Changes in Cancer Patients' and Caregivers' Disease Perceptions While Receiving Early Palliative Care: A Qualitative and Quantitative Analysis

Abstract

Background. Little is known about the underlying mechanisms through which early palliative care (EPC) improves multiple outcomes in patients with cancer and their caregivers. The aim of this study was to qualitatively and quantitatively analyze patients' and caregivers' thoughts and emotional and cognitive perceptions about the disease prior to and during the EPC intervention, and in the end of life, following the exposure to EPC. Materials and Methods. Seventy-seven patients with advanced cancer and 48 caregivers from two cancer centers participated in semistructured interviews. Their reports were qualitatively and quantitatively analyzed by the means of the grounded theory and a text-analysis program.Results. Participants reported their past as overwhelmed by unmanaged symptoms, with detrimental physical and psychosocial consequences. The EPC intervention allowed a prompt resolution of symptoms and of their consequences

Gratitude among advanced cancer patients and their caregivers: The role of early palliative care

“…Our study fills this gap by assessing the frequency of gratitude in the palliative care context not only for caregivers but also for patients. The high percentages of expressions of gratitude found may indicate that gratitude in the EPC context is not linked to personality dispositions but, rather, to an indirect, secondary benefit arising from the well-known, primary benefits attributed to EPC, like symptom control (2,37,42), reduced therapy aggressiveness (3,(42)(43)(44) and risk of severe pain (32,37), improved QoL (2,3,37,(44)(45)(46)(47), mood (2,3,37,(44)(45)(46)(47), and prognostic awareness (2,48,49). Most of SOC interventions have primary benefits on cancer itself but lead to secondary, indirect issues (2,37).…”

“…The high percentages of expressions of gratitude found may indicate that gratitude in the EPC context is not linked to personality dispositions but, rather, to an indirect, secondary benefit arising from the well-known, primary benefits attributed to EPC, like symptom control (2,37,42), reduced therapy aggressiveness (3,(42)(43)(44) and risk of severe pain (32,37), improved QoL (2,3,37,(44)(45)(46)(47), mood (2,3,37,(44)(45)(46)(47), and prognostic awareness (2,48,49). Most of SOC interventions have primary benefits on cancer itself but lead to secondary, indirect issues (2,37). The availability of a model of cancer care that allows, beyond the resolutions of such issues, secondary benefits such as the elicitation of gratitude is of utmost value, given its potential relevance as an indicator of the clinical outcome.…”

“…The detection of an abnormality on self- or routine examination, the following laboratory tests and screening procedures, and the communication of a life-threatening illness are shocking and cause patients to face an escalation of fear and uncertainty that leaves them vulnerable and apparently with no control over events ( 1 ). Once on standard oncology care (SOC), patients are overwhelmed by the side effects ( 2 ) that may not get fully addressed by oncologists ( 3 ) and trigger cascading consequences on their physical and psychosocial wellbeing ( 2 ). Their primary caregivers experience similar feelings, exacerbated by the burden of their responsibility ( 2 ).…”

“…Once on standard oncology care (SOC), patients are overwhelmed by the side effects ( 2 ) that may not get fully addressed by oncologists ( 3 ) and trigger cascading consequences on their physical and psychosocial wellbeing ( 2 ). Their primary caregivers experience similar feelings, exacerbated by the burden of their responsibility ( 2 ). Apparently, there are no reasons to feel grateful in such a situation.…”

The Paradigm Shift from End of Life to Pre-Emptive Palliative Care in Patients with Cancer

“…In the last ten years, it has been clearly stated that cancer patients who access earlier palliative care have better clinical outcomes at potentially lower costs [ 3 , 4 , 5 ].…”