Unmet Needs in the Process of Chemotherapy Provision in Pancreatic Cancer Patients from the Healthcare Provider Perspective: A Phenomenological Study in Greece

Introduction

Pancreatic cancer is the fourth leading cause of cancer death overall, with 1.5 years life expectancy and minimal therapeutic progress in the last decades. Despite the burden it causes, there is little research on the needs of this specific population. This study aimed to explore healthcare professionals' views on providing care and patients' unsatisfied needs.

Methods

This qualitative descriptive study was carried out at a cancer hospital in Northern Greece. A total of 12 participants (6 physicians and 6 nurses), treating patients with pancreatic cancer undergoing chemotherapy, were recruited through purposive sampling and underwent face-to-face semi-structured interviews. Data were analyzed through the thematic analysis method in NVivo12 software.

Results

The analysis highlighted two themes: "needs of patients with pancreatic cancer" consisted of 6 subthemes ("daily activities", "symptoms management", "psychological support", "information needs", "multidisciplinary care" and "end-of-life care") and "needs of healthcare professionals" had 3 subthemes ("psychological support", "education" and "organizational support"). Several symptoms are identified and affect the daily activities of these patients, and psychological support is important for the majority of them, even at the time of diagnosis. The participants express dissatisfaction with the absence of palliative care structures and services and stated that an interdisciplinary approach would improve the quality of care.

Conclusions

Healthcare professionals report a wide range of unsatisfied needs of patients with pancreatic cancer, with the majority expressing their concerns about the complete lack of patient support in the last stages of their lives.

Immigrant Origin and Disability Increase Risk for Anxiety Among Youth During COVID-19: The Role of Unmet Needs for Support in Distance Learning and Family Conflicts

PURPOSE

Shifting to distance learning due to COVID-19 may decrease teacher support and increase family conflicts, potentially increasing anxiety. Nevertheless, there is scarce information on this topic among disability and/or immigrant-origin groups. Thus, we investigated whether these minority groups reported more anxiety than the reference group-Finnish-origin youth without disabilities-and whether unmet needs for support in distance learning and family conflicts mediated differences in anxiety during the pandemic. Differences in these mediators were also investigated.

METHODS

Population-based data of 165,033 youth aged 12 to 29 from the cross-sectional Finnish School Health Promotion study were obtained in 2021 using total population sampling. Logistic regressions with Stata were used to investigate the differences between the target (youth with disabilities, immigrant backgrounds, or both of these characteristics) and reference groups. The Karlson-Holm-Breen method was used to test for mediation.

RESULTS

The groups with disabilities (odds ratio [OR] = 4.14 [95% confidence interval (CI): 4.02-4.27]), immigrant backgrounds (OR = 1.15 [95% CI: 1.06-1.25]), or both of these characteristics (OR = 5.03 [95% CI: 4.59-5.52]) reported anxiety more often than the reference group. The difference between the minority and reference groups in unmet needs in distance learning and family conflicts were significant. Immigrant-origin youth with disabilities were most vulnerable to family conflicts, and the groups with disabilities were more prone to unmet needs. Unmet needs and family conflicts accounted for 28% of the association between immigrant-origin youth without disabilities and anxiety, whereas the mediating percentage was smaller for immigrant-origin youth with disabilities (13%) and Finnish-origin youth with disabilities (11%).

DISCUSSION

Immigrant-origin youth with disabilities need targeted support to prevent anxiety. Alleviating family conflicts and unmet needs in distance learning during crises could help decrease anxiety. Support for distance learning should be provided to youth with disabilities, regardless of their immigrant backgrounds.

Heart failure with mildly reduced and preserved ejection fraction: A review of disease burden and remaining unmet medical needs within a new treatment landscape

This review provides a comprehensive overview of heart failure with mildly reduced and preserved ejection fraction (HFmrEF/HFpEF), including its definition, diagnosis, and epidemiology; clinical, humanistic, and economic burdens; current pharmacologic landscape in key pharmaceutical markets; and unmet needs to identify key knowledge gaps. We conducted a targeted literature review in electronic databases and prioritized articles with valuable insights into HFmrEF/HFpEF. Overall, 27 randomized controlled trials (RCTs), 66 real-world evidence studies, 18 clinical practice guidelines, and 25 additional publications were included. Although recent heart failure (HF) guidelines set left ventricular ejection fraction thresholds to differentiate categories, characterization and diagnosis criteria vary because of the incomplete disease understanding. Recent epidemiological data are limited and diverse. Approximately 50% of symptomatic HF patients have HFpEF, more common than HFmrEF. Prevalence varies with country because of differing definitions and study characteristics, making prevalence interpretation challenging. HFmrEF/HFpEF has considerable mortality risk, and the mortality rate varies with study and patient characteristics and treatments. HFmrEF/HFpEF is associated with considerable morbidity, poor patient outcomes, and common comorbidities. Patients require frequent hospitalizations; therefore, early intervention is crucial to prevent disease burden. Recent RCTs show promising results like risk reduction of composite cardiovascular death or HF hospitalization. Costs data are scarce, but the economic burden is increasing. Despite new drugs, unmet medical needs requiring new treatments remain. Thus, HFmrEF/HFpEF is a growing global healthcare concern. With improving yet incomplete understanding of this disease and its promising treatments, further research is required for better patient outcomes.

Cancer survivorship: understanding the patients' journey and perspectives on post-treatment needs

BACKGROUND

Cancer treatments have many adverse effects on patient's health leading to poor cardiorespiratory capacity, muscular- degeneration, fatigue, loss of strength and physical function, altered body-composition, compromised immune-function, peripheral neuropathy, and reduced quality of life (QOL). Exercise programs can significantly increase functional capacity when tailored to individual needs, thus improving health. Exercise interventions in cancer rehabilitation, when supported by appropriate nutrition can be effective in attaining a healthy weight and body-composition. The successful rehabilitation program should also include psycho-social education aimed to reduce anxiety and improve motivation.

METHODS

The current study aimed to collect information on the post-treatment needs of cancer patients including barriers and expectations facing them, their caregivers and their families through consultation in focus group interviews. Cancer survivors living in the Republic of Ireland were recruited from the University Hospital Galway, community-based cancer centres, cancer support groups and social media platforms to participate in the study and attend a focus group interview. The focus group discussions were designed to obtain information on the collective views of cancer survivors on relevant topics selected. The topics were developed in consultation with a patient and public involvement (PPI) group supporting the study. The topics list was circulated to all participants prior to the focus group. The interviews were audio recorded and transcribed verbatim. Focus group transcripts were analysed subjected to a thematic framework analysis using NVivo.

RESULTS

Thirty-six participants took part in 9 focus groups. Our analysis uncovered two main themes. The first theme 'cast adrift with no direction' was grouped into three sub-themes: everything revolves around treatment; panic and fear; and what exercise should I be doing? The second theme 'everybody is different' was clustered into two sub-themes: side effects get in the way; and personalised exercise program.

CONCLUSION

The study highlighted the lack of information and support needed by patients living with and beyond cancer. The study also highlighted the need for a personalised exercise programme designed to target the individual patient symptoms that would be ideal for the mitigation of long term symptoms and in improving QOL.

Survivorship concerns among individuals diagnosed with metastatic cancer: Findings from the Cancer Experience Registry

INTRODUCTION

Individuals with metastatic cancer experience many medical, physical, and emotional challenges due to changing medical regimens, oscillating disease states, and side effects. The purpose of this study was to describe the type and prevalence of survivorship concerns reported by individuals with metastatic cancer, and their associations with cancer diagnosis, treatment, and socio-demographic variables.

METHODS

This study utilized data from the Cancer Support Community's Cancer Experience Registry. Individuals were included if they self-reported a solid tumor metastatic cancer and completed CancerSupportSource, which evaluates five domains of concerns (emotional well-being, symptom burden, body image/healthy lifestyle, healthcare team communication, and relationships/intimacy). Multivariable linear regression examined associations between independent predictors of each survivorship concern domain.

RESULTS

Of the 403 included participants, individuals reported a metastatic diagnosis of breast (43%), colorectal (20%), prostate (7%), lung (7%), gynecologic cancer (6%) and other. Nearly all (96%) reported at least one survivorship concern, with the most prevalent concern about cancer progression or recurrence. Survivorship concerns were higher across multiple domains for individuals unemployed due to disability. Individuals who were less than five years since diagnosis reported higher concerns related to emotional well-being, symptom burden, and healthcare communication compared to those more than five years since diagnosis.

CONCLUSION

Individuals with metastatic cancer experience a variety of moderate-to-severe survivorship concerns that warrant additional investigation.

IMPLICATIONS FOR CANCER SURVIVORS

As the population of individuals with metastatic cancer lives longer, future research must investigate solutions to address modifiable factors associated with survivorship concerns, such as unemployment due to disability.

Advanced fibrosis associated with non-alcoholic steatohepatitis (NASH) in Spain: results of a Delphi study

OBJECTIVE

To describe in detail the epidemiology, diagnosis, clinical management, treatment options, impact on quality of life and unmet needs of patients with advanced liver fibrosis (F3-F4) associated with non-alcoholic steatohepatitis (NASH) in Spain.

