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   Table of Contents - Current issue
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April-June 2019
Volume 6 | Issue 2
Page Nos. 101-205

Online since Thursday, January 31, 2019

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SPECIAL TOPIC ON SPIRITUAL CARE: EDITORIAL  

Spiritual Care for Cancer Patients p. 101
Yi-Hui Lee
DOI:10.4103/apjon.apjon_65_18  PMID:30931352
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SPECIAL TOPIC ON SPIRITUAL CARE: REVIEW ARTICLE Top

Interconnections: Spirituality, Spiritual Care, and Patient-Centered Care Highly accessed article p. 104
Barbara B Vincensi
DOI:10.4103/apjon.apjon_48_18  PMID:30931353
The interconnections of spirituality, spiritual care (SC), and patient-centered care (PCC) have implications for advanced practice nurses (APNs) and specialty care nurses (SNs) in their everyday practice. Spirituality has been identified as an inner resource for health, promoting hope, coping, and resilience during illness concerns; encouraging health promotion and maintenance; and improving patient outcomes. SC supports this inner resource and is provided by others. Systems can help facilitate SC by supporting the inter-personal relationships as well as transdisciplinary collaborations of PCC models. SC and PCC occur within inter-personal relationships and specific healthcare environments or systems when implementing them within a spirituality framework. This article provides a brief review on conceptual definitions of spirituality, SC, and PCC models and their relationship to each other within the inter-personal connections. Exploration of implementing such care in practice is presented. Search parameters for this review included manuscripts which provided conceptual as well as quantitative and qualitative research between 1990 and 2018, in English only, with keywords of spirituality, SC, PCC, nurse, nurse practitioner, APNs, and systems. Databases searched included CINHAL, Medline, PubMed, ALTA Religion, Psych-INFO, and Ovid. Articles included in this review were based on research of the above concepts as well as operationalizing the concepts into practice.
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SPECIAL TOPIC ON SPIRITUAL CARE: ORIGINAL ARTICLES Top

Patient Perspectives about Spirituality and Spiritual Care p. 111
Margaret I Fitch, Ruth Bartlett
DOI:10.4103/apjon.apjon_62_18  PMID:30931354
Objective: This study was undertaken to explore the perspectives regarding spirituality and spiritual care held by individuals with advanced disease. The aim was to gain a deeper understanding about their viewpoints surrounding spiritual care and the role of health-care professionals in providing such care. Methods: Sixteen individuals with advanced disease and a prognosis of <12 months underwent an in-depth interview. Transcripts were subjected to a qualitative descriptive analysis to identify salient content and themes. Results: Four overall themes were identified: Spirituality is personal, spiritual distress is about separation, spiritual care is about connecting, and conversations about spirituality must align with the patient's beliefs. Subthemes emphasized the individuality of spiritual expression, the potential for illness impacting spiritual beliefs, and the value of connections to one's spiritual community. Participants thought healthcare providers needed to be able to identify individuals who were experiencing a spiritual struggle, acknowledge the reality of that struggle, and connect the individual with the appropriate resource or person. Conclusions: Patients with advanced disease are likely to express their spirituality in unique ways. Being able to talk about their spiritual beliefs and doubts during illness without judgment was seen as a benefit to them. Healthcare providers ought to be able to identify those patients who require assistance in connecting to appropriate spiritual care resources.
