Qualitative research into the symptom experiences of adult cancer patients after treatments: a systematic review and meta-synthesis

The impact of patient engagement on patient safety in care transitions after cancer treatment: Protocol for a systematic review and meta-analysis

BACKGROUND

Transitions of care after cancer treatment pose a major challenge for patient safety as adverse events and unplanned healthcare utilization occur frequently. At this point, patient and family engagement (PFE) is particularly valuable since patients and their families experience various challenges along this pathway, such as changing roles and recurrent needs to navigate across structural gaps between different services. However, there is currently a lack of evidence on the impact of PFE on patient safety in transitions after cancer treatment.

OBJECTIVE

To systematically review and synthesize evidence on effects of different PFE interventions on patient safety in the transition of care after cancer treatment.

METHODS

This protocol for a systematic review with meta-analysis follows PRISMA-P guidelines. A comprehensive database search will be conducted in MEDLINE, EMBASE, CENTRAL, CINAHL, and APA PsycInfo. Trial registries and grey literature will be searched, forward and backward citation tracking will be performed. Trials with prospective, longitudinal, interventional study designs will be included if they evaluate PFE interventions on patient safety outcomes (primary outcomes: healthcare utilization, patient harm, adherence, patient experience; secondary: quality of life, distress); eligible studies need to survey patients with any oncological disease during or after transition following cancer treatment. Results will be synthesized narratively and meta-analytically using a random-effects model. Risk of bias will be assessed using the Cochrane RoB-2 and revised JBI critical appraisal tool. The certainty of evidence will be judged according to the GRADE approach.

DISCUSSION

Robust evidence of effectiveness is needed to establish PFE interventions for patient safety in care transitions for oncological patients. This review will allow evidence-based conclusions about types and effects of different PFE interventions for transitional safety in oncology care and inform stakeholders in designing sustainable PFE activities.

TRIAL REGISTRATION

PROSPERO (CRD42024546938), OSF (doi.org/10.17605/OSF.IO/9XAMU).

A Discourse of Deviance: Blame, Shame, Stigma and the Social Construction of Head and Neck Cancer

Cancer of the head and neck is a confronting condition, as the disease and its treatments alter the appearance and function of body organs associated with physical appearance and identity. Many of the risk factors for head and neck cancers, including tobacco, alcohol, and human papilloma virus, can also have significant negative social and moral permutations. Language and action (discourse) plays an important role in constructing disease and illness and shape the way it is managed, both institutionally and socially. This research used a critical constructionist lens to investigate how the common discourses surrounding head and neck cancer are constructed within the healthcare context and how this influences patients and healthcare professionals' responses to the illness. Data were collected through semi-structured interviews, field noting, journaling and literature reviews. Analysis was guided by a three-dimensional approach to critical discourse analysis that investigated text, discursive practices, and social context. The overarching finding was that deviance dominates the common discourse and shapes head and neck cancer and responses to it. Deviance is channelled through metaphors, adjectives, descriptors, and collective nouns and is made overt through labelling, avoidance, blaming, shame, and categorization. Discourse is contextualized by a sociocultural understanding that when someone deviates from what is perceived as normal, they are devalued. Open dialogue and reflection on head and neck cancer discourse could enable better understanding of how people experience their condition and inform more supportive responses.

Coping with breast cancer during medical and occupational rehabilitation: a qualitative study of strategies and contextual factors

PURPOSE

This study aimed to gain a deeper understanding of the coping processes of breast cancer survivors (BCSs) during medical and occupational rehabilitation after acute treatment.

METHODS

This study is part of the mixed-methods Breast Cancer Patients' Return to Work study conducted in Germany. Data were collected through semistructured interviews with 26 female BCSs 5-6 years after their diagnosis. A qualitative content analysis was conducted to investigate the coping strategies and contextual factors of coping of BCSs.

RESULTS

The participants used different strategies for coping with their breast cancer, namely, approach- versus avoidance-oriented coping and emotion- versus problem-focused coping. During the medical rehabilitation process, coping behavior was used mainly to address disease management and its consequences. During the occupational rehabilitation process, most coping strategies were used to overcome discrepancies between the patient's current work capacity and the job requirements. The contextual factors of coping were in the health, healthcare, work-related, and personal domains.

CONCLUSION

The study findings provide in-depth insights into the coping processes for BCSs during the rehabilitation phase and highlight the importance of survivorship care after acute cancer treatment.

IMPLICATIONS FOR CANCER SURVIVORS

The results indicate that BCSs employ approach- and avoidance-oriented strategies to cope with their cancer during rehabilitation. As both attempts are helpful in the short term to cope with physical and emotional consequences of the cancer, healthcare and psychosocial personnel should respect the coping strategies of BCSs while also being aware of the potential long-term negative impact of avoidance-oriented coping on the rehabilitation process.

Cancer-related pain experienced in daily life is difficult to communicate and to manage - for patients and for professionals

OBJECTIVES

The aim of this study was to gain qualitative insight into cancer patients' experiences, explanations, and management strategies regarding their cancer-related pain (CP).

METHODS

Seventeen patients with CP were interviewed using a semi-structured interview approach. Braun and Clarke's thematic analysis method was used to analyze the transcribed interviews. The patients all participated in cancer rehabilitation courses arranged by the research clinic at The Danish Knowledge Centre for Rehabilitation and Palliative Care.

RESULTS

Three themes were identified: (1) Explaining CP: Patients found it difficult to explain how they experienced their pain. They lacked words, and they frequently used invasive metaphors such as "Pain feels like a heart attack" (2). Strategies and barriers to the management of CP: Initiatives provided by healthcare professionals (HCPs) were perceived as insufficient, and the patients missed guidance in both pharmacological and non-pharmacological approaches to pain management. Several saw medicine as unnatural for their body, and they focused on side effects and the medicine affecting their quality of life. (3) Responsibility for managing CP: A lack of responsiveness from the HCPs and taking on responsibility for pain management were experienced by several of the patients. The patients expressed uncertainty about whom to contact for help with the management of their CP.

CONCLUSION

The patients' difficulties in explaining, understanding, and communicating their pain and pain management contributed to insufficient pain management. They were also uncertain about who had the responsibility to help them to achieve pain relief. These results share the evidence drawn from studies on patients with chronic non-cancer pain. This qualitative study highlights the need for having more focus on a common language and shared understanding between patients and HCPs. It also underpins the importance of HCPs to assume their responsibility to help patients manage their pain conditions.

