Treatment and Rehabilitation for Esophageal Cancer-Striving to Meet Obstacles and Long-term Impacts: A Qualitative Descriptive Study.

BACKGROUND: Following esophagogastric cancer treatment, patients with esophageal cancer and their relatives struggle with adjusting to a new everyday life as they experience various challenges after treatment requiring rehabilitation. Health professionals must address long-term impacts on patients' health, everyday life, family functioning, and support needs. OBJECTIVE: This qualitative descriptive study aimed to explore patients', relatives', and health professionals' experience with long-term impacts and rehabilitation after treatment for esophageal cancer. METHODS: A qualitative approach based on a phenomenological-hermeneutical methodology was used. Two methods were selected in the study: focus group interviews with health professionals and individual interviews with patients and relatives. Inductive thematic analysis with inspiration from Braun and Clarke was used for data analysis. RESULTS: Three main themes emerged from the data analysis: (1) forced into limitations in everyday life, (2) learning and navigating a new everyday life, and (3) rehabilitation accepting new normality. CONCLUSION: Patients and relatives experience persistent long-term impacts after treatment for esophageal cancer, making rehabilitation strenuous and demanding. Relatives take considerable responsibility for the patients' rehabilitation but feel invisible and unsupported by health professionals. Health professionals acknowledge the severity of long-term impacts but fail to prepare patients and relatives for the impacts and do not see the relatives' need for support. IMPLICATIONS FOR PRACTICE: The study emphasizes the need for a proactive approach in the healthcare system, addressing patients' and relatives' physical and psychological vulnerability. Cancer nurses need to prepare and involve patients and relatives in treatment, long-term impacts, and rehabilitation.

'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.

Ready to Go Home? Nurses' Perspectives of Prolonged Admission for Patients Undergoing Video-Assisted Thoracic Surgery for Non-Small-Cell Lung Cancer in Denmark.

Enhanced recovery after surgery programs with median postoperative hospitalization of 2 days improve outcomes after lung cancer surgery. This article explores nursing care practices for patients with lung cancer who remain hospitalized despite having recovered somatically. Qualitative focus group interviews were conducted with 16 nurses. Ricoeur's phenomenological hermeneutics underpins the methodology applied in this study, and we relied on Benner and Wrubel's theory. The nurses emphasized that the thoughts of patients with a recent lung cancer diagnosis revolve around more than the surgery. Nursing comprises not only practicalities but also attending to patients' stress and their coping with being struck with lung cancer and having undergone surgery. A counterculture emerged to counteract the logic of productivity, indicating that caring as a worthy end in itself may be underestimated in protocol-driven care. Prolonging hospitalization largely depends on clinical judgment. The nurses' aim is not to keep patients in the hospital but to avoid any needless suffering, allowing them to reclaim the primacy of caring.

Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery: A qualitative study.

BACKGROUND: Closed-incision negative pressure therapy may lower the risk of surgical site infections in patients after peripheral arterial surgery. AIM: To explore patient experience of negative pressure therapy applied to groin incisions after discharge following peripheral arterial surgery, and to study their perception and attitudes toward the self-care information sheet they received at the vascular department. METHODS: A qualitative study underpinned by Gadamer's philosophical hermeneutics was conducted semi-structured interviews by telephone around day seven after therapy ended with ten participants. All had received self-care information sheet at the discharge and been home with closed-incision negative pressure therapy for 3-6 days. The participants had open peripheral arterial surgery in the groin in form of femoral thromboendarterectomy. Kvale and Brinkmann's research guided the data collection, analysis, and interpretation. FINDINGS: Patients found themselves coping with an unfamiliar situation after peripheral arterial surgery and the need arose to conceal the pump and tubing that were part of their incision treatment to protect their self-image. Their treatment became a constant companion, with some patients viewing the equipment as an extension of their bodies and others feeling its impact on activities of daily living. Patients perceived the treatment as providing reassurance, albeit with constraints, leading to feelings of manageability and an increasing sense of control. They viewed the written information as informative but with room for improvement. CONCLUSIONS: Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery showed that they perceived it as safe and manageable. Patients need support, however, in learning how to hide the treatment and to expand their own involvement and improve self-care. The study found that patient involvement and individually tailored information is essential to facilitating a healthy transition from hospital to self-care at home and that written information must be improved further.

