Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis.

PURPOSE: Exercise-based cancer rehabilitation via digital technologies can provide a promising alternative to centre-based exercise training, but data for cancer patients and survivors are limited. We conducted a meta-analysis examining the effect of telehealth exercise-based cancer rehabilitation in cancer survivors on cardiorespiratory fitness, physical activity, muscle strength, health-related quality of life, and self-reported symptoms. METHODS: PubMed, Web of Science, and reference lists of articles related to the aim were searched up to March 2023. Randomized controlled clinical trials were included comparing the effect of telehealth exercise-based cancer rehabilitation with guideline-based usual care in adult cancer survivors. The primary result was cardiorespiratory fitness expressed by peak oxygen consumption. RESULTS: A total of 1510 participants were identified, and ten randomized controlled trials (n = 855) were included in the meta-analysis. The study sample was 85% female, and the mean age was 52.7 years. Meta-analysis indicated that telehealth exercise-based cancer rehabilitation significantly improved cardiorespiratory fitness (SMD = 0.34, 95% CI 0.20, 0.49, I2 = 42%, p < 0.001) and physical activity (SMD = 0.34, 95% CI, 0.17, 0.51, I2 = 71%, p < 0.001). It was uncertain whether telehealth exercise-based cancer rehabilitation, compared with guideline-based usual care, improved the quality of life (SMD = 0.23, 95%CI, -0.07, 0.52, I2 = 67%, p = 0.14) body mass index (MD = 0.46, 95% CI, -1.19, 2.12, I2 = 60%, p = 0.58) and muscle strength (SMD = 0.07, 95% CI, -0.14, 0.28, I2 = 37%, p = 0.51). CONCLUSION: This meta-analysis showed that telehealth exercise cancer rehabilitation could significantly increase cardiorespiratory fitness and physical activity levels and decrease fatigue. It is uncertain whether these interventions improve quality of life and muscle strength. High-quality and robust studies are needed to investigate specific home-based exercise regimens in different cancer subgroups to increase the certainty of the evidence.

Effectiveness of creative arts therapy for adult patients with cancer: a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to assess the effectiveness of creative arts therapy (CAT) interventions on the health outcomes of adult patients with cancer. METHODS: A comprehensive search was conducted in six databases from their inception to June 10, 2023, with no restrictions on sex, age, cancer type, cancer stage, or treatment type. The Cochrane Risk of Bias (RoB2) tool for randomized controlled trials (RCTs) and the equivalent tool for non-RCTs (ROBINS-I) were used to assess the risk of bias. Meta-analyses were conducted to pool estimates of the effects of CAT on patients' health-related outcomes. A narrative synthesis of outcomes was performed where meta-analysis was not appropriate. RESULTS: A total of 25 studies (8 RCTs and 17 quasi-RCTs) involving 1489 cancer patients and survivors were included in the final data analysis. Most studies focused on patients with mixed cancer diagnoses who were undergoing active chemotherapy treatment. Most studies utilized painting, drawing, and/or sculpting as CAT interventions. The overall risk of bias in the included studies was moderate to high. Meta-analysis demonstrated a significant improvement in quality of life (SMD with 95% CI = 17.50, 10.05-24.95, P =.0000) and the social aspect of quality of life in cancer patients (SMD with 95% CI = 03.1 (0.06-0.55), P = .01), but no significant effects were found for depressive symptoms and coping strategies among patients who participated in CAT compared to control groups. Narrative analysis and non-RCTs suggested the potential of CAT in reducing levels of depression and anxiety, as well as improving self-image, hope, emotional expression/state, and processing in patients with cancer. However, inconsistent findings were reported regarding the effectiveness of CAT interventions on fatigue, spirituality, and psychosomatic distress/symptom intensity. CONCLUSION: The findings indicated significant and potential benefits of CAT for individuals with cancer, primarily related to quality of life. However, caution is needed in interpreting these findings due to limitations in the methodologies utilized in the included studies. Further large-scale RCTs are needed to examine the effectiveness of CAT on health outcomes, particularly in relation to self-image, hope, and emotional expression/state and processing among patients with cancer or those in palliative care.

