Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-25T20:57:52.641Z Has data issue: false hasContentIssue false
  • English
  • Français

The meaning of being in transition to end-of-life care for female partners of spouses with cancer

Published online by Cambridge University Press:  26 November 2009

Nisha Sutherland
Nisha Sutherland*
Affiliation:
Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, Canada
*
Address correspondence and reprint requests to: Nisha Sutherland, Conestoga College Institute of Technology and Advanced Learning, 299 Doon Valley Drive, Kitchener, ON N2G 4M4, Canada. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Female partners of cancer patients are at high risk for psychological distress. However, the majority of studies have focused on measurement of female partners' psychological distress during diagnosis and early treatment. There is a gap in the literature with regard to qualitative studies that examine the experiences of female partners of spouses with cancer during the transition to end-of-life care. The purpose of this qualitative study was to explore the meaning of being in transition to end-of-life care among female partners of spouses with cancer.

Methods:

An interpretive phenomenological approach based on Gadamer's (1960/1975) philosophy was used to gain a deeper understanding of the phenomenon of end-of-life transition. Eight female partners from two in-patient hospices and a community-based palliative care service were interviewed using a semistructured approach.

Results:

Three major themes and associated subthemes were identified that outlined female partners' experiences. One major theme, Meaning of Our Lives, included the subthemes Our Relationship, Significance of His Life, and Searching for Understanding. In another theme, Dying with Cancer, partners undertook the Burden of Caring, experienced an Uncertain Path and were Looking for Hope. In the last theme, Glimpses of the Future, participants Faced Tomorrow and confirmed their Capacity to Survive.

Significance of results:

The results centered on three major concepts: meaning making, anticipatory mourning, and hope. Although meaning making has been identified as a fundamental way in which bereaved individuals cope with loss, results of this study suggested that female partners made meaning of their situations before their spouses' deaths. Participants also spontaneously described aspects of anticipatory mourning, thus, validating a concept that has been widely accepted despite limited research. Another finding was that participants shouldered the responsibility of adjusting spouses' hopes in order to help them to cope. Implications for practice and research are drawn from these findings.

