Showing papers in "Cancer Nursing in 1993"

Development of an intervention to restore attention in cancer patients.

Abstract: Developing interventions to maintain or restore attentional capacity during demanding phases of illness will help promote effective functioning in people with cancer. This study tested the effects of an experimental intervention aimed at maintaining or restoring attentional capacity in 32 women during the 3 months after surgery for localized (Stage I or II) breast cancer. The intervention was designed to minimize or prevent attentional fatigue through regular participation in activities that engage fascination and have other restorative properties. Attentional capacity was assessed using objective and subjective measures at four time points, approximately 3, 18, 60, and 90 days after breast cancer surgery. After the first observation, subjects were randomly assigned to receive the intervention (n = 16) or not to receive intervention (n = 16). Repeated measures ANOVA showed a significant interaction of experimental intervention and time on attentional capacity. Specifically, subjects in the intervention group showed significant improvement in attentional capacity over the four time points, while the nonintervention group showed a pattern of inconsistent performance over time. Findings suggest that nurses can intervene to maintain or restore attentional capacity in women after surgery for localized breast cancer. The theoretical basis for further development of attention-restoring interventions in patients with cancer is discussed.

The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain.

Abstract: The purpose of this exploratory study was to examine the effects of therapeutic massage (consisting of effleurage, petrissage, and myofascial trigger point therapy) on pain perception, anxiety, and relaxation levels in hospitalized patients experiencing significant cancer pain. Thirty minutes of therapeutic massage was administered on two consecutive evenings to nine hospitalized males diagnosed with cancer and experiencing cancer pain. The subjects' self-reports of pain and relaxation (measured by Visual Analogue Scales) as well as anxiety (measured by the Spielberger State Anxiety Inventory) were recorded before and immediately after the intervention. The objective physiologic measures of heart rate, respiratory rate, and blood pressure were obtained before, immediately after, and, finally, 10 min after the massage intervention. Massage therapy significantly reduced the subjects' level of pain perception (average = 60%) and anxiety (average = 24%) while enhancing their feelings of relaxation by an average of 58%. In addition to these subjective measures, all physiological measures (heart rate, respiratory rate, and blood pressure) tended to decrease from baseline, providing further indication of relaxation. In conclusion, although the exact mechanism is not known, therapeutic massage is a beneficial nursing intervention that promotes relaxation and alleviates the perception of pain and anxiety in hospitalized cancer patients.

Long-term survivors of breast cancer. A qualitative descriptive study.

Abstract: The purpose of this study was to explore the daily lived experience of women who have survived breast cancer beyond 5 years without recurrence. A qualitative descriptive approach was used to collect and analyze the stories of 25 women, 40–78 years of age, with 5–26 years of survival time. Informants

Determinants of participation in state-of-the-art cancer prevention, early detection/screening, and treatment trials among African-Americans.

Abstract: It has been suggested that the greatest potential for reducing cancer mortality in high-risk populations may be realized through aggressive implementation of prevention, diagnostic, and state-of-the-art treatment programs and increasing participation in cancer trials. However, the national data suggest that African-Americans are most often underrepresented in such programs and/or trials. Multiple factors are assumed to contribute to this situation, but currently few studies have been conducted to validate their influence. A study focused on identifying factors that contribute to participation of African-Americans in investigational cancer programs and/or trials was therefore conducted. Two hundred twenty African-American men and women were recruited to participate in a regional survey. There was evidence to support the impact that perceptions, attitudes, and beliefs have on willingness to participate in investigational programs and/or trials. The factor having the greatest influence on willingness to participate in investigational programs and/or trials was perceived efficacy of the investigational programs and/or trials. Among this sample there was an apparent hesitancy of many to participate in research programs and/or trials. The prevailing belief that such programs and/or trials were only for those with the disease or condition under study appeared to influence their response. However, when provided information on the opportunities for participation in prevention, diagnostic, and treatment programs and/or projects for those within the general community (especially for those at higher risk) and on the benefits of participation, a much greater willingness to participate was expressed by participants.

