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Zhang S, Song H, Liu Q, Zhao M, Bai X, Ding Y, Chen L, Yin H. The effectiveness of brief reminiscence-based psychosocial interventions for cancer patients: A systematic review and meta-analysis. J Clin Nurs 2024; 33:2775-2796. [PMID: 38519834 DOI: 10.1111/jocn.17137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/05/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
AIM To determine the effectiveness of brief reminiscence-based psychosocial interventions in alleviating psychological distress in cancer patients. BACKGROUND Cancer patients suffer tremendous psycho-spiritual pain, which affects their quality of life. Brief reminiscence-based psychosocial interventions have demonstrated positive effects on the mental health of cancer patients; however, the efficacy of these interventions has been inconsistent. DESIGN A systematic review and meta-analysis. METHODS This review was conducted and reported in accordance with the PRISMA 2020 checklist provided by the EQUATOR network. The Cochrane Library, Web of Science, PsycINFO, PubMed, Embase, CINAHL and Scopus databases were systematically searched from inception to 27 November 2022 to identify randomised controlled trials (RCTs) published in English. RESULTS Twenty studies involving 1744 cancer participants were included. The meta-analysis showed statistically significant effects of brief reminiscence-based psychosocial interventions on hope, anxiety and depression at post-intervention. A separate analysis revealed that brief reminiscence-based psychosocial interventions had a sustainable effect on hope, spiritual well-being, anxiety and depression at 1 month after the intervention. However, no statistically significant effect on quality of life was found in our study either immediately after the intervention or at 1 month. CONCLUSIONS Brief reminiscence-based psychosocial interventions can significantly reduce anxiety and depressive symptoms and improve hope and spiritual well-being in cancer patients. RELEVANCE TO CLINICAL PRACTICE This study further supports that brief reminiscence-based psychosocial interventions should be incorporated into the routine care of cancer patients to address their psychosocial distress. PATIENT OR PUBLIC CONTRIBUTION All authors of this article contributed to the study conception and design. All authors of the included studies provided original data for this paper.
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Affiliation(s)
- Sitao Zhang
- Jilin University School of Nursing, Changchun, China
| | - Huali Song
- Bethune First Hospital of Jilin University, Changchun, China
| | - Qian Liu
- Jilin University School of Nursing, Changchun, China
| | - Mingzhu Zhao
- Jilin University School of Nursing, Changchun, China
| | - Xuechun Bai
- Jilin University School of Nursing, Changchun, China
| | - Yiwen Ding
- Jilin University School of Nursing, Changchun, China
| | - Li Chen
- Jilin University School of Nursing, Changchun, China
| | - Huiru Yin
- Jilin University School of Nursing, Changchun, China
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Izgu N, Metin ZG, Eroglu H, Semerci R, Pars H. Impact of spiritual interventions in individuals with cancer: A systematic review and meta-analysis. Eur J Oncol Nurs 2024; 71:102646. [PMID: 38943773 DOI: 10.1016/j.ejon.2024.102646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/05/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE This meta-analysis aimed to determine how spiritual interventions affect cancer patients' physical, emotional, and spiritual outcomes and quality of life. METHODS Between 2012 and May 2024, the Cochrane Library, Scopus, PubMed, and Web of Science were searched considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Twenty-six randomized controlled trials were included, and 16 were synthesized in the meta-analysis. Bias risk was evaluated using the Cochrane risk-of-bias methodology for randomized studies. The Grading of Recommendations, Assessment, Development, and Evaluations tool was employed for evidence certainty. Heterogeneity was expressed through I2 and Q statistics. Hedge's g was calculated for effect sizes. Egger's and Kendall's Tau were used for publication bias. RESULTS Spiritual interventions yielded beneficial effects on fatigue (Hedges's g = 0.900, p < 0.001) and pain (Hedges's g = 0.670, p < 0.001) but not for overall symptom burden (Hedges's g = 0.208, p = 0.176). Significant effects were found for anxiety (Hedges's g = 0.301, p < 0.001), depression (Hedges's g = 0.175, p = 0.016), and psychological distress (Hedges's g = 0.178, p = 0.024), except for hopelessness (Hedges's g = 0.144, p = 0.091). Spiritual interventions enhanced faith (Hedges's g = 0.232, p = 0.035), the meaning of life (Hedges's g = 0.259, p = 0.002), spiritual well-being (Hedges's g = 0.268, p < 0.001), and quality of life (Hedges's g = 245, p < 0.001). Moderator analysis pointed out that cancer stage, total duration, delivery format, providers' qualification, content, and conceptual base of spiritual interventions significantly affect physical, emotional, and spiritual outcomes and quality of life. CONCLUSION This meta-analysis highlighted the benefits of spiritual interventions with varying effect sizes on patients' outcomes, as well as quality of life in cancer, and shed on how to incorporate these approaches into clinical practice.
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Affiliation(s)
- Nur Izgu
- Hacettepe University Faculty of Nursing, Internal Medicince Nursing Department, Ankara, Turkey.
| | - Zehra Gok Metin
- Hacettepe University Faculty of Nursing, Internal Medicince Nursing Department, Ankara, Turkey
| | - Hacer Eroglu
- Healthcare Vocational School, Lokman Hekim University, Ankara, Turkey
| | - Remziye Semerci
- Department of Pediatric Nursing, School of Nursing, Koç University, İstanbul, Turkey
| | - Hatice Pars
- Epidemiology MSc Program, The Institute of Health Sciences, Hacettepe University, Ankara, Turkey
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Grassi L, Nanni MG, Riba M, Folesani F. Dignity in Medicine: Definition, Assessment and Therapy. Curr Psychiatry Rep 2024; 26:273-293. [PMID: 38809393 PMCID: PMC11147872 DOI: 10.1007/s11920-024-01506-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions. RECENT FINDINGS We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient's wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings.
