Hopelessness, Death Anxiety, and Social Support of Hospitalized Patients With Gynecologic Cancer and Their Caregivers

Developing and assessing a vomiting-free ward workflow for gynecological patients receiving chemotherapy

BACKGROUND

Chemotherapy-induced nausea and vomiting (CINV) significantly diminishes the quality of life (QoL) for patients undergoing early and late-stage cancer treatments. Despite preventive antiemetic measures, CINV remains a challenge, with limited response rates. CINV adversely affects not only patients' physical health but also their psychological well-being, social interactions, and treatment adherence.

OBJECTIVE

This study aimed to evaluate the impact of a vomiting-free ward initiative on managing CINV and its effects on the psychological well-being and QoL of gynecological cancer patients receiving chemotherapy.

METHOD

In this study, 960 gynecological oncology patients receiving inpatient chemotherapy at a premier obstetrics and gynecology hospital in Sichuan Province were enrolled from January to December 2023. They were evenly divided into intervention and control groups based on their admission dates. Both groups underwent standard care, and the intervention group followed a vomiting-free ward protocol. The effectiveness of this specialized ward was evaluated using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool, the Functional Living Index-Emesis (FLIE), and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

The intervention group showed significant improvements in the frequency and severity of both acute and delayed CINV compared to the control group. Furthermore, there was a 9.7% and 7.2% decrease in the impact of severe nausea and vomiting on leisure activities and a 6.9% and 8.6% reduction in how moderate to severe nausea and vomiting affected daily living, respectively. The introduction of the vomiting-free ward significantly reduced levels of patient anxiety (t = - 3.148, P < 0.001) and depression (t = - 3.223, P < 0.001) compared to standard care.

CONCLUSION

The implementation of a vomiting-free ward effectively mitigates nausea and vomiting, enhances QoL, and decreases anxiety and depression among gynecological oncology patients. This innovative approach can be integrated into clinical practice, providing valuable insights and guidelines for healthcare professionals.

Incidence of Death Anxiety in Palliative Care: A Systematic Review and Meta-Analysis

Objective: To explore the incidence of death anxiety in palliative care patients, find some existing and potential causes, and put forward suggestions. Methods: Publication bias, sensitivity analysis, subgroup analysis, and regression analysis were also conducted to explore the sources of the heterogeneity in our analysis. Results: The 607 studies were obtained, and 20 studies were included after reading the articles and quality evaluation. The incidence of death anxiety in patients was 0.44 (95%CI:0.38,0.51, p < 0.001). and heterogeneity was significant (I2 = 98.2%, p < 0.001). In the test of regression analysis, the average age (I2 = 98.15%, R2 = - 6.99%, p < 0.001); in gender (I2 = 97.84%, R2 = 1.14%, p < 0.001), its heterogeneity was also significant. Conclusion: The incidence of death anxiety is relatively high. More often occur in elderly female patients. This requires more attention to life itself rather than death.

The level of cancer-related concerns and affecting factors in Turkish cancer survivors: A cross-sectional study

AIM

To examine and compare the level of cancer-related concerns and affecting factors between cancer survivors who completed their treatment and those still receiving treatment.

DESIGN

The study has a cross-sectional comparative design.

METHODS

Convenience sampling was used and the study included 350 Turkish cancer survivors. Data were collected between March and June 2022 online with a descriptive characteristics form and the Assessment of Survivor Concerns. Obtained data were analysed with numbers, percentages, mean values, t-test and multiple linear regression analysis.

RESULTS

The cancer survivors who completed their treatment had a significantly higher level of concerns than those who were still on treatment. Female cancer survivors, cancer survivors with less than 5-year time elapsing after diagnosis and gynaecological cancer survivors with completed cancer treatment can also have a higher level of cancer-related concerns.

CONCLUSION

Cancer survivors who have completed their treatment have a higher level of concerns than those who still receive treatment. Gender, time elapsing after diagnosis and type of cancer affect the level of concerns.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses should evaluate psychosocial care and needs of cancer survivors in addition to their physical care. Raising awareness about the concerns of the cancer survivors with completed treatment in addition to those still receiving treatment and providing holistic care to them can reduce their concerns.

IMPACT

It is of great importance to be aware of the factors likely to increase cancer-related concerns during and after cancer treatment. This study identifies cancer-related concerns in cancer survivors who completed or were still receiving treatment and provides a comparison with other studies in the literature.

REPORTING METHOD

We have adhered to STROBE statement using STROBE checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement.

Death Anxiety and Its Influencing Factors Among Family Caregivers of Cancer Patients: A Cross-Sectional Study

BACKGROUND

In China, caregiving for cancer patients is primarily the responsibility of family members. This role often exposes family caregivers to the contemplation of mortality. Death anxiety among family caregivers may influence the care they offer to cancer patients.

OBJECTIVE

This study aims to evaluate the prevailing level of death anxiety among Chinese family caregivers of cancer patients and identify its influencing factors.

DESIGN

This cross-sectional study followed the STROBE statement.

METHODS

A total of 220 family caregivers of cancer patients were recruited from a prominent tertiary hospital in southern China. The survey included a general information questionnaire, the Collett-Lester Fear of Death Scale, the Social Support Rating Scale and the Simple Coping Style Questionnaire. In addition to descriptive statistics, ANOVA, mean differences, correlations and regression analyses were computed.

RESULTS

The average score for death anxiety among family caregivers of cancer patients was 104.27 ± 21.02. Death anxiety was negatively correlated with a positive coping style and social support. Multiple linear regression analysis revealed that marital status, death education, patients' fear of death and coping style accounted for 41.0% of the variance in death anxiety among family caregivers.

CONCLUSIONS

Family caregivers of cancer patients experienced a moderate level of death anxiety. Individuals who were unmarried or divorced, lacked death education, had negative coping styles or cared for patients with fear of death tended to have high levels of death anxiety.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should act as credible educators to reduce caregivers' death anxiety by imparting positive coping styles and accurate knowledge and values about death so caregivers can provide high-quality care to patients.

The Relationship Between Death Anxiety and COVID-19 Fear and Anxiety in Women With Breast Cancer

This study determined the relationship between death anxiety and COVID-19 related fear and anxiety in women with breast cancer. This is a descriptive correlation-seeking study. The research included 140 women with breast cancer who visit the day treatment unit of the oncology department of a state university hospital. Personal Information Form, Fear of COVID-19 Scale (FCV-19S), Coronavirus Anxiety Scale (CAS), and Death Anxiety Scale (DAS) were used to collect data. A significant difference was found between the DAS score and body mass index (p = .019) and between FCV-19S score and COVID-19 vaccination status (p = .007). As the fear of COVID-19 and coronavirus anxiety of women with breast cancer increase, death anxiety also increases. In conclusion, death anxiety should be taken into consideration for this patient group while maintaining the continuity of care for these patients now and in future pandemics.