Acute symptoms associated with antineoplastic drug handling among nurses

Abstract: Antineoplastic drug handling in the absence of adequate protective measures has been associated with biological uptake of the drugs among pharmacists and nurses. This study investigated the association between occupational exposure to antineoplastics and the presence of acute symptoms in a nationwide sample of 2,048 nurses and nurses' aides. Reported skin contact with the drugs was associated with a small but statistically significant increase in reported symptoms. Although number of doses handled and extent of protection used were significantly associated with number of symptoms, their effect was not independent of skin contact.

The experience of dyspnea in late-stage cancer. Patients' and nurses' perspectives.

Abstract: We examined the phenomenon of dyspnea during the last weeks of life as it is experienced by patients with cancer and understood by the nurses providing their care The literature on late-stage cancer suggests a discrepancy between the prevalence of this symptom and the degree to which it is considered clinically significant Using a range of descriptive and interpretive approaches, we sought to interpret that discrepancy through an understanding of how patients and nurses interpret the nature and meaning of this serious and distressing symptom Data sources included a pencil-and-paper survey of late-stage cancer patients, chart audit of a population of late-stage cancer patients in a metropolitan home-care hospice program, and intensive interviews with selected patients and nurses The findings showed that although dyspnea seems to be a significant clinical problem for patients in late-stage cancer, and although effective intervention and management strategies are available, dyspnea often goes unreported by patients and unnoticed by healthcare professionals

Breast cancer survivors: an exploration of quality of life issues.

Abstract: This article explores long-term survivorship (5 years or longer) through focus group discussions with women who have experienced breast cancer. The data revealed four major themes; integration of the disease process into current life, change in perspective, and unresolved issues. These data begin to shed light on the issues of breast cancer survivors and can provide a basis for development of a quantitative instrument to be tested with larger populations.

Perceived informational needs of breast cancer patients receiving radiation therapy after excisional biopsy and axillary node dissection

Abstract: This study assessed the informational needs of female breast cancer patients receiving radiation therapy after excisional biopsy and axillary node dissection. Two groups of subjects were interviewed: women in the first week of radiation therapy (T1) and women at their first clinic visit after the completion of radiation therapy (T2). A total of 40 women (20 in each group) completed the Informational Needs Questionnaire-Breast Cancer (INQ-BC) to assess their perceived informational need. The INQ-BC assessed the women's informational needs concerning diagnosis, investigative tests, treatment, physical and psychological functioning, family, and available financial resources. All subjects had informational needs on all seven subscales of the INQ-BC. The T1 group had significantly higher scores than did the T2 group. However, for both groups the highest scores were in the Treatment and Physical subscales, suggesting a similarity in the women's informational needs. The results suggest that during the illness experience women seek information about their cancer treatment and related physical care. The results also indicate the importance of assessing the breast cancer patients' perceived informational needs at various points in the treatment continuum.

Pain management at home. Struggle, comfort, and mission.

Abstract: This article presents findings from an exploratory, descriptive study that investigated the experiences of pain in the home from the perspective of the patient, the primary family caregiver, and the home care nurse. The following research questions are addressed: What are the special problems associ

Reducing the incidence of stomatitis using a quality assessment and improvement approach.

Abstract: Stomatitis occurs in approximately 40% of the patients receiving systemic administration of chemotherapy and cancer treatments such as radiation to the head and neck. The presence of stomatitis affects the course of treatment and a patient's quality of life. An oncology nursing unit developed a quality assessment and improvement indicator addressing stomatitis. Oral cavity screening, dental consultations, oral care techniques, and patient teaching were included in the nursing interventions, which resulted in a marked reduction of new cases of stomatitis.

Oral- and pharyngeal-cancer patients' perceived symptoms and health.

