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.

Skin Microbiome and Radiation-Induced Skin Injury: Unraveling the Relationship, Mechanisms, and Therapeutic Implications

Radiotherapy (RT) is a treatment method commonly used in oncology. A vast majority of patients undergoing RT suffer from radiation-induced skin injury (RISI), which results from complex biochemical reactions in the irradiated skin. Current strategies for preventing and managing RISI are insufficient for achieving full skin regeneration. Multiple studies have shown that alterations in the skin microbiome correlate with the development and severity of RISI. These studies suggest that dysbiosis is a crucial factor in promoting radiation-associated dermatitis. Targeting the skin microbiota presents a potential therapeutic approach that could significantly improve the quality of life for patients undergoing RT. This review aims to present current findings on the interplay between the skin microbiome and radiation-induced skin damage as well as to discuss potential therapeutic strategies for preventing and mitigating this condition.

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.

Neurotoxicity associated with cancer chemotherapy: the first study in the Palestinian healthcare system

BACKGROUND

Chemotherapy-induced neurotoxicity is a significant concern in cancer treatment as it adversely affects treatment outcomes. However, research on this subject within the Palestinian healthcare system is limited. This study aimed to evaluate the prevalence, clinical manifestations, and associated factors of neurotoxicity in cancer patients receiving chemotherapy in Palestine.

METHODS

This retrospective cohort study included 196 cancer patients who underwent chemotherapy at multiple hospitals across Palestine. Data on patient demographics, cancer characteristics, chemotherapy regimens, and neurotoxicity symptoms were extracted from electronic medical records. Neurotoxicity was evaluated using a comprehensive 65-item functional neurotoxicity scale.

RESULTS

A total of 196 cancer patients were included in the study. The median age was 56.9 years, with the majority being female (113 out of 196; 57.7%) and diagnosed with solid cancers (140 out of 196; 71.4%). The most common agents utilized were fluorouracil/5-FU (108 patients; 55.1%) and oxaliplatin (96 patients; 49.0%). Neurotoxicity symptoms were highly prevalent, with 119 patients (60.7%) experiencing moderate neurotoxicity and 47 patients (24.0%) experiencing severe neurotoxicity. The severity of neurotoxicity was significantly associated with female sex (p-value = 0.032) and a diagnosis of solid cancer (p-value = 0.015), while patients exhibiting neurotoxicity were also significantly older (p-value = 0.045) and received a larger number of chemotherapy cycles (p-value = 0.037).

CONCLUSION

This study highlights the significant prevalence of chemotherapy-induced neurotoxicity among cancer patients in Palestine and underscores the need for personalized treatment approaches and proactive symptom management strategies. Multidisciplinary collaboration among healthcare providers, researchers, and policymakers is essential to develop comprehensive guidelines and interventions aimed at optimizing patient outcomes. Furthermore, additional research is warranted to explore the long-term impact of neurotoxicity and to evaluate the effectiveness of supportive care interventions in this population.

Effects of different types of Advance Care Planning workshops: A scoping review protocol

INTRODUCTION

Advance Care Planning(ACP) plays a crucial role in ensuring that patients' wishes are respected and fulfilled, helping to improve the quality of care and the efficient use of resources. Achieving effective ACP promotion depends on appropriate education and training. Evidence exists that ACP workshops are feasible and effective in enhancing the understanding, competence, confidence, and engagement in ACP among trainees. Systematic summary and analysis of existing ACP workshop-related research will help identify knowledge gaps and research trends in the current field and provide a standardized framework and empirical support for future training design.

OBJECTIVES

The overall aim of this scoping review was to systematically map existing literature about ACP workshops, provide an overview of the contents and effects of various ACP workshops, and identify limitations and gaps in knowledge.

METHODS

This scoping review will adhere to the JBI methodology and the results will reported according to the PRISMA-ScR guidelines. Relevant articles will be systematically searched in six electronic databases (Pubmed, PsycINFO, CINAHL, Scopus, Web of Science, and Google Scholar). The research on ACP workshops conducted in any population will be included. Two reviewers individually selected the studies: first by screening titles and abstracts and second by screening full-text articles. A third reviewer will arbitrate discrepancies during the screening process. Extract data in a standardized manner using forms that have undergone team review, and data will then be synthesized and interpreted.

DISCUSSION

This scoping review will identify effective training methods, topics, and research gaps by comparing the content and effectiveness of different workshops, which will help to form best practices and enhance the effectiveness of ACP training. REGISTRATION DETAILS: Open Science Framework under https://doi.org/10.17605/OSF.IO/2ZUP6.

Assessing artificial intelligence ability in predicting hospitalization duration for pleural empyema patients managed with uniportal video-assisted thoracoscopic surgery: a retrospective observational study

BACKGROUND

This retrospective observational research evaluates the potential applicability of artificial intelligence models to predict the length of hospital stay for patients with pleural empyema who underwent uniportal video-assisted thoracoscopic surgery.

METHODS

Data from 56 patients were analyzed using two artificial intelligence models. A Random Forest Regressor, the initial model, was trained using clinical data unique to each patient. Weighted factors from evidence-based research were incorporated into the second model, which was created using a prediction approach informed by the literature.

RESULTS

The two models tested showed poor prediction accuracy. The first one had a mean absolute error of 4.56 days and a negative R2 value. The literature-informed model performed similarly, with a mean absolute error of 4.53 days and an R2 below zero.

CONCLUSIONS

While artificial intelligence holds promise in supporting clinical decision-making, this study demonstrates the challenges of predicting length of stay in pleural empyema patients due to significant clinical variability and the current limitations of AI-based models. Future research should focus on integrating larger, multi-center datasets and more advanced machine learning approaches to enhance predictive accuracy.

Global Trends in Childhood Acute Lymphoblastic Leukemia Burden and Quality of Care Inequalities Across Regions, 1990 to 2021: A Systematic Analysis Using Global Burden of Disease Study 2021 Data

OBJECTIVE

To reveal the global trends in the burden and quality of care for childhood ALL from 1990 to 2021, along with inequalities in quality of care across regions, thus identifying regions requiring targeted interventions for optimizing health care resource allocation.

METHODS

Utilizing Global Burden of Disease Study 2021 data, this research analyzed the temporal trends in the global burden of childhood ALL from 1990 to 2021. The quality of care index (QCI) was used to quantify care quality, and the gender disparity ratio (GDR) was used to assess gender disparities. Trend analyses were conducted using the estimated annual percentage change (EAPC), and the associations between QCI, GDR, and the sociodemographic index (SDI) were explored. Inequalities in QCI and GDR across regions were evaluated using the slope index of inequality (SII) and health inequality concentration index.

RESULTS

From 1990 to 2021, the incidence and death rates, as well as disability-adjusted life years (DALYs) and years of life lost (YLLs) due to childhood ALL, significantly decreased. However, the number of prevalence and prevalence crude rate increased by 66.818% and 37.923%, respectively. Global care quality continued to improve, with an EAPC of 2.566 (95% CI: 2.488-2.645). In 2021, regions with high QCI were concentrated in high-income areas like Western Europe, while low QCI regions were primarily in low-income areas like sub-Saharan Africa and Oceania. Although the health inequality concentration index of global quality of care decreased from 0.550 in 1990 to 0.395 in 2021, the SII increased from 35.396 to 87.141. Care quality was consistently higher in females than in males, particularly in low and low-middle SDI regions, while the disparities in high and middle SDI regions were gradually narrowing.

CONCLUSION

Despite the gradual decrease in the burden of childhood ALL globally and the steady improvement in quality of care, absolute inequalities remain a significant challenge. Future efforts should focus on increasing health care resource allocation in low SDI regions, enhancing international cooperation, improving the quality and accessibility of care in priority regions, and promoting global health equity.

Spatial and temporal distribution and evolutionary trend of thyroid cancer incidence in Guangzhou, 2010-2020

PURPOSE

The spatial and temporal distribution of thyroid cancer in Guangzhou was studied using spatial information system technology, offering a scientific foundation for successful thyroid cancer prevention and treatment.

METHODS

The Joinpoint model was used to assess the incidence rate of thyroid cancer over time in various regions. Hierarchical maps were created with the ArcGIS software to investigate the spatial distribution features of the incidence rate. Spatial autocorrelation and spatiotemporal scanning analysis methods were used to assess geographical clustering. Standard deviation ellipse analysis was used to analyze the spatial and temporal trends of incidence.

RESULTS

The age-standardized incidence rate (ASIR) increased from 6.46/105 in 2010 to 33.15/105 in 2020, showing a nearly five-fold increase. The ASIR of urban regions was highest, but the growth rates of suburban regions and rural regions were faster than that of urban regions, and the regional disparity was gradually narrowing. The spatial distribution of thyroid cancer incidence has significant spatial heterogeneity and clustering. The hotspots clustered in the urban regions, Panyu and Nansha districts in the south, Huadu district in the north, and Zengcheng district in the east. The spatiotemporal evolution trends showed that since 2010, the incidence rate first migrated to the south-west, and then migrated to the north-east from 2015.

CONCLUSIONS

Significant heterogeneity and clustering were seen in the spatial distribution of the thyroid cancer incidence rate in Guangzhou, and the regional disparity decreased. The direction of evolution consistent with Guangzhou's "Southern Expansion, Northern Enhancement, Eastern Advancement, Western Integration and Central Revitalization" spatial development policy.

"I was doubtful of being the true father of the preterm baby": factors affecting fathers' involvement in the care of preterm babies admitted in the neonatal unit at Kawempe National Referral Hospital, Uganda. a qualitative study

BACKGROUND

Fathers' involvement in the care of preterm babies has been associated with good health outcomes for the mother and the baby. However, fathers' involvement in the Neonatal Unit (NU) in Uganda remains sub-optimal and factors influencing this are not well understood. Therefore, this study aimed at exploring the factors affecting fathers' involvement in the care of preterm babies admitted in neonatal unit at Kawempe National Referral Hospital (KNRH).

METHODS

This was a qualitative exploratory study conducted in the NU at Kawempe National Referral Hospital between April and July 2023. It included fathers whose preterm babies were admitted in the NU and were stable at the time of study. Data was collected using an in-depth interview guide with 24 fathers of preterm babies and key informant interview guide with the nine health workers who were working in the NU. Data was analyzed using manual thematic analysis.

RESULTS

The fathers in this study had a mean age of 33 years, most of them were married and were employed in the informal sector. The perceived and actual roles of fathers of admitted preterm babies reported in this study mostly included providing financial support, direct childcare activities, providing emotional and physical support to the mother. The key facilitators to fathers' involvement in the care of the preterm babies were; at individual level; improvement in health condition of the preterm baby, desire to fulfil responsibility, at interpersonal level, support from friends and relatives; at health facility level, the good quality of service delivery; and at community level, the positive cultural and religious beliefs. Barriers included the fear of preterm babies, financial constraints, busy work schedules of fathers, discouragements from peers, poor relationship between couples; poor attitude of hospital staff, long hospital stay and inhibiting interaction between the father of preterm and mother-in-law.

CONCLUSION

Most perceived roles were actually played by fathers whose preterm babies were admitted in the NU and various facilitators encouraged them to get involved in the care. However, fathers faced multiple barriers which needed to be resolved to increase their involvement.

Addressing Domestic Abuse Among Couples Experiencing Breast or Gynecologic Cancer in Africa

This article discusses the intersection of domestic abuse and cancer, particularly in couples experiencing breast and gynecologic cancers, and its impact on patients in Africa. It aims to uncover the challenges faced in this.

Nutrition Education to Build Oncology Nurse Confidence and Affect Patient Care

BACKGROUND

Nutrition is an essential part of care for patients with cancer, but healthcare providers lack confidence in discussing nutrition-related topics with their patients. Nurses provided with education can increase their confidence in teaching patients about nutrition; however, data are limited on the effects of this education on patient care.

OBJECTIVES

The purpose of this project was to provide education for outpatient oncology nurses about nutrition and assess its impact on nurses' confidence, use of nutrition resources, and patient care.

METHODS

This quality improvement project used a pre- and postsurvey to evaluate the implementation of evidence-based, nutrition-focused nurse education. Data were collected on nurse confidence, patient nutrition needs, patient experiences with nutrition education, and use of nutrition resources.

FINDINGS

The education was completed by 16 infusion nurses. Implementation of nutrition-focused education for outpatient oncology nurses increased nurse confidence and the use of nutrition resources. The most frequent nutrition complaint among patients was related to weight loss, with nearly half of nutrition consultations placed for that reason.

Manual therapy considerations for adhesive capsulitis in the breast cancer population: a clinical perspective

Adhesive capsulitis (AC) is common in women aged 40-60, overlapping with the population at higher risk for breast cancer. Many breast cancer survivors develop shoulder dysfunction, including AC, due to cancer treatments such as surgery, chemotherapy, and radiation, leading to pain, limited mobility, altered biomechanics, and soft tissue contracture. Despite the prevalence of AC in this population, clinical guidelines for its management remain underexplored. Manual therapy can play a key role in improving quality of life for these individuals.Understanding the pain mechanisms - nociceptive, neuropathic, and nociplastic - can inform appropriate treatment strategies for breast cancer survivors with AC. This clinical perspective integrates manual therapy principles into the evaluation and management of AC in this population. As breast cancer cases continue to rise, clinicians must recognize the impact of cancer treatment sequelae on orthopedic conditions to optimize patient care.

How Does Family Function Affect the Activation Of patients With Cancer Anorexia Undergoing Chemotherapy? A Mixed Methods Study

OBJECTIVE

To understand the current status of patient activation among chemotherapy patients with Cancer-related Anorexia (CA) and explore the relationship between family function, negative emotions, and patient activation. Additionally, to clarify patients' experiences in self-management and examine how family function influences their activation in disease management.

METHODS

A total of 302 chemotherapy patients with CA participated in the questionnaire survey. The investigation utilized a general information questionnaire, the Patient Activation Measure, the Hospital Anxiety and Depression Scale, and the Family Care Index Questionnaire. Based on the quantitative research, qualitative research was conducted, involving semi-structured interviews with 16 chemotherapy patients with CA.

RESULTS

The patient activation score for chemotherapy patients with CA was 66.08 ± 13.70, indicating a moderate level. Structural equation modeling analysis revealed that anxiety and depression acting as partial mediators between family function and patient activation. Interview results identified 3 main barriers to patient activation among chemotherapy patients with CA: (1) lack of self-management knowledge, (2) inadequate self-management behaviors, and (3) intrusion of negative emotions. Additionally, family function was found to promote patient activation through 2 key themes: (1) positive family adjustment and (2) a closer overall family atmosphere.

CONCLUSIONS

By integrating quantitative and qualitative evidence, this study uncovers the multifaceted processes shaping patient activation among individuals undergoing chemotherapy with CA. Family function emerges as a critical factor in both emotional regulation and the enhancement of patient activation.

IMPLICATIONS FOR NURSING PRACTICE

The findings can guide healthcare professionals in helping chemotherapy patients with CA to identify the strengths and resources within family support, fully harnessing the role of family function to enhance patient activation.

Molecular mechanisms and clinical value of the correlation between depression and cancer

According to the World Health Organization, cancer remains the primary cause of death of millions of individuals annually and the foremost cause of mortality worldwide. Cancer imposes substantial economic and mental challenges on patients and their families and strains healthcare systems. Depression, one of the most prevalent mental health conditions, affects approximately 3.8% of the global population and is a significant global health challenge. Research indicates increasing incidence rates of depression among patients with cancer. Depression also appears to influence cancer development and progression, worsening patient prognosis and quality of life, thereby creating additional challenges for clinical treatment. Correlation of depression and cancer is a complicated yet promising field with fast-paced progression and vital clinical values. Therefore, we discussed in this review the associations between depression and cancer and their potential mechanisms by analyzing the specific role of depression in the development and progression of tumors from the perspective of suppressing tumor immunity, inhibiting tumor cell apoptosis, inducing DNA damage, promoting tumor cell mesenchymal transition, enhancing tumor cell stemness, and promoting tumor angiogenesis. This review also discusses how tumors influence the development of depression via inflammatory factors and the significance of identifying and treating depression to enhance the quality of life and prognosis of patients with cancer. Promising biomarkers and effective treatments are also highlighted. Despite available data, limited research exists on how treating depression affects cancer prognosis, and whether timely treatment can reduce cancer risk remains unclear, which necessitates further investigation. This review summarizes the molecular mechanisms involved in the relationship between cancer and depression to help identify new biomarkers and provide precise medical care for patients with depression. We hope this review will lay the foundation for future research, advancing new biomarkers and therapies for early diagnosis of cancer and depression comorbidity.

