Nature-based experiences and health of cancer survivors

Biofeedback-Based Proprioceptive Training to Improve Functional Prerequisites of Dragon Boating in Breast Cancer Survivors

Breast cancer (BC)-related sequelae drastically impact the psychophysical functioning and quality of life of affected women. Adapted physical activity (APA) has proved to effectively counteract these impairments in a non-medicalized framework. In particular, dragon boats are able to promote body functionality, social interaction, and quality of life in BC survivors, but the literature on specific motor gestures is scarce and practice is still based more on a re-educative perspective than a performative one. In this context, the present longitudinal study investigated the benefits of an adapted biofeedback-based sensorimotor training intervention on upper body functionality in a team of dragon ladies. The 8-week intervention was conceived as integrated dry workout sessions led by an APA kinesiologist and applied a novel sensorized proprioceptive device, such as a Libra board. Post-protocol evaluation revealed a significant improvement in bilateral upper limb mobility, core endurance, and trunk stability along with a distress decrease and quality of life enhancement through validated assessment tools. Our findings suggest that integrating biofeedback-based workout sessions can effectively promote upper body functionality in BC survivors practicing dragon boating. Furthermore, our innovative approach could help spread methodological hints able to boost exercise adherence in this target population, thus counteracting cancer recurrence while promoting overall well-being.

Implementation of a Mindful Walking Intervention in Breast Cancer Patients After Their Primary Oncologic Treatment: Results of a Qualitative Study Within a Randomized Controlled Trial

BACKGROUND

Breast cancer survivors often suffer from diagnosis- and therapy-related long-term side effects, such as cancer related fatigue, restricted stress resilience and quality of life. Walking as a physical activity and mindfulness practice have been shown to be helpful in studies. The aim of this study was to compare the individual experiences and subjectively perceived effects of walking in combination with mindfulness practice with moderate walking alone in breast cancer patients. This paper focuses on the qualitative results of a mixed-methods pilot study.

METHODS

Breast cancer patients who had finished their primary oncologic treatment at least 6 months ago were randomized to an 8-week group intervention program of either mindful walking or moderate walking. Within the qualitative study part, semi-structured focus group interviews (2 interviews per study arm) were conducted and analyzed using a qualitative content analysis approach. Audio recorded interviews were transcribed verbatim and pseudonymized. The subsequent data analysis was performed by using MAXQDA®.

RESULTS

A total of 51 women (mean age 55.8 [SD 10.9] years) were included in the RCT, among these 20 (mean age 56.7 [SD 12.0] years) participated in the focus group interviews (n = 11 patients of the mindful walking group; n = 9 patients of the walking group). Breast cancer patients in both groups described different effects in the complex areas of self-efficacy, coping, body awareness and self-reflection. While mindful walking primarily promoted body awareness and inner strength by mindfulness in breast cancer patients, moderate walking promoted self-efficacy by a confidence of their body and an easily integrated and accepted way of physical activity.

CONCLUSIONS

Study interventions and the study setting triggered processes and reflections on one's own health and situation. However, mindful walking and moderate walking seem to address different resources. This important knowledge may help oncologists and other therapists to assess what type of interventions can best meet the needs and requirements of individual patients.

TRIAL REGISTRATION

DKRS00011521; prospectively registered 21.12.2016; https://drks.de/search/de/trial/DRKS00011521.

Benefits of nature-based walking for breast cancer survivors

INTRODUCTION

Physical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits for cancer survivors, the role of the environment in achieving optimal outcomes has yet to be determined. This paper presents a protocol for a clinical trial to evaluate the feasibility of a 3-month nature-based walking programme for breast cancer survivors. Secondary outcomes assessed include the impact of the intervention on fitness, quality of life outcomes, and biomarkers of ageing and inflammation.

METHODS AND ANALYSIS

The trial is a 12-week single-arm pilot study. Twenty female breast cancer survivors will engage in a supervised moderate intensity walking intervention in small groups in a nature reserve for 50 minutes three times per week. Data will be collected at baseline and end of study, and include assessment of inflammatory cytokines and anti-inflammatory myokines (TNF-α, IL-1ß, IL-6, CRP, TGF-ß, IL-10, IL-13), as well as ageing (DNA methylation, ageing genes) biomarkers; surveys (Patient-Reported Outcomes Measurement Information System-29, Functional Assessment of Cancer Therapy-General, Post-Traumatic Growth Inventory); and fitness assessments (6 min Walk Test, Grip-Strength, One Repetition-Maximum Leg Press). Participants will also complete weekly surveys assessing social support and participate in an exit interview. This is an important first step for future research on the influence of exercise environment on cancer survivor PA outcomes.

