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Strang, Peter
Publications (10 of 31) Show all publications
Rydé, K., Strang, P. & Friedrichsen, M. (2008). Crying in solitude or with someone for support and consolation - experiences from family members in palliative home care. Cancer Nursing, 31(5), 345-353
Open this publication in new window or tab >>Crying in solitude or with someone for support and consolation - experiences from family members in palliative home care
2008 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 31, no 5, p. 345-353Article in journal (Refereed) Published
Abstract [en]

Crying has not been studied from the perspective of family members of patients in palliative care. The aim of this study was to explore the significance of family members crying in a palliative care context with special reference to factors that influence crying. Interviews were carried out with 14 family members of patients admitted to palliative care. A hermeneutic approach according to Gadamer was used. Three main categories emerged. (1) Before the start of crying, some prerequisites for crying had to be fulfilled, such as an allowing attitude and courage, time, feeling secure, honesty, and trusting relationships. These prerequisites did not cause crying themselves; rather crying emerged when triggering factors occurred. (2) Triggers for crying were circumstances that created uncertainty and turbulence (bad news), exhaustion due to lack of own time, and sympathy from others. (3) Family members tried to do the best possible by adopting or hiding their crying, to ease the patient's burden and to create a positive counterbalance to suffering and grief. As an interpretation of the whole, crying could be expressed as being shared with someone for support and consolation or escape to solitude for integrity and respite. As a conclusion, crying may be an efficient strategy for family members in palliative care to express their suffering and to gain new energy to continue.

Keywords
Adaptation, Cancer, Coping, Crying, Emotions, Family members, Hermeneutic, Palliative care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14657 (URN)10.1097/01.NCC.0000305758.66238.a1 (DOI)
Available from: 2007-09-28 Created: 2007-09-28 Last updated: 2017-12-13
Rydé, K., Friedrichsen, M. & Strang, P. (2007). Crying: A force to balance emotions among cancer patients in palliative home care. Palliative & Supportive Care, 5(1), 51-59
Open this publication in new window or tab >>Crying: A force to balance emotions among cancer patients in palliative home care
2007 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 5, no 1, p. 51-59Article in journal (Refereed) Published
Abstract [en]

Objective: Crying is a common but seldom studied phenomenon in palliative care. The aim of this study was to explore the significance of patients crying in a palliative care context.

Methods: Tape-recorded interviews with 14 cancer patients in palliative home care were carried out. To gain deeper understanding, a hermeneutic analysis and interpretation was used.

Results: Crying was described in different dimensions: (1) intense and despondent crying as a way of ventilating urgent needs, (2) gentle, sorrowful crying as a conscious release of emotions, and (3) quiet, tearless crying as a protection strategy. Crying seems to be an expression for an inner emotional force, provoked by different factors, which cause changes in the present balance. To cry openly but also to cry on the inside meant being able to achieve or maintain balance. Crying may be something useful, which could create release and help reduce tension, but it may also have a negative impact as it consumes energy and creates feelings of shame.

Significance of results: Professionals need to understand the different levels of crying. In such situations sometimes comforting the patient may not be the best solution, as some may need privacy.

Place, publisher, year, edition, pages
Cambridge University Press, 2007
Keywords
Crying, Palliative care, Cancer, Emotions, Hermeneutic
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-14656 (URN)10.1017/S1478951507070071 (DOI)
Available from: 2007-09-28 Created: 2007-09-28 Last updated: 2018-03-14
Friedrichsen, M. & Strang, P. (2003). Doctors' strategies when breaking bad news to terminally ill cancer patients. Journal of Palliative Medicine, 6(4), 565-574
Open this publication in new window or tab >>Doctors' strategies when breaking bad news to terminally ill cancer patients
2003 (English)In: Journal of Palliative Medicine, ISSN 1096-6218, Vol. 6, no 4, p. 565-574Article in journal (Refereed) Published
Abstract [en]

