Integration of oncology and palliative care : a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care

Cultural Insiders and Research Fieldwork

The status of the insider and outsider is an important concept for cross-cultural research. Being a cultural insider is recognized as a strength that allows the researcher to take part in the everyday lives of local people and to get closer to the participants. We explore these issues using examples from our own research with Thai people in southern Thailand and in Melbourne, Australia. We suggest that insider status has an impact on whether the researchers can conduct successful fieldwork and obtain in-depth understanding of the phenomenon being investigated. Being an insider enables a researcher to conduct research more sensitively. It helps in gaining a deeper understanding of the sociocultural contexts of the research setting. However, there are also challenges associated with insider status. These include the need to reestablish our position in a community, our assumptions about what the participants tell us, and participants’ expectations about us. This article provides case examples for researchers who are interested in conducting research, particularly within the Thai context. It should contribute to a conceptual understanding of real life experiences in a cross-cultural context in general

Breast cancer treatment : experiences of changes and social stigma among Thai women in southern Thailand

Background: Women with breast cancer receive different forms of treatment. Although treatment can save the lives of women, they can result in adverse physical, psychological, and social effects that can impact the women’s quality of life. Objective: The objective of this study was to describe the experiences of breast cancer treatment among Thai women in southern Thailand. Methods: This study used qualitative methods (in-depth interviewing and drawings) with 20 Thai women who had been diagnosed with breast cancer. Data were analyzed using thematic analysis methods. Results: Three themes emerged: (a) being a breast cancer patient: visible signs and adverse effects of therapy, (b) experiencing emotional chaos, and (c) experiencing social dysfunction. The women had to deal with physical body changes, emotional burden, treatment-related social stigma, and being marginalized within their own social context. Conclusions: Women experienced changes including social stigma after receiving breast cancer treatments. They had to manage stigma and difficulties themselves without sufficient professional support. Implications for Practice: It is important for nurses to understand such experiences so that they may support appropriate coping strategies suited to each woman. Community health nurses need to view each woman with breast cancer as a unique person and appreciate how to provide appropriate care and support based on each woman’s experience with her illness and treatment

Social support and women living with breast cancer in the South of Thailand

Purpose: To discuss social support among women with breast cancer in rural communities in southern Thailand. Design: Qualitative research that allowed researchers to understand the lived experiences of women living with breast cancer and social support. Methods: In-depth interviewing and drawing methods were adopted with 20 women with breast cancer. Thematic analysis was employed to analyze the data. Findings: Most women with breast cancer received three types of social support: emotional support, tangible support, and informational support. Most support came from family members and relatives. Religion was also a form of social support for women. Many women, however, received insufficient social support from healthcare providers. This reduced their capacity to manage their illness, thus impacting their well-being. Conclusions: Various forms of support are essential for women with breast cancer so that they can better cope with their condition. Clinical Relevance: Nurses and other health professionals are an important source of social support for women with breast cancer. Through having an understanding of and being sensitive to these women's experiences, culture, and challenges, nurses and healthcare professionals can provide more individualized support and care to women during a vulnerable period of their life. We contend that the cultural perspectives of patients are crucial in nursing science. Nurses need to appreciate the importance of culture for the support of patients with breast cancer

Living with breast cancer : the experiences and meaning-making among women in Southern Thailand

We conducted in-depth interviews with 20 women living with breast cancer and invited them to take part in a drawing method. In this paper, we discuss the lived experiences and meaning-making of breast cancer among women in southern Thailand. Our data revealed that the diagnosis of breast cancer generated numerous emotional responses. However, after the initial shock, most women started to accept their reality. The acceptance of their breast cancer played an essential role in the meaning-making discourse because it assisted the women to be able to sustain the equilibrium of their emotional well-being. Meaning-making and the Buddhist belief about bad karma was a prominent theme. The belief that adversities in life were the result of bad deeds that one had committed to others in the past not only helped the women to accept their fate but also to deal with their life situations better. Our findings suggest that these women act in their own agencies to counteract any negativity they might encounter from their breast cancer trajectory. It provides a theoretical understanding about the ways Thai women deal with their breast cancer which can be adopted as a means to provide culturally sensitive care for women with breast cancer in Thailand and elsewhere

