The Impact of Culture and Sociological and Psychological Issues on Muslim Patients With Breast Cancer in Pakistan

Broken yet Brave: Arabic Women's Experience of a Breast Cancer Diagnosis

INTRODUCTION

Breast cancer is the most common cancer in Arabic women and is often diagnosed in advanced stages, resulting in an increased likelihood of requiring a mastectomy. Despite this, there is a lack of contemporary literature exploring Arabic women's experiences of breast cancer and its sequelae.

METHOD

Semi-structured interviews were conducted between 2019 and 2022 of Arabic women diagnosed with breast cancer. Data were analyzed using thematic analysis as described by Braun and Clark.

RESULTS

Two main themes were identified: (a) Broken yet brave describes participants' experiences when diagnosed and (b) Making decisions about treatment and experiences of support detailing their lack of decision-making autonomy and perceptions of support.

DISCUSSION

Arabic women believe in the concept of fate and faith, and their cultural conditioning is to prioritize family over themselves, often with limited support. They lack autonomy in decision-making due to the patriarchal society they live in.

Care burden and the predictive role of spiritual well-being and religious coping: A cross sectional study among Iranian family caregivers of patients with stroke

Background and Aims

The burden of care after a stroke is gaining recognition as a significant healthcare issue. Factors like religion and spirituality, encompassing religious coping and spiritual health, prove to be influential in anticipating the challenges faced by caregivers. The present study aimed to determine the relationship between care burden, spiritual health, and religious coping among caregivers of stroke patients.

Methods

This cross-sectional research was conducted with the participation of 129 caregivers of stroke patients. The data was collected using the Ellison and Paloutzian spiritual well-being instruments, Pargament Religious Coping (RCOPE) brief version, and the Zarit burden interview (ZBI). Through a census, participants were recruited for the investigation. Data were analyzed using descriptive and inferential statistics (multivariate linear regression analysis).

Results

The study results indicate a strong and statistically significant relationship between the burden of caring and spiritual health (p < 0.001, β = 0.33). Furthermore, specific variables were identified as indicators of an increased burden of care, including positive religious coping (p = 0.04, β = 0.63), the familial relationship between the caregiver and patient, specifically as a child (p = 0.001, β = 29.26), and a sister (p < 0.001, β = 35.93).

Conclusion

It is advisable to consider adopting and implementing appropriate support measures for coping strategies rooted in religion and spirituality. So, it is recommended to enhance the provision of comprehensive support, including psychological and religious interventions. This can be achieved through the collaborative efforts of support groups comprising psychiatric nurses, psychiatrists, psychologists, and religious experts.

Navigating mental health in a post-COVID world: the experience of colorectal cancer patients

The impact of the post-COVID-19 pandemic on individuals with colorectal cancer (CRC) was evaluated in a study with 465 cases and controls. Participants completed a questionnaire, and data analysis was conducted using SPSS software. Results showed a higher prevalence of emotional stress symptoms such as fear, depression, and worry among cases compared to controls. Additionally, cases reported greater physiological stress symptoms, such as low energy levels. The results also indicated that cases had higher rates of racing thoughts, pessimism, and avoidance of responsibilities compared to controls. These findings highlight the significant negative impact of the pandemic on individuals with CRC and the need for prompt attention and support.

Psychometric properties of an Arabic translation of the multidimensional social support scale (MSPSS) in a community sample of adults

BACKGROUND

There is a lack of methodologically strong measure to assess perceived social support among Arabic-speaking populations. Our main objective was therefore to examine the psychometric properties of an Arabic translation of the Multidimensional Social Support Scale (MSPSS) in a sample of Arabic-speaking Lebanese adults from the general population.

METHODS

We adopted a cross-sectional design involving a convenience sample of 387 non-clinical Lebanese adults aged 26.17 ± 11.47 years (58.4% females). Participants were administered a web-based anonymous questionnaire containing the MSPSS, the 10-item Connor-Davidson Resilience Scale, and the Post traumatic growth Inventory-Short Form. The forward-backward translation method was applied. Confirmatory factor analysis (CFA) and gender invariance in the MSPSS were examined. McDonald's ω coefficients were calculated as internal consistency indicators.

RESULTS

The Arabic MSPSS and its subscales have a high internal consistency with McDonald's ω values between 0.94 and 0.97. CFA indicated that fit of the three-factor model was acceptable. All indices suggested that configural, metric, and scalar invariance was supported across gender. Both genders exhibited no significant difference in all MSPSS dimensions. Convergent validity was supported by showing that all three MSPSS sub-scores and total score correlated significantly and positively with resilience and posttraumatic growth scores.

CONCLUSION

Although further cross-cultural validations involving other Arab countries and communities are still needed, we preliminarily suggest that this scale is applicable to the broad Arabic-speaking people for the measurement of perceived social support in clinical and research contexts.

Designing and validating an adaptation questionnaire among the husbands of Iranian Muslim women with breast cancer

Background

Breast cancer is the most common cancer among women and is the second leading cause of cancer death. This disease affects all aspects of the patient's life and family, especially the patient's spouse, which confirms the need to adapt to these changes. The common instruments used for the investigation of adaptation among husbands of women with breast cancer are mainly outdated, one-dimensional, or non-concordant with the Iranian culture. Therefore, the present study aimed to design and validate an adaptation scale among the husbands of Iranian Muslim women suffering from breast cancer.

