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Symptom burden, psychological distress, and health-related quality of life in cancer survivors with pelvic late radiation tissue injuries. Support Care Cancer 2021; 30:2477-2486. [PMID: 34779920 PMCID: PMC8794896 DOI: 10.1007/s00520-021-06684-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/04/2021] [Indexed: 12/03/2022]
Abstract
Purpose Curative radiotherapy for cancer may lead to severe late radiation tissue injuries (LRTIs). However, limited knowledge exists about pelvic cancer survivors’ LRTI symptoms, distress, and health-related quality of life (HRQOL). We sought to assess the symptom burden, distress, and HRQOL in survivors with established pelvic LRTIs compared to norm populations and to investigate the relation between these factors. Methods Cancer survivors referred for treatment of established pelvic LRTIs were recruited nationwide. LTRIs were assessed with the Expanded Prostate Cancer Index Composite (EPIC), psychological distress was assessed with the General Health Questionnaire (GHQ-12), and HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORCT-QLQ-C30). Results A total of 107 participants (mean age 64, 53% men) were included. Compared to norms, participants reported more urinary (mean 68.7 vs. 89.5; p = 0.00; d = 1.4) and bowel symptoms (mean 62.5 vs. 92.4; p = 0.00; d = 2.7), increased psychological distress (mean 13.4 vs. 10.3; p = 0.00; d = 0.6), and overall poorer HRQOL (mean 54.9 vs. 71.2; p = 0.00; d = 0.7). Higher symptom burden and higher levels of psychological distress were associated with lower HRQOL (r2 = 46%), but psychological distress did not moderate the influence of symptoms on HRQOL. Conclusion Cancer survivors with established pelvic LRTIs are highly burdened compared to norms. The association of the LRTI-related symptom burden with HRQOL is independent of the level of psychological distress. Both coping and treatment interventions are crucial to promoting long-term health and HRQOL. Trial registration NCT03570229.
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Pituskin E, Fairchild A. Prostate Cancer with Bone Metastases: Addressing Chronic Pain from the Perspective of the Radiation Oncology Nurse Practitioner. Semin Oncol Nurs 2021; 37:151175. [PMID: 34304921 DOI: 10.1016/j.soncn.2021.151175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To discuss the symptom burden experienced among patients with castrate-resistant prostate cancer and bone metastases and the role of the oncology nurse practitioner in evaluation for palliative radiotherapy. DATA SOURCES These include PubMed, international consensus documents, and clinician experience. CONCLUSION Men with advanced prostate cancer may live for several years after diagnosis of bone metastases; however, pain and other difficult symptoms are problematic. Pain is effectively treated with palliative radiotherapy, but careful assessment and intervention of other difficult symptoms must be addressed over time. IMPLICATIONS FOR NURSING PRACTICE Nurse practitioners in radiation oncology should be well-versed in the disease trajectory of this patient population. Careful symptom inquiry and comprehensive physical examination is a key responsibility. Palliative radiotherapy, alongside analgesics and supportive care measures, can effectively reduce symptoms and improve quality of life in men with prostate cancer metastatic to bone.
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Affiliation(s)
- Edith Pituskin
- Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, Alb, Canada.
| | - Alysa Fairchild
- Associate Professor, Department of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alb, Canada
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Cansian JM, de Oliveira TMRDR, Moreira AM, de Mattos MOT, Borré CI, Carniel BP, da Luz Viega Borges V, Ziliotto MB, Salvador TV, Hanemann T, Júnior MAF, Saraiva T, Roithmann S, Rosa DD. What Cancer Patients Want to Know? Questions from Oncologic Patients in a Brazilian Private Cancer Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:106-109. [PMID: 31418159 DOI: 10.1007/s13187-019-01605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To establish the more relevant questions oncologic patients may have during cancer treatment. Cross-sectional observational study with all patients undergoing chemotherapy or radiotherapy for cancer in a Brazilian health institution. A questionnaire with open and close questions about cancer diagnosis, treatment, and prognosis was applied. A total of 198 patients were evaluated of whom 122 (62%) were female and 80% of the patients were between 50 and 89 years old. Sixty-one percent of women and 62% of men had questions about cancer diagnosis and treatment. Although questions about nutrition were the most frequent for all patients (72% of men and 48% of women), treatment short- and long-term consequences were a concern for 31% of men and treatment effects on esthetics for 21% of women. After having been informed by the oncology team about their diagnosis and treatment, 49% of the patients also searched for other sources of information. Thirty-eight patients (20%) searched for alternative treatments for cancer. About half of the patients searched for other sources of information after having been informed by the oncology team about their cancer diagnosis and treatment. The present study reinforces the importance for the oncologic health team to spend sufficient time with patients in order to clarify doubts about cancer diagnosis and treatment.
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Affiliation(s)
- João Marcos Cansian
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil.
| | | | - Augusto Marques Moreira
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Mariana Oliveira Tripoli de Mattos
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Carla Isabel Borré
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Bruno Perosa Carniel
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Victória da Luz Viega Borges
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Marieli Barp Ziliotto
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Thais Vanessa Salvador
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Thaísa Hanemann
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Marco Aurélio Farina Júnior
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Taiana Saraiva
- Hospital Moinhos de Vento, Ramiro Barcelos St., 910, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Sergio Roithmann
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
- Hospital Moinhos de Vento, Ramiro Barcelos St., 910, Porto Alegre, State of Rio Grande do Sul, Brazil
| | - Daniela Dornelles Rosa
- Hospital Moinhos de Vento, Ramiro Barcelos St., 910, Porto Alegre, State of Rio Grande do Sul, Brazil
- Post-Graduation Program in Pathology, UFCSPA, Sarmento Leite St., 245, Porto Alegre, State of Rio Grande do Sul, Brazil
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Heywood R, McCarthy AL, Skinner TL. Efficacy of Exercise Interventions in Patients With Advanced Cancer: A Systematic Review. Arch Phys Med Rehabil 2018; 99:2595-2620. [DOI: 10.1016/j.apmr.2018.04.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/13/2018] [Accepted: 04/07/2018] [Indexed: 12/14/2022]
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Krongyuth P, Silpasuwan P, Viwatwongkasem C, Campbell C. Needs of patient with advanced stages of cancer in a Thai community. JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.1108/jhr-08-2018-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this paper is to explore the needs of people with cancer in advanced stages and to analyze factors that influence them.
