<p>Mindfulness-based interventions (MBIs) have demonstrated efficacy in reducing symptoms in survivors of early-stage cancer and have shown promise in adults with advanced cancer and their family caregivers. These interventions may be especially helpful for coping with advanced cancer because acceptance and a greater focus on present-moment experiences are central to the adjustment process. Mindfulness may be a potential mechanism underlying MBI’s health effects, yet suboptimal assessment of mindfulness hinders examination of this hypothesis. Widely used self-report measures of mindfulness require participants to have high self-awareness and comprehend a complex skill and show limited responsiveness to MBIs. Behavioral assessment of mindfulness may address the limitations of self-report measures. The goal of the current study was to obtain preliminary evidence of the validity of a behavioral measure of mindfulness, Levinson and colleagues’ breath counting task, and its responsiveness to MBI among patients and caregivers coping with advanced cancer. Fifty-five patient-caregiver dyads were recruited from a university hospital and community clinics in Indiana. Dyads were randomized to either a 6-week MBI or a usual care control condition. Measures were administered at baseline prior to intervention (week 0), at the end of the 6-week intervention period (week 6), and 1-month post-intervention (week 10). Measures included the breath counting task, self-reported mindfulness, avoidant coping, and distress. Linear mixed modeling was used to determine whether the MEANING intervention led to increased behavioral and self-reported mindfulness compared to the usual care group. Caregivers in the MEANING condition showed improved behavioral mindfulness relative to caregivers in usual care, whereas patients in both the MEANING and usual care conditions showed relatively stable behavioral mindfulness over time. Additionally, there was no evidence that the MEANING intervention impacted behavioral mindfulness to a greater extent than self-reported mindfulness. To further examine the behavioral mindfulness measure’s validity, its relations with self-reported mindfulness, avoidant coping, and distress were examined at all time points. For both patients and caregivers, correlations between behavioral and self-reported mindfulness were small or nearly zero and were not uniformly positive. In the MEANING condition, correlations showed mostly small changes over time, and in the control condition, correlations generally showed little change over time. In addition, for patients and caregivers, most correlations between behavioral mindfulness and distress and avoidant coping were approaching zero or small. Results support the feasibility of the breath counting task in adults with advanced cancer and their caregivers, but provide limited support for its validity. The task warrants further evaluation in populations coping with chronic illness. </p>

