Clarification of Supportive and Palliative Needs of Iranian Patients with cancer: a Qualitative Study

Clarification of Supportive and Palliative Needs of Iranian Patients with cancer: a Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clarification of Supportive and Palliative Needs of Iranian Patients with cancer: a Qualitative Study Reza Negarandeh, Afzal Shamsi, Mamak Tahmasebi, Rebecca H Lehto This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6250759/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cancer is the serious concern of public health worldwide, leading to the problems and various needs of patients. The accurate recognition of patient's needs and finding a way to meet them result in increasing the longevity and improving the quality of patient's life. This qualitative study aimed to clarify the palliative and supportive needs of Iranian patients with cancer. Methods The study sample was selected using purposive sampling in healthcare centers affiliated with Tehran University of Medical Sciences. Participants (n = 26) included eight patients with cancer, nine patient companions, two physicians, and seven nurses. Data were collected until data saturation using semi-structured in-depth interviews. Results The supportive and palliative needs of individuals with cancer were differentiated into five principal sets: 1) physical comfort (five subclasses); 2) mental integration (two subclasses); 3) Social presence (two subclasses); 4) social support (two subclasses); and 5) beliefs and spiritual practices (four subclasses). Conclusion Study findings identified that patients with cancer have many supportive and palliative needs, including physical comfort, mental integration, social presence, social assistance, and attentiveness to beliefs and spiritual practices. Comprehensive planning, with consideration of cultural, social, and religious contexts, is necessary to meet the needs of these patients. cancer Palliative Care qualitative study 1. Introduction Cancer is an international public health problem affecting all nations, races, and social classes [ 1 ]. The burden of cancer incidence and mortality is increasing worldwide. In 2020, there was an estimated 19.3 million new cancer cases. Further, the global prevalence is estimated to increase by 47% to 28.4 million cancer cases by 2040 [ 2 ]. Concerningly, cancer is a leading cause of death, with approximately 1 in 6 deaths worldwide attributed to it in 2020 (i.e., 10 million deaths) [ 2 ]. In Iran, specifically, cancer incidence approximately doubled between 2000 to 2016, with a crude rate of 155 cases per 100,000 people in 2016 [ 3 ]. Cancer is associated with significant symptom burden and impaired quality of life. For instance, patients with cancer experience a wide range of physical, psychological, and social needs, including needs for health information, psychological care, and assistance with daily living [ 4 ]. Unfortunately, these needs often go unmet during traditional cancer treatment [ 4 ]. A systematic review by Wang et al. [ 5 ] identified emotional support, fatigue, and communication of side-effects of treatment as prominent unmet needs of patients with advanced cancer. Further, these unmet needs are associated with patients’ quality of life, physical symptoms, and anxiety [ 5 ]. Supportive and palliative care can thus be utilized to address these unmet needs and assist patients with managing the difficulties of cancer diagnosis and treatment. Supportive and palliative care integrates therapies into cancer treatment to improve the quality of life of patients, with a focus on preventing and treating adverse symptoms and side-effects of treatment [ 6 ]. Research has shown that accurately identifying patients' needs and resolving them through supportive and palliative care can increase life expectancy and improve quality of life [ 7 , 8 ]. Further, supportive and palliative care integration into cancer treatment planning has been found to relieve pain [ 9 ], allow patients to have more active and positive lives, integrate psychosocial and emotional dimensions of patient care [ 10 ], and reduce medical errors [ 11 ]. Despite the numerous benefits of supportive and palliative care, many patients who may benefit from supportive and palliative care services are unaware of them or are unable to access them due to lack of referral [ 12 ]. According to the World Health Organization (2020), only 14% of patients in need of palliative care have access to it [ 13 ]. Further, the worldwide demand for palliative care will continue to expand as the population ages and the prevalence of non-communicable diseases increases [ 14 ]. There is thus a need for improved access to supportive and palliative care worldwide, especially in countries with a high proportion of patients at advanced stages of cancer, such as in third world countries [ 15 ]. Of the approximately 40 million people who need palliative care annually, 78% live in low- and middle-income countries, such as Iran [ 13 ]. Although there is considerable need for supportive and palliative care in Iran, there are numerous barriers restricting access for patients who would benefit from it [ 16 ]. One study of cancer patients in Iran reported that patients had limited knowledge of palliative care and considerable misinformation around its uses [ 17 ]. There is also a shortage of providers who are able to provide supportive and palliative care in Iran. In 2015, Iran was ranked 78th of 80 in the global ranking of access to professionals trained to deliver palliative care [ 18 ]. Because of this limited access to supportive and palliative care in Iran, there is a need for identifying the distinct needs of Iranian patients with cancer as a first step in addressing the barriers to accessing services and remedying the unmet needs of these patients. There has been considerable qualitative research conducted in Western countries to determine the supportive and palliative needs of patients with cancer. For example, Preisler et al [ 19 ]. in Germany, Fjose et al. [ 20 ] in Norway, Melhem et al [ 21 ]. in Canada, Zeng et al [ 22 ]. in China, and Boucher et al [ 23 ]. in the United Statesn. There have also been a few studies in Iran adopting a quantitative approach to determine the needs of cancer patients. For instance, Masoudi et al [ 24 ]. assessed the supportive care needs of elderly patients with cancer, while Borjalilu et al [ 25 ]. examined the information needs of parents of children with cancer. Finally, Lilabadi et al [ 26 ]. evaluated the self-reported needs of a sample of women with cancer. However, these studies were restricted to assessing the needs of patients or parents and did not take into consideration the perspectives of providers. Hence, to our knowledge, no qualitative research has comprehensively assessed the needs of Iranian patients with cancer through the perspectives of the treatment team, patients, and companions. The current study seeks to clarify the palliative and supportive needs of Iranian patients with cancer through the perspectives of patients, companions, and health providers. 2. Methods 2.1. Settings and participants This study was conducted from October 2017 to November 2018. Participants (n = 26) included patients with cancer (n = 8), patient companions (n = 9), and the patients’ treatment team [ physicians (n = 2) and nurses (n = 7)]. Purposive sampling with maximum variation was used to recruit participants from healthcare centers affiliated with the Tehran University of Medical Sciences. Inclusion criteria for all participants included fluency in Persian. In addition, patients required a cancer diagnosis in order to participate. Treatment team members were included if they had attained 4 + years of work experience in cancer wards. Exclusion criteria included patients and families with severe psychological problems (e.g., amnesia and Alzheimer's). Sampling was continued until data saturation. 2.2. Data collection Adherence with the 32-item Consolidated Criteria for Reporting Qualitative (COREQ) was performed in the present study. Data were collected using in-depth semi-structured interviews. Interviews were recorded using a digital audio recorder. The professional staff were interviewed using the following general questions: "What do cancer patients and their families need?", "What are challenges in this area?", “What structure and facilities are available to meet these needs?”. Patients and their families were interviewed using the following questions: "What needs do you have about your illness?", "What steps do you need to take to meet these needs?" Also, some follow-up questions were asked, including "Please explain more", “What are your expectations?” "When you say… what do you mean?", "Did I understand right about what you said?" Participants were asked to share their experiences and understanding of cancer-related needs. The interview continued to gain an in-depth understanding of the phenomenon under study. Interviews lasted between 40–90 minutes depending on the interest and communicability of the participants. 2.3. Data analysis Participants' views and experiences were analyzed with content analysis using the Graneheim and Lundman method [ 27 ]. The text of each interview was first written on paper, and each interview was read several times for an overall understanding of the text. Then, the data were divided into semantic units and assigned a conceptual name (code). Repetitive codes were removed and then codes with the same concept were grouped and classes were formed. The codes of each interview were continually compared to other interviews until the subcategories and then the main categories were created. Data saturation occurred after 26 interviews. 2.4. Data trustworthiness Data validation was ensured using the proposed criteria of Guba and Lincoln [ 27 ]. The credibility of data was performed by the constant comparison of data and prolonged engagement with participants. The prolonged engagement with the participants and dedicated time to collecting data allowed for the research team to better understand the participants’ experiences. The dependability of the data was verified using a member check technique. The confirmability of data was achieved through regular data collection and preservation of research documentation. Maximum variation sampling was used for data transferability. 