Multiple myeloma in people of working age in Czechia, Germany, and Poland: findings from a qualitative interview study

PURPOSE

The study sought to understand the experiences of working age adults with myeloma and their partner/family members, living in Czechia, Germany, and Poland.

METHODS

Qualitative interviews were conducted with 36 working age adults living with myeloma, and three family members. Data were collected from May to October 2022. Thematic analysis was applied to the data.

RESULTS

Healthcare and state support within each country are described. The degree of work engagement was informed by patients' symptom burden, treatment needs, state financial aid, and family/financial obligations. Many did not conceptualise their status as involving 'return to work' as they had continued to be engaged with their jobs throughout. For some, remote working enabled them to manage treatments/side-effects and their job, while avoiding infection. In some cases, patients did not tell their employer or colleagues about their illness, for fear of discrimination.

CONCLUSION

While experiences varied between countries, common across accounts was a struggle to balance ongoing treatments with employment, at a time when participants were expected to finance their own households and maintain their income and roles. Implications for Cancer Survivors To improve quality of life, clinical discussions around treatment decision-making should take into account patients' attitudes/approach to work, type of work engaged in, and other activities considered important to them. European Union and national cancer plans should set out optimum standards for employers, to ensure an equitable benchmark for how employees are supported. Such approaches would improve legal protections and better enforcement of employer policies to accommodate patients' limitations in the workplace.

Oral Anticancer Therapies: Addressing Nonadherence in Patients With Breast Cancer

This review aims to investigate the issue of treatment nonadherence and to present the available strategies to improve adherence to oral treatments in breast cancer. A literature search was conducted to contextualise the issue of nonadherence, investigate the reasons behind nonadherence, and demonstrate strategies to address treatment nonadherence in breast cancer. Findings indicate that adherence rates decrease while discontinuation rates increase with increasing lengths of breast cancer treatment course. Lack of adherence is proven to be detrimental to treatment outcomes. Patients struggle to adhere to treatment due to inadequate relationships with healthcare providers, lack of information, psychological distress, and side effects. Healthcare providers should evaluate patient's experience to provide the necessary support. Following this assessment, healthcare providers may recommend interventions addressing patient knowledge, psychological distress or side effects. Treatment adherence remains an issue for oral therapeutics in breast cancer. After patient assessment, healthcare providers can offer personalised strategies to improve treatment adherence. The most crucial interventions address patient knowledge, psychological distress, and side effects.

Survivorship Care for People Affected by Advanced or Metastatic Cancer: Building on the Recent Multinational Association of Supportive Care in Cancer-ASCO Standards and Practice Recommendations

Although there is a growing number of people living with advanced or metastatic cancer, primarily because of more effective treatment regimens, there are limited estimates of the actual number of people living with advanced or metastatic cancer. Many people will have treatable but not curable cancers, may have survival measured in years, and may have periods on and off therapy. People with advanced or metastatic disease, as well as their families and caregivers, may experience significant unmet needs, overlapping yet distinct to those with potentially curable cancer. Recently, the Multinational Association of Supportive Care in Cancer and ASCO developed standards and practice recommendations relevant to the delivery of quality survivorship care for people living with advanced or metastatic cancer. The recommendations included seven domains: (1) person-centered care; (2) coordinated and integrated care; (3) evidence-based and comprehensive care; (4) evaluated and communicated care; (5) accessible and equitable care; (6) sustainable and resourced care; and (7) research and data-driven care. Immediate priorities to improve clinical care include focusing on (1) discussions regarding prognosis and goals of care; (2) routinely assessing physical, psychological, and social unmet needs with referral to appropriate supportive care services; and (3) creating blended models of care, incorporating elements of palliative care and survivorship services. Additional areas for focus include (1) advocacy and policy; (2) system design and health care delivery; (3) defining, measuring, and managing quality; (4) addressing inequity; and (5) research specifically focused on these cancer populations.

Switching between Medicare Advantage and Traditional Medicare for individuals newly diagnosed with cancer 2015-2019

BACKGROUND

Medicare Advantage (MA) plans may offer more benefits and lower costs relative to Traditional Medicare (TM), but may also provide narrower provider networks and preauthorization requirements. We explore the impact of a cancer diagnosis on switching between MA and TM after diagnosis.

METHODS

We used the 2015-2019 Surveillance, Epidemiology and End Results-Medicare data to examine patterns of switching between MA and TM after cancer relative to those without cancer. We used binomial generalized estimating equations to evaluate the cancer and sociodemographic characteristics of those with higher probabilities of switching.

RESULTS

Among those initially enrolled in MA plans (39.27% of those with vs 40.79% without cancer), 3.76% of individuals with cancer switched to TM compared with 2.23% without cancer. For those initially enrolled in TM, 2.96% of individuals with cancer switched to MA vs 4.35% without cancer. Multivariable analyses demonstrated that, among individuals starting in MA, a cancer diagnosis was associated with a 52.02% increase in switching relative to those without cancer, whereas among those starting in TM, a cancer diagnosis was associated with a 26.90% reduction in switching. Younger individuals, males, dual-eligible, those with more comorbidities, rural-dwellers, and those living in zip codes with higher education and income levels also had higher probabilities of switching from MA to TM.

CONCLUSIONS

Prior to diagnosis, MA enrollment is comparable between individuals with and without cancer. However, after diagnosis, individuals with cancer have higher probability of switching from MA to TM and lower probability of switching from TM to MA.

Professionally led support groups for people living with advanced or metastatic cancer: a systematic scoping review of effectiveness and factors critical to implementation success within real-world healthcare and community settings

PURPOSE

To examine the effectiveness of professionally led support groups for people with advanced or metastatic cancer, and identify factors critical to implementation success within real-world settings.

METHODS

Databases (MEDLINE; PsychINFO; CINAHL) and grey literature were searched for empirical publications and evaluations. Articles were screened for eligibility and data systematically extracted, charted and summarised using a modified scoping review methodology. Implementation factors were mapped using Proctor's implementation framework and the Consolidated Framework for Implementation Research 2.0.

RESULTS

A total of 1691 publications were identified; 19 were eligible for inclusion (8 randomised controlled trials, 7 qualitative studies, 2 cohort studies, 2 mixed methods studies). Most (n=18) studies focused on tumour-specific support groups. Evidence supported professionally led support groups in reducing mood disturbances (n=5), distress (i.e. traumatic stress, depression) (n=4) and pain (n=2). Other benefits included social connectedness (n=6), addressing existential distress (n=5), information and knowledge (n=6), empowerment and sense of control (n=2), relationships with families (n=2) and communication with health professionals (n=2). Thirteen studies identified factors predicting successful adoption, implementation or sustainment, including acceptability (n=12; 63%), feasibility (n=6; 32%) and appropriateness (n=1; 5%). Key determinants of successful implementation included group leaders' skills/experience, mode of operation, travelling distance, group composition and membership and resourcing.

CONCLUSIONS

Professionally led tumour-specific support groups demonstrate effectiveness in reducing mood disturbances, distress and pain among patients. Successful implementation hinges on factors such as leadership expertise, operational methods and resource allocation.

IMPLICATIONS FOR CANCER SURVIVORS

Professionally led support groups may fill an important gap in supportive care for people with advanced or metastatic cancer.

Association of Social Vulnerability Index With Declining Recommended Surgical Treatment in Head and Neck Cancer Patients

OBJECTIVE

To investigate the impact of county-level social vulnerability on patients' decision to refuse recommended surgical treatment.

METHODS

Retrospective cohort analysis conducted on HNSCC cases documented in the latest available SEER databases from 2000 to 2020; various demographic, including county of residence, and disease-related variables were collected. CDC's Social Vulnerability Index (SVI) was assigned based on patients' county of residence, and patients were subsequently categorized into four SVI quartiles. Pearson chi-square tests and binomial logistic regression was conducted to determine the impact of variables on patients' refusal of surgical treatment.

RESULTS

Among 83,184 patients, 2.6% (2,165) refused surgical intervention recommended by their physician as part of treatment. Social vulnerability (higher SVI), male sex, older age, more advanced disease stage, belonging to non-Hispanic Black or Native Hawaiian/Asian Pacific Islander Race and Origin, and single marital status were associated with higher likelihood of refusing surgery.

CONCLUSION

SVI is a significant factor in the refusal of recommended surgical treatment in HNSCC patients. Advanced disease stages and social vulnerability appear to interplay, influencing treatment decisions. Culturally competent care and support for socially vulnerable patients may mitigate disparities in treatment acceptance, potentially improving survival outcomes.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:2062-2069, 2025.

The Dyadic Relationship of Illness Perception and Fear of Progression in Patients With Digestive System Cancers and Their Caregivers: An Actor-Partner Interdependence Model Analysis

This study employs a dyadic analysis approach to explore the relationship between illness perception and fear of progression among digestive system cancer patients and caregivers using the Actor-Partner Interdependence Model (APIM). We selected 242 pairs of digestive system cancer patients and their primary caregivers from two tertiary hospitals in Guangdong Province using convenient sampling method. Participants completed the Brief Illness Perception Questionnaire and Fear of Progression Questionnaire. Structural equation modelling based on the APIM framework was used to assess both actor effects (individuals' illness perception on their own fear of progression) and partner effects (individuals' illness perception on the other member's fear of progression). This study included a total of 242 sets of participants, with patients having an average age of 55.97 (SD = 14.19) years and caregivers having an average age of 49.40 (SD = 13.18) years. The study revealed that the paired patterns of illness perception and fear of progression among patients and caregivers were couple patterns. Specifically, in terms of actor effects, illness perception among digestive system cancer patients and their caregivers was able to influence their own fear of progression (β = 0.238, 0.163; 95% CI = 0.167-0.310, 0.094-0.233; both p < 0.001). Regarding the partner effects, the illness perception of digestive system cancer patients and their caregivers positively influenced each other's fear of progression (β = 0.238, 0.163; 95% CI = 0.167-0.310, 0.094-0.233; both p < 0.001). This study confirms the existence of the actor-partner relationships between illness perception and fear of progression among digestive system cancer patients and their caregivers. These interdependent effects highlight the importance of adopting dyad-centred interventions in psycho-oncology care, where clinicians should address both patients and caregivers as an emotionally connected unit rather than isolated individuals.

