Traveling through the cancer trajectory: social support perceived by women with gynecologic cancer in Hong Kong

The effect of educational intervention based on social support theory on the perceived stress caused by the covid-19 pandemic in patients with diabetes in hormozgan (2020-2021)

BACKGROUND

People with diabetes are more at risk of covid-19. Perceived social support plays an important role in maintaining people's health and reducing the negative effects of stress caused by the environment and society. The present study was designed and implemented with the purpose of determining the effect of educational intervention based on social support theory in reducing stress caused by the covid-19 pandemic in people with diabetes.

METHODS

The current investigation was an interventional and semi-experimental study conducted on 212 patients diagnosed with type 2 diabetes. Eligible participants were diabetic individuals capable of utilizing virtual platforms and not afflicted with COVID-19. Exclusion criteria encompassed unwillingness to continue study participation, absence from multiple training sessions, and development of a specific illness during the study period. Random allocation placed patients into either the control or intervention group. The intervention group received educational materials via WhatsApp, while the control group did not receive any intervention. The researcher administered a questionnaire to collect demographic information and assess perceived social support among the patients. Data analysis involved the use of chi-square tests, independent and paired t-tests, as well as ANCOVA.

RESULTS

This study revealed that the mean age of patients in the control and intervention groups was 46.35 ± 14.15 and 51.72 ± 11.57, respectively. Most of the diabetic patients in both groups were female, married, had a diploma, were housekeepers, and had an income between 2 and 5 million Tomans. According to the results obtained in all subscales of social support theory as well as the perceived stress score due to the corona pandemic after the educational intervention, a statistically significant difference was observed between the two groups (P < 0.05), so that the score of all subscales of social support theory in the intervention group was higher than the control group. But the perceived stress score caused by Corona in the intervention group was significantly lower than the control group.

CONCLUSION

The results of this study illustrate the noteworthy influence of social support training in lessening perceived stress among patients with diabetes during the COVID-19 pandemic. Consequently, healthcare providers are encouraged to integrate social support education programs into comprehensive care initiatives for diabetic patients, particularly during periods of heightened stress like the current coronavirus pandemic.

Changes in unmet care needs, social support and distress from initial diagnosis to post-surgery in patients with gynecological cancer: A longitudinal study

PURPOSE

This study aimed to explore the changes in unmet care needs, perceived social support, and levels of distress experienced by newly diagnosed Greek patients with gynecological cancer during the phase after diagnosis and before surgical treatment (T0), and 4 months after surgical treatment at the first postoperative follow-up visit (T1).

METHODS

This was a prospective, longitudinal, descriptive study based on the framework of stress and coping theory. The Needs Evaluation Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic and clinical data questionnaire were distributed to a convenience sample of 86 patients.

RESULTS

A convenience sample of 86 patients newly diagnoised with gynecological cancer participated in the study. The mean age of the participants was 60.7 years (SD = 10.9 years) while 57.6% of them were married. Overall, patients' needs and social support had significantly decreased at T1 compared to T0 (p = 0.005 and p = 0.029, respectively). DASS-21 subscale scores did not change significantly at T1, whereas anxiety levels were significantly lower at follow-up (p = 0.048). Changes in anxiety levels were associated with changes in needs related to family (p < 0.001), need for assistance/care (p = 0.013) and support (p = 0.004), and total needs (p = 0.004).

CONCLUSION

The phase following cancer diagnosis and awaiting surgery is a high-risk period for the mental health of women with gynecological cancer, and one that requires special attention from healthcare professionals. By identifying unmet needs, addressing anxiety and providing appropriate social support, healthcare professional can contribute significantly to improving patients' quality of life throughout their cancer journey.

The role of social networks in the self-management support for young women recently diagnosed with breast cancer

It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016-2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes.

