Evaluating the “Good Death” Concept from Iranian Bereaved Family

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