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Open Access Article

The Challenge of Existential Issues in Acute Care: Nursing Considerations for the Patient With a New Diagnosis of Lung Cancer

Rebecca Lehto

lung neoplasms, acute care settings
CJON 2012, 16(1), E4-E11. DOI: 10.1188/12.CJON.E1-E8

A new diagnosis of lung cancer is a highly threatening experience that raises personally relevant existential issues and brings death-related thoughts and concerns to mind. Those issues can be very disturbing to patients, leading to distress and potentially to a lowered quality of life. The purpose of this article is to present to the practicing oncology nurse the types of existential and death-related concerns that patients with a new diagnosis of lung cancer may have. In addition, the article identifies practical strategies and resources for oncology nurses who can help patients accept and manage the normal but often distressing responses to a life-threatening diagnosis.

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    References

    Barnard, D., Street, A., & Love, A. W. (2006). Relationships between stressors, work supports, and burnout among cancer nurses. Cancer Nursing, 29, 338-345. doi:10.1097/00002820-200607000-00013
    Breitbart, W., Gibson, C., Poppito, S. R., & Berg, A. (2004). Psycho-therapeutic interventions at the end of life: A focus on meaning and spirituality. Canadian Journal of Psychiatry, 49, 366-372.
    Breitbart, W., & Heller, K. (2003). Reframing hope: Meaning-centered care for patients near the end of life. Journal of Palliative Medicine, 6, 979-988. doi:10.1089/109662103322654901
    Browall, M., Melin-Johansson, C., Strang, S., Danielson, E., & Henoch, I. (2010). Healthcare staff's opinions about existential issues among patients with cancer. Palliative and Supportive Care, 8, 59-68. doi:10.1017/S14789515099071X
    Carpenito-Moyet, L. J. (2008). Handbook of nursing diagnosis. Philadelphia, PA: Lippincott Williams and Wilkins.
    Cole, B., & Pargament, K. (1999). Recreating your life: A spiritual/psychotherapeutic intervention for people diagnosed with cancer. Psycho-Oncology, 8, 395-407. doi:10.1002/(SICI)1099-1611(199909/10)8:5<395::AID-PON408>3.0.CO;2-B
    Cunningham, A. J. (2002). Group psychological therapy: An integral part of care for cancer patients. Integrative Cancer Therapies, 4, 178-186. doi:10.1177/1534735405275648
    Deffner, J. M., & Bell, S. K. (2005). Nurses' death anxiety, comfort level during communication with patients and families regarding death, and exposure to communication education: A quantitative study. Journal for Nurses in Staff Development, 21, 19-23. doi:10.1097/00124645-200501000-00005
    Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The cognitive role of intolerance of uncertainty in etiology and maintenance. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 143-163). New York, NY: Guilford Press.
    Fitzsimmons, D., Mullan, D., Wilson, J. S., Conway, B., Corcoran, B., Dempster, M., … Fogarty, D. (2007). The challenge of patients' unmet palliative care needs in the final stages of illness. Palliative Medicine, 21, 313-322. doi:10.1177/0269216307077711
    Frankl, V. (1985). Man's search for meaning. New York, NY: Simon and Schuster.
    Henoch, I., & Danielson, E. (2009). Existential concerns among patients with cancer and interventions to meet them: An integrative literature review. Psycho-Oncology, 18, 225-236. doi:10.1002/pon.1424
    Hill, K. M., Muers, A. Z., Connolly, K., & Round, C. (2003). Do newly diagnosed lung cancer patients feel their concerns are being met? European Journal of Cancer Care, 12, 35-45. doi:10.1046/j.1365-2354.2003.00324.x
    Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169-183. doi:10.1037/a0018555
    Jacobsen, P. B., & Jim, H. S. (2008). Psychosocial interventions for anxiety and depression in adult cancer patients: Achievements and challenges. CA: A Cancer Journal for Clinicians, 58, 214-230. doi:10.3322/CA.2008.0003
    Janis, I. L. (1985). Coping patterns among patients with life-threatening illnesses. Issues in Mental Health Nursing, 7, 461-476. doi:10.3109/01612848509009466
    Kearney, A. R., & Kaplan, S. (1997). Toward a methodology for the measurement of knowledge structures of ordinary people: The Conceptual Content Cognitive Map (3CM). Environment and Behavior, 29, 579-617. doi:10.1177/0013916597295001