'Those whom I have to talk to, I can't talk to': Perceived social isolation in the context of anxiety symptoms among pregnant women in Pakistan

Anxiety during pregnancy is highly prevalent in low- and middle-income countries. The relative importance of different sources and types of perceived support in the Pakistani context is unknown. We explored social support during pregnancy and the role of social isolation in Pakistani women's experiences of antenatal anxiety. We conducted semi-structured interviews with 19 pregnant women with symptoms of anxiety and 10 female healthcare providers at a public urban hospital. We used inductive and deductive thematic coding to analyse the data. Many pregnant women reported feelings of physical and social isolation, even when living in joint families with larger social networks. Often fearing censure by their in-laws and peers for sharing or seeking help with pregnancy-related anxieties, women reported relying on husbands or natal family members. Normative expectations around pregnancy such as male gender preference, perceived immutability of wives' domestic responsibilities and expectations of accompanied travel by women may serve as sources of disconnectedness in the antenatal period. Providers viewed social isolation and deficits in social support during pregnancy as contributing to worse anxiety symptoms, reduced access to care and poorer health behaviours. One limitation is that the hospital setting for this study may have resulted in underreporting of abuse or neglect and limited inclusion of pregnant women who do not utilise facility-based antenatal care. In conclusion, husbands and natal families were key in reducing social isolation in pregnancy and mitigating anxiety, while in-laws did not always confer support. Targeted strategies should enhance existing support and strengthen in-law family relationships in pregnancy.

What factors shape quality of life for women affected by gynaecological cancer in South, South East and East Asian countries? A critical review

Background

Gynaecological cancers are among the most prevalent cancers worldwide, with profound effects on the lives of women and their families. In this critical review, we explore the impacts of these cancers on quality of life (QOL) of women in Asian countries, and highlight areas for future inquiry.

Methods

A systematic search of the literature was conducted in six electronic databases: Web of Science, Scopus, Global Health (CAB Direct), PsycINFO (Ovid), EBMR (Ovid), and Medline (Ovid). Screening resulted in the inclusion of 53 relevant articles reporting on 48 studies.

Results

Most studies were conducted in high and upper-middle income countries in East Asia and used quantitative approaches. Women had predominantly been diagnosed with cervical or ovarian cancer, and most had completed treatment. Four key interrelated domains emerged as most relevant in shaping QOL of women affected by gynaecological cancer: support, including identified needs, sources and forms; mental health, covering psychological distress associated with cancer, risk and protective factors, and coping strategies; sexual function and sexuality, focused on physiological, emotional and relational changes caused by gynaecological cancers and treatments, and the impacts of these on women’s identities; and physical health, covering the physical conditions associated with gynaecological cancers and their impacts on women’s daily activities.

Conclusion

QOL of women affected by gynaecological cancer is shaped by their mental and physical health, support, and changes in sexual function and sexuality. The limited number of studies from lower- and middle-income countries in South and Southeast Asia highlights important knowledge gaps requiring future research.

Multiple factors shape the quality of life of women affected by gynaecological cancers in Asian countries as elsewhere. We identified 53 articles reporting on 48 studies, most conducted in high- and upper-middle income East Asian countries, with much less attention to women in lower income countries in South and Southeast Asia. Most studies used quantitative research methods to gain an understanding of the impact on women diagnosed with cervical or ovarian cancer who had completed treatment. Women’s quality of life was shaped by their mental and physical health, their support needs, and the changes they experienced in sexual function and sexuality.

Dilemma: Disclosure Experience Among Young Female Breast Cancer Survivors in China

Purpose: Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods: Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results: From the analysis of the interviews of the 31 participants, three main themes were identified: (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including: to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion. Conclusions: For young women diagnosed with breast cancer in China, it is a very complicated matter whether they choose to disclose their diagnosis to others. While disclosure can bring many benefits, it is important to look at the reasons why these women are concealing their diagnosis.

Interrelatedness of Distress Among Chinese-Speaking Patients and Family Caregivers

BACKGROUND

Cancer is a family disease, affecting the individual patient and the family. For Chinese patients and their families in Canada, adjusting to cancer may be particularly distressing when culture and language are not congruent with the mainstream model of care delivery.

OBJECTIVE

In view of the limited research on the cancer experience of Chinese families, this study aims to examine the interrelatedness of patients and family caregivers' distress among a Chinese-speaking cancer population in Canada.

METHODS

Semi-structured interviews were conducted with a purposive sample of 10 Chinese-speaking cancer patients and 6 family caregivers. Qualitative analysis of the interview data was conducted to construct cross-cutting themes regarding the experiences of distress after a cancer diagnosis.

RESULTS

Four overarching themes emerged from the analysis: (1) misconception about cancer, (2) tensions in disclosure, (3) patient and family caregiver distress, and (4) concealing emotion in patient and family caregiver. Notably, the interrelatedness of patients and family caregivers' distress was highlighted, as patients and family caregivers both sought to regulate their own emotions to protect one another's mental well-being.

