Cancer Nursing最新文献

Background: Following surgery, women with breast cancer (BC) frequently experience emotional and physiological negative consequences.

Objective: To evaluate the effect of a nurse-led mobile app (NL-Mapp) intervention on quality of life (QoL) in patients after surgery for BC.

Methods: This single-center, 12-month, nonrandomized controlled trial, with 2 parallel groups, represents the final stage of 3-step research. In this study, women were assigned to either the intervention (n = 45) or control (n = 45) group. The intervention group participated in the NL-Mapp, whereas participants in the control group received standard care. The main outcomes were measured using the Functional Assessment of Cancer Therapy-Breast at 3 time points (baseline and 1 and 12 months after the intervention). Clinical Trial number: NCT06505538.

Results: The intervention participants reported significant improvement in physical well-being, emotional well-being, and the BC-specific subscale compared with the control group at the 1-month postsurgery mark. Equally noteworthy, at the 1-year follow-up, consistent improvements were observed across all QoL subscale scores for the intervention group, except for the BC-specific subscale for additional concerns.

Conclusion: Our study revealed a notable enhancement in the QoL among postoperative women with BC who utilized the NL-Mapp. This program emerges as an effective intervention for providing short-term and longer-term supportive care to women affected by BC, leading to tangible improvements in their QoL.

Implication for nursing: The study's findings offer valuable evidence supporting the integration of mobile health services into clinical and transitional nursing care.

Background: Decrements in energy are a significant problem associated with chemotherapy. To date, no study examined the variability of energy in patients with gynecologic cancers.

Objective: To identify distinct morning and evening energy profiles in patients with gynecologic cancers and evaluate for differences in demographic and clinical characteristics, other common symptoms, and quality-of-life (QOL) outcomes.

Methods: A sample of 232 patients with gynecologic cancers completed questionnaires 6 times over 2 cycles of chemotherapy. Latent profile analysis was used to identify distinct morning and evening energy profiles. Differences in demographic and clinical characteristics, other common symptoms, and QOL outcomes were evaluated using parametric and nonparametric tests.

Results: Three distinct morning (ie, high [9.2%], low [63.1%], very low [27.1%]) and 2 distinct evening (moderate [30.6%], very low [69.4%]) energy classes were identified. Clinical risk factors associated with the worst morning energy profiles included lower functional status and a higher comorbidity burden. Less likely to exercise on a regular basis was the only characteristic associated with the worst evening energy profile. For both symptoms, the worst profiles were associated with higher levels of depression and sleep disturbance, lower levels of cognitive function, and poorer QOL.

Conclusions: Approximately 70% of patients with gynecologic cancers experienced decrements in morning and evening energy. The study identified modifiable risk factors associated with more decrements in morning and evening energy.

Implications for practice: Clinicians can use these findings to identify higher-risk patients and develop individualized energy conservation interventions for these vulnerable patients.

Background: The International Society of Geriatric Oncology recommends that all older people with cancer have a geriatric evaluation before beginning treatment.

Objective: To determine the prevalence of frailty in people 75 years and older diagnosed with lung or gynecological cancer and evaluate the adaptation of standard therapeutic strategies based on frailty, following the implementation of telephone-based frailty screening with the Vulnerable Elders Survey (VES-13).

Interventions/methods: We performed a retrospective observational study in 362 people screened by an advanced practice nurse before their first oncology appointment. We collected secondary data from electronic medical records. The main variables were degree of frailty (according to VES-13 and comprehensive geriatric assessment), type of cancer treatment (standard and prescribed), treatment completion, sociodemographic characteristics, and comorbidities.

Results: The VES-13 detected 186 people (51.4%) at risk of health deterioration, and the comprehensive geriatric assessment confirmed some degree of frailty in 157 people (43.4%), with a κ coefficient of 0.84. People with more comorbidities, greater frailty, and more geriatric syndromes were more likely to need treatment readjustment ( P < .001).

Conclusions: Telephone-based frailty screening by an advanced practice nurse showed high applicability, with very good agreement between the proportion of people classified as frail before the initial visit and in the subsequent geriatric assessment.

Implications for practice: A protocol for establishing frailty risk through telephone screening by an advanced practice nurse facilitates the care process and helps clinicians adapt therapeutic decision-making to the needs of each patient and their family.