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Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy
| | - Michelle Riba
- Department of Psychiatry, and PsychOncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy.
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy.
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Yang Y, Yi Y, Shi X, Yang X. Comparative efficacy of psychological interventions on anxiety and depression in patients with cancer: A systematic review and network meta-analysis. Medicine (Baltimore) 2024; 103:e38155. [PMID: 38787974 PMCID: PMC11124676 DOI: 10.1097/md.0000000000038155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Numerous studies have demonstrated that psychological interventions are effective in alleviating anxiety and depression in patients with cancer. However, the optimal psychological intervention to alleviate anxiety and depression in patients with cancer remains unknown. This study was carried out to compare and rank the comparative effectiveness of various psychological interventions on anxiety and depression in patients with cancer. METHODS Databases, namely PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CNKI, WanFang, VIP and CBM were systematically searched from their inception dates to December 2023 for randomized controlled trials of psychological interventions for anxiety and depression in patients with cancer. Utilizing the Cochrane Review Manager 5.4, we evaluated the risk of bias in the studies included in the current study based on the Cochrane Handbook 5.1.0 Methodological Quality Evaluation Criteria. The NMA was conducted using STATA 15.0. This study did not involve human participants and therefore did not require ethical approval. RESULTS Thirty-one randomized controlled trials involving 3471 participants were included. MT [SMD = 1.35, 95% CI (0.76, 1.93)] and cognitive behavioral therapy (CBT) [SMD = 0.97, 95% CI (0.53, 1.42)] were superior to usual care in alleviating anxiety. Besides, interpersonal psychotherapy (IPT) [SMD = 1.17, 95% CI (0.06, 2.28)], CBT [SMD = 0.97, 95 % CI (0.63, 1.30)], and MT [SMD = 0.93, 95% CI (0.35, 1.50)] were superior to usual care in alleviating depression. In addition, CBT was superior to family therapy in alleviating depression [SMD = 0.73, 95% CI (0.08, 1.38)]. The MT, CBT, and IPT ranked in the top three in alleviating anxiety, while IPT, CBT, and MT ranked in the top three in alleviating depression. CONCLUSION MT and IPT would be a more appropriate option in alleviating anxiety and depression in patients with cancer, respectively. This study also suggested that CBT had a significant effect in alleviating negative emotions in patients with cancer. However, the results need to be validated by high-quality and large-sample studies.
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Affiliation(s)
- Yinhao Yang
- School of Nursing, Hubei University of Medicine, Shiyan, China
- Institute of Cancer Clinical Prevention and Control, Medical Department of Jingchu University of Technology, Jingmen, China
| | - Yingying Yi
- School of Nursing, Hubei University of Medicine, Shiyan, China
| | - Xixi Shi
- Institute of Cancer Clinical Prevention and Control, Medical Department of Jingchu University of Technology, Jingmen, China
| | - Xueqin Yang
- Institute of Cancer Clinical Prevention and Control, Medical Department of Jingchu University of Technology, Jingmen, China
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Wang N, Wang K, Lu X, Zhang S, Sun X, Zhang Y. Effects of family dignity interventions combined with standard palliative care on family adaptability, cohesion, and anticipatory grief in adult advanced cancer survivors and their family caregivers: A randomized controlled trial. Heliyon 2024; 10:e28593. [PMID: 38576586 PMCID: PMC10990954 DOI: 10.1016/j.heliyon.2024.e28593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/03/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024] Open
Abstract
Background Family involvement and comfort are equally important in palliative care. Dignity undertook a new meaning and novel challenges as a result of restrictions on visits and companionship during the pandemic. Family-centered family dignity interventions have been shown to be effective in increasing patients' sense of dignity, increasing levels of hope, and reducing psychological distress; however, the effectiveness in enhancing family adaptability and intimacy in the survivor-caregiver binary and reducing expected grief have been inconclusive. Objectives The primary objective of this study was to assess the efficacy of family dignity interventions on family adaptability and cohesion. The secondary objective was to explore the effects of the interventions on anticipatory grief and psychological distress, and the lasting effect 1 month after the intervention. Design A single-blinded, two-arm parallel group, randomized controlled trial was conducted in China. Settings and methods: Ninety-eight dyads who met the inclusion criteria were randomly assigned to the family dignity intervention (n = 51) or standard palliative care group (n = 47) between June and August 2022. Study outcomes were measured at baseline, immediately post-intervention, and at the 1-month follow-up post-intervention evaluation. Data were analyzed using the Kolmogorov-Smirnov test, chi-square test, Fisher's exact test, independent sample t-test, Wilcoxon rank-sum test, and generalized estimation equations. The Intention-To-Treat analysis was performed for all available data. Results In comparison to the control group, significant improvements in family adaptability and cohesion and anticipatory grief over post-intervention and 1-month follow-up were demonstrated among the patients in the intervention group. The intervention group of caregivers had significant improvement in anticipatory grief at post-intervention and 1-month follow-up. The level of psychological distress was significantly lower in the intervention group than the control group (p < 0.05) at 1-month follow-up but the differences were not statistically significant at post-intervention. All outcomes showed clear differences from baseline after the intervention and at the 1-month follow-up evaluation but not between post-intervention and at the 1-month follow-up evaluation. Conclusion This study further verifies the actual effect of family dignity intervention program through randomized controlled trials, and provides a reference for improving the family relationship between advanced cancer patients and their family caregivers, and improving their mental health. The addition of family dignity intervention to standard palliative care greatly increased the adaptability and cohesion between survivors and their families, lessened the anticipatory grief of the survivor-caregiver pair, and relieved caregivers' anxiety and despair. We did not detect a statistically significant difference between post-intervention and the 1-month follow-up evaluation, suggesting that the intervention may have a durable impact at least 1 month.
