Discussing potential recurrence after lung cancer surgery: Uncertainties and challenges

Abstract

Patients with lung cancer who undergo surgery may potentially be cured. The resulting pathological staging gives an indication of 5-year survival and whether further treatment is recommended. To date, there is little research evidence regarding the way potential recurrence is communicated to patients by staff. This qualitative research used case studies to explore how information disclosure about possible recurrence was managed following lung cancer surgery and aimed to identify practice implications for clinical teams. Twelve patients were recruited and first postoperative surgical and subsequent oncology or follow-up consultations were recorded and transcribed. The perspective of the professionals involved in these clinics was ascertained through 30 in-depth interviews. Key themes in the data were identified using Framework Analysis. Recurrence risk was communicated to patients in a number of ways and levels of clarity and openness. Information provided by participants about early warning signs of recurrence varied. Findings indicate information provided was linked to the patient's prognosis and individual professionals' underlying communication approach. This study provides a unique insight into the views of lung cancer specialists regarding information disclosure and reveals the challenging nature and complexity of discussing recurrence following lung cancer surgery.

Dominant restitution narratives of ‘being lucky’: An ethnographic exploration of narratives about operable lung cancer

“…So how can we understand why the restitution narrative of ‘being lucky’ dominates? As mentioned in the introduction, a study by Johnson et al (2018) found that surgeons wanted to boost patients' hopes with an optimistic message, even when the prognosis was rather poor. The desire to induce hope and downplay illness and treatment is similarly found in the present study when the surgeon call surgery ‘a quiet day at the office’ and adjuvant chemotherapy is deemphasised by calling information at the outpatient clinic ‘good news’.…”

“…There is little research exploring how patients with lung cancer and clinicians engage in dialogue about illness and treatment. One study by Johnson et al (2018) found that lung cancer is described in positive terms with an emphasis on hope; surgeons found it essential to deliver information in an optimistic way, even when the information was not particularly good. There is a paradox in the experiences described by lung cancer patients, where a high prevalence of emotional distress and physical and psychosocial challenges contrasts with an unmet need for support from clinicians, who tend to present the disease in a positive light.…”

Research on the effect of health care integration on patients’ negative emotions and satisfaction with lung cancer nursing activities

“…Lung cancer has a high incidence and mortality[ 11 , 12 ], and the current clinical treatment for patients with lung cancer is surgery[ 13 , 14 ]; even after surgery, patients are prone to recurrence[ 15 ]; therefore, more patients need to be treated with adjuvant chemotherapy to reduce the risk of disease recurrence and ensure the effectiveness of treatment[ 16 ]. However, due to the fear of disease and surgery and the side effects of chemotherapy, patients are prone to self-abdication, and therefore, they receive insufficient treatment[ 17 ], which affects their overall outcome[ 18 ].…”

‘Staying cool, calm and positive’: A dialogical narrative analysis of emotional reactions in narratives about operable lung cancer

“…Thus, dominant illness narratives seem to have an effect on how emotional reactions can be expressed and thereby the possibility for ill people to be heard and recognised in their suffering. Furthermore, research indicates an under-recognition of lung cancer patients' worries and concerns in the clinical encounter with healthcare professionals [9,[22][23][24]. In addition, lung cancer is seen as an individual responsibility because of the association between the disease and smoking, implying emotions of stigma, shame and blame [25].…”