Family-oriented care and health-related quality of life for women with gynaecological cancer: A cross-sectional mixed-method study

AIMS

This study aims to describe the experiences of women with gynaecological cancer regarding family-oriented care (FOC) and how they rated their health-related quality of life (HRQoL) using a 15D instrument (15D©).

DESIGN

A cross-sectional mixed-method study.

METHODS

The data were collected by electronic surveys of two Finnish cancer associations from gynaecological cancer patients (n = 53). The qualitative data were analysed using thematic analysis. The HRQoL answers were analysed statistically using IBM SPSS Statistics (Version 27).

RESULTS

The results emphasized that FOC is not yet part of the care process. Furthermore, comprehensive encounters are lacking, and the experience of being a woman is forgotten during the care process. The results of the HRQoL analysis suggest that distress and the discomfort and symptoms of cancer patients are perceived as significant factors affecting their quality of life during different phases of treatment. Family status also has an impact on perceived quality of life, whereby those living alone gave worse ratings for the depression and vitality dimensions.

CONCLUSION

In part, the quantitative and qualitative data supported each other, but the descriptions provided a more comprehensive view of issues that affect women in a more multidimensional way, such as sexual health issues. More research on the effectiveness of FOC is needed to develop the capacity for effective healthcare.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study was able to identify important areas for improvement in clinical practice from the perspective of patients and their families.

REPORTING METHOD

This study was prepared and reported according to the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Relationship between social support and self-care ability among patients with breast cancer during rehabilitation: The multiple mediating roles of resilience and depression

AIMS

To identify the multiple mediating effects of resilience and depression between social support and self-care ability among patients with breast cancer during rehabilitation to provide reference for developing and implementing targeted interventions.

DESIGN

A cross-sectional study reported according to the STROBE checklist.

METHODS

A convenience sample of 320 patients with breast cancer during rehabilitation was recruited from one hospital in China. Data were collected from April to August 2022 using a self-report questionnaire, including the demographic and clinical information, Appraisal of Self-Care Agency Scale-Revised, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale-10 item, and Patient Health Questionnaire-9. The mediation analysis was conducted using the SPSS Process macro.

RESULTS

Self-care ability was positively associated with social support (β = .229) and resilience (β = .290), and negatively associated with depression (β = -.208). The relationship between social support and self-care ability was mediated by resilience and depression, respectively, and together in serial. The multiple mediating effects accounted for 34.0% of the total effect of social support on self-care ability.

CONCLUSION

Our findings identify resilience and depression as multiple mediators between social support and self-care ability and highlight the important roles of social support, resilience and depression in improving self-care ability.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should pay great attention to the underlying mechanisms of how social support affects patients' self-care ability during breast cancer rehabilitation. Integrated intervention programmes targeted at enhancing social support, building resilience and alleviating depression might be beneficial to the improvement of self-care ability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.

Translation and Psychometric Validation of the German Version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study

Supporting families experiencing critical illness through family interventions is essential to ease illness burden, enable family management, and reduce their risk for adverse health. Thus far, there is no validated German instrument to measure the perceived support families receive from nurses. We translated the 14-item Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and tested its psychometric properties with 77 family members of intensive care patients. Compared with the original instrument, the construct validity of the German ICE-FPSQ (FPSQ-G) showed unstable results with a partially divergent structure, most likely caused by the limited sample size. The first two principal components explained 61% of the overall variance and a good internal consistency with a Cronbach's alpha of .92. The FPSQ-G is a promising instrument to measure family members' perceptions of the support they received from nurses in the acute critical care setting but requires further validation.