Design/methodology/approach
A concurrent mixed-method design was used. Descriptive design was conducted in Ubon Ratchathani Province, Thailand. Data were collected from a convenience sample of patients with advanced cancer of any tissue or organ. Questionnaires were completed by 110 patients aged 60 years and above (response rate 110/130=84.6 percent). In-depth interviews were conducted with a total of eight patients. Content analysis of semi-structured interviews of a sub-sample was subsequently performed to better understand the real needs of patients with advanced stages of cancer at home setting.
Findings
The majority (77.5 percent) reported a preference to spend their final days at home. The four most common palliative care needs were more information about disease and medical treatment (98.2 percent), more treatment for pain (97.3 percent), health education for family caregivers (95.5 percent) and health volunteers visit at home (95.5 percent). Content analysis of the qualitative data suggested that patient needs health care providers to deliver open communication, pain management and provide psychosocial supports.
Originality/value
The result showed that patients-related variables are associated with the palliative care needs in patients with advanced stages of cancer. Communication skills and pain management are the key components to support the need for palliative care at home and to benefit the quality of life in terminally ill patients.
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Family Functioning Predicts End-of-Life Care Quality in Patients With Cancer: Multicenter Prospective Cohort Study. Cancer Nurs 2017; 41:E1-E10. [PMID: 28426540 DOI: 10.1097/ncc.0000000000000495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treating patients with cancer within a family setting is the accepted standard of care and a hallmark of end-of-life (EoL) quality of care (QoC). OBJECTIVE The aim of this study was to determine whether family caregiver functioning predicts EoL QoC received by terminally ill patients with cancer. METHODS Family caregivers of terminally ill patients with cancer (n = 264) were enrolled from oncology inpatient and outpatient units of 12 large hospitals located in different regions throughout South Korea. Caregivers were administered self-reported questionnaires about family functioning and EoL QoC at the time of an incurable cancer diagnosis, 4 to 6 weeks later, and again 2 to 3 months later. Family functioning and QoC were measured using the family Apgar and Quality Care Questionnaire-End of Life scales, respectively. RESULTS Improved adaptability to resource sharing and attention received predicted improved family relationships for the 3 time points. Increased participation in decision making and communication predicted improved individualized care and family relationships for the 3 time points. Increased affection predicted improvements in dignity-conserving care and family relationships for the 3 time points. Improved resolution regarding sharing time and satisfaction with commitments predicted increases in all QoC domains for the 3 time points, including dignity-conserving care, care by healthcare professionals, individualized care, and family relationships. CONCLUSIONS Family functioning may contribute to improved EoL QoC of patients with terminal cancer. IMPLICATIONS FOR PRACTICE Patients' family caregivers are a valued source of affection and communicative support, improving EoL QoC. More family-oriented cancer support systems can better maintain the effectiveness of QoC until EoL.
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Wisotzky E, Khanna A, Hanrahan N, Maltser S. Scope of Practice in Cancer Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0144-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit. PLoS One 2016; 11:e0158830. [PMID: 27389693 PMCID: PMC4936709 DOI: 10.1371/journal.pone.0158830] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/22/2016] [Indexed: 11/19/2022] Open
Abstract
Objective The aims of the study were to examine a) patients’ knowledge of palliative care, b) patients’ expectations and needs when being admitted to a palliative care unit, and c) patient’s concept of a good palliative care physician. Methods The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques. Results The results revealed four themes: (1) information about palliative care, (2) supportive care needs, (3) being treated in a palliative care unit, and (4) qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient’s language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment. Conclusions The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient’s needs will enable medical teams to improve professional and individualized care.
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Brédart A, Untas A, Copel L, Leufroy M, Mino JC, Boiron C, Dolbeault S, Kop JL. Breast Cancer Survivors' Supportive Care Needs, Posttraumatic Growth and Satisfaction with Doctors' Interpersonal Skills in Relation to Physical Activity 8 Months after the End of Treatment: A Prospective Exploratory Study. Oncology 2016; 90:151-9. [PMID: 26882537 DOI: 10.1159/000443766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We assessed whether breast cancer survivors' (BCSs) supportive care needs, posttraumatic growth (positive psychological changes) and satisfaction with doctors' interpersonal skills could be related to physical activity (PA). METHODS A total of 426 BCSs were approached during the last week of treatment. Eight months later, 278 (65%) provided information on their PA levels. Ordinal logistic multiple regressions were performed. RESULTS PA levels included no PA (n = 68), some PA (n = 83), high PA levels more than twice or more than 2 h per week (n = 127). The multivariate model significantly explained 13% of PA variance (p = 0.001). An increase in posttraumatic growth total scores (proportional OR = 1.310; p < 0.05) and a decrease in physical and daily living supportive care needs subscale scores (proportional OR = 0.980; p < 0.001) and in satisfaction with doctors' interpersonal skill scores (proportional OR = 0.898; p < 0.05) were significantly associated with an increase in the likelihood of performing higher levels of PA. A lower educational level was associated with a decrease in the likelihood of performing PA. CONCLUSION The prevalence of PA in BCSs should be improved. Positive psychological changes after a breast cancer experience might contribute to performing PA. Encouraging PA needs to be accompanied by the alleviation of physical symptoms.
