The process of life adjustment in patients at onset of glioma who are receiving continuous oral anticancer drug: A qualitative descriptive study

Objective: Patients with malignant gliomas have to adjust their daily lives because of the threat of impending death and declining abilities.Thus,clarifying the process of life adjustment in such patients would help them lead a normal life.To clarify the process of life adjustment in patients at the onset of glioma,who continuously receive oral anticancer drug.Methods: The study institution consisted of two designated cancer centers.Semi-structured interviews were conducted with 10 patients,and the data were analyzed using the Modified Grounded Theory Approach of Kinoshita (M-GTA).Results: As a core category representing the process of life adjustment in patients at the onset of glioma,"trials and errors for self-fulfillment even in a limited lifespan" was extracted.Patients began "seeking information about the unfamiliar life-threatening disease," and "imaging their uncertain lives after the disease and the resulting disability" while "conducting repeated trials and errors to establish coping methods according to their abilities." When facing difficulties in such trials and errors,they reported "losing self-confidence due to unexpected limitations." However,they regulated their feelings by "resigning themselves to their unchangeable reality." Contrarily,as "functional improvement enhanced their motivation to recover," they attempted to promote functional recovery and organized their daily lives in "fulfilling their desires in their limited lifespan." Conclusion: The process of life adjustment in patients with malignant gliomas involved identifying a way of living despite limited lifespan.To ensure appropriate nursing care for patients at the onset of glioma,it is important to help them establish coping methods in accordance with their abilities.

Process of Decision-Making of Anti-Cancer Treatment in Elderly Patients with Advanced Lung Cancer

The aim of this study was to identify the decision-making process of anti-cancer treatment in elderly patients with advanced lung cancer. Semi-structured interviews were conducted with 17 patients aged 70 and above to collect data on their feelings and thoughts from the time of diagnosis till they made treatment decisions. The data was analyzed using the Modified Grounded Theory Approach that was modified by Prof. Yasuhito Kinoshita. We found the process to be composed of six categories. The results showed that elderly patients with advanced lung cancer were panicked over unavoidable death when informed of stage IV lung cancer and offered suggestions about anti-cancer treatment. However, trying to accept the situation where death is imminent, patients reconsidered having cancer in older age and recognized a desire to survive even in older age. This process diverged into two paths: one group of patients changed their ideas from radical to life-prolonging treatment by recognizing a desire to survive even in older age and then made anti-cancer treatment decisions by carefully choosing treatment that would allow to carry on their usual way of life;the other group of patients made treatment decisions by carefully choosing physicians to whom they could entrust their life in older age. These findings suggest that it is important for nurses to: 1) encourage patients to talk in order to have them think about what they have valued and want to value in the rest of their life;2) assess if patients prefer to decide on their own by carefully choosing treatment or entrust treatment decisions to physicians;and 3) offer support according to patients’ preferences.

Decision-Making Process for the Place of Death of Elderly Patients with Advanced Cancer and Their Families

Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pairs of elderly patients and members of their family. The patients had finished anticancer treatment and made some decision about the preferred place of death. A modified grounded-theory approach was used for the data analysis. Results: Making a “tentative” decision for the place of death of the elderly patients is a process with the core category [carefully choosing the final place for self-fulfillment]. The patients were “conducting a comprehensive review of the place of death” and “embracing the wishes for a way of life without difficulty”. Involving the family in making a “tentative” decision about the place of death of the elderly patients is the process with the core category [realizing the wish of patients in the terminal condition for the way for death]. The families were “examining the place of death from different aspects” and “respecting the patient’s intention as far as possible”. Conclusions: When the patients [carefully choosing the final place for self-fulfillment], it was important to reconcile their wishes with the burden on the families. When the families were trying to [realize the wish of patients in the terminal condition for the way for dying], it was important to balance the respect for the patient intentions and homecare they can provide for the patient. For the patients and their families, it is essential to mutually understand the intentions and wishes of the other party in decision making about the place of death.

Process of Patients Telling Children about Newly Diagnosed Breast Cancer

Objective: This study aims to determine the process of patients with newly diagnosed breast cancer in Japan telling their children about the disease, and how they have thought about it after the diagnosis. Methods: Semi-structured interviews were conducted with 15 patients with newly diagnosed breast cancer who had 3- to 14-year-old children. Narratives of participants about how they told their children about the disease were analysed by a qualitative and descriptive study design using the Modified Grounded Theory Approach (M-GTA). Results: In the process by which patients with newly diagnosed breast cancer tell their children about the disease, participants were [Maintaining mental balance in the face of the threat of the cancer] after the breast cancer diagnosis, and used the “Facing the cancer through the relationship with the children” as the core category in the process. The participants had [Determined to tell the children about the disease], while [Being worried about the influence of cancer on the children], [Thinking about the benefits of not hiding the cancer], and [Feeling difficulty in communicating the diagnosis of cancer to their children]. They were [Encouraged to tell about the disease to the children] by people around them, and did tell the children that they had a “disease” or “cancer”. The participants who told the children that they had the disease while [Determining the impact on the children] repeated the [Making herself look unconcerned] in the process. Those who told the children that they had cancer while [Determining the impact on the children] repeated [Talking openly about cancer and death] between parents and children. Conclusions: The participants came to face their own cancer by maintaining mental balance in the face of the threat of the cancer and telling their children about the disease. Nurses need to assist these patients to be able to deal openly with their children from the early stage of the diagnosis and solve problems by family members.