Qualitative exploration of the perceptions of exercise in patients with cancer initiated during chemotherapy: a meta-synthesis.

OBJECTIVE: To synthesise qualitative literature on (1) the perceptions of patients with cancer of participating in an exercise intervention while undergoing chemotherapy and (2) to inform and guide professionals in oncology and haematology practice. DESIGN: A qualitative meta-synthesis based on Noblit and Hare's seven-step meta-ethnography. DATA SOURCES: Six electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE, PubMed, SCI-Expanded-SSCI and Scopus (final search June 2022) were used to identify qualitative literature containing individual or focus group interviews. The transparency of reporting for each study was assessed using the Consolidated criteria for Reporting Qualitative research checklist. RESULTS: The search identified 5002 articles, 107 of which were selected for full-text review. Seventeen articles from five countries with patients undergoing chemotherapy during exercise interventions were included. Eleven articles were included in the meta-synthesis, which comprised 193 patients with various cancer diagnoses, disease stages, sexes and ages. Four main themes were identified: chemotherapy overpowers the body; exercise in battle with side effects; a break from gloomy thoughts; and a question of survivorship. CONCLUSIONS AND IMPLICATIONS: The meta-synthesis emphasised that patients with cancer undergoing chemotherapy and simultaneously participating in exercise interventions may experience momentary relief from overwhelming side effects, even though full bodily recovery may be perceived as a distant prospect. The synthesis offers a sparse empirical basis for gaining insight into what patients experience existentially following exercise interventions. It is up to patients to independently apply the transfer value of exercise to their own existential circumstances.

How Adolescents and Young Adults with Cancer Experience an Age-Appropriate Intervention When Undergoing Treatment in Adult Surgery Clinics: A Qualitative Study.

Purpose: Despite growing international attention, few interventions specifically target adolescents and young adults (AYAs) with cancer even though appropriate interventions may improve care delivery during cancer treatment. The study's purpose was to explore how AYAs with cancer experience an age-appropriate intervention when undergoing treatment in adult surgery clinics. Methods: Twenty AYAs with cancer, aged 18-29 years, from five surgery clinics at Copenhagen University Hospital Rigshospitalet participated in an intervention consisting of three main components: care provided by trained youth coordinator nurses (YCNs) to the greatest extent possible; a 1-hour one-on-one conversation with a YCN during hospitalization; and a postdischarge phone call. Semistructured interviews were used to collect data, which were analyzed in a stepwise process based on inductive content analysis. Results: Three themes were identified: a beacon in the dark; from patient to person; and the caring check-up. Participants felt safe and experienced a sense of presence and a caring environment in a significant and trusting relationship with YCNs, which encouraged them to share thoughts, feelings, and needs they previously had kept silent about. The one-on-one conversations helped them begin reflecting and in emotional processing and the postdischarge phone call was perceived as a caring check-up. Conclusions: The study shows how an age-appropriate intervention was experienced overall as meaningful for the participants hospitalized in adult surgery clinics, but more research is required to further examine the significance and effect of interventions that target AYAs with cancer.

Do enhanced recovery after lung cancer surgery programs risk putting primacy of caring at stake? A qualitative focus group study on nurses' perspectives.