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Affiliation(s)
- Anne Brédart
- Psychology Institute, LPPS EA 4057, University Paris Descartes, Sorbonne Paris Citx00E9;, Boulogne-Billancourt, France
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McClellan MA, Karumur RP, Vogel RI, Petzel SV, Cragg J, Chan D, Jacko JA, Sainfort F, Geller MA. Designing an Educational Website to Improve Quality of Supportive Oncology Care for Women with Ovarian Cancer: An Expert Usability Review and Analysis. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2016; 32:297-307. [PMID: 27110082 PMCID: PMC4838192 DOI: 10.1080/10447318.2016.1140528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A broad-based research team developed a Health Insurance Portability and Accountability Act (HIPAA)-compliant educational website for women with ovarian cancer to improve the quality of supportive oncology care. Prior to a randomized clinical trial of the website, initial usability testing was implemented to evaluate the website. The initial review found that 165/247 checklist items had sufficient information to allow for evaluation with the website achieving an overall score of 63%. By category, lowest scores were for the Home Page, Task Orientation, Page Layout & Visual Design, and Help, Feedback & Error Tolerance. Major issues thought to potentially impede actual usage were prioritized in redevelopment and the second usability review, conducted by the same expert, saw an improvement in scores. Incorporating usability concepts from the start of development, fulfilling the positive expectations of end-users and identifying technical and personal factors that optimize use may greatly enhance usage of health websites.
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Affiliation(s)
| | - Raghav Pavan Karumur
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | | | - Sue V. Petzel
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Julie Cragg
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Chan
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Julie A. Jacko
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - François Sainfort
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Melissa A. Geller
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
- Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
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Rouhollahi MR, Saghafinia M, Zandehdel K, Motlagh AG, Kazemian A, Mohagheghi MA, Tahmasebi M. Assessment of a Hospital Palliative Care Unit (HPCU) for Cancer Patients; A Conceptual Framework. Indian J Palliat Care 2015; 21:317-27. [PMID: 26600701 PMCID: PMC4617040 DOI: 10.4103/0973-1075.164901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: The first hospital palliative care unit (HPCU) in Iran (FARS-HPCU) has been established in 2008 in the Cancer Institute, which is the largest referral cancer center in the country. We attempted to assess the performance of the HPCU based on a comprehensive conceptual framework. The main aim of this study was to develop a conceptual framework for assessment of the HPCU performances through designing a value chain in line with the goals and the main processes (core and support). Materials and Methods: We collected data from a variety of sources, including international guidelines, international best practices, and expert opinions in the country and compared them with national policies and priorities. We also took into consideration the trend of the HPCU development in the Cancer Institute of Iran. Through benchmarking the gap area with the performance standards, some recommendations for better outcome are proposed. Results: The framework for performance assessment consisted of 154 process indicators (PIs), based on which the main stakeholders of the HPCU (including staff, patients, and families) offered their scoring. The outcome revealed the state of the processes as well as the gaps Conclusion: Despite a significant improvement in many processes and indicators, more development in the comprehensive and integrative aspects of FARS-HPCU performance is required. Consideration of all supportive and palliative requirements of the patients through interdisciplinary and collaborative approaches is recommended.
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Affiliation(s)
- Mohammad Reza Rouhollahi
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Saghafinia
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran ; Department of Anesthesiology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kazem Zandehdel
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari Motlagh
- Department of Radiotherapy, Shahid Baheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kazemian
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Tahmasebi
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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"We both just trusted and leaned on the Lord": a qualitative study of religiousness and spirituality among African American breast cancer survivors and their caregivers. Qual Life Res 2014; 23:1909-20. [PMID: 24578149 DOI: 10.1007/s11136-014-0654-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE Most breast cancer (BC) survivorship research focuses on the general population of survivors. Scant research investigates the potentially unique experiences of minorities, especially during and after the difficult transition from primary treatment to post-treatment. This qualitative study explored African American BC survivors' and caregivers' quality-of-life in the post-treatment period with a focus on social and spiritual well-being. METHODS Participants included a convenience sample of African American women with stage I-III BC (N = 23) who completed treatment 6-24 months before enrollment. Primary caregivers (N = 22) included friends, spouses and other family members (21 complete dyads). Participants completed separate semi-structured telephone interviews. Template analysis was used to evaluate themes related to religiousness and spirituality, both across and within dyads. RESULTS After treatment, religiousness and spirituality played a major role in both survivors' and caregivers' lives by: (1) providing global guidance, (2) guiding illness management efforts and (3) facilitating recovery. Participants described a spiritual connectedness with God and others in their social networks. Dyad members shared the goal of keeping a positive attitude and described positive growth from cancer. Few future concerns were expressed due to the belief that survivors were healed and "done" with cancer. Beyond practical and emotional support, provision of spiritual assistance was common. CONCLUSIONS Results highlight the principal, positive role of religiousness and spirituality for African American BC survivors and caregivers after treatment. Findings emphasize the need to assess the importance of religious and spiritual beliefs and practices, and if appropriate, to provide resources that promote spiritual well-being.
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Egan R, McKechnie R, Jobson J, Herbison P, Richards R. Perspectives on psychosocial and spiritual cancer support services in New Zealand. J Psychosoc Oncol 2014; 31:659-74. [PMID: 24175901 DOI: 10.1080/07347332.2013.835017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In New Zealand, support services have been developed in response to patient need but are variable. The benefits of psycho-social-spiritual care in reducing distress and enhancing quality of life for people with cancer and their families are well established yet unmet needs continue to feature. This project aimed to examine how health care professionals assessed for psycho-social-spiritual distress and unmet need, decisions on appropriate support, and identification of barriers in the referral process. A mixed-methods approach was used for this research. The qualitative phase entailed semistructured interviews with health care professionals working in cancer care. The quantitative phase was an online survey of oncologists and nurses. Thematic analysis was carried out by performing a side-by-side analysis of both sets of data. Nurses were most likely to assess for psycho-social-spiritual need and to refer to support services. Despite a clear mandate to provide regular psycho-social-spiritual assessment, there is no consistency of assessment and referral across New Zealand. There are clearly unmet psycho-social-spiritual needs among people affected by cancer in New Zealand, with health care professionals in this study noting structural impediments to adequate supportive care. There is a mismatch between the importance placed on such care and the capacity that is currently available. The results of this study provide evidence that can be used to argue for improvements in the infrastructure, funding allocation and policy that would allow for better psycho-social-spiritual care within the challenging context of increasing numbers of those affected by cancer.