METHODOLOGY

Delphi study of two rounds of consultation rounds with 41 expert hepatologists from 16 autonomous communities to collect their experience in clinical practice.

RESULTS

The estimated prevalence of adult patients diagnosed with F3-F4 fibrosis associated with NASH in Spain is 0.019% (95% confidence interval [CI]: 0.019-0.020%). Approximately 7,588 adults with this condition are currently diagnosed and managed in the Digestive System Services of Spanish hospitals, and around 1,881 new patients are diagnosed each year. Management is multidisciplinary and includes the specialties of Digestive System, Endocrinology and Internal Medicine, considering the frequently associated metabolic comorbidities (obesity, type 2 diabetes mellitus or dysmetabolic iron overload). Despite a clear impact on quality of life, this it is not routinely evaluated in clinical practice. The most widely used non-invasive diagnostic techniques are transitional elastography and liver fibrosis index 4 (FIB-4). The absence of effective and safe treatments appears as the main unmet need for the management of these patients.

CONCLUSIONS

This study provides a representation of the current situation of patients diagnosed with F3-F4 fibrosis associated with NASH in Spain, increasing the evidence available and contributing to informed decision-making by professionals and the health system.

Unmet Needs of Patients Living with Migraine in the Gulf Cooperation Council (GCC) Countries

The scale of migraine and its impact on the lives of patients in the Gulf Cooperation Council (GCC) countries may be underestimated by healthcare professionals and the public and unmet needs in the provision of migraine medical care may exist. This article reports the key outcomes from a meeting of migraine specialists and their patients organised by the Emirates Neurology Society to learn more about the patient diagnosis and treatment journey and the extent to which migraine affects daily life. Patient stories indicate that the burden of migraine is underestimated, migraine is not generally recognised as a disease, delayed and incorrect diagnoses are common, and that achieving symptom control is often more a question of good luck rather than good management. Disease awareness campaigns are recommended to elevate societal understanding of migraine and reduce stigma toward patients affected by migraine. Recommendations for an improved healthcare system experience for patients affected by migraine include education initiatives targeting patients and physicians as well as initiatives to address gaps in the diagnosis and treatment of migraine.

Exploring Unmet Needs in Prostate Cancer Care: A Cross-sectional Descriptive Study

Background and objective

Prostate cancer, the most common cancer among men worldwide, has significant impact on quality of life. Supportive care needs for those affected by prostate cancer are not well understood. This study aims to describe patient-reported unmet needs and explore supportive care priorities of men treated for prostate cancer.

Methods

A cross-sectional survey was distributed to all men who had accessed prostate cancer services (including surgical, radiation, and medical oncology treatment modalities) at a tertiary hospital. The survey included qualitative questions exploring patient experience and a validated patient-reported outcome measure (Supportive Care Needs Survey Short Form 34). Clinical information was collected. Analyses included, descriptive statistics, multivariate logistic regression models and qualitative analyses using a framework method.

Key findings and limitations

A total of 162 participants provided survey data. Domains about information, self-management, and sexual function were the highest ranked items with unmet needs. A qualitative analysis also identified "relationships", "information", and "the value of hindsight" constructs. Participants who identified three or more unmet needs expressed treatment regret (odds ratio 5.92, 1.98-22.23, p = 0.01).

Conclusions and clinical implications

Understanding the unmet needs of patients may better inform supportive care interventions that address what is important to patients. Importantly, participants valued relationships. There may be opportunities to better meet the needs of patients by improving access to information and self-management resources, particularly around sexuality. Further research is warranted.

Patient summary

Prostate cancer and its treatment impacts are not well understood. Prioritisation of relationships and improving access to information and self-management resources are important. Further attention to prostate cancer supportive care in clinical practice is needed.

Management of Metastatic Urothelial Carcinoma in Emerging Markets (EM): An Expert Opinion

Urothelial carcinoma (UC) is the 10th most common cancer globally with an almost 4 times higher prevalence in men. The main risk factors for development of urothelial carcinoma are advanced age, smoking, arsenic contamination, exposure to carcinogens. Metastatic urothelial carcinoma (mUC) has overall poor prognosis with a 5-year overall survival rate of only < 5%. The standard of care comprises of platinum-based chemotherapy, but the responses are often not sustained. A working group was established with an objective to discuss the most recent clinical data on the genitourinary tumors of interest and comprised of experts across Latin America, Emerging Asia (except China, Japan, and South Korea), Africa, and the Middle East (known as Emerging Markets or EM). There is an evident disparity in terms of uneven mortality and incidence rate distribution among various regions. There is a lack and/or insufficient data on epidemiology, treatment, and outcomes in the EM. The lack of registries impacts the healthcare decisions and the lower incidence from the region might not be reflective of the true disease burden. The treatment outcomes of mUC can be improved by understanding the current disease burden and treatment approach of mUC and identifying the gaps and challenges associated with management. Hence, a literature review was developed to summarize the current disease burden and treatment approach of mUC across EM. The review also highlights the unmet needs for mUC management in EM and suggests a way forward to improve the current situation in order to better serve the patients.

Patients' evaluation of aftercare following hospitalization for COVID-19: satisfaction and unmet needs

BACKGROUND

Patient experiences with COVID-19 aftercare remain largely unknown. We evaluated COVID-19 aftercare from a patient perspective one year after hospitalization, assessing satisfaction and its associated factors, and unmet needs.

METHODS

The Satisfaction with COVID-19 Aftercare Questionnaire (SCAQ) was developed as part of a multicenter prospective cohort study and administered one year after hospital discharge. The SCAQ assesses (1) patient satisfaction, comprising information provision, rehabilitation, follow-up by hospitals and general practitioners (GPs), the most important aftercare topics, and overall satisfaction, and (2) unmet needs.

RESULTS

487/561 (87%) COVID-19 patients completed the SCAQ, all had been discharged from the hospital between March 2020 and May 2021. Among responders, the median age of patients was 60 (IQR 54-67) years, 338 (69%) were male, and the median length of stay in the hospital was 13 (6-27) days. Patients were least satisfied with information on who could be contacted with questions when health problems arise (59% satisfied or very satisfied). Many patients (75%) received rehabilitation, most frequently community-based (70%). Across the different community-based therapies, ≥ 60% of patients were satisfied with shared-decision making and ≥ 70% with the received therapy; a majority (≥ 79%) indicated a preference for receiving the same therapy again if needed. Regarding follow-up by hospitals, 86% of patients received this follow-up, most frequently visiting a pulmonologist (96%), being generally satisfied with the received aftercare. Aftercare from GPs was received by 39% of patients, with 88% being satisfied with the GP's availability and 79% with referral to appropriate aftercare providers. Patients (> 50%) considered information-related items most important in aftercare. Overall, patients rated their satisfaction with aftercare 8/10 (7-9) points. Those who received medical rehabilitation (versus no rehabilitation, adjusted beta 0.61 [95%CI 0.11 to 1.11], p = 0.02) or aftercare by a hospital medical specialist (1.1 [0.46 to 1.64], p < 0.001) or GP (0.39 [0.053 to 0.72], p = 0.023) reported significantly higher satisfaction than those without such aftercare. Unmet needs were reported by 35% of patients, with lack of information (20%) and lack of additional aftercare and/or involvement of their GP (19%) being the most frequently reported.

CONCLUSION

Despite the forced quick development of COVID-19 aftercare, patients were generally satisfied. Follow-up by healthcare professionals and information provision is important to meet patients' aftercare needs.

Identifying the unmet needs of post-treatment colorectal cancer survivors: A critical literature review

PURPOSE

Following treatment completion, colorectal cancer (CRC) survivors experience various unmet needs. This review aims to synthesize the unmet needs of CRC survivors after treatment and to identify demographic, disease or treatment-related, healthcare-related, and psychosocial factors correlated with unmet needs.

METHOD

English or Chinese articles that focused on CRC survivors' post-treatment unmet needs were systematically searched from the five electronic databases, which included CINAHL, PubMed, Embase, PsycINFO, and the China Academic Journal Full-text Database, from the launch of databases to July 2023. The reference lists of the subsequent articles were further screened.

RESULTS

136 individual needs extracted from 50 manuscripts were classified into nine domains based on the Supportive Care Framework. The top four unmet needs identified by CRC survivors were assistance with fears of cancer recurrence, information about managing illness and side effects at home, emotional or psychological support and reassurance, and help with sexuality problems. Following surgery, CRC survivors showed strong demand in the physical, psychological, and information domains. Survivors completed treatment within 1-year had more diverse needs than those who completed 1-3 years. Unmet needs may be greater among CRC survivors who were young, female, more educated, and unmarried. Furthermore, greater unmet needs were associated with distress, anxiety, depression, and worse quality of life.

CONCLUSIONS

Despite diverse needs experienced by post-treatment CRC survivors, a predominant focus on fears of cancer recurrence, information, psychological support, and sexuality needs is noted. Future studies should further explore the needs of CRC survivors after specific treatment and in different post-treatment periods.

