Self-care behaviors in patients with cancer treated with oral anticancer agents: a systematic review

Psychometric properties of the caregiver contribution to self-care of oral anticancer agents index: Longitudinal study

BACKGROUND

The use of oral anticancer agents (OAAs) has increased in recent decades. Despite the advantages of OAAs, people with cancer face challenges such as adherence, prevention, recognition, and management of OAA side effects. Informal caregivers can help their patients who take OAAs by facing the above challenges with the implementation of behaviours to maintain stability (Caregiver contribution to self-care maintenance), monitoring (Caregiver contribution to self-care monitoring) and managing (Caregiver contribution to self-care management) the conditions of their patients.

OBJECTIVE

To develop and test the psychometric properties of the Caregiver Contribution to self-care in the Oral Anticancer Agents Index (CC-SCOAAI).

METHODS

A longitudinal study was conducted. Factorial validity was tested using Confirmatory Factor Analysis (CFA). Furthermore, we also tested the internal consistency and validity of the CC-SCOAAI construct. The Mann-Whitney U test was used to demonstrate associations between CC-SCOAAI scores and patient's re-hospitalizations, emergency-room attendances, and mortality.

RESULTS

We enrolled 318 caregivers, mostly female (63.52 %), with an age of <44 (39.94 %) and spouse of the patient (54.66 %). The CFA demonstrated the factorial validity of the CC-SCOAAI. Caregivers of patients with more re-hospitalizations had a lower contribution to self-care maintenance (U = 2933.500; p = .04), while caregivers of patients with more emergency room admissions (U = 1392.500; p < .001) and re-hospitalizations (U = 2385.500; p < .001) had a lower contribution to self-care management. Caregivers of patients with emergency-room admissions (U = 1392.500; p = .005), re-hospitalisations (U = 2322.500; p < .001) and mortality (U = 515.500; p = .001) had lower contribution to self-care monitoring.

CONCLUSIONS

CC-SCOAAI is a valid and reliable tool. Given that caregivers are crucial in supporting these patients, the CC-SCOAAI may help clinicians improve caregiver efficacy and researchers using CC-SCOAAI to determine better self-care outcomes in patients with OAA.

Self-care experiences and behaviors in people with osteoporosis: A meta-synthesis

Osteoporosis is a chronic systemic skeletal disease that can benefit from patient-led self-care behaviors. The purpose of this meta-synthesis is to summarize the knowledge about the experiences in self-care behaviors, according to Riegel's middle-range theory of self-care, of patients affected by osteoporosis. A systematic review of the literature and a meta-synthesis of the results were performed to identify qualitative and mixed-method studies through database research conducted on six databases until June 2023 that identified 27 articles. Three dimensions of self-care were recognized within the articles: 'maintenance' was the most reported, mostly associated with therapy adherence; 'monitoring', predominantly related to instrumental test; and, 'management', mainly related to the management of symptoms. A cross-cutting topic that emerges and has been shown to be relevant is that of the relationship with health professionals.

Psychometric Properties of the Self Care Oral Anticancer Agents Index (SCOAAI)

OBJECTIVE

To test the Self-Care Oral Anticancer Agents Index (SCOAAI)'s psychometric properties (structural validity, convergent validity, predictive validity, and internal consistency) in a sample of patients with solid tumour on Oral anticancer agents (OAA).

METHODS

A methodological research in five in- or out-patient Italian facilities. Structural validity was tested by confirmatory factor analysis, and internal consistency was assessed through Cronbach's alpha and composite reliability. The Mann-Whitney U-test was used to test associations between SCOAAI scores and patient's emergency room admission, re-hospitalization, mortality, and quality of life measured three months after baseline.

