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The incidence of childhood cancers has been gradually rising worldwide. The rate of leukemia, which is the most common cancer type in childhood, has been increasing as well. In recent years, multiple chemotherapeutic agents, radiotherapy and bone marrow transplantation have been using in leukemia treatment. Children receiving treatment for leukemia may experience many symptoms due to the disease and its treatment. These concurrent symptoms may have a complex relationship. The aim of this paper is to review and compile current literature data related to symptom clusters used to explain multiple symptoms that occur in a complex structure due to leukemia and its treatment. Symptom clustering is used in oncology nursing to explain the complex relationship among multiple symptoms and to find out the effects that symptoms have on each other and patient outcomes. There are generally two statistical approaches to modeling symptom clusters. One is to establish the symptom clusters by grounding on clinical experiences, while the other is to establish them according to the results of statistical analysis and then clinical experiences. With the latter method, symptom clusters can be established more objectively and more number of symptoms can be assessed. In the literature, there are four instruments available for the measurement of a large number of symptoms in children. It is important to increase use of symptom clusters in nursing care for a better understanding of the relationship among multiple symptoms experienced during leukemia treatment, a more effective symptom management, and a more holistic care.

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In an environment in which evidence-based practice is the espoused norm, nurses have understandably sought to frame the knowledge they deem relevant to practice decisions, including the findings of their qualitative studies, as a form of evidence. However, since cancer patients face a significant challenge interpreting various evidence claims, it is important to recognize that the results of our qualitative studies reflect a different form of knowledge from that which an evidence-based practice definition of evidence presumes. Thus, we need to rethink our relationship to what qualitative studies offer to the evidentiary dialog. An approach to qualitative inquiry that derives from a nursing disciplinary logic model is, therefore, presented as an alternative means by which to generate the kinds of knowledge nurses need to practice and to gain expertise in clinical wisdom. Drawing on cancer communications research as an example, a nursing angle of vision on how best to use qualitative approaches to interpret evidence and inform practice emerges.

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Objective: The aim of this study was to compare toxicity and locoregional control of short duration hypofractionated (HF) radiotherapy (RT) with conventional RT in breast cancer patients. Methods: A total of 100 postmastectomy breast cancer patients were randomized for adjuvant RT in control group (comprising fifty patients who received the standard conventional dose of 50 Gy in 25 fractions with 2 Gy per fraction) and study group (comprising fifty patients who received HF RT with dose of 42.72 Gy in 16 fractions with 2.67 Gy per fraction). All patients were treated on linear accelerator with 3-dimensional conformal RT technique. Outcome was analyzed in terms of toxicity, tolerability, and locoregional control. Results: In the present study, at a median follow-up of 20 months, almost similar results were seen in both the groups in terms of toxicity, tolerability, and locoregional control. Adjuvant postmastectomy HF RT was found to be well tolerated with mild-to-moderate side effects that neither reached statistical significance nor warranted any treatment interruption/hospitalization. Conclusions: HF postmastectomy RT is comparable to conventional RT without evidence of higher adverse effects or inferior locoregional tumor control and has an added advantage of increased compliance because of short duration; hence, it can help in accommodating more breast cancer patients in a calendar year, ultimately resulting in decreased waiting list, increased turnover, and reduced cost of treatment.

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Objective: The purpose of this study was to determine the effect of education based on health belief model (HBM) on the behavior of breast cancer screening (bCS) in women. Methods: This quasi-experimental study was conducted on 226 women who were selected with cluster sampling method from those referred to Dezful health centers. Data collection tool was a researcher-made questionnaire. Demographic questionnaire bCS- scale, and the Knowledge about questionnaire, all given before and 3 months after the intervention. Results: According to the findings of the study, there was a significant relationship between women's performance and variables of knowledge, perceived sensitivity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Conclusions: Poor knowledge of women indicates a crucial need for formal educational programs to sensitize women regarding the importance of bCS. These educational programs should consider factors affecting bCS behaviors.