Perceived communication efficacy and unmet needs for chemotherapy-associated symptom management in patients with lung and colorectal cancer: a cross-sectional study

BACKGROUND

Understanding cancer patients' unmet needs for chemotherapy-related symptom management will assist clinicians in developing tailored intervention programs. Little is known about the association between perceived communication efficacy and unmet care needs for symptom management in patients with lung and colorectal cancer.

OBJECTIVES

To examine the unmet care needs for symptom management of patients with lung and colorectal cancer and their association with perceived communication efficacy.

METHODS

A cross-sectional survey was conducted in a tertiary hospital in China from July to November 2020. A convenience sample of 203 patients with lung and colorectal cancer undergoing chemotherapy completed survey questionnaires, including the MD Anderson Symptom Inventory Scale and the Perceived Efficacy in Patient‒Physician Interactions Scale.

RESULTS

Approximately 43% of participants had at least one symptom with unmet needs. Fatigue was reported as the symptom with the highest occurrence (66%), the highest demand for supportive care (36%), and the highest prevalence of unmet needs (19%). Low levels of perceived communication efficacy independently predicted participants' unmet needs for symptom management (β=-0.13, p = 0.011).

CONCLUSIONS

This study highlights the necessity of introducing clinical assessment tools and guidelines to address fatigue and other chemotherapy-induced symptoms in patients with lung and colorectal cancer. Clinical programs designed to actively engage cancer patients to voice their needs and strengthen their communication efficacy are also warranted.

Gaps in pediatric oncologic end of life care as recounted by the bereaved parents in Isarel

PURPOSE

This study investigated parents' perception of their needs and those of their children with cancer at the end-of-life period, including unmet needs and their expectations regarding providers.

DESIGN AND METHODS

This cross-sectional study involved 26 parents recruited from three pediatric hematology-oncology wards in Israel who completed demographic and medical questionnaires of the child, and a parental needs questionnaire based on The Needs Assessment of Family Caregivers-Cancer questionnaire, following the death of their child.

FINDINGS

Parents expressed needs related to medical care, including pain management, decision-making, and finding optimal treatment options for their children. The most prominent unmet needs were financial and psychological factors, of which, paying for medical expenses and helping their child adjust to the end of their life received the highest mean scores. There were notable gaps between desired and actual support from service providers, particularly in relation to emotional aspects. While over half of the parents believed the psychosocial team should assist with their child's emotional distress, this need was not adequately fulfilled. Some parents also expressed a desire for better emotional support during the end-of-life period.

CONCLUSIONS

The study emphasizes the importance of understanding parents' needs and perspectives during this challenging time. The identified gaps in support can be attributed to parental roles, the struggle with losing hope, communication barriers between care teams and parents, among others.

PRACTICE IMPLICATIONS

By gaining insight into these needs and perceptions, care teams can enhance the provision of palliative care and optimize the distribution of responsibilities within the team.

Identifying definite patterns of unmet needs in patients with multiple sclerosis using unsupervised machine learning

INTRODUCTION

People with multiple sclerosis (PwMS) exhibit a spectrum of needs that extend beyond solely disease-related determinants. Investigating unmet needs from the patient perspective may address daily difficulties and optimize care. Our aim was to identify patterns of unmet needs among PwMS and their determinants.

METHODS

We conducted a cross-sectional multicentre study. Data were collected through an anonymous, self-administered online form. To cluster PwMS according to their main unmet needs, we performed agglomerative hierarchical clustering algorithm. Principal component analysis (PCA) was applied to visualize cluster distribution. Pairwise comparisons were used to evaluate demographics and clinical distribution among clusters.

RESULTS

Out of 1764 mailed questionnaires, we received 690 responses. Access to primary care was the main contributor to the overall unmet need burden. Four patterns were identified: cluster C1, 'information-seekers with few unmet needs'; cluster C2, 'high unmet needs'; cluster C3, 'socially and assistance-dependent'; cluster C4, 'self-sufficient with few unmet needs'. PCA identified two main components in determining the patterns: the 'public sphere' (access to information and care) and the 'private sphere' (need for assistance and social life). Older age, lower education, longer disease duration and higher disability characterized clusters with more unmet needs in the private sphere. However, demographic and clinical factors failed in explaining the four identified patterns.

CONCLUSION

Our study identified four unmet need patterns among PwMS, emphasizing the importance of personalized care. While clinical and demographic factors provide some insight, additional variables warrant further investigation to fully understand unmet needs in PwMS.

Unmet non-medical needs of cancer patients in Poland: a quantitative and qualitative study

PURPOSE

Cancer itself and its treatment have a multifaceted impact on patients' daily lives. The aim of the study was to determine unmet non-medical needs among Polish cancer patients.

METHODS

Survey research using a 23-item Needs Evaluation Questionnaire (NEQ) was carried out among 1062 cancer patients from different regions of Poland. Quantitative and qualitative analyses were performed.

RESULTS

The quantitative analysis showed that 48% of the NEQ items (11/23) were expressed as unmet needs by at least half of patients. Unmet information needs were indicated by patients most often: information about their diagnosis, exams, treatment, future condition, funding and economic support. Cancer patients would like to get more attention from medical staff. Unmet needs were most frequently expressed by respondents who were men, with a lower level of education, living in village, pensioners. Qualitative analysis showed that each need may be understood in a variety of different ways across the cohort. Some patients added comments that the completing NEQ helped them to notice their non-medical needs.

CONCLUSION

Polish cancer patients have some unmet non-medical needs, especially informative needs.

Phenylketonuria from the perspectives of patients in Türkiye

BACKGROUND

The present study aimed to determine the problems, unmet needs and expectations of phenylketonuria (PKU) patients in Türkiye regarding follow-up and treatment in order to provide data for future planning and implementations on PKU.

METHODS

The study included patients diagnosed with PKU and/or their parents. They were informed about the study via phone calls and their verbal consents were obtained. Questions in the data collection forms, which were established separately for pediatric, adolescent, and adult age groups, were applied during the interviews and the answers were recorded.

RESULTS

Among 182 classical PKU patients, 66 (36.3%) were in the pediatric group (0-12 years old), 44 (24.2%) were in the adolescent group (13-19 years old), and 72 (39.5%) were in the adult group (≥ 20 years old). In all patient groups, phenylalanine-restricted diet and medical nutrition products were the main options for treatment. The median of the last measured blood phenylalanine concentration (patient-reported) was 290 µmol/L, 425 µmol/L, and 750 µmol/L in the pediatric, adolescent, and adult groups, respectively. The frequency of blood testing for serum phenylalanine level according to the age groups was appropriate in nearly half of the patients. While the majority of the patients have been visiting the metabolism center they have been diagnosed with PKU for control, considerable proportion of the patients would like to change the center or the doctor they visit for control if they could. It was determined that nearly half of the patients had trouble in accessing the metabolism center. Treatment options' being limited and expensive were the major problems. The main requests of the patients and patient relatives included easier access to the metabolism centers and more options for treatment and diet.

CONCLUSIONS

Access to the services should be easier to improve the patients' follow-up and treatment. There is need for low-cost, easily applicable, and accessible nutrition products and effective novel pharmacological agents. Focusing on these issues in health policies by providing pedagogic/psychological support, establishing support programs also comprising the families, and increasing the awareness activities were the key outcomes.

Impact of disease recurrence on the supportive care needs of patients with ovarian cancer and their caregivers

OBJECTIVE

We aimed to explore the supportive care needs of ovarian cancer patients and their caregivers before and after the first cancer recurrence, the top unmet needs after recurrence, and the relationship between patient and caregiver needs at recurrence.

METHODS

Participants were 288 patients and 140 caregivers from the Australian Ovarian Cancer Study-Quality of Life (AOCS-QoL) cohort. They completed Supportive Care Needs Surveys (patients: SCNS-SF34, caregivers: SCNS-P&C44) every three-to-six months for up to two years. Linear mixed models tracked changes in needs over time. We calculated the percentage reporting moderate-to-high needs after recurrence. LASSO regression analysed patient-caregiver need relationships.

RESULTS

Both patients' and caregivers' psychological, health system/service and information needs increased with recurrence along with patients' support and physical needs. These remained stable at nine months after recurrence. Dominant patient needs post-recurrence included 'fear of recurrence' (38%) and 'concerns about the worries of those close' (34%), while caregivers expressed 'concerns about recurrence' (41%) and 'recovery of the patient not turning out as expected' (31%). Among dyads, when patients had 'fears about the cancer spreading' this was associated with caregivers having a need for help with 'reducing stress in the patients' life'; when caregivers had concerns about 'recurrence' this was associated with patients needing help with 'uncertainty about the future' and 'information about things they can do to help themselves'.

CONCLUSIONS

Recurrent ovarian cancer intensifies disease-related fears and concerns for patients and loved ones. Addressing dyadic concerns through supportive care interventions may enhance cohesion during the challenging journey of recurrent disease.

Unmet health care needs over the first 2 years after pediatric traumatic brain injury

AIM

Few studies have addressed how children and adolescents with traumatic brain injuries (TBIs) access health care and educational services. This study aimed to investigate the course of symptoms during the first two years after TBI, whether symptoms implied a need for health care and/or educational services, and the extent of unmet needs. The association between unmet needs and health-related quality of life was also explored.

