Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review

Identifying the heterogeneity of self-advocacy in Chinese patients with breast cancer using latent profile analysis and symptom networks

Objective

This study aims to identify subgroups of self-advocacy in patients with breast cancer, assess the heterogeneity among different subgroups, and further delineate symptom networks within each subgroup.

Methods

A cross-sectional survey was conducted among 320 patients with breast cancer in Wuxi, China, from September 2023 to March 2024, who completed questionnaires about their demographic and clinical characteristics, the M.D. Anderson Symptom Inventory, and the Female Self Advocacy in Cancer Survivorship scale. Latent profile analysis was conducted to identify subgroups of self-advocacy. Multinomial logistic regression was employed to reveal the heterogeneity of each subgroup in demographics and clinical characteristics. Network analysis was performed to unveil the network structure of clinical symptoms within each subgroup.

Results

Three subgroups were identified: "Profile 1: low self-advocacy", "Profile 2: moderate self-advocacy", and "Profile 3: high self-advocacy". Compared with patients in Profile 3, those in Profile 1 and Profile 2 showed a higher tendency to have more severe symptoms. Network analysis further revealed that "lack of appetite" emerged as the core symptom in Profile 1, while the core symptom in Profile 2 and Profile 3 was "distress".

Conclusions

Patients in different subgroups manifest individualized self-advocacy. The severity of clinical symptoms might serve as an important risk factor for those with low levels of self-advocacy. Conducting symptom networks of diverse subgroups can facilitate tailored symptom management by focusing on core symptoms, thereby enhancing the effectiveness of interventions and improving patients' self-advocacy and overall quality of life.

The effect of unmet needs on the health-related Quality of life of family caregivers of cancer patients in South Korea

This study was conducted to explore the unmet needs and health-related quality of life (QOL) of family caregivers who support cancer patients, and to determine the impact of these unmet needs on their health-related QOL. A descriptive study was conducted from July 1 to July 30, 2023, in which a survey was administered to 129 family caregivers of cancer patients undergoing outpatient treatment at a general hospital of South Korea. The effect of unmet needs on health-related QOL was analyzed using stepwise multiple regression analysis, while controlling for covariates such as the general characteristics of the participants. Stepwise multiple regression analysis revealed that unmet needs significantly impacted health-related QOL. The final regression model explained a substantial portion of the variance in health-related QOL, with an R-squared value of.466 (46.6%). Unmet needs of health and psychological problems (β = -.37) as well as religious/spiritual support (β = -.20) had a significant independent effect on the health-related QOL of family caregivers of cancer patients. Additionally, the health-related QOL of caregivers was significantly better when they did not live with the patient (β = .29) and when they had higher income levels (β = .18) for incomes between 300-500 million won, and β = .29 for incomes of 500 million won or more, compared to those earning less than 100 million won). The health-related QOL of family caregivers for cancer patients can be adversely affected by unmet needs, including health and psychological problems as well as religious and spiritual support. It is therefore necessary to develop and implement support programs or systems that promote physical, psychological, and spiritual health for these caregivers.

The family caregiver-targeted web-based intervention "narstaende.se" facilitated everyday life for couples facing life-threatening illness: A qualitative study

BACKGROUND

Life-threatening illness affects both patients and spouses, and spousal caregivers report high levels of distress. Web-based interventions could benefit spouses' and patients' needs and shared everyday life.

AIM

To explore how a family caregiver-targeted web-based psychoeducational intervention influences couples' experiences of sharing everyday life at home while facing life-threatening illness.

DESIGN

This qualitative sub-study involved dyadic interviews with couples (spouse-patient) where the spouse was allocated to the intervention arm of a randomized controlled trial evaluating a web-based family caregiver-targeted intervention. Data were analyzed using Interpretive description.

SETTING/PARTICIPANTS

Participants were recruited from five specialized home care services in Sweden. In total, 32 participants, spouses (n = 16) and patients (n = 16) were interviewed as couples after the spouse had accessed the intervention for 4 weeks.

RESULTS

Couples described how the spouses' access to the intervention had provided knowledge that enhanced the couple's understanding of each other's strategies for managing the impacts of the illness. The topics covered in the intervention prompted the spouses to initiate conversations that helped couples maintain a sense of mutuality. The intervention provided support to balance the tension between previous and new relational roles, which had changed due to the patient's illness.

CONCLUSIONS

Altogether, the results show that the benefits of family caregiver-targeted interventions may extend from spouse to patient, facilitating their everyday life. Our findings complement previous intervention evaluations by providing insights into how they may be effective. The goal should be that interventions potentially benefit patients and family caregivers.

TRIAL REGISTRY

The randomized controlled trial is registered at ClinicalTrials.gov, ID NCT05785494.

Unmet supportive care needs in patients with advanced cancer and its impact on distress

PURPOSE

Patients with advanced cancer endure considerable physical and emotional distress without sufficient supportive care. This cross-sectional study examined the relationship between cancer-related symptoms, supportive care needs, and distress levels in patients with advanced lung, head and neck, or gastrointestinal cancers.

METHODS

158 patients were assessed for symptom burden and distress levels using the M.D. Anderson Symptom Inventory (MDASI) and unmet needs using the Supportive Care Needs Survey (SCNS-34) within one month of treatment initiation. Pearson correlations and multiple regression analyses were used to explore associations between supportive care needs and distress.

RESULTS

Distress levels were moderate across the study population, with fatigue, pain, and disturbed sleep being the most reported symptoms. Patients who lived with their caregivers reported significantly lower needs in four out of five domains. Positive correlations were found between distress levels and supportive care needs in the psychological (r = 0.342, p < 0.001), health system (r = 0.253, p = 0.001), patient care and support (r = 0.237, p = 0.003), and physical and daily living domains (r = 0.378, p < 0.001). Multiple regression analysis showed that these domains collectively explained a significant portion of the variance in distress levels (R2 = 0.169, p < 0.001).

CONCLUSION

Independent of demographic or clinic characteristics, patients with advanced cancer experience moderate distress and unmet supportive care needs, particularly in psychological and health system domains. The association between living with caregivers and lower reported needs suggests that caregiver support may play a crucial role in meeting these needs. Therefore, integrating strategies that involve and support caregivers could potentially reduce distress and improve the quality of life for patients with advanced cancer.

Supporting relatives when general palliative care is provided at home- a focus group study based on nurses' experiences

BACKGROUND

Relative's efforts are essential when palliative care is provided at home and support from healthcare professionals is needed. Despite this, since the support provided varies, relatives may have unmet support needs. Many people receive general palliative care at home rather than specialised care, and nurses play a significant role in supporting relatives. This study aimed to explore registered nurses' experiences of supporting relatives before and after a patient's death when general palliative care is provided at home.

METHODS

This study used a qualitative explorative design. Data were collected through focus group interviews with 18 registered nurses in home care in Sweden and were analysed using content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used for explicit reporting.

RESULTS

The findings are presented in four categories with subcategories: receiving support to provide support, continuously providing understandable information, balancing different needs and building relationships facilitates safety and identifying needs.

CONCLUSIONS

Even if registered nurses support relatives to some extent, they rarely reflect on the support they provide and lack structure in providing support both before and after the patient's death. The findings showed inadequacies in support after the patient's death, which is also emphasised in previous studies. The findings also showed deficiencies in routines, local guidelines and checklists as well as in training and education on how to support relatives when palliative care is provided at home, thereby risking that relatives' needs remain unmet. This highlights the need for creating routines and developing detailed local guidelines and checklists on providing support to relatives both before and after the patient's death.

Unmet Needs of Palliative Cancer Patients: A Grounded Theory Study

BackgroundAdult patients in oncological palliative care often do not readily express their concerns to physicians or nurses, leading to the oversight of needs that remain unexplored and require additional support. These needs that remain unaddressed are classified as unmet needs.AimThis study aimed to construct a conceptual framework of the unmet needs of cancer patients in palliative care settings. Method: Charmaz's constructivist grounded theory approach was adopted. Semi-structured interviews were conducted with eligible patients until theoretical saturation was reached, as outlined by the methodology. The interviews were transcribed and analyzed through two coding cycles: line-by-line coding and focused coding, using NVIVO 14 software.Setting/participantsA total of 29 patients were recruited from home palliative care, hospice, and outpatient settings at the Istituto Nazionale dei Tumori of Milan's Palliative Care - Hospice, Pain Therapy, and Rehabilitation Complex Unit.ResultsThis process led to the identification of five categories: Seeking Empowerment Through Daily Support, Need to Contain the Risk of Losing Dignity, Support in Managing the Progression of the Disease, Understanding and Openness to the Future, and Seeking Existential Support, along with a core category defined as the Need for Acknowledgment. The core category encompasses patients' need to express their most intimate needs, emphasizing how crucial it is for them to be seen and understood not only as individuals facing illness but as people with unique, complex life stories.ConclusionsThe conceptual model developed enabled the identification of these hidden needs, providing a deeper understanding of the emotional and psychological dimensions that shape the experience of advanced illness.

A global perspective of epidemiological trends in oncological emergencies

PURPOSE OF REVIEW

Oncologic emergencies are a critical interface between oncology and acute-care medicine. As global cancer trends evolve and healthcare disparities persist, this review seeks to address the pressing need to understand the epidemiology, predictors of outcomes, and care strategies for oncological emergencies across diverse healthcare contexts. The limited data available in this field underscores the vast knowledge gaps and the potential for significant scientific discovery.

RECENT FINDINGS

North American research networks have highlighted the variability in emergency department admissions and identified key determinants of outcomes, including functional status and disease staging. European studies have revealed that emergency presentations are frequently linked to advanced disease, whereas data from Asia and Oceania suggest that tumor burden and ethnicity significantly influence emergency care. In resource-limited regions, infection-related malignancies and inadequate healthcare infrastructure exacerbate challenges in managing oncologic emergencies. Despite these regional differences, consistent predictors of clinical outcomes, such as performance status and disease stage, have emerged as universal themes.