3. Results Demographic information of the study sample is summarized in Table 1 . Patients were on average 52.62 ± 1.18 years old, companions were 52.62 ± 1.18 years old, and the treatment team was 52.62 ± 1.18 years old. As summarized in Table 2 , patients' needs were classified into five the main categories: "physical comfort", "mental integration", "social presence", "receiving social support", and "using beliefs and spiritual practices". Table 1 Specifications of Participants Status Patients Companions Treatment team Gender Male 4 (50) 6(66.6) 5(55.5) Female 4(50) 3(33.3) 4(44.4) Marital Status Single 2(25) 4(44.4) 2(22.2) married 8(75) 5(55.6) 7(88.8) Education Illiterate 1(12.5) 1(11.1) 0 Under diploma 3(37.5) 1(11.1) 0 Academic degree 4(50) 7(77.7) 9(100) Cancer Type breast 2(25) - - Colon 2(25) Lung 1(12.5) pelvis 1(12.5) Bladder 1(12.5) Uterus 1(12.5) Table 2 The Main Categories and Subcategories Obtained from the Participant's Experiences Main Categories Subcategories the need for physical comfort Pain relief Infection control Attention to the unique nutritional needs Needs to exercise and movement the need for mental integrity Decreasing negative emotions and feelings Needs for promoting psychological health the need for social presence Needs for facilitating the social presence of patients Needs for increasing interactions the need for receiving social support Needs for supporting family and surroundings Needs for increasing social supportive resources the need for resorting to spiritual beliefs and practices Religious beliefs Needs for communication with God Praying Needs for spiritual support 3 − 1. The need for physical comfort Participants reported increasing physical problems and complications as the cancer advanced. They thus reported needs of pain relief, infection control, a fitting nutrition program, exercise, and mobility for comfort and physical relaxation. All participants believed that pain relief was one of the most critical needs of the patients. With the progression of the disease and metastasis, the patients experienced exacerbated pain, so they had to use pain pumps, long-acting painkillers, herbal painkillers, or painkillers. Some patients reported favorable pain control experiences with opium and preferred it over injectable drugs, especially early in the disease. One pain specialist said: "We usually take painkillers inside the hospital for pain relief, including morphine. Some patients usually consume opium to reduce the pain inside the house. These patients are abundant, and it seems that opium is more effective for them". Infection control was also identified as an essential need of the patients. A 70-year-old man with lung cancer reported: "Our bodies are weak in terms of physical resistance. All of us need to be careful. I will not allow any client to visit me during my treatment because clients may make the environment more polluted". According to the participants, providers needs to consider the unique nutritional needs of the patients. A high-quality diet should be planned under the supervision of a nutritionist based on the patients' preferences and disease symptoms. A 46-year-old woman with a 4-year history of breast cancer said: "I get anorexia after chemotherapy. I cannot eat all the foods. They have to make certain foods for me". Participants believe that physical activity programs and specific exercises tailored to the patients' ability should be included in their treatment plan, because it promotes happiness, increased physical fitness, and improved treatment effects for patients. The experience of a 34-year-old woman with a 4-year history of cervical cancer was as follows: "Exercise is crucial for cancer patients; it helps us a lot. Every patient should exercise according to their abilities." 3 − 2. The need for mental integration Participants stated that patients experienced mental disruption following the awareness of cancer and the onset of its symptoms. They reported needs for both reducing the adverse feelings and emotions of patients and also enhancing their mental health. Participants emphasized that patients need to assistance with reducing negative emotions, including disappointment, fear, and anxiety. Experiences of a nurse were as follows: "These patients are more psychologically damaged than physically, especially early in the illness. ... We need to increase our communication with patients. We need to understand them. It should be a real understanding because the patient realizes it". According to the participants, promoting mental health was another prominent psychological need of the patients. Promoting mental health could include increased recreation, expert counseling and support, attending self-help groups, music therapy, occupational therapy, providing comfort and relaxation, patient and companion education, and team-based understanding. Some participants believed that the psychological needs of some patients were more pressing than their physical needs. Further, there was a belief that meeting psychological needs could also help to reduce the amount and severity of physical needs. The experiences of a woman with cancer were as follows: "A patient with cancer is ruining his whole psyche. Psychiatric problems can lead to the ruin of a human. We need much mental relief. ... For example, a psychologist can help a lot." 3–3. The need for social presence Participants believed that patients with cancer experience financial and occupational concerns. Employers should also collaborate to facilitate occupational activity commensurate with patients' abilities. There was also demand for increased presence in the community and the improvement of impaired social and family interactions. Participants reported a desire for providing patients with a social presence and enhancing their social interactions (especially with family, relatives, and friends). A 34-year-old woman with four years of ovarian cancer who underwent chemotherapy reported: "When I go out, everyone looks at me somehow. It is like seeing a strange person. I get very annoyed. ... I try not to get into the community." 3–4. The need for social support All participants highlighted the need for extensive support for cancer patients by family, community, government, and community members. There is a desire for families to support their patients emotionally and participate in caring for their patients. Patients consider the family an incentive to continue treatment. The experiences of one patient's companion (a 26-year man) were as the following: "My father needed us more after the illness. He would love to be with him. ... When we are with him, he seems to tolerate the disease and the treatment of the disease (chemotherapy) more efficiently." From the participants' point of view, patients also need increased sources of government support (e.g., financial support, access to chemotherapy and opiates, occupational support, appropriate insurance coverage) and support from other resources (e.g., associations and charities). They believed that collaboration and assistance between organizations could facilitate patients' conditions. The wife of a patient with metastatic lung cancer asserted: "The lack of chemotherapy drugs has raised the price of these drugs. We are boycotting the drug, and consequently, these drugs do not enter the country. At least, there should be exceptions in these cases. The government should support so that people can provide these drugs". 3–5. The need for resorting to spiritual beliefs and practices Following cancer, patients developed four types of spiritual needs, including religious beliefs, communication with God, worship, and spiritual support. In addition to gaining tranquility, participants believed that religious beliefs could positively impact the treatment of patients. Some participants reported that patients needed communication with God (trusting and closeness to God) and worship (prayer and religious rites), as these would enable the patients to accept illness and death, reduce psychological problems, and potentially cure the disease. Participants believed that spiritual support should be tailored to the patients' beliefs by an expert (e.g., clergy) and with the help of the treatment team. The experiences of the daughter of a patient with metastatic breast cancer were as follows: "She would get very restless, I read the Qoran, she would be reticent, and she would go to sleep without any pain. It was very effective. As if, when they are approaching God, they can understand their illness more easily. " 4. Discussion The study evaluated supportive care needs of Iranian cancer patients in palliative care. Included participants identified five major areas of focus: physical comfort, mental integration, social presence, receiving social support, and integrating spiritual beliefs and practices. Most patients had experienced at least one type of unmet physical need following diagnosis with cancer. The results of similar studies showed that cancer patients have many needs [ 28 – 32 ]. In most of these studies, researchers report pain as a major problem in cancer patients and emphasize the need for immediate relief of pain with painkillers [ 29 , 31 , 32 ]. This is in line with the results of the present study in which one of the most critical needs of these patients was pain relief. Some participants in the present study emphasized the use of inhaled opium as the first choice for pain relief, especially in the early stages of the disease. This preference has not been identified in previous studies [ 29 , 31 , 32 ]. There are several explanations for this unique pain relief preference of Iranian patients with cancer. First, the geographical location of Iran in the Middle East and the high prevalence of opioids in this area enable easy access, affordability, social acceptance of its use for pain relief, and the lack of need for it to be prescribed by health care providers. Future studies should replicate this finding. In addition to the need for pain relief, infection control was another essential need of the patients. This finding has been idenfied in several previous studies. Nies et al. [ 29 ] reported that patients were aware of their poor immune systems, so they adhered to infection control by banning visits in health centers and at home to prevent becoming ill. In the qualitative study of Irajpour et al.