RESULTS

We enrolled 356 patients; mostly were male (52.24%), and mean age was 59.10 years. Analyses demonstrated the SCOAAI's factorial validity and internal consistency. Moreover, patients that experienced emergency room admissions (U = 3484.5; P = .002) and re-hospitalization (U = 2446.0; P = .001) showed lower self-care maintenance scores; those who experienced emergency room admission (U = 3263.5; P = .019) and died at follow-up (U = 700.5; P = .025) had lower self-care monitoring scores; while patients that experienced re-hospitalisation (U = 2931.5; P = .040) and emergency room admission (U = 3285.0; P = .012) had lower self-care management scores. Patients with adequate self-care (≥ 70) reported significantly higher quality of life (self-care maintenance U = 1228.500, P < .001; self-care monitoring U = 3512.500, P < .001; self-care management U = 3287.500, P < .001).

CONCLUSION

According to our findings the SCOAAI is a valid and reliable tool. Patients with inadequate self-care can experience more emergency room accesses, re-hospitalization, death, and lower quality of life.

IMPLICATIONS FOR NURSING PRACTICE

Adequate self-care behaviors can improve patient's outcomes and should be assessed by healthcare providers during the disease pathway.

Predictors of self-care in patients with cancer treated with oral anticancer agents: A systematic review

BACKGROUND

In the last two decades, the use of oral anticancer agents (OAAs) has increased in cancer patients. Despite this, patients and their caregivers face some challenging issues (side effects, drug-to-drug interactions, etc.) related to OAA administration. The three dimensions of self-care by Riegel et al., self-care maintenance (i.e., stability of patient condition), self-care monitoring (i.e., detection of side effects), and self-care management (i.e., management of side effects), may be implemented to avoid negative outcomes. However, knowledge of self-care determinants is necessary to recognise people at risk of poor self-care behaviours.

AIMS

Determine which are the predictors of self-care maintenance, self-care monitoring and self-care management in patients with cancer taking OAA.

METHODS

A systematic review with narrative synthesis was conducted. We included studies on adult patients with cancer using any kind of oral anticancer agent and describing a predictor of self-care. The search was performed on PubMed, CINAHL/PsycINFO, and Web of Science.

RESULTS

Of 3,061 records, 45 studies were included in this review. Forty-six predictors organised into 14 categories were identified. In general, all studies focused only on adherence, considered as a self-care maintenance component, and none of them focused on other dimensions of self-care. The predictors of OAA adherence most reported were age, side effects, and socioeconomic factors (e.g., insurance status, and annual income).

CONCLUSIONS

This systematic review highlighted the literature gap on the analysis of determinants of self-care behaviours in patients taking OAAs. This element could be a starting point for future research that can provide elements to support the oncology nursing research agenda, aimed at recognising patients at risk of poor self-care.

Cost-effectiveness of the ONCORAL multidisciplinary programme for the management of outpatients taking oral anticancer agents at risk of drug-related event: protocol for a pragmatic randomised controlled study

INTRODUCTION

The development of oral anticancer agents (OAA) has profoundly changed cancer care, leading patients to manage their chemotherapy treatment on an outpatient basis. The prevention of iatrogenic effects of OAA remains a major concern, especially since their side effects are not less serious than those of intravenous chemotherapy. The ONCORAL programme was set up to secure the management of OAA in cancer patients followed at the Lyon University Hospital. This multidisciplinary programme involves hospital pharmacists, nurses, oncologists, and haematologists, as well as community health professionals. Given the economic stakes that this programme entails for the health system, a medico-economic study was designed.

METHODS AND ANALYSIS

This is a prospective controlled study, with individual open-label randomisation. A total of 216 outpatients treated with OAA and at risk of developing a drug-related iatrogenic event, will be randomised (2:1) to undergo follow-up in the ONCORAL programme or usual care. The primary outcome will be the estimation of the incremental cost-effectiveness ratio (difference in total costs per quality adjusted life years gained) at 12 months between the two groups. The secondary outcomes will be evaluation of OAA management consequences (relative-dose intensity, adherence, adverse drug events, drug-drug interactions, and proven medication errors), evaluation of overall survival and cancer-related quality of life, and patient-reported outcomes in relation to the treatment. A budget impact analysis will be implemented. Patient and health professional satisfaction regarding the ONCORAL programme will be measured.