CONCLUSION

The study provides insights into the distress of living with cancer and the impact on family relationships. Understanding the patients and family members' cultural and social contexts also provides the foundation for patient- and family-centered care.

IMPLICATIONS FOR PRACTICE

Healthcare professionals can provide culturally appropriate care by recognizing the needs, values, and beliefs of cancer patients and their families. Furthermore, the patient-family-caregiver dyad needs to be considered as the unit of care.

The association between fear of cancer recurrence and quality of life among Chinese cancer survivors: main effect hypothesis and buffering hypothesis

PURPOSE

The aim of the present study is to examine whether fear of cancer recurrence (FCR) is related to health-related quality of life (HRQOL) among Chinese cancer survivors, an understudied population (i.e., main effect hypothesis). Also, we investigated whether the FCR-HRQOL link is moderated by two coping strategies, avoidance and positive reappraisal (i.e., buffering hypothesis).

METHODS

This is a cross-sectional study conducted among 238 Chinese cancer survivors in Beijing. Participants completed a set of questionnaires including FCR, coping, and HRQOL.

RESULTS

FCR was related to lower physical, psychological, social, and spiritual well-beings, even when demographics, cancer-related factors, and coping were taken into account. There was only one moderation effect between FCR and avoidance coping. Surprisingly, the detrimental effect of FCR on spiritual well-being was lessened among those with high avoidance coping such that the negative association between FCR and spiritual well-being was only found in those with low avoidance coping and not among those with high avoidance coping.

CONCLUSIONS

Findings largely supported the main effect hypothesis. FCR was associated with diverse domains of HRQOL among Chinese cancer survivors. The buffering hypothesis was largely not supported in this population. Rather, in some cases, the effects of FCR and coping strategies on HRQOL were independent. Thus, ways to attenuate the harmful effects of FCR on HRQOL among Chinese cancer survivors remain unresolved. It is urgent and timely that future studies focus on FCR and HRQOL in this population.

Initial Validation of the Daily Spiritual Experiences Scale in Chinese Immigrants With Cancer Pain

CONTEXT

Evaluating religious/spiritual influences in the growing Chinese-American population may inform the development of culturally relevant palliative care interventions.

OBJECTIVES

We assessed the psychometric properties and acceptability of the Daily Spiritual Experiences Scale-Chinese (DSES-C) in Chinese Americans with cancer-related pain.

METHODS

The translated 16-item DSES-C was administered as part of a symptom intervention for Chinese-American cancer patients. Patients were recruited from four New York community oncology practices.

RESULTS

Of 321 patients, 78.7% were born in Mainland China, 79.1% spoke Cantonese, and 70.2% endorsed a religious affiliation (Ancestor worship, 31.7%; Chinese God worship, 29.8%; Buddhism, 17.1%; Christianity, 14.0%). In total, 82.6% completed the DSES-C (mean age = 57.7 years; 60.8% women) and 17.4% declined (mean age = 59.3 years; 52.0% women). Reasons for declining included low religiosity or perceived relevance of the scale items and difficulties separating spirituality from religiosity terms. Individuals having a religious affiliation were more likely to complete the DSES-C, whereas those not engaging in individual spiritual/religious practices or frequent group spiritual/religious practices tended to decline (all P < 0.05). The DSES-C (mean total score = 43.6, SD = 19.3) demonstrated high reliability (alpha = 0.94). Exploratory factor analysis suggested a one-factor solution, with significant loadings (>0.40) across items except Item 14 ("Accept others"). Construct validity was suggested by a positive association between DSES-C scores and having a religious affiliation (P < 0.05).

CONCLUSION

In Chinese Americans with cancer pain, the DSES-C demonstrated acceptable psychometrics. Some participants experienced linguistic or cultural barriers preventing completion. Future investigations should provide additional validation in different Asian subgroups and those with varied medical conditions.

Perceived unmet needs and health-related quality of life of Chinese cancer survivors at 1 year after treatment

BACKGROUND

Although advanced cancer treatments prolong survivors' lives, a significant proportion experienced poorer health-related quality of life (HRQoL) than general populations. Identifying their needs is essential to develop a health service delivery model to improve patient outcomes.

