Spirituality and Factors Relevant to Spiritual Nursing-Care Needs Among Chinese Patients with Cancer

This study aimed to identify the factors associated with the spiritual nursing-care needs of adult Chinese cancer patients. A questionnaire survey was conducted and the 158 respondents in the total sample were classified into two groups based on the presence or absence of spiritual nursing-care needs. The group requiring spiritual nursing-care exhibited lower scores on the Meaning and Peace scales and higher scores on the Faith scale compared to the other group. The between-group difference was significant only in the case of Peace. The results indicated that the Peace score was the sole significant predictor of spiritual nursing-care needs (OR 0.83, 95% CI [0.74, 0.94]). These findings suggest that nurses should provide spiritual care to help foster Chinese patients' peace of mind.

The Heidelberg Decision Aid for Patients With Lung Cancer (HELP)—Findings of a Randomized Controlled Trial

BACKGROUND

Advanced lung cancer typifies the challenges of shared decision-making in oncology. With a limited prognosis for survival, the increasingly numerous and complex treatment options must continually be weighed against issues of fragility, quality of life, and the end of life.

METHODS

This randomized, controlled trial, carried out on 138 patients, concerned the use of a decision aid combined with decision coaching, versus standard care. The primary endpoint was clarity of the patient's personal attitude, as assessed on the Decisional Conflict Scale. The secondary endpoints were self-efficacy, decisional conflict, perceived preparedness and participation in decision-making, and anxiety/depression. The data were analyzed with descriptive statistics and intergroup comparisons. The trial was entered into the German registry of clinical trials (DRKS00028023).

RESULTS

No statistically significant difference with regard to the primary endpoint (clarity of the patient's personal attitude concerning the decision) was found in a comparison between the intervention group and the control group (IG: median/IQR: 41.67/47.92; CG: median/IQR: 33.33/43.75; p = 0.35). The descriptive statistics revealed a high level of decisional conflict in the overall group of study participants: 57.6% had a very high level of decisional conflict, composed in particular of the dimensions of feeling inadequately informed (64.4%) and of uncertainty (58.9%). Most participants judged the intervention to be helpful in preparing them to make a decision.

CONCLUSION

Even though the intervention was perceived as helpful preparation for decision-making, it did not bring about any improvement in the high level of decisional conflict. With the continual development of new treatments and the associated increase in prognostic uncertainty, there is an important role for individualized patient information and the training of physicians in how to deal with uncertainty.

Immune Checkpoint Inhibitor-Associated Cutaneous Adverse Events: Mechanisms of Occurrence

Immunotherapy, particularly that based on blocking checkpoint proteins in many tumors, including melanoma, Merkel cell carcinoma, non-small cell lung cancer (NSCLC), triple-negative breast (TNB cancer), renal cancer, and gastrointestinal and endometrial neoplasms, is a therapeutic alternative to chemotherapy. Immune checkpoint inhibitor (ICI)-based therapies have the potential to target different pathways leading to the destruction of cancer cells. Although ICIs are an effective treatment strategy for patients with highly immune-infiltrated cancers, the development of different adverse effects including cutaneous adverse effects during and after the treatment with ICIs is common. ICI-associated cutaneous adverse effects include mostly inflammatory and bullous dermatoses, as well as severe cutaneous side reactions such as rash or inflammatory dermatitis encompassing erythema multiforme; lichenoid, eczematous, psoriasiform, and morbilliform lesions; and palmoplantar erythrodysesthesia. The development of immunotherapy-related adverse effects is a consequence of ICIs' unique molecular action that is mainly mediated by the activation of cytotoxic CD4+/CD8+ T cells. ICI-associated cutaneous disorders are the most prevalent effects induced in response to anti-programmed cell death 1 (PD-1), anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), and anti-programmed cell death ligand 1 (PD-L1) agents. Herein, we will elucidate the mechanisms regulating the occurrence of cutaneous adverse effects following treatment with ICIs.

Cognitive impairment in young adults after cancer treatment: A descriptive correlational study on levels and associations with disease-related, psychological, and lifestyle factors

PURPOSE

Young adults report challenges concerning cancer--related cognitive impairment (CRCI). This study aimed to: (1) describe cognition in young adults post-cancer treatment using self-report and performance-based measures, and (2) examine associations between cognition and relevant disease-related, psychological, and lifestyle (physical activity; PA) factors.

METHODS

Forty-six young adults (Mage = 31.4 ± 5.4 years; 91.3% female) completed web-based questionnaires and neuropsychological tests; data were analyzed via descriptive statistics and bivariate correlations.

RESULTS

Most (60.9%) self-reported clinically meaningful CRCI and displayed poorer executive functioning and processing speed (but not working memory) than normative data. Disease-related factors, psychological factors, and PA had null-to-moderate (rs = -0.32-0.28), small-to-large (rs = -0.74-0.77), and trivial-to-moderate (rs = -0.16 - 0.36) correlations with cognition (respectively), with differences in magnitude between self--reported and objective cognition.

CONCLUSION

The observed correlations warrant further exploration in larger prospective studies, and trials should investigate causative mechanisms and specific PA parameters.

Spiritual assessment in palliative care: multicentre study

OBJECTIVES

This study aims to provide an in-depth exploration of everyday spiritual concerns of patients with advanced cancer seeking palliative care in Bangladesh, and assess their spiritual well-being (SWB).

METHODS

This study was conducted among 163 patients with advanced cancer from three tertiary care hospitals in Bangladesh. It was divided into two parts: a quantitative segment that assessed the SWB of the participants using the EORTC QLQ SWB32, and a qualitative segment that explored their spiritual history.

RESULT

Spirituality was commonly interpreted and understood synonymously with religion by all participants, and their sense of life's meaning centred on their families and friends. The lack of support from religious organisations led to feelings of isolation and disconnection from spiritual communities. Highest scores in SWB were observed in Relationships with God and Someone/Something Greater Scales. The lowest score was observed for Existential fulfilment. Patients expressed a desire for their palliative care team to address their spiritual concerns, regardless of their training in this area.

CONCLUSION

Spirituality is a deeply personal aspect of the human experience. Understanding and respecting these beliefs can empower palliative care professionals to deliver culturally sensitive care to their patients, irrespective of their level of training.

Immune Checkpoint Inhibitors in Patients with Testicular Cancer: A Systematic Review

Germ cell tumors (GCTs) are chemosensitive neoplasms with high cure rates; however, a small group of patients present tumors with refractory chemotherapy, with a dismal prognosis and few effective management options. Although immune checkpoint inhibitors (ICIs) are approved for use in chemotherapy refractory GCT, the evidence supporting this indication remains scarce. Original research studies were included on patients with GCTs refractory to chemotherapy treated with ICI up to December 2023. Comprehensive search strategies databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and oncological outcomes were recorded. A total of 13 studies (n = 106) were included, five single-patient case reports, one retrospective cohort, six-phase II randomized controlled trials (RCTs), and an abstract from the preliminary results of a phase II RCT. Most of the studies evaluated did not request biomarkers as inclusion criteria. Median overall response rate across studies was 3.4% (range, 0-57) and 0% (range, 0-6) in retrospective cohort and phase II studies. Progressive disease as the best response was present in most patients, with 75% (range, 0-82.9) in the overall population and 82% (range, 75 -83) in the retrospective cohort and phase II trials. Some of the most durable clinical responses documented in this systematic review corresponded to high tumor mutational burden (TMB-H) or high microsatellite instability (MSI-H)/dMMR tumors. Retrospective cohorts and clinical trials evaluating ICIs for the treatment of chemo-refractory GCTs documented limited activity of these drugs as a single intervention in patients not selected by biomarkers, with a tendency to better results described in those with TMB-H or MSI-H/dMMR tumors.

Disparities in Cervical Cancer Among LHS+ Women: A Primer for Medical Students

Introduction

Latina, Latino, Latinx, Latine, Hispanic, or of Spanish origin+ (LHS+) women face higher cervical cancer risks, incidence, and mortality compared to non-Hispanic White women. These disparities are attributable to socioeconomic factors, limited access to health care, language and cultural barriers, and negative health care experiences.

Methods

We used the Kern model to design, implement, and evaluate a workshop to educate medical students and health care professionals on cervical cancer disparities among LHS+ women and culturally competent communication skills. The workshop included a 60-minute session featuring a PowerPoint presentation, video, and case discussions.

Results

We conducted the workshop four times, both in person and virtually. We administered pre- and posttests to 46 participants, including medical students and health care professionals. Only 39 participants completed both forms, yielding an 85% response rate. Analysis using the related-samples Wilcoxon signed rank test on responses revealed a significant increase in confidence for each learning objective (p < .01). Participants rated the workshop as very good or excellent, and their feedback highlighted the value of interactive activities like the video and case discussions.

Discussion

Increasing health care providers' awareness of and knowledge about cervical cancer disparities in LHS+ women is essential to improve health care experiences and outcomes. Future workshops should incorporate culturally specific materials for different Spanish-speaking nationalities (e.g., Dominican, Mexican, etc.), medical Spanish training, and cervical cancer education for LGBTQ+ LHS+ women.

Development of ICF-based patient-reported outcome and experience measures to study social participation among people with chronic diseases: a mixed-methods protocol

INTRODUCTION

Living with a chronic disease impacts many aspects of life, including the ability to participate in activities that enable interactions with others in society, that is, social participation (SP). Despite efforts to monitor the quality of care and life of chronically ill people in Belgium, no disease-specific patient-reported measures (PRMs) have been used. These tools are essential to understand SP and to develop evidence-based recommendations to support its improvement. This protocol presents the phases for the disease-specific development of patient-reported outcome and experience measures to assess SP and its potential determinants among people living in Belgium with cancer, cystic fibrosis, diabetes, HIV or a neuromuscular disease.

