Existential concerns among patients with cancer and interventions to meet them: An integrative literature review

Psycho-Oncology

Volumn 18, Issue 3, 2009, Pages 225-236

  Henoch, Ingela ^a,b   Danielson, Ella ^c,d  

^a Research Unit   (Sweden)

^b KAROLINSKA INSTITUTE   (Sweden)

^c Institute of Health and Care Sciences   (Sweden)

^d UNIVERSITY OF GOTHENBURG   (Sweden)

Author keywords

Cancer; Existential concerns; Integrative review; Interventions; Oncology

Indexed keywords

ALTERNATIVE MEDICINE; CANCER PATIENT; CINAHL; CLINICAL TRIAL; COCHRANE LIBRARY; COPING BEHAVIOR; DESCRIPTIVE RESEARCH; HEALTH CARE PERSONNEL; HEALTH CARE PRACTICE; HUMAN; MALIGNANT NEOPLASTIC DISEASE; MEDLINE; OUTCOME ASSESSMENT; PATIENT COUNSELING; PSYCHOLOGICAL ASPECT; PSYCHOLOGICAL WELL BEING; PSYCHOSOCIAL CARE; PSYCHOTHERAPY; PSYCINFO; QUALITATIVE RESEARCH; QUANTITATIVE STUDY; REVIEW; ATTITUDE TO HEALTH; EXISTENTIALISM; HEALTH SERVICE; INTEGRATIVE MEDICINE; NEOPLASM;

ATTITUDE TO HEALTH; EXISTENTIALISM; HEALTH SERVICES; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; INTEGRATIVE MEDICINE; NEOPLASMS;

EID: 67650189540     PISSN: 10579249     EISSN: 10991611     Source Type: Journal    
DOI: 10.1002/pon.1424     Document Type: Review

References (132)