ETHICS AND DISSEMINATION

This study was approved by the Cedars Sinai Medical Center Institutional Review Board (IIT2020-20). Findings will be disseminated through academic manuscripts, conferences, and community presentations.

TRIAL REGISTRATION NUMBER

NCT04896580.

Nature-Based Interventions and Exposure among Cancer Survivors: A Scoping Review

BACKGROUND AND PURPOSE

nature-based interventions (NBI) have been shown to have positive effects on physical, psychological, social, and spiritual health. The purpose of this scoping literature review was to describe what is known regarding the cancer survivor experience in relationship to their interaction with the natural environment. Description/methods: this review was completed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The research strategy included a combination of these terms: cancer, neoplasms, nature, and forest therapy. The articles were blinded and screened by four independent researchers. A total of twelve articles were selected. Outcome/results: a total of 2786 cancer survivors participated in the twelve studies with multiple types and stages of cancer represented. The studies used multiple designs and measures. Results showed improvements in anxiety, depression, sleep, connectedness, stress, tension, confusion, fatigue, and pain. Participants reported that nature was the most important resource in coping with their cancer.

CONCLUSIONS AND IMPLICATIONS

nature is beneficial for cancer survivors while they experience cancer diagnosis and treatment. Nature opportunities can be feasibly delivered with this population and need to be explored further and safely implemented to support the overall health and well-being of cancer survivors.

A Quasi-experimental of a Virtual Reality Content Intervention for Level of Comfort of Indonesian Cancer Patients

This study aims to determine the effect of virtual reality content on the comfort level of cancer patients. This study used a quasi-experimental non-equivalent control group design and was conducted on 60 cancer patients. The intervention uses the virtual reality content "My Comfortable Environment," which was developed based on Kolcaba's comfort theory. Comfort level was measured using the Shortened General Comfort Questionnaire. The Wilcoxon and Mann-Whitney U tests were used to determine the differences before and after the intervention within the group and between the study groups. There was a significant mean difference between pre-test and post-test in the intervention group with P < .000, Z = -4.785, and in the control group with P < .041, Z = -2.032. These results indicate that interventions with virtual reality content and guided imagery both affect the comfort level of cancer patients. However, if the test was conducted between groups, there was a significant difference between the intervention group and the control group with a P value of <.000. These results indicate that the virtual reality content intervention can significantly increase the level of patient comfort through modifying various aspects of patient comfort, especially environmental aspects.

Health effects of outdoor water sports in chronic disease: a scoping review

Background

Although outdoor water sport activities are gaining increasing attention for their therapeutic potential in the social and care management of populations with chronic diseases, these practices are currently underutilised. Moreover, the available body of literature on the topic has not been critically and comprehensively assessed yet.

Aims

(1) To appraise the health effects of outdoor water sport activities for chronic disease populations; (2) to preliminarily assess the potential size and scope of the available research literature for this emerging field and identify potential gaps and avenues of development.

Methods

A literature search was performed scanning PubMed (including MEDLINE), Physiotherapy Evidence Database (PEDro) and Scopus from inception to December 2021. A scoping review was carried out by appraising all the available evidence on outdoor water sport interventions specifically designed for therapeutic purposes for individuals with chronic disease. The quality score of each study was calculated with the Tool for the assEssment of Study qualiTy and reporting in Exercise (TESTEX) tool.

Results

Fifteen studies (five RCTs, seven non-RCTs and three CTs with healthy subjects as controls) met the inclusion criteria and were assessed. Among the studies selected, two focused on canoa kayak, one on stand-up paddle, two on surfing, two on sailing activity, and eight on dragon boat padding. The median TESTEX score for study quality and reporting was 6/15, i.e., “very low” (range 5–8). Based on the qualitative analysis, the few individual studies that could be included reported generally positive results, ranging from improvements in antioxidant action and cardiovascular function for dragon boating, to beneficial effects on balance, postural control, and flexibility for on-water paddle board activities. Overall, outdoor water sport interventions were associated to higher rates of adherence than conventional trainings.