METHODS AND ANALYSIS

This protocol applies the PROMIS Instrument Development and Validation Scientific Standards and COnsensus-based Standards for the selection of health Measurement INstruments to develop PRMs in a disease-specific manner to quantify the components of the International Classification of Functioning, Disability and Health (ICF). A mixed-method approach is used to create broad initial item pools based on patient (focus groups) and literature perspectives which are compared within ICF-standardised language by applying the refined ICF linking rules. An item set is first created based on this cross-matching exercise and then validated by multidisciplinary expert panels. Cognitive assessment and pilot testing are followed by the dissemination of the survey to a representative sample in Belgium. Advanced psychometric testing (classical test theory and item response theory) is applied to inform an item reduction strategy for the final measures and to develop scales for the ICF components.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Ethics Committee of the Ghent University Hospital on 20 February 2023 to organise the patient focus groups (ONZ-2022-0470). Ethical approval for dissemination of the PRMs and psychometric testing will be sought at the Ghent University Hospital Ethics Committee at the start of Phase 6. Results will be disseminated through peer-reviewed journals and professional conferences.

Current status and influencing factors of nutrition management in patients with digestive tract cancer from the integrated perspective of medical care staff, patients, and family caregivers: a qualitative study

BACKGROUND

The research aimed to collect experience and viewpoints related to the nutrition management of patients with digestive tract cancers from medical care staff, patients, and family caregivers and provide reasonable and effective references for the mode of nutrition management of these patients.

METHODS

Using a phenomenological qualitative research method, six physicians, six nurses, three nutritionists, six patients, and six family caregivers from a tertiary A cancer hospital in Jiangsu Province were chosen by purposive sampling methods from February to June 2023. Data was collected through semi-structured in-depth interviews and analyzed by the content analysis method.

RESULTS

Data analysis revealed two major themes, each with four subcategories: current status of clinical nutrition management tract cancers which consisted of "lack of whole-process nutrition management model," "inadequate role of nutrition management professionals," "lack of a mechanism for continuous improvement of nutrition management quality," and "lack of nutrition science popularization and training system" and influencing factors of clinical nutrition management that contained "patient-related factors," "family-related factors," "medical staff-related factors," and "hospital environment and policy-related factors."

CONCLUSIONS

Nutritional management of digestive cancer patients is currently inadequate and should be viewed through an integrated perspective. Improvements should be made at four angles: patient, family, healthcare provider, and hospital environment by establishing a multidisciplinary nutritional management team.

Mapping an evidence-based end-of-life care framework for older adults in Chinese nursing homes: protocol for a scoping review

INTRODUCTION

End-of-life care is essential for older adults aged ≥60, particularly those residing in long-term care facilities, such as nursing homes, which are known for their home-like environments compared with hospitals. Due to potential limitations in medical resources, collaboration with external healthcare providers is crucial to ensure comprehensive services within these settings. Previous studies have primarily focused on team-based models for end-of-life care in hospitals and home-based settings. However, there is a lack of sufficient evidence on practices in such facilities, particularly for Chinese older adults. The aim of this scoping review is to map the existing literature and inform the development of an appropriate care framework for end-of-life care in nursing homes. The focus of this article will be on the scope of services, guidelines for decision making, roles within interdisciplinary teams, and the practical feasibility of care provision.

METHODS AND ANALYSIS

A systematic search will be conducted across nine electronic databases: PubMed, Scopus, EMBASE, Cochrane, PsycINFO, ERIC, CINAHL, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The search will identify literature published in English and Chinese from January 2012 onwards. Articles will be selected based on their relevance to older adults aged ≥60 with disabilities or life-threatening chronic conditions receiving end-of-life care in nursing homes or similar settings. The data extraction process will be guided by the Canadian Hospice Palliative Care Association model (CHPCA) and the Respectful Death model. Qualitative data analysis will be performed using a framework method and thematic analysis, employing both inductive and deductive approaches, with three reviewers participating in the review process.

ETHICS AND DISSEMINATION

Ethical approval is not required because the data for this review is obtained from selected publicly available articles. The results will be disseminated through publications in peer-reviewed journals and presented at relevant conferences. Furthermore, the findings will be shared with policymakers and healthcare professionals engaged in end-of-life care to inform practice and decision making.

STUDY REGISTRATION

The review protocol has been registered on osf.io (https://osf.io/3u4mp).

Death competence profiles and influencing factors among novice oncology nurses: a latent profile analysis

BACKGROUND

Preparing novice oncology nurses to competently care for dying cancer patients is challenging, particularly in cultures where death and dying are taboo subjects. This study aims to explore the various profiles of death competence among novice oncology nurses through latent profile analysis, identifies distinguishing characteristics, and examines influential factors within these subgroups.

METHODS

A multisite cross-sectional study was conducted from August 2021 to July 2022, involving 506 novice oncology nurses from six tertiary cancer hospitals and centers across mainland China. Participants completed a questionnaire that included the Chinese version of the Coping with Death Scale, the Big Five Personality Traits Scale, and general demographic information. Latent profile analysis, univariate analysis, and multinomial logistic regression were utilized to identify death competence profiles and interindividual variability.

RESULTS

Three latent profiles were identified: 'Low Death Competence with Attitude Change toward Living' group (21.5%, Profile 1), 'Moderate Death Competence' group (52.0%, Profile 2), and 'High Death Competence with No Attitude Change toward Living' group (26.5%, Profile 3). Specifically, for Profile 2, being male and having a conscientious personality were facilitating factors for death competence. Conversely, an agreeable personality and frequent exposure to patient death emerged as hindering factors. In Profile 3, working in Intensive Care Units and Palliative Care Units, along with personality traits of conscientiousness, openness, or extraversion, were associated with higher death competence, although frequent exposure to patient death was identified as a potential hindering factor even for this highly competent group.

CONCLUSION

Significant variability in death competence exists among the three groups of novice oncology nurses, reflecting the complexity of their experiences. These findings underscore the necessity for tailored, culturally sensitive death education and training programs. This study also provides vital insights for developing such programs, customized to meet the unique characteristics and needs of different subgroups of novice oncology nurses, ultimately enhancing their death competence and improving end-of-life cancer care.

Per- And Poly-Fluoroalkyl Substances (PFAS) Exposure and Risk of Breast, and Female Genital Cancers: A Systematic Review and Meta-Analysis

BACKGROUND

PFASs, synthetic chemicals, can be encountered by humans through occupational or environmental exposure, and some reports suggest that they can disrupt endocrine and hormonal activities. In this comprehensive review and meta-analysis, we explored the connection between exposure to PFASs and the risks of breast and female genital cancers.

METHODS

We systematically reviewed the literature from IARC Monographs, ATSDR documents, and PubMed (as of January 2024) for cohort, case-control, and ecological studies on PFAS exposure and breast or female genital cancers. Four reviewers independently screened studies, and data extraction included study design, patient characteristics, and effect size measures. The quality of studies was assessed using the modified version of the Newcastle-Ottawa Scale (NOS). Forest plots of relative risks (RR) were constructed for breast and female genital cancer. Meta-analyses were conducted using random-effects models, stratified analyses, dose-response assessments, and publication bias evaluation.

RESULTS

The meta-analysis included 24 studies, comprising 10 cohort, 13 case-control, and one ecological study. The summary relative risk (RR) of breast cancer for PFOA exposure was 1.08 (95% CI = 0.97-1.20; n=21), and for PFOS was 1.00 (95% CI = 0.85-1.18; n=12). The RR for ovarian cancer and PFAS was 1.07 (95% CI = 1.04-1.09; n=12). The stratification by quality score, year of publication, and exposure source did not reveal any differences. However, analysis by geographical region (p=0.01) and study design (p=0.03) did show differences, particularly in terms of incidence. Stratified analyses of the dose-response relationship did not reveal a trend in the risk of breast cancer or female genital cancers, and no publication bias was found for either cancer type. No results were available for cervical and endometrial cancers.

CONCLUSION

In summary, we have found an association between PFAS exposure and ovarian cancer and a possible effect on breast cancer incidence in some specific groups. Although potential bias and confounding prevent conclusions regarding causality, these findings may hold significance for females who encounter such pollutants in their occupational or daily environments.

Caregiver Distress: An Interdisciplinary Approach to Patient Care

BACKGROUND

Advanced cancer severely impacts the lives of patients as well as their caregivers and loved ones. The burden of the caregiver role often results in significant distress, especially near the end of life. Identifying ways to support patients and caregivers is an important focus of palliative care.

OBJECTIVES

To report two cases depicting the negative impact of caregiver distress on patient care and end-of-life decision-making, requiring the collaboration of an interdisciplinary team. The cases outline interdisciplinary approaches to patient and caregiver support during this transition.

CONCLUSIONS

Medical facilities providing cancer care should have structures and processes capable of assessing and managing caregiver distress. Interdisciplinary teams are needed to identify a process of supporting caregivers to minimize negative impacts of emotional dysregulation on patients, their caregivers, and staff.

