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A Qualitative Exploration of District Nurses’ Care of Patients With Advanced Cancer: The Challenges of Supporting Families Within the Home

Wilson, Charlotte BSc, MA (Econ); Griffiths, Jane PhD, BNurs, RGN, NDNCert; Ewing, Gail PhD, BSc, RGN, RHV; Connolly, Michael MPhil, RGN; Grande, Gunn PhD, MSc

doi: 10.1097/NCC.0b013e31829a9a56

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.

Author Affiliations: School of Nursing, Midwifery & Social Work, University of Manchester (Ms Wilson and Drs Griffiths and Grande); Supportive & Palliative Care, University Hospital South Manchester (Mr Connolly); and Centre for Family Research, University of Cambridge (Dr Ewing), United Kingdom.

The study was funded by Dimbleby Cancer Care with NIHR-PCRN support and was awarded ethical approval by a local NRES committee.

The authors have no conflicts of interest to disclose.

Correspondence: Jane Griffiths, PhD, BNurs, RGN, NDNCert, School of Nursing, University of Manchester, Midwifery & Social Work, Oxford Rd, Manchester M13 9PL, United Kingdom (

Accepted for publication May 5, 2013.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins