Background: Cancer-related financial toxicity (FT) is a global challenge encompassing material burden, psychological distress, and cost-related behaviors such as delaying or forgoing treatment. Behavioral FT affects adherence but remains understudied. Objective: To examine independent, interactive, and combined associations of social support and residential setting with behavioral FT among patients with cancer. Methods: This secondary analysis included 1208 patients with cancer from 12 hospitals across 3 Chinese provinces. Hierarchical logistic regression examined independent associations and multiplicative interaction between social support and residential setting on behavioral FT, adjusting for 11 covariates. Additive interaction was assessed using relative excess risk due to interaction, attributable proportion, and synergy index. A 4-group composite variable was used to evaluate the combined association. Results: After adjustment for household income and other covariates, rural residence (odds ratio [OR] = 2.03, P < .001) and low social support (OR = 1.59, P = .005) were independently associated with greater behavioral FT, with no significant multiplicative or additive interaction. However, compared with urban high-support patients, the odds of behavioral FT increased progressively across the urban low-support (OR = 1.90, P = .036), rural high-support (OR = 2.19, P < .001), and rural low-support (OR = 3.26, P < .001) groups. Conclusions: Rural residence and low social support were independently associated with greater behavioral FT, with the highest vulnerability among patients experiencing both. Implications for Oncology Nursing Practice: Oncology nurses should routinely assess patients’ financial concerns and social support, particularly among rural patients, and facilitate referral to financial navigation and supportive services.
BACKGROUND:In a rural setting, individuals who receive a cancer diagnosis experience an interconnected group of challenges that contribute to the lived experience of space and time. Philosophers offer a perspective of human experience that provides insight into how individuals manage life challenges. OBJECTIVE:To understand the lived experiences by inserting the lenses of Merleau-Ponty (MP) and Heidegger as they relate to space and time, and work toward a holistic practice that is maximally effective. METHODS:This qualitative secondary analysis applied hermeneutic phenomenology when reviewing interview transcripts from 15 participants. Participants discussed their experiences in ways that resonated with philosophical work from MP and Heidegger, highlighting their applicability to the nature of the participants' experiences. RESULTS:Two main themes and several subthemes were identified and interpreted using philosophical viewpoints. Theme 1, Experiencing limitations in one's space, and subthemes Sacrificing independence and personal space and Leaving the rural environment, are well explicated by MP's notion of "being-in-the-world.' Theme 2, Being thrown into life with a cancer diagnosis, and subthemes Prioritizing health, Striving for normalcy, and Living authentically, are well explained by Heidegger's impressions of temporality and thrownness. CONCLUSIONS:Incorporation of philosophers' viewpoints is valuable in providing a holistic understanding of the lived experience of participants. Nurses are on the frontline of healthcare and can ensure that individual needs are met while providing best-practice care for rural patients. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Providing authentic care, recognizing the strengths of the rural community, and practicing advocacy for the rural patient are important.
Background: In a rural setting, individuals who receive a cancer diagnosis experience an interconnected group of challenges that contribute to the lived experience of space and time. Philosophers offer a perspective of human experience that provides insight into how individuals manage life challenges. Objective: To understand the lived experiences by inserting the lenses of Merleau-Ponty (MP) and Heidegger as they relate to space and time, and work toward a holistic practice that is maximally effective. Methods: This qualitative secondary analysis applied hermeneutic phenomenology when reviewing interview transcripts from 15 participants. Participants discussed their experiences in ways that resonated with philosophical work from MP and Heidegger, highlighting their applicability to the nature of the participants’ experiences. Results: Two main themes and several subthemes were identified and interpreted using philosophical viewpoints. Theme 1, Experiencing limitations in one’s space , and subthemes Sacrificing independence and personal space and Leaving the rural environment, are well explicated by MP’s notion of “being-in-the-world.’ Theme 2, Being thrown into life with a cancer diagnosis, and subthemes Prioritizing health, Striving for normalcy, and Living authentically, are well explained by Heidegger’s impressions of temporality and thrownness. Conclusions: Incorporation of philosophers’ viewpoints is valuable in providing a holistic understanding of the lived experience of participants. Nurses are on the frontline of healthcare and can ensure that individual needs are met while providing best-practice care for rural patients. Implications for Oncology Nursing Practice: Providing authentic care, recognizing the strengths of the rural community, and practicing advocacy for the rural patient are important.