Methods

This exploratory sequential mixed study was conducted in two qualitative and quantitative stages. In the qualitative stage, semi-structured interviews were performed with 21 participants. Then, items were developed through content analysis using the approach proposed by Elo and Kyngas on the basis of Roy's adaptation model. In the quantitative stage, the extracted items were reduced and psychometric properties such as face, content, and construct validity as well as reliability were explored. To investigate the construct validity, a cross-sectional descriptive study was conducted on 300 husbands of women with breast cancer selected via cluster sampling.

Results

The initial questionnaire contained 79 items. After the assessment of face and content validity, 59 items were evaluated regarding construct validity using exploratory factor analysis. At this stage, six adaptation dimensions were observed among the women's husbands, with the variance of 51.71. The Cronbach's alpha and correlation coefficient of the questionnaire were 0.912 and 0.701, respectively.

Conclusion

The developed 51-item adaptation scale had an appropriate validity and reliability and could be used for the assessment of adaptation in the target group.

Recently Top Trending Cancers in a Tertiary Cancer Hospital in Pakistan

Cancer is a leading cause of death, and its incidence is increasing, as reported in recent studies by GLOBOCAN. Cancer registry programs provide insights into currently trending tumors worldwide and aid in determining possible risk factors. This study was based on 7 years of cancer registry data recorded at NIMRA cancer hospital, Sindh, from 2015 to 2021. A total of 16,191 cancer patients were registered. In men, head and neck, lung, liver, colorectal and urinary tract cancers were most common. In women, breast cancer, head and neck cancer, gynecological tumors, esophageal cancer and colorectal cancer predominated. The overall data analysis indicated trending cancers in both sexes, including head and neck cancer (37.76%), breast cancer (13.83%), gynecological tumors (10.22%), esophageal cancer (5.18%), lung cancer (4.79%), colorectal cancer (4.27%), liver cancer (3.87%), lymphoma (3.16%), urinary tract cancer (3.11) and prostate cancer (1.53%). The mean age was 50.41 ± 11.78 years in men and 48.47 ± 11.88 years in women. Cancer prevalence has markedly increased worldwide, and is particularly alarming in developing countries. Various risk factors are involved in this increase, including the use of tobacco, areca nut, chewable tobacco, snuff or niswar. Current disease trends are substantially different from those in older studies at the institute.

'Oral Cancer is a Punishment for my Sins': Oral Histories of Oral Cancer, Fatalism and Islamic Religious Beliefs in Pakistan

This paper explores how Islamic religious beliefs; spiritual practices and fatalism may act as barriers to a diagnosis of oral cancer in Rawalpindi/Islamabad Pakistan. The qualitative methodology is oral history and interviews took place with fifteen women diagnosed with oral cancer and receiving treatment in hospital. The research provides a model illustrating how religiosity, fatalism and the social determinants of health exist on a continuum and influence the perspectives of women in Pakistan, contributing to their late presentation and diagnosis of oral cancer. Analysis of the patients' oral histories, suggests improved communication between medical professionals and integration of spiritual/traditional healers into the existing health care system of Pakistan which may assist in reducing oral health inequalities.

Experiences of Newly Diagnosed Oral Cancer Patients during the First Wave of the COVID-19 Pandemic: A Qualitative Study from Pakistan

The COVID-19 pandemic has resulted in the scaling back or postponement of non-emergency hospital services, including care of cancer patients. The present qualitative study explored the experiences of newly diagnosed oral cancer patients during the first wave of the COVID-19 pandemic in Pakistan. Patients who attended the Department of Maxillofacial Surgery, Khyber College of Dentistry in July 2020 were selected using a maximum variation purposive sampling method. Seventeen semi-structured interviews were conducted in Pashto, the local language of Khyber Pakhtunkhwa. All interviews were audiotaped, transcribed verbatim, and translated into English. Thematic content analysis yielded eight major themes: pain and generalised physical weakness, shock at diagnosis, psychological distress of the COVID-19 pandemic, faith and religion, double hit loss of employment, social isolation, social support from caregivers, and lack of support from health care professionals. In conclusion, the COVID-19 pandemic has a clear impact on the life experiences of newly diagnosed oral cancer patients. Distress due to delay in accessing health care and lack of support from health care providers are a matter of great concern. Appropriate interventions should be introduced to ensure psychological and social support strategies are in place for patients during interruptions of health care services.

Development, validation, and implementation of a Short Breast Health Perception Questionnaire

BACKGROUND

Health status and perception can be assessed by general or disease-specific questionnaires, and disease specific questionnaires are more specific than general questionnaires. Considering the importance of breast health perception (BHP) in women's lives and the lack of any pertinent questionnaires, we performed this study to develop a valid and reliable short BHP questionnaire (BHPQ); and then used it to assess the participants' BHP.

METHODS

We first designed and developed the instrument and then measured its inter-rater agreement (IRA), content validity including content validity index (I-CVI) and scale content validity index (S-CVI), and reliability (through internal consistency and test-retest). We then evaluated the BHP of eligible women with normal breasts and benign breast disorders who attended our breast clinic.

RESULTS

The IRA index (78.6%) showed the optimal relevance and clarity of the questionnaire. The content validity was acceptable; with S-CVIs of 87.35 and 84.42 for clarity and relevance, respectively. The internal reliability was high (Cronbach's alpha = 0.93). Three questions were eliminated for internal consistency (intraclass correlation coefficient < 0.7) but the rest of the questions showed good and excellent reliability. In the next step, BHP in the 350 eligible participants showed an overall score of 43.89 ± 9.09.