[ 33 ], participants reported infection control as an essential and necessary need of cancer patients. It is thus necessary to enforce infection control standards in cancer units, limit potential exposure through unncessesary appointments, and instruct patients, companions, and personnel to adhere to infection control practices. There is also a need for additional medical centers in Iran. The shortage of cancer facilities and standard treatment centers in most parts of Iran was a critical complaint of the participants of this study. Most patients had to go to Tehran to receive medical services, which resulted in some patients not following the treatment plan because of high financial costs and fear of infection. Considering the susceptibility of these patients to infection, particularly during epidemics such as Coronavirus, many of these patients also develop other infections, which further exacerbates their disease. Hence, it is required to create new medical centers and equip and standardize existing cancer-related centers across Iran. The participants in this study also identified a need for providers to address their unique nutritional needs. Other similar studies [ 30 – 32 , 34 ]. also reported findings consistent with the present study. In a qualitative study, Nies et al. [ 29 ] found that cancer and chemotherapy resulted in patients limiting their food intake to reduce gastrointestinal symptoms. The patients thus required a special diet to reduce gastrointestinal symptoms. Movahed et al. [ 1 ] revealed that more than half of Iranian cancer patients suffer from severe malnutrition; however, malnutrition was lower in patients also receiving palliative care. The researchers also documented that malnutrition was related to increased morbidity and mortality among these patients. Because of this increased risk of malnutrition among patients with cancer, treatment plans should integrate proper nutritional interventions. Participants also emphasized needs for exercise and mobility. Saunders and Brunet [ 28 ] reported that participation of cancer patients in physical activity programs has widespread public health benefits, including managing psychological concerns, maintaining functionality and quality of life, reducing the risk of complications, and improving treatment outcomes. Other studies have also reported exercise as an essential need of cancer patients [ 30 , 31 , 34 ]. In the present study, participants also reported various psychological needs. Patients endorsed needing to reduce their negative emotions, hopelessness, and fear, while also needing to promote mental health. Some activities they associated with improved mental health included recreation, counseling, support, self-help groups, music therapy, and occupational therapy. Participants also endorsed needs for instilling hope and optimism, providing comfort and welfare, educating patients and their companions, and treatment team-based understanding. In the context of the above needs, numerous studies have shown that training and providing sufficient information to patients can manage their concerns and improve their physical, psychological, and social outcomes [ 29 , 30 , 35 ]. In a qualitative study, Malone et al. [ 34 ] identified that psychological counseling, psychological support with medication and psychotherapy, group therapy, and giving comfort and morale are integral for reducing the psychological problems of patients with cancer. Another similar study emphasized the need for recreational programs, exercise, symptom management training, counseling, and psychological support by professionals and patients’ relatives for reducing mental health problems [ 31 ]. In the current study, some participants believed that psychological needs preceded the physical needs and that the occurrence and severity of their physical needs could be improved by reducing their psychological needs. This finding is not mentioned in other similar studies [ 29 – 31 , 34 , 35 ]. According to the findings of this research, it is essential for providers to address patients’ mental health concerns while also incorporating activities that will concurrently improve patients’ mental health. It is also necessary to identify and address the mental needs of patients immediately after diagnosis. In this regard, it is essential for there to be cooperation of the treatment team, family, community members, associations, and the government in providing holistic, comprehensive physical and mental health care to patients with cancer. The findings of the present study also indicate that patients with cancer need support from family, relatives, caregivers, and the community. Numerous studies have emphasized the need for comprehensive support of patients [ 29 , 31 ]. up until death [ 30 ], by the family, community, and health system. Wet et al. [ 31 ] emphasized the need for community and government support for patients. In the current study, participants also identified needs for improving interactions and maintaining presence in the community. Moghaddasi et al. [ 36 ] found that most patients with cancer experienced financial problems and disruption of patient-family interactions. In another qualitative study, Bayly et al. [ 30 ] reported that patients with cancer need social activities and opportunities for enhancing social interactions. These findings are in agreement with the results of the present study. Cancer patients require extensive support to adapt efficiently to their chronic illness. Patients with adequate support report easier tolerance of the disease, they feel less that they have reached the end of their life, and the disease has less recurrence [ 37 ]. Patients may feel more supported with an extensive network of social support, including family, government, community members, and treatment team. Patients should be encouraged to build this social network and participate in activities that will foster social engagement. In this investigation, participants complained about financial difficulties and inadequate access to drugs. Hence, patients considered the need for support and services supplied by the government and charities as a critical need that needed immediate addressing. Similarly, Soltani et al. [ 38 ] indicated that the most significant concern of cancer patients was related to the inadequate financial support received from supportive centers and charities. Finally, the present study identified four types of spiritual needs, including religious beliefs, communication with God, worship, and spiritual support appropriate to the cultural context. Further, participants endorsed that fulfullment of these needs enabled comfort and acceptance of illness and death by the patient. The treatment team, along with religious experts (religious clerics), should provide spiritual healing to patients. In a similar study, Moosavi et al. [ 35 ] reported that a spiritual care team comprised of physicians, nurses, clergy, social workers, and psychologists specializing in cancer patients should be formed to implement spiritual care at all levels of the hospital. Moghaddasi et al. [ 36 ] reported that participants endorsed the strengthening of religious beliefs and communication with God as a means of coping with cancer-related problems. Other studies have also introduced spirituality as a necessity for patients who believe in religion [ 34 , 36 ]. According to Malone et al. [ 34 ] spiritual support is related to better medical outcomes, improved quality of life, and can improve mental health outcomes. Strengths and limitations : There were numerous strengths of the current study. The study included participants from different groups, including patients, companions, and treatment team (i.e., pain specialists and nurses). The included patients were diagnosed with various types of cancer, which enabled a broad understanding of the needs of patients with cancer, not just patients with a specific type of cancer. We also continued participant recruitment until data saturation. Further, the Cancer Center affiliated with Tehran University of Medical Sciences is the scientific and clinical center of Iran, so cancer patients come to this center to receive services from all over the country. Hence, these patients represent a large community of patients in the country, which improves generalizability of the study findings. We also utilized in-depth interviews. However, there were a few study limitations. The participants were recruited using purposive sampling, so there was not randomized recruitment of participants. This may have limited the generalizability of the study findings. Patients in end of life care were unable to share their experiences. Implications for clinical : Study findings identfied various needs of patients with cancer that can be addressed using supportive and palliative care. Meeting these needs will require an interdisciplinary approach. Nurses, as central members of the healthcare team, play a vital role in responding to the needs of patients, and they can improve the quality of care by choosing care based on the individualized needs of their patients. Understanding supportive and palliative to meet the needs of patients with cancer should be incorporated into the training programs of nurses working in cancer departments. Conclusion The current study identified that patients with cancer in Iran have many supportive and palliative needs, including physical comfort, mental integrity, social presence, receiving social support, and comfort through spiritual beliefs and practices. Identifying and addressing these needs by health care personnel is essential for maintaining health and reducing problems in these patients. Therefore, comprehensive planning should be developed appropriate to the cultural, social, and religious context of these patients. Further research is needed to identify the palliative support needs of these patients and ways to respond to these needs in other geographical areas, cultures, and religions. Declarations Ethics approval and consent to participate: The present study was approved by the Research Ethics Committee of the Tehran University of Medical Sciences with the code of ethics (IR.TUMS.FNM.REC.1396.3240). The goals and methods used in the research were clearly explained to the participants. Written informed consent was obtained from all participants prior to study participation. Participants were assured of confidentiality and anonymity. Participants were informed of the voluntary nature of the research and the permissibility of withdrawal at any stage of the study without any consequences. The scheduling of interviews and interview locations were determined based on the preferences of the participants. Consent for publication: Not applicable. Availability of data and materials: Please contact the corresponding author for data availability. Competing interests The authors declare no competing interests. Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors Authors' contributions RN and ASh conceptualised and designed the research. RN, Ash, RHL and MT reviewed titles, abstracts and full-text papers for eligibility. RN and ASh were responsible for extracting data, and all data extraction was verified by RN. ASh prepared the initial draft manuscript. RN, ASh and RHL reviewed and edited the manuscript. Acknowledgments We want to thank the Research Vice-Chancellor of Tehran University of Medical Sciences and the Cancer Research Network for their financial and spiritual support and the cooperation of all participants in this research. References Bahnassy AA, Abdellateif MS, Zekri AN. 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Masoudi A JL, Roshandel G, Behnampour N, Khandoozi R, Hazini A et al . The supportive care needs of elderly patients with cancer in northern Iran (2018). J Gorgan Univ Med Sci. 2020; 21 (4) :93-99. URL: http://goums.ac.ir/journal/article-1-3561-fa.html. Borjalilu S SZ, Sabbagh-Bani-Azad M, Afzali M, Koochakzadeh L, Afzali M. The Information Needs of Parents of Children with Cancer: A Qualitative Study. J Qual Res Health Sci. 2017; 6(3): 228-37. https://jqr1.kmu.ac.ir/article_90896.html. Leilabady L NzF, Nazari Geirani M, Hosseini F. Patients with breast cancer and their needs. IJN. 2005; 17(40) :28-38URL: http://ijn.iums.ac.ir/article-1-33-fa.html. Graneheim UH, Lundma, B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24: 105-12. Saunders S, Brunet J. A qualitative study exploring what it takes to be physically active with a stoma after surgery for rectal cancer. Support Care Cancer. 2019 Apr;27(4):1481-1489. doi: 10.1007/s00520-018-4516-3 Nies YH, Ali AM, Abdullah N,et al. A qualitative study among breast cancer patients on chemotherapy: experiences and side-effects. Patient Prefer Adherence. 2018 Sep 28;12:1955-1964. doi: 10.2147/PPA.S168638 . Bayly J, Edwards, B.M., Peat, N., Warwick, G., Hennig, I.M., Arora, A., Maddocks, M. Developing an integrated rehabilitation model for thoracic cancer services: views of patients, informal carers and clinicians. Pilot Feasibility Stud. 2018; 4(160): 1-12. https://doi.org/10.1186/s40814-018-0350-0. de Wet R, Lane H, Tandon A, et al. 'It is a journey of discovery': living with myeloma. Support Care Cancer. 2019 Jul;27(7):2435-2442. doi: 10.1007/s00520-018-4502-9 . Chan CW, Cheng H, Au SK, et al. Living with chemotherapy-induced peripheral neuropathy: Uncovering the symptom experience and self-management of neuropathic symptoms among cancer survivors. Eur J Oncol Nurs. 2018 Oct;36:135-141. doi: 10.1016/j.ejon.2018.09.003 . Irajpour A, Alavi, M., Izadikhah, A. Situation Analysis and Designing an Interprofessional Curriculum for Palliative Care of the Cancer Patients. Iranian Journal of Medical Education. 2015; 14(2): 1040-1050. URL: http://ijme.mui.ac.ir/article-1-3356-en.html. Malone TC, Mennenga SE, Guss J, Podrebarac SK, Owens LT, Bossis AP, Belser AB, Agin-Liebes G, Bogenschutz MP, Ross S. Individual Experiences in Four Cancer Patients Following Psilocybin-Assisted Psychotherapy. Front Pharmacol. 2018 Apr 3;9:256. doi: 10.3389/fphar.2018.00256 . Moosavi S, Rohani C, Borhani F, et al. Factors affecting spiritual care practices of oncology nurses: a qualitative study. Support Care Cancer. 2019 Mar;27(3):901-909. doi: 10.1007/s00520-018-4378-8 . Moghaddasi J, Taleghani F, Moafi A, Malekian A, Keshvari M, Ilkhani M. Family interactions in childhood leukemia: an exploratory descriptive study. Support Care Cancer. 2018 Dec;26(12):4161-4168. doi: 10.1007/s00520-018-4289-8. Parsa-Yekta Z SH, Ramezanzade-Tabriz E, Yekaninejad M. Relationship between Emotional Needs and the Level of Self-Efficacy of Cancer Patients Admitted to Omid Hospital in Mashhad in 2014. JRUMS. 2016; 15 (8) :727-738. URL: http://journal.rums.ac.ir/article-1-3308-en.html. Soltani L, Khoshnood, Z. Social Support Needs in Patients with Cancer: A Qualitative Study. Middle East Journal of Cancer, 2021; 12(3): 429-438. doi: 10.30476/mejc.2021.83954.1210. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6250759","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452870526,"identity":"68fe838c-0606-49e8-a800-648333131b64","order_by":0,"name":"Reza Negarandeh","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Reza","middleName":"","lastName":"Negarandeh","suffix":""},{"id":452870527,"identity":"11911fc4-64e3-4372-8088-efbc286b7ec5","order_by":1,"name":"Afzal Shamsi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYDAC5gMMDA8YGBL4+ZsPMDA2EKOFLQGoHogkZxxLIFGLQUOOAXFa+NvYH35IYKjLM2A4803i5w4bOQb2w0c34NMicYwhWSKB4XCxOXPvNsneM2nGDDxpaTfwWnO/4QBQy4HEnQ1nt0nwth1ObJDgMcOrRf4YY/MPoMMSNxzIeSb5lxgtBseY2YC2MIO0sEkTZYvhMTY2C6BfEmfOOGZsLduWZsxGyC9yx9gf3/gAdFg/f/PDm2/bbOT42Q8fw+99EGD8B6ZYJEAkG0HlSID5AymqR8EoGAWjYOQAACgJTlO88l2BAAAAAElFTkSuQmCC","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Afzal","middleName":"","lastName":"Shamsi","suffix":""},{"id":452870528,"identity":"78fd5725-3375-485e-8f84-c1ca0e67b161","order_by":2,"name":"Mamak Tahmasebi","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mamak","middleName":"","lastName":"Tahmasebi","suffix":""},{"id":452870529,"identity":"e4a80229-6d92-40de-91f5-1390ac9201fe","order_by":3,"name":"Rebecca H Lehto","email":"","orcid":"","institution":"Michigan State University","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"H","lastName":"Lehto","suffix":""}],"badges":[],"createdAt":"2025-03-18 08:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6250759/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6250759/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101723274,"identity":"5c39392c-3db8-4ba4-a543-8993c64009a8","added_by":"auto","created_at":"2026-02-03 03:41:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":663514,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6250759/v1/25312d30-f86a-42e1-b4c3-5329fe89431f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clarification of Supportive and Palliative Needs of Iranian Patients with cancer: a Qualitative Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eCancer is an international public health problem affecting all nations, races, and social classes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The burden of cancer incidence and mortality is increasing worldwide. In 2020, there was an estimated 19.3\u0026nbsp;million new cancer cases. Further, the global prevalence is estimated to increase by 47% to 28.4\u0026nbsp;million cancer cases by 2040 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Concerningly, cancer is a leading cause of death, with approximately 1 in 6 deaths worldwide attributed to it in 2020 (i.e., 10\u0026nbsp;million deaths) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Iran, specifically, cancer incidence approximately doubled between 2000 to 2016, with a crude rate of 155 cases per 100,000 people in 2016 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCancer is associated with significant symptom burden and impaired quality of life. For instance, patients with cancer experience a wide range of physical, psychological, and social needs, including needs for health information, psychological care, and assistance with daily living [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Unfortunately, these needs often go unmet during traditional cancer treatment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A systematic review by Wang et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] identified emotional support, fatigue, and communication of side-effects of treatment as prominent unmet needs of patients with advanced cancer. Further, these unmet needs are associated with patients\u0026rsquo; quality of life, physical symptoms, and anxiety [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Supportive and palliative care can thus be utilized to address these unmet needs and assist patients with managing the difficulties of cancer diagnosis and treatment. Supportive and palliative care integrates therapies into cancer treatment to improve the quality of life of patients, with a focus on preventing and treating adverse symptoms and side-effects of treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Research has shown that accurately identifying patients' needs and resolving them through supportive and palliative care can increase life expectancy and improve quality of life [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Further, supportive and palliative care integration into cancer treatment planning has been found to relieve pain [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], allow patients to have more active and positive lives, integrate psychosocial and emotional dimensions of patient care [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and reduce medical errors [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the numerous benefits of supportive and palliative care, many patients who may benefit from supportive and palliative care services are unaware of them or are unable to access them due to lack of referral [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. According to the World Health Organization (2020), only 14% of patients in need of palliative care have access to it [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Further, the worldwide demand for palliative care will continue to expand as the population ages and the prevalence of non-communicable diseases increases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. There is thus a need for improved access to supportive and palliative care worldwide, especially in countries with a high proportion of patients at advanced stages of cancer, such as in third world countries [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Of the approximately 40\u0026nbsp;million people who need palliative care annually, 78% live in low- and middle-income countries, such as Iran [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough there is considerable need for supportive and palliative care in Iran, there are numerous barriers restricting access for patients who would benefit from it [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. One study of cancer patients in Iran reported that patients had limited