Feasibility study of a telehealth delivered, psychoeducational support group for allogeneic hematopoietic stem cell transplant patients.

OBJECTIVE: This study investigates the feasibility and efficacy of a telehealth delivered psychoeducational support group for allogeneic hematopoietic stem cell transplant (AHSCT) survivors. METHODS: All AHSCT survivors 0-3 years post-transplant from the Tom Baker Cancer Centre, Calgary, Alta., Canada were contacted over a 4-year period and invited to participate. Groups were led by trained facilitators and the didactic content included many of the concerns commonly reported by AHSCT survivors. Participants met with facilitators and other group members via videoconferencing equipment located at various community health centres across Alberta, British Columbia, and Saskatchewan. RESULTS: Of the 19 AHSCT survivors who chose to participate, 74% attended five or more of the six sessions and 100% stated that they were satisfied with the program. The groups were found to be feasible and well liked by all participants. While participants appeared to have gained a greater appreciation of life, they did not demonstrate any significant improvements in quality of life, spirituality and meaning making, distress, or positive growth as measured by the questionnaires in the pre/post-package. CONCLUSIONS: Attendance and satisfaction ratings suggest that participants gleaned some benefit from participation. Psychoeducational support groups via videoconferencing may provide a viable alternative for those with limited access to psychosocial support. Clearly, more rigorous research is required to determine the utility of these psychoeducational support groups.

Lived experiences of Canadian women with metastatic breast cancer in preparation for their death: a qualitative study. Part I--preparations and consequences.

OBJECTIVES: This study aimed to detail the tasks of death preparation and the consequences of such preparation for women with metastatic breast cancer. METHODS: A phenomenological qualitative approach was used. Five women with metastatic breast cancer were interviewed on two occasions. Themes were analyzed, described, and validated, until saturation was met. Outcomes of thematic analysis related to the impetus, process, and consequences of preparing for one's own death. FINDINGS: The women prepared for their death by: acknowledging their grief; preparing mentally; seeking information and support; preparing the family; and preparing for the end of life. They also engaged in creating life projects that enhanced their connections with loved ones, and lived full and joyful lives. These activities helped increased their readiness to die in peace. CONCLUSIONS: Preparing for their own death can help women with incurable cancer live full, satisfying lives, and be prepared to face their own death with peace. Helping women express their feelings around their own death and their preparation for death should be a key interdisciplinary psychosocial nursing intervention.

Lived experiences of Canadian women with metastatic breast cancer in preparation for their death: a qualitative study. Part II--enabling and inhibiting factors; the paradox of death preparation.

OBJECTIVES: This study examined the essence of lived experiences of a sample of women with metastatic breast cancer in preparing themselves for their own death, with the goal of informing health provider interventions that support an acceptance of and preparation for death. METHODS: A phenomenological qualitative approach was used. Five women with metastatic breast cancer were interviewed on two occasions. Themes were analyzed, described, and validated, until saturation was met. Qualitative outcomes of the thematic analysis related to the enabling and inhibiting factors involved in preparing for one's own death. RESULTS: Factors that enabled and inhibited death preparation tasks in these women included: personal past death experiences; the availability of time and a place to think, learn, and work on death preparation activities; a chance to connect with others in similar situations; and personal and cultural attitudes towards death. Gaps and unmet needs within the health care system were identified. Finally, the paradoxical nature of various aspects of death preparation was highlighted. CONCLUSIONS: Death preparation can be accomplished through enhancing supportive care from health care professionals, with beneficial outcomes for patients and families. Nurses should be conscious of the paradoxical nature of death preparation, and help women to confront and manage these.

A home study-based spirituality education program decreases emotional distress and increases quality of life--a randomized, controlled trial.

CONTEXT: Although epidemiological studies have reported protective effects of religion and spirituality on mental health, it is unknown whether spirituality can be used as an intervention to improve psychological well-being. OBJECTIVE: To evaluate the efficacy of a home study-based spirituality program on mood disturbance in emotionally distressed patients. DESIGN, SETTING, AND PARTICIPANTS: A non-blinded, randomized, wait list-controlled trial of 165 individuals with mood disturbance [score of >40 on the Profile of Mood States (POMS)] were recruited from primary care clinics in a Canadian city between August 2000 and March 2001. INTERVENTIONS: Participants were randomized to a spirituality group (an 8-week audiotaped spirituality home-study program), a mindfulness meditation-based stress reduction group (attendance at facilitated classes for 8 weeks), or a wait-list control group (no intervention for 12 weeks). MAIN OUTCOME MEASURES: Primary outcomes were mood disturbance, measured using POMS, and quality of life, measured using the SF-36, a short-form health survey with 36 questions. The POMS and the SF-36 were completed at baseline, at 8 weeks, and at 12 weeks. RESULTS: At the end of the 8-week intervention period, the mean POMS score improvement was -43.1 (-45.7%) for the spirituality group, -22.6 (-26.3%) for the meditation group, and -10.3 (11.3%) for the control group (P<.001 for spirituality vs control group; P=.034 for spirituality vs meditation group). Mean improvement in the SF-36 mental component summary score was 14.4 (48.6%) for the spirituality group, 7.1 (22.3%) for the meditation group, and 4.7 (16.1%) for the control group (P<.001 for spirituality vs control group; P=.029 for spirituality vs meditation group). At 12 weeks, POMS and SF-36 scores remained significantly different from baseline for the spirituality group.

Impact of a residential psychosocial program for cancer patients: a focus group investigation.

Focus groups of past program participants were conducted to explore the impact of a novel residential psychosocial intervention for cancer patients. All participants had attended the program between 6 months and 1 year prior to the study. The intention was to elicit a broad range of feedback regarding the program's effects on people living with cancer. Of particular interest was the assessment of lasting outcomes for participants, and possibilities for program improvement. This article reports the substantive understanding resulting from these focus groups, and discusses the beneficial impact, effective program characteristics, and controversial issues of residential psychosocial programming.

Tapestry: a retreat program of support for persons living with cancer.

PURPOSE: In an effort to mitigate the negative psychological sequelae of a cancer diagnosis and cancer treatment, efforts have been made to explore a variety of psychosocial issues and interventions. This article describes the provision and preliminary evaluation of a novel psychosocial service delivery, a residential "retreat" program called Tapestry, which is run under the aegis of the established cancer care community in Alberta, Canada. OVERVIEW: Retreat programs offer a novel way to provide psychosocial support for those persons who are living with cancer. The retreats are unique in the provision of a respite and the opportunity to address the isolation and other existential issues arising from a cancer diagnosis. The program described in this article has provided such a service six times per year since 1998. The intervention is described, and preliminary evaluation data are presented. CLINICAL IMPLICATIONS: Cancer care has begun to move beyond a solely biomedical paradigm toward a more holistic ethos in service delivery and research orientation. While the face value of and demand for such programming continues to grow, few residential psychosocial programs are offered under the auspices of conventional cancer care centers, and little work has been done to examine the nature and possible efficacy of retreat programs as a valid forum for psychosocial service delivery.