CONCLUSION

This study introduces a valid and reliable 11-item BHPQ. We propose its use in various circumstances throughout breast cancer screening, diagnosis, and treatment; and in the assessment of BHP in various physiologic and reproductive situations.

The Hidden Shadow Pandemic of Marital Rape During COVID-19 Pandemic Outbreak: A Critical Role of Women’s March for Awareness of Rape, Consent, and Sexual and Reproductive Rights

Introduction:

Aurat March–the women’s rights movement has left an indelible imprint on a contradictive ensemble of a revolutionary women’s rights demand in a conventional socializing segment of society. Women’s March is an intersectional, intergenerational and inclusive feminist discourse centrally concerned with the health, education, engagement, advocacy, gender equality, freedom and empowerment. Anecdotal discourse of Aurat March, enacted amidst COVID-19 pandemic, is centrally concerned with achieving space in private and public sphere and equal sexual and reproductive rights in the marriage institution.

Method:

A broad research of literature and online data base related to marital rape using PsycINFO, PsycNet, PubMed, ERIC, EMBASE, Scopus, Google Scholar and Elsevier was undertaken. Manual searches of the specific intimate partner violence journals (e.g., Journal of Interpersonal Violence, Journal of Family Issues) and news articles were also included.

Result:

This analysis provides epistemological and media representation grounds for strategy and intervening analysis on the re-construction of the narrative of semantics of stereotyped gender roles. Further, this paper is embedded in the measure of women’s rights, bodily autonomy, sexual and reproductive rights, differential context of consent between sex and rape within the institution of marriage.

The lived experience during the peri-diagnostic period of breast cancer: A scoping review

OBJECTIVES

The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer.

METHODS

Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches.

RESULTS

A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period.

CONCLUSIONS

The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity.

PRACTICE IMPLICATIONS

Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.

Better Reporting and Awareness Campaigns Needed for Breast Cancer in Pakistani Women

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths in women globally. In 2018, 2.1 million new cases were reported, with 627,000 deaths. Pakistan has the highest incidence rate of breast cancer among Asian countries: one in every nine women has a lifetime risk of being diagnosed with breast cancer. By reason of many misconceptions about the etiology of the disease and socioeconomic factors, Pakistani women have very low rates of early detection and diagnose breast cancer at advance stages with fewer chances of survival. The key to cure the breast cancer is early diagnosis. The aim of current review is to highlight the factors leading to the delays in early presentation of breast cancer in Pakistani women and to summarize possible recommendations for educating women about early diagnosis along with palliative care facilities for patients suffering from breast cancer. Furthermore, this study appeals to both the general public and government in the belief that better reporting and awareness campaigns may bring more women to clinics for early diagnosis.

Medical and Psychosocial Challenges Associated with Breast Cancer Survivorship

Objective

To assess the association between common survivorship issues and characteristics of breast cancer survivors presenting at a tertiary care hospital in Karachi, Pakistan. 

Methodology

This study was conducted in the medical oncology department of Jinnah Medical Postgraduate Center from March 27, 2019, to September 27, 2019. A number of 257 females of age group 18-90 years who had either completed their treatment or were undergoing treatment at the time were included using non-probability consecutive sampling techniques. Face-to-face interviews were personally conducted by the researcher, and data regarding the socio-demographics and common survivorship issues faced by breast cancer patients were obtained. The data acquired were entered and analyzed using SPSS version 23 (IBM Corp, Armonk, NY).

Results

The mean age of the breast cancer survivors were 42.58 ± 10.07 years. Of the main challenges, lack of energy received the highest mean score of 3.44 ± 1.26, followed by fatigue and financial issues. Overall the most common survivorship issue were financial issues (81.3%), followed by fatigue (80.9%), cessation of the menstrual cycle (66.1%), weak social support (59.1%), and cosmetic disfigurement (51.8%).

Conclusion

Breast cancer survivors have various psychological, medical, and social issues and may require unique attention during follow-up visits.

Psychometric properties of the Urdu version of the Geriatric Oral Health Assessment Index (GOHAI) and oral health-related quality of life in the elder Pakistani population

OBJECTIVE

The study aimed to translate the English version of the Geriatric Oral Health Assessment Index, assess its reliability and validity, and demonstrate its psychometric properties with regard to OHRQoL in the elder Pakistani population.

MATERIAL AND METHODS

In this cross-sectional study, 408 elder people were randomly recruited from three day-care centres. In the translation process, the translated Urdu version was reviewed by a committee of experts, followed by back-translation into English and re-reviewed by the same committee of experts. The questionnaire sought information about socio-demographic characteristics information and self-perception of oral, general health and treatment needs. OHRQoL was examined using GOHAI-U, and intraoral examination recorded the decayed, missing, and filled teeth. Reliability, internal consistency, convergent and discriminant validity of GOHAI-U were examined.

RESULTS

The mean GOHAI-U score was 40.2 (SD = 5.7, range = 20-55). The Cronbach's alpha for GOHAI score was 0.71, item-scale correlation coefficients ranged from 0.63 to 0.76, and test-retest correlation ranged from 0.59 to 0.74. Three factors supported the theoretical construction in the component factor analysis of the index. For convergent validity, there was a significant relationship between the GOHAI score and self-perceived oral, general health and treatment needs (P < .05). For discriminant validity, a significant correlation was found between the GOHAI score and clinical measures of dental health status except with the carious teeth.