Conclusions

Very low to low quality evidence from a limited set of pilot studies seems to suggest beneficial effects of outdoor water sports for chronic disease populations. However, such preliminary findings need to be replicated through large, high-quality RCTs to be conducted in target populations. Avenues of development, scoping directions and translational perspectives for this specific research field are proposed and discussed.

A present from the forest: Focus group interviews on cancer survivors’ forest experiences

Objective

To explore cancer survivors' forest experiences and to understand the relevance of these experiences from their perspectives in the context of the growing interest in nature's impact on health and quality of life.

Methods

From July 29 to August 12, 2021, four focus group interviews were conducted with cancer survivors who visited forests in South Korea. The data were analyzed using qualitative content and thematic analysis.

Results

The participants were 21 female cancer survivors with a mean age of 58.4 (age range 44–69) years. The focus group interviews revealed three themes and 10 sub-themes regarding subjective perceptions and experiences related to forests. The overarching themes were as follows: (1) awakened bodily senses and fascination with the forest; (2) remedial effect; and (3) a source of inspiration. These three themes capture the impact of forest experiences on participants’ lives and the value they derived from these experiences. The participants considered these experiences a gift from forests. In particular, they experienced aesthetic enrichment and restorative effects such as boosted energy levels, reduced fatigue, and a buffer against mood swings. Finally, forests were a source of inspiration that led the participants toward personal growth.

Conclusions

By gaining a better understanding of survivors' forest experiences, we identified that forest-based interventions for supportive cancer care can align with patients’ values and preferences and serve as a secure space where they can feel cared for. This study can contribute to the development of forest-based interventions for cancer survivorship care.

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Cancer survivors experienced awakened bodily senses and fascination with the forest.

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Cancer survivors realized the remedial effects of forests.

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Forests also became sources of inspiration for cancer survivors.

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These results can contribute to the development of forest-based interventions.

Protocol of a mixed-method randomised controlled pilot study evaluating a wilderness programme for adolescent and young adult cancer survivors: the WAYA study

INTRODUCTION

The majority of childhood, adolescent and young adult (AYA) cancer survivors suffer from long-term and late effects such as fatigue, psychological distress or comorbid diseases. Effective health promotion strategies are needed to support the health of this vulnerable group. This protocol provides a methodological description of a study that aims to examine the feasibility and safety of performing a randomised clinical trial (RCT) on a wilderness programme that is developed to support the health of AYA cancer survivors.

METHODS AND ANALYSIS

The pilot RCT study has a mixed-method design, including quantitative and qualitative evaluations. Participants are AYAs, aged 16-39 years, that have been diagnosed with cancer during childhood, adolescence or young adulthood. A total of 40 participants will be randomly assigned to a wilderness programme (n=20) or a holiday programme (n=20). Both arms include participation in an 8-day summer programme, followed by a 4-day programme 3 months later. Primary outcomes are feasibility and safety parameters such as time to recruitment, willingness to be randomised, programme adherence and adverse effects. Secondary outcomes include self-reported health such as self-esteem, quality of life, self-efficacy and lived experiences. Descriptive statistics will be used to analyse outcomes and explore indications of differences between the programmes. Interviews are analysed by directed content analysis and hermeneutic phenomenology. A convergent parallel mixed-method analysis design will be applied to integrate quantitative and qualitative data. Results of this feasibility study will inform the preparation for a larger RCT with AYA cancer survivors.

ETHICS AND DISSEMINATION

The study protocol is approved by the Swedish Ethical Review Authority (reference: 2020-00239). This study will be performed between January 2021 and December 2023. Results will be published in international peer-reviewed journals, presented at conferences and disseminated to participants, cancer societies, healthcare professionals and outdoor instructors.

TRIAL REGISTRATION NUMBER

NCT04761042.

Market Segmentation by Motivations of Urban Forest Users and Differences in Perceived Effects

The purpose of this study aims at segmenting the urban forest users' market by motivation and analyzing the difference in perceived effects of urban forests. Based on a literature review, the study selected seven motivating factors of urban forest users: experiential activity, relaxatin/healing, health management, escape from everday life, daily leisure, affinity toward nature. Data were collected online from 21 to 29 Sepember 2020 with urban forest visitors. We analyzed 878 questionnaires received from those with experience of visiting an urban forest within the previous 24 months. We performed a cluster analysis to classify the subjects according to the characteristics of urban forest utilization, and assigned them to four clusters (rest in nature, family leisure, passive participation, and multiple pursuit). An additional analysis was performed to determine intergroup differences, which revealed differences in perceived benefits and healing effects of urban forests as well as satisfaction. The results of this study provide implications for urban forest operation and strategy setup.