The role of professional identity, psychological resilience, and coping styles in mitigating compassion fatigue among geriatric services and management interns

OBJECTIVE

To examine the impact of professional identity, psychological resilience, and coping styles on compassion fatigue among Geriatric Services and Management interns. It further elucidates how these factors interact within the framework of Kumpfer's resilience model and Lazarus and Folkman's psychological stress and coping theory in managing compassion fatigue.

METHODS

A multicenter cross-sectional survey of 654 Geriatric Services and Management interns was designed.

RESULTS

Among the 636 valid questionnaires, the average score on the Compassion Fatigue Short Scale was 54.84. Psychological resilience and coping styles had direct effects on compassion fatigue. Professional identity influenced compassion fatigue through two mediating pathways: (a) psychological resilience (β = -0.036, P < 0.001); and (b) psychological resilience combined with coping styles (negative coping styles [β = -0.012, P < 0.001], and positive coping styles [β = -0.010, P < 0.001]).

CONCLUSION

Geriatric Services and Management interns generally exhibit moderate levels of compassion fatigue. Psychological resilience and coping styles fully mediated the relationship between professional identity and compassion fatigue. Training programs focusing on psychological resilience and coping strategies are recommended to maximize the protective effect of professional identity against compassion fatigue.

Prediction of bacterial and fungal bloodstream infections using machine learning in patients undergoing chemotherapy

PURPOSE

This study aimed to develop a machine learning (ML) model to predict bloodstream infection (BSI) in chemotherapy patients.

PATIENTS AND METHODS

We included all cancer patients undergoing chemotherapy at a tertiary cancer hospital from 2017 to 2022. Data were collected per chemotherapy cycle, including chemotherapy drugs, indications, cycle number, cancer type, body mass index, age, gender, complete blood count, creatinine levels, and microbial cultures. BSI was assessed within 21 days after chemotherapy. The ML algorithms tested included logistic regression, ridge regression, k-nearest neighbors, Naive Bayes, Perceptron, neural networks, decision trees, boosting methods, Random Forests, and Support Vector Machines. The SHapley Additive exPlanations (SHAP) method was used to measure feature importance.

RESULTS

Among 107,757 cycles from 19,225 patients, 91.7 % had solid tumors, primarily breast (36.8 %) and gastrointestinal (19.4 %) cancers. The first cycle accounted for 23.7 % of cycles, and palliative chemotherapy made up 52.9 %. Alkylating agent was the most common drug class used (55.5 %). BSI occurred in 1.33 % of cycles, with 34 % of these cases occurring in neutropenic patients. Of the bacteremia cases, 11.8 % were polymicrobial, and 69.3 % involved gram-negative bacteria. The best model was a neural network with one hidden layer (5 neurons), achieving 70.7 % sensitivity, 93.49 % specificity, 93.19 % accuracy, and an area under a receiver operating characteristic curve of 91.93 %. Key predictors included the first cycle, antimetabolite use, palliative chemotherapy, monocytopenia, and hematological malignancies.

CONCLUSION

ML effectively predicts bacteremia in chemotherapy patients, including non-neutropenic cases, and could be used in clinical practice to guide treatment and infection workup.

Considerations to forgo systemic treatment in patients with advanced esophageal or gastric cancer: A real-world evidence study

The majority of patients with advanced esophageal or gastric cancer do not start palliative systemic treatment. To gain insight into the considerations underlying the decision not to start systemic treatment, we analyzed characteristics of patients starting and not starting systemic treatment, reasons for not starting systemic treatment, and receipt of local palliative treatments on a nationwide scale. Patients diagnosed with advanced esophageal or gastric cancer between 2015 and 2021 were included (n = 10,948). Survival was compared using propensity score matching on patient and disease characteristics. Most patients did not start systemic treatment (esophageal cancer 59%; gastric cancer 64%). These patients were generally older, more often female, had more comorbidities and a worse performance status. The main reason for not starting systemic treatment was patient or family preference (35%). Among patients who did not start systemic treatment, 47% (esophageal) and 19% (gastric), received local palliative treatment, most commonly radiotherapy. Patients who did not start systemic treatment had worse median overall survival compared to patients who did start (esophageal cancer 2.9 months vs. 8.9 months; gastric cancer 2.2 vs. 8.2 months). These findings indicate that patient condition and disease burden are important aspects in systemic treatment decisions. However, patient or family preference was the main reason for not starting systemic treatment, highlighting that their priorities also strongly influence the decision. Systemic treatment did show to be associated with improved overall survival in matched patients, and therefore adequately weighing treatment risks and benefits based on real world data against patient preferences is of utmost importance.

Assessment of the financial toxicity in patients with differentiated thyroid cancer: a cross-sectional study in western China

Objective

Using the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity (FT) among differentiated thyroid cancer (DTC) patients in China and investigate the association between FT and psychological distress.

Methods

We carried out a cross-sectional investigation of individuals who had survived DTC in two tertiary medical facilities. The assessment of FT was performed using the Chinese version of the COST tool. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) was used to measure psychological distress. A multivariate logistic regression model was constructed to identify factors related to FT, and the Pearson correlation was used to evaluate the association between COST and DT scores.

Results

Out of the 207 patients who participated in this study, the average COST score was 16.3. Notably, the prevalence of financial toxicity was 47.8% (95% CI: 41% ~ 54.7%) of the patients. Of these, 22.7% (47/207) were mild FT, 23.7% (49/207) were moderate FT, and 1.4% (3/207) were severe FT. Four variables were found to be associated with increased FT in the logistic regression model, younger age (odd ratio [OR], 4.52; p = 0.003), lower educational level [OR], 1.13; p = 0.040, uninsured (odd ratio [OR], 6.53; p = 0.028), had lower household income (odd ratio [OR], 6.34; p = 0.037), and advanced cancer (odd ratio [OR], 2.99; p = 0.034). Furthermore, the Pearson correlation revealed a mild correlation between financial toxicity and psychological distress (r = -0.53, p < 0.001).

Conclusion

In this study, the prevalence of FT in DTC patients was 47.8%. FT was associated with younger age, lower educational level, uninsured, had lower household income, and advanced cancer. Clinicians should identify patients by predictors early and conduct psychological interventions.

Malnutrition risk in older adults with cancer: A prospective cross-sectional study in one setting

BACKGROUND

This descriptive and cross-sectional study evaluated the nutrition status of geriatric patients with cancer undergoing chemotherapy.

METHODS

Data were collected by researchers in the Medical Oncology Unit of a university hospital between January and September 2024 to assess the nutrition status of 100 geriatric patients with cancer undergoing chemotherapy. Malnutrition risk was evaluated using the Mini Nutritional Assessment (MNA).

RESULTS

The mean ± SD age of the study participants was 72.03 ± 5.40 years. The study found that 21% of the patients were undergoing treatment for colon cancer, 20% for lung cancer, and 16% for pancreatic cancer. Most patients were diagnosed at advanced stages, with 28% at stage III and 65% at stage IV. The nutrition risk assessment of the patients found that 34% had a normal MNA score (24-30 points), 30% were at risk of malnutrition (17-23.5 points), and 36% were malnourished (<17 points). The following symptoms affecting nutrition were observed: nausea and vomiting (39%), taste changes (24%), weakness and fatigue (73%), pain (5%), and weight loss (27%). The most commonly used type of chemotherapy was FOLFOX (folinic acid, 5-fluorouracil and oxaliplatin, 18%).