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Affiliation(s)
| | - Kun Wang
- The First Affiliated Hospital of Dalian Medical University, China
| | - Xinyu Lu
- Nanjing University of Chinese Medicine, China
| | - Shuyu Zhang
- Nanjing University of Chinese Medicine, China
| | - Xuhan Sun
- Nanjing University of Chinese Medicine, China
| | - Yuxi Zhang
- Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, China
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Seiler A, Amann M, Hertler C, Christ SM, Schettle M, Kaeppeli BM, Jung-Amstutz J, Nigg C, Pestalozzi BC, Imesch P, Dummer R, Blum D, Jenewein J. Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers - a randomized controlled study. BMC Palliat Care 2024; 23:73. [PMID: 38486192 PMCID: PMC10938771 DOI: 10.1186/s12904-024-01408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. METHODS In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADStot ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. RESULTS The coalesced group (DT and DT +) revealed a significant increase in patients' perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADStot of patients in the intervention group remained stable over the pre-post period, the control group's HADStot increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. CONCLUSIONS The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one's final days. TRIAL REGISTRATION This study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted.
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Affiliation(s)
- Annina Seiler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Manuel Amann
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian M Christ
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | | | | | - Bernhard C Pestalozzi
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Josef Jenewein
- Privatklinik Hohenegg, Meilen, Switzerland
- University of Zurich, Zurich, Switzerland
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Xie M, Wang C, Li Z, Xu W, Wang Y, Wu Y, Hu R. Effects of remote dignity therapy on mental health among patients with hematologic neoplasms and their significant others: A randomized controlled trial. Int J Nurs Stud 2024; 151:104668. [PMID: 38211363 DOI: 10.1016/j.ijnurstu.2023.104668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Families of patients with hematologic neoplasms involved in dignity therapy have exhibited a remarkable improvement in psychological well-being and family functioning. However, the applicability and generalizability of family participatory dignity therapy are limited as it is influenced by factors such as intervention time, place, and participants. Whether remote support from significant others is feasible and effective remains unknown. OBJECTIVES This study aimed to confirm the efficacy of significant others participating in remote dignity therapy (r-DT) on hope, dignity loss, meaning of life, and sense of stigma among patients with hematologic neoplasms as well as their significant others' depression and anxiety. DESIGN A randomized, single-blinded, two-arm, parallel-group controlled trial. SETTING(S) AND PARTICIPANTS Participants included patients with hematologic neoplasms and their significant others, who were recruited from Fujian Medical University Union Hospital from May 2021 to January 2022. METHODS A total of 72 eligible participants (patients and significant others) agreed to participate, and were randomly assigned to an intervention group (n = 35) or a control group (n = 37). Each pair of participants in the intervention group participated in two or three conversations based on the online video function of the WeChat platform, performed by one therapist in accordance with a specific communication outline. To evaluate the effects of the intervention, we assessed the patients' degree of dignity loss, hope level, meaning of life, and sense of stigma, as well as their significant others' depression, anxiety, and intimacy at baseline (T0), 15 days (T1), 30 days (T2), and 60 days (T3), and compared the scores between the two groups after the completion of the intervention. The Generalized Estimation Equation Model (GEE) was used to examine the effects of time, group, and their interaction. RESULTS The intervention group statistically significantly differed in lower dignity loss (t = 2.190, p = 0.032), higher hope level (t = -2.010, p = 0.049), and higher meaning of life (t = -2.066, p = 0.043) than the control group at T1. Regarding their significant others, the results of the comparison between the two groups showed that significant others in the intervention group had reduced levels of anxiety and depression at T1 and T2 (p < 0.05). The majority of patients (84.38 %) and significant others (75.00 %) provided positive evaluations of the program. CONCLUSIONS The r-DT showed a short-term positive effect on decreasing patients' dignity loss and promoting patients' hope and meaning of life; among their significant others, it decreased anxiety and depression. TRIAL REGISTRATION Registered in the China Clinical Trial Registry on 17 March 2021(ChiCTR2100044374). TWEETABLE ABSTRACT Remote dignity therapy decreased patients' dignity loss and promoted their hope and meaning of life; among their significant others, it decreased anxiety and depression.
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Affiliation(s)
- Mengting Xie
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Chunfeng Wang
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Zhangjie Li
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Wenkui Xu
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Ying Wang
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Yong Wu
- Department of hematology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou City, Fujian Province, China.
| | - Rong Hu
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China.
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Yang X, Yin D, Chen SQ. Effect of nursing on postoperative respiratory function and mental health of lung cancer patients. World J Clin Cases 2024; 12:922-930. [PMID: 38414608 PMCID: PMC10895621 DOI: 10.12998/wjcc.v12.i5.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Both pulmonary rehabilitation training and psychological care have been shown to have a positive effect on the postoperative recovery of patients with lung cancer. However, few studies have combined the two to explore their combined effect. Therefore, this study aimed to investigate the effects of pulmonary rehabilitation training combined with psychological care on postoperative respiratory function and mental health in lung cancer patients. AIM To investigate effect of nursing on postoperative respiratory function and mental health of lung cancer patients. METHODS 122 cases of lung cancer patients who underwent surgical treatment in our hospital and were treated in our department from January 2022 to April 2023 were selected and randomly divided into the control group and observation group. The control group performed the routine care intervention. The observation group was given pulmonary rehabilitation training and psychological care based on conventional nursing interventions. Forced expiratory volume, forced vital capacity. Maximum ventilatory volume (MVV) in one second was measured, and the patient's 6-min walking distance and dyspnoea index scale were used to assess the patient's respiratory condition. The Connor-Davidson resilience scale (CD-RISC), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were used to evaluate the mental health of the patients. RESULTS There was no difference between the two groups regarding age, gender, education level, surgical procedure, type of pathology, and treatment (P > 0.05). After treatment, MVV, 6-min walking distance, toughness, strength, optimism, and total CD-RISC scores were significantly higher in the observation group (P < 0.05), dyspnoea scores, SAS, and SDS scores were substantially lower in the control group compared to the observation group (P < 0.05). CONCLUSION Pulmonary rehabilitation training combined with psychological care for patients after lung cancer resection could improve lung function, enhance daily activities, effectively relieve negative emotions such as anxiety and depression, and reduce complications.