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Evaluation of Health-Care Providers' Perception of Spiritual Care and the Obstacles to Its Implementation p. 122
Azam Shirinabadi Farahani, Maryam Rassouli, Nayereh Salmani, Leila Khanali Mojen, Moosa Sajjadi, Mehdi Heidarzadeh, Zeynab Masoudifar, Fateme Khademi
DOI:10.4103/apjon.apjon_69_18  PMID:30931355
Objective: Cancer patients face many health challenges, including spiritual issues. Therefore, an awareness of health-care providers' perspective on spiritual care provision is important. This study aimed to determine health-care providers' perception of spiritual care and to examine the individual barriers to its implementation in cancer patients. Methods: The present descriptive study included 136 physicians and nurses. The Spiritual Care Survey was used as a research tool. Data were analyzed through descriptive statistics using IBM SPSS Statistics for Windows, version 20.0. Results: In this study, 70.6% of the participants considered spiritual care to be influential in the patients' quality of life. However, 64.7% had received no spiritual care training, while 82.4% indicated a willingness to attend these courses. Regarding the obstacles to providing spiritual care, the highest and lowest scores, respectively, belonged to the lack of time and the person's reluctance to talk about spiritual issues. Conclusions: Spiritual care has not yet found its proper place in the care setting of Iran, and health-care team members do not have sufficient training to provide this kind of care despite their belief in its positive impact on patients' quality of life.
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Cultural Diversity and Spiritual/Religious Health Care of Patients with Cancer at the Dominican Republic p. 130
Héctor E Lopez-Sierra
DOI:10.4103/apjon.apjon_70_18  PMID:30931356
Objective: Noncommunicable diseases have become a global pandemic with disproportionately higher rates in low-and middle-income countries. Dominican Republic (DR) as a Latin Americans and Spanish-speaking Caribbean developing country shares a socioculturally distinctive spiritual and religious pattern. It underlines their attitudes, values, and belief systems, socioeconomic reality, and racial attitudes. Social sciences and religious studies suggest that a relationship between spirituality, religion, health-care services (Sp/Re-HCS), and cultural diversity exists. This article argues in favor of a descriptive historical analysis of that relationship. Methods: Systematic search of academic articles, abstracts, and conclusions published in Medline, EBSCO, PsycINFO (OVID), ATLA Religion Database, and Google Scholar was undertaken using a combination of English and Spanish relevant terms. The analysis of articles was examined through a historical background approach, a systematic review, and a content analysis. Results: A Roman Catholic organization, Voluntariado Jesús con los Niños Foundation, serves to cancer patients that have almost no financial protection. The Dominican Evangelical Church (DEC) founded in 1932 a medical service base at the International Hospital in Santo Domingo (IHSD). When the DR government developed medical services, the DEC closed the IHSD. Since then, there is no any DR Evangelical or Protestant organization that offers Sp/Re-HCS to cancer patients (S/R-HCSCP). Conclusions: This analysis suggests that a relationship between S/R-HCS and cultural diversity exists. In this sociohistorical analysis, the nonhomogeneous cultural distinctiveness of the Sp/Re-HCS has been demonstrated through the analytical description of the only one organization of S/R-HCSCP at DR.
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Consequences of Spiritual Care for Cancer Patients and Oncology Nurses: a Qualitative Study p. 137
Soolmaz Moosavi, Camelia Rohani, Fariba Borhani, Mohammad Esmaeel Akbari
DOI:10.4103/apjon.apjon_37_18  PMID:30931357
Objective: The nature of cancer increases the spiritual needs of patients and necessitates the provision of holistic care for them. By trying to meet the spiritual needs of patients, oncology nurses can help them adapt, gain inner peace, and develop positive thoughts and attitudes. This study aimed to explore the consequences of spiritual care for cancer patients and oncology nurses from the perspective of the patients, family members, nurses, and other health-care team members. Methods: The present qualitative study was conducted using conventional content analysis in 2016–2017. The data were collected through semi-structured deep interviews of the 18 participants. Results: The theme extracted from the data was “spiritual growth” and comprised the major categories of “nurse's spiritual development” and “patient's spiritual development.” There were three subcategories in the nurse's spiritual development and 11 subcategories in the patient's spiritual development. Conclusions: Spiritual care places the cancer patient and the oncology nurse on the path to spiritual growth. The achievement of peace by the patient and the nurse was a common consequence of spiritual care. It helps the nurse promote comfort and a sense of peace in the patient and eventually to obtain inner satisfaction. Considering the transcendental effects of spiritual care, a systematic plan should be devised to enhance sensitivity in oncology nurses and encourage them to make spiritual care a component of interventional plans.