CONCLUSION

Malnutrition was very common in geriatric patients with cancer undergoing chemotherapy. Therefore, it is crucial for healthcare professionals, particularly dietitians and nutritionists, to diagnose and manage malnutrition risk early and effectively.

Regorafenib-Induced Hand-Foot Skin Reaction in an Adolescent

Regorafenib is a multikinase inhibitor commonly used in the management of hepatocellular carcinoma, gastrointestinal stromal tumors (GIST), and colorectal cancer. It is also used off-label for progressive or metastatic osteosarcoma, which is the most common primary bone malignancy in children and adolescents. While hand-foot skin reaction (HFSR) is a well-documented side effect associated with regorafenib use, no standard guidelines currently exist for preventing and managing regorafenib-associated HFSR in children, or for HFSR and hand-foot syndrome related to other chemotherapy agents. We present a case of regorafenib-induced HFSR in an adolescent with metastatic osteosarcoma that highlights an effective dose-reduction regimen and treatment plan that ultimately resolved her grade 3 HFSR and allowed her to resume alternate anticancer treatment immediately.

Trajectories of illness perceptions in patients with kidney disease receiving dialysis: Relationship with psychological and physical symptoms

Illness perceptions play an important role in outcomes for patients with advanced kidney failure receiving dialysis, though they are rarely examined over a sustained period and in distinct cultural settings. This observational cohort study used a prospective longitudinal design to examine how illness perceptions change overtime. It also considered whether these trajectories are related to patient experience of psychological and physical symptoms including those associated with dialysis, and depressive mood. Data were collected from 181 patients recruited from four dialysis centres in Northern Cyprus between 2020-2021. There were 124 patients receiving dialysis (91.1% haemodialysis) and 57 patients in the pre-dialysis phase at baseline. Self-reported measures including the Brief Illness Perception Questionnaire, Patient Health Questionnaire-9, and Dialysis Symptom Index, were completed at the start (time 1) of the study and then again at six months (Time 2) and at 12 months (Time 3) using versions validated in the local language (Turkish). Multilevel Models (MLM) for repeated measures were used to understand trajectories of illness perceptions over the 12-months of follow-up. On average, perceptions of consequences and emotional response to illness decreased over a one-year period. Depressive symptoms and dialysis symptom burden were found to be relatively stable over the same period. However, patients who reported higher perceptions of illness consequences and emotional response at baseline were more likely to report greater depressive symptoms at 12 months. Similarly, those already receiving dialysis who reported greater emotional response and lower levels of personal control at baseline were more likely to continue to report higher dialysis symptom burden at 12 months. The findings underscore the importance of illness perceptions as a framework to identify patients who may benefit from support, importantly offering an anchor for intervention design. Establishing cultural acceptability of such an approach will be an important next step.

Clinical Outcome Assessment Tools for Evaluating the Management of Gliomas

In recent times, a greater emphasis has been placed on framing patient clinical assessments and QOL as both endpoints and prognostic factors for neuro-oncological care. However, there is currently a lack of consensus on the most effective metrics and instruments for use in patients with primary brain tumors. Due to the heterogeneity in clinical characteristics, histological classification, anatomical location, and available treatment modalities for glioma, quantifying patient clinical condition and QOL within this unique population is particularly challenging. In this paper, we comprehensively review the available literature on the use of clinical assessment tools in glioma patients, highlighting the strengths and limitations of prominent instruments. We demonstrate that clinical outcome assessment (COA) instruments provide valuable and complementary insights into the physical, psychological, and spiritual well-being of glioma patients.

Symptom and functional networks of patients with cancer in different latent risk subgroups based on patient-reported outcomes

BACKGROUND

Currently, risk stratification and effective management of heterogeneous patients with cancer based on patient-reported outcomes (PROs), used to evaluate clinical efficacy and outcomes, are relatively rare and urgently needed. We aimed to explore latent risk subgroups and delineate multidimensional networks of symptoms and functions based on PROs in this study.

METHODS

Patients with cancer were recruited from eight hospitals in two Provinces in China. The PROs measure for patients with cancer (CA-PROM) was used to measure patients' HRQoL, symptoms, and functions. Latent profile analysis (LPA) was used to explore latent risk subgroups using four fitting indicators on the patients' HRQoL. Network model (NM) of multidimensional symptoms and functions was applied at the item level of the CA-PROM. The expected influence (EI), bridge EI, and predictability of each node were used to evaluate the centrality and predictability of NM. Network accuracy and stability were tested using a case-dropping bootstrap procedure. Finally, a network comparison test (NCT) was conducted to examine whether network characteristics differed among the various risk subgroups.

RESULTS

In total, 1,404 valid questionnaires were collected. Three latent risk subgroups were determined based on the four fitting indicators. Considering the mean difference in HRQoL, subgroups 1, 2, and 3 were indicated as high-risk (n = 196), low-risk (n = 716), and medium-risk (n = 492) subgroups, respectively. There were statistically significant differences in most demographic data, disease conditions, and treatment among three latent risk subgroups. Network analysis revealed that some symptoms and functions (e.g., despair, gastrointestinal abnormalities, care and support from their families and friends, appetite, and so on) played more important roles in the heterogeneity of HRQoL for Chinese patients w ith cancer. But the performance of these symptoms and functions reported by patients varied among three subgroups. Network accuracy and stability basically met the preset criteria. NCT results showed that edge differences were observed in five nodes, and seven nodes with different EI values could be informative for targeted support for the patients of different clusters.

CONCLUSION

Different central and bridge symptoms or functions in multidimensional networks of PROs may serve as potential targets for personalized interventions among patients with cancer who are at different risk levels of HRQoL.

Effectiveness of isometric muscle training combined with manual lymphatic drainage on secondary lower extremity lymphedema following gynecologic cancer surgery

Objective

To investigate the effects of isokinetic strength training combined with manual lymphatic drainage (MLD) on leg circumference, walking ability and muscle strength in patients with secondary lymphedema following gynecologic cancer surgery.

Design

Randomized controlled trial.

Setting

Inpatient rehabilitation department.

Participants

Sixty-six patients with secondary lymphedema of the lower extremities following gynecologic cancer surgery were randomly allocated into an experimental group and a control group, each comprising 33 patients.

Interventions

The control group participated in a 4-week standardized MLD program. In addition to the MLD program, participants in the experimental group received additional isokinetic strength training for 20 min daily over the same 4-week period.

Outcomes

Lower limb volume derived from the circumference measurements, Holden Gait Scale and Lovett muscle strength grading.

Results

Prior to the intervention, no statistically significant differences were observed between the two groups across all outcomes (P > 0.05). Post-intervention, statistically significant improvements were noted in the experimental group compared to the control group with respect to reduced lower extremity volume, improved walking ability, and increased muscle strength (P < 0.05).

Conclusion

For patients with secondary lower limb lymphedema following gynecological tumor surgery, a combination of isokinetic strength training and MLD has been found to be more effective than MLD alone in reducing edema, improving walking ability, and enhancing muscle strength.

Examining the Effects of the Protection Motivation Theory-Based Online Intervention on Improving the Cognitive Behavioral Outcomes of Caregivers of Children With Atopic Diseases: Quasi-Experimental Study

BACKGROUND

The increasing prevalence of pediatric atopic diseases in China poses substantial risks to children's physical health, mental well-being, and quality of life. Cognitive behavioral interventions for caregivers are effective in managing pediatric atopic diseases. Existing interventions are typically siloed and lack integration across the comorbidities of the atopic march. The protection motivation theory (PMT) could provide an integrated cognitive behavioral intervention framework for addressing shared pathophysiological mechanisms and unifying management strategies across atopic diseases, while online interventions offer advantages in accessibility, cost-effectiveness, and scalability, particularly for caregiver-mediated pediatric care.

OBJECTIVE

This study aimed to develop and evaluate a PMT-based cognitive behavioral online (PMT-CBO) intervention for caregivers of children with atopic diseases, assessing its effects on caregivers' protective motivation, behavioral intentions, preventive practices, and children's atopic disease outcomes.