'Life became slow down': A descriptive qualitative study of the experiences of cancer-related fatigue amongst people with advanced lung cancer

BACKGROUND

Cancer-related fatigue is a complex multidimensional concept. However, little is known about the experience of cancer-related fatigue in people with advanced lung cancer. How they emotionally react to and cope with the experience of cancer-related fatigue according to cultural influences has not been extensively explored.

AIM

To explore the experience of cancer-related fatigue, its impacts and emotional reactions to and coping strategies for cancer-related fatigue amongst people with advanced lung cancer in China.

DESIGN

This was a cross-sectional, descriptive qualitative study with face-to-face semi-structured interviews. Data were analysed using content analysis.

SETTING/PARTICIPANTS

Twenty-one people with advanced lung cancer who experienced cancer-related fatigue were recruited in a hospital setting.

RESULTS

Four themes were identified: multifaceted experiences of cancer-related fatigue, impacts of cancer-related fatigue, negative perceptions of cancer-related fatigue and avoiding cancer-related fatigue. The multifaceted experience of cancer-related fatigue had physical, psychological and social impacts along the cancer trajectory. Informants regarded it as a sign of a 'bad ending', searched for root causes and had negative attitudes towards role changes. Avoiding coping strategies included not discussing cancer-related fatigue, refusing encouragement and support, hiding feelings, withdrawing from social life and attempting to control cancer-related fatigue.

CONCLUSION

The findings provide insights into the lack of flexibility of people with advanced lung cancer to adapt to the multidimensional experience of cancer-related fatigue. The reactions and coping towards cancer-related fatigue are profoundly influenced by Chinese culture. Developing psychological interventions based on the cultural background are highly recommended to cultivate the ability to cope flexibly with stressful events and live a meaningful cancer life.

Navigating severe chronic cancer-related fatigue: an interpretative phenomenological analysis

OBJECTIVE

This article presents a phenomenological study on the embodied experiences of patients with Chronic Cancer-Related Fatigue (CCRF), aiming to better understand this complex phenomenon.

DESIGN

Data collection consisted of individual interviews with 25 participants who suffered from severe CCRF for at least three months after cancer treatment was finished.

MAIN OUTCOME MEASURES

Against the theoretical background of philosophical phenomenology, we explored embodied experiences, incorporated temporal and spatial aspects of living with CCRF. We applied interpretative phenomenological analysis (IPA) to analyze the transcripts of the interviews.

RESULTS

Using IPA, we identified four themes on how chronic fatigue is experienced post-cancer: (1) Worn out; (2) Diminishment of one's 'I can'; (3) Invisibility; and (4) Regaining one's 'I can'.

CONCLUSION

For clinical practice, these results imply that professionals could focus more on the role of the body and limitations of one's 'I can' when treating CCRF. By studying these embodied CCRF experiences in individual patients, future research could help personalize and optimize treatment.

Delivery of Cancer Survivorship Education to Community Healthcare Professionals

Our pilot study aimed to evaluate the needs of community oncology providers with regard to cancer survivorship education, develop a survivorship curriculum based on the needs assessment, and evaluate the acceptability of the Project ECHO® (Extension for Community Healthcare Outcomes) model for delivery of the survivorship curriculum. A needs assessment was delivered to participants in suburban community cancer practices, and a curriculum was developed based on the results. Participants were enrolled in an ECHO curriculum consisting of 6 sessions from October to December 2019. Participants included registered nurses (RN), registered dietitians (RD), clinical social workers (LCSW), advanced practice providers (APP), radiation oncologists, and medical oncologists (MD). Participants were invited to participate in exit interviews designed to better evaluate the participant experience. Ninety percent of needs assessment participants (n = 37) expressed an interest in cancer survivorship education. Eight participants from 3 community practices in suburban Connecticut enrolled in the ECHO curriculum. Four participants (50%) agreed to participate in exit interviews. Five themes emerged from the exit interviews: interest in survivorship, time, positive experience, empowerment, and community. Our Survivorship ECHO pilot demonstrated the acceptability of the Project ECHO® model for delivering cancer survivorship education to oncology providers. Further research confirming the feasibility of this model in additional oncology provider settings is needed.

Psychometric assessment of the Concerns about Late Effects in Oncology Questionnaire (CLEO) among female breast cancer survivors

OBJECTIVE

The Concerns about Late Effects in Oncology (CLEO) questionnaire was developed to measure concerns cancer survivors may have about late effects. The current study sought to assess the Concerns about Late Effects in Oncology's (CLEO) psychometric properties - factor structure, construct validity, discriminatory power, and internal consistency.

METHODS

147 breast cancer survivors completed a survey. Factor structure was determined by exploratory factor analysis (EFA). Construct validity was assessed against fear of cancer recurrence, anxiety, depression, quality of life, and neuroticism. Discriminatory power was assessed against participants' age and clinical characteristics.

RESULTS

The EFA confirmed a 4-factor structure; health professionals' support, psychological impacts, adapting, and daily functional impacts. There was only partial support for construct validity and discriminatory power. The CLEO demonstrated excellent internal consistency, with an overall Cronbach's α = 0.87 (health professionals' support: α = 0.89, psychological impacts: α = 0.93, adapting: α = 0.82, and daily functional impacts: α = 0.89).

CONCLUSION

The findings suggest further development of the CLEO should focus on the psychological and functional impacts of late effects.

PRACTICE IMPLICATIONS

Use of the CLEO may enhance communication about the impact of late effects, ensuring earlier identification and management of late effects in this population.

Measuring female breast cancer survivors' concerns about late effects of treatment: initial development of the Concerns about Late Effects in Oncology Questionnaire (CLEO)

PURPOSE

While an increasing number of women are surviving breast cancer, survivors remain at risk of developing late effects. Late effects are long-term side effects which may emerge months to years after completing active treatment. Survivors may experience chronic worry and concern about the unpredictable and debilitating nature of late effects. This qualitative study aimed to explore the content validity of items included in the first patient-reported outcome measure (PROM) to quantify survivors' concerns about late effects: the Concerns about Late Effects in Oncology Questionnaire (CLEO).

METHOD

Items included in the CLEO were informed by a literature review and consultation with expert stakeholders. Breast cancer survivors completed "think aloud" interviews to explore the perceived acceptability, relevance, clarity, and feasibility of the CLEO. Interviews were transcribed verbatim and analyzed using framework analysis.

RESULTS

Twenty-eight participants were interviewed. Participants indicated the CLEO was acceptable, relevant to women's experiences of late effects, and easy to use and understand. Of the 55 proposed items, participants endorsed 33 items across six domains and suggested to include one additional item.

