Interventions for Prevention and Management of Gynecological Cancer-Related Lower Limb Lymphedema: A Systematic Scoping Review

OBJECTIVES

This scoping review aims to map out evidence on interventions for reducing lower limb lymphedema incidence and symptoms after gynecological cancer surgery.

METHODS

This scoping review followed the methods and protocol outlined by the Joanna Briggs Institute Methods Manual. Five databases, including Pubmed, Scopus, Web of Science, CINAHL, and PsycINFO were searched in January 2024.

RESULTS

The review included 15 interventions primarily designed to prevent and manage cancer-related lower extremity lymphedema. Most studies have examined the effect of interventions on the development of lymphedema-related symptoms and quality of life. Most studies tested complex decongestive therapy (CDT) (n = 6, 39.9%), including various techniques, such as manual lymphatic drainage, compression, exercise, and skincare. Of the interventions, 86.6% improved at least one outcome measurement, such as quality of life, lymphedema incidence, symptoms, and lower limb volume.

CONCLUSIONS

Limited evidence shows that the use of interventions appears to have the potential to reduce the risk and symptoms of lymphedema and improve the quality of life in women undergoing gynecological cancer treatment.

IMPLICATIONS FOR NURSING PRACTICE

Developing and testing comprehensive lymphedema education and management strategies in nursing practice is essential to optimize patient outcomes and enhance the quality of life for women undergoing gynecological cancer treatment.

Psychological resilience, dyadic coping, and dyadic adjustment in couples dealing with cervical cancer in Northwest China: A cross-sectional study

PURPOSE

To examine the relationship between dyadic coping and dyadic adjustment in patients with cervical cancer and their spouses in northwest China, and explore the mediating role of psychological resilience in this relationship.

METHODS

A cross-sectional study was conducted from June to October 2024 in two tertiary hospitals in Xinjiang Province, China; 260 patients with cervical cancer and their spouses were enrolled. Participants independently completed demographic and clinical questionnaires as well as Chinese versions of the Resilience Scale, Dyadic Coping Inventory, and Locke-Wallace Marital Adjustment Scale. The Actor-Partner Interdependence Model was employed to analyze dyadic data.

RESULTS

Patients with cervical cancer and their spouses both exhibited actor effects (β = 0.197, P < 0.001; β = 0.342, P < 0.001) and partner effects (β = 0.276, P < 0.001; β = 0.264, P < 0.001) in the association between dyadic coping and dyadic adjustment. Regarding the mediating role of psychological resilience, spouses' dyadic coping directly affected patients' psychological resilience, and patients' psychological resilience indirectly influenced their own dyadic adjustment (β = 0.061, 95% CI = 0.019, 0.121; β = 0.074, 95% CI = 0.019, 0.144).

CONCLUSIONS

Our findings suggested that psychological resilience plays an essential role in enhancing dyadic coping and cultivating dyadic adjustment among patients with cervical cancer and their spouses. Healthcare professionals should identify couples who have difficulty coping and adapting, and consider couple-centered dyadic resilience interventions to improve these behaviors.

A Rapid Review on Shared Decision Making in Pediatric Palliative Care and End-of-Life Care: Implications for Clinical Practice, Research, and Policy

Shared decision making is a concept essential to establishing meaningful goals of care that reflect one's preferences, values, beliefs, culture, and quality of life. This rapid review considered shared decision making from the perspective of seriously ill or medically complex children receiving inpatient palliative or end-of-life care, where shared decision making is made on behalf of and in the child's best interest. A total of 118 articles were screened, resulting in the selection of 12 articles using a systematic process. Emergent themes noted and discussed include the roles of family and clinicians, explorative communication, transparency, cultural implications, and ethical challenges.

Profiles of chemotherapy-induced peripheral neuropathy in breast cancer patients undergoing taxane-based chemotherapy: A latent class analysis

PURPOSE

This study aimed to identify the potential subgroups of chemotherapy-induced peripheral neuropathy (CIPN) in breast cancer patients undergoing taxane-based chemotherapy and examine the association of the latent subtype with patient characteristics.

METHODS

This multi-center, cross-sectional investigation was conducted between April 2022 and March 2023. CIPN was evaluated using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity scale. Latent class analysis was employed to identify distinct CIPN subgroups, and multinomial logistic regression was used to analyze the associations between these subgroups and patient characteristics.

RESULTS

In total, 397 individuals were categorized into three subgroups: high symptoms with high dysfunction (Class 1; 25.4%), moderate symptoms with low dysfunction (Class 2; 39.2%), and low symptoms with low dysfunction (Class 3; 35.3%). Taxane type, chemotherapy cycles, fatigue, β-blocker use, and depression were significant predictors of the subgroups (P < .05).

CONCLUSION

CIPN symptoms in breast cancer patients are heterogeneous. Significant factors for the latent subgroups included taxane type, chemotherapy cycles, β-blocker use, fatigue, and depression. Identifying different subgroups of chemotherapy-induced peripheral neuropathy would help develop interventions tailored to the patients.

Explore Potential Profiles and Influencing Factors for Financial Toxicity in Patients with Colorectal Cancer Undergoing Chemotherapy: A Cross-Sectional Study

OBJECTIVES

To explore the potential financial toxicity (FT) profiles in patients with colorectal cancer (CRC) undergoing chemotherapy and analyze its influencing factors.

METHODS

A cross-sectional study was conducted on 373 CRC patients undergoing chemotherapy in southwest China from January 2024 to May 2024. We utilized the General Information Questionnaire, the FT based on Patient-Reported Outcome Measures (COST-PROM), the Brief Illness Perception Questionnaire (BIPQ), and the Family APGAR Index (APGAR). Latent profile analysis (LPA) by Mplus8.3 was used to identify the latent profiles of the FT. Multinomial logistic regression analysis was used to analyze the relevant factors in the different categories.

RESULTS

The patients with CRC undergoing chemotherapy were divided into four profiles: high FT group (44.5%), moderate FT-low psychological adaptation group (22.8%), moderate FT-high psychological adaptation group (18.0%), and low FT group (14.7%). Age, average monthly household income per capita, employment status, disease duration, round of chemotherapy, illness perception, and family function were the influencing factors for potential profiles of FT in CRC chemotherapy patients (P < 0.05).

CONCLUSIONS

There are four potential profiles of FT in patients with CRC undergoing chemotherapy. Healthcare providers should pay attention to patients with CRC undergoing chemotherapy aged 18 to 59 years old, employed and unemployed, with lower average monthly household income per capita, disease duration of less than 1 year, and more times of chemotherapy. Additionally, reducing patients' negative perceptions of the disease and improving family function can help lower the level of FT.

IMPLICATION FOR NURSING PRACTICE

This research can assist nurses in identifying patients at high risk of FT, enabling early intervention and the implementation of targeted psychological nursing interventions. Nurses can help patients develop positive perceptions of the disease and improve family relationships, thereby mitigating the negative effects of FT.

The longitudinal association between resilience and sleep quality in breast cancer

PURPOSE

To estimate the longitudinal association between resilience and sleep quality in patients with newly diagnosed breast cancer within the first 6 months.

METHOD

Between July 2023 and September 2023, 155 newly diagnosed BC patients were recruited to participate in the Be Resilience to Breast Cancer program (Abbreviated as BRBC). They completed the 10-item Connor-Davidson Resilience scale and Pittsburgh Sleep Quality Index Scale. The following three timepoints were set to collect the data, including 1 month after initial diagnosis (T0), 3 months (T1), and 6 months (T2). Data were analyzed using Cross-lagged Panel Model (CLPM), and Parallel Latent Growth Model (PLGM).

RESULTS

Excluded questionnaires with a large number of missing items and finally 125 patients were included, with the response rate of 83.3%. CLPM indicated that resilience at T1 predicted PSQI at T2 (r = -0.168, P < 0.001), and PSQI at T1 predicted resilience at T2 (r = -0.112, P< 0.001). PLGM demonstrated that changes in resilience was significantly associated with changes in PSQI (r = -0.874, P< 0.001).

CONCLUSION

A longitudinal association between resilience and sleep quality was confirmed in patients with newly diagnosed breast cancer. Resilience was a protective factor in the development of sleep quality.

A pilot randomized controlled trial of a yoga program for alleviating cancer-related fatigue and psychological distress in women with gynecological cancer

PURPOSE

Yoga can alleviate cancer-related fatigue and psychological distress while improving health-related quality of life. However, most studies focused on breast cancer. This study aimed to evaluate the feasibility and acceptability of a yoga program for women with gynecological cancer and estimate its preliminary effects on cancer-related fatigue, psychological distress, and health-related quality of life.

METHODS

This pilot study used a single-blinded randomized controlled trial design. Participants in the intervention group received the yoga program and usual care, while the control group only received usual care. Feasibility was assessed using eligibility, consent, attrition, and adherence rates. Acceptability was measured using a satisfaction questionnaire. Preliminary effects were evaluated on cancer-related fatigue, psychological distress, and health-related quality of life outcomes.

RESULTS

The yoga program demonstrated feasibility, with satisfactory rates of eligibility (62.7%), consent (64.9%), attrition (4.2%), and adherence (75%). The participants reported high satisfaction with the program. Significant intervention effects were observed on the behavioral/severity dimension of cancer-related fatigue (Hedges's g = 0.86). The intervention group demonstrated greater reductions in overall and other cancer-related fatigue subscales than the control group. Greater improvements in distress, anxiety, depression, and health-related quality of life were noted in the intervention group than in the control group, with effect sizes of 0.29, 0.77, 0.21, and 0.12, respectively.