knowledge of palliative care and considerable misinformation around its uses [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. There is also a shortage of providers who are able to provide supportive and palliative care in Iran. In 2015, Iran was ranked 78th of 80 in the global ranking of access to professionals trained to deliver palliative care [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBecause of this limited access to supportive and palliative care in Iran, there is a need for identifying the distinct needs of Iranian patients with cancer as a first step in addressing the barriers to accessing services and remedying the unmet needs of these patients. There has been considerable qualitative research conducted in Western countries to determine the supportive and palliative needs of patients with cancer. For example, Preisler et al [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. in Germany, Fjose et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] in Norway, Melhem et al [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. in Canada, Zeng et al [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. in China, and Boucher et al [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. in the United Statesn. There have also been a few studies in Iran adopting a quantitative approach to determine the needs of cancer patients. For instance, Masoudi et al [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. assessed the supportive care needs of elderly patients with cancer, while Borjalilu et al [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. examined the information needs of parents of children with cancer. Finally, Lilabadi et al [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. evaluated the self-reported needs of a sample of women with cancer. However, these studies were restricted to assessing the needs of patients or parents and did not take into consideration the perspectives of providers. Hence, to our knowledge, no qualitative research has comprehensively assessed the needs of Iranian patients with cancer through the perspectives of the treatment team, patients, and companions. The current study seeks to clarify the palliative and supportive needs of Iranian patients with cancer through the perspectives of patients, companions, and health providers.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Settings and participants\u003c/h2\u003e \u003cp\u003eThis study was conducted from October 2017 to November 2018. Participants (n\u0026thinsp;=\u0026thinsp;26) included patients with cancer (n\u0026thinsp;=\u0026thinsp;8), patient companions (n\u0026thinsp;=\u0026thinsp;9), and the patients\u0026rsquo; treatment team [ physicians (n\u0026thinsp;=\u0026thinsp;2) and nurses (n\u0026thinsp;=\u0026thinsp;7)]. Purposive sampling with maximum variation was used to recruit participants from healthcare centers affiliated with the Tehran University of Medical Sciences. Inclusion criteria for all participants included fluency in Persian. In addition, patients required a cancer diagnosis in order to participate. Treatment team members were included if they had attained 4\u0026thinsp;+\u0026thinsp;years of work experience in cancer wards. Exclusion criteria included patients and families with severe psychological problems (e.g., amnesia and Alzheimer's). Sampling was continued until data saturation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Data collection\u003c/h2\u003e \u003cp\u003eAdherence with the 32-item Consolidated Criteria for Reporting Qualitative (COREQ) was performed in the present study. Data were collected using in-depth semi-structured interviews. Interviews were recorded using a digital audio recorder. The professional staff were interviewed using the following general questions: \"What do cancer patients and their families need?\", \"What are challenges in this area?\", \u0026ldquo;What structure and facilities are available to meet these needs?\u0026rdquo;. Patients and their families were interviewed using the following questions: \"What needs do you have about your illness?\", \"What steps do you need to take to meet these needs?\" Also, some follow-up questions were asked, including \"Please explain more\", \u0026ldquo;What are your expectations?\u0026rdquo; \"When you say\u0026hellip; what do you mean?\", \"Did I understand right about what you said?\" Participants were asked to share their experiences and understanding of cancer-related needs. The interview continued to gain an in-depth understanding of the phenomenon under study. Interviews lasted between 40\u0026ndash;90 minutes depending on the interest and communicability of the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Data analysis\u003c/h2\u003e \u003cp\u003eParticipants' views and experiences were analyzed with content analysis using the Graneheim and Lundman method [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The text of each interview was first written on paper, and each interview was read several times for an overall understanding of the text. Then, the data were divided into semantic units and assigned a conceptual name (code). Repetitive codes were removed and then codes with the same concept were grouped and classes were formed. The codes of each interview were continually compared to other interviews until the subcategories and then the main categories were created. Data saturation occurred after 26 interviews.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data trustworthiness\u003c/h2\u003e \u003cp\u003eData validation was ensured using the proposed criteria of Guba and Lincoln [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The credibility of data was performed by the constant comparison of data and prolonged engagement with participants. The prolonged engagement with the participants and dedicated time to collecting data allowed for the research team to better understand the participants\u0026rsquo; experiences. The dependability of the data was verified using a member check technique. The confirmability of data was achieved through regular data collection and preservation of research documentation. Maximum variation sampling was used for data transferability.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eDemographic information of the study sample is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Patients were on average 52.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 years old, companions were 52.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 years old, and the treatment team was 52.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 years old. As summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, patients' needs were classified into five the main categories: \"physical comfort\", \"mental integration\", \"social presence\", \"receiving social support\", and \"using beliefs and spiritual practices\".\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpecifications of Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStatus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCompanions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTreatment team\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(66.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(55.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(44.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(88.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(77.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eCancer Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epelvis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Main Categories and Subcategories Obtained from the Participant's Experiences\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubcategories\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ethe need for physical comfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain relief\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfection control\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAttention to the unique nutritional needs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeeds to exercise and movement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ethe need for mental integrity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreasing negative emotions and feelings\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeeds for promoting psychological health\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ethe need for social presence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeeds for facilitating the social presence of patients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeeds for increasing interactions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ethe need for receiving social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeeds for supporting family and surroundings\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeeds for increasing social supportive resources\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ethe need for resorting to spiritual beliefs and practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReligious beliefs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeeds for communication with God\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePraying\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeeds for spiritual support\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e3 − 1. The need for physical comfort\u003c/h3\u003e\n\u003cp\u003eParticipants reported increasing physical problems and complications as the cancer advanced. They thus reported needs of pain relief, infection control, a fitting nutrition program, exercise, and mobility for comfort and physical relaxation.\u003c/p\u003e \u003cp\u003eAll participants believed that pain relief was one of the most critical needs of the patients. With the progression of the disease and metastasis, the patients experienced exacerbated pain, so they had to use pain pumps, long-acting painkillers, herbal painkillers, or painkillers. Some patients reported favorable pain control experiences with opium and preferred it over injectable drugs, especially early in the disease. One pain specialist said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We usually take painkillers inside the hospital for pain relief, including morphine. Some patients usually consume opium to reduce the pain inside the house. These patients are abundant, and it seems that opium is more effective for them\".