The sexual adjustment process of cancer patients and their partners : a qualitative evidence synthesis

When confronted with cancer, a prominent challenge for patients and their partners is their changed sexual relationship. An empirically based theoretical model of the sexual adaptation process during cancer might be helpful in guiding the development of adequate interventions for couples who struggle with their sexual relationship. Therefore, the purpose of this study was to synthesize evidence from primary qualitative research studies and to arrive at a detailed description of the process of sexual adjustment during cancer. We conducted a qualitative evidence synthesis of a purposeful sample of 16 qualitative papers, using the meta-ethnography approach to synthesis. We found that the subsequent studies used different theoretical approaches to describe the sexual adaptation process. This led to three divergent sexual adaptation processes: (1) the pathway of grief and mourning, depicting sexual changes as a loss; (2) the pathway of restructuring, depicting the adjustment process toward sexual changes as a cognitive process with a strong focus on the social and cultural forces that shape the values and experiences of sexuality; and (3) the pathway of sexual rehabilitation, depicting sexual changes as a bodily dysfunction that needs treatment and specific behavioral strategies. All three pathways have their own opportunities and challenges. A greater awareness of these different pathways could help healthcare providers to better understand the ways a particular couple might cope with changed sexuality, offering them opportunities to discover alternative pathways for sexual adjustment

The use of purposeful sampling in a qualitative evidence synthesis: A worked example on sexual adjustment to a cancer trajectory

Abstract Background An increasing number of qualitative evidence syntheses papers are found in health care literature. Many of these syntheses use a strictly exhaustive search strategy to collect articles, mirroring the standard template developed by major review organizations such as the Cochrane and Campbell Collaboration. The hegemonic idea behind it is that non-comprehensive samples in systematic reviews may introduce selection bias. However, exhaustive sampling in a qualitative evidence synthesis has been questioned, and a more purposeful way of sampling papers has been proposed as an alternative, although there is a lack of transparency on how these purposeful sampling strategies might be applied to a qualitative evidence synthesis. We discuss in our paper why and how we used purposeful sampling in a qualitative evidence synthesis about ‘sexual adjustment to a cancer trajectory’, by giving a worked example. Methods We have chosen a mixed purposeful sampling, combining three different strategies that we considered the most consistent with our research purpose: intensity sampling, maximum variation sampling and confirming/disconfirming case sampling. Results The concept of purposeful sampling on the meta-level could not readily been borrowed from the logic applied in basic research projects. It also demands a considerable amount of flexibility, and is labour-intensive, which goes against the argument of many authors that using purposeful sampling provides a pragmatic solution or a short cut for researchers, compared with exhaustive sampling. Opportunities of purposeful sampling were the possible inclusion of new perspectives to the line-of-argument and the enhancement of the theoretical diversity of the papers being included, which could make the results more conceptually aligned with the synthesis purpose. Conclusions This paper helps researchers to make decisions related to purposeful sampling in a more systematic and transparent way. Future research could confirm or disconfirm the hypothesis of conceptual enhancement by comparing the findings of a purposefully sampled qualitative evidence synthesis with those drawing on an exhaustive sample of the literature

Het omgaan met veranderde seksualiteit door kanker bij koppels: een synthese van de kwalitatieve onderzoeksliteratuur

Doel: Wanneer een koppel geconfronteerd wordt met kanker, is de verandering in de seksuele relatie vaak één van de grootste uitdagingen, zowel voor de partner als voor de patiënt. Er is behoefte aan een theoretisch, empirisch model voor het in kaart brengen van het omgaan met de seksuele veranderingen door het koppel. Methodiek: We presenteren een overzicht van bevindingen uit zestien wetenschappelijke artikelen met een kwalitatieve methodologie. We gebruikten de methodologie van de meta-etnografie om de artikelen te selecteren, analyseren en synthetiseren. Resultaten: We vonden dat er in de artikelen op drie verschillende mogelijke manieren gekeken werd naar het omgaan met seksualiteit bij kanker, telkens met een ander theoretisch accent: (1) als een rouwproces waarbij seksuele verandering wordt gezien als een verlieservaring; (2) als een cognitief herstructureringsproces waar de focus vooral ligt op de sociaal-culturele invloeden op de seksualiteitsbeleving van het koppel, en (3) als een revalidatieproces waarbij de seksuele veranderingen vooral gezien worden als lichamelijke disfuncties die dienen te worden ‘genezen’. Elk van deze benaderingen heeft zijn kansen en uitdagingen voor de praktijk. Conclusie: Een betere kennis van deze drie processen zou zorgverleners in de oncologische setting kunnen helpen om koppels die worstelen met hun seksualiteit beter te begrijpen en te begeleiden.status: publishe

Acting independently while living alone : the strategies and struggles of cancer patients

Cancer patients who live alone place specific importance on acting independently during treatment. We want to describe what it means to act independently and which strategies patients use to continue to act independently. We used a qualitative design, based on grounded theory. We interviewed 32 patients, 17 of them a second time. Patients who live alone defined acting independently in two different ways: It meant not only doing things alone but also using the help of others in a controlled way. These two meanings lead to two types of strategies. As treatment evolves, patients needed to change their preferred type of strategies to continue acting independently. Succeeding to change led to a feeling of mastery and success. However, failing to change led to struggling, whereby patients' needs became invisible. Health care providers should anticipate patients' inability to change strategies during cancer treatment, thereby preventing the patient's struggle from only becoming visible during crisis