title: Patients With Hepatocellular Carcinoma Near the End of Life: A Longitudinal Qualitative Study of Their Illness Experiences.
abstract: BACKGROUND
  In the United States, the incidence of hepatocellular carcinoma (HCC) is rising. For those diagnosed with terminal HCC, there is no curative treatment and duration of survival is typically 1 to 2 years. Research on illness and treatment experiences toward the end of life for patients with terminal HCC is limited.
  
  
  OBJECTIVE
  The aim of this study was to explore the illness experiences of patients with terminal HCC as they approached the end of life.
  
  
  METHODS
  This study used a prospective, longitudinal descriptive design. Interview data were collected from 14 patients once a month for up to 6 months, for a total of 45 interviews. Data were analyzed using conventional content analysis.
  
  
  RESULTS
  Three major themes (illness perceptions, decision to start treatment, and navigating treatment over time) and 10 subthemes were identified that were reflected across time in all patient experiences. Patients faced challenges with symptom experiences, treatment decisions, and unmet information needs affecting their quality of life.
  
  
  CONCLUSIONS
  Gaining knowledge about the challenges facing patients with HCC is crucial for designing interventions that optimize their quality of life.
  
  
  CONCLUSIONS
  Healthcare professionals may improve the quality of life of patients with terminal HCC by eliciting patients' perceptions of their illness and treatment decisions, symptom experiences, and information needs as the disease progresses and providing symptom management and offering information tailored to their needs. Care for patients with HCC who are approaching the end of life should be multidisciplinary and include timely referral to palliative care.
authors.affiliation: Author Affiliations: School of Nursing (Dr Hansen and Ms Rosenkranz) and Knight Cancer Institute (Dr Vaccaro), Oregon Health & Science University, Portland; and Portland Veterans Affairs Medical Center, Oregon (Dr Chang).
authors.forename: Lissi
authors.initials: L
authors.lastname: Hansen
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Rosenkranz
authors.forename: Gina M
authors.initials: GM
authors.lastname: Vaccaro
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chang
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D008016:Life Change Events; D008113:Liver Neoplasms / Q000150:complications / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D014481:United States