Effects of an app-assisted self-management intervention for urinary incontinence on self-efficacy and related outcomes in men with prostate cancer: A randomized controlled feasibility trial

PURPOSE

To assess the feasibility, acceptability, and effectiveness of an app-assisted self-management intervention for urinary incontinence (App-SMI-UI) in men with prostate cancer.

METHODS

We recruited men (n = 85) who had been diagnosed with prostate cancer and experienced urinary incontinence following radical prostatectomy. Participants were randomly assigned to the self-management group (n = 43) or the attrition control group (n = 42). The self-management group underwent a 12-week App-SMI-UI while the control group received a single session of multimedia dietary information. Data was collected at baseline, week 12, and week 16. The variables measured were cancer-related self-efficacy, urinary symptoms, social participation, demoralization, resilience, and satisfaction with the intervention.

RESULTS

Compared to the control group, the self-management group had fewer urinary symptoms and a higher willingness to engage in and satisfaction with social activity participation at week 12. By week 16, the self-management group exhibited higher cancer-related self-efficacy, greater participation in interpersonal relationship activities, and continued willingness to engage in and satisfaction with social activity participation.

CONCLUSION

The App-SMI-UI contributes to improving urinary symptoms, self-efficacy, and social participation among men with prostate cancer. Healthcare providers can use self-management programs to manage urinary incontinence and support prostate cancer men.

Experience and Coping Strategies of Endocrine Therapy-Related Symptoms in Breast Cancer Patients: A Systematic Review and Qualitative Meta-Synthesis

OBJECTIVE

Endocrine therapy is an essential treatment to improve disease-free and overall survival in patients with hormone receptor-positive breast cancer. However, symptoms associated with endocrine therapy severely affect patients' quality of life and medication adherence. To inform symptom management strategies, this study systematically reviews research on patients' symptom experiences and coping strategies during endocrine therapy.

METHODS

This study conducted a thematic synthesis of qualitative research, including patients' experiences with endocrine therapy-related symptoms and the coping strategies they employ. Systematic searches were conducted in nine databases, including six English-language databases (PsycINFO, PubMed, CINAHL, Cochrane Library, Embase, and Web of Science) and three Chinese-language databases (SinoMed, CNKI, and Weipu), with searches covering the period from database inception to May 2024. The PICoS (Population, Interest of phenomena, Context, Study design) search strategy was applied to include the required qualitative studies.

RESULTS

A total of 1758 studies were screened, and 19 qualitative studies were ultimately included, comprising 584 female patients receiving endocrine therapy. Identified five main themes: (1) antecedent factors influence symptom perception and adaptation; (2) outcomes of symptom experiences; (3) the complexity and diversity of symptoms; (4) selection of coping strategies; (5) symptom management needs. Reveals the impact of antecedent factors on symptom perception and adaptation, provides recommendations for managing endocrine therapy-related symptoms, and indicate the clinical significance and limitations of the research.

CONCLUSIONS

Findings indicate that information accessibility and individual differences influence symptom perception, while physiological changes, experiences, psychological states, and information affect symptom adaptation. After symptom onset, patients often face distress and daily life/work limitations. A major challenge in symptom management is the lack of a systematic approach that accounts for symptom complexity and dynamics. Additionally, patients' informational needs are unmet, and professional support is lacking.

TRIAL REGISTRATION

This systematic review has been registered on PROSPERO (CRD:42023444435).

The safety and efficacy of endoscopic submucosal dissection for superficial pharyngeal squamous cell neoplasms: a single-center study in China

BACKGROUND AND AIMS

Endoscopic submucosal dissection (ESD) is a mainstream treatment for superficial pharyngeal squamous cell neoplasms (SPSCN) in Japan. There were few reports of it in China, which were small in scale and lack long-term follow-up data. Quality of life (QoL) outcomes of ESD for SPSCN have also not been studied. The aims of this study were to clarify the safety and efficacy of ESD for SPSCN and its outcomes in the Chinese setting.

METHODS

Eighty-four consecutive patients with 145 lesions treated with ESD for SPSCN from January 2014 to August 2022 were enrolled. Their curability, complications, metachronous SPSCN, local recurrence, lymph node metastasis, and overall and disease-specific survival rates were analyzed. The quality of life was measured by MD Anderson Symptom Inventory-Head and Neck (MDASI-HN).

RESULTS

The en-bloc resection rate was 94.5%, and the R0 resection rate was 74.5%. The postoperative adverse event rate was 2.6%. The median follow-up period was 36.28 months. The 3-year rates of metachronous pharyngeal cancer, local recurrence, lymph node metastasis, overall survival, and disease-specific survival were 14.1%, 7.6%, 9.6%, 92.4%, and 98.0%, respectively. The mean symptom composite score and interference score of MDASI-HN were 10.3 and 2.3, respectively.

CONCLUSIONS

In the Chinese setting, pharyngeal ESD achieves curability, safety, and long-term outcomes comparable to those observed in Japan. The postoperative QoL is satisfactory.

Family Resilience and Perceived Stress: A Three-Level Meta-Analysis

Although numerous studies have observed a negative correlation between family resilience and perceived stress, the strength of this relationship has exhibited significant variability in previous research. This study aimed to elucidate the relationship between family resilience and perceived stress, investigating the moderating roles of various factors. Employing a three-level meta-analysis, the research scrutinized 23 selected studies involving 17,480 participants and 99 effect sizes, following a comprehensive literature search and screening. The results revealed a significant negative correlation between family resilience and perceived stress, r = -0.25. Notably, the family resilience systems theory showed a significant negative correlation, r = -0.28, than other models, suggesting its superior ability to explain the resilience-stress relationship. Furthermore, the study found that the mean age of adults significantly moderated this relationship, with older adults demonstrating a more pronounced negative correlation, r = -0.24, implying that established resilience practices and life experience may enhance stress management in this group. These findings highlight the need for age-specific interventions that target the management of family resilience and perceived stress, emphasizing the critical role of appropriate theoretical frameworks.

Effects of a theoretical and workshop-based educational intervention on emergency department nurses' knowledge and attitudes towards pain management

BACKGROUND

Patients have a fundamental right to freedom from pain, and proper pain assessment and management are prerequisites for pain relief. However, most emergency department nurses lack knowledge of pain management.

PURPOSE

This study aims to assess the impact of a pain management education program on emergency department nurses' knowledge and attitudes regarding pain assessment and management.

METHODS

This was a quasi-experimental study in which 120 nurses were recruited from the emergency department to participate in the study for an 8-week educational intervention, and pain knowledge levels were assessed pre- and post-intervention using the Knowledge and Attitude Survey regarding Pain (KASRP) questionnaire.

RESULTS

The mean score of pain knowledge and attitude (21.87 ± 6.523) after the intervention was significantly higher than the mean score before the intervention (18.59 ± 4.118).

CONCLUSION

The theory-based and workshop-based educational intervention significantly improved emergency department nurses' knowledge and attitudes toward pain management (p < 0.001). The findings suggest that implementing evidence-based continuing education programs for emergency department nurses on pain management could enhance patient care quality. Therefore, it is recommended that hospital managers develop and evaluate feasible training programs to ensure their effectiveness and sustainability.

The Effect of Nursing-Based Enhanced Recovery After Surgery on Quality of Life in Lung Cancer Patients Receiving Surgery: A Systematic Review and Meta-Analysis

Enhanced recovery after surgery (ERAS) is an evidence-based, multidisciplinary protocol aimed at reducing surgical stress and expediting postoperative recovery. This meta-analysis will provide a comprehensive examination of the implications of ERAS care for the quality of life (QOL) of postoperative Lung cancer (LC) patients. The literature databases were searched to identify randomized controlled trials that implemented an ERAS program for adult patients with LC who underwent surgical treatment and reported QOL results. Thirty-one studies were included in the analysis. ERAS/FTS significantly improved the overall QOL of postoperative LC patients according to the Short Form-36 (SF-36) score (mean difference (MD): 8.58; 95% confidence interval (CI): 6.17, 11.00; p < 0.001). For physical functioning, the ERAS/FTS significantly improved the SF-36 score (MD: 10.45; 95% CI: 7.41, 13.50; p < 0.001). In the role-physical dimension, the ERAS/FTS nurse strategy had a significant advantage in improving the role-physical score on the SF-36 scale (MD: 10.06; 95% CI: 7.00, 13.13; p < 0.001). The ERAS has a highly positive impact on QOL in postoperative LC patients, especially in the physical functioning and role-physical dimensions.

Socioeconomic/health-related factors associated with HPV vaccination initiation/completion among females of paediatric age: A systematic review with meta-analysis

Objectives

To systematically identify, appraise, and summarise published evidence on individual socioeconomic and health-related factors associated with human papillomavirus (HPV) vaccination initiation and completion among females of paediatric age.

Study design

A global systematic review with meta-analysis (PROSPERO: CRD42023445721).

Methods

We performed a literature search in December 2022 and supplemented the search on August 1, 2023. Appropriate data were pooled using an inverse variance, random-effects model and the results were expressed as odds ratios, with 95 % confidence intervals. A statistically significant point pooled increased/decreased odds of 30-69 % was regarded to be strongly associated, and ≥70 % was very strongly associated.

Results

We included 83 cross-sectional studies. Among several significantly associated factors, being an older girl: 1.67 (1.44-1.93), having health insurance: 1.41 (1.16-1.72), and being in a public school: 1.54 (1.05-2.26) strongly increased the odds of vaccination initiation, and nativity in the country of study: 1.82 (1.33-2.50), use of contraception: 2.00 (1.16-3.46), receipt of influenza vaccination: 1.75 (1.54-2.00) and having visited a healthcare provider: 1.85 (1.51-2.28) in the preceding year very strongly increased the odds of vaccination initiation. Likewise, being an older girl: 1.36 (1.23-1.49) and having visited a healthcare provider in the preceding year: 1.46 (1.05-2.04) strongly increased the odds of vaccination series completion, and school-based vaccination: 3.08 (1.05-9.07), having health insurance: 1.72 (1.27-2.33), and receipt of influenza vaccination in the preceding year: 1.72 (1.62-1.83) very strongly increased the odds of vaccination series completion. We made similar observations when the studies were limited to the United States.