Keywords

Transition to end-of-lifeFemale partnersMeaning makingAnticipatory griefHope
Type
Original Articles
Information
Palliative & Supportive Care , Volume 7 , Issue 4 , December 2009 , pp. 423 - 433
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Allen, S. (1994). Gender differences in spousal caregiving and unmet need for care. Journal of Gerontology, 49, S187–S195.CrossRefGoogle ScholarPubMed
Attig, T. (2000). Anticipatory mourning and the transition to loving in absence. In Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers, Rando, T. (ed.), pp. 115–134. Champaign, IL: Research Press.Google Scholar
Attig, T. (2001). Relearning the world: Making and finding meanings. InMeaning Reconstruction and the Experience of Loss, Neimeyer, R.A. (ed.), pp. 33–53. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Baider, L., Kaufman, B., Peretz, T., et al. (1996). Mutuality of fate: Adaption and psychological distress in cancer patients and their partners. InCancer and the Family, Baider, L. et al. (eds.), pp. 173–186. Toronto: John Wiley & Sons.Google Scholar
Baider, L., Koch, U., Esacson, R., et al. (1998). Prospective study of cancer patients and their spouses: The weakness of marital strength. Psycho-Oncology, 7, 49–56.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Benzein, E., Norberg, A. & Saveman, B. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 15, 117–126.CrossRefGoogle ScholarPubMed
Carey, P., Oberst, M., McCubbin, M., et al. (1991). Appraisal and caregiving burden in family members caring for patients receiving chemotherapy. Oncology Nursing Forum, 18, 1341–1348.Google ScholarPubMed
Cassileth, B., Lusk, E., Strouse, T., et al. (1985). A psychological analysis of cancer patients and their next-of-kin. Cancer, 55, 72–76.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
Chekryn, J. (1984). Cancer recurrence: Personal meaning, communication, and marital adjustment. Cancer Nursing, 491–498.Google ScholarPubMed
Clayton, J., Butow, P., Arnold, R. & Tattersall, M. (2005). Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer, 103, 1965–1975.CrossRefGoogle ScholarPubMed
Corr, C. & Corr, D. (2000). Anticipatory mourning and coping with dying: Similarities, differences, and suggested guidelines for helpers. InClinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers, Rando, T. (ed.), pp. 223–252. Champaign, IL: Research Press.Google Scholar
Creswell, J.W. (1998). Qualitative Inquiry and Research Design: Choosing among Five Traditions. Thousand Oaks, CA: Sage.Google Scholar
Davies, B., Remier, C. & Martens, N. (1990). Families in supportive care: The transition of fading away: The nature of the transition. Journal of Palliative care, 6, 12–20.CrossRefGoogle ScholarPubMed
Doka, K. (2000). Re-creating meaning in the face of illness. InClinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers, Rando, T. (ed.), pp. 103–114. Champaign, IL: Research Press.Google Scholar
Duke, S. (1998). An exploration of anticipatory grief: The lived experience of people during their spouses' terminal illness and in bereavement. Journal of Advanced Nursing, 28, 829–839.CrossRefGoogle ScholarPubMed
Ey, S., Compas, B., Epping-Jordan, J., et al. (1998). Stress responses and psychological adjustment in patients with cancer and their spouses. Journal of Psychosocial Oncology, 16, 59–77.CrossRefGoogle Scholar
Firestone, W. (1993). Alternative arguments for generalizing from data as applied to qualitative research. Educational Researcher, 22, 16–23.CrossRefGoogle Scholar
Fleming, V., Gaidys, U. & Robb, Y. (2003). Hermeneutic research in nursing: Developing a Gadamerian-based research method. Nursing Inquiry, 10, 113–120.CrossRefGoogle ScholarPubMed
Folkman, S. (1997). Positive psychological states and coping with severe stress. Social Science & Medicine, 45, 1207–1221.CrossRefGoogle ScholarPubMed
Folkman, S. & Greer, S. (2000). Promoting psychological well-being in the face of serious illness: When theory, research and practice inform each other. Psycho-oncology, 9, 11–19.3.0.CO;2-Z>CrossRefGoogle ScholarPubMed
Fulton, G., Madden, C. & Minichiello, V. (1996). The social construction of anticipatory grief. Social Science & Medicine, 43, 1349–1358.CrossRefGoogle ScholarPubMed
Gadamer, H. (1975). Truth and Method (2nd ed.), Weinsheimer, J. & Marshall, D.G. (trans.). New York: Continuum (original work published in 1960).Google Scholar
Geanellos, R. (1998). Hermeneutic philosophy. Part 1: Implications of its use as methodology in interpretive nursing research. Nursing Inquiry, 5, 154–163.CrossRefGoogle Scholar
Germino, B., Fife, B. & Funk, S. (1995). Cancer and the partner relationship. What is its meaning? Seminars in Oncology Nursing, 11, 43–50.CrossRefGoogle ScholarPubMed
Gilbar, O. (1999). Gender as a predictor of burden and psychological distress of elderly husbands and wives of cancer patients. Psycho-Oncology, 8, 287–294.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Gillies, J. & Neimeyer, R. (2006). Loss, grief, and the search for significance: Toward a model of meaning reconstruction in bereavement. Journal of Constructivist Psychology, 19, 31–65.CrossRefGoogle Scholar
Gray, R., Fitch, M., Phillips, C., et al. (2000). Managing the impact of illness: The experiences of men with prostate cancer and their spouses. Journal of Health Psychology, 5, 531–548.CrossRefGoogle ScholarPubMed
Halliburton, P., Larson, P., Dibble, S., et al. (1992). The recurrence experience: Family concerns during cancer chemotherapy. Journal of Clinical Nursing, 1, 275–281.CrossRefGoogle Scholar