Depression and anxiety disorders in chronic obstructive pulmonary disease patients: Prevalence, disease impact, treatment

Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder that often co-occurs with depression and anxiety, worsening disease progression and reducing quality of life. A thorough review of the existing literature was conducted, including searches in PubMed, Embase, PsycINFO, and Cochrane Library databases up to 2024. This review encompasses a critical analysis of studies reporting on the prevalence, impact, and management of depression and anxiety in COPD patients. We found a high prevalence of psychological comorbidities in COPD patients, which were associated with worse disease outcomes, including increased exacerbations, hospitalizations, and reduced health-related quality of life. Diagnosing and managing these conditions is complex due to overlapping symptoms, necessitating a comprehensive patient care approach. While there has been progress in understanding COPD comorbidities, there is a need for more personalized and integrated treatments. This review emphasizes the need for increased awareness, tailored treatment plans, and further research for effective interventions.

A Randomized Controlled Feasibility Study to Evaluate the Online Delivery of Storytelling Through Music With Oncology Nurses

BACKGROUND

Oncology nurses frequently contend with intense work-related emotions stemming from their roles, which include bearing witness to suffering, managing end-of-life care, and navigating ethical dilemmas. These emotional challenges can lead to burnout, compassion fatigue, and overall psychological distress.

OBJECTIVE

To determine the feasibility, acceptability, and preliminary effect of implementing Storytelling Through Music (STM) online with oncology nurses.

INTERVENTION/METHODS

This study (trial registration: NCT04775524) was a 2-group, randomized wait-list controlled trial, utilizing quantitative and qualitative methods. STM is a 6-week intervention that combines storytelling, reflective writing, songwriting, and psychoeducation. Data were collected in both groups at 3 timepoints and analyzed with descriptive statistics, conventional content analysis, and nonparametric tests.

RESULTS

The oncology nurses (n = 24) were primarily female (96%) and White (79%), with an average of 15.98 (range, 2-51) years of nursing experience. All STM participants completed the intervention and found it acceptable. STM participants had greater improvements in burnout, secondary traumatic stress, anxiety, depression, and posttraumatic growth.

CONCLUSION

The online delivery of STM proved feasible and acceptable, demonstrating potential scalability across diverse geographic locations, and showed promise in reducing psychological distress and burnout. Future research should consider larger-scale studies with diverse participant demographics and settings to validate these findings further.

IMPLICATIONS FOR PRACTICE

Results highlight the potential value of integrating expressive arts into comprehensive support programs for nurses. By implementing interventions that acknowledge and support the emotional demands of their work, healthcare organizations can better equip oncology nurses to navigate the complexities of their roles while maintaining their well-being.

Knowledge and quality of life in cancer patients receiving immunotherapy for the first time. A cross-sectional study about being informed

PURPOSE

Patients receiving immunotherapy need to have a good understanding of how immunology works and which toxicities they can expect. This study aimed to assess patients' knowledge on their immunotherapies and their quality of life before and after receiving immunotherapy for the first time in a cancer centre.

METHODS

From July 2018 to September 2020, all patients treated at the cancer centre receiving first-time immunotherapy were invited to participate in a cross-sectional descriptive study. Non-probabilistic sampling was used to recruit 138 patients, who answered a basal ad hoc questionnaire with ten items assessing their previous knowledge on immunotherapy. Clinical variables were collected from records and by advanced clinical specialist nurses' interviews, and quality of life was evaluated at 2 points (basal and 8 weeks of treatment), using the European Organisation for Research and Treatment of Cancer-Quality of Life C30 scale.

RESULTS

Our descriptive analysis of 138 participants with solid tumours showed that 98.5% knew they were receiving immunotherapy. Regarding complications, 89.8% reported that skin reactions were a major problem. The pre-post comparison of overall health status/health-related quality of life did not show significant changes with treatment.

CONCLUSION

Our participants were comprised primarily of men with lung cancer, receiving care at a multidisciplinary outpatient unit where they got information from their oncologist and were later assessed by clinical nurse specialists. Almost all considered themselves to be well informed, despite receiving the immunotherapy for the first time. Specific expertise, skills and abilities of the health team, oncologist and nurses providing the care that patients receiving immunotherapy needs are essential.

The effect of an escape room game on students' academic self-efficacy and motivation for critical thinking: oncology nursing course

OBJECTIVE

This study investigated the effect of an escape room game on oncology nursing course students academic self-efficacy and motivation for critical thinking.

METHODS

This study adopted a one-group pretest-posttest experimental research design. The sample consisted of forty-two nursing students. Data were collected using a personal information form, the Academic Nurses' Self- Efficacy Scale, and the Critical Thinking Motivational Scale. The data were analyzed using descriptive statistics, t-test, Pearson-Spearman, Wilcoxon test.

RESULTS

None of the nursing students had played an escape room game for educational purposes before (100%; n = 42). The escape room game helped nursing students develop academic self-efficacy and boosted their motivation for thinking critically respectively (t = -3.252, p = 0.002; Z = -2.027, p = 0.043). More than 90% of the students reported that the escape room game helped them understand the subject, retain information, and apply it effectively.

CONCLUSION

Universities should incorporate escape room games within the scope of oncology nursing courses as an alternative teaching approach to help students enhance their academic self-efficacy and critical thinking motivation. Researchers should plan studies with different samples to investigate the impact of escape room games on academic self-efficacy and critical thinking motivation.

Prevalence and Predictors of the Unmet Supportive Needs of Patients With Cancer in Oman

BACKGROUND

Unmet supportive needs are directly correlated with more frequent psychological distress, reduced quality of life, and low patient satisfaction with healthcare and indirectly connected with low compliance with treatment and increased care-related costs.

OBJECTIVE

To assess the spectrum of unmet needs among patients with cancer in Oman and identify predictors of these needs and their relationship with psychological distress and symptom burden.

METHOD

A descriptive, correlational study design was used, involving 551 patients with cancer from 2 major healthcare facilities in Muscat, Oman. Data on patients' unmet needs were collected between January and June 2023 using the Supportive Care Needs Survey Short-Form 34.

RESULTS

Participants had a mean age of 45.8 (SD, 15.6) years, with female patients comprising 65.5% of the sample. Breast cancer was the most prevalent type of cancer. The mean unmet need score was 31.0/100 (SD, 20.1). Statistical analysis revealed significant predictors of unmet needs, including marital status, treatment type, performance status, symptom interference, and psychological distress, with the regression model explaining 26% of the variance in unmet needs.

CONCLUSIONS

Healthcare providers must regularly assess supportive needs, recognizing that they may vary across populations and are influenced by cultural factors. Additionally, individuals identified as having characteristics that predict higher levels of need should receive focused and prioritized supportive care.

IMPLICATIONS FOR PRACTICE

By adopting regular tailored assessments that address the comprehensive supportive needs of patients with cancer, clinicians can significantly enhance patients' quality of life and optimize treatment outcomes.

"I Cannot Walk Far or Go Anywhere": The Experience of Lower Limb Lymphedema Among Women With Gynecological Cancer

BACKGROUND

Lower limb lymphedema (LLL) significantly impacts the quality of life in women who have undergone gynecological cancer surgery, limiting their physical activities, household chores, and social interactions. Despite its prevalence, there is a lack of comprehensive understanding of the lived experiences of these women.

OBJECTIVE

To explore the experiences of LLL in Taiwanese women following gynecological cancer surgery.

METHODS

Using a qualitative, descriptive design, 12 Taiwanese participants aged between 48 and 74 years who had LLL after gynecological cancer surgery were interviewed. Interview data were analyzed using inductive content analysis to identify key themes and subthemes.

RESULTS

Four main themes and 13 subthemes emerged from the data: lacking awareness and vigilance, suffering from lymphedema, adapting to body image changes, and self-managing everyday life. These themes illustrate the extensive physical, psychological, and social challenges faced by the participants.

CONCLUSION

Findings depict the profound impact of LLL on daily life among Taiwanese women after gynecological cancer surgery. The findings highlight the need for comprehensive care that addresses the multifaceted challenges posed by lymphedema.

IMPLICATION FOR PRACTICE

Oncology healthcare providers should integrate education and symptom management skills about lymphedema into patient care. In addition, there is an urgent need for accessible lymphedema care resources to support these women.

Illness Perception and Risk Management Behaviors Among Patients With Gynecologic Cancer at Risk of Lower Extremity Lymphedema

BACKGROUND

Patients with gynecologic cancer who undergo lymphadenectomy are at increased risk of lower extremity lymphedema (LEL). They are encouraged to be alert to the possibility of LEL and take risk-management measures throughout life. However, we know little about the perception for LEL and adherence to risk-management measures of Chinese patients with gynecologic cancer.

OBJECTIVE

To assess the illness perception and risk management behaviors of Chinese gynecologic cancer patients and further examine the effect of illness perception on risk management behaviors.

METHODS

This was a cross-sectional study. From June to December 2023, gynecologic cancer patients at risk of LEL were surveyed (n = 223). Questionnaires on illness perception and risk management behaviors specifically for LEL were utilized. Descriptive statistics, Pearson correlation analysis, univariate analysis, and multiple linear regression analysis were used for data analysis.

RESULTS

The participants exhibited suboptimal LEL risk management behaviors, with the physical activity dimension receiving the lowest score (3.24 ± 1.02). Patients' self-perceived understanding of LEL was relatively low (2.88 ± 0.83). Multiple linear regression analysis revealed that the identity, cause, and control dimensions of illness perception, as well as several demographic and disease variables, were significant predictors of patients' LEL risk management behaviors.