Breaking bad news to patients with a terminal disease is a difficult task for physicians. The aim of this study was to study how doctors perceive their strategies when giving information to cancer patients about discontinuing active tumour treatment. Thirty doctors with different demographic characteristics working with patients with cancer in Sweden participated. Semistructured interviews were conducted and analyzed using a qualitative phenomenographic method. The goal when giving this information was described as making the patient understands while being as considerate as possible. However, the strategies for reaching this goal were different: (1) explaining and convincing information, (i.e., giving a long explanation about why treatment has to be discontinued); (2) softening the impact of the information, with the doctor recommending discontinuation of treatment; (3) and preparing either the patient or the physician himself/herself for the information; (4) adapting or tailoring the information to the patient, with the doctor actively seeking knowledge about the patient in order to be able to adapt the information to the patient's level, or with the doctor briefly describing the situation and then remaining silent, allowing room for the patient's reactions and questions (i.e., letting the patient take an active part). When giving information, the doctors' goal was to make patients understand, but the strategies differed depending on the context.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13727 (URN)10.1089/109662103768253678 (DOI)
Available from: 2002-05-24 Created: 2002-05-24 Last updated: 2015-06-10
Heedman, P. A. & Strang, P. (2003). Pain and pain alleviation in hospital-based home care: demographic, biological and treatment factors. Supportive Care in Cancer, 11(1), 35-40
Open this publication in new window or tab >>Pain and pain alleviation in hospital-based home care: demographic, biological and treatment factors
2003 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 11, no 1, p. 35-40Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to contrast two opposed groups, namely palliative cancer patients who were suffering significant pain (VASgreater than or equal to4) and palliative cancer patients with no pain (VAS = 0) in hospital-based home care and, retrospectively, to study possible differences in relation to demographic, biological and treatment factors. The ESAS (Edmonton Symptom Assessment Scale) was used to assess 191 palliative cancer patients on admission and after I week of home care. Fifty-two (27%) had pain (mean 5.5+/-1.7) and 72 (38%) had no pain on admission [the middle group, (n=67) had VAS 1-3]. Activity was more severely affected (5.4 vs 4.2, p<0.01) and nausea less well controlled in patients with pain (2.3 vs 0.7, P<0.0001). Pain was associated with the diagnosis of prostate cancer (P<0.01) and the presence of skeletal metastases (P<0.001), whereas pain-free patients, with or without analgesics, more often had colorectal cancer (P<.01) or melanoma (P<0.05). The medication profiles differed between the two groups: 22 (42%) of the 52 patients with pain were on step 3 of the WHO analgesic ladder and 24 of 51 (47%) were receiving antiemetics, whereas 42 (58%) of the 72 patients with no current pain had no analgesic prescribed and only 25% of them had antiemetics prescribed, indicating biological differences. If pain was present on admission a pain analysis was formally documented in 23 (44%) of the 52 cases and the medication was changed in 27 of the 52 (52%). The patients improved after I week (5.4+/-1.6 vs 3.9+/-2.3, P<0.001), and the improvement was significant even when a pain analysis was not documented or when medication was not changed. In conclusion, the results of this study indicate biological differences in pain alleviation and the need for a more structured way of working.

Keywords
pain, palliative care, ESAS, opioids, neoplasm
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47819 (URN)10.1007/s00520-002-0398-4 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
Friedrichsen, M., Strang, P. & Carlsson, M. (2002). Cancer patients' interpretations of verbal expressions when given information about ending cancer treatment. Palliative Medicine, 16(4), 323-330
Open this publication in new window or tab >>Cancer patients' interpretations of verbal expressions when given information about ending cancer treatment
2002 (English)In: Palliative Medicine, ISSN 0269-2163, Vol. 16, no 4, p. 323-330Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cancer patients' interpretations of the meaning of words used when given bad news are not well studied in medical settings. The aim of this study was to ascertain what significance verbal expressions had for cancer patients when they were given information about ending active tumour treatment, and what message they felt they received.

METHODS: Tape-recorded semi-structured interviews were performed and analysed using a qualitative phenomenographical approach.

RESULTS: Thirty patients with incurable cancer admitted to hospital-based home care unit in Sweden participated. Three main categories about the significance of words emerged: 1) words could indicate indirect warnings as being forewarnings, evasive or ambiguous; 2) words could also be perceived as emotionally trying, as threats or abandoning; 3) other words were fortifying and strengthened the patient in this situation. The overall message given during the information could be interpreted differently: either focused on treatment, on quality of life, or on threat and death.

CONCLUSION: The understanding of the significance of words to tailor the information to patients helps the physician to use forewarnings and fortifying words and to identify and avoid the use of threatening words.

Keywords
communication, neoplasms, palliative care, patient perception, phenomenography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13725 (URN)10.1191/0269216302pm543oa (DOI)
Available from: 2002-05-24 Created: 2002-05-24 Last updated: 2015-06-10
Milberg, A. & Strang, P. (2002). Sense of coherence experienced by next-of-kin in hospital-based home care. Journal of Palliative Care, 18(3)
Open this publication in new window or tab >>Sense of coherence experienced by next-of-kin in hospital-based home care
2002 (English)In: Journal of Palliative Care, ISSN 0825-8597, Vol. 18, no 3, p. 216-216Conference paper, Published paper (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-48468 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Friedrichsen, M., Strang, P. & Carlsson, M. (2001). Receiving bad news- experiences of family members. Journal of Palliative Care, 17(4), 241-247
Open this publication in new window or tab >>Receiving bad news- experiences of family members
2001 (English)In: Journal of Palliative Care, ISSN 0825-8597, Vol. 17, no 4, p. 241-247Article in journal (Refereed) Published
Abstract [en]

Little is known about how next-of-kin experience receiving bad news. The aim of this study was to explore the experiences of family members when receiving information about ending tumour treatment, with a focus on their role in this context.

METHODS: Semi-structured interviews were performed and analyzed using a qualitative phenomenographic method.

RESULTS: Twenty family members of patients with incurable progressive cancer admitted to hospital-based home care were included in the study. Data showed that family members want to protect, represent, or act on behalf of the patient. Some described themselves as assuming prominent roles: the demander-of-truth role, the secret-keeper role, and the controller role. Others assumed more passive roles: the surrendering role, the considerate listener role, and the excluded outsider role.