METHODS

A quasi-experimental design was conducted in 3 health care institutions in Hangzhou, China, where 2 health care institutions were assigned to the PMT-CBO group (127/243, 52.3%) and 1 health care institution was assigned to the control group (116/243, 47.7%). Caregivers in the PMT-CBO group received a 4-week structured course comprising 16 online modules delivered via a WeChat mini-program, whereas controls received routine care with verbal education. Primary outcomes included caregivers' PMT dimensions (threat appraisal and coping appraisal), behavioral intentions, and preventive behaviors, and secondary outcomes involved children's symptom severity and medication adherence. The primary outcome scales or questionnaires were designed by the research team, while the secondary outcome scales were derived from established studies. All scales demonstrated good reliability and validity. Intention-to-treat analysis was used.

RESULTS

Compared to the control group, the PMT-CBO group demonstrated significant improvements in overall PMT scores (Z=-6.289; P<.001) and most subdimensions (response efficacy, self-efficacy, threat severity, and response cost, with P<.05), except susceptibility (Z=-1.321; P=.19) and reward appraisals (Z=-0.989; P=.32). In the intervention group, caregivers exhibited stronger intentions and partial behavioral optimization (eg, environmental allergen control, with Z=-3.025; P=.002) and children showed improved medication adherence (Z=-4.457; P<.001) and alleviated eczema (Z=-3.112; P=.002) and allergic rhinitis symptoms (Z=-3.277; P<.001), although no significant differences emerged in asthma control (Z=-.830; P=.41) or food allergy-related caregiver burden (Z=-1.693; P=.09).

CONCLUSIONS

The PMT-CBO intervention enhanced caregivers' motivation and intentions and children's medication adherence and eczema and rhinitis outcomes, with a 91.3% (116/127) completion rate via WeChat's scalable platform. Limited improvements in asthma control and food allergy management implied the future need for additional condition-specific plug-ins, beyond the core PMT-CBO modules. Moreover, merging this PMT-CBO intervention with implementation techniques or ecological frameworks could help address intention-behavior gaps and external barriers, thereby promoting equitable and precision-based allergy care.

A qualitative study on ICU nurses' perceptions of palliative care

INTRODUCTION

Providing palliative care is one of the most essential responsibilities of nurses toward patients and their families. To fulfill this role effectively, nurses require specific skills to understand patients better and gain their trust. Given the necessity of delivering palliative care and the limited studies available in Intensive Care Units (ICUs), this study aimed to explore the perceptions of nurses working in ICUs in Kermanshah Province.

METHODS

This qualitative study employed a descriptive phenomenological approach. Data were collected through purposive sampling via semi-structured interviews with 13 ICU nurses employed at hospitals affiliated with Kermanshah University of Medical Sciences. The interviews were recorded, transcribed verbatim, and analyzed using the Collaizi method, with data management conducted through MAXQDA-10 software.

RESULTS

Of the 13 participating nurses, 9 were female and 4 were male, with a mean age and work experience of 29.69, and 6.54 years, respectively. Four main themes and nine sub-themes emerged from the qualitative analysis. The primary themes included: "Understanding the meaning and concept of palliative care," "Nurses' perception of the types of palliative care," "Strengthening the foundations of palliative care for ICU nurses," and " Factors contributing to palliative care".

CONCLUSION

The findings highlighted several critical factors necessary for the effective provision of palliative care in ICUs, including nurses' understanding, patience, required knowledge, and a strong work ethic. These factors collectively enhance the quality of palliative care provided to patients. Given the pivotal role of palliative care in improving nursing care for critically ill patients, it is recommended that further qualitative studies be conducted to deepen nurses' understanding of palliative care in ICUs.

Impact of technology- and parent-based psychosocial interventions on family dynamics factors in children with cancer: A systematic review

OBJECTIVE

This systematic review aimed to examine the impact of technology- and parent-based psychosocial interventions on family factors among children with cancer, focusing on family dynamics.

METHODS

Data were sourced from ten databases (CNKI, Wanfang, VIP, Sinomed, the Cochrane Library, Embase, PubMed, Web of Science, Scopus, and CINAHL) up to August 2024. The PRISMA statement guidelines, the Cochrane risk bias assessment tool, and the non-randomized controlled trial risk bias assessment tool were used in this study and experimental and quasi-experimental studies were included. The review protocol is registered in PROSPERO (CRD42023435402).

RESULTS

Twelve studies, including seven randomized controlled trials and five quasi-experimental studies, involving 1,309 parents of children with cancer, were included in the review. These studies utilized various theoretical models and delivered interventions through different modes, such as Internet-based platforms and telehealth. Overall, technology- and parent-based interventions have demonstrated positive effects on family dynamics factors, including family function, communication, coping ability, and family burden.

CONCLUSIONS

Technology- and parent-based psychosocial interventions showed promise in enhancing family dynamics factors although intervention methods varied across studies. This review recommends larger-scale randomized controlled trials to evaluate the effectiveness of technology- and parent-based psychosocial interventions on family dynamics factors among this vulnerable population and highlights the potential of such interventions to improve care quality, treatment outcomes, and resource allocation in pediatric oncology.

Personalized Nutrition Strategies for Patients in the Intensive Care Unit: A Narrative Review on the Future of Critical Care Nutrition

Introduction: Critically ill patients in intensive care units (ICUs) are at high risk of malnutrition, which can result in muscle atrophy, polyneuropathy, increased mortality, or prolonged hospitalizations with complications and higher costs during the recovery period. They often develop ICU-acquired weakness, exacerbated by sepsis, immobilization, and drug treatments, leading to rapid muscle mass loss and long-term complications. Studies indicate that adequate protein and calorie intake can decrease mortality and improve prognosis and recovery. However, optimal implementation remains a critical challenge. Objectives: This narrative review aims to summarize recent advances in nutritional strategies for critically ill patients. It highlights the benefits and limitations of current approaches including enteral (EN) and parenteral nutrition (PN) and examines their impact on clinical outcomes and overall mortality. Additionally, the review explores the emerging role of precision nutrition in critical care using technologies such as metabolomics and artificial intelligence (AI) to provide valuable insights into optimizing nutritional care in critically ill patients. Methods: A comprehensive literature search was conducted to identify recent studies, clinical guidelines, and expert consensus papers on nutritional support for ICU patients. The investigation focused on critical aspects such as the optimal timing for intervention, the route of administration, specific protein and energy targets, and technological innovations to support personalized nutrition, ensuring that each patient receives tailored support based on their unique needs. Results: Guidelines recommend initiating EN or PN nutrition within the first 48 h of admission, using indirect calorimetry (IC) to estimate energy needs, and supplementing protein up to 1.2 g/kg/day after stabilization. IC has gained importance in assessing energy needs but is still underused in the ICU. EN is preferred because it maintains intestinal integrity, reduces the risk of infections, and is recommended within the first 48 h of ICU admission. PN is used when EN is infeasible, but it increases the risk of infection. By integrating metabolomics with transcriptomic and genomic data, we can gain a deeper understanding of the effect of nutrition on cellular homeostasis, facilitating personalized treatments and enhancing the recovery of critically ill patients. Conclusions: AI is becoming increasingly important in monitoring and evaluating artificial nutrition, providing a more accurate and efficient alternative to traditional methods. AI can assist in identifying and managing malnutrition and is effective for estimating caloric and nutrient intake. AI minimizes human error, enables continuous monitoring, and integrates various data sources. The nutritional care of critically ill patients requires collaboration among specialists from diverse fields, including physicians, nutritionists, pharmacists, radiologists, IT experts, and policymakers.