Background: The Children's Oncology Group (COG) Nursing Discipline developed expert consensus recommendations and resources to guide the delivery of new diagnosis education across its member institutions. Current new diagnosis education practices across COG member institutions are unknown.

Objective: To understand current new diagnosis education practices across COG member institutions.

Methods: We conducted a cross-sectional survey of COG nurses between July and October 2023 to elicit current practices to deliver new diagnosis education to families across COG institutions. Data were collected and managed using REDCap electronic data capture tools. Individual responses from single institutions were averaged as a single institution-level response.

Results: Respondents included 146/227 (64.3%) COG institutions across 5 countries. Advanced practice nurses and nurse educators have primary responsibility for new diagnosis education at 28.1% and 26.7% of institutions, respectively. Less than half (42.4%) of institutions have a clearly defined process for delivering new diagnosis patient/family education. Almost all (88.2%) institutions use the COG Family Handbook; 64.7% use the COG New Diagnosis Guide, and 41.9% use the COG KidsCare app to support the delivery of new diagnosis education. More than half (61.5%) of institutions use checklists to facilitate the delivery of new diagnosis education, with 81.6% of large institutions versus 44.1% of small institutions reporting the use of checklists ( P = .004).

Conclusions: There is variability in current new diagnosis education practices across COG institutions.

Implications for practice: These findings highlight opportunities for implementing standardized approaches aligned with expert consensus recommendations for the delivery of new diagnosis education.

Background: Symptom distress and functional impairments in children with leukemia directly affect their quality of life.

Objectives: To identify subgroups of symptom distress and functional impairments in Chinese children with leukemia and to examine the associations of the latent classes with individual characteristics.

Methods: This multicenter cross-sectional survey study recruited children with leukemia who received chemotherapy in 4 hospitals in Shanghai, Jiangsu, Zhejiang, and Guangdong Province. The participants were surveyed via PROMIS-25 (Patient-Reported Outcomes Measurement Information System Pediatric-25 Profile). Latent profile analysis and multinomial logistic regression model were performed to identify subgroups of symptom distress and function impairments among children with leukemia.

Results: Latent profile analysis results suggested the classification of 3 subgroups: profile 1: "moderate symptom distress, moderate mobility impairment with fair peer relationship function" group (69, 28.3%), profile 2: "mild symptom distress, no mobility impairment with good peer relationship function" group (97, 39.8%), and profile 3: "no symptom distress, no mobility impairment with good peer relationship function" group (78, 32.0%). Sociodemographic characteristics, including gender of the children, gender and marital status of the parents, average monthly income of the family, and reimbursement ratio of treatment expenses, had significant associations with the latent profile membership ( P < .05).

Conclusion: This study identified 3 distinct profiles of symptom distress and functional impairments in children with leukemia and found significant associations between these profiles and sociodemographic characteristics.

Implications for practice: The classification of the 3 latent profiles in children with leukemia helps to provide targeted supportive intervention to those children and their families.

Background: Unpleasant symptoms are common in children with cancer. However, research identifying subgroups of children with cancer who experience similar levels of self-reported symptoms in China is limited.

Objectives: This study aimed to classify the symptom profiles of children with cancer and detect the possible predictors of the profiles and their effect on children's quality of life (QoL).

Methods: A total of 272 children aged 8 to 17 years completed the Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System short form measures, the Pediatric QOL Inventory general core and cancer modules. Latent profile analysis was used to identify symptom profiles, and ordinal logistic regression and analysis of variance were used to examine predictors of symptom profile membership and profile differences on QoL.

Results: The best fit was a 3-profile model: low, moderate, and severe symptom distress. Children who had been inpatients in the past 7 days and were currently under treatment are more likely to have severe symptoms. Participants in the low symptom distress profile reported significantly greater QoL than those in the other profiles.

Conclusions: Children with cancer are heterogeneous in their experience of symptoms. Children's characteristics, such as inpatient history and treatment status, are predictors of profiles; different symptom profiles are associated with QoL.

Implications for practice: This study identified distinct groups of patients who predictably experience higher symptoms and their predictors, which could help to place children within a profile and perhaps allow nurses to provide targeted supportive care to match children's specific symptom profile.