CONCLUSIONS

The yoga program is feasible and acceptable, showing a trend in reducing cancer-related fatigue and psychological distress and improving health-related quality of life in women with gynecological cancer. A full-scale randomized controlled trial is warranted.

Effect of exercise before and/or during taxane-containing chemotherapy treatment on chemotherapy-induced peripheral neuropathy symptoms in women with breast cancer: systematic review and meta-analysis

PURPOSE

To systematically review and meta-analyse the efficacy of exercise interventions delivered before and/or during taxane-containing chemotherapy regimens on chemotherapy-induced peripheral neuropathy (CIPN), fatigue, and health-related quality of life (HR-QoL), in women with breast cancer.

METHODS

Seven electronic databases were systematically searched for randomised controlled trials (RCTs) reporting on the effects of exercise interventions in women with breast cancer receiving taxane-containing chemotherapeutic treatment. Meta-analyses evaluated the effects of exercise on CIPN symptoms, fatigue, and HR-QoL.

RESULTS

Ten trials involving exercise interventions ranging between 2 and 12 months were included. The combined results of four RCTs consisting of 171 participants showed a reduction in CIPN symptoms following exercise compared with usual care (standardised mean difference - 0.71, 95% CI - 1.24 to - 0.17, p = 0.012; moderate-quality evidence, I2 = 76.9%). Pooled results from six RCTs with 609 participants showed that exercise interventions before and/or during taxane-containing chemotherapy regimens improved HR-QoL (SMD 0.42, 95% CI 0.07 to 0.76, p = 0.03; moderate-quality evidence, I2 = 49.6%). There was no evidence of an effect of exercise on fatigue (- 0.39, 95% CI - 0.95 to 0.18, p = 0.15; very low-quality evidence, I2 = 90.1%).

CONCLUSIONS

This systematic review found reduced levels of CIPN symptoms and an improvement in HR-QoL in women with breast cancer who exercised before and/or during taxane-based chemotherapy versus usual care controls.

IMPLICATIONS FOR CANCER SURVIVORS

This evidence supports the role of exercise as an adjunctive treatment for attenuating the adverse effects of taxane-containing chemotherapy on CIPN symptoms and HR-QoL.

Identifying Key Factors Influencing Non-adherence to Imatinib Therapy in Patients With Chronic Myeloid Leukemia

BACKGROUND

The effective treatment of chronic myeloid leukemia (CML) remains a challenge due to patient non-adherence to imatinib. Medication non-adherence can lead to poor treatment outcomes, increased healthcare costs, and potential development of drug resistance in patients. In this study, we aimed to assess the factors associated with non-adherence to imatinib therapy in newly diagnosed CML patients.

METHODS

In this study, 82 adult patients initiated on imatinib therapy were recruited. Adherence was measured using the medication possession ratio (MPR) and visual analogue scale (VAS) at 90 days. Demographic, clinical and quality-of-life variables were assessed at baseline. Pearson's correlation and linear regression analyses were performed to identify associations and independent predictors of non-adherence, respectively.

RESULTS

A total of 22% (18/82) of patients were non-adherent (MPR ≤ 85). Self-reported adherence via VAS correlated significantly with MPR. Among various factors, cognitive function score and occurrence of an adverse drug reaction (ADR) were associated with adherence. The impact of disease on daily life score was negatively associated with adherence. The independent predictors of adherence were role function score and impact of disease on mood score.

CONCLUSION

This study identified cognitive and role function, impact of disease on daily life and mood and occurrence of ADR as variables influencing non-adherence to imatinib in CML patients. Early identification of these factors can guide interventions to improve adherence and treatment outcomes.

The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review

BACKGROUND

Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high-income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition-related challenges during treatment.

METHODS

This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice.

RESULTS

The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high-energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high-risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status.

CONCLUSIONS

With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary.

Breast Radiation Therapy Survivorship and Cancer Support Groups: an Opportunity for Community Engagement and Education Through the Addressing Breast Cancer Dermatologic Side Effects (ABCDEs) Program

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths in women in the USA. To serve under-insured breast cancer patients in South Texas, we designed a patient education program to improve health literacy of secondary dermatologic changes after completing radiation therapy. A needs assessment survey was distributed to better understand the patients' stage of treatment, experiences with radiation-induced dermatologic side effects, and over-the-counter skin products and home remedies used. Of the 33 patients that participated in this program, nearly all patients (93.94%, n = 31) are either currently undergoing treatment or have completed treatment. Of the 31 individuals, 74.19% of patients (n = 23) have completed treatment at least 9-12 months ago, 22.58% (n = 7) are currently receiving chemotherapy, and 3.23% (n = 1) are currently undergoing radiation therapy. Among the dermatologic side effects, patients experienced changes to skin color, redness, and burns/burning sensation at the greatest severity. The top products used by survey participants were prescription-strength topical corticosteroids (65.63%) followed by oral analgesics (28.13%) and compression sleeves (25.00%). Aloe vera (15.63%) was the most used complementary and alternative therapeutic treatment. By surveying experiences of radiation-induced dermatologic side effects in predominantly under-resourced and minority communities, we can better tailor patient education programs to reflect patients' experiences. Overall, this program can enhance clinicians' insight on under-resourced patient experiences to improve health literacy and dispel common misconceptions surrounding breast cancer treatment, management, and survivorship.

Respect for the Patient-Oncologist Relationship May Limit Serious Illness Communication by Acute and Postacute Care Clinicians After Discharge to a Skilled Nursing Facility

PURPOSE

There is a need to increase palliative care access for hospitalized older adults with cancer discharged to a skilled nursing facility (SNF) at risk of poor outcomes. Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care intervention developed to address this gap. This study gathered perspectives from clinicians across care settings to describe perceptions on serious illness communication and care coordination for patients with cancer after discharge to a SNF to guide ALIGN refinements.

METHODS

We conducted 37 semistructured interviews with clinicians and leaders in hospital medicine (n = 12), oncology (n = 9), palliative care (n = 12), home health care (n = 6), and hospice (n = 4). Some participants had experience working in more than one specialty. The Practical Robust Implementation and Sustainability Model framework was used to develop the interview guide that explored barriers to care, prognosis discussions, and hospice recommendations. Interviews were coded and analyzed using thematic content analysis.

RESULTS

Analysis identified four themes: (1) discharge to a SNF is recognized as a time of worsening prognosis; (2) care silos create communication and information barriers during a period of increasing palliative care need; (3) family caregiver distress escalates following care transitions; and (4) lack of clarity of roles and respect for the patient-oncologist relationship limits prognostic communication and changes in focus of treatment.

CONCLUSION

These findings suggest that acute and postacute care clinicians defer serious illness conversations to the oncologist when patients are on a steep trajectory of decline, experiencing multiple care transitions, and may have limited contact with their oncologist. There is a need to clarify roles among nononcology and oncology clinicians in discussing prognosis and recommending hospice for older adults discharged to SNF.

Identification of the Core Nutrition Impact Symptoms Cluster in Patients with Lung Cancer During Chemotherapy: A Symptom Network Analysis

OBJECTIVES

Lung cancer patients undergoing chemotherapy are present in multiple Nutrition Impact Symptoms (NIS). There have been no studies utilizing symptom networks to identify core NIS in lung cancer patients undergoing chemotherapy, it is necessary to identify core symptoms for effective and precise symptom management. We aimed to construct a symptom network of NIS in lung cancer patients receiving chemotherapy, and explore the core Nutrition Impact Symptoms cluster.

METHODS

A cross-sectional survey was conducted among 315 patients with lung cancer. The Patient-Generated Subjective Global Assessment-Short Form was used to assess the prevalence and severity of NIS. We constructed a symptom network and identified centrality indexes using R packages.

RESULTS

Fatigue emerged as the most prevalent and severe symptom, affecting 87% of participants, with an intensity of 3.0 ± 1.3. The network density was measured at 0.5. Strength centrality showed a stability coefficient of 0.7, with fatigue (Rs = 0.73), lack of appetite (Rs = 1.02), and nausea (Rs = 0.70) ranking as the top three symptoms. For betweenness centrality, the stability coefficient was 0.3, highlighting fatigue (Rb = 12), lack of appetite (Rb = 34), and emotional change (Rb = 18) as the primary symptoms.

CONCLUSIONS

This study identified a core symptom cluster consisting of fatigue, lack of appetite, and emotional change. These findings provide valuable insights for developing targeted symptom management strategies and interventions for this patient population in the future.

IMPLICATIONS FOR NURSING PRACTICE

Nurses need to comprehensively consider the interaction of multidimensional symptoms to provide lung chemotherapy cancer with targeted symptom management strategies and intervention guidance to reduce the burden of symptoms and improve quality of life.

Effectiveness of Postoperative Dietary Intervention in Patients with Gastric Cancer who Underwent Gastrectomy: Quasi-Experimental Study Design

OBJECTIVES

This article aims to investigate the effects of a postoperative dietary intervention on fatigue, self-efficacy in managing gastrointestinal side effects, self-efficacy for nutritional management, self-care activity, and unmet nursing needs among patients with gastric cancer who have undergone gastrectomy.

METHODS

We used a quasi-experimental study design (nonequivalent control group pretest-posttest). Data were collected from 59 patients with gastric cancer (30 in the experimental group and 29 in the control patients) hospitalized for gastrectomy in Daegu, South Korea. The control group completed a preintervention survey, received routine care, and then completed a postintervention survey. After the control group finished their routine care and tests, the experimental group received a postoperative dietary intervention. This intervention included individual face-to-face education and telephone counseling on managing gastrectomy side effects, eating methods to prevent symptoms, foods to avoid, ways to consume sufficient calories, maintaining a balanced diet, and pledge writing. The control group served as a waitlist control. After all interventions and tests for the experimental group were completed, the same dietary intervention was offered to the control group upon their request. This experimental study was conducted from June 2021 to February 2023.