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Affiliation(s)
- Xiang Yang
- Department of Rehabilitation, The First People's Hospital of Jiangxia District, Wuhan (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan 430200, Hubei Province, China
| | - Dan Yin
- Department of Intensive Care, The First People's Hospital of Jiangxia District, Wuhan (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan 430200, Hubei Province, China
| | - Shi-Qing Chen
- Department of Neurology, The First People's Hospital of Jiangxia District, Wuhan (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan 430200, Hubei Province, China
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Freitas MJ, Remondes-Costa S, Veiga E, Macedo G, Teixeira RJ, Leite M. Life beyond Loss: A Retrospective Analysis of the Impact of Meaning of Life Therapy on the Grieving Process of Cancer Patients' Family Caregivers. Healthcare (Basel) 2024; 12:471. [PMID: 38391846 PMCID: PMC10887668 DOI: 10.3390/healthcare12040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/18/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
Oncological disease in the palliative stage is a huge challenge for patients and their family caregivers (FCs) due to the fact that it confronts them with death, as well as physical, psychological, and existential suffering. Meaning of Life Therapy (MLT) is a brief structured psycho-existential intervention aiming to help patients in a meaning-making life review process, promoting end-of-life adaptation. The Life Letter (LL) resulting from MLT is an element that facilitates communication between the patient and their caregivers. The goal of this study was to understand the impact of MLT on the grieving processes of eight FCs and to study their perceptions of the role of the LL on grief through semi-structured interviews. The results of our qualitative analysis indicate that MLT was perceived by the FCs as a positive experience despite the conspiracy of silence being identified as a drawback. The LL was interpreted as a communicational element, promoting emotional closeness with the cancer patients and serving as a valuable tool in the FCs' adaptation to loss. Our research findings show that the needs of FCs, especially after experiencing the loss of their relative, are dynamic and specific. This is why it is urgent to develop interventions that consider the idiosyncrasies of end-of-life cancer patients and their FCs in order to avoid frustrated farewells, lonely deaths, and maladaptive grieving processes. This is the direction in which MLT should evolve.
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Affiliation(s)
- Maria João Freitas
- Department of Social and Behavioural Sciences, University Institute of Health Sciences (IUCS-CESPU), 4585-116 Gandra, Portugal
| | - Sónia Remondes-Costa
- Department of Education and Psychology, University of Trás-os-Montes e Alto Douro, 5000-622 Vila Real, Portugal
| | - Elisa Veiga
- Research Centre for Human Development, Faculty of Education and Psychology, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - Gerly Macedo
- Clinical and Health Psychology Unit, Psychiatry and Mental Health Service, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Ricardo João Teixeira
- REACH-Mental Health Clinic, 4000-138 Porto, Portugal
- CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Intervention), Faculty of Psychology and Education Sciences, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Manuela Leite
- Department of Social and Behavioural Sciences, University Institute of Health Sciences (IUCS-CESPU), 4585-116 Gandra, Portugal
- iHealth4Well-Being-Innovation in Health and Well-Being-Research Unit, Instituto Politécnico de Saúde do Norte, CESPU, 4560-462 Penafiel, Portugal
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Yuan D, Huang Y, Wu J, Guo Z, Li S, Zhang Y. Anxiety and depression in lung cancer: effect of psychological interventions - network meta-analysis. BMJ Support Palliat Care 2024; 13:e554-e560. [PMID: 36344246 DOI: 10.1136/spcare-2022-003808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prevalence of depression and anxiety is high in patients with lung cancer, while multiple psychological interventions have revealed a positive impact on patients' negative emotions. However, it remains scarce which psychological intervention is the best choice for patients.This study was conducted to compare and rank the efficacy of psychological interventions on anxiety and depression in patients with lung cancer using a network meta-analysis. METHODS The Chinese academic database (CNKI, Wan Fang and Vip) and English academic database (The Cochrane Library, PubMed, PsycINFO and Web of Science) were searched from their inception to March 2022. Randomised controlled studies of psychological interventions on depression and anxiety in patients with lung cancer were included. Study selection and evaluation were conducted independently by two researchers. Included studies were performed a network meta-analysis to compare and rank the psychological interventions for negative emotions of patients with lung cancer. The clustered ranking of psychotherapies in the network was based on surface under the cumulative probability ranking curve values. RESULTS 23 studies (2221 participants) with 13 psychological interventions were retrieved. The random-effects model showed a significantly large effect size of supportive therapy for anxiety (mean difference, MD 14.38, 95% CI 2.42 to 26.21) and depression (MD 14.29, 95% CI 2.74 to 25.70). The supportive therapy, sandplay therapy and music therapy were top three rankings of interventions for anxiety, while supportive therapy, dignity therapy and sandplay therapy were the top three interventions for depression. CONCLUSIONS Supportive therapy would be a more appropriate option for alleviating negative emotions in patients with lung cancer. Other psychological intervention techniques may be used as alternatives, such as sandplay therapy and music therapy for anxiety, dignity therapy and sandplay therapy for depression. PROSPERO REGISTRATION NUMBER CRD42022320188.