Abstract: The purpose of this study was to describe the perceived eating problems, general symptoms, and general health of a group of oral- and pharyngeal- cancer patients before surgery in order to facilitate nursing care planning. A total of 29 patients (20 men and nine women) participated. Two groups were formed: in group 1, 13 patients participated before and, in group 2, 16 patients participated after the presurgical radiotherapy. Questionnaires were used to collect data. Eating disabilities were evident in both groups. The patients who had had their radiation therapy experienced problems such as bad taste function, mouth dryness, difficulties in chewing, and mouth pain more frequently than those who had not been treated. Only five patients in group 2 ate solid food, compared with 10 in group 1. Shoulder and back pain and feelings of worry and anxiety were perceived as the most frequent general symptoms. Most of the patients perceived their general health as being rather good, but some indicated poor health, several symptoms, poor appetite, and/or severe eating problems. Patients with oral and pharyngeal cancer should be carefully assessed before surgery because of their disparity of symptoms and disabilities so as to identify those who need specific nursing interventions.

The meaning and impact of empathic relationships in hospice nursing.

Abstract: This naturalistic field study was designed to explore the patient's perspective of the nature, meaning, and impact of empathic relationships with hospice nurses. The findings are part of a larger study, focused on the meaning and impact of empathic relationships that develop between hospice nurses and their patients. Data were generated through in-depth interviews with 14 terminally ill adults receiving home-based hospice care. According to the hospice patient, an empathic relationship developed through a process of reciprocal sharing and revealing of personhood within a context of caring and acceptance. The experience of an empathic relationship meant being acknowledged as an individual, a person of value. The outcome of the empathic relationships between hospice nurses and their patients was the improvement and maintenance of patients' physical and emotional well-being. Understanding the patient's perspective is critical for effective nursing interventions and meaningful outcomes. Future research needs to explore empathic relationships between the nurse and family caregivers in various settings.

The influence of diagnosis and treatment choice

Abstract: This exploratory study examined breast cancer patients' psychosocial and functional status at the time of diagnosis and during the initial phase of treatment. The purpose was to better understand the impact of diagnosis and treatment on patients' physical state and psychosocial well-being. A convenience sample was drawn from a population of newly diagnosed stage 1 and 2 breast cancer patients undergoing either modified radical mastectomy or lumpectomy with radiation. Subjects completed instruments designed to measure uncertainty, quality of life, functional status, and reaction to diagnosis on two separate occasions: at the time of diagnosis, but before treatment selection and then approximately 8 weeks after surgery. Data obtained from 52 subjects indicated that patients' perceptual uncertainty and various aspects of their functional status declined over the initial course of treatment, but that quality of life was unaffected. The results also showed no relationship between type of breast cancer treatment and patients' uncertainty, quality of life, and functional status. Mastectomy and lumpectomy patients also responded in similar ways to the cancer diagnosis. Both groups experienced the same amount of distress and used conformational coping strategies to similar degrees. Clinical implications are discussed and recommendations are made for future research.

Experienced nurses' narratives of their being in ethically difficult care situations. The problem to act in accordance with one's ethical reasoning and feelings.

Abstract: In previous interviews, experienced nurses have reported that their decisions in ethical matters depended "on the situation at hand." We interviewed 18 good, experienced cancer nurses to determine how they handled ethical decisions. They were asked to give an account of difficult situations that required ethical decisions to be made. The 60 narrated situations were interpreted step-by-step departing from the following two questions: What do nurses experience when being in ethically difficult care situations? What does the expression "it depends on the situation at hand how I act" mean? In complex situations, the nurses reported that the ethical situations that arose were regarded either as overwhelming or at the other end of the spectrum, as possible to grasp, and they expressed either loneliness or togetherness, respectively. When reporting overwhelming situations, the nurses mostly referred to themselves by using the word "one," i.e., "one would" and used "they" when referring to their coactors. When narrating situations possible to grasp, they used the terms "I" and "we." The most important situational factor that was revealed in these narratives was whether or not the nurses had a support group in which to share their thoughts. Without the support group, they reported difficulties acting in accordance with their ethical reasoning and feelings.

