Asia-Pacific Journal of Oncology Nursing最新文献_第9页

Upper limb symptoms in breast cancer survivors with lymphedema: A latent class analysis and network analysis 淋巴水肿乳腺癌幸存者的上肢症状：潜在分类分析和网络分析

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-05-02 DOI: 10.1016/j.apjon.2025.100713

Aomei Shen , Nada Lukkahatai , Zijuan Zhang , Hongmeng Zhao , Nezar Ahmed Salim , Gyumin Han , Wanmin Qiang , Qian Lu

Objective

Breast cancer survivors (BCS) with lymphedema experience multiple symptoms in upper limbs that significantly impact their quality of life. The complexity of symptomology and the connection among these symptoms are unclear. This study aimed to identify upper limb symptom subgroups and symptom networks among BCS.

Methods

This secondary analysis included individuals with lymphedema (defined as an inter-limb circumference difference of ≥ 2 cm) from three cross-sectional studies among post-surgery BCS. Upper limb symptoms were assessed by the Breast Cancer and Lymphedema Symptom Experience Index. Descriptive analysis, latent class analysis, logistic regression analysis, and network analysis were performed.

Results

A total of 341 BCS with upper limb lymphedema were included. Swelling, heaviness and tightness were the most prevalent symptoms. Four distinct latent classes were identified: “Severe symptom” group (Class 1: 9.4%), “Movement-limitation and lymph-stasis” group (Class 2: 24.6%), “Lymph-stasis” group (Class 3: 37.5%), and “Mild symptom” group (Class 4: 28.4%). BCS with axillary lymph node dissection, radiotherapy, longer post-surgery duration, and without medical insurance were less likely to belong to the mild symptom group (P < 0.001). Symptom network density decreased from Class 1 to 4. Core symptoms for each symptom network were tenderness, firmness, arm-swelling, and heaviness, respectively.

Conclusions

This study identified four distinct categories of upper limb symptoms and influencing factors among individuals with breast cancer-related lymphedema (BCRL). Our findings suggest the need to consider individualized approaches to symptom management and support for BCRL, taking into account their specific symptom clusters and associated risk factors.

目的：患有淋巴水肿的乳腺癌幸存者（BCS）上肢出现多种症状，严重影响其生活质量。症状的复杂性和这些症状之间的联系尚不清楚。本研究旨在确定BCS患者的上肢症状亚群和症状网络。方法二级分析纳入了术后BCS患者中三个横断面研究中出现淋巴水肿（定义为肢间围差≥2cm）的个体。采用乳腺癌和淋巴水肿症状体验指数评估上肢症状。进行描述性分析、潜在类分析、逻辑回归分析和网络分析。结果共纳入341例伴有上肢淋巴水肿的BCS。肿胀、沉重和紧绷是最常见的症状。发现了四个明显的潜在类别：“严重症状”组（1类：9.4%），“运动受限和淋巴淤积”组（2类：24.6%），“淋巴淤积”组（3类：37.5%）和“轻度症状”组（4类：28.4%）。伴有腋窝淋巴结清扫、放疗、术后时间较长、无医疗保险的BCS属于轻症组的可能性较小(P <；0.001)。症状网络密度由1级降至4级。每个症状网络的核心症状分别为压痛、僵硬、手臂肿胀和沉重。结论本研究确定了乳腺癌相关淋巴水肿（BCRL）患者上肢症状的四种不同类型及其影响因素。我们的研究结果表明，需要考虑个性化的症状管理方法和对BCRL的支持，考虑到他们特定的症状群和相关的危险因素。

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引用次数: 0

Symptoms experience during the oral intake rehabilitation period following esophagectomy: A network analysis 食管癌术后口服摄入康复期的症状：网络分析

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-29 DOI: 10.1016/j.apjon.2025.100710

Hanxue Liu , Xiaoju Zhang , Jiajia Qiu , Zhenqi Lu , Chong Chen

Objective

Patients experience diverse symptoms during the oral intake rehabilitation period after esophagectomy, yet symptom interactions remain poorly understood. This study aimed to identify symptom clusters, core symptoms, and their relationships to inform targeted nursing interventions.