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Australia is a multicultural nation with a large migrant population. Migrants with cancer report inferior quality of life and the need for more information in their own language. This paper describes lessons learnt from developing culturally appropriate written information resources with and for Arabic, Italian, and Vietnamese cancer survivors and carers. The information needs of survivors from these language groups as well as guidelines for the development of written resources for culturally diverse populations were identified through literature review. Community consultation was undertaken with focus groups. The content was developed and tested with health professionals who spoke the appropriate language and focus group participants, ensuring relevance and appropriateness. Resource design and dissemination were informed through community consultation. A number of key tasks for developing resources were identified as follows: (1) community engagement and consultation; (2) culturally sensitive data collection; (3) focus group facilitators (recruitment and training); (4) content development; (5) translation and review process; (6) design; and (7) sustainability. This project reinforced literature review findings on the importance of cultural sensitivity in the development of resources. Engaging with community groups and incorporating culturally appropriate recruitment strategies optimises recruitment to focus groups and facilitates content development. Stakeholders and lay persons from the intended ethnic-minority communities should be involved in the development and formative evaluation of resources to ensure appropriateness and relevance and in the dissemination strategy to optimize penetration. We believe the lessons we have learnt will be relevant to any group intending to develop health information for culturally and linguistic diverse groups.

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Objective: The objective of this study was to examine the experiences of student nurses who have provided care to cancer patients. Methods: A mixed method approach consisting of semistructured focus groups (n = 61) and a survey questionnaire (n = 129) was used in the study. Student nurses were first interviewed, and then, a questionnaire was developed for them to answer. Following the content analysis, three themes and 19 subthemes were identified. Frequency and percent were used for qualitative data. Results: Among the student nurses, 80.6% reported that working with cancer patients was “difficult.” Difficulties experienced by the student nurses included patients rejecting their care, a large number of problems cases encountered when providing care to cancer patients, communication problems (38.0%), working with patients and attendants who fear death, and problems arising from family attendants who obstruct care. The majority of students experienced patients fearing death (28.7%) and felt feelings such as pity (71.1%), sadness (50.0%), and fear of cancer (41.9%) during their internships in oncology clinics. Conclusions: Students should be supported by instructors and oncology nurses, and nursing curricula should contain topics on how to best approach cancer patients.

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The risk for developing breast cancer can be influenced by a number of critical factors. An individual's age, gender, personal and family health history, nutritional status, level of physical activity, environmental exposures, and substance use can significantly shift the recommended screening guidelines format from the general risk population to a high-risk population. It is essential for health-care providers to become proficient in obtaining a complete cancer genetic risk assessment to accurately identify those who may be at high risk. There are a number of evidence-based risk models that can be utilized by providers to determine if an individual is indeed at a higher risk to develop breast cancer. In addition, there are evidence-based guidelines for breast cancer screening and possible recommendations for medical management/risk reduction that are appropriate to discuss for those high-risk individuals.

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Objective: The objective of this study was to describe the perspectives and experiences of South African nurses caring for patients receiving palliative chemotherapy. Methods: A qualitative descriptive design was used and purposive sampling allowed us to select 11 nurses practising in a private ambulatory cancer care center in Port Elizabeth. In-depth interviews, guided by three broad themes were conducted and analyzed using qualitative content analyses. Data saturation determined the sample size. Results: Two themes emerged from the data – the patients cling to hope and the positive influence of palliative chemotherapy. The participants believed that patients consenting to palliative chemotherapy were clinging to false hope. They were also of the opinion that family members pressurize patients to consent to treatment. The participants experienced palliative chemotherapy positively, especially when an improvement in the patients' quality of life or pain relief was evident. Fatigue was highlighted as the major side effect, but it did not temper the participants' positive attitudes toward the treatment. Conclusions: Although the participants believed that patients cling to hope and consent to palliative chemotherapy because they hope to be cured, they experienced the treatment as positive. For them, the improvement in pain and quality of life outweighed the side effects the patients experienced. The positive attitude patients upheld while receiving this treatment encouraged them. Nurses should gain more knowledge about the meaning, people living with advanced cancer, attach to hope to prevent them from interpreting patients' hope as denial and false.