ETHICS AND DISSEMINATION

Approval to conduct this study was obtained from an Ethics Committee (Comité de Protection des Personnes Ile-de-France VI) in October 2019, and from the French data protection agency (Commission Nationale de l'Informatique et des Libertés), according to the French Law. Trial results will be disseminated at clinical conferences and published in peer-reviewed journals.

TRIAL REGISTRATION

NCT03660670.

Self-Care Behavior and Associated Factors of Nursing Students with Dysmenorrhea: A Structural Equation Model

Objective

To assess the factors influencing the self-care behavior among nursing students with dysmenorrhea.

Background

The practice of self-care behavior for dysmenorrhea has gradually attracted immense attention from society; however, thus far, only a few studies have been conducted to predict this behavior and analyze the associated factors by creating a structural equation model.

Methods

A cross-sectional multistage cluster sampling study was conducted among nursing students within six universities in Shaanxi province, China. A model was constructed, and structured questionnaires were adopted to measure model variables, including e-health literacy, negative emotion, self-efficacy, self-care agency, degree of dysmenorrhea, and self-care behavior for dysmenorrhea. Descriptive data analysis was performed using SPSS 23.0 software, and AMOS 23.0 was used to verify and analyze the structural model.

Results

In total, 1851 valid questionnaires were collected; the effective recovery rate was 93.15%, and the prevalence of dysmenorrhea was 64.51%. e-Health literacy (B = 0.171, P < 0.001), self-efficacy (B = 0.416, P < 0.001), self-care agency (B = 1.177, P < 0.001), and degree of dysmenorrhea (B = 0.310, P < 0.001) significantly influenced self-care behavior for dysmenorrhea. The total, direct, and indirect effects of e-health literacy and self-efficacy on self-care behavior for dysmenorrhea were 0.158 and 0.492, 0.128 and 0.248, and 0.030 and 0.244, respectively.

Conclusion

The self-care behavior for dysmenorrhea is affected by several factors and self-efficacy has the greatest effect on it. To promote girls to actively implement self-care behavior for dysmenorrhea, educators should strengthen the training of self-efficacy and self-care agency of the nursing students to alleviate the uncomfortable experience brought by dysmenorrhea and decrease the harm of dysmenorrhea. Implications for Nursing Management. Nursing managers should work with constant efforts to explore and optimize the management model for dysmenorrhea, encouraging young women to actively engage in self-care behavior for dysmenorrhea, to alleviate the discomfort experienced by individuals and improve women's overall health.

Development and Content Validity of the Self-Care of Oral Anticancer Agents Index (SCOAAI)

OBJECTIVE

To develop and test the content validity of the Self-Care of Oral Anticancer Agents Index (SCOAAI).

DATA SOURCES

SCOAAI items were developed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. The Middle Range Theory of Self-Care of Chronic Illnesses informed item generation. A four-phase procedure was followed; Phase 1: items were created based on a previous systematic review and a qualitative study; Phase 2: the SCOAAI comprehensibility and comprehensiveness were established through qualitative interviews with clinical experts and with patients (Phase 3); and Phase 4: the SCOAAI was then administered through an online survey to a group of clinical experts for the Content Validity Index (CVI) calculation.

CONCLUSION

The first version of the SCOAAI included 27 items. Five clinical experts and 10 patients tested the comprehensiveness and comprehensibility of instructions, items, and response options. Fifty-three experts (71.7% female, mean experience with patients on oral anticancer agents 5.8 years [standard deviation ± .2]; 66% nurses) participated in the online survey for content validity testing. The final version of the SCOAAI includes 32 items. Item CVI ranges between 0.79 and 1; the average Scale CVI is 0.95. Future studies will test the psychometric properties of the tool.

IMPLICATIONS FOR NURSING PRACTICE

The SCOAAI showed excellent content validity, confirming its usefulness for assessing self-care behaviors for patients on oral anticancer agents. By implementing this instrument, nurses could define and implement targeted interventions for improving self-care and obtaining more positive outcomes (eg, better quality of life, reduced hospitalizations and emergency department visits).