AIMS AND OBJECTIVES: To gain insight into nursing in an enhanced recovery after surgery program for lung cancer, we explored its meaning for nurses in a thoracic surgery unit. BACKGROUND: Since nurses play a key role in overcoming implementation barriers in enhanced recovery after surgery programs, successful implementation depends on their care approach during the surgery pathway. DESIGN: Qualitative focus group study. METHODS: A hermeneutic approach inspired by Gadamer guided the research. Sixteen thoracic surgery nurses participated in focus group interviews. Benner and Wrubel's primacy of caring theory enhanced understanding of the findings. COREQ guidelines were followed. RESULTS: The thoracic surgery nurses compared the streamlined trajectory in the program to working in a factory. Shifting focus away from a dialogue-based, situated care practice compromised their professional nursing identity. The program made combining scientific evidence with patients' lifeworld perspectives challenging. Although the nurses recognised that the physiological processes and positive outcomes promoted recovery, they felt each patient's life situation was not sufficiently considered. To meet the program's professional nursing responsibilities and provide comprehensive care, specialised thoracic nursing should continue after discharge to allow professional care while meaningfully engaging with the patient's situatedness and lifeworld. CONCLUSIONS: Primacy of caring risks being compromised if accelerated treatment is implemented uncritically. If care is based on the dominant rational justifications underpinning surgical nursing, living conditions and patient values might be overlooked, affecting how disease, illness and health are managed. RELEVANCE TO CLINICAL PRACTICE: Our findings focus on obvious unintended consequences of enhanced recovery after surgery programs. To avoid dehumanising patients, surgical lung cancer programs must adopt a humanistic attitude in a caring practice guided by the moral art and ethics of care and responsibility. PUBLIC CONTRIBUTION: To reminding us of what matters and helping us think differently, we discussed the results of the study with organisational stakeholders.

Understanding Existential Anxiety and the Soothing Nature of Nostalgia in Life With Incurable Esophageal Cancer: A Phenomenological Hermeneutical Investigation of Patient Narratives.

BACKGROUND: Research has identified how people living with incurable esophageal cancer experience existential concerns. OBJECTIVE: The aim of this study was to examine the phenomenon of existential anxiety when living with esophageal cancer in the context of receiving general palliative care in a hospital setting. METHODS: This qualitative study is inspired by phenomenological and hermeneutical aspects of the philosophies of Ricoeur and Heidegger. Applying Heidegger's theory of existential anxiety and nostalgia, we interpreted the narratives of 18 patients receiving palliative care due to incurable esophageal cancer. RESULTS: The patients experienced existential anxiety at the loss of a future and homeliness when receiving palliative care. Their existence was reduced to the present, with a break in temporal continuity. An anxious mood permeated their entire being-in-the-world in an unhomelike way. Despite this, patients initiated a restoration of home and meaning expressed as a soothing sense of nostalgia that served as an atmospheric, safe space allowing them to inhabit the borderline between past, present, and future. CONCLUSIONS: The study suggests an empirical interpretation of the existential anxiety patients experience when receiving palliation for incurable esophageal cancer. It sheds light on how these patients would benefit from healthcare professionals inviting them to narrate significant aspects of their life stories in which the soothing presence of nostalgia can be supported. IMPLICATION FOR PRACTICE: Providing care conditions for a life heading toward death, where the patient can live alongside anxiety, involves focusing on "being with" the patient and on incorporating a nostalgic dimension to facilitate soothing restoration of home for patients.

The Needs and Care Experiences of Adolescents and Young Adults Treated for Cancer in Adult Surgery Clinics: A Qualitative Study.

Purpose: Adolescents and young adults (AYAs) with cancer hospitalized in adult surgery clinics are an overlooked group of patients. They are a minority hospitalized among elderly surgical patients, and the surroundings and care are designed with older patients in mind. A growing body of research focuses on AYAs' experiences of cancer care. However, studies exploring care experiences in terms of in-patient surgery treatment are still needed. Hence, the purpose of the study was to explore the needs and care experiences of AYAs, 15-29 years of age, treated for cancer in adult surgery clinics. Methods: This qualitative study was based on semistructured interviews with 15 AYAs with cancer from seven surgery clinics at Rigshospitalet, Copenhagen University Hospital, Denmark. Data were analyzed and interpreted using inductive content analysis. The Danish Data Protection Agency approved the study (project no.: 05617). Results: Three themes were identified: (1) being the black sheep - experiences of being young in an adult environment, (2) the significant nurse - experiences of the essential relationship between AYAs and the nurses, and (3) the wounded body - experiences of how the physically changed body affects the mind. Conclusions: Our findings showed that the psychosocial needs of AYAs with cancer hospitalized in adult surgery clinics were not being adequately met. Initiatives are needed to improve the psychological and social well-being of this vulnerable patient group, while hospitalized for treatment in surgery clinics.