Methods

In this cross-sectional study, 252 participants completed the Anderson Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer quality of life questionnaire, specifically the esophageal-specific module (EORTC QLQ-OES18). Symptom clusters were derived via Principal Component Analysis (SPSS 26.0), and a network analysis (R4.3.1) was conducted to explore symptom centrality and interconnectedness.

Results

Five symptom clusters emerged: reflux symptoms, unpleasant eating changes, low spirits symptoms, nerve damage symptoms, and energy deficiency symptoms. Distress (strength = 4.878, betweenness = 20, closeness = 0.263) and trouble enjoying meals (strength = 4.666, betweenness = 28, closeness = 0.258) were identified as core symptoms and with the highest bridge strength (distress: 3.400; trouble enjoying meals: 3.210). Patients experiencing these symptoms exhibited significantly greater weight loss (distress: 2.60 ± 2.52 vs. 1.68 ± 2.10 kg, P = 0.002; trouble enjoying meals:2.42 ± 2.56 vs. 1.65 ± 2.00 kg, P = 0.009).

Conclusions

Distress and trouble enjoying meals are not only core symptoms but also bridge symptoms. Future interventions targeting these two symptoms may be able to alleviate the overall symptoms and reduce weight loss during the oral intake rehabilitation period following esophagectomy.

目的：食管切除术后患者在口腔摄入康复期间出现多种症状，但症状间的相互作用尚不清楚。本研究旨在确定症状群、核心症状及其关系，为有针对性的护理干预提供信息。方法在本横断面研究中，252名参与者完成了安德森症状评估量表和欧洲癌症研究与治疗组织生活质量问卷，特别是食管特异性模块（EORTC QLQ-OES18）。通过主成分分析（SPSS 26.0）得出症状聚类，并进行网络分析（R4.3.1）来探索症状的中心性和相互关联性。结果出现5组症状：反流症状、饮食改变、情绪低落症状、神经损伤症状和能量不足症状。焦虑（强度= 4.878，中间值= 20，亲密度= 0.263）和难以享受饮食（强度= 4.666，中间值= 28，亲密度= 0.258）被确定为核心症状，并且桥强度最高(焦虑：3.400；享受美食的困难：3.210)。出现这些症状的患者表现出更大的体重减轻(痛苦：2.60±2.52 vs 1.68±2.10 kg, P = 0.002；进食困难：2.42±2.56 vs. 1.65±2.00 kg, P = 0.009)。结论焦虑、不享受饮食既是核心症状，也是桥梁症状。未来针对这两种症状的干预措施可能能够减轻食管癌术后口服摄入康复期间的整体症状和体重减轻。

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引用次数: 0

Self-care practices among hospice nurses in general hospitals in China: A qualitative study 中国综合医院安宁疗护护士自我照护行为之质性研究

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-28 DOI: 10.1016/j.apjon.2025.100706

Rong Tan , Jing Wang , Fen Teng , Jiaqing Wang , Yundan Wang , Wenjuan Zhou , Deying Hu

Objective

This study was aimed at exploring the real-world self-care experiences and challenges encountered by hospice nurses caring for terminally ill patients at general hospitals in mainland China.

Methods

Semi-structured interviews were conducted with 15 hospice care nurses at 10 general hospitals in China from June 2022 to February 2023. Using Colaizzi's seven-step method, we analyzed and distilled the data into key themes.

Results

Three themes were identified: 1) benefits of self-care (personal growth and self-worth affirmation); 2) effective self-care strategies (physical health management, psychological resilience building, support resource mobilisation, and gaining spiritual consolation); and 3) challenges in self-care (professional development-related challenges and work environment-related challenges). The participants consisted of 14 women and 1 man, with the nurses having a maximum of 5 years of hospice experience. Despite efforts to balance participant numbers from different levels of hospital-based hospice care units, more hospice nurses from provincial tertiary general hospitals were recruited. This imbalance may limit the generalizability of the findings to other health care settings.

Conclusions

This study highlighted the importance and benefits of self-care for hospice nurses. Implementing effective self-care strategies can strengthen hospice nurses’ well-being and psychological resilience, expand their access to support resources, and ultimately improve the quality of care. Health care institutions and hospice providers should prioritize understanding and promotion of self-care practices among hospice nurses.