Conclusions

Several individual socioeconomic/health-related factors may determine initiating and completing the HPV vaccination series among paediatric females. These factors provide insights that may be key to identifying girls at increased risk of not being vaccinated and may aid targeted public health messaging.

Perceptions, educational expectations and knowledge gaps of patients with non-metastatic breast cancer regarding radiotherapy: Integrative review

Objective

This integrative review investigates perceptions, educational expectations, and knowledge gaps of patients with breast cancer (BC) regarding radiotherapy (RT).

Methods

The included studies were analysed using a thematic analysis approach. Each segment of data was coded with open coding. The codes were gathered into subthemes as they emerged and into overarching themes, after which the data was analysed again.

Results

22 studies were included: 11 qualitative, 10 cross-sectional, and 1 case study. Our findings indicate that breast cancer patients perceptions of radiation therapy (RT) are influenced by their understanding of RT, its side effects, the treatment burden, emotional state or feelings, effectiveness if RT, prognosis, and viewing RT as the end-of-care phase. They expect education on the treatment pathway, psychosocial support, personalised aspects of RT, planning, delivery, follow-up, and side effects. Additionally, women undergoing RT have knowledge gaps related to preparedness and support, unforeseen risks and side effects, as well as daily practical issues.

Conclusion

Tailored, culturally sensitive education is essential to bridge gaps in understanding, manage anxiety, and build trust. It requires individualized communication strategies and psychosocial support. By integrating personalized information and leveraging technological solutions, healthcare providers can empower patients, improve adherence, and enhance outcomes, particularly in resource-limited settings.

Immunosenescence in skeletal muscle: The role-play in cancer cachexia chessboard

With the increase in life expectancy, age-related conditions and diseases have become a widespread and relevant social burden. Among these, immunosenescence and cancer cachexia play a significant often intertwined role. Immunosenescence is the progressive aging decline of both the innate and adaptive immune systems leading to increased infection susceptibility, poor vaccination efficacy, autoimmune disease, and malignancies. Cancer cachexia affects elderly patients with cancer causing severe weight loss, muscle wasting, inflammation, and reduced response to therapies. Whereas the connections between immunosenescence and cancer cachexia have been raising attention, the molecular mechanisms still need to be completely elucidated. This review aims at providing the current knowledge about the interplay between immunosenescence, skeletal muscle, and cancer cachexia, analyzing the molecular pathways known so far to be involved. Finally, we highlight potential therapeutic strategies suited for elderly population aimed to block immunosenescence and to preserve muscle mass in cachexia, also presenting the analysis of the current state-of-the-art of related clinical trials.

An Empowerment-Based Intervention for Chinese Immigrant Women Experiencing Intimate Partner Violence: Feasibility and Acceptability

BACKGROUND

Intimate partner violence (IPV) is a significant public health concern, particularly in vulnerable populations such as Chinese immigrant women.

AIM

This study aimed to assess the feasibility and acceptability of an empowerment-based intervention integrated with relaxation and self-compassion techniques for Chinese immigrant women experiencing IPV.

METHODS

The present study was a part of a pilot randomized controlled trial (RCT). A total of 50 Chinese immigrant women who had experienced IPV in the past year were recruited online and randomized to either the intervention or the control group. The intervention group engaged in seven weekly sessions delivered with a phone call and a mobile application. Quantitative and qualitative data were collected through surveys and interviews to evaluate intervention adherence, participants' perceptions, and areas for improvement.

RESULTS

64% of the participants completed each weekly session, demonstrating favorable intervention adherence. The intervention was perceived to be helpful by most participants, with reported decreases in stress, anxiety, fatigue, pain, and family conflicts, and with reported improvements in emotion regulation and self-compassion. However, technical issues with the mobile platform and lack of personalization were identified as limitations.

CONCLUSION

This study demonstrates the feasibility and acceptability of the intervention for Chinese immigrant women experiencing IPV and warrants a full-scale RCT to determine its efficacy. It will be essential to personalize the intervention and reduce any barriers to participation.

Analysis of factors influencing chemotherapy-induced peripheral neuropathy in breast cancer patients using a random forest model

OBJECTIVE

This study aimed to analyze the factors influencing chemotherapy-induced peripheral neuropathy (CIPN) in breast cancer patients, identify modifiable factors, and provide a theoretical basis for targeted interventions.

METHODS

A total of 542 patients with breast cancer who were hospitalized for chemotherapy in multiple hospitals from September 2022 to September 2023 were selected as the study objects. Data were collected using questionnaires covering demographic characteristics, disease-related information, lifestyle, and psychological status. Lasso-logistic regression was employed to identify influencing factors, and a random forest model was used to rank the importance of variables.

RESULTS

Lasso-logistic regression analysis identified age, BMI, cumulative chemotherapy dose, hypertension, physical activity level, and depression as significant factors associated with CIPN (P < 0.05). The variable importance ranking from the random forest model was as follows: age, BMI, cumulative chemotherapy dose, physical activity, hypertension, and depression.

CONCLUSION

Early identification of high-risk CIPN patients is crucial for guiding clinical nursing practices. These findings provide a foundation for the management and intervention of CIPN in breast cancer patients.

Healthcare professionals' perspectives towards the role of ward-based advanced practice nurses: A cross-sectional study

AIMS

1. To explore the perceptions of physicians, registered nurses (RN) and allied health professionals (AHP) towards the role of ward-based advanced practice nurse (APN). 2. To examine healthcare professionals' perception of APN role expansion in inpatient care.

DESIGN

Cross-sectional study.

METHODS

A 43-item survey comprising of five domains was conducted on healthcare professionals' perceptions towards ward-based APNs in five medical wards of a tertiary hospital from November 2022 to February 2023. The participants were recruited using convenience sampling via email and cross-platform messaging service.

RESULTS

A total of 181 completed respondents including 26 physicians, 102 nurses and 45 AHPs. Statistical analysis was performed with IBM SPSS Version 28.0. APNs were perceived to be spending a great extent of time across all five domains, namely, 'direct comprehensive care', 'support of systems', 'research', 'education' and 'publication and professional leadership'. Significant differences were noted in perceptions based on prior experience with APNs and between different healthcare professions. The majority recognized APNs' positive impact on patient safety, efficiency and patient-centeredness.

CONCLUSION

This study offers valuable insights into ward-based APNs' practice patterns, roles and impact, revealing a positive shift in their acceptance and expanding roles within inpatient general wards. It also highlights the valuable roles and impact of ward-based APNs in direct patient care, system support, research, education and leadership, despite ongoing challenges in role clarity, particularly in treatment planning and ward rounds.

IMPLICATIONS FOR THE PROFESSION

APNs are highly regarded as competent and a consistent personnel in the wards. However, there are divided views on clinical activities that APNs undertake.

IMPACT (ADDRESSING)

What problem did the study address? ○ Role ambiguity for ward-based APNs. ○ Healthcare professionals' readiness and acceptance of APNs. What were the main findings? ○ APNs are perceived to have a strong involvement in direct patient care, support of system, research, education and leadership. ○ APNs are recognized for their significant impact on patient safety, efficiency and patient-centredness, but there were varied perceptions on the extent of time they spend in different practice domains. ○ The critical roles of APNs participating in daily ward rounds and initiating discharge plans were highlighted, emphasizing their importance in timeliness and continuity of care. Where and on whom will the research have an impact? ○ It will affect healthcare professionals including physicians, nurses, allied health professionals and healthcare administrators by providing insights into the roles and contributions of ward-based APNs. ○ The findings will guide policymakers and nurse leaders in making informed decisions about the implementation and development of APN roles, ultimately improving patient care and outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Mediating effects of psychological resilience on the relationship between social support and body image dissatisfaction among patients with primary brain tumors in China

Several studies have documented that patients with different types of tumors experience serious body image dissatisfaction (BID). However, few studies have explored BID in patients with brain tumors. This study examined the level of BID and verified the mediating effects of psychological resilience on the relationship between social support and BID among Chinese patients with primary brain tumors. Participants included 226 Chinese patients with primary brain tumor (64.2% women) between 18 and 80 years of age (mean age = 48.36 ± 12.44), who completed the measures of a demographic questionnaire, the Multidimensional Perceived Social Support Scale (MPSSS), Resilience Scale-14 (RS-14), and Body Image Scale (BIS). The average BIS score among Chinese patients with primary brain tumors was 6.20 (SD = 4.85; range, 0-24), and 200 (88.5%) participants experienced body image dissatisfaction (BIS score ≥ 1), and 50 (22.1%) were significant body image dissatisfaction (BIS score ≥ 10). Spearman's rank-order correlation indicated that BID, psychological resilience, and social support were significantly correlated. Mediation analysis indicated that the direct paths from social support to psychological resilience and psychological resilience to BID were both significant, but the path from social support to BID was not, psychological resilience played a complete mediating role between social support and BID. The current results support that Chinese patients with brain tumors experience BID, and more awareness and interventions should be given from healthcare professionals. These findings have implications for developing and implementing intervention programs to enhance social support and psychological resilience among this population and cope with BID.