Effectiveness of dance movement therapy and dance movement interventions on cancer patients' health-related outcomes: a systematic review and meta-analysis.

OBJECTIVES: This review examined the effectiveness of using dance movement therapy (DMT) and dance movement interventions (DMIs) with cancer and palliative care patients. METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases were searched from inception to July 9, 2022, without limits on year or age. Searching was updated on July 10, 2023. The risk of bias was assessed by the Cochrane (RoB 2) and ROBINS-I tools. Meta-analyses were conducted to pool estimates of the effects of DMT and DMI on patients' health-related outcomes. A narrative synthesis of outcomes was performed where meta-analysis was not appropriate. RESULTS: Among a total of 16 studies included in this review, nine were randomized controlled trials and seven were non-randomized trials, with a total of 893 participants. Only six of these studies were fully or partially described as true DMTs (some with less clarity than others), whereas the majority (n = 10) were DMIs with unclear therapeutic alignment. Most studies focused on female patients with breast cancer. Cancer patients undergoing palliative care received little attention. The overall risk of bias from the evaluated studies was high. Meta-analysis of two trials revealed that DMTs had no effect on QOL in cancer patients (SMD - 0.09, 95% CI - 0.21-0.40, P = 0.54), while narrative analysis and non-randomized trials showed no overall effect of DMTs on anxiety, depression, body image, self-esteem, or sleep disturbance but significant positive effects on perceived stress, pain severity, and pain interference. DMIs had significant positive effects on cancer patients' depression (SMD - 0.53, 95% CI - 0.93 to - 0.14, P = 0.008) and fatigue (SMD - 0.42, 95% CI - 0.70 to - 0.14, P = 0.003). DMI trials synthesized narratively showed an effect on patients' body image, self-esteem, physical function, right and left handgrip strength, life satisfaction, and the mental component of QOL. CONCLUSION: Both DMT and DMIs had promising effects on several health outcomes, but results were inconsistent, and the evidence was weak. The reviewed studies' low evidence quality and small sample sizes affected the findings' robustness and reliability. Large-scale, high-quality randomized controlled trials with sufficient sample sizes, and clear and veracious DMT and DMI protocols and data are required to provide more credible research evidence and influence practice.

Phenomenography: An emerging qualitative research design for nursing.

BACKGROUND: Phenomenography emerged from pedagogy to examine the qualitatively different ways that individuals experience and perceive the same phenomenon. Despite its uniqueness, the uptake of phenomenography in nursing research is still limited. Potentially, this may be related to confusion regarding what the design is about, its philosophical underpinnings and how distinct it is from other qualitative designs. OBJECTIVES: To offer a better understanding of phenomenography by comparing it with other established qualitative research designs, examining its theoretical foundations, highlighting some studies that have employed the approach in nursing and offering methodological guidance to improve its uptake in nursing. DESIGN: Discussion paper. FINDINGS: Compared to the traditional qualitative designs employed in nursing, phenomenography has been utilized in fewer studies. The ontological, epistemological and methodological basis of phenomenography highlights it as a distinct design. The strength of phenomenography lies in its emphasis on understanding the collective variations between participants and presenting these holistically as an 'outcome space'. DISCUSSION: Phenomenography is a distinct qualitative research approach that presents a unique opportunity for nursing to further its use. Issues regarding bracketing, the inclusion of phenomenography studies in qualitative meta-synthesis and employing a hermeneutic approach to phenomenography are avenues for further work in nursing. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution.

Compassionate care during the COVID-19 pandemic.