1. Arlebrink J. Döden och döendet. Studentlitterarur: Lund, 1999.
2. National Cancer Institute. Spirituality in cancer care. Available from: http://www.cancer.gov/cancertopics/pdq/supportivecare/spirituality/ patient/page2, retrieved 2008-04-08.
3. Breitbart W. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 2002;10:272-280.
4. McSherry W, Cash K. The language of spirituality: an emerging taxonomy. Int J Nurs Stud 2004;41:151-161.
5. Henery N. Constructions of spirituality in contemporary nursing theory. J Adv Nurs 2003;42:550-557.
6. Strang P. Existential consequences of unrelieved cancer pain. Palliat Med 1997;11:299-305.
7. Whitehead D. Beyond the metaphysical: health-promoting existential mechanisms and their impact on the health status of clients. J Clin Nurs 2003;12:678-688.
8. Ersek M, Ferrell BR. Providing relief from cancer pain by assisting in the search for meaning. J Palliat Care 1994;10:15-22.
9. Ross L. Spiritual care in nursing: an overview of the research to date. J Clin Nurs 2006;15:852-862.
10. Williams A. Perspectives on spirituality at the end of life: a meta-summary. Palliat Support Care 2006;4: 407-417.
11. Chochinov HM, Krisjanson LJ, Hack TF, Hassard T, McClement S, Harlos M. Dignity in the terminally ill: revisited. J Palliat Med 2006; 9:666-672.
12. Arman M, Rehnsfeldt A. The hidden suffering among breast cancer patients: a qualitative metasynthesis. Qual Health Res 2003; 13:510-527.
13. Efficace F, Marrone R. Spiritual issues and quality of life assessment in cancer care. Death Stud 2002; 26:743-756.
14. Lin H, Wu SM. Psycho-spiritual well-being in patients with advanced cancer: an integrative review of the literature. J Adv Nurs 2003;44:69-80.
15. Meyer TJ, Mark MM. E.ects of psychosocial interventions with adult cancer patients: a meta-analysis of randomized experiments. Health Psychol 1995; 14:101-108.
16. Thuné-Boyle IC, Stygall JA, Keshtgar MR, Newman SP. Do religious/ spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature. Soc Sci Med 2006; 63:151-164.
17. Kaplar ME, Wachholtz AB, O'Brien WH. The effect of religious and spiritual interventions on the biological, psychological, and spiritual outcomes of oncology patients: a meta-analytic review. J Psychosoc Oncol 2004;22:39-49.
18. Coward DD, Kahn DL. Resolution of spiritual disequilibrium by women newly diagnosed with breast cancer. Oncol Nurs Forum 2004; 31:E24-E31.
19. Boston PH, Mount BM. The caregiver's perspective on existential and spiritual distress in palliative care. J Pain Symptom Manage 2006;32:13-26.
20. Blinderman CD, Cherny NI. Existential issues do not necessarily result in existential suffering: lessons from cancer patients in Israel. Palliat Med 2005;19:371-380.
21. Bolmsjö I. Existential issues in palliative care-interviews with cancer patients. J Palliat Care 2000;16:20-24.
22. Halldorsdottir S, Hamrin E. Experiencing existential changes: the lived experience of having cancer. Cancer Nurs 1996; 19:29-36.
23. Moene M, Bergbom I, Skott C. Patients' existential situation prior to colorectal surgery. J Adv Nurs 2006; 54:199-207.
24. Thomé B, Dykes A, Gunnars B, Hallberg IR. The experiences of older people living with cancer. Cancer Nurs 2003;26:85-96.
25. Fagerstrom L, Eriksson K, Engberg IB. The patient's perceived caring needs as a message of suffering. J Adv Nurs 1998; 28:978-987.
26. Morita T, Kawa M, Honke Y, Kohara H, Maeyama E, Kizawa Y et al. Existential concerns of terminally ill cancer patients receiving specialized palliative care in Japan. Support Care Cancer 2004; 12:137-140.
27. Tan HM, Braunack-Mayer A, Beilby J. The impact of the hospice environment on patient spiritual expression. Oncol Nurs Forum 2005;32:1049-1055.
28. Buckley J, Herth K. Fostering hope in terminally ill patients. Nurs Stand 2004;19:33-41.
29. Ryan PY. Approaching death: a phenomenologic study of five older adults with advanced cancer. Oncol Nurs Forum 2005;32:1101-1108.
30. Westman B, Bergenmar M, Andersson L. Life, illness and death - existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer. Eur J Oncol Nurs 2006;10:169-176.
