Everyday Struggling to Survive: Experience of the Urban Poor Living With Advanced Cancer

PURPOSE/OBJECTIVES: To understand the meaning of dignity to the urban poor and to describe their experiences living with advanced cancer. DESIGN: Qualitative approach using interpretive phenomenology. SETTING: Various community residential and clinical sites in a western city in the United States. SAMPLE: 14 patients (6 men and 8 women) with stage III or IV solid tumors who ranged in age from 45-69 years; 50% were people of color. METHODS: Patients were recruited from providers caring for the urban poor. Data were collected from in-depth interviews that were audiotaped and transcribed. Patients were interviewed as many as three times. Interview transcripts and field notes provided data for the analysis, which was part of a larger project. Researchers identified and analyzed themes within and across cases. FINDINGS: Many of the urban poor had difficult backgrounds prior to being diagnosed with cancer. Most patients, even those only weeks from death, focused on living not on dying. Participants' descriptions of their experiences focused on indignity not dignity. Indignity stories, such as being talked down to, not being listened to, and the embarrassment of fecal or urinary incontinence, were described in vivid detail. CONCLUSIONS: This research confirms the importance of cancer care that recognizes patients' humanity regardless of their psychosocial circumstances. IMPLICATIONS FOR NURSING: Nurses need to expediently meet hygiene and toileting needs to decrease threats to patient dignity.