The role of empathy and emotional regulation self-efficacy in adult attachment type and marital adjustment in breast cancer patients-a moderated mediation model

To date, previous research has elucidated the impact of adult attachment type on marital relationships. However, the mechanisms underpinning the relationship between attachment type and marital adjustment in breast cancer patients remain unclear. In this study, a cohort of 272 breast cancer patients was surveyed using several instruments: the General Information Questionnaire, Revised Marital Adjustment Scale (RDAS), Adult Attachment Scale (AAS), Interpersonal Reactivity Indicator Scale (IRI), and Regulated Emotional Self-Efficacy Scale (RESS). We conducted moderated mediation analyses using the SPSS macro program PROCESS plug-in. Empathy was found to mediate the association between attachment type (attachment anxiety/attachment avoidance) and marital adjustment, with indirect effects of -0.141 (95% CI [-0.260, -0.063]) and 0.157 (95% CI [0.073,0.289]), respectively. Additionally, affect regulation self-efficacy was found to mediate the subsequent impact of attachment type (attachment anxiety/attachment avoidance) on marital adjustment via empathy, with moderated effects of 0.380 (95% CI [0.236, 0.525]) and 0.374 (95% CI [0.240, 0.509]), respectively. Consequently, the presence of insecure attachment in breast cancer patients appears to influence their empathy levels, thereby negatively impacting marital adjustment. Encouragingly, enhancing emotional regulation self-efficacy in patients holds the potential to mitigate these adverse effects. These findings contribute not only to a deeper theoretical understanding but also lay a solid foundation for practical interventions aimed at enhancing marital relationships among breast cancer patients.

Connecting the Dots: Practical Strategies for Academic and Community Oncology Synergy to Advance Multidisciplinary Management in Immunotherapy Toxicity Care

Immunotherapy has significantly affected cancer treatment and survival rates, accompanied by an increase in immune-related adverse events (irAEs) requiring new management strategies. irAEs can affect various organ systems and have varying severity levels, with higher rates observed when combining immune checkpoint inhibitors. National organizations such as ASCO, the National Comprehensive Cancer Network, the Society for Immunotherapy of Cancer, and the European Society for Medical Oncology have created guidelines for managing irAEs. This chapter expands on these guidelines by discussing practical strategies to improve the multidisciplinary management in irAE care, focusing on the who, what, and how to bridge gaps in care and enhance collaboration between academic and community oncology practices. Effective irAE management involves early recognition and guideline-adherent approaches using a multidisciplinary team, including oncologists, other subspecialists, primary care clinicians, and all care team members. Institutions are developing methods to integrate irAE care into clinical workflows, such as incorporating urgent care clinics and e-consults for efficient irAE management and developing hub-and-spoke models to extend specialized care from academic centers to community hospitals for equitable care delivery. Additionally, effective patient education is critical for improving irAE recognition and health literacy. The new ASCO Community of Practice called the Alliance for Support and Prevention of Immune-Related Adverse Events consortium and patient advocacy group Standing Together to Optimize Research, Interventions, and Education in irAEs initiatives aim to advance irAE clinical care, research, and education through global collaboration, standardized data collection, and improved outreach to patients and caregivers.

Sociodemographic predictors of quality of life and cognitive status among patients with carotid artery stenosis: A prospective cohort study

OBJECTIVE

Carotid stenosis can lead to cerebral hypoperfusion. However, the impact of carotid stenosis on cognitive function and quality of life (QoL) remains unclear, particularly in low and middle income countries. The aim of this study was to explore the impact of carotid stenosis on cognitive screening scores and QoL in Jordan.

METHOD

A prospective cohort design was utilized, with a convenience sample of 140 patients with carotid artery stenosis. Carotid stenosis was measured by Dopplerultrasound and defined as mild (<50 %), moderate (50-70 %), and severe (>70 %). Cognitive screening was performed using the Mini-Mental State Examination, and QoL was measured with the World Health Organization Quality of Life-Brief. Outcomes were assessed during the first clinic visit, which occurred two weeks after being discharged from the hospital.

RESULT

The mean age of participants was 61 years (standard deviation (SD) = 12.27). Most participants had moderate to severe carotid artery stenosis (62.1 %) and Mini Mental State Examination scores of 11-20 (83.6 %), with a mean QoL score of 52.91 (SD = 13.97). Female gender, absence of insurance, and MMSE scores indicating cognitive impairment were associated with poorer QoL. After controlling for sociodemographic variables, severe CAS was associated with a poor QoL.

CONCLUSION

Cognitive dysfunction and poor QoL are common among patients with carotid stenosis in Jordan and are associated with stenosis severity, gender, and insurance status. Pre-existing factors, such as baseline cognitive status or socioeconomic conditions, may have contributed to low MMSE and QoL scores in this patient populations. Lower education levels were associated with worse stenosis severity. Even after controlling for education and other demographic factors, worse carotid stenosis was associated with lower QoL and MMSE scores. Future studies are warranted to investigate the casual or mechanistic links between these variables, particularly given the confounds in our correlational design. Low- and middle-income countries have distinct education levels and sociodemographic characteristics compared to high-income countries. While this may limit the generalizability of the findings, it provides unique evidence about this patient population.

Psychosocial Experiences of African American Parents of Children With Cancer

OBJECTIVE

To explore the psychosocial experiences of African American families affected by childhood cancer.

METHODS

A qualitative investigation was conducted using grounded theory methods. Data collection consisted of in-depth semistructured interviews of purposively sampled participants. Eligible participants were English-speaking parents who self-identified as African American and whose children received cancer care at 3 US cancer centers. Interviews were conducted by a single trained interviewer via telephone or confidential video conference. The research team employed constant comparative analysis to analyze interview transcripts. The analytic process incorporated memoing and regular meetings to discuss the emergent theory.

RESULTS

Enrolled African American parents (n = 45) were primarily college-educated (n = 33; 73%) women (n = 37; 82%) from single-parent households (n = 23; 51%) with a household income of $50 000 or less (n = 26; 58%) from 3 cancer centers in the Eastern and Southern United States. The emergent theory of psychosocial experiences was magnified existential crisis, defined as emotional distress related to the child's illness and intensified by disconnected and discordant health care interactions and economic worries. These external threats (disconnected and discordant care, economic hardships) related to parents' membership within a marginalized population. Parents used coping resources (religiosity, spirituality, optimism, bolstering communication) to buffer the existential crisis.

CONCLUSION

This sample of African American parents of children with cancer experienced magnified existential crisis. This emergent theory may inform intervention development. Interventions that address both psychosocial and economic needs may be essential to reduce distress among African American parents of children with cancer.

"I Often Just Don't Know what to Say!": Variations in Multidisciplinary Palliative Care Clinicians' Confidence and Needs Related to Spiritual Care

BackgroundSpiritual care is a core component of high-quality palliative care, yet gaps exist in spiritual care provision. Understanding clinicians' levels of confidence around spiritual care and their perceptions of necessary knowledge/skills to enhance their ability to provide spiritual care is foundational for improving delivery of spiritual care in practice.ObjectivesTo understand confidence levels with providing spiritual care and perceived needs in relation to the provision of spiritual care among palliative clinicians (nurses, social workers, chaplains).DesignN = 260 clinicians participating in interprofessional communication and end-of-life care training programs completed a structured survey.MeasurementsClinicians responded to 42 closed-ended questions assessing their confidence in engaging in spiritual care across 6 dimensions, and one open-ended question: "What areas of knowledge or skill would best help to improve your ability to provide spiritual care across diverse populations?"ResultsFindings reveal varied levels of confidence with spiritual care across dimensions. Chaplains reported the highest levels of confidence compared with nurses and social workers. Key areas of knowledge/skills to improve spiritual care provision were: (1) Training and support for clinicians in spiritual care; (2) Strategies for providing spiritual care to patients from diverse cultural and/or religious backgrounds; (3) Better understanding of specific populations and contexts that may affect spiritual care provision; and (4) Clinicians' personal growth & practices to improve spiritual care.ConclusionsAdditional support with spiritual care provision is needed, especially among spiritual care generalists. A focus on culturally attuned care is needed, honoring unique patient contexts and centering patient and family priorities.

Evaluation of Future Nurses' Beliefs and Fears About Pain: A Descriptive and Correlational Study

BACKGROUND

How nurses manage pain and their decisions to treat it depend on their attitudes, beliefs, and misconceptions about pain. Therefore, the first step to promoting positive behaviour change in nurses is to determine their attitudes, beliefs, fears, knowledge, and behaviour towards pain management. Nurses with negative or false beliefs about pain are likely to provide inadequate pain management and care. Nursing students are the nurses of tomorrow who will play a key role in pain management and treatment. This study aimed to evaluate nursing students' beliefs and fears about pain.

METHODS

This descriptive and correlational study was carried out on 342 nursing students of a university in Türkiye. Data were collected using an individual information form, the Fear of Pain Questionnaire-III (FPQ-III), and the Pain Beliefs Questionnaire (PBQ).

RESULTS

The mean scores of the participants from FPQ-III, Severe Pain, Minor Pain, Medical Pain subscales were 83.71 ± 19.14, 32.54 ± 7.97, 24.48 ± 6.89 and 26.68 ± 7.92, respectively. The participants' mean scores on the Organic Beliefs and Psychological Beliefs subscales were 3.50 ± 0.72 and 4.60 ± 0.96, respectively. There was a positive correlation between FPQ-III and PBQ scores. The psychological belief subscale explained only 2.1% of the total change in the fear of pain score (R2 = 0.021, p < 0.05).

CONCLUSION

Participants had high 'psychological beliefs' and 'severe pain' scores. It may be recommended to use interactive education methods such as case-based teaching for students to learn effective methods of coping with pain and realise their own beliefs and attitudes. Establishing simulation laboratories where students can experience all pain-related processes is also important in gaining knowledge and skills on pain management.

Social determinants of health, diet, and symptom experiences in colorectal cancer survivors: A scoping review

PURPOSE

Colorectal cancer is the third most common cancer in the United States, and many colorectal cancer survivors often experience various symptoms significantly influenced by diet. Although it is known that social determinants of health can lead to notable inequities that affect lifestyle and quality of life, limited studies have examined the interplay of social determinants of health and diet on symptom experiences in this population. This scoping review aimed to explore relationships among social determinants of health, diet, and symptom experiences in colorectal cancer survivors.

METHODS

This study adhered to the Joanna Briggs Institute scoping review methodology, following the framework established by Arksey and O'Malley. Five databases were searched on September 22, 2023, and updated on April 2, 2024, including Medline, CINAHL, Embase, Web of Science, and APA PsycINFO. The review was performed using the PCC (Population, Concept, Context) format to examine symptom experiences in the context of social determinants of health and diet among colorectal cancer survivors.

