Josianne Scerri

Coping with non-Hodgkin’s lymphoma: a qualitative study of patient perceptions and supportive care needs whilst undergoing chemotherapy

PurposeResearch to date on patients with non-Hodgkin’s lymphoma has focused on the physical and psychological impact of undergoing chemotherapy. However, there is a dearth of studies targeting the coping strategies in this patient group. This article addresses the dearth in literature by exploring the coping strategies and supportive care needs of patients with non-Hodgkin’s lymphoma whilst undergoing chemotherapy.MethodsAn exploratory qualitative phenomenological design was used. Six adult patients with non-Hodgkin’s lymphoma and who were receiving chemotherapy were each interviewed twice using semi-structured interviews, which were audio-recorded. The data was transcribed verbatim and analysed using interpretative phenomenological analysis.ResultsFour themes emerged which outline how patients with non-Hodgkin’s lymphoma cope with the challenges of undergoing chemotherapy. These are as follows: ‘Interpreting life through a different lens’, ‘Wearing a mask’, ‘Suppressing thoughts about chemotherapy’ and ‘Support along the journey’.ConclusionsThis article provides insight into the coping strategies and supportive care needs of patients with non-Hodgkin’s lymphoma and who are undergoing chemotherapy. Some participants described attributing a new meaning to life, while others tried suppressing thoughts about cancer and chemotherapy. Additionally, some participants described hiding their true feelings by ‘wearing a mask’ in an effort to avoid distressing their families and consequently themselves. Nevertheless, all the participants emphasised the importance of support from health care providers, family and friends. These results provide insight which may guide future support services and interventional research aimed at assisting patients with non-Hodgkin’s lymphoma to cope with the challenges of undergoing chemotherapy.

Systemic inflammation in COPD is not influenced by pulmonary rehabilitation

Abstract Purpose: Pulmonary rehabilitation is known to lead to improvements in exercise tolerance, health-related quality of life and help reduce symptoms. Exercise, one of the largest components of such an intervention, although of great benefit, can increase the inflammatory response related to chronic obstructive pulmonary disease, depending on intensity and duration. Through this study, the effects of a 12week, high-intensity PR programme on COPD inflammatory-related markers were investigated. Materials and methods: This study is a longitudinal, observational type of study. Sixty COPD patients were enrolled, 49 of which completed the programme. A 2-h high-intensity PR programme was delivered, twice weekly for 12 weeks. The following markers were assessed at baseline, 4, 8 and 12 weeks through rehabilitation – C-reactive protein, erythrocyte sedimentation rate, neutrophil, eosinophil counts, complete blood count, six-minute walk test and St. George’s Respiratory Questionnaire. Serum amyloid A levels were assessed at baseline, week 8 and 12 and exhaled NO at baseline and upon completion of the programme. Results: This 12-week PR programme resulted in no changes in the inflammatory markers but resulted in significant improvements in both the 6MW distance and health quality of life. Conclusions: Beneficial effects on functional and HRQoL measures resulted, which, however, appear unrelated to changes in the systemic inflammatory markers.

Intimate partner violence: psychological and verbal abuse during pregnancy

AIMS AND OBJECTIVES To examine the association between sociodemographic, pregnancy-related variables and psychological and verbal intimate partner abuse, as well as to determine which of these variables are predictors of psychological and verbal intimate partner abuse during pregnancy. BACKGROUND Intimate partner violence is a significant health issue, with severe implications to both mother and foetus. However, much of the research to date focuses on the outcomes of physical abuse. This article addresses the dearth in the literature by examining the association between sociodemographic, pregnancy-related variables and psychological and verbal intimate partner abuse during pregnancy. DESIGN A survey research design was used. METHOD Three hundred postnatal women were recruited by convenience, nonproportional quota sampling technique. The WHO Violence Against Women Instrument was self-administered by participants. The association between categorical variables was assessed using Pearsons chi-square test, the strength of association using Cramers V and the phi coefficient, and the identification of predictor variables for psychological and verbal abuse using logistic regression analysis. RESULTS Four predictors were identified for psychological abuse, namely low education level in women, an unplanned pregnancy, experiencing two or more pregnancy-related health problems and living with an unemployed partner. However, unemployment in women, an unplanned pregnancy, fear of partner and a low education level of partner were identified as the predictors of verbal abuse. CONCLUSION This study identified a number of variables that strongly predict psychological and verbal intimate partner abuse during pregnancy; however, it extends the available literature by identifying a low standard of education in males, unemployment and fear of the intimate partner as the significant predictors of psychological and verbal intimate partner abuse. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should be aware of the predictors predisposing pregnant women to abuse. This would enable the identification of pregnant women who are susceptible to psychological and verbal intimate partner abuse, thus enabling the provision of adequate support. There is also a need to introduce routine screening for psychological and verbal intimate partner abuse during the antenatal period, following extensive training to all professionals concerned.