31. Richer M, Ezer H. Living in it, living with it, and moving on: dimensions of meaning during chemotherapy. Oncol Nurs Forum 2002;29:113-119.
32. Lethborg C, Aranda S, Bloch S, Kissane D. The role of meaning in advanced cancer-integrating the constructs of assumptive world, sense of coherence and meaning-based coping. J Psychosoc Oncol 2006; 24:27-42.
33. Murray SA, Kendall M, Boyd K, Worth A, Benton TF. Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliat Med 2004;18:39-45.
34. Edser SJ, May CG. Spiritual life after cancer: connectedness and the will to meaning as an expression of self-help. J Psychosoc Oncol 2007;25:67-85.
35. Rehnsfeldt A, Eriksson K. The progression of suffering implies alleviated suffering. Scand J Caring Sci 2004; 18:264-272.
36. Carter H, MacLeod R, Brander P, McPherson K. Living with a terminal illness: patients' priorities. J Adv Nurs 2004;45:611-620.
37. Tamura K, Kikui K, Watanabe M. Caring for the spiritual pain of patients with advanced cancer: a phenomenological approach to the lived experience. Palliat Support Care 2006;4:189-196.
38. Strang S, Strang P. Spiritual thoughts, coping and 'sense of coherence' in brain tumour patients and their spouses. Palliat Med 2001; 15:127-134.
39. Grumann MM, Spiegel D. Living in the face of death: interviews with 12 terminally ill women on home hospice care. Palliat Support Care 2003;1:23-32.
40. Grant E,Murray SA, KendallM, Boyd K, Tilley S, Ryan D. Spiritual issues and needs: perspectives from patients with advanced cancer and nonmalignant disease. A qualitative study. Palliat Support Care 2004;2:371-378.
41. Landmark BT, Strandmark M, Wahl AK. Living with newly diagnosed breast cancer - the meaning of existential issues: a qualitative study of 10 women with newly diagnosed breast cancer, based on grounded theory. Cancer Nurs 2001;24:220-226.
42. Rydahl-Hansen S. Hospitalized patients experienced suffering in life with incurable cancer. Scand J Caring Sci 2005;19:213-222.
43. Mako C, Galek K, Poppito SR. Spiritual pain among patients with advanced cancer in palliative care. J Palliat Med 2006;9:1106-1113.
44. Arman M, Rehnsfeldt A, Lindholm L, Hamrin E, Eriksson K. Suffering related to health care: a study of breast cancer patients' experiences. Int J Nurs Pract 2004;10:248-256.
45. Choumanova I, Wanat S, Barrett R, Koopman C. Religion and spirituality in coping with breast cancer: perspectives of Chilean women. Breast J 2006;12: 349-352.
46. Bowie JV, Sydnor KD, Granot M, Pargament KI. Spirituality and coping among survivors of prostate cancer. J Psychosoc Oncol 2004; 22:41-56.
47. Sand L, Strang P. Existential loneliness in a palliative home care setting. J Palliat Med 2006;9:1376-1387.
48. Hermann CP. Spiritual needs of dying patients: a qualitative study. Oncol Nurs Forum 2001;28:67-72.
49. Ando M, Tsuda A, Morita T. Life review interviews on the spiritual well-being of terminally ill cancer patients. Support Care Cancer 2007;15:225-231.
50. Logan J, Hackbusch-Pinto R, Grasse CE. Women undergoing breast diagnostics: the lived experience of spirituality. Oncol Nurs Forum 2006;33:121-126.
51. Kawa M, Kayama M, Maeyama E, Iba N, Murata H, Imamura Y, et al. Distress of inpatients with terminal cancer in Japanese palliative care units: from the viewpoint of spirituality. Support Care Cancer 2003; 11:481-490.
52. Jakobsson L, Hallberg IR, Loven L. Met and unmet nursing care needs in men with prostate cancer. An explorative study. Part II. Eur J Cancer Care (Engl) 1997;6:117-123.
53. van Leeuwen R, Tiesinga LJ, Post D, Jochemsen H. Spiritual care: implications for nurses' professional responsibility. J Clin Nurs 2006;15:875-884.
54. Narayanasamy A, Owens J. A critical incident study of nurses' responses to the spiritual needs of their patients. J Adv Nurs 2001; 33:446-455.
55. Hamilton JB, Powe BD, Pollard A, Lee KJ, Felton AM. Spirituality among African American cancer survivors: having a personal relationship with God. Cancer Nurs 2007;30:309-316.
