Informal educational interventions for caregivers of adult cancer survivors

This review study explores the available data relating to the informal education aspects of effective interventions applied in caregivers of adult cancer survivors to maintain their own health and quality of life (QoL) and as such to provide the optimal care to the cancer patient. The implications of these interventions in oncology practice are also discussed. Available data show that, over the last years, a significant proportion of caregivers of cancer survivors are increasingly offered informal education interventions towards the reduction of their burden. More specifically, educational, skills training, and therapeutic counseling interventions seem to positively affect caregivers' well-being and overall QoL. However, based on available data, one cannot generalize these interventions on improving caregivers' outcomes of daily living activities and QoL. As such, available intervention strategies should be further tested and validated in larger samples, whereas novel health promotion educational approaches are expected to be designed to effectively address and comply with the appropriate needs of caregivers of cancer patients.

Informal education and health promoting approaches in adult cancer survivors

This review looks at the available data relating to the informal education aspects and other health promoting approaches applied by adult cancer survivors to reduce the risk of cancer. The implications of such behavioral interventions on oncology practice are discussed. We also highlight areas of future research to pursue. Available data show that many cancer survivors remain engaged in risky health behaviors post-diagnosis, which are associated with an increased risk of disease's recurrence. However, over the last years patients seem to increasingly receive adequate risk-based medical care. The application of appropriate informal education approaches, such as diet, exercise, and cessation of former unhealthy habits, such as smoking and alcohol has facilitated behavioral changes in cancer survivors, thoroughly improving their well being and overall quality of life (QOL). Most of the research studies published to date have applied structured lifestyle interventions on intensive, individualized counseling sessions delivered by trained personnel or psychosocial-based mediations and reported that these approaches are largely effective in promoting the adoption of a healthier lifestyle in cancer survivors. These interventions have been reported to reduce the risk of cancer recurrence and thus to obtain an obvious positive impact on their well-being and overall QOL. However, there is still insufficient evidence to conclude and support with confidence the effectiveness of any of these behavioral interventions and therefore future interventions should be initiated to assess the long-term effects and validating outcomes of lifestyle and other psychosocial interventions.

Promises and hurdles of undergraduate medical development in Greece

AIM

In this paper we sought to explore undergraduate medical students' views about their professional development during their studies that are considered to be related to medical professionalism.

METHOD

A descriptive cross-sectional study using interpretative analysis of anonymous 10-item questionnaires was conducted at the University of Patras Medical School (UPMS), Greece. The study sample consisted of 134 undergraduate students in their fifth and sixth year of study at UPMS.

RESULTS

Undergraduate students emphasized the great significance of daily clinically-oriented practice in the wards in the group of behaviors consistent with medical professionalism. The integrated curriculum and informal discussions with members of the academic staff in the form of role models were also regarded as valuable approaches strongly enhancing professionalism. Students' personal statements contained attributes regarding premium professional skills, including constancy and perfectionism throughout a lifelong learning process, so as to be able to provide high quality medical care to patients.

CONCLUSION

According to our undergraduate medical students themselves, the last 2 years of their studies are important to understand the essence of professionalism and develop their professional medical attitudes. Clinically-oriented teaching activities together with the informal curriculum of enhanced role modeling promote medical professional behaviors and increase standards of health care provided to patients.

Quality of life and emotional burden of primary caregivers: a case-control study of multiple sclerosis patients in Greece

PURPOSE

Our aim was to assess the perceived emotional burden and quality of life (QOL) in a sample of Greek primary caregivers of patients with multiple sclerosis (MS).

METHODS

Twenty-two male and 13 female primary caregivers (mean age 47.3 ± 12.4 years), and an equal number of patients with MS, completed the Greek validated version of the hospital anxiety and depression scale (HADS) and the Greek validated version of EuroQOL (EQ-5D). Thirty-five age-, gender-, and education-matched healthy controls were used for comparison.

RESULTS

Caregivers experienced higher degree of anxiety than depression. The mean score of the HADS-A subscale was 9.5 ± 4 (range 3-15), and the mean score of the HADS-D subscale was 7.1 ± 3.1 (range 2-14). The mean scores of caregivers on both HADS-A and HADS-D were significantly higher than the controls' (P < 0.0001). Twenty-two caregivers were diagnosed with manifesting anxiety, whereas 12 of them also presented depression. Highly educated caregivers were more prone to manifest increased levels of anxiety and depression. The increased psychological distress was further supported by the responses in the anxiety/depression dimension on the EQ-5D: 27 reported a moderate level of anxiety/depression and three indicated an extreme degree. The caregivers reported a mean EQ-VAS value of 61.9 ± 13.8 (range 40-100), with 10 caregivers rating their health status a score of 50 or lower; the controls scored significantly higher (90.3 ± 7.1; P < 0.0001).