Death anxiety among caregivers of patients with advanced cancer: a cross-sectional survey

PURPOSE

This study aimed to investigate death anxiety (DA) in caregivers of patients with advanced cancer and identify associated factors in the context of Chinese culture.

METHODS

Caregivers (N = 588) of advanced cancer patients in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of the Templer Death Anxiety Scale (C-T-DAS), the Quality-of-Life Scale, the State-Trait Anxiety Scale, and the Social Support Rating Scale. Data were analyzed in SPSS (IBM Corp, Armonk, NY, USA) using descriptive statistics, Pearson's correlation test, and linear regression.

RESULTS

Respondents returned 588 (93.03%) of the 632 questionnaires. The total C-T-DAS score was 7.92 ± 2.68 points. The top-scoring dimension was "Stress and pain" (3.19 ± 1.29 points), followed by "Emotion" (2.28 ± 1.31 points) and "Cognition" (1.40 ± 0.94 points). In contrast, the lowest-scoring dimension was "Time" (1.06 ± 0.77 points). Factors associated with DA (R2 = 0.274, F = 13.348, p < 0.001) included quality of life (QoL), trait anxious personality, social support, caregiver length of care, caregiver gender, and patients' level of activities of daily living (ADL).

CONCLUSIONS

Our results demonstrated high levels of DA in caregivers of patients with advanced cancer. Generally, female caregivers and those with low social support had high DA. Caregivers caring for patients with low ADL levels or with a low QoL and trait anxious personality reported high DA. Certain associated factors help to reduce caregivers DA. Social interventions are recommended to improve the end-of-life transition and trait anxious personality as well as quality of life for caregivers.

Quality of life and death anxiety among caregivers of patients with advanced cancer: the mediating effect of trait anxious personality and the moderating effect of social support

PURPOSE

To explore the mediating role of trait anxious personality in the association between quality of life (QoL) and death anxiety (DA), as well as to test the moderating effect of social support in the mediation model.

METHODS

The Death Anxiety Scale, Quality of Life Scale, State-Trait Anxiety Scale, and Social Support Rating Scale were used to measure 588 family caregivers of advanced cancer patients. We then constructed a moderated mediation model.

RESULTS

The presence of QoL was negatively associated with DA (β =  - 0.67, p < 0.01). Trait anxious personality partially mediated the relationship between QoL and DA (indirect effect β =  - 0.08, p < 0.01). Social support moderated both the antecedent and subsequent segments of the mediating paths of "QoL → trait anxious personality → DA" and the direct relationship between QoL and DA. Among caregivers with a low level of social support, the mediating effect coefficient of trait anxious personality was higher at 0.25 (95% confidence interval (CI): 0.059-0.182), in contrast to caregivers with a high level of social support, where the mediating effect coefficient of trait anxious personality was 0.11 (95% CI: 0.029-0.072).

CONCLUSION

QoL is directly associated with an increased risk of DA and indirectly related to DA by increasing the risk of trait anxious personality among caregivers. Social support can moderate the mediating effect of trait anxious personality and the relationship between QoL and DA. The intervention strategy for preventing DA among caregivers who have encountered QoL reduction should focus on reducing trait anxious personality and social support.

Correlation of death anxiety with coping strategies among Palestinian women with breast cancer: a cross-sectional study

Background

Death anxiety and maladaptive coping accompany breast cancer diagnoses. The coping mechanisms and death anxiety among Palestinian patients with breast cancer have not been studied.

Aim

To assess the prevalence of death anxiety and its relationship with coping strategies among Palestinian women with breast cancer who are treated in Beit Jala Governmental Hospital in Bethlehem.

Method

A cross-sectional design was used, and 214 breast cancer patients who visited the Beit Jala Governmental Hospital in Bethlehem were recruited. Templer's Death Anxiety Scale and the Brief COPE Scale were used. To investigate the relationship between coping strategies and death anxiety, frequency, percentages, chi-square tests, and Pearson's correlation tests were utilized.

Results

The results indicated that 58.40% of the patients experienced death anxiety. The participants who used positive reframing (adjusted odds ratio (AOR) = 1.487, p = < 0.026), self-blame (AOR = 1.309, p = < 0.023), and religion (AOR = 1.260, p = < 0.031) as coping mechanisms were more likely to experience death anxiety. Conversely, the participants who adopted substance use (AOR = 0.657, p < 0.005) and active coping (AOR = 0.629, p < 0.007) as coping strategies had a lower likelihood of experiencing death anxiety.

Conclusion

The study revealed that breast cancer patients tended to use a combination of functional and emotional coping strategies and that a significant proportion of these patients (58.4%) experienced symptoms of death anxiety. This study emphasizes the significance of screening for death anxiety and understanding the coping strategies utilized by the patients. Gaining this understanding will assist in identifying patients who need more guidance and support.

Effect of Spirituality on Psychological Resilience and Hope in Patient-Family Caregiver Dyads Experiencing Gynecological Cancer: An Actor-Partner Interdependence Analysis

BACKGROUND

Women experiencing gynecological cancer (GCPs) and family caregivers (FCGs) use spirituality to cope with cancer. However, the dual relationship between the impact of spirituality on psychological resilience and hope among both GCPs and FCGs has not yet been explored.

OBJECTIVE

To examine the interdependent relationship between spirituality, psychological resilience, and hope of women with gynecological cancer and their FCGs at the dyadic level.

METHODS

In this cross-sectional study, 107 dyads were recruited from the gynecological oncology departments of 2 university hospitals in Ankara, Turkey. The GCPs and FCGs completed a Patient/Family Caregiver Information Form, Spiritual Well-being Scale, Connor-Davidson Resilience Scale, and Dispositional Hope Scale. Data were analyzed using descriptive statistics and Pearson's correlations. This study used the Actor-Partner Interdependence Model.

RESULTS

Spirituality of both GCPs and FCGs had a significant positive effect on their psychological resilience ( B = 0.918, P < .001; B = 0.435, P < .001, respectively) and hope ( B = 0.350, P < .001; B = 0.246, P < .001, respectively). However, the spirituality of GCPs and FCGs did not have a partner effect on psychological resilience ( B = -0.150, P < .052; B = -0.150, P = .052, respectively) and hope ( B = -0.012, P = .810; B = 0.073, P = .157, respectively).