RESULTS

Compared with the control group, the experimental group showed significant improvements in fatigue (P = .005), self-efficacy in managing gastrointestinal side effects (P < .001), self-efficacy for nutritional management (P = .03), self-care activity (P < .001), and unmet nursing needs (P < .001).

CONCLUSION

Postoperative dietary interventions contribute to improving self-efficacy, fatigue levels, and self-care activity among patients with gastric cancer.

IMPLICATIONS FOR NURSING PRACTICE

Upon discharge, implementing a needs-based and loss-framed message-based dietary intervention, alongside routine discharge education, for patients who underwent gastrectomy for gastric cancer can enhance fatigue levels, self-efficacy in managing nutrition and gastrointestinal side effects, self-care activity, and unmet nursing needs.

Incidence, mortality, and global burden of retinoblastoma in 204 countries worldwide from 1990 to 2021: Data and systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

Retinoblastoma (Rb), the primary intraocular malignancy in children, poses significant risks, yet its overall burden remains inadequately assessed. This study aims to analyze global Rb trends using Global Burden of Disease, Injuries, and Risk Factors study (GBD) 2021 data.

METHODS

GBD 2021 data was analyzed to assess Rb incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. Average annual percentage changes (AAPCs) were calculated across genders, age groups (0-9 years), and geographic regions categorized by socio-demographic index (SDI) quintiles.

RESULTS

From 1990 to 2021, the global Rb age-standardized incidence rate (ASIR) increased from 0.08 (per 100,000, range: 0.05 to 0.10) to 0.09 (per 100,000, range: 0.06 to 0.13). ASIR was not significantly correlated with SDI (R = -0.095, P = 0.18), while age-standardized DALYs rate (R = -0.693, P < 0.001) and age-standardized mortality rate (ASMR) (R = -0.71, P < 0.001) were significantly and negatively correlated with SDI. Increases in ASIR were concentrated in Asia, Europe, and northern and southern Africa. The highest standardized DALYs and ASMR were noted in certain countries in Asia, Europe, and South Africa. Among age groups, the highest disease burdens were observed in the "0-6 days" and "2-4 years" groups. There were no significant gender differences in Rb burden globally.

CONCLUSIONS

Despite global progress, regions with lower SDI face elevated Rb burden and mortality. Females exhibit higher burdens during infancy, necessitating further investigation. Effective Rb management in resource-limited areas requires international collaboration focused on health education, early diagnosis, and prenatal screening for high-risk families.

Factors Influencing Cervical Cancer Screening: A Cross-Sectional Study Among Ethnically Diverse Women in the Kumasi Metropolis of Ghana

Background

Globally, Ghana is one of the countries with the greatest cervical cancer (CC) burdens and mortality rates. Available research has focused primarily on women's experiences in the general population neglecting factors that influence cervical cancer screening (CCS) among ethnically diverse populations in Ghana.

Aim

This study explored the factors influencing CCS among ethnically diverse women in the Kumasi Metropolis of Ghana.

Method

From April to June 2023, a community-based cross-sectional study was carried out in the Aboabo and Asawase communities of the Ashanti Region. Binary and multivariable logistic regressions were employed to determine the relationships between the dependent and independent variables. Outcome variables with p-values < 0.05 were considered statistically significant.

Results

Habits, knowledge, perceived benefits, and facilitating factors influenced CCS among ethnically diverse women. An overall self-reported CCS rate of 7.2% (n = 32) with an early age of sexual initiation of 15-20 years was recorded. While habits (OR = 0.23, 95% CI 0.09, 0.58; p = 0.002), affect (OR = 0.00, 95% CI 0.00, 0.03; p < 0.001), and the perceived benefits of screening (OR = 3.07, 95% Cl 1.01, 10.8; p = 0.059) were associated with CCS. Norms (OR = 0.00, 95% CI 0.00, 20,948,726,859,075; p > 0.9), knowledge (OR = 1.27, 95% CI 0.61, 2.53; p = 0.5), and facilitating factors (OR = 1.02, 95% CI 0.51, 2.01; p > 0.9) were not statistically significant with CCS.

Conclusion

Poor knowledge, lower perceived benefits of CCS, and weak facilitating factors were identified as barriers to CCS. Implementing national CCS and vaccination campaigns to improve awareness, and screening to reduce women's risk is encouraged.

Effectiveness of mHealth-based psychosocial interventions for breast cancer patients and their caregivers: A systematic review and meta-analysis

BACKGROUND

Breast cancer causes significant distress in patient-caregiver dyads. While psychosocial and/or mHealth-based interventions have shown efficacy in improving their psychosocial well-being, no reviews have synthesised the effectiveness of such interventions delivered specifically to the breast cancer patient-caregiver dyad.

OBJECTIVE

To synthesise available evidence examining the effectiveness of mHealth-based psychosocial interventions among breast cancer patient-caregiver dyads in improving their psychosocial well-being (primary outcomes: dyadic adjustment, depression and anxiety; secondary outcomes: stress, symptom distress, social well-being and relationship quality), compared to active or non-active controls.

DESIGN

A systematic review and meta-analysis.

METHODS

Randomised controlled trials and quasi-experimental studies were comprehensively searched from seven electronic databases (PubMed, CENTRAL, CINAHL, Embase, PsycINFO, Scopus, Web of Science), ongoing trial registries (ClinicalTrials.gov, WHO ICTRP) and grey literature (ProQuest Dissertations and Theses Global) from inception of databases till 23 December 2022. Studies involving breast cancer patient-caregiver dyads participating in mHealth-based psychosocial interventions, compared to active or non-active controls, were included. Exclusion criteria were terminally ill patients and/or participants with psychiatric disorders or cognitive impairment and interventions collecting symptomatic data, promoting breast cancer screening or involving only physical activities. Screening, data extraction and quality appraisal of studies were conducted independently by two reviewers. Cochrane Risk of Bias Tool version 1 and JBI Critical Appraisal Checklist were used to appraise the randomised controlled trials and quasi-experimental studies, respectively. Meta-analyses using Review Manager 5.4.1 synthesised the effects of outcomes of interest. Sensitivity and subgroup analyses were conducted. The GRADE approach appraised the overall evidence quality.

RESULTS

Twelve trials involving 1204 breast cancer patient-caregiver dyads were included. Meta-analyses found statistically significant increase in caregiver anxiety (standardised mean difference (SMD) = 0.43, 95% confidence interval (CI) [0.09, 0.77], Z = 2.47, p = 0.01), involving 479 caregivers in 5 studies, and stress (SMD = 0.25, 95% CI [0.05, 0.45], Z = 2.44, p = 0.01), involving 387 caregivers in 4 studies post-intervention, favouring control groups. The intervention effects on the remaining outcomes were statistically insignificant. Beneficial effects of such interventions remain uncertain. The overall quality of evidence was very low for all primary outcomes.

CONCLUSIONS

Results of the effectiveness of mHealth-based psychosocial interventions on the psychosocial well-being of breast cancer patient-caregiver dyads are inconclusive. The high heterogeneity shown in the meta-analyses and very-low overall quality of evidence imply the need for cautious interpretation of findings. Higher-quality studies are needed to assess the effects of psychosocial interventions on dyadic outcomes and determine optimal intervention regimes.

Quitting smoking after a cancer diagnosis is associated with reductions in stigma and anxiety: A longitudinal mediation analysis

Internalized cancer stigma is high among cancer patients who smoke, but it is unknown whether the experience of stigma changes after quitting smoking post-diagnosis. Using data from an RCT of tobacco treatment, we conducted a secondary data analysis and hypothesized that 1) cancer patients who quit smoking would report greater reductions in internalized cancer stigma, compared to patients who did not quit and that 2) greater reductions in stigma would significantly mediate the relationship between smoking abstinence and subsequent decreases in anxiety and depressive symptoms. Participants (n=303; 56.1% female) were adults recruited from two comprehensive cancer centers who had smoked in the past 30 days, spoke English or Spanish, and were being treated for a recent diagnosis of cancer. Participants completed questionnaires at baseline, 3-month follow-up, and 6-month follow-up, and biochemically verified smoking abstinence was determined by participants' salivary cotinine or carbon monoxide levels. Smoking abstinence at 3-month follow-up was significantly associated with reductions in cancer-related stigma from baseline to 3-month follow-up (b = -1.50, p < .001), controlling for sociodemographic and medical covariates. Additionally, reductions in stigma were associated with reductions in anxiety at 6-month follow-up (b = 0.28, p < .05), but not depressive symptoms. Reductions in stigma significantly mediated the relationship between smoking abstinence and decreased anxiety (indirect effect = -0.42, p < .05), but not depressive symptoms. Smoking cessation may be associated with reduction in internalized cancer stigma. Thus, in addition to benefits for medical outcomes, quitting smoking post-diagnosis may improve psychosocial well-being.

The Effect of Spiritual Therapies on the Quality of Life of Women with Breast Cancer: A Systematic Review

The number of studies investigating the effects of spiritual therapies on the quality of life of women diagnosed with breast cancer is quite limited. This systematic review searched the databases "Scopus, Web of Science, PubMed" using the keywords "Breast cancer," "Spirituality" and "Spiritual therapies" and found a total of four studies. The scanning was conducted by two independent reviewers between March 19 and 22, 2024. Included studies were published between 2013 and 2024. These studies found that spiritual therapy has positive effects on the quality of life of women with breast cancer. It is recommended that studies of high methodological quality are conducted to investigate the effect of spiritual therapy on the quality of life of women with breast cancer.