BACKGROUND: There was a substantial documented call for healthcare professionals to provide compassionate care during the COVID-19 pandemic and significant criticism voiced when it was lacking. This study aimed to explore perspectives on compassionate care among healthcare professionals providing care during the COVID-19 pandemic. The study focuses on healthcare professionals who participated in a wide range of COVID-19 measures, including testing, quarantine, diagnosis, and care provision (patients with COVID-19 or patients with other illnesses and comorbid with COVID-19). METHODS: A qualitative design with an interpretative phenomenological analysis approach was used. Twenty frontline healthcare professionals (15 nurses and five physicians) who had worked in COVID-19 facilities in China were interviewed individually. RESULTS: Participants stated that a commitment to 'offering oneself' and 'balancing the advantages/disadvantages' in providing care during the pandemic were key to alleviate population-level suffering. On a personal level, they described a desire for obtaining 'mutual support' and improving 'professional competencies' to safeguard their physical and mental well-being. Two professional competencies were notable: coping with grief and implementing infection control across the organization. Additionally, they emphasized the importance of receiving support from the health care organization, the public, and leaders in creating an 'environment conducive to fostering compassionate care.' CONCLUSION: Healthcare professionals recognized the centrality of compassionate care during the pandemic which entailed a commitment to offering themselves, the balancing of advantages and disadvantages in order to find the best solution, as well as the need to safeguard themselves using professional competencies. Such findings can enrich the contemporary understanding of compassion, including when it is lacking. Support from the healthcare organization, the public, and leadership were crucial in fostering compassionate care in healthcare professionals during the pandemic and in moving the field forward in the future.

Effects of mind-body exercise on physical and psychosocial well-being of stroke patients: A systematic review and network meta-analysis.

This study conducted pairwise and network meta-analysis to evaluate the effectiveness of three mind-body exercise interventions (Tai Chi, Qigong, and yoga) on physical capacity, psychological well-being, and quality of life in stroke patients. The research encompassed 30 studies involving 2107 participants and utilized the Risk of Bias 2.0 tool for quality assessment. Pairwise analysis revealed that all three mind-body exercises significantly enhanced patients' quality of life. Tai Chi demonstrated the most comprehensive improvements in balance, limb motor function, activities of daily living, and depression. Network meta-analysis indicated that Qigong was the most effective in improving balance and quality of life for post-stroke patients, followed by Tai Chi. These findings underscore the positive impact of mind-body exercises on both physical and psychosocial outcomes in stroke patients. However, further research involving rigorously designed and adequately powered trials is necessary to enhance the level of evidence in this area.

Providing compassionate care via eHealth.

BACKGROUND: eHealth was widely used during the COVID-19 pandemic. Much attention was given to the technical aspects of eHealth, such as infrastructure and cost, while the soft skill of compassion remained underexplored. The wide belief in compassionate care is more compatible with in-person interactions but difficult to deliver via e-platforms where personal and environmental clues were lacking urges studying this topic. PURPOSE: to explore the experience of delivering compassionate care via an eHealth platform among healthcare professionals working to contain the COVID-19 pandemic. METHODS: A qualitative study design with an interpretative phenomenological analysis approach was used. Twenty healthcare professionals (fifteen nurses and five physicians) who provided care using technology platforms, such as telephone hotlines, mobile apps, and social media, were interviewed individually. ETHICAL CONSIDERATIONS: Permission to conduct the study was obtained from the Institutional Review Board. RESULTS: Participants stated that "eHealth enabled compassionate care during the pandemic" by ensuring patient care availability and accessibility. They shared experiences of "communicating compassionate care via eHealth" with suggestions of addressing patients' needs with empathy, adopting a structured protocol to guide eHealth communication, and using more advanced visual-media methods to promote human-to-human interaction. They recommended "setting realistic mutual expectations" considering the limitations of eHealth in handling complex health situations and staffing shortages. Participants considered "low eHealth literacy hinders compassion." Additionally, they recommended the need for "institutional/system-level support to foster compassionate care." CONCLUSION: Participants recognized the importance of integrating compassion into eHealth services. Promotion of compassionate care requires standardization of eHealth services with institutional and system-level support. This also includes preparing adequate staffing who can communicate compassionate care via eHealth, set realistic expectation, and adjust communication to eHealth literacy level while meeting the needs of their patients.

The associations between spiritual well-being, hope and psychological symptoms in Chinese childhood cancer patients: A path analysis.