CONCLUSION: This study has revealed possible-explanations as to why family members are dissatisfied with information. The results of this study may help doctors in clinical practice recognize the different types of behaviour family members exhibit when receiving bad news.

Place, publisher, year, edition, pages
Montreal, Canada: Centre for Bioethics, 2001
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13726 (URN)000173319900004 ()
Available from: 2002-05-24 Created: 2002-05-24 Last updated: 2017-12-13
Strang, S. & Strang, P. (2001). Spiritual thoughts, coping and 'sense of coherence' in brain tumour patients and their spouses. Palliative Medicine: A Multiprofessional Journal, 15(2), 127-134
Open this publication in new window or tab >>Spiritual thoughts, coping and 'sense of coherence' in brain tumour patients and their spouses
2001 (English)In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 15, no 2, p. 127-134Article in journal (Refereed) Published
Abstract [en]

When a person is diagnosed with a life-threatening disease, existential questions are easily triggered. The aims of this study were to explore to what extent brain tumour patients and their next of kin were able to cope, understand and create meaning in their situation, to explore whether spirituality could be supportive and to analyse whether these concepts are related to Antonovsky's concept of sense of coherence. Using a purposive sampling technique, 20 patients and 16 of their next of kin look part in tape-recorded interviews. A content and context analysis was performed using a hermeneutic approach. We found that comprehensibility was to a large extent constructed by the patient's own thoughts and theories, despite an insecure situation. Manageability was achieved by active information-seeking strategies, by social support and by coping, including positive reinterpretation of the situation. Meaningfulness was central for quality of life and was created by close relations and faith, as well as by work. A crucial factor was whether the person had a 'fighting spirit' that motivated him or her to go on. As only three patients were believers, trust in God had generally been replaced by a belief and confidence in oneself, in science, in positive thinking and by closeness to nature. Sense of coherence as a concept can explain how exposed persons handle their situation. In its construction, sence of coherence integrates essential parts of the stress/coping model (comprehensibility, manageability) and of spirituality (meaning).

Keywords
sense of coherence, spiritual, coping, brain tumour, spouse
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-49313 (URN)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Heedman, P.-A. & Strang, P. (2001). Symptom assessment in advanced palliative home care for cancer patients using the ESAS: Clinical aspects. Anticancer Research, 21(6 A), 4077-4082
Open this publication in new window or tab >>Symptom assessment in advanced palliative home care for cancer patients using the ESAS: Clinical aspects
2001 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 21, no 6 A, p. 4077-4082Article in journal (Refereed) Published
Abstract [en]

Four hundred and thirty-one cancer patients were assessed with the ESAS and a VAS-QoL at admission to Hospital-based home care (HBHC) and subsequently. Results: Pain and nausea were well-controlled (mean 2.5 and 1.8) whereas patients were less satisfied with appetite, activity and sense of well-being. Dyspnoea and anxiety (lung cancer, p<0.001 and p<0.01) and pain (prostate cancer, p<0.01), were related to diagnosis while activity, drowsiness, appetite and well-being to survival (p<0.05 to p<0.001). The correlations between individual symptoms and well-being were low (0.2-0.5), whereas the correlation between well-being and the Symptom Distress Score (SDS) was 0.76. "Well-being" was a better word to use than QoL. Discussion: ESAS is useful in HBHC and data show that symptoms other than merely pain and nausea are of importance. As the global measurement (one VAS) of well-being has a high correlation with SDS, this single measurement may be clinically adequate for quality assurance of symptom control in dying cancer patients.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25383 (URN)9826 (Local ID)9826 (Archive number)9826 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Kälkner, K. M., Westlin, J.-E. & Strang, P. (2000). 89Strontium in the management of painful sceletal metastases. Anticancer Research, 20(2 B), 1109-1114
Open this publication in new window or tab >>89Strontium in the management of painful sceletal metastases
2000 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 20, no 2 B, p. 1109-1114Article in journal (Refereed) Published
Abstract [en]

Purpose: To make a review of the literature of 89strontium-chloride and a retrospective study of time to palliative intended external irradiation number of portals and overall-survival after 89strontium-chloride therapy. Results: In total 93 patients were treated 116 times with 89strontium. The patients with prostatic carcinoma received 91% of all 89strontium therapies. Median over-all survival was 10 months after injection. In those cases when 89strontium was given before palliative radiotherapy, the average of total number of local fields was significantly lower (1.1 versus 4.1) compared to those cases where local fields preceded 89strontium therapy. However, time to 89new external irradiation after 89strontium injection was equal between these groups (3.8 versus 2.9 months). Conclusion:A review of literature conclude that 89strontium is effective for the reduction of pain originating from osteoblastic metastases. It also reduce the need for external radiotherapy and therefore is cost-effective. However, 89strontium is more effective in an early phase of the metastatic disease and preferably as an adjuvance to external radiotherapy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25375 (URN)9818 (Local ID)9818 (Archive number)9818 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
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