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Background: Despite improving survival rates, people with advanced cancer experience high symptom burden, functional challenges, and negative impacts upon their quality of life. Moreover, these individuals frequently report unfulfilled needs related to supportive care, including rehabilitation support. Leisure-time physical activity (LPA), including exercise, has been found to be beneficial for people following diagnosis of cancer. However, little is known about LPA for individuals living with advanced cancer, particularly from a rehabilitation perspective. Purpose and objectives: The overall purpose of my dissertation research is to explore LPA in people with advanced cancer, through the perspectives of adults diagnosed with stage 4 cancer as well as those of oncology physiotherapists. Specific objectives are: (1) to map the research and understand key concepts from the literature about LPA in individuals with advanced cancer; (2) to explore the perspectives and experiences of LPA in adults diagnosed with stage 4 cancer; and (3) to describe the clinical practices, knowledge, skills, and perspectives of oncology physiotherapists related to LPA in the advanced cancer population. Methods: To meet these objectives, I conducted three research studies: (1) a scoping review of 92 articles exploring LPA in people with advanced cancer; (2) a qualitative interpretive-description study, involving individual, semi-structured interviews with 20 Canadian adults diagnosed with stage 4 cancer; and (3) a mixed-methods study, consisting of an online survey with 62 Canadian oncology physiotherapists, followed by qualitative, individual interviews with 13 physiotherapists. Results: The scoping review demonstrated a recent surge in research on the topic of LPA in advanced cancer, with many studies adopting quantitative methods and investigating aerobic and resistance exercise interventions. These studies have contributed to important research developments highlighting the safety, feasibility, and benefits of such interventions for people with advanced cancer. This scoping review also identified several gaps in the literature, particularly highlighted by the few qualitative studies exploring patient perspectives and experiences with different types of LPA. The second study helped address some of the research gaps noted in the scoping review. In this qualitative interpretive-description study, individuals with stage 4 cancer revealed the diverse and fluid nature of their experiences with LPA, necessitating intentional planning and modifications of activities. Moreover, important health benefits and psychosocial meanings of activity participation were identified. In addition, common supportive care needs related to LPA were recognized through this work. In particular, the participants desired professional LPA support that is integrated, interprofessional, accessible, and tailored to their individual abilities and preferences. To complement the patient perspectives and experiences, the third study offered insight on the perspectives of rehabilitation professionals. This mixed-methods study with oncology physiotherapists demonstrated positive views about the safety, importance, and benefits of activity in people with advanced cancer. Key considerations with this population included addressing cancer-related issues (e.g., bone metastases), identifying individually meaningful goals, and tailoring activity recommendations. The physiotherapists also highlighted their overall roles in optimizing functional capacity and alleviating symptom burden in people with advanced cancer. The lack of awareness about the role of physiotherapy and the limited access to rehabilitation services in oncology were identified as important challenges. Conclusions: The overall findings from this dissertation research highlight the scope of literature on LPA in advanced cancer and offer patient and professional perspectives related to this topic. As such, these findings may help inform the design and integration of supportive care resources targeted to this population. Strategies to promote LPA in this population require consideration of the complexities associated with advanced cancer and the important meanings of LPA for people living with this challenging diagnosis. Physiotherapists can be well-suited to promote safe, meaningful LPA in the advanced cancer population, as well as to optimize functional activity and symptom management. Practically, these findings support a patient-centered approach to encourage appropriate LPA in the care of people with advanced cancer. Key elements include: (1) comprehensive, regular patient assessment; (2) open communication with patients and families; (3) interprofessional collaboration between oncology care providers and specialized rehabilitation professionals; (4) integrated, routine delivery of LPA information and individualized activity recommendations; and (5) access to tailored LPA resources and programs within cancer care and community-based settings. Additional research is warranted to examine different types of LPA and explore other rehabilitation needs, particularly in understudied subgroups of advanced cancer (e.g., non-breast cancer). Moreover, further efforts are needed to develop, evaluate, and implement clinical strategies targeting LPA within integrated care models for advanced cancer. Simultaneously, educational initiatives are necessary to enhance relevant knowledge in physiotherapists and oncology care providers. These can support the personalization of LPA resources, facilitate interprofessional collaboration, and improve the quality and integration of rehabilitation services in cancer care. Therefore, the findings of my dissertation research provide comprehensive and applicable knowledge about diverse patient and professional perspectives related to LPA in the advanced cancer population. This work can support future efforts aimed at facilitating LPA participation and enhancing supportive care experiences in individuals living with advanced cancer.

Bakgrund: Cancer är en av de vanligaste sjukdomarna globalt sett. En halv miljon svenskar har någon gång fått en cancerdiagnos. Varje dag förlorar cirka tre barn under 18 år en förälder i cancer i Sverige. För att hjälpa dessa utsatta barn behöver samhället öka kunskapen i ämnet för att kunna skapa bättre förutsättningar inför framtiden. Syfte: Syftet med litteraturstudien var att belysa barns och tonåringars upplevelser av att leva med en förälder som drabbats av avancerad cancersjukdom. Metod: En litteraturstudie med kvalitativa artiklar valdes. Artiklarna söktes upp i databaserna Cinahl, PubMed och PsycINFO. Åtta vetenskapliga studier har valts ut som överensstämmer med syftet. Resultatet i studierna har sammanställts med hjälp av Fribergs 5-stegsmodell.  Resultat: Analysen resulterade i 5 kategorier och 13 underkategorier. Kategorierna är: känslomässiga reaktioner, barns sätt att hantera situationen, det viktiga stödet, förändrat familje- och socialt liv och att växa med erfarenheten. Konklusion: En öppen kommunikation och att bli involverade i förälderns sjukdom är viktigt för barnen. Sjuksköterskan bör arbeta efter ett familjecentrerat förhållningssätt för att lättare kunna hjälpa barnen. / Background: Cancer is, globally, one of the most common diseases. Half a million Swedes recive a cancer diagnosis during their lifetime. In one day, approximately 3 Swedish children experience the loss of their parent due to cancer. To help these vulnerable children the community needs to increase knowledge of the subject in order to create better conditions for the childrens future.  Aim: The aim of this litterature study was to illuinate the experiences of children and adolescents living with a parent diagnosed with advanced cancer. Metodhs: A literature study with qualitative articles was selected. The articles were found in Cinahl, PubMed and PsycINfO. Eight scientific articles conformed to the aim. The result in the studies were analyzed with help of a 5-stepmodel as described by Friberg. Results: The analysis resulted in 5 categories and 13 subcategories. The categories are: emotional reactions, how children cope with the situation, the main support, changes in family- and social life and growing with the experience.  Conclusion: An open communication and to be involved in the parent´s desease is important for the children. The nurse should work in a family-centred approach to provide good care for the children.