目的探讨中国内地综合医院临终关怀护士护理临终病人的自我护理经验及面临的挑战。方法于2022年6月至2023年2月对全国10家综合医院的15名临终关怀护士进行半结构化访谈。使用Colaizzi的七步法，我们对数据进行分析并提炼成关键主题。结果确定了三个主题：1)自我保健的益处（个人成长和自我价值肯定）；2)有效的自我照顾策略（身体健康管理、心理弹性建设、支持资源动员和获得精神安慰）；3)自我护理方面的挑战（专业发展方面的挑战和工作环境方面的挑战）。参与者包括14名女性和1名男性，护士最多有5年的临终关怀经验。尽管努力平衡来自不同级别医院临终关怀单位的参与者人数，但从省级三级综合医院招募了更多的临终关怀护士。这种不平衡可能会限制研究结果在其他卫生保健机构的推广。结论本研究强调安宁疗护护士自我照护的重要性及益处。实施有效的自我照护策略，可增强安宁疗护护士的幸福感和心理弹性，扩大其获得支援资源的途径，最终提升照护品质。卫生保健机构和安宁疗护提供者应优先了解和促进安宁疗护护士的自我疗护实践。

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引用次数: 0

How to improve quality of life in children with cancer from family-based perspectives? Insights from network analysis 如何从家庭角度改善癌症儿童的生活质量？来自网络分析的见解

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-26 DOI: 10.1016/j.apjon.2025.100709

Jingran Lyu , Dongyu Song , Yaoyi Pan , Weiyi Lin , Yuli Li , Yunpeng Dai , Ka Yan Ho , Yuanyuan Han

Objective

A child's cancer diagnosis is a significant family event, and there is a need to explore factors that influence the quality of life of children with cancer from family-based perspectives. This study aimed to explore the interrelationships between parental burnout, sibling relationship quality, and quality of life in children with cancer.

Methods

This cross-sectional study enrolled 218 children with cancer and their parents in three tertiary hospitals in Shandong Province using convenience sampling. Children completed the Chinese version of the Pediatric Quality of Life Inventory 4.0, while their parents completed the Parental Perceptions of Children's Sibling Relationship Quality Questionnaire and Maslach Burnout Inventory, and provided their own sociodemographic information, as well as their children's sociodemographic and clinical characteristics. Network analysis was employed to examine the relationships between variables.

Results

In the overall network, social functioning in children with cancer exhibited the highest strength (r_s = 1.03), while warmth in sibling relationship quality showed the highest bridge strength (r_bs = 0.42). Social functioning was positively associated with warmth in sibling relationship quality (r = 0.15), and negatively associated with personal achievement (r = −0.13) and depersonalization (r = −0.09) in parental burnout. Emotional functioning was negatively associated with emotional exhaustion in parental burnout (r = −0.10) and jealousy in sibling relationship quality (r = −0.10).

Conclusions

There are significant interrelationships between the network structure of family related variables and quality of life in children with cancer. These findings offer guidance for healthcare professionals focusing on family-based interventions to improve the quality of life of children with cancer.

目的儿童癌症诊断是一个重大的家庭事件，有必要从家庭角度探讨影响癌症儿童生活质量的因素。本研究旨在探讨癌症患儿父母职业倦怠、兄弟姐妹关系质量与生活质量之间的相互关系。方法采用方便抽样方法，对山东省三所三级医院218例肿瘤患儿及其家长进行横断面研究。儿童填写中文版《儿童生活质量量表4.0》，家长填写《父母对子女兄弟姐妹关系质量的感知问卷》和《马斯拉克倦怠量表》，并提供自己的社会人口学信息以及子女的社会人口学和临床特征。采用网络分析来检验变量之间的关系。结果在整个网络中，癌症患儿的社会功能表现出最高的桥梁强度（rs = 1.03），兄弟姐妹关系质量中的温暖表现出最高的桥梁强度（rs = 0.42）。社会功能与兄弟姐妹关系质量中的温暖度呈正相关（r = 0.15），与父母倦怠中的个人成就（r = - 0.13）和人格解体（r = - 0.09）呈负相关。情绪功能与父母倦怠中的情绪耗竭（r = - 0.10）和兄弟姐妹关系质量中的嫉妒（r = - 0.10）呈负相关。结论家庭相关变量网络结构与癌症患儿生活质量存在显著的相关关系。这些发现为注重以家庭为基础的干预措施以改善癌症儿童生活质量的医疗保健专业人员提供了指导。

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引用次数: 0

Empowerment mediates the impact of upper extremity function on posttraumatic growth in breast cancer survivors 赋权介导上肢功能对乳腺癌幸存者创伤后生长的影响

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-26 DOI: 10.1016/j.apjon.2025.100708

Chaewon Yun , Yujin Jeong

Objective

This study aimed to investigate the relationship between upper extremity function and posttraumatic growth (PTG) in breast cancer survivors, focusing on the mediating role of empowerment while controlling for spirituality.

