Evaluating palliative care needs in Middle Eastern countries.

BACKGROUND: Cancer incidence in Middle Eastern countries, most categorized as low- and middle-income, is predicted to double in the next 10 years, greater than in any other part of the world. While progress has been made in cancer diagnosis/treatment, much remains to be done to improve palliative care for the majority of patients with cancer who present with advanced disease. OBJECTIVE: To determine knowledge, beliefs, barriers, and resources regarding palliative care services in Middle Eastern countries and use findings to inform future educational and training activities. DESIGN: Descriptive survey. SETTING/SUBJECTS: Fifteen Middle Eastern countries; convenience sample of 776 nurses (44.3%), physicians (38.3%) and psychosocial, academic, and other health care professionals (17.4%) employed in varied settings. MEASUREMENTS: Palliative care needs assessment. RESULTS: Improved pain management services are key facilitators. Top barriers include lack of designated palliative care beds/services, community awareness, staff training, access to hospice services, and personnel/time. The nonexistence of functioning home-based and hospice services leaves families/providers unable to honor patient wishes. Respondents were least satisfied with discussions around advance directives and wish to learn more about palliative care focusing on communication techniques. Populations requiring special consideration comprise: patients with ethnic diversity, language barriers, and low literacy; pediatric and young adults; and the elderly. CONCLUSIONS: The majority of Middle Eastern patients with cancer are treated in outlying regions; the community is pivotal and must be incorporated into future plans for developing palliative care services. Promoting palliative care education and certification for physicians and nurses is crucial; home-based and hospice services must be sustained.

Liminality as biographical disruption: unclassifiability following hormonal therapy for advanced prostate cancer.

The hormonal treatment of advanced prostate cancer involves life disruptive side-effects, such as impotence, libido loss and bodily feminisation. Conflicting views on the weight of the disruption they cause as against the therapy's survival benefits currently underlie debates over its appropriate mode of administration and its optimal timing in cases that do not necessitate immediate intervention. On the basis of a study of the disruptions caused to various life domains of 15 Israeli patients receiving such treatment, the present paper illustrates an integrated approach to their analysis that sheds new light on their intensity. The study was conducted by means of in-depth interviews and its data were processed according to the constant comparative analysis method. Its findings indicate that the therapy allowed the patients to regain their strength, to retain their need of love, basic masculine self-identification and spousal ties, and to renew their past social contacts. On the other hand they could no longer define themselves as healthy, sexually competent and 'male' in all respects, and their pre-treatment relationships with partners and friends lost the sense of closeness. Further psychosocial costs that were detected include patients' deprivation of their sense of continuity, excitements, hopes and coping capabilities. An integrated analysis of the concurrent normalisation and deviantisation processes undergone by them yielded the conclusion that the therapy subjects them to a liminal state, that is, the inability to classify themselves into culturally available categories. The difficulties entailed in this state highlight the need to take them into consideration when patients' condition allows a choice between alternative forms of hormonal therapy and between its early or deferred commencement. The interpretation of the disruption to their lives in terms of liminality also clarifies former studies' confusing reference to this subject and points to issues that still await investigation.

Advanced prostate cancer patients' ways of coping with the hormonal therapy's effect on body, sexuality, and spousal ties.

The authors examine the coping strategies employed by advanced prostate cancer patients receiving hormonal therapy to learn from their experience about potential solutions to their nonmedical needs. The study was based on in-depth interviews with 15 such patients and data analysis by the constant comparative method. The main psychosocial difficulties detected were patients' bodily feminization, sexual dysfunction, and disruption of spousal intimacy. Participants contended with these difficulties through disguise, diversion, and avoidance strategies applied in social interactions, and through self-redefining, self-distancing, and self-solacing cognitive tactics. The analysis of these coping techniques clarifies the motives behind their adoption by the participants, their changing patterns over time, their advantages and disadvantages, and the potential that understanding these issues possesses for improving interventions aimed at alleviating patients' difficulties.

Advanced prostate cancer patients' relationships with their spouses following hormonal therapy.

The paper analyses the adverse impact of the hormonal therapy's side-effects on advanced prostate cancer patients' capacity for maintaining their pre-treatment spousal relationships, the pros and cons of their ways of coping with the difficulties involved, and the implications of these issues for oncology nursing interventions. In-depth interviews were conducted with 15 Israeli prostate cancer patients, and the data were processed according to the constant comparative analysis method. The findings show that partners' supportive attitude and patients' attempts to stage resilience led to pre-treatment relationships' maintenance, and that, accordingly, patients' rejection by their partners and resignation to this difficulty resulted in spousal ties' disruption. However, whereas the relationships' maintenance came at the cost of burdensome constant pretence, their disruption was eventually reconstructed by the patients in positive terms. These findings are analysed against the backdrop of the constraints imposed by the hormonal therapy on patients' general coping competence and ability to enjoy non-sexual activities, which impair their capability to solve their marital problems more effectively. They would thus benefit from training oncology nurses who specialize in the unique difficulties facing them and their partners, and from oncology nursing interventions that focus on relevant information provision and counselling.