CONCLUSION

The GOHAI-U has sufficient reliability and constructs validity to be used as an efficient measure of oral health-related quality of life in the Pakistani elder population.

Coping Through Religiosity, Spirituality and Social Support Among Muslim Chronic Hepatitis Patients

Academics acknowledge religiosity, spirituality and social support as socio-behavioral factors that influence patients' ability to deal with chronic illness. This study has attempted to describe empirical reality of how these factors influence patients. The sample of this study was 500 chronically ill hepatitis patients and was selected through the multistage sampling techniques. Through structured interview schedule, data were collected during the period of September 2016 to March 2017 from five most populated cities of Punjab (Pakistan). Data were analyzed through descriptive (frequency and percentage) and inferential statistics (Cronbach's alpha, Pearson correlation, and structural equation modeling). The study suggests some recommendations and suggestions to policy makers regarding the significance of religiosity, spirituality and social support as coping strategies during chronic illness. The findings illustrate that social support has more association with coping than religiosity and spirituality of the patients.

Psychosocial Aspects of Female Breast Cancer in the Middle East and North Africa

Breast cancer, the most common cancer among women in the Middle East and North Africa (MENA) region, is associated with social and psychological implications deriving from women's socio-cultural contexts. Examining 74 articles published between 2007 and 2019, this literature/narrative review explores the psychosocial aspects of female breast cancer in the MENA region. It highlights socio-cultural barriers to seeking help and socio-political factors influencing women's experience with the disease. In 17 of 22 Arab countries, common findings emerge which derive from shared cultural values. Findings indicate that women lack knowledge of breast cancer screening (BCS) and breast cancer self-examination (BSE) benefits/techniques due to a lack of physicians' recommendations, fear, embarrassment, cultural beliefs, and a lack of formal and informal support systems. Women in rural areas or with low socioeconomic status further lack access to health services. Women with breast cancer, report low self-esteem due to gender dynamics and a tendency towards fatalism. Collaboration between mass media, health and education systems, and leading social-religious figures plays a major role in overcoming psychological and cultural barriers, including beliefs surrounding pain, fear, embarrassment, and modesty, particularly for women of lower socioeconomic status and women living in crises and conflict zones.

The TP63 Gene Polymorphism rs17506395 is Associated with Early Breast Cancer in Cameroon

BACKGROUND

Breast cancer (BC) is a leading female cancer worldwide and cause of cancer-related death, especially in developing countries. Genetic predispositions to BC development in African population is poorly studied, and meanwhile the SNP rs17506395 in TP63 gene locus has been associated with the development of breast cancer in Asian women, no investigation has been undertaken within African population. We investigated the impact of this polymorphism in a representative African population.

METHODS

We undertook a case-control study including 335 women, of which 111 were breast cancer patients and 224 controls. Using blood-derived germline DNA, PCR-RFLP was used to investigate the polymorphism of TP63 gene at rs17506395 locus. Unconditional logistic regression was used to study the association between the TP63 gene polymorphism and risk of BC development. After stratification into different age and ethno-linguistic groups as well as menopausal status, the Cochran-Mantel-Haenszel test was used to measure significance of the associations.

RESULTS

Comparing cases with controls, no significant associations between genotype and disease development was observed. Similarly, when cases were stratified according to menopausal status and ethno-linguistic groups, no significant association was observed between genotype and disease development. However, in women of 40 years and below, TT and TG genotypes were associated with breast cancer development. The minor G allele seems to protective against early breast cancer onset OR of 0.5 (95%CI = 0.26-0.94, p = 0.03).

CONCLUSION

Our data revealed an association between rs15706395 and the risk of early breast cancer onset. The GG genotype seems to reduce the risk of early breast cancer. Larger studies are needed to confirm the potential of this SNP as biomarker for breast cancer prognostic.
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Dialysis Decision Making and Preferences for End-of-Life Care: Perspectives of Pakistani Patients Receiving Maintenance Dialysis

CONTEXT

Previous studies from the U.S. and Canada report deficiencies in informed decision making and a need to improve end-of-life (EoL) care in patients undergoing dialysis. However, there is a paucity of literature on these issues in Pakistani dialysis patients, who differ from Western patients in culture, religion, and available health care services.

OBJECTIVES

To study informed dialysis decision-making and EoL attitudes and beliefs in Pakistani patients receiving dialysis.

METHODS

We used convenience sampling to collect 522 surveys (90% response rate) from patients in seven different dialysis units in Pakistan. We used an existing dialysis survey tool, translated into Urdu, and backtranslated to English. A facilitator distributed the survey, explained questions, and orally administered it to patients unable to read.

RESULTS

Less than one-fourth of the respondents (23%) felt informed about their medical condition, and 45% were hopeful that their condition would improve in the future. More than half (54%) wished to know their prognosis, and 80% reported having no prognostic discussion. Almost 63% deemed EoL planning important, but only 5% recalled discussing EoL decisions with a doctor during the last 12 months. Nearly 62% of the patients regretted their decision to start dialysis. Patients' self-reported knowledge of hospice (5%) and palliative care (7.9%) services was very limited, yet 46% preferred a treatment plan focused on comfort and symptom management rather than life extension.