RESULT

A total of 21 articles were included. Reported symptoms included gastrointestinal, chemotherapy-related, physical, and psychological symptoms. Social determinants of health at the individual level (age, gender, race/ethnicity, marital status, education, income) and relationship level (social support needs) were identified as influencing symptom experiences. Dietary choices and intake also impacted symptom experiences.

CONCLUSION/IMPLICATION

Significant associations exist between social determinants of health, diet, and symptom experiences in colorectal cancer survivors. Further exploration into how these factors influence symptom experiences is necessary to inform future tailored interventions to better support this population.

Pneumocystis jirovecii pneumonia in patients with lung cancer receiving immune checkpoint inhibitors: a retrospective nationwide population-based cohort study from South Korea

BACKGROUND

This study determined the incidence of Pneumocystis jirovecii pneumonia (PCP) in patients with lung cancer based on immune checkpoint inhibitor (ICI) exposure.

METHODS

National claims data were obtained from 68,174 patients with lung cancer treated with ICIs or comparator non-ICIs (cytotoxic chemotherapy, targeted therapy, or both) between August 2017 and December 2021 in South Korea. The ICI exposure group included patients who were treated with ICIs at least once during the study period. The incidence and standardized incidence ratios were computed according to sex, 10-year age, and calendar-specific cancer population, to estimate the effects of ICIs and non-ICIs on the incidence of PCP. A logistic regression analysis was performed that adjusted for sex, age, comorbidities, and concomitant immunosuppressive drugs use.

RESULTS

A total of 18,043 (26.4%) patients were in the ICI exposure group, and 50,131 (73.6%) were in the ICI non-exposure group. More than half of the patients in the ICI exposure group were men aged 60-79 years. Twenty-one PCP events occurred every 42,000.39 person-years in the ICI exposure group, and the incidence of PCP was lower than that in the ICI non-exposure group. Compared to the total cancer population, the incidence of PCP in patients with lung cancer was not significantly affected by ICI exposure, sex, or age. A 36% decreased risk of PCP with ICI exposure compared with non-exposure was estimated; however, this result was not statistically significant.

CONCLUSIONS

The incidence of PCP in patients with lung cancer treated with ICIs did not differ significantly from that in patients not treated with ICIs.

Dyadic effects of family resilience and mutuality on self-care in chronic heart failure patients and caregivers: an Actor-Partner Interdependence Mediation Model

AIMS

Self-care and caregivers' contribution to self-care are vital for chronic heart failure (CHF) patients. Family resilience and mutuality are known protective factors for self-care. However, little is known about how family resilience and mutuality contribute to self-care among heart failure patient-caregiver dyads. This study aims to examine actor and partner effects of family resilience on self-care through mutuality among CHF patients and caregiver dyads.

METHODS AND RESULTS

In the cross-sectional study, 220 CHF patient-caregiver dyads (n = 440 participants) were enrolled. Family resilience, mutuality, self-care, and self-care contribution to CHF were assessed by self-report questionnaires. The Actor-Partner Interdependence Mediation Model analysis was used to identify the direct and indirect effects of family resilience on self-care through mutuality in CHF patient-caregiver dyads. Actor effects showed that caregivers' family resilience had a direct effect on their own self-care contribution [direct actor effect, B = 0.385; 95% confidence interval (CI), 0.263-0.506]. Caregivers' mutuality (indirect actor effect, B = 0.057; 95% CI, 0.004-0.111) and CHF patients' mutuality (indirect actor effect, B = 0.04; 95% CI, 0.010-0.103) mediated caregivers' family resilience and self-care contribution. Partner effect showed that caregivers' family resilience predicted CHF patients' self-care behaviour (direct partner effect, B = -0.334; 95% CI, -0.406 to -0.251). Chronic heart failure patients' family resilience had indirect effects on caregivers' contribution to self-care via patients' mutuality (indirect partner effect, B = 0.019; 95% CI, 0.001-0.066) and caregivers' mutuality (indirect partner effect, B = 0.025, 95% CI, 0.001-0.058).

CONCLUSION

The results demonstrated a reciprocal influence on self-care between CHF patients and their caregivers. Family resilience within these dyads has impacted not only their own self-care but also those of their caregivers, with mutuality playing a mediating role. These results provided empirical support for improving the patients' self-care behaviour and caregivers' contribution at the dyadic level.

REGISTRATION

Chinese Clinical Trial Registry: ChiCTR2200064561.

Effect of PERMA-based psychological intervention and predictive care in malignant tumor patients following chemotherapy

BACKGROUND

Alleviating the toxic and adverse reactions associated with chemotherapy is crucial for improving patient outcomes. This study aimed to assess the impacts of positive emotion, engagement, relationships, meaning, and accomplishment (PERMA) model-based psychological interventions and predictive chemotherapy reaction nursing on patients with malignant tumors following chemotherapy.

RESEARCH DESIGN AND METHODS

The control group (n = 43) received conventional care, while the observation group (n = 43) received psychological intervention based on PERMA model alongside predictive nursing care. Chemotherapy-induced toxicity and side effects, fatigue levels, coping mode, psychological status, and quality of life were assessed.

RESULTS

Compared to the control group, the observation group exhibited a lower incidence of gastrointestinal adverse reactions, myelosuppression, alopecia, and oral ulcers (p < 0.05), reduced behavioral, cognitive, somatic, and emotional fatigue (p < 0.001), lower scores in avoidance and yielding coping styles (p < 0.001), higher scores in confrontation coding mode (p = 0.056), improved quality of life, and better outcomes in anxiety, depression, and overall psychological state of patients (p < 0.001).

CONCLUSION

PERMA model-based psychological interventions and predictive chemotherapy reaction nursing interventions effectively reduce the incidence of chemotherapy-induced toxicity, alleviate fatigue, enhance quality of life, and improve psychological well-being in cancer patients.

Effects of a theory driven and culturally tailored educational program on promoting cervical cancer screening in rural populations

Urban-rural disparities in the uptake rate of cervical cancer screening are significant, while one major barrier to rural populations completing the screening is a lack of knowledge. Therefore, implementing health education targeted towards rural populations is crucial. This study aimed to investigate the impact of a theory-driven, culture-tailored educational program on promoting cervical cancer screening among rural Chinese women. The study, a two-arm parallel, non-randomized controlled trial, was conducted in 10 villages. A total of 362 rural women aged 25-64 years (Mean = 45.18, SD = 9.11) were recruited and assigned to the intervention arm or the control arm, with 181 participants in each. Both groups received routine local health education on cervical cancer screening, while the intervention arm also participated in a five-session nurse-led educational program based on social cognitive theory and adapted to the rural Chinese sociocultural context. The primary outcome measured was the cervical cancer screening uptake rate, with secondary outcomes including self-efficacy and knowledge of cervical cancer screening. Data analysis was performed using Chi-square and generalized estimating equation (GEE) models. Results indicated that the intervention arm demonstrated significantly greater improvements in self-efficacy and knowledge than the control arm immediately after the intervention and at three months post-intervention (p < 0.001). At six months post-intervention, the screening uptake rate in the intervention arm was significantly higher (p < 0.001). Furthermore, 18 months post-intervention, the self-efficacy and knowledge of the intervention arm remained at relatively high levels (p < 0.001). The study findings demonstrated that the educational program had a positive impact on increasing participation in cervical cancer screening within rural communities. As a result, the theory-driven and culture-tailored educational program could be incorporated into cancer prevention promotion strategies in rural areas. However, further high-quality randomized control trials are necessary to assess and generalize this educational approach more widely.Trial registration Chinese Clinical Trial Registry, ChiCTR2200055954. Registered 29 January 2022, https://www.chictr.org.cn/showprojEN.html?proj=150955 .

Factors influencing health-related quality of life among people with uncontrolled type II diabetes mellitus in Wenzhou, China: A cross-sectional study

Background

China has a high prevalence of Type 2 Diabetes Mellitus (T2DM), and more than half of the population has uncontrolled blood sugar levels. As a result, this leads to a reduction in health-related quality of life (HRQOL). Therefore, identifying the factors that influence HRQOL in individuals with uncontrolled T2DM is a clinical priority.

Objectives

This study aimed to describe the level of HRQOL among people with uncontrolled T2DM in Wenzhou, China, and to examine the predictive factors, including social support, diabetes distress, self-efficacy, and health literacy, in relation to HRQOL among these individuals.

Methods

This predictive correlational study used a simple random sampling technique to recruit 107 adults with uncontrolled T2DM from the Endocrinology outpatient department at the First Affiliated Hospital of Wenzhou Medical University in Wenzhou, China, between August and September 2024. Data were collected through questionnaires and standardized tools to assess the correlation between HRQOL, social support, health literacy, self-efficacy, and diabetes distress. Data were analyzed using descriptive statistics and multiple regression analysis.

Results

The HRQOL in this study was moderate (Mean = 3.34, SD = 0.31). Significant factors associated with HRQOL were health literacy (r = 0.819, p <0.01), self-efficacy (r = 0.825, p <0.01), and social support (r = 0.477, p <0.01). All predictor variables in the regression model collectively explained 79.8% of the variance in HRQOL among individuals with uncontrolled T2DM. Furthermore, health literacy (β = 0.426, p <0.001), self-efficacy (β = 0.463, p <0.001), and social support (β = 0.130, p = 0.009) were significant predictors of HRQOL.

Conclusion

Enhancing health literacy, self-efficacy, and social support is crucial for improving HRQOL. Healthcare professionals and nurses should develop and implement intervention programs that help individuals and families enhance their critical thinking abilities and adopt lifestyles that support disease management and improve HRQOL.

Process evaluation of a person-centred outcome measures-based quality improvement program in a hospital-based palliative care in mainland China

PURPOSE

This study aimed to understand Chinese palliative care clinicians' experience in integrating the Palliative Care Outcome Collaboration (PCOC) model into their clinical practice and to learn lessons for sustainability.

METHODS

An explanatory mixed-methods study was conducted. Combing semi-structured in-depth interviews with palliative care clinicians guided by Normalization Process Theory (NPT) with analysis of clinical documents to examine implementation outcomes. Qualitative data were analysed using a combination of inductive and deductive content analysis, quantitative data were presented using frequencies and percentages.