Cross-Cultural Adaptation and Psychometric Properties of the Persian Version of the Spiritual Distress Scale (P-SDS) Among Older Adults with Cancer in Iran

Spiritual health integrates physical, mental, and social aspects of life and helps adapt to disease. This study aimed to assess the psychometric properties of the Spiritual Distress Scale (SDS) in Iranian older adults diagnosed with cancer, as no existing measure was available in Iran. Conducted between May and July 2024, this methodological study used convenience sampling at the Cancer Institute in Tehran, Iran. The SDS was translated and culturally adapted, and its psychometric properties were examined. Floor and ceiling effects were examined and the level of statistical significance was set at p < 0.05. A total of 300 older patients aged 60 or older, participated in this study. Face, content (SCVI/average = 0.96) and cross-cultural validity were established by the experts. Confirmatory factor analysis demonstrated that the extracted model was a good fit (χ2/df = 2.16, RMSEA = 0.06 and CFI = 0.90). The Pearson correlation between P-SDS and spiritual wellbeing scale was significant and inverse (r =  - 0.82; p-value = 0.001). The internal consistency (Cronbach's α = 0.95) and test-retest reliability (ICC = 0.94) of the Persian version (P-SDS) were both satisfactory. Several variables, including gender (p value = 0.001), cancer stage (p value = 0.001), occupation (p value = 0.0006), and living arrangements (p value = 0.020) showed significant relationships with the P-SDS scores. No floor or ceiling effects were found. The P-SDS demonstrates high reliability and validity, making it a valuable tool for researchers to assess SD among older adults in clinical settings.

Aiming for survival: a qualitative single case study of support for family members across the care process in outpatient colorectal cancer care

BACKGROUND

At times of cancer, also family members may need support from healthcare professionals. For support to be relevant it needs to be tailored to a person's needs. Tailored support is recognized as support co-created through an intangible interaction between the supporter and the supported. Despite this, studies primarily focus on the supporter (healthcare professionals) or the supported (family members). As a result, the co-created dimension is lost. Therefore, the purpose was to describe and compare family members´ supportive care needs with support from cancer nurses across the care process in outpatient colorectal cancer care.

METHODS

This study is designed as a qualitative single case study with two embedded units: family members and Contact Nurses. Data consisted of transcribed semi-structured interviews from 23 family members and 21 Contact Nurses. Both within and across units, analyses were undertaken using conventional qualitative content analysis. Reporting adheres to the Consolidated Criteria for Reporting Qualitative Research checklist.

RESULTS

Analysis generated a main category: Aiming for survival illustrating the common goal of the two units and its implications for support for family members in routine colorectal cancer care. Three subcategories describe family members´ supportive care needs in relation to Contact Nurses´ support for family members across the colorectal cancer care process: (1) The diagnostic phase: Narrowed sight in treatment preparation; (2) The treatment phase: Foregrounding family caregiving while backgrounding family support; and (3) The surveillance phase: An enduring cancer experience despite being considered a co-survivor.

CONCLUSIONS

Support tailored to family members' supportive care needs should derive from the family members' cancer experiences and include strategies for bringing their needs to light. This could possibly be achieved by strengthening the collaboration between contact nurses and clinical social workers. In addition, family members require preparation for and support during their entire cancer trajectory to enable a healthy family recovery post-treatment. In addition, they need guidance on where and whom to turn to at each stage of the care process.

Quality of Life and Coping Strategies of Palestinian Women with Breast Cancer in the West Bank: A Cross-Sectional Study

Background/Objectives: Breast cancer (BC) is the most prevalent cancer among Palestinian women and significantly affects their quality of life (QoL). Coping strategies are pivotal in shaping QoL outcomes; however, research examining coping strategies and QoL in the Palestinian context remains scarce. This study aims to evaluate coping strategies among newly diagnosed BC patients and their impact on QoL in the southern West Bank. Methods: A cross-sectional study recruited 147 newly diagnosed BC patients undergoing treatment in governmental hospitals in the Hebron and Bethlehem governorates. Data were collected via face-to-face questionnaires, which included the EORTC QLQ-C30, the Cancer Coping Questionnaire (CCQ), sociodemographic and clinical characteristics, and social support. Results: Participants exhibited moderate QoL scores, with physical functioning scoring highest (67) and emotional functioning lowest (49). Fatigue, insomnia, and pain were the most common symptoms. Coping strategies were moderately utilized, and global QoL was significantly associated with these strategies. Hierarchical regression showed education had a small positive effect on global QoL (R2 = 0.052, p = 0.005), while family support was a moderate predictor (R2 = 0.080, p = 0.041). The CCQ coping score negatively impacted global QoL (R2 = 0.186, p < 0.001), whereas CCQ positive focus (R2 = 0.342, p < 0.001) and diversion techniques (R2 = 0.406, p < 0.001) had substantial positive effects. Conclusions: Positive coping strategies, education, and family support play a vital role in enhancing QoL for newly diagnosed BC patients. Coping-focused interventions should be integrated into oncology care in Palestine to improve patient outcomes.

Interdependence of health between patients with colorectal cancer and family caregivers: a cross-sectional study

BACKGROUND

Despite numerous shared health challenges during treatment and recovery, the interdependence of health between patients with colorectal cancer and their family caregivers remains underexplored. This study applied the actor-partner interdependence model (APIM) to examine this dyadic relationship.

METHODS

This descriptive correlational survey involved patients with colorectal cancer who visited the outpatient department for postoperative follow-up, along with their family caregivers. From 343 consenting participants, responses from 100 matched patient-caregiver pairs were analyzed. Data collection occurred at J Hospital from August 2023 to May 2024. Key variables included the psychological health and quality of life (QoL) of both patients and caregivers, patient self-care, and caregiver contribution to self-care. Statistical analysis was performed using Stata 16.1, with structural equation modeling.

RESULTS

The mean age of patients was 65.57 years; 51% were male, 66% had colon cancer, and 34% rectal cancer. The caregivers' mean age was 56.11 years; 55% were female, and 66% were spouses. The analysis of actor effects showed that the psychological health and QoL of both patients and caregivers independently influenced their respective outcomes. The analysis of partner effects revealed mutual influences between the psychological health of patients and caregivers; moreover, the psychological health of caregivers impacted patients' self-care. While there was a correlation between the QoL of patients and caregivers, it was not statistically significant in the structural equation modeling.

CONCLUSIONS

This study underscores the profound interdependence of health between patients with colorectal cancer and their caregivers, revealing significant mutual impacts on psychological health and, to a lesser extent, self-care. These insights suggest the need for targeted interventions to improve both patient recovery and caregiver support, even where some correlations lack statistical significance.

TRIAL REGISTRATION

Prospectively registered with the Clinical Research Information Service (CRIS) under the Clinical Trial Number KCT0008743 (Registration Date: 2023.08.25).

Feasibility and Acceptability of Using an Evidence-Based Tai Chi Intervention for Managing the Fatigue-Sleep Disturbance-Depression Symptom Cluster in Breast Cancer Patients

Objective: To explore the feasibility and acceptability of using an evidence-based Tai Chi intervention to manage the fatigue-sleep disturbance-depression symptom cluster (FSDSC) in female breast cancer patients. Methods: This study reported the feasibility outcomes of a pilot randomized controlled trial (RCT), along with a nested qualitative process evaluation. Seventy-two female breast cancer patients experiencing the FSDSC were randomized into either a Tai Chi group or a control group. The Tai Chi group received an eight-week Tai Chi intervention consisting of two one-hour sessions per week, along with routine care, while the control group received routine care only. The feasibility and acceptability of the study procedure and Tai Chi intervention protocol were assessed by measuring recruitment, referral, retention and drop-out rates, questionnaire completion rates (including the Brief Fatigue Inventory [BFI], Pittsburgh Sleep Quality Index [PSQI], Hospital Anxiety and Depression Scale-Depression [HADS-D], and Functional Assessment of Cancer Therapy-Breast [FACT-B]), intervention adherence, and safety outcomes. The nested qualitative process evaluation consisted of semi-structured interviews conducted among 22 participants to further explore their experiences of participating in this study and practicing Tai Chi. Descriptive data analysis was employed to present the feasibility and acceptability outcomes. Content analysis was employed to analyze the data from the qualitative process evaluation. Results: A total of 72 breast cancer patients were successfully recruited over six months, with a recruitment rate of 79.1%, retention rate of 95.8%, and dropout rate of 4.2%. No missing data was found in the BFI, PSQI, or HADS-D. However, a notable number of missing values were found in the FACT-B, particularly for items related to sexual satisfaction. The Tai Chi intervention demonstrated a high level of feasibility, with an average adherence rate of 86.8%. Only eight participants reported minor discomforts, such as minor musculoskeletal discomfort and dizziness, but they were transient and manageable after stopping Tai Chi practice. Semi-structured interviews with 22 participants highlighted that Tai Chi was experienced to be generally convenient, energy-saving, and low intensity for FSDSC management. Participants also felt that the study questionnaires were comprehensible and straightforward. Many interviewees from the Tai Chi group reported perceiving favorable effects on FSDSC management, as well as overall functional health and well-being. Conclusions: The evidence-based Tai Chi intervention proved feasible, safe, and convenient as a non-pharmacological intervention for managing FSDSC in breast cancer patients. Future large-scale studies are needed to evaluate Tai Chi's definite effects on improving FSDSC among breast cancer patients.

