Living with advanced cancer: Rich Pictures as a means for health care providers to explore the experiences of advanced cancer patients

Abstract

Background To provide holistic care to patients with advanced cancer, health care professionals need to gain insight in patients’ experiences across the different domains of health. However, describing such complex experiences verbally may be difficult for patients. The use of a visual tool, such as Rich Pictures (RPs) could be helpful. We explore the use of RPs to gain insight in the experiences of patients with advanced cancer. Methods Eighteen patients with advanced cancer were asked to draw a RP expressing how they experienced living with cancer, followed by a semi‐structured interview. Qualitative content analysis, including the examination of all elements in the drawings and their interrelationships, was used to analyze the RPs, which was further informed by the interviews. Results The RPs clearly showed what was most important to an individual patient and made relations between elements visible at a glance. Themes identified included: medical aspects, the experience of loss, feelings related to loss, support from others and meaningful activities, and integration of cancer in one's life. The added value of RPs lies in the ability to represent these themes in one single snapshot. Conclusions RPs allow for a complementary view on the experiences of advanced cancer patients, as they show and relate different aspects of patients’ lives. A RP can provide health care professionals a visual summary of the experiences of a patient. For patients, telling their story to health care professionals might be facilitated when using RPs.

Repeated use of rich pictures to explore changes in subjective experiences over time of patients with advanced cancer

“…The RP viewing sessions and gallery walks resulted in an initial set of open codes, that were further developed and clustered into themes through open and focused coding of the corresponding interview transcripts. 20 The second set of RPs was again analyzed by Z.M.B. and E.H. and, for each patient, compared to the first RP of that particular patient.…”

“…The findings of the first round of RP interviews were previously published. 20 The present study will specifically focus on the repeated use of the RPs. We adopted a constructivist research paradigm acknowledging that knowledge is co-created between researchers and patients.…”

“…[15][16][17][18][19] We recently found that a specific visual tool, originating from systems thinking, that is, rich pictures (RPs), could provide a more comprehensive view of the experiences of patients with advanced cancer. 20 RPs are drawings that research participants create to express their experiences, including different elements, for example, people, materials, processes, interactions, and feelings. 5,6,12,13,21 RPs were found to combine different aspects of patients' lives, communicating these in one single snapshot.…”

“…5,6,12,13,21 RPs were found to combine different aspects of patients' lives, communicating these in one single snapshot. 20 This promising finding encouraged us to address the subsequent question: How can the repeated use of RPs make changes in subjective experiences of patients with advanced cancer visible over time and what are the most optimal research conditions to achieve this? We explored these questions in a qualitative study among the same patients with advanced cancer who had drawn an RP previously.…”

“…We explored these questions in a qualitative study among the same patients with advanced cancer who had drawn an RP previously. 20 …”