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Affiliation(s)
- Dongling Yuan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuda Huang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jialing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenli Guo
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shansi Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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McAndrew NS, Gray TF, Wallace L, Calkins K, Guttormson J, Harding ES, Applebaum AJ. Existential distress in family caregivers: scoping review of meaning-making interventions. BMJ Support Palliat Care 2024; 13:e676-e685. [PMID: 37604657 PMCID: PMC11040498 DOI: 10.1136/spcare-2023-004448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Family and friend caregivers often feel overwhelmed by and ill-prepared for their responsibilities. Many feel helpless living with uncertainty about the outcome of the patient's illness, which leads to existential distress. Supportive care interventions that address existential distress by promoting meaning and purpose buffer the negative effects of caregiver burden and promote resilience and growth. The purpose of this scoping review is to describe the depth and breadth of available interventions targeting caregiver existential distress. METHODS We followed the Joanna Briggs Institute's scoping review methods and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension checklist. SCOPUS, Ovid MEDLINE and PsycINFO databases were searched for interventions that targeted existential distress by promoting meaning-making, spiritual well-being, post-traumatic growth and/or benefit finding for caregivers of seriously ill adult patients. RESULTS We screened 1377 titles/abstracts and 42 full-text articles. Thirty-one articles (28 unique studies) met inclusion criteria. Most interventions were designed for caregivers supporting patients with cancer (n=14) or patients receiving palliative care (n=9). Promising interventions included Meaning-Centered Psychotherapy for Cancer Caregivers, Meaning-Based Intervention for Patients and their Partners, Legacy Intervention for Family Enactment, Family Participatory Dignity Therapy and Existential Behavioural Therapy. More than half of the studies (n=20, 64%) were in the feasibility/acceptability/pilot stage of intervention testing. CONCLUSION Large randomised controlled trials with more diverse samples of caregivers are needed. Future research should explore the impact of delivering meaning-making interventions to caregivers throughout the illness trajectory. Developing strategies for scaling up and conducting cost analyses will narrow the research and practice gap for meaning-making interventions.
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Affiliation(s)
- Natalie S McAndrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Department of Patient Care Research, Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lyndsey Wallace
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kelly Calkins
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Jill Guttormson
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Eric S Harding
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
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Yang Y, Chen X, Pan X, Tang X, Fan J, Li Y. The unmet needs of patients in the early rehabilitation stage after lung cancer surgery: a qualitative study based on Maslow's hierarchy of needs theory. Support Care Cancer 2023; 31:677. [PMID: 37934256 DOI: 10.1007/s00520-023-08129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This study aimed to explore the unmet needs of lung cancer patients in early rehabilitation, based on Maslow's hierarchy of needs theory. METHODS Information on the experiences of 20 patients was collected through semi-structured interviews. The interviews were conducted in the surgical nursing clinic within 1 week of discharge from hospital. The data were analysed using a combination of deductive (theory-driven) and inductive (data-driven) methods, using Maslow's Hierarchy of Needs as a framework for identifying and organising themes. RESULTS Patients had a mean age of 50.92 years (SD 11.88); n = 11 (55%) were female. Major themes aligned with the dimensions of Maslow's hierarchy of needs model. Five major themes with 12 corresponding sub-themes emerged: (1) physiological needs, including "self-care and independence in life", "return to pre-operative status as soon as possible", "increase exercise under specialist guidance" and "reduce cough and pain and improve sleep quality"; (2) safety and security needs, such as "symptom management", "regulation of the emotions of worry and fear" and "access accurate treatment information"; (3) love and belonging needs, including "accompany family members" and "chat with friends";(4)Esteem needs: "live with dignity";(5) Self-actualization, such as "accept and submit to the reality of cancer" and "live meaningfully". CONCLUSIONS The findings of this study indicated that there were many unmet needs for patients during the early recovery period after lung cancer surgery. An overview of the different areas of need identified in this study may guide future research and development of interventions to improve patients' quality of life during the home rehabilitation phase.
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Affiliation(s)
- Yingzi Yang
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People's Republic of China
- Department of Nursing, Huadong Sanatorium, No. 67, Dajishan, Wuxi City, Jiangsu Province, 214100, People's Republic of China
| | - Xinxin Chen
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People's Republic of China
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, No.507, Zhengmin Road, Shanghai, 200433, People's Republic of China
| | - Xiaoting Pan
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People's Republic of China
| | - Xuefeng Tang
- Department of Nursing, Huadong Sanatorium, No. 67, Dajishan, Wuxi City, Jiangsu Province, 214100, People's Republic of China
| | - Jiaxin Fan
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, People's Republic of China
| | - Yumei Li
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, No.507, Zhengmin Road, Shanghai, 200433, People's Republic of China.