Family-Oriented Therapeutic Conversations: A Systematic Scoping Review

There is increasing evidence that highlights the benefits of Family-oriented Therapeutic Conversations (FAM-TC) for the patient and the family; however, studies show variability regarding the content and the way these interventions are offered. This may hamper its further development in clinical practice. This review systematically maps the available literature on nurse-led FAM-TC and offers a solid synthesis of the characteristic, effectiveness, and feasibility of these interventions. A systematic search in PubMed, CINAHL, Cochrane, Web of Science, PsycINFO, Trip (Turning Research Into Practice), BASE (Bielefeld Academic Search Engine), OATD (Open Access Theses and Dissertations), and ProQuest databases identified 37 studies. The interventions varied in interventionist nurses' profile, the intervention content, or the duration of the sessions offered. Most of the interventions showed beneficial effects on perceived family support and family functioning. This review offers suggestions for future studies, such as the inclusion of specific theoretical frameworks for intervention design, targeting both the patient and the family and offered by nurses with family nursing competency.

How Do Presenteeism and Family Functioning Affect the Association Between Chinese Nurses' Job Stress and Intention to Stay?

BACKGROUND

Despite a great deal of existing research on nurses' job stress and intention to stay, it is still unclear how the association between Chinese nurses' job stress and intention to stay is affected by presenteeism and family functioning.

AIMS

This study aimed to investigate the correlations of Chinese nurses' job stress, presenteeism, and family functioning with their intention to stay and clarify the mediating effect of presenteeism and the moderating effect of family functioning on the association between their job stress and intention to stay.

METHOD

A cross-sectional study of 1,008 nurses was performed in a major general hospital in Qiqihar City, Heilongjiang Province, China. The participants were invited to engage in a questionnaire survey regarding job stress, presenteeism, family functioning, and intention to stay. A moderated mediation analysis was conducted through multiple linear regression analysis and the PROCESS macro.

RESULTS

Job stress and presenteeism were negatively correlated with intention to stay, whereas family functioning was positively correlated with intention to stay. The effect of job stress on intention to stay was partially mediated by presenteeism (Effect = -0.147, 95% CI = [-0.305, -0.003]). In addition, family functioning moderated the direct effect of job stress on intention to stay (Index = -0.134, 95% CI = [-0.274, -0.001]).

CONCLUSIONS

Presenteeism and family functioning were found to play mediating and moderating roles, respectively, in the relationship between job stress and intention to stay. Relevant interventions or family-friendly programs should be developed to enhance nurses' intention to stay.

Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses

PURPOSE

In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology.

METHODS

81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression.

RESULTS

Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers.

CONCLUSIONS

While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.

Translation, Cultural Adaptation, and Psychometric Validation of the European Portuguese Version of the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ)

A family's experience of mental illness can change the family's functioning. In clinical contexts, valid and reliable instruments that assess family functioning, therapeutic changes, and the effects of family nursing interventions are needed. This study focuses on the linguistic and cultural adaptation of the Iceland-Expressive Family Functioning Questionnaire (ICE-EFFQ) to European Portuguese and examines the psychometric properties of this instrument. A non-random sample of 121 Portuguese depressed patients and their relatives completed the questionnaire. Principal components analysis extracted 4 factors, explaining 55.58% of the total variance. Confirmatory factor analysis revealed acceptable adjustment quality indices. Cronbach's alpha coefficient was adequate for the global scale α = .86 and for the 4 subscales: communication α = .79, expression of emotions α = .68, problem-solving α = .71, and cooperation α = .61. The Portuguese version of ICE-EFFQ is a sensitive, valid, and reliable instrument for use with Portuguese families with adult members with depression and can be valuable in assessing these families' expressive functioning, before and after intervention.

The client and family experience of attending a nurse-led clinic for chronic wounds

BACKGROUND

The quality of life for individuals with chronic wounds is diminished due to poor health-related outcomes and the financial burden of wound care. The literature has shown nurse-led wound care to have a positive impact on wound healing and psychosocial wellbeing. However, there is minimal research investigating the lived experience of attending a nurse-led clinic for chronic wounds. The purpose of this study was to explore the client and family experience of attending a nurse-led clinic for chronic wounds.

METHODS

Qualitative descriptive study. Semi-structured telephone interviews were transcribed verbatim and thematic analysis was undertaken.