\u003c/em\u003e \u003c/p\u003e \u003cp\u003eInfection control was also identified as an essential need of the patients. A 70-year-old man with lung cancer reported:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Our bodies are weak in terms of physical resistance. All of us need to be careful. I will not allow any client to visit me during my treatment because clients may make the environment more polluted\".\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAccording to the participants, providers needs to consider the unique nutritional needs of the patients. A high-quality diet should be planned under the supervision of a nutritionist based on the patients' preferences and disease symptoms. A 46-year-old woman with a 4-year history of breast cancer said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I get anorexia after chemotherapy. I cannot eat all the foods. They have to make certain foods for me\".\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants believe that physical activity programs and specific exercises tailored to the patients' ability should be included in their treatment plan, because it promotes happiness, increased physical fitness, and improved treatment effects for patients. The experience of a 34-year-old woman with a 4-year history of cervical cancer was as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Exercise is crucial for cancer patients; it helps us a lot. Every patient should exercise according to their abilities.\"\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003e3 − 2. The need for mental integration\u003c/h3\u003e\n\u003cp\u003eParticipants stated that patients experienced mental disruption following the awareness of cancer and the onset of its symptoms. They reported needs for both reducing the adverse feelings and emotions of patients and also enhancing their mental health.\u003c/p\u003e \u003cp\u003e Participants emphasized that patients need to assistance with reducing negative emotions, including disappointment, fear, and anxiety. Experiences of a nurse were as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"These patients are more psychologically damaged than physically, especially early in the illness. ... We need to increase our communication with patients. We need to understand them. It should be a real understanding because the patient realizes it\".\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAccording to the participants, promoting mental health was another prominent psychological need of the patients. Promoting mental health could include increased recreation, expert counseling and support, attending self-help groups, music therapy, occupational therapy, providing comfort and relaxation, patient and companion education, and team-based understanding. Some participants believed that the psychological needs of some patients were more pressing than their physical needs. Further, there was a belief that meeting psychological needs could also help to reduce the amount and severity of physical needs. The experiences of a woman with cancer were as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"A patient with cancer is ruining his whole psyche. Psychiatric problems can lead to the ruin of a human. We need much mental relief. ... For example, a psychologist can help a lot.\"\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003e3–3. The need for social presence\u003c/h3\u003e\n\u003cp\u003eParticipants believed that patients with cancer experience financial and occupational concerns. Employers should also collaborate to facilitate occupational activity commensurate with patients' abilities. There was also demand for increased presence in the community and the improvement of impaired social and family interactions. Participants reported a desire for providing patients with a social presence and enhancing their social interactions (especially with family, relatives, and friends). A 34-year-old woman with four years of ovarian cancer who underwent chemotherapy reported:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When I go out, everyone looks at me somehow. It is like seeing a strange person. I get very annoyed. ... I try not to get into the community.\"\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003e3–4. The need for social support\u003c/h3\u003e\n\u003cp\u003eAll participants highlighted the need for extensive support for cancer patients by family, community, government, and community members. There is a desire for families to support their patients emotionally and participate in caring for their patients. Patients consider the family an incentive to continue treatment. The experiences of one patient's companion (a 26-year man) were as the following:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My father needed us more after the illness. He would love to be with him. ... When we are with him, he seems to tolerate the disease and the treatment of the disease (chemotherapy) more efficiently.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFrom the participants' point of view, patients also need increased sources of government support (e.g., financial support, access to chemotherapy and opiates, occupational support, appropriate insurance coverage) and support from other resources (e.g., associations and charities). They believed that collaboration and assistance between organizations could facilitate patients' conditions.\u003c/p\u003e \u003cp\u003eThe wife of a patient with metastatic lung cancer asserted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The lack of chemotherapy drugs has raised the price of these drugs. We are boycotting the drug, and consequently, these drugs do not enter the country. At least, there should be exceptions in these cases. The government should support so that people can provide these drugs\".\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003e3–5. The need for resorting to spiritual beliefs and practices\u003c/h3\u003e\n\u003cp\u003eFollowing cancer, patients developed four types of spiritual needs, including religious beliefs, communication with God, worship, and spiritual support. In addition to gaining tranquility, participants believed that religious beliefs could positively impact the treatment of patients. Some participants reported that patients needed communication with God (trusting and closeness to God) and worship (prayer and religious rites), as these would enable the patients to accept illness and death, reduce psychological problems, and potentially cure the disease. Participants believed that spiritual support should be tailored to the patients' beliefs by an expert (e.g., clergy) and with the help of the treatment team.\u003c/p\u003e \u003cp\u003eThe experiences of the daughter of a patient with metastatic breast cancer were as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"She would get very restless, I read the Qoran, she would be reticent, and she would go to sleep without any pain. It was very effective. As if, when they are approaching God, they can understand their illness more easily. \"\u003c/em\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e The study evaluated supportive care needs of Iranian cancer patients in palliative care. Included participants identified five major areas of focus: physical comfort, mental integration, social presence, receiving social support, and integrating spiritual beliefs and practices.\u003c/p\u003e \u003cp\u003eMost patients had experienced at least one type of unmet physical need following diagnosis with cancer. The results of similar studies showed that cancer patients have many needs [\u003cspan additionalcitationids=\"CR29 CR30 CR31\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e–\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In most of these studies, researchers report pain as a major problem in cancer patients and emphasize the need for immediate relief of pain with painkillers [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This is in line with the results of the present study in which one of the most critical needs of these patients was pain relief. Some participants in the present study emphasized the use of inhaled opium as the first choice for pain relief, especially in the early stages of the disease. This preference has not been identified in previous studies [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. There are several explanations for this unique pain relief preference of Iranian patients with cancer. First, the geographical location of Iran in the Middle East and the high prevalence of opioids in this area enable easy access, affordability, social acceptance of its use for pain relief, and the lack of need for it to be prescribed by health care providers. Future studies should replicate this finding.\u003c/p\u003e \u003cp\u003eIn addition to the need for pain relief, infection control was another essential need of the patients. This finding has been idenfied in several previous studies. Nies et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] reported that patients were aware of their poor immune systems, so they adhered to infection control by banning visits in health centers and at home to prevent becoming ill. In the qualitative study of Irajpour et al.[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], participants reported infection control as an essential and necessary need of cancer patients. It is thus necessary to enforce infection control standards in cancer units, limit potential exposure through unncessesary appointments, and instruct patients, companions, and personnel to adhere to infection control practices.\u003c/p\u003e \u003cp\u003eThere is also a need for additional medical centers in Iran. The shortage of cancer facilities and standard treatment centers in most parts of Iran was a critical complaint of the participants of this study. Most patients had to go to Tehran to receive medical services, which resulted in some patients not following the treatment plan because of high financial costs and fear of infection. Considering the susceptibility of these patients to infection, particularly during epidemics such as Coronavirus, many of these patients also develop other infections, which further exacerbates their disease. Hence, it is required to create new medical centers and equip and standardize existing cancer-related centers across Iran.