CONCLUSIONS

Spirituality of GCPs and their FCGs positively affected their psychological resilience and hope, but the effect on each other was limited.

IMPLICATIONS FOR PRACTICE

Health professionals, especially nurses, should focus on tailoring spiritual care interventions to the unique needs of each individual within the GCP and FCG dyads. Personalized approaches that recognize and address the specific spiritual concerns of patients and caregivers may be more effective in promoting psychological resilience and hope.

Structural Equation Model of Factors Related to Death Anxiety for Chinese Patients with Cancer

This study aimed to develop a model that specifies the predictive effects of factors on death anxiety among Chinese patients with cancer using structural equation modeling. Using convenience sampling, data were collected from 353 cancer patients. Self-administered questionnaires included Social Support Rating Scale, Rosenberg Self-Esteem Scale, Connor Davidson Resilience Scale, Templer's Death Anxiety Scale, and socio-demographic factors. The results showed that social support, self-esteem, and resilience significantly impacted death anxiety. The final model fitted the data acceptably (χ2 = 37.319, df =31, p = 0.201). Social support mediated death anxiety through self-esteem and resilience. Resilience mediated the buffer effect of self-esteem on death anxiety as an intermediary factor. Findings suggest the need for further studies to explore effective interventions to provide social support and improve self-esteem and resilience among patients with cancer to alleviate death anxiety.

Investigating spiritual care perceptions and religious coping methods among the relatives of terminally ill patients during the COVID-19 pandemic: the case of Turkey

BACKGROUND

The COVID-19 pandemic in Turkey and around the world has had a profound impact on the families of terminally ill patients. In this challenging period, investigating the spiritual care perceptions and religious coping methods of patients' relatives is an essential step towards understanding the experiences in this process with the additional challenges brought by the pandemic and developing appropriate support services. This study aims to determine the spiritual care perceptions and the use of religious coping methods among the relatives of terminally ill patients in Turkey during the COVID-19 pandemic.

METHODS

The sample of this descriptive and correlational study consisted of the relatives of terminally ill patients (n = 147) who were receiving treatment in the Anesthesiology and Reanimation Intensive Care Unit of a state hospital in Turkey. Spirituality and Spiritual Care Rating Scale and the Religious Coping Scale to them using face-to-face interviews. Mann-Whitney U test, Kruskal-Wallis test, and Spearman's correlation analysis were used to analyze the data.

RESULTS

The mean age of the participants was 38.84 ± 11.19 years. Also, 63.3% of them were employed. The participant's total score on the Spirituality and Spiritual Care Rating Scale was 57.16 ± 6.41, and it was determined that the participants' level of perception of spirituality and spiritual care concepts was close to good. When the Religious Coping Scale scores of the participants were examined, it was found that both Positive Religious Coping levels (23.11 ± 2.34) and Negative Religious Coping levels (9.48 ± 1.47) were close to high. There was no correlation between the scores of RCOPE and SSCRS (p > 0.05).

CONCLUSION

As a result, it was determined that the level of perception of spirituality and spiritual care concepts of the relatives of terminally ill patients during the COVID-19 pandemic was close to sound, and their Positive Religious Coping levels were high. Epidemics are a reality of the world, and it is essential to learn lessons from this process and take precautions for the future. We offer a perspective to realize the coping power of religion and spirituality, which are integral parts of life. The needs of terminally ill patients' relatives, a sensitive group, become visible.

Correlates of death anxiety for patients with cancer: A systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence.

DESIGN

This systematic review and meta-analysis followed the PRISMA 2020 guidelines.

METHODS

Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software.

RESULTS

In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs.

CONCLUSIONS

Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients.

RELEVANCE TO CLINICAL PRACTICE

Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a meta-analysis based on data from previous studies.

Predictors of death anxiety among Iranian cancer patients: Contribution of sense of Coherence

BACKGROUND

Death anxiety is a negative consequence of cancer that influences the quality of life of many patients. This study determined the predictors of death anxiety and the contribution of the sense of coherence to this disorder among Iranians with cancer.

METHODS

The present research was a descriptive-analytical study that examined cancer patients referring to one of the educational hospitals in Tehran, Iran. Two hundred eligible patients selected by purposeful sampling filled out a clinical and demographic questionnaire. The data were analyzed by the SPSS 20 software.

RESULTS

The correlational results revealed a negative and significant relationship between death anxiety and a sense of coherence (r = -0.610). Likewise, age, gender, marital status, occupational and economic circumstances, and cancer type were among the variables that correlated with death anxiety and predicted 85% of this psychological state.

CONCLUSION

The researchers recommend mental assessment in oncological care to identify psychological challenges to realize the ultimate goal of palliative care, i.e. improving patients' quality of life.

Death Anxiety in Caregivers of Chronic Patients

This study aimed to determine the extent to which caregivers of patients with chronic illnesses experience death anxiety, and which variables from caregivers and patients might potentially be related to their death anxiety. It also aimed to compare the levels of death anxiety between patients and caregivers. Web of Science, Scopus, PubMed, Psychology Database, Cochrane, and Google Scholar were searched for original studies available until December 2022 that quantitatively addressed death anxiety in family and informal caregivers of individuals with chronic illnesses. The methodological quality of the included studies was assessed, and a meta-analysis was conducted using Hedges' g as the effect size index and the DerSimonian-Laird method to analyze differences between patients and caregivers in death anxiety. The results of the 11 included studies showed moderate levels of death anxiety in caregivers, and the meta-analysis (k = 7; 614 patients and 586 caregivers) revealed non-significant differences between the death anxiety experienced by patients and caregivers (pooled Hedges' g = -0.03, 95% CI = -0.29 to 0.25, p = 0.802). Some sociodemographic and psychological factors (e.g., gender, depression, and anxiety) might be related to the death anxiety experienced, but additional research is necessary to validate these findings.

Existential distress among family caregivers of patients with advanced cancer: A systematic review and meta-analysis

OBJECTIVE

Caregiving for a loved one is challenging and requires significant resources. Existential distress in family caregivers may include hopelessness, demoralization, fear of death, pre-loss grief, or a sense of not being emotionally prepared. The aim of this systematic review is to synthesize the quantitative literature on existential distress among family caregivers of patients with advanced cancer, focusing on its prevalence, association with mental disorders, as well as with sociodemographic, disease, and treatment-related factors.

METHODS

We systematically searched electronic databases for quantitative studies of the above-described existential distress concepts in family caregivers of patients with advanced cancer. Two independent reviewers extracted data and evaluated study quality. Data were analyzed using random-effects meta-analysis.