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Zeng D, Mizuno M. The concept of spirituality in the context of Chinese patients with cancer: A scoping review. J Adv Nurs 2023; 79:3258-3273. [PMID: 37350035 DOI: 10.1111/jan.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/16/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
AIM To elucidate how the concept of spirituality has been addressed in studies with Chinese people with cancer. DESIGN A scoping review. METHODS Patterns in conceptual definitions of spirituality and indicators for measuring spirituality were analysed. DATA SOURCES (INCLUDE SEARCH DATES) Literature published from inception to August 2022 was searched in five electronic databases (CINAHL, PubMed, Web of Science, PsycINFO and a Chinese database). RESULTS Using data from 10 qualitative studies, a new taxonomy of concepts of spirituality among Chinese people with cancer was derived, consisting of four categories: Creation of meaning, Connection, Transcendence and Existence. A total of 12 instruments developed outside of Chinese contexts and used to measure dimensions of spirituality across 27 quantitative studies were compared to the taxonomy developed in this review, and patterns were identified according to the dimensions of spirituality. Several instruments required modifications or additional explanations in questions regarding God/Higher Power and religion. CONCLUSION The four categories of spirituality classified in the current review are considered universal across all cultural contexts. Spirituality is multidimensional and functional concept, and the components of the instruments differed depending on which dimension of spirituality was being measured. IMPACT The findings of this study suggest that for measuring spirituality in research and clinical settings with Chinese people with cancer, it is important to use culturally appropriate scales that are consistent with the dimensions of spirituality being measured. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Even instruments developed outside of the Chinese context could be used for Chinese people with cancer if appropriately selected for their intended use. REPORTING METHOD This paper adheres to the EQUATOR guidelines and has no direct patient or public contribution.
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Affiliation(s)
- Dongyan Zeng
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Michiyo Mizuno
- Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Martinez-Calderon J, García-Muñoz C, Cano-García FJ, Heredia-Rizo AM. Psychological and spiritual interventions to enhance meaning in adults diagnosed with cancer: a systematic review with meta-analysis and meta-regression. Support Care Cancer 2023; 31:523. [PMID: 37584817 DOI: 10.1007/s00520-023-07986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE To summarize the evidence on the effectiveness that psychological and/or spiritual interventions may have to change the levels of meaning, measured with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), in adults diagnosed with cancer. METHODS Systematic review with meta-analysis and meta-regression. CINAHL (via EBSCOhost), Embase, PubMed, PsycINFO (via ProQuest), and the Cochrane Library were searched from inception to 21st October 2022. Manual searches were conducted. Only randomized clinical trials (RCTs) were included. The risk of bias was assessed with the Cochrane Risk of Bias tool 2. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to judge the certainty of the evidence. RESULTS Eight RCTs were included (N = 1682). Although some individual studies showed positive effects to enhance meaning using mindfulness or dignity therapy, the overall and individual meta-analyses showed a lack of effect of psychological and spiritual interventions in comparison to comparator interventions (MD (95%CI) = -0.19 (-0.45 to 0.06), p = 0.11, Tau2 = 0.0015, I2 = 2%). Publication bias was undetected (Egger's test = 0.35). Furthermore, no RCTs were judged to have a low risk of bias and the overall certainty of the evidence was judged as low. Meta-regression and subgroups meta-analyses also found possible sources of heterogeneity such as some cancer characteristics, the educational stage, or the religious affiliation. CONCLUSIONS Despite some RCTs may show promising results following mindfulness or dignity therapy, no effects were observed in the meta-analysis. Moreover, important methodological and clinical concerns precluded us to make sound clinical recommendations with the available evidence. OPEN SCIENCE FRAMEWORK DOI REGISTRATION: https://doi.org/10.17605/OSF.IO/4YMTK .
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Affiliation(s)
- Javier Martinez-Calderon
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/Avicena s/n, Sevilla, Spain
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMMS) Research Group, Andalusia, Spain
| | - Cristina García-Muñoz
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMMS) Research Group, Andalusia, Spain.
- Universidad Loyola de Andalucía, Avda. de las Universidades s/n, 41704 Sevilla, Sevilla, Spain.
| | - Francisco Javier Cano-García
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Universidad de Sevilla, 41018, Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMMS) Research Group, Andalusia, Spain
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain
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Wang G, Xiao J, Chen Z, Huang C, Deng Y, Tang S. Good death from cancer-the patient view: systematic review of qualitative studies. BMJ Support Palliat Care 2023:spcare-2022-004146. [PMID: 37353313 DOI: 10.1136/spcare-2022-004146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND AND OBJECTIVE An in-depth understanding of what constitutes a good death among patients with cancer is vital to providing patient-centred palliative care. This review aimed to synthesise evidence on the perceptions of a good death among patients with cancer. METHODS This systematic review involved a synthesis of qualitative data. A three-step process suggested by the Joanna Briggs Institute was used to synthesise the data. RESULTS A total of 1432 records were identified, and five articles met the inclusion criteria. Seven synthesised findings emerged: (1) being aware of cancer, (2) pain and symptom management, (3) dying well, (4) being remembered after death, (5) individual perspectives of a good death, (6) individual behaviours leading to a good death, and (7) culture and religions. A structural framework was developed to elicit two layers that could be regarded as determinants of a good death. One layer suggested how multiple external issues impact a good death, whereas the other layer involves patients' internal attributes that shape their experiences of a good death. The elements in the two layers were inter-related to exert a crossover effect on good death in specific cultural and religious contexts. CONCLUSION A good death is a process initiated from the time of awareness of cancer and extends beyond demise. Holistic approaches encompassing the management of physical and psychological distress along with psychosocial behavioural interventions to enhance patients' positive perspectives and behaviours are recommended to improve their quality of life and death.