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Spiritual Experiences of Women with Breast Cancer in Singapore: a Qualitative Study p. 145
M Kamala Devi, Karis Cheng Kin Fong
DOI:10.4103/apjon.apjon_77_18  PMID:30931358
Objective: Although there has been increasing emphasis on the importance of spirituality in patients with cancer, few studies have examined the spiritual experiences of an ethnically diverse sample of Asian women with breast cancer. The objective of this study was to examine the spiritual experiences of Singaporean women with breast cancer in the first year of diagnosis. Methods: A qualitative exploratory study design was used and data were gathered using individual semi-structured interviews. Purposive sampling selected the participants and data saturation sample size was reached after interviews with 28 participants. Data were analyzed using Braun and Clarke's thematic approach. Results: The participants were aged between 28 and 64 years and included women from the three major ethnic groups. The three themes that emerged from the data included transcendental experiences, meaning and purpose, and changing perspectives. Conclusions: This study informs that while spiritual needs are common, Singaporean women in their first year of the breast cancer diagnosis express spirituality in culturally specific ways. The clinical implications of the study emphasize the importance of addressing women's spiritual concerns, with attention to cultural differences so as to render holistic patient-centered care.
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EDITORIAL Top

National Consensus Project Clinical Practice Guidelines for Quality Palliative Care: Implications for Oncology Nursing p. 151
Betty Ferrell
DOI:10.4103/apjon.apjon_75_18  PMID:30931359
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REVIEW ARTICLES Top

Management of Immune-Related Adverse Events Associated with Immune Checkpoint Inhibitor Therapy: A Minireview of Current Clinical Guidelines p. 154
Saralinh Trinh, Alex Le, Sajida Gowani, Ninh M La-Beck
DOI:10.4103/apjon.apjon_3_19  PMID:30931360
Successful targeting and inhibition of the cytotoxic T-lymphocyte-associated antigen 4 and programmed cell death-1 protein/programmed cell death ligand 1 immune checkpoint pathways has led to a rapidly expanding repertoire of immune checkpoint inhibitors for the treatment of various cancers. The approved agents now include ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvalumab, avelumab, and cemiplimab. In addition to antitumor responses, immune checkpoint inhibition can lead to activation of autoreactive T-cells resulting in unique immune-related adverse events (irAEs). Therefore, it is imperative that oncology nurses, and other clinicians involved in the care of cancer patients, are familiar with the management of irAEs which differ significantly from the management of adverse events from cytotoxic chemotherapy. Herein, we review the mechanisms of irAEs and strategies for management of irAEs and highlight similarities as well as differences among clinical guidelines from the National Comprehensive Cancer Network, American Society of Clinical Oncology, Society for Immunotherapy of Cancer, and European Society for Medical Oncology. Understanding these similarities and key differences will facilitate the development and implementation of a practice site-specific plan for the management of irAEs.
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A Systematic Review: Mindfulness Intervention for Cancer-Related Pain p. 161
Srisuda Ngamkham, Janean E Holden, Ellen Lavoie Smith
DOI:10.4103/apjon.apjon_67_18  PMID:30931361
Moderate-to-severe pain is a common problem experienced by patients with cancer. Although analgesic drugs are effective, adverse side effects are common and some analgesic drugs are addictive. Nonpharmacological treatment may be a way to treat cancer pain without causing negative side effects. Mindfulness is used as an effective nonpharmacological treatment to improve quality of life (QoL) and to address psychological problems including distress, anxiety, stress, and depression. However, the effect of mindfulness on pain severity has not been sufficiently investigated. Therefore, a systematic review was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. The search was conducted in PubMed, Ovid MEDLINE, and CINAHL and included only empirical studies published from 2008 to 2017. Search terms included mindfulness, mindfulness-based intervention, meditation, cancer, pain, and cancer-related pain. Six studies met the search criteria. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL. However, most studies reviewed were conducted in the United States and Denmark. Further research is needed to test culturally appropriate mindfulness interventions to reduce pain.