OBJECTIVE

The objective of this study was to examine the perceived unmet needs and HRQoL of Chinese cancer survivors who completed treatment less than 1 year ago.

METHODS

Three hundred seventy-six participants completed a self-report survey: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy: General. Descriptive statistics were used to examine the prevalence of unmet needs. Multivariable logistic regressions were conducted to identify participants' characteristics that were associated with unmet needs. Multiple linear regression was used to delineate which domains of unmet needs were significantly associated with HRQoL with adjustment for potential confounding factors.

RESULTS

Healthcare information was the most common unmet needs among the survivors. Age, stage of cancer, and remission were significantly associated with 1 or more unmet need domains. Participants with unmet needs in physical, psychological, and patient care domains, on average, have poorer HRQoL.

CONCLUSIONS

Chinese cancer survivors have various unmet needs that might have adverse effects on their HRQoL. Younger age, more advanced stages of cancer, and remission were factors contributing to further unmet needs.

IMPLICATIONS FOR PRACTICE

The results provided useful information on the special needs of survivors that may affect their HRQoL, enabling clinicians to plan better how to allocate existing limited resources to those who most require them.

Chinese women living with cervical cancer in the first 3 months after diagnosis: a qualitative study

BACKGROUND

An earlier study revealed that Mainland Chinese women experienced a relatively low health-related quality of life during the first 3 months after being diagnosed with cervical cancer. This merited conducting a qualitative study to explore their experiences during this period.

OBJECTIVE

The aim of this study was to describe the experiences of Chinese women with cervical cancer in the first 3 months after diagnosis.

METHODS

A descriptive phenomenological method was used. Fourteen participants were interviewed at the time of diagnosis and 10 were reinterviewed 3 months later. The number of interviews conducted was determined by data saturation.

RESULTS

Five themes were discerned: dealing with the emotional chaos down to the hassles caused by the disease and its treatment, handling the diagnosis and the disease in my own way and in accordance with Chinese culture, instinctively depending on my partner and experiencing improved relationships within the family but no sexual life, sharing information and support with fellow patients but hiding the diagnosis from friends and acquaintances, and returning to previous existence wanting to be treated as normal but with changed attitudes to life.

CONCLUSIONS

The lived experience was seen as a sudden life transition triggered by receiving the diagnosis. Cultural and societal contexts influenced patient adaptation to the situation.

IMPLICATIONS FOR PRACTICE

Family members and fellow patients could be mobilized to help patients since their support was highly valued. Regarding their hope for an ordinary life, patients could benefit from the relief of adverse effects and information, for instance, on how to resume sexual activity.

Social support and quality of life among Chinese breast cancer survivors: findings from a mixed methods study

BACKGROUND

Social support has been identified as a significant factor positively influencing quality of life (QOL) in breast cancer survivors. However, less is known about whether and how social support remains important among cancer survivors over the course of the survivorship trajectory.

AIM

To explore social support and its relationship with QOL in breast cancer survivors in China.

METHODS

This was a sequential mixed methods study. In Phase I, 100 breast cancer survivors were surveyed using standardized questionnaires. A multivariate regression analysis was performed to examine the relationship between social support and QOL after controlling for annual household income and length of survivorship. In Phase II, individual in-depth interviews were conducted to understand social support experience from 29 survivors selected from Phase I. Interview data were transcribed and analyzed using qualitative content analysis.

RESULTS

Survivors reported a median support network size of 2.2 persons (interquartile range = 1.2-3.8) and a median support satisfaction score of 5.5 (interquartile range = 5-6). While support satisfaction was found to be associated with QOL, no association was found between support network size and QOL. Interview findings revealed that close family members and peer survivors constituted the major source of breast cancer survivors' support, especially in emotional and informational support aspects. Cultural factors played a role in the perception and utilization of support of the breast cancer survivors.

CONCLUSIONS

This study has indicated that support satisfaction is more critical than support network size in influencing various aspects of survivors' QOL through the underlying different types of situation-specific support.