CONCLUSIONS

The LEL risk management behaviors of patients with gynecologic cancer need to be improved. Consideration of perceptions of identity, cause, and control is crucial for enhancing LEL risk management behaviors.

IMPLICATIONS FOR PRACTICE

Health professionals can implement targeted health education based on an assessment of patients' perceptions of LEL, thereby promoting lymphedema risk management.

Spirituality and Work-Related Outcomes Among Nurses During the COVID Pandemic: An Observational Study

OBJECTIVES

This study aimed to identify the spiritual responses of nurses providing direct patient care during the COVID pandemic and explore how religious/spiritual struggles are associated with selected nurse outcomes.

METHODS

A quantitative, cross-sectional observational study was conducted, based on the STROBE checklist, with 364 registered nurses recruited via convenience sampling between January 24 and March 12, 2022, in hospitals in Iran admitting COVID-19 patients. Data were collected through a self-report questionnaire, including the Moral Injury Symptom Scale-Health Professionals, Religious/Spiritual Struggles Scale-Short Form, Posttraumatic Growth Inventory, Job Satisfaction Scale, Copenhagen Burnout Inventory, Turnover Intention Scale, and Employee Engagement Scale.

RESULTS

Nurses reported high levels of moral injury during the pandemic, with an average score of 43.79 ± 15.20. Religious/spiritual struggles were generally low, with demonic struggles scoring the lowest (0.36 ± 0.68) and ultimate meaning struggles the highest (1.54 ± 0.99). Posttraumatic growth scores for spiritual change were moderately high (26.17 ± 4.73). Work-related burnout was moderate (64.31 ± 100.00), intention to leave was low (8.84 ± 3.92), and job satisfaction was moderate (3.67 ± 1.75).

CONCLUSION

The study found that nurses experienced both positive and negative spiritual responses during the pandemic. While most nurses reported a high level of moral injury and moderate job satisfaction, they experienced low religious/spiritual struggles and some spiritual growth. Incorporating spirituality into nursing practice may enhance professional fulfilment and nurse outcomes.

Living well with advanced cancer: a scoping review of non-pharmacological supportive care interventions

PURPOSE

The increasing number of people living longer with advanced cancer presents unique physical, psychosocial, financial, legal, practical and complex care needs. Supportive care interventions aim to address these needs by improving symptom management, promoting wellbeing, enhancing quality of life and potentially improving prognosis. To integrate supportive care interventions into clinical practice, a comprehensive review of existing studies is needed. This scoping review maps the evidence on non-pharmacological supportive care interventions for people with advanced cancer and identifies gaps to inform future research.

METHODS

We systematically searched four electronic databases-CINAHL, Medline, Cochrane and PsycINFO-for peer-reviewed original research on non-pharmacological supportive care interventions for adults with advanced cancer, published from January 1, 2013, to July 1, 2024.

RESULTS

Out of 3716 studies, 84 publications met the inclusion criteria. These studies were categorised into key supportive care domains: physical activity, psychosocial support, patient care and autonomy, multimodal approaches and others. Most publications focused on interventions addressing physical and psychosocial needs, showing benefits such as reduced fatigue, pain and improved mood. However, significant gaps were found in research on interventions addressing practical needs essential to autonomy, including health system and information needs, patient care and support and financial needs.

CONCLUSION

Mapping the studies to the needs of the advanced cancer population showed that domains with greatest unmet needs have the fewest interventions available. Our scoping review suggests that non-pharmacological supportive care interventions can improve the wellbeing and quality of life of people living with advanced cancer. However, addressing methodological limitations requires further large-scale, multi-centre studies focusing on the identified gaps to inform the implementation of suitable supportive care programs.

IMPLICATIONS FOR CANCER SURVIVORS

Non-pharmacological interventions can boost wellbeing and quality of life for advanced cancer survivors, but addressing gaps in practical and systemic support is crucial.

Association of Systemic Inflammation with Dietary Intake, Nutrition Impact Symptoms, and Eating-Related Distress Among Patients with Advanced Cancer

BACKGROUND

Serum C-reactive protein (CRP) levels are correlated with patient outcomes in cancer. This study aimed to determine associations between the CRP level and the dietary intake, symptoms, and eating-related distress (ERD).

METHODS

We conducted a multicenter survey among advanced cancer patients. Information on patient characteristics was retrieved from the electronic medical records. Data on patient outcomes were obtained through the questionnaire. Patients were categorized into the low CRP group (<5 mg/dL) and the high CRP group (≥5 mg/dL). Comparisons were calculated using the Mann-Whitney U test or chi-squared test. To assess associations between CRP levels and ERD, multivariate logistic regression analysis was performed.

RESULTS

A total of 191 patients were enrolled and divided into the low CRP group (n = 117) and the high CRP group (n = 74). The high CRP group had a more reduced dietary intake (p = 0.002) and more severe appetite loss (p = 0.008). The total scores of the ERD questionnaire (both the long and short versions) were significantly higher in the high CRP group (p = 0.040 and 0.029). The high CRP group also had significantly higher risks for ERD, as assessed using the long and short versions of the questionnaire (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.10-4.11; OR 2.06, 95% CI 1.05-4.05).

CONCLUSIONS

High CRP levels were significantly associated with reduced dietary intake, appetite loss, and ERD. A serum CRP value of 5 mg/dL may be a useful indicator for initiating cancer cachexia care.

Family participation in dignity interventions for patients with cancer receiving palliative care: a scoping review protocol

INTRODUCTION

The global burden of cancer is escalating, with Asia accounting for over half of cancer-related deaths worldwide. As cancer often diminishes patients' quality of life and sense of dignity, dignity-related interventions have gained prominence in palliative care for patients with cancer. However, a more in-depth exploration of the involvement of families, as the fundamental social units in Confucian Asian cultures, and cultural considerations is currently lacking. This scoping review focuses specifically on patients with cancer receiving palliative care and aims to offer a comprehensive synthesis of the existing evidence on family participatory dignity interventions, addressing the need for a holistic understanding of this emerging field to guide future research and clinical practice.

METHODS AND ANALYSIS

This scoping review will be meticulously structured according to the five-stage framework established by Arksey and O'Malley, complemented by the scoping review methodology of the Joanna Briggs Institute. Our search will encompass a comprehensive array of databases, including PubMed, Embase, The Cochrane Library, CINAHL, Web of Science, PsycINFO, Scopus, CNKI and Wanfang Data, from their inception up to August 2024, targeting both English and Chinese relevant literature. To ensure a thorough exploration, we will also delve into grey literature via OpenGrey, Google Scholar and citation chaining. This scoping review will include all types of quantitative or mixed methods designs and qualitative studies. We will extract data on study design, sample size, intervention details, outcome measures and any other relevant information. The screening process will be conducted by two independent reviewers, who will meticulously assess the titles and abstracts, followed by a full-text review to select relevant studies. Discrepancies will be resolved through consensus discussions with a third reviewer. Data extraction will be executed using a standardised tool, and the findings will be systematically presented in tabular form with an accompanying narrative to summarise all relevant interventions, their characteristics, outcomes and key findings.

ETHICS AND DISSEMINATION

Ethical approval for this scoping review is not required, since the methodology merely involves the collection and review of publicly available literature. Our findings will not only be presented and discussed in a peer-reviewed article but also shared at conferences relevant to the topic.

TRIAL REGISTRATION

Our scoping review protocol has been formally registered with the Open Science Framework. Registration details can be accessed at the provided link: https://osf.io/fyhrm/.

Unraveling the complexity of follicular lymphoma: insights and innovations

This review discusses multiple aspects of follicular lymphoma (FL), including etiology, treatment challenges, and future perspectives. First, we delve into the etiology of FL, which involves a variety of pathogenic mechanisms such as gene mutations, chromosomal abnormalities, immune escape, immune system dysregulation, familial inheritance, and environmental factors. These mechanisms provide the context for understanding the diversity and complexity of FL. Second, we discuss the challenges faced when treating FL, particularly treatment resistance. Therapeutic resistance is a common problem in treatment, but by delving into the mechanisms of resistance, scientists have looked for strategies to combat it, including developing new drugs, improving treatments, and exploring combination therapy strategies. We also emphasize the breakthroughs in molecular biology, especially the study of targeting the BCL2 gene, which provides a new direction for targeted therapy in FL. Immunotherapy, small molecule targeted drugs, and individualized treatment strategies are also promising for the future treatment of FL. Finally, we look to the future, including research on therapeutic resistance, in-depth studies of genetics and gene expression, applications of gene editing and precision medicine, and clinical trials of new treatments. These lines of research offer additional opportunities for treating FL, and despite the challenges, the future is promising. This literature review provides comprehensive and integrated information for the in-depth understanding of FL and relevant treatment approaches.

Psychosocial Factors Affecting Wellbeing and Sources of Support of Young Adult Cancer Survivors: A Scoping Review

BACKGROUND/OBJECTIVES

To identify and analyze what is known about the psychosocial factors affecting the wellbeing and sources of support of young adult (YA) cancer survivors.

METHODS

The search strategy included Neoplasms, young adults, psycho* or emotional well* or mental health. The OVID Medline and CINAHL databases were searched. Included were cancer survivors (YA) ages 18-39 at the time of the study. The studies included qualitative and quantitative designs, written in English, and published between January 2016 and October 2024. The results were recorded according to PRISMA-ScR guidelines.