Methods

A descriptive cross-sectional survey was conducted among 191 breast cancer survivors in self-help groups in South Korea. Participants included women aged > 40 years who had undergone surgery, radiation, or chemotherapy, with no metastasis to other organs and no cognitive disabilities. Data were collected between July and October 2019. Measures included upper extremity function, empowerment, spirituality, and PTG.

Results

The participants' mean age was 59.29 years. Significant positive correlations were found between upper extremity function and empowerment (r = 0.28, P < 0.001), upper extremity function and PTG (r = 0.22, P = 0.002), and empowerment and PTG (r = 0.18, P = 0.015). Spirituality was positively correlated with PTG (r = 0.55, P < 0.001). On mediation analysis, upper extremity function, directly and indirectly, affected PTG through empowerment. Furthermore, a significant difference in PTG based on educational attainment was observed, with higher PTG levels observed in survivors with a college degree or higher than in those with a high school education or lower.

Conclusions

These findings highlight the importance of upper extremity function and empowerment in enhancing PTG among breast cancer survivors. Although spirituality did not have a direct effect, it remains a crucial factor in coping strategies. Holistic interventions addressing physical and psychological aspects of recovery may foster PTG and overall well-being of breast cancer survivors.

目的探讨乳腺癌幸存者上肢功能与创伤后生长（PTG）之间的关系，重点探讨授权在控制灵性的同时的中介作用。方法对韩国191例乳腺癌幸存者进行描述性横断面调查。参与者包括年龄在>；40岁，接受过手术、放疗或化疗，无其他器官转移，无认知障碍。数据收集于2019年7月至10月。测量包括上肢功能、授权、灵性和PTG。结果参与者平均年龄为59.29岁。上肢功能与赋权呈显著正相关(r = 0.28, P <；0.001)、上肢功能与PTG （r = 0.22, P = 0.002）、赋权与PTG （r = 0.18, P = 0.015）。精神性与PTG呈正相关(r = 0.55, P <；0.001)。在中介分析中，上肢功能通过赋能直接和间接影响PTG。此外，观察到基于教育程度的PTG显着差异，具有大学学历或更高学历的幸存者的PTG水平高于具有高中学历或更低学历的幸存者。结论这些发现强调了上肢功能和赋权在增强乳腺癌幸存者PTG中的重要性。虽然精神没有直接影响，但它仍然是应对策略的关键因素。针对身体和心理康复方面的整体干预可能会促进PTG和乳腺癌幸存者的整体福祉。

{"title":"Empowerment mediates the impact of upper extremity function on posttraumatic growth in breast cancer survivors","authors":"Chaewon Yun , Yujin Jeong","doi":"10.1016/j.apjon.2025.100708","DOIUrl":"10.1016/j.apjon.2025.100708","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the relationship between upper extremity function and posttraumatic growth (PTG) in breast cancer survivors, focusing on the mediating role of empowerment while controlling for spirituality.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional survey was conducted among 191 breast cancer survivors in self-help groups in South Korea. Participants included women aged > 40 years who had undergone surgery, radiation, or chemotherapy, with no metastasis to other organs and no cognitive disabilities. Data were collected between July and October 2019. Measures included upper extremity function, empowerment, spirituality, and PTG.</div></div><div><h3>Results</h3><div>The participants' mean age was 59.29 years. Significant positive correlations were found between upper extremity function and empowerment (<em>r</em> = 0.28, <em>P</em> < 0.001), upper extremity function and PTG (<em>r</em> = 0.22, <em>P</em> = 0.002), and empowerment and PTG (<em>r</em> = 0.18, <em>P</em> = 0.015). Spirituality was positively correlated with PTG (<em>r</em> = 0.55, <em>P</em> < 0.001). On mediation analysis, upper extremity function, directly and indirectly, affected PTG through empowerment. Furthermore, a significant difference in PTG based on educational attainment was observed, with higher PTG levels observed in survivors with a college degree or higher than in those with a high school education or lower.</div></div><div><h3>Conclusions</h3><div>These findings highlight the importance of upper extremity function and empowerment in enhancing PTG among breast cancer survivors. Although spirituality did not have a direct effect, it remains a crucial factor in coping strategies. Holistic interventions addressing physical and psychological aspects of recovery may foster PTG and overall well-being of breast cancer survivors.</div></div>","PeriodicalId":8569,"journal":{"name":"Asia-Pacific Journal of Oncology Nursing","volume":"12 ","pages":"Article 100708"},"PeriodicalIF":2.4,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development and validation of colorectal cancer and colonoscopy screening health beliefs scale for first-degree relatives of people with colorectal cancer (CCHBS-FDR) in China 中国结直肠癌患者一级亲属结直肠癌和结肠镜筛查健康信念量表（CCHBS-FDR）的编制与验证