RESULTS

We retrieved 17.587 records, of which 31 studies fulfilled inclusion criteria. 63% of the studies (n = 20) provided sufficient data for meta-analysis for 5558 patients. We found an overall pooled prevalence of 30.6% for existential distress, 95% CI [24.2-37.0]. For existential distress subconcepts, prevalence rates were 57.0%, 95% CI [37.8-76.2], for death anxiety, 13.9%, 95% CI [10.8-17.0], for demoralization, 24.0%, 95% CI [18.0-30.0], for pre-loss grief, 18.4%, 95% CI [4.0-32.7], for hopelessness, 35.2%, 95% CI [28.2-42.2], for loneliness, and 35.6%, 95% CI [13.0-58.3], for emotional unpreparedness.

CONCLUSIONS

Approximately one third of the respondents were affected by high levels of existential distress. The review provides evidence for further development of support services that can reduce existential distress, focused on death anxiety, and improve the quality of life for family caregivers of patients with advanced cancer.

Supportive care needs in predicting the acceptance of illness among gynecological cancer patients undergoing therapy: a cross-sectional study

PURPOSE

This study aimed to examine the effect of supportive care needs and related factors in the acceptance of illness by gynecological cancer patients undergoing therapy.

METHODS

A cross-sectional design was adopted. The study included 190 gynecologic cancer patients by convenience sampling method. The personal information form, Acceptance of Illness Scale, and Supportive Care Needs a Survey-Short Form were used for data collection. ANOVA, t-test, Pearson's correlation test, and hierarchical regression analysis were used for analyzing the data.

RESULTS

Most participants (72.6%) had moderate acceptance of illness, and the Supportive Care Needs a Survey-Short Form total score was a moderate level, at 84.93 ± 18.86. All the patients stated that their need for supportive care had caused them much concern, thus needing additional help. The acceptance of illness was negatively related to unmet supportive care needs (r =-0.515, p = 0.001) and all its subscales [health care service and informing, psychology, sexuality, daily life, (r = -0.343, r = -0.447, r = -0.341, r = -0.408, respectively; p < 0.05)]. Hierarchical regression analyses indicated unmet psychology (β = -0.305), daily life (β = -0.205) and sexuality needs (β = -0.167), perceived income (β = 0.290), and occupation (β = -0.167), explaining 45% of the acceptance of illness.

CONCLUSIONS

Acceptance of illness of gynecological cancer patients undergoing therapy needs to be improved. Perceived income and occupation are positive predictors, and unmet psychology, daily life, and sexuality needs are negative predictors of acceptance of illness.

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.

Family resilience in cancer treatment and key influencing factors: A systematic review

OBJECTIVE

To identify the status quo and key influencing factors of family resilience in cancer treatment.

METHODS

Eight electronic databases (PubMed, Cochrane Library, Embase, CINAHL, Web of Science, CNKI, Wan Fang Database, VIP Database) were searched from 2000 to 10 May 2023. Inclusion criteria were the following: (a) study subjects were cancer patients or their family caregivers, (b) family resilience was measured as a variable, (c) reported factors associated with family resilience, (d) employed either quantitative or mixed methods design, (e) written in English or Chinese, (f) published in peer-reviewed journals. All included studies were evaluated for quality using the Mixed Method Appraisal Tool.

RESULTS

Thirty studies were included in the systematic review. According to our analysis, the family resilience of cancer patients could be influenced by various factors associated with six clusters: (a) demographic characteristics, (b) severe staging and treatment of cancer, (c) psychological and health statuses, (d) family, and (e) social environment. Meanwhile, several specific protective factors and risk factors of family resilience were also identified.

CONCLUSION

Family resilience plays an important role in promoting positive adaptation in the face of adversity in families of cancer patients/caregivers. This study classifies related influencing factors by analyzing both protective factors and risk factors (and some controversial factors of family resilience). We found that longitudinal studies are needed to further verify the dynamic changes of family resilience, and future research should focus on understanding family resilience from the dual perspectives of cancer patients and their caregivers, to provide comprehensive information for health professionals, and facilitate the development of effective family resilience intervention programs.

"I Am Grateful for Every Day I Live": A Qualitative Study on the Spiritual Experiences of Women With Gynecological Cancer

BACKGROUND

Considering the life-threatening nature of gynecological cancers, spirituality and religious beliefs may play a key role in the experiences of the patients during the disease process and their coping.

OBJECTIVE

The aim of this study was to understand the spiritual experiences of Muslim women with gynecological cancer during the disease process.

METHODS

A qualitative, phenomenological, and hermeneutic approach was followed in the research. Fourteen women with gynecological cancer in Turkey were interviewed individually. The thematic analysis approach of Braun and Clarke was used to evaluate the data.

RESULTS

The results of the data analysis revealed 3 themes (consisting of 9 subthemes): (1) reaction to cancer: spiritual distress (fear of death, perception of punishment, fear of obscurity and uncertainty, and being a cause of spiritual distress in the family); (2) reaction to cancer: spiritual well-being (accepting whatever may come from Allah, strengthening the faith in Allah); and (3) spiritual resources for coping with cancer (religious practices, hobbies and complementary practices, and family support).

CONCLUSIONS

The results of the study shed light on the cases that may cause spiritual distress and improve the spiritual well-being that is experienced by Muslim women with gynecological cancer during the disease process; they also reveal that religion has an effect on the experiences during the cancer process and the coping methods.

IMPLICATIONS FOR PRACTICE

Healthcare professionals who care for Muslim women with gynecological cancer should plan spiritual care by being aware of the cultural characteristics and religious beliefs of these women and their families.

Measuring hopelessness in advanced cancer: a secondary analysis of the Hopelessness Assessment in Illness questionnaire (HAI)

OBJECTIVE

Hopelessness, or a sense of despair about the future, has been a growing focus of psychological research among patients with serious medical illnesses. This study evaluated the psychometric properties of the Hopelessness Assessment in Illness (HAI) questionnaire, developed specifically for those facing a life-threatening illness. Participants were 344 advanced cancer patients (e.g. lung, breast, gastrointestinal, etc.) participating in two psychotherapy research trials.

DESIGN

Descriptive statistics characterised participants in regard to both demographic (age, gender, race, ethnicity, religiosity) and clinical characteristics (cancer type). Scale properties were assessed for internal consistency using Cronbach's coefficient alpha, item-total correlations, Principle Axis factor analysis, and its correlation to relevant psychological constructs. Nonlinear confirmatory factor analysis (CFA) assessed for latent construct variance by gender.