CONCLUSION

The sample of caregivers we studied was psychologically burdened to a significant degree, a fact that obviously deteriorates their QOL. Appropriate psychopharmacological interventions are warranted to reduce caregivers' burden.

Undergraduate nursing students' views on Oncology. A case study in Greece

PURPOSE

To investigate the views of undergraduate nursing students at the Patras Higher Technological Education Institution (HTEI), Greece, on the subject of Nursing Oncology, as well as their attitudes towards cancer.

METHODS

In total, 105 students of the last year participated in the study. All participants were anonymously administered a specifically designed questionnaire including various educational and practical training aspects.

RESULTS

Data analysis revealed inadequacies in Oncology education and highlighted the need for improving preclinical training and developing students' skills with regard to patients' care and the management of various psychological and ethical issues. Furthermore, suggestions were made for increasing Oncology teaching staff, cooperation among subject specialists, increasing the hours devoted to Nursing Oncology, enhancing the basic and clinical courses, and introducing new subjects in the undergraduate curriculum.

CONCLUSION

In conclusion, a well-organized Nursing Oncology education at the Nursing School of Patras HTEl should combine the theoretical background with practical training so as to prevent fragmentation of Oncology as an independent subject and its incorporation into other disciplines.

Emotional distress in cancer patients at the beginning of chemotherapy and its relation to quality of life

PURPOSE

The present study sought to determine the prevalence of emotional distress and evaluate demographic and clinical factors related to anxiety and depression in treatment-naïve cancer patients at the beginning of chemotherapy. Another objective was to explore the associations between emotional distress and quality of life (QoL), an endpoint of great importance in current cancer care.

PATIENTS AND METHODS

Adult outpatients with a variety of cancer diagnoses were administered the Hospital Anxiety and Depression Scale (HADS) and the European Organization for Research and Treatment of Cancer (EORTC QLQC30) questionnaire prior to the initiation of treatment.

RESULTS

A total of 265 patients took part in the study. A sizeable minority of our patients reported intense levels of anxiety (27.2%) and depression (19.6%). Patients without a partner, females, and patients with advanced disease or lower physician-rated performance status (PS) were more likely to experience clinically significant emotional distress. Levels of anxiety and mainly depression were negatively related to all QoL domains.

CONCLUSION

Our results indicate that a significant proportion of Greek cancer patients experience intense anxiety and depression prior to chemotherapy, and confirm the adverse impact of psychological morbidity on patients' QoL. Standardized and timely screening of emotional distress across all phases of cancer will help to effectively identify patients whose symptoms warrant attention. Future studies should continue to develop and evaluate rapid measures for detecting significant emotional distress in cancer patients, and to devise appropriate interventions to treat distress and enhance patients' QoL.

Medical students' views of undergraduate Oncology education: A comparative study

CONTEXT

An ongoing concern of undergraduate medical education regarding oncology has been intensified in Patras Medical School, Greece, aiming at a more comprehensive teaching approach.

OBJECTIVE

A second-step research project was conducted to examine medical students' views of their undergraduate education in oncology, six years after the first investigation, and to assess the impact of the changes on the curriculum.

METHODS

The same questionnaire used in the previous study was again distributed to 210 different medical students.

FINDINGS

Our study revealed that although the quality of education in Oncology has been improved, it has not as yet reached high standards. The improvements over the last six years were mainly attributed to the increased presence of specialized oncology staff and their coordination with other basic and clinical scientists, as well as to the increased focus on research issues. Most of the students suggested putting more emphasis on psychosocial aspects of cancer care and ethical topics.

DISCUSSION

Despite the progress made in the curriculum, there is still a need for further improvements in the students' undergraduate education so as to meet current demands. Medical education in Greece still pays lip service to communication and ethical issues while remaining disease-oriented in its approach. Therefore, the target of undergraduate education in Oncology should not only be the provision of updated medical knowledge, but also the development of a proper attitude towards all cancer-related issues.