Cardiovascular Rehabilitation Increases Walking Distance in Patients With Intermittent Claudication. Results of the CIPIC Rehab Study: A Randomised Controlled Trial.

OBJECTIVE: To examine whether a cardiac rehabilitation programme in a community based setting for patients with intermittent claudication (IC) affects walking ability, quality of life, and changes in health behaviour. The trial investigated a cross sector cardiovascular rehabilitation programme compared with usual care for patients having non-operative management. METHODS: The trial allocated 118 patients, with 1:1 individual randomisation to either an intervention or control group. Data were collected at a department of vascular surgery and at a healthcare centre in Denmark. The rehabilitation intervention consisted of usual care plus 12 weeks of exercise training, pedometer, health education, and text messages. The primary outcome was maximum walking distance at six months measured by treadmill walking test. The secondary outcomes were maximum walking distance at 12 months and pain free walking distance measured by treadmill walking test, healthy diet, level of physical activity, and quality of life (QoL) at six and 12 months. RESULTS: In the intervention group, 46 participants were analysed, with 47 in the control group. Following three months of rehabilitation, a 37% difference (95% CI 1.10 - 1.70; p = .005) was found between groups in maximum walking distance at six and 12 months, in favour of the intervention group. The same positive effect was found in physical activity, QoL, and healthy diet, but was not statistically significant in pain free walking distance and smoking. CONCLUSION: A specialised community based cardiac rehabilitation programme for patients with IC showed statistically and clinically significant effects on maximum walking distance, physical activity, quality of life, and healthy diet, but not on pain free walking distance and smoking, compared with usual care without rehabilitation.

What's going on after hospital? - Exploring the transition from hospital to home and patient experiences of nurse-led follow-up phone calls.

AIMS AND OBJECTIVES: To explore the transition from hospital to home and patient experiences of nurse-led post-operative follow-up phone calls after thoracic surgery. BACKGROUND: Enhanced Recovery After Surgery protocol places new demands on patients after hospital. Need for a proactive approach to improve the post-operative follow-up process in the home is required. DESIGN: Qualitative intervention study. METHODS: Interviews were conducted with patients who had received a post-operative phone call after hospital discharge (n = 15). The analysis was inspired by Gadamer and Meleis. COREQ guidelines were followed. RESULTS: Two overall themes emerged: (1) The follow-up phone call, which concerns experiences involving the actual call and (2) Transitioning from hospital to home, which through four subthemes illuminates; how patients describe their initial time at home, that patients experience a changed body after surgery, that patients feel alone after returning home and that a call from a nurse can help patients not to feel left out and finally why it is absolutely essential that nurses initiate the phone call. CONCLUSION: Patients are at different stages in their transition process after hospital, making timing of follow-up tricky. Being part of an Enhanced Recovery After Surgery programme has implications for the initial period after discharge; dominated by fatigue, pain and experiences of a changed body. Patients experience being left alone with their illness, and the phone call helps to relieve this isolation. It is essential that the nurse call the patient since the patients want to avoid disturbing the staff. RELEVANCE TO CLINICAL PRACTICE: Healthcare workers can use the findings to understand how patients experience the transition from hospital to home when enrolled in an Enhanced Recovery After Surgery programme. Need for support from a nurse following discharge is suggested.

Am I going to die now? Experiences of hospitalisation and subsequent life after being diagnosed with aortic dissection.