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Affiliation(s)
- Richard Egan
- a CSNZ Social & Behavioural Research Unit, Te Hunga Rangahau Ārai Mate Pukupuku, Department of Preventive & Social Medicine , Dunedin School of Medicine, University of Otago , Dunedin , New Zealand
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Paiva CE, Barroso EM, Carneseca EC, de Pádua Souza C, dos Santos FT, Mendoza López RV, Ribeiro Paiva SB. A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review. BMC Med Res Methodol 2014; 14:8. [PMID: 24447633 PMCID: PMC3899385 DOI: 10.1186/1471-2288-14-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/13/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patient-reported outcome validation needs to achieve validity and reliability standards. Among reliability analysis parameters, test-retest reliability is an important psychometric property. Retested patients must be in a clinically stable condition. This is particularly problematic in palliative care (PC) settings because advanced cancer patients are prone to a faster rate of clinical deterioration. The aim of this study was to evaluate the methods by which multi-symptom and health-related qualities of life (HRQoL) based on patient-reported outcomes (PROs) have been validated in oncological PC settings with regards to test-retest reliability. METHODS A systematic search of PubMed (1966 to June 2013), EMBASE (1980 to June 2013), PsychInfo (1806 to June 2013), CINAHL (1980 to June 2013), and SCIELO (1998 to June 2013), and specific PRO databases was performed. Studies were included if they described a set of validation studies. Studies were included if they described a set of validation studies for an instrument developed to measure multi-symptom or multidimensional HRQoL in advanced cancer patients under PC. The COSMIN checklist was used to rate the methodological quality of the study designs. RESULTS We identified 89 validation studies from 746 potentially relevant articles. From those 89 articles, 31 measured test-retest reliability and were included in this review. Upon critical analysis of the overall quality of the criteria used to determine the test-retest reliability, 6 (19.4%), 17 (54.8%), and 8 (25.8%) of these articles were rated as good, fair, or poor, respectively, and no article was classified as excellent. Multi-symptom instruments were retested over a shortened interval when compared to the HRQoL instruments (median values 24 hours and 168 hours, respectively; p = 0.001). Validation studies that included objective confirmation of clinical stability in their design yielded better results for the test-retest analysis with regard to both pain and global HRQoL scores (p < 0.05). The quality of the statistical analysis and its description were of great concern. CONCLUSION Test-retest reliability has been infrequently and poorly evaluated. The confirmation of clinical stability was an important factor in our analysis, and we suggest that special attention be focused on clinical stability when designing a PRO validation study that includes advanced cancer patients under PC.
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Affiliation(s)
- Carlos Eduardo Paiva
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Eliane Marçon Barroso
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Estela Cristina Carneseca
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristiano de Pádua Souza
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
| | - Felipe Thomé dos Santos
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo CEP 14784-400, Brazil
| | | | - Sakamoto Bianca Ribeiro Paiva
- Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Researcher Support Center, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Berg L, Nolbris MJ, Koinberg I, Melin-Johansson C, Möller A, Ohlén J. Characterisation of cancer support and rehabilitation programmes: a Swedish multiple case study. Open Nurs J 2014; 8:1-7. [PMID: 24478809 PMCID: PMC3905349 DOI: 10.2174/1874434601408010001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 11/22/2022] Open
Abstract
Cancer support and rehabilitation are suggested to be an integral part of cancer care strategies. This study focuses on comparativeness of cancer support and rehabilitation programmes. The aim of this study was to analyse available cancer support and rehabilitation programmes in Sweden presented as complementary to cancer rehabilitation at cancer clinics. A multiple case study design was chosen in order to inquire the small number of existing supportive and rehabilitative cancer programmes. Based on the structures, processes and outcomes of the nine included programmes, three types of cancer support and rehabilitation programmes were identified: multimodal rehabilitation, comprehensive cancer support and art therapy. Cancer support and rehabilitation programmes offer a variety of activities and therapies which are highly valuable and relevant for people with cancer. The typology of cancer support and rehabilitation programmes and comparability between programmes need further inquiry.
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Affiliation(s)
- Linda Berg
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Margaretha Jenholt Nolbris
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Ingalill Koinberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Christina Melin-Johansson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Anders Möller
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Joakim Ohlén
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
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Abstract
The focus of this column is the interface between policy and end-of-life care, particularly as provided by advanced nurse practitioners. The complexities of end-of-life along with barriers in practice can diminish quality of life for patients and their families. Changes in policy are needed to enable nurse practitioners their full scope of practice in a way that benefits patients and families at end-of-life. Three areas particularly relevant to policy for nursing practitioners and end-of-life care are addressed: scope of practice, reimbursement, and prescribing practices. Other recommendations for policy and end-of-life care are discussed.