CONCLUSIONS

These findings suggest the CLEO captured concerns relevant to breast cancer survivors and provides initial validation of items for inclusion in the CLEO. The CLEO may improve communication about late effects in clinical settings and prompt future research into evidence-based interventions for survivors. Future research should assess the relevance of the CLEO items to other cancer populations. The psychometric properties of the CLEO will be evaluated in future stages of questionnaire development.

Routine Cancer Treatment Regimens and Its Impact on Fine Motor Dexterity in Breast Cancer

INTRODUCTION

Breast cancer can be a major challenge for those affected. Knowledge of changes in fine motor dexterity in affected women due to routine cancer therapies can help guide effective support.

METHODS

For this prospective observational study, we collected data of 79 women with a mean age 54.6 ± 9.5 years prior to, after breast cancer therapy (T1), and at 3-month follow-up. The fine motor dexterity was assessed for 4 treatment subgroups: SC = Surgery + Chemotherapy, SCR = Surgery + Chemotherapy + Radiotherapy Therapy, SR = Surgery + Radiotherapy, and S = Surgery.

RESULTS

Over time, women with breast cancer showed significant decreases in fine motor dexterity across all treatment groups (p < 0.001). The strongest negative effect was seen in the treatment groups receiving additional chemotherapy. SCR group showed pronounced limitations for dominant hand (DH) -12%; non-dominant hand (NDH) -15%; both hands (BH) -17%; assembly (ASSY) -11% at T1. Significant interaction was noticeable in DH (F = 5.59, p < 0.001), NDH (F = 6.61, p < 0.001), BH (F = 13.11 p < 0.001), and ASSY (F = 5.84 p < 0.001).

DISCUSSION/CONCLUSION

Our study showed that the extent of change in fine motor dexterity depends on the treatment regimen. The detection of unmet care needs could help to personalize and optimize clinical and survivorship care. Based on our findings, multidisciplinary support initiated early in breast cancer therapy is required.

Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer

Purpose

The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis.

Methods

We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test.

Results

The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively).

Conclusion

In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

Chronic Obstructive Pulmonary Disease Symptom Cluster Composition, Associated Factors, and Methodologies: A Systematic Review

This systematic review details symptom clusters, their compositions, and associated factors and appraises the methodologies of studies that reported symptom clusters in patients with chronic obstructive pulmonary disease (COPD). Ten studies were eligible for inclusion in this study. Four common symptom clusters were identified. Two theoretical frameworks, four statistical methods, and various symptom assessment tools were used to identify symptom clusters. Factors associated with symptom clusters included demographic, clinical, and biological factors. No studies examined the subjective experiences of symptom clusters. Overall, inconsistencies were identified in the composition of symptom clusters across studies. This may be due to variations in study design, assessment tools, and statistical methods. Future studies should attempt to arrive at a common definition, especially that is theoretically derived, for symptom clusters, standardize the criteria for symptoms for inclusion in the clusters, and focus on patients' subjective experience to inform which clusters are clinically relevant.

A Mixed Methods Study of Symptom Experience in Patients With End-Stage Renal Disease

BACKGROUND

Patients with end-stage renal disease receiving dialysis experience a significant symptom burden. Identifying factors associated with this burden may improve symptom management. However, specific evidence about patients' experiences is lacking.

OBJECTIVES

The aim of this study was to explore factors that are associated with patients' symptom experiences.

METHODS

The convergent parallel mixed methods design was used. In the quantitative component, the Dialysis Symptom Index was used to assess the symptom burden of 271 participants to examine its associations with patient characteristics using correlation coefficients and multivariate regression analyses. In the qualitative component, associated factors reported by 10 participants were identified through semistructured interviews using content analysis. Assessments were conducted at enrollment, 6 months, and 12 months. After separate data analyses, findings were integrated using side-by-side comparison and joint display.

RESULTS

Several significant associations were identified between patient characteristics and symptom burden, and the participants described four categories of factors (i.e., treatment related, pathophysiological, situational, dietary) associated with a higher symptom burden during their interviews. Across both components of this study, three factors were consistent (i.e., employment, hyperphosphatemia, anemia). Participants described several factors not reported previously.

DISCUSSION

This study explored subjective and objective factors influencing the symptom experiences of patients with end-stage renal disease using a mixed methods design. These risk factors can be used to identify high-risk patients. Our findings suggest that participants relied on laboratory results and treatments to explain their symptom experiences. These findings suggest that assessment of both subjective and objective factors is needed to explore patients' symptom experiences.

A qualitative evaluation of the use of interventions to treat fatigue among cancer survivors: A healthcare provider's view

OBJECTIVE

Cancer-related fatigue (CRF) is among the most common and distressing side effects of cancer treatment. Different types of interventions, including physical activity (PA), psychosocial and mind-body interventions, have been shown to reduce CRF. We aimed to explore HCPs' practices and barriers to refer patients towards interventions to reduce CRF.

METHODS

We performed a qualitative study using key informant interviews among a sample of 20 HCPs including medical, surgical and radiation oncologists, pain specialists, nurses, psychologists, psychiatrists and physiotherapists recruited from breast, prostate and colorectal cancer disease groups from a comprehensive cancer centre.

RESULTS

Most interviewees reported not to address CRF spontaneously during consultations. When the topic of CRF was brought up by patients, all interviewees acknowledged to recommend PA, whereas few would recommend psychosocial or mind-body interventions. Barriers to recommend interventions to manage CRF included: lack of knowledge about CRF and its treatment, lack of time and complexity of the referral due to their accessibility and cost.

CONCLUSION

In a diverse sample of HCPs, most acknowledged not to address CRF proactively with their patients, but identified several actionable barriers. Specific training on screening and management of CRF and improving the referral network dedicated to interventions need to be implemented.

Stress and coping strategies among allogeneic haematopoietic stem cell transplantation survivors: A qualitative study

OBJECTIVE

The aim of this qualitative study was to explore allogeneic haematopoietic stem cell transplantation (allo-HSCT) survivors' perspectives of stresses and their coping strategies, in order to attain a deeper understanding of their experience.

METHODS

We conducted semi-structured interviews with 20 Japanese allo-HSCT survivors about the stresses they experienced and how they coped. We then conducted a content-driven thematic analysis of the interview results. The interview questions probed stresses and coping strategies related to allo-HSCT.

RESULTS

We identified 74 stresses across 7 domains: symptoms after transplantation, limitations in daily life, appearance changes, relationship anxieties, work impairment and financial issues, uncertainty and disappointed expectations. In addition, 21 coping strategies were identified across 3 domains: direct efforts to manage problems, adaptive attitude, and seeking and using social support.