Aortic dissection is a life-threatening condition with mortality up to 75%. In the acute phase, patients are constrained with total bed rest until pain relief and blood pressure has been stabilised. Some need surgery. Aortic dissection is associated with anxiety and poor health-related quality of life. However, no study has explored the experience of living through aortic dissection. The aim of this study was to explore the patient experience of living through aortic dissection. Data were collected in interviews with 10 patients who lived through aortic dissection. Data were gathered and analysed using a phenomenological approach. The qualitative analysis revealed four themes; 'Am I going to die now? - the existential turning point when diagnosed with life-threatening aortic dissection', 'compromised integrity during admission - experiences of hospitalisation', 'Signals from my body - a new awareness of the body after discharge', 'What can I do? - uncertainties about physical activity in daily life posthospitalisation'. Experiences of aortic dissection are a life-threatening and overwhelming existential life situation which includes a period of constraining hospitalisation and experiences a compromised integrity. Patients have substantial concerns regarding body signals and a constantly uncertainty about what kind of activity level they can sustain which affect their mental well-being and their daily life. These findings contribute to understanding and elaborating a more nuanced description of being diagnosed with aortic dissection, which is essential when planning high-quality treatment and care, developing sufficient follow-up and preventing adverse events.

The Understanding of Dignity Among In-Hospital Patients Living With Incurable Esophageal Cancer.

BACKGROUND: Dignity is an inherent value in palliative care, but understanding dignity among people living with and hospitalized for incurable esophageal cancer has not been explored. OBJECTIVE: The aim of this study was to empirically explore the meaning of dignity in people hospitalized with incurable esophageal cancer. METHODS: A qualitative hermeneutic approach, inspired by Gadamer, guided the research process and interpretation of the transcribed interviews. Eighteen patients participated in the study. RESULTS: The meaning of dignity was revealed as reverential response in care relationships and eating as an undignifying activity. A balance of the healthcare system's framework with the lifeworld of the patient was significant in preserving dignity and gave patients a sense of reverent response. Patients were unable to eat ordinary daily meals, which affected their perception of own body and identity, including interactions with others. The resulting bodily changes and social consequences were of crucial importance to the perceived dignity. CONCLUSIONS: A dialogical and understanding approach is significant in making the patient feel worthy, consequently helping to uphold a sense of dignity. The changing and decaying body due to eating difficulties bears witness to illness, altering the individual's sense of self, in turn threatening the dignity of identity. IMPLICATION FOR PRACTICE: The care should be based on a reverential response based on the patients' lifeworld. In doing so, storytelling might be a way. Palliative care for these people needs to stress that patients share other aspects of life that is not totally dominated by their illness, inability to eat, and unrecognizable body.

A radical change: A qualitative study of patients' experiences of eating and daily living through the first year after oesophageal resection.

PURPOSE: The purpose of this study is to explore the lived experiences of patients in terms of eating and consequences in everyday life in the first year after oesophageal cancer surgery. METHODS: Thirteen patients participated in qualitative interviews one year after surgery for oesophageal cancer. Descriptions capturing the meaning of the lived experiences of patients were then derived from subsequent analysis and interpretation of the interviews. A phenomenological hermeneutical approach comprised the epistemological stance, and theoretical perspectives were drawn from Schutz' theory of everyday life. RESULTS: Patient descriptions of their experiences with food, eating and everyday life in the first year after oesophageal cancer surgery fell into four themes: Adjusting to a different anatomy - food and eating as a dominant and difficult activity; changed body - food and eating as an underlying shadow; feeling different - social consequences of changed eating; a nutritional jungle - guidance and support in an uncertain time. CONCLUSION: The physical and social consequences of oesophageal cancer resection upend everyday structures, requiring patients to adopt a new, conscious and reflexive approach to food and eating as a social activity. Continuous support from healthcare professionals and patient-to-patient interaction can help redefine everyday life.

Early initiated postoperative rehabilitation enhances quality of life in patients with operable lung cancer: Secondary outcomes from a randomized trial.