CONCLUSION

Pakistani patients reported a need for better informed dialysis decision making and EoL care and better access to palliative care services. These findings underscore the need for palliative care training of Pakistani physicians and in other developing countries to help address communication and EoL needs of their dialysis patients.

Social Support for Arab People with Chronic Conditions: A Scoping Review

Social support can play a crucial role in psycho-social well-being of people with chronic conditions. There is limited information about the experiences, barriers and sources of social support of Arab people affected by chronic conditions. The purpose of this review is to explore the experiences, barriers and sources of social support of Arab people affected by chronic conditions. A scoping review of the literature, based on Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines. Articles (n = 13) were identified for appraisal based on a group of inclusion and exclusion criteria. Eight articles were included in the final analysis. Three broad themes were identified: (a) Social support benefits-physical, emotional and financial benefits; (b) Source of social support-family and friends support, and (c) Support services utilization-cultural barrier, Arab migrants language and unfamiliarity with the health system barriers. Appropriate future support programs should be tailored based on Arab cultural beliefs and the inherent responsibility of the family together inside the Arab community.

Belief in God's Help During Hepatitis C: A Qualitative Study on Muslim Patients in Pakistan

Religious/spiritual beliefs play an important role in nursing of patients during chronic condition. Religion comprises an institutionalized set of transcendent ideas, while spirituality is personal and subjective dimension of religious experience in search of sacred (Hill and Pargament in Psychol Relig Spiritual S(1):3-17, 2008). The prevailing literature describes the influential impact of religiosity/spirituality on coping with chronic disease, but specifically patients with chronic liver disease (CLD) have not been studied in Pakistani context. This study examined the patients' belief in religious/spiritual coping, role of religious/spiritual beliefs and prayer as coping strategy. Furthermore, it explored the importance of religious/spiritual beliefs in diverting attention from pain and other needs of CLD patient. A total of 20 patients with chronic liver disease were selected through an appropriate screening process. Subsequently, in-depth detailed interviews were conducted to gather experiences of the hepatitis patients. Religious/spiritual beliefs put forth multiple positive effects that help in coping with chronic hepatitis C. It has been found that patients of hepatitis C use prayer as a coping strategy. Religious/spiritual beliefs have been found as source of diverting attention from pain for the patients suffering from chronic hepatitis C.

Coping Assessment Tools in the Family Caregivers of Patients with Breast Cancer: A Systematic Review

Background

Breast cancer is a problem that affects not only the individual's health and quality of life, but also the functionality of the family system. Caregivers experience stress when their patients cannot cope with the symptoms of their disease. The stress experienced by caregivers gives rise to psychological and physical symptoms in them. This study seeks to present a complete set of tools for assessing coping in the spouses or caregivers of women with breast cancer and evaluate the various instruments developed within these lines of inquiry.

Methods

A search was carried out in PubMed, Scopus, Web of Science, CINAHL, PsycINFO, Medline, ProQuest, Scopus and Google Scholar and also in the reference lists of the key articles retrieved for any coping assessment instrument targeting family caregivers' needs that had acceptable psychometric properties and was published until September 2019. The instruments used to assess coping in the spouses and caregivers of women with breast cancer were thus identified and their properties were described.

Results

Overall, 88 adaptation assessment tools related to family caregivers of patients with breast cancer were identified in 28 related articles. The tools examine different dimensions of adaptation such as satisfaction, stress, burden and needs of spouses and caregivers of patients with breast cancer.

Conclusion

Assessing family caregivers' coping is essential for providing them with the appropriate sources of support. Although several instruments have been used to assess coping in the spouses and caregivers of women with breast cancer, the properties of these instruments have to be examined before they can be more widely implemented.

Pathways to care for patients in Pakistan experiencing signs or symptoms of breast cancer

Multiple social and financial barriers exist to breast cancer detection in Pakistan, which may cause a delay in seeking care and the final diagnosis. This analytical study documents the pathways and time courses associated with referral to diagnostic centres to evaluate the clinical signs and symptoms of breast cancer. This report also verifies the association between socio-demographic and clinical indicators concerning the length of time spent before reaching diagnostic facilities. A purposive sample of 200 patients was selected from two tertiary care hospitals in Lahore, Pakistan, for the interviews. Descriptive statistics (that is, percentages, frequencies, and measures of central tendencies) and a multiple linear regression model were used to achieve the study objectives. The descriptive model showed 31-128 days interval between a patient's awareness of a clinical sign or symptom and receiving care. The healthcare system, including traditional healers, took from 7 to 194 days, and the time to diagnosis ranged from 15 to 30 days. Pain severity, larger tumour size, lack of clinical improvement, and the desire to obtain better treatment were reasons given for seeking care, but lack of awareness and fear of financial burden related to accessing healthcare facilities were identified as barriers. Moreover, socio-demographic and other predictive clinical factors were potentially associated with and substantially influenced the likelihood of the increased length of breast cancer patients' time to reach diagnostic centres. In conclusion, referrals by multiple healthcare providers, especially traditional healers and general practitioners, was a significant predictor for delay in diagnosis. Therefore, increased awareness and a responsive healthcare system may reduce the time from the recognition of symptoms to the early detection of breast cancer among women, thus improving outcomes in a developing country.

Exploring Lived Experiences of Married Pakistani Women Post-Mastectomy

Objective:

This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy.