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Objective: To translate the English work-related acceptance and action questionnaire (WAAQ), make cross-cultural adaptations, and examine its psychometric properties when used by Chinese oncology nurses. Methods: After translation, the psychometric properties of the Chinese WAAQ were analyzed among 417 nurses, and content validity was determined by six experts. Results: Item-level content validity index (CVI) values were between 0.83 and 1.00; scale-level CVI/universal agreement (S-CVI/UA) and S-CVI/average were 0.86 and 0.98, respectively, which implicated a good content validity. The correlation of the Chinese WAAQ with AAQ-II (r_s= −0.247, P < 0.001) suggested criterion validity, and those with General Health Questionnaire-12 (−0.250, <0.001) and general self-efficacy scale (0.491, <0.001) and Utrecht work engagement scale (UWES) (0.439, <0.001) suggested convergent validity. Exploratory factor analysis identified a seven-item, one-factor structure of WAAQ. The Chinese version of WAAQ had high internal consistency (Cronbach's α = 0.920), with an item-total correlation coefficient of 0.702–0.828 (P < 0.05), split-half reliability of 0.933, and test-retest reliability of 0.772. Conclusions: The Chinese WAAQ is a reliable and valid tool for assessing psychological flexibility in Chinese oncology nurses.

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Most of the world's population lives in Asia. Prevention and detection of cancer, as well as ensuring equitable access to cancer care for all Asians remains a major public health issue and requires governmental involvement and dedicated resources. Palliative care, a medical and nursing specialty, promotes holistic attention to suffering and provides compassionate and interdisciplinary care to the most vulnerable in all societies—those with serious illness. It is nurses who provide the majority of care for patients with cancer, as no other healthcare professional spends more time at the bedside or out in the community assessing and managing these patients and their families. The purpose of this article is to showcase nursing leaders throughout Asia who are receiving palliative care education, educating their colleagues in this care, improving clinical practice, participating in the development of healthcare policies, and advocating for this care.

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Objective: The purpose of this study was to analyze the difficult experiences of nurses who cared for patients undergoing radiation therapy and factors related to patient feelings toward the progress and difficulties of treatment and the kind of care needed. Methods: A descriptive survey using a questionnaire. Anonymous self-report data were collected from a sample of 228 nurses who had 2–5 years of nursing experience in a National University Hospital in Japan. Years of working experience; knowledge and training in radiation therapy and difficult experiences of nurses caring for patients undergoing radiation therapy. Results: In hospital “A”, about 80% of the nurses had cared for patients undergoing radiation therapy, and about 40% had experience with difficult cases. The characteristics of competent nurses in radiation nursing were the following: while not having knowledge and experience, they were seriously facing their patients. However, the treatment process could not be predicted, skills related to the whole-human involvement of patients were insufficient, and communication was similar. In addition, the characteristics of competent nurses in radiation nursing became apparent. Although these nurses lacked knowledge and experience, they interacted with patients in a serious manner. However, the treatment process could not be predicted, and the skills related to the holistic involvement of patients were insufficient. Furthermore, communication between the nurses and patients was difficult. Conclusions: Competent nurses with 2–5 years of working experience, but lacking specific knowledge and experience regarding radiation therapy could cope with difficult radiation therapy cases. However, additional education, training, and mentoring from expert nurses would improve the quality of care for patients undergoing radiation therapy and reduce distress for nurses with less experience. In this study, the need for educational measures and a support system to help competent nurses face difficult cases were suggested.

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Objective: We explored, qualitatively, in a sample of Australian early-stage breast cancer patients eligible for neoadjuvant systemic therapy (NAST): (i) their understanding of the choice of having NAST; (ii) when and with whom the decision on NAST was made; and (iii) strategies used by patients to facilitate their decision on NAST. Methods: A sub-sample of patients participating in a larger intervention trial took part in this study. A total of 24 semi-structured phone interviews were analyzed using framework analysis. Results: A number of women perceived they were not offered a treatment choice. Most patients reported that the decision on NAST was made during or shortly after the initial consultation with their doctor. Women facilitated decision-making by reducing deciding factors and “claiming” the decision. Most women reported that they made the final decision, although they did not feel actively involved in the decision-making process. Conclusions: When deciding on NAST, patient-centered care is not always delivered to patients. Clinicians should emphasize to patients that they have a treatment choice, explain the preference-sensitive nature of deciding on NAST and highlight that patients should be involved in this treatment decision. Providing patients with appropriate time and tailored take-home information might facilitate patient decision-making. Process-orientated research is needed to adequately examine patient involvement in complex treatment decisions.