56. Levy RD, Chan J. Spiritual coaching in cancer patients: treating the spirit as well as the disease. J Pastoral Care Counsel 2006; 60:395-404.
57. Strang P, Strang S, Hultborn R, Arner S. Existential pain - an entity, a provocation, or a challenge? J Pain Symptom Manage 2004; 27:241-250.
58. De Faye BJ, Wilson KG, Chater S, Viola RA, Hall P. Stress and coping with advanced cancer. Palliat Support Care 2006;4:239-249.
59. Cohen SR, Mount BM, Tomas JJ, Mount LF. Existential well-being is an important determinant of quality of life. Evidence from the McGill Quality of Life Questionnaire. Cancer 1996;77:576-586.
60. Romero C, Kalidas M, Elledge R, Chang J, Liscum KR, Friedman LC. Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer. J Behav Med 2006;29:29-36.
61. Canada AL, Parker PA, Basen-Engquist K, de Moor JS, Ramondetta LM. Active coping mediates the association between religion/spirituality and functional well-being in ovarian cancer. Gynecol Oncol 2005; 99:S125.
62. Manning-Walsh J. Spiritual struggle: effect on quality of life and life satisfaction in women with breast cancer. J Holist Nurs 2005; 23: 120-140; discussion 141-144.
63. Daugherty CK, Fitchett G, Murphy PE, Peterman AH, Banik DM, Hlubocky F, et al. Trusting God and medicine: spirituality in advanced cancer patients volunteering for clinical trials of experimental agents. Psycho-Oncology 2005;14:135-146.
64. Samano ES, Goldenstein PT, Ribeiro Lde M, Lewin F, Filho ES, Soares HP, et al. Praying correlates with higher quality of life: results from a survey on complementary/alternative medicine use among a group of Brazilian cancer patients. Sao Paulo Med J 2004; 122:60-63.
65. Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology 1999;8:417-428.
66. Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E. Exploring the relationships among spiritual wellbeing, quality of life, and psychological adjustment in women with breast cancer. Psycho-Oncology 1999; 8:429-438.
67. Balboni TA, Vanderwerker LC, Block SD, Paulk ME, Lathan CS, Peteet JR, et al. Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol 2007;25:555-560.
68. Morita T, Tsunoda J, Inoue S, Chihara S. An exploratory factor analysis of existential suffering in Japanese terminally ill cancer patients. Psycho-Oncology 2000;9:164-168.
69. Tarakeshwar N, Vanderwerker LC, Paulk E, Pearce MJ, Kasl SV, Prigerson HG. Religious coping is associated with the quality of life of patients with advanced cancer. J Palliat Med 2006;9:646-657.
70. Laubmeier KK, Zakowski SG, Bair JP. The role of spirituality in the psychological adjustment to cancer: a test of the transactional model of stress and coping. Int J Behav Med 2004;11:48-55.
71. Taylor EJ. Prevalence and associated factors of spiritual needs among patients with cancer and family caregivers. Oncol Nurs Forum 2006;33:729-735.
72. Leung K, Chiu T, Chen C. The influence of awareness of terminal condition on spiritual well-being in terminal cancer patients. J Pain Symptom Manage 2006;31: 449-456.
73. Wilson KG, Chochinov HM, McPherson CJ, LeMay K, Allard P, Chary S, et al. Suffering with advanced cancer. J Clin Oncol 2007; 25:1691-1697.
74. Chung LY, Wong FK, Chan MF. Relationship of nurses' spirituality to their understanding and practice of spiritual care. J Adv Nurs 2007;58:158-170.
75. Gioiella ME, Berkman B, Robinson M. Spirituality and quality of life in gynecologic oncology patients. Cancer Pract 1998;6:333-338.
76. McIllmurray MB, Francis B, Harman JC, Morris SM, Soothill K, Thomas C. Psychosocial needs in cancer patients related to religious belief. Palliat Med 2003; 17:49-54.
77. Krupski TL, Kwan L, Fink A, Sonn GA, Maliski S, Litwin MS. Spirituality in.uences health related quality of life in men with prostate cancer. Psycho-Oncology 2006;15:121-131.
78. Tatsumura Y, Maskarinec G, Shumay DM, Kakai H. Religious and spiritual resources, CAM, and conventional treatment in the lives of cancer patients. Altern Ther Health Med 2003;9:64-71.