Methods:

Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified.

Results:

Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations.

Conclusions:

The study findings revealed that effective coping strategies were beneficial for these women, as these women coped well after being diagnosed with breast cancer. Strong recommendations were made by the participants for the formulation of support groups, which could help them reduce their anxiety through information exchange.

Antecedents and Outcomes of Uncertainty in Older Adults With Cancer: A Scoping Review of the Literature

PROBLEM IDENTIFICATION

Uncertainty is a major source of distress for cancer survivors. Because cancer is primarily a disease of older adults, a comprehensive understanding of the antecedents and outcomes of uncertainty in older adults with cancer is essential. 
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LITERATURE SEARCH

MEDLINE®, PsycINFO®, Scopus, and CINAHL® were searched from inception to December 2015. Medical Subject Headings (MeSH) terms and free text words were used for the search concepts, including neoplasms, uncertainty, and aging. 
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DATA EVALUATION

Extracted data included research aims; research design or analysis approach; sample size; mean age; type, stage, and duration of cancer; type and duration of treatment; uncertainty scale; and major results. 
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SYNTHESIS

Of 2,584 articles initially identified, 44 studies (30 qualitative, 12 quantitative, and 2 mixed-methods) were included. Evidence tables were developed to organize quantitative and qualitative data. Descriptive numeric and thematic analyses were used to analyze quantitative results and qualitative findings, respectively. Outcomes were reported under four main categories.

CONCLUSIONS

Uncertainty is an enduring and common experience in cancer survivorship. Uncertainty is affected by a number of demographic and clinical factors and affects quality of life (QOL) and psychological well-being. 
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IMPLICATIONS FOR PRACTICE

Uncertainty should be considered a contributing factor to psychological well-being and QOL in older adults with cancer. Nurses are in a unique position to assess negative effects of uncertainty and manage these consequences by providing patients with information and emotional support.

Experiences of the Breast Cancer Patients Undergoing Radiotherapy at a Public Hospital Peshawar Pakistan

Objective

This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan.

Methods

This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually.

Results

Four main categories emerged from data analysis, which were: feelings and perceptions of the patients, their challenges, coping strategies, and teaching and informational needs.

Conclusions

Women undergoing RT in this culture experience more intense psychological effects, as compared to the physical effects. Keeping in mind, the magnitude of the emotional stress experienced by the participants, recommendations for policy reforms, and training for female RT staff are suggested based on findings of this research.

A phenomenological account of social sources, coping effects and relational role of social support in nursing among chronic patients with hepatitis

Social support plays an important role in the nursing of patients at a terminal stage. A literature review explored the influential link of social support in coping with chronic disease, but patients with chronic liver disease have not been studied in this context. The current study examined the lived experiences of social sources of social support, patients' expectations and the role of social support. Furthermore, it explored the importance of support for patients, coping effect and whose support matters for nursing of terminal chronic liver disease patients. A total of 21 terminally ill patients with chronic liver disease were selected through an appropriate screening process. Subsequently, in-depth detailed interviews were conducted to gather experiences of the hepatitis patients. Researchers fulfilled all the ethical considerations during the process of data collection. Social support exerts multiple beneficial effects that help in coping with chronic diseases of terminally ill patients. It was found that patients with hepatitis expected emotional, instrumental and informational support from social relations. Social support was a source of emotional gratification and a buffer in psychological distress, and helped in enabling a peaceful death for patients with chronic diseases. Among all social sources of support, spousal and child support were the most important for patients.

Spirituality in Arab Muslim Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Approach

BACKGROUND

A cancer diagnosis and treatment can be a stressful, life-altering experience that can pose a threat to life and raise existential challenges. Spirituality may influence the process of coping with the stress of the cancer experience. Studies of the role of spirituality for Muslim cancer patients and survivors are limited.

OBJECTIVE

The aim of this study was to understand the role of spirituality in the cancer experience among Arab Muslim hematopoietic stem cell transplant (HSCT) survivors.

METHODS

In this qualitative, descriptive study, 63 HSCT survivors (mean, 20.2 months) responded to 2 open-ended, self-report questions on the role of spirituality in their HSCT experience. Thematic analysis was used to identify themes related to spirituality.

RESULTS

Three dimensions that helped patients cope with their experiences were identified: sickness viewed in light of belief in God, use of religious/spiritual resources, and support from family and community. Two general themes described changes in their faith as a result of having the HSCT procedure: strengthening of faith in God and greater reliance on religious/spiritual activities.

CONCLUSION

Spirituality was important to the Arab Muslim survivors in coping with cancer and HSCT treatment. Muslim cancer survivors are often deeply connected to their religion.

IMPLICATIONS FOR PRACTICE

Healthcare providers in the United States and other Western countries need to be aware of the unique religious and spiritual needs of Muslim cancer survivors in order to provide them with culturally sensitive care. More research on the spiritual needs of Muslim cancer patients and survivors residing in Western countries is needed.

Exploring Meaning in the Life of Chinese Breast Cancer Survivors

BACKGROUND

Breast cancer is the most common cancer among women worldwide, and spiritual fulfillment such as experiencing meaning in life plays an important role in coping with the disease.

OBJECTIVE

The objectives of this study were to explore and understand Chinese breast cancer survivors' perspective on meaning in life.

METHODS

This study used Grounded Theory; 23 participants were recruited using convenience sampling, purposive sampling, and theoretical sampling. Semistructured interviews were conducted, and the data were analyzed using open coding, axial coding, and selective coding.