Pulmonary rehabilitation in chronic obstructive pulmonary disease: Outcomes in a 12 week programme

Abstract Objective. The optimal time-frame for pulmonary rehabilitation (PR) in patients diagnosed with chronic obstructive pulmonary disease (COPD) is still debated. A 12 week programme was designed looking at whether the benefits were reached at or before a 12 week period of PR for COPD patients. Method. Seventy-five patients (59 males, 16 females) aged 40 75 years were referred from the local general hospital in Malta. Baseline assessments were carried out on all patients 2 weeks before initiation of the programme. Sixty patients were eligible to start a twice-weekly, 12 week multidisciplinary programme delivered after the screening process. The Six-Minute Walk Test (6MWT), dyspnoea score using the Borg scale, spirometry testing, plethysmography, COPD Assessment Tool (CAT) score, St Georges Respiratory Questionnaire (SGRQ) and Hospital and Anxiety scale score were monitored at 4 weekly intervals throughout the 12 weeks of PR for these COPD patients. Results. The 6MWT distance increased by a mean total of 132.45 m (p < 0.001) by 12 weeks, with the highest change recorded in the first 4 weeks for the milder COPD patients. Lung function test improvements were marginal. Borg scale readings at rest and following exertion decreased significantly from weeks 0 to 4 but remained fairly constant thereafter. The Body mass index, airway Obstruction, Dyspnoea, and Exercise capacity (BODE) index, SGRQ and CAT score values decreased significantly throughout the weeks irrespective of the initial Medical Research Council score. Anxiety scoring decreased significantly by 12 weeks, while the depression rating improved by 8 weeks. Conclusion. These findings show that 12 weeks of PR in this cohort of COPD patients resulted in clinically significant changes in functional outcome measures which are supported by statistically significant changes in health-related quality of life measures. In milder COPD cases, by 4 weeks of PR gains in exercise tolerance had already resulted. The more severe group required more time to obtain improvements. Therefore, hospitals could organize shorter PR programmes for larger numbers of patients with milder COPD.

Illness perceptions, depression and anxiety in informal carers of persons with depression: a cross-sectional survey

PurposeTo examine the illness perceptions of informal carers of persons with depression, using the theoretical framework of Leventhal’s Common-Sense Model (CSM) and to determine whether these illness perceptions are predictors of anxiety and depression, as measures of psychological well-being.MethodsA cross-sectional survey was conducted with 94 Maltese individuals caring for a person with depression within a community setting. The informal carers completed the modified Illness Perception Questionnaire (IPQS-Relatives version) and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using descriptive statistics, Spearman’s rank order correlations and ANCOVA regression models, to identify predictors of anxiety and depression respectively in the informal carers.ResultsThe informal carers perceived depression as a cyclical condition, having negative consequences on both the patient and on themselves. Participants perceived the causes of depression to be mainly psychosocial in nature and generally viewed the treatment as effective. Caring for a person with depression was perceived as having a considerable negative emotional impact on them. Years of caring was identified as a predictor of anxiety accounting for 20.4% of the variance, and timeline chronicity beliefs, consequences (relative) and illness coherence were identified as predictors of depression, accounting for 56.8% of the variance.ConclusionIllness cognitions are significant predictors of depression, thereby suggesting that cognition-based interventions may be effective in targeting depression in these informal carers. Thus, health professionals should explore the carers’ personal understanding of the disease, their timeline beliefs and the perceived consequences of providing care, as they relate to their psychological well-being.