Neoadjuvant chemotherapy in breast cancer: a retrospective pathway assessment in a regional cancer centre

BACKGROUND

The optimal care pathway (OCP) for people with breast cancer provides a framework for investigation and management of patients with breast cancer, with delays previously identified regionally.

AIM

With emphasis on the neoadjuvant pathway, the primary aim of this study was to assess the practicality of implementing the breast cancer OCP timeframes regionally in comparison to nationally referenced standards.

METHODS

A retrospective institutional audit was performed for patients undergoing neoadjuvant therapy for breast cancer. The time from referral to specialist review, completion of investigations, discussion at multidisciplinary team (MDT) meetings, initiation of neoadjuvant chemotherapy (NACT) and surgery were calculated and compared to OCP.

RESULTS

Fifty-three patients were included, with 19 patients living rurally (36%). Twenty-four patients (45%) were seen by a specialist surgeon within 2 weeks of referral. Following surgical review, 44 patients (83%) completed investigations within 2 weeks, and 43 patient cases (81%) were discussed at MDT meetings within 2 weeks. Forty-eight patients (91%) were commenced on neoadjuvant treatment within 4 weeks of decision to treat, and 43 patients (81%) underwent surgery within 6 weeks of neoadjuvant treatment completion. Delays from initial referral to NACT were more frequent in rural patients compared to urban (79% vs 94%, P < 0.05).

CONCLUSION

Adherence to OCP timeframes for patients undergoing neoadjuvant therapy in a regional centre was feasible and strategies are needed to bridge gaps identified for rural patients.

Social support, fear of cancer recurrence and sleep quality in breast cancer: A moderated network analysis

PURPOSE

Fear of cancer recurrence (FCR) contributes to sleep problems and social support is a buffering factor in the literature. However, the moderating effect of social support between FCR and sleep quality is unclear.

METHODS

The moderating role of social support was examined in a cohort of 460 breast cancer patients from the 2024 Be Resilient to Breast Cancer (BRBC) program from a microscopic perspective using moderated network analysis, and then assessed macroscopically by Johnson-Neyman and response surface analysis. The Fear of Progression Questionnaire-Short Form, Perceived Social Support Scale and Pittsburgh Sleep Quality Index scale were employed in this study.

RESULTS

Social support significantly moderated the relationship between general anxiety and sleep efficiency. General anxiety was positively correlated with sleep efficiency at high levels of social support (t = 3.774, P < 0.001). Patients with high social support and low FCR experienced better sleep (F = 6.166, P < 0.01).

CONCLUSION

Our study deepens the understanding of the association between FCR, social support, and sleep quality, and emphasizes social support as a positive strategy for cancer patients to improve their physical and mental health.

Association between psychological flexibility and self-perceived burden in patients with cervical cancer: A computer-simulated network analysis

PURPOSE

The study aimed to identify the profiles of psychological flexibility in patients with cervical cancer and how self-perceived burden networked to different psychological flexibility profiles.

METHODS

The Personalized Psychological Flexibility Index and the Self-Perceived Burden for Cancer Patients were used to measure psychological flexibility and self-perceived burden in patients from the "Be Resilient to Cancer" project. Latent profile analysis was used to identify profiles and computer-simulated network analysis was conducted to determine if self-perceived burden networked to any of the psychological flexibility profiles.

RESULTS

A total of 325 patients with cervical cancer were recruited in this study. Mean age was 42.26 years, the majority were married (71%) and 75.4% had early stage disease (I or II). Three profiles of psychological flexibility were identified: moderate avoidance-low acceptance/harnessing (34.8%), high avoidance-moderate acceptance/harnessing (36.9%), low avoidance and high acceptance/harnessing (28.3%). Furthermore, "worrying about damaging family relationships" and "feeling guilty about affecting family's life plans" were the most bridge symptoms as well as the targeted intervention symptoms for alleviating and aggravating the self-perceived burden respectively.

CONCLUSION

Three patterns of psychological flexibility were recognized with two symptoms might be targeted to improve the self-perceived burden in women with cervical cancer.

Social Connections in Older Adults With Systemic Lupus Erythematosus: Patient Perspectives

OBJECTIVE

Interpersonal relationships are crucial to healthy aging. Social isolation is associated with multiple adverse health outcomes in older adults, including depression. Those with chronic conditions, such as systemic lupus erythematosus (SLE), may be particularly vulnerable to social isolation. In this qualitative study, we elicited lived experiences of older adults with SLE related to social connections and emotional health.

METHODS

Adults ≥65 years of age with SLE participated in semistructured interviews based on a descriptive phenomenological design to describe the experience of aging with SLE. We collected self-reported data on sociodemographic and disease characteristics, social networks, and health-related quality of life. We probed participants regarding their interpersonal relationships and the effect of SLE on general health in the context of aging. We analyzed qualitative data thematically.

RESULTS

Among 30 participants with a mean age of 71.3 years, three themes emerged as essential to characterizing aging with SLE: (1) social isolation, (2) perceived burden to loved ones, and (3) adverse mental health effects of SLE. Participants frequently reported social isolation, often related to SLE disease manifestations rather than unavailability of social networks and situated within the context of burdening loved ones and mental health effects of SLE.

CONCLUSION

Social isolation was commonly reported by older adults with SLE. Larger observational studies are needed to improve characterization of social isolation in this population and understand its association with depression and other adverse health outcomes. Investigational studies integrating strategies to improve social isolation in older adults with SLE may improve their health and well-being.

Factors influencing unrelated stem cell donation a mixed-methods integrated systematic review

PURPOSE

There is an imbalance between demand for and availability of stem cell donors worldwide. The purpose of this systematic review is to provide the first comprehensive understanding of facilitators and barriers influencing unrelated stem cell donation (USCD) in adults, through a data synthesis of qualitative and quantitative evidence. Identification of the facilitators and barriers associated with stem cell donation intention and behaviour is essential to inform the development of behaviour change interventions to meet the current demand.

METHODS

Four databases were searched (Embase, PsycINFO, MEDLINE and CINAHL) and the last search was in February 2021. The search was limited to studies written in English and published from 1980 to present. Screening, quality assessment, data extraction and data synthesis incorporating the COM-B model were undertaken in line with the Joanna Briggs Institute methodology for an integrated mixed-methods review.

RESULTS

Fifty studies were included in the review, analysis and mapping produced four integrated findings. Donation-related knowledge was a facilitator and conversely, lack of knowledge was a barrier to donation related behaviours. Perceived convenience, positive social influences, religious beliefs and the accessibility of positive donation-related social norms promoted positive donation related behaviours. Altruism and sense of duty were the most commonly cited motives for donation related behaviours.Through mapping to the COM-B model, Communication/Marketing, and Service Provision are the primary policy categories that can be used to change donation related behaviours.

CONCLUSION

Future interventions should focus on targeted education regarding unrelated stem cell donation and creating recruitment campaigns that emphasise the life-saving potential of donation.

Living With Cancer: Child-Parent Dyads' Perspectives and Experiences From a Private Tertiary Care Hospital in Pakistan

The life experiences of children with cancer and their parents as individuals have been well documented in literature. However, little is known about their experiences as child-parent dyads in Pakistan regarding these children's quality of life. Thus, the study was conducted in the context of the family-centric society of Pakistan. In-depth interviews were conducted with 28 participants (14 child-parent dyads), comprising 9 female and 5 male children receiving cancer treatment and 8 mothers and 6 fathers (primary caregivers). All the participants were Muslims and hailed from diverse ethnic backgrounds, and most belonged to middle socioeconomic backgrounds. Thematic analysis was performed using Braun and Clarke's (2006) framework, which revealed four themes: (1) Stress, Fears, and Optimism; (2) Reactions to Restrictions; (3) Adaptation and Coping; and (4) Support Structure and Mechanisms. The findings indicated that children's and parents' daily lives were affected in various ways during the children's cancer journey. They faced several challenges which impacted their well-being. Particularly, the children considered their symptoms as restrictions in the way of carrying out their routine lives. However, children and parents also elaborated on using different coping strategies, such as play, reminiscing the past, incorporating religious practices into their daily routines, and keeping a family-centred approach towards the child's care. The parents also recommended that cancer-specialised services and support groups should be accessible. Conclusively, these findings are useful for healthcare providers in giving family-centred care to afflicted families and devising innovative interventions that address the needs of children with cancer and improve their quality of life.

Exploration of symptom cluster patterns and their trajectory in esophageal cancer surgery patients

PURPOSE

To investigate symptom burden and symptom cluster trajectories in patients undergoing surgery for esophageal cancer.

METHODS

A convenience sample of 210 patients who underwent thoracoscopic surgery for esophageal cancer was included from July to December 2023. The symptoms of the patients were evaluated at the following time points: preoperatively (T0), 1-3 days postoperatively (T1), 7 days postoperatively (T2), 1 month postoperatively (T3), and 3 months postoperatively (T4). This was done via the Chinese version of the MD Anderson Symptom Scale and the Supplementary Questionnaire for Perioperative Esophageal Cancer Symptoms. Exploratory factor analysis was used to identify symptom clusters, and latent class growth modeling was used to analyze the trajectories of each different symptom cluster.

RESULTS

Exploratory factor analysis revealed the presence of four symptom clusters: mood-related symptom clusters (worst at T1, T2, and T4), gastrointestinal symptom clusters (worst at T0), fatigue-related symptom clusters (worst at T3), and surgery-related symptom clusters, with cumulative variance contribution rates of 64.34%, 62.29%, 68.23%, 70.29%, and 63.82%, respectively. The latent category growth model identified the existence of 2-3 distinct trajectories in each symptom cluster.

