The transition experience of rural older persons with advanced cancer and their families : a grounded theory study
Date
2010-04-26
Authors
Duggleby, Wendy D.
Penz, Kelly L
Wilson, Donna M.
Leipert, Beverly D.
Berry, Patricia H.
Keall, Sylvia R.
Justice, Christopher J.
Goodridge, Donna M.
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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.
Description
BioMed Central
Keywords
Citation
Duggleby et al., The transition experience of rural older persons with advanced cancer and their families: a grounded theory study BMC Palliative Care 2010, 9:5