Claire Taylor

Restoring embodied control following surgical treatment for colorectal cancer: a longitudinal qualitative study.

BACKGROUNDnThis article presents the findings of a study about recovery following surgery for colorectal cancer. Most patients diagnosed with this cancer are treated with surgery. Few studies have employed a qualitative approach to examine their experiences and perceptions of recovering from this treatment.nnnOBJECTIVESnThe purpose of this study was to discover the process of recovery for individuals following curative surgery for colorectal cancer.nnnDESIGNnThis qualitative study drew on grounded theory methods and used a prospective longitudinal design.nnnSETTINGSnEthical approval was granted by three Local Research Ethics Committees enabling patients to be recruited from three different hospitals in the South of England.nnnPARTICIPANTSnPurposive sampling was used to identify patients diagnosed with colorectal cancer who had had surgery with curative intent.nnnMETHODSnEach participant was interviewed up to four times following their surgery: at 6 weeks then at 3, 6 and 12 months. Sixty-two interviews were conducted. Emerging concepts from the analysis defined further data collection. Relevant literature was theoretically sampled and all data analysed using constant comparison. Theoretical saturation was achieved.nnnRESULTSnSixteen participants were recruited. Analysis of study data identified four conceptual stages representing the main phases individuals can experience during their recovery. They are: disembodiment, restoring embodiment, reclaiming control and managing embodied control. These occur in a stepwise progression, reflecting the emotional, physical and social processes involved in restoring perceived control over the body. They reflect the difficulty individuals can experience in understanding and self-managing their bodies. There is a desire to regain confidence and certainty over body function but this is threatened by fears about future health.nnnCONCLUSIONSnAchieving a sense of control of ones body, after surgery for colorectal cancer, proves to be a major challenge. Greater recognition of the consequences of cancer and its treatment upon the body and individualised management is required. Addressing how individuals can regain embodied control during their recovery needs to be integral within post-treatment support.

A literature review of the potential of telephone follow‐up in colorectal cancer

AIMSnThe aim of this review is to examine the potential of telephone follow-up for patients with colorectal cancer.nnnBACKGROUNDnMore people are surviving cancer and entering into follow-up care. It is recognised that improvements in cancer follow-up care are needed in the UK. Telephone use has proved a very successful medium for conducting health care in other specialties and may offer an acceptable alternative to face-to-face follow-up appointments. Nurse specialists could assume responsibility for patients follow-up by offering telephone consultations.nnnDESIGNnA literature review was conducted via a systematic electronic and hand search of relevant literature.nnnMETHODnThematic content analysis was used to achieve the objectives of the review. Results.u2002 The findings demonstrate that telephone follow-up conducted by an experienced nurse specialist is cost-effective and accepted by the majority of patients. Aspects of care such as symptom management and reassurance are possible over the phone.nnnCONCLUSIONnTelephone follow-up meets patients satisfaction, support and information needs and has potential to deliver high standards of aftercare when conducted by a nurse specialist. It is at least equivalent to traditional follow-up in meeting the needs of patients with cancer. Because of the disparity of the studies examined, further research in the area of nurse-led telephone follow-up vs. nurse-led traditional follow-up would be constructive in the development of this new initiative.nnnRELEVANCE TO CLINICAL PRACTICEnNurses are now increasingly involved in patient follow-up care and telephone dialogue after hospital discharge. However, the ideal structure, method and timing of telephone follow-up as well as the skills required to carry out such care over the phone are often not considered and have not been articulated. The option of telephone follow-up could, for some patients, dramatically improve their care experience.

Quality of life following reversal of temporary stoma after rectal cancer treatment

PURPOSEnAn examination of quality of life outcomes following reversal of a temporary stoma after rectal cancer treatment.nnnMETHODnAn extensive search of the literature was conducted. Studies selected examine the consequences of stoma reversal on individuals lives. Methodological issues and implications for nursing practice are also considered.nnnRESULTSnIt is clear that after stoma reversal, there is often a temporary alteration in bowel function, impacting on individuals physical, social and psychological health for several months. There is possibility of permanent difficulties for some, significantly affecting their quality of life if left untreated. These effects can lead to more negative post-operative experiences than expected.nnnCONCLUSIONnThis review prompts discussion about how to provide appropriate support for patients following stoma reversal but also optimal pre-operative preparation, to foster realistic expectations and subsequent adaptation. It is suggested that nursing support should be targeted to the first few months post-reversal when bowel symptoms tend to be most troublesome.

