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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 7 | Issue 1
Page Nos. 1-113

Online since Wednesday, December 11, 2019

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EDITORIAL  

Welcome Message from the New Editor-in-Chief p. 1
Winnie KW So
DOI:10.4103/apjon.apjon_58_19  PMID:31879676
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PERSPECTIVE Top

Improving the Care of Adult Cancer Survivors p. 2
Michael Jefford
DOI:10.4103/apjon.apjon_42_19  PMID:31879677
Internationally, there are growing numbers of cancer survivors. Survivors report a range of persistent symptoms and unmet needs, which are quite consistent, internationally. Current models of post-treatment survivorship care are suboptimal, and unsustainable given the number of survivors, and limited health workforce. The most appropriate model of care for an individual will depend on a range of patient, disease and treatment factors. Alternatives to traditional follow up have been evaluated including nurse led follow up, follow up led by a primary care physician and formalized models of shared care. There should be greater focus on implementation of proven models.
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REVIEW ARTICLE Top

Cancer Screening and Prevention in Lesbian, Gay, Bisexual, and Transgendered Community and Asian Lesbian, Gay, Bisexual, and Transgendered Members p. 6
Carolee Polek, Thomas Hardie
DOI:10.4103/apjon.apjon_46_19  PMID:31879678
Participation in cancer screening and prevention (cessation of or reduction in modifiable health risk behaviors) are the most effective methods of reducing cancer morbidity and mortality. Some members of the lesbian, gay, bisexual, and transgendered (LGBT) communities have not participated in screening for a variety of reasons which have been explored in the literature. Common and unique behavioral risks are also reviewed. Knowledge about Asian members of the LGBT community participation in cancer screening and prevention is limited. This paper reviews the current literature on participation and barriers to cancer screening and prevention for the LGBT community and provides some insights for the Asian LGBT subcommunity. Potential interventions that have been demonstrated to be effective are presented for potential implementation within nursing practice and practice settings. Suggestions for future research are also provided to enhance the care of the LGBT community.
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ORIGINAL ARTICLES Top

A Mixed-Method Study Examining Cancer Screening Uptake among South Asian Ethnic Minorities in Hong Kong p. 12
Winnie K.W. So, Bernard M.H. Law, Kai Chow Choi, Dorothy N.S. Chan, Carmen W.H. Chan
DOI:10.4103/apjon.apjon_36_19  PMID:31879679
Objective: Utilization of cancer screening is an effective means of cancer prevention. However, South Asian ethnic minorities in Western countries are reported to face barriers in cancer screening utilization, resulting in a low screening uptake by these individuals. The purpose of this mixed-method study is to assess the uptake rate of cancer screening among South Asian ethnic minorities in the Chinese Society of Hong Kong and to examine the factors affecting their participation in cancer screening. Methods: This study utilized a sequential mixed-method design, involving two phases. Following the implementation of a self-report survey among South Asian participants via an author-developed questionnaire with 1547 participants in Phase 1, a focus group interview was conducted with 34 participants in Phase 2 to assess the barriers to screening utilization. Convenience sampling was adopted to recruit participants at South Asian community centers in Phase 1, whereas purposive sampling was used for recruiting participants in Phase 2. Results: The findings revealed a low (<40%) uptake rate of cancer screening among the participants. Health illiteracy, language barrier, limited access to health information and screening services, and cultural issues were the major barriers to their cancer screening utilization. Conclusions: Our findings provided valuable information for both policymakers and health professionals to better understand the needs of ethnic minorities in Hong Kong. As cancer death rates can be lowered by early detection and primary preventive measures, health professionals should focus on the development of culture-specific interventions. Similarly, training the community health workers can strengthen the primary care system in enhancing knowledge on cancer, its prevention, and access to cancer screening services among local ethnic minorities.
