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. 2010 Apr 26:9:5.
doi: 10.1186/1472-684X-9-5.

The transition experience of rural older persons with advanced cancer and their families: a grounded theory study

Wendy D Duggleby  1 , Kelly L Penz, Donna M Goodridge, Donna M Wilson, Beverly D Leipert, Patricia H Berry, Sylvia R Keall, Christopher J Justice
Affiliations

The transition experience of rural older persons with advanced cancer and their families: a grounded theory study

Wendy D Duggleby et al. BMC Palliat Care. .

Abstract

Background: Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population.

Methods: Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz's constructivist grounded theory approach.

Results: Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of "Navigating Unknown Waters". This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes.

Conclusion: The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population.

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Figures

Figure 1
Figure 1
Navigating Unknown Waters.
See this image and copyright information in PMC

References

    1. Olsson K, Ek A. Transition: How a concept has been used in nursing science. Theoria, Journal of Nursing Theory. 2002;11(4):4–12.
    1. Kralik D, Visten K, van Loon A. Transitions: A literature review. Journal of Advanced Nursing. 2006;55(3):320–329. doi: 10.1111/j.1365-2648.2006.03899.x. - DOI - PubMed
    1. Reinke LF, Englebet RA, Shannon SE, Wenrich MD, Vig EK, Back AL, Curtis JR. Transitions regarding palliative and end of life care in severe chronic obstructive pulmonary disease or advanced cancer: Themes identified by patients, families and clinicians. Journal of Palliative Medicine. 2008;11(4):601–609. doi: 10.1089/jpm.2007.0236. - DOI - PMC - PubMed
    1. Duggleby W, Berry P. Transitions and shifting goals of care for palliative patients and their families. Clinical Journal of Oncology Nursing. 2005;9(4):425–428. doi: 10.1188/05.CJON.425-428. - DOI - PubMed
    1. Ronaldson S, Devery K. The experience of transition to palliative care services: Perspectives of patients and nurses. International Journal of Palliative Nursing. 2001;7:171–177. - PubMed

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