Useful Interview Questions to Promote Spiritual Health: Post-Traumatic Adaptation among Taiwanese Hepatocellular Carcinoma Patients

In-Fun Li1,2, Tseng-En Wang3, Fu-Jung Huang2, Ming-Jong Bair4 and Yvonne Hsiung1* 1Department of Nursing, Mackey Medical College, New Taipei City, Taiwan 2Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan 3Division of Gastroenterology, Department of Internal Medicine and Liver Medical Center, Mackay Memorial Hospital, Taipei 4Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taiwan *Corresponding author: Yvonne Hsiung, Department of Nursing, Mackey Medical College, No.46, Sec. 3, Zhongzheng Rd, Sanzhi District, New Taipei City 252, Taiwan, Tel: 886226360606, ext.: 1318; E-mail: yvonnebear@mmc.edu.tw


Commentary
The majority of health care providers recognize the importance of spiritual interventions in the role of promoting cancer patients' holistic health and wellbeing [1]. For those survivors in the advanced disease stages, spirituality might be the most essential element in end-of-life care. Nevertheless, literatures are scarce regarding why, what service, under what circumstances, and how interventions might be properly designed to increase patients' spirituality [2]. In addition, since most spiritual interventions were developed within one specific patient population and/or within a single institute, the health care providers' shared beliefs about and uses of spiritual modalities might surprisingly "…resist certain spiritual therapies [2] due to certain organizational, cultural biases. Further research therefore suggests a need to pilot test spiritual interventions in a thoughtful, methodical manner prior to implementation.
Up to now, there remains a lack of guidance for using patient-center experiences in the context of implementing spiritual interventions, and specifically, how illness related reflective thoughts and perceptions may be used to promote post-cancer spiritual health. The majority of reference has focused on the use of interview data for phenomena explanation and ground theory development. In this short article, we intend to share several open-ended questions modified from our previous semi-instructed guide of another qualitative study with the aim to describe a group of Taiwanese liver cancer patients' illness experiences. Respondents' feedback may serve as stepping-stones for program planners to design a systematic spiritual intervention without organizational biases.
Our qualitative study was proposed to response to the national emphasis of improving gastrointestinal cancer patients' quality of life. In the recent Taiwanese health survey, approximately 40% of the newly diagnosed cancer was gastrointestinal, accounting for 45% of the national oncology morality. Hepatocellular carcinoma (HCC), liver cancer, has contributed to the first highest incurability and fatality rate of GI cancers. The discovery of tumor cells [3] and available treatment procedures [4], according to the standard of Barcelona clinical guidance, remain difficult processes for most Taiwanese HCC patients to experience [5]. Other than disease and treatment related symptoms, cancer survivors and their families are often impacted with severe demoralization, a sense of dysphoric state, and other emotional distress, such as anxiety and depression [6].
"Considering the high death rate among people diagnosed with HCC and the lack of research about illness and treatment experiences toward the end of life [7], a recent study reported terminally HCC patients' illness experiences over time and referenced several Taiwanese studies [8][9][10] in this research area. Our study was then inspired to highlight this knowledge gap and interview questions were originally designed to elicit HCC patients' reflective experiences undergoing cancer treatment. Individuals were recruited after their cancer diagnosis was confirmed, and contents of perceptions were analyzed in understanding the consequent cancer impacts on life, fear of cancer progressions, loss and grief, coping strategies, and care needs, etc. A convenience sample of 13 cancer survivors from two teaching hospitals in Northern Taiwan, with a majority of older males suffering from hepatocellular carcinoma symptoms, has been individually interviewed, each for less than an hour. A series of open-ended questions were carried out from an ice-breaking session and closed by a general ending question.
As the study continued, our pilot findings revealed that due to the suffering and pain from disease progressions and treatment complications, many survivors considered their cancer an extremely traumatic event. The entire subject group has reported various levels of adaptation in daily life and noticeable spiritual growing. While the majority of them have shared newly adopted coping strategies, our rich data from HCC survivors' individual viewpoints about life changes have generated valuable opportunities for clinical health care providers and researchers to understand how, when, and why cancer patients require additional spiritual facilitations. The following open-ended questions have been subtracted and modified from our semi-instructed guide. This structure that captured respondents' holistic experiences in relation to spiritual perceptiveness may serve as stepping-stones for program planners to design possible spiritual interventions for cancer survivors in general. Lessons learned from our experience is that in-depth interviewing, a rather traditional data collection approach long been used in nursing fields, is a useful tool to explore individuals' needs in searching for spiritual meanings. By using interviews, additional benefits could inform researchers to design activities tailored to enhance advanced cancer survivors' spiritual health. The above questions may be further modified to solicit patients' unique post-cancer coping experiences and perceptions in other different cancer groups. We also recognize the possible downside of individual interviews that they may not be as advantageous as other methods of data collection to allow spontaneous discussions and free expressions of spiritual topics. Nonetheless, pilot interviews exploring patients' post-cancer growth are particularly relevant in designing unbiased spiritual interventions. It is our hope that in the face of serious illness, HCC and other cancer survivors' awareness of and motivation to search for post-traumatic growth [11] may be awakened by properly designed interview questions.