AIMS: We aimed to test a model in which hope and spiritual well-being acted as protective factors against anxiety and depressive symptoms in childhood cancer patients (CCPs). We hypothesized that hope and spiritual well-being were mutually reinforcing factors that would both reduce anxiety and depressive symptoms. METHODS: Using path analysis, the hypothetical model was tested on a cross-sectional sample of 412 Chinese CCPs aged 8-17 years. Self-reported measures were used to obtain data on participants' social and clinical characteristics, spiritual well-being, hope, anxiety and depressive symptoms. RESULTS: The hypothetical model was supported. Results suggested that sex, treatment type and diagnosis predicted spiritual well-being; diagnosis and time since diagnosis predicted hope. Spiritual well-being and hope were mutually predictive and mutually reinforcing, and were both negatively associated with anxiety and depressive symptoms. This model predicted 40% of the variance in spiritual well-being, 37% in hope, 39% in depressive symptoms, and 28% in anxiety. CONCLUSION: Spiritual well-being and hope were mutually reinforcing and served as protective factors against anxiety and depressive symptoms. These support the value for integrating spiritual and hope elements in developing interventions for CCPs to improve their spiritual and psychological well-being along the disease trajectory.

Systematic review and meta-analysis of the effectiveness of expressive writing disclosure on cancer and palliative care patients' health-related outcomes.

OBJECTIVES: This review aimed to synthesize the available evidence on the effectiveness of expressive writing (EW) on health outcomes of patients with cancer. METHODS: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases were searched from 1986 to 9 July 2022. The searches were updated on 3 October 2023. Methodological quality was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and ROBINS-I tool for non-RCTs Mixed Methods Appraisal Tool. Narrative synthesis of outcomes was performed where meta-analysis was not appropriate. RESULTS: Thirty-four studies with 4316 participants were identified, including 31 RCTs and three non-RCTs. Twenty-one studies focused on women with breast cancer; the remainder recruited people with various cancer types. There was a significant improvement in fatigue (SMD = - 0.3, 95% CI - 0.55 to - 0.66, P = .002), passive mood (MD = - 3.26, 95% CI = - 5.83 to - 0.69, P = 0.001), and the physical dimension of quality of life (MD = 3.21, 95% CI 0.18 to 6.25, P = 0.04) but not for anxiety, depression, and global quality of life among patients who participated in EW when compared with control groups. CONCLUSION: Findings showed some benefits of EW for people with cancer, but not necessarily in anxiety or depression. Heterogeneity in the delivery of interventions and their content, and shortcomings in the methodologies used highlight the need for stronger evidence in the field through high-quality trials and consistencies in the protocol, focusing on outcomes that this review highlighted as potential outcome targets.

A meta-ethnography of developing and living with post-burn scars.

INTRODUCTION: Post-burn scarring is often cosmetically unappealing and create discomfort. This makes it crucial to understand the experience of individuals living with scars which can offer insights into their recovery. This review sought to develop an in-depth understanding of living with post-burn scars. DESIGN: A systematic review and meta-ethnography approach were employed. We utilized an interpretive approach to inductively generate codes. These codes were examined iteratively using a constant comparison strategy following which they were re-interpreted to formulate themes which formed the basis of undertaking a narrative synthesis. RESULTS: Twenty-five studies were retained. The analytical process yielded two themes: emergence of a new identity and living with the redefined self. The experience of living with scars is entwined with the initial trauma as the scars served as a permanent reminder of the injury. Emergence of a new identity involved a process of meaning making, mourning the loss of the old self, confronting the new self, reconciling the remains of the old self with the new, rebuilding a new identity, and navigating through functional restrictions. These processes were particularly challenging for persons involved in self-immolation. Positive coping and changing one's perspective emerged as strategies to facilitate living with the redefined self. CONCLUSION: Living with scars is a challenging process which is more difficult for persons whose injuries are due to self-immolation (act of burning oneself). The findings highlight a latent yet ongoing process towards subjective recovery. Clinicians need to be aware of the processes and incorporate these into rehabilitation programmes. CLINICAL RELEVANCE: Burn survivors need ongoing professional support to adjust to and live with the scars. Victims of self-immolation should be considered for early psychosocial support.

