Preserving Oneself in the Face of Uncertainty: A Grounded Theory Study of Women With Ovarian Cancer.

PURPOSE: To describe the cancer care process as it is perceived by women with ovarian cancer. PARTICIPANTS & SETTING: 18 English-speaking adult women with ovarian cancer were recruited from an advocacy organization for patients with ovarian cancer and the gynecologic oncology clinic at a community-based teaching hospital in Burlington, Massachusetts. METHODOLOGIC APPROACH: A grounded theory approach was used. Data were collected via individual interviews with participants. FINDINGS: An overarching theme of preserving oneself in the face of uncertainty was described by the participants. Trajectories from prediagnosis to treatment were influenced by the quality of patient-provider communication, support from significant others, and self-concept aspects. IMPLICATIONS FOR NURSING: Comprehensive care that validates patient concerns and supports information exchange is essential. Nurses can promote the physical and psychological well-being of women with ovarian cancer by identifying institutional and community-based resources for support and specialty care.

Adding Silver to the Rainbow: Palliative and End-of-Life Care for the Geriatric LGBTQ Patient.

Lesbian, gay bisexual, transgender, and queer or questioning (LGBTQ) older adults have unique health care needs, especially in the palliative care and hospice setting. In this article, we present a male patient with metastatic ovarian cancer, admitted with worsening dyspnea, now at the end of life. Only his wife was aware of his identified gender, and nondisclosure was very important to him. As he continued to decline, the team navigated LGBTQ-sensitive care within the health care setting, insurance inequalities, and support and communication to his family. This case study summarizes clinical recommendations for the LGBTQ individual in the hospice and palliative care setting, suggesting how our patient's care may have been improved. With the changes in social acceptance and attitudes, the LGBTQ community has become more visible and their numbers appear to be growing. It is important, therefore, that hospice and palliative care providers be educated on their needs to provide competent and inclusive health care.

Economic Impact Among Family Caregivers of Patients With Advanced Ovarian Cancer.

OBJECTIVES: The life of a family caregiver changes in many ways when cancer is diagnosed. Changes regard also financial costs. To the authors' knowledge, little work has been done to estimate the costs associated with caregiving for cancer patients. The aim of the present study is to evaluate for the first time in literature the economic changes among family caregivers of advanced ovarian cancer during the first-line treatment in an Italian survey. METHODS: Between January 2009 and June 2014, the primary family caregivers of patients with advanced ovarian cancer (N = 172) were recruited from to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome within 4 weeks of the patient's new diagnosis. Caregivers reported demographic, medical information, and economic cost, such as traveling to and from medical appointments, waiting with patients for appointments, missing work, and attending to patients who are hospitalized. RESULTS: Between January 2009 and June 2014, 172 primary family caregivers of patients with advanced ovarian cancer were enrolled in the study. The mean age of the study cohort was 54.01 years. They reported 3% of missing workdays. The mean cost for all caregivers was &OV0556;1,888,732 per year. Therefore, the mean cost for each caregiver was &OV0556;10,981 annually. CONCLUSIONS: This economic analysis of caregiving in patients with advanced ovarian cancer reports the significant burden that cancer treatment places on both families and society. These findings underscore the importance, when appropriate, of including valid estimates of the cost of informal caregiving when evaluating the cost-effectiveness of cancer treatments.

"Cautiously optimistic that today will be another day with my disease under control": understanding women's lived experiences of ovarian cancer.

BACKGROUND: Women diagnosed with ovarian cancer face a multitude of physical, psychological, and social issues. However, existing research has typically focused on those newly diagnosed with an initial occurrence or recurrence or women with advanced disease. As such, few studies have examined women's experiences across the illness trajectory and the impact of ovarian cancer on their everyday lives. OBJECTIVE: This research explores women's lived experiences of ovarian cancer and how they negotiate and make sense of illness-related issues. METHODS: Sixteen women participated in face-to-face interviews and e-mail follow-ups that were informed by hermeneutic and social phenomenological approaches. RESULTS: Five broad themes emerged from data analysis related to changes in health status and the body, disruptions to everyday activities and relationships, uncertainty, and coping and finding meaning in illness. These themes reflect the structures of participants' experiences and constitute the essence of living with ovarian cancer, "cautious optimism." CONCLUSIONS: This research contributes to our understanding of women's lived experiences of ovarian cancer across the illness trajectory; specifically, the findings indicate that embodiment and relationships were a central focus for participants as they sought to cope with myriad issues resulting from ovarian cancer. IMPLICATIONS FOR PRACTICE: Insight into women's ovarian cancer experiences can help nurses in their provision of care to this population. Furthermore, the findings can inform support interventions for affected women across the illness trajectory, as participants' experiences show that support needs often persist following treatment as women negotiate survivorship or recurrence.