INTRODUCTION: Patients with lung cancer report a lower degree of Health Related Quality of Life (HRQoL) compared with other cancer patients. HRQoL reflects how patients experience the impact of their disease and its treatment on their quality of daily living. A widely used questionnaire in lung cancer patients is the Functional Assessment of Cancer Therapy - Lung (FACT-L) questionnaire. Here we report the secondary outcomes on FACT-L data from the Postoperative Rehabilitation in Operation for Lung CAncer (PROLUCA) study, which describes the effect of early (14 days) versus late initiated (14 weeks) postoperative rehabilitation. MATERIALS AND METHODS: The PROLUCA study was designed as a two-armed randomized controlled trial with an early rehabilitation group (14 days after surgery (ERG)) or a control arm with a late rehabilitation group (14 weeks after surgery (LRG)). The results for seven domain scores obtained using the FACT-L at the following time-points: baseline, 14 weeks, 26 weeks and 52 weeks after surgery are presented here. RESULTS: 119 patients were randomized to the ERG and 116 to the LRG. In the ERG, HRQoL measured by both FACT-L and FACT-G (general core instrument) showed a continuous improvement up to 26 weeks after which HRQoL decreased after further 26 weeks without structured intervention. In the LRG a non-significant deterioration was detected over the first 14 weeks after surgery. After participation in the 12 weeks rehabilitation program, an increase in HRQoL was seen, without reaching the same level as the early group. CONCLUSION: Analyses of the seven domain scores obtained using FACT-L and FACT-G reflect the importance of starting exercise early after surgery since the ERG avoid a temporary decrease in HRQoL. It is therefore recommended to start up a structured rehabilitation program 14 days after surgery, containing high intensity interval training and strength exercise twice a week for 12 weeks.

Questionnaire measuring patient participation in health care: Scale development and psychometric evaluation.

BACKGROUND: Patient participation in treatment and care is often encouraged and is desirable because of its proven positive impact on treatment, quality of care and patient safety. AIMS: To develop an instrument to measure patient participation in health care and to investigate the measurement properties of the Patient Participation Questionnaire (PPQ). METHODS: A literature review was conducted to develop a model of patient participation. The PPQ was constructed consisting of 17 items organized into four subscales. Psychometric evaluation of factor structure, convergent construct validity by hypothesis testing and analyses of internal consistency using Cronbach's alpha were performed on data from a hospitalised mixed group of patients with cardiac disease, pulmonary disease and cancer (N=378 patients). RESULTS: Confirmatory factor analysis did not show a clear model fit, which is why an exploratory factor analysis was performed, suggesting a different four subscale structure consisting of a total of 16 items. The four subscales were labelled Shared decision power, Adapted and individualized knowledge, Collaboration and Human approach. There were strong ceiling effects on all items. Analysis of convergent construct validity showed a moderate correlation (0.59) between the PPQ and another instrument measuring patient participation. Internal consistency for the total PPQ score was high: 0.89. CONCLUSION: In a mixed group of patients with cardiac disease, pulmonary disease and cancer, the PPQ showed promising psychometric properties in terms of factor structure, convergent construct validity and internal consistency. The PPQ may be used to shed light on the experience of patient participation and guide quality improvements.

Food and heart-the nutritional jungle: Patients' experiences of dietary habits and nutritional counselling after coronary artery bypass grafting.

AIMS AND OBJECTIVES: The aim of the study was to examine patients' experience of dietary habits and nutritional counselling in the early period during hospitalisation after coronary artery bypass surgery (CABG). BACKGROUND: Undergoing CABG, patients have two different nutritional needs, extra proteins and calories for the first period after surgery and a heart-healthy diet when the recovery period is over. These needs can be difficult to manage for the patients. DESIGN: Qualitative study. METHODS: Interviews were conducted and analysed within a phenomenological-hermeneutic frame inspired by the French philosopher Paul Ricoeur. Patients undergoing CABG were interviewed 4-5 days after surgery at Odense University Hospital from March to May, 2017. The study adhered to the COREQ guidelines. RESULTS: In total, 15 patients were interviewed (mean age 65 years, 87% men). After analysing the interviews following themes emerged, "Different needs-the nutritional jungle", "Food and heart-the lacking attention," and "The force of habits-being under the influence from spouses on dietary habits". CONCLUSION: The interviewed patients had no or only a little knowledge about how to eat after heart surgery. In general, they experienced a lack of attention to nutritional counselling by the nursing staff during hospitalisation. Furthermore, the health behaviour of men seems to be different from women's, and therefore, interventions aiming at optimising men's health might be prioritised. Finally, spouses have a great influence on eating habits, why they should be involved in nutritional counselling. RELEVANCE TO CLINICAL PRACTICE: This study provides important and relevant knowledge about patients' lacking knowledge about nutrition. When planning nutritional measures, whether it is promoting healing after heart surgery or preventing progression of arteriosclerosis, the study contributes with suggestions as to which factors should be considered in this process-men's health behaviour and spouses' influence on dietary habits in the household.