CONCLUSION

By identifying a broad range of stressors associated with allo-HSCT, insight was gained as to the impact of allo-HSCT on survivors' lives. These results provide a foundation for the future development of resources for survivors, their significant others and clinicians. Stressors and coping strategies among allo-HSCT survivors were comprehensively characterised, which will provide useful information for patients and enable healthcare practitioners to provide better care.

Oncology nurses' experiences of meeting with men with cancer-related fatigue: a qualitative study

BACKGROUND

Cancer treatment often causes side effects, among which fatigue is common and can persist for years among disease-free cancer survivors. Living with fatigue can lead to reduced life expectancy and quality of life.

AIMS AND OBJECTIVES

To describe oncology nurses' experiences of meeting with men with cancer and talking about cancer-related fatigue.

DESIGN AND METHODS

The data were collected via semi-structured interviews with nine oncology nurses recruited using a purposeful sampling method and analysed using thematic content analysis. This qualitative design was conducted to describe and interpret the content of experiences.

ETHICAL ISSUES AND APPROVAL

The study was approved by a regional Ethical Review Board, and research ethical principles were followed.

RESULTS

The analysis revealed one major theme, namely take the whole person into consideration, and three subthemes: the importance of (i) establishing trust in the nurse-patient relationship, (ii) supporting the patient's understanding of cancer-related fatigue, and (iii) managing the challenging emotions experienced by patients. The major theme describes the oncology nurses' approach when meeting with men with cancer-related fatigue.

CONCLUSION

The results provide insight into how oncology nurses can increase their knowledge about fatigue to establish trust in nurse-patient relationships. They can acquire knowledge about how to make men with cancer-related fatigue feel safe when handling their daily lives despite their fatigue. Oncology nurses require knowledge, presence and commitment in their interactions with men with cancer-related fatigue to be able to take the whole person into consideration. This study demonstrates the importance of the approach oncology nurses take when interacting with men with cancer-related fatigue and the strategies required when talking about cancer-related fatigue.

Open Wounds and Healed Scars: A Qualitative Study of Elderly Women's Experiences With Breast Cancer

BACKGROUND

Breast cancer is more prevalent among women 60 years or older than among women younger than 60 years. However, we know much more about the breast cancer experiences of younger women than of older women. Such knowledge is important, for example, to guide treatment decisions or to provide psychosocial care.

OBJECTIVE

The aim of this study was to gain insight into the experiences of women with breast cancer 70 years or older.

METHODS

Semistructured interviews were conducted with 21 older patients with breast cancer in the Netherlands. We used open coding and affinity diagramming to evoke the themes reflecting the experiences of these women.

RESULTS

Four themes emerged from the data: living through and coping with breast cancer, information exchange and informed choice, support experiences, and impact on daily life. Getting breast cancer took some women by surprise. However, older women with breast cancer coped fairly well and were satisfied with the support they received, especially from oncology nurses. Disturbing treatment adverse effects and changes in appearance, comorbid diseases, lack of clear information, and/or an unsupportive environment complicated their living with breast cancer.

CONCLUSIONS

Even though many older women with breast cancer handle their disease rather well, some women do encounter difficulties. Lack of support, comorbid diseases, and treatment adverse effects warrant extra attention.

IMPLICATIONS FOR PRACTICE

Nurses' close attention to women at risk and early intervention could help relieve individual suffering, while taking these womens' strengths into account can enhance self-management.

Beneficios de un programa grupal de tratamiento no farmacológico en el afrontamiento del cáncer en mujeres españolas. Una síntesis cualitativa

Resumen En el presente trabajo se analizan los beneficios de un programa grupal de tratamiento no farmacológico realizado por la Asociación Española contra el Cáncer en Galicia (España). Se analizaron 14 ediciones del programa en las que participaron 361 mujeres con cáncer de edades comprendidas entre los 33 y los 82 años. Se adoptó un diseño descriptivo de carácter etnográfico triangulando las técnicas de análisis y las fuentes de recogida de datos por medio de un cuestionario de satisfacción, 32 entrevistas en profundidad y un grupo de discusión con profesionales. Los resultados apoyan la idea de que el programa grupal analizado ha conseguido un elevado grado de satisfacción entre las mujeres participantes en todas las ediciones, ha favorecido la aceptación y el afrontamiento positivo de la enfermedad, aumentado los conocimientos y las habilidades para resolver los problemas relacionados con el proceso, así como promovido las relaciones sociales, la participación en la comunidad y el apoyo social. Desde el punto de vista práctico y profesional, nuestro estudio evidencia la importancia de diseñar e implementar programas grupales desde el ámbito psicosocial y con carácter interdisciplinar que permitan mejorar las estrategias de afrontamiento y el apoyo en poblaciones de mujeres diagnosticadas de cáncer.

Exercise: A positive feature on functioning in daily life during cancer treatment - Experiences from the Phys-Can study

PURPOSE

Impaired functioning due to cancer treatment is a challenge for daily life. Exercise during treatment can improve functioning. However, research describing experiences of how exercise affects activities of daily life is limited. We aimed to explore how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life.

METHODS

Twenty-one participants were recruited from Phys-Can, an exercise intervention study. Semi-structured interviews were conducted after the intervention had finished, and data was analysed using thematic analysis.

RESULTS

Two main themes evolved: "Striving to maintain a normal life in a new context" and "Struggling with impairments from side effects of cancer treatment". The supervised group exercise proved popular, and participants reported positive effects on physical and psychological functioning, as well as social and informative support from other participants. Participants struggled with impaired cognitive and physical functioning and exhaustion. They strove to maintain a normal life by adjusting their activities.

CONCLUSIONS

Perceived physical and psychological benefits from exercise during cancer treatment suggest that exercise should be a part of cancer rehabilitation to facilitate activities and participation in daily life. Striving to maintain a normal life during cancer treatment is vital, and adjustments are needed to maintain activities and participation in daily life. Cancer nurses should motivate patients to engage in physical activity and encourage the introduction of exercise as part of their rehabilitation. They could also support patients in making adjustments to maintain functioning in daily life.

Process evaluation of a tailored work-related support intervention for patients diagnosed with gastrointestinal cancer

Purpose

To perform a process evaluation of a tailored work-related support intervention for patients diagnosed with gastrointestinal cancer.

Methods

The intervention comprised three tailored psychosocial work-related support meetings. To outline the process evaluation of this intervention, we used six key components: recruitment, context, reach, dose delivered, dose received and fidelity. Data were collected using questionnaires, checklists and research logbooks and were analysed both quantitatively and qualitatively.

