As reported, cancer patients and their significant others need information promoting their understanding of events throughout the illness, and support in mobilizing coping strategies when they consider the situational demands to exceed their personal resources. In the present study the provision of information was merged into the field of education and combined with emotional support to facilitate efforts to cope with the cancer experience. A patient education programme entitled Learning to live with cancer was developed (part I) and evaluated (part II). Cancer patients and their significant others (n = 127) participated in group sessions. Open interviews organized around experiences of increased knowledge and understanding, decreased confusion and anxiety, and enhanced coping capacity related to participation in the programme were conducted with the participants. The interviews were analysed using the Grounded Theory approach. The findings indicate that supportive education, sensitively responsive to expressed learning needs and learning capability, has the power to promote proper understanding and facilitate coping efforts. Becoming familiar with facts and feelings reinforced confidence in evolving appropriate coping strategies for living with cancer.

The aim of this exploratory study was to describe quality of life (QL) domains and independence in activities of daily living (ADL) in patients (n = 86) undergoing surgery for colorectal cancer. The patients were consecutively included, and two validated instruments, EORTC's QLQ-C30 and the Katz'/Hulter Asberg Index of Independence in ADL, were used preoperatively and at follow-up after 5-8 months. The findings were related to tumour localization, tumour burden according to Dukes' classification and to preoperative radiotherapy treatment. The results showed a significant improvement in the patients' scores for emotional functioning, appetite and global QL and a significant increase in financial impact at follow-up. The patients with colon cancer (n = 39) also had significantly less pain and less constipation at follow-up compared with preoperatively than did patients with rectal cancer (n = 47). The patients with rectal cancer, having undergone preoperative radiotherapy treatment, had significantly lower confidence intervals for means (95%) on the physical functioning and role functioning scales at follow-up versus preoperatively. Total ADL independence decreased from 70% of the patients preoperatively to 57% at follow-up, and independence in instrumental ADL decreased from 72% to 64% of the patients. No patient was dependent in personal ADL preoperatively, while 3% were dependent at follow-up. A lower mean score of global QL was found preoperatively and at follow-up for patients who were dependent in ADL than for patients who were independent in ADL. The instruments were found useful for evaluating individual patients in clinical practice.

Cancer patients and their significant others need information to understand events throughout the course of cancer. They also need support in mobilizing coping strategies as situational demands exceed their personal resources. Following a learning-needs assessment, Swedish cancer patients and their significant others demonstrated a desire to learn not only about the disease and treatment procedures, but also about the adaptation process to live with the uncertainty inherent in a diagnosis of cancer. It has, however, repeatedly been reported that communication barriers exist, and that information does not always reach the intended target. Thus, to increase knowledge and facilitate efforts to cope with the cancer experience an approach was used in which the provision of information was combined with emotional support in an education course. Patients and their significant others (n = 149) were actively involved in developing the education and support programme together with extensive learning materials. The programme, entitled Learning to live with cancer, has its roots in the educational philosophy of human learning, and is based on the findings from the original learning-needs assessment.

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Giving of information to cancer patients and their family members regarding the disease, the treatment procedures and the adaptation process for living with the uncertainty inherent in a diagnosis of cancer, is as reported often not effective due to peoples' failure to understand. The impact of emotional stress creates communication difficulties. Information not based on assessed learning needs and considered individual differences as to learning militates against proper understanding. In developing an educational programme a study has been carried out aiming to assess learning needs. Cancer patients (n = 50), their family members (n = 20) and staff members within cancer care (n = 30) were asked to answer a need assessment questionnaire. The patients/family members indicated an extensive desire to learn about cancer and its ramifications, whereas staff members indicated that they seldom were approached regarding some questions in the area. The findings support the appropriateness for providing a structured patient education programme based on assessed needs and planned to meet individual differences in learning readiness and learning capabilities, that would complement the information currently given by staff members.