MAIN OUTCOME MEASURES

Psychometric properties of the Hopelessness Assessment in Illness questionnaire.

RESULTS

Results indicated strong internal consistency and temporal stability of the HAI, with significant correlations between the HAI and several theoretically related psychological constructs. CFA suggested the same single underlying factor for males and females.

CONCLUSIONS

The HAI demonstrated strong psychometric properties in the context of advanced cancer. Future research is needed to assess the utility of the HAI in more medically and geographically diverse populations.

Social Support in a Cancer Patient-Informal Caregiver Dyad: A Scoping Review

Social support that includes promoting healthy behaviours throughout the oncology pathway, from diagnosis to treatment to survival, can leverage existing support networks and improve the health of patients and family members in supportive roles. This scoping review aimed to identify and summarise the impact of social support on the patient-informal caregiver relationship during cancer treatment. Inclusion criteria were related to a high focus on dyadic cancer patient-informal caregiver relationships, considering a population of adult cancer patients in active hospitalisation on an oncology ward, and published between 2012 and 2022 to get a portrait of the literature that might influence the current practice. A systematic search using the "Population, Concept, and Context" framework was performed in PubMed, Web of Science, SCOPUS, EBSCO Medline, and CINAHL: 13 articles from the 16,425 pre-qualified articles published between 2012 and 2022. The narrative synthesis of the included studies highlighted that social support, encompassing its different forms within the context of dyads, is frequently associated with an enhanced quality of life, hope, and resilience of both patients and informal caregivers. However, it is important to recognize that the support interventions provided to patients, particularly caregivers, were frequently not thoroughly evaluated or explained, and the sample sizes of the included studies were often limited. Therefore, this review clarified the social and clinical potential of social support for the patient-informal caregiver relationship, paving the way for future robust studies that require to be powered and designed on specific outcomes to allow informing the practice on specific recommendations.

Relationship between supportive care needs with coronavirus anxiety and death anxiety of women with gynecologic cancer during the COVID-19 pandemic

AIM

The study aimed to determine the relationship between supportive care needs with coronavirus anxiety and death anxiety of women with gynecologic cancer during COVID-19.

METHODS

The population of the study was women with gynecologic cancer who received chemotherapy in a university hospital. The study sample was calculated using G*Power 3.1.9.4 analysis program and completed with 64 patients who agreed to participate and met the research criteria. The personal information form, supportive care needs survey-short form (SCNS-SF29^Tr ), coronavirus anxiety scale (CAS), and death anxiety scale (DAS) were used for data collection.

RESULTS

The participants' SCNS-SF29^Tr mean score was 105.7 ± 17.26, CAS mean score was 11.19 ± 3.96, and DAS mean score was 40.13 ± 15.5. There was a positive, very high-level correlation between the health system and information and psychological needs subscales of SCNS-SF29^Tr and CAS (r = 0.809, r = 0.878, respectively; p < 0.05). In addition, a high-level relationship was found between the daily life subscale of SCNS-SF29^Tr and CAS (r = 0.674; p < 0.001). A positive low-level relationship was determined between the health system and information, daily life, and psychological needs (except for the sexuality) subscales of SCNS-SF29^Tr and DAS (r = 0.357, r = 0.252, r = 0.353 respectively; p < 0.05).

CONCLUSION

Gynecologic cancer participants had unmet supportive care needs in all subscales except for the sexuality. The participants had higher supportive care needs, high-level coronavirus anxiety, and medium-level death anxiety. In addition, the participants' all supportive care needs have increased as their coronavirus anxiety levels have increased. The participants' supportive care needs have increased, except for sexuality, as their death anxiety levels have increased.

The effectiveness of psychoeducational interventions on caregiver-oriented outcomes in caregivers of adult cancer patients: A systematic review and meta-analysis

OBJECTIVE

Cancer caregiving can result in increased psychosocial distress and poor health-related quality of life (QOL). Psychoeducation has been shown to be effective in enhancing caregiving-oriented outcomes. A systematic assessment of the overall effect of psychoeducational intervention (PEI) and identification of individual intervention characteristics that may contribute to the effectiveness of PEI is needed.

METHODS

For this meta-analysis, relevant articles were identified through electronic databases using key search terms and their medical subject heading such as "family caregiver," "cancer," and "psychoeducational intervention."

RESULTS

Twenty-eight controlled trials with 3876 participants were included. PEIs had beneficial effect on depression (Standardized Mean Difference [SMD] -0.26; 95% CI = -0.50 to -0.01, p < 0.04), anxiety (SMD -0.41; 95% CI = -0.82 to 0.01, p < 0.05), caregiver burden (SMD -0.84; 95% CI = -1.22 to -0.46, p < 0.0001) and QOL (SMD 0.59, 95% CI 0.24-0.93; p < 0.0009) at the immediate post-intervention period. At longer-term follow-up, the effectiveness of PEI was maintained on QOL (SMD 0.39, 95% CI = -0.00 to -0.77, p < 0.05), and anxiety (SMD -0.57; 95% CI = -1.09 to -0.06, p < 0.03). Moderation analysis showed that intervention characteristics such as studies conducted in high-income countries, group intervention and studies that focused on specific and mixed cancers explain some of the high variations observed among the included studies.

CONCLUSIONS

PEI may benefit caregivers of cancer patients through the significant effects on caregiver burden, QOL, anxiety, and depression. The findings from the moderation analysis may be important for the design of future interventions.

Mediator role of presence of meaning and self-esteem in the relationship of social support and death anxiety

Introduction

Death anxiety has increased following the COVID-19 pandemic. Although terror management theory has suggested social support, presence of meaning and self-esteem functioned as death anxiety buffers, few existing works have explored the mechanism of how social support, presence of meaning, and self-esteem buffer death anxiety. To identify these mechanisms is the aim of this study.

Methods

Our cross-sectional study was conducted with 1167 people in China from 19 May 2020 to 1 June 2020 during the COVID-19 outbreak. The average age of participants was 26 years. Data were by questionnaire, including demographic information, the Templer's Death anxiety scale, the multidimensional scale of perceived social support, the presence of meaning scale, and the Rosenberg self-esteem scale.

Results

Results using structural equation modeling showed presence of meaning and self-esteem fully mediated the relationship between social support and death anxiety, respectively and sequentially. The proposed model showed good fit of indices: χ² = 243.384, df = 58, p < 0.001; CFI = 0.968, TLI = 0.954, RMSEA = 0.052, SRMR = 0.044.