\u003c/p\u003e \u003cp\u003eThe participants in this study also identified a need for providers to address their unique nutritional needs. Other similar studies [\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e–\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. also reported findings consistent with the present study. In a qualitative study, Nies et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] found that cancer and chemotherapy resulted in patients limiting their food intake to reduce gastrointestinal symptoms. The patients thus required a special diet to reduce gastrointestinal symptoms. Movahed et al. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] revealed that more than half of Iranian cancer patients suffer from severe malnutrition; however, malnutrition was lower in patients also receiving palliative care. The researchers also documented that malnutrition was related to increased morbidity and mortality among these patients. Because of this increased risk of malnutrition among patients with cancer, treatment plans should integrate proper nutritional interventions.\u003c/p\u003e \u003cp\u003eParticipants also emphasized needs for exercise and mobility. Saunders and Brunet [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] reported that participation of cancer patients in physical activity programs has widespread public health benefits, including managing psychological concerns, maintaining functionality and quality of life, reducing the risk of complications, and improving treatment outcomes. Other studies have also reported exercise as an essential need of cancer patients [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, participants also reported various psychological needs. Patients endorsed needing to reduce their negative emotions, hopelessness, and fear, while also needing to promote mental health. Some activities they associated with improved mental health included recreation, counseling, support, self-help groups, music therapy, and occupational therapy. Participants also endorsed needs for instilling hope and optimism, providing comfort and welfare, educating patients and their companions, and treatment team-based understanding. In the context of the above needs, numerous studies have shown that training and providing sufficient information to patients can manage their concerns and improve their physical, psychological, and social outcomes [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In a qualitative study, Malone et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] identified that psychological counseling, psychological support with medication and psychotherapy, group therapy, and giving comfort and morale are integral for reducing the psychological problems of patients with cancer. Another similar study emphasized the need for recreational programs, exercise, symptom management training, counseling, and psychological support by professionals and patients’ relatives for reducing mental health problems [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In the current study, some participants believed that psychological needs preceded the physical needs and that the occurrence and severity of their physical needs could be improved by reducing their psychological needs. This finding is not mentioned in other similar studies [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e–\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. According to the findings of this research, it is essential for providers to address patients’ mental health concerns while also incorporating activities that will concurrently improve patients’ mental health. It is also necessary to identify and address the mental needs of patients immediately after diagnosis. In this regard, it is essential for there to be cooperation of the treatment team, family, community members, associations, and the government in providing holistic, comprehensive physical and mental health care to patients with cancer.\u003c/p\u003e \u003cp\u003eThe findings of the present study also indicate that patients with cancer need support from family, relatives, caregivers, and the community. Numerous studies have emphasized the need for comprehensive support of patients [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. up until death [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], by the family, community, and health system. Wet et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] emphasized the need for community and government support for patients. In the current study, participants also identified needs for improving interactions and maintaining presence in the community. Moghaddasi et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] found that most patients with cancer experienced financial problems and disruption of patient-family interactions. In another qualitative study, Bayly et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] reported that patients with cancer need social activities and opportunities for enhancing social interactions. These findings are in agreement with the results of the present study. Cancer patients require extensive support to adapt efficiently to their chronic illness. Patients with adequate support report easier tolerance of the disease, they feel less that they have reached the end of their life, and the disease has less recurrence [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Patients may feel more supported with an extensive network of social support, including family, government, community members, and treatment team. Patients should be encouraged to build this social network and participate in activities that will foster social engagement.\u003c/p\u003e \u003cp\u003eIn this investigation, participants complained about financial difficulties and inadequate access to drugs. Hence, patients considered the need for support and services supplied by the government and charities as a critical need that needed immediate addressing. Similarly, Soltani et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] indicated that the most significant concern of cancer patients was related to the inadequate financial support received from supportive centers and charities.\u003c/p\u003e \u003cp\u003eFinally, the present study identified four types of spiritual needs, including religious beliefs, communication with God, worship, and spiritual support appropriate to the cultural context. Further, participants endorsed that fulfullment of these needs enabled comfort and acceptance of illness and death by the patient. The treatment team, along with religious experts (religious clerics), should provide spiritual healing to patients. In a similar study, Moosavi et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] reported that a spiritual care team comprised of physicians, nurses, clergy, social workers, and psychologists specializing in cancer patients should be formed to implement spiritual care at all levels of the hospital. Moghaddasi et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] reported that participants endorsed the strengthening of religious beliefs and communication with God as a means of coping with cancer-related problems. Other studies have also introduced spirituality as a necessity for patients who believe in religion [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. According to Malone et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] spiritual support is related to better medical outcomes, improved quality of life, and can improve mental health outcomes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStrengths and limitations\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThere were numerous strengths of the current study. The study included participants from different groups, including patients, companions, and treatment team (i.e., pain specialists and nurses). The included patients were diagnosed with various types of cancer, which enabled a broad understanding of the needs of patients with cancer, not just patients with a specific type of cancer. We also continued participant recruitment until data saturation. Further, the Cancer Center affiliated with Tehran University of Medical Sciences is the scientific and clinical center of Iran, so cancer patients come to this center to receive services from all over the country. Hence, these patients represent a large community of patients in the country, which improves generalizability of the study findings. We also utilized in-depth interviews.\u003c/p\u003e \u003cp\u003eHowever, there were a few study limitations. The participants were recruited using purposive sampling, so there was not randomized recruitment of participants. This may have limited the generalizability of the study findings. Patients in end of life care were unable to share their experiences.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplications for clinical\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eStudy findings identfied various needs of patients with cancer that can be addressed using supportive and palliative care. Meeting these needs will require an interdisciplinary approach. Nurses, as central members of the healthcare team, play a vital role in responding to the needs of patients, and they can improve the quality of care by choosing care based on the individualized needs of their patients. Understanding supportive and palliative to meet the needs of patients with cancer should be incorporated into the training programs of nurses working in cancer departments.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eThe current study identified that patients with cancer in Iran have many supportive and palliative needs, including physical comfort, mental integrity, social presence, receiving social support, and comfort through spiritual beliefs and practices. Identifying and addressing these needs by health care personnel is essential for maintaining health and reducing problems in these patients. Therefore, comprehensive planning should be developed appropriate to the cultural, social, and religious context of these patients. Further research is needed to identify the palliative support needs of these patients and ways to respond to these needs in other geographical areas, cultures, and religions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was approved by the Research Ethics Committee of the Tehran University of Medical Sciences with the code of ethics (IR.TUMS.FNM.REC.1396.3240). The goals and methods used in the research were clearly explained to the participants. Written informed consent was obtained from all participants prior to study participation. Participants were assured of confidentiality and anonymity. Participants were informed of the voluntary nature of the research and the permissibility of withdrawal at any stage of the study without any consequences. The scheduling of interviews and interview locations were determined based on the preferences of the participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePlease contact the corresponding author for data availability.