METHODS

This prospective cohort study was conducted at Oslo University Hospital, Norway, from 2015 to 2018. Forty-nine patients aged 1-15 years hospitalized due to TBI were included and followed for 24 months. Registration of symptoms and identification of unmet needs was based on clinical assessment, self-reports and interviews with patients and parents during the acute phase and at 6 and 24 months postinjury.

RESULTS

Twenty-five percent of the sample presented with unmet needs at 24 months. Compared to the group with no needs and met needs, these patients reported lasting cognitive and emotional symptoms affecting school and social interaction and scored lower on health-related quality of life.

CONCLUSION

Pediatric patients with TBI may have long-term symptom burden affecting school and social functioning, leading to unmet needs if targeted services are not provided.

Effects of disability-related limitations in daily living on unmet needs: a longitudinal-study1

BACKGROUND

Unmet health needs are particularly important to people with disabilities; however, these unmet needs owing to limitations in daily life have been under-researched thus far. This study examined the effects of disability-related limitations in daily life on unmet needs.

METHODS

This study included 5,074 adults with disabilities from the 2018-2020 Korea Disability and Life Dynamics Panel. We analyzed the effects of disability-related limitations in daily life on unmet needs using logistic regression with a generalized estimating equation model.

RESULTS

Overall, 4.8% men and 4.6% women with disabilities had unmet needs. For men, unmet needs were 1.46 times (95% confidence interval [CI] 1.09-1.96) higher for those with moderate limitations in daily life. For women, unmet needs were 1.79 times (95% CI 1.22-2.39) higher when there were moderate limitations in daily life. The prominent factors causing this effect were physical or brain lesion disability for men and internal or facial disability and burden of medical expenses for women.

CONCLUSIONS

Limitations in daily life due to disability increase the risk of having unmet needs, an effect that is significantly more pronounced in men. These unmet needs differ depending on an individual's sex, disability type, limited body parts, and other specific causes. Efforts are required to reduce the unmet needs of people with disabilities by considering the type of disability, impaired body parts, and causes of unmet needs in daily life.

Unmet needs in β-thalassemia and the evolving treatment landscape

β-thalassemias are genetic disorders causing an imbalance in hemoglobin production, leading to varying degrees of anemia, with two clinical phenotypes: transfusion-dependent thalassemia (TDT) and non-transfusion-dependent thalassemia (NTDT). Red blood cell transfusions and iron chelation therapy are the conventional treatment options for the management of β-thalassemia. Currently available conventional therapies in thalassemia have many challenges and limitations. Accordingly, multiple novel therapeutic approaches are currently being developed for the treatment of β-thalassemias. These strategies can be classified into three categories based on their efforts to address different aspects of the underlying pathophysiology of β-thalassemia: correction of the α/β globin chain imbalance, addressing ineffective erythropoiesis, and targeting iron dysregulation. Managing β- thalassemia presents challenges due to the many complications that can manifest, limited access and availability of blood products, and lack of compliance/adherence to treatment. Novel therapies targeting ineffective erythropoiesis and thus improving anemia and reducing the need for chronic blood transfusions seem promising. However, the complex nature of the disease itself requires personalized treatment plans for each patient. Collaborations and partnerships between thalassemia centers can also help share knowledge and resources, particularly in regions with higher prevalence and limited resources. This review will explore the different conventional treatment modalities available today for the management of β-thalassemia, discuss the unmet needs and challenges associated with them in addition to exploring the role of some novel therapeutic agents in the field.

Challenges Experienced by Black Women with Breast Cancer During Active Treatment: Relationship to Treatment Adherence

BACKGROUND

Although rates of death from breast cancer have declined in the USA for both Black and White women since 1990, mortality rates for Black women remain strikingly higher - 40% higher compared to White women (American Cancer Society 1). The barriers and challenges that may be triggering unfavorable treatment-related outcomes and diminished treatment adherence among Black women are not well understood.

METHODS

We recruited 25 Black women with breast cancer who were to receive surgery and chemotherapy and/or radiation therapy. Through weekly electronic surveys, we assessed types and severity of challenges across various life domains. Because the participants rarely missed treatments or appointments, we examined the impact of severity of weekly challenges on thoughts of skipping treatment or appointment with their cancer care team using a mixed-effects location scale model.

RESULTS

Both a higher average severity of challenges and a higher deviation of severity reported across weeks were associated with increased thoughts on skipping treatment or appointment. The correlation between the random location and scale effects was positive; thus, those women that reported more thoughts on skipping a dose of medicine or appointment were also more unpredictable with respect to the severity of challenges reported.

CONCLUSIONS

Black women with breast cancer are impacted by familial, social, work-related, and medical care factors, and these may in turn affect adherence to treatment. Providers are encouraged to actively screen and communicate with patients regarding life challenges and to build networks of support within the medical care team and social community that can help patients successfully complete treatment as planned.

Use of Radiotherapy in Advanced Breast Cancer: The Role of a Nurse

OBJECTIVES

Systemic therapy is the mainstay in advanced breast cancer (ABC), but innovations in radiation oncology have given radiotherapy a crucial role in the treatment of both intracranial and extracranial ABC. Breast cancer specialists include, in addition to medical and clinical oncologists, breast cancer nurses with unique theoretical knowledge and significant clinical experience. This review aims to discuss the function of radiotherapy in ABC and to highlight the role and importance of specialized nursing care for ABC patients receiving radiotherapy.

DATA SOURCES

An extensive literature review was conducted on the role of radiotherapy and its implementation in various settings of ABC and the pivotal contribution of nursing practices to the quality of life of these patients, with a particular focus on symptom and side effect management and prevention, education, as well as unmet patient needs. The Advanced Breast Cancer International Consensus Guidelines (ABC-5) were also included. All the above data were combined with the expert and practical considerations of breast cancer specialists within the team.

CONCLUSION

The sophisticated application of radiotherapy and the complexity of ABC patient management, concerning symptoms, side effects, and overall well-being necessitate collaborative efforts to optimize patient care. Breast cancer nurses hold a central role in this framework.

IMPLICATIONS FOR NURSING PRACTICE

The significance of specialized nursing in contributing to comprehensive patient care for ABC patients treated with radiotherapy outlines the need for extensive training that aims to provide a holistic approach and entails physical, mental, and emotional support and patient and caregiver education.

The Unmet Needs of Women with Maternal Near Miss Experience: A Qualitative Study

Introduction

A maternal near-miss (MNM) case is defined as "a woman who nearly died but survived from life-threatening pregnancy or childbirth complication". This study was conducted on health care providers and near-miss mothers (NMMs) with the aim of discovering the unmet needs of Iranian NMM.

Methods

In this qualitative study 37 participants of key informants, health providers, NMMs and their husbands were selected using purposive sampling. Semi-structured in-depth interviews were conducted for data collection until data saturation was achieved. Data were analyzed using Graneheim and Lundman conventional content analysis.

Results

The analysis revealed the core category of "the need for comprehensive support". Eight categories included "psychological", "fertility", "information", "improvement the quality of care", "sociocultural", "financial", "breastfeeding" and "nutritional" needs emerging from 18 sub-categories, were formed from 2112 codes.

Conclusion

Many of the real needs of NMM have been ignored. Maternal health policymakers should provide standard guidelines based on the needs discovered in this study to support the NMMs' unmet needs.

Support needs of carers of cancer patients and the effects of the patient's age and cancer type on their needs

PURPOSE

This study aimed to investigate support needs of carers of cancer patients and the effects of the patient's age and cancer type on their needs.

METHODS

In this descriptive and comparative study, the data were collected from the carers (n = 120) of the patient admitted to inpatient and outpatient clinics of a university hospital between June 2021 and October 2022. Patient identification form, carer identification form, and Carer Support Needs Assessment Tool (CSNAT) were used for data collection. The comparisons of the support needs were done for the carers according to the patient's age (<65 versus ≥65 years) and cancer type (hematological malignancies versus solid tumors).

RESULTS

Caring duration (19.78 ± 29.64 vs 10.33 ± 18.77 months) and caring hours per week (47.58 ± 26.90 vs 32.75 ± 25.75 h) were high in those caring for older adults. Carers of older adults need more support in providing personal care for their relatives (eg dressing, washing, toileting) (X2 = 8.000, p = 0.005). Carers of patients with hematological malignancies need more support in understanding their relative's illness (X2 = 6.136, p = 0.013), having time themselves in the day (X2 = 4.089, p = 0.043), managing their relative's symptoms, including giving medicines? (X2 = 5.263, p = 0.022), and their beliefs or spiritual concerns (X2 = 4.728, p = 0.030) compared to the carers of the patients with solid tumors.

CONCLUSION

The support needs of the carers vary depending on the patient's age and cancer type. Carers of older adults and patients with hematological malignancies need more support.