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-26 DOI: 10.1016/j.apjon.2025.100707

Yingli Yang , Shuya Lin , Lei Cai , Jun Zhong , Yinxuan Ding , Jingyi Wang , Baojia Luo , Xia Yang , Yang Bai

Objective

The purpose of the study was to develop and validate the psychometric properties of the Colorectal Cancer and Colonoscopy Screening Health Beliefs Scale for First-Degree Relatives (CCHBS-FDR) instrument for the first-degree relatives (FDRs) of people with colorectal cancer (CRC) in China.

Methods

This study was conducted in two phases: scale development and psychometric testing. In the scale development phase, a preliminary item pool was established based on a systematic review, qualitative interviews (n = 42), and the Revised Colorectal Cancer Perception and Screening (RCRCPS) instrument. The scale was then refined through expert consultation and laymen review. Psychometric properties were tested by item analysis, validity assessment and reliability evaluation on a convenience sample of 258 Chinese FDRs of patients with CRC.

Results

A preliminary 37-item scale with six dimensions, perceived severity, perceived susceptibility, perceived benefits, barriers-priority, barriers-concerns and barriers-knowledge, was developed in the first phase. The content validity index of the CCHBS-FDR was satisfactory (I-CVI = 0.86–1, S-CVI/UA = 0.89, S-CVI/Ave = 0.98). Cronbach's α coefficient for overall scale was 0.863, and subscales ranged from 0.689 to 0.939. Confirmatory factor analysis results suggested that the CCHBS-FDR conformed to the six-factor model (χ²/df = 2.075, RMSEA = 0.065, CFI = 0.892, TLI = 0.880, and SRMR = 0.077).

Conclusions

The CCHBS-FDR demonstrated acceptable reliability and validity as a culturally specific instrument for assessing health beliefs among FDRs with CRC. It can serve as a valuable tool for providing a more precise assessment of health beliefs and helping healthcare professionals develop and evaluate tailored communication interventions to promote colonoscopy screening among FDRs.

目的开发并验证中国结直肠癌患者一级亲属筛查健康信念量表（CCHBS-FDR）的心理测量特性。方法本研究分量表编制和心理测试两个阶段进行。在量表开发阶段，基于系统综述、定性访谈（n = 42）和修订的结直肠癌感知和筛查（RCRCPS）工具，建立了初步的项目库。然后通过专家咨询和外行审查来完善量表。采用项目分析、效度评估和信度评估对258份中国结直肠癌患者的心理测量特性进行检验。结果第一阶段初步编制了一份37题量表，包括感知严重性、感知易感性、感知利益、感知障碍优先、感知障碍关注和感知障碍知识6个维度。CCHBS-FDR的内容效度指标令人满意（I-CVI = 0.86-1, S-CVI/UA = 0.89, S-CVI/Ave = 0.98）。总量表的Cronbach’s α系数为0.863，子量表的Cronbach’s α系数为0.689 ~ 0.939。验证性因子分析结果显示，CCHBS-FDR符合六因素模型（χ2/df = 2.075, RMSEA = 0.065, CFI = 0.892, TLI = 0.880, SRMR = 0.077）。结论CCHBS-FDR作为一种文化特异性的评估CRC患者健康信念的工具，具有可接受的信度和效度。它可以作为一种有价值的工具，提供更精确的健康信念评估，并帮助保健专业人员开发和评估量身定制的沟通干预措施，以促进fdr的结肠镜检查。

