Study On The Strategies Of Hope Adjustment In Patients With Advanced Lung Cancer Receiving Targeted Therapy

BackgroundHope is the significant mainstay for patients with terminal cancer to actively deal with the disease and death threats.With the rapid development of precision medicine,molecular targeted therapy has brought new hope for patients with advanced lung cancer,but targeted therapy has high specificity and individual differences in curative effect.It is extremely easy to appear drug resistance or forced to reduce or even stop treatment because of serious side effects and so on,so that hope will break.High hope level brought positive effect for targeted therapy,but it is not the higher the better for the unrealistic “false” hope will make patients deeply disappointed and worried--not conducive to treatment.It can be said that as the “last lifeline” for patients with advanced lung cancer,the new hope kindled by targeted therapy has a unique life-and-death experience.The kindled and dashed hope also run through the treatment--hope and fear are at each other's throats.Although some scholars had carried out relevant research on the hope,as well as there were many intervention strategies to enhance it with some evidences,the hope experience and the mechanism of hope change in this particular clinical situation are not clear.Further exploration is still needed for the reasonable application of the intervention strategy,better management and moderate maintenance of hope.ObjectiveThe purpose of this study is to explore the experience of hope and the mechanism of hope change in the course of targeted therapy for patients with advanced lung cancer.In order to help advanced lung cancer patients to get better management of hope in the process of targeted therapy,obtaining more clinical benefits,improving the quality of life,and extending life,hope management strategy are built.The specific objectives include:(1)To explore the perception of hope in patients with targeted therapy for advanced lung cancer,and to form the mechanism of understanding the change of hope;(2)To construct the strategy of hope management for patients with advanced lung cancer treated by targeted therapy;(3)To evaluate the strategies of hope management in patients with targeted therapy for advanced lung cancer.MethodsIn this study,a qualitative study was carried out to explore the unique mechanism of hope changes of patients with targeted therapy for advanced lung cancer,mechanism integration of Hope Management Strategy based on project explorations and on-site evaluations.This project was divided into three parts:Part I: The qualitative study on the hope of targeted therapy for patients with advanced lung cancer:A qualitative research approach was adopted.Purposive and theoretical sampling strategies were used in the study.25 advanced lung cancer patients with oral targeted drugs were enrolled in the study,who were treated in a grade III a general hospital in Hangzhou,Zhejiang Province or in an oncology hospital in Hangzhou from July 2019 to November2020.The structure of the relationship between category and category is constructed by means of substantive coding(open coding and selective coding)and theoretical coding strategy guided by the grounded theory.Analytical techniques such as questioning and continuous comparison were used for analysis.Finally,from the perspective of game theory,the theory of hope adjustment for patients with advanced lung cancer receiving targeted therapy was formed.Part ?: The strategy research of hope management:Evidences were extracted,analyzed and synthesized by using the method of literature research.The strategies of hope management for patients with advanced cancer were preliminarily constructed.Based on the theory of hope adjustment,combined with the characteristics of patients with advanced lung cancer targeted therapy,from the perspective of game theory,multi-disciplinary expert group discussion method was used to establish motivation management strategy and path management strategy.Part III: Evaluation of the best strategies for hope management:An expert field study was conducted to evaluate the best strategies for hope management in patients with advanced lung cancer receiving targeted drug therapy,the feasibility,appropriateness,meaningfulness and effectiveness of the strategies.ResultsPart I: Qualitative research results for patients with advanced lung cancer targeted therapy:1.Results of interviews and topic coding: more than 184,000 words were transcribed and the average interview time was 32.5 minutes with 25 patients.In this study,two major themes of “hope perception” and “hope adjustment” had been identified by qualitative research.After an in-depth analysis of data,the theme of “hope perception” was divided into four categories,“wish for survival” coexisted with “concern about the availability of the therapy”,“hope to prolong survival” and “worry about the sustainability of the therapy”,“expect for better curative effects” and “worry about the benefits from the therapy”,with “desire to recuperate” and “anxiety of cancer metastasis and recurrence”.The theme of “Hope Adjustment” included 10 sub-themes of “Spiritual Belief”,“Living in the Moment”,“Positive Thinking”,“Professional Support”,“Emotional Response”,“Interpersonal Relationship”,“Symptom Control”,“Expectation of normality”,“Empowerment” and “Threat Control”,and 20 taxa and many subclasses.2.Theoretical results: the theory of hope adjustment in patients with advanced lung cancer targeted therapy had been formed.The core contents include:(1)“Hope” and“Worry” coexist in a game relationship in the target therapy of advanced lung cancer;(2)“Hope” and “Worry” in the target therapy of advanced lung cancer can be adjusted to reach the recent steady state of the game;(3)the strategies of hope adjustment in patients with advanced lung cancer targeted therapy needs both “Dynamic Thinking” and “Path Thinking” to adjust hope together to achieve the target of hope adjustment.Part II: Results of the study on the hope adjustment strategy in patients with targeted therapy for advanced lung cancer:Based on the results of theoretical research,the strategy of literature retrieval was determined,and finally 16 articles were included,including 1 BPI,3 Randomized controlled trials,5 quasi-experimental studies and 6 qualitative studies.A total of 135 strategies were extracted and evaluated,which were grouped into 15 themes(including 10sub-themes from qualitative research).After two rounds of group discussion by 12 multidisciplinary experts,combining the characteristics of patients and the theory of hope adjustment,the optimal strategies of hope adjustment for patients with advanced lung cancer receiving targeted therapy were finally formed.There are 73 strategies in 14 themes,including “building the desire to live”,“living in the moment”,“maximizing personal strength” and “minimizing uncertainty”,including 31 motivation management strategies and 42 path management strategies--58 strong recommendations and 15 weak recommendations.Part III: Evaluation of prospective management strategies in patients with targeted therapy for advanced lung cancer:The optimal strategies for patients with advanced lung cancer who received targeted therapy were evaluated by expert field demonstration,the results showed that the agreement rate of feasibility,validity and suitability was above 83.33%,and the agreement rate of clinical evaluation was above 91.67%.Conclusions1.Hopes and worries are coexisted in minds of patients advanced lung cancer receiving targeted therapy,and they hope to adapt to different stress events.The hope adjustment theory constructed in this study provides theoretical guidance for medical staff to understand the hope perception and adjustment strategy of patients with advanced lung cancer in the process of receiving targeted therapy and related follow-up studies.2.Based on the theory of hope adjustment in the early stage,the hope adjustment strategy of the patients receiving targeted therapy for advanced lung cancer can help the patients receiving targeted therapy to obtain and maintain hope effectively,reducing the sense of worry and despair,thus improve the quality of life of patients and extend the survival time,with maximized benefits of treatment of targeted therapy.