Mammography in women ≥50 years of age Predisposing and enabling characteristics

Abstract: The purpose of this study was to identify the relationship of selected predisposing and enabling characteristics of women > or = 50 years of age to mammography utilization. Andersen and Aday's theoretical model for health services utilization guided data collection. Data were collected from a convenience sample of 161 women members of four urban churches, using a mailed survey. Results showed that 81% reported at least one mammogram and 24% had followed mammography guidelines for the preceding 3 years. Results of logistic regression analyses with variables having a bivariate significance of p $50 out of pocket for a mammogram was significant for 3 year adherence. Additionally, the sociodemographic variables of age and religion were associated with adherence, whereas a college education was highly significant (odds ratio = 13.78) for ever having a mammogram. Having a regular place for health care and having yearly Papanicolaou tests were associated with ever having a mammogram, but not adherence. Finally, intending to get a mammogram was associated with ever having a mammogram. In this study, belief and knowledge variables showed no association with utilization, and social influence had bivariate significance only for ever having a mammogram. This study suggests the importance of addressing economic and health-care delivery system factors to promote increased mammography utilization, particularly for older women.

A comparison of American and Egyptian cancer patients' attitudes and unmet needs

Abstract: The purpose of this descriptive study was to compare and contrast similarities and differences in statements made by American and Egyptian cancer patients who expressed their attitudes toward cancer and reported their unmet needs. A total of 61 American and 66 Egyptian patients, who were receiving chemotherapy or radiotherapy, or a combination of the two treatments at the time of data collection, participated in the study. The American sample was drawn from patients at a large midwestern hospital, whereas the Egyptian sample was drawn from patients at the largest university hospital in Cairo, Egypt. Data were collected through a structured interview method in both patient populations. Analyses of responses showed five categories of attitudes for the American patients: (a) fighting spirit and adaptation, (b) fear/anxiety/disbelief (c) hope, (d) passivity in plan of care, and (e) faith. For Egyptian patients, seven categories emerged: (a) stoicism and fatalism, (b) dependency, (c) compliance with the medical regimen, (d) anxiety/fear/ insecurity, (e) powerlessness, (f) hope and optimism, and (g) family support. American cancer patients reported their unmet needs as (a) information, (b) needs related to treatment side effects, and (c) psychological support. Egyptian cancer patients reported their unmet needs as (a) relief from dependency, (b) relief from physical symptoms, and (c) information. These findings have implications for international oncology nursing, and imply the need for further research to determine if attitudes and unmet needs affect coping effectiveness and quality of life among cancer patients.

Relationships of barriers and facilitators to breast self-examination, mammography, and clinical breast examination in a worksite population

Abstract: The American Cancer Society recommends a regimen for breast cancer screening that includes mammograms, clinical breast examination, and breast self-examination. Compliance with breast cancer screening guidelines has been linked to a number of barriers and facilitators. These barriers and facilitators seem to lie within the cognitive framework and generalized beliefs of women, and in the situational contexts in which they lead their lives. A comprehensive study was designed to investigate variables related to breast cancer screening behaviors (breast self-examination, mammography, and clinical breast examination) of working women > or = 35 years of age at their worksite environments. A factor analysis identified similar sets of composite variables related to each of the screening modalities, and a discriminant analysis was performed for each screening technique to identify those variables that were most significant in predicting compliance with screening guidelines. The variables discomfort, perceived efficacy, and desire for control over health were significant for all three screening behaviors. Perceived importance was identified as a fourth variable for mammography and clinical breast examination, and lack of knowledge was a fourth variable for breast self-examination. Effective breast cancer screening programs involve all three screening techniques. In the design of education and intervention programs at worksites, it is critical to emphasize the commonalities of the variables that emerged in this study as important for each screening technique. Health-care professionals who implement such intervention programs need to explore and bring into the open these common barriers and facilitators to maximize working women's compliance with breast screening guidelines.

Dependent care, caregiver burden, and self-care agency of spouse caregivers.