The Perspectives of Families in Decision-Making Conflicts Related to Palliative Care Patients With Mechanical Ventilation in Taiwan

BackgroundFamily members experience decision-making conflicts regarding changes in patient care. If the medical team does not attempt to understand the family members' awareness of palliative care, family members may experience medical decision-making stress and dilemmas. This study examined the decision-making conflicts of the family members of patients dependent on prolonged mechanical ventilator regarding palliative care in Taiwan.MethodsA cross-sectional design was used in this study. Family members of such patients in the subacute respiratory care ward and the respiratory intensive care unit of a medical center in Taiwan were recruited. A structured questionnaire was used to collect data.ResultsAmong the family members of the 127 patients included, 57.5% hesitated to make palliative medical decisions and 61.4% experienced palliative medical decision conflicts. The absence of other chronic diseases, family members' inability to accept the movement of patients to palliative care, and family members' hesitation in palliative care medical decision-making resulted in decision-making conflicts. In this study, 127 prolonged mechanical ventilation-dependent patients (PMVDP) and their family members were examined. The results revealed that family members experienced palliative care medical decision-making difficulties (61.40% = <2.5). Predictors of palliative care decision-making conflict for PMVDP and their family members included the following: absence of other comorbid chronic diseases, the inability of family to accept palliative care on behalf of patients, and hesitation in palliative care medical decision-making by family members.ConclusionThe study results are able to help Taiwanese medical staff in evaluating such conflicts and palliative care medical decisions of PMVDP.

Acceptance, distress tolerance and sexual adjustment among women with breast cancer

Breast cancer is the most prevalent cancer among women, significantly impacting various aspects of their lives. This study aimed to investigate the mediating role of distress tolerance in the relationship between acceptance and sexual adjustment among women diagnosed with breast cancer. This study adopts a descriptive-correlational approach employing structural equation modeling. A total of 233 women diagnosed with breast cancer were selected through convenience sampling from members of the Cancer Council in Isfahan, Iran. Data were collected using the Distress Tolerance Scale, the Acceptance and Action Questionnaire, and the Sexual Adjustment Scale. The coefficient of the direct path from acceptance to distress tolerance (β = .47, p < .01) and sexual adjustment (β = .33, p < .01) was found to be positive and significant. Additionally, distress tolerance was revealed to play a significant mediating role in the relationship between acceptance and sexual adjustment among women with breast cancer (β = .12, p < .01). The ability to accept their diagnosis may help women with breast cancer manage the negative thoughts and emotions that naturally arise from such a potentially threatening situation. These findings highlight the importance of incorporating acceptance and distress tolerance training into psychological support programs to improve sexual adjustment in women with breast cancer.

A systematic review on the effects of logotherapy and meaning-centered therapy on psychological and existential symptoms in women with breast and gynecological cancer

PURPOSE

Women diagnosed with breast cancer (BC) and gynecological cancer (GC) face psychological and existential challenges common to all cancers, such as anxiety and depression, along with specific issues related to body image and sexuality. Logotherapy and meaning-centered therapy (MCT) have shown positive effects on the psychological well-being of cancer patients.

METHODS

A systematic review was conducted following PRISMA guidelines to assess the impact of logotherapy and meaning-centered therapy (MCT) on women diagnosed with BC and GC from January 2014 to December 2024. Empirical research articles published in English were included, while literature reviews, meta-analyses, doctoral theses, preprints, books, and studies involving other cancer types or metastatic/comorbid conditions were excluded. The search was conducted across Web of Science, Scopus, and PubMed databases using terms like uterine cancer, ovarian cancer, breast cancer, mastectomy, logotherapy, and MCT. The Boolean operators AND and OR were used in the Title and Abstract search fields across all three databases, as well as in the Topic search field for the WoS database.

RESULTS

Out of the 36 articles initially obtained, 29 remained after eliminating duplicates and, finally, six papers were selected. The included studies examined various psychological and existential issues in patients with breast and gynecological cancer, including anxiety, distress, depression, hopelessness, death anxiety, post-traumatic stress, perception of physical symptoms, quality of life, post-traumatic growth, spiritual well-being, and meaning in life.

CONCLUSION

Findings suggest that logotherapy decreases depressive symptoms, anxiety, and post-traumatic stress, whereas improves meaning in life, quality of life, physical symptom perception, and post-traumatic growth in women with BC and GC. Implementing logotherapy in cancer care units through a multidisciplinary approach could be valuable, considering biopsychosocial factors, and incorporating aspects of self-image and sexuality in treatment would also be beneficial.

Financial Toxicity in Dementia Caregiving: Sociodemographic Predictors in a U.S. Nationally Representative Survey

BACKGROUND AND OBJECTIVES

"Financial toxicity" describes the negative effects of medical expenses on financial security and health-related quality of life. Beyond dementia, financial toxicity is used to address the financial and health consequences of illness. Here, we utilize the COmprehensive Score for financial Toxicity (COST) to examine the experience of financial toxicity in dementia caregiving.

RESEARCH DESIGN AND METHODS

We conducted a nationally representative survey of 317 dementia caregivers. Financial toxicity was defined as COST<26 and categorized as mild (COST ≥14 and <26), moderate (COST >0 and <14), or severe (COST = 0). Nested multivariable regression examined potential predictors of financial toxicity. Mediation analyses were performed to assess whether the influence of basic caregiver demographic predictors was mediated by care recipient clinical characteristics, caregiver socioeconomic demographics, or relational characteristics.

RESULTS

52.7% of dementia caregivers in the United States experience financial toxicity. Of those, 73.1% endure mild, 25.7% moderate, and 1.2% severe toxicity. 69.5% of Black, 54.1% of Hispanic, and 42.3% of White caregivers report financial toxicity, with prevalence significantly higher in Black caregivers compared to White caregivers (p = .017). Older caregiver age was associated with less financial toxicity (p = .024). Caregiver employment status mediated this effect, with retirement associated with less financial toxicity (p < .001) and unemployment associated with greater financial toxicity (p < .001).

DISCUSSION AND IMPLICATIONS

Most dementia caregivers in the United States experience financial toxicity, with Black caregivers bearing the highest risk. Older caregiver age protects against financial toxicity, reflecting the relationship between age and employment status.

Patient-Specific Factors to Differentiate Between Branchial Cleft Cysts and CUP Syndrome: A 10 Year Unicenter Study

OBJECTIVES

Due to its generally-poor prognosis and varied clinical presentation, cervical cancer of unknown primary (CUP) poses particular challenges for clinical and imaging diagnosis. Differential diagnoses of CUP syndrome may also include lateral cervical cysts. When a benign neck cyst is initially suspected, squamous cell carcinoma is often diagnosed after receiving histopathology. Our study investigates the risk factors to differentiate between CUP syndrome and lateral neck cysts (LNC) to possibly improve the prognosis.

METHODS

Between 2013 and 2023, 244 patients with an initial diagnosis of LNC (n = 121) or CUP (n = 123) were recruited from the Department of Otorhinolaryngology of Heidelberg University Hospital and underwent panendoscopy with lymph node removal. In general, disease- and progression-free survival, prognostic relevant risk factors, and treatment data were recorded and analyzed.

RESULTS

The mean age of patients with CUP was significantly higher at 65 ± 13.2 years than that of patients with LNC (41 ± 15.8 years; P = .000). The calculated cutoff value was 50 to 59 years for a 50% chance of CUP syndrome or other malignant neck mass. Alcohol and tobacco consumption were not found to be risk factors. Previous tumor diseases were diagnosed more frequently in patients with CUP than in patients with LNC (P = .045). The 5 year overall survival for patients with CUP was 77.0% and did not differ significantly between the other various tumor entities (P = .423).