Perception of eHealth Programs for Cardiovascular Health: Qualitative Systematic Review and Meta-synthesis.

BACKGROUND: Despite emerging evidence on the effectiveness of eHealth interventions in improving cardiovascular health, little is known about the perception of use and efficacy of these interventions and real-world application. OBJECTIVE: We sought to develop an in-depth understanding of the perceptions of eHealth interventions in improving cardiovascular health. METHODS: This is a systematic review and meta-synthesis of qualitative studies. A comprehensive search of multiple databases and a manual search of the references list were conducted. Meta-synthesis of qualitative data was performed to review and interpret the findings. The study report followed the ENTREQ checklist. RESULTS: Four themes emerged regarding perceptions of eHealth interventions: preferred eHealth intervention design features, enabling healthcare professionals' support, eHealth engagement for health benefits, and barriers to eHealth engagement. Intervention design features should integrate motivational elements, use an eHealth literacy lens, and enhance cultural relevance. Healthcare professionals appreciated these new working methods but voiced concern about competency building. Real-world usage initiation was driven by perceived needs and usefulness, whereas persistent engagement was inspired by intrinsic motivation in participants. CONCLUSIONS: eHealth interventions were appreciated as a valuable opportunity for providing alternative/supplementary cardiac care for health optimization. Participants commented on the need for more explicit and accurate health information presentation, and they appreciated the motivational elements in empowering them with self-determination over daily self-care behaviors. Professionals raised the need for specific guidance to enhance competency and intervention fidelity when delivering eHealth care.

Technology: A metaparadigm concept of nursing.

Undoubtedly, technology continues to permeate the world at an unprecedented pace. The discipline of nursing is not alien to this phenomenon as nurses continue to employ various technological objects and applications in clinical practice, education, administration and research. Despite the centrality of technology in nursing, it has not been recognised as a metaparadigm domain of interest in the discipline of nursing. Thus, this paper sought to examine if technology truly reflected a metaparadigm domain using the four requirements posited by Fawcett. Using these requirements, we examined the onto-epistemology of technology in relation to nursing and conclude that technology potentially represents a distinct domain that intersects with nursing (particularly, from the humanities perspective). Also, technology encompasses some phenomena of interest to the discipline of nursing, demonstrates perspective-neutrality, and is international in scope and substance albeit with some nuances which do not fit well with nursing onto-epistemology. Put together, it is highlighted that technology intersects with the existing metaparadigm domains (person, health, environment and nursing) which positions it as a potential phenomenon of interest to the discipline of nursing requiring further work to articulate its position and role.

Analysis of the unmet needs of Palestinian advanced cancer patients and their relationship to emotional distress: results from a cross-sectional study.

BACKGROUND: Although several studies assessing the needs of advanced cancer patients have been conducted globally, most have focused on a specific type of cancer such as lung or breast cancer. The variation across studies has also created difficulties in generalizing the results and applying the findings in other countries. The aim of this study was to provide comprehensive information on the needs of Palestinian advanced cancer patients. The quality of life (QOL), distress levels, depression, anxiety, and spiritual well-being of the patients were also assessed. METHODS: A hospital-based study with a cross-sectional design was conducted on a convenience sample of patients aged 18 or above who had been diagnosed with advanced-stage cancer. The unmet needs of the patients were assessed using the Short form of the Supportive Care Needs Survey (SCNS-SF34). Four instruments were utilized to examine their distress, anxiety, depression, QOL, and spirituality. A modified Supportive Care Framework was adopted to guide the design of this study. Descriptive statistics and hierarchical linear regression were utilized to analyse the data. RESULTS: Of the 404 cancer patients invited to the study, 379 patients consented to participate and complete the questionnaire. Of them 96.8% stated that they had at least one 'moderate to high' level unmet need. The most frequent unmet needs were those in the physical aspects of daily living (Mean 58.94; SD ± 20.93) and psychological (Mean 58.84; SD ± 19.49) domains. Most of the patients (91%) were physically ill and reported experiencing physical symptoms. About 78.1% had a high level of distress. Almost 90% reported signs of depression and anxiety. Although they felt that their spiritual well-being was good, their QOL was poor. Hierarchical linear regression analyses confirmed that educational level, age, gender, marital status, cancer stage, cancer type, physical symptoms, depression, anxiety, distress, QOL, and spirituality were independently associated with unmet supportive care needs. CONCLUSION: Palestinian advanced cancer patients exhibit a significantly higher prevalence of unmet needs than those in other countries, indicating a need to develop a palliative care programme within the healthcare system. They have a great need for physical, emotional/psychosocial, self-management and other services, which should be made available to them, particularly in the routine delivery of cancer care.