Variables Associated with Quality of Life Among Individuals Living in Permanent Supportive Housing

This study identified individual sociodemographic and clinical characteristics and service use patterns associated with quality of life (QoL) among 308 individuals living in permanent supportive housing (PSH) in Québec (Canada). Data were collected between 2020 and 2022, and linear multivariate analyses produced. Results demonstrated that better individual psychosocial conditions were positively associated with higher QoL. As well, living in PSH located in good neighborhoods for at least 5 years, higher self-esteem and community integration were positively associated with greater QoL. Met needs, satisfaction with housing support services, and no use of acute care were also linked with positive QoL. Comprehensive efforts to improve treatment for mental health disabilities responsive to the needs of PSH residents, and sustained long-term housing may reinforce QoL. Encouraging active participation in community-based activities, incorporating biophilic design into the neighborhoods around PSH, and promoting satisfaction with care may also enhance QoL.

Prevalence of Unmet Rehabilitation Needs Among Canadians Living With Long-term Conditions or Disabilities During the First Wave of the COVID-19 Pandemic

OBJECTIVE

We aimed to describe the prevalence of unmet rehabilitation needs among a sample of Canadians living with long-term conditions or disabilities during the first wave of the COVID-19 pandemic.

DESIGN

Cross-sectional survey.

SETTING

Individuals residing in Canada during the first wave of the COVID-19 pandemic.

PARTICIPANTS

Eligible participants were Canadians living with long-term conditions or disabilities, 15 years or older living in 1 of the 10 provinces or 3 territories (n=13,487).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

We defined unmet rehabilitation needs as those who reported needing rehabilitation (ie, physiotherapy/massage therapy/chiropractic, speech, or occupational therapy, counseling services, support groups) but did not receive it because of the COVID-19 pandemic. We calculated the national, age, gender, and province/territory-specific prevalence and 95% confidence interval of unmet rehabilitation needs.

RESULTS

During the first wave of the pandemic, the prevalence of unmet rehabilitation needs among Canadians with long-term conditions or disabilities was 49.3% (95% confidence interval [CI]; 48.3, 50.3]). The age-specific prevalence was higher among individuals 15-49 years old (55.6%; 95% CI [54.2, 57.1]) than those 50 years and older (46.0%; 95% CI [44.5, 47.4]). Females (53.7%; 95% CI [52.6, 54.9]) had higher unmet needs than males (44.1%; 95% CI [42.3, 45.9]). Unmet rehabilitation needs varied across provinces and territories.

CONCLUSIONS

In this sample, almost 50% of Canadians living with long-term conditions or disabilities had unmet rehabilitation needs during the first wave of the COVID-19 pandemic. This suggests that a significant gap between the needs for and delivery of rehabilitation care existed during the early phase of the pandemic.

"What if I die and no one had ever romantically loved me?": sexual well-being in a sample of YA cancer survivors

PURPOSE

Among young adult (YA) cancer survivors, sexual health is often exclusively focused on sexual functioning, or the completion of sexual tasks. However, it has become clear that there is another element of sexual health, sexual well-being-one's subjective experience of sex (e.g., body image or sexual/romantic relationship satisfaction)-that may be just as impaired as sexual functioning. In this study, we sought to elucidate potential themes that YA cancer survivors experience that cross both sexual functioning and well-being, thus encouraging more comprehensive sexual health education among those diagnosed with cancer.

METHODS

Semi-structured interviews were conducted as part of a larger qualitative study. Three codes developed by a team of coders-Social Isolation: Dating and Sex, Self-Evaluative Emotion: Shame in Dating and Relationships, and Self-Evaluative Emotion: Shame in Body Image/Physical Ability Concerns-included both sexual functioning and sexual well-being, and therefore guided this analysis.

RESULTS

Our sample consisted of thirty-five YA cancer survivors who were predominately female (86%) and non-Latino White (77%). Four themes emerged: missing out/aging out, inability to please (potential) partners, body image concerns, and unmet needs for social support.

CONCLUSION

While current research has identified sexual functioning as making up most of the sexual health education that cancer survivors receive, there is an interrelationship between sexual functioning and sexual well-being.

IMPLICATIONS FOR CANCER SURVIVORS

The clinical ramifications of the data are clear: more work must be done to address sexuality within both the couple and the individual survivor, and that work cannot be exclusively devoted to sexual functioning.

Utilization of modern menstrual methods and related unmet needs among college going women in Coimbatore district: a descriptive cross-sectional study

OBJECTIVES

The primary objectives were to determine the proportion of modern menstrual method (MMM) users among college going women in Coimbatore district, Tamil Nadu; and to estimate the unmet needs associated with use of MMMs in comparison with other menstrual hygiene methods (MHMs). We also assessed the factors that determine MMM use among college going women.

METHODS

This was a descriptive cross-sectional study conducted among college going women in Coimbatore district, Tamil Nadu, India between October 2022 and January 2023 using a purpose predesigned, pretested, semi-structured proforma that included validated Menstrual Practice Needs Scale (MPNS-36).

RESULTS

Only 1.4% of the study participants used MMMs - menstrual cups (1.3%) and tampons (0.1%). Sanitary pads were the most common MHM of choice (96.3%); of which majority (98.6%) used disposable pads and more than half (50.4%) used non-biodegradable pads. Importantly, one in six (16.5%) were not aware of nature of sanitary pads (biodegradable or nonbiodegradable) used. The unmet needs associated with MMMs (menstrual cups and tampons) were significantly lower than that for other MHMs (including sanitary pads), in particular, the unmet material and home environment needs, unmet material reliability concerns, unmet reuse needs and unmet reuse insecurity. However, we found no significant difference between MMMs, sanitary pads and other MHMs in terms of unmet transport, college environment, change and disposal insecurity needs. The significant predictors of use of MMMs were age (more than 21 years of age), residence (urban), type of stay (off campus including home), socioeconomic status (upper), fathers' and mothers' education (high school and above), and presence of personal income. Discussions with friends (or peers) both before and after menarche regarding menstruation resulted in higher adoption of modern menstrual methods.

CONCLUSION

MMMs provided comparative advantage with lesser unmet needs for material reliability and reuse insecurity concerns, particularly in home environment. However, none of the MHMs fulfilled the user expectations for transport and disposal insecurity concerns, particularly outdoors.

Illuminating the nutrition-related policy-practice gaps in colorectal cancer survivorship

PURPOSE

Colorectal cancer (CRC) is among the three most commonly diagnosed cancers globally, after breast and lung cancer, with an estimated 2 million new cases each year, comprising ten per cent of all cancers worldwide. CRC has a complex aetiology associated with several nutrition-related risk factors. Cancer survivors frequently report alterations to their dietary habits and nutritional intake, with related adverse impacts on health-related quality of life (QOL). Whilst nutrition-related factors are recognised as survivor priorities and embedded in survivor care policies, dietary support is frequently not the standard of care in practice.

METHODS AND RESULTS

In this Commentary, we present details of a critical policy-practice gap for CRC survivors across the spectrum of nutrition care that we have seen growing in the literature, in hospitals, community and private practice.

CONCLUSION

As these nutrition concerns can adversely impact QOL and morbidity and mortality risks, we hope to raise awareness of these issues to provide a basis of future work in this area, so that policymakers and clinicians can improve support and outcomes for CRC survivors and their families.

"Systems seem to get in the way": a qualitative study exploring experiences of accessing and receiving support among informal caregivers of people living with chronic kidney disease

BACKGROUND

The well-being of informal caregivers of people living with chronic kidney disease is influenced by their experiences with support, however, few studies have focused on exploring these experiences. This study aimed to explore informal caregivers' experiences accessing and receiving support while caring for someone living with chronic kidney disease.

METHODS

Informal caregivers of people living with chronic kidney disease (n = 13) in the United Kingdom were primarily recruited via community organisations and social media adverts to participate in semi-structured interviews. Interviews explored support needs, experiences of receiving support from different groups (e.g. healthcare professionals, family/friends), and barriers and facilitators to accessing support. Support was understood as including emotional, practical, and informational support. Data were analysed using reflexive thematic analysis.

RESULTS

Three themes were generated: (1) "Systems seem to get in the way" - challenges within support systems, illustrating the challenges informal caregivers encountered when navigating complex support systems; (2) Relying on yourself, describing how informal caregivers leveraged their existing skills and networks to access support independently, while recognising the limitations of having to rely on yourself to find support; and (3) Support systems can "take the pressure off", showing how support systems were able to help informal caregivers cope with the challenges they experienced if certain conditions were met.

CONCLUSIONS

In response to the challenges informal caregivers experienced when seeking support, improvements are needed to better consider informal caregiver needs within healthcare systems, and to develop interventions tailored to informal caregiver needs and context. Within the healthcare system, informal caregivers may benefit from system navigation support and better integration within healthcare teams to ensure their informational support needs are met. New interventions developed to support informal caregivers should fit within their existing support systems and incorporate the qualities of support, such as empathy, that were valued. Additionally, use of an equity framework and user-centered design approaches during intervention development could help ensure interventions are accessible and acceptable.

Unmet needs and the effect of healthcare system generosity on prevention activity - A multilevel analysis

INTRODUCTION

Maintaining a healthy lifestyle and obtaining preventive care (hereafter, prevention-activity) usually have an inverse association with poverty status and unmet needs. We seek to estimate the extent to which the effect of individual unmet needs status on prevention-activity is moderated by the generosity of the healthcare system.