Being and doing in the outdoors brings something extra! Evaluating the Danish Healthy in Nature Project

PURPOSE

Little is known of the potential of using nature and outdoor activities in relation to community-based health promotion programmes. This study seeks a better understanding of how people with mental or chronic physical health problems experience a local outdoor health promotion or rehabilitation programmes and a better understanding of how these programs contribute to the participant's health and well-being.

METHODS

The study is based on data from the Healthy in Nature project targeting adults with chronic physical health problems and adults with mental health problems. Data was collected using a qualitative multiple case study design involving five selected cases with both qualitative interviews and observation. Data was analysed using Braun et al.'s 6-phase guide to qualitative reflexive thematic analysis, employing Self-Determination Theory as a theoretical framework. Results: Overall, the participants in the two groups experienced increased competence, autonomy, and relatedness, and the participants expressed the importance of both being in a natural environment and doing outdoor activities (friluftsliv).

CONCLUSIONS

The study makes a valuable contribution to the field of health promotion and rehabilitation pointing to nature and friluftsliv as important elements that offer great potential to community-based health promotion.

Development and Assessment of a Web-Based National Spatial Data Infrastructure for Nature-Based Solutions and Their Social, Hydrological, Ecological, and Environmental Co-Benefits

Comprehensive datasets for nature-based solutions (NBS), and their diverse relationships have not yet been accumulated into a deployable format. This research describes the development of a novel National Spatial Data Infrastructure (NSDI) system for NBS co-benefits throughout the contiguous United States. Here, we gather and integrate robust geospatial datasets from the social, ecological, environmental, and hydrologic domains using seamless, cloud-based data services to facilitate the trans-disciplinary assessment of NBSs as a function of society and Earth. This research enhances practical decision making and research by assimilating web-based datasets and describing the missing links between national policy and robust adoption of NBSs as a sustainability solution. This NSDI serves to foster participatory planning capabilities and integrate local sustainability goals into decision–support frameworks. Such a platform strengthens the knowledge base necessary for addressing multiple, co-evolving issues of societal relevance, an essential component of fully espousing NBSs within the realm of socio-technological systems and improving policies and implementation regarding sustainable solutions. The efficacy of the proposed platform to serve as a holistic data information system is assessed by exploring important characteristics associated with geospatial NSDI tools, namely, openness, spatial functionality, scalability, and standardization. By placing GIS strengths and weaknesses in the context of transdisciplinary NBSs, we reveal strategic directions toward further co-production of such NSDIs. We conclude with recommendations for facilitating a shared vision of transdisciplinary technologies to strengthen the amalgamation of broad co-benefits and multi-disciplinary influences in sustainability planning.

Impact of Rowing Training on Quality of Life and Physical Activity Levels in Female Breast Cancer Survivors

The aim of this longitudinal study was to determine whether a rowing training program improved the quality of life and the physical activity levels in female breast cancer survivors (n = 28) (stage 1–4.54%; stage 2–36.36%; stage 3–54.54%; and stage 4–4.54%), diagnosed 4.68 ± 3.00 years previously, who had undergone a subsequent intervention (preservation 56.53% and total mastectomy 43.47%) and had a current mean age of 52.30 ± 3.78 years. The participants (n = 28) engaged in a 12-week training program, each week comprising three sessions and each session lasting 60–90 min. The short form of the International Physical Activity Questionnaire (IPAQ-SF) and the Short Form 36 Health Survey (SF-36) were also administered. The results showed statistically significant improvements in levels of physical activity and in the dimensions of quality of life. We can conclude that a 12-week rowing training program tailored to women who have had breast cancer increases physical activity levels, leading to improved health status and quality of life.