Phum panya chao baan (local wisdom) and traditional healers in Southern Thailand

Thailand is now focusing on forming the sufficient health-care system by using local wisdom and traditional health resources. The use of local resources such as traditional medicine (TM) and traditional healers to share expenses can be cost-effective in increasing good health of the Thai people. Traditional healers have played an important role in Thai health long before the introduction of Western medicine. Although modern health providers play a key role in the provision of health care in the Thai health-care system, traditional healers and their practice still exist in most rural areas of Thailand. Thai people continue to seek help from traditional healers because they perceive that there is no single healing system that could promote a total well-being. They look for the one that could best help them to return to normal health. The individuals expect that any healing form would be complementary, or an alternative, to another. Thai health policy has recognized traditional medicine (TM) and traditional healers as local resources in Thai health. Thus, these resources are promoted in Thai health today. The cooperation between traditional healing system and modern health care could also increase choices for consumers within the Thai health-care system. However, obstacles to smooth cooperation between the two groups still remain

Ethnographic performance and its flexibility in researching a traditional healing system in southern Thailand

Purpose: The purpose of this paper is to discuss the experience of carrying out an ethnographic research in the real world with six different participant groups from different backgrounds and embodying different expertise in traditional medicine. The paper will discuss why some approaches do not go well with some key informant groups and will demonstrate a suitable method that function better with those groups. The paper also argues that there is unpredictability of doing research in the real world, and this is crucial knowledge for novice researchers, and researchers who wish to embark on their research in different communities. Design/methodology/approach: Ethnography comprising of in-depth interviews, participant observation, focus group and unobtrusive methods. Findings: Listening to traditional healers' explanation of their roles, patients' perspectives of their treatments and the views of other participant groups will help us to understand the role of traditional healers, how effective their treatment is, and the possibilities for, and barriers to co-operation with the modern health care system. Ethnographic approach addresses deep understanding about cultural phenomena and issues in the real world because it captures everyday life and practices among local people. Practical implications: The principle of ethnography requires a researcher being in the field and living with the local people for a long period of time. This provides the researcher with the opportunity to learn and experience a new world on his/her own. Originality/value: Although the process of carrying out an ethnographic study is unpredictable, the methodological approach the paper employs in this study has resulted in valuable outcomes to a novice ethnographer. The paper would suggest to other novice ethnographers that this methodology is a very worthwhile approach in terms of exploring, learning and understanding the new world

Traditional health services utilization among Indigenous peoples

Traditional health services (THS) play a significant role in the health care systems of indigenous peoples in developed and developing nations (World Health Organization 2002). In most rural areas, in particular, THS provide the main source of care for many people (Sermsri, 1989; Suwankhong, Liamputtong, and Rumbold 2012). The principles of THS are related to natural, folk, and spiritual remedies and these involve the use of plants and herbs, physical manipulation, spiritual healing rituals, and religious practices, rather than basing on scientific premises (Sermsri 1989; Kayne 2010). These principles are continually practiced by indigenous healers through their healing traditions, which link with historical circumstances, social contexts, and the cultural beliefs of indigenous peoples to achieve a desired outcome (World Health Organization 2002)

Early detection of breast cancer and barrier to screening programmes amongst Thai migrant women in Australia : a qualitative study

Background: Breast cancer screening programme is seen as the best practice to detect breast cancer early. However, there are circumstances that can prevent immigrant women from attending screening programmes. Little is known about Thai migrants and the barriers to their seeking breast cancer screening when living in a new homeland. This paper aimed to discuss the barriers to attending screening services among Thai migrant women living in Australia. Methods: This study adopted qualitative approach. Semi-structured in-depth interviewing and drawing methods were employed as data collection technique with 25 Thai migrant women who had not experienced breast cancer and were living in Metropolitan Melbourne, Australia. Thematic analysis method was employed to analyse the data. Results: Basing on the Health Belief Model, most Thai migrant women did not perceive that they were at risk of breast cancer. Despite seeing a breast cancer screening programme as important, the women rarely paid attention to breast cancer screening and used the mammography services provided by the Australian health care system. The barriers included the location of the services, unfamiliar patterns of health care provision, and language difficulties. Conclusions: There are many barriers that that they encountered in Australia that prevent Thai migrant women living in Melbourne Australia to pay attention to mammographic screening service provided by Australia health system. Our findings suggest that health services and interventions need to be designed more sensitive to the needs and socio-cultural context of migrant women in general and Thai migrant women in particular