RESULTS

Thirteen studies with 4992 participants found psychosocial factors to be the most important influence on life satisfaction with social support the most decisive factor. This expands the results of previous reviews by including a variety of study designs and data collection tools to provide a comprehensive understanding of the YA experience. Psychosocial concerns affecting wellbeing led to social isolation, low connectedness with family and friends, and significant distress. Consistent with previous reviews, the greatest challenges to wellbeing were psychosocial needs, which included seeking and delivering information that is easy to understand but detailed, which can decrease frustration and anger, and needs to be readily available and accessible. Unlike older adult cancer survivors, YA survivors are more likely to have reduced psychosocial functioning compared to their peers and suffer from higher distress than their adult peers and non-YA cancer survivors with anxiety as the most reported symptom.

CONCLUSIONS

Interventions need to be developed that lessen the impact of a cancer diagnosis and cancer treatments. The specific needs of YAs must be further researched and evaluated to determine specific interventions and the support needed during this crucial stage of cancer survivorship. Future research must also increase the focus on the racial and ethnic diversity of participants as well as prioritizing underserved populations and the impact of the COVID-19 pandemic.

Ethical Dilemmas Among Oncology Nurses in China: Cross-Sectional Study

Background

Effective communication about cancer prognosis is imperative for enhancing the quality of end-of-life care and improving patient well-being. This practice is sensitive and is heavily influenced by cultural values, beliefs, and norms, which can lead to ethical dilemmas. Despite their significance, ethical challenges in nursing related to prognosis communication are understudied in China.

Objective

This study aimed to examine the ethical dilemmas relating to cancer prognosis communication and their associated factors.

Methods

A cross-sectional design was employed to survey 373 oncology nurses in mainland China. Data were collected on ethical dilemmas, attitudes, barriers, experiences with prognosis communication, sociodemographics, and practice-related information. Ordinary least squares regressions were used to identify factors contributing to ethical dilemmas.

Results

Participants reported a moderate level of ethical dilemmas in prognostic communication (mean 13.5, SD 3.42; range 5-20). Significant predictors of these dilemmas included perceived barriers (P<.001), experiences with prognosis communication (P<.001), and years of work experience (P=.002). Nurses who perceived greater communication barriers, had more negative experiences with prognosis communication, and had less work experience were more likely to encounter ethical dilemmas in prognosis-related communication.

Conclusions

Chinese oncology nurses frequently encounter ethical dilemmas, as well as barriers, in communicating cancer prognoses. This study's findings emphasize the importance of culturally tailored communication training. Collaborative interprofessional training, particularly through physician-nurse partnerships, can perhaps enhance the proficiency of cancer prognosis-related communication.

Therapy-Related Symptoms and Sense of Coherence: The Mediating Role of Social Support and Hope in Lung Cancer Patients Undergoing Chemotherapy

Aim

To investigate the current status of the sense of coherence in lung cancer patients undergoing chemotherapy and explore the mediating role of social support and hope in the relationship between therapy-related symptoms and sense of coherence.

Methods

We conducted a cross-sectional study to investigate lung cancer chemotherapy patients aged 18 years or older who completed at least two cycles of chemotherapy. Patients were recruited from the First Affiliated Hospital of Guangzhou Medical University's chemotherapy day ward from May to December 2023. Patients were required to complete a questionnaire that included the Sense of Coherence Scale, the Perceived Social Support Scale, the Herth Hope Index, and the Therapy-related Symptoms Checklist. The structural equation model was used to test the mediating role of social support and hope between therapy-related symptoms and the sense of coherence.

Results

A total of 241 patients were included. The scores of the sense of coherence, hope level, therapy-related symptoms, and social support were 68.79 ± 11.24, 38.94 ± 4.25, 11.53 ± 8.15, and 69.49 ± 8.15, respectively. Sense of coherence, social support, hope, and therapy-related symptoms were significantly related (P<0.01). Therapy-related symptoms had a direct negative influence on the sense of coherence [B=-0.144, 95% CI (-0.209, -0.070)]. Meanwhile, therapy-related symptoms influenced the sense of coherence via three pathways: independent mediation of social support [B=-0.021, 95% CI (-0.065, -0.002)], independent mediation of hope [B=-0.022, 95% CI (-0.057, -0.000)], and chain mediation of social support and hope [B=-0.012, 95% CI (-0.035, -0.002)].

Conclusion

Lung cancer patients undergoing chemotherapy experience a medium sense of coherence. This study's findings indicate that the relationship between therapy-related symptoms and sense of coherence is affected by the independent mediating effect of social support and hope and the chain mediating effect of social support and hope. Therefore, reducing the burden of their therapy-related symptoms, providing them with social support, and fostering their hope can enhance patients' sense of coherence and improve their quality of life.

Recognizing Distress in Cancer Patients in Day Hospital, by Trained Nurses vs. Non-Trained Nurses: A Pilot Study

Background: Psychological distress impacts 35-40% of cancer patients, significantly affecting their quality of life, treatment adherence, and relationships with healthcare professionals. Given this, there is a critical need to enhance nursing competencies to effectively monitor and address psychological distress. Previous studies have highlighted discrepancies in capabilities based on nurses' training status, emphasizing trained nurses' critical role in providing appropriate psycho-social referrals. Objective: To evaluate the impact that trained nurses have on the detection of distress and the timely referral of patients for a psycho-oncology consultation. Methods: A blinded, random, descriptive, monocentric pilot study was conducted. The participants were adult patients in Day Hospital 1 of the National Cancer Institute Regina Elena, Rome, irrespective of illness stage. Tools used included a socio-demographic and clinical data form, distress thermometer (DT), and visual analogic scale (VAS). Patients were randomly divided into two groups: Group A, where questionnaires were administered by trained nurses, and Group B, where non-trained nurses administered questionnaires. Nurses indicated whether patients needed a psycho-oncology consultation. All patients were then seen by a psycho-oncology specialist to determine whether the nurse's referral was appropriate. Patients and psycho-oncologists were all unaware of the nurses' training status. The effectiveness of the training was measured by the degree of agreement between evaluators. Results: This study involved 20 patients and four nurses. The average DT score was 5, mainly related to physical and emotional problems. Agreement between evaluators was higher in the trained nurses' group. Conclusions: Specific training on DT enabled nurses to acquire advanced skills to accurately refer patients for psychological consultations.

Exploring Spiritual Concerns, Needs, and Resources in Outpatient Healthcare Facilities Serving Under-Resourced Black Patients: A Qualitative Study

BACKGROUND

Acknowledging patients' spiritual concerns can enhance well-being and is essential to patient-centered chronic illness care. However, unmet spiritual care needs remain a major area of suffering, particularly among under-resourced populations. Limited research exists on how spiritual concerns are acknowledged and integrated into the care of chronically ill older Black patients in these settings.

PURPOSE

This study aimed to explore the spiritual concerns and needs of chronically ill older Black patients from under-resourced areas and to identify available spiritual support resources for patients seeking healthcare through a community safety net health service.

METHODS

Using a qualitative descriptive design, we interviewed 13 chronically ill, older Black patients and key clinicians (physicians, nurse practitioners, allied health, and clergy). The interview focused on patients' illness-related spiritual concerns, sources of distress, and desired spiritual support resources. Participants also reviewed the Spiritual Care and Assessment Intervention (SCAI), a spiritual care intervention, and provided feedback on its content, format, and delivery.

RESULTS

Five themes emerged from qualitative interviews: (1) spirituality is integral to seriously ill Southern patients; (2) clinicians should strive to address spiritual health in encounters; (3) socioeconomic barriers and competing demands impact priority of accessing spiritual care services; (4) spiritual care interventions should be patient-driven, compassionate, and fully integrated into medical care as a comprehensive service; and (5) participants thought SCAI was appropriate for use but should be shortened and provided in-person to increase accessibility.

DISCUSSION

Findings will inform the development and piloting of small-scale culturally responsive spiritual care intervention tailored for seriously ill older Black adults in an ambulatory care setting.

Assessing Quality of Life with the Novel QLQ-CAX24 Questionnaire and Body Composition Parameters in Rectal Cancer Patients: A Single-Center Prospective Study

BACKGROUND

Patients with rectal cancer (RC) are at risk of developing cancer-related cachexia, a complex metabolic syndrome that can negatively impact quality of life (QoL), treatment tolerance, and clinical response.

OBJECTIVES

The aim of the study was to explore the possible associations of the novel European Organization for Research and Treatment of Cancer QoL Questionnaire-Cancer Cachexia (EORTC QLQ-CAX24) scores with body composition parameters and physical performance in patients with locally advanced RC (LARC).

METHODS

This prospective observational study involved RC patients evaluated at the dedicated outpatient clinic of Clinical Nutrition at the Fondazione Policlinico Agostino Gemelli IRCCS. Patients with a confirmed diagnosis of LARC were enrolled between January and December 2023. The body composition parameters were measured using the preoperative computed tomography scan at the level of the third lumbar vertebra as well as using bioimpedance analysis before and after the radiotherapy treatment. QoL was measured by the EORTC QLQ-C30 and EORTC QLQ-CAX24 questionnaires.

RESULTS

A total of 56 RC patients were enrolled. Significant associations (p < 0.05) were found between EORTC QLQ-CAX24 values and the presence of cachexia, body composition, handgrip strength, and malnutrition diagnosis. Muscle mass was significatively also associated with EORTC QLQ-CAX24 results, suggesting a link between subjective perception of QoL and objectively measured body composition.

CONCLUSIONS

The EORTC CAX24 questionnaire can be an effective tool for monitoring changes in cachexia status during radiotherapy, enabling early detection of cachexia-related complications and timely intervention.

Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study

OBJECTIVES

To explore the experiences of women who have made the decision to decline breast screening and/or breast cancer treatment for overdiagnosis/overtreatment reasons after being invited to the National Health Service Breast Screening Programme (NHS BSP).

DESIGN

Qualitative interview study using reflexive thematic analysis.

SETTING

Participants were recruited via social media, online forums and word of mouth. Semi-structured interviews were conducted between May 2021 and April 2022.

PARTICIPANTS

20 women aged between 49 and 76 years old who had declined one or more of the following after receiving an invitation to participate in the NHS BSP: (1) screening investigation, that is, mammogram; (2) further investigations, for example, biopsy, ultrasound; (3) treatment, for example, mastectomy, chemotherapy, radiotherapy and (4) any other medical intervention, for example, ongoing medication.

RESULTS

The three main themes were as follows: (1) the perception that the NHS BSP information was biased towards uptake and so constrained choice; (2) taking an active role in decision-making by considering the benefits and harms of the NHS BSP and (3) navigating potential regret for having declined.

CONCLUSIONS

In-depth understanding of the potential harms of overdiagnosis and overtreatment influenced the decision to decline for these participants and contributed to their dissatisfactions with the way that information was presented in the invitation to the NHS BSP and the women felt confident in their assessments of the benefits and harms. These findings differ from previous studies, which have suggested that the vast majority lack knowledge and understanding of what overdiagnosis and overtreatment are whereas the participants in this study demonstrated high levels of health literacy. Findings have implications for the way informed choice is considered and constructed in relation to the NHS BSP.

Awareness and acceptance of human papillomavirus vaccine in the Middle East: A systematic review, meta-analysis, and meta-regression of 159 studies

Cervical cancer, closely linked to human papillomavirus (HPV) infection, is a major global health concern. Our study aims to fill the gap in understanding HPV vaccine awareness and acceptance in the Middle East, where national immunization programs are often lacking and cultural perceptions hinder acceptance. This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search across several databases was conducted on 5 September 2023. We included quantitative studies on HPV vaccine awareness and acceptance in Middle Eastern countries. Data extraction and quality assessment were conducted independently by multiple reviewers to ensure accuracy. Statistical analyses, including subgroup analyses, were performed using R to calculate pooled estimates, assess heterogeneity, and publication bias. We reviewed 159 articles from 15 Middle Eastern countries, focusing on 93,730 participants, predominantly female and healthcare workers. HPV vaccine awareness was found to be 41.7% (95% CI 37.4%-46.1%), with higher awareness among healthcare workers. The pooled acceptance rate was 45.6% (95% CI 41.3%-50.1%), with similar rates between healthcare and non-healthcare workers. Our study highlights the critical need for increased HPV vaccine awareness and acceptance in the Middle East, emphasizing the importance of integrating the vaccine into national immunization programs and addressing cultural and religious factors to improve public health outcomes.

Cancer Nursing Frameworks to Guide Clinical Capability, Education and Careers: A Scoping Review of the International Literature

AIM

This review aimed to provide a current global profile of all existing cancer nursing competency, capability, education and career frameworks and map capabilities and competencies to the clinical, facilitation of education, management and research pillars of practice.

DESIGN

Scoping review.

DATA SOURCES

Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Epistemonikos, Google Scholar, Medline, and PubMed. Gray literature searches and reference list searches were also performed.

METHODS

This review was guided by Arksey and O'Malley's method and followed PRISMA guidelines for reporting. Screening and data extraction was conducted independently by two or more authors. The quality of frameworks were assessed using The Joanna Briggs Institute (JBI) critical appraisal checklist for textual evidence: policy/consensus guidelines. Data were analyzed and narratively synthesized by experienced cancer nurse researchers.

RESULTS

Thirty-four articles were included, comprising of 29 cancer nursing frameworks. Frameworks were categorized as competency frameworks, career and education frameworks, education/learning pathways, and career/professional development frameworks. Competencies and capabilities described in the frameworks were mapped to the four pillars of practice including clinical (n = 27), facilitation of learning (n = 20), leadership and management (n = 23), and research and scholarship (n = 24).

CONCLUSIONS

Comprehensive cancer nursing frameworks are pivotal in enabling nurse leaders to grow and develop the cancer nursing workforce globally. They are also integral to support cancer nurses in providing high-quality, effective, and safe care for patients and their families across the cancer continuum.

IMPACT

This is the first review to comprehensively capture and synthesize the capabilities, educational components, and career pathways outlined in existing cancer nursing frameworks worldwide and highlights where areas of improvement are needed to support professional growth, job satisfaction and retention of cancer nurses.

NO PATIENT OF PUBLIC CONTRIBUTION

This article is a review of frameworks and does not include patient or public contribution.

Comprehensive scoping review of palliative care development in Africa: recent advances and persistent gaps

Worldwide 56·8 million people need palliative care (PC), and Africa shows the highest demand. This study updates the 2017 review of African PC development, using a scoping review methodology based on Arksey and O'Malley's framework and the PRISMA-ScR checklist. The review was conducted across PUBMED, CINAHL, Embase, government websites, and the African PC Association Atlas, from 2017 to 2023, charting its progress using the new WHO framework for PC Development, which, in addition to Services, Education, Medicines, and Policies, two new dimensions were incorporated: Research and Empowerment of people and Communities. Of the 4.420 records, 118 met the inclusion criteria. Findings showed increased adult specialised services (n = 675), and 15 of 54 countries have paediatric services. Nonetheless, the ratio of services per population mostly remains under 0,10 per 100.000 inhabitants. PC education was included in undergraduate curricula in 29 countries; despite the rise in morphine availability (28 countries), median consumption remains under 3 mg/per capita/year, and 14 countries presented stand-alone policies. Publications on PC development increased, and 26 countries have National PC Associations. Notwithstanding progress since 2017, significant hurdles remain, highlighting the need for ongoing research and policy development to ensure equitable access to palliative care in Africa.

Enhancing the Resilience of Bereaved Parents: Practical Experiences and Needs Perceived by Healthcare Professionals

AIMS

To explore the practical experiences and perceived needs of healthcare professionals in fostering resilience among bereaved parents.

DESIGN

A qualitative descriptive study was conducted.

METHODS

Twenty-seven healthcare professionals were recruited from the Paediatric Palliative Care Special Group of the Paediatrics Society of the Chinese Medical Association. The participants included 9 physicians, 7 nurses and 11 social workers from 22 hospitals and 5 community-based services. In-depth interviews were conducted between July and December 2022. Data were analysed using content analysis.

RESULTS

Guided by the Society-to-Cells Resilience Theory, this study identified 10 categories of practical experiences and seven of perceived needs, encompassing multiple levels: society (integrating multidisciplinary resource; preserving relevant cultural tradition; advocating for system enhancements; raising public awareness), community (establishing an accessible support network; fostering an inclusive community; offering proactive community support), family (providing anticipatory guidance; enhancing family cohesion; navigating bereavement resources; providing ongoing follow-up and support), individual (evaluating grief-related experiences; offering tailored personal support; sustaining connections; addressing spiritual needs) and physiological (managing body reactions; maintaining physical well-being).

CONCLUSION

This study provides insights from healthcare professionals, highlighting practices and identifying significant gaps in current approaches to building resilience in bereaved parents. The findings suggest that resilience is a socially constructed, multidimensional process that can be nurtured through a holistic approach to better support this vulnerable group.

IMPACT

The study's findings lay the foundation for developing targeted interventions to foster resilience among bereaved parents. A holistic, empowering approach is essential to strengthen their coping mechanisms and facilitate healing at multiple levels, ultimately contributing to the creation of a robust, effective support system for this resilient yet vulnerable population.

NO PATIENT OR PUBLIC CONTRIBUTION

This study was about the experiences and perceptions of healthcare providers. It was designed and conducted by researchers who were both researchers and healthcare providers.

Supportive care needs of parents caring for children with leukemia: a latent profile analysis

BACKGROUND

Parents' supportive care needs directly affect their quality of life and the quality of care for their children diagnosed with leukemia.

OBJECTIVES

To identify supportive care needs of Chinese parents in the unobserved subgroups who care for children with leukemia and to examine the associations of the latent class membership with individual characteristics.

METHODS

A multicenter cross-sectional survey study was conducted. A total of 221 parents who had children with leukemia were surveyed in China with the Chinese version of the Supportive Care Needs Survey for Caregivers of Children with Pediatric Cancer (SCNS-C-Ped-C). Latent profile analysis (LPA) was applied to identify latent classes of parents according to supportive care needs. Binary logistic regression model was used to identify the association between individual characteristics and the latent class membership.

RESULTS

LPA results suggested a 2-class solution: class 1-"high supportive care needs" class (n = 126, 57.0%) and class 2-"low supportive care needs" class (n = 95, 43.0%). The class membership was significantly associated with children's treatment duration, family income, distance to the hospital, parents' caregiving ability, and coping strategy.

CONCLUSION

There existed two distinct classes of parents caring for children with leukemia on the basis of supportive care needs. Children's treatment duration, parents' socio-demographic characteristics, caregiving ability, and coping strategy significantly influenced class membership.

IMPLICATIONS FOR PRACTICE

This study highlights the need for tailored interventions to address the specific needs of parents, especially those in the "high supportive care needs" class. Healthcare providers should consider factors related to the class membership when developing the supportive care interventions. Addressing these supportive care needs could improve both parental well-being and the quality of care provided to their children.