Evaluation of a Positive Psychology Group Intervention in Nature for Young Cancer Survivors to Promote Well-Being and Post-Cancer Identity Development

Purpose: Adolescent and young adult (AYA) cancer survivors (15-39 years) often struggle with their post-cancer identity. We developed an age-appropriate positive psychology group intervention with fellow AYA cancer survivors in a nature-rich environment. The aim of this study was to examine the needs and expectations of participants of this new, 1-week post-cancer identity intervention, and to evaluate their experiences to identify factors that contribute to the quality and impact of post-cancer mental health care interventions. Methods: This was a mixed-method exploratory pilot study evaluating a new, 1-week post-cancer identity intervention. The participants (n = 13) completed questionnaires at baseline measuring needs and expectations, and on the last day of the intervention and at 1-month follow-up, measuring experiences. Results: Participants' expectations to be supported in finding their post-cancer identity and receiving acknowledgment and recognition of their suffering in fellow AYAs were met. The intervention was perceived as positively contributing to post-cancer identity development (n = 11) and several aspects of well-being. Most appreciated elements of the intervention were peer support and the nature-rich environment on perceived well-being. Conclusion: The group-based positive psychology after care intervention in nature for AYA oncology was well received by participants and provided useful feedback for improvement of future editions. The intervention could offer support to AYA's in the promotion of their well-being and post-cancer identity development, but more research is needed to confirm this.

Active by nature: exploring cancer survivors' exercise barriers, facilitators, preferences, and psychosocial benefits of engaging in outdoor physical activity

Introduction

Large numbers of cancer survivors struggle with mental health after cancer diagnosis. Cancer survivors are encouraged to engage in physical activity in order to improve physical and mental health. Additional benefits to physical activity engagement in natural environments have been reported but this has not been explored in cancer survivors.

Methods

Study participants had to be over the age of 19, a Canadian resident, and have had a cancer diagnosis. Recruitment to complete an online survey occurred through social media and snowball sampling. The data collected included physical activity participation, preferences and location, barriers and facilitators of engagement in outdoor physical activity, nature-related questions, and measures of psychosocial health. The sample was split by the number of outdoor physical activity minutes (> 150 min per week). Correlations were computed to examine the role of outdoor physical activity minutes on measured psychosocial health outcomes.

Results

One hundred and fourteen (N = 114) cancer survivors completed the online questionnaire. More than half of the respondents indicated that an outdoor environment was central to their physical activity of choice with walking identified as the most common outdoor physical activity. Group support was the main expected facilitator of success in an outdoor walking program. Outdoor active participants were significantly more motivated and confident to be physically active and reported significantly more benefit and enjoyment in being physically active than outdoor inactive participants. Minutes of outdoor physical activity was significantly correlated with subjective happiness, nature relatedness, and higher quality of life. No significant correlations were found between minutes of outdoor physical activity and generalized anxiety.

Conclusion

While future research is needed to further explore the role of nature in cancer survivor psychosocial health, we believe that our data suggests preference and benefit for outdoor physical activity in cancer survivors.

A scoping review to map the concept, content, and outcome of wilderness programs for childhood cancer survivors

OBJECTIVES

Systematic mapping of the concept, content, and outcome of wilderness programs for childhood cancer survivors.

DESIGN

Scoping review.

SEARCH STRATEGY

Searches were performed in 13 databases and the grey literature. Included studies describe participation of childhood cancer survivors in wilderness programs where the role of nature had a contextual and therapeutic premise. At least two authors independently performed screening, data extraction and analysis.

RESULTS

Database searches yielded 1848 articles, of which 15 met the inclusion criteria. The majority of programs (73%) employed adventure therapy. Five activity categories were identified as components of wilderness programs: challenge/risk, free time/leisure, experiential learning, physical activity and psychotherapeutic activities. A majority of the participating childhood cancer survivors were female, white, aged 8-40 years, with a wide range of cancer diagnoses. Reported outcomes included increased social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity. Key gaps identified included the absence of randomized controlled trials (RCTs), lack of studies on long-term effects, lack of information on the multicultural aspects of programs, and missing information on engagement in nature activities after the program ended.

CONCLUSIONS

This scoping review guides childhood cancer survivors, their families, practitioners, clinicians and researchers in the development and optimization of wilderness programs for childhood cancer survivors. In addition, it informs the utilization of these programs, and identifies gaps in the evidence base of wilderness programs. It is recommended that future study reporting on wilderness programs include more detail and explicitly address the role of nature in the program. Performing RCTs on wilderness programs is challenging, as they occur in real-life contexts in which participants cannot be blinded. Creative solutions in the design of pragmatic trials and mixed method studies are thus needed for further investigation of the effectiveness and safety of wilderness programs in childhood cancer survivors.