Discussion

This study demonstrates significant mediator roles of presence of meaning and self-esteem in the relationship of social support and death anxiety. Multi-component interventions are needed to manage death anxiety by targeting increasing social support, presence of meaning and self-esteem and increasing presence of meaning and self-esteem when social support is diminished in the pandemic.

What is the direction of the association between social support and coping in cancer patients? A systematic review

The aims of this systematic review were (a) to analyze recent studies about the association between social support and coping strategies in cancer patients after an established diagnosis; (b) to evaluate the direction of this association; and (c) to highlight any differences among different cancer types. Seven databases were searched for studies reporting the association between coping and social support for cancer patients in the last 51 years. Most of the 52 included studies highlighted the association between coping and social support, regardless of the source. Our findings supported a bidirectional association. No significant differences were found among the different types of cancer. In conclusion, our results sustain the importance of knowledge in studying this association to identify social limits and resources for the well-being of oncological patients. This knowledge could lead to the creation of holistic protocols to prevent poor adjustment to cancer.

Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer-A cross-sectional survey in China

OBJECTIVE

This study explores the factors influencing death anxiety in patients with advanced cancer, and to investigate the role of family function on death anxiety, and the correlation between meaning in life and death anxiety.

METHODS

Patients with advanced cancer who were hospitalized in three institutions from November 2020 to May 2021 were recruited in this cross-sectional study. The Chinese version of the Death and Dying Distress Scale, Meaning in Life Scale For Advanced Cancer Patients and Family APGAR Index were used to assess death anxiety, meaning in life and family function. Pain symptoms were evaluated by the Numeric Rating Scale. Karnofsky Performance Status, patients' socio-demographic and clinical variables were also recorded. Statistical analyses were performed using IBM SPSS Statistics for Windows (version 26.0). Multivariate regression analysis was performed to examine the correlations of social-demographic and clinical variables with family function and death anxiety.

RESULTS

Three hundred and twenty-eight patients with advanced cancer were included in this study. The results showed that 12.2% of patients experienced moderate to severe death anxiety. Meaning in Life Scale For Advanced Cancer Patients (acceptance of death, controlling one's life), types of institution (oncology department of tertiary hospitals), self-perceived economic burden (extreme), Karnofsky Performance Status score, age, and medical insurance status (self-paid, inter-provincial medical insurance) were identified as associated factors of death anxiety (R ² ​= ​0.335, F ​= ​20.072, P ​< ​0.001). Patients with good family function scores had significantly low level of death anxiety in univariate analysis (F ​= ​5.892, P ​= ​0.003). Multivariate analysis revealed no significant association between family function and death anxiety.

CONCLUSIONS

Our results demonstrated that the oncology department of a tertiary hospital, extremely high of self-perceived economic burden, self-pay, and inter-provincial medical insurance might be associated with higher death anxiety in patients with advanced cancer. Lower level death anxiety was associated with higher level acceptance of death, a greater sense of life control, better physical performance, and older age. Further confirmation about the association between family function and death anxiety in patients with advanced cancer is warranted in the future.

Mitigating negative emotions through virtual reality and embodiment

Oncological treatments are responsible for many of the physical changes (aesthetic and functional) associated with cancer. Because of this, cancer patients are at high risk of developing mental health problems. The aim of this study is to propose an innovative Virtual Reality (VR) training that uses a somatic technique (i.e., embodiment) to create a bridge with the bodily dimension of cancer. After undergoing a psycho-educational procedure, a combination of exposure, out-of-body experience, and body swapping will gradually train the patient to cope with cancer-related difficulties, increasing stress tolerance, and patient empowerment. The most engaging step of this advanced form of Stress Inoculation Training is the body swapping experience, which will guide the patient in embodying a resilient cancer patient who is facing similar difficulties. Through the VR ability to simulate the human brain functioning, and the potential of embodiment to hook to the somatic dimension of illness, we expect that once the concepts endured through the patient’s experience of resilience are triggered, the patient will be more prone to implement functional coping strategies in real life, reaching empowerment and adjusting to the post-treatment difficulties. When the scenarios are built and the training tested, our intervention could be used to support patients with different oncological diseases and who are treated in different cancer hospitals, as well as patients with other non-oncological problems (e.g., social anxiety). Future research should focus on using our paradigm for other clinical populations, and supporting cancer patients in coping with different distressing situations.

Effects of Psychotherapy on Hope/Hopelessness in Adults with Cancer: a Systematic Review and Meta-analysis

BACKGROUND

Although psychotherapy is a common treatment for hopelessness and hope, the effectiveness remains controversial. The purpose of this study was to quantitatively synthesize available evidence related to the effect of a broad range of psychotherapy interventions on hope/hopelessness in cancer patients.

METHOD

Eight electronic databases were searched for studies with adult cancer patients (mean age ≥ 18 years) receiving psychotherapy interventions with hope/hopelessness measured as outcomes and written in English. We used the random-effects model to compute effect size using Hedges' g and conducted moderator analyses.

RESULTS

We found 27 primary studies which included 1,998 participants who were 57.6 ± 8.0 years old across studies. The psychotherapy effect size ranged from - 0.86 to 2.92. Researchers who conducted psychotherapy at hospital/health centers showed higher effects, that is, improved hope scores (g = 0.63), than those who conducted psychotherapy in the community (g = 0.05). When researchers enrolled participants alone, psychotherapy resulted in higher effects (g = 0.62) than when partners/caregivers were involved (g = - 0.04). Researchers who included group discussion showed lower effects (g = 0.36) than without group discussion (g = 1.10). Researchers who examined fidelity found lower effects (g = 0.16) than researchers who did not examine fidelity (g = 0.66). Interestingly, researchers who studied people with breast cancer showed higher effects (g = 0.96) than those who studied people with other types of cancer (g = 0.26). Researchers who included higher percentages of women showed greater effects (slope = 0.008, Q_model = 3.99, p = 0.046). Finally, the greater the time span between psychotherapy and the measurement of hope, the lower the psychotherapy effects (slope = - 0.002, Q_model = 4.25, p = 0.039).

CONCLUSION

Psychotherapy had a solid moderate effect on reducing hopelessness and improving hope in cancer patients compared to controls.

The relationship between spiritual well-being, hope and depression in gynecologic oncology patients

The authors' aim in this study was to determine the relationship between spiritual well-being, hope and depression in gynecologic oncology patients. This is a descriptive and correlational study. The patients received a total of 41.59 ± 12.11 points from the Spiritual Well-Being Scale, 5.57 ± 4.19 points from the Beck Hopelessness Scale, and 14.92 ± 11.61 points from the Beck Depression Scale. Gynecologic oncology patients had high spiritual well-being levels and low hopelessness and depression levels, and their hopelessness and depression levels decreased and hope levels increased as their spiritual well-being levels increased.

