Open Access Article

Everyday Struggling to Survive: Experience of the Urban Poor Living With Advanced Cancer

Anne Hughes

Maria Gudmundsdottir

Betty Davies

cancer, patient empowerment
ONF 2007, 34(6), 1113-1118. DOI: 10.1188/07.ONF.1113-1118

Purpose/Objectives: To understand the meaning of dignity to the urban poor and to describe their experiences living with advanced cancer.

Design: Qualitative approach using interpretive phenomenology.

Setting: Various community residential and clinical sites in a western city in the United States.

Sample: 14 patients (6 men and 8 women) with stage III or IV solid tumors who ranged in age from 45-69 years; 50% were people of color.

Methods: Patients were recruited from providers caring for the urban poor. Data were collected from in-depth interviews that were audiotaped and transcribed. Patients were interviewed as many as three times. Interview transcripts and field notes provided data for the analysis, which was part of a larger project. Researchers identified and analyzed themes within and across cases.

Findings: Many of the urban poor had difficult backgrounds prior to being diagnosed with cancer. Most patients, even those only weeks from death, focused on living not on dying. Participants' descriptions of their experiences focused on indignity not dignity. Indignity stories, such as being talked down to, not being listened to, and the embarrassment of fecal or urinary incontinence, were described in vivid detail.

Conclusions: This research confirms the importance of cancer care that recognizes patients' humanity regardless of their psychosocial circumstances.

Implications for Nursing: Nurses need to expediently meet hygiene and toileting needs to decrease threats to patient dignity.

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    Benner, P. (1994). The tradition and skill of interpretative phenomenology in studying health, illness and caring practices. In P. Benner (Ed.), Interpretative phenomenology: Embodiment, caring and ethics in health and illness (pp. 99-128). Thousand Oaks, CA: Sage.
    Benner, P., Tanner, C.A., & Chesla, C.A. (1996). Background and method. In P. Benner, C.A. Tanner, & C.A. Chesla (Eds.), Expertise in nursing practice: Caring, clinical judgment and ethics (pp. 351-372). New York: Springer.
    Chochinov, H.M., Hack, T., McClement, S., Kristjanson, L., & Harlos, M. (2002). Dignity in the terminally ill: A developing empirical model. Social Science and Medicine, 54, 433-443.
    Crawley, L., Payne, R., Bolden, J., Payne, T., Washington, P., & Williams, S. (2000). Palliative and end-of-life care in the African American community. JAMA, 284, 2518-2521.
    Creswell, J.W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage.
    Crist, J.D., & Tanner, C.A. (2003). Interpretation/analysis methods in hermeneutic interpretive phenomenology. Nursing Research, 52, 202-205.
    Doolittle, N.D. (1994). A clinical ethnography of stroke recovery. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring and ethics in health and illness (pp. 211-223). Thousand Oaks, CA: Sage.
    Dreyfus, H.L. (1991). Being-in-the-world: A commentary on Heidegger's being and time. Cambridge, MA: MIT Press.
    Enes, S.P. (2003). An exploration of dignity in palliative care. Palliative Medicine, 17, 263-269.
    Freeman, H.P., & Chu, K.C. (2005). Determinants of cancer disparities: Barriers to screening, diagnosis, and treatment. Surgical Oncology Clinics of North America, 14, 655-669.
    Gudmundsdottir, M., & Chesla, C.A. (2006). Building a new world: Habits and practices of healing following the death of a child. Journal of Family Nursing, 12, 143-164.
    Hack, T.F., Chochinov, H.M., Hassard, T., Kristjanson, L.J., McClement, S., & Harlos, M. (2004). Defining dignity in terminally ill cancer patients: A factor-analytic approach. Psycho-Oncology, 13, 700-708.
    Heidegger, M. (1927/1962). Being and time (J. Macquarrie & E. Robinson, Trans.). New York: Harper Collins.
    Hewitt, M., Greenfield, S., & Stovall, E. (2006). From cancer patient to cancer survivor. Washington, DC: National Academies Press.
    Hughes, A. (2005). Poverty and palliative care in the U.S.: Issues facing the urban poor. International Journal of Palliative Nursing, 11, 6-13.
    Hughes, A. (2006). The poor, homeless and underserved. In B. Ferrell & N. Coyle (Eds.), Textbook of palliative nursing (2nd ed., pp. 661-670). New York: Oxford University Press.
    Koenig, B.A. (1997). Cultural diversity in decision-making about care at the end of life. In M.J. Field & C.K. Cassel (Eds.), Approaching death: Improving care at the end of life (pp. 363-382). Washington, DC: National Academy Press.
    Leonard, V.W. (1994). A Heideggerian phenomenological perspective on the concept of person. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring and ethics in health and illness (pp. 43-63). Thousand Oaks, CA: Sage.
    Moller, D.W. (2004). Dancing with broken bones: Portraits of death and dying among inner-city poor. New York: Oxford University Press.
    Singh, G.K., Miller, B.A., Hankey, B.F., & Edwards, B.K. (2003). Area socio-economic variations in U.S. cancer incidence, mortality, stage, treatment, and survival, 1975-1999 [NIH Publication No. 03-0000]. Bethesda, MD: National Cancer Institute.
    Smedley, B.D., Smith, A.Y., & Nelson, A.R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.
    Song, J., Ratner, E.R., & Bartels, D.M. (2005). Dying while homeless: Is it a concern when life itself is such a struggle? Journal of Clinical Ethics, 16, 251-261.
    Sontag, S. (1978). Illness as a metaphor. New York: Doubleday.
    Turner, K., Chye, R., Aggarwal, G., Philip, J., Skeels, A., & Lickiss, J. (1996). Dignity in dying: A preliminary study of patients in the last three days of life. Journal of Palliative Care, 12(2), 7-13.
    Ward, E., Jemel, A., Cokkinides, V., Singh, G.K., Cardinez, C., Ghafoor, A., et al. (2004). Cancer disparities by race/ethnicity and socioeconomic status. CA: A Cancer Journal for Clinicians, 54, 78-93.
    Williams, B.R. (2004). Dying young, dying poor: A sociological examination of existential suffering among low socio-economic status patients. Journal of Palliative Medicine, 7(1), 27-37.