79. Hampton DM, Hollis DE, Lloyd DA, Taylor J, McMillan SC. Spiritual needs of persons with advanced cancer. Am J Hosp Palliat Care 2007; 24:42-48.
80. Manning-Walsh JK. Psychospiritual well-being and symptom distress in women with breast cancer. Oncol Nurs Forum 2005;32:543.
81. Sephton SE, Koopman C, Schaal M, Thoresen C, Spiegel D. Spiritual expression and immune status in women with metastatic breast cancer: an exploratory study. Breast J 2001;7:345-353.
82. McCoubrie RC, Davies AN. Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer? Support Care Cancer 2006;14:379-385.
83. Nelson CJ, Rosenfeld B, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics 2002; 43:213-220.
84. Kaczorowski JM. Spiritual well-being and anxiety in adults diagnosed with cancer. Hosp J 1989;5:105-116.
85. Hamrick N, Diefenbach MA. Religion and spirituality among patients with localized prostate cancer. Palliat Support Care 2006; 4:345-355.
86. Inman A, Kirsh KL, Passik SD. A pilot study to examine the relationship between boredom and spirituality in cancer patients. Palliat Support Care 2003; 1:143-151.
87. Boscaglia N, Clarke DM, Jobling TW, Quinn MA. The contribution of spirituality and spiritual coping to anxiety and depression in women with a recent diagnosis of gynecological cancer. Int J Gynecol Cancer 2005;15:755-761.
88. Fehring RJ, Miller JF, Shaw C. Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer. Oncol Nurs Forum 1997;24:663-671.
89. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Understanding the will to live in patients nearing death. Psychosomatics 2005;46:7-10.
90. Smith ED, Stefanek ME, Joseph MV, Verdieck MJ. Spiritual awareness, personal perspective on death, and psychosocial distress among cancer patients: an initial investigation. J Psychosoc Oncol 1993; 11:89-103.
91. Schnoll RA, Harlow LL, Brower L. Spirituality, demographic and disease factors, and adjustment to cancer. Cancer Pract 2000; 8:298-304.
92. Galuszka A. Cognitive-affective correlates of meaningfulness in life in chronic somatic disease. Pol Psychol Bull 2006;37:111-119.
93. Mickley JR, Soeken K, Belcher A. Spiritual well-being, religiousness and hope among women with breast cancer. J Nurs Scholarsh 1992; 24:267-272.
94. McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 2003;361:1603-1607.
95. Mystakidou K, Tsilika E, Parpa E, Pathiaki M, Patiraki E, Galanos A, et al. Exploring the relationships between depression, hopelessness, cognitive status, pain, and spirituality in patients with advanced cancer. Arch Psychiatr Nurs 2007;21:150-161.
96. Ambs AH, Miller MF, Smith AW, Goldstein MS, Hsiao AF, Ballard-Barbash R. Religious and spiritual practices and identification among individuals living with cancer and other chronic disease. J Soc Integr Oncol 2007;5:53-60.
97. Levine EG, Targ E. Spiritual correlates of functional well-being in women with breast cancer. Integr Cancer Ther 2002; 1:166-174.
98. Gall TL. Relationship with God and the quality of life of prostate cancer survivors. Qual Life Res 2004;13: 1357-1368.
99. Meraviglia MG. The effects of spirituality on well-being of people with lung cancer. Oncol Nurs Forum 2004;31:89-94.
100. Taylor EJ. Factors associated with meaning in life among people with recurrent cancer. Oncol Nurs Forum 1993;20: 1399-1405; discussion 1406-1407.
101. Thompson P. The relationship of fatigue and meaning in life in breast cancer survivors. Oncol Nurs Forum 2007;34:653-660.
102. Schoen EG, Nicholas DR. Existential meaning through illness: the case of patients with breast cancer. J Psychosoc Oncol 2004; 22:61-76.
103. Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL. Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychol 2006;25:753-761.
104. Boscaglia N, Clarke DM. Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynaecological cancer. Psycho-Oncology 2007;16:189-195.
105. Hermann CP. The degree to which spiritual needs of patients near the end of life are met. Oncol Nurs Forum 2007;34:70-78.
106. Cole B, Pargament K. Re-creating your life: a spiritual/ psychotherapeutic intervention for people diagnosed with cancer. Psycho-Oncology 1999;8:395-407.