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引用次数: 0

Initial quality of life and influencing factors in patients with advanced cancer receiving home hospice care: A propensity score-matched analysis stratified by survival period 晚期癌症患者接受家庭安宁疗护的初始生活品质及影响因素：按生存期分层的倾向评分匹配分析

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-22 DOI: 10.1016/j.apjon.2025.100704

Yitao Wei , Huina Zou , Wan Cheng , Hong Wu , Shaowei Lin , Jianwei Zheng , Huimin Xiao

Objective

Quality of life (QoL) is increasingly recognized as an important prognostic indicator and has been identified to be associated with reduced survival in patients with advanced cancer during the last months of life. This study aimed to compare the initial QoL and influencing factors of patients with advanced cancer receiving home hospice care with less than 3-month survival period.

Methods

A secondary data analysis study was conducted using the data from a Fujian provincial home hospice center, in China, between 2010 and 2020. Propensity score matching was performed in 2761 cases to match patients with a less than 1 month survival period and those with a 1–3 months survival period. Differences in QoL between the two groups were analyzed using the ANOVA or Wilcoxon Mann–Whitney test, and the influencing factors were analyzed using multiple linear regression analysis.

Results

No significant differences in QoL were identified between cancer patients with a 1–3 month survival period and those with a survival period of less than 1 month. However, a significant difference was detected after the propensity score matching adjustment (P < 0.05). Sources of living, awareness of disease, and performance status commonly affected the QoL of patients with different survival periods (P < 0.05). Chemotherapy, weight loss, anorexia, and tumor type only affected the QoL of patients with a survival period of less than 1 month (P < 0.05).

Conclusions

The QoL of patients with advanced cancer receiving home hospice care is poor but does not necessarily deteriorate continuously during the last 3 months. Notably, the complexity of factors influencing QoL increases significantly as patients approach death.

生活质量（QoL）越来越被认为是一个重要的预后指标，并已被确定与晚期癌症患者生命最后几个月的生存率降低有关。本研究旨在比较生存期不足3个月的晚期癌症居家安宁疗护患者的初始生活品质及影响因素。方法采用2010 - 2020年福建省家庭安宁疗护中心的数据进行二次数据分析。对2761例患者进行倾向评分匹配，将生存期不足1个月的患者与生存期1 - 3个月的患者进行匹配。采用方差分析（ANOVA）或Wilcoxon Mann-Whitney检验分析两组患者生活质量的差异，采用多元线性回归分析影响因素。结果生存期1 - 3个月与生存期不足1个月的肿瘤患者生活质量无显著差异。然而，在倾向得分匹配调整后，发现显著差异(P <；0.05)。不同生存期患者生活来源、疾病意识、运动状态共同影响其生活质量(P <；0.05)。化疗、减肥、厌食和肿瘤类型仅影响生存期小于1个月的患者的生活质量(P <；0.05)。结论接受居家安宁疗护的晚期癌症患者的生活质量较差，但在最后3个月内不一定持续恶化。值得注意的是，随着患者接近死亡，影响生活质量因素的复杂性显著增加。

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引用次数: 0

Evidence-based leakage management in cancer-preventive ileostomy care: A Delphi consensus integrating systematic review and clinical expertise 癌症预防回肠造口护理中的循证渗漏管理：系统评价与临床专业知识相结合的德尔菲共识

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-21 DOI: 10.1016/j.apjon.2025.100703

Songxian Zhao , Xueling Ma , Yujue Wang , Yan Bai , Chongyu Yan

Objective

This study aimed to synthesize the best available evidence and integrate clinical expertise to develop a structured, evidence-based leakage management system for cancer-preventive ileostomy care.

Methods

A two-phase mixed-methods design was employed. First, a systematic review was conducted following the PIPOST framework (Population: cancer-preventive ileostomy patients; Intervention: leakage management strategies; Professionals: ostomy caregivers; Outcomes: leakage incidence and skin complications; Setting: hospitals; Evidence types: clinical decisions, guidelines, evidence summaries, best practices, systematic reviews, and expert consensus). Databases and clinical repositories were searched from inception to June 2024, yielding 23 high-quality documents. Second, a Delphi consensus process involving 15 ostomy nursing experts across six Chinese provinces refined the evidence into actionable clinical protocols through two iterative consultation rounds. Consensus thresholds included a Likert score ≥ 4 and coefficient of variation < 0.25.