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Exploring Complicity of Cervical Cancer Screening in Malawi: The Interplay of Behavioral, Cultural, and Societal Influences p. 18
Haeok Lee, Jasintha T Mtengezo, Deogwoon Kim, Mary Sue Makin, Younhee Kang, Address Malata, Joyce Fitzpatrick
DOI:10.4103/apjon.apjon_48_19  PMID:31879680
Objective: Cervical cancer is preventable, and early diagnosis is possible using low-cost technologies, but a scant number of women receive cancer screening in Malawi. This study aims to identify facilitators and barriers that influence the uptakes of cervical cancer screening behavior in Malawi. Methods: A rapid ethnographic approach with the goal of optimizing planning for a future intervention study was utilized. Data were collected from three focus groups and seven individual interviews with adults in their communities, stakeholders, and health-care providers. Results: Three categories (sociocultural influences, access to the health-care system, and individual factors) have emerged as facilitators or barriers to cervical cancer screening among Malawian women. The findings also showed that cervical cancer screening behavior is situated socially through cultural and health-care services of a given community. Conclusions: Cancer screenings are only sought when illness symptoms persist or worsen. Awareness and knowledge of cervical cancer and cervical cancer screening is low among both health-care providers and the general population. Health-care systems are donor driven and focus on a single disease, health-care access is the greatest challenge to cervical cancer screening, and health-care providers are not adequately prepared to work for rapid increase in the prevalence of cervical cancer. Integrating cervical cancer screening into the existing health-care system is sustainable way forward, and nurses prepared to handle cervical cancer management can play an essential role to promote cervical cancer screening in a health resource-constrained setting.
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Stress, Social Support, and Sexual Adjustment in Married Female Patients with Breast Cancer in Korea p. 28
Jiyoung Kim, Miyoung Jang
DOI:10.4103/apjon.apjon_31_19  PMID:31879681
Objective: This study identified the level of stress, social support, and sexual adjustment in married women with breast cancer in Korea. Methods: This study used a subgroup analysis, prospective, cross-sectional, and descriptive correlation design. Data were obtained using the perceived stress scale, multidimensional scale of perceived social support, and sexual adjustment subscale of the Korean version of the psychosocial adjustment to illness scale. From May 2015 to April 2016, 272 married female patients who had been diagnosed with breast cancer were recruited at a university hospital in Korea. Data were analyzed using SPSS Win 21.0. Results: The mean score of stress level was 17.53 ± 4.13, social support was 5.37 ± 1.07, and sexual adjustment was 6.36 ± 3.29. A significant positive correlation emerged between sexual adjustment and stress (r = 0.161, P = 0.008). Significant negative correlations were observed among sexual adjustment and family support (r = –0.177, P = 0.003) and friends' support (r = –0.205, P = 0.001). Conclusions: The assessment of stress level and social support may be used in planning sexual-adjustment interventions appropriate for married female breast cancer patients in Korea.
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Does Being A Cancer Patient or Family Caregiver of A Cancer Patient Affect Stem Cell Donation Awareness? p. 36
Gulcan Bagcivan, Nurten Ozen, Damla Bayrak, Fatma Ilknur Cinar
DOI:10.4103/apjon.apjon_22_19  PMID:31879682
Objective: One of the most difficult challenges regarding hematopoietic stem cell transplantation in Turkey is finding donors for allogeneic transplantation candidates who do not have related donors. This study aims to determine whether there is any difference in the awareness of stem cell donation and transplantation between cancer and noncancer patients and their family caregivers. In addition, this study aims to determine the awareness of stem cell donation and transplantation in the entire study population. Methods: This descriptive study was conducted in Turkey using a data collection form comprising questions about demographics, stem cell transplantations, donations, and medical history. On analyzing the research data, variables were expressed as mean ± standard deviation and as numbers (n) and percentages (%). The Chi-square and Fisher's exact tests were performed to evaluate differences among cancer and noncancer diagnosed patients and their family members. Results: A total of 192 patients and 169 family caregivers participated in the study. In comparison with noncancer patients, cancer patients showed more awareness on what stem cell transplantation is, how lifesaving it is, and how to donate stem cells. Similarly, the family caregivers of cancer patients were more aware of what stem cell transplantation is and how to donate stem cells. Conclusions: The results of this study showed that cancer patients and their families were more aware of stem cell donation and transplantation; however, most of the patients and families did not know enough about the national registry program and how to donate stem cells.
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Factors Affecting Stress Levels in Hospitalized Patients after Implementation of Fast.track Protocol in Hepatopancreatobiliary Surgery p. 44
Maria Kapritsou, Dimitrios P Korkolis, Margarita Giannakopoulou, Theodoros Katsoulas, Maria Bastaki, Evangelos A Konstantinou
DOI:10.4103/apjon.apjon_24_19  PMID:31879683
Objective: The objective was to explore factors affecting stress levels in hospitalized patients after implementation of fast-track (FT) protocol in hepatopancreatobiliary surgery. Methods: This was a prospective cross-sectional study, where 90 patients were included. Exploration of environmental postoperative stress levels was conducted by serum adrenocorticotropic hormone and cortisol levels, the Intensive Care Unit Environmental Stressor Scale, and three self-reported Numeric Analog Scale questions, with regard to emotional/stress level, specifically “How sad do you feel right now?” “How stressed do you feel right now?” and “How optimistic do you feel right now, about the future?” at 3 time points: (T1) Before surgery, (T2) the day of surgery, and (T3) the 3rd postoperative day. The trial profile is conformed according to the CONSORT guidelines. Statistical analysis was carried out by SPSS software version 22 (IBM SPSS software, Chicago, Illinois, USA) at a significance level of 0.05. Results: Serum cortisol T2levels were positively correlated with the day of removal the drainage tube (rho = 0.235, P = 0.027). Furthermore, serum cortisol T3levels were positively correlated with age and body mass index and negatively with the day of drainage tube removal (rho = 0.231, P = 0.028, rho = 0.235, P = 0.026, and rho = −0.279, P = 0.008, respectively). Conclusions: The findings of this study highlight that after evaluation of stress levels; nurses could interfere and reduce stress levels, knowing the factors which cause the increased stress levels, after the implementation of FT protocols.