MATERIALS AND METHODS

Two datasets were combined: Pre-Covid Wave-8 (2019-2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE, Release 8.0.0), with 46,500 individuals aged 50+ from 27 countries (26 European countries and Israel) and 12 healthcare generosity variables obtained from the OECD Health Statistics Library. An econometric two-level model was used in three sequentially models. Outcome variables included five prevention-activities align over a continuum (sports, smoking, flu vaccinations, mammography, and colon cancer screening) and unmet needs status, defined as the lack of resources necessary to meet basic human and medical needs.

RESULTS

We found that unmet needs at the individual level had a significant negative fixed effect in all of the prevention-activity models including a healthy lifestyle, primary prevention and secondary prevention. Sources of intra-country variation were social/public insurance, health expenditure and number of nurses, which have had a significant and positive effect on an individual's prevention-activities (except years of smoking). Nonetheless, the gaps in generous countries between people reporting on unmet need and others were larger or similar to those in less generous countries, suggesting that disparities increase with the generosity of the health system.

CONCLUSIONS

The study provides insight into the effect of health system generosity on socioeconomic inequalities in healthy lifestyle and prevention care. Our findings suggest that the state has an important and decisive role to play in ensuring that prevention services are accessible to the entire population, particularly those reporting unmet needs.

How did unmet care needs during the pandemic affect health outcomes of older European individuals?

The first wave of the COVID-19 pandemic left many people with unmet health care needs, which could have detrimental effects on their health. This paper examines the effects of these unmet needs during the first wave of the pandemic on health outcomes one year later. We combine two waves of the SHARE survey collected during the COVID-19 pandemic (in June/July 2020 and 2021), as well as four waves collected before the pandemic. Our health outcomes are four dummy variables: fatigue, falling, fear of falling and dizziness/faints/blackouts issues. Finally, we use OLS regression with individual and time fixed effects for our difference-in-difference analysis, as well as a doubly robust estimator to condition the parallel trend assumption on pre-pandemic covariates. We find substantial effects of having had unmet healthcare needs during 2020 on the probability of having trouble with fatigue and fear of falling one year later. We particularly find strong effects for general practitioner (GP) and specialist care, and in lower extent of physiotherapist, psychotherapist, and rehabilitation care.

Patient-reported unmet supportive care needs in long-term colorectal cancer survivors after curative treatment in an Asian population

OBJECTIVES

Despite an increase in colorectal cancer (CRC) survival, less is known about CRC-specific long-term unmet supportive needs in Asian patients. This study aimed to examine the prevalence of long-term unmet needs and identify clinical and socio-demographic factors associated with increased unmet needs in Asian CRC survivors.

DESIGN AND SETTING

We conducted a cross-sectional study that assessed unmet needs using the Cancer Survivors' Unmet Needs scale. CRC survivors of at least two years after undergoing curative surgery were recruited from an outpatient clinic of a large public hospital in Singapore.

RESULTS

In total, 400 CRC survivors with a mean age of 64 and a median survival time post-surgery of 78 months participated in the study. Approximately half of patients (52%) reported at least one unmet need. Male gender (RR 1.19, p = 0.01), age greater than 65 years (RR 0.63, p < 0.0001), longer follow up of more than 5 years (RR 0.80, p = 0.009), presence of a permanent stoma (RR 1.78, p < 0.0001), prior radiotherapy in treatment course (RR 1.99, p < 0.0001), higher educational status (RR 1.30, p = 0.0002), currently employed (RR 0.84, p = 0.014), currently married (RR 0.84, p = 0.01) were significant predictors for increased unmet needs.

CONCLUSION

There is a high prevalence of unmet needs in long-term Asian CRC survivors, which underscores the importance of screening patients to allow for early detection of unmet needs. Our findings on sociodemographic and clinical predictors can inform the development of targeted interventions tailored to the need domains and improvement of survivorship programmes.

Technology for dementia care: what would good technology look like and do, from carers' perspectives?

BACKGROUND

The development of technology in dementia care has largely been without consultation with carers, and has primarily focused on safety, monitoring devices, and supporting activities of daily living. Further, while involving end-users in the design of technology has been recommended, this is yet to become common practice.

METHOD

We conducted a mixed methods study with the aim of investigating carers' values and priorities for technology development, including prior experiences, barriers to use, and what they would like technology to do. Importantly, we asked carers for their design ideas and bespoke technology solutions for future development.

RESULTS

Carers of people living with dementia (N = 127), including both unpaid (n = 102) and paid carers (n = 25) residing in Australia, completed an online survey. In addition, a subsample of carers (n = 23) participated in semi-structured interviews. Findings demonstrate that carers want technology to be person-centred, customisable, and to increase opportunities for meaningful social connection. Findings also demonstrate the ability of carers to generate creative design solutions for dementia care.

CONCLUSIONS

These findings and implications will be discussed in relation to the importance of co-design with carers and engineers during the design phase of assistive technology. Also, the importance of technology to enhance, not replace, human-to-human social interactions is highlighted.

Family Ties and Older Adult Well-Being: Incorporating Social Networks and Proximity

OBJECTIVES

This paper examines the family ties of older adults in the United States and how they are associated with mental health and social activity. We compare older adults with 4 types of family ties: adults "close" to family in proximity and social network, "kinless" older adults without a partner or children, "distanced" adults who live far from close kin, and "disconnected" older adults who do not report kin in their social network or do not report a location for some kin.

METHODS

Using pooled data from the National Health and Aging Trends Study 2015-2019 for older adults aged 70 and older (N = 24,818 person-waves), we examine how family ties are associated with mental health and social activity, and whether lacking family is tied to poor well-being because older adults' needs are not being met.

RESULTS

Kinless older adults and disconnected older adults have poorer outcomes (lower mental health scores and less social activity), compared to those close to their family. These findings suggest that both the presence and quality of the connection, as measured here via both location and social network, are critical for understanding which older adults are "at risk." Older adults who were not geographically proximate to their close kin (i.e., distanced) were not disadvantaged relative to those close to their families. Unmet needs do not help explain these patterns.

DISCUSSION

Our results highlight that family ties are important for older adults well-being, not just through their existence but also their quality and strength.

Supportive care needs in Australian melanoma patients and caregivers: results from a quantitative cross-sectional survey

PURPOSE

This study aimed to investigate the supportive care needs of Australian melanoma patients and their caregivers to form the basis for improving services.

METHODS

General and melanoma-related supportive care needs in melanoma patients were measured using the SCNS-SF34 and SCNS-M12 respectively, whereas caregivers completed the SCNS-P&C. Patients also completed the MCQ-28 and FCRI-9, with all participants completing the QLQ-C30, DASS-21, and questions measuring utilisation and preference for supportive health services. Multivariable stepwise logistic regression was used to identify variables associated with unmet needs in melanoma patients.

RESULTS

A total of 56 early-stage patients, 100 advanced-stage patients, and 37 caregivers participated. At least three-quarters ([Formula: see text] 75%) of each participant group reported at least one unmet need. Of the ten most reported unmet needs in each participant group, at least six ([Formula: see text] 60%) were related to psychological and emotional well-being, with access to a psychologist the most desired service (> 25%). Fear of cancer recurrence was equally prevalent in both patient groups at a level indicative of need for intervention. Advanced-stage patients reported significantly (p < 0.05) more unmet psychological, physical and daily living, and sexuality needs, and significantly (p < 0.05) worse functioning than early-stage patients.

CONCLUSION

Australian melanoma patients and caregivers report substantial unmet supportive care needs, particularly regarding their psychological and emotional well-being. Psychological and emotional well-being services, such as access to a clinical psychologist or implementation of patient-reported outcome measures, should be incorporated into routine melanoma care to address unmet patient and caregiver needs and improve well-being.

Patient and Caregiver Outcomes After Onasemnogene Abeparvovec Treatment: Findings from the Cure SMA 2021 Membership Survey

INTRODUCTION

Onasemnogene abeparvovec (OA) is the only gene replacement therapy currently approved for spinal muscular atrophy (SMA) treatment. We sought to assess real-world patient and caregiver outcomes after OA treatment for SMA.

METHODS

Patients who received OA were identified from the 2021 Cure SMA Membership Survey. Those treated at 6-23 months of age were matched to non-patients treated with OA on the basis of age at the time of survey and survival motor neuron 2 gene copy number. Patient characteristics, motor milestones, and resource and supportive care use, as well as caregiver proxy-reported health-related quality of life (HRQOL), were described. Caregiver unmet needs and HRQOL were also assessed.

RESULTS

Of the 614 patients in the survey, 64 received OA, and 17 were matched with 28 non-OA-treated patients. In general, a greater percentage of OA-treated patients achieved various motor milestones, including 100% sitting without support and 58.8% walking with assistance. OA-treated patients also had numerically lower rates of hospitalization and surgery. None required tracheostomy with a ventilator. The rate of using oxygen or a breathing machine for more than 16 h was also lower for OA-treated patients. OA-treated patients had less frequent trouble swallowing. HRQOL was reported to be similar to non-OA-treated patients. Caregivers of OA-treated patients reported better patient mobility scores and less work impairment.

