Making meaning of everyday life in the context of lung cancer treatment-a qualitative study of outpatients' perspectives.

BACKGROUND: The increasing survival after a lung cancer diagnosis implies that patients live longer with the disease, which means that symptoms and side effects of the treatment become part of everyday life. AIM: The study explored how older adults make meaning of everyday life when undergoing treatment for their lung cancer. MATERIAL AND METHODS: A qualitative study using semi-structured interviews was conducted with 12 older adults with lung cancer undergoing various treatments. The analysis followed Giorgi's phenomenologic five-step method. RESULTS: The analysis revealed three partly overlapping themes: meeting the health care system, losing identity, and struggling for meaning in everyday life. The patients appreciate clear and coherent communication at the oncology clinic. They had different needs for support from organised support groups, friends, communities, or relatives to make meaning of everyday life. CONCLUSION: Creating meaning in everyday life is essential despite the disease and the treatments' side effects. Interpersonal relationships create meaningfulness in everyday life through a salutogenic perspective that makes everyday life comprehensible and manageable. SIGNIFICANCE: The patients need an everyday life perspective on the disease and the side effects, which a salutogenic approach in the encounter with the health care system could support.

Pre-vocational therapy in mental health. Clients' desired and achieved productivity status.

BACKGROUND: Knowledge about work-related occupational therapy in psychiatric inpatient and day hospital clients is limited. AIMS: The aim of the study was to explore the desired and achieved productivity status in mental health service users participating in a pre-vocational therapy (PVT) intervention. Outcome variables were productivity status and achievement of desired productivity status at discharge, and change or persistence of productivity status between admission and discharge. METHODS: This is a short-term prospective study based on observational data from health records (N = 98). RESULTS: At admission, 53.2% of participants named a clear desired productivity status; 46.8% did not. Of the former, 76.9% expressed a desire for employment or education on the regular job market; 28.0% achieved their desired outcome at discharge, whereas 72.0% did not. Overall, 58.5% retained, established or increased productive activities, while 41.5% were not engaged in or had reduced productive activities at discharge. These two groups differed in socio-economic and social-security-related characteristics, treatment-related characteristics and psychiatric diagnosis. CONCLUSIONS AND SIGNIFICANCE: Some, but not all kinds of clients in acute psychiatric inpatient and day hospital settings manage to take a first step towards productive activities during the first phase of treatment.

Occupational performance and prioritized problematic everyday occupations among people with advanced cancer living alone versus living with someone.

BACKGROUND: People living at home with advanced cancer wish to maintain and preserve domestic life, but they experience several barriers in their everyday occupations and thereby occupational performance. There is little knowledge of these barriers experienced by people living alone versus people living with someone. OBJECTIVE/AIM: To investigate differences in self-perceived occupational performance and the prioritisation of getting self-reported problematic everyday occupations solved among people with advanced cancer, taking living status into consideration. METHOD: A cross-sectional study using baseline data from an RCT including 174 participants with advanced cancer living at home. Difficulty and priorisation of everyday occupations were assessed using the Individually Prioritised Problem Assessment (IPPA). RESULTS: In total, 731 problematic everyday occupations were reported, mainly related to the categories of housework, self-care and leisure. CONCLUSIONS/SIGNIFICANCE: Overall, no statistically significant difference in self-reported occupational performance was found. However, people living alone perceived statistically significantly more frequently showering/bathing and doing laundry as difficult and therefore important to address. In contrast, people living with someone prioritised social interaction and home maintenance statistically significantly more frequently.

'When I can ride my bike, I think, am I at all as sick as they say?' An exploration of how men with advanced lung cancer form illness perceptions in everyday life.

OBJECTIVE: The purpose of this study was to explore how men with advanced lung cancer form perceptions of their illness in everyday life and how this influences perceptions about rehabilitation. METHODS: Constructivist grounded theory principles guided the collection and analysis of data from in-depth interviews with 10 men with advanced lung cancer. RESULTS: The findings show that the men's illness perception was fluid, contextual and formed by interrelated factors. Engaging in daily activities and maintaining everyday life was a strong influence on their illness perception. CONCLUSION: In order to make rehabilitation relevant to men with lung cancer, consideration should be given to how the men's everyday lives may be incorporated into the service provision.

The development of the 'Cancer Home-Life Intervention': An occupational therapy-based intervention programme for people with advanced cancer living at home.

BACKGROUND: Occupational therapy-based interventions may help people with advanced cancer to live actively despite their illness. However, there is limited evidence concerning what kinds of content intervention should encompass, and how this should be done. OBJECTIVE: To describe the development and content of an occupational therapy-based intervention programme for people with advanced cancer living at home. MATERIAL AND METHODS: In the development of the intervention, an evidence synthesis was performed based on a systematic literature search, data from a cross-sectional study, and experiences from an expert panel. RESULTS: The programme contains six components: 1) An initial interview to select which of the other five components to address, based on the participants' individual needs. The interview addressed problems and needs of participants in relation to prioritized activities, in order to tailor the following components: 2) prioritisation of resources, energy and everyday activities; 3) adaptation of activities; 4) adaptation of posture and seating; 5) provision of assistive technology; and, 6) modification of the physical home environment. CONCLUSION: An occupational therapy-based intervention programme for people with advanced cancer living at home has been developed. The study generates knowledge and insights relevant to improving the treatment of this patient group.