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.

The use of personal narratives in hospital-based palliative care interventions: An integrative literature review.

BACKGROUND: People living with life-threatening illness experience unmet existential needs despite the growing research and clinical field of palliative care. Narrative interventions show promise in managing these problems, but more knowledge is needed on the characteristics of narrative interventions and the feasibility of using personal narratives in a hospital. AIM: To review the literature on personal narratives in hospital-based palliative care interventions and to strengthen palliative care practices. DESIGN: We conducted a systematic integrative review with qualitative analysis and narrative synthesis in accordance with PRISMA where applicable (PROSPERO#:CRD42018089202). DATA SOURCES: We conducted a systematic search in PubMed, Embase, Scopus, Cinahl, SocINDEX and PsychInfo for primary research articles published until June 2018. We assessed full-text articles against the eligibility criteria followed by a discussion of quality using the Critical Appraisal Skills Programme. RESULTS: Of 480 articles, we found 24 eligible for this review: 8 qualitative, 14 quantitative and 2 mixed methods. The articles reported on dignity therapy, legacy building, outlook, short-term life review and life review. Data analysis resulted in five themes: core principles, theoretical framework, content of narrative, outcome and, finally, acceptability and feasibility. CONCLUSION: Various types of systematic palliative care interventions use personal narratives. Common to these is a shared psychotherapeutic theoretical understanding and aim. Clinical application in a hospital setting is both feasible and acceptable but requires flexibility regarding the practices of the setting and the needs of the patient.

Table in the corner: a qualitative study of life situation and perspectives of the everyday lives of oesophageal cancer patients in palliative care.

BACKGROUND: Incurable oesophageal cancer patients are often affected by existential distress and deterioration of quality of life. Knowledge about the life situation of this patient group is important to provide relevant palliative care and support. The purpose of this study is to illuminate the ways in which incurable oesophageal cancer disrupts the patients' lives and how the patients experience and adapt to life with the disease. METHODS: Seventeen patients receiving palliative care for oesophageal cancer were interviewed 1-23 months after diagnosis. The epistemological approach was inspired by phenomenology and hermeneutics, and the method of data collection, analysis and interpretation consisted of individual qualitative interviews and meaning condensation, inspired by Kvale and Brinkmann. RESULTS: The study reveals how patients with incurable oesophageal cancer experience metaphorically to end up at a "table in the corner". The patients experience loss of dignity, identity and community. The study illuminated how illness and symptoms impact and control daily life and social relations, described under these subheadings: "sense of isolation"; "being in a zombie-like state"; "one day at a time"; and "at sea". Patients feel alone with the threat to their lives and everyday existence; they feel isolated due to the inhibiting symptoms of their illness, anxiety, worry and daily losses and challenges. CONCLUSIONS: The patients' lives are turned upside down, and they experience loss of health, function and familiar, daily habits. The prominent issues for the patients are loneliness and lack of continuity. As far as their normal everyday lives, social networks and the health system are concerned, patients feel they have been banished to a "table in the corner". These patients have a particular need for healthcare professionals who are dedicated to identifying what can be done to support the patients in their everyday lives, preserve dignity and provide additional palliative care.