CONCLUSIONS

The study suggests that treatment with OA is associated with greater rates of motor milestone achievements and less resource and supportive care use for patients with SMA treated at 6-23 months of age in the real world. For caregivers, it may also potentially reduce unmet needs, improve HRQOL, and reduce work impairment.

Testicular Cancer: The Unmet Needs of a Younger Generation of Cancer Survivors

Unmet holistic needs of various cancer populations, with examples including prostate, bladder, gynecologic, kidney, penile, breast, and colorectal, along with holistic impacts of cancer on older adults, have been defined by a growing number of systematic reviews. Unfortunately, there continues to be a lack of clinical insight into the unique needs of younger men with testicular cancer. Survival rate based on low mortality rates and good prognosis if early detection and treatment implementation grows the number of men who need support as long-term survivors with an average life expectancy of approximately 30 to 50 years after treatment. Providers and clinicians need to approach testicular cancer survivors with the tools and strategies that meet these unmet needs for navigation from diagnosis through survivorship. When strategies of specific resources and education are implemented based on the unique needs of these individuals, positive outcomes and increased health care-related quality of life will be prevalent.

Informal caregivers' experiences of supporting patients with pancreatic cancer: A qualitative study in Greece

PURPOSE

The purpose of the present study was to explore informal caregivers' experiences of supporting family members with pancreatic cancer.

METHODS

A qualitative descriptive study was conducted with individual semi-structured telephone interviews and inductive thematic analysis. Data were collected from 10 informal caregivers in the only cancer hospital in Northern Greece.

RESULTS

The findings of the thematic analysis highlighted three themes, "supportive needs of patients with pancreatic cancer", "supportive needs of informal caregivers" and "evaluation of provided care". In the first theme, four individual subcategories of themes emerged: "psychological support", "managing symptoms and side effects", "daily activities" and "participation in decision-making". The theme "supportive needs of informal caregivers" consists of five sub-themes, "psychological support", "support in care activities", "financial support", "communication with the patient" and "information". Finally, the theme "evaluation of provided care" three sub-categories of topics were reported, "staff evaluation", "process evaluation" and "palliative care".

CONCLUSION

Pancreatic cancer patients and their informal caregivers experience multiple unmet needs. The health system, lacking an efficient treatment for this type of cancer, should provide a basis for improving the quality of life of these families with targeted support interventions.

Exploring the perspectives of cancer patients parenting minor children: A qualitative study on family-centered cancer care experiences

OBJECTIVES

Parents with cancer experience not only disease-related burden but also child- and family-related concerns. According to the German guidelines, all professionals working in oncology are responsible for addressing these burdens and needs and for involving the patient's relatives. This study aims to explore patients' perspectives on their experiences regarding family-centeredness in cancer care.

METHODS

We conducted interviews with 18 cancer patients parenting at least one minor child (< 18). The interviews were audio-recorded, transcribed verbatim and analyzed using qualitative content analysis.

RESULTS

Most parents reported that their healthcare professionals (HCPs) rarely or not routinely discussed family issues. There was a wide range of ways in which HCPs communicated about family issues. Parents often felt unsure about professionals' responsibilities and many of them expressed a desire for more proactive communication.

CONCLUSIONS

The findings suggest that the majority of patients have unmet needs related to comprehensive care as parents.

PRACTICE IMPLICATIONS

HCPs need to be sensitized to identify parents facing additional burdens and needs. It is essential that HCPs clarify parents' preferences regarding the extent of involvement of family issues in cancer care.

Food insecurity and delayed or forgone health care among pregnant and postpartum women in the United States, 2019-2021

OBJECTIVE

Despite the growing food insecurity crisis in the United States, limited evidence exists about the effects of food insecurity on the unmet health care needs of peripartum (pregnant and postpartum) women. The aim of this study was to examine the association between food insecurity and delayed or forgone health care among peripartum women in the United States from 2019 to 2021.

METHODS

We conducted a pooled cross-sectional analysis using data from the 2019, 2020, and 2021 National Health Interview Surveys. Food security status was defined by type (high/marginal, low, and very low). Descriptive analysis and multivariable logistic regression, adjusted for sociodemographic and health-related characteristics, were conducted to estimate the overall and specific delayed or forgone health care (yes or no) between the different categories of food security.

RESULTS

Of the 1525 peripartum women (weighted, N = 5,580,186), 11% of peripartum women in the United States experienced suboptimal food security in the 12 mo between 2019 and 2021, with 5% experiencing low and 5% experiencing very low food security. This included 6% (95% confidence interval [CI], 5-8%) who reported delaying filling a medical prescription, 6% (95% CI, 5-8%) who required counseling or therapy from a mental health professional but did not receive it, 6% (5-8%) who delayed counseling or therapy from a mental health professional, 8% (95% CI, 6-10%) who needed medical care but did not receive it, and 9% (95% CI, 7-10%) who delayed medical care. Peripartum women with low and very food security were more likely to delay or forego health care due to cost concerns than food-secure peripartum women. In the multivariable analyses adjusted for predisposing, enabling, and need-based factors, women with low and very low food security had higher risk for delayed or forgone health care than those with marginal or high food security.

CONCLUSION

This study demonstrated a positive association between food insecurity and cost-related unmet health care needs among peripartum women. Future empirical studies are needed to assess the effects of peripartum health care interventions targeting food insecurity on reducing health care access disparities associated with costs and improving peripartum health outcomes.

Prevalence of unmet supportive care needs reported by individuals ever diagnosed with cancer in Australia: a systematic review to support service prioritisation

PURPOSE

Improved health outcomes for individuals ever diagnosed with cancer require comprehensive, coordinated care that addresses their supportive care needs. Implementing interventions to address these is confounded by a lack of evidence on population needs and a large pool of potential interventions. This systematic review estimates the point prevalence of different supportive care needs stratified by the tool used to measure needs and cancer type in Australia.

METHODS

We searched MEDLINE, Embase, and Scopus from 2010 to April 2023 to identify relevant studies published on the prevalence of supportive care needs in Australia.

RESULTS

We identified 35 studies that met the inclusion criteria. The highest prevalent unmet need across all cancers was 'fear of cancer spreading' (20.7%) from the Supportive Care Needs Survey Short-Form 34 (SCNS-SF34), ranging from 9.4% for individuals ever diagnosed with haematological cancer to 36.3% for individuals ever diagnosed with gynaecological cancer, and 'concerns about cancer coming back' (17.9%) from the Cancer Survivors' Unmet Needs (CaSUN), ranging from 9.7% for individuals ever diagnosed with prostate cancer to 37.8% for individuals ever diagnosed with breast cancer. Two studies assessed needs in Aboriginal and Torres Strait Islander populations, reporting the highest needs for financial worries (21.1%).

CONCLUSIONS

Point prevalence estimates presented here, combined with estimates of the costs and effects of potential interventions, can be used within economic evaluations to inform evidence-based local service provision to address the supportive care needs of individuals ever diagnosed with cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Local health services can use local evidence to prioritise the implementation of interventions targeted at unmet needs.

Approach to the Epidemiology, Disease Management, and Current Challenges in the Management of Generalized Pustular Psoriasis Through a Survey Conducted Among Spanish Dermatologists

BACKGROUND

Generalized pustular psoriasis (GPP) is a rare and severe inflammatory skin disease characterised by recurrent or intermittent flares. Epidemiological and disease management data in Spain are limited. Our goal was to estimate the epidemiology of GPP, explore its management, and reach consensus on the current challenges faced in Spain.

METHODS

An electronic survey was submitted to dermatologists from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group. This group is experienced in the management of GPP. It included a Delphi consensus to establish the current challenges.

RESULTS

A total of 33 dermatologists responded to the survey. A 5-year prevalence and incidence of 13.05 and 7.01 cases per million inhabitants, respectively, were estimated. According to respondents, the most common GPP symptoms are pustules, erythema, and desquamation, while 45% of patients present > 1 annual flares. A total of 45% of respondents indicated that flares often require a length of stay between 1 and 2 weeks. In the presence of a flare, 67% of respondents often or always prescribe a non-biological systemic treatment as the first-line therapy [cyclosporine (55%); oral retinoid (30%)], and 45% a biological treatment [anti-TNFα (52%); anti-IL-17 (39%)]. The dermatologists agreed that the main challenges are to define and establish specific therapeutic goals to treat the disease including the patients' perspective on the management of the disease.

CONCLUSION

Our study describes the current situation on the management of GPP in Spain, increasing the present knowledge on the disease, and highlighting the current challenges faced at the moment.

Unmet Social Needs are Associated with Lower Adherence to Antiretroviral Therapy (ART) Medication Among a Sample of Black People Living with HIV (PLHIV)

The current study examined the prevalence and typology of unmet needs and the association between unmet needs and HIV antiretroviral therapy (ART) medication adherence among a sample of Black people living with HIV(PLHIV) (N = 304) in Los Angeles, CA. We found a high prevalence of unmet needs, with 32% of participants reporting having two or more unmet needs. The most common unmet needs category was basic benefits needs (35%), followed by subsistence needs (33%), and health needs (27%). Significant correlates of unmet needs included food insecurity, history of homelessness, and history of incarceration. A greater number of unmet needs and any unmet basic benefits needs were each significantly associated with lower odds of HIV ART medication adherence. These findings provide further evidence linking the social determinants of health and social disenfranchisement to ART medication adherence among Black PLHIV.