RESULTS

Twelve clients and two family members participated, and the average length of interviews was 20min. Three main themes emerged: (1) expecting and managing pain; (2) receiving expert advice and reflecting on previous care; and (3) managing the cost of care. There was an emphasis on the impact of chronic wounds on pain and the ability to complete the activities of daily living. Expert advice, client satisfaction and physical accessibility were highlighted as benefits of the clinic. Cost and minimal client education were identified as challenges of the clinic.

CONCLUSIONS

The findings demonstrated that chronic wounds have a significant impact on the client and family attending the nurse-led clinic. Comprehensive pain assessment, improved social support, better client education and cost-effective care is required to optimise the experience for people attending the nurse-led clinic.

The influence of resourcefulness on the family functioning of young- and middle-aged lymphoma patients in China: a cross-sectional study

BACKGROUND

Lymphoma has become 1 of the 10 most common cancers with increased prevalence in young- and middle-aged adults in China. This poses a tremendous burden on patients and their families and brings great challenges to maintaining the balance of family functioning in young- and middle-aged patients.

OBJECTIVE

This cross-sectional study aimed to analyse the influence of resourcefulness on the family functioning of Chinese young- and middle-aged lymphoma patients.

METHODS

A total of 172 Chinese young- and middle-aged patients with lymphoma were recruited from the oncology departments of two tertiary hospitals in Zhengzhou, Henan, China. They were invited to complete a survey that included a demographic questionnaire, the Resourcefulness Scale and the Chinese Version Family Adaptability and Cohesion Scale II. Multiple linear regression was used to analyse the related factors for family functioning.

RESULTS

The multiple regression analysis revealed that the main influencing factors of family cohesion were resourcefulness (β = 0.338, 95% CI (0.072, 0.173)), spouse caregiver (β = 0.376, 95% CI (1.938, 10.395)), and cancer stage (β = -0.274, 95% CI (-3.219, -1.047)). Resourcefulness (β = 0.438, 95% CI (0.096, 0.181)), spouse caregiver (β = 0.340, 95% CI (1.348, 8.363)), and family per capita monthly income (β = 0.157, 95% CI (0.066, 2.243)) were the influencing factors of family adaptability.

CONCLUSIONS

Healthcare professionals and family scholars should value young- and middle-aged lymphoma patients' family functioning throughout the cancer treatment process, and family interventions should be designed by healthcare providers based on patients' resourcefulness. Moreover, healthcare providers need to pay attention to the risk factors of patients' family cohesion and adaptability, such as low family per capita monthly income, and consider employing corresponding measures to help them.

The Effect of Family Nursing Conversations as an Add-on to Multidisciplinary Treatment in Patients with Chronic Non-Cancer Pain: A Quasi-Experimental Trial

Introduction

Chronic non-cancer pain (CNCP) is a lifelong condition with radical consequences, calling for management involving patients' families. Interventions based on the family systems nursing framework by Wright and Leahey have proved beneficial in other populations but require investigation in a CNCP population. This trial assumed that family nursing conversations (FNCs) based on the family systems nursing framework would increase patients' and family members' self-efficacy concerning CNCP management.

Objective

To investigate whether an intervention with FNCs as an add-on to the usual multidisciplinary treatment of CNCP would have an effect on patients' and family members' self-efficacy. Additionally, to investigate any impact on family function, health-related quality of life, anxiety, and depression.

Methods

The trial applied a prospective non-blinded quasi-experimental design with two comparable groups of patients and family members: a historical control group (HCG) and an intervention group (IG). The intervention was executed by nurses employed at a multidisciplinary pain center in the Capital Region of Denmark. HCG data were collected before the nurses' intervention training. The primary outcome was self-efficacy. Secondary outcomes were family function, health-related quality of life, anxiety, and depression.

Results

In total, 58 patients and 85 family members were included. The primary outcome, self-efficacy, detected no statistically significant between-group differences in mean change for patients, p = .990, or family members, p = .765. A statistically significant effect in favor of the IG was found in between-group differences in mean change in patients' behavioral family function, p = .034, and anxiety, p = .031. No statistically significant between-group differences were detected in family members' secondary outcomes.