Results

The finalized leakage management system comprises three domains—prevention, assessment, and intervention—organized into 11 themes and 46 actionable items. Key components include preventive strategies for ileostomy leakage, dynamic ostomy appliance selection, and protocols for managing leakage-related skin damage. Expert consensus highlighted the importance of individualized care, with adjustments based on effluent characteristics and gas production. The Delphi panel achieved high agreement (Cr = 0.89, Kendall's W = 0.194–0.137, P < 0.05).

Conclusions

This study presents a robust, evidence-based leakage management system tailored to the needs of cancer-preventive ileostomy survivors. By integrating high-quality evidence with practical clinical insights, the system offers valuable guidance for improving patient outcomes and enhancing the quality of ostomy nursing care in real-world settings.

Systematic review registration

ES20245104.

目的综合现有的最佳证据，结合临床专业知识，建立一套结构化的、循证的回肠造口预防护理渗漏管理系统。方法采用两相混合法设计。首先，根据PIPOST框架(人群：癌症预防性回肠造口患者；干预措施：泄漏管理策略；专业：造口护理人员；结果：渗漏发生率及皮肤并发症；设置:医院;证据类型：临床决策、指南、证据摘要、最佳实践、系统评价和专家共识)。从开始到2024年6月，检索了数据库和临床知识库，产生了23份高质量的文档。其次，来自中国6个省份的15名造口护理专家参与了德尔菲共识过程，通过两轮反复咨询，将证据细化为可操作的临床方案。共识阈值包括李克特评分≥4和变异系数<；0.25.结果最终确定的泄漏管理体系包括预防、评估和干预三个领域，共分为11个主题和46个可操作项目。关键的组成部分包括预防策略的回肠造口漏，动态造口器具的选择，并处理泄漏相关的皮肤损伤的协议。专家共识强调了个性化护理的重要性，并根据流出物特征和产气量进行调整。德尔菲面板达到了高一致性(Cr = 0.89, Kendall's W = 0.194-0.137, P <；0.05)。本研究提出了一种针对癌症预防性回肠造口幸存者需求的可靠的、循证的泄漏管理系统。通过将高质量的证据与实际的临床见解相结合，该系统为改善患者预后和提高现实环境中造口护理的质量提供了有价值的指导。系统评价注册号：es20245104。

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引用次数: 0

The effect of symptom distress on medication adherence in patients with breast cancer undergoing endocrine therapy: A moderated mediation model 乳腺癌内分泌治疗患者症状困扰对药物依从性的影响：一个有调节的中介模型

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-15 DOI: 10.1016/j.apjon.2025.100701

Huanxi Li , Chunlei Liu , Sangsang Ke , Linna Cui , Mengying Sun , Ying Bian , Yanru Song , Qian Lu

Objective

Poor medication adherence is common among breast cancer patients undergoing endocrine therapy. Although previous studies have shown that symptom distress, illness perception, and fear of recurrence can have a connection with medication adherence, the underlying mechanism remains unclear. This study explored the effect of symptom distress on medication adherence, the mediating role of illness perception between symptom distress and medication adherence, and the moderating role of fear of recurrence among those factors.

Methods

Symptom distress, illness perception, fear of recurrence, and medication adherence were assessed in 405 patients. A structural equation model verified the mediating role of illness perception, and a multi-cluster analysis tested the moderating role of fear of recurrence.

Results

Illness perception had a mediating effect between symptom distress and medication adherence (effect size: −0.213), accounting for 28% of the total effect. A significant difference was observed in the path coefficient of “illness perception → medication adherence” between the low and high fear of recurrence group (CR = |-3.578| > 1.96, P < 0.05). In the high fear of recurrence group, the association between symptom distress and medication adherence was mediated by illness perception, while in the low fear of recurrence group, medication adherence was only connected by symptom distress.

Conclusions

The links of symptom distress and medication adherence were mediated by illness perception, whereas fear of recurrence moderated this relationship. To improve medication adherence, oncology nurses should alleviate symptom distress and implement interventions for patients with high fear of recurrence to reduce negative illness perception.

