Patient pathways as social drama: a qualitative study of cancer trajectories from the patient’s perspective

Hansen, Frank; Berntsen, Gro; Salamonsen, Anita

doi:10.1080/17482631.2019.1639461

Cited by 6 publications

(3 citation statements)

References 40 publications

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“…The anxiety- and depression-like behavior of cancer patients following chemotherapy affects the mental and physical health of patients gravely ( 28 ). Nutritherapy is one of the vital approaches for preventing and intervening with anxiety- and depression-like behavior following chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Tilapia Skin Peptides Ameliorate Cyclophosphamide-Induced Anxiety- and Depression-Like Behavior via Improving Oxidative Stress, Neuroinflammation, Neuron Apoptosis, and Neurogenesis in Mice

Zhao

Yin

et al. 2022

Front. Nutr.

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Anxiety- and depression-like behavior following chemotherapy treatment occurs in cancer patients with high probability and no specific therapeutics are available for treatment and prevention of this complication. Here, tilapia skin peptides (TSP), a novel enzymatically hydrolyzed bioactive peptide mixture, obtained from tilapia (Oreochromis mossambicus) scraps, were studied on cyclophosphamide (CP)-induced anxiety- and depression-like behavior in mice. Mice were received intraperitoneal injection of CP for 2 weeks, while TSP was administered for 4 weeks. After the end of the animal experiment, behavioral, biochemical, and molecular tests were carried out. The mice decreased preference for sugar water, increased immobility time in the forced swimming and tail suspension test, and decreased travel distance in the open field test in the Model group, compared with the Control group. Abnormal changes in behavioral tests were significantly improved after the TSP treatment. Additionally, abnormalities on superoxide dismutase, malondialdehyde, glutathione peroxidase were rescued by administration of 1000 mg/kg/d TSP in mice than that of the Model group. TSP has normalized the expression of Iba-1 and the levels of TNF-α and IL-1β in the hippocampus of mice, which indicated that TSP could observably ameliorate neuroinflammatory response in the hippocampus of mice. TSP ameliorated the apoptosis of hippocampal neurons of CA1 and CA3 regions in the TSP group vs. the Model group. The number of doublecortin positive cells was drastically increased by administering 1000 mg/kg/d TSP in mice vs. the Model group. Furthermore, TSP reversed the Nrf2/HO-1 signaling pathway, BDNF/TrkB/CREB signaling pathway, and reduced the Bcl-2/Bax/caspase-3 apoptosis pathway. In conclusion, TSP could restore CP-induced anxiety- and depression-like behavior via improving oxidative stress, neuroinflammation, neuron apoptosis, and neurogenesis in mice hippocampus.

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Section: Discussionmentioning

confidence: 99%

Tilapia Skin Peptides Ameliorate Cyclophosphamide-Induced Anxiety- and Depression-Like Behavior via Improving Oxidative Stress, Neuroinflammation, Neuron Apoptosis, and Neurogenesis in Mice

Zhao

Yin

et al. 2022

Front. Nutr.

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“…In the literature, it is discussed whether it is possible to combine individualization with standardization in cancer care (21,22,30). In a meta-ethnography study, Kvael,Hellesø (22) identify an urgent need for a coordinated conceptualization of the experienced tension in balancing standardization and individualization in CPP to ensure better health care services for patients and health care personnel.…”

Section: Fragmented Treatment Offermentioning

confidence: 99%

Lost in the loop - A qualitative study on patient experiences of care in standardized patient pathways

