'Staying cool, calm and positive': A dialogical narrative analysis of emotional reactions in narratives about operable lung cancer.

BACKGROUND: Patients with lung cancer suffer from physical, psychosocial and particularly emotional challenges. Twenty-five percent of patients with lung cancer are offered surgery as a potential cure. Nevertheless, 40% of surgically treated patients will experience recurrence. Paradoxically, research shows a dominant narrative of operable lung cancer patients 'being lucky', which silences other narratives about suffering, worries and emotional challenges. AIM: To explore narratives about operable lung cancer, particularly emotional reactions to illness and suffering in these narratives. METHODS: A qualitative design was applied. Six women and four men diagnosed with operable lung cancer were included from one university hospital in Denmark and interviewed 1 month after surgery using active interviews. The interviews were subject to dialogical narrative analysis. The theoretical foundation is social constructivism, with socio-narratological inspiration. FINDINGS: A typology of three emotional narratives emerged: 'staying cool', 'staying calm' and 'staying positive'. All three types of narrative are characterised by managing emotional reactions. Staying cool is characterised by not showing emotional reactions; staying calm narratives acknowledge emotional reactions, but that they need to be managed so that they do not burden relatives; and the last, staying positive, is characterised by managing emotional reactions in a positive direction. Together this typology of three emotional narratives revealed that operable lung cancer patients are under normative pressure from these socially preferred narratives of ideal emotional reactions to lung cancer. CONCLUSION: A typology of three emotional narratives were identified and can be called 'feeling rules' that guide patients after lung cancer surgery to manage their emotions. Consequently, if patients do not live up to these three emotional narratives of staying cool, calm and positive, they may be socially isolated and restricted from access to support.

Dominant restitution narratives of 'being lucky': An ethnographic exploration of narratives about operable lung cancer.

OBJECTIVE: Patients with operable lung cancer experience physical and psychosocial challenges early in their treatment trajectory. However, these patients have unmet needs for a dialogue with clinicians and report that especially psychosocial challenges are not addressed in the clinical encounter. Aiming to understand the reasons for this, this study explores dominant narratives about operable lung cancer. METHODS: An ethnographic study was conducted at a Danish hospital providing surgery for lung cancer. Interactions between patients, relatives and clinicians were observed during hospitalisation. Ten patients were included from September 2019 to March 2020. RESULTS: One overarching dominant narrative of 'being lucky' was found, supported by three narrative subthemes, related to different aspects of the treatment. First, the possibility of surgical treatment was 'like winning the lottery'. Second, surgery was a minor intervention like 'a quiet day at the office'. Third, even if adjuvant chemotherapy was necessary, as long as the surgery went well, it was 'good news' in the outpatient clinic. CONCLUSION: 'Being lucky' is a dominant restitution narrative about operable lung cancer. A predominance of restitution narratives implies that clinicians are the active party, while patients remain passive, which limits their perspective and thus silences their concerns unrelated to curative treatment.

The Lived Experiences, Perceptions, and Considerations of Patients After Operable Lung Cancer Concerning Nonparticipation in a Randomized Clinical Rehabilitation Trial.

The purpose of this study was to explore the lived experiences, perceptions, and considerations of individuals who declined participation in a randomized clinical trial involving exercise rehabilitation after surgery for lung cancer. An interpretive phenomenological approach was applied comprising interviews with 15 individuals who did not wish to participate in the trial. The findings shed light on a discrepancy between their freedom to act and make decisions and the limitations of having to act in a certain way. The participants found themselves in a gray area between a healthy life and a good life, as influenced by societal norms and taking responsibility for one's own health and rehabilitation. When including patients in rehabilitation after lung cancer, having insight into the underlying narrative on values and the good life, priorities in daily life, social context and the norms embedded in people's self-understanding is crucial.

A sense of understanding and belonging when life is at stake-Operable lung cancer patients' lived experiences of participation in exercise.

OBJECTIVE: To explore the lived experiences and social benefits among patients with operable Non-small-cell lung cancer who participated in an exercise intervention. METHODS: Eighteen patients enrolled in an exercise intervention at 2 weeks post-surgery participated in qualitative interviews at three time points. A phenomenological hermeneutical approach comprised the epistemological stance inspired by Ricoeur's philosophy. Analysis and interpretation provided descriptions that captured the meaning of the patients' lived experiences. RESULTS: The exercise intervention was significant in terms of the patients' social capital, and the patients experienced themselves as part of a community. Patients gained access to resources that derived from human interaction in the exercise group, and their illness and treatment became easier to manage when shared with others in the same situation. The intervention helped to create a community for patients after lung cancer surgery, and the patients experienced a feeling of belonging and equality with the other participants. CONCLUSION: The group-based exercise intervention created opportunities for mutual understanding between patients, making illness and treatment easier to manage. The patients experienced support to reformulate their identity during the exercise intervention in their interaction with peers in the group.

Effectiveness of storytelling interventions on psychosocial outcomes in adult patients with a life-threatening illness: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify the effectiveness of storytelling interventions on psychosocial outcomes. In this review, storytelling is where adult patients with a life-threatening illness tell their illness story, facilitated by a healthcare professional.Specifically the review questions are.