Challenges, care gaps, and coping mechanisms in patients with advanced cancer and their caregivers following palliative gastrointestinal surgery.

BACKGROUND

Palliative gastrointestinal surgery improves symptoms and health-related quality of life in patients who present with complications from advanced cancer. However, palliative surgery near the end-of-life is associated with significant physiological and psychological stressors for both patients and their caregivers. Yet literature on patient and caregiver centric narratives following surgery remains limited.

OBJECTIVES

We aim to explore challenges, perceived care gaps, and coping mechanisms of patients with advanced cancer and their caregivers following palliative gastrointestinal surgery.

DESIGN &

METHODS

We conducted qualitative in-depth interviews with 25 purposively sampled patients with advanced cancer and 13 caregivers following palliative gastrointestinal surgery. Interviews were transcribed verbatim and thematically analyzed.

RESULTS

There were four major themes that identified as challenges and perceived care gaps among patients and caregivers: (1) physical, emotional, and systemic challenges of living with a stoma after palliative gastrointestinal surgery, (2) emotional, existential, and relational challenges of living with advanced cancer, (3) navigating uncertainty amid suboptimal surgical communication, and (4) emotional and relational strain from lack of compassionate surgical care. Four themes identified as coping mechanisms: (1) emotion- (2) meaning-, (3) problem- and (4) avoidance-focused coping.

CONCLUSION

Patients and caregivers face multifaceted challenges related to the impact of gastrointestinal surgery and their life-limiting advanced cancer condition. They also perceive significant gaps in surgical care delivery. Our findings shed light on unmet needs among patients with advanced cancer and their caregivers, highlighting opportunities for targeted intervention to improve the quality of surgical care delivery following palliative surgery.