SUMMARY

This review highlights the need for targeted research and innovative interventions to bridge gaps in knowledge and care delivery. Region-specific strategies based on local epidemiological insights can improve patient outcomes and promote equity in oncological emergency management worldwide.

Psychometric properties of the modified Chinese version of the family resilience assessment for families of patients with cancer

Family resilience is critical for families recovering and growing from a cancer crisis; however, there remains a lack of universal family resilience assessment tools for families of patients with cancer. This study aimed to modify the Family Resilience Assessment Scale (FRA) and examine its psychometric properties. First, the FRA scale was modified into the Family Resilience Assessment Scale for Family Cancer (FRAS-FC) based on cultural adaptations and cancer population applicability. During the modification phase, items were deleted, added, and reclassified through expert consultation and group discussion. The language of the scale items was further optimized after the pilot study, resulting in a test version of the FRAS-FC. Subsequently, a total of 455 patients with cancer or their family caregivers from China participated in scale validation. The factor analysis showed a 6-factor structure with reasonable fit (χ2/df = 2.064, RMR = 0.043, SRMR = 0.056, IFI = 0.903, CFI = 0.902, RMSEA = 0.066). Satisfactory indicators of convergent and concurrent criterion validity further supported the validity of the scale. The internal consistency was good (Cronbach's alpha = 0.939). The Pearson correlation coefficient for the test-retest sample was 0.719 (p < 0.01), reflecting the stability of the scale measures across time. The findings support the 29-item FRAS-FC as a valid and reliable tool for measuring family resilience in patients with cancer or their family caregivers. The FRAS-FC enables healthcare professionals to identify family resilience and act accordingly to fulfill the role of the family better. The modified scale can be used in a wider range of families living with cancer or be validated separately for different types of cancers. Further validation in a wider cancer population is still needed.

Meeting the Needs of Palliative Care Patients: General Practitioners' Survey on the Last Three Months of Life

CONTEXT

Evaluating palliative care is challenging. Quality and efficiency indicators are not standardized, especially in primary care.

OBJECTIVES

To assess the adequacy of care to the patients' needs and associated factors, during the last three months of life, for palliative care patients followed up in general practice.

METHODS

A quantitative study based on a mortality follow-back survey of general practitioners (GPs), in metropolitan France. From November 2020 to November 2021, GPs included adult patients who died a predictable death. For each patient, they retrospectively rated how well the care provided met the patient's needs using a numerical scale. A generalized mixed model of logistic regression was used to examine associations between a positive evaluation and GP, patient, and care characteristics.

RESULTS

Ninety-five GPs reported 295 patients. The median age was 85 years and 54% were women. The most common disease was cancer (41%) and 43% had dementia. Care assessment was mostly positive (76%). Cancer and hospitalization were negative factors (OR [95% CI] = 0.46 [0.25-0.86] and OR = 0.51 [0.26-0.98] respectively). Dementia, psychologist intervention and discussions with the family tended to be associated with positive evaluation but results were not significant due to a lack of statistical power (OR = 1.86 [0.98-3.52]; OR = 10.5 [2.12-51.8], OR = 2.74 [0.99-7.57] respectively).

CONCLUSION

In end-of-life, GPs' evaluation of care adequacy to patient's needs was mostly positive. Indicators for palliative care evaluation, in a patient-centered approach, should consider inequalities due to medical conditions such as dementia and consider all the different possible care settings. Communication, psychosocial and spiritual approaches should be encouraged.

Impact of Social Media on Oncology Care

This review examines the evolving role of social media (SM) in oncology, highlighting its impact on patient support, professional collaboration, and public health communication. SM platforms enable cancer patients, survivors, caregivers, and oncology professionals to share information, seek support, connect with one another, and engage in education. However, the widespread use of SM introduces challenges, including misinformation and privacy concerns. The article discusses current practices, emerging trends, and the potential of SM in enhancing oncology care, with a focus on its impact across various stakeholders, while emphasizing the need for strategies to manage associated risks and fully harness SM's benefits.

Implementing physical activity for individuals with cancer during treatment: protocol for the IMPACT implementation-effectiveness trial

INTRODUCTION

The prevalence of cancer in Canada is growing, leading to multiple lasting side effects in survivors. The physical and psychosocial benefits of regular physical activity (PA) during and after treatment for individuals with cancer are well established, however, not well implemented in a clinical setting. The overall aim of this project is to build on previous work and conduct a multicentred randomised controlled trial (RCT) and evaluate the effectiveness of a novel implementation strategy using PA and self-management versus usual care during cancer treatment.

METHODS AND ANALYSIS

Study design: a hybrid implementation-effectiveness RCT will occur at five cancer centres across Ontario, Canada. Participants: eligible participants include adults with a cancer diagnosis (any type or stage) who are receiving treatment and cleared for exercise by their oncology care team. Intervention: participants (n=129) will be randomised to one of three groups: (1) institution-based exercise and self-management (SM) (eight in-person sessions of aerobic exercise and eight SM modules), (2) SM alone (SM only: eight virtual modules) or (3) usual care (no intervention). Outcomes: the Reach, Effectiveness, Adoption, Implementation and Maintenance framework will assess implementation outcomes. The primary effectiveness outcome is self-report PA level postintervention. Data analysis: outcomes will be measured at four time points (baseline, postintervention, 6- and 12-month follow-up). Descriptive statistics will be used to present implementation outcomes. An analysis of covariance will assess change between groups over time.

ETHICS AND DISSEMINATION

Findings from this trial will build on previous work and inform the way PA services are provided within cancer institutions across Ontario, Canada, and inform decision-making on how to incorporate exercise evidence into real-world clinical practice in cancer care. The Hamilton Integrated Research Ethics Board (ID: 7673 & 17454) has approved this study. Results will be disseminated using a combination of peer-reviewed publications, conference presentations and community organisation presentations. Participants will contribute to dissemination by sharing 'participant perspectives', highlighting their experience in the project and thoughts on the implementation strategies used.

TRIAL REGISTRATION NUMBER

The study is registered on clinicaltrials.gov (ID: NCT06323707).

Does anxiety influence the use of complementary or alternative medicine among cancer patients?

PURPOSE

The aim of this study was to investigate the extent to which patients' anxiety due to their cancerous disease has an influence on the use of complementary and alternative medicine (CAM) methods.

METHODS

230 patients completed an anonymous voluntary questionnaire that was sent to outpatient oncological facilities participating in the survey. This questionnaire included standardised tests such as the Allgemeine Selbstwirksamkeit Kurzskala (ASKU, self-efficacy short scale) and the State-Trait-Anxiety-Inventory (STAI) as well as socio-demographic information and a section on CAM use. Statistical analyses and regression models were used to identify correlations.

RESULTS

Female gender, high level of education (high school diploma or university degree) and increased trait anxiety were related to CAM use. All other variables analysed showed no significant results.

CONCLUSION

This study demonstrates that trait anxiety and sociodemographic factors significantly influence CAM usage among cancer patients. Physicians and health care providers should consider this in consultations to guarantee the best possible care for patients.

The psychosocial impact of pancreatic cancer on caregivers: a scoping review

BACKGROUND

Family caregivers are essential members of the care team of someone with pancreatic cancer, supporting their physical and psychological needs. Caregivers are often unprepared for this which may cause substantial psychosocial impact. This may be exacerbated by the short life-expectancy and rapid deterioration associated with pancreatic cancer. A scoping review was conducted to identify, from the existing literature, what is currently known about the psychosocial impact of pancreatic cancer on caregivers across the disease trajectory.

METHODS

A Joanna Briggs Institute (JBI) mixed methods scoping review was conducted across four databases (CINAHL, EMBASE, MEDLINE, PsycINFO). All identified citations were uploaded to Covidence, and were screened independently by two reviewers. Data were extracted and synthesised following a deductive approach guided by 'The Cancer Family Caregiving Experience' model (Fletcher et al., 2012).

RESULTS

42 studies were included: 22 qualitative, 15 quantitative, 5 mixed methods. Results of the included studies were collated into the proposed constructs of Fletcher et al.'s (2012) model: primary stressors, secondary stressors, appraisal, cognitive-behavioural responses, health and wellbeing outcomes, as well as the influence of disease trajectory and contextual factors. The literature highlighted pancreatic cancer caregivers experienced stress related to caregiving activities, disruptions in their daily life and family relationships, high levels of unmet need, and poorer quality of life compared to other cancer caregivers. They were also at increased risk for various psychiatric disorders and reported a persistent lack of support which exacerbated the psychosocial impact.

CONCLUSIONS

Pancreatic cancer caregivers experience negative psychosocial impacts, exacerbated by the disease's trajectory. Feelings of a lack of support were reflected throughout the included literature and emphasise the need for future research into how pancreatic cancer caregivers may be best supported, and sign-posted to existing support, to minimise the substantial psychosocial impact they may experience.

The current status of cancer rehabilitation provided by palliative care units in Japan: a nationwide survey

BACKGROUND

To our knowledge, the current status of and barriers to cancer rehabilitation in palliative care units (PCUs) in Japan remain to be elucidated. If clarified, this information could help develop rehabilitation strategies to improve the quality of life of patients with cancer who need palliative care. Hence, this study aimed to clarify the current status of and barriers to cancer rehabilitation in PCUs in Japan by conducting a nationwide questionnaire survey.