Development of Patient-Centered End-of-Life Care Quality Measures in China: A Modified Delphi Process

Objective: Patient-centered care is widely recognized as a crucial component of high-quality end-of-life care. As this approach remains limited in China, this study sought to develop quality measures specifically tailored to end-of-life care within the country. Methods: Initial indicators were established through a comprehensive review of existing measures. Using the modified Delphi Method, a two-round survey with experts (n = 14) was applied to evaluate the importance of each item. Results: The authoritative coefficient of two rounds of expert consultation was 0.86 and 0.87, and the Kendall coefficient of concordance for the two rounds was 0.232 and 0.270 (P < 0.001), respectively, demonstrating an acceptable consensus among the experts. As a result, 31 key quality indicators were identified and deemed important. Conclusions: This study developed a scale for patient-centered end-of-life care quality measurement in China, consisting of six dimensions and 31 indicators. This scale lays a solid foundation for quality improvement initiatives and future development of patient-centered end-of-life care.

Research progress on assessment tools related to occupational fatigue in nurses: a traditional review

Nurse occupational fatigue is a significant factor affecting nursing quality and medical safety. Scientific and effective assessment of occupational fatigue is beneficial for strengthening nurse occupational health management, improving the quality of life for nurses, and ensuring patient safety. This article provides a narrative review of the content, reliability, validity, characteristics, application status, and advantages and disadvantages of assessment tools related to nurse occupational fatigue. These tools include single-dimensional assessment scales (Fatigue Severity Scale, Chinese version of Li Fatigue Scale), multidimensional assessment scales (Fatigue Scale-14, Fatigue Assessment Scale, Multidimensional Fatigue Scale, etc.), and other assessment tools. Our review reveals limitations in existing occupational fatigue assessment tools, such as variability in accuracy and applicability across different populations, and potential biases. These findings underscore the critical role of these tools in nursing management and occupational health, advocating for continuous refinement and innovation. Future research should focus on developing more comprehensive, context-specific tools to address the multifaceted nature of nurse occupational fatigue. Nursing managers must carefully select appropriate tools to effectively identify and mitigate fatigue, thereby enhancing nurse well-being and patient care quality.

Peripheral Neuropathy Instruments for Individuals with Cancer: A COSMIN-Based Systematic Review of Measurement Properties

Although the literature on patient-reported outcomes (PROMs) continues to expand, challenges persist in selecting reliable and valid instruments for assessing peripheral neuropathy (PN) in patients with cancer. This systematic review aimed to identify all validated self-report PN scales and critically appraise their measurement properties. This review was conducted using the COSMIN methodology for PROMs and the PRISMA statement. Five databases were searched from inception to August 2024, identifying 46 eligible studies and 16 PROMs. Evidence quality ranged from "very low" to "moderate", with notable inconsistencies in the content and structural validity phases of most instruments. Instruments such as the Chemotherapy-induced peripheral neuropathy assessment tool and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity demonstrated moderate quality and potential utility in clinical practice, while others, including the Location-based assessment of sensory symptoms in cancer and the Measure of Ovarian Symptoms and Treatment, had insufficient evidence to support their use. Importantly, all PROMs focused on chemotherapy-induced peripheral neuropathy, highlighting a significant gap in instruments addressing other PN causes, such as radiotherapy or tumor-related nerve damage. Further research should prioritize developing and validating instruments for distinct cancer populations, ensuring robust psychometric properties and clinical applicability.

Arm symptom pattern among breast cancer survivors with and without lymphedema: a contemporaneous network analysis

BACKGROUND

Arm symptoms commonly endure in post-breast cancer period and persist into long-term survivorship. However, a knowledge gap existed regarding the interactions among these symptoms. This study aimed to construct symptom networks and visualize the interrelationships among arm symptoms in breast cancer survivors (BCS) both with and without lymphedema (LE).

PATIENTS AND METHODS

We conducted a secondary analysis of 3 cross-sectional studies. All participants underwent arm circumference measurements and symptom assessment. We analyzed 17 symptoms with a prevalence >15%, identifying clusters and covariates through exploratory factor and linear regression analysis. Contemporaneous networks were constructed with centrality indices calculated. Network comparison tests were performed.

RESULTS

1116 cases without missing data were analyzed, revealing a 29.84% prevalence of LE. Axillary lymph node dissection [ALND] (vs sentinel lymph node biopsy [SLNB]), longer post-surgery duration, and radiotherapy significantly impacted overall symptom severity (P < .001). "Lymphatic Stasis," "Nerve Injury," and "Movement Limitation" symptom clusters were identified. Core symptoms varied: tightness for total sample network, firmness for non-LE network, and tightness for LE network. LE survivors reported more prevalent and severe arm symptoms with stronger network connections than non-LE group (P = .010). No significant differences were observed among different subgroups of covariates (P > .05). Network structures were significantly different between ALND and SLNB groups.

CONCLUSION

Our study revealed arm symptoms pattern and interrelationships in BCS. Targeting core symptoms in assessment and intervention might be efficient for arm symptoms management. Future research is warranted to construct dynamic symptom networks in longitudinal data and investigate causal relationships among symptoms.

Effectiveness of non-pharmacological interventions in managing symptom clusters among lung cancer patients: a systematic review

BACKGROUND

Non-pharmacological interventions, as complements to pharmacological treatments, are widely employed for managing symptom clusters in patients with lung cancer. Although numerous systematic reviews and meta-analyses have explored the effects of these interventions, most studies have centred on the broader cancer population and specific symptom clusters. This review aims to consolidate existing non-pharmacological interventions and assess their effectiveness in managing symptom clusters among lung cancer patients.

METHODS

A comprehensive literature search, encompassing eight databases from inception to October 1, 2024, was conducted. Two independent reviewers carried out the study selection, quality assessment, and data extraction. Methodological quality was evaluated using the Cochrane Risk-of-Bias 2 tool and the Risk of Bias in Non-randomized Studies of Interventions. The findings were synthesized narratively based on intervention type and supplemented by meta-analysis using RevMan 5.4 software. The study protocol was registered with PROSPERO (CRD42023467406).

RESULTS

This systematic review comprised 15 relevant studies involving 1,692 patients, published between 2011 and 2024. The analysis revealed the effectiveness of psychological, educational, and complementary or alternative medicine interventions in alleviating the severity of most symptom clusters. However, the efficacy of exercise-based and multimodal interventions remained inconclusive. The meta-analysis demonstrated a positive impact of non-pharmacological interventions on depression compared with the control conditions (SMD = -0.30, 95% CI [-0.46, -0.15], p < 0.01, I2 = 6%). Additionally, the educational intervention subgroup showed low heterogeneity and effectively improved fatigue (SMD = -0.50, 95% CI [-0.68, -0.33], p < 0.01, I2 = 0%).

CONCLUSIONS

Psychological and educational interventions have proven effective in managing symptom clusters in lung cancer patients. However, further research is needed to explore the effects of exercise, multimodal approaches, and complementary or alternative medicine. To enhance symptom management, future research could focus on core symptom clusters.

A Six-Week Smartphone-Based Program for HPV Prevention Among Mothers of School-Aged Boys: A Quasi-Experimental Study in South Korea

BACKGROUND

Human papilloma virus (HPV) affects both males and females, but in South Korea, vaccination rates for boys are significantly lower due to cultural stigma and limited awareness. Effective strategies are needed to close this gap.

METHODS

This study evaluated a 6-week smartphone-based HPV prevention program for mothers of school-aged boys, designed using the extended theory of planned behavior (E-TPB). The program aimed to enhance knowledge, attitudes, subjective norms, and self-efficacy, with the goal of increasing vaccination intention and uptake. The E-TPB incorporated knowledge as a key element to improve behavioral intention and vaccination uptake. A nonequivalent control group pre-test-post-test design included 54 mothers (28 in the experimental group and 26 in the control group).

RESULTS

The experimental group showed significant improvements in HPV knowledge (p < 0.001; d = 1.41), HPV vaccine knowledge (p < 0.001; d = 1.13), attitudes (p < 0.001; r = 0.48), subjective norms (p = 0.014; d = 0.61), self-efficacy (p < 0.001; r = 0.53), and vaccination intention (p < 0.001; r = 0.58). The experimental group achieved a vaccination uptake rate of 25.0%, compared to 4.0% in the control group, representing a six-fold increase (RR = 6.25; p = 0.033; h = 0.64).

CONCLUSIONS

The program effectively addressed key factors influencing vaccination behavior, leading to significant increases in HPV vaccination rates among boys. Smartphone-based education shows promise in reducing gender disparities in vaccination uptake, though further studies with larger samples are needed to validate these findings.

Latent Profile Analysis and Determinants of Marital Adjustment in Patients with Breast Cancer

Objective

The aim of this study is to assess the latent profile types of marital adjustment in patients with breast cancer and to analyze the factors influencing these various profiles.

Methods

Patients with breast cancer who visited the Breast Surgery Department from January to June 2023 were selected using convenience sampling. These patients were surveyed using a general data questionnaire, the Revised Dyadic Adjustment Scale (RDAS), the Interpersonal Reactivity Index-C (IRI-C), and the Emotional Regulation Self-Efficacy Scale (RESS). Latent profile analysis (LPA) was used to determine different types of marital adjustment among patients, and influencing factors for the various profiles were identified through univariate analysis and multivariate logistic regression analysis.