RESULTS

Twelve out of 16 clinicians participated in this study. Six months post-implementation, over half reported successful integration of the model into their unit. Implementation outcomes indicated strong clinician adherence, with all inpatients assessed and 75% of clinicians participating. Eleven sub-themes were identified within the NPT constructs, explaining the mechanisms contributing to its success and failure. These included clinicians' perception of the model's value and effectiveness (Coherence), accurate assessment and effective use of results and quality reports (Collective Action), and a supportive network that fully incorporated clinicians' views (Cognitive Participation), and aligning the PCOC model with existing workflows, reducing redundant tools, and streamlining documentation (Reflexive Monitoring).

CONCLUSIONS

To effectively implement a PCOMs-based quality improvement program into routine clinical practice, a "top-down" followed by a "bottom-up" implementation approach is recommended. Effectively utilizing the program to achieve its value and fit into existing workflows without adding unnecessary workload could ensure its sustainability. Furthermore, in countries and regions where palliative care is emerging, priorities should focus on enhancing clinicians' knowledge, self-efficacy, and supporting multidisciplinary collaboration.

The Relationship Between Palliative Care Needs and Spiritual Well-being of Maintenance Hemodialysis Individuals in China: A Cross-Sectional Study

This study investigated the current status of palliative care needs among maintenance hemodialysis individuals and their correlation with spiritual well-being. In this cross-sectional study, 363 maintenance hemodialysis individuals at five hospital hemodialysis centers in Chengdu, Sichuan Province, China, were surveyed using the General Information Questionnaire, the Disease-Related Information Questionnaire, the Palliative Care Outcome Scale (POS), and the Assessment of Chronic Disease Therapeutic Function-Mental Health Scale (FACIT-Sp-12). While the FACIT-Sp-12 scale has certain limitations-particularly that its "peace" and "meaning" subscales predominantly reflect mental health rather than spiritual well-being, with only the "faith" subscale truly measuring spiritual well-being (thus requiring cautious interpretation)-it has demonstrated satisfactory reliability and validity in Chinese patients undergoing maintenance hemodialysis. Hemodialysis individuals exhibited a moderate level of palliative care needs, and these needs were negatively correlated with their spiritual well-being. The dimensions of peace and faith in the FACIT-Sp-12 were part of the predictors of palliative care needs. Clinical healthcare professionals can enhance the spiritual well-being of individuals undergoing MHD by promoting inner peace and firm faith within them, reduce the need for palliative care, improve the quality of nursing services, and ultimately improve overall quality of life.

Information Seeking Behaviors and Preferences of Cancer Survivors: A Cross-sectional Study in Shanghai, China

The information needs of cancer survivors are numerous and chronically difficult to meet, and the information sources currently available to them are far from ideal. The purpose of this study was to investigate the information-seeking behaviors and preferences of cancer survivors and explore the differences in information needs among cancer survivors of different types in Shanghai, China. A quota sampling method was used to select cancer survivors living in all districts of Shanghai as the study population. Data collection used the Unmet Information Needs Scale for Cancer Patients. ANOVA were used to assess differences in unmet need scores among subgroups. The mean age of 4195 cancer survivors was 63.2 ± 7.4 years, comprising 823 males (19.6%) and 3372 females (80.4%). Among the current sources of information, 36.2% of cancer survivors opted for consultations with tertiary-level doctors. In terms of desired sources, 43.9% preferred tertiary-level doctors. Regardless of the current or future situation, tertiary-level doctors, patient friends, and primary care doctor remain the top three preferred sources for health information. Kidney cancer, metastatic cancer, and nasopharyngeal cancer demonstrated the highest information requirement scores, scoring 39.4, 37.5, and 36.6, respectively. Cancer survivors of different cancer types showed differences in focus and information needs. Current and expected information sources for cancer survivors differ at different stages of survival. Tertiary-level doctors are the most popular providers of information. Unmet information needs for different cancer types are diverse and complex.

Knowledge, attitudes and practices relating to nutritional support and immune-related adverse events among patients undergoing immunotherapy for liver cancer: cross-sectional study

OBJECTIVES

To examine the knowledge, attitude and practice (KAP) regarding immune-related adverse events (irAEs) and nutritional support among patients with liver cancer (LC).

DESIGN

Cross-sectional study.

SETTING

Recruitment was carried out at Haikou People's Hospital, Haikou, China, from December 2022 to April 2023.

PARTICIPANTS

Patients undergoing immunotherapy for LC.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mean knowledge, attitudes, practices, and lifestyle scores were assessed using an investigator-designed questionnaire completed by patients during immunotherapy.

RESULTS

The study included 402 participants. The mean knowledge, attitudes, practices and lifestyle scores were 6.60±3.51 (/10, 66.00%), 41.26±5.06 (/50, 82.52%), 30.74±4.20 (/40, 76.85%) and 42.37±6.04 (/55, 77.04%), respectively. Attitude scores were associated with practice scores (β=0.381, p<0.001) and lifestyle (β=1.928, p<0.001). Urban residence was associated with higher attitude scores (β=1.242, p=0.013). Living with someone was associated with a higher attitude score (β=1.619, p=0.044). More than one immunotherapy line was associated with a higher lifestyle score (β=1.928, p<0.001). Finally, the female gender was associated with a lifestyle score (β=1.431, p=0.023).

CONCLUSION

Patients with LC and undergoing immunotherapy had moderate KAP towards irAEs and nutritional support. They also displayed moderate lifestyle scores. Urban residents, people not living alone, females and those having received two or more immunotherapy treatments were positively associated with attitude, while attitude was positively associated with practice and lifestyle.

Peer2Me - impact of peer support on self-efficacy in young adult cancer survivors (YA-CS): findings from a comprehensive cohort design

BACKGROUND

Numerous studies suggest that young adult cancer survivors (YA-CS) experience unmet needs regarding informational exchange about their disease and emotional support from peers. Currently, there is a lack of evaluated peer support interventions in Germany. This study aimed to evaluate the effectiveness of "Peer2Me", a three-month one-to-one peer mentoring program, designed to improve self-efficacy among YA-CS.

METHODS

This study conducted a bi-center comprehensive cohort design and enrolled YA-CS (18-39 years old) undergoing acute treatment in Leipzig and Hamburg (Germany) across all tumour entities diagnosed within the last six months. YA-CS were allocated by preference to the intervention (IG, receiving peer mentoring) and comparison group (CG, care as usual). Following mentor training, tandems were matched by diagnosis, age, and gender. YA-CS completed questionnaires at baseline (t1), post-intervention (3 months later, t2) and three months post-intervention (t3). The primary outcome was self-efficacy measured with the Generalized Self-Efficacy Scale (GSES) and the Cancer Behaviour Inventory (CBI-B). Statistical analyses included mixed-design ANOVA and ANCOVA, controlling for baseline scores.

RESULTS

Out of 274 eligible YA-CS, a total of 106 YA-CS (IG: n = 77, CG: n = 29) completed the study. Two-thirds of YA-CS (66.7%) expressed a clear preference to be allocated to the IG. Baseline differences in coping behaviors were noted, with the IG demonstrating lower scores, suggesting a higher need for support. The ANCOVA revealed no group effects for the change of mean GSES scores from t1 to t2 (p =.897) or from t1 to t3 (p =.779). Also, no significant differences in the improvement of mean CBI-B scores between groups could be found from t1 to t2 (p =.903) or from t1 to t3 (p =.995).

CONCLUSIONS

The "Peer2Me" program did not demonstrate a significant effect on improving self-efficacy among YA-CS during acute treatment. Although interest in peer mentoring was high, the intervention showed no measurable benefit in comparison with standard care. While the need for support was evident, further research is required to optimize peer interventions for this group.

TRIAL REGISTRATION

The study was retrospectively registered on February 4, 2022 at clinicaltrials.gov (NCT05336318).

Perceived stigmatization in cancer patients during the first year after diagnosis: the role of socioeconomic status

PURPOSE

Stigmatization in cancer patients leads to poorer health-related outcomes. The effect of socioeconomic status (SES) on stigmatization has not been investigated. We therefore aim to investigate, which differences in stigmatization in cancer patients regarding SES exist up to one year after diagnosis and which medical and demographic characteristics are associated with stigmatization.

METHODS

Patients with different solid cancer diagnoses were assessed within two months after diagnosis (t1) and at a 12-month follow-up (t2). Stigmatization was assessed using the Social Impact Scale (SIS), which comprises four dimensions: isolation, rejection, shame and financial insecurity. An SIS-total score can be computed. Bivariate and multiple regression analysis were performed.

RESULTS

Six hundred-eighty patients completed the assessments (mean age 60.4; 51.2% male; most prevalent cancers: prostate (21.0%), skin (17.1%), breast (16.2%)). Stigmatization at t1 was moderate in all dimensions, independent of SES. It decreased at t2, especially in patients with middle or high SES (p < 0.001). Low SES was identified as a risk factor for stigmatization at t2 (p = 0.036 - p < 0.001). Other predictors include stigmatization at t1 as well as distress, disease stage and cancer diagnosis, e.g. lung cancer. The predictors explained 27-43% of the variance in stigmatization in the four dimensions resp. in the SIS-total score.

CONCLUSION

Stigmatization after cancer diagnosis was dependent of SES. Reasons may be fewer social and economic resources, lower health literacy and insufficient consideration of the specific needs of this patient group in the healthcare system.

IMPLICATION FOR CANCER SURVIVORS

Patients with low SES should receive greater attention in the medical care system and in scientific research to identify and mitigate possible burdens and subsequent problems.

Meaning in life as a mediator between death anxiety and life satisfaction

Research based on Terror Management Theory suggests that death anxiety is a fundamental existential concern that threatens individuals' life satisfaction and that, in the process of coping with this anxiety, individuals tend to seek meaning in life. However, studies directly examining the impact of death anxiety on life satisfaction and the mediating role of meaning are lacking. This study aims to investigate the relationship between death anxiety and life satisfaction among adults and to test the mediating role of meaning in life in this relationship. 396 participants completed online scales measuring death anxiety, life satisfaction, and meaning in life. The findings revealed that death anxiety significantly predicted life satisfaction and that meaning in life partially mediated this relationship. The results suggest that meaning in life may play a buffering role in the association between death anxiety and life satisfaction.