METHODS

This nationwide questionnaire-based survey included 462 hospitals that met the facility criteria for PCU inpatient charges, and notified local health authorities. The questionnaire included questions on the implementation rate of cancer rehabilitation, the sufficiency/insufficiency of cancer rehabilitation and its reasons, and the reasons for and need not implement cancer rehabilitation in PCUs.

RESULTS

Among the 462 hospitals, we received responses from 268 hospitals (response rate: 58.0%). Cancer rehabilitation was implemented in 244 (91.0%) responding hospital PCUs. Among the implementing hospitals, 155 (63.5%) recognized cancer rehabilitation as inadequate. The main reasons for this insufficiency were ineligibility for medical fees for disease rehabilitation and a lack of rehabilitation staff. Among the non-implementing hospitals, the main reasons for not implementing cancer rehabilitation were ineligibility for medical fees for disease rehabilitation and a lack of rehabilitation staff. Of the non-implementation hospitals, 76.2% (n = 16) indicated the need for cancer rehabilitation in their PCUs.

CONCLUSIONS

To ensure sufficient and quality-assured cancer rehabilitation in PCUs, it is necessary to allocate medical fees for disease rehabilitation, provide additional reimbursements, and increase the number of rehabilitation staff.

The Extent to Which Artificial Intelligence Can Help Fulfill Metastatic Breast Cancer Patient Healthcare Needs: A Mixed-Methods Study

The Artificial Intelligence Patient Librarian (AIPL) was designed to meet the psychosocial and supportive care needs of Metastatic Breast Cancer (MBC) patients with HR+/HER2- subtypes. AIPL provides conversational patient education, answers user questions, and offers tailored online resource recommendations. This study, conducted in three phases, assessed AIPL's impact on patients' ability to manage their advanced disease. In Phase 1, educational content was adapted for chatbot delivery, and over 100 credible online resources were annotated using a Convolutional Neural Network (CNN) to drive recommendations. Phase 2 involved 42 participants who completed pre- and post-surveys after using AIPL for two weeks. The surveys measured patient activation using the Patient Activation Measure (PAM) tool and evaluated user experience with the System Usability Scale (SUS). Phase 3 included focus groups to explore user experiences in depth. Of the 42 participants, 36 completed the study, with 10 participating in focus groups. Most participants were aged 40-64. PAM scores showed no significant differences between pre-survey (mean = 59.33, SD = 5.19) and post-survey (mean = 59.22, SD = 6.16), while SUS scores indicated good usability. Thematic analysis revealed four key themes: AIPL offers basic wellness and health guidance, provides limited support for managing relationships, offers limited condition-specific medical information, and is unable to offer hope to patients. Despite showing no impact on the PAM, possibly due to high baseline activation, AIPL demonstrated good usability and met basic information needs, particularly for newly diagnosed MBC patients. Future iterations will incorporate a large language model (LLM) to provide more comprehensive and personalized assistance.

Examining unmet needs in older adults with lung cancer: A systematic review and narrative synthesis

INTRODUCTION

Unmet needs in the older population with cancer are complex due to aging-related health conditions. A review of unmet needs in older people with cancer showed that needs varied among different cancer types. In lung cancer, a higher incidence of geriatric syndromes and comorbidities exist compared to other cancer cohorts, impacting treatment tolerance and completion. Consequently, it is crucial to identify and understand unmet needs to address supportive care needs beyond cancer diagnosis and treatment. This systematic review aims to synthesise the available literature to analyse the number and nature of unmet needs experienced by older patients with lung cancer.

MATERIALS AND METHODS

We performed a systematic search following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, which was registered in PROSPERO(CRD42022311105). We searched CINAHL, Medline, Embase, and Scopus electronic databases for published literature (January 2002 to November 2023) on unmet needs of patients ≥65 years diagnosed with lung cancer. We used a narrative synthesis approach to summarise the results and identify themes.

RESULTS

The search yielded 1356 articles, of which 35 met the inclusion criteria. A significant portion of older patients with lung cancer reported experiencing unmet needs, ranging from 78 % to100 %. Compared to other cancer streams, older patients with lung cancer experienced a higher burden of unmet needs, with a mean of seven unmet needs per person. Most studies identified psychological and physical/daily living domains as having the greatest prevalence and highest burden of unmet need.

DISCUSSION

Increased psychological distress and poorer quality of life correlated with increased unmet needs. Identifying and addressing unmet needs is critical for patient wellbeing and should be prioritised when developing models of care and tailored interventions for older people with lung cancer.

Emotional Supportive Care Needs in Patients with Advanced Cancer and Their Associated Characteristics: A Multicenter Observational Cohort Study (eQuiPe Study)

Background: Patients with advanced cancer often have emotional problems such as inadequate coping, fear of new metastases, or the prospect of enduring physical suffering. Some will need professional emotional support to cope with these problems. Accurately identifying these patients requires a thorough understanding of their characteristics. Aim: To assess the need for emotional supportive care in patients with advanced cancer who have emotional problems, and their associated sociodemographic, disease-related, clinical, and psychosocial characteristics. Design: Prospective multicenter observational study on experienced quality of care and quality of life in patients with advanced cancer and their relatives. Setting/Participants: Baseline data were used of 892 patients with advanced cancer who had emotional problems. Results: In total, 92% of the patients with advanced cancer had emotional problems and 33% of these had emotional supportive care needs. Most patients without emotional supportive care needs had contact with an oncology nurse (70%), while a minority received additional psychosocial support. Our multivariable logistic regression analysis shows that fatigue (odds ratio [OR]: 2.65, 95% confidence interval [CI]: 1.82-3.86), pain (OR: 1.50, 95% CI: 1.07-2.12), and less social support (OR: 0.95, 95% CI: 0.91-0.99) were associated with having emotional supportive care needs. Conclusions: One-third of patients with advanced cancer who have emotional problems in the eQuiPe study report emotional supportive care needs. Oncologists and oncology nurses should be aware that emotional supportive care needs are more common in patients with advanced cancer who experience increased pain, fatigue, or decreased social support in addition to their emotional problems. The eQuiPe study is registered as NTR6584 in the Netherlands Trial Register.

Developing and implementing a nurse-delivered and a web-based dyadic psychoeducational program for people with advanced cancer and their family caregivers: sharing experiences from a three-arm international randomized controlled trial (DIAdIC)

Background

Each year millions are diagnosed with cancer, impacting both patients and caregivers. Few interventions target both patients and family caregivers together, despite their shared experiences. While dyadic psychoeducational programs are gaining attention, evidence on developing and implementing these in international trials is limited. The DIAdIC trial faced unique challenges requiring innovative solutions to maintain study integrity.

Objectives

To present our experiences with the development and implementation of two dyadic psychoeducational home-based programs, FOCUS+ and iFOCUS in the context of a randomized controlled trial (RCT) in six European countries.

Design

A case report detailing our experiences in the development and implementation of two dyadic psychoeducational home-based programs (one face-to-face and one web-based) across multiple countries, highlighting the challenges and mitigating strategies in an international context.

Methods

A chronological narrative describing experiences with the development and implementation of iFOCUS and FOCUS+.

Results

The FOCUS+ and iFOCUS programs were successfully developed for the European context through rigorous translation and adaptation processes. Despite recruitment challenges including COVID-19 restrictions and administrative hurdles, 431 patient-caregiver dyads were enrolled across 6 European countries. Quantitative and qualitative data assessed the outcomes of FOCUS+ and iFOCUS interventions, including the primary endpoints of emotional functioning and self-efficacy. Fidelity was evaluated using audio recordings, checklists, and user data. Challenges in trial management were addressed with flexible timelines and technical support.

Conclusion

The international DIAdIC trial developed and implemented two psychoeducational dyadic programs for patients with advanced cancer and their family caregivers. Based on our experiences we share several insights for future similar studies. These relate to the attention needed for context-specific adaptations when using existing interventions or programs, the translation of human-facilitated programs to standalone eHealth versions, the challenges of adopting a dyadic focus in the study, the pragmatic challenges of conducting an RCT and evaluating implementation and effects, and the technology used for study management.

Models of care and associated targeted implementation strategies for cancer survivorship support in Europe: a scoping review protocol

INTRODUCTION

Cancer and its treatments can lead to a wide range of side-effects that can persist long after treatments have ended. Across Europe, survivorship care is traditionally hospital-based specialist-led follow-up, leading to gaps in supportive care. Improved screening, diagnosis and treatment increase survival rates. With more individuals living with, through and beyond cancer, the predominance of the hospital-based specialist model is unsustainable, costly and resource-intensive. An understanding of what alternative Models of Care are available and the barriers and facilitators to their implementation is a first step towards enhancing supportive care across the cancer journey. The aim of this scoping review is to source and synthesise information from studies evaluating patient-oriented models of cancer survivorship supportive care for adults in Europe.

METHODS AND ANALYSIS

The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Review Extension guidelines and will be guided by a six-stage methodological framework. A search strategy has been developed according to the Population, Concept and Context structure and will be applied to seven databases. A targeted search of grey literature will be completed. All identified records will be screened using predefined eligibility criteria by at least two researchers and undergo full-text review for inclusion. Data pertaining to the conceptualisation, evaluation and implementation of sourced Models of Care will be extracted.

ETHICS AND DISSEMINATION

As there is no primary data, ethical approval is not required. This review will be conducted as part of the EU COST Action CA21152-Implementation Network Europe for Cancer Survivorship Care. The protocol and subsequent scoping review will be published in a peer-reviewed journal. The Action involves representatives from most countries across Europe which will assist with the dissemination of the work to key stakeholders.

Person-centred care in oncological home services: a scoping review of patients' and caregivers' experience and needs

BACKGROUND

Cancer became a chronic disease that could be managed at home. Homecare supported person-centred care, which was guided by the Picker Principles defining key elements for care delivery. The study aimed to explore and appraise the dimensions underlying cancer patients' and caregivers' experience and expectations with Home Cancer Care, adopting a person-centerd care framework.

