The Occupational Impact of Surviving Bowel Cancer
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This study explored and identified the impact of bowel cancer on daily occupations. Approximately 60% of survivors live with ongoing psychological and physical issues. New Zealand has one of the highest bowel cancer rates in the world, with over 3000 people diagnosed every year. Using interpretive description methodology, this research investigated the experiences of a group of survivors. Most cancer care focuses on the treatment or end of life stages of bowel cancer; however, this study involved the often overlooked survivorship phase. Moreover, bowel cancer literature often uses quantitative methods. In contrast, the constructivist approach of this study facilitated the co-construction of knowledge with bowel cancer survivors, thus furthering the existing and emerging body of evidence regarding the life experienced by this population. The study was conducted over three phases which are reported across four manuscripts. The first of these manuscripts, phase one, presents a scoping review designed to gain an understanding of the current state of knowledge regarding bowel cancer and occupations. Six domains of occupation impacted by bowel cancer were identified: social activity, physical activity, sexual activity, employment and role functioning, physical functioning, and self-care. The review also reported on a lack of health professional support after completion of treatment. Review findings informed the second phase, semi-structured interviews with 15 participants – made up of bowel cancer survivors and some partners – exploring the occupational impact of bowel cancer. Taking an occupational science view of survivors as occupational beings, the second manuscript reports on three themes: “I had to heal myself”, “Life’s too short”, and “The person I’ve become”. The third phase involved a further round of interviews with three new participants and two involved in the first round. These interviews had a dual focus; 1) to ascertain whether the identified themes resonated with participants and captured their experiences, and 2), to generate participant guidance as to the information needs of bowel cancer survivors. Findings of the second and third phases are reported in two additional manuscripts, the first of which addressed the potential role of occupational therapy, currently underrepresented in oncology. Four themes emphasised the occupational impact across multiple aspects of life: changes in eating habits, changes in toileting habits, changes in relationships, and rethinking occupational choices. Findings revealed a possible role for occupational therapists through focused assessments and self-management, making use of peers to provide a credible, relatable voice. The final manuscript explored considerations for content and delivery of information to bowel cancer survivors across four themes: using a variety of media, the importance of relatability, pressure to conform, and someone who knows. Hearing accounts of the challenges to everyday life and the practical and attitudinal responses experienced by bowel cancer survivors highlights the significant impact of the disease. Whilst some pre-cancer occupations are surrendered or adapted, others are increased or introduced, with significant variation amongst participants. This information can help survivors prepare for life after treatment, and health professionals understand the unique challenges faced by this population and thus improve health and well-being.