Machine learning model for prediction of palliative care phases in patients with advanced cancer: a retrospective study

BACKGROUND

Developing an accurate predictive model for palliative care phases is crucial for improving cancer patient management, enabling healthcare providers to identify those in need of specific care plans and streamlining decision-making process for patients and caregivers. This study aims to identify symptom and functional indicators from Palliative Care Outcomes Collaboration (PCOC) data and develop a predictive model capable of accurately categorizing palliative care phases in advanced cancer patients.

METHODS

A retrospective cohort study design was adopted in this study. Data on PCOC information were collected and analyzed from patients admitted to a palliative care unit at a cancer hospital in China between April 2023 and December 2024. The Gradient Boosting Decision Tree in the machine learning algorithm to establish a palliative care phase prediction model and evaluated the prediction performance of this model.

RESULTS

A total of 9,787 assessments from 793 patients were included in the analysis of this study. Significant differences were identified among the four PCOC phases of care in terms of the symptom distress, palliative care problem severity, functional status and daily living activities. The machine learning model developed in this study achieved areas under the curve (AUCs) of 0.997, 0.996, 0.999, and 0.999 for predicting the stable, unstable, deteriorating, and terminal phases in the training group, respectively. In the testing group, the corresponding AUCs were 0.976, 0.965, 0.971, and 0.998.

CONCLUSIONS

The prediction model developed in this study based on the machine learning algorithm showed good performance, offering significant potential for facilitating timely interventions, enhancing symptom management, and optimizing palliative care resource allocation in advanced cancer patients in mainland China.

Rationale and design of an exercise intervention for patients with cancer cachexia: protocol for a one-year follow-up prospective study (2CAPA)

BACKGROUND

The prevalence of cancer with cachexia is rising sharply. More than 80% of digestive cancer patients are affected by cancer cachexia. Cachexia leads to weight loss, and reduces quality of life, cancer treatment response and survival. Exercise could counteract the deleterious effects of cachexia. The 2CAPA study aims to assess the effectiveness of a 12-week exercise program on various symptoms associated with cancer cachexia, including food intake, body composition, physical fitness, physical activity levels, Health-Related QoL (HRQoL) and fatigue. Additionally, it seeks to examine compliance with the exercise program, identify barriers to regular exercise and determine how compliance influences physical and psychological effects. Furthermore, we will determine the maintenance of physical activity levels and the effects post-program for one year follow-up on cachexia-related symptoms.

METHODS

This study will include 31 cancer patients with cachexia. Participants will receive a supervised exercise program lasting 12-weeks with two sessions per week combining endurance and resistance training. Our outcomes include food intake, anthropometric parameters, physical performances, and physical activity levels, HRQoL, and fatigue, at baseline, at the end of the 12-week exercise program, and at 3-, 6- and 12- months post-intervention. Outcomes will be compared between cancer patients with cachexia and a control group of 31 non-cachectic patients.

CONCLUSION

This study is the first prospective, monocenter, real-life investigation designed to assess the efficacy of a supervised 12-week exercise program on physical and psychological cachexia-related symptoms at the end of the program and then during a one-year follow-up. Moreover, our study will identify compliance and barriers to regular exercise for patients with cachexia. Our results will contribute to the management of cachexia-associated with cancer and provide recommendations to ensure that the program achieves the greatest possible effects and the greatest possible compliance.

ETHICS AND DISSEMINATION

This study was reviewed and approved by Ethics Committee of Rennes (N°2023-039). The findings will be disseminated to the scientific and medical community via publications in peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

NCT06323733, 21/03/2024.

Identification of the Central Symptoms of Multidimensional Frailty Among Older Adults Using the Tilburg Frailty Indicator: A Network Analysis

BACKGROUND

Symptom networks offer a new approach to explore the relationships among various symptoms and provide information for optimising precise symptom management strategies. However, no previous studies have identified the central symptoms of multidimensional frailty.

DESIGN

A cross-sectional study was conducted from December 2023 to March 2024 in China.

SETTINGS AND PARTICIPANTS

A total of 933 community-dwelling older adults (aged 60 years or older) in China were recruited via convenience sampling.

METHODS

Sociodemographic variables, clinical variables and scores on the Tilburg Frailty Indicator were assessed in all participants. The qgraph package and IsingFit package of R software were applied to construct the symptom network. Three node centrality indices (strength, betweenness and closeness) and the expected influence were calculated to identify the central symptoms of the multidimensional frailty network. All statistical analyses were performed in R.

RESULTS

A total of 933 individuals were surveyed in this study, including 472 (50.6%) females. The median age of all participants was 71.0 years. A total of 408 subjects were assessed as multidimensional frailty. The prevalence of multidimensional frailty was 43.7%. The centrality indices revealed that 'difficulty in walking', 'difficulty in maintaining balance', and 'feeling down' were the symptoms with the largest strength and expected influence values.

CONCLUSION

This study primarily utilised network analysis to construct a symptom network of multidimensional frailty among community-dwelling older adults. The findings revealed that difficulty in walking, difficulty in maintaining balance, and feeling down were the most central symptoms.

IMPLICATIONS

This study identified the central symptoms of multidimensional frailty in older adults, which may serve as primary intervention targets. Nursing staff could incorporate targeted physical and psychological interventions into person-centred care plans.

REPORTING METHODS

This study was reported in accordance with the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was involved in this study.

The Impact of the ERAS-MDT-Based Nursing Interventions on Postoperative Recovery, Nutritional Status, and Complications in Patients Undergoing Total Laryngectomy for Laryngeal Cancer

Aims/Background Throat cancer is a common malignant tumor in the head and neck region, with postoperative recovery influenced by various factors. The enhanced recovery after surgery-multidisciplinary team (ERAS-MDT) concept emphasizes the use of multidisciplinary collaboration to optimize preoperative, intraoperative, and postoperative care and treatment, aiming to accelerate patient recovery, reduce complications, and improve treatment outcomes. Therefore, this study aims to explore the impact of the ERAS-MDT-based nursing intervention in postoperative rehabilitation, nutritional status, and complication rates among patients undergoing total resection of laryngeal cancer. Methods This retrospective study recruited 85 of patients who underwent total laryngectomy for laryngeal cancer at the Second Affiliated Hospital of Jiaxing University between April 2020 and February 2024. Among them, 45 patients who received team-based nursing interventions following the ERAS-MDT concept were categorized as the ERAS-MDT group. Another 40 patients who received routine nursing interventions, were randomly included in the conventional group. The study compared nutritional indicators, Patient Health Questionnaire-9 (PHQ-9) scores, Patient-Generated Subjective Global Assessment (PG-SGA) scores, and Generalized Anxiety Disorder-7 (GAD-7) scores before and after nursing intervention. Additionally, gastrointestinal function recovery, total hospitalization costs, patient satisfaction, length of hospital stay, and complication rates were evaluated for both groups. Results There was no statistically significant difference in nutritional status between the two groups before nursing (p > 0.05). The post-nursing hemoglobin, albumin, prealbumin, and total protein levels in the ERAS-MDT group were 125.63 ± 10.77 g/L, 44.14 ± 4.93 g/L, 261.74 ± 28.82 mg/L, and 64.83 ± 5.36 g/L, respectively. In contrast, the post-nursing hemoglobin, albumin, prealbumin, and total protein levels in the conventional group were 114.56 ± 8.96 g/L, 39.01 ± 4.81 g/L, 222.84 ± 26.98 mg/L, and 57.85 ± 5.11 g/L, respectively. All indicators in both groups were higher than before nursing levels, with the ERAS-MDT group exhibiting significantly higher levels than the conventional group (p < 0.05). The time to first mobilization (10.52 ± 2.17 hours), first bowel movement (21.41 ± 4.50 hours), and hospitalization time (11.57 ± 1.91 days) were significantly shorter in the ERAS-MDT group than those in the conventional group (p < 0.05). However, there was no statistically significant difference in total hospitalization costs (p > 0.05). Furthermore, the differences in the PHQ-9, GAD-7, and PG-SGA scores were statistically insignificant between the two groups before nursing (p > 0.05). After nursing, the PHQ-9 score (2.81 ± 0.78), GAD-7 score (6.68 ± 1.05), and PG-SGA score (4.69 ± 1.24) were significantly reduced in the ERAS-MDT group than pre-nursing levels, with the ERAS-MDT group demonstrating substantial decrease than the conventional group (p < 0.05). Moreover, the satisfaction rate was 95.56% (43 cases/45 cases) in the ERAS-MDT group and 80.00% (32 cases/40 cases) in the conventional group. However, the difference was statistically insignificant (p > 0.05). Additionally, the incidence of complications was 8.89% (4 cases/45 cases) in the ERAS-MDT group compared to 17.50% (7 cases/40 cases) in the conventional group, indicating statistically insignificant difference (p > 0.05). Conclusion The ERAS-MDT concept team-based nursing intervention can improve hemoglobin, albumin, prealbumin, and total protein, promote postoperative recovery, and enhance patient satisfaction in those undergoing total laryngectomy for laryngeal cancer.

The Effects of Acupressure Applied After Bariatric Surgery on Gastrointestinal Functions, Pain, and Anxiety

BACKGROUND

This study was conducted to determine the effects of acupressure applied to patients after bariatric surgery on gastrointestinal functions, pain, and anxiety.

METHODS

The study was conducted as a randomized controlled experimental trial with a placebo group. The research data were collected at the General Surgery Clinic of Private Aktif Kocaeli Hospital between January 2023 and March 2024 from 90 patients (30 in the control group, 30 in the intervention group, and 30 in the placebo group) who underwent bariatric surgery. The "Patient Descriptive Form," "Postoperative Gastrointestinal Functions Assessment Form," "Visual Analog Scale," "Verbal Pain Scale,'' and "State-Trait Anxiety Inventory" were used in data collection. The data were analyzed using the SPSS 22 package program, and the results were interpreted at a p < 0.05 significance level.