Death anxiety among advanced cancer patients: a cross-sectional survey

PURPOSE

This study aimed to investigate death anxiety in advanced cancer patients and identify associated factors in the context of Chinese culture.

METHODS

Participants (N = 270) with advanced cancer in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of a Likert-type Templer-Death Anxiety Scale, Rosenberg's Self-esteem Scale, Medical Coping Modes Questionnaire, the Social Support Rating Scale, and Connor-Davidson Resilience Scale. Data were analyzed in SPSS using descriptive statistics, Student's t test, Pearson correlation test, and linear regression.

RESULTS

Respondents returned 252 (93.33%) of the 270 questionnaires. The total CL-TDAS score was 39.56 ± 10.20. The top three items were "I fear dying a painful death" (3.59 ± 1.41), "I often think about how shortly life really is" (3.11 ± 1.33), and "1 am not particularly afraid of getting cancer" (3.09 ± 1.35). Associated factors of death anxiety (R² = .333, F = 15.756, p < .001) were the medical coping mode (resignation, confronce), self-esteem, the participants' adult children, the patient-primary caregivers' relationship, resilience, and the level of activity of daily living.

CONCLUSIONS

Our results demonstrate high levels of death anxiety in advanced cancer patients. Generally, patients with adult children, high self-esteem and resilience had low death anxiety. Conversely, patients with low levels of activity of daily living and high coping mode (resignation, confrontation) reported high death anxiety. We determined that associated factors contributed to reduce death anxiety. Social interventions are recommended to improve the end-of-life transition for patients and caregivers.

Associations between perceived stress and quality of life in gynaecologic cancer patient-family caregiver dyads

PURPOSE

This study aims to explore the level of stress perceived and quality of life (QOL) by gynaecologic cancer (GC) patients and family caregivers' dyads.

METHODS

In this cross-sectional study, 86 dyads were recruited from the gynaecological oncology department of a general hospital in Taichung City, Taiwan. The patients and family caregivers completed a sociodemographic information sheet, the Perceived Stress Scale, and the Taiwanese version of World Health Organization Quality of Life-BREF questionnaire. Data were analysed using descriptive statistics and Pearson's correlations. This study used the actor-partner interdependence model (APIM) with distinguishable dyads to examine the effect of patients' and caregivers' perceived stress on QOL in patient-caregiver dyads.

RESULTS

GC patients' and caregivers' level of QOL was influenced by their own stress level (actor effect). Caregivers' stress was statistically negatively associated with the patients' QOL (partner effect); however, there were no partner effect from GC patients to caregivers. Both patients and family caregivers with higher perceived stress had poorer QOL. Therefore, we identified that stress has some level of actor and partner effects on QOL in GC patient-family caregiver dyads.

CONCLUSIONS

Family caregivers' stress displayed both actor and partner effects within the first year of the cancer diagnosis; therefore, patient-and caregiver-based interventions, such as stress reduction strategies, should be developed to enhance patients' and caregivers' QOL and stress management ability.

The Effect of Treatment on Quality of Life, Symptoms, and Social Life in Gynecologic Cancer Patients

This study was carried out to determine the effect of treatment on quality of life, symptoms, and social life in patients with gynecologic cancer. Data were collected through face-to-face interviews to evaluate the individual and disease characteristics of the patients. The Edmonton Symptom Assessment Scale was used to determine the severity of the side effects. Functional Assessment of Cancer Therapy-General 4 was used to evaluate the quality of life. The total post-treatment quality of life scores of the patients were lower than their total pre-treatment scores. Patients who received chemotherapy and chemoradiotherapy had a lower quality of life than those who received radiotherapy, and they were less involved in social activities. Half of the individuals participated in social activities in the pre-treatment period, but this rate decreased to 16.4% after the treatment started. In this study, the quality-of-life scores of the patients who received gynecologic cancer treatment decreased after treatment and the patients experienced many symptoms at an increasingly severe level.

Desesperanza y su relación con el apoyo social percibido en pacientes peruanos con neoplasias hematológicas

Objetivo: El propósito del presente estudio fue determinar la relación significativa entre el apoyo social y la desesperanza en pacientes peruanos con neoplasias hematológicas que se encuentren en alguna de las fases del tratamiento. Método: El estudio fue de tipo descriptivo-correlacional. La muestra estuvo conformada por 110 pacientes hematooncológicos de ambos sexos, con edades entre 16 a 25 años. Los instrumentos utilizados fueron la Escala Multidimensional de Apoyo Social Percibido (MSPSS) y la Escala de Desesperanza de Beck (BHS). Resultados: Se reportan niveles altos de apoyo social percibido (81%) y niveles normales de desesperanza (82%) en los pacientes hematooncológicos. El apoyo social percibido se correlaciona inversa y significativamente con la desesperanza, aunque en magnitudes bajas a moderadas. Cabe destacar que la dimensión Expectativa de desgracia en el futuro, no se correlaciona significativamente con el apoyo social percibido y sus dimensiones. Igualmente, la dimensión Creencias que los acontecimientos negativos son durables, no se correlaciona con la dimensión Apoyo de familia. Por otro lado, se encontró diferencias significativas del apoyo social percibido con el sexo y la religión, asimismo, la desesperanza con la edad, tiempo de diagnóstico y fase de tratamiento. Conclusión: El apoyo social percibido se relaciona con la desesperanza en pacientes hematooncológicos peruanos. Por tanto, se corrobora que el apoyo social que recibe el paciente ante la desesperanza de una enfermedad hematooncológica, sirve como soporte y tolerancia de dicha enfermedad y sus efectos durante el tratamiento.

Exploring the needs and experiences of palliative home care from the perspectives of patients with advanced cancer in China: a qualitative study

PURPOSE

The needs and experiences of palliative home care for patients with advanced cancer have received little research attention. We aimed to explore the needs and experiences of palliative home care among patients with advanced cancer in China.

METHODS

This qualitative study was conducted using semi-structured interviews with patients with advanced cancer. Participants (n = 15) were recruited from an oncology palliative care unit and a hospice outpatient unit, and were selected using purposive sampling from October 2019 to March 2020. Interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Two researchers coded the interviews independently in NVivo 12 and developed major themes and subthemes by inductive and constant comparison.

