Evaluating the “Good Death” Concept from Iranian Bereaved Family

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O R I G I N A L R E S E A R C H Symptom Experience in Patients with Gynecological Cancers: The Development of Symptom Clusters through Patient Narratives Violeta Lopez, RN, PhD, Gina Copp, RN, PhD, Lisa Brunton, RN, MSN, and Alexander Molassiotis, RN, PhD Being diagnosed with gynecological cancer is associated with high distress levels, particularly in younger patients and in advanced disease. 1 The residual effects of surgery and various treatments are known to have a profound and long-lasting impact on quality-oflife issues with significant and potentially detrimental change to women’s self-esteem, mental health, sexual functioning, and fertility. 2 Although recent medical advances have increased survival rates, few investigations have been conducted to examine the interplay of physical and psychological symptoms on this group of patients. Moreover, previous studies have focused predominantly on gathering quantitative data such as the frequencies and types of symptoms, with little or no information about the gynecological cancer patients’ symptom experiences. 2,3 This knowledge is important to gain if we are to understand the quality-of-life and supportive care issues that affect this group of patients. Thus, our current knowledge about gynecological cancer patients’ experiences from a qualitative perspective remains limited. From the Research Centre for Nursing and Midwifery Practice, Australian National University, Medical School, Canberra, Australia; School of Health and Social Sciences, Middlesex University, London; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom. Manuscript submitted February 22, 2010; accepted December 13, 2011. Correspondence to: Violeta Lopez, TCH, RCNMP, Building 6, Level 3, East Wing, Yamba Drive, Garran, 2605, Canberra, Australian Capital Territory (ACT), Australia; telephone: �612 6244 2333; fax: �612 6244 2573; e-mail: violeta. lopez@anu.edu.au; violeta.lopez@act.gov.au J Support Oncol 2011;9:64–71 © 2011 Published by Elsevier Inc. doi:10.1016/j.suponc.2011.01.005 Abstract The vast majority of the increasing cancer literature on physical and psychological symptom clusters is quantitative, attempting either to model clusters through statistical techniques or to test priori clusters for their strength of relationship. Narrative symptom clusters can be particularly sensitive outcomes that can generate conceptually meaningful hypotheses for symptom cluster research. We conducted a study to explore the explanation of patients about the development and coexistence of symptoms and how patients attempted to selfmanage them. We collected 12-month qualitative longitudinal data over four assessment points consisting of 39 interview data sets from 10 participants with gynecological cancer. Participants’ experiences highlighted the presence of physical and psychological symptom clusters, complicating the patients’ symptom experience that often lasted 1 year. While some complementary and self-management approaches were used to manage symptoms, few options and interventions were discussed. The cancer care team may be able to develop strategies for a more thorough patient assessment of symptoms reported as the most bothersome and patient-centered sensitive interventions that encompass the physiological, psychological, sociocultural, and behavioral components of the symptom experience essential for effective symptom management. The physical effects on women after being diagnosed with gynecological cancer are often attributed not only to the symptoms arising from the disease itself but, most importantly, from the side effects of treatment such as surgery, chemotherapy, and radiotherapy. 3–5 Symptoms such as fatigue, frequency of urination, bleeding, weight loss, and ascites are commonly experienced by patients, particularly those with ovarian cancers. 6 Once diagnosed, gynecological cancer patients often go on to face a prolonged course of treatments which contribute to further symptoms such as chemotherapy-induced alopecia, 7 dermatolog- 64 www.SupportiveOncology.net THE JOURNAL OF SUPPORTIVE ONCOLOGY
Page 1 and 2: Editor-in-Chief Michael J. Fisch, M
Page 3 and 4: Michael J. Fisch David Cella Thomas
Page 5 and 6: Mission The mission of The Journal
Page 7 and 8: R E V I E W Personality Disorders i
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Evaluating the “Good Death” Concept from Iranian Bereaved Family

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