Process evaluation of the Cancer Home-Life Intervention: What can we learn from it for future intervention studies?

BACKGROUND: The Cancer Home-Life Intervention showed no significant effects, and examination of the processes affecting or inhibiting outcomes is relevant. AIM: To evaluate the Cancer Home-Life Intervention for its processes of implementation, mechanisms of impact and contextual factors. DESIGN: Process evaluation conducted alongside the randomised controlled trial, using quantitative and qualitative methods (ClinicalTrials.gov NCT02356627). The Cancer Home-Life Intervention is a tailored, occupational therapy-based programme. SETTING/PARTICIPANTS: This study took place in participants' homes and at hospital. A total of 113 home-dwelling adults (⩾18 years) with advanced cancer who had received the Cancer Home-Life Intervention were included, together with five intervention-therapists. RESULTS: All 113 participants (100%) received a first home visit; 32 participants (26%) received a second visit; and 4 participants (3%) received a third visit. Median number of delivered intervention components were 3 (interquartile range: 2; 4). Identified barriers for effect included unclear decision process for intervention dosage; participants' low expectations; participants' lack of energy; and insufficient time to adopt new strategies. The trial design constituted a barrier as the intervention could only be provided within a specific short period of time and not when relevant. Intervention components working to solve practical everyday problems, enhance enjoyment and increase a sense of safety were perceived as useful. CONCLUSION: Future interventions can benefit from inclusion criteria closely related to the intervention focus and clear procedures for when to continue, follow-up and terminate intervention. Decisions about dose and timing may benefit from learning theory by taking into account the time and practice needed to acquire new skills.

The 'Cancer Home-Life Intervention': A randomised controlled trial evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer.

BACKGROUND: People with advanced cancer face difficulties with their everyday activities at home that may reduce their health-related quality of life. To address these difficulties, we developed the 'Cancer Home-Life Intervention'. AIM: To evaluate the efficacy of the 'Cancer Home Life-Intervention' compared with usual care with regard to patients' performance of, and participation in, everyday activities, and their health-related quality of life. DESIGN AND INTERVENTION: A randomised controlled trial ( ClinicalTrials.gov NCT02356627). The 'Cancer Home-Life Intervention' is a brief, tailored, occupational therapy-based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities. SETTING/PARTICIPANTS: Home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were assessed at baseline, and at 6 and 12 weeks of follow-up. The primary outcome was activities of daily living motor ability. Secondary outcomes were activities of daily living process ability, difficulty performing prioritised everyday activities, participation restrictions and health-related quality of life. RESULTS: A total of 242 participants were randomised either to the intervention group ( n = 121) or the control group ( n = 121). No effect was found on the primary outcome (between-group mean change: -0.04 logits (95% confidence interval: -0.23 to 0.15); p = 0.69). Nor was any effect on the secondary outcomes observed. CONCLUSION: In most cases, the 'Cancer Home-Life Intervention' was delivered through only one home visit and one follow-up telephone contact, which not was effective in maintaining or improving participants' everyday activities and health-related quality of life. Future research should pay even more attention to intervention development and feasibility testing.

Performance of activities of daily living among hospitalized cancer patients.

BACKGROUND: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data. METHODS: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55). RESULTS: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. RESULTS from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments. CONCLUSION: Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.

Evaluation of a complex intervention to improve activities of daily living of disabled cancer patients: protocol for a randomised controlled study and feasibility of recruitment and intervention.

BACKGROUND: Many cancer patients have problems performing activities of daily living (ADL). A randomised controlled trial was designed to examine the effects of an ADL intervention in addition to standard treatment and care in a hospital setting. The objective of this article was to present the study and to analyse the feasibility of the recruitment process and the intervention. METHODS: Adult disabled cancer patients at Næstved Hospital in Denmark were enrolled between 1 March 2010 and 30 June 2011 and randomised into an ADL intervention or to a control group. The intervention was performed by occupational therapists. The feasibility of the recruitment was analysed with regard to success in achieving the estimated number of participants and identification of barriers, and feasibility of the intervention was based on calculations of patient attendance and patient acceptability. The primary outcome of the randomised controlled trial was patients' health-related quality of life 2 and 8 weeks after baseline. RESULTS: A total of 118 disabled cancer patients were enrolled in the study over a time span of 16 months. Very few meetings between occupational therapist and patient were cancelled. Time spent on the intervention varied considerably, but for the majority of patients, time consumption was between 1-3 hours. CONCLUSIONS: Despite difficulties with recruitment, participation was considered feasible and the intervention was accepted among patients. Missing data in the follow-up period were mostly due to death among participants. Very few participants declined to complete questionnaires during follow-up.