The impact of cancer on family relationships among Chinese patients

This study examines the impact of cancer on family relationships among members of a Chinese cancer support group. A qualitative research design was used, including participant observation of 96 participants at group meetings over an 8-month period and in-depth interviews with seven group members. Findings indicated that family members were integral to the support group, constituting almost 40% of the participants. Patients in the group expressed concerns about family, with family members identified as having "equal suffering" when caring for patients. Notably, among both patients and family members, there was a strong emphasis on the need to conceal emotion, coupled with a focus on instrumental support in caregiving. Furthermore, patients' anxiety about "burdening" their family appeared to inflate their own experience of distress, as patients and their family carers both sought to maintain a positive front. The findings highlight the need for practitioners to focus on the entire family when designing interventions to help patients cope with cancer. More important, interventions need to be culturally sensitive that will empower patients and family members in living with the illness.

Religious and spiritual beliefs of gynecologic oncologists may influence medical decision making

BACKGROUND

Religious (R) and spiritual (S) beliefs often affect patients' health care decisions, particularly with regard to care at the end of life. Furthermore, patients desire more R/S involvement by the medical community; however, physicians typically do not incorporate R/S assessment into medical interviews with patients. The effects of physicians' R/S beliefs on willingness to participate in controversial clinical practices such as medical abortions and physician-assisted suicide has been evaluated, but how a physician's R/S beliefs may affect other medical decision-making is unclear.

METHODS

Using SurveyMonkey, an online survey tool, we surveyed 1972 members of the International Gynecologic Oncologists Society and the Society of Gynecologic Oncologists to determine the R/S characteristics of gynecologic oncologists and whether their R/S beliefs affected their clinical practice. Demographics, religiosity, and spirituality data were collected. Physicians were also asked to evaluate 5 complex case scenarios.

RESULTS

: Two hundred seventy-three (14%) physicians responded. Sixty percent "agreed" or "somewhat agreed" that their R/S beliefs were a source of personal comfort. Forty-five percent reported that their R/S beliefs ("sometimes," "frequently," or "always") play a role in the medical options they offered patients, but only 34% "frequently" or "always" take a R/S history from patients. Interestingly, 90% reported that they consider patients' R/S beliefs when discussing end-of-life issues. Responses to case scenarios largely differed by years of experience, although age and R/S beliefs also had influence.

CONCLUSIONS

Our results suggest that gynecologic oncologists' R/S beliefs may affect patient care but that most physicians fail to take an R/S history from their patients. More work needs to be done to evaluate possible barriers that prevent physicians from taking a spiritual history and engaging in discussions over these matters with patients.

Perceptions of food and eating among Chinese patients with cancer: findings of an ethnographic study

This article explores the ways that participants in a Chinese cancer support group talk about food, diet, and eating. An ethnographic research design was used, including participant observation at a Chinese cancer support group over an 8-month period and key informant interviews with 7 members of the group. Food, eating, and diet were a recurrent focus of discussion at support group meetings throughout the fieldwork period. The ways in which support group participants talked about food centered on 3 distinct but interconnected themes: the prevalence of eating issues as an adverse effect of cancer and its treatment, the importance of eating ability, and questions and concerns connected with the differing and often contradictory cultural models of diet that they were exposed to. Culturally specific understandings of the relationship between food and health informed Chinese patients' experience of eating issues during cancer treatments and their ongoing concern with food and nutrition after the completion of treatment. Health professionals need to pay more attention to the meanings and attributes of food and eating beyond their physiological properties, and further research needs to be conducted with other immigrant populations with culturally distinct understandings of food.

Methodological challenges in cross-language qualitative research: a research review

OBJECTIVES

Cross-language qualitative research occurs when a language barrier is present between researchers and participants. The language barrier is frequently mediated through the use of a translator or interpreter. The purpose of this analysis of cross-language qualitative research was threefold: (1) review the methods literature addressing cross-language research; (2) synthesize the methodological recommendations from the literature into a list of criteria that could evaluate how researchers methodologically managed translators and interpreters in their qualitative studies; (3) test these criteria on published cross-language qualitative studies.

DATA SOURCES

A group of 40 purposively selected cross-language qualitative studies found in nursing and health sciences journals.

REVIEW METHODS

The synthesis of the cross-language methods literature produced 14 criteria to evaluate how qualitative researchers managed the language barrier between themselves and their study participants. To test the criteria, the researcher conducted a summative content analysis framed by discourse analysis techniques of the 40 cross-language studies.