Conclusion

The intervention had no effect on patients' or family members' self-efficacy but a positive effect on patients' behavioral family function and anxiety. The intervention was deeply affected by the COVID-19 pandemic. Hence, any results should be interpreted with caution.

Protective Buffering: Nurses Facilitating Communication Between Adults With Cancer and Their Adult Family Caregivers Who Overprotect One Another-An Integrative Review

The aim of this study was to explore how nurses can alleviate protective buffering between adult patients with cancer and their adult family caregivers (PROSPERO No. CRD42020207072). An integrative review was conducted. PubMed, CINAHL, Embase, and Cochrane Library were searched for primary research articles published between January 2010 and April 2022. Only research conducted in oncology, hematology, or multiple settings and investigating communication between adult patients with cancer and their adult family caregivers and/or the communication between patients, family caregivers, and nurses was included. The constant comparison method outlined the approach to the analysis and synthesis of the included studies. Titles and abstracts of 7,073 references were screened; 22 articles (19 qualitative and three quantitative studies) were included in the review. Three themes emerged during data analysis: (a) family coping, (b) an isolating journey, and (c) the nurse's role. A study limitation was that "protective buffering" is not a common term in the nursing literature. There is a need for further research on protective buffering in families with cancer, particularly on psychosocial interventions that focus on the whole family across various cancer types.

Effectiveness of mHealth-based psychosocial interventions for breast cancer patients and their caregivers: A systematic review and meta-analysis

BACKGROUND

Breast cancer causes significant distress in patient-caregiver dyads. While psychosocial and/or mHealth-based interventions have shown efficacy in improving their psychosocial well-being, no reviews have synthesised the effectiveness of such interventions delivered specifically to the breast cancer patient-caregiver dyad.

OBJECTIVE

To synthesise available evidence examining the effectiveness of mHealth-based psychosocial interventions among breast cancer patient-caregiver dyads in improving their psychosocial well-being (primary outcomes: dyadic adjustment, depression and anxiety; secondary outcomes: stress, symptom distress, social well-being and relationship quality), compared to active or non-active controls.

DESIGN

A systematic review and meta-analysis.

METHODS

Randomised controlled trials and quasi-experimental studies were comprehensively searched from seven electronic databases (PubMed, CENTRAL, CINAHL, Embase, PsycINFO, Scopus, Web of Science), ongoing trial registries (ClinicalTrials.gov, WHO ICTRP) and grey literature (ProQuest Dissertations and Theses Global) from inception of databases till 23 December 2022. Studies involving breast cancer patient-caregiver dyads participating in mHealth-based psychosocial interventions, compared to active or non-active controls, were included. Exclusion criteria were terminally ill patients and/or participants with psychiatric disorders or cognitive impairment and interventions collecting symptomatic data, promoting breast cancer screening or involving only physical activities. Screening, data extraction and quality appraisal of studies were conducted independently by two reviewers. Cochrane Risk of Bias Tool version 1 and JBI Critical Appraisal Checklist were used to appraise the randomised controlled trials and quasi-experimental studies, respectively. Meta-analyses using Review Manager 5.4.1 synthesised the effects of outcomes of interest. Sensitivity and subgroup analyses were conducted. The GRADE approach appraised the overall evidence quality.

RESULTS

Twelve trials involving 1204 breast cancer patient-caregiver dyads were included. Meta-analyses found statistically significant increase in caregiver anxiety (standardised mean difference (SMD) = 0.43, 95% confidence interval (CI) [0.09, 0.77], Z = 2.47, p = 0.01), involving 479 caregivers in 5 studies, and stress (SMD = 0.25, 95% CI [0.05, 0.45], Z = 2.44, p = 0.01), involving 387 caregivers in 4 studies post-intervention, favouring control groups. The intervention effects on the remaining outcomes were statistically insignificant. Beneficial effects of such interventions remain uncertain. The overall quality of evidence was very low for all primary outcomes.

CONCLUSIONS

Results of the effectiveness of mHealth-based psychosocial interventions on the psychosocial well-being of breast cancer patient-caregiver dyads are inconclusive. The high heterogeneity shown in the meta-analyses and very-low overall quality of evidence imply the need for cautious interpretation of findings. Higher-quality studies are needed to assess the effects of psychosocial interventions on dyadic outcomes and determine optimal intervention regimes.