目的乳腺癌内分泌治疗患者药物依从性较差。尽管先前的研究表明，症状困扰、疾病感知和对复发的恐惧可能与药物依从性有关，但其潜在机制尚不清楚。本研究旨在探讨症状困扰对药物依从性的影响，疾病知觉在症状困扰与药物依从性之间的中介作用，以及复发恐惧在这些因素中的调节作用。方法对405例患者进行症状困扰、疾病感知、复发恐惧及药物依从性评估。结构方程模型验证了疾病知觉的中介作用，多聚类分析检验了复发恐惧的调节作用。结果疾病知觉在症状困扰和药物依从性之间具有中介作用（效应量为- 0.213），占总效应的28%。低恐惧复发组与高恐惧复发组的“疾病感知→服药依从性”路径系数(CR = |-3.578| >；1.96, P <；0.05)。在高恐惧复发组中，症状困扰与药物依从性之间的关联通过疾病感知介导，而在低恐惧复发组中，药物依从性仅通过症状困扰介导。结论症状困扰与药物依从性的关系受疾病知觉的调节，而复发恐惧调节了两者之间的关系。为提高依从性，肿瘤科护士应减轻患者的症状困扰，并对复发高度恐惧的患者实施干预措施，以减少对疾病的负面认知。

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引用次数: 0

Shared-care management standards of palliative care in Chinese adults: A Delphi study 中国成人姑息治疗共享医疗管理标准：德尔菲研究

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing

Pub Date : 2025-04-15 DOI: 10.1016/j.apjon.2025.100702

Junchen Guo , Linghao Zeng , Yunyun Dai , Xianghua Xu , Yonghong Hu , Yongyi Chen

Objective

Shared-care management (SCM) in palliative care is a collaborative model where shared care teams work in partnership with patients' original health care providers, employing multimodal strategies including consultations and coordinated referrals to enhance quality of care for patients. The evidence regarding its implementation remains fragmented and lacks detailed explanations, which impedes its application in clinical practice. This study aimed to develop a SCM standard of palliative care in adults in mainland regions of China.

Methods

Initial standard framework identification was achieved via literature evidence summary. From April to August 2024, two rounds of Delphi method was conducted with the purposes of modifying the standard. To establish consensus, items with a mean importance score > 3.50 and the coefficient of variation of item scores < 0.25 were retained.

Results

The first round involved 35 experts, with a follow-up participation of 33 in the second round. The Kendall concordance coefficients of the two rounds of experts consultation were 0.128 and 0.134, respectively (all P < 0.001), indicating consensus among the experts. At the end of the second round, the average importance score of each item was 4.73–5.00. A total of 8 modules including SCM team, applicable population, process of SCM, contents of SCM, start time, precautions, effectiveness evaluation and quality control, and the corresponding 22 items were finally identified in this standard.

Conclusions

The establishment of the standard in this study provides a critical framework that can be adopted by health care institutions to ensure that SCM services are delivered uniformly and effectively in mainland regions of China.

目的姑息治疗中的共享医疗管理（SCM）是一种协作模式，共享医疗团队与患者原来的医疗服务提供者合作，采用包括会诊和协调转诊在内的多模式策略来提高患者的护理质量。关于其实施的证据仍然支离破碎，缺乏详细的解释，这阻碍了其在临床实践中的应用。本研究旨在建立中国大陆地区成人姑息治疗的SCM标准。方法通过文献证据总结，初步确定标准框架。从2024年4月到8月，进行了两轮德尔菲法，目的是修改标准。为了建立共识，具有平均重要性得分的项目>；3.50和项目得分变异系数<；保留0.25个。结果第一轮有35名专家参与，第二轮有33名专家参与。两轮专家咨询的肯德尔一致性系数分别为0.128和0.134(均P <；0.001)，表明专家之间的共识。在第二轮结束时，每个项目的平均重要性得分为4.73-5.00。本标准最终确定了SCM团队、适用人群、SCM过程、SCM内容、启动时间、注意事项、有效性评价和质量控制等8个模块，共22个项目。结论本研究标准的建立为医疗机构提供了一个重要的框架，以确保供应链管理服务在中国大陆地区的统一和有效提供。

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引用次数: 0