A qualitative exploration of district nurses' care of patients with advanced cancer: the challenges of supporting families within the home.

BACKGROUND

In the United Kingdom, district nurses (DNs) support patients with advanced cancer in their homes. Although evidence suggests that DNs emphasize the distinctiveness of home rather than hospital settings, little is known about the specific challenges of delivering care in family-home settings.

OBJECTIVE

The objective of this study was to explore DNs' experiences of supporting patients within families.

METHODS

Focus groups were conducted with 40 DNs from 4 areas in the United Kingdom. The groups were digitally recorded and facilitated by researchers using a flexible topic guide.

ANALYSIS

Verbatim transcripts were analyzed using thematic content analysis.

RESULTS

Case-load complexity (household volatility) and family dynamics posed distinct challenges for nurses supporting patients. Many family members struggled with accepting the patients' prognosis and were complicit in withholding information. At times, this foreclosed a consideration of palliative options.

CONCLUSIONS

Carers provide a great deal of positive supportive care within the home. However, for some, the home is characterized by conflict rather than consensus. Complexities surrounding family relationships pose a distinctive and challenging environment for DNs.

IMPLICATIONS FOR PRACTICE

Education and training of DNs should be designed to address the challenges of supporting patients within the family-home setting.