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ORIGINAL ARTICLES Top

Association between Daily Life Difficulties and Acceptance of Disability in Cancer Survivors after Total Laryngectomy: a Cross-Sectional Survey p. 170
Noriko Teruya, Yoko Sunagawa, Takehiko Toyosato, Takao Yokota
DOI:10.4103/apjon.apjon_50_18  PMID:30931362
Objective: This study aimed to clarify the relationships between the acceptance of disability and daily life difficulties in patients after total laryngectomy. Methods: An anonymous questionnaire was mailed to 135 patients who were participating in a self-help group after laryngectomy. The questionnaire included items on personal attributes, daily life difficulties, and acceptance of disability according to the Nottingham Adjustment Scale – Japanese Laryngectomy version (NAS-J-L). Multiple regression analysis was conducted using the NAS-J-L acceptance of disability subscale score as the dependent variable and daily life difficulties as the independent variables. Results: Among the 57 respondents, 43 who provided valid answers were included in the analysis (41 men and 2 women; mean age = 67.5 ± 10.6 years). Acceptance of disability was significantly associated with difficulties in defecation (β = −0.409, P < 0.01) and breathing (β = −0.356, P < 0.05). Conclusions: Our findings suggested that difficulties in defecation and breathing due to airway alterations influence acceptance of disability after laryngectomy. Therefore, nurses should carefully assess daily life difficulties and patient's ability to perform self-care activities such as defecating and breathing to promote acceptance of disability and facilitate adaptation to daily life after total laryngectomy.
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Adaptation of the Sexuality Scale for Women with Gynecologic Cancer for Turkish Patients p. 177
Çigdem Marangoz, Ayten Demir, Eda Özge Yazgan
DOI:10.4103/apjon.apjon_49_18  PMID:30931363
Objective: Diagnosis and treatment of gynecologic cancers can have a negative impact on sexuality. Identification of sexual problems and concerns is key to enable appropriate management. Therefore, there is a need for a valid and reliable instrument for evaluating the sexuality of patients. This study aimed to adapt the sexuality scale for women with gynecologic cancer for Turkish patients with gynecologic cancer. Methods: A cross-sectional study of 150 volunteer patients with gynecologic cancer was undertaken in Turkey. The patients completed a semi-structured demographic data form and the sexuality scale for women with gynecologic cancer. We assessed the reliability, language accuracy, and content and construct validities of the Turkish version of the scale. Results: Exploratory and confirmatory factor analyses showed that the scale had four factors. In the exploratory factor analysis, seven items were discarded from the scale because their load values were <0.3. In the confirmatory factor analysis, the coefficients were higher than 0.3. The total Cronbach's α was 0.72. Conclusions: The sexuality scale for women with gynecologic cancer (Turkish version) is a valid and reliable instrument for evaluating the sexuality of Turkish patients with gynecologic cancer.
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Concerns and Returns to Work in Patients with Breast Cancer Receiving Outpatient Chemotherapy: a Pilot Study p. 187
Saori Tamura, Koichi Sakaguchi, Ryuya Yamanaka
DOI:10.4103/apjon.apjon_58_18  PMID:30931364
Objective: Breast cancer survivors are increasing in number among survivors of all types of cancer, and survivors returning to work are extremely important. The development of outpatient chemotherapy has increased the working population of patients undergoing cancer therapy. Consequently, a significant number of breast cancer survivors experience physical, psychological, and social problems. This study aimed to clarify differences in concerns among patients with breast cancer receiving outpatient chemotherapy according to their employment status. Methods: Twenty-eight patients with breast cancer undergoing outpatient chemotherapy were recruited. A questionnaire was used to survey the attributes, employment status, and levels of concern in these patients based on the Cancer-chemotherapy Concerns Rating Scale (CCRS). Data from three groups (employed full time, employed part-time, and unemployed) were analyzed using multiple comparison tests. Results: The patients' mean age was (55.1 ± 9.9) years. According to the CCRS findings, the following three parameters differed between the three groups: scores for the items “I always think about my disease” (employed vs. unemployed, P = 0.005) and “I can't work (housework/schoolwork)” (employed full time vs. part time, P = 0.045), and scores for the “self-existence” subscale (employed vs. unemployed, P = 0.024). Conclusions: This study revealed the characteristics of concerns in patients with breast cancer according to their employment status. Being able to continue working is considered to enhance the social health of these patients. Predicting concerns in employed patients will help gain perspective in early nursing interventions.