CONCLUSION

This study identified 4 distinct symptom clusters in patients undergoing esophageal cancer surgery. The mood-related and gastrointestinal symptom clusters exhibited worsening and recurrence within 7 days post-surgery, necessitating particular attention. A subset of patients in the fatigue-related symptom cluster showed a tendency for continued exacerbation, emphasizing the need for long-term monitoring. Furthermore, symptom management strategies can be prioritized based on the severity of the symptom clusters.

Navigating specific targets of breast cancer symptoms: An innovative computer-simulated intervention analysis

PURPOSE

To pinpoint optimal interventions by dissecting the complex symptom interactions, encompassing both their static and temporal dimensions.

METHODS

The study incorporated a cross-sectional survey utilizing the MD Anderson Symptom Inventory. Participants with breast cancer undergoing chemotherapy were recruited from the "Be Resilient to Breast Cancer" from April 2023 to June 2024. Static symptom interrelationships were elucidated using undirected and Bayesian network models, complemented by an exploration of their dynamic counterparts through computer-simulated interventions.

RESULTS

The study included 602 patients with breast cancer. Both undirected networks and computer-simulated interventions concurred on the symptoms of distress and fatigue as optimal alleviation targets. The Bayesian network and computer-simulated interventions both emphasized "shortness of breath" as preventive care. Notably, Distress appeared to be the most effective target for interventions, and compared to fatigue (decreasing score = 1.84-2.20, decreasing prevalence = 14.2-16.7%). Conversely, disturbed sleep, despite its high position in Bayesian network, had no propelling effects on increasing the network's overall symptom activity levels (increasing score<1).

CONCLUSIONS

Computer-simulated intervention integrating with traditional network analysis can improve intervention precision and efficacy by prioritizing individual symptom impacts, both statically and dynamically.

Where you live, what you do: depression differences among diverse Chinese nongmin through cognitive openness

Objective

This study aims to investigate the depression levels among Workers with Agricultural Hukou (WAH) in China, considering their varied living environments, types of work, and social discrimination experiences. It specifically addresses the research question: Is there a significant discrepancy in depression levels among different subgroups within WAH?

Methods

The study utilizes data from the China Family Panel Studies (CFPS) for the years 2018 and 2020. To estimate the depression levels and their variances across different WAH subgroups, we employed three analytical methods: Ordinary Least Squares, Propensity Score Matching, and Two-Stage Least Squares.

Results

Our findings indicate that all WAH subgroups experience higher levels of depression compared to Workers with Non-Agricultural Hukou (WNAH). Among the WAH subgroups, the depression levels, in ascending order, are observed in Rural-to-Urban Migrant Workers (RUMW), Rural Non-Agricultural Workers (RNAW), Subsistence Farmers, and Agricultural Laborers. Notably, these differences in depression levels may be influenced by the mechanism of cognitive openness.

Conclusion

The study concludes that there are significant disparities in depression levels among WAH subgroups. Understanding these differences is crucial for targeted mental health interventions and for addressing the broader implications of social discrimination and work-related stress among agricultural workers in China.

Survey situation of mental health of pregnant women with breast cancer: A systematic review study

A pregnant woman struggles with physical and mental problems caused by hormonal changes during her pregnancy. Now, if cancer is added to these difficult conditions, the pregnant woman will suffer a lot of psychological burden. We decided to conduct a systematic review study titled "Mental health examination of pregnant women with breast cancer" so that by examining this issue and emphasizing it more, we can reduce this mental burden. A systematic review was conducted on the English and Persian documents published throughout a 10-year period (2013-2023) in PubMed or MEDLINE, ScienceDirect, Web of Science, and Google Scholar databases. All documents were assessed for eligibility by titles or abstracts according to the search strategy, with the terms, such as mental health, pregnant woman, and pregnancy with breast cancer. The screening process was conducted by two independent authors. The selected articles were checked regarding inclusion and exclusion criteria. In total, 235 relevant studies were searched in 2013-2023, and after evaluating the full text of the article, 32 full-text articles were opted in accordance with the eligibility criteria, and finally, 26 full-text articles were reviewed systematically. According to the studies that were analyzed, the most common mental health disorders in pregnant women with breast cancer were depression, anxiety, and stress, which were created as a result of the fear of the possible consequences of cancer in the pregnant mother. To improve the level of mental health of women with cancer in Iran, the following solutions are suggested: 1. strengthening mental health services in primary health care, 2. appointing the trustee of the unit to improve the level of interdepartmental leadership and intradepartmental governance, 3. determining sustainable and targeted financial resources to provide mental health services needed by pregnant women with cancer, 4. moving the financial resources allocated to insurance mechanisms for greater financial protection, 5. expanding the umbrella of social support, and 6. a behavioral educational program that can be used to improve mental health, especially the symptoms of depression and anxiety in pregnant women with cancer.

Unravelling pharmacological mechanisms and effects of Tianma Siwu Decoction-derived compounds on ischemic stroke by multidimensional network pharmacological analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Ischemic stroke (IS) a complex pathological event emerging as one of the most serious threats with huge economic impact in the 21st century. Following IS, multiple cascades and pathways are stimulated, culminating in long term consequences. One of Chinese Traditional Medicine, Tianma Siwu Decoction (TSD), is known to have sedative-hypnotic, anticonvulsant and anti-inflammatory effects, which is usually used to treat migraine and ischemic stroke, but its potential pharmacological mechanism remains unclear.

AIM OF THE STUDY

This study is aimed to identify the active principles from TSD that has strong pharmacological effect on the treatment of IS.

MATERIALS AND METHODS

Based on liquid chromatography-triple quadrupole mass spectrometry (LC-Q-MS/MS) technology, a new three-step-based approach integrating concentration parameters and Quality marker (Q-marker) with network pharmacology and bioactivity evaluation to explore the therapeutic effects and mechanisms of TSD on ischemic stroke. Ultimately, as the main herb of the TSD, high-concentration compounds from Gastrodia elata Blume (GEB) were identified and collected by LC-Q-MS/MS, and an optimized analytical model in multidimensional network pharmacology was introduced to more accurately explore the potential mechanisms by which TSD affects IS.

RESULTS

The results showed that 280 overlapping targets of TSD were obtained after the introduction of compound concentration parameters into the multidimensional network pharmacology analysis. Additionally, TSD might regulate IS through the AGE-RAGE and Rap1 signaling pathways. Through an in vitro hypoxia-reoxygenation injury cell model, it was discovered that as the Q-markers of GEB, gastrodin and parishin could effectively reduce neuronal hypoxic injury by modulating the expression levels of p-JNK and p-p38 proteins. According to the results of molecular docking, gastrodin and baicalin exhibits strong binding affinity to GAPDH and MAPK3, respectively (≦-7 kcal/mol).

CONCLUSION

We discovered that compound concentration is a key factor that influence the activity of substances, affects the accuracy and reliability of predictive outcomes. Consequently, the study enhances the network pharmacology model by incorporating concentration factors, aiming for a more accurate understanding of the potential mechanisms behind TSD anti-ischemic stroke actions.

Effects on Quality of Life and Self-Efficacy of Instant Messaging Services in Self-Management Programs for Prostate Cancer: A Systematic Review and Meta-Analysis

Background: Prostate cancer is one of the most common cancers among men worldwide. Management options include active surveillance, surgery, radiation, and chemotherapy, while self-management and behavioral interventions have shown promise in improving health-promoting behaviors and addressing barriers to care. Mobile health interventions, particularly instant messaging platforms, offer a growing opportunity for effective therapeutic support, but evidence on their role in self-management remains limited. The objective was to investigate the efficacy of self-management interventions based on instant messaging on quality of life and self-efficacy in patients diagnosed with prostate cancer through a systematic review and meta-analysis. Methods: A search was conducted of three databases from their inception to November 2024. Randomized controlled trials were included. Two reviewers performed independent data extraction and methodologic quality assessment of the studies. Results: A total of seven studies were included in the review. Instant messaging interventions were recognized by a previously published taxonomy of collaborative technologies. The meta-analysis showed that self-management interventions based on instant messaging have an effect on quality of life and self-efficacy. Conclusions: This systematic review highlights the potential benefits of self-management interventions incorporating instant messaging for improving quality of life and self-efficacy in prostate cancer patients.

Barriers to healthcare professionals screening, recognizing, and managing delirium in the adult patients receiving specialist palliative care: a mixed-methods systematic review

BACKGROUND

Delirium frequently occurs in palliative care settings, yet its screening, identification, and management remain suboptimal in clinical practice. This review aims to elucidate the barriers preventing healthcare professionals from effectively screening, recognizing, and managing delirium in adult patients receiving specialist palliative care, with the goal of developing strategies to enhance clinical practice.

METHODS

A mixed-methods systematic review was conducted (PROSPERO: CRD42024563666). Literature was sourced from PubMed, Web of Science, Embase, CINAHL, The Cochrane Library, and Clinical Trials databases from their inception to November 16, 2024, without language restrictions. Studies that were primary quantitative, qualitative, and mixed-methods research, and reported the barriers to healthcare professionals' screening, recognition, and management of delirium in adult patients receiving specialist palliative care (including inpatient hospice/hospital care, consultation teams, and outpatient/community services) were included. Studies were excluded if they did not permit barrier factor extraction, had duplicate or incomplete data, or were case reports or conference abstracts. The Mixed Methods Appraisal Tool (MMAT) version 2018 was employed to evaluate the methodological quality of included studies. Data synthesis used the convergent-integrated JBI mixed-methods approach.