Results

Marital adjustment in patients with breast cancer was categorized into three latent profiles: the "low marital adjustment-low cohesion group" (20.2%), the "midlevel marital adjustment group" (35.3%), and the "high marital adjustment-satisfaction group" (44.4%). The influencing factors included age, marital status, primary caregiver, type of surgical intervention, empathy, and emotional regulation self-efficacy (P < 0.05).

Conclusion

The marital adjustment levels of patients with breast cancer exhibited significant heterogeneity. Medical staff can implement targeted interventions based on the distinct characteristics of each marital adjustment profile, thereby enhancing the marital adjustment of these patients.

The Evolving Role of the Oncology Nurse in the United States of America-A Survey Exploring Their Perspective

BACKGROUND

The role of the oncology nurse has evolved since the COVID-19 pandemic to continuously meet patient needs, resulting in an increased virtual presence. However, there is little information about whether these roles have continued since the pandemic and how it is affecting nurses.

METHODS

The aim of this study, conducted via an electronic survey questionnaire, was to examine the perspective of oncology nurses in the United States of America regarding how their role has changed, the adaptation to telehealth, challenges, and needs.

RESULTS

Over 5 months, 197 respondents from 17 different states completed the survey. They were all registered nurses working in oncology with different roles, such as being nurse practitioners (23%), nurse navigators (20%), infusion nurses (23%), and working in outpatient settings (93%). The findings of the survey highlight the multifaceted responsibilities of nurses in providing care across the cancer care continuum, emphasizing patient-centered care, communication, education, and empowerment, in addition to expected duties such as the administration of anticancer therapy, monitoring of side effects, and symptom management. A total of 82.6% of United States of America oncology nurses feel their workload has increased. The role of nurses in oncology is continuously evolving and the impact of the COVID-19 pandemic, in certain areas such as telehealth, is here to stay.

CONCLUSIONS

The results of the study allow a better understanding of the emergent roles of oncology nursing. The importance of self-care initiatives and education are emphasized as critical to support nurses in their complex, busy, and emotionally charged work environment and to help retain existing nurses and attract new individuals into the profession. The study ultimately seeks to inform policy and drive professional development in oncology nursing in the United States of America.

A practical framework for the design of resistance exercise interventions in oncology research settings-a narrative review

Resistance exercise (RE) has been demonstrated to result in a myriad of benefits for individuals treated for cancer, including improvements in muscle mass, strength, physical function, and quality of life. Though this has resulted in the development of recommendations for RE in cancer management from various international governing bodies, there is also increasing recognition of the need to improve the design of RE interventions in oncology. The design and execution of RE trials are notoriously complex, attempting to account for numerous cancer/treatment related symptoms/side effects. Further, the design of exercise trials in oncology also present numerous logistical challenges, particularly those that are scaled for effectiveness, where multi-site trials with numerous exercise facilities are almost a necessity. As such, this review paper highlights these considerations, and takes evidence from relevant areas (RE trials/recommendations in oncology, older adults, and other clinical populations), and provide a practical framework for consideration in the design and delivery of RE trials. Ultimately, the purpose of this framework is to provide suggestions for researchers on how to design/conduct RE trials for individuals with cancer, rather than synthesizing evidence for guidelines/recommendations on the optimal RE dose/program.

Information Needs Among Thai Women Breast Cancer Patients During the Initial Treatment Phase: A Cross-Sectional Study

AIMS

To examine the information needs of breast cancer patients during the initial phase of treatment and to analyse the factors that influenced these needs.

BACKGROUND

Providing comprehensive and timely information during early breast cancer treatment is crucial for informed decision-making and effective coping. Healthcare providers must address these needs to enhance patient support and improve outcomes.

DESIGN

A cross-sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

METHODS

A total of 123 post-mastectomy patients were selected through purposive sampling and completed the Thai version of the Sri Lankan Information Needs Assessment Questionnaire-BC (SINAQ-BC). Direct associations between demographic data and information needs were analysed descriptively, while bivariate analysis and linear regression were used to identify significant predictors of information needs.

RESULTS

The findings revealed that patients exhibited high overall information needs (224.7/260.0), with the greatest demand focused on physical care, treatment and diagnosis. In contrast, needs related to disease specifics and psychosocial care were less prominent. A total of 94 respondents (76.4%) expressed a particularly high demand for information regarding physical care. Education level was identified as an influencing factor, accounting for 7.7% of the variance in information needs among women with breast cancer.

CONCLUSIONS

Patients with higher education levels had significantly greater information needs. Nursing staff should provide customised information packages that are tailored to the participants' education levels. Further testing of the Thai version of the SLINQ-BC would also be warranted.

IMPLICATIONS FOR PATIENT CARE

Patients are increasingly expected to manage their own care even as medical treatment grows more complex and technical. Nursing staff can contribute to the care of patients by being ready to evaluate, monitor and address breast cancer patient's individual information needs in the early stage of treatment based on factors such as educational level.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution because the nature of the study's design, data analysis and writing did not require patient or public contribution.

Sleep quality and risk of obstructive sleep apnea among breast cancer survivors with and without lymphedema

PURPOSE

Breast cancer survivors (BCSs) tend to have sleep disturbances such as obstructive sleep apnea (OSA). However, limited evidence exists on the role of breast cancer-related lymphedema (BCRL) in sleep disturbances and OSA. Therefore, this study aimed to investigate the quality of sleep (QoS) and OSA risk among women with and without BCRL.

METHODS

The quality of life (QoL) was evaluated using the SF-12 and EORTC-QLQ C-30 questionnaires, while their sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The STOP-bang questionnaire (SBQ) was utilized to quantify OSA risk. Sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Also, neck and waist circumference and the excessive volume in the affected limb were measured using a tape measure. The statistical analyses were performed using the SPSS 21.0 software.

RESULTS

Seventy-one women with BCRL and 84 BCS without lymphedema were included. The comparison of PSQI, SBQ, ESS, SF-12, and EORTC QLQ-C30 questionnaires exhibited no significant difference between these two groups. The overnight snoring and average neck circumference were significantly higher in the BCRL group than in the control. The BCRL stage significantly correlated with neck circumference and SBQ total score. Additionally, the mean volume difference indicated a significant correlation with the ESS total score and both physical and mental summary components of the SF-12 questionnaire.

CONCLUSION

The prevalence of sleep disturbances among BCSs with and without BCRL is high. Women with advanced stages of BCRL might be at high risk for OSA. Therefore clinical evaluation of BMI, neck circumference, and, snoring overnight should be emphasized among this population.

The effect of hand massage on fatigue in women with cancer receiving brachytherapy: randomized clinical trial

PURPOSE

This randomized controlled study was conducted to analyze the effect of hand massage on the fatigue level of the women receiving brachytherapy.

METHODS

It was determined that 12 patients were included in each group (control and hand massage group), so 24 women with gynecologic cancer were included in the study. The application was performed on each hand for 5 min, a total of 10 min in hand massage group. Hand massage was applied before each brachytherapy (at the first, second, and third sessions, a total of three times) every other day for 1 week in the hand massage group. No intervention was performed to the control group during the study. The data were collected using the Patient Information Form and Brief Fatigue Inventory (BFI).

RESULTS

At the end of the brachytherapy, the fatigue severity score and impact of fatigue on activities of daily living scores of the group that applied hand massage were determined to be lower than the control group (p < 0.05).

CONCLUSION

It was determined that hand massage effectively controlled fatigue and the impact of fatigue on activities of daily living. Hand massage is a safe and economical method that can be performed by certified nurses.

TRIAL REGISTRATION

This clinical trial is registered at ClinicalTrials.gov (NCT06056713-09/21/2023).

Personal and workplace factors influencing the resilience of nurses caring for women with cervical cancer in a resource-constrained setting in Ghana

INTRODUCTION

Cervical cancer has been identified as the fourth most common form of malignancy affecting and killing women globally. Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation and the burden of care. Resilience has been identified as one of the effective ways of helping nurses to cope well with the stress of oncology nursing, but this remains undetermined in Ghana.

AIM

This study explored personal and workplace factors influencing the resilience of nurses caring for women diagnosed with advanced cervical cancer (stage III and IV) in a resource-constrained setting in Ghana.

METHOD

Using a qualitative approach, we recruited twenty nurses and midwives who had worked for a year and above caring for advanced-stage cervical cancer patients at the national referral hospital in Ghana. We conducted in-depth interviews between July, 2022 to September, 2022 which were audio-taped with participants' consent. Transcription was done verbatim, and analysis conducted using thematic analysis approach with the aid of NVivo 10.0.

RESULTS

The results revealed experience as a safety toolkit, inherent desire to help/care for the patient, emotional numbness and maintaining professional outlook as personal factors influencing resilience among the participants. Regarding the workplace factors influencing resilience, we identified the main theme of demands of caregiving for advanced cervical cancer patients with the following sub-themes; severity of cases managed, nature of care rendered, activities of care given, reshuffling, schedules and gender mirroring as an exacerbator of psychological suffering.

CONCLUSION

Resilience among nurses and midwives caring for terminally ill cervical cancer patients is influenced by longer years of service, intrinsic motivation to work as a nurse, and the defense strategy of emotional numbness and professionalism at the individual level. Also, the huge demand of caregiving serves as a major workplace factor affecting the resilience of nurses and midwives. We recommend strategies such as regular ward conferences and in-service trainings aimed at enhancing job-experience, inherent desire to render care and professionalism be adopted in resource-constrained settings to improve nurses' resilience. In addition, political actors and management of hospitals must prioritize allocation of resources for advanced cervical cancer care with particular focus on providing more specialized nurses and midwives.