Effect of rowing on mobility, functionality, and quality of life in women with and without breast cancer: a 4-month intervention

PURPOSE

Of the different modalities of rowing, dragon boat training is the most analyzed in breast cancer (BC). However, other types of boats, such as the felucca, use different biomechanical techniques, which have not been studied in the scientific literature. Consequently, in this study, we sought to determine the benefits of felucca rowing on the physical, psychological, and emotional well-being of patients with BC and healthy persons.

METHODS

A pre- and post-intervention, single-arm study without a control group with a 4-month intervention was carried out in Spain in 2019. The study sample included six women with BC and 15 healthy women. The following questionnaires were administered before and after the intervention: Disabilities of the Arm, Shoulder, and Hand (DASH), Constant-Murley score (CMS), and the European Quality of Life 5 Dimensions (EQ-5D, rate your health today). Differences were determined before and after the intervention using the paired t test.

RESULTS

Significant differences (p < 0.05) were found in the results of all the questionnaires for the women with BC and for the healthy women: DASH (- 13.8 BC and - 6.7 healthy), CMS (+ 12.0 BC and 9.2 healthy), and EQ-5D (+ 8.5 BC and 10.5 healthy).

CONCLUSION

Felucca rowing showed benefits in health and quality of life in both women with BC and healthy women. In future studies with controlled design, values regarding clinical relevance, such as effect sizes/confidence intervals, are needed to corroborate our results.

Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain Intentional Outdoor Nature Contact Behavior among College Students

Nature contact is an emerging health behavior and is defined as the interaction between human beings and animals, plants, natural scenic views, or outdoor activities. Studies have shown that exposure to the outdoors (as a means of contact with nature) reduces perceived stress and promotes health and wellbeing among varying populations in many settings. To date, however, there are few studies exploring the impact of nature contact among college students, especially in the United States. In addition, the determinants of nature contact behavior have not adequately been explored using behavioral theories. The purpose of this study was to use the multi-theory model (MTM) of health behavior change, a contemporary fourth-generation behavioral theory in explaining intentional outdoor nature contact behavior among college students. Using a cross-sectional design, 401 students completed the validated survey based on MTM. Of these, 281 met the inclusion criteria. The mean score for perceived stress based on the Perceived Stress Scale (PSS-10) in the sample was 21.60 (7.08) units, with a possible minimum and maximum scores ranging from 0 to 40 units. Constructs of behavioral confidence (standardized coefficient = 0.591, p < 0.001) and changes in the physical environment (standardized coefficient = 0.271, p < 0.001) from MTM accounted for 57.5% of the variance in the initiation for intentional outdoor nature contact behavior. All the three constructs of MTM—namely, emotional transformation (standardized coefficient = 0.173, p = 0.021), practice for change (standardized coefficient = 0.317, p < 0.001), and changes in the social environment (standardized coefficient = 0.204, p = 0.002)—were statistically significant and contributed substantively toward the variance (31.0%) in sustenance. MTM provides a useful and pragmatic framework for designing interventions to promote intentional nature contact behavior among college students.

Mapping the concept, content and outcome of wilderness therapy for childhood cancer survivors: protocol for a scoping review

INTRODUCTION

Long-term childhood cancer survivors are at risk for frailty and have significant health-related issues in adulthood. Various health promotion interventions have been proposed to enhance quality of life including wilderness therapy, which applies the impact of nature on health in a therapeutic context. Previous studies have described positive outcomes linked with various wilderness-related therapies for cancer survivors. However, there is no clarity on the role these therapies play in childhood cancer. The current scoping review aims to systematically map the concept, content and outcome of wilderness therapy for childhood cancer survivors.

METHODS AND ANALYSIS

This review will be guided by the Joanna Briggs Institute Reviewers' manual for scoping reviews. A systematic literature search using medical subject headings (MeSH) and text words related to wilderness therapy and childhood cancer survivors will be performed in EMBASE, ERIC, Medline, Psycinfo, CINAHL, Scopus, Web of Science, SPORTDiscus and Svemed+, Sociological Abstracts, supplemented by grey literature searches. Eligible quantitative and qualitative studies will be screened, included, assessed for quality and extracted for data by two reviewers independently. Results will be described in a narrative style, reported in extraction tables and diagrams, and where appropriate in themes and text.