Limitations on participation and global quality of life among CRC survivors with permanent stomas: moderated mediation analysis of psychological distress and family functioning

PURPOSE

Although a cancer diagnosis and stoma creation leave colorectal cancer (CRC) survivors with significant limitations on participation in life activities that would impair their global quality of life (QoL), the underlying psychological mechanisms are understudied. The aim of this cross-section study was to examine whether psychological distress mediates the association of limitations on participation in life activity with global QoL, and whether family functioning moderated the indirect effects of limitations on participation in life activities on global QoL through psychological distress.

METHODS

CRC survivors with permanent stomas (n = 282) completed questionnaires assessing socio-demographic and clinical characteristics, limitations on participation in life activities, psychological distress, family functioning, and global QoL. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS.

RESULTS

Mediation analysis showed that the association of limitations on participation in life activities with global QoL was partially mediated by psychological distress (indirect effect = -0.087, 95% CI = -0.135 to -0.041). Moderated mediation analysis indicated that the indirect effects of limitations on participation in life activities on global QoL through psychological distress were significantly moderated by family functioning. Specifically, the indirect effects decreased were significant as family functioning levels increased.

CONCLUSION

CRC survivors with permanent stomas experienced poor global QoL. The moderated mediation model provides a better understanding of how limitations on participation in life activities, psychological distress, and family functioning work together to affect global QoL. Interventions aiming to improve QoL among CRC survivors with permanent stomas should consider targeting these aspects.

Factors associated with reproductive concerns among young female patients with colorectal cancer: A cross-sectional study

AIMS AND OBJECTIVES

The aim of this study was to describe the prevalence of reproductive concerns among young female patients with colorectal cancer and explore the associated factors.

BACKGROUND

With the trend of longer survival and younger age at diagnosis of colorectal cancer patients, reproductive concerns have become increasingly prevalent among young female colorectal cancer patients.

DESIGN

Cross-sectional design.

METHODS

The study included 150 young female patients with colorectal cancer who completed cancer treatment at 2 hospitals in Guangzhou, China, between November 2020 and December 2021 completed an investigation comprising A general questionnaire, The Reproductive Concerns After Cancer scale, The Family Adaptation and Cohesion Evaluation Scale II and unmet fertility information needs questionnaire. Multivariable linear regression analysis was performed in order to identify factors that influence reproductive concerns. This study was prepared and is reported according to the STROBE checklist.

RESULTS

The mean (SD) score on the Reproductive Concerns After Cancer scale was 54.78 ± 8.97. The highest score was for the children's health subscale (3.84 ± .92) and the lowest was for acceptance (2.24 ± .70). Multiple regression analysis showed that patients with fewer children, female children, lower education level (less than undergraduate degree), earlier disease stage, lower family function and higher unmet need for fertility information had more reproductive concerns, which explained 26.9% of the total variation of the model.

CONCLUSIONS

The patients with fewer children, female children, low cultural degree (less than bachelor), early clinical patients, poorer family function and higher unmet fertility information needs had higher reproductive concerns.

RELEVANCE TO CLINICAL PRACTICE

These findings can guide the development of interventions to mitigate reproductive concerns, including understand and meet their fertility information needs, improve the level of family function.

PATIENT OR PUBLIC CONTRIBUTION

Survey questionnaires were completed by participants among young female with colorectal cancer in this study.

Perception of Nurses' Support among Family Members of Hospitalized Patients in A Tertiary Health Facility in South-West, Nigeria

Introduction

Family members of hospitalized patients are often faced with challenges and may experience difficulty in coping without appropriate support. The aim of this study was to assess hospitalized patients' family members' perception of nurses' support.