Solberg

Berg

Andreassen

2023

Preprint

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Background The Norwegian health authorities introduced standardized cancer patient pathways in 2015, aiming to reduce practice variations across hospitals and regions, and improve the continuity, coordination and overall quality of the health care service provided to cancer patients. Health service research has investigated the organisational and economic benefits of standardized pathways, whereas the element of care and the patient perspective has gained less attention. In this article we explore the care element in cancer patient pathways through an in-depth study of patient experiences. Methods Through a longitudinal qualitative design with in-depth patient interviews conducted during 2018–2021, we built a corpus of data on patient experiences from before, during and after treatment. The patients were enrolled approximately three years after the introduction of standardized cancer patient pathways in Norway. The empirical catchment area was eastern Norway. We did a thematic analysis driven by our analytical question on patient experiences of care, i.e., a theoretical thematic analysis. In the analytical work we were interested in the patients’ detailed stories as well as identifying what underlying ideas of care were shaping the patients experiences of the health service. Results The patient interviewees described it as a challenge that the cancer patient pathways were time-limited, with a clear start and stop, whereas their experience and understanding of the cancer diagnosis extended into their past and future lives. They further experienced that the services they received were fragmented, that there was a lack of continuity and collaboration within and between different health services, and that the help they received had a bio-medical focus on treatment only. Conclusions We conclude that cancer patient pathways offer good medical treatment, but that the care element deserves more attention. Current CPPs are trapped in a logic of choice, preventing room for the element of care to receive the attention it requires for the patient to truly experience holistic person-centred care and continuous, well-coordinated services.

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“…The model pays close attention to people's journeys and how these may dynamically change over time. By taking both biographical and clinical aspects of people's journeys into account, this model could be an alternative to clinical pathway models, with a sharper focus on humanizing care . Good doctor‐patient communication is of great importance to facilitate accurate diagnosis, when breaking bad news, and to establish a caring relationship with patients.…”

Section: Introductionmentioning

confidence: 99%

Patients' illness narratives—From being healthy to living with incurable cancer: Encounters with doctors through the disease trajectory

2019

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Background: Narrative medicine emphasizes how stories can increase the understanding of patients' experiences and give important insights into how patients interpret and strive to make meaning in the situation they find themselves in.Aim: The aim of this study was to gain insight into the illness narratives of cancer patients, from the day they suspected that something was wrong until living with incurable cancer. Methods and results: Six men and seven women, aged 47 to 79 years, diagnosed with metastatic cancer and undergoing chemotherapy with life-prolonging intent in an oncology outpatient clinic, were asked to tell their illness stories as freely as possible, without guiding questions. Stories were tape recorded, transcribed, and analyzed by a thematic narrative analysis. Encounters with doctors through the disease trajectory were highlighted by all narrators. Several informants described poor communication and consequences in the form of "doctors delay" and substandard psychosocial care. Continuity in follow-up and the physician's ability or inability to break bad news and adapt information to the patient's wishes and preferences were particularly emphasized. Conclusion: A key finding was the importance of the doctor's role throughout the whole trajectory. A good doctor-patient relationship was characterized by continuity of care in follow-up, and trust acquired over time, based on the physician's thorough medical knowledge combined with sensitive communication and empathy. K E Y W O R D S cancer patients, communication, continuity of care, doctor-patient relationship, doctor's delay, illness narratives 1 | INTRODUCTION The last decades have seen an increasing research interest in patients' experiences of living with a cancer disease. 1-3 Doctor-patient communication has also been a central research topic for many years, and many different communication models are recommended, such as the SPIKES model 4,5 and the Four Habits model. 6 Another model is the Turner Social Drama Model. 7 This model emphasizes people's perspectives, values, needs, and experiences contextualized in an illness process. The model pays close attention to people's journeys and how these may dynamically change over time. By taking both biographical and clinical aspects of people's journeys into account, this model could be an alternative to clinical pathway models, with a sharper focus on humanizing care. 7,8 Good doctor-patient communication is

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Patient pathways as social drama: a qualitative study of cancer trajectories from the patient’s perspective

Cited by 6 publications

References 40 publications

Tilapia Skin Peptides Ameliorate Cyclophosphamide-Induced Anxiety- and Depression-Like Behavior via Improving Oxidative Stress, Neuroinflammation, Neuron Apoptosis, and Neurogenesis in Mice

Tilapia Skin Peptides Ameliorate Cyclophosphamide-Induced Anxiety- and Depression-Like Behavior via Improving Oxidative Stress, Neuroinflammation, Neuron Apoptosis, and Neurogenesis in Mice

Lost in the loop - A qualitative study on patient experiences of care in standardized patient pathways

Patients' illness narratives—From being healthy to living with incurable cancer: Encounters with doctors through the disease trajectory

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