An exploration of the patients' lived experience with antineoplastic medicines for colorectal cancer in Malta.

Brincat, Alison

Abstract

Cancer is a global health problem, with colorectal cancer being the third most common cancer worldwide. Antineoplastic medicines are considered the backbone of treatment for colorectal cancer, administered with the intent to relieve symptoms and achieve cure or prolong life. Consequently, patients have to cope with the burden of this treatment in addition to the symptoms of a life-threatening illness. This can be challenging and is poorly understood. The overall aim of this research was to explore the patients' lived experience with antineoplastic medicines for colorectal cancer in Malta. This research involved three phases. Phase I consisted of a systematic review to appraise, synthesise and present the available evidence of patients' lived experience with antineoplastic medicines prescribed for the management of malignant solid tumours. This review of ten studies showed the dynamic processes and socio-cultural influences that affected the patients' beliefs, practice and burden with antineoplastic medicines. Despite the lack of longitudinal qualitative studies, patients were still noted to undergo a continuous process of reinterpretations about their treatment along its journey. As this review captured almost all aspects mentioned in the original conceptual model of patients' lived experience with medicines (PLEM) for any acute and chronic illness (Mohammed, Moles and Chen 2016), it was likely to be transferable to the oncology setting with minor modifications. Phase II involved a longitudinal qualitative study which explored the perceptions and experiences of 16 patients receiving a six month cycle of antineoplastic medicines (FOLFOX or XELOX) for the management of colorectal cancer. In parallel, another longitudinal qualitative study was conducted for Phase III by interviews with significant others nominated by patients participating in Phase II. This phase aimed to explore the significant others' perspective on the patients' lived experience with antineoplastic medicines. All interviews were audio-recorded and transcribed verbatim, with data analysed using Interpretative Phenomenological Analysis for Phase II and Framework Analysis for Phase III. Five themes were generated from the analyses: (1) perceptions and knowledge of the illness and treatment; (2) the healthcare system in relation to the illness and treatment; (3) patient's involvement in treatment decision-making and their experience of medicine-taking; (4) medicine and illness-related impact on patients and (5) personal support structure. The longitudinal analysis of these themes supported inferences relevant to development in these areas along the treatment trajectory. Whilst patients faced the prospect of the treatment journey with fear, they had high expectations to achieve cure irrespective of treatment intent. Almost all patients passively consented to the oncologist's recommendations but still criticised the lack of provision of specific treatment information. Patients praised the personalised service of the nurse navigator particularly upon encountering difficulties in between cycles. To mitigate the substantial impact of treatment on their everyday life, patients sought refuge in spirituality and religion in addition to self-regulation coping strategies. Support was crucial for patients as they sought to develop a personal support network, mainly involving their significant other as from initiation of treatment. In conclusion, this doctoral research showed that the patients' lived experience with antineoplastic medicines is complex and remained challenging long-term. It also highlighted that the patients' needs go beyond the provision of medicines. Despite improvements made in the local healthcare system, further specific patient-tailored interventions are warranted such as the introduction of buddy system and the provision of specific information at appropriate timepoints in the treatment journey. Further research is required to explore their potential implementation and adoption into practice.

Citation

BRINCAT, A. 2023. An exploration of the patients' lived experience with antineoplastic medicines for colorectal cancer in Malta. Robert Gordon University, PhD thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-2270694

• Thesis Type: Thesis
• Deposit Date: Mar 12, 2024
• Publicly Available Date: Mar 12, 2024
• DOI: https://doi.org/10.48526/rgu-wt-2270694
• Keywords: Patient experiences; Antineoplastic medicines; Colorectal cancer
• Public URL: https://rgu-repository.worktribe.com/output/2270694
• Award Date: Sep 30, 2023