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The Emergence of Breast Care Nursing in A Developing Nation: A Sri Lankan–Australian Training Partnership p. 49
Meagan E Brennan, Kim Kerin-Ayres, Suraj Perera, Sujatha Samarakoon
DOI:10.4103/apjon.apjon_40_19  PMID:31879684
Objective: In Sri Lanka, the incidence of breast cancer is increasing. Yet, Sri Lankan nurses have limited specialist education opportunities and no formal recognition of the breast care nurse (BCN) role to address this growing need. This project aimed to encourage the emergence of the BCN role in Sri Lanka by delivering a workshop for nurses to increase the knowledge and confidence in delivering breast cancer care. Methods: This project was initiated by Zonta, a nonprofit, service organization, in collaboration with the National Cancer Control Programme of the Ministry of Health, Nutrition and Indigenous Medicine, Sri Lanka. A 2-day intensive workshop was designed by a collaborative team of Australian and Sri Lankan health professionals and delivered in Colombo. Its effectiveness was evaluated by measuring the knowledge about breast cancer, confidence with clinical care, and satisfaction with the workshop. Results: Fifty nursing participants attended the workshop. Outcomes included a statistically significant increase in knowledge about breast cancer (P = 0.012) and confidence in clinical care (P < 0.003 for all aspects of confidence). All participants were highly satisfied with the workshop, agreeing that the content was relevant and that they developed new skills. Conclusions: Nurses in Sri Lanka have unmet needs for specialty training and education. A 2-day workshop can improve knowledge and confidence, with the potential to improve patient care and increase the recognition of the BCN role. Lessons learnt from the collaboration between the nongovernment and government partners provide a model for the development of specialist nursing education.
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Intervention Protocol: Technology-Based Psychosocial Motivation for Children with Cancer and Their Parents: A Randomized Trial p. 55
Zeynep Kisecik Sengul, Ebru Kilicarslan Toruner
DOI:10.4103/apjon.apjon_25_19  PMID:31879685
Objective: This experimental randomized controlled trial will be to examine the impact of a technology-based psychosocial motivation program on children and families who are being followed up on a diagnosis of cancer. Methods: The research is based on the “Transactional Model of Stress and Coping.” This study will be conducted on children with leukemia, aged 9–18 years, and their parents, who will be followed in the consolidation treatment phase in the hematology wards and outpatient clinic of a university hospital. Data collection will consist of the children's and parents' descriptive characteristic form, the Spielberger State Anxiety Inventory for Parents, the State-Trait Anxiety Inventory for Children, the Pediatric Cancer Coping Scale, the Pediatric Quality of Life Inventory, and process evaluation forms. A 10-week program will be implemented for the children in the intervention group through web-based training, coaching interviews and counseling via video mobile calls, mobile messages and children's stories, progressive muscle relaxation and breathing exercises, and imagination interventions. During the same period, parents will also receive web-based training, coaching sessions, counseling, mobile messages, and progressive muscle relaxation exercises. Results: It is thought that after the intervention the stress level of the child and the family will decrease, the coping skills of the children will improve, and their quality of life will increase. Conclusions: It is thought that the treatment process can be affected positively by providing psychosocial support to children and their families who receive cancer treatment.