Abstract: A convenience sample of 113 spouse caregivers was used to examine the relationships between dependent care, caregiver burden, and self-care agency. Subjects were the spouses of radiation oncology or chemotherapy patients in a large metropolitan hospital. The Denyes Self-Care Agency Instrument was used to measure self-care agency. The Task Scale was used to operationalize dependent care, and the Burden Scales were used to measure caregiver burden. Demographic data were collected on the number of weeks in the caregiver role, presence of health problems in the caregiver, gender, age, income, and education. In the total sample, subjective burden was negatively and significantly related to self-care agency and objective burden, in addition, dependent care and objective burden were also negatively related. When the data were divided into subsamples based on gender, several of the relationships were in opposite directions. The most notable of these were the relationships between dependent care and self-care agency. It is evident that interventions should take these gender differences into account.

Breast cancer in African-American women. Review of the literature.

Abstract: Decreased survival rates from breast cancer in the poor and in many African-American women are pressing public health problems. Health care providers are challenged to reduce breast cancer deaths in high-risk poor and African-American populations to achieve the National Cancer Institute's goal of reducing cancer deaths 50% by the year 2000. This article presents findings from a review of the literature concerning (a) the disproportionate distribution of cancer deaths in poor and African-American populations compared with non-poor white populations; (b) breast cancer detection initiatives and barriers to health services utilization; (c) primary prevention of breast cancer; and (d) broad strategies to empower poor and African-American women better to control their destiny through enhanced health practices and public policy initiatives.

Humor as a nursing intervention.

Abstract: This article describes the use of humor as a nursing intervention and asks if nurses can justify the integration of the use of humor into the repertoire of nursing interventions. Several uses for humor are illustrated, and humor is differentiated from laughter. The article quotes many nurse leaders' opinions about humor and identifies do's and do not's of appropriate humor; it discusses six research studies in which health care professionals used humor as a treatment protocol. The studies were in the areas of preoperative teaching, clinical evaluation, strategies to prevent hopelessness in adolescents with oncologic illness, and group cohesiveness. Results of these six studies give some evidence, although not robust, that humor is an effective intervention. Methods of determining and implementing humor as an appropriate nursing intervention are included.

Application of primary nursing within a team setting in the hospice care of cancer patients.

Abstract: A qualitative study was conducted to obtain a deeper understanding of the hospice care of terminally ill cancer patients, where care was delivered via a primary nursing system combined with a team setting. Relatives of terminally ill cancer patients (n = 20) and the personnel (n = 8) participated in open-ended interviews. Phenomena relating to the philosophy of primary nursing and the hospice movement (continuity: closeness: accountability 24 h/day: individualized care: satisfied physical, psychological, social, and spiritual needs: and support to relatives) were experienced by the relatives, nurses, and physician as “good care.” Most of the phenomena defined as important needs by the relatives and personnel were met when the primary nurse was on duty and the team was intact. Needs that were unmet were mainly a result of lack of continuity. Caring for the terminally ill via primary nursing in a team setting was regarded as two-sided by the nurses. It was seen as stimulating and rewarding, as well as demanding and burdensome. Therefore, the need for support to the nurses involved was deeply stressed.

Evaluation of high-risk smoking practices used by the homeless.

Abstract: The purpose of this study was to evaluate the prevalence of high-risk smoking practices in a homeless population. High-risk cigarette smoking practices include misuse of tobacco products or alternative methods of cigarette smoking that increase the likelihood of ingestion of toxic substances and infectious agents that can potentiate the hazards associated with cigarette smoking. An 84-item questionnaire was developed by the researcher to measure these practices. Fifty-six male and three female homeless people were interviewed in downtown Los Angeles. The most common high-risk smoking practices were cigarette sharing (86%); smoking cigarettes remade from discarded cigarette butts and filters (71%); smoking cigarettes remade by others (63%); smoking discarded cigarette butts (63%); blocking filter vents (24%); using things other than tobacco, such as discarded cigarette filters and drugs, in remaking cigarettes (22%); and smoking discarded cigarette filters (19%). These high-risk smoking practices pose a greater risk of exposure to toxins trapped in filters and tobacco remains and increase the threat of infectious disease transmission. The long-term effects of high-risk smoking practices among the homeless have potential economic implications for society.