Patient-reported outcome measure to implement routine assessment of cancer survivors' unmet needs: An overview of reviews and COSMIN analysis

As the number of cancer survivors (CSs) is increasing worldwide, providing services relevant to the specific, unmet needs of these individuals is crucial. There are currently various patient-reported outcome measures (PROMs) whose aim is to identify the unmet needs of CSs. Still, limited guidance supports healthcare providers in choosing the most valid and reliable PROMs for this purpose. We conducted this overview of systematic reviews (SRs) on the psychometric properties of PROMs addressing the unmet needs of adult CSs suffering from non-cutaneous cancers. We searched databases for SRs published between 2012 and January 2023. Two SRs were included, covering 14 PROMs tested on 19,151 CSs. These were assessed according to the COSMIN methodology for SRs of PROMs for the quality of their measurement properties and risk of bias, thus providing guidance in selecting PROMs that appropriately reflect the unmet needs of CSs.

Assessing unmet needs in patients with hidradenitis suppurativa

The diagnosis and management of hidradenitis suppurativa (HS) varies greatly between providers, often resulting in gaps in care including diagnostic delays and poor outcomes. As dermatologists strive to improve HS management, understanding patient perspectives is key. This study aims to characterize existing gaps in HS care as understood through patients' experiences. This study recruited adult patients with a diagnosis of HS seen at dermatology practices affiliated with Northwestern University. Data were collected through participant surveys and three semi-structured focus groups. Focus group meetings were transcribed verbatim and data were abstracted into themes using conventional content analysis. Six final themes were abstracted after review of 20 pages of transcribed conversation. Four themes centered on improved medical management of HS (access to care, disease-modifying therapies, symptom treatment, prevention of treatment-related adverse events). Two themes centered on supportive care (mental health support, specialized daily wear products). Limitations of this study include single-center recruitment and recall bias introduced by the focus group format. This study identifies six unmet needs for patients with HS and highlights the efficacy of a virtual format for research, conversation, and possibly clinical engagement. Moreover, multiple themes underscore the need for further collaboration across specialties in managing HS.

Knowledge needs in patients with Liver Disease: a qualitative study

BACKGROUND

Knowledge is essential for patients' disease management strategies and a critical component of healthcare. The importance of increasing patients level of knowledge has become more widely acknowledge in liver disease management in recent years, but further studies are needed to address patients experiences of unmet knowledge needs to develop appropriate patient education strategies. Therefore, the aim of this study was to explore knowledge needs in patients' with liver disease of different etiology and severity.

METHODS

A qualitative study was designed and an inductive method was chosen. Thirty-three patients with liver disease of different etiology and severity were interviewed using a semi-structured interview guide. Content analysis was used as an inspiration to describe and compare patients' needs for knowledge across disease etiology and severity. The reporting followed consolidated criteria for reporting qualitative research.

RESULTS

The analysis generated three categories and nine subcategories. In general, the patients described lack of knowledge related to their liver disease, which made it difficult for them to manage their disease. Patients wished to be more involved in care and treatment of the liver disease. However, patients' had difficulties to assess and understand the importance of the information they received from healthcare professionals. Due to lack of knowledge, patients' had a misconception of the liver disease. Patients' had variation in knowledge needs depending on liver disease etiology and severity.

CONCLUSION

Within liver disease management, knowledge of patients' experiences is vital to meet patients' knowledge needs and to develop appropriate patient education strategies. Therefore, it is important to ascertain a patient-centered approach to accommodate patients' individual knowledge needs, involve patients in care and treatment, and insure understanding to strengthen their self-management and give the patients the necessary skills to manage their disease and everyday life.

REGISTRATION NUMBER

Open Science Framework registration DOI https://doi.org/10.17605/OSF.IO/W28RC .

Oral health, stress and barriers accessing dental health care among war-affected Ukrainian refugees in Germany

BACKGROUND

After Russian invasion many Ukrainians fled to European countries including Germany. In this context, the German health care system faced challenges delivering dental care to a displaced population. Recently surfaced obstacles as well as different cultural and medical traits need to be considered in order to deliver appropriate medical care. The aim of this study was to evaluate oral health and hygiene of Ukrainian refugees, identify barriers accessing dental health care and explore the relation to their mental health state.

METHODS

This cross-sectional study was conducted using a self-assessment questionnaire, distributed via non-probability snowball sampling method among war-affected Ukrainians, who fled to Germany. The online form was distributed via web-based platforms, the printed version was hand-delivered across diverse local venues. Chi-Square Tests, T-Tests and Mann-Whitney-U Tests were performed. Analysis of variance and Spearman correlation coefficient analysis were also conducted.

RESULTS

From 819 completed questionnaires, 724 questionnaires were included in the analysis with 78 males (10.8%) and 640 females (88.6%) and a mean age of 37.5 years (SD = 10.5). The majority of participants rated their state of teeth (77%) and gums (81%) as average or better. The main problems, caused by state of their teeth, were: "Have avoided smiling because of teeth" (23.6%) or "Felt embarrassed due to appearance of teeth" (22.2%). The most frequent limiting factors to access dental care were finances (82.6%), language (82.2%) and complicated health care system (74.1%). 45.8% of the participants scored 10 or more in the Patient Health Questionnaire and 37.4% in the Generalized Anxiety Disorder 7-item scale, respectively. These participants were more likely to report pain, poor state of teeth and gums and to fail a dental consultation. Overall, 59.6% participants reported not consulting a dentist, when needed. Failed consultations were associated with a poorer reported state of teeth and gums.

CONCLUSIONS

Ukrainian refugees reported barriers accessing dental health care in Germany. It is important to improve oral health literacy and dental services for displaced people and provide help and guidance in seeking dental care.

Is there a need for change in cancer survivorship care? A qualitative exploration of survivor experiences and needs at the Sydney Cancer Survivorship Centre Clinic

PURPOSE

Effective cancer survivorship care is contingent on a comprehensive understanding and management of the dynamic needs of cancer survivors. The Sydney Cancer Survivorship Centre (SCSC) clinic established a holistic, multidisciplinary model of survivorship care. We aimed to explore survivors' experiences and perceptions of the clinic, and to identify their unmet needs.

METHODS

Semi-structured focus groups (FGs) involving participants recruited from the SCSC clinic were conducted by an experienced facilitator and observer using a guide covering: survivor perceptions of first SCSC clinic visit, services accessed, ongoing unmet needs, and how needs changed over time. FGs were audio-recorded and transcribed. Interpretive description using a Framework approach was undertaken and participant characteristics summarised descriptively.

RESULTS

Eight FGs were conducted involving a total of 26 participants (mean age: 60), most were female (n = 20), born in Australia (n = 14), and with breast cancer diagnoses (n = 16). Four overarching themes were identified: (i) perceptions of the SCSC clinic; (ii) patient-centred care; (iii) adjustment to illness; and (iv) external supports and resources. Participants valued the centralisation of multidisciplinary survivorship care at the SCSC clinic, which helped their recovery. Mitigating ongoing treatment sequelae, reassurance of good-health, normalisation of survivorship experiences, and handling caregiver stress represent some needs identified.

CONCLUSIONS

The SCSC clinic offers holistic, specialised care and reassurance to cancer survivors. Adjustment to the survivorship journey, inter-survivor shared experiences, and management of physical treatment sequelae were perceived as important in their recovery. Managing survivor needs is integral to improving long-term survivorship care.

Translation, cultural adaptation, and psychometric testing of the Supportive care needs survey for partners and caregivers for Swedish family members of persons diagnosed with colorectal cancer

BACKGROUND

Colorectal cancer is the third most common cancer diagnosis globally and is increasing in both incidence and prevalence. Despite evidence showing that family members of persons diagnosed with cancer have supportive care needs, no validated questionnaire measuring the needs of family members of persons diagnosed with CRC exists in Swedish. Thus, the objective of the present study was to translate, culturally adapt, and evaluate the psychometric properties the Supportive Care Needs Survey - Partners and Caregivers 45.

METHODS

The translation and cultural adaptation followed a systematic yet iterative process. Firstly, the questionnaire was translated using a forward-backward approach. Secondly, face and content validity and comprehensibility were evaluated by two expert panels of colorectal cancer specialist nurses and family members, respectively. Lastly, the psychometric properties, validity, and reliability of the translated questionnaire were evaluated among 45 Swedish family members of persons diagnosed with colorectal cancer.

RESULTS

The face, content, and construct validity of the translated questionnaire were evaluated as satisfying. Moreover, psychometric evaluations showed high data quality and satisfactory internal consistency. However, the results also revealed unsolved issues regarding relevance, targeting, and internal consistency, as well as a probable scaling failure.

CONCLUSION

The translated and adapted questionnaire can be used to identify family members unmet needs of support throughout the colorectal cancer trajectory. The questionnaire showed promising validity and reliability in the target population. However, it needs to be further evaluated in a larger sample, preferably involving factor analysis and stability over time.