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Symptoms, care needs and diagnosis in palliative cancer patients in acute care hospitals: A 5-year follow-up survey
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Region Kronoberg, Sweden.ORCID iD: 0000-0002-3155-575x
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Jönköping university, Sweden.
Lund university, Sweden.
Stockholms Sjukhems FoUU, Sweden;Karolinska Institutet.
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2010 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 49, no 4, p. 460-466(7)Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Palliative cancer care in acute hospitals is scarcely studied. We therefore described and compared symptoms, care needs and types of cancer sites in 2002 compared to 2007 and analysed the relationships between these factors. METHODS: The study was population-based with a cross-sectional design and was carried out in medical, surgical and oncology wards in two acute care hospitals with no advanced palliative home care service. In 2002, 82 one-day-inventories were done (1 352 patients) compared to 142 one-day-inventories in 2007 (2 972 patients). Symptoms, care needs and cancer site were registered according to a questionnaire. Multiple logistic regression models were used to analyse associations between symptoms, care needs and cancer site. RESULTS: The proportion of palliative cancer patients had decreased during a five year period (14% vs. 11%, p<0.01). The patients were older in 2007 (74 vs. 70 years, p<0.001) and had more symptoms and care needs per patient (2.6 vs. 1.6, p<0.001). The most common symptoms were pain and deterioration and the most common cancer sites were prostate and colorectal cancer in both samples. Associations between symptoms, care needs and cancer site were mostly weak. Deterioration was associated with colorectal cancer, whereas pain was not associated with any specific cancer site. In haematological malignancies there was a high occurrence of infections and a high need of blood transfusions and infusions. Stomach/oesophagus cancers were significantly associated with nausea, nutritional problems and need of infusions while unknown primary malignancies were associated with abdominal surgery and infusions. DISCUSSION: Although we do not know all the causes for hospitalization, this study indicates that more focus should be on the symptoms instead of the specific cancer diagnosis. The findings also indicate that many palliative cancer patients' problems would be suitable for advanced palliative home care instead of acute hospital care.

Place, publisher, year, edition, pages
Informa Healthcare, 2010. Vol. 49, no 4, p. 460-466(7)
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
URN: urn:nbn:se:lnu:diva-2500DOI: 10.3109/02841860903463991ISI: 000276762700010PubMedID: 20121671OAI: oai:DiVA.org:lnu-2500DiVA, id: diva2:310777
Available from: 2010-04-16 Created: 2010-04-16 Last updated: 2019-04-16Bibliographically approved
In thesis
1. Deciphering Unwritten Rules: Patients, relatives and nurses in palliative cancer care
Open this publication in new window or tab >>Deciphering Unwritten Rules: Patients, relatives and nurses in palliative cancer care
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on palliative cancer care in acute care hospitals and home care settings. The overall aim was to generate a grounded theory explaining the latent patterns of behavior of patients, relatives and nurses. The thesis includes one population-based study with cross-sectional design and four classic grounded theory studies.

Study I was conducted in two acute care hospitals. In this 5-year follow-up study, the proportion of hospitalized palliative cancer patients had decreased. The patients were older with more symptoms and care needs per patient. In both years, the most common symptoms were pain and deterioration and the most common cancer sites were prostate and colorectal. The results showed that associations between symptoms, care needs and cancer site were mostly weak.

In study II, striving for emotional survival emerged as the pattern of behavior through which nurses in acute care hospitals deal with their main concern, the risk of being emotionally overloaded. Striving for emotional survival involves emotional shielding, emotional processing and emotional postponing.

In study III, doing good care emerged as the pattern of behavior through which nurses in home care deal with their main concern, their desire to give good care. Doing good care involves three different caring behaviors: anticipatory caring, momentary caring and stagnated caring.    

In study IV, living on hold emerged as the pattern of behavior through which patients and relatives deal with their main concern, being put on hold. Living on hold involves three modes: fighting, adjusting and surrendering.

The overall theory, deciphering unwritten rules, explains how patients, relatives and nurses are dealing with the uncertainty of how to act and behave.   Deciphering unwritten rules involves figuring out, deliberating, maneuvering and evaluating.

In conclusion, this thesis demonstrates the complexities of palliative cancer care and the importance of knowledge, resources and counseling. Patients should be cared for at the right care level according to their care needs and the care focus should be on treating symptoms irrespective of the diagnosis. The palliative care approach therefore needs to be implemented in all caring contexts with dying people.

Place, publisher, year, edition, pages
Växjö, Kalmar: Linnaeus University Press, 2010
Series
Linnaeus University Dissertations ; 14/2010
Keywords
cancer, deciphering, unwritten rules, grounded theory, nursing, palliative care, patient, relative
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-2502 (URN)978-91-86491-19-2 (ISBN)
Public defence
2010-05-21, Myrdal, Växjö, 10:30 (Swedish)
Opponent
Supervisors
Available from: 2010-04-21 Created: 2010-04-16 Last updated: 2018-05-17Bibliographically approved

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Sandgren, AnnaFridlund, BengtThulesius, Hans

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