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Patel SK, Fernandez N, Wong AL, Mullins W, Turk A, Dekel N, Smith M, Ferrell B. Changes in self-reported distress in end-of-life pediatric cancer patients and their parents using the pediatric distress thermometer. Psychooncology 2013; 23:592-6. [PMID: 24375665 DOI: 10.1002/pon.3469] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/19/2013] [Accepted: 12/02/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Sunita K Patel
- Department of Population Sciences, City of Hope Medical Center, Duarte, CA, USA; Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA; Department of Pediatrics, City of Hope, Duarte, CA, USA
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Cooley ME, Lobach DF, Johns E, Halpenny B, Saunders TA, Del Fiol G, Rabin MS, Calarese P, Berenbaum IL, Zaner K, Finn K, Berry DL, Abrahm JL. Creating computable algorithms for symptom management in an outpatient thoracic oncology setting. J Pain Symptom Manage 2013; 46:911-924.e1. [PMID: 23680580 PMCID: PMC4096777 DOI: 10.1016/j.jpainsymman.2013.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/12/2013] [Accepted: 01/28/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians. OBJECTIVES This article reports on a process of adapting research evidence for use in a clinical decision support system that provided individualized symptom management recommendations to clinicians at the point of care. METHODS Using a modified ADAPTE process, panels of local experts adapted national guidelines and integrated research evidence to create computable algorithms with explicit recommendations for management of the most common symptoms (pain, fatigue, dyspnea, depression, and anxiety) associated with lung cancer. RESULTS Small multidisciplinary groups and a consensus panel, using a nominal group technique, modified and subsequently approved computable algorithms for fatigue, dyspnea, moderate pain, severe pain, depression, and anxiety. The approved algorithms represented the consensus of multidisciplinary clinicians on pharmacological and behavioral interventions tailored to the patient's age, comorbidities, laboratory values, current medications, and patient-reported symptom severity. Algorithms also were reconciled with one another to enable simultaneous management of several symptoms. CONCLUSION A modified ADAPTE process and nominal group technique enabled the development and approval of locally adapted computable algorithms for individualized symptom management in patients with lung cancer. The process was more complex and required more time and resources than initially anticipated, but it resulted in computable algorithms that represented the consensus of many experts.
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Affiliation(s)
- Mary E Cooley
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Maguire R, Papadopoulou C, Kotronoulas G, Simpson MF, McPhelim J, Irvine L. A systematic review of supportive care needs of people living with lung cancer. Eur J Oncol Nurs 2013; 17:449-64. [PMID: 23246484 DOI: 10.1016/j.ejon.2012.10.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/23/2012] [Accepted: 10/30/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Roma Maguire
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
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VanderWalde NA, Fleming M, Weiss J, Chera BS. Treatment of older patients with head and neck cancer: a review. Oncologist 2013; 18:568-78. [PMID: 23635557 DOI: 10.1634/theoncologist.2012-0427] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of head and neck cancer (HNC) in the elderly is increasing. The treatment of HNC often includes multimodality therapy that can be quite morbid. Older patients (herein, defined as ≥65 years) with HNC often have significant comorbidity and impaired functional status that may hinder their ability to receive and tolerate combined modality therapy. They have often been excluded from clinical trials that have defined standards of care. Therefore, tailoring cancer therapy for older patients with HNC can be quite challenging. In this paper, we performed a comprehensive literature review to better understand and discuss issues related to therapeutic recommendations that are particular to patients 65 years and older. Evidence suggests that older patients have similar survival outcomes compared with their younger peers; however, they may experience worse toxicity, especially with treatment intensification. Similarly, older patients may require more supportive care throughout the treatment process. Future studies incorporating geriatric tools for predictive and interventional purposes will potentially allow for improved patient selection and tolerance to intensive treatment.
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Affiliation(s)
- Noam A VanderWalde
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA
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Payne S, Chan N, Davies A, Poon E, Connor S, Goh C. Supportive, palliative, and end-of-life care for patients with cancer in Asia: resource-stratified guidelines from the Asian Oncology Summit 2012. Lancet Oncol 2013; 13:e492-500. [PMID: 23117004 DOI: 10.1016/s1470-2045(12)70380-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The burden of cancer in Asia is high; 6·1 million new cases were diagnosed in the continent in 2008, which accounted for 48% of new cases worldwide. Deaths from cancer are expected to continue to rise because of ageing populations and modifiable risk factors such as tobacco and alcohol use, diet, and obesity. Most patients who are diagnosed with cancer in Asia have advanced disease that is not amenable to curative treatment, which means that they are likely to have pain and other symptoms and psychosocial concerns. These burdens vary with the economic and political situation of the different countries and are affected by such factors as an absence of screening programmes, insufficient cancer diagnostic and treatment services (especially in sparsely populated and rural areas), legal restrictions on access to drugs to relieve pain, and a medical culture in which quality-of-life considerations are undervalued in relation to imperatives to treat. These issues could be ameliorated by increased investment in cancer screening, removal of restrictions on prescription of opioids, and improvements in medical education to increase recognition of treatment futility. Supportive, palliative, and end-of-life care offer the potential to enhance quality of life, improve pain control, and reduce suffering for patients with cancer and their families, and to give patients a dignified death. All patients should have access to such care-in resource-rich regions these services should be integrated into oncology services, whereas in resource-poor regions they should be the main focus of treatment. The form of care should depend on the economic circumstances within and across countries, and recommendations are made across four resource classifications (basic to maximal) to take account of the diversity of settings in Asia.
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
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Kassam A, Skiadaresis J, Habib S, Alexander S, Wolfe J. Moving toward quality palliative cancer care: parent and clinician perspectives on gaps between what matters and what is accessible. J Clin Oncol 2012. [PMID: 23182989 DOI: 10.1200/jco.2012.44.8936] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The National Consensus Project (NCP) published a set of standards for quality palliative care delivery. A key step before applying these guidelines to pediatric oncology is to evaluate how much families and clinicians value these standards. We aimed to determine which elements of palliative care are considered important according to bereaved parents and pediatric oncology clinicians and to determine accessibility of these elements. METHODS We administered questionnaires to 75 bereaved parents (response rate, 54%) and 48 pediatric oncology clinicians (response rate, 91%) at a large teaching hospital. Outcome measures included importance ratings and accessibility of core elements of palliative care delivery. RESULTS Fifteen of 20 core elements were highly valued by both parents and clinicians (defined as > 60% of parents and clinicians reporting the item as important). Compared with clinicians, parents gave higher ratings to receiving cancer-directed therapy during the last month of life (P < .01) and involvement of a spiritual mentor (P = .03). Of the valued elements, only three were accessible more than 60% of the time according to clinicians and parents. Valued elements least likely to be accessible included a direct admission policy to hospital, sibling support, and parent preparation for medical aspects surrounding death. CONCLUSION Parents and clinicians highly value a majority of palliative care elements described in the NCP framework. Children with advanced cancer may not be receiving key elements of palliative care despite parents and clinicians recognizing them as important. Evaluation of barriers to provision of quality palliative care and strategies for overcoming them are critical.