Results

In total, 16 hospitals, 33 nurses and 7 oncological occupational physicians (OOPs) participated. Analysis of the six key components revealed that the inclusion rate of eligible patients was 47%. Thirty-eight intervention patients were included: 35 actually had a first meeting, 32 had a second and 17 had a third. For 31 patients (89%), the first meeting was face to face, as per protocol. However, in only 32% of the cases referred to support type A (oncological nurse) and 13% of the cases referred to support type B (OOP), the first meeting was before the start of the treatment, as per protocol. The average duration of the support type A meetings was around the pre-established 30 min; for the OOPs, the average was 50 min. Protocol was easy to follow according to the healthcare professionals. Overall, the patients considered the intervention useful.

Conclusions

This study has shown that the strategy of tailored work-related support is appreciated by both patients and healthcare professionals and applicable in clinical practice.

Implications for Cancer survivors

The intervention was appreciated by patients; however, whether the timing of the work-related support was adequate (i.e. before treatment was started) requires further research.

Trial registration

NTR5022.

Electronic supplementary material

The online version of this article (10.1007/s11764-019-00797-3) contains supplementary material, which is available to authorized users.

Experiencing and responding to chronic cancer-related fatigue: A meta-ethnography of qualitative research

Objective

One of the most prevalent and disrupting symptoms experienced by cancer patients is chronic cancer‐related fatigue (CCRF). A better understanding of the chronic nature of CCRF can provide valuable insights for theory and practice. The purpose of this meta‐ethnography was to derive an overarching interpretative narrative on patients' experiences and responses to CCRF.

Methods

We conducted a comprehensive systematic literature search in five databases (05‐03‐2018). In addition, papers from reference lists were retrieved. Two researchers independently screened the papers for eligibility and appraised quality (CASP‐criteria). We followed the seven phases of meta‐ethnography to extract, translate, and synthesise first‐order constructs (ie, patients' views) and second‐order constructs (ie, authors' views) from the selected studies into third‐order constructs (ie, new interpretations).

Results

Of the 1178 collected articles, 16 articles were included. Through synthesis, a new figure of six interrelated third‐order constructs was developed: (1) embodied experience entails the dominating presence of the body; (2) (mis)recognition includes lack of recognition of CCRF by patients, relatives, and health providers; (3) small horizon describes a resultant narrowed world; (4) role change encompasses adopting other life roles; (5) loss of self refers to the impact on one's identity; and (6) regaining one's footing describes the struggle against CCRF, adaptation to CCRF and finally acceptance of a “new normal with CCRF.”

Conclusion

A new embodiment figure of CCRF with social (eg, (mis)recognition), spatial (eg, small horizon) and temporal dimensions (eg, regaining one's footing) was developed. This figure can help professionals to recognise CCRF, inform patients, and personalise treatment.

Cancer Survivors' Experiences and Explanations of Postcancer Fatigue: An Analysis of Online Blogs

BACKGROUND

Postcancer fatigue (PCF) is a form of chronic fatigue that is very common and can persist for years among disease-free cancer survivors. Despite this, PCF remains underreported and often goes untreated.

OBJECTIVE

The aim of this study is to explore PCF from the perspective of cancer survivors via online blogs, with a focus on their experiences and personal explanations of PCF.

METHODS

An online search identified 15 recent blogs written by cancer survivors who specifically discussed their PCF. Thematic analysis was used to analyze blog content.

RESULTS

Bloggers explained PCF as a severe and unpredictable symptom in their lives. They identified anxiety, emotional trauma, and cancer side effects to be the key causal factors of their PCF. Coping strategies adopted by bloggers included diet, exercise, acceptance and reducing workload to manage their fatigue.

CONCLUSIONS

Online blogs are a rich source of qualitative data that can give unique insight into issues faced by cancer survivors. Bloggers' accounts confirmed that PCF is a complex issue that can be a significant source of frustration in their everyday lives. This study highlighted that bloggers with PCF appear to have some coping strategies and understanding of PCF, yet these are not always consistent with current medical and psychological knowledge.

IMPLICATIONS FOR PRACTICE

This study has demonstrated that blogs can offer valuable information to existing knowledge of cancer survivors' experiences and explanations of PCF. The findings may assist healthcare professionals with educating patients about PCF and with increasing the legitimacy, awareness, and understanding of PCF.

The psychosocial issues of women with cancer of the vulva

Background

Cancer of the vulva is rare, it is a disease commonly diagnosed in elderly women, however, the incidence in younger women is rising. Many patients diagnosed and treated for vulval cancer face physical, social, sexual and psychological challenges. It is essential that therapy radiographers and members of the wider multidisciplinary team understand such challenges in order to provide patient centred care.

Aim

This review aims to highlight the key psycho-social issues experienced by patients with cancer of the vulva, identifying implications for practice in order to improve the holistic care for this patient group.

Method

A search of English literature was performed using Medline, Pubmed, CINAHL and PsycINFO. Search terms included, vulva or vulval cancer, psychosocial, psychosexual impact and quality of life. Articles were excluded if they focussed on cancers other than gynaecological and vulval cancers.

Results and Conclusions

Although there are numerous reports on the psychological and psychosocial problems faced by gynaecological cancer patients; there was a paucity of literature pertaining to patients with cancer of the vulva, this is consistent with previous research. Studies show a significant negative, psychosocial impact experienced by these women. Common themes being isolation, loneliness, stigmatisation and lack of information for patients and their carers, themes spanning over three decades. Nevertheless, it is important to be aware of the findings from recent studies consistent with patient’s needs, highlighting that listening to women’s narratives on living with cancer of the vulva is essential if we are to help with the psychosocial issues experienced by these women. They underline a necessity to raise awareness among healthcare professionals and the general public, to improve holistic support for this particular group of women. This is particularly important in the radiotherapy setting as many of these women undergo lengthy courses of treatment and the appropriately trained therapeutic radiographer can play a vital role in addressing the physical and psychosocial problems.

Living life precariously with rheumatoid arthritis - a mega-ethnography of nine qualitative evidence syntheses

Background

Rheumatoid arthritis is an autoimmune disease that causes joint inflammation. It affects around 400,000 people in the UK and 1 million adults in the USA. Given the appropriate treatment, many can have relatively few symptoms. It is therefore important to understand what it is like to live with rheumatoid arthritis and gain insight into peoples’ decisions about utilising healthcare. The aims of this study were: (1) to bring together qualitative evidence syntheses that explore patients’ experience of living with rheumatoid arthritis and (2) develop a conceptual understanding of what it is like to live with rheumatoid arthritis.