METHODS

We carried out a scoping review of the literature using three databases, PubMed, Scopus, and WoS for a total of 703 articles. PRISMA guidelines were followed. 57 articles were included in the review. The extracted data were categorized according to the type of care (Palliative, Support, Therapeutic, Recovery after transplant, Rehabilitation), the target population (patients or caregivers), the study design, and the principles related to patients and caregivers' experience, classified through the Picker framework.

RESULTS

The most common type of care in the home setting was palliative care. According to the Picker Principles, most of the studies reported "Emotional support, empathy and respect," followed by "Clear information, communication, and support for self-care," as key consideration for both patients and caregivers. The findings from these studies indicate many positive experiences regarding treatments, services, and interactions with health professionals. Caregivers' needs were most frequently (29%) classified as relational and social. From the patient's perspective, the most common needs fell under the category of "Health System And Information" (43%).

CONCLUSION

We could state that HCCs align with the PCC paradigm; however, careful attention is needed to ensure that the experience of both patients and caregivers remains positive. In our study, a strong need for psychological support does not emerge either for patients or caregivers, unlike previous studies in which psychological needs were among the most frequently cited. Given the growing role of technology in home care, a new category addressing the usefulness and ease of use of technology could be added to the person-centred framework. Recent articles have highlighted the growing use of telemedicine in the home care setting as a support tool for self-care.

Evaluating the acceptability of a self-directed, self-management intervention for patients and caregivers facing advanced cancer

OBJECTIVES

Coping-Together is a self-directed, self-management intervention initially developed for patients in early-stages of cancer and their caregivers. This study evaluated its acceptability among patients with advanced cancer and their caregivers.

METHODS

Twenty-six participants (patients with advanced cancer n = 15 and their caregivers n = 11) were given the Coping-Together materials (6 booklets and a workbook) for 7 weeks. Participants were interviewed twice during this time to solicit feedback on the intervention's content, design, and recommended changes. Audio-recorded interviews were transcribed verbatim, and thematic analysis was conducted.

RESULTS

Participants found Coping-Together was mostly relevant. All (n = 26, 100%) participants expressed interest and a desire to improve their self-management skills. Perceived benefits included learning to develop SMARTTER (specific, measurable, attainable, relevant, timely, and done together) self-management plans, normalizing challenges, and enhancing communication within the dyad and with their healthcare team. Most (n = 25, 96%) identified strategies from the booklets that benefited them. Top strategies learned were skills to manage physical health (n = 20, 77%) (e.g., monitoring symptoms), emotional well-being (n = 21, 81%) (e.g., reducing stress by reframing thoughts), as well as social well-being (n = 24, 92%) (e.g., communicating with their healthcare team). Barriers included illness severity and time constraints. The unique advanced cancer needs that are to be integrated include support related to fear of death, uncertainty, palliative care and advanced care planning. Suggested modifications involved enhancing accessibility and including more advanced cancer information (e.g., end-of-life planning, comfort care, resources).

SIGNIFICANCE OF RESULTS

Participants reported several benefits from using Coping-Together, with minimal adaptations needed. Creating SMARTTER self-management plans helped them implement self-management strategies. Specific areas for improvement addressed the need for improved accessibility and more content related to advanced cancer. Findings demonstrate how Coping-Together is acceptable for those living with advanced cancer and their caregivers, offering much of the support needed to enhance day-to-day quality of life.

Identifying physicians' needs in community-based palliative care consultation for cancer patients in palliative care specialist-deficient settings: a qualitative study

BACKGROUND

Consultation with palliative care specialists can be beneficial in addressing the numerous demands of patients with cancers and their families within communities. In settings lacking palliative care specialists, establishing a new community-based palliative care consultation system necessitates gathering evidence to support its development. This study aimed to identify the specific palliative care consultation needs and the consultation methods requested by Japanese physicians in settings without palliative care specialists.

METHODS

A qualitative descriptive study utilizing semi-structured virtual interviews. From August 2023 to October 2023, we conducted interviews with 11 physicians providing cancer treatment in hospitals or clinics in a prefecture within the Kanto region of Japan without palliative care specialists. Participants were asked about the specific palliative care consultation needs they have and the need for consultation methods.

RESULTS

Of the 11 physicians, nine had completed the nationwide basic primary palliative care education program. The survey revealed three themes regarding their consultation needs: 'receiving specialized insight', 'inspiring confidence', and 'improving care capacity', Two themes emerged regarding the need for consultation methods: 'enhancing care collaboration' and 'improving accessibility'.

CONCLUSIONS

Physicians require consultation systems to empower them and enhance the community care capacity, in addition to providing specialized knowledge. These systems would include collaboration with specialists through outreach consultations, utilization of information and communications technology, and the establishment of nurse-led consultation teams to improve access to palliative care teams.

The information and communication needs of patients with advanced incurable cancer: A rapid review

OBJECTIVES

This review aimed to collate evidence on the key information and communication needs of patients with advanced incurable cancer and their caregivers. It also sought to identify barriers and facilitators to communicating, understanding and receiving information, with the view of influencing improvements to future practice.

METHODS

This study used a rapid review methodology. Databases were searched on the Ovid platform to identify relevant qualitative data. Methodological quality was assessed, and data extraction was completed. A thematic synthesis approach was used for data analysis.

RESULTS

Findings from 42 articles highlighted that key information should be communicated in accordance with individual needs, including tailoring when and how information is provided. It also highlighted the need for healthcare professionals to provide adequate time, openness, and sensitivity to facilitate understanding of prognosis, treatment and care options. Barriers to receiving, communicating and understanding information relating to healthcare professionals and healthcare systems focus on inadequate time in consultations and a lack of specified point of contact. Patient level barriers included difficulties engaging with and processing challenging information, and inadequate health and death literacy. Facilitators included incremental information provision and early access to palliative care specialists.

CONCLUSIONS

Key communication and information needs identified in the review's synthesised findings should be considered when developing communication strategies alongside the barriers and facilitators.

PRACTICE IMPLICATIONS

HCPs should provide patients and caregivers with bespoke support to improve their health and death literacy, and a direct point of contact. Health service training could focus on personalised and empathetic information delivery.

Validity and Reliability of the Korean Version of Supportive Care Needs Survey-Short Form 34 for Patients With Cancer: A Methodological Study

PURPOSE

The Supportive Care Needs Survey-Short Form 34 (SCNS-SF34) measures the perceived care needs of patients with cancer. This study aimed to evaluate the reliability and validity of the Korean version of the SCNS-SF34 (i.e., the SCNS-SF34-K).

METHODS

The SCNS-SF34 was translated into Korean following a World Health Organization translation guideline. We recruited 208 patients with cancer via an online survey in 2022. The data were analyzed using SPSS 27.0 and Amos 23.0, and the construct validity, known-group validity, and internal consistency were tested.

RESULTS

The SCNS-SF34-K validated the final five-factor model via confirmatory factor analysis. The SCNS-SF34-K's subscales demonstrated discriminant and convergent validity. In addition, known-group validity was confirmed using the Eastern Cooperative Oncology Group Performance Status Scale (t = -7.12), Patient Health Questionnaire-9 (t = -7.61), and Distress Thermometer (t = -9.22). McDonald's Omega coefficient for the total scale was .96, and each sub-domain ranged from .88 to .95.

CONCLUSION

This research provides initial findings on the validity and reliability of the SCNS-SF34-K, a tool for measuring the supportive care needs of Korean cancer patients. The SCNS-SF34-K demonstrates potential for evaluating various aspects of patient needs and may be valuable for both clinical oncology practice and research in Korea.

Fear of Cancer Progression and Death Anxiety in Survivors of Advanced Colorectal Cancer: A Qualitative Study Exploring Coping Strategies and Quality of Life

This study aimed to examine coping strategies used by advanced colorectal cancer (CRC-A) survivors to manage death anxiety and fear of cancer progression, and links between these strategies and quality of life (QoL), distress, and death acceptance. Qualitative semi-structured interviews of 38 CRC-A survivors (22 female) were analysed via framework analysis. QoL and distress were assessed through the FACT-C and Distress Thermometer. Eleven themes were identified and mapped to active avoidance (keeping busy and distracted), passive avoidance (hoping for a cure), active confrontation (managing negative emotions; reaching out to others; focusing on the present; staying resilient), meaning-making (redefining one's identity; contributing to society; gaining perspective; remaining spiritual), and acceptance (accepting one's situation). Active confrontation (specifically utilising informal support networks) and meaning-making appeared beneficial coping strategies; more research is needed to develop and evaluate interventions which increase CRC-A survivors' use of these strategies to manage and cope with their death anxiety.

A randomized controlled trial of an intervention for unmet supportive care needs addressing colorectal cancer couples

PURPOSE

Supported by the Supportive Care Needs Framework (SCNF), we developed a colorectal cancer (CRC) couple-based unmet supportive care needs (USCNs) intervention program, which has been proven to be feasible. The intention was to assess what the clinical efficacy of this intervention would be in CRC couples.

METHODS

One hundred and sixty-eight CRC couples were randomly assigned to one of two groups: a control group (receiving normal care) or an intervention group (receiving normal care plus a five-week USCNs intervention). Information on USCNs, mutual communication, quality of life, and psychological adjustment was gathered from CRC couples both at baseline and right after the intervention. The collected data were examined using repeated measures analysis of variance (ANOVA).