RESULTS

21 articles that meet the selection criteria have been identified, with 11 quantitative, 8 qualitative and 2 mixed-methods, collectively involving 857 patients and 649 healthcare professionals. Four themes were identified from the includes studies: (1) Individual level: knowledge and understanding gaps among healthcare professionals; (2) Operational level: implementation challenges in clinical practice; (3) Organizational level: structural and resource deficiencies; (4) Contextual level: specific impacts of situational factors.

CONCLUSION

The systematic review uncovered a complex interplay of barriers spanning individual, operational, organizational, and contextual levels in palliative settings. To address these challenges, recommended strategies include developing targeted training programs, implementing standardized delirium assessment tools, improving guideline accessibility, and promoting interdisciplinary collaboration to enhance delirium screening and management in palliative care.

Dimensional structure of the Brief Illness Perception Questionnaire and Association with adverse childhood experiences in patients with an implantable cardioverter-defibrillator

Illness perceptions (IP), as measured by the Brief Illness Perception Questionnaire (BIPQ), and adverse childhood experiences (ACE) have been shown to affect the physical and psychological well-being in different patient populations. However, little is known about IP and ACE in patients with an implantable cardioverter-defibrillator (ICD). Our objectives were to investigate the dimensional structure and to evaluate correlates of the BIPQ in ICD patients. 423 patients with an ICD were prospectively recruited. We conducted a principal component analysis to determine the dimensional structure of the BIPQ. Associations between ACE, other sociodemographic and clinical variables, and IP were analysed using a multivariable linear regression. We identified a two-factor structure (I = Consequences, II = Control) of the BIPQ. Among others, a higher number of ICD shocks in the past (0.21, 95% CI = 0.01-0.41, p = 0.036), low physical activity (-2.16, 95% CI = -4.37 to -0.37, p = 0.045), more frequent ACE (0.56, 95% CI = 0.08-1.22, p = 0.030), ICD shock-related concerns (0.75, 95% CI 0.62-0.89, p < 0.001), and primary ICD indication (-2.29, 95% CI -4.47 to -0.11, p = 0.039) were significantly associated with more threatening IP. The identification of those variables might lead to more precise interventions targeting maladaptive IP in this vulnerable patient population.

Bridging the gap: attitudes and practices toward complementary and alternative medicine among oncology patients and healthcare professionals in Croatia

The prevalence of complementary and alternative medicine (CAM) use among oncology patients ranges from 30 to 80%, particularly higher in the United States compared to Europe. However, limited research exists on the attitudes of healthcare professionals and oncology patients toward CAM, especially within Western evidence-based medical settings. This study aims to address this gap by assessing CAM use prevalence among healthcare professionals and oncology patients and analyzing their cognitive, affective, and behavioral attitudes. Additionally, it explores the influence of sociodemographic factors and personal experiences on these attitudes. A cross-sectional survey was conducted between November 2022 and May 2023 at University Hospital Center Sisters of Mercy, Zagreb, Croatia. The study included 832 participants: 411 oncology patients and 421 healthcare professionals (100 physicians, 321 nurses/technicians). Data were collected using modified versions of the Health Belief Questionnaire (CHBQ) and Integrative Medicine Attitude Questionnaire (IMAQ). Statistical analysis included descriptive methods and tests such as Chi-square, Mann-Whitney U, Kruskal-Wallis, ANOVA, and post hoc Tukey tests. The results showed that 55.6% of oncology patients and 32.2% of healthcare workers had used CAM at least once. Oncology patients were more likely to use CAM than healthcare professionals, and among healthcare professionals, nurses/technicians used CAM more frequently than physicians. Significant differences in attitudes were observed based on sociodemographic factors. Positive attitudes were more common among women, older adults, individuals with lower education levels, nurses/technicians, those with longer work experience, non-oncology healthcare workers, believers, and those with lower incomes. Marital status and place of residence showed no significant effect. This study highlights a gap between cancer patients' frequent, unsupervised CAM use and healthcare providers' often skeptical attitudes, particularly among physicians. The findings underscore the need for targeted education for healthcare professionals, development of CAM management guidelines in oncology, and fostering open dialogue between patients and providers to optimize outcomes. Longitudinal research is recommended to explore CAM's impact on clinical outcomes.

Influence of religion and spirituality on head and neck cancer patients and their caregivers: a protocol for a scoping review

INTRODUCTION

Head and neck cancers (HNC) are devastating, thus imposing a negative impact on the appearance of an individual as well as vital activities such as eating, swallowing, speaking, and breathing. Therefore, HNC patients undergo distress, while their caregivers become overburdened. Religion and spirituality can be helpful for patients and their caregivers from diverse cultural backgrounds to cope with cancer. Though well established in palliative care, religion and spirituality are rarely incorporated into usual early oncological care. Despite the availability of heterogeneous literature examining the influence of religion and spirituality on cancer patients, there is notably limited research on this topic across the HNC trajectory. Therefore, this scoping review attempts to answer "What is the influence of religion or spirituality on HNC patients and their caregivers in different contexts?" and will map the evidence on the influence of religion and spirituality on HNC patients and their caregivers in different contexts including geographical areas, cultures, health care systems, and different study settings.

METHODS

This scoping review was formulated using the guidelines of Joanna Briggs Institute (JBI) manual for evidence synthesis: scoping reviews and will be reported confirming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR checklist). A comprehensive search strategy will include Embase, CINAHL, Scopus, and APA PsycINFO. The OPENGREU.EU and Google Scholar will be used as gray literature sources complimented by manual searches. Our eligibility criteria follow the population, concept, and context (PCC) framework. Patients aged ≥ 18 years diagnosed with HNC and their informal, nonpaid caregivers aged > 18 years will be included. The data will be extracted using piloted data extraction form on sociodemographic, disease-related, and treatment-related factors and outcomes, and the data will be analyzed through descriptive statistics and thematic analysis. The results will be narratively synthesized.

CONCLUSIONS/DISCUSSION

This review will aim to explore existing literature and summarize the findings of studies that examine the influence of religion and spirituality among HNC patients and their caregivers and vice versa over a range of physical, psychological, and social outcomes including quality of life. We also aim to identify existing research gaps. The findings of this review would generate evidence to better inform health care providers in countries and cultures in the management of patients diagnosed with HNC in usual oncological care with due consideration to caregivers.

"The biggest challenge is there's never a routine": a qualitative study of the time burdens of cancer care at home

PURPOSE

As cancer care is increasingly delivered in the home, more tasks and responsibilities fall on patients and their informal care partners. These time costs can present significant mental, physical, and financial burdens, and are undercounted in current measures of time toxicity that only consider care received in formal healthcare settings.

METHODS

Semi-structured qualitative interviews were conducted with patients with gastrointestinal cancer and informal care partners at a single tertiary cancer center between March and October 2023. Interviews explored cancer care tasks conducted when home, associated time burdens, how these time burdens compared to facility-based care, and whether home-based care should be included in objective measures of time toxicity. Two coders transcribed interviews and analyzed data using a grounded theory approach.

RESULTS

A single interviewer conducted semi-structured interviews with 15 patients and 18 care partners, and identified five major themes: (1) unexpected home-based care activities are time burdensome; (2) other burdens interact with and impact time burdens; (3) time burdens evolve over the disease course and differentially impact patients and care partners; (4) several factors influence the choice of home-based versus in-facility care; and (5) home-based care is generally perceived as less time-burdensome than in-facility care. Overall, 12 of 33 (36%) participants recommended including days with home-based care in the current contact days measure of time toxicity.

CONCLUSION

In addition to characterizing time burdens associated with home-based cancer care, this study builds on existing literature to explore if and how to incorporate days with home-based care into the contact days measure.

Unmet Supportive Care Needs of Lung Cancer Survival Patients at Different Cancer Stages and Treatment Phases

Purpose

This study examined the unmet supportive care needs of lung cancer patients across different cancer stages and treatment phases, as well as the factors associated with these unmet needs.

Patients and methods

Data from 501 lung cancer patients at a cancer center in central Taiwan were analyzed to assess their unmet supportive care needs across dimensions such as health information, patient care, treatment, nutrition, psychosocial, and economic needs. Associations with sex, age, cancer stage, and treatment phase were investigated.

Results

Compared with male patients, female patients exhibited fewer unmet health information needs (aOR=0.40; p=0.021). Older patients had greater patient care needs than younger patients did (aOR=3.08, p=0.026). Patients in the in-treatment (p<0.001) and follow-up (p=0.025) phases exhibited significantly lower needs for health information than did those in the newly diagnosed phase. Similarly, patients in the treatment (aOR=0.42, p=0.006), recurrence (aOR=0.24, p=0.043), and follow-up (aOR=0.12, p=0.007) phases exhibited significantly lower needs for patient care than did those in the newly diagnosed phase. Regarding treatment needs, patients in the treatment phase also demonstrated lower needs than did those in the newly diagnosed phase (aOR=0.12, p=0.004). Patients in the treatment phase had lower nutritional needs than did those in the newly diagnosed phase (aOR=0.54, p=0.043). However, psychosocial needs were greater during the treatment (aOR=2.75, p=0.004) and recurrence phases (aOR=7.61, p=0.001).

Conclusion

The unmet needs of lung cancer patients vary based on demographic characteristics and disease-related factors. Patients in the newly diagnosed phase have significantly higher unmet needs compared to other stages. Therefore, Healthcare professionals should provide appropriate and timely individualized care to address these needs.