RESULTS

Of the patients in the intervention group, 63.3% flatulated at the 12th postoperative hour, 43.3% passed stool, and there was a significant difference between the groups (p < 0.05); they consumed more food daily (p < 0.05), their pain (3.43 ± 0.97) and distension (3.20 ± 1.06) scores were lower, and more patients (46.7%) experienced mild pain (p < 0.05). Although there was no statistically significant difference between the mean nausea scores of the groups at the 6th, 12th, 24th, and 48th postoperative hours, the mean nausea scores of the patients in the intervention group at the 12th postoperative hour (0.33 ± 5.07) were lower than those of the control (1.33 ± 1.83) and placebo groups (1.33 ± 4.34) (p > 0.05). All three groups had similar mean state-trait anxiety scores (p > 0.05).

CONCLUSION

The study found that acupressure applied after bariatric surgery ensured that patients flatulated and passed stool in the early period, increased food consumption, and reduced abdominal distension and pain. In line with these results, it can be recommended that acupressure be applied in clinics after surgery.

Humanistic nursing combined with Neuman's nursing in the application for oncology patients

OBJECTIVE

We aimed to explore the application effects of humanistic nursing combined with Neuman's nursing in oncology patients.

METHODS

One hundred oncology patients were randomly divided into the observation and control groups, with 50 patients in each. Comparisons were made between both groups in terms of SF-36 scores, treatment compliance, nursing quality scores, Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores, and Pittsburgh Sleep Quality Index (PSQI) scores.

RESULTS

The observation group showed higher scores in the physical domain, physiological function, material life, and overall health of the SF-36 scale (P < 0.05). The observation group also exhibited higher treatment compliance rate (X² = 9.470), and higher scores in nurse-patient communication, nursing system, nursing service, and nursing environment of the nursing quality assessment (P < 0.05). After nursing, the observation group performed lower SAS and SDS scores (t = 17.556, 10.004), and higher scores in sleep quality, sleep duration, sleep disturbance, sleep onset latency, sleep efficiency, hypnotic medication use, and daytime dysfunction based on the PSQI (P < 0.05).

CONCLUSION

The combination of humanistic nursing and Neuman's nursing improves the quality of life and treatment compliance in oncology patients, with improvements in negative emotions and sleep quality. However, this study's small sample of 100 cancer patients may not fully represent the diverse characteristics of various cancer types and stages, limiting conclusion generalizability. Furthermore, the short duration may have missed later-stage nursing intervention impacts. Thus, large-scale, long-term research is needed to provide reliable clinical evidence.

Exploring barriers to resilience among preoperative non-small cell lung cancer patients: a qualitative study in China

BACKGROUND

Resilience is crucial for lung cancer patients to navigate the challenges they face. However, current research on the barriers to resilience, particularly in relation to various levels of stressors, is limited. This study seeks to explore and analyze the barriers at various levels affecting resilience among preoperative lung cancer patients.

METHODS

A descriptive phenomenological qualitative research method was employed, conducting semi-structured interviews with 23 patients who had received a preliminary diagnosis of lung cancer and were preparing for surgical treatment. Data were analyzed using Colaizzi's seven-step method within the social-ecological framework.

RESULTS

Three categories and 11 themes were identified among lung cancer patients: (i) Micro-level system: Individual vulnerability (Fear of the unknown, Empathy for pain, Self-blame, Physical function decline, Waning interest). (ii) Meso-level system: Unstable family structure (Family enmeshment, Role conflicts, Communication barriers between couples). (iii) Macro-level system: Weak support systems (Lung cancer demonization, Workplace discrimination, Insufficient information support).

CONCLUSION

This study sheds light on barriers to resilience at the individual, family, and societal levels among preoperative lung cancer patients. Given the variability in patient experiences, there is a critical need for patient-centered psychological, informational, and self-management support. Particularly in China, enhancing public awareness of lung cancer stands as a vital measure. Exploring the intricate dynamics of the empathy for pain, familial enmeshment, and the demonization of lung cancer emerges as pivotal areas for future inquiry. These knowledge can inform enhanced pain management strategies, improved family support systems, and a more accurate and less stigmatizing perception of lung cancer.

TRIAL REGISTRATION

The registered No. from Chinese Clinical Trial Registry (CHICTR) was ChiCTR2300074853 and the registration date is August 17, 2023 (Archived by Webcite at https://www.chictr.org.cn/showproj.html?proj=205091 ).

Strategies to assess and promote the socio-emotional competencies of university students in the socio-educational and healthcare fields: A scoping review

This scoping review systematically analyses and synthesises empirical evidence on measures and intervention programmes aimed at promoting socio-emotional competencies (SECs) in university students in socio-educational and healthcare fields. A comprehensive literature search was conducted of the Scopus, PubMed, ERIC and PsycINFO databases, and a narrative synthesis approach was employed to analyse the findings from a total of 288 studies. The results highlight a general consensus on the importance of fostering SECs in university students in both fields, while revealing a significant lack of research in the socio-educational sector. Regarding both populations, a notable heterogeneity was found in the measurement of SECs and in the wide variety of tools used, which were based on different theoretical approaches, and were often not standardised or not exclusively designed to measure this type of competencies. In the intervention programmes reviewed, the SECs most frequently promoted were empathy and interpersonal emotional perception, communication, and identification, understanding, and regulation of one's own emotions. Nonetheless, many studies lacked detailed reporting on the theoretical frameworks and intervention procedures applied, therefore limiting their replicability. Future intervention programmes should align targeted competencies with students' profiles, future roles and professional needs, using standardised, profile-adapted measures to better evaluate their effectiveness.

Evaluation of the implementation of a multi-component advance care planning programme in nursing homes

Advance care planning (ACP) increases the likelihood that nursing home (NH) residents will receive end-of-life care that is consistent with their preferences. However, their preferences are often unknown. This paper aims to identify the key enablers and constraints that influenced the implementation of a new multicomponent ACP programme. A qualitative study guided by the Normalisation Process Theory was conducted. Six ACP leaders and eighteen implementers participated in interviews and focus group discussions respectively. Data were analysed using reflexive thematic analysis and revealed five themes: (1) making sense of ACP in a NH context, (2) upskilling with new processes, (3) lack of collective action to adapt and integrate ACP, (4) appraisal of structural and process challenges, and (5) experience of cognitive dissonance. While the programme supported the building of individual and collective competency for ACP facilitation, prevailing sectoral and organisational context challenged NHs' ability to integrate ACP and to reap its expected benefits.

Neuromodulation through brain stimulation-assisted cognitive training in patients with post-chemotherapy subjective cognitive impairment (Neuromod-PCSCI) after breast cancer: study protocol for a double-blinded randomised controlled trial

INTRODUCTION

Breast cancer is the most common form of cancer in women. A considerable number of women with breast cancer who have been treated with chemotherapy subsequently develop neurological symptoms such as concentration and memory difficulties (also known as 'chemobrain'). Currently, there are no validated therapeutic approaches available to treat these symptoms. Cognitive training holds the potential to counteract cognitive impairment. Combining cognitive training with concurrent transcranial direct current stimulation (tDCS) could enhance and maintain the effects of this training, potentially providing a new approach to treat post-chemotherapy subjective cognitive impairment (PCSCI). With this study, we aim to investigate the effects of multi-session tDCS over the left dorsolateral prefrontal cortex in combination with cognitive training on cognition and quality of life in women with PCSCI.

METHODS AND ANALYSIS

The Neuromod-PCSCI trial is a monocentric, randomised, double-blind, placebo-controlled study. Fifty-two women with PCSCI after breast cancer therapy will receive a 3-week tDCS-assisted cognitive training with anodal tDCS over the left dorsolateral prefrontal cortex (target intervention), compared with cognitive training plus sham tDCS (control intervention). Cognitive training will consist of a letter updating task. Primary outcome will be the performance in an untrained task (n-back task) after training. In addition, feasibility, safety and tolerability, as well as quality of life and performance in additional untrained tasks will be investigated. A follow-up visit will be performed 1 month after intervention to assess possible long-term effects. In an exploratory approach, structural and functional MRI will be acquired before the intervention and at post-intervention to identify possible neural predictors for successful intervention.

ETHICS AND DISSEMINATION

Ethical approval was granted by the ethics committee of the University Medicine Greifswald (BB236/20). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov; NCT04817566, registered on 26 March 2021.

Postoperative symptom network analysis in non-small cell lung cancer patients: a cross-sectional study

OBJECTIVE

To investigate the incidence and severity of symptoms in postoperative non-small-cell lung cancer patients undergoing thoracoscopic surgery, construct a symptom network, and analyze centrality indicators of the network to identify core symptoms and provide a basis for precise symptom management.

METHODS

A convenience sampling method was used to select postoperative NSCLC patients from the Department of Thoracic Surgery at the First Affiliated Hospital of Army Medical University between September 2024 and December 2024. The Chinese version of the Anderson Symptom Inventory Core Symptom Module and the revised Lung Cancer-Specific Symptom Module were used to survey the incidence and severity of symptoms. A symptom network was constructed with R software with the EBICgloss function and Spearman correlation analysis, and the centrality indicators were then calculated.

RESULTS

In total, 404 questionnaires were distributed, and 367 valid questionnaires were returned (effective response rate, 90.8%). The top three symptoms in terms of incidence and severity during the postoperative hospitalization of NSCLC patients were pain (100%), fatigue (99%), and shortness of breath (98%). The results of the centrality indicators of the symptom network revealed that the top three symptoms in terms of strength centrality were shortness of breath (rs = 5.44), fatigue (rs = 5.43), and pain (rs = 5.34).

CONCLUSION

Postoperative NSCLC patients experience various symptoms, with shortness of breath being the core symptom. Targeted intervention strategies are needed to improve the efficiency and accuracy of symptom management, reduce the symptom burden on patients, and increase their quality of life.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry (NO. ChiCTR2500096720), registered on 5 February 2025, retrospectively registered.