Methods

We used the methods of mega-ethnography. The innovation of mega-ethnography is to use conceptual findings from qualitative evidence syntheses as primary data. We searched four bibliographic databases from inception until September 2018 to identify qualitative evidence syntheses that explored patients’ experience of rheumatoid arthritis.

Results

We identified 373 qualitative evidence syntheses, removed 179 duplicates and screened 194 full text studies. We identified 42 qualitative evidence syntheses that explored the experience of pain or arthritis and 9 of these explored the experience of rheumatoid arthritis. We abstracted ideas into 10 conceptual categories: (1) rheumatoid arthritis is in control of my body (2) rheumatoid arthritis alters reciprocity; (3) rheumatoid arthritis is an emotional challenge; (4) rheumatoid arthritis disrupts my present and future self; (5) the challenge of balancing personal and work life; (6) I am trying to make sense of what is happening; (7) rheumatoid arthritis is variable and unpredictable; (8) rheumatoid arthritis is invisible; (9) I need a positive experience of healthcare, and (10) I need to reframe the situation. We developed a conceptual model underpinned by living life precariously with rheumatoid arthritis.

Conclusions

This is the second mega-ethnography, or synthesis of qualitative evidence syntheses using the methods of meta-ethnography. Future research should consider the proliferation of qualitative evidence synthesis in order to avoid duplication of research effort. Our model for rheumatoid arthritis has some important clinical implications that might be transferable to other musculoskeletal conditions.

Electronic supplementary material

The online version of this article (10.1186/s41927-018-0049-0) contains supplementary material, which is available to authorized users.

The Experience of Fatigue in Breast Cancer Patients 1-12 Month Post-Chemotherapy: A Qualitative Study

The study explored the experience of fatigue, its effects and ways of coping with fatigue and the role of family and social support among breast cancer patients. In-depth, semi-structured interviews were conducted with 13 breast cancer patients stages I-III, aged 34-67, who were up to one year after the termination of chemotherapy. Two main themes emerged: "Being imprisoned in the body of an 80-year-old," focuses the fatigue experienced by younger and older women, during and post treatment, including the different patterns of fatigue and the various means of coping with fatigue; The "Family's bear-hug" exemplifies the role of the environment in coping with the experience of fatigue and the complexities entailed in receiving support from family and friends. The study provides a comprehensive picture of fatigue in its various contexts during and post-treatment and its impact on family relations and quality of life among younger and older breast cancer patients.

Experiences of newly diagnosed cancer patients in confronting the finitudes of life: a qualitative systematic review protocol

REVIEW QUESTION

What is the experience of newly diagnosed patients with cancer when facing the finitude of life and undergoing initial anti-cancer treatment?

Barriers to empathy-based care: oncology nurses' perceptions

Purpose The purpose of this paper is to explore oncology nurses' barriers to empathy-based care perceptions. Design/methodology/approach The authors used a descriptive qualitative method. In total, 18 oncology nurses were selected via purposive sampling. Data were collected through in-depth interviews and qualitative content analysis using an inductive approach. Findings Three main categories emerged from the data analysis: barriers related to nursing including: lacking compassion; disinterest in oncology nursing and self-criticism; psychological distress; barriers related to healthcare: job strain; task-centeredness; no formal training; poor manager support; nurse-patient gender imbalance; and barriers related to cancer care including: difficulty maintaining empathy with cancer patients; and inappropriate cancer patient Practical implications Oncology nurses provided insights into barriers to empathy-based care and the challenges they encountered while caring for cancer patients. Understanding these barriers is the first step to overcoming obstacles and creating an open and caring environment to provide an empathic care culture. Originality/value Given that oncology nurses experience several emotions, positive coping strategies for these distresses should be adopted. Healthcare systems should change cancer-caring culture from task-centered to patient-centered care. Compassion and empathy should become patient care values.

Alternative Exercise Traditions in Cancer Rehabilitation

Alternative exercise traditions (AETs) such as Pilates, yoga, Tai Chi Chuan, Qigong, and various forms of dance offer the potential to improve diverse outcomes among cancer survivors by reducing adverse symptoms and mood disorders, and by enhancing function. Additionally AETs have emerged as a potential means to address deficits in current disease-focused care delivery models which are marked by prevalent under-treatment of symptoms and physical impairments. Relative to therapeutic exercise in allopathic models, many AETs are comparatively affordable and accessible. AETs have the further potential to simultaneously address needs spanning multiple domains including social, physical, and psycho-emotional. AETs additionally offer the salient benefits of promoting integrated whole body movement and concurrently enhancing strength, coordination, balance, posture, flexibility, and kinesthetic awareness. Despite AETs' benefits, compelling concerns leave many clinicians ambivalent and reluctant to endorse or even discuss them. One issue is the extensive heterogeneity across and even within specific AETs. An additional concern is that the one-size-fits-many nature of AET group classes undermines an instructor's capacity to individualize dose, type, frequency, and intensity, which are cornerstones of effective therapeutic exercise. Inconsistencies in AET practitioner expertise and certification, as well as the extent of practitioner familiarity with vulnerabilities unique to cancer populations, may also be problematic. At this juncture, an extensive literature of inconsistent quality that spans diverse cancer populations frustrates efforts to precisely determine the effect size of any specific AET in improving a specific outcome; Although systematic reviews and meta-analyses have concluded that AETs have beneficial effects, they consistently identify a high risk of bias in a majority of trials related to a lack of blinding, poor allocation concealment, small sample sizes, and incomplete outcome data.

Measuring the Psychosocial Dimensions of Quality of Life in Patients With Advanced Cancer: Psychometrics of the German Quality of Life at the End of Life-Cancer-Psychosocial Questionnaire

CONTEXT

Quality of life (QoL) is a central focus of care in advanced cancer. Specialized instruments, such as the Quality of Life at the End of Life-Cancer (QUAL-EC), may be useful to assess psychosocial issues associated with QoL unique to this population.

OBJECTIVES

To evaluate the measurement of the psychosocial dimensions of QoL using the German translation of the QUAL-EC-Psychosocial (QUAL-EC-P) questionnaire, including factor structure and psychometrics.

METHODS

About 183 patients with advanced cancer from the University Medical Center Hamburg-Eppendorf and University Medical Center Leipzig completed the QUAL-EC-P questionnaire. We conducted exploratory factor analysis as well as item and reliability analysis. We examined convergent validity with correlations between the scale and relevant psychological constructs.