107. Lantz J, Gregoire T. Existential psychotherapy with couples facing breast cancer: a twenty year report. Contemp Fam Ther 2000; 22:315-327.
108. Classen C, Butler LD, Koopman C, Miller E, DiMiceli S, Giese-Davis J, et al. Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial. Arch Gen Psychiatry 2001;58:494-501.
109. Angen MJ, MacRae JH, Simpson JSA, Hundleby M. Tapestry: a retreat program of support for persons living with cancer. Cancer Pract 2002;10: 297-304.
110. Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, et al. Cognitive-existential group psychotherapy for women with primary breast cancer: a randomized controlled trial. Psycho-Oncology 2003; 12:532-546.
111. Kissane DW, Love A, Hatton A, Bloch S, Smith G, Clarke DM, et al. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. J Clin Oncol 2004;22:4255-4260.
112. Cohen ST, Block S. Issues in psychotherapy with terminally ill patients. Palliat Support Care 2004;2: 181-189.
113. Iglesias A. Hypnosis and existential psychotherapy with end-stage terminally ill patients. Am J Clin Hypn 2004;46:201-213.
114. Cole BS. Spiritually-focused psychotherapy for people diagnosed with cancer: a pilot outcome study. Ment Health Relig Cult 2005; 8:217-226.
115. Kristeller JL, Rhodes M, Cripe LD, Sheets V. Oncologist Assisted Spiritual Intervention Study (OASIS): patient acceptability and initial evidence of effects. Int J Psychiatry Med 2005; 35: 329-347.
116. Cunningham AJ. Integrating spirituality into a group psychological therapy program for cancer patients. Integr Cancer Ther 2005; 4:178-186.
117. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 2005;23:5520-5525.
118. Strasser F, Walker P, Bruera E. Palliative pain management: when both pain and suffering hurt. J Palliat Care 2005;21:69-79.
119. Rummans TA, Clark MM, Sloan JA, Frost MH, Bostwick JM, Atherton PJ, et al. Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. J Clin Oncol 2006;24:635-642.
120. Lee V, Cohen SR, Edgar L, Laizner AM, Gagnon AJ. Meaning-making and psychological adjustment to cancer: development of an intervention and pilot results. Oncol Nurs Forum 2006;33:291-302.
121. Lee V, Cohen SR, Edgar L, Laizner AM, Gagnon AJ. Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med 2006; 62:3133-3145.
122. Duggleby WD, Degner L, Williams A, Wright K, Cooper D, Popkin D, et al. Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients. J Pain Symptom Manage 2007;33:247-257.
123. Morita T, Murata H, Hirai K, Tamura K, Kataoka J, Ohnishi H, et al., Japanese Spiritual Care Task Force. Meaninglessness in terminally ill cancer patients: a validation study and nurse education intervention trial. J Pain Symptom Manage 2007;34:160-170.
124. Murata H, Morita T, Japanese Task Force. Conceptualization of psycho-existential suffering by the Japanese Task Force: the first step of a nationwide project. Palliat Support Care 2006; 4:279-285.
125. Tanyi RA. Towards clarification of the meaning of spirituality. J Adv Nurs 2002;39:500-509.
126. Richer MC, Ezer H. Understanding beliefs and meanings in the experience of cancer: a concept analysis. J Adv Nurs 2000; 32:1108-1115.
127. Chi GC. The role of hope in patients with cancer. Oncol Nurs Forum 2007;34:415-424.
128. Cox T. Theory and exemplars of advanced practice spiritual intervention. Complement Ther Nurs Midwifery 2003;9:30-34.
129. van Meijel B, Gamel C, van Swieten-Duijfjes B, Grypdonck MH. The development of evidence-based nursing interventions: methodological considerations. J Adv Nurs 2004;48:84-92.
130. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, et al. Framework for design and evaluation of complex interventions to improve health. Br Med J 2000; 321:694-696.
131. Blackwood B. Methodological issues in evaluating complex healthcare interventions. J Adv Nurs 2006; 54:612-622.
132. Loh KY. Exploring terminally ill patients' and their families' perceptions of holistic care in Malaysia. Int J Palliat Nurs 2006;12:38-41.