Waiting for scheduled surgery: A complex patient experience.

The aim of this study was to understand experiences of wait time among patients awaiting scheduled orthopaedic or cardiac surgery. Using a qualitative approach, 32 patients completed two interviews each regarding their wait time experiences, including effects of waiting. Patient experiences of wait time varied regardless of actual wait time and included reports of restriction, uncertainty, resignation, coping and opportunity. Participants' waiting experiences indicate a complex relationship between greater symptom severity and less tolerance for wait time. We suggest healthcare resources focus on alleviating the deleterious effects of waiting for certain patients rather than reducing absolute wait times.

An Abundance of Selves: Young Adults' Narrative Identities While Living With Cancer.

BACKGROUND: Identity negotiations of people living with cancer have been shown to be significant psychosocial challenges throughout cancer trajectories but have not been adequately explored among young adults with cancer. Narrative approaches might help to reveal moments of (dis)empowerment that affect their identity negotiations. OBJECTIVE: The aim of this study is to explore how young adults speak to their identities in relation to their narratives of having cancer and receiving care. METHODS: A total of 21 young adults (18-45 years old) provided cancer narratives through semistructured life history interviews. Thematic narrative analysis was used to determine how participants represented themselves in their stories. RESULTS: Participants used a wide diversity of identities well beyond those most familiar in dominant discourses (eg, patients, survivors, and fighters), and their identities frequently changed at significant "turning points" in their narratives, especially in relation to good and bad experiences of care. CONCLUSIONS: Cancer-related identities often undergo personal and social negotiation over time, and not just among young adults still feeling the effects of treatment. Psychosocial oncology could take further steps toward incorporating this fluidity and multiplicity within the discipline's discourses of identity. IMPLICATIONS FOR PRACTICE: The identities gathered here may contribute to a more comprehensive toolkit of narrative resources for empowering young adults (and others) with cancer, serving as a starting point for negotiating identities with their care providers. Our findings raise questions about which identities should be fostered and how healthcare professionals might be (unknowingly) involved in patients' identity negotiations.

Developing and pilot-testing a Finding Balance Intervention for older adult bereaved family caregivers: A randomized feasibility trial.

PURPOSE: This study aimed to test the feasibility of a psychosocially supportive writing intervention focused on finding balance for older adult bereaved family caregivers of advanced cancer patients. METHOD: The Finding Balance Intervention (FBI) was tested for feasibility, acceptability and potential influence on increasing hope, coping and balance through a multi-method pilot study employing a randomized trial design with 19 older adults with an average age of 72 years. The intervention group received the FBI and a follow up visit from an RN-RA. The control group received the FBI at a second visit. The FBI, a theory-based intervention was developed from grounded theory qualitative data, applying Delphi methods to design a self-administered, psychosocially supportive, writing intervention for older adults who had lost a spouse after caregiving. RESULTS: Feasibility was assessed and specific modifications identified. The FBI was easy to use, acceptable and of benefit. The FBI offered validation of emotions and ways to discover new ideas to find balance, which may enable bereaved caregivers to move forward on a unique journey through grief. The treatment group showed a statistically significant increase in restoration-oriented coping and higher oscillation activity. CONCLUSIONS: The results suggest the FBI was easy to use, acceptable and of benefit. A full scale study, with specific modifications to the design, is needed to test the effectiveness of this innovative intervention.

Tricksterdom in narratives of young adult cancer: performances of uncertainty, subversion, and possibility.

OBJECTIVE: As people with cancer attempt the difficult task of giving voice to life with illness, they often turn to mythic figures and stories (e.g., when people talk about battling cancer or embarking on a journey toward recovery). Little attention has been paid to the mythic figure of the trickster, recently identified by Arthur Frank (2009) as a prominent trope in some narrative accounts of illness. We investigated the prevalence of 3 tricksterly themes expressed within young adults' stories of cancer: destabilizing social or cosmic order (uncertainty), challenging dominant expectations for human life (subversion), and exploring alternative ways of viewing the world (possibility). METHOD: We recruited 21 young adults with cancer from across Canada and conducted semistructured interviews. We then analyzed their stories using some elements of thematic, structural, and dialogical/performative narrative analysis-drawing attention to what was told and how/to whom were they told (Crossley, 2000; Frank, 2012; Riessman, 2008). RESULTS: We describe each of the 3 themes in turn (i.e., uncertainty, subversion, and possibility) using excerpts from 6 interview transcripts, and show how they meaningfully converge into an interpretive framework of tricksterdom. CONCLUSION: We conclude that the 3 themes of uncertainty, subversion, and possibility seem to come together as tricksterly performances, disrupting audiences' expectations of more typical forms of cancer narratives and calling attention to less familiar, structured, and "tellable" ways of narrating illness.

Time while waiting: patients' experiences of scheduled surgery.

Research on patients' experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients' experiences of time while waiting for three types of surgery with varied wait times--hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care.

Waiting for surgery from the patient perspective.

The aim of this study was to perform a systematic review of the impact of waiting for elective surgery from the patient perspective, with a focus on maximum tolerance, quality of life, and the nature of the waiting experience. Searches were conducted using Medline, PubMed, CINAHL, EMBASE, and HealthSTAR. Twenty-seven original research articles were identified which included each of these three themes. The current literature suggested that first, patients tend to state longer wait times as unacceptable when they experienced severe symptoms or functional impairment. Second, the relationship between length of wait and health-related quality of life depended on the nature and severity of proposed surgical intervention at the time of booking. Third, the waiting experience was consistently described as stressful and anxiety provoking. While many patients expressed anger and frustration at communication within the system, the experience of waiting was not uniformly negative. Some patients experienced waiting as an opportunity to live full lives despite pain and disability. The relatively unexamined relationship between waiting, illness and patient experience of time represents an area for future research.