ETHICS AND DISSEMINATION

This study describes a protocol for a scoping review that will undertake secondary analysis of data already published in literature and is therefore exempt from medical ethical review. The scoping review will inform understanding of the benefits and risks of wilderness therapy for childhood cancer survivors, their families, practitioners, clinicians and researchers, and will help elucidate the steps necessary for building its evidence base going forward. Results will be published in a peer-reviewed scientific journal.

"A place to call our own": The impact of camp experiences on the psychosocial wellbeing of children and youth affected by cancer - A narrative review

BACKGROUND

Although childhood cancer mortality rates are decreasing, intensive treatment modalities and missed school days may leave childhood cancer patients psychologically and socially vulnerable. Children with cancer often have increased anxiety, lower levels of self-esteem, and higher rates of depression, all of which may impair their psychosocial wellbeing. Specialized camps for children with cancer are becoming increasingly popular, as they provide a stress-free, outdoor environment in which children are able to interact with individuals similar to themselves, while experiencing the joys of a "normal childhood."

OBJECTIVE

The aim of this review was to explore how camp participation impacts the psychosocial wellbeing of childhood cancer patients and survivors.

METHODS

Six databases (MEDLINE, PsychINFO, EMBASE, CINHAL, Sociological Abstracts, Social Sciences Citation Index) were systematically searched for English literature published between 2007 and 2018. The search generated 1707 titles, and after being evaluated for relevance, 18 articles met the inclusion criteria. A thematic analysis was conducted.

RESULTS

A variety of camp programs and methodologies were employed among the studies. Camp participation led to improved social health, followed by enhanced constructions of the self, quality of life, sense of normalcy, and attitude.

CONCLUSION

This review demonstrates the potential ability of camp to buffer psychosocial losses for children affected by cancer. Addressing limitations, such as the lack of child-centered methodologies employed in camp settings, may not only help to guide future research on therapeutic recreation experiences for children with cancer, but also expand the evidence base for children living with other chronic illnesses and disabilities.

The effect of nature as positive distractibility on the Healing Process of Patients with cancer in therapeutic settings

BACKGROUND

Environmental design has a positive effect on patient health. The aim of this study was to examine the effect of nature on positive distraction on the Healing Process of Patients with Cancer.

METHOD

This research is a descriptive-correlational study which conducted on 80 cancer patients in an educational center with two different outlooks (natural view and no natural view) in Hamadan, Iran from March to May 2017. Patients were selected by convenience sampling method based on inclusion criteria. Two kinds of questionnaires including State-Trait Anxiety Inventory (STAI) and visual analog scale (VAS) about pain were distributed among who view natural landscapes (nature group) and who don't view natural landscapes (no nature group). Two groups compared in terms of pain and anxiety. Statistical analysis was done by SPSS version 22.

RESULTS

Findings of the study indicate that admitted patients viewing natural scenery had less anxiety (P < 0.001) and pain (P = 0.02) than admitted patients viewing no natural scenes.

CONCLUSION

Natural scenes caused to reduce the pain and anxiety, so using this healing power of nature leads to positive distraction.

Patient-centered communication between adolescent and young adult cancer survivors and their healthcare providers: Identifying research gaps with a scoping review

OBJECTIVE

To conduct a scoping literature review to identify practices or programs that promote AYA patient-centered communication.

METHODS

Between January and May of 2016, we applied standard scoping review methodology to systematically review articles. We considered peer-reviewed, English language articles written at any phase of intervention research. Both qualitative and quantitative studies were eligible, and no additional search restrictions were applied. We retained articles that included explicit or implicit outcomes for one of the six functions of patient-centered communication in cancer care. At least two independent reviewers assessed the articles.

RESULTS

We screened a total of 4072 titles and abstracts, retaining 27 for full-text review. Ultimately, eight titles met the review's inclusion criteria. We categorized each publication by the action or setting used to improve patient-centered communication, resulting in five categories. Most studies were not included because they did not include a patient-centered communication outcome.

CONCLUSION

This area of research is still emerging, as indicated by the small number of eligible studies and predominance of qualitative, descriptive, pilot, and feasibility studies with small sample sizes.

PRACTICE IMPLICATIONS

Our results suggest a clear need to develop and evaluate interventions focused on improving patient-centered communication between AYA survivors and their healthcare providers.

Nature-based care opportunities and barriers in oncology contexts: a modified international e-Delphi survey

OBJECTIVE

To develop recommendations regarding opportunities and barriers for nature-based care in oncology contexts using a structured knowledge generation process involving relevant healthcare and design experts.

