Abstract
ObjectivesTo understand successful strategies used by people to cope well when living with advanced cancer; to explore how professionals can support effective coping strategies; to understand how to support development of effective coping strategies for patients and family carers.DesignQualitative serial (4–12 week intervals) interview study with people with advanced cancer and their informal carers followed by focus groups. The iterative design had a novel focus on positive coping strategies. Interview analysis focused on patients and carers as individuals and pairs, exploring multiple dimensions of their coping experiences. Focus group analysis explored strategies for intervention development.Participants26 people with advanced (stage 3–4) breast, prostate, lung or colorectal cancer, or in receipt of palliative care, and 24 paired nominated informal/family carers.SettingParticipants recruited through outpatient clinics at two tertiary cancer centres in Merseyside and Manchester, UK, between June 2012 and July 2013.Results45 patient and 41 carer interviews were conducted plus 4 focus groups (16 participants). People with advanced cancer and their informal/family carers develop coping strategies which enable effective management of psychological wellbeing. People draw from pre-diagnosis coping strategies, but these develop through responding to the experience of living with advanced cancer. Strategies include being realistic, indulgence, support, and learning from others, which enabled participants to regain a sense of wellbeing after emotional challenge. Learning from peers emerged as particularly important in promoting psychological wellbeing through the development of effective ‘everyday’, non-clinical coping strategies.ConclusionsOur findings challenge current models of providing psychological support for those with advanced cancer which focus on professional intervention. It is important to recognise, enable and support peoples’ own resources and coping strategies. Peer support may have potential, and could be a patient-centred, cost effective way of managing the needs of a growing population of those living with advanced cancer.
Highlights
Many different healthcare workers provide care to people with advanced cancer as the number of people with advanced cancer increases, and the likely trajectory of their disease course elongates[1]
Our findings challenge current models of providing psychological support for those with advanced cancer which focus on professional intervention
Peer support may have potential, and could be a patient-centred, cost effective way of managing the needs of a growing population of those living with advanced cancer
Summary
Many different healthcare workers provide care to people with advanced cancer as the number of people with advanced cancer increases, and the likely trajectory of their disease course elongates[1]. Current clinical guidance suggests that all healthcare professionals should be able to provide basic psychological support, but promotes a tiered approach where increasing professional expertise in psychological care should be sought with increasing severity or complexity of problems[2]. Access to such services can, be problematic due to availability issues[7], and many healthcare professionals are known to focus on physical rather than psychological symptoms[8, 9]. Psychological issues are common in those with advanced cancer, but the evidence base for effective interventions addressing issues such as depression and anxiety is scarce
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