Methods

A cross-sectional descriptive design was utilized. A total of 138 family members of hospitalized patients in a tertiary health facility were selected using a purposive sampling technique. Data were collected with an adopted structured questionnaire. Analyses of data were performed using frequency, percentage, mean, standard deviation, and multiple regression. The level of significance was set at 0.05 (p < .05. Also, age, gender, and type of family were the predictors of emotional support (R2 = 84, F(6, 131) = 5.92, p < .05.

Results

Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as "Preparation," "Welcomed and wanted" and "Supervision experiences". A conceptual model of clinical placement elements conducive to nursing students' learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed.

Conclusion

A significant number of families of hospitalized patients reported poor perception of cognitive, emotional, and overall support from nurses. Adequate staffing is a prerequisite for effective family support. Nurses also need appropriate training in providing family support. The focus of family support training should emphasize practices that nurses can use in everyday interactions with patients and family members.

Psychometric Properties of the Portuguese Version of the Iceland-Family Perceived Support Questionnaire in Parents of Children and Adolescents with Chronic Condition

The support from nurses perceived by family members of children with chronic conditions has been shown to be a protective factor at different levels in a family's health. As such, nurses need to have instruments that assess this perception to increase the quality of the care provided to those families. This methodological study aimed to analyze the psychometric properties of the Portuguese translation of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) in parents of children/adolescents with chronic conditions. The ICE-FPSQ was administered to 237 parents recruited from the day hospital and outpatient services of four hospitals in Northern Portugal. Cronbach's alpha reliability coefficients for the Total Scale, Cognitive Support, and Emotional Support subscales were excellent (α = 0.96, α = 0.93, α = 0.96, respectively). Reasonable fit indexes were found by confirmatory factor analysis (χ²/df = 2.799; CFI = 0.960; PCFI = 0.791, and RMSEA = 0.087), indicating a good model fit to the original structure. The ICE-FPSQ is a valid and reliable instrument to measure perceived support.

An emotional roller coaster - family members' experiences of being a caregiver throughout a cancer trajectory

Purpose

To explore family members’ experiences of caregiving throughout a cancer trajectory from diagnosis until around one year after chemotherapy and radiation treatment ended.

Method

We conducted a longitudinal qualitative study using in-depth interviews with 13 family members at one to three points of time: before, during, and after treatment. To analyse the interviews, we leaned on Braun and Clark procedure for thematic analysis.

Result

The analysis revealed three themes in family members’ experiences of being a caregiver to a cancer patient throughout a cancer trajectory. These were: (1) From the time of diagnosis—overwhelming and uncertain; (2) During and after treatment—invisible and not involved; (3) Throughout the cancer trajectory—an emotional roller coaster.

Conclusion

The results indicated that the family members felt invisible and not involved and they experienced being a caregiver throughout the cancer trajectory as an emotional roller coaster. Our empirical findings thus indicate that in cancer care, family perspectives are yet to be implemented in daily practice. This is in contrast to explicit goals in current health policies underlining support and involvement of family members as a core aspect in cancer care.

The relationship between hope levels and unmet needs of caregivers of advanced cancer patients†

AIM

The effects in cultural and health provisions can lead to different unmet support needs. Hope is seen as an important support, a supportive power, and an efficient coping strategy for cancer caregivers. The purpose of this study in Turkish society is to determine supportive care needs of caregivers of cancer patients, to determine the hope levels of those caring for cancer patients and foresee how variables and hope can trigger needs.

METHODS

To identify the unmet needs and hope levels of caregivers of advanced cancer patients in Turkish society. Data were collected using the Supportive Care Needs of Caregivers Scale and Herth Hope Index.

RESULTS

More than half of the advanced cancer caregivers (56.51%) reported unmet care needs. Their unmet needs and hope levels were above average. Regression analysis showed the total score for hope was related to health care and information needs, work-social needs.

CONCLUSION

Hope was related to health care and information needs and work-social needs. Oncology nurses should focus on the unmet needs of caregivers, taking into account their cultural differences in order to raise their hopes.