Healthcare utilization in women after abdominal surgery for ovarian cancer.

BACKGROUND: Women undergoing surgery for ovarian cancer are severely ill and are high users of health services. Contributing to these increased utilization rates are the multiple modalities used to treat ovarian cancer and the complications and side effects from those treatments. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of an intervention provided by advanced practice nurses and a psychiatric consultation-liaison nurse on patients' self-report of healthcare utilization compared with an attention control intervention in women undergoing surgery for a suspected diagnosis of ovarian cancer. METHODS: A two-group, experimental, longitudinal design was used to compare women who were assigned randomly to the intervention group or to an attention control group at baseline within 48 hours after surgery and 1, 3, and 6 months after surgery. Healthcare utilization was measured as the number of self-reported inpatient admissions and outpatient visits, including emergency room visits, oncology outpatient visits, and primary care visits. Nurse interventions consisted of 16 contacts: symptom management, counseling, education, direct nursing care, coordination of resources, and referrals. The attention control interventions consisted of nine contacts that included instructions on use of a symptom management toolkit and strategies on how to manage symptoms. RESULTS: There were no differences in hospitalizations and oncology outpatient visits between the two groups. The main finding of this study was a significant difference in the number of primary care visits between the two groups. Women in the attention control group went to their primary care providers more often than the intervention group. The women who reported more visits also reported more depressive symptoms. In addition, a trend was found in the number of emergency room visits between the two groups. The intervention group visited the emergency room more often because the nurse instructed patients to go when they recognized symptoms that needed urgent care after hours. DISCUSSION: Women in the intervention group appropriately used the emergency room to manage their problems after hours, whereas more women in the attention control group reported significantly more primary care visits. These findings highlight the need for healthcare providers representing various disciplines to coordinate services across specialties, especially for women who have depressive symptoms.

Quicker cancer care: reshaping patient pathways.

A new pathway has been devised for patients with ovarian cancer who attend a day-care unit for chemotherapy. This pathway, which is provided by nurses and doctors, has reduced patients' waiting time for treatment. Its implementation shows, therefore, that good clinical leadership can effect positive change.

Routine follow-up after treatment for ovarian cancer in the United Kingdom (UK): patient and health professional views.

PURPOSE: The aim of this study was to explore patients and health professional's perceptions of follow-up service provision following treatment for ovarian cancer. In the United Kingdom, where this study took place, ovarian cancer is the most common gynaecological cancer in women. The causes are unknown, symptoms are often vague and most cases are diagnosed at an advanced stage. There is a high likelihood of disease progression and little evidence on the benefits of routine follow-up after treatment for gynaecological cancer. METHOD: Two focus groups were conducted with patients (n=6) and health professionals (n=7) at a hospital in North-West England. RESULTS: From the patient group, three main themes emerged: reassurance, the need for support and information, and alternative approaches to follow-up care. Three main themes emerged from the health professional group: patient attendance at outpatient clinics to monitor for disease progression; the need to modernise the current system; and patients should be encouraged to self-manage their disease. CONCLUSIONS: There were similarities and differences in perceptions of follow-up care procedures between the two focus groups. Patients placed importance on clinical examination in indicating disease recurrence, whereas health professionals viewed this as historical practice with no evidence base. Accurate information on how disease progression is monitored should be communicated to patients. A modified approach to follow-up procedures is suggested as a useful strategy to tailor services to individual needs and preferences, whilst responding to service demands.

Cost, quality of life and outcome measures in ovarian cancer.

As research into cancer intensifies and treatments proliferate, life-interval gained is no longer a question of simply measuring time. Ovarian cancer patients, especially, have benefited from efforts to develop feasible screening processes and the new treatment modalities for this type of cancer. Within the last decade, medicine has come to realize that survival intervals and cure rates are useless to patients if they cannot retrieve out of the process at least some aspects of their lives before cancer and for as long a period of time as possible. This article focuses on measuring and assessing the effects of treatment in terms of outcome and quality of life from the patient's perspective. Medicine as a science, and being a science, has not been comfortable in taking into account intangibles when assessing its own performance and success rates. However, the roles of caregivers and health providers have been rapidly evolving from that of treating the disease to treating the patient, and often the patient's family, with all that implies.