RESULTS

There were 135 CRC couples who completed the five-week intervention and post-intervention outcome measures (retention rate: 80.4%). Combining with the ANOVA results (p < 0.001 for both couples) and the intervention effect sizes Cohen's d (d = 0.33-0.60 for patients, d = 0.22-0.59 for spousal caregivers), the USCNs intervention is effective in improving USCNs, mutual communication, mental health, positive emotions, and negative emotions in CRC couples.

CONCLUSION

The CRC couple-based USCNs intervention effectively reduces USCNs and promotes cancer adjustment among CRC couples. This intervention can assist clinical staff in refining routine care components to enable couples to manage CRC more effectively. In the future, it will be essential to lengthen the follow-up duration to assess the efficacy of the intervention in the long term.

Why do most people on dialysis not accept psychological care to increase perceptions of control in life?

OBJECTIVES

People with chronic kidney failure (CKF) on dialysis who perceive little control in life are at risk for a reduced well-being. We developed and tested an intervention aiming to enhance their perceptions of control. To gain insight into patients' care needs and acceptance of the intervention, we examined the prevalence of patients perceiving low control, their characteristics, and their reasons for (not) accepting the intervention.

DESIGN

We consecutively screened 430 people on dialysis on perceived control, with those reporting low control offered to participate in the intervention study.

METHODS

We used data of a Randomized Controlled Trial examining the feasibility, acceptability and efficacy of the intervention. Perceived control was assessed with the Pearlin Mastery scale.

RESULTS

About half (55%) of the sample perceived low control, particularly those with more comorbidities. Most persons eligible for receiving the intervention did not accept the intervention (89%), especially older persons. Main reasons were experiencing little burden of perceiving low control as well as no need for care to increase perceived control.

CONCLUSIONS

A significant number of people on dialysis perceived low control in life, yet very few accepted an intervention for regaining a sense of control. In-depth qualitative research is needed for a more comprehensive understanding of the personal experience and perceived impact of low control on health and well-being, activities and relationships as well as people's reasons and needs for enhancing a sense of control and attitude towards psychological interventions aiming to enhance perceived control.

Changes in physical activity since cancer diagnosis and associations with health-related quality of life: a study of adults living with advanced cancer

PURPOSE

Physical activity (PA) is associated with better quality of life for cancer survivors; however, less is known about this association among individuals with advanced cancer. This study assesses whether changes in PA following an advanced cancer diagnosis are associated with health-related quality of life (HRQoL) outcomes.

METHODS

Data were collected from 247 participants in a survey of adults with advanced cancer who visited the University of Wisconsin Carbone Cancer Center (January 2021-2023). PA since cancer diagnosis was assessed using a validated, self-reported tool. HRQoL was assessed using the Functional Assessment of Cancer Therapy - General and Patient-Reported Outcomes Measurement Information System measures of physical function, fatigue, and pain interference. We used generalized linear models to assess relationships between PA and HRQoL.

RESULTS

Most adults with advanced cancer were insufficiently active (53%), and reported a lot less activity (41%) after diagnosis, followed by a little less activity (33%), and the same/more activity (26%). Compared to the other activity groups, those who reported a lot less activity had the worst HRQoL scores, including lower HRQoL (x̄ = 70.3 vs. x̄ = 82.6, 90.7) and physical function (x̄ = 40.3 vs. x̄ = 47.3, 52.5), and higher fatigue (x̄ = 59.3 vs. x̄ = 51.4, 42.3) and pain interference (x̄ = 55.5 vs. x̄ = 48.8, 45.6).

CONCLUSIONS

Adults with advanced cancer who report PA reductions have worse HRQoL, higher pain and fatigue, and lower physical function than those engaging in the same/more PA since their diagnosis. Future interventions focused on improving HRQoL among adults with advanced cancer should incorporate light-intensity PA to reduce declines following diagnosis.

Resonance, self-reflection, and preparedness through a web-based intervention for family caregivers of patients with life-threatening illness receiving specialised home care

OBJECTIVES

In home-based care for severely ill patients, family caregivers' contributions are crucial. This study aimed to explore how a web-based psychoeducational intervention influences family caregivers' experiences in addressing challenges while caring for a patient with life-threatening illnesses during specialized home care.

METHODS

This qualitative study undertook semi-structured interviews with family caregivers of patients with life-threatening illness receiving specialized home care. Family caregivers participated in a randomized controlled trial evaluating a psychoeducational intervention delivered through a website. Interviews were performed with 17 family caregivers; 13 spouses, 2 adult children, 1 parent, and 1 sibling, and analyzed using qualitative content analysis.

RESULTS

The results indicate that the intervention resonated with the family caregivers' situation which gave them comfort and awareness. It inspired self-reflection on the caregiver role that provided new insights and encouraged communication with the patient. The intervention prepared family caregivers for the patient's progressing illness and death. While preparing was a help for some, others did not feel ready to face this, which led them to avoid parts of the website.

SIGNIFICANCE OF RESULTS

This psychoeducational web-based intervention guided family caregivers as they addressed challenges in caregiving and prepared for the future, and they valued having access to such an intervention. In a time of decreasing healthcare resources, web-based support may be a useful alternative to in-person interventions. It is important to continue developing, evaluating, and implementing web-based interventions to meet the needs of family caregivers.

The Implementation of Decision Aids During Medical Consultations for Lung Cancer Patients: A Focus Group Within I3LUNG Project

Lung cancer patients generally receive several information regarding their illness characteristics and available intervention. Therefore, patients can experience confusion, leading to anxiety and distress that might damage the relationship with physicians and treatment adherence. Literature showed that implementing decision aid tools during consultation can promote patients' knowledge and awareness about lung cancer and available oncological intervention, improving a shared decision-making process. However, not all lung cancer patients always appreciate decision aids' implementation. The present qualitative study explored patients' opinions and preferences regarding the implementation of decision aids during medical consultation. Twenty-two lung cancer patients who have already attended medical consultations for lung cancer voluntarily participated in four online focus groups carried out between January 2023 and December 2024. A thematic analysis with a bottom-up approach highlighted three main themes: the typology and number of information that patients would have received, the relevance of patient-and-doctor relationship, and the effects of providing additional decision-making tools on patients' emotions and preferences. Findings showed controversial opinions among patients, highlighting the relevance of personalized intervention tailored to patients' preferences. Practical implications are given.

Motivations and perceptions for physical activity in women living with metastatic breast cancer: a qualitative interview study

BACKGROUND

The beneficial role of physical activity for people living with cancer is well established. However, the importance of physical activity to women living with metastatic breast cancer is not known. As motivations and perceptions around physical activity influence behavioural uptake, a qualitative study was undertaken to explore the motivations and perceptions towards physical activity of this group.

METHODS

Women living with metastatic breast cancer were recruited through a metropolitan cancer centre in Australia to participate in semi-structured interviews about their physical activity. Open-ended questions explored health-specific factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed.

RESULTS

Twenty-three women participated; median age was 60 years (IQR: 20) and median time since metastatic diagnosis was 3.3 years (IQR: 3.0). Twelve women were engaged with physical activity, seven reported intentions to be active but found it challenging, and four reported nominal interest in physical activity. Four categories, covering nine themes, were identified: (i) predispositions towards physical activity, incorporating themes on enjoyment and energy, and positivity and mental resilience; (ii) health-related motivations behind physical activity, incorporating themes on physical and mental health benefits; (iii) social motivations behind physical activity, incorporating themes on enjoying exercise with others, role models and social support, and others' negative perceptions of metastatic breast cancer; and (iv) connections between physical activity and metastatic breast cancer, incorporating themes on prognosis uncertainty, and reframing limiting perceptions.

CONCLUSIONS

Participants described a wide-ranging spectrum of experiences and perceptions toward physical activity. Whilst most women perceived improved physical and mental well-being from being physically active, some women were not engaged in being physically active. Behaviour change strategies that target both their attitudes and those around them may address this gap.

Informational Needs of Lung Cancer Patients and Caregivers

The provision of information is critical to the care and support for cancer patients. Relevant information leads to lower anxiety, increased patient control and involvement in decision-making, greater satisfaction, and improved coping skills. To identify the unique needs of lung cancer patients and their caregivers (LPCs), a needs assessment was conducted. LPCs who attended lung cancer clinic completed a self-report survey that assessed informational needs across 6 domains: medical, physical, practical, social, emotional, and spiritual. The questionnaire investigated the importance of information as well as the preferred mode of delivery. One hundred three patients and 96 caregivers completed the survey. Most patients were female (57%), with a median age of 70 (33-91). Most patients were born outside Canada (65%); and majority (56%) identified as Caucasian followed by East Asian (23%). Most patients had non-small cell lung cancer (64%) and were receiving treatment (64%), and half had metastatic disease at diagnosis. Most caregivers were female (65%), median age 55 (23-85), were the primary caregiver (84%), and spent 20 + h/week caregiving (44%). LPCs prioritized the medical and physical domains, with a focus on treatment options, prognosis, managing symptoms, follow-up visits, and complications. One-on-one counseling with a healthcare provider was the preferred method for the medical domain. Caregivers also preferred one-on-one counseling for the physical domain, while patients preferred pamphlets. This study highlights the information that LPCs need and the format they wish to receive it in. The results will guide the development of tailored resources to address specific needs.

Developing a city-wide, community-engaged cancer disparities research agenda

INTRODUCTION

In response to high levels of cancer disparities in Philadelphia, PA, three NCI-designated clinical cancer centers formed Philadelphia Communities Conquering Cancer (PC3) to bring stakeholders together and establish infrastructure for future cancer reducing initiatives. The PC3 coalition aimed to develop a prioritized cancer disparities research agenda in order to align cancer center resources and research interests with the concerns of the community about cancer, and to ensure that initiatives were patient- and community-centered.