<p>The general aim was to explore philosophy of life, expectations and optimism in patients and spouses in two different cancer situations, and to determine whether these aspects had relevance for psychological distress and quality of life. The first situation was being newly diagnosed with advanced cancer. Data on philosophy of life, optimism and psychological distress were gathered on one occasion (I). In addition, changes in life were described using a qualitative approach in a sub-sample (II). The second situation was having completed curative cancer treatment. Data on expectations for the recovery period, optimism, psychological distress and quality of life were gathered on three occasions (III). Moreover, expectations and how these turned out were described using a qualitative approach in a sub-sample (IV). The results show that being diagnosed with an advanced cancer influenced aspects of patients’ and spouses’ philosophy of life, including that existential questions were common and were related to higher psychological distress (I). All experienced substantial mental changes in life, often also physical, practical and sometimes positive changes. Patients more often seemed to accept their situation and prepared themselves for death, whereas spouses had more difficulties in handling the situation (II). Patients who had completed curative treatment generally had higher expectations for the recovery period than did their spouses, and patients expectations were fulfilled to a lesser degree, however, this generally had little importance for psychological distress or quality of life (III). Patients’ expectation for their recovery period was generally that they would get well. For those whose recovery period had been tough, expectations were often unfulfilled, but they were often satisfied with their current life anyway owing to positive changes (IV). Being optimistic was the most beneficial for decreased psychological distress in both samples, as well as for better quality of life in the recovery group (I, III).</p>

The general aim was to explore philosophy of life, expectations and optimism in patients and spouses in two different cancer situations, and to determine whether these aspects had relevance for psychological distress and quality of life. The first situation was being newly diagnosed with advanced cancer. Data on philosophy of life, optimism and psychological distress were gathered on one occasion (I). In addition, changes in life were described using a qualitative approach in a sub-sample (II). The second situation was having completed curative cancer treatment. Data on expectations for the recovery period, optimism, psychological distress and quality of life were gathered on three occasions (III). Moreover, expectations and how these turned out were described using a qualitative approach in a sub-sample (IV). The results show that being diagnosed with an advanced cancer influenced aspects of patients’ and spouses’ philosophy of life, including that existential questions were common and were related to higher psychological distress (I). All experienced substantial mental changes in life, often also physical, practical and sometimes positive changes. Patients more often seemed to accept their situation and prepared themselves for death, whereas spouses had more difficulties in handling the situation (II). Patients who had completed curative treatment generally had higher expectations for the recovery period than did their spouses, and patients expectations were fulfilled to a lesser degree, however, this generally had little importance for psychological distress or quality of life (III). Patients’ expectation for their recovery period was generally that they would get well. For those whose recovery period had been tough, expectations were often unfulfilled, but they were often satisfied with their current life anyway owing to positive changes (IV). Being optimistic was the most beneficial for decreased psychological distress in both samples, as well as for better quality of life in the recovery group (I, III).

Title: Spiritual Care Interventions and Quality of Life in Cancer Patients Receiving Palliative Care Background: Despite the evidence supporting spiritual care in nursing and an increased quality of life among patients, patients feel that their spiritual needs are not being supported by medical professionals. Nurses agree that the role they play is significant in addressing the needs of cancer patients; however, they feel that they lack the knowledge for addressing spirituality concerns at the end of life. The purpose of this study is to identify spiritual care interventions that nurses can implement to improve quality of life (QOL) in patients with advanced cancer receiving palliative care. Method: This literature review consisted of articles retrieved from several databases, including CINAHL, PubMED, and PsychINFO, PsychARTICLES, ATLA Religion databases using the key words "cancer'" and "quality of life" "therapeutic communication", "spirit' therapy", "relaxation therapy", and "self-care". Inclusion criteria consisted of research conducted after the year 2000, peer reviewed work and research studies written in the English language. Results: Results from this literature review include recommended nursing interventions that provide spiritual care to patients with advanced cancer receiving palliative care for the purpose of improved quality of life. Spiritual care interventions identified in this study include Meaning Centered Group Psychotherapy (MCGP), Supportive Group Psychotherapy (SGP), mental relaxation, mental images, TM, art therapy, socializing, communicative acts, aromatherapy, massage, exercise, hatha yoga, meditation, and activities such as gardening, watching TV, resting/sleeping and socializing.

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