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Affiliation(s)
- Guiyun Wang
- School of Nursing, Shandong Xiehe University, Jinan, Shandong, China
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zhihan Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yinghua Deng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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16
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Yang W, Zhang X, Li Y, Lv Q, Gao X, Lin M, Zang X. Advanced heart failure patients and family caregivers health and function: randomised controlled pilot trial of online dignity therapy. BMJ Support Palliat Care 2023:spcare-2022-003945. [PMID: 37041071 DOI: 10.1136/spcare-2022-003945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVES This research investigated the effectiveness of the caregiver-mediated online dignity therapy in enhancing dyadic health and family function. METHODS Heart failure (HF) family dyads were recruited between May and December 2021 from a university-affiliated hospital in China. The dyads (N=70) were randomly allocated to the intervention group and the control group. We assessed patients' outcomes (hope, well-being, Family APGAR Index and quality of life (QoL)) and their family caregivers' outcomes (anxiety, depression and Family APGAR Index) at baseline (T0), 1 week (T1), 4 weeks (T2) and 8 weeks (T3) after discharge. RESULTS For patients, the difference over time was significant in QoL (p<0.001). The interaction effects were significant for hope (p<0.001), well-being (p<0.001), Family APGAR Index (p<0.001) and QoL (p=0.007). For family caregivers, a significant difference in depression (p=0.001) was found within groups. Meanwhile, the interaction effects were significant on anxiety (p=0.002) and depression (p=0.016). CONCLUSIONS Caregiver-mediated online dignity therapy among patients with advanced HF had potential to enhance patient outcomes (level of hope, well-being, family function and QoL) and alleviate caregiver outcomes (anxiety, depression) at 4-week and 8-week follow-up. Thus, we provided scientific evidence for palliative care for advanced HF. TRIAL REGISTRATION NUMBER ChiCTR2100053758.
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Affiliation(s)
- Weiling Yang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yanting Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qingyun Lv
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xinxing Gao
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Mei Lin
- Department of Nursing, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
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Ghezeljeh TN, Seyedfatemi N, Bolhari J, Kamyari N, Rezaei M. Effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of patients with cancer: a randomized controlled trial. BMC Psychiatry 2023; 23:220. [PMID: 37005577 PMCID: PMC10068160 DOI: 10.1186/s12888-023-04715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/23/2023] [Indexed: 04/04/2023] Open
Abstract
Family caregivers of dying cancer patients may suffer from grief experiences and bereavement complications. Previous studies have proposed some psycho-emotional interventions for the management of these complications. However, little attention has been given to family-based dignity intervention and expressive writing. This study was conducted to examine the effects of family-based dignity intervention and expressive writing, combined and alone, on anticipatory grief in family caregivers of dying cancer patients. This was a randomized controlled trial, in which 200 family caregivers of dying cancer patients were randomly assigned to four intervention groups: family-based dignity intervention (n = 50), expressive writing intervention (n = 50), combined family-based single dignity intervention and expressive writing (n = 50), and control group (n = 50). In three times (baseline, 1 week, and 2 weeks after the interventions), anticipatory grief was assessed by a 13-item anticipatory grief scale (AGS). Finally, we found a significant reducing effect of family-based dignity intervention on AGS (-8.12 ± 1.53 vs. -1.57 ± 1.52, P = 0.01) and its subscales including behavioral (-5.92 ± 0.97 vs. -2.17 ± 0.96, P = 0.04) and emotional (-2.38 ± 0.78 vs. 0.68 ± 0.77, P = 0.03) subscales compared to the control group. However, no significant effect was seen for expressive writing intervention and combined interventions of expressive writing and family-based dignity intervention. In conclusion, family-based dignity intervention may be a safe intervention for relieving anticipatory grief among family caregivers of dying cancer patients. Additional clinical trials are needed to confirm our findings. Registration number: IRCT20210111050010N1. Trial registration date:2021-02-06.
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Affiliation(s)
- Tahereh Najafi Ghezeljeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Naima Seyedfatemi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, School of Behavioral Sciences and Mental Health, University of Medical Sciences, Tehran, Iran
| | - Naser Kamyari
- Department of Public Health, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Masoud Rezaei
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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Lin J, Guo Q, Xi L, Zhang H, Liu F, Zheng R, Liu W. The effect of Chinese culture-adapted dignity therapy on advanced cancer patients receiving chemotherapy in the day oncology unit: A quasi-experimental study. Eur J Oncol Nurs 2023; 63:102301. [PMID: 36889242 DOI: 10.1016/j.ejon.2023.102301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/19/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To examine the effects of Chinese culture-adapted dignity therapy on dignity-related and psychological, spiritual distress and family function for advanced cancer patients receiving chemotherapy in the day oncology unit. METHOD This is a quasi-experimental study. Patients were recruited from a day oncology unit at a tertiary cancer hospital in Northern China. A total of 39 patients agreeing to participate were assigned to receive Chinese culture-adapted dignity therapy (intervention group, n = 21) or supportive interview (control group, n = 18) according to their admission time. Patients' dignity-related, psychological, spiritual distress, and family function were assessed at baseline (T0) and after completing the intervention (T1) and the scores were compared between and within the groups. Besides, the interviews were conducted with patients at T1 to obtain their feedback, which were analyzed and integrated with the quantitative results. RESULTS There was no statistical significance in all outcomes at T1 between the two groups, as well as in most outcomes between T0 and T1 in the intervention groups except for the relieved dignity-related distress (P = 0.017), especially the physical distress (P = 0.026), and the improved family function (P = 0.005), especially the family adaptability (P = 0.006). The synthesized quantitative and qualitative results showed that the intervention could relieve physical and psychological distress, enhance the sense of dignity, and improve the spiritual well-being and family function of patients. CONCLUSIONS The Chinese culture-adapted dignity therapy showed positive effects on the life experiences of patients receiving chemotherapy in the day oncology unit and their family, and it might be a suitable, indirect communication prompt for Chinese families.