METHODS

Agenda development activities culminated in a city-wide cancer disparities conference. The conference, attended by 55 diverse stakeholders, was the venue for small group discussion sessions about cancer concerns related to prevention, early detection, treatment, survivorship, and quality of life. Sessions were guided by a moderator guide and were audiorecorded, transcribed, and analyzed by the PC3 leadership team. Results were reviewed and consensus was achieved with the help of PC3's Stakeholder Advisory Committee.

RESULTS

Stakeholders identified four thematic areas as top priorities for cancer disparities research and action in Philadelphia: communication between patients, providers, and caregivers; education that reaches patients and community members with tailored and targeted information; navigation that assists people in finding and accessing the right cancer screening or treatment option for them; and representation that diversifies the workforce in clinics, cancer centers, and research offices.

CONCLUSION

A community-informed, prioritized research agenda provides a road map for the three cancer centers to collaborate on future initiatives that are important to patients and stakeholders, to ultimately reduce the burden of cancer for all Philadelphians.

Family Peace and Affecting Factors in Family Caregivers of Patients With Cancer: A Cross-Sectional Study

Objective: During the care process, family members who provide care for a patient with cancer are confronted with changes in their family dynamics. The purpose of this study was to evaluate the family peace of caregivers of patient with cancer and the associated factors. Methods: A cross-sectional study was conducted in a single center. The sample of the study included caregivers who were family members of patients with cancer. Data were collected with Caregiver and Patient Information Forms, General Self-Efficacy Scale, Family Peace Scale, Self-Care Behaviors Scale, and MD Anderson Symptom Inventory. Results: It was found that the mean age of the caregivers was 50.20 ± 0.71 years, 64.1% were female, 78.7% were married. The mean score of the caregivers on the total family peace scale was above the average value with 46 ± 0.75 out of 75 points. The caregivers' level of family peace increases as their scores on the scale increase. The family peace of caregivers who were widowed or divorced, were self-employed, had less income than their expenses, had a chronic disease, reported that their health was affected, had low self-efficacy was worse than that of others. The family peace of caregivers of patients who had gynecological cancer and had a good income was better (P < 0.05). The self-efficacy level of the caregivers and the symptoms of the patient with cancer were significant predictors of family peace (P < 0.001). Conclusions: Family peace of caregivers was affected by the type of cancer, symptom burden, self-care behaviors of the patient, and caregivers' income status, chronic disease, marital status, and self-efficacy. Physicians and nurses, who are in close contact with caregivers of cancer patients, should be aware of the issue, professionals should assess the family environment of the caregivers of patient with cancer and counseling should be provided if deemed necessary.

Spanish Society of Medical Oncology recommendations for comprehensive assessment and care of cancer survivors' needs

This article reviews the contemporary and inclusive definition of cancer survivorship, including patients with and without disease who have completed or continue to undergo treatment. The Spanish Society of Medical Oncology (SEOM) describes in this article the needs of these patients and outlines a care model based on an estimation of cancer incidence and identification of patient needs, to enable the provision of practical actions to achieve effective care. The objectives of this review are to identify the main effects of cancer on survivors and to establish appropriate ways of measuring these effects, as well as discussing the management of physical, psychological and social, occupational, financial, and other health-related needs. We suggest a multidisciplinary care model and training programs for the different professionals involved in care, and highlight challenges and the future role of the SEOM and health-care policy in ensuring optimum care of cancer survivors.

Dyadic interventions for cancer patient-caregiver dyads: A systematic review and network meta-analysis

BACKGROUND

Cancer imposes significant psychological distress on both patients and caregivers. Dyadic interventions are designed to concurrently address the health problems of both, yet there remains limited evidence as to which specific dyadic interventions yield the most effective outcomes for both partners.

OBJECTIVES

To systematically synthesize and evaluate the comparative efficacy of various dyadic interventions on a wide range of outcomes within cancer patient-caregiver dyads.

METHODS

Searches of eight electronic databases from inception to July 2, 2023, were performed. Data extraction and quality assessment were independently conducted by two reviewers utilizing the Cochrane risk of bias tool and the Jadad score. Stata 17.0 was used for network meta-analysis, with the Surface Under the Cumulative Ranking (SUCRA) curve employed to rank interventions based on efficacy for each outcome. Effect sizes were reported using standardized mean difference (SMD) with a 95 % confidence interval (CI), and publication bias was assessed via Egger's test. The study protocol was registered in PROSPERO under CRD42023467172.

RESULT

A total of 37 studies, spanning 8 countries, were included. According to SUCRA rankings, WeChat couple-based psychosocial support and the eHealth symptom and complication management program were identified as the most effective interventions for improving quality of life in both patients and caregivers (SUCRA = 82.1 %, SMD = 7.30, 95 % CI: 1.02, 13.58; SUCRA = 86.6 %, SMD =1.17, 95 % CI: 0.04, 2.31, respectively). Emotionally focused therapy was ranked as the most effective intervention for enhancing dyadic adjustment (SUCRA = 100 %, SMD = 1.63, 95 % CI: 0.91, 2.36; SUCRA = 99.9 %, SMD = 2.04, 95 % CI: 1.26, 2.82, respectively). Couple-based intimacy enhancement and telephone-based dyadic psychosocial interventions were deemed most effective interventions in alleviating anxiety (SUCRA = 88.2 %, SMD = -0.83, 95 % CI: -1.65, -0.00; SUCRA = 95.6 %, SMD = -1.08, 95 % CI: -1.76, -0.41, respectively), while telephone-based dyadic psychosocial intervention and coping skills training were the most efficacious interventions for reducing depression in both partners (SUCRA = 95.2 %, SMD = -0.89, 95 % CI: -1.55, -0.23; SUCRA = 99.8 %, SMD = -2.31, 95 % CI: -3.27, -1.35, respectively). Additionally, caregiver educational program was ranked highest for reducing caregivers burden (SUCRA = 95.6 %, SMD = -1.20, 95 % CI: -1.55, -0.23).

CONCLUSION

The highest-ranked dyadic interventions identified in this analysis offer valuable insights for clinical practice, providing strategies to enhance the quality of life, strengthen dyadic relationships, and alleviate anxiety, depression, and caregiver burden. Nevertheless, further robust randomized controlled trials are necessary to confirm these findings.

Relatives' Unmet Needs in the Last Year of Life of Patients With Advanced Cancer: Results of a Dutch Prospective, Longitudinal Study (eQuiPe)

Objective(s): Unmet needs of relatives of patients with advanced cancer not only reduce their own health-related quality of life, but may also negatively affect patients' health outcomes. The aim of this study was to assess changes in relatives' unmet needs of patients with advanced cancer in the last year of life and to identify differences in unmet needs by gender and type of relationship. Methods: Relatives of patients with advanced cancer in the Netherlands were included in a prospective, longitudinal, observational study. Relatives' unmet needs were measured every 3 months with an adapted version of the Problems and Needs in Palliative Care (PNPC) questionnaire Caregiver form (44 items, 12 domains). Questionnaires completed in the patients' last year of life were analyzed. Change of unmet needs in the last year, and differences in unmet needs by gender and type of relationship were analyzed. Results: A total of 409 relatives were included with a median of 4 unmet needs in the patient's last year. Unmet needs were most prevalent at all time points during the last year in the domains "caring for the patient" (highest need = 35%) and "psychological issues" (highest need = 40%). The number of unmet needs of relatives did not change significantly during the last year of life (P=.807). There were no significant differences in the number of unmet needs between male and female partners and between partners and other relatives. Conclusion: The most unmet needs for relatives were in the domains "caring for the patient" and "psychological issues." Professional support should focus on these items. Within these domains, it seems especially important that relatives get more knowledge and support about what scenarios to expect and how to deal with them.

Ambivalent and heavy burdened wanderers on a road less travelled: a meta-ethnography on end-of-life care experiences among family caregivers in rural areas

BACKGROUND

As the population ages, more people will be diagnosed with cancer, and they will live longer due to receiving better treatment and optimized palliative care. Family members will be expected to take on more responsibilities related to providing palliative care at home. Several countries have expressed their vision of making home death an option, but such a vision can be more challenging in rural areas. There is a lack of synthesized research providing an in-depth understanding of rural family caregiving for people with cancer at the end of life. Thus, the purpose of this study was to synthesize and reinterpret the findings from qualitative research on rural family caregivers of adult cancer patients at the end of life.

METHODS

We conducted a meta-ethnography following Noblit and Hare's approach. A systematic literature search of four databases and extensive manual searches were completed in April 2022. The final sample included twelve studies from six different countries published in 2011-2022.

RESULTS

Based on the translation and synthesis of the included studies, four themes were developed (1) providing family care at the end of life in rural areas-a challenging endeavour; (2) the heavy responsibility of rural caregiving-a lonesome experience; (3) working on and behind the scenes; and (4) the strong and weak spots of community connectedness in rural areas. An overarching metaphor, namely, "ambivalent and heavy burdened wanderers on a road less travelled", provides a deeper understanding of the meaning of rural family caregiving at the end of life.

CONCLUSIONS

This study provides valuable insights into end-of-life cancer care for rural families on four continents. It is crucial to prepare family caregivers for the demanding role of palliative caregiving in rural areas. To address the long distances and poor access related to specialized health care services, outpatient palliative teams tailored to the families' individual needs should be provided. In addition, more telehealth services, palliative units, or beds in local nursing facilities may reduce the number of exhausting trips that need to be made by caregivers and patients. Healthcare workers in rural areas need further education in palliative care.

TRIAL REGISTRATION

The study was registered in PROSPERO.