Background: Although early palliative care is linked to improved health-related quality of life, satisfaction with care, and symptom management, the clinical strategies that nurses use to actively initiate this care are unknown.

Objectives: The aims of this study were to conceptualize the clinical strategies that outpatient oncology nurses use to introduce early palliative care and to determine how these strategies align with the framework of practice.

Methods: A constructivist-informed grounded theory study was conducted in a tertiary cancer care center in Toronto, Canada. Twenty nurses (6 staff nurses, 10 nurse practitioners, and 4 advanced practice nurses) from multiple outpatient oncology clinics (ie, breast, pancreatic, hematology) completed semistructured interviews. Analysis occurred concurrently with data collection and used constant comparison until theoretical saturation was reached.

Results: The overarching core category, pulling it all together , outlines the strategies used by oncology nurses to support timely palliative care referral, drawing on the coordinating, collaborating, relational, and advocacy dimensions of practice. The core category incorporated 3 subcategories: (1) catalyzing and facilitating synergy among disciplines and settings , (2) promoting and considering palliative care within patients' personal narratives , and (3) widening the focus from disease-focused treatment to living well with cancer .

Conclusion: Outpatient oncology nurses enact unique clinical strategies, which are aligned with the nursing framework and reflected multiple dimensions of practice, to introduce early palliative care.

Implications for practice: Our findings have clinical, educational, and policy implications for fostering the conditions in which nurses are supported to maximize their full potential in the introduction of early palliative care.

Background: Learning and performing tracheostomy care are challenging for laypersons. Effective pictorial patient education handouts are needed for nonprofessional individuals to learn health management skills.

Objectives: The study aims to (1) evaluate the preliminary efficacy of the pictorial education handout on patients' and family members' self-efficacy in tracheostomy care and (2) identify demographic, psychological, and education-related factors associated with lower self-efficacy on tracheostomy care.

Interventions/methods: This was a preliminary pilot study with a pretest-posttest design. We recruited a total of 39 participants, including 22 patients with head and neck cancer-related tracheostomy and 17 family caregivers in 2021. All participants received A3-size (297 × 420 mm) pictorial patient education handouts on how to suction and how to clean their tracheostomy at home.

Results: Pictorial education handouts showed a medium to large effect size on self-efficacy in the patient (Cohen D = 0.46) and caregiver participants (Cohen D = 0.78). Participants with higher anxiety were associated with a greater gain in self-efficacy with the pictorial patient education handouts ( r = 0.35, P = .027).

Conclusions: Pictorial patient education handouts were effective tools for improving patients' and family caregivers' confidence in tracheostomy care, and it is particularly helpful for individuals with high anxiety with tracheostomy.

Implication for practice: Clinical nurses should use the pictorial education handouts not only to assist patients and family members on learning and practicing tracheostomy care but also to relieve anxiety associated with tracheostomy care at home.

Background: Cancer itself and surgery put a heavy burden on lung cancer patients, physiologically and psychologically. Enhancing self-efficacy during high-intensity interval training is essential for achieving the full benefit of pulmonary rehabilitation in lung cancer patients.

Objective: This study aimed to explore the effects of high-intensity interval training combined with team empowerment education on patients with lung resection.

Methods: This is a quasi-experimental trial with a pretest-posttest design. Participants were assigned to one of the 3 groups according to the order of admission: (1) combined intervention group, (2) intervention group, or (3) routine care group. The outcome measures included dyspnea, exercise capacity, exercise self-efficacy, anxiety, depression, postoperative indwelling time of thoracic drainage tube, and total in-hospital stay.

Results: Per-protocol results showed that dyspnea, exercise capacity, exercise self-efficacy, anxiety, and depression of the patients in the combined intervention group were significantly improved. However, no significant difference was observed in postoperative indwelling time of thoracic drainage tube or total in-hospital stay among the 3 groups.

Conclusion: This hospital-based short-term high-intensity interval training combined with team empowerment education for lung cancer patients undergoing surgery was safe and feasible, indicating this program can be a promising strategy to manage perioperative symptoms.

Implications for practice: This study provides evidence supporting preoperative high-intensity interval training as a promising method to make the best use of preoperative time, thus improving adverse symptoms in lung cancer patients undergoing surgery, and also provides a new strategy to raise exercise self-efficacy and promote patients' rehabilitation.