RESULTS

The evaluation showed that only 6 out of 40 studies met all the criteria recommended by the cross-language methods literature for the production of trustworthy results in cross-language qualitative studies. Multiple inconsistencies, reflecting disadvantageous methodological choices by cross-language researchers, appeared in the remaining 33 studies. To name a few, these included rendering the translator or interpreter as an invisible part of the research process, failure to pilot test interview questions in the participant's language, no description of translator or interpreter credentials, failure to acknowledge translation as a limitation of the study, and inappropriate methodological frameworks for cross-language research.

CONCLUSIONS

The finding about researchers making the role of the translator or interpreter invisible during the research process supports studies completed by other authors examining this issue. The analysis demonstrated that the criteria produced by this study may provide useful guidelines for evaluating cross-language research and for novice cross-language researchers designing their first studies. Finally, the study also indicates that researchers attempting cross-language studies need to address the methodological issues surrounding language barriers between researchers and participants more systematically.

Women?s experience of internal radiation treatment for uterine cervical cancer

AIM

This paper is a report of a study to explore the experiences of women undergoing internal radiation for cervical cancer.

BACKGROUND

Cervical cancer continues to be one of the most common cancers and one of the leading causes of cancer deaths globally. Women's experiences of undergoing internal radiation for cervical cancer remain relatively unexplored, in particular in Hong Kong. Better understanding of the experiences of this specific group could inform the provision of supportive care services and provide useful information to be included in education programmes for them.

METHOD

A phenomenological approach was adopted and unstructured telephone interviews were carried out with eight participants between July and October 2004. The interviews were audio-taped and analysed using the procedures described by Giorgi, 1985.

FINDINGS

Three themes were identified from the data: (1) isolation versus social intercourse, (2) unbearable symptom distress versus endurance and coping and (3) growth from the experience. The most distressing aspects of undergoing internal cervical irradiation reported by the patients were the experience of isolation and various physical and psychological symptoms. Specific provisions in the physical environment, psychological support provided by healthcare professionals, family and fellow patients and a positive attitude helped them to cope. They also felt that they became stronger through their hardship and suffering.

CONCLUSION

The findings highlight the importance of adequate preparation of patients, carers and friends before the procedure, more sensitive support during the procedure and debriefing afterwards. There might also be benefits in delivering therapy to two women in adjacent beds to enable them to support each other.

Concept Comparison of Caring and Social Support

PURPOSE

To explicate the similarities and differences between the concepts of caring and social support.

METHODS

Qualitative concept comparison.

FINDINGS

Similarities and/or subtle and substantive differences exist between caring and social support. Both concepts are characterized as dynamic interpersonal processes that involve sensitivity. Caring appears to lie within the purview of expert nurse providers, while social support is located primarily within the domain of lay providers. Social support is perfunctory and focused, whereas caring encounters are more intimate and holistic. Caring results in improved mental well-being for both recipients and providers, while improvements in mental health are limited to social support recipients. Unlike social support, physical well-being is an outcome of caring.

CONCLUSIONS

Caring and social support share common attributes and outcomes; however, they appear to be different processes that predominately exist in separate domains. Caring appears to reside within the professional paradigm of nursing, while social support exists primarily within the sphere of lay providers.

IMPLICATIONS

Nurses are encouraged to develop and use well-delineated conceptual frameworks to guide practice and research.

The relationship of sick leave benefits, employment patterns, and individual characteristics to radiation therapy-related fatigue

PURPOSE/OBJECTIVES

To examine the relationship among sick leave benefits, employment patterns, individual characteristics, and fatigue in patients receiving radiation therapy.

DESIGN

Prospective, longitudinal design.

SETTING

A community hospital radiation oncology department.

SAMPLE

77 patients receiving radiation therapy to the breast, chest, head and neck, pelvis, or prostate. All were employed at the time of diagnosis.

METHODS

The Piper Integrated Fatigue Model guided the study. The Revised Piper Fatigue Scale (PFS), Brief Fatigue Inventory, and a single-item scale were used to measure five dimensions of subjective fatigue. Sick leave, employment, individual characteristics, and fatigue were measured at baseline, weekly during treatment, and at one month post-treatment.

MAIN RESEARCH VARIABLES

Employment patterns, availability of sick leave benefits, and fatigue.

FINDINGS

Mean total fatigue scores on the PFS ranged from 0-4.77 at baseline (mean = 0.46, SD = 0.93), 0-8.77 at the completion of treatment (mean = 2.84, SD = 2.40), and 0-4.82 at one month post-treatment (mean = 0.77, SD = 1.20). Side effects, education, living situation, age, treatment site, and work were associated with fatigue along the trajectory of radiation therapy. Study participants who were working at the end of radiation had lower fatigue scores than those who were not. Availability of sick leave benefits was associated with employment patterns during treatment.