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Objective: Due to extensive literature on colorectal cancer and their heterogeneous results, this study aimed to summarize the systematic reviews which review the cost-effectiveness studies on different aspects of colorectal cancer. Methods: The required data were collected by searching the following key words according to MeSH: “colorectal cancer,” “colorectal oncology,” “colorectal carcinoma,” “colorectal neoplasm,” “colorectal tumors,” “cost-effectiveness,” “systematic review,” and “meta-analysis.” The following databases were searched: PubMed, Cochrane, Google Scholar, and Scopus. Two reviewers evaluated the articles according to the checklist of “assessment of multiple systematic reviews” (AMSTAR) tool. Results: Finally, eight systematic reviews were included in the study. The Drummond checklist was mostly used for assessing the quality of the articles. The main perspective was related to the payer and the least was relevant to the social. The majority of the cases referred to sensitivity analysis (in 76% of the cases) and the lowest point also was allocated to discounting (in 37% of cases). The Markov model was used most widely in the studies. Treatment methods examined in the studies were not cost-effective in comparison with the studied units. Among the screening methods, computerized tomographic colonography and fecal DNA were cost-effective. The average score of the articles' qualities was high (9.8 out of 11). Conclusions: The community perspective should be taken into consideration at large in the studies. It is necessary to pay more attention to discounting subject in studies. More frequent application of the Markov model is recommended.

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Hospice and palliative care have been demonstrated to improve quality of life, shorten hospital stays, and save costs. As a developing country, faced with a rapidly aging population and an increasing number of patients with life-threatening illnesses such as cancer, China has made great progress in promoting hospice and palliative care during the past few decades. A trained nurse can play a significant role in promoting quality hospice and palliative care by providing care, coordinating a multidisciplinary team, calling for policy support, and raising public awareness. It is critical for nurses to clearly understand the development and challenges that currently exist in the country. With this awareness, nurses will improve their ability to recognize and address patients' and families' needs, resulting in quality, dignified, and individualized end-of-life care.

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In the latest 2015 Quality of Death Index, Singapore managed to move SIX steps forward from 18^th to the 12^th position. This advancement has been hard-won, with victories to improve the level of palliative care such as creating awareness of palliative service, improving coordinated care and growing an adequate capacity to meet the demand of care in our fast -growing ageing population. But it hasn't always been easy. Despite being a first world country, Asian societies like Singapore have inherited taboos regarding public dialogue about death and dying. Such dialogue is traditionally avoided. However, through years of continual effort in improving the standard of palliative care delivery, redesigning education module, creating public awareness and improving funding system, Singapore's palliative care providers have improved the lives of those with life-limiting illnesses. Nevertheless, the government will continue to improve and work toward achieving single digits in the next ranking of the Quality of Death Index.

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The field of palliative care is growing in acceptance and sophistication globally. No longer considered just for patients at end-of-life, palliative care is now being incorporated early in the disease trajectory. Despite professional guidelines supporting early palliative care, there are few models that have been created that can be translated into practice cross-culturally. In the United States, the Educate, Nurture, Advise, Before, Life Ends (ENABLE) early palliative care telehealth model has demonstrated effectiveness in improving quality of life, mood, symptom relief, and survival for patients with cancer and is now being tested in patients with heart failure. Family caregivers of patients who have received ENABLE concurrent with their care recipients have also demonstrated positive outcomes in quality of life and caregiver burden. Internationally, a number of investigators are culturally adapting ENABLE for patients and family caregivers. While some elements of ENABLE, such as symptom management and self-care, and the caregiving role are relevant cross-culturally, others have been built on Western principles of self-determination or represent concepts such as advance care planning which will require more cultural adaptation. In addition, ENABLE was initially an in-person approach that was converted to telehealth to accommodate a rural population-it will be important to understand cultural norms related to receiving care by phone or if an in-person approach will be more culturally acceptable. This paper describes efforts in Turkey and Singapore to culturally adapt the ENABLE early palliative care principles for their countries.

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