Hawes, S., Malcarne, V., Ko, C., et al. (2006). Identifying problems faced by spouses and partners of patients with prostate cancer. Oncology Nursing Forum, 33, 807–814.CrossRefGoogle ScholarPubMed
Jansen, C., Halliburton, P., Dibble, S., et al. (1993). Family problems during cancer chemotherapy. Oncology Nursing Forum, 20, 689–694.Google ScholarPubMed
Jo, S., Brazil, K., Lohfeld, L., et al. (2007). Caregiving at the end of life: Perspectives from spousal caregivers and care recipients. Palliative and Supportive Care, 5, 11–17.CrossRefGoogle ScholarPubMed
Jones, R., Hansford, J. & Fisk, J. (1993). Death from cancer at home: The carers' perspective. British Medical Journal, 306, 249–256.CrossRefGoogle ScholarPubMed
Kalayjian, A. (1989). Coping with cancer: The spouse's perspective. Archives of Psychiatric Nursing, 3, 166–172.Google ScholarPubMed
Kehl, K. (2005). Recognition and support of anticipatory mourning. Journal of Hospice and Palliative Nursing, 7, 206–211.CrossRefGoogle Scholar
Keller, M., Henrich, G., Sellschopp, A., et al. (1996). Between distress and support: Spouses of cancer patients. InCancer and the Family, Baider, L. et al. (eds.), pp. 187–222. Toronto: John Wiley & Sons.Google Scholar
Klemm, P. & Wheeler, E. (2005). Cancer caregivers online: Hope, emotional rollercoaster, and physical, psychological responses. CIN: Computers, Informatics, Nursing, 23, 38–45.Google Scholar
Lewis, F. & Deal, L. (1995). Balancing our lives: A study of the married couple's experience with breast cancer recurrence. Oncology Nursing Forum, 22, 943–953.Google ScholarPubMed
Mahon, S., Cella, D. & Donovan, M. (1990). Psychosocial adjustment to recurrent cancer. Oncology Nursing Forum, 17, 47–54.Google ScholarPubMed
Morse, J. (2000). Determining sample size. Qualitative Health Research, 10, 3–5.CrossRefGoogle Scholar
Morse, J. & Doberneck, B. (1995). Delineating the concept of hope. Image, 27, 277–285.Google ScholarPubMed
Morse, S. & Fife, B. (1998). Coping with a partner's cancer: Adjustment at four stages of the illness trajectory. Oncology Nursing Forum, 25, 751–760.Google ScholarPubMed
Nadeau, J. (2001). Family construction of meaning. InMeaning Reconstruction and the Experience of Loss, Neimeyer, R.A. (ed.), pp. 95–112. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Neimeyer, R. (2001). Meaning Reconstruction and Loss. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Northouse, L., Dorris, G. & Charron-Moore, C. (1995). Factors affecting couples' adjustment to recurrent breast cancer. Social Science & Medicine, 41, 69–71.CrossRefGoogle ScholarPubMed
Northouse, L., Mood, D., Templin, T., et al. (2000). Couples' patterns of adjustment to colon cancer. Social Science & Medicine, 50, 271–284.CrossRefGoogle ScholarPubMed
Osse, B., Vernooij-Dassen, M., Schade, E., et al. (2006). Problems experienced by the informal caregivers of cancer patients and their needs for support. Cancer Nursing, 29, 378–388.CrossRefGoogle ScholarPubMed
Patton, M. (2003). Qualitative Research and Evaluation Methods (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
Pistrang, N. & Barker, C. (1995). The partner relationship in psychological response to breast cancer. Social Science & Medicine, 40, 789–797.CrossRefGoogle ScholarPubMed
Porter, L., Keefe, F., Hurwitz, H. & Faber, M. (2005). Disclosure between patients with gastrointestinal cancer and their spouses. Psycho-oncology, 14, 1030–1042.CrossRefGoogle ScholarPubMed
Proot, I., Abu-Saad, H., Crebolder, H., et al. (2003). Vulnerability of family caregivers in terminal palliative care at home: Balancing between burden and capacity. Scandinavian Journal of Caring Science, 17, 113–121.CrossRefGoogle ScholarPubMed
Quinn, M., Fontana, A. & Reznikoff, M. (1986). Psychological distress in reaction to lung cancer as a function of spousal support and coping strategy. Journal of Psychosocial Oncology, 4, 79–91.CrossRefGoogle Scholar
Rando, T. (2000). Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers. Champaign, IL: Research Press.Google Scholar
Sandelowski, M. (1986). The problem of rigor in qualitative research. Advanced Nursing Science, 16, 1–8.CrossRefGoogle Scholar
Sandelowski, M. (1995). Focus on qualitative methods: Sample size in qualitative research. Research in Nursing and Health, 18, 179–183.CrossRefGoogle Scholar
Schulman-Green, D., McCorkle, R., Curry, L., et al. (2004). At the crossroads: Making the transition to hospice. Palliative and Supportive Care, 2, 351–360.CrossRefGoogle ScholarPubMed
Spiegel, D., Bloom, J. & Gottheil, E. (1983). Family environment as a predictor of adjustment to metastatic breast carcinoma. Journal of Psychosocial Oncology, 1, 33–44.CrossRefGoogle Scholar
Stajduhar, K. (2003). Examining the perspectives of family members involved in the delivery of palliative care at home. Journal of Palliative Care, 19, 27–35.CrossRefGoogle ScholarPubMed
Waldrop, D., Kramer, B., Skretny, J., et al. (2005). Final transitions: Family caregiving at the end of life. Journal of Palliative Medicine, 8, 623–638.CrossRefGoogle ScholarPubMed
Winterling, J., Wasteson, E., Glimelius, B., et al. (2004). Substantial changes in life: Perceptions of patients with newly diagnosed advanced cancer and their spouses. Cancer Nursing, 27, 381–388.CrossRefGoogle ScholarPubMed
Wolf, Z. (2003). Exploring the audit trail for qualitative investigations. Nurse Educator, 28, 175–178.CrossRefGoogle ScholarPubMed
Wright, K. & Dyck, S. (1984). Expressed concerns of adult cancer patients' family members. Cancer Nursing, 7, 371–374.CrossRefGoogle ScholarPubMed
Wright, M. & Leahey, M. (2000). Nurses and Families: A Guide to Family Assessment and Intervention (3rd ed.). Philadelphia: F.A. Davis.Google Scholar