RESULTS

The sample was 60% female with mean age of 57.7 (SD = 11.7). We extracted three factors accounting for 44% of the variance aligning with the structure of the instrument. The QUAL-EC-P questionnaire showed good to acceptable internal consistency for the QoL-psychosocial total score (α = 0.77), the Life completion subscale (α = 0.77), and the Relationship with health care provider subscale (α = 0.81). The Preparation for end of life subscale had adequate albeit low internal consistency (α = 0.64) because concerns about family were less associated with financial worry and fear of death than expected. The psychosocial dimensions of QoL correlated negatively with depression (r = -0.27, P ≤ 0.001), anxiety (r = -0.32, P ≤ 0.001), demoralization (r = -0.63, P ≤ 0.001), and attachment insecurity (r = -0.51, P ≤ 0.001) and positively with spiritual well-being (r = 0.63, P ≤ 0.001).

CONCLUSION

The QUAL-EC-P questionnaire may be used to assess the psychosocial aspects of QoL and promote their clinical discussion in patients with advanced cancer.

The Experience of Adolescents and Young Adults Treated for Cancer in an Adult Setting: A Review of the Literature

The purpose of this review is to explore the literature on the experience of adolescents and young adults (AYAs) having cancer treatment in an adult setting, rather than on a specialist adolescent cancer unit. The integrative review method was used to explore the current literature. Primary research on the topic was located systematically and then synthesized into a thematic narrative. The experience of AYAs undergoing treatment in an adult setting was generally negative. This can be attributed to three themes: feeling isolated in the adult setting; the lack of empathy from staff working in the adult setting; and the inappropriateness of the adult environment for this age group. As many AYAs with cancer will continue to have treatment in adult settings, staff working in this environment should be aware of the negative experience of this cohort and the impact this can have on a vulnerable group of patients. Staff could consider simple ways of improving the AYA experience, such as connecting AYA patients with their peers to reduce isolation; adapting their approach to take account of the unique emotional needs of this age group; and considering ways of making the environment more welcoming and age-appropriate.

Occupational Therapy's Role in Cancer Survivorship as a Chronic Condition

Improved medical care has resulted in a documented increase in cancer survivors in the United States. Cancer survivors face challenges in participation across all facets of life as a result of the cancer and subsequent cancer treatments. Long-term and late-term sequelae can result in impairments in neurological systems, decreased stamina, loss of range of motion, and changes in sensation and cognition. These impairments are often long lasting, which categorizes cancer survivorship as a chronic condition. This categorization presents treatment challenges, especially in creating rehabilitation and habilitation service options that support cancer survivors. Occupational therapy provides a unique focus that can benefit cancer survivors as they face limitations in participation in all aspects of daily living. Research, advocacy, and education efforts are needed to focus on the specific rehabilitation and habilitation needs of cancer survivors to increase access to occupational therapy's distinct value.

Chemotherapy-Induced Neuropathy in Cancer Survivors

CONTEXT

Evidence suggests that chemotherapy-induced neuropathy (CIN) is a significant problem for cancer survivors. However, a detailed phenotypic characterization of CIN in cancer survivors is not available.

OBJECTIVES

To evaluate between-group differences in demographic and clinical characteristics, as well as in measures of sensation, function, and postural control, in a sample of cancer survivors who received a platinum and/or a taxane-based CTX regimen and did (n = 426) and did not (n = 197) develop CIN.

METHODS

Survivors completed self-report questionnaires and underwent objective testing (i.e., light touch, pain sensation, cold sensation, vibration, muscle strength, grip strength, Purdue Pegboard test, Timed Get Up and Go test, Fullerton Advanced Balance test). Parametric and nonparametric statistics were used to compare between-group differences in study outcomes.

RESULTS

Of the 426 survivors with CIN, 4.9% had CIN only in their upper extremities, 27.0% only in their lower extremities, and 68.1% in both their upper and lower extremities. Demographic and clinical characteristics associated with CIN included the following: older age, lower annual income, higher body mass index, a higher level of comorbidity, being born prematurely, receipt of a higher cumulative dose of chemotherapy, and a poorer functional status. Survivors with CIN had worse outcomes for all of the following objective measures: light touch, pain, temperature, vibration, upper and lower extremity function, and balance.

CONCLUSIONS

This study is the first to provide a detailed phenotypic characterization of CIN in cancer survivors who received a platinum and/or a taxane compound. These data can serve as a benchmark for future studies of CIN in cancer survivors.

Effects of an interactive mHealth innovation for early detection of patient-reported symptom distress with focus on participatory care: protocol for a study based on prospective, randomised, controlled trials in patients with prostate and breast cancer

Background

Cancer patients are predominantly treated as out-patients and as they often experience difficult symptoms and side effects it is important to facilitate and improve patient-clinician communication to support symptom management and self-care. Although the number of projects within supportive cancer care evaluating mobile health is increasing, few evidence-based interventions are described in the literature and thus there is a need for good quality clinical studies with a randomised design and sufficient power to guide future implementations. An interactive information and communications technology platform, including a smartphone/computer tablet app for reporting symptoms during cancer treatment was created in collaboration with a company specialising in health care management. The aim of this paper is to evaluate the effects of using the platform for patients with breast cancer during neo adjuvant chemotherapy treatment and patients with locally advanced prostate cancer during curative radiotherapy treatment. The main hypothesis is that the use of the platform will improve clinical management, reduce costs, and promote safe and participatory care.

Method

The study is a prospective, randomised, controlled trial for each patient group and it is based on repeated measurements. Patients are consecutively included and randomised. The intervention groups report symptoms via the app daily, during treatment and up to three weeks after end of treatment, as a complement to standard care. Patients in the control groups receive standard care alone. Outcomes targeted are symptom burden, quality of life, health literacy (capacity to understand and communicate health needs and promote healthy behaviours), disease progress and health care costs. Data will be collected before and after treatment by questionnaires, registers, medical records and biomarkers. Lastly, participants will be interviewed about participatory and meaningful care.

Discussion

Results will generate knowledge to enhance understanding about how to develop person-centred care using mobile technology. Supporting patients’ involvement in their care to identify problems early, promotes more timely initiation of necessary treatment. This can benefit patients treated outside the hospital setting in regard to maintaining their safety.

Clinical trial registration

June 12 2015 NCT02477137 (Prostate cancer) and June 12 2015 NCT02479607 (Breast cancer).

The social trajectory of brain tumor: a qualitative metasynthesis

PURPOSE

Research indicates that strong social ties can buffer the adverse effects of chronic illness on psychological well-being. Brain tumor typically leads to serious functional impairments that affect relationships and reduce social participation. This metasynthesis aimed to identify, appraise and integrate the findings of qualitative studies that reveal the impact of brain tumor on social networks.

