Closure for patients at the end of a cancer clinical trial: literature review

Abstract

This paper is a report of a literature review to explore theories of psychological closure in order to understand the outcomes of a trial in which nurses attempted to facilitate psychological closure for their patients with cancer. Patients' accounts have highlighted a feeling of abandonment and a need for support after a period of treatment for cancer but this is rarely addressed in the nursing literature or in practice. The British Nursing Index, the CINAHL, Ovid Medline, PsychInfo and EMBASE databases were searched without date limits using the keywords 'closure', 'ending', 'finishing', 'treatment', 'cancer care', 'therapeutic relationships' and 'transitions'. The search took place concurrently with the implementation of a randomized controlled trial from 2001 to 2005 in which nurses attempted to facilitate closure for patients at the end of a cancer chemotherapy trial. Literature on the concept of 'rites of passage' enabled us to view nurses as supporting patients' transition from one life-stage to another. Literature on debriefing deepened our understanding of patients' anxieties and needs. Our review also drew attention to power imbalances in the ending of nurse-patient or doctor-patient relationships, and highlighted the importance of good endings and the need to mark endings formally. Achieving closure is an important element in promoting patient well-being when undergoing treatment for cancer. Nurses and other healthcare staff can facilitate this with simple interventions such feedback and discussion at the end of a period of active treatment.