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Purpose: Referral to supportive and palliative care services for people with high-grade primary malignant glioma (PMG) often occurs late in the illness course, despite significant care needs and overall poor prognosis. This study aimed to understand patient experience at the end of life and document supportive and palliative care needs. Methods: A qualitative study was conducted involving ten PMG patients who were at different stages in the illness course including the end of life and had varying levels of physical and cognitive function. Consecutive, eligible patients attending neurosurgery, oncology, and palliative care services of two metropolitan hospitals were recruited. In-depth interviews explored supportive and palliative care needs across the disease trajectory. Interviews were analysed independently by three investigators consistent with a grounded theory approach, and emerging ideas were compared and refined to define key patient experiences. Results: Despite the medical treatment and supportive care available, there remains a gap in services addressing complex existential and psychosocial needs that were markedly valued by patients. Patient experience was characterised by a pervasive loss of all that encompassed their former sense of self and a focus on immediate needs. Conclusions: Patients in this study had substantial needs, which were often not shared and not addressed by the current medical system of care. An improved multidisciplinary care model is indicated, which proactively (1) engages care coordination and advocacy; (2) minimises patients' sense of waiting and uncertainty through mapping out a plan, including involvement of palliative care in a timely fashion; and (3) actively invites discussion around goals and preferences for care to promote patients' sense of self. [ABSTRACT FROM AUTHOR]

The article explores on how the experience of meaning in people with advanced cancer can be understood within an integrated framework of assumptive world, sense of coherence and meaning based coping. A conversational style of interviewing has been used for the study. Assumptive world, sense of coherence and meaning based coping domains interact dynamically in a way that patients can harness courage to counterfeit the commitment to make the most of their remaining life. Meaning moderates the assumptions that have been formed from a person's view of the world and mediates healing which is needed to restore a coherent self.

A clear percentage of women with early breast cancer cope with the active period of treatment and then struggle to adjust as medical support becomes less intensive. This study highlights issues that can arise in a phase of illness relatively neglected previously. Recognition of the needs of women at completion of adjuvant chemotherapy and radiotherapy necessitates a new approach to delivery of care with a targeted intervention that specifically addresses their adjustment to potential survivorship. [ABSTRACT FROM AUTHOR]