Acute and long-term effects of radiation therapy to the eye in children.

Abstract: The goal of radiation therapy in pediatric cancer is to destroy cancer cells and preserve functional surrounding normal cells. Although all radiation for pediatric cancers does not result in complications of the eye, acute and long-term radiation effects can occur after treatment. Acute radiation effects to the eye include erythema, epilation, conjunctivitis, dermatitis, keratitis, corneal ulceration, iritis, and retinal edema. Long-term radiation effects include tissue necrosis, decreased tear production, telangiectasia, scleral melting, cataract, corneal neovascularization, radiation retinopathy, retarded bone growth (of bones within the irradiated field), and radiation-induced cancers. Nursing interventions and implications will be presented in conjunction with medical management for each of these acute and long-term effects.

Cultural awareness in the context of terminal illness

Abstract: While cultural awareness provides direction for planning effective nursing interventions at all stages of health and illness, this article specifically addresses applications for patients who are terminally ill. Professional nurses encounter unique challenges in caring for terminally ill patients. Assisting patients to achieve an "appropriate death" requires communication and collaboration among patients, family members, and professional caregivers. Since patients and their families represent many systems of complex beliefs and values, nurses must be aware of the impact of cultural pluralism on nursing assessment and intervention in terminal illness. Reordering priorities and redistributing resources have been identified as new approaches in caring for terminally ill patients and their families. Two concepts that cut across all cultural boundaries are loss and grief. Expressions of loss and grief take on a variety of forms among members of diverse cultures. It is critical that nurses recognize, understand, and respect each family's culture-specific patterns with regard to terminal illness. Understanding the culture will lead to the design of culturally appropriate nursing care for patients and families. Culture brokerage is defined as an act of translation, where messages, instructions, and belief systems are exchanged between cultural groups. This strategy has the potential to increase understanding among those with diverse cultural backgrounds, resulting in increased patient/family satisfaction within the supportive care setting. Consonance between patients' needs and nurses' understanding of those needs will lead to more culturally appropriate intervention strategies.

Concerns of families in which one member has head and neck cancer.

Abstract: This descriptive/exploratory study examined the concerns of families of patients with head and neck cancer. A convenience sample from a metropolitan hospital included four families. Data were collected through semistructured interviews, observations, and chart reviews over three time periods (before treatment, during treatment, and during rehabilitation) over a period of 5 months. Analysis of data showed five major types of concerns: cancer and its meaning, social relations, experience with hospitalization, treatment, and future placement. Findings showed that the types of concerns related to head and neck cancer are perceived as threatening and harmful. Concerns among patients were different from those of their family members across the different time periods. Our findings are useful in helping nurses understand the experience of head and neck cancer from the perspectives of the patient and their family members, and impact on their successful adjustment.

Personality types of oncology nurses.

Abstract: Personality type influences the choice of occupation. The breadth of specialty areas within oncology nursing allows for divergent activities and relationships and, thus, the accommodation of different personality characteristics. This exploratory study examined personality types for a convenience sample of oncology nurses predominantly employed in hospitals. According to the personality typology defined by Carl Jung, a person demonstrates a preference among four dimensions, i.e., extraversion/introversion, sensory/intuition, thinking/feeling, and judging/perceiving. The type with the strongest self-selection for these oncology nurses was ISFJ, where feeling is introverted and perception is practical, so that helping others is both a responsibility and a pleasure. The discussion relates the personality types to Jung's theory and their impact in clinical practice. Strengths and weaknesses of each personality type are described.