Patient, Family Caregiver, and Nurse Involvement in End-of-Life Discussions During Palliative Chemotherapy: A Phenomenological Hermeneutic Study

The aim of this study was to investigate current nursing practice related to end-of-life discussions with incurable lung cancer patients and their family caregivers from the perspectives of patients, family caregivers, and nurses in an oncology outpatient clinic. This phenomenological hermeneutic study included nine patients, eight family caregivers, and 11 nurses. Data were collected using participant observation, informal and semi-structured individual or joint interviews with patients and family caregivers, and focus group interviews with nurses. A Ricoeur-inspired approach was used to analyze the data. Three themes were identified: (a) content of end-of-life discussions, (b) timing of end-of-life discussions, and (c) challenges in end-of-life discussions. End-of-life discussions were seldom initiated; when they were, it was often too late. Discussions addressed treatment, place of care, practical/economic concerns, and existential matters. The physical environment at the outpatient clinic, lack of continuity, and nurses' instrumental task workloads and time pressure posed challenges to initiating end-of-life discussions.

Patient perspectives on relatives and significant others in cancer care: An interview study

PURPOSE

In this study, patient perspectives on their relative's involvement in gynaecological cancer treatment and care are investigated.

METHODS

In total 17 women participated in two qualitative research interviews each during their treatment period. By applying a phenomenological-hermeneutic text interpretation methodology, the findings were systematically identified, interpreted, and discussed. This process gave rise to two main themes: "Relatives include more than family members" and "Interactions with relatives and significant others".

RESULTS

The findings showed that, besides family members, in particular neighbours and people who had experienced cancer themselves were an important and valuable support to the patients. Help with daily activities and errands, and providing informal company, represented a substantial support in difficult times, and generated a sense of social belonging and the experience of fellowship. Interactions with relatives were influenced by the patients' personal reflections and experiences and posed several positive as well as negative challenges. Firstly, the patients had many concerns about passing on the news of their cancer disease to their social network. Loneliness, in various representations, was a persistent theme, which reflected various experiences of vulnerability.

CONCLUSION

Positive family relations represented a unique resource during cancer treatment; however, due to relatives' worries or lack of support, patients could experience strain. This perspective on relatives' involvement - from the patient's point of view - seems to be understudied.

The Usefulness of Brief Family Health Conversations Offered to Families Following the Diagnosis of Breast Cancer

Currently, there are few studies which examine targeted family-focused support when a family member is diagnosed with breast cancer. Thus, the aim of this study was to explore families' experiences of participating in a family nursing intervention identified as Brief Family Health Conversations (BFamHC) following the diagnosis of breast cancer. Semi-structured family interviews were conducted with nine families (including 29 family members) 2 weeks following the family-focused intervention of three sessions of BFamHC. Thematic analysis was used to analyze the data. Families reported the BFamHC as positive and as a unique kind of family health conversation, one that afforded them the opportunity to communicate and share their experiences as a family group. A family conversation, even one as time-limited as BFamHC, offered a sense of relational sharing and togetherness, thus preventing feelings of isolation and vulnerability. Therapeutic family-focused conversations, such as BFamHC, hold promise as a useful family nursing intervention following the diagnosis of breast cancer.

Effects of Implementing a Brief Family Nursing Intervention With Hospitalized Oncology Patients and Their Families in Germany: A Quasi-Experimental Study

Family nursing, based on the Calgary Family and Intervention Models, was implemented in a German oncological inpatient unit to promote effective family functioning in the context of cancer care. The objective of this study was to investigate the effects of implementing family nursing care on several psychological and physical outcomes of patients and their family members. A quasi-experimental study with 214 patients with a cancer diagnosis and 122 family members was conducted. Findings indicate that the superiority of family nursing, when compared to traditional care, could not be confirmed with respect to patients' outcomes (psychological burden, social support, satisfaction with care) and family members' outcomes (psychological burden, physical complaints, satisfaction with care). Various factors, such as country-specific structures and challenges in implementing family nursing care on an inpatient unit, may have contributed to these findings. Further replication attempts in similar settings in other countries are needed to shed light on the factors impairing or promoting the implementation of family nursing in practice settings.

Family experience living with advanced neoplasm: a glance at the rural population

OBJECTIVES

to understand the experience of rural families living with advanced cancer, from Family Management Style Framework's perspective.