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Affiliation(s)
- Junyi Lin
- School of Nursing, Capital Medical University, Beijing, China
| | - Qiaohong Guo
- School of Nursing, Capital Medical University, Beijing, China.
| | - Lanxin Xi
- School of Nursing, Capital Medical University, Beijing, China
| | - Hong Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Day Oncology Unit, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Day Oncology Unit, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ruishuang Zheng
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin, China
| | - Wei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Day Oncology Unit, Peking University Cancer Hospital and Institute, Beijing, China
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Wallner M, Mayer H, Adlbrecht L, Hoffmann AL, Fahsold A, Holle B, Zeller A, Palm R. Theory-based evaluation and programme theories in nursing: A discussion on the occasion of the updated Medical Research Council (MRC) Framework. Int J Nurs Stud 2023; 140:104451. [PMID: 36812849 DOI: 10.1016/j.ijnurstu.2023.104451] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
Developing and evaluating health interventions for the benefit of patients is notoriously difficult. This also applies to the discipline of nursing, owing to the complexity of nursing interventions. Following significant revision, the updated guidance of the Medical Research Council (MRC) adopts a pluralistic view to intervention development and evaluation, including a theory-based perspective. This perspective promotes the use of program theory, aiming to understand how and under what circumstances interventions lead to change. In this discussion paper, we reflect the recommended use of program theory in the context of evaluation studies addressing complex nursing interventions. First, we review the literature by investigating the question whether and how evaluation studies targeting complex interventions used theory and to what extent program theories may contribute to enhance the theoretical foundations of intervention studies in nursing. Second, we illustrate the nature of theory-based evaluation and program theories. Third, we argue how this may impact theory building in nursing in general. We finish by discussing which resources, skills and competencies are necessary to fulfill the demanding task of undertaking theory-based evaluations. We caution against an oversimplified interpretation of the updated MRC guidance regarding the theory-based perspective, e.g. by using simple linear logic models, rather than articulating program theories. Instead, we encourage researchers to embrace the corresponding methodology, i.e. theory-based evaluation. With the prevailing perspective of knowledge production in crisis, we might be on the verge of a paradigm shift in health intervention research. Viewed through this lens, the updated MRC guidance could lead to a renewed understanding of what constitutes useful knowledge in nursing. This may facilitate knowledge production and, thereby, contribute to improve nursing practice for the benefit of the patient.
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Affiliation(s)
- Martin Wallner
- Karl Landsteiner University of Health Sciences, Division of Nursing Science with focus on Person-Centred Care Research, Krems, Austria; University of Vienna, Vienna Doctoral School of Social Sciences, Department of Nursing Science, Vienna, Austria.
| | - Hanna Mayer
- Karl Landsteiner University of Health Sciences, Division of Nursing Science with focus on Person-Centred Care Research, Krems, Austria
| | - Laura Adlbrecht
- OST Eastern Switzerland University of Applied Sciences, Department of Health, Competence Center Dementia Care, St. Gallen, Switzerland
| | - Anna Louisa Hoffmann
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Anne Fahsold
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Bernhard Holle
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Adelheid Zeller
- OST Eastern Switzerland University of Applied Sciences, Department of Health, Competence Center Dementia Care, St. Gallen, Switzerland
| | - Rebecca Palm
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany
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Xiao J, Chow KM, Chen J, Huang X, Tang S, Wang G, Chan WC. Family-oriented dignity therapy for patients with lung cancer undergoing chemotherapy: How does it work better? Asia Pac J Oncol Nurs 2022; 10:100168. [PMID: 36578350 PMCID: PMC9791319 DOI: 10.1016/j.apjon.2022.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This study aimed to examine the fidelity of intervention delivery and identify precursory factors contributing to the successful delivery and beneficial effects of family-oriented dignity therapy. Methods This was a process evaluation with quantitative and qualitative methods alongside a randomized controlled trial from March to May 2019. Nonparametric statistics were used to analyze how participants' demographics (n = 45 dyads) and process variables influenced the intervention effects. Fourteen patients, 11 family caregivers, and 11 nurses were interviewed to explore their perception of the intervention. Conventional content analysis was adopted to analyze the qualitative data. Results The fidelity was achieved with minor deviations from the protocol. Higher educational level and higher income were significantly correlated with lower levels of existential distress (H = 12.20, P = 0.030) and higher spiritual well-being (H = -16.310, P = 0.031), respectively. Higher levels of interest were significantly correlated with lower levels of existential distress (H = 10.396, P = 0.035) and peace of mind distress (H = -16.778, P = 0.006) and higher levels of life meaning (H = -12.808, P = 0.047). Patients who had higher response levels to the question were significantly correlated with lower levels of symptom distress (H = -13.879, P = 0.035). Four major categories were identified from the interview data: (1) benefits of the intervention, (2) risks of the intervention, (3) factors that enhance successful dignity-conserving care, and (4) difficulties and barriers to the delivery of dignity-conserving care. Conclusions Fidelity and precursory factors that enhance the beneficial effects of family-oriented dignity therapy were identified. Reinforcement strategies, such as using supplementary video, audio, and reading materials; developing a flexible approach to expressing feelings; and exploring lessons and achievements from various perspectives, are recommended for future research to enhance intervention effects. Trial registration The study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1900020806).
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Affiliation(s)
- Jinnan Xiao
- Xiangya School of Nursing, Central South University, China
| | - Ka Ming Chow
- The Nethersole School of Nursing, the Chinese University of Hong Kong, Hong Kong
| | - Jiarui Chen
- Xiangya School of Nursing, Central South University, China
| | - Xiaoting Huang
- Xiangya School of Nursing, Central South University, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, China
| | - Guiyun Wang
- School of Nursing, Shandong Xiehe University, China,Corresponding author.
| | - W.H. Carmen Chan
- The Nethersole School of Nursing, the Chinese University of Hong Kong, Hong Kong
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