resources (GRRs) in a stressful life situation, and by that contribute to promotion and maintenance of their sense of coherence. METHODS AND SAMPLE: A hermeneutical approach was chosen for analysing the data. The informants were cancer patients in an oncology ward in a regional hospital in Norway. Twenty patients were interviewed, ten women and ten men. The patients had various cancer diagnoses at different stages and had different prognoses. KEY FINDINGS: The findings indicate that most of the patients succeeded in activating their GRRs in dealing with the stressor. Nurses, doctors, family and friends can be seen to function as vital resources at their disposal when needed. Most likely good caring supported the patient's promotion and maintenance of the components of meaningfulness, comprehensibility and manageability which form the concept sense of coherence (SOC). CONCLUSION: Health personnel can support the patients' meaningfulness by listening to the patients' stories about what still gives them meaning in life and their comprehensibility by giving good information. Alleviation of physical suffering may promote and maintain their manageability. Because all three components are intertwined, it is important to focus on all of them when caring for cancer patients.

Patients' perceptions of the importance of nurses' knowledge about cancer and its treatment for quality nursing care.

PURPOSE/OBJECTIVES: To gain insight into how and why patients' perceptions of nurses' knowledge about cancer and its treatments relate to quality nursing care. DESIGN: Qualitative study inspired by Giorgi's approach to phenomenology. SETTING: An oncology ward in a regional hospital in Norway. SAMPLE: 20 patients (10 women and 10 men). Most received life-prolonging and symptom-relieving treatment, whereas 4 had the possibility of being cured. METHODS: In-depth interviews were tape recorded, transcribed, and analyzed. The text was read as a whole, condensed into units of meaning, and clustered into themes of importance. Finally, the consistency between identified themes and the general structure of the interviews was checked. FINDINGS: Patients regarded knowledge about cancer and its treatment as basic in nursing and took for granted that nurses had this competency. Three themes were identified that explained why the knowledge was important: (a) it makes patients feel safe and secure and alleviates suffering by providing useful information, (b) it prevents and alleviates suffering and insecurity during chemotherapy, and (c) it alleviates suffering by relieving side effects caused by the treatment and symptoms caused by the disease. CONCLUSIONS: Patients appreciated meeting nurses who had experience and could combine clinical and biologic knowledge and nursing skills with a human touch. In addition, nurses alleviated patients' bodily and existential suffering and made them feel safe and secure. IMPLICATIONS FOR NURSING: Experienced, effective nurses with knowledge about cancer and its treatments are needed in oncology wards to provide optimal care to patients.

What is important for patient centred care? A qualitative study about the perceptions of patients with cancer.

BACKGROUND: This article deals with one of the themes from interviews in a larger qualitative study about cancer patients' perceptions of good caring. It is widely recognized today that patient centred care is important. Patients' values and perceptions must be acknowledged in order to make care evidence based and to meet the demands of quality improvement processes. AIM: The aim was to get insight in patients with cancers' perceptions of the importance of being respected as partners and share control of decisions about interventions and management of their health problems and the reasons behind their wishes. METHOD: Giorgio's scientific approach to phenomenology was used. Twenty cancer inpatients with various cancer diagnoses at different stages and with different prognoses were interviewed. The sampling was purposive. ETHICAL ISSUES: Permission to carry out the research was given by a Regional Committee of Research Ethics in Western Norway and the data collection followed the guidelines of the Data Inspectorate of Norway. MAIN FINDINGS: The units of meaning identified could be clustered into three themes with significance for patient centred care from patients' perspectives: (1) empowerment (being respected, listened to, given honest information, being valued); (2) shared decision making about the treatment of the disease (discussing the treatment, but letting the doctor decide in the end); and (3) partnership in nursing care. CONCLUSION: Health care professionals can practise patient centred care by treating patients with respect, giving honest information, making them feel valued as persons and by inviting them to take part in all decisions about their daily life and care. However, cancer patients' desire to make decisions about their treatments must not be taken for granted. Doctors must find out the extent to which each patient wants to participate and then give the necessary information.

Do cancer patients always want to talk about difficult emotions? A qualitative study of cancer inpatients communication needs.

The aim of this study was to find out, through qualitative in depth interviews, if cancer patients in an Oncology ward always want to talk about their feelings and difficult emotions regarding the disease and their future while they are inpatients, and if not, to identify the reasons why. People with cancer often face emotional and spiritual distress, but try to cope with their life situation optimally. It is therefore important to determine their communication needs when they are inpatients. Giorgi's approach to phenomenology was used as research method. Twenty inpatients with various cancer diagnoses in different stages and with different prognoses were interviewed. The findings revealed that cancer patients did not always want to talk to the nurses about their difficult feelings regarding the future when they were inpatients in an Oncology ward. The main themes identified why were: cognitive avoidance and distancing; normalization, finding meaning and living in the present, and support from family and friends. The patients wanted to talk about normal life, their hobbies and their families. This conversation seemed to support their coping strategies by helping them to find meaning and hope, and must be recognized as important aspects of spiritual and emotional care.