METHODS

a qualitative research conducted in seven cities of the northern of state of Rio Grande do Sul in homes of 11 families (27 people). Data collection took place in 2014, using the genogram and narrative interview. Analysis followed Family Management Style Framework's theoretical model.

RESULTS

the results were organized into three categories based on conceptual components of the referred model: no more normal life: situation definition; attempt to reconcile care and work: management behavior; imminence of the finitude of life: perception of consequences.

FINAL CONSIDERATIONS

living in rural context gives families specific ways of dealing with advanced cancer. Understanding the movements undertaken by rural families throughout the experience can guide nursing professionals in planning interventions collaborating with this population's health.

Patient Rounds With Video-Consulted Relatives: Qualitative Study on Possibilities and Barriers From the Perspective of Healthcare Providers

Background

In cancer settings, relatives are often seen as a resource as they are able to support the patient and remember information during hospitalization. However, geographic distance to hospitals, work, and family obligations are reasons that may cause difficulties for relatives’ physical participation during hospitalization. This provided inspiration to uncover the possibility of telehealth care in connection with enabling participation by relatives during patient rounds. Telehealth is used advantageously in health care systems but is also at risk of failing during the implementation process because of, for instance, health care professionals’ resistance to change. Research on the implications for health care professionals in involving relatives’ participation through virtual presence during patient rounds is limited.

Objective

This study aimed to investigate health care professionals’ experiences in using and implementing technology to involve relatives during video-consulted patient rounds.

Methods

The design was a qualitative approach. Methods used were focus group interviews, short open interviews, and field observations of health care professionals working at a cancer department. The text material was analyzed using interpretative phenomenological analysis.

Results

Field observational studies were conducted for 15 days, yielding 75 hours of observation. A total of 14 sessions of video-consulted patient rounds were observed and 15 pages of field notes written, along with 8 short open interviews with physicians, nurses, and staff from management. Moreover, 2 focus group interviews with 9 health care professionals were conducted.

Health care professionals experienced the use of technology as a way to facilitate involvement of the patient’s relatives, without them being physically present. Moreover, it raised questions about whether this way of conducting patient rounds could address the needs of both the patients and the relatives. Time, culture, and change of work routines were found to be the major barriers when implementing new technology involving relatives.

Conclusions

This study identified a double change by introducing both new technology and virtual participation by relatives at the same time. The change had consequences on health care professionals’ work routines with regard to work load, culture, and organization because of the complexity in health care systems.

Experiences of cancer rehabilitation: A cross-sectional study

AIMS AND OBJECTIVES

To investigate the cancer rehabilitation experiences of working-age cancer survivors.

BACKGROUND

Cancer survivors have extremely complex needs, spanning physical, vocational and sexual domains. Although cancer rehabilitation services have been found to eliminate or reduce these strains, these services are often underutilised.

DESIGN

A cross-sectional study design was employed.

METHODS

A survey of persons over the age of 18 with a cancer diagnosis, enrolled in the Social Insurance Agency in a municipality in southern Sweden (n = 168, 68% women), was conducted.

RESULTS

Patients who used the cancer rehabilitation service (57%) were generally satisfied with it. Of participants, 26% reported not having received an offer of rehabilitation. Of those who reported that they received information about cancer rehabilitation services, most also reported that they received this information from a healthcare service professional (69%); for example, from the oncology nurse or the oncologist, whereas 20% claimed they received the information from the administrator of the Swedish Social Insurance Agency. A minority of children and family members of patients received support from the healthcare system.

CONCLUSIONS

More efforts should be taken to reach patients in need of cancer rehabilitation. Additionally, more attention should be directed towards family members and young children.

RELEVANCE TO CLINICAL PRACTICE

More than one in four patients claimed to not have received an offer of cancer rehabilitation, and an even greater number of patients claimed that their spouses and children had never received an offer for this service either. Hence, there is a communication barrier that needs to be overcome. Health providers should be aware that information needs to be repeated several times, and presented both orally and in writing.