Suicidality, resilience and burnout in a population of oncology nurses

Oncology care gives employees the opportunity to care for people during the most difficult periods of their lives, which can affect the psychological well-being of nurses in different domains. The aim of this work is to examine is suicidality connected with resilience and burnout in the populations of oncology and non-oncology nurses, nursing students and administrative workers, as well as to determine if oncology nurses differ from other groups. The study included a total of 75 oncology nurses, 74 non-oncology nurses, 71 administrative workers and 70 nursing students. The respondents filled out the Serbian version of the Risk Assessment Suicidality Scale, the Serbian version of the Brief Resilience Scale, and the Maslach Burnout Inventory. The observed variables were compared by Spearman's Rho correlation. In the population of oncology nurses, resilience and suicidality are negatively correlated (r = - 0.375, p = 0.001). In the same population, suicidality and burnout are not correlated, but the correlation was significant in all other control groups. Our research established the importance of strengthening the resilience of employees in the health sector, through various programs and trainings. Working professionals are more often forced to develop individual protective strategies and incorporate them into daily practice.

The relationship of cultural variables to attitudes toward prescription drug usage among Iranian/Persian Americans

The present study examined the effects of cultural factors(ethnic identity, acculturation, perceived discrimination, and religiosity), derived from the Multicultural Assessment-Intervention Process (MAIP) model, on attitudes toward prescription drug use among Iranian/Persian Americans across the United States. The study consisted of a final sample of 454 Iranian/Persian American adult participants. The results indicated that Iranian/Persian American attitudes toward prescription drug use are impacted by demographic and cultural factors. Less heritage acculturation was found to be a predictor of attitudes toward the use of recreational and achievement-oriented prescription drug use. Further, perceived discrimination, specifically, perceived stigmatization and threat/aggression as well as less identification with Iranian/Persian heritage culture, were found to predict more positive attitudes toward prescription drug use among Iranian/Persian Americans. Religiosity was not found to be predictive of prescription drug usage. The present study underscores the usefulness of considering the impact of Iranian/Persian American ethnic identity, acculturation, and perceived discrimination in treating substance abuse within this population. Clinical implications, limitations, and future research are discussed.

Fall risk factors and mitigation strategies for hematological malignancy patients: insights from a qualitative study using the reason model

PURPOSE

Our study aim was to understand the (human and organizational) factors influencing fall risk among people with hematological malignancies using the Reason model as a framework, providing insights that can inform the development of safe and effective fall management strategies.

METHODS

Purposive sampling was employed to conduct semi-structured interviews with 13 people with hematological malignancies and 12 nurses from the hematology department of a tertiary grade A hospital in Guangzhou from December 2023 to February 2024. The topic analysis method was utilized to analyze the interview data.

RESULTS

Factors influencing fall risk among people with hematological malignancies were categorized into four themes: (1) precondition of unsafe arts (lack of work experience in junior nurses, poor patient compliance, adverse drug reactions, inadequate ward facilities); (2) unsafe supervision (inadequate inspection management, inadequate accompanying capacity); (3) unsafe arts (variability in subjective assessment, lack of bidirectional education); and (4) organizational influences (limited nursing human resources, lack of organizational process management models).

CONCLUSION

The specific fall risk factors among people with hematological malignancies, as summarized based on the Reason model framework, provide a theoretical basis and direction for the construction of specialized fall risk assessment tools, aiming to improve the quality of fall management for inpatients and reduce the incidence of falls.

Artificial Intelligence in Oral Cancer: A Comprehensive Scoping Review of Diagnostic and Prognostic Applications

Background/Objectives: Oral cancer, the sixth most common cancer worldwide, is linked to smoke, alcohol, and HPV. This scoping analysis summarized early-onset oral cancer diagnosis applications to address a gap. Methods: A scoping review identified, selected, and synthesized AI-based oral cancer diagnosis, screening, and prognosis literature. The review verified study quality and relevance using frameworks and inclusion criteria. A full search included keywords, MeSH phrases, and Pubmed. Oral cancer AI applications were tested through data extraction and synthesis. Results: AI outperforms traditional oral cancer screening, analysis, and prediction approaches. Medical pictures can be used to diagnose oral cancer with convolutional neural networks. Smartphone and AI-enabled telemedicine make screening affordable and accessible in resource-constrained areas. AI methods predict oral cancer risk using patient data. AI can also arrange treatment using histopathology images and address data heterogeneity, restricted longitudinal research, clinical practice inclusion, and ethical and legal difficulties. Future potential includes uniform standards, long-term investigations, ethical and regulatory frameworks, and healthcare professional training. Conclusions: AI may transform oral cancer diagnosis and treatment. It can develop early detection, risk modelling, imaging phenotypic change, and prognosis. AI approaches should be standardized, tested longitudinally, and ethical and practical issues related to real-world deployment should be addressed.

Clinicians knowledge of cancer: A study in Ghana's Bono region

BACKGROUND

Cancer is a growing public health concern in Ghana, with rising prevalence, incidence, and mortality rates. Clinicians play a crucial role in cancer prevention and control by providing accurate information and early detection services. This study assessed the level of cancer knowledge among a cross-section of clinicians in the Bono region of Ghana, focusing on their knowledge of cancer, signs, symptoms, and risk factors.

METHOD

This was a cross-sectional study conducted using a validated questionnaire. The recruitment included doctors, pharmacists, nurses, laboratory technologists, radiographers, pharmacy technologists and other healthcare staff from four hospitals. Correlation between continuous variables and knowledge, signs and symptoms, and risk factors of cancer were assessed using bivariate correlation analysis.

RESULTS

Our findings showed that the majority of participants (96.6%, n = 237) had adequate knowledge of cancer, with most (91.7%, n = 225 and 62.8%, n = 154) demonstrating adequate knowledge of cancer signs and risk factors, respectively. However, significant knowledge gaps were identified regarding specific warning signs and symptoms, such as indigestion, changes in bowel or bladder habits, and persistent cough or hoarseness. Moreover, a substantial portion of participants lacked knowledge of risk factors like excessive meat intake, insufficient physical activity, and a lack of fruits and vegetables.

CONCLUSION

This study underscores the need to implement strategies for enhancing cancer awareness and knowledge among healthcare professionals in Ghana, with a particular focus on addressing the identified knowledge gaps. Clinicians should be empowered to effectively educate the public on cancer signs, symptoms, risk factors, and the importance of early detection.

Role of digital technology in epidemic control: a scoping review on COVID-19 and Ebola

OBJECTIVE

To synthesise the role of digital technologies in epidemic control and prevention, focussing on Ebola and COVID-19.

DESIGN

A scoping review.

DATA SOURCES

A systematic search was done on PubMed, HINARI, Web of Science, Google Scholar and a direct Google search until 10 September 2024.

ELIGIBILITY CRITERIA

We included all qualitative and quantitative studies, conference papers or abstracts, anonymous reports, editorial reports and viewpoints published in English.

DATA EXTRACTION AND SYNTHESIS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist was used to select the included study. Data analysis was performed using Gale's framework thematic analysis method, resulting in the identification of key themes.

RESULTS

A total of 64 articles that examined the role of digital technology in the Ebola and COVID-19 pandemics were included in the final review. Five main themes emerged: digital epidemiological surveillance (using data visualisation tools and online sources for early disease detection), rapid case identification, community transmission prevention (via digital contact tracing and assessing interventions with mobility data), public education messages and clinical care. The identified barriers encompassed legal, ethical and privacy concerns, as well as organisational and workforce challenges.

CONCLUSION

Digital technologies have proven good for disease prevention and control during pandemics. While the adoption of these technologies has lagged in public health compared with other sectors, tools such as artificial intelligence, telehealth, wearable devices and data analytics offer significant potential to enhance epidemic responses. However, barriers to widespread implementation remain, and investments in digital infrastructure, training and strong data protection are needed to build trust among users. Future efforts should focus on integrating digital solutions into health systems, ensuring equitable access and addressing ethical concerns. As public health increasingly embraces digital innovations, collaboration among stakeholders will be crucial for effective pandemic preparedness and management.

The Effects of Online Yoga Practice on Cancer Patients: A Systematic Review

Background: Cancer remains a leading cause of death, with 9.7 million deaths in 2022. Despite advancements in diagnosis and treatment, many cancer patients experience side effects that significantly impact their quality of life, including chronic pain, anxiety, depression, sleep disturbances, and cancer-related fatigue. Non-pharmacological interventions, such as yoga, have gained attention for their potential to reduce stress and improve overall well-being. However, barriers such as fatigue, pain, and transportation issues limit access to in-person yoga, leading to the growing adoption of online yoga as a viable alternative. Objective: This systematic review synthesizes research on the effectiveness of online yoga for cancer patients. A comprehensive search was conducted across Medline, PsycINFO, and Scopus databases on 24 October 2024. The methodological quality of the studies was assessed using the CASP Checklist. Of 6266 articles initially identified, 14 studies met the inclusion criteria, comprising qualitative (n = 4) and quantitative (n = 10) studies. Results: The results suggest that online yoga can improve stress and sleep quality, with moderate effects on anxiety, depression, and fatigue. However, variability in study designs and methodological limitations complicate the evaluation of its overall effectiveness. Conclusions: Online yoga offers a practical, accessible option for cancer patients unable to attend in-person sessions, showing the potential to enhance mental and physical health outcomes. Nevertheless, the variability in study methodologies highlights the need for more standardized research to establish its role as a supportive intervention in oncology care.

Exploring the role of different coping styles in mediating the relationship between dyadic adjustment status and postpartum depression among postnatal women: a single-centre, cross-sectional study

OBJECTIVES

Postpartum depression (PPD) is a prevalent complication of childbearing, with numerous risk factors associated with its onset. Although the risk factors for PPD among postpartum women have been studied, the mechanisms underlying these factors remain inadequately understood. This study aimed to investigate the direct and mediating roles of different coping styles in the relationship between dyadic adjustment status and PPD among women 6 weeks postdelivery.