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Benitez-Rosario MA, Castillo-Padrós M, Garrido-Bernet B, Ascanio-León B. Quality of care in palliative sedation: audit and compliance monitoring of a clinical protocol. J Pain Symptom Manage 2012; 44:532-41. [PMID: 22795052 DOI: 10.1016/j.jpainsymman.2011.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 10/25/2011] [Accepted: 11/01/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT The European Association for Palliative Care and the U.S. National Hospice and Palliative Care Organization have published statements that recommend an audit of palliative sedation practices. OBJECTIVES The aim was to assess the feasibility of a quality care project in palliative sedation. METHODS We carried out an audit of adherence to a guideline regarding palliative sedation, undertaken as a yearly assessment during two years, of a sample of patient charts. With an audit tool, the charts were evaluated as to the presence of the ethical sedation checklist, information that justified palliative sedation, patient and/or family agreement, and the appropriateness of treatment in concordance with the clinical protocol. An educational program and result feedback meetings were used as the implementation strategy. RESULTS Roughly 25% of the medical charts of patients who died in the palliative care unit were evaluated, 94 in 2007 and 110 in 2008. In 2007 and 2008, 63% and 57% of the patients, respectively, whose median age was 65 years, were sedated, with a median length of two days. The main reason for sedation was agitation concomitant with respiratory failure in roughly 60% and 75% of the cases in 2007 and 2008, respectively. Agreement of the patient/family about sedation was collected from 100% of the cases. The concordance of procedures with the sedation guideline was 100% in both years. CONCLUSION Our quality-of-care strategy was shown to obtain a higher level of compliance with the palliative sedation guideline for at least two years.
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Masel EK, Schur S, Watzke HH. Life is uncertain. death is certain. Buddhism and palliative care. J Pain Symptom Manage 2012; 44:307-12. [PMID: 22871512 DOI: 10.1016/j.jpainsymman.2012.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 02/23/2012] [Accepted: 02/28/2012] [Indexed: 11/20/2022]
Abstract
It is part of a palliative care assessment to identify patients' spiritual needs. According to Buddhism, suffering is inherent to all human beings. Advice on how suffering can be reduced in the course of serious illness might be helpful to patients with incurable and progressive diseases. Palliative care could benefit from Buddhist insights in the form of compassionate care and relating death to life. Buddhist teachings may lead to a more profound understanding of incurable diseases and offer patients the means by which to focus their minds while dealing with physical symptoms and ailments. This might not only be beneficial to followers of Buddhism but to all patients.
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Affiliation(s)
- Eva K Masel
- Palliative Care Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
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BRÉDART A, KOP JL, GRIESSER AC, ZAMAN K, PANES-RUEDIN B, JEANNERET W, DELALOYE JF, ZIMMERS S, JACOB A, BERTHET V, FISZER C, DOLBEAULT S. Validation of the 34-item Supportive Care Needs Survey and 8-item Breast module French versions (SCNS-SF34-Fr and SCNS-BR8-Fr) in breast cancer patients. Eur J Cancer Care (Engl) 2012; 21:450-9. [DOI: 10.1111/j.1365-2354.2012.01356.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shin DW, Hwang SS, Oh J, Kim JH, Park JH, Cho J, Cho B, Jung KT, Park EC. Variations in pain management outcomes among palliative care centers and the impact of organizational factors. Cancer 2012; 118:5688-97. [PMID: 22570083 DOI: 10.1002/cncr.26722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 10/27/2011] [Accepted: 10/27/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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Development of Generic Quality Indicators for Patient-Centered Cancer Care by Using a RAND Modified Delphi Method. Cancer Nurs 2012; 35:29-37. [DOI: 10.1097/ncc.0b013e318210e3a2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schreiber JA, Brockopp DY. Twenty-five years later--what do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review. J Cancer Surviv 2011; 6:82-94. [PMID: 22198806 DOI: 10.1007/s11764-011-0193-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 08/25/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION A diagnosis of cancer is a life-changing event for most people. The trauma and uncertainties of a breast cancer diagnosis can affect survivors' psychological well-being. Religion and/or spirituality can provide a means of support for many women as they live with the realities of a diagnosis of cancer. The purpose of this focused review is to critically analyze and synthesize relationships among psychological well-being, religion, and spirituality among women with breast cancer. METHODS MEDLINE, CINAHL, Web of Science, Cambridge Scientific Abstracts, Cochrane CENTRAL, and PsycINFO databases were searched: January 1985-March 2010. The search terms religi*(religious/religion), spiritu*(spiritual/spirituality), breast cancer, psychological adjustment, psychological outcomes, psychological distress, psychological well-being, and outcomes were searched for separately and in combination. RESULTS Eighteen quantitative studies were analyzed in order to examine associations among religion, spirituality, and psychological well-being for women diagnosed with breast cancer. These three variables were operationally defined as follows: (a) religious practice, religious coping, and perception of God; (b) spiritual distress, spiritual reframing, spiritual well-being, and spiritual integration; and (c) combined measure of both the religion and spirituality constructs. DISCUSSION/CONCLUSIONS Results of this review suggest that within this population, limited relationships exist among religion, spirituality, and psychological well-being. Given the various definitions used for the three variables, the strength and clarity of relationships are not clear. In addition, the time of assessment along the course of the disease varies greatly and in some instances is not reported. Diagnosis and/or prognosis, factors that could influence psychological well-being, are frequently not factored into results. There does, however, appear to be sufficient evidence to include a brief, clinically focused assessment of women diagnosed with breast cancer regarding the importance of a given belief system as they face the diagnosis and treatment of their disease. IMPLICATIONS FOR CANCER SURVIVORS The implications for cancer survivors are as follows: (a) Psychological well-being of women diagnosed with breast cancer may depend to some extent on their belief system. (b) Coping through "turning to God" for women without a significant prior relationship with God, or minimal spiritual behaviors, may experience diminished well-being. (c) Longitudinal studies suggest that struggling with, or questioning, one's belief system in early survivorship may also be associated with lower levels of well-being. This diminished well-being often resolves over time.