CONCLUSIONS

Work may have benefits during radiation therapy but may be affected by radiation therapy-related fatigue.

IMPLICATIONS FOR NURSING

Management of treatment side effects, including fatigue, may help patients remain in the workforce during radiation.

Cancer survivors' received and needed social support from their work place and the occupational health services

GOALS OF WORK

Even though a lot of studies have been conducted concerning cancer patients' social support, the importance of social support from the work life is unclear. We examined the amount of emotional and practical support that cancer survivors needed and had actually received from their coworkers, supervisors, and the occupational health personnel. We also examined whether disease-related or sociodemographic background variables were associated with needed or received support. Finally, we investigated whether there were differences between various sources in received or needed support.

PATIENTS AND METHODS

The data consisted of a total of 640 cancer survivors with breast cancer, lymphoma, testicular or prostate cancer, aged 25-57 years at the time of diagnosis. Information on social support was collected with a mailed questionnaire using an adapted version of the Structural-Functional Social Support Scale (SFSS).

MAIN RESULTS

The cancer survivors had received most support from their coworkers and they hoped for more support especially from the occupational health care personnel (39% of women and 29% of men). The men who had lymphoma, had received chemotherapy, or had low education level needed more support. The need for practical support from the occupational health personnel was fivefold between the chemotherapy-treated and those not treated. The women both received and needed more support than the men did.

CONCLUSIONS

There is a clear need for additional social support from work life among the cancer survivors especially from the occupational health personnel.

Supportive care: experiences of cancer patients

The aim of this study was to explore how cancer patients with progressive disease perceived and experienced supportive care at the different stages of their cancer journey and to compare this to the perceptions of health care professionals. It was a single centre study using qualitative data obtained from two focus group interviews in an independent centre for specialist palliative care. Eight patients attending the centre were interviewed in two focus groups to ascertain their views on the supportive care that they had experienced during the course of their illness, focusing on: time of diagnosis, acute treatment phase and palliative care phase. Themes that emerged from the analysis of the interview transcripts using the QSR NUD*IST (version 4) software package included the following: manner in which diagnosis was revealed, information made available to family and friends, patients' acceptance of cancer; service provision such as a named contact person, choices in treatment and care, problems of limited resources; feelings of being unsupported, and ways in which supportive care could be improved.

Social Support as a Mediator Between Symptom Distress and Quality of Life in Women With Breast Cancer

OBJECTIVE

To examine relationships between symptom distress and quality of life when religious support and personal support were introduced as mediating variables.

DESIGN

Cross-sectional, correlational.

SETTING

Internet recruitment following university institutional review board approval.

PARTICIPANTS

Mailed questionnaires from 100 women with breast cancer, mean age 46, length of time since surgery 1 to 24 months, predominantly White.

INSTRUMENTS

Symptom Distress Scale, Religious Support Scale, FACT-B, and Facit-Sp-12.

RESULTS

Personal support was positively related to quality of life and partially mediated the effects of symptom distress. Religious support did not mediate symptom distress and was not directly related to quality of life.

CONCLUSIONS

Social support from family members and friends helped to decrease the negative effects of symptoms on quality of life. This study underscores the need to continue to assess for symptom distress and adequacy of personal support throughout the cancer trajectory and to facilitate the garnering of support resources when needed.

Clarification of social support

PURPOSE

To clarify the concept of social support.

DESIGN

Template Verification and Expansion Model.

METHODS

Meta-synthesis strategies.

FINDINGS

Social support is composed of emotional and instrumental support. It is an advocative interpersonal process characterized by reciprocal exchange of information, it is context specific, and it results in improved mental health. Antecedents of emotional and instrumental support include a perceived need plus a social network and climate that are conducive to the exchange of social support.

CONCLUSIONS

In keeping with the nonprofessional nature of social support, nurses are advised to encourage patients to use and enhance personal support networks. For the same reason, nurses should reconsider investigating social support as a nursing intervention. Expanded efforts are needed to differentiate social support from concepts such as caring.