Surviving cancer treatment: An investigation of the experience of fear about, and monitoring for, recurrence in patients following treatment for colorectal cancer

BACKGROUNDnIt is known that many individuals worry about their cancer recurring after colorectal cancer treatment but the significance and specific manifestations of this problem require exploration.nnnPURPOSEnThis paper reports upon the research findings of a qualitative study to explain how fears of recurrence can affect individuals recovering from curative colorectal cancer surgery.nnnMETHODSnA longitudinal, grounded theory study was conducted. Sixteen participants who had received curative treatment for colorectal cancer were interviewed on up to four occasions during the 12 months following their surgery, 62 interviews were conducted in total.nnnRESULTSnMany participants expressed anxiety about if and when their cancer might return, despite the knowledge that they had had successful treatment for early-stage colorectal cancer. This fear led some to adopt new behaviours in a desire to achieve a more dependable and controllable body. Heightened monitoring and management of the body characterised a state of guarding - a concept developed from the data. By contrast, other participants did not perceive the risk of cancer recurrence to be as personally threatening or were able to assume strategies to manage any such concerns and find a sense of resolution to their recovery.nnnCONCLUSIONnThe nature of an individuals response to fears of recurrence and consequent impact on their recovery warrants greater clinical consideration. Providing opportunities to openly discuss the possibility of cancer recurrence, assessing individual fears and offering suggestions on possible coping strategies to lessen the associated distress, are essential supportive activities enabling transition to life beyond cancer.

Tied to the toilet: lived experiences of altered bowel function (anterior resection syndrome) after temporary stoma reversal.

PURPOSE: The purpose of this study was to explore the lived experiences of patients with anterior resection syndrome, defined as altered bowel function as a consequence of rectal cancer treatment. Interviews were completed 4 to 6 weeks post–temporary stoma reversal. SUBJECTS AND SETTING: Eight rectal cancer patients, who had completed their primary treatment, and were now up to 6 weeks poststoma closure and reported altered bowel function, were recruited. The sample was drawn from St. Marks Hospital, which is an NHS Trust situated in Greater London, England. METHODS: Data were collected via semistructured in-depth interviews. A Husserlian phenomenological approach was used in order to explore the lived experiences of respondents. Interviews were transcribed and analyzed using framework analysis. RESULTS: Participants reported significant alteration in bowel function following stoma reversal that impacted or dictated daily routines. A lack of certainty over when and how bowel movements occurred caused distress and feelings of vulnerability. Consequently respondents stated they often felt as if they were tied to the toilet. Coping strategies included conservative measures such as the use of prescribed drugs, dietary modification, and incontinence pads. These strategies did not always prove effective and most individuals perceived they were not self-managing their symptoms satisfactorily. CONCLUSIONS: Rectal cancer patients should be made aware of the potential for altered bowel function post stoma closure and encouraged to report bothersome bowel elimination symptoms. Treatment should promote a proactive strategy to reduce distress and the risk of symptom chronicity.

Factors affecting closure of a temporary stoma.

PURPOSE: The purpose of the study was to examine time to reversal of a temporary ostomy, reasons for delayed closure, and patient satisfaction with the scheduling of their closure and related hospital care. DESIGN: Cross-sectional, descriptive study. SUBJECTS AND SETTING: The target population comprised patients who underwent creation of a temporary ostomy and reversal surgery within one National Health System Hospital Trust in the United Kingdom. The population served by this Trust are ethnically and socioeconomically diverse, predominantly living in urban areas around Greater London. Sixty-one persons who met inclusion criteria were identified. METHODS: A two-step analytical process was undertaken. First, a literature review examining incidence and causes of delayed stoma closure was undertaken. Second, a postal survey of all patients who had had their stoma closed in 2009 was conducted. Respondents were allowed 2 weeks to complete and return the questionnaire. INSTRUMENT: The survey instrument was developed locally and subjected to content validation using ostomy patients, surgical and nursing colleagues. It consisted of 9 questions querying time from original surgery to closure, reasons for delaying closure surgery beyond 12 weeks, and satisfaction with care. RESULTS: Twenty-seven patients returned their questionnaires, indicating they consented to participate; a response rate of 44%. Half of the respondents (n = 14 [52%]) underwent closure surgery within 6 months of stoma formation; the remaining 48% waited more than 6 months (median: 6.5 months, range: 1.5–26 months). Thirteen patients (48%) reported a delay in receiving their stoma closure; the main reason cited was the need for a course of adjuvant postoperative chemotherapy. Three quarters of respondents (22 [74%]) were satisfied with the overall care they received. CONCLUSION: Findings from this study suggest that stoma closure may be associated with fewest complications if performed before 12 weeks.

Quantitative assessment of birth experience remains elusive

Measuring an individuals experience of healthcare is complex, let alone when the experience concerns pregnancy, birth and postnatal care. Giving birth is a major life event, likely to be viewed in retrospect by women as a time of fluctuating physical and psychological health and well‐being, altered body image, and positive and negative views of support offered by those they come into contact with. Given the ebbs and flows of the pregnancy, birth and postnatal journey, providing ‘hard data’ to inform an objective measure of experience which also reflects the context, environment and quality of care, is not an easy task. Nevertheless, with increasing recognition of the importance of patient experience as a driving force for service improvement and resource allocation, knowing what contributes to a more (or less) positive experience is important. How, when and what to measure are important questions.