The role of social, economic, and medical marginalization in cancer clinical trial participation inequities: A systematic review

Extant literature reveals how patients of marginalized social identities, socioeconomic status (SES), and medical experiences - especially patients of color and older adults - are underrepresented in cancer clinical trials (CCTs). Emerging evidence increasingly indicates CCT underrepresentation among patients of lower SES or rural origin, sexual and gender minorities, and patients with comorbid disability. This review applies an intersectional perspective to characterizing CCT representativeness across race and ethnicity, age, sexual and gender identity, SES, and disability. Four databases were systematically queried for articles addressing CCT participation inequities across these marginalizing indicators, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. One hundred one articles were included in a qualitative evaluation of CCT representativeness within each target population in the context of their intersectional impacts on participation. Findings corroborate strong evidence of CCT underrepresentation among patients of color, older age, lower SES, rural origin, and comorbid disabling conditions while highlighting systemic limitations in data available to characterize representativeness. Results emphasize how observed inequities interactively manifest through the compounding effects of minoritized social identity, inequitable economic conditions, and marginalizing medical experiences. Recommendations are discussed to more accurately quantify CCT participation inequities across underserved cancer populations and understand their underpinning mechanisms.

Comprehensive needs assessment tool for informal cancer caregivers (CNAT-ICs): Instrument development and cross-sectional validation study

Background

Growing cancer incidence and its subsequent burden is a worldwide concern. Needs assessment for caregivers has recently received growing attention, as it identifies specific unmet needs. The remaining tools have been established within the healthcare context of Western countries and have been studied only in some Asian populations; it seems appropriate to develop needs assessment tools that apply to a wider ethnic and socio-cultural context.

Objective

This study planned to adapt and examine the psychometric properties of the CNAT-C for the Sri Lankan informal caregivers for wider applicability.

Design

An instrument development and cross-sectional validation study was conducted.

Setting

Apeksha Hospital Maharagama, Sri Lanka (National Cancer Institute).

Participants

A sample of 226 informal caregivers (ICs) providing palliative care for patients with advanced cancer was selected.

Methods

A CNAT-C (41 items; seven factors) was incorporated and used after a cross-cultural adaptation following WHO guidelines after the permission and pilot test. ICs completed the socio-demographic and clinical details along with the validated Centre for Epidemiological Studies-Depression (CES-D), and the World Health Organization-Quality of Life-Brief (WHOQOL-BREF). Internal consistency and test-retest were used to check the reliability. Convergent and divergent validity of the Sinhala version of CNAT (S-CNAT) was confirmed using the CES-D scale and WHOQOL-BREF. Construct validity was evaluated using the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Results

Most of the participants were female (60 %) and married (72 %), and the mean age was 41.78 (SD+14.54). Face and content validity were established during the cross-cultural adaptation. Cronbach's alpha was 0.903 for the overall S-CNAT and the test-retest reliability was 0.965. The S-CNAT was associated positively with the CES-D while negatively with the WHOQOL-BREF. Both EFA and CFA discovered a structure contained seven factors (35 items); domain named as healthcare staff/nurses' support and information, physical/practical needs, medical officers' support, psychological needs, social/family support, spiritual/religious support, and hospital facilities/service.

Conclusions

The Sinhala version of CNAT is shown to have adequate validity and reliability in assessing the comprehensive and multidimensional/unmet needs of informal caregivers of patients with advanced cancer (S-CNAT-ICs). It would be a helpful tool to determine the unmet needs of ICs and guide future interventions to meet those needs and enhance or maintain the quality of life for patients and their informal caregivers.

A mixed-method systematic review of unmet care and support needs among Japanese cancer survivors

PURPOSE

To synthesize published studies regarding Japanese cancer survivors' needs/unmet needs of care/support, change of unmet needs over time, and preferred care/support providers.

METHODS

A mixed-method systematic review was conducted. MEDLINE, PsycINFO, CINAHL, and Ichu-shi were searched from inception to May 2022. Quantitative and qualitative studies were separately analyzed using narrative synthesis and meta-ethnography. Each finding was synthesized using a line of argument.

RESULTS

Twenty-four studies (13 quantitative and 11 qualitative studies) were included. Six quantitative studies reported unmet needs in survivors of adolescent and young adult (n=1) and adulthood (n=5) cancer. No longitudinal studies regarding changes in unmet needs were identified. One study reported that adults preferred care/support providers. The quantitative studies identified more help in physical (48.2-51.0%, n=2) and psychological issues (17.4-78.8%, n=5), information (27.9-58.0%, n=3), and healthcare services (25.3-67.1%, n=2) among adults. The qualitative studies emphasized more tailor-made information about life events for young cancer survivors. More empathic and trustworthy interactions with surrounding people, including healthcare professionals, were demanded, regardless of age. A line of argument illustrated that cancer survivors had insufficient resources for activities and empowerment to face life with cancer at all phases.

CONCLUSIONS

Japanese cancer survivors' unmet needs are diverse. More information and resources for psychological care/support and local healthcare services post-treatment are needed, which may hinder the optimal transition to survivorship.

IMPLICATIONS FOR CANCER SURVIVORS

The synthesized evidence should be utilized to implement a comprehensive care/support system in practice and educate people surrounding cancer survivors, regardless of age.

Survivorship transitions in blood cancer: Identifying experiences and supportive care needs for caregivers

PURPOSE

Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicated. We sought to better understand blood cancer caregivers' experiences as their diagnosed family member encountered "survivorship transitions" across the continuum.

METHODS

We conducted semi-structured interviews with adults caring for a parent or a child with a blood cancer. Caregivers were segmented into survivorship groups based on two transitional contexts: (1) when patients transitioned to a new line of therapy (active treatment or maintenance therapy); (2) when patients ended treatment. We conducted a thematic analysis and triangulated findings to compare transitional experiences.

RESULTS

Caregivers in both groups reported experiencing a "new normal," which included personal, relational, and environmental adjustments. Caregivers in the treatment transitions group (n = 23) also described uncertainty challenges (e.g., losing their "safety net") and disrupted expectations (e.g., feeling "caught off guard" by challenges). Whereas caregivers in the end-of-treatment transitions group (n = 15) described relief coupled with worry (e.g., feeling hopeful yet worried).

CONCLUSIONS

Survivorship transitions for caregivers are riddled with challenges that include difficult readjustments, uncertainty/worry, and unmet expectations. While there seems to be a cohesive experience of "survivorship transitions," each transition group revealed nuanced distinctions.

IMPLICATIONS FOR CANCER SURVIVORS

Tailored supportive resources are needed for caregivers throughout survivorship transitions.

Development and Validation of the Home Hospice Care Needs Questionnaire for the Dying Old Adult (HHCNQ-DE) in Mainland China

Context: Home hospice needs assessment is the key to the development of home hospice services. Therefore, there is a need to develop assessment tools in mainland China to meet the comprehensive needs of the old adult at the end of life. Objective: To develop and validate a tool to assess Chinese mainland palliative care needs of the dying old adult at home. Methods: Using the Harmony Nursing Theory as a theoretical framework, through reference to the China home hospice care needs scale, literature research, in-depth conversations with the dying old adult, and group discussions among members of the research team, 43 original questionnaire items were preliminarily drafted. A 31-item predictive questionnaire was formed through 2 rounds of expert review and small sample testing. From April to September 2023, 199 old adult at the end of life at home in Jinzhou, Liaoning Province were investigated to determine the reliability and validity of the questionnaire. Results: The final questionnaire included 31 items. Exploratory factor analysis extracted 5 common factors, and the cumulative variance contribution rate was 68.811%; the Cronbach's alpha coefficient of the total questionnaire was 0.832, and the re-test reliability was .806; the content validity index of the questionnaire was 0.982, and the content validity index of the items was 0.83-1.00. Conclusion: The construction method of the HHCNQ-DE is scientific and reliable, with good reliability and validity, and it can be used as a tool to measure the needs of home hospice care in mainland China in the future.

The effect of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To investigate the efficacy of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients, along with the consequences of various intervention types.

DESIGN

This study performed a comprehensive review and a meta-analysis of randomized controlled trials.

METHOD

An extensive search was carried out across eight databases, namely, PubMed, Embase, CLNAHL, PsyclNFO, Cochrane, VIP, CNKI, and WANFANG, spanning from the inception of the library to May 4, 2024. Two examiners independently screened the articles and extracted the data according to the eligibility criteria formulated in accordance with the PICOS principles. The meta-analysis was conducted utilizing the StataCorp (version 16.0), estimating the impacts of the interventions through the computation of the standardized mean difference (SMD) and the 95 % confidence interval (CI). Sensitivity analysis was carried out using a one-way-out method. Egger's test and the Duval and Tweedie trim-and-fill methods were used to explore the potential publication bias. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included studies, and the overall quality of evidence was evaluated using the GRADE method.

RESULTS

This study pooled 16 RCTs (including 2046 informal caregivers) that were published from 2007 to 2023. The meta-analysis results indicated that the targeted palliative care interventions significantly improved depression (SMD = -0.74, 95 % CI: [-1.25, -0.23], P < 0.01) and quality of life (SMD = 0.63, 95 % CI: [0.08, 1.17], P = 0.03), though not in terms of caregiver burden (SMD = -0.33, 95 % CI: [-0.95, 0.29], P = 0.30) among informal caregivers of advanced cancer patients. Analysis of the subgroups revealed a correlation between short-term interventions, under three months, and the improvement of depression. Strategies focused solely on caregivers have proven effective in alleviating depression. Interventions utilizing offline methods have been shown to not only lower depression levels but also improve the quality of life for caregivers.

CONCLUSIONS

The targeted palliative care interventions effectively improved informal caregivers' depression and quality of life, yet they fail to markedly lessen the caregiver burden. To better support informal caregivers, interveners ought to adopt personalized strategies based on comprehensive consideration of the duration, format, and delivery methods of the interventions. Simultaneously, further exploration and effort from scholars are necessary to enhance the accessibility of palliative care services, and to effectively incorporate academic research findings into clinical practice.

