End‐of‐life trajectory of coping and self‐care of patients with idiopathic pulmonary fibrosis: A meta‐synthesis using meta‐ethnography

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Abstract
Aim: This study aimed to extract patient narratives regarding the end‐of‐life trajectory of their self‐care and coping experiences as patients with idiopathic pulmonary fibrosis and to use meta‐ethnography to discover common metaphors of their experience in order to inform the development of nursing interventions.Methods: A comprehensive search of qualitative research using electronic databases, in English and Japanese, regarding patients with IPF, identified four articles. The meta‐ethnography approach followed seven steps, which provided a synthesis of the phenomena from both comparative and cumulative analyses of the qualitative data.Results: Seven key concepts and metaphors were synthesized: (i) an extended period before obtaining a diagnosis (“Waiting for the other shoe to drop”); (ii) suffering as the pathway of illness (“Gloom and doom”); (iii) the burden of the symptoms and loss of independence (“Staggering under the load”); (iv) acceptance and living with the restrictions of home oxygen therapy (“A double‐edged sword”); (v) changes in the family role (“All in the same boat”); (vi) existential suffering (“Dead‐end streets and rays of hope”); and (vii) challenges to maintain independent living (“Making the best of it”). Reciprocal, refutational, and line‐of‐argument modes of synthesis revealed the relationships of the metaphors. Meta‐ethnography provided a mechanism for a cumulative knowledge base for necessary nursing interventions.Conclusions: The critical nursing interventions were: the relief of symptoms, particularly dyspnea and cough; coordinating lifestyle changes; providing psychological support for living with an illness beginning from the time of diagnosis; and carefully starting the end‐of‐life discussions with patients and families.

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