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Effectiveness of Mindfulness-Based Art Therapy on Healthy Quality of Life in Women with Breast Cancer p. 193
Zeinab Jalambadani, Abasalt Borji
DOI:10.4103/apjon.apjon_36_18  PMID:30931365
Objective: The purpose of this study was to determine the effectiveness of mindfulness-based art therapy (MBAT) in promoting quality of life in Neyshabur women with breast cancer. Methods: This study was an interventional design that was conducted on 124 women with breast cancer (any stage) in Iran 2018. One hundred and fourteen women with breast cancer were paired by age and randomized to either 12-week MBAT intervention group or a wait-list-control group. One hundred and fourteen women with breast cancer completed both the pre-and post-study measurements. As compared to the control group, the MBAT group demonstrated a significant decrease in symptoms of distress and significant improvements in key aspects of the health-related quality of life (as measured by the World Health Organization Quality-of-Life - BREF questionnaire). Results: The MBAT interventions had a significant effect on improving quality of life behaviors (P < 0.05). Among the dimensions of quality of life, the highest mean score was for subpsychological (18.14 ± 2.35), and the lowest score was achieved by the subdomains of social relationships (13.54 ± 1.12). The mean (standard deviation) scores of physical health and environment were 17.19 ± 3.55 and 16.10 ± 1.87, respectively. Conclusions: This investigation of MBAT provides initial encouraging data that support a possible future role for the intervention as a psychosocial option for decrease in symptoms of women with breast cancer and quality of life.
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Investigating the Effect of Self-Care Training on Life Expectancy and Quality of Life in Patients with Gastrointestinal Cancer under Radiotherapy p. 198
Davood Hekmatpou, Azadeh Nasiri, Fatholah Mohaghegh
DOI:10.4103/apjon.apjon_47_18  PMID:30931366
Objective: A huge amount of the efforts made by health teams is dedicated to caring for cancer patients. This study has aimed to investigate the effect of self-care training on life expectancy and quality of life (QOL) in patients with gastrointestinal cancer who were under radiotherapy. Methods: In this clinical trial, 50 patients were selected using the block randomization method. The intervention was performed at Ayatollah Khansari Hospital in Arak, Iran. The patients in the intervention group received three sessions of face-to-face training. The data collection tools included Schneider's Life Expectancy Questionnaire and EORTC QOLQ-C30. Data were analyzed by SPSS version 23. Results: In the control group, 16 were male (64%) and 9 female (36%), and in the intervention group, 14 were male (56%) and 11 were female (44%). Before the intervention, the two groups were homogenous regarding all variables. After the intervention, the mean of QOL was 67 ± 22.62 in the intervention group and 56 ± 18.55 in the control group (P < 0.05). In examining the different dimensions of QOL, improvement in all functional dimensions was observed in the intervention group. After the intervention, the mean score of life expectancy showed a significant difference (P < 0.05) between the intervention group (39.52 ± 5.26) and the control group (31.6 ± 7.13). Conclusions: It was found that self-care training improved the QOL and life expectancy of patients with gastrointestinal cancer who were under radiotherapy. Therefore, self-care training is recommended to improve the QOL and the life expectancy of cancer patients.
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