CONCLUSIONS

The consideration of patient-specific factors such as age or synchronous/asynchronous malignancies is crucial in the diagnostic decision-making process. In the age group of 50 to 59 years, there is ~50% probability of diagnosing CUP syndrome with unilateral painless neck swelling. A thorough clinical examination using panendoscopy with at least 1 unilateral tonsillectomy and biopsies from the base of the tongue is essential to detect a possible primarius early and improve the prognosis.

Coping strategies for fear of cancer recurrence among breast cancer survivors: a systematic review and thematic synthesis of qualitative studies

AIM

Breast cancer (BC) is the most common cancer in women, and many survivors experience fear of cancer recurrence (FCR). This study aimed to explore and integrate qualitative evidence on the coping strategies BC survivors use to manage FCR.

METHODS

A systematic review and thematic synthesis of qualitative studies was conducted. Six databases including PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and Embase were searched without any time restrictions using predefined keywords. Inductive thematic synthesis was conducted to identify key coping strategies used by BC survivors.

RESULTS

Sixteen studies were included, identifying four themes of coping strategies: "seeking support," "transforming health behaviors and lifestyle" "avoidance and emotional detachment", and "building resilience and emotional strength". Each encompassed sub-themes.

CONCLUSION

This review identified various coping strategies used by BC survivors to manage the FCR. They highlight the complexity and diversity of responses to FCR, rather than assessing their effectiveness. The findings underscore the importance of understanding coping mechanisms within the context of survivorship care, which can inform future research on their short- and long-term impacts. Healthcare providers should consider individualized approaches that acknowledge the nuanced nature of coping strategies used by BC survivors.

Impact of personalised risk predictions on breast cancer risk perceptions: insights from the BREATHE study

OBJECTIVE

Biennial mammography screening is well-established for women aged 50 and above, but guidelines for younger women are less clear. Risk-based screening may provide women with key information to make informed decisions about their breast cancer risk and screening. This study examines how predicted breast cancer (BC) risk shapes women's perception and confidence in risk prediction.

METHODS

Women aged 35 to 59 years were recruited for a prospective multi-centre cohort and stratified into above-average, average, or below-average BC risk categories based on genetic and non-genetic risk factors. Perceived risk was assessed at enrolment and after participants were informed of their predicted risk. We used ordinal models to identify predictors of perceived risk and logistic regression to examine the relationship between changes in perceived risk and confidence in the risk prediction.

RESULTS

At enrolment, 43% and 47% of 4112 participants perceived their BC risk pre-result as low or average, respectively. Thirty-five percent adjusted their perceived risk to align more closely with their predicted risk. Predictors of perceived risk post-result: perceived risk pre-result, predicted risk, ethnicity and having regular menstruation. Participants who underestimated their BC risk were nearly eight times more likely to have low confidence in the accuracy of their predicted risk (OR for underestimation vs. accurate perception: 7.94 [95% CI 5.60-11.28]). Predictors of perceived risk post-result: perceived risk pre-result, predicted risk, ethnicity and having regular menstruation. Confidence in risk prediction was lowest when women's perceived risk pre-result was lower than their predicted risk (OR-2 vs 0 [95%CI] 5.06 [3.67 to 6.97]).

CONCLUSION

Many women underestimated their BC risk, and their initial perceptions were influenced by the knowledge of their predicted risk. Women who underestimated their risk had less confidence in their predicted risk scores.

The Mechanism by 18 RCTs Psychosocial Interventions Affect the Personality, Emotions, and Behaviours of Paediatric and Young Adult Cancer Patients: A Systematic Review

Background/Objectives: Psychosocial interventions bring mental and social benefits to paediatric and young adult patients. Gaining insight into the optimal psychosocial intervention strategies and their process mechanisms can contribute to the deepening of practice in this field. Methods: This systematic review evaluates the psychosocial interventions that promote adaptability, resilience, and positive changes among paediatric and young adult patients. Following the Cochrane guidelines, the literature from 2000 to 2024 was reviewed, focusing on randomised controlled trials (RCTs). Results: Eighteen studies were included and analysed using a logic model framework. Therapeutic interventions that involved the reframing of cognition activities shaped personality changes, including resilience and adaptation, requiring significant investment, and they were influenced by individual characteristics and background. Process-oriented activities, such as art-, play-, and music-based therapies, improved emotional well-being and were affected by pain, cognitive abilities, and language skills. Behavioural changes are best achieved through interactive interventions, particularly group-based and parent-involved approaches, which improve social integration and physical abilities. Conclusions: Psychosocial interventions lead to positive changes in paediatric and young adult patients in terms of personality, emotion, and behaviour. Although the sample size for the behavioural changes is insufficient, understanding the mechanisms underlying these interventions benefits practice.

At-home Breast Oncology care Delivered with EHealth solutions (ABODE) study protocol: a randomised controlled trial

INTRODUCTION

The COVID-19 pandemic disrupted healthcare delivery for patients with breast cancer. eHealth solutions enable remote care and may improve patient activation, which is defined as having the knowledge, skills and confidence to manage one's health. Thus, we developed the Breast Cancer Treatment Application (app) for patients and practitioners to use throughout the cancer care continuum. The app facilitates virtual assistance, delivers educational resources, collects patient-reported outcome measures and provides individualised support via volunteer e-coaches. Among newly diagnosed patients with breast cancer, we will compare changes in patient activation, other patient-reported outcomes and health service outcomes over 1 year between those using the app and Fitbit, and those receiving standard care and Fitbit only.

METHODS AND ANALYSIS

This randomised controlled trial will include 200 patients with breast cancer seen at a tertiary care cancer centre in Ontario, Canada. The intervention group (n=100) will use the app in addition to standard care and Fitbit for 13 months following diagnosis. The control group (n=100) will receive standard care and Fitbit only. Patients will complete questionnaires at enrolment, 6 and 12 months post-diagnosis to measure patient activation (Patient Activation Measure-13 score), distress, anxiety, quality of life and experiences with their care and information received. All patients will also receive Fitbits to measure activity and heart rate. We will also measure wait times and number of visits to ambulatory care services to understand the impact of the app on the use of in-person services.

ETHICS AND DISSEMINATION

Ethics approval was obtained on 6 January 2023. Protocol version 2.0 was approved on 6 January 2023. The trial is registered with ClinicalTrials.gov. Study findings will be disseminated via publication in a peer-reviewed journal and shared with participants, patient programmes and cancer awareness groups. The app has also been approved as a secure communication method at our trial institution, thus we are well-positioned to support future integration of the app into standard care through collaboration with our hospital network.

TRIAL REGISTRATION NUMBER

NCT05989477.

Effects of an Educational Health Belief Model Program on Promoting Preventive Behaviors for Breast Cancer Among Women in Iran

Breast cancer is regarded as a healthcare issue for women worldwide and affects women of all races, ethnicities, and social classes. The study aimed to examine the effects of the health belief model (HBM)-based educational program on knowledge, practices, and how to prevent breast cancer in women who go to health centers in Iran, which is in the province of Alborz in Iran. A quasi-experimental study was carried out based on a pretest-posttest design with the control group in 2022. A study targeted 128 women in 2 interventions (n = 64) and control (n = 64) groups. The data were collected from participants using a researcher-made questionnaire developed based on key constructs of the HBM, before and 2 months after the educational intervention. Educational intervention was held for 6 sessions of 60 min duration each. The health belief model evaluates 7 components of individuals, including perceived susceptibility, perceived severity, perceived barriers, perceived benefits, self-efficacy, cues to action, and practice. The Mann-Whitney test was utilized to compare the levels of quantitative variables between the 2 groups. A chi-squared test was utilized for the categorical variables. A robust analysis of covariance (ANCOVA) was employed to evaluate the effect of the intervention on all 7 HBM components. The results showed that using the health belief model can increase awareness, perceived benefits, perceived susceptibility, perceived severity, and self-efficacy of women for the prevention of breast cancer.