The experience of living with an ileoanal pouch : an interpretative phenomenological analysis

The purpose of this study was to explore the lived experiences of individuals living with an ileoanal pouch. A qualitative, phenomenological methodology was used to elicit detailed accounts of the impact of living with an ileoanal pouch. Ten individuals having an ileoanal pouch, formed as a consequence of ulcerative colitis, participated in the study. Semistructured interviews were conducted and analyzed using interpretative phenomenological analysis. The following 4 themes emerged from the analysis: “a flood of emotions”; “changed body image”; “changes in lifestyle”; and “intimacy and sexual relationships.” Participants indicated that their quality of life after surgery has improved because they were no longer suffering from the devastating symptoms of ulcerative colitis. However, a considerable number of these participants disclosed that they are still living a restricted lifestyle and reported profound changes not only in their physical self but also in their social and sexual relationships. By acknowledging these experiences, healthcare professionals have the potential to improve the psychological, sexual, and social care that these individuals receive.

Health status of COPD patients undergoing pulmonary rehabilitation : a comparative responsiveness of the CAT and SGRQ

The St. George’s Respiratory Questionnaire (SGRQ) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) are the measures used to assess health status. This study aims to examine the responsiveness of these tools by severity of dyspnoea category in patients with COPD. Forty-nine COPD patients who underwent a 12-week pulmonary rehabilitation (PR) programme were assessed at baseline, 12 weeks and at 28-week follow-up. Patients were categorized into two groups by severity of dyspnoea category (i.e. mild to moderate (modified Medical Research Council (mMRC) 1–2) and severe to very severe (mMRC 3–4)) using the mMRC dyspnoea scale. Effect size (ES) was computed as estimates of responsiveness. The SGRQ demonstrated greater responsiveness by total sample (SGRQ, ES = 0.87; CAT, ES = 0.75) and for the mMRC 3–4 category (SGRQ, ES = 0.91; CAT, ES = 0.76) on completion of PR. At 28-week follow-up, overall comparable responsiveness of the CAT and SGRQ was identified by total sample (SGRQ, ES = 0.75; CAT, ES = 0.74) and by severity of dyspnoea category. The symptom, impact and activity domains of the SGRQ showed good responsiveness, with greater ESs obtained overall for the mMRC 3–4 category. On completion of PR, the SGRQ demonstrates a greater responsiveness with COPD patients, especially in relation to the mMRC 3–4 category, while both the CAT and SGRQ show comparable responsiveness on follow-up.

The impact of providing care to relatives with a severe mental illness : the caregivers’ experience

The purpose of this study is to explore the impact on Maltese family caregivers in providing care to a relative with a severe mental illness (SMI). Purposive sampling and in-depth semi-structured interviews were conducted with seven caregivers (four females and three males). The interview data were transcribed verbatim and analysed using Interpretative Phenomenological Analysis (IPA). Four themes emerged from the analysis, namely Range of Emotions, Increased Responsibility, Toll on Physical Health and Change in Lifestyle. This study demonstrates that the caregivers experienced a range of negative emotional and physical responses. Changes in their lifestyle were made, as caregivers provided complete care to their ill relative, as well as ensured that they came to no harm. Female participants tended to self-blame, attributing behavioural problems in the ill relative to their actions. Parent caregivers experienced distress regarding care provision in the eventuality that they suffered from ill health or death. Although parents acknowledged the support provided by siblings, they strived to cope by themselves, as siblings were perceived to have responsibilities of their own. The role of mental health professionals in such a scenario includes the understanding of the unique perceptions of family caregivers, as well as targeting any dysfunctional perceptions. Furthermore, caregivers should be made aware of entities that provide support within the community setting. Sufficient resources also need to be provided to ensure effective community support to family caregivers.