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Psychometric Properties of the Persian Food-Life Questionnaire Short Form among Obese Breast Cancer Survivors p. 64
Babak Nejati, Chung-Ying Lin, Mark D Griffiths, Amir H Pakpour
DOI:10.4103/apjon.apjon_43_19  PMID:31879686
Objective: To assist weight control among women with breast cancer, improving their food attitudes may be an effective method. Therefore, the present study validated a short instrument assessing food attitudes (i.e., the Short Form of the Food-Life Questionnaire [FLQ-SF]) among Iranian women with breast cancer who are overweight. Methods: Women with breast cancer who were overweight (n = 493; mean ± standard deviation age = 52.3 ± 10.7 years) participated in the study. All of them completed the FLQ-SF, questions designed using the theory of planned behavior (TPB; including subjective norm, perceived behavioral control, and behavioral intention), and food frequency questionnaire (FFQ). Both classical test theory and Rasch models were used to examine the psychometric properties of the FLQ-SF. More specifically, the factorial structure of the FLQ-SF was assessed using confirmatory factor analysis (CFA), the item fit was examined using the Rasch model, and the concurrent validity was evaluated using the correlation between the FLQ-SF, TPB elements, and FFQ. Results: CFA results confirmed the Persian FLQ-SF has a five-factor structure. Rasch models indicated that all the FLQ-SF items fit in the construct of food attitudes. Significant correlations between FLQ-SF and other instruments (TPB elements and FFQ) supported the concurrent validity of the FLQ-SF. Conclusions: The psychometric findings of the present study demonstrated that Persian FLQ-SF is a reliable and valid instrument. Therefore, the Persian FLQ-SF can be applied to assess food attitudes among Iranian women with breast cancer who are overweight.
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Experience of Adolescent Survivors of Childhood Cancer about Self-Care Needs: A Content Analysis p. 72
Leila Valizadeh, Vahid Zamanzadeh, Akram Ghahremanian, Saeed Musavi, Masumeh Akbarbegloo, Fang-Yu Chou
DOI:10.4103/apjon.apjon_47_19  PMID:31879687
Objective: In cancer care management, patients or their family are usually responsible for continuing health care. Achieving this goal requires identification of their self-care needs. The purpose of this study is to explore the perception of self-care needs of adolescent cancer survivors. Methods: This study was conducted by the qualitative content analysis method. Participants were 19 adolescent childhood cancer survivors and six parents, nurses, physicians, and charity institution staff from children teaching hospitals in Iran. Participants were selected through purposeful sampling, and individual semistructured interviews were used for data collection. Graneheim and Lundman stages of content analysis were employed for data analysis. Data were managed with the MAXQDA10 software. Results: Content analysis revealed nine subcategories as follows: (1) nutritional protection, (2) prevention from infection, (3) prevention from physical damage, (4) control over cancer recurrence, (5) informational needs, (6) pain management, (7) releasing positive thoughts, (8) continuing routine life, and (9) family protection. The first six subthemes were related to protection against physical distress, and the final three ones were related to protection against psychological distress. These two categories form one theme: “protective self-care need” as an essential self-care need in adolescent cancer survivors. Conclusions: Pediatric and school health nurses can prepare strategies to meet these needs by providing effective informational and psychosocial supports, and healthcare providers are able to check periodically the status of survivors care to provide second or third level of care to prevent escalation and incidence of the adverse outcomes of the disease.
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Using Mixed-Methods Research to Study Coping Strategies among Colorectal Cancer Patients p. 81
Loai Abu Sharour, Omar AL Omari, Malakeh Z Malak, Ayman Bani Salameh, Dalal Yehia, Maha Subih, Mohammad Alrshoud
DOI:10.4103/apjon.apjon_20_19  PMID:31879688
Objective: The objective was to identify and understand the coping strategies of colorectal cancer (CRC) patients. Methods: A mixed-methods approach including quantitative and qualitative methods was used to collect data from Jordanian patients. In the quantitative phase, we aimed to determine the coping strategies employed in a representative sample (n = 200) of Jordanian adult patients with CRC using the Jalowiec Coping Scale. In the qualitative phase, we aimed to understand these coping strategies through an in-depth and detailed exploration. A sample of ten participants was chosen purposefully based on their coping score in the quantitative phase, and interviews were conducted. Quantitative data were analyzed using SPSS software version 23. Qualitative data were analyzed using directed content analysis. Results: Results from the quantitative phase indicated that evasive coping strategies were used predominantly, followed by confrontive coping strategies and optimistic coping strategies. In contrast, fatalistic and emotive coping strategies had the lowest scores. In addition, the results indicated that the total scores for the effectiveness of coping strategies ranged from 42 to 143, with a mean of 93.45 (standard deviation 13.67); higher scores reflected greater effectiveness. Content analysis in the qualitative phase identified three themes, and subcategories emerged, including perceived collaborative support, increased awareness of treatment, and internal power. Conclusions: CRC patients used different coping strategies to face the new challenge. Oncology nurses can play a pivotal role in enhancing these coping strategies through implementing multidisciplinary programs.