DESIGN

Single-centre, cross-sectional study.

SETTING

A tertiary care setting in Chengdu City, Sichuan Province, China, from July 2022 to January 2023.

PARTICIPANTS

The study involved 626 women 6 weeks post-delivery.

OUTCOME MEASURES

The Dyadic Adjustment Scale, the Simplified Coping Style Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS) were used to evaluate the dyadic adjustment status, coping styles and the depressive condition of postpartum women, respectively. Data analysis encompassed correlation and mediation analyses based on structural equation modelling.

RESULTS

EPDS scores were significantly correlated with all four dimensions of dyadic adjustments status as well as with both positive and negative coping styles. Dyadic consensus (β = -0.16, p=0.005), affectional expression (β = -0.14, p=0.008) and dyadic cohesion (β = -0.10, p=0.037) directly correlated with PPD after adjusting for covariates. For dyadic satisfaction, the mediating effects of positive and negative coping styles on PPD were -0.04 (95% CI: -0.08 to -0.01) and -0.07 (95% CI: -0.11 to -0.03), respectively. Moreover, both positive and negative coping styles were identified as mediators in the relationship between dyadic cohesion and PPD, with mediating effects of -0.01 (95% CI: -0.03 to -0.00) and -0.09 (95% CI: -0.14 to -0.04), respectively. No mediation was found in the association between affectional expression and PPD.

CONCLUSION

Our findings suggest that both positive and negative coping styles mediate the relationship between dyadic adjustment status and PPD, especially concerning dyadic satisfaction and dyadic cohesion.

Results comparison of cervical cancer early detection using cerviray ® with VIA test

OBJECTIVES

This study investigates the performance of artificial intelligence (AI) technology, namely Cerviray AI®, compared with Cerviray® expert, aiming to compare its sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic curve (AUC ROC). The Visual Inspection with Acetic Acid (VIA) test is used as the gold standard.

RESULTS

The study involved 44 patients from various health centers in West Java Province. Performance of Cerviray AI®, or Cerviray® expert, and lastly VIA tests were compared in their ability to detect pre-cancerous cervical lesions in high-risk women of childbearing age. The current study indicated that Cerviray AI® had a sensitivity of 42.9%, specificity of 100%, PPV of 100%, and ROC AUC values of 71.4%. In comparison, the evaluation of the Cerviray® expert demonstrated a sensitivity of 71.4%, specificity of 97.3%, PPV of 83.3%, and ROC AUC values of 84.4%. In conclusion, the evaluation of Cerviray® expert outperformed Cerviray AI® in ROC AUC values.

TRIAL REGISTRATION

Clinical Trials.gov Identifier NCT06518070 Retrospectively registered.

Decision Regret About Treatment Amongst Women With Early Breast Cancer: An Integrative Review

AIMS

To synthesise evidence on decision regret about treatment amongst women with early breast cancer, including (1) the type of treatment related to decision regret, (2) the level of decision regret, and (3) factors associated with decision regret.

DESIGN

Integrative review.

METHODS

Studies published between January 2000 and December 2023 were searched from five online databases to provide up-to-date evidence. The Joanna Briggs Institute critical appraisal tools were used to evaluate the quality of the studies. The constant comparison strategy was employed for data analysis.

RESULTS

A total of 26 studies were included. Breast cancer surgery was the most frequently studied treatment in relation to decision regret amongst women with early breast cancer, while adjuvant therapies were less studied. Most studies reported low levels of decision regret, while several studies found high levels. The proportion of women reporting decision regret varied considerably from 2.5% to 69% across the included studies. Factors associated with decision regret included various socio-demographic and clinical characteristics (age, ethnicity, employment, education, health literacy, cancer stage, and treatment types), decision-making experiences (patient involvement, patient preference, accessing information, and the use of decision support tools), and mental health.

CONCLUSION

Decision regret occurs in women with early breast cancer after surgery and adjuvant therapies. A variety of factors should be considered during the treatment decision-making process to minimise decision regret. More robust studies are needed to disaggregate decision regret by treatment type and to evaluate the effectiveness of decision support tools in reducing decision regret in women with early breast cancer.

IMPACT

Nurses and other healthcare professionals should be aware of the potential for decision regret related to surgery and adjuvant therapies in women with early breast cancer. The findings can help nurses and other healthcare professionals identify women at higher risk of experiencing decision regret and provide support during the treatment decision-making process to mitigate it.

REPORTING METHOD

PRISMA 2020 Statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution to this review.

Relationship between sense of coherence and subjective well-being among family caregivers of breast cancer patients: a latent profile analysis

Objective

Sense of coherence (SOC) assists cancer-affected caregivers in overcoming challenges in the process of caregiving and may potentially influence an individual's subjective well-being (SWB). This study aimed to explore distinct SOC profiles among caregivers of breast cancer patients, identify the distribution differences of these profiles in sociodemographic and clinical characteristics, and explore their relationship with SWB.

Methods

A total of 360 patients with caregivers of breast cancer patients from one tertiary hospitals in Jiangsu completed the Sociodemographic and clinical characteristics, the Sense of Coherence Scale (SOC-13), and the General Subjective Well-Being Schedule (GWB). Mplus 8.3 for latent profile was performed to identify SOC classes. Multivariate logistic regression was used to analyze the impact of various factors on the different categories, and ANOVA was applied to compare the SWB among caregivers of different categories.

Results

Three latent profiles of SOC were identified: the "low sense of coherence-meaning group" (7.9%), the "moderate sense of coherence-manageability group" (37.3%), and the "high sense of coherence-optimism group" (54.7%). Age, residence, health status, financial pressure, caregiving duration, and breast cancer stage significantly influenced the distribution of SOC in caregivers of breast cancer patients. The SWB level differed significantly among these three categories.

Conclusion

This study identified three distinct classes of SOC among caregivers. It is recommended that health care providers screen caregivers with diverse profiles of SOC and pay more attention to young, rural, long-term caregiving duration, heavy economic burden, and caregivers in poor physical condition.

Young Adult Community Health Advisor-Led Intervention to Promote Colorectal Cancer Screening Uptake Among South Asians in Hong Kong: A Randomized Controlled Trial

BACKGROUND

Colorectal cancer is the most common cancer globally, and its prevalence is high in minority populations.

OBJECTIVES

To investigate the effectiveness of a young adult community health advisor (YACHA)-led intervention in enhancing the colorectal cancer (CRC) screening uptake rate among asymptomatic South Asians aged 50 to 75 years residing in Hong Kong and to investigate the acceptability of this intervention.

METHODS

A randomized controlled trial design was adopted. Eighty asymptomatic South Asian participants aged 50 to 75 years were recruited from the community in Hong Kong and then randomly allocated either to a YACHA-led intervention group or a control group. The intervention group received YACHA-led intervention, whereas the control group would receive the intervention after all follow-up assessments. The outcome measure was the uptake of CRC screening test. The acceptability of the intervention was explored through semistructured interviews.

RESULTS

The findings showed that the CRC screening uptake rate of the intervention group was significantly higher than that of the control group (85.0% vs 2.5%, P < .001). All the interviewees were satisfied with the intervention.

CONCLUSION

The YACHA-led intervention improves the uptake of CRC screening among asymptomatic South Asians.

IMPLICATIONS FOR PRACTICE

It is suggested that more resources should be allocated to empower young members of minority groups to reduce the health disparity.

Cultural adaptation of ENABLE (Educate, Nurture, Advise, Before Life Ends) an early palliative care model for Iranian patients with heart failure and their caregivers: a qualitative study protocol

BACKGROUND

ENABLE (Educate, Nurture, Advise, Before Life Ends) is a model of nurse-led, early palliative care that was originally developed for U.S. patients with advanced cancer and their family caregivers and then adapted for patients with heart failure. ENABLE coaching topics include problem-solving, communication, advance care planning, symptom management, and self-care. The purpose of this paper is to detail a qualitative study protocol to assess the cultural acceptability of ENABLE among heart failure patients and their family caregivers in Iran.

METHODS

This qualitative study employs reflexive thematic analysis (RTA) to guide the cultural adaptation of the ENABLE model. The study is conducted in two phases. In Phase 1, the ENABLE content will be translated and validated into Persian using a forward-backward translation process and expert panel review to ensure linguistic and cultural appropriateness. In Phase 2, semi-structured interviews will be conducted with individuals living with HF, their caregivers, and healthcare providers at Tehran University of Medical Sciences. The one-on-one semi-structured interviews will explore three main areas: (1) the primary needs and challenges faced by individuals with heart failure and their family caregivers, (2) the extent of patients' involvement in healthcare decision-making, and (3) participants' preferences for content and delivery method of ENABLE. Maximum variation sampling will be employed to ensure diverse representation, and data collection will continue until saturation is achieved. Interview audio recordings will be transcribed verbatim and analyzed using Braun and Clarke's reflexive thematic analysis approach. The analysis will involve iterative coding to identify patterns and the development of themes that align with the core components of the ENABLE model while ensuring cultural relevance. Trustworthiness and rigor will be ensured through reflexivity, peer debriefing, and data triangulation, ensuring credible and robust findings to guide the cultural adaptation of the ENABLE model for Iran.

DISCUSSION

This study will develop a framework for adapting the ENABLE model to Iran, offering insights into cultural and contextual factors influencing palliative care. The adapted model aims to enhance the quality of life for individuals with HF and their caregivers while addressing gaps in palliative care delivery in Iran.