RESULTS

A core category emerged as "satisfaction with my life" to explain Chinese breast cancer survivors' perspective of meaning in life, and 4 subcategories described the core category including (1) living a healthy and peaceful life, (2) having a good relationship with others, (3) achieving purpose in life, and (4) fulfilling responsibility.

CONCLUSION

Chinese breast cancer survivors value physical health as well as spiritual fulfillment. The experience of adapting to life with cancer, having a good relationship with others, pursuing life goals, and fulfilling responsibility consists of a satisfying life, which makes life more meaningful.

IMPLICATIONS FOR PRACTICE

Health providers should pay more attention to survivors' experience of meaning in life and help them enhance meaning in life and improve their quality of life through building good relationship with others, achieving purpose in life, and fulfilling responsibility for family and society.

Quality of Life and Its Determinants in Adult Cancer Patients Undergoing Chemotherapy Treatment in Pakistan

Objective:

Cancer is a leading cause of death worldwide. Likewise, in Pakistan, it is a major health problem, with an approximate increase each year. Cancer treatment, particularly chemotherapy, produces a detrimental effect on individuals’ well-being. Since the past few years, quality of life (QOL) is considered as the primary goal of cancer treatment in patients’ survival. This study aimed to assess the QOL and its determinants in adult cancer patients undergoing chemotherapy treatment.

Methods:

An analytical cross-sectional design was employed to achieve the study objectives, utilizing consecutive sampling technique. A total of 150 adult (>19 years) cancer patients were recruited from a Tertiary Care Hospital in Karachi, Pakistan. The data were collected using the Functional Assessment of Cancer Therapy-General, a QOL questionnaire. Multiple linear regression was run to determine the effect of predictor variables, with a mean QOL score.

Results:

The overall mean score of QOL as 57.37. The domains of physical and emotional well-being were mainly affected by the chemotherapy treatment. Variables such as no previous hospitalization and no significant changes in life events were positively associated with the QOL. On the other hand, being female, unemployed, chemotherapy side effects (>1 week), impaired socialization, and discrimination by family/relatives were negatively associated with the QOL.

Conclusions:

The study findings suggested an overall low QOL among adult cancer patients undergoing chemotherapy treatment. It is recognized as a stressful treatment, which adversely affects the QOL of cancer patients. Interventions should focus on both the physical and psychological issues and need to be addressed to improve the QOL of adult cancer patients.

Women Experiences of Using External Breast Prosthesis after Mastectomy

Objective:

The aim of this study was to identify the experiences of breast cancer patients using external breast prostheses (EBP) in the context of the Pakistani society.

Methods:

A qualitative descriptive exploratory design was used in the study. In-depth individual interviews were conducted with 15 postmastectomy women using EBP. A semi-structured interview guide with open-ended questions was used for the interviews. The analysis of the data was organized into four categories according to the study questions including reasons for using EBP, feeling about EBP, challenges for using EBP, and coping with lost breast. Each category was further divided into subcategories.

Results:

Women used EBP because they felt strange, incomplete, and embarrassed in front of other people, due to the asymmetrical shape of the chest after mastectomy. They faced several challenges with regard to obtaining and using the EBP. While EBP was used as an alternative of their lost breast, they experienced sadness and embarrassment. They found it challenging to take care of the EBP and were required to make changes in their lifestyle. However, they accepted living with their lost breast, either through rationalization, family support, or faith and prayers, which helped them to cope.

Conclusions:

The study findings have given insight into some real experiences of mastectomy patients. Mastectomy not only affects women's physical health but also their psychological health, as a result of which they become reluctant to socialize. Using EBP can help them to improve their body image and body posture. Health-care providers' support is very important to the families of the patients specifically where patients are very shy to openly seek information due to cultural constraints.

Are oncologists accountable only to patients or also to their families? An international perspective

In most societies, health professionals traditionally carry responsibility only toward their patients. However, this is not the case in all cultures. In the contemporary practice of oncology in Western cultures, there is a shift toward assuming broader responsibility for patients with cancer' families during the illness course, the grieving stage, and in cancer prevention and genetic counseling. Traditional family, community, and religious values play a central role in determining people's perceptions and attitudes toward life and death as well as toward caregiving for a sick relative. The meaning of cancer illness within the family culture is thus influenced not only by each individual's values and beliefs but also by the family's makeup and dynamics, as well as their taboos and secrets. Global cancer care should therefore be directed at the family as a unit, while respecting patient autonomy and privacy. This reappraisal of our traditional understanding of physicians' duty as solely directed at the patient is reflected in the recent US trend toward a patient- and family-centered care approach. An additional challenge for oncology professionals is to integrate and tailor interventions toward the needs of both care recipients and caregivers and relate it to this dyad as the basic and enduring unit of care.

The effect of individualized patient education, along with emotional support, on the quality of life of breast cancer patients - A pilot study

PURPOSE

This study aimed to determine the effect of individualized patient education along with emotional support on the quality of life (QoL) of breast cancer patients undergoing chemotherapy. It also aimed to determine the intervention's feasibility in the Pakistani context.