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Evaluation of Pain as a Fifth Vital Sign: Nurses' Opinions and Beliefs p. 88
Sevinç Kutluturkan, Aydan Eda Urvaylıoǧlu
DOI:10.4103/apjon.apjon_39_19  PMID:31879689
Objective: After the American Pain Society recognized pain as a fifth vital sign, many countries adopted similar pain screening approaches. The routine evaluation of pain has recently come to the agenda in Turkey, along with the important role played by nurses in pain evaluation, and hence, this study focuses on the opinions of nurses on the evaluation of pain as a fifth vital sign, their pain beliefs, and how their pain beliefs influence their opinions. Methods: This descriptive study was conducted in a City Hospital with the involvement of 223 nurses. A questionnaire and a Pain Beliefs Questionnaire were used for the collection of data, and the data were analyzed using descriptive statistics, and Mann–Whitney U-test, analysis of variance, and Kruskal–Wallis tests. Results: Of the respondent nurses, 31.8% of the nurses were working in medical inpatient clinics, and 56.5% stated that pain should not be evaluated as a fifth vital sign, giving the following reasons: if patients are in pain, they already report it (40.5%), and overwork and the lack of sufficient nurses (34.9%). There was no difference in the pain beliefs scores of the nurses who stated that pain should not be evaluated as a fifth vital sign (56.5%) and the scores of those who stated the opposite (43.5%) (P > 0.05). Conclusions: Most of the nurses do not think that pain should be evaluated as a fifth vital sign. Furthermore, the pain beliefs of nurses do not influence their opinions regarding the assessment of pain as a fifth vital sign.
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Cancer-Related Stigma and Depression in Cancer Patients in A Middle-Income Country p. 95
Medine Yilmaz, Gulcin Dissiz, Ayse Kurtulusoglu Usluoğlu, Sibel Iriz, Filiz Demir, Ahmet Alacacioglu
DOI:10.4103/apjon.apjon_45_19  PMID:31879690
Objective: The aim of the current study are to determine the depression levels of adult oncology patients in the cancer treatment phase and identify both cancer-related stigma and the factors affecting their depression levels. Methods: In this correlational study, 303 adult patients who had been treated at a medical outpatient clinic were surveyed using the convenience sampling method. The “questionnaire for measuring attitudes toward cancer – patient version,” a sociodemographic characteristics questionnaire, and the beck depression inventory were used. A multivariable linear regression model was used for the analysis. Results: The questionnaire and its subscale scores indicated a positive relationship between depression and attitudes toward cancer. The predictive variables for depression were “being younger than 40-year-old” and “feelings of social exclusion,” which accounted for 4% of the total variance. Four factors indicating negative attitudes toward cancer were “being more than 60-year-old,” “higher education,” “low income,” and “feelings of social exclusion,” which accounted for 11% of the total variance. Conclusions: Cancer-related stigma, which underlies patients' emotional and behavioral outlooks, should be reduced in cancer patients. Members of health teams should be sensitive to cancer-related stigma.
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Decision-Making about the Place of Death for Cancer Patients: A Concept Analysis p. 103
Yoko Minamiguchi
DOI:10.4103/apjon.apjon_38_19  PMID:31879691
Objective: The objective of the study was to conduct a concept analysis of “decision-making about the place of death for cancer patients” to develop a theoretical definition of the concept and identify its attributes, antecedents, and outcomes. Methods: The Rodgers' evolutionary model of concept analysis was used. A literature search for papers published from 2000 to 2017 was conducted using the keywords: “cancer,” “place,” “death,” and “decision-making” for the search of the electronic databases. Results: Thirty articles were selected for this analysis. As a result, five attributes, six antecedents, and five consequences were extracted. [options to choose as a place of death], [wishes of the patients themselves], [consideration of the burden on the family], [open discussions with other persons concerned], and [best choice according to circumstances] are considered to be the characteristics in the decision-making about the place of death for cancer patients. Conclusions: This concept is defined as “The best choice according to circumstances of the cancer patients among different options for a place of death, resulting from a careful evaluation of the wishes of these patients and the burden on the family, as well as through open discussions with other persons concerned.” Nurses need to assist patients discuss deaths with important others, such as family members, in making decisions about the place of death. Further studies are necessary to elucidate the details of the categories and relationships shown in the attributes in this study, investigating the actual conditions of the patients and their families.
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ERRATUM Top

Erratum: Physiological Factor Evaluation of the Warm Humidification of Anesthetic Gas Nursing Care p. 113

DOI:10.4103/apjon.apjon_60_19  PMID:31879692
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