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Wright P, Smith AB, Keding A, Velikova G. The Social Difficulties Inventory (SDI): development of subscales and scoring guidance for staff. Psychooncology 2011; 20:36-43. [PMID: 20186841 DOI: 10.1002/pon.1705] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To develop subscales for clinical use of the Social Difficulties Inventory (SDI) with score interpretation guidance for use in routine oncology practice. BACKGROUND Patient-reported outcome measures are used increasingly in cancer care but successful implementation is dependent on a combination of sound psychometrics, guidance on clinical meaning and good clinical judgement. The SDI, a 21-item instrument (SDI-21) developed for use in cancer care, demonstrated good psychometric properties. Rasch analysis of the SDI resulted in a 16-item interval scale of Social Distress (SD-16), which allowed for establishment of some clinical utility guidance but further work was required to optimise meaningful interpretation in clinical practice. DATA SOURCES Data were pooled from three studies investigating psychometrics and clinical utility of the SDI-21. STATISTICAL ANALYSES Common factor analysis was undertaken on SD-16 items. Subscales were derived from the resulting factors and calculated by summing the scores of associated items. Subscale reliability was evaluated using Cronbach's α. RESULTS There were 652 participants. A three-factor model explaining 53.3% of the variance was extracted forming the basis of the subscales: Everyday living, Money matters and Self and others. Subscale reliability was good. In a clinical setting, a 2-point change in subscale score could be interpreted as a clinically meaningful difference. CONCLUSION The development of three subscales and clinically significant difference scores for the SD-16, combined with the previously developed cut-off points, improves the clinical utility of the SDI-21 when assessing social issues in oncology care.
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Affiliation(s)
- Penny Wright
- Psychosocial Oncology and Clinical Practice Research Group, Leeds Institute of Molecular Medicine, University of Leeds, Beckett Street, Leeds, West Yorkshire, UK.
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Bakitas M, Bishop MF, Caron P, Stephens L. Developing successful models of cancer palliative care services. Semin Oncol Nurs 2010; 26:266-84. [PMID: 20971407 PMCID: PMC2976669 DOI: 10.1016/j.soncn.2010.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This article describes successful institutionally based programs for providing high-quality palliative care to persons with cancer and their family members. Challenges and opportunities for program development are also described. DATA SOURCES Published literature from 2000 to present describing concurrent oncology palliative care clinical trials, standards, and guidelines were reviewed. CONCLUSION Clinical trials have shown feasibility and positive outcomes and formed the basis for consensus guidelines that support concurrent oncology palliative care models. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses should advocate for all patients with advanced cancer and their families to have access to concurrent oncology palliative care from the time of diagnosis with a life-limiting cancer.
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Affiliation(s)
- Marie Bakitas
- Section of Palliative Medicine, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Pituskin E, Fairchild A, Dutka J, Gagnon L, Driga A, Tachynski P, Borschneck JA, Ghosh S. Multidisciplinary Team Contributions Within a Dedicated Outpatient Palliative Radiotherapy Clinic: A Prospective Descriptive Study. Int J Radiat Oncol Biol Phys 2010; 78:527-32. [DOI: 10.1016/j.ijrobp.2009.07.1698] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 07/28/2009] [Accepted: 07/28/2009] [Indexed: 10/19/2022]
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Zafar SY, Currow DC, Daugherty CK, Abernethy AP. Standards for Palliative Care Delivery in Oncology Settings. Cancer J 2010; 16:436-43. [DOI: 10.1097/ppo.0b13e3181f289f7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hui D, Elsayem A, De La Cruz M, Berger A, Zhukovsky DS, Palla S, Evans A, Fadul N, Palmer JL, Bruera E. Availability and integration of palliative care at US cancer centers. JAMA 2010; 303:1054-61. [PMID: 20233823 PMCID: PMC3426918 DOI: 10.1001/jama.2010.258] [Citation(s) in RCA: 376] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT The current state of palliative care in cancer centers is not known. OBJECTIVES To determine the availability and degree of integration of palliative care services and to compare between National Cancer Institute (NCI) and non-NCI cancer centers in the United States. DESIGN, SETTING, AND PARTICIPANTS A survey of 71 NCI-designated cancer centers and a random sample of 71 non-NCI cancer centers of both executives and palliative care clinical program leaders, where applicable, regarding their palliative care services between June and October 2009. Survey questions were generated after a comprehensive literature search, review of guidelines from the National Quality Forum, and discussions among 7 physicians with research interest in palliative oncology. Executives were also asked about their attitudes toward palliative care. MAIN OUTCOME MEASURE Availability of palliative care services in the cancer center, defined as the presence of at least 1 palliative care physician. RESULTS A total of 142 and 120 surveys were sent to executives and program leaders, with response rates of 71% and 82%, respectively. National Cancer Institute cancer centers were significantly more likely to have a palliative care program (50/51 [98%] vs 39/50 [78%]; P = .002), at least 1 palliative care physician (46/50 [92%] vs 28/38 [74%]; P = .04), an inpatient palliative care consultation team (47/51 [92%] vs 28/50 [56%]; P < .001), and an outpatient palliative care clinic (30/51 [59%] vs 11/50 [22%]; P < .001). Few centers had dedicated palliative care beds (23/101 [23%]) or an institution-operated hospice (37/101 [37%]). The median (interquartile range) reported durations from referral to death were 7 (4-16), 7 (5-10), and 90 (30-120) days for inpatient consultation teams, inpatient units, and outpatient clinics, respectively. Research programs, palliative care fellowships, and mandatory rotations for oncology fellows were uncommon. Executives were supportive of stronger integration and increasing palliative care resources. CONCLUSION Most cancer centers reported a palliative care program, although the scope of services and the degree of integration varied widely.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Ahmed Elsayem
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Maxine De La Cruz
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Ann Berger