    Kissane, D., Bloch, S., Smith, G., Miach, P., Clarke, D. M., Ikin, J., … McKenzie, D. (2003). Cognitive-existential group psychotherapy for women with primary breast cancer: A randomized controlled trial. Psycho-Oncology, 12, 532-546. doi:10.1002/pon.683
    Krelstein, M. (2010). Exploring the interface between cancer and psychiatry. Oncology (Williston Park), 24, 657-658.
    Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: A meta-analysis. Psycho-Oncology, 18, 571-579. doi:10.1002/pon.1400
    Lehto, R. H. (2004). Worry and cognitive representations of illness in cancer (Unpublished doctoral dissertation). University of Michigan: Ann Arbor.
    Lehto, R. H., & Stein, K. F. (2009). Death anxiety: An analysis of an evolving concept. Research and Theory for Nursing Practice, 23, 23-41. doi:10.1891/1541-6577 .23.1.23
    Lehto, R. H., & Therrien, B. (2010). Death concerns in individuals newly diagnosed with lung cancer. Death Studies, 34, 931-946. doi:10.1080/07481181003765477
    LeMay, K., & Wilson, K. G. (2008). Treatment of existential distress in life threatening illness: A review of manualized interventions. Clinical Psychology Review, 28, 472-493. doi:10.1016/j.cpr.2007.07.013
    Leung, D., & Esplan, M. J. (2010). Alleviating existential distress of cancer patients: Can relational ethics guide clinicians? European Journal of Cancer Care, 19, 30-38. doi:10.1111/j.1365-2354.2008.0969.x
    Molassiotis, A., Panteli, V., Patiraki, E., Ozden, G., Platin, N., Madsen, E., … Margulies, A. (2006). Complementary and alternative medicine use in lung cancer patients in eight European countries. Complementary Therapies in Clinical Practice, 12, 34-39. doi:10.1016/j.ctcp.2005.09.007
    Molina, J. R., Yang, P., Cassivi, S. D., Schild, S. E., & Adiel, A. A. (2008). Non-small cell lung cancer: Epidemiology, risk factors, treatment, and survivorship. Mayo Clinic Proceedings, 83, 584-594. doi:10.4065/83.5.584
    Osborn, R. L., Demoncada, A. C., & Feuerstein, M. (2006). Psychosoical interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analyses. International Journal of Psychiatry in Medicine, 36, 13-34. doi:10.2190/EUFN-RV1K-Y3TR-FK0L
    Rolke, H. B., Bakke, P. S., & Gallefoss, F. (2008). Health-related quality of life, mood disorders, and coping abilities in an unselected sample of patients with primary lung cancer. Respiratory Medicine, 102, 1460-1467. doi:10.1016/j.rmed.2008.04.002
    Shearer, S., & Gordon, L. (2006). The patient with excessive worry. American Family Physician, 73, 1049-1058.
    Siegal, R., Ward, E., Brawley, O., & Jemal, A. (2011). Cancer statistics 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA: A Cancer Journal for Clinicians, 61, 212-236. doi:10.3322/caac.20121
    Stanton, A. L. (2006). Psychosocial concerns and interventions for cancer survivors. Journal of Clinical Oncology, 32, 5132-5137. doi:10.1200/JCO.2006.06.8775
    Thompson, E., Solà, I., & Subirana, M. (2005). Noninvasive interventions for improving well-being and quality of life in patients with lung cancer—A systematic review of the evidence. Lung Cancer, 50, 165-176. doi:10.1016/j.lungcan.2005.06.004
    Udo, C., Melin-Johansson, C., & Danielson, E. (2010). Existential issues among healthcare staff in surgical care—Discussions in supervision settings. European Journal of Oncology Nursing, 15, 447-453. doi:10.10.1016/j.ejon.2010.11.010
    Weisman, A. D., & Worden, J. W. (1976-1977). The existential plight in cancer: Significance of the first 100 days. International Journal of Psychiatry in Medicine, 7, 1-15.
    Wells, M., Sarna, L., Cooley, M. E., Brown, J. K., Chernecky, C., Williams, R. D., … Danao, L. L. (2007). Use of complementary and alternative medicine strategies to control symptoms in women living with lung cancer. Cancer Nursing, 30, 45-55.
    Westman, B., Bergenmar, M., & Andersson, L. (2006). Life, illness, and death—Existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer. European Journal of Oncology Nursing, 10, 169-176. doi:10.1016/j.ejon.2005.06.002
    Yalom, I. D. (1980). Existential psychotherapy. New York, NY: Basic Books.
    Yalom, I. D. (1985). The theory and practice of group psychotherapy. New York, NY: Basic Books.
    Yalom, I. D. (2008). Staring at the sun: Overcoming the terror of death. San Francisco, CA: Jossey-Bass.
    Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19-28.