REGISTRATION

CRD42023475620.

The Perspective of Cancer Patients in Palliative Care on Unmet Needs: A Qualitative Synthesis Using Meta-Ethnography

BACKGROUND

As cancer patients approach the end of life, their needs become more complex, increasing the demand for palliative care. Advanced-stage cancer patients encounter increasing unmet psychological, physical, autonomy, and communication needs, reflecting the difference between patients' perceived requirements and the support from health care professionals. The objective of this study was to synthesize qualitative evidence on unmet needs in palliative cancer care among inpatient and outpatient adults.

METHODS

We conducted a meta-ethnographic review according to Noblit and Hare's framework and the operationalized guidelines developed by Sattar. The eMERGe Reporting Guidance was followed. A literature search was conducted in Cinahl, Embase, Medline, Scopus, Web of Science, PsycINFO and Google Scholar for gray literature. For all the studies, direct quotes from the participants and authors' results were identified, coded and analyzed in NVivo 1.7.1 and extracted as I and II order constructs from which higher third-order themes originated.

RESULTS

Eight studies were included. Four new themes emerged, representing areas where palliative cancer care patients expressed a need for help: the need for comprehensive, patient-centered care, the need for maintaining a sense of autonomy and dignity, the need for attentive support to patients' soul and the need for accessible and timely care.

CONCLUSIONS

Palliative care patients require a secure, suffering-free end-of-life journey with informed decision-making and team support. Ensuring continuity of care, validating their suffering, and allocating sufficient time are crucial aspects of care. This involves maintaining a consistent care plan, respecting patients' emotions and experiences, and providing services tailored to individual needs.

Symptom management interventions influence unscheduled health services use among cancer survivors and caregivers

PURPOSE

Three sequences of telephone symptom management interventions were tested on use of unscheduled health services among cancer survivors with depressive or anxiety symptoms during treatment (N = 334) and their informal caregivers (N = 333).

METHODS

The three 12-week intervention sequences were as follows: (1) Symptom Management and Survivorship Handbook (SMSH), (2) a combined 8-week SMSH + Telephone Interpersonal Counseling (TIPC) followed by SMSH for 4 weeks, and (3) SMSH for 4 weeks followed by a combined SMSH + TIPC if no response to SMSH alone. Survivor-caregiver dyads were first randomized to SMSH or a combined SMSH + TIPC. If the survivor's depressive or anxiety symptoms persisted after 4 weeks of SMSH alone, the dyad was randomized the second time to continue with SMSH alone or TIPC was added to SMSH. All participants were assessed at baseline and 13 and 17 weeks. Health service use was compared between randomized groups and among the three sequences.

RESULTS

Survivors were 60.2 years of age, 79% were female, and 41% were Hispanic. Caregivers were 54.8 years of age; 67% were female. The significantly lower rate of emergency department (ED) or urgent care visits for survivors was found in the SMSH + TIPC intervention sequence compared to the SMSH alone in the second randomization and for the third intervention sequence compared to the first.

CONCLUSIONS

Adding TIPC to SMSH after week 4 when survivors experienced persisting depressive or anxiety symptoms reduced ED/urgent care visits compared to SMSH alone.

IMPLICATIONS FOR CANCER SURVIVORS

Managing depression and anxiety symptoms may help prevent ED/urgent care visits and worsening of other symptoms.

The Support Needs of Patients Requesting Medical Aid in Dying and Their Relatives: A Qualitative Study Using Semi-Structured Interviews and Written Narratives

Objectives

To explore the support needs that patients and relatives experience throughout their medical aid in dying (MAID) trajectories.

Methods

A qualitative study in Belgium in 2022 using 1) semi-structured interviews with and personal written narratives of patients requesting MAID and 2) semi-structured interviews with relatives of patients requesting MAID. We performed a qualitative content analysis.

Results

We included in our analysis the lived experiences of 15 patients and 21 of their relatives. We identified eight types of support needs: support for 1) maximizing daily functioning (only reported by patients), 2) making sense of the unbearable suffering (only reported by relatives), 3) managing meaningful activities, 4) navigating existential questions, 5) psycho-emotional regulation, 6) facilitating social interaction, 7) understanding the process toward MAID, 8) and handling organizational and practical matters.

Conclusion

Patients and relatives might experience multidimensional support needs throughout their MAID trajectories. Our findings suggest that they experience these trajectories more as social/existential pathways than as medical ones. A palliative care approach may be an effective way to fulfill the support needs of patients and relatives throughout their MAID trajectories.

Perceived unmet needs and impact on quality of life of patients living with advanced bladder cancer and their caregivers: results of a social media listening study conducted in five European countries

BACKGROUND

Advanced bladder cancer (aBC) is a significant health concern in Europe and has a poor prognosis. Patients with aBC face numerous unmet needs and challenges that significantly impact their quality of life (QoL). This study aims to analyze social media data from five European countries to address gaps in our understanding of the unmet needs, challenges, and impact on QoL in European patients with aBC and their caregivers.

METHODS

This retrospective, real-world study includes public social media posts geolocated in France, Italy, Germany, Spain, and the UK, posted between October 2017 and January 2022. To enhance the filtering process, natural language processing methods and specific algorithms were used to remove irrelevant content and retain posts from patients and caregivers. QoL impacts were identified using a deep-learning algorithm, followed by qualitative analysis. Unmet needs were analyzed via annotation of messages and the saturation method.

RESULTS

A total of 1670 posts from 1396 users (699 posts from 546 patients and 971 posts from 850 caregivers) discussing aBC in 91 publicly available online sources were identified. Half of patients were male (n = 272, 49.8%) while more caregivers were female (n = 474, 55.8%), with an average age of 58.2 and 35.2 years, respectively. Patients and caregivers expressed an impact on QoL, wherein 40.0% (558/1396) of users mentioned at least an impact on one aspect of QoL. Among those, 56.8% (317/558) and 48.6% (271/558) of users expressed physical and psychological challenges, respectively. Most unmet needs identified belonged to two main categories: transversal, i.e., arising throughout the patient's care pathway (307/1092 [28.1%]), and disease specific (295/1092 [27.0%]). Main challenges included worsening of the disease (n = 141, 12.9%), psychological impact (n = 112, 10.3%), and need to share experiences and seek support (n = 94, 8.6%).

CONCLUSIONS

This social media listening study demonstrated the profound emotional and physical burden on patients with aBC and their caregivers, and a genuine need for support and an outlet to discuss their challenges, particularly in terms of managing the illness. These results underscore the importance of enhancing education for both patients and caregivers and the necessity for more effective systemic cancer therapies and better palliative care alternatives.

What do family caregivers of patients with life-threatening diseases need from healthcare professionals? A qualitative study

OBJECTIVES

To explore the common ground of what family caregivers need in their various roles (caregiver, care recipient and patient's partner, child or friend) from healthcare professionals across healthcare settings and disease trajectories.

DESIGN

Interviews were conducted with family caregivers of patients with life-threatening diseases who were treated at home, in hospitals, nursing homes or hospices between 2017 and 2022. Reflexive thematic analysis was performed.

SETTING/PARTICIPANTS

63 family caregivers of 65 patients were interviewed. Of the patients, 36 (55%) had COVID-19 and 29 (45%) had other life-threatening diseases (eg, advanced cancer, dementia). The majority of family caregivers were women (83%) and children of the patient (56%).

RESULTS

Three themes were developed regarding family caregivers' core needs across their different roles: (1) 'feeling seen and valued', (2) 'experiencing trust in the provided care' and (3) 'experiencing guidance and security'. Actions of healthcare professionals that meet those needs relate to their contact and relationship with family caregivers, information provision, practical and emotional support, the care for the patient and facilitating the connection between family caregivers and patients.

DISCUSSION

Healthcare professionals should be trained in meeting family caregivers' core needs, in which their (collaborative) relationship with them plays an important role. Efforts to meet the core needs should be incorporated into healthcare organisations' workflows, and future research should investigate related barriers and facilitators.

Self-Assessment of Psychosocial Care Proficiency among Nurses and Oncologists at the Mohammed VI University Hospital Center (Morocco)

 In Morocco, cancer is a disease with a concerning incidence to the point that patients are diagnosed at advanced stages. As a result, patient care requires a holistic approach, integrating medical treatment and appropriate psychosocial support to improve their well-being. This study aimed to evaluate the psychosocial care competencies of oncology healthcare professionals at the Mohammed VI University Hospital Center (CHU) in Marrakech. This was a cross-sectional descriptive study of doctors and nurses in the oncology department of the Mohammed VI University Hospital Center, Marrakech. A questionnaire containing sociodemographic variables was drawn up, together with the Psychosocial Care Competency Self-Assessment Scale (PCCSAS), which measures psychosocial care competencies. A descriptive and analytical analysis was performed via SPSS software (V.26). The overall PCCSAS score was moderate (54.99 ± 13.96), with similar scores for the subscales of symptom diagnosis, intervention, information use and psychosocial care assessment. Professionals working in day hospitals scored significantly higher than those in inpatient settings did (p < 0.05), although the differences between nurses and oncologists were not statistically significant. Seniority showed no significant association with the PCCSAS score, although professionals with 15 or more years of experience obtained the highest scores (61.71 ± 11.22). A significant correlation was observed between the PCCSAS scale and its subscales (p < 0.005). This study revealed a moderate level of psychosocial care skills among healthcare professionals in oncology, compounded by a lack of specialized training. In the Moroccan context, developing a profile of nurses specializing in psychosocial care, introducing continuing education programs adapted to the specific needs of different departments, and promoting experience sharing between professionals to strengthen practical skills and improve the quality of patient care are recommended.