- Department of Palliative Care, National Cancer Institute Clinical Cancer Center, Bethesda, MD
| | - Donna S. Zhukovsky
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Shana Palla
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Avery Evans
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Nada Fadul
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J. Lynn Palmer
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Abstract
AbstractObjective:Tending to the spiritual needs of patients has begun to be formally recognized by professional spiritual care providers, health care councils, and health delivery systems over the last 30 years. Recognition of these programs has coincided with evidence-based research on the effect of spirituality on health. Palliative care has served as a forerunner to an integrated professional spiritual care approach, recognizing the importance of addressing the spiritual needs of the dying from its inauguration within Western medicine almost 50 years ago. Oncology programs have also begun to recognize the importance of spirituality to patients along the cancer continuum, especially those who are approaching the end of life. Although standards and best practice guidelines have been established and incorporated into practice, little is known about the actual factors affecting the practice of spiritual care programs or professional chaplains working within an oncology setting.Methods:Participant observation and interactive interviews occurred at five cancer programs after we conducted a literature search.Results:This study identified underlying organizational challenges, cultural and professional issues, academic program development challenges, administrative duties, and therapeutic interventions that determined the success of oncology spiritual care programs in practice.Significance of results:Although spiritual care services have developed as a profession and become recognized as a service within oncology and palliative care, organizational and operational issues were underrecognized yet significant factors in the success of oncology spiritual care programs. Spiritual care programs that were centrally located within the cancer care center, reported and provided guidance to senior leaders, reflected a multifaith approach, and had an academic role were better resourced, utilized more frequently, and seen to be integral members of an interdisciplinary care team than those services who did not reflect these characteristics.
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Vail DM. Supporting the veterinary cancer patient on chemotherapy: neutropenia and gastrointestinal toxicity. Top Companion Anim Med 2009; 24:122-9. [PMID: 19732730 DOI: 10.1053/j.tcam.2009.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Accepted: 02/15/2009] [Indexed: 11/11/2022]
Abstract
The application of effective chemotherapy protocols in companion animals with sensitive tumors may result in return to a good quality of life and extended long-term survival. However, the potential for adding adverse events that impact overall quality of life in veterinary cancer patients is an important consideration. To ensure the experience is a positive one for our clients and patients alike, the practicing veterinary oncologist must ensure clients are appropriately educated as to the type and likelihood of adverse events that may occur in their companions and should plan for appropriate preventative and therapeutic protocols to manage them. Such attention to detail will help guarantee their clients' experience with medical treatment is positive and worthwhile, and will result in improvement in the well-being of their companion.
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Affiliation(s)
- David M Vail
- University of Wisconsin-Madison, School of Veterinary Medicine, Madison, WI 53706, USA.
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Chen SC, Liao CT, Lin CC, Chang JTC, Lai YH. Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery. Oral Oncol 2009; 45:815-20. [DOI: 10.1016/j.oraloncology.2009.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/25/2008] [Accepted: 01/02/2009] [Indexed: 11/16/2022]
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Abstract
Prostate cancer is now a chronic condition. Screening, diagnosis, and treatment pose specific psychosocial challenges for men diagnosed and surviving with prostate cancer. Depression, anxiety, and cognitive impairment lead to emotional distress and difficulty coping. Treatments for psychosocial distress are targeted at couples and individuals. Lifestyle modification may improve coping and quality-of-life indicators.
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Affiliation(s)
- Keira Chism
- Thomas Jefferson University, 1020 Sansom Street, Thompson Building, Suite 1652, Philadelphia, PA 19107, USA.
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Ozanne EM, Partridge A, Moy B, Ellis KJ, Sepucha KR. Doctor–Patient Communication about Advance Directives in Metastatic Breast Cancer. J Palliat Med 2009; 12:547-53. [DOI: 10.1089/jpm.2008.0254] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elissa M. Ozanne
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ann Partridge
- Harvard Medical School, Boston, Massachusetts
- Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts
| | - Beverly Moy
- Harvard Medical School, Boston, Massachusetts
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine J. Ellis
- Harvard Medical School, Boston, Massachusetts
- Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Karen R. Sepucha
- Harvard Medical School, Boston, Massachusetts
- Health Decision Research Unit, Massachusetts General Hospital, Boston, Massachusetts
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Chu DZ. Quality of Care Review: Some Progress, and Toward What Goal? J Clin Oncol 2009; 27:1524. [DOI: 10.1200/jco.2008.20.0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Guntinas-Lichius O, Rühlow S, Veelken F, Klussmann JP. Quality of life during first-line palliative chemotherapy for recurrent and metastatic head and neck cancer with weekly cisplatin and docetaxel. J Cancer Res Clin Oncol 2008; 135:901-8. [DOI: 10.1007/s00432-008-0525-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 11/25/2008] [Indexed: 11/30/2022]
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Bibliography. PROGRESS IN PALLIATIVE CARE 2008. [DOI: 10.1179/096992608x346198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lorenz KA. Progress in quality-of-care research and hope for supportive cancer care. J Clin Oncol 2008; 26:3821-3. [PMID: 18688047 DOI: 10.1200/jco.2008.18.7294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Karl A Lorenz
- Veterans Administration, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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