Patients?? descriptions of age-related aspects of cancer and care in Stockholm

Abstract: This exploratory study examines the situation of a heterogeneous group of 46 cancer patients from one general hospital in the Stockholm area who were diagnosed with a malignant disease in 1987. Forty-six patients were interviewed to determine how they experience and cope with their sickness. Although age-related issues were not directly addressed by the interviewer, they were frequently commented upon by the respondents. A questionnaire was also used to quantify various psychosocial aspects of the individual's cancer experience. Quantitative and qualitative data were used in a complementary fashion. The patients interviewed ranged in age from 29 to 88 years (median 61). Issues related to age were frequently addressed spontaneously by the interviewed persons, which led to further exploration of age-related aspects of care. Although few age-related differences in symptom distress were found, some differences were seen in patients' perceptions of the response of the professional health-care system. The older patients related that they have less quantitative contact with specialized formal resources, and perceive less sense of engagement and concern from the professional health-care sector. The qualitative analysis suggests that age may be used by patients as an explanatory factor in a variety of situations, functioning as a means of \"making sense\" of sickness experiences.

Management of acute radiodermatitis. Pharmacological or nonpharmacological remedies

Abstract: The medical and nursing literature suggests a wide variety of pharmacological and nonpharmacological approaches to treatment of acute radiation skin damages (erythema, dry and moist desquamation, ulceration), but no specific and standardized therapy. The incidence of radiodermatitis has decreased with mega-voltage instruments, but it can nevertheless influence the therapeutic program and impair quality of life of patients. A study has been conducted to evaluate the tolerability and effectiveness of a nonpharmacological remedy, a mixture of hydrophobic (stearic acid) and hydrophilic (propylene glycol, glycerol, and polyunsaturated alcohols) components in a foam emulsion for the treatment of acute skin injuries following radiotherapy. Thirty-eight of 42 initial patients were evaluable: we observed a complete response in 22 (57.9%), improvement in 14 (36.8%), and failure in only two (5.3%).

Relaxation training and psychoimmunological status of bereaved spouses. A pilot study.

Abstract: The death of a family member is one of the most stressful and disruptive life events. Although the literature abounds with subjective pieces concerning bereavement, little is known about the complex biological processes that follow in its wake. However, there is a growing body of evidence that psychological distress may compromise immunocompetence and that support strategies may enhance immune function. Our exploratory study examined the influence of relaxation training on the immunological and psychological status (including anxiety and depression) of bereaved spouses. Nine female spouses, all survivors of patients who died from cancer, were recruited from two hospice programs to participate in this relaxation-training program. Standardized psychological instruments and immunological assays were completed at three data-collection points: before the initiation of the relaxation training (approximately 6 weeks after the death of the spouse); at the conclusion of the training; and 4 weeks after the relaxation training. The subjects received a 1-h relaxation-training program weekly for 4 weeks. It included progressive muscle relaxation training and guided imagery supervised by a psychiatric nurse clinical specialist. The results indicated that the relaxation-training program was well-received by the subjects, with promising psychoimmunological trends that merit more rigorous investigation. This exploratory study has demonstrated the feasibility of conducting a relaxation-training intervention for bereaved spouses and has laid the foundation for continuing research to study the physiological and psychological responses of the bereaved.

Who cares? Patients' descriptions of age-related aspects of cancer and care in Stockholm.

Abstract: This exploratory study examines the situation of a heterogeneous group of 46 cancer patients from one general hospital in the Stockholm area who were diagnosed with a malignant disease in 1987. Forty-six patients were interviewed to determine how they experience and cope with their sickness. Although age-related issues were not directly addressed by the interviewer, they were frequently commented upon by the respondents. A questionnaire was also used to quantify various psychosocial aspects of the individual's cancer experience. Quantitative and qualitative data were used in a complementary fashion. The patients interviewed ranged in age from 29 to 88 years (median 61). Issues related to age were frequently addressed spontaneously by the interviewed persons, which led to further exploration of age-related aspects of care. Although few age-related differences in symptom distress were found, some differences were seen in patients' perceptions of the response of the professional health-care system. The older patients related that they have less quantitative contact with specialized formal resources, and perceive less sense of engagement and concern from the professional health-care sector. The qualitative analysis suggests that age may be used by patients as an explanatory factor in a variety of situations, functioning as a means of "making sense" of sickness experiences.