RESULTS

Five themes were identified: (1) physical need; (2) psychological experience; (3) spiritual need; (4) social need; and (5) information need. Patients need to manage their symptoms (especially cancer pain), prolong life as long as possible, reconstruct their attitudes to adapt to their roles, be socially supported, be respected, maintain spiritual peace, and obtain more information about illness and home care.

CONCLUSIONS

The current palliative home care services are imperfect, and patients face substantial challenges, including physical symptoms, psychological/spiritual distress, and inadequate social support and information. Our findings may provide evidence and a reference for the development of palliative home care in China.

Anxio-depressive symptoms in Moroccan women with gynecological cancer: Relief factors

INTRODUCTION

Psychosocial determinants can affect the mental health of women who have been diagnosed with gynecological cancer. The aim of this study was to examine how social support and self-esteem are associated with anxiety and depression symptoms in women with gynecological cancer, and who are treated by radical surgery.

METHODS

A cross-sectional study was performed, within the oncology department of Ibn Rochd University Hospital, Casablanca, on 100 Moroccan women. They all had undergone radical surgery for gynecological cancer, hysterectomy and/or oophorectomy.

RESULTS

Our results showed that patients with gynecological cancer treated by radical surgery exhibited high prevalence rates of anxiety (66%) and depression symptoms (59%). Associations showed that age, having children, medical coverage system, area of residence, working status and socioeconomic status were significantly related to the prevalence of anxiety and depression symptoms (P<0.05). The general social support, family support and significant other support besides high self-esteem reduce significantly the risk of getting anxiety and depression symptoms (P-values<0.05).

DISCUSSION

Among patients with gynecological cancer treated by radical surgery, high prevalence of anxiety and depression symptoms was found. Social support and high self-esteem could help improve mental health issues related to this type of cancer.

Effects of a nursing care program based on the theory of human caring on women diagnosed with gynecologic cancer: a pilot study from Turkey

PURPOSE/OBJECTIVES

This pilot study aimed to determine the effects of a nursing care program based on the Theory of Human Caring (THC) on chemotherapy symptoms, hope, and meaning in life in women diagnosed with gynecologic cancer.

DESIGN/METHODS

This pilot study was conducted in a single-blinded, randomized controlled trial on 52 women diagnosed with gynecologic cancer in Turkey. In the present study, the experimental group was given a nursing care program based on the THC alongside routine nursing care for five sessions, while the control group received solely routine nursing care. Data were collected using the Chemotherapy Symptom Assessment Scale, the Herth Hope Scale, and the Life Attitude Profile.

FINDINGS

There was a statistically significant decrease in the frequency, severity, and degree of discomfort of some chemotherapy symptoms in the experimental group. In addition, the mean scores of hope and meaning in life were significantly higher in the study group compared to the control group.

CONCLUSIONS/IMPLICATIONS

This study revealed that a nursing care program based on the Theory of Human Caring might be of benefit for decreasing the frequency, intensity, and discomfort level of some chemotherapy symptoms, and also for improving the level of hope and meaning in life in women diagnosed with gynecologic cancer.

Death anxiety in patients with cancer: A systematic review and meta-analysis

PURPOSE

The present study was designed to estimate the rate of death anxiety and the factors influencing its occurrence in cancer patients using a systematic review and meta-analysis approach.

METHOD

Five academic databases, including Scopus, PubMed, Science Direct, Embase, and ProQuest, were searched systematically from inception until the end of January 2020. Observational studies that reported mean score of death anxiety in cancer patients, regardless of language restriction, were eligible to be included. The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies. A meta-analysis was performed using a random effect model with the DerSimonian and Laird weighted method. Publication bias was assessed using the funnel plot and Begg's and Egger's tests.

RESULTS

The estimated pooled mean for death anxiety among cancer patients was 6.84 (CI_95% = [5.98, 7.69]). Publication bias and small study effects were not detected. Subgroup analysis and a meta-regression showed that the estimated pooled mean was higher in Asian studies (M = 7.57) compared to European (M = 6.47) and North American studies (M = 5.57); in breast cancer patients (M = 9.68) compared to studies examining different types of cancers; in female only participants (M = 7.37) compared to studies with both genders (M = 6.60); and in married participants compared to non-married participants.

CONCLUSIONS

The findings suggest that death anxiety in patients with cancer is moderate and is influenced by socio-demographic factors such as region, type of cancer, sex, and marital status.

Health care utilization as a predictor of death anxiety in older adults

The relationship between health care utilization and death anxiety in older adults is underexplored. This secondary analysis of the 2012 Health and Retirement Study examined health care utilization as a predictor of death anxiety in a nationally representative sample of American older adults (N = 3,960). Hierarchical binary logistic regression results revealed that overnight hospitalization, overnight nursing home placement, and outpatient visit were all statistically significant predictors of death anxiety. Outpatient visit was the strongest health care utilization predictor in the model. Increased end-of-life training for providers may improve patient-provider communication and alleviate patients' death anxiety. Future research should explore the directionality between study variables.

Temporal trends and characteristics of suicide among women with gynecologic malignancy in the United States

Objective

To examine the trends, characteristics, and outcomes of women with gynecologic malignancies who died of suicide in the United States.

Methods

This is a retrospective, observational study using the Surveillance, Epidemiology and End Results program from 1973 to 2013. Women with uterine, ovarian, and cervical cancers who had cause of death recorded as suicide or self-inflicted injury were included, and temporal trends, patient and tumor characteristics, and outcomes were assessed.

Results

Of 467,368 women with gynecologic cancers, there were 309 (0.07%) suicides during the study period. Across the three malignancies, suicide rates significantly decreased during the study period, with uterine cancer exhibiting the highest interval decrease (relative reduction: uterine cancer 88.2%, cervical cancer 78.1%, and ovarian cancer 73.6%; all, P < 0.05). Women with cervical cancer were younger at age of suicide (median age, 50 versus 60-68 years), and women with ovarian cancer had a shorter time to suicide from diagnosis (median time, 27 versus 66-67 months) (both, P < 0.05). On multivariable analysis, white race (hazard ratio [HR] 3.619), Western U.S. residence (HR 2.012), ovarian cancer (HR 1.991), cervical cancer (HR 1.765), stage IV disease (HR 1.735), and divorced status (HR 1.491) remained independent clinico-pathological characteristics associated with increased risk of suicide (all, P < 0.05).

Conclusion

This study found that suicide rates in women with gynecologic malignancies have decreased in the United States. Characteristics of suicide vary across cancer types, and certain risk factors of suicide identified in this study may be useful to triage patients at risk for suicidal behavior and inform prevention strategies.