Women’s Objects of Hope and Benefit Finding at Cancer Recurrence

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Women’s Objects of Hope and Benefit Finding at Cancer Recurrence

  1. 1. Mary M. Step Ashley M. Sandella Department of Family MedicineCase Western Reserve University, Cleveland, OH
  2. 2.  Cancer recurrence is traumatic 1-3  Patients learned coping in primary illness 4-6  Key is finding or maintaining hope Definitions of hope:  Dynamic, multidimensional life force that is vital to coping with chronic illness 9-12  A positive attitude toward future events that is grounded in subjectively derived sources of meaning in a person’s life 13
  3. 3.  Benefit-finding & hope  May aid adjustment to chronic disease 16  Demonstrated across a range of chronic diseases 17-19 Benefit-finding has been associated with: 21,22  Optimism 21  Positive reframing 21  Religious coping 21  Posttraumatic growth 22
  4. 4.  Hope and benefit-finding are important to coping with illness, however little is known about how these resources are experienced by recurrent cancer patients 23-25 This study aimed to explore patients’ perceptions of hope and benefits at the time of cancer recurrence with an eye toward identifying distinct sources of hope and types of benefits
  5. 5.  Drew on data from a prospective study of clinician- patient communication during first 6 months of a cancer recurrence  Mixed methods featuring semi-structured interviews, patient reported outcomes, and observations of visits  Analyzed segments of patient interviews that were focused on hope and benefit-finding
  6. 6.  Oncologists (n = 11) at a comprehensive cancer center referred newly recurrent patients (n = 30) Eligibility:  Female  First distant recurrence of breast, colorectal, gynecologic, head and neck, or lung cancer  ECOG status 0-2  Disease-free at least six months prior to recurrence  Enrolled within 4 months of recurrence diagnosis  No symptomatic brain metastases
  7. 7.  Participant demographics:  Age range:  42 – 84 years (M = 63.0, SD = 11.5)  Disease info:  23 breast  4 lung  1 colon  1 gynecologic  1 head and neck  Disease-free time:  2 – 35 years (M = 7.4, SD = 7.5)
  8. 8.  Digital audio and transcribed recordings of interviews Interview duration :  30 – 76 minutes (M = 48.3, SD = 12.1) Interview questions organized around themes of communication, support, prognosis talk and coping  As the iterative interview process progressed, hope and benefit-finding were revealed as common themes in the narratives
  9. 9.  Audio and transcripts were imported into QSR NVivo 8 coding software Included demographic and disease characteristics  Age  Tumor type  Months of neutral time  Oncologist continuity
  10. 10.  Analysis procedures:  Following thorough grounding in hope literature, authors reviewed several cases together to form consensus of construct definition/features  Identified transcript sections relating to having or maintaining hope  Identified expressed positive benefits  Independent inter-rater agreement (ϰ = >.80)  Authors used crystallization/immersion method to identify potentially thematic constructs
  11. 11.  Identified objects of hope:  Hope for more time  Image of future  “Yes. That is more, because what she’s (doctor) given me is a little bit of hope that maybe in a year I’ll be here for my nephew, and that helps.”  Doctor’s commitment to maximizing time  “So you know I feel like she truly is in my corner and that whether I’m an experiment or whatever I happen to be, that she’s going to read and find whatever she can to help me make it through every day that I can.”  Hope for cure  Miraculous cure  “…but you know I also look at I have people praying for me all over the country, and I have people saying to me, ‘You are going to be the miracle person,’ and you know it’s hard to think that about yourself, but given my faith I do believe in miracles, so I’ll take it.”  Medical cure  “Yeah it gives me hope, and especially when she (doctor) said that ‘We’re going to find out what this is and we’re going to take care of it.’”
  12. 12.  Doctor as object of hope  MD is gatekeeper of expressed optimism  “He (doctor) talks very confident. I mean you know he doesn’t make it sound like, ‘You’re going to be dead in 10 months,’ or you know what I mean. He’s confidence.”  Information-giving  “He’s (doctor) also concrete about exactly what’s happening medically, biologically.”
  13. 13.  Patients identified having a lack of hope:  Lack of future  “My outlook ain’t so good right now.”  Cancer is equated with death  “Cause you know at that point you’re not having hope. All you hear is cancer and still cancer is a stigma, you’re going to die.”  “…the rug was pulled out from under me, you know. When I went home, I felt like I was going home to get ready to die.”  Perceptions of absence  “I mean of course nobody wants to die. I don’t want to die, but my biggest thing is my grandchildren. I just, that tears me up, because my oldest one, he’s 11 years old and he’s just one of these quiet, sensitive kids, and he and I are very close and I just would be scared to death of what would happen to him. I don’t think he could handle it, and that scares me, so…”
  14. 14.  Identified benefits  Gratitude  “So I can remember when she (doctor) gave me all of that time when I first met her, and one day she was late coming in and she said, ‘I’m sorry. You know I had a problem,’ and I said, ‘You know, you take all the time you need, because when I needed it, you gave it to me.’”  Avoiding consequences  “…and so I felt that you were really in a sense, I was blessed you didn’t have to suffer that.” (Patient’s daughter)
  15. 15.  Existential benefits  “You increase your faith again, I suppose, which shouldn’t be the way it should be, but you know you do.” Authentic friends  “You learn who really, really cares about you, who comes and calls and says prayers and you know things like that. You learn you know that there’s a lot of people that care about you.” Increased ‘other’ orientation  “I decided after doing quite a bit of reading the first go-round that if I want people to be open and be there for me, I have to be open to them.”
  16. 16.  Patients’ hope in the early months of cancer recurrence is deeply tied to a survival time horizon  This conclusion stems from both the objects of hope and perceptions on lack of hope described by patients  Goal is as much survival time as possible  Cure offers time, whether by science or by more supernatural means  Patients consider time from a quantitative rather than qualitative perspective  Idea of retaining hope without cure isn’t evident Patients’ buffer the scientific reality of their prognosis with the physician’s expressed optimism  Verbally  Nonverbally
  17. 17.  Benefit-finding appears to facilitate a shift in focus from treatment to other interpersonal or existential sources of hope and comfort Future interventions for recurrent patients may best focus on helping patients generate personal benefits in order to focus more fully on quality of life Limitations  Small sample size  Self-reported patient outcomes
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