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRN and ASh conceptualised and designed the research. RN, Ash, RHL and MT reviewed titles, abstracts and full-text papers for eligibility. RN and ASh were responsible for extracting data, and all data extraction was verified by RN. ASh prepared the initial draft manuscript. RN, ASh and RHL reviewed and edited the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe want to thank the Research Vice-Chancellor of Tehran University of Medical Sciences and the Cancer Research Network for their financial and spiritual support and the cooperation of all participants in this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBahnassy AA, Abdellateif MS, Zekri AN. Cancer in Africa: Is It a Genetic or Environmental Health Problem? Front Oncol. 2020 Dec 14;10:604214. doi: 10.3389/fonc.2020.604214.\u003c/li\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, et al. 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J Palliat Med. 2012 Aug;15(8):923-30. doi: 10.1089/jpm.2011.0217 .\u003c/li\u003e\n\u003cli\u003eGuidance on the adaptation of clinical practice guidelines. getting evidence into practice. Dublin: National Council for the Professional Development of Nursing and Midwifery. 2013. \u003c/li\u003e\n\u003cli\u003eBittencourt NCCM, Duarte SDCM, Marcon SS, Chagas MC, Telles AC, S\u0026aacute; EMCDS, Silva MMD. Patient Safety in Palliative Care at the End of Life from the Perspective of Complex Thinking. Healthcare (Basel). 2023 Jul 15;11(14):2030. doi: 10.3390/healthcare11142030. \u003c/li\u003e\n\u003cli\u003eHorton R. A milestone for palliative care and pain relief. Lancet. 2018 Apr 7;391(10128):1338-1339. doi: 10.1016/S0140-6736(17)32560-6 .\u003c/li\u003e\n\u003cli\u003eRassouli M, Sajjadi M. Palliative Care in Iran: Moving Toward the Development of Palliative Care for Cancer. Am J Hosp Palliat Care. 2016 Apr;33(3):240-4. doi: 10.1177/1049909114561856 .\u003c/li\u003e\n\u003cli\u003eAtena D, Imane B, Maryam R, et al. The level of knowledge about palliative care in Iranian patients with cancer. BMC Palliat Care. 2022 Mar 10;21(1):33. doi: 10.1186/s12904-022-00920-9.\u003c/li\u003e\n\u003cli\u003eAbarshi E PT, et al. The 2015 quality of death index, ranking palliative care across the world. The Economist Intelligence Unit. 2015:1-72. https://www.basw.co.uk/resources/2015-quality-death-index-ranking-palliative-care-across-world.\u003c/li\u003e\n\u003cli\u003ePreisler M, Rohrmoser A, Goerling U, et al. Early palliative care for those who care: A qualitative exploration of cancer caregivers\u0026apos; information needs during hospital stays. Eur J Cancer Care (Engl). 2019 Mar;28(2):e12990. doi: 10.1111/ecc.12990 .\u003c/li\u003e\n\u003cli\u003eFjose M, Eilertsen G, Kirkevold M, Grov EK. \u0026quot;Non-palliative care\u0026quot; - a qualitative study of older cancer patients\u0026apos; and their family members\u0026apos; experiences with the health care system. BMC Health Serv Res. 2018 Sep 29;18(1):745. doi: 10.1186/s12913-018-3548-1.\u003c/li\u003e\n\u003cli\u003eMelhem D, Daneault S. Needs of cancer patients in palliative care during medical visits: Qualitative study. Can Fam Physician. 2017 Dec;63(12):e536-e542. PMID: 29237650; PMCID: PMC5729158.\u003c/li\u003e\n\u003cli\u003eZeng Y, Cheng AS, Liu X, Chan CC. Cervical cancer survivors\u0026apos; perceived cognitive complaints and supportive care needs in mainland China: a qualitative study. BMJ Open. 2017 Jun 22;7(6):e014078. doi: 10.1136/bmjopen-2016-014078 .\u003c/li\u003e\n\u003cli\u003eBoucher NA, Johnson, K.S., LeBlanc, T.W. Acute Leukemia Patients\u0026apos; Needs: Qualitative Findings and Opportunities for Early Palliative Care. J Pain Symptom Manage. 2018; 55(2): 433-439. doi: 10.1016/j.jpainsymman.2017.09.014 . \u003c/li\u003e\n\u003cli\u003eMasoudi A JL, Roshandel G, Behnampour N, Khandoozi R, Hazini A et al . The supportive care needs of elderly patients with cancer in northern Iran (2018). J Gorgan Univ Med Sci. 2020; 21 (4) :93-99. URL: http://goums.ac.ir/journal/article-1-3561-fa.html.\u003c/li\u003e\n\u003cli\u003eBorjalilu S SZ, Sabbagh-Bani-Azad M, Afzali M, Koochakzadeh L, Afzali M. The Information Needs of Parents of Children with Cancer: A Qualitative Study. J Qual Res Health Sci. 2017; 6(3): 228-37. https://jqr1.kmu.ac.ir/article_90896.html. \u003c/li\u003e\n\u003cli\u003eLeilabady L NzF, Nazari Geirani M, Hosseini F. Patients with breast cancer and their needs. IJN. 2005; 17(40) :28-38URL: http://ijn.iums.ac.ir/article-1-33-fa.html.\u003c/li\u003e\n\u003cli\u003eGraneheim UH, Lundma, B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24: 105-12.\u003c/li\u003e\n\u003cli\u003eSaunders S, Brunet J. A qualitative study exploring what it takes to be physically active with a stoma after surgery for rectal cancer. Support Care Cancer. 2019 Apr;27(4):1481-1489. doi: 10.1007/s00520-018-4516-3 \u003c/li\u003e\n\u003cli\u003eNies YH, Ali AM, Abdullah N,et al. A qualitative study among breast cancer patients on chemotherapy: experiences and side-effects. Patient Prefer Adherence. 2018 Sep 28;12:1955-1964. doi: 10.2147/PPA.S168638 .\u003c/li\u003e\n\u003cli\u003eBayly J, Edwards, B.M., Peat, N., Warwick, G., Hennig, I.M., Arora, A., Maddocks, M. Developing an integrated rehabilitation model for thoracic cancer services: views of patients, informal carers and clinicians. Pilot Feasibility Stud. 2018; 4(160): 1-12. https://doi.org/10.1186/s40814-018-0350-0. \u003c/li\u003e\n\u003cli\u003ede Wet R, Lane H, Tandon A, et al. \u0026apos;It is a journey of discovery\u0026apos;: living with myeloma. Support Care Cancer. 2019 Jul;27(7):2435-2442. doi: 10.1007/s00520-018-4502-9 .\u003c/li\u003e\n\u003cli\u003eChan CW, Cheng H, Au SK, et al. Living with chemotherapy-induced peripheral neuropathy: Uncovering the symptom experience and self-management of neuropathic symptoms among cancer survivors. Eur J Oncol Nurs. 2018 Oct;36:135-141. doi: 10.1016/j.ejon.2018.09.003 .\u003c/li\u003e\n\u003cli\u003eIrajpour A, Alavi, M., Izadikhah, A. Situation Analysis and Designing an Interprofessional Curriculum for Palliative Care of the Cancer Patients. Iranian Journal of Medical Education. 2015; 14(2): 1040-1050. URL: http://ijme.mui.ac.ir/article-1-3356-en.html. \u003c/li\u003e\n\u003cli\u003eMalone TC, Mennenga SE, Guss J, Podrebarac SK, Owens LT, Bossis AP, Belser AB, Agin-Liebes G, Bogenschutz MP, Ross S. Individual Experiences in Four Cancer Patients Following Psilocybin-Assisted Psychotherapy. Front Pharmacol. 2018 Apr 3;9:256. doi: 10.3389/fphar.2018.00256 .\u003c/li\u003e\n\u003cli\u003eMoosavi S, Rohani C, Borhani F, et al. Factors affecting spiritual care practices of oncology nurses: a qualitative study. Support Care Cancer. 2019 Mar;27(3):901-909. doi: 10.1007/s00520-018-4378-8 .\u003c/li\u003e\n\u003cli\u003eMoghaddasi J, Taleghani F, Moafi A, Malekian A, Keshvari M, Ilkhani M. Family interactions in childhood leukemia: an exploratory descriptive study. Support Care Cancer. 2018 Dec;26(12):4161-4168. doi: 10.1007/s00520-018-4289-8. \u003c/li\u003e\n\u003cli\u003eParsa-Yekta Z SH, Ramezanzade-Tabriz E, Yekaninejad M. Relationship between Emotional Needs and the Level of Self-Efficacy of Cancer Patients Admitted to Omid Hospital in Mashhad in 2014. JRUMS. 2016; 15 (8) :727-738. URL: http://journal.rums.ac.ir/article-1-3308-en.html.\u003c/li\u003e\n\u003cli\u003eSoltani L, Khoshnood, Z. Social Support Needs in Patients with Cancer: A Qualitative Study. Middle East Journal of Cancer, 2021; 12(3): 429-438. doi: 10.30476/mejc.2021.83954.1210.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cancer, Palliative Care, qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-6250759/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6250759/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCancer is the serious concern of public health worldwide, leading to the problems and various needs of patients. The accurate recognition of patient's needs and finding a way to meet them result in increasing the longevity and improving the quality of patient's life. This qualitative study aimed to clarify the palliative and supportive needs of Iranian patients with cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study sample was selected using purposive sampling in healthcare centers affiliated with Tehran University of Medical Sciences. Participants (n\u0026thinsp;=\u0026thinsp;26) included eight patients with cancer, nine patient companions, two physicians, and seven nurses. Data were collected until data saturation using semi-structured in-depth interviews.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe supportive and palliative needs of individuals with cancer were differentiated into five principal sets: 1) physical comfort (five subclasses); 2) mental integration (two subclasses); 3) Social presence (two subclasses); 4) social support (two subclasses); and 5) beliefs and spiritual practices (four subclasses).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eStudy findings identified that patients with cancer have many supportive and palliative needs, including physical comfort, mental integration, social presence, social assistance, and attentiveness to beliefs and spiritual practices. Comprehensive planning, with consideration of cultural, social, and religious contexts, is necessary to meet the needs of these patients.\u003c/p\u003e","manuscriptTitle":"Clarification of Supportive and Palliative Needs of Iranian Patients with cancer: a Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 14:10:11","doi":"10.21203/rs.3.rs-6250759/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"41e9653f-d2bc-46f6-891c-a63e21c58b8d","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T03:40:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-08 14:10:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6250759","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6250759","identity":"rs-6250759","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}