Hong Kong families and breast cancer: Beliefs and adaptation strategies

In Chinese society the family not the individual is the basic structural and functional unit. Family beliefs significantly determine the impact of the illness, choice of coping patterns and ultimately the physical and behavioral reactions of both the women and their family members. The purpose of this study was to identify the family beliefs about breast cancer and how the beliefs influenced family functioning. Twenty Hong Kong Chinese families where the woman had breast cancer (N=59) were interviewed using a minimally structured schedule. Interpretive phenomenology was the qualitative methodology used in the study. Gadamer's philosophical hermeneutics related to the process of understanding, application and interpretation was used to guide the analysis. Patterns of disharmony related to stress and emotion, diet, exercise, genetics and fate were evident in the family beliefs about the causes of breast cancer and guided the cognitive, emotional and behavioral strategies they adopted to negotiate the illness experience.

Hospital service quality: a managerial challenge

While much is known generally about predictions of customer-perceived service quality, their application to health services is rarer. No attempt has been made to examine the impact of social support and patient education on overall service quality perception. Together with six quality dimensions identified from the literature, this study seeks to provide a more holistic comprehension of hospital service quality prediction. Although 79 percent of variation is explained, other than technical quality the impact of the remaining factors on quality perception is far from constant, and socio-economic variables further complicate unpredictability. Contrary to established beliefs, the cost factor was found to be insignificant. Hence, to manage service quality effectively, the test lies in how well healthcare providers know the customers they serve. It is not only crucial in a globalized environment, where trans-national patient mobility is increasingly the norm, but also within homogeneous societies that appear to converge culturally.

Spirituality in gynecological oncology: a review

The following is a review of some of the work that has been published on issues related to definitions of spirituality and the many ways in which religious or spiritual concerns inform and can sometimes mold the relationships between gynecologic oncology patients, their physicians, and their health. Moreover, we have raised the question whether there is something specific or unique to the experience of women patients with reproductive cancers? Although it might seem clear to many of us that these patients are unique, it is hard to say exactly why. While there are differences between the various types of reproductive cancers, all share a common thread and all undermine the patient's identity as a woman. For oncologists, exploring the connection between the healing of the body and the healing of the spirit recognizes the comprehensive character of cancer treatment, and furthers the understanding that both physicians and patients share a knowledge that what patients lose in their battle with cancer is more than simply a medical life.

Social Support and Coping in Chinese Patients Undergoing Cancer Surgery

Patients undergoing cancer surgery experience the threats from both cancer and surgery. The unique sociocultural characteristics of Hong Kong Chinese may affect their perception of social support and how they face these threatening experiences. Sixty eligible patients were recruited from 2 regional hospitals in Hong Kong. They were asked to respond to a set of questionnaires, including Norbeck Social Support Questionnaire (NSSQ), Informational Support Questionnaire, and Jalowiec Coping Scale, following cancer surgery. The results showed that although family members and spouse/partner represented the largest source of social support network, the overall quantity of social support received by Chinese patients after cancer surgery was low. Positive correlations were found between coping effectiveness with tangible support (r = 0.31, P <.05) and coping effectiveness with informational support (r = 0.52, P <.01). The findings of this study support the link between social support and successful coping following cancer surgery. Tangible and informational supports appear more relevant to effective coping than emotional support during the postoperative period. Inclusion of family members in patient care during the postoperative period is crucial. Special attention should be paid to those patients who are older and poorly educated as they may be highly at risk for inadequate social support. Further studies with other cultural groups are suggested in order to better understand the sociocultural factors associated with cancer care.

Emotional support for dying patients--the nurses' perspective

This study describes and explains the provision of emotional support to the dying patients from the nurses' viewpoint. The results are part of a questionnaire survey concerned with terminal care on inpatient wards at community health centres in Finland. The sample consisted of 328 nurses from 32 health centres. The data were collected using a structured questionnaire in which emotional support was measured by multiple-choice items and one open-ended question. The data were analysed using content analysis. Listening, touching, expressing empathy, attending to the patients' wishes, comforting, encouraging and being present were the most common forms of emotional support. The support was mainly provided in connection with basic care. Problems concerning the provision of emotional support were focused on organisational resources, nursing staff, patients and family members. The size of the health centre, further training in the care of terminal patients and reading the literature were associated with the provision of support. In conclusion, nurses feel they need time as well as sufficient skills and competencies so that they can provide emotional support to the extent and in the way that they themselves want to.