DESIGN

Four-round modified electronic Delphi study. Oncology patients' nature-based recommendations, uncovered in preceding qualitative investigation, were included in the first round for the expert participants' consideration. Key items (opportunities and barriers) were developed using data aggregation and synthesis, followed by item prioritisation and 10-point Likert scale ranking (1=not important, 10=very important). Descriptive statistics were calculated to assess items of highest importance representing expert recommendations.

CONTEXT

Online Delphi process constituting an electronic international survey.

PARTICIPANTS

A purposive sample of 200 potential panellists (recruitment target n=40) comprising healthcare practitioners, managers, designers, architects and researchers were invited to participate; experts were identified via research networks, snowballing and systematic literature review.

RESULTS

38 experts across seven countries (Australia, USA, UK, New Zealand, Canada, Denmark and Sweden) returned questionnaire 1, which determined consent and acceptance for participation. Initial response rate was 19%, and subsequent response rates were 84%, 82% and 84% for rounds 2, 3 and 4, respectively. The Delphi panel developed recommendations consisting of 10 opportunities and 10 barriers. The following opportunities were rated to be of highest importance: window views from clinical areas onto nature; outdoor settings, gardens and courtyards with easy and effortless access; and nature-based physical exercise adapted to patient requirements. Highest-rated barriers for nature-based oncology care included lack of knowledge and awareness about benefits of nature engagement and inaccessibility, not considering access requirements for the very sick and frail.

CONCLUSIONS

Experts suggested and agreed on a set of recommendations, which represent critical considerations for the safe adoption of nature-based oncology opportunities. These findings fill a gap in understanding about helpful nature-based oncology care and may translate into oncology design and innovation.

Sound as a supportive design intervention for improving health care experience in the clinical ecosystem: A qualitative study

PURPOSE

Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment.

METHODS

Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar.

RESULTS

Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff.

CONCLUSIONS

Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures.

Nature Contact and Human Health: A Research Agenda

BACKGROUND

At a time of increasing disconnectedness from nature, scientific interest in the potential health benefits of nature contact has grown. Research in recent decades has yielded substantial evidence, but large gaps remain in our understanding.

OBJECTIVES

We propose a research agenda on nature contact and health, identifying principal domains of research and key questions that, if answered, would provide the basis for evidence-based public health interventions.

DISCUSSION

We identify research questions in seven domains: a) mechanistic biomedical studies; b) exposure science; c) epidemiology of health benefits; d) diversity and equity considerations; e) technological nature; f) economic and policy studies; and g) implementation science.

CONCLUSIONS

Nature contact may offer a range of human health benefits. Although much evidence is already available, much remains unknown. A robust research effort, guided by a focus on key unanswered questions, has the potential to yield high-impact, consequential public health insights. https://doi.org/10.1289/EHP1663.

The role of nature in cancer patients' lives: a systematic review and qualitative meta-synthesis

Background

A systematic review and meta-synthesis was conducted to identify, compare and synthesize the published qualitative literature contributing to our understanding of the role of nature in cancer patients’ lives.

Method

An electronic search of Medline, CINAHL, PsycINFO and Cochrane Databases was conducted to identify qualitative studies focused on cancer patients’ nature experiences published between January 1985 and May 2015. Records were assessed according to pre-defined inclusion criteria. Data were extracted on study characteristics and evaluated using the COREQ guidelines for comprehensive quality reporting. Qualitative data from ‘results’ and ‘findings’ sections were entered into data management software NVivo in order to identify recurring themes and facilitate interpretation across studies.

Results

From 11 eligible publications, seven inter-related core themes with descriptive themes were identified as follows: connecting with what is valued; being elsewhere, seeing and feeling differently; exploration, inner and outer excursions; home and safe; symbolism, understanding and communicating differently; benefitting from old and new physical activities; and, enriching aesthetic experiences.

Conclusions

Nature provides patients with unburdened physical and psychic space invested with personal significance. Findings propose nature’s role as a “secure base” offering patients a familiar and nurturing context from which new perspectives can emerge and caring connections can be made with themselves, others, the past, and the future. As such, nature supported patients to navigate the clinical and personal consequences of cancer. Comprehensive representation of cancer patients’ nature experiences identified patient values and care opportunities embedded in clinical and personal environments, which may be considered for future research and care service development.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3366-6) contains supplementary material, which is available to authorized users.