METHODS

Four major databases (PubMed, CINAHL, Cochrane Library and PsycINFO) were systematically searched from inception to September 2016 for qualitative studies that reported findings on the impact of primary brain tumor on social networks during adulthood. Twenty-one eligible studies were identified and appraised according to the Consolidated Criteria for Reporting Qualitative Research. Key findings of these studies were integrated to form superordinate themes.

RESULTS

The metasynthesis revealed the core themes of: 1) Life disrupted; 2) Navigating the new reality of life; and 3) Social survivorship versus separation.

CONCLUSIONS

Multiple changes typically occur across the social trajectory of brain tumor, including a loss of pre-illness networks and the emergence of new ones. Understanding the barriers and facilitators for maintaining social connection may guide interventions for strengthening social networks and enhancing well-being in the context of brain tumor. Implications for rehabilitation Social networks and roles are disrupted throughout the entire trajectory of living with brain tumor Physical, cognitive and psychological factors represent barriers to social integration Barriers to social integration may be addressed by supportive care interventions Compensatory strategies, adjusting goals and expectations, educating friends and family and accepting support from others facilitate social reintegration throughout the trajectory of living with brain tumor.

Symptom clusters in patients receiving haemodialysis: a systematic review of observational studies

AIMS AND OBJECTIVES

To systematically review the common composition and the analytical methods performed to derive symptom clusters in patients receiving haemodialysis, and to examine their common predictive and outcome variables.

BACKGROUND

Patients receiving haemodialysis may suffer from multiple and interactive symptoms simultaneously, which may impact their mortality, morbidity and quality of life. The composition of these symptom clusters varies depending on the different assessment tools, the variant evaluation timing points and the various statistical methodologies. A detailed review of existing studies is needed.

DESIGN

A systematic review of observational studies.

METHODS

Medline from 1950, CINAHL from 1960, Embase from 1980 and PsycINFO from 1967 as well as additional sources were searched. Content analysis was conducted to identify articles assessing the interrelationships of multiple symptoms.

RESULTS

Five studies were identified. Several symptom clusters were identified with five common groupings being uraemic cluster, neuromuscular cluster, skin cluster, gastrointestinal cluster and energy/fatigue cluster. Four studies performed the principal component analysis with varimax rotation to extract symptom clusters and one study used correlation analysis. Different symptom assessment tools were used and each involving different array of symptoms. The predictive and outcome variables of symptom clusters also varied considerably. No studies have examined the longitudinal course and patients' subjective experiences of symptom clusters.

CONCLUSIONS

Inconsistencies in the composition of symptom clusters across studies were identified due to inconsistencies in symptom assessment tools and statistical methodologies. Future studies should focus on an agreement about a robust and clinically relevant definition on symptom clusters; a multidimensional, valid and reliable symptom assessment tool; and an optimal analytical method in patients receiving haemodialysis.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of symptom clusters may contribute to understanding the aetiology and pathophysiology of multiple concurrent and interactive symptoms in patients receiving haemodialysis and exploring the effects of these symptoms on clinical outcomes.

Empathy, Burnout, Demographic Variables and their Relationships in Oncology Nurses

INTRODUCTION

Development of nurse-patient empathic communication in the oncology ward is of great importance for the patients to relieve their psychological stress, however, nursing care of cancer patients is accompanied with high stress and burnout. The present study aimed to define the level of empathy and its association with burnout and some demographic characteristics of oncology nurses.

MATERIALS AND METHODS

This descriptive/correlation study was conducted in a professional cancer treatment center in Isfahan. Through census sampling, 67 oncology nurses were selected. The data collection tools were Jefferson Scale of Nursing Empathy, Maslach Burnout Inventory, and demographic characteristics questionnaire.

RESULTS

Mean nurses' empathy and overall burnout scores were 62.28 out of 100 and 38.8 out of 100, respectively. Score of empathy showed an inverse correlation with overall burnout score (r = -0.189, P = 0.04), depersonalization (r = -0.218, P = 0.02), and personal accomplishment (r = -0.265, P = 0.01). Multiple regression test was used to detect which dimension of burnout was a better predictor for the reduction of empathy score. Results showed that the best predictors were lack of personal accomplishment (P = 0.02), depersonalization (P = 0.04), and emotional exhaustion (P = 0.14), respectively. The most influential demographic factor on empathy was work experience (r = 0.304, P = 0.004). One-way analysis of variance showed that official staff had a higher empathy score (f = 2.39, P = 0.045) and their burnout was lower (f = 2.56, P = 0.04).

CONCLUSIONS

Results showed a negative relationship between empathy and burnout in oncology nurses. Therefore, nursing support from managers to reduce burnout increases empathic behavior of nurses.

Cancer-related fatigue in post-treatment cancer survivors: application of the common sense model of illness representations

BACKGROUND

Cancer-related fatigue (CrF) is a common and disruptive symptom that may be experienced during and after cancer. Research into the subjective experience of fatigue in this group is required. The common sense model of self-regulation of health and illness (SRM) addresses personal beliefs or mental representations-whether medically sound or unsubstantiated- that a person holds about a health issue. The current study assesses if the SRM could be used as a theoretical framework for organizing the experiences of people with CrF, with a view to identifying methods to address fatigue in cancer survivors.

METHOD

Four focus groups were held with a total of 18 cancer survivors who reported they experienced 'significant fatigue or reduced energy.' A thematic analysis was conducted within the framework of the SRM.

RESULTS

Findings were aligned with the SRM, with participants discussing fatigue with reference to representation, coping, and appraisal of symptoms. In particular, the wider social context of CrF was frequently addressed. Perceived inadequacies in support available to those with lingering fatigue after the completion of cancer treatment were highlighted by the participants.

CONCLUSION

This study explored the subjective experience of fatigue after cancer using the SRM. CrF should be approached as a complex psychosocial issue and considered from the patient perspective to facilitate better understanding and management of symptoms. The SRM is an applicable framework for identifying modifiable factors that could lead to improved coping with CrF in post-treatment cancer survivors.

'It gets into your head as well as your body': The experiences of patients with cancer during oncology treatment with curative intent

This study explored the psychosocial experiences of patients with cancer during the course of oncology treatment with curative intent. Our aim was to gather in-depth insights into the shared elements of oncology treatment across a range of cancer types. A total of 10 individuals undergoing oncology treatment participated in semi-structured interviews. Six themes were identified using interpretative phenomenological analysis: diminished well-being, perceived role changes in intimate relationships, heightened awareness of limited time, a new order of priorities, taking things as they come and development of trust in health professionals. These themes indicate relevant areas of patients' well-being, which might be enhanced through psychosocial support services.