METHODS

A quasi-experimental design, with pre- and post-test, in two groups, via time block, was used. The study was conducted at a public hospital in Karachi with a sample of 50 patients; 25 patients each in the intervention and control group. The intervention was delivered over a period of six weeks. It comprised verbal and written patient education, availability of a nurse during patients' chemotherapy administration and over the telephone, and a telephone follow-up of the patients by the nurse. patients' QoL was assessed at baseline and at the sixth week of receiving chemotherapy.

RESULTS

Tests indicated a significant improvement in the overall QoL, breast cancer subscale scores, and the physical and emotional well-being of the intervention group, as compared to the control group. The intervention effect size was moderate (0.655) for the QoL.

CONCLUSION

The intervention was found to be effective in improving patients' QoL. However, a larger study, in a multi-center setting, is recommended to ascertain the findings of this pilot study.

Meta-synthesis exploring barriers to health seeking behaviour among Malaysian breast cancer patients

Barriers to health seeking constitute a challenging issue in the treatment of breast cancer. The current meta- synthesis aimed to explore common barriers to health seeking among Malaysian breast cancer patients. From the systematic search, nine studies were found meeting the inclusion criteria. Data extraction revealed that health behavior towards breast cancer among Malaysia women was influenced by knowledge, psychological, sociocultural and medical system factors. In terms of knowledge, most of the Malaysian patients were observed to have cursory information and the reliance on the information provided by media was limiting. Among psychological factors, stress and sense of denial were some of the common factors leading to delay in treatment seeking. Family member's advice, cultural beliefs towards traditional care were some of the common sociocultural factors hindering immediate access to advanced medical diagnosis and care. Lastly, the delay in referral was one of the most common health system-related problems highlighted in most of the studies. In conclusion, there is an immediate need to improve the knowledge and understanding of Malaysian women towards breast cancer. Mass media should liaise with the cancer specialists to disseminate accurate and up-to-date information for the readers and audience, helping in modification of cultural beliefs that hinder timing health seeking. However, such intervention will not improve or rectify the health system related barriers to treatment seeking. Therefore, there is an immediate need for resource adjustment and training programs among health professional to improve their competency and professionalism required to develop an efficient health system.

Evaluating psychosocial support needs of female cancer patients in the State of Qatar

Patient perceived perceptions of psychosocial support are increasingly important to understanding appropriate holistic patient-centred care. Information is scarce regarding the attitudes of female cancer patients in Arab and Muslim populations. This study was undertaken in the State of Qatar among female cancer patients. The aim of this study was to investigate what extent women undergoing cancer treatment in the State of Qatar view the importance of psychosocial support? Another aim of this study was to determine which demographic indicators, if any, may predict for certain preferences in support. The authors hypothesized that a majority of female cancer patients will perceive psychosocial support as an important aspect. This study used English and Arabic questionnaires to glean data from female cancer patients attending clinics at the National Centre for Cancer Care and Research in Doha, Qatar. For the purpose of this study, psychosocial support was defined under four categories: 1) family support, 2) religious/spiritual support, 3) support groups 4) physician referred support. Results showed that 88% of female respondents rated psychosocial support categories as important. There was no significance between patient demographics and specific preferences for the support categories in the study. This study may provide some areas for future research that may shape guidelines for improving holistic patient care and in assisting the Supreme Health Council in meeting its targets for the Qatar National Cancer strategy, which states that cancer treatment should be patient-centred focusing on both medical and psychosocial needs of patients.

Psychosocial impact of breast cancer diagnosis among omani women

OBJECTIVES

The aim of this study was to explore different psychosocial impacts on Omani women diagnosed with breast cancer.

METHODS

Semi-structured individual interviews were conducted with 19 Omani women diagnosed with breast cancer to describe the impact of the disease on their personal and social life. Women were recruited from wards and out-patient clinics at the Sultan Qaboos University Hospital, Muscat.

RESULTS

Four main themes emerged. These were: a) factors related to psychological distress of the disease and uncertainty (worry of death, interference with work and family responsibilities, searching for hope/cure, travelling overseas); b) reactions of family members (shocked, saddened, unity, pressure to seek traditional treatments); c) views of society (sympathy, isolation, reluctant to disclose information); and d) worries and threats about the future (side effects of chemotherapy, spread of the disease, effect on offspring).

CONCLUSION

Breast cancer diagnosis has several devastating psychosocial impacts on women in Oman. Healthcare professionals working with women with breast cancer should be aware of the different psychosocial impacts of the disease on women's lives. Appropriate measures must be taken by the decision makers whenever needed, including enforcing positive views and support of Oman's society towards women with breast cancer.

Controlling fear: Jordanian women's perceptions of the diagnosis and surgical treatment of early-stage breast cancer

BACKGROUND

Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early-stage breast cancer and surgical treatment.

OBJECTIVE

The objective of this study was to gain understanding of the diagnosis and surgical treatment experience of Jordanian women with a diagnosis of early-stage breast cancer.

METHODS

An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early-stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology.

RESULTS

Fear had a profound effect on Jordanian women's stories of diagnosis and surgical treatment of early-stage breast cancer. Women's experience with breast cancer and its treatment was shaped by their preexisting fear of breast cancer, the disparity in the quality of care at various healthcare institutions, and sociodemographic factors (eg, education, age).

CONCLUSIONS

Early after the diagnosis, fear was very strong, and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the healthcare system, surgeons, family, friends, and/or neighbors and often accepted treatment offered by their surgeons without questioning.

IMPLICATIONS FOR PRACTICE

Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and the support necessary to help them cope with their illness.