Gathering policymakers' perspectives as an essential step in planning and implementing palliative care services at a national level: an example from a resource-limited country.

BACKGROUND: Despite increasing recognition of the role played by palliative care (PC) services, the priorities of policymakers in supporting PC remain unclear and have sometimes engendered controversy. There are few studies exploring policymakers' perspectives towards PC services, with most shedding light on obstacles to PC development. Furthermore, no study has explored policymakers' perspectives towards providing PC at the national level in resource-limited countries. This study provides a platform for providing PC as part of the Palestinian healthcare system (HCS) by exploring policymakers' perspectives on PC, an essential step to developing a PC programme. METHODS: A descriptive qualitative study design was employed using semi-structured interviews. Participants were those identified as responsible for making executive and legislative decisions about health services (including PC) in the HCS. Data were analysed using qualitative content analysis. RESULTS: Twelve decision and policymakers participated in the study. Four categories were generated from the content analysis: (1) the nature of current PC healthcare services, (2) the potential benefits of PC, (3) challenges to providing PC, and (4) considerations in providing PC. The current PC services provided to Palestinian patients with life-limiting illnesses and their families are not comprehensive, and are limited to symptom management. There is a Palestinian national strategic plan for developing PC; however, the development goals are not clearly defined, and the plan's capabilities are inadequate. Several challenges to the provision of PC were found to relate to issues of education and training, the allocation of funding, and the availability of medications. CONCLUSIONS: Integrating PC into the Palestinian university curricula as a compulsory course and establishing higher degree programmes in PC to overcome the shortage of PC specialists is required. Developing policies aligned with national laws could help enhance health services to patients and their families and resolve several challenges. Cooperating with national and international institutions in seeking funding could boost PC development and medication availability.

Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews.

BACKGROUND: Despite the significant benefits of palliative care (PC) services for cancer patients, multiple challenges hinder the provision of PC services for these patients. Low- and middle-income countries (LMICs) are witnessing a sharp growth in the burden of non-communicable diseases. There is a significant gap between demand and supply of PC in LMICs in current health services. This review aims to synthesise evidence from previous reviews and deliver a more comprehensive mapping of the existing literature about personal, system, policy, and organisational challenges and possible facilitators on the provision of PC services for cancer patients in LMICs. METHODS: A systematic review of reviews was performed following PRISMA guidelines. PubMed, EMBASE, SCOPUS, PsycINFO, Web of Sciences, CINAHL, and Cochrane Library databases were searched to identify review papers published between 2000 and 2018 that considered challenges and possible facilitators to PC provision. A modified socioecological model was used as a framework for analysing and summarising findings. RESULTS: Fourteen reviews were included. The reviews varied in terms of aim, settings, and detail of the challenges and possible facilitators. The main challenges of personal and health care systems included knowledge deficits and misunderstandings from patients, families, the general public, and health care providers about PC; and inadequate number of trained workforce. Besides, limited physical infrastructure, insufficient drugs for symptom relief and lack of a comprehensive national plan for implementing PC were the core organisational and policy level challenges that were recognised. Furthermore, the main possible facilitators that were identified included provision of adequate training for health care providers and health education for patients, families and the general public to enhance their knowledge, beliefs, and attitudes to PC. Finally, involvement of policymakers and making drugs available for symptom relief should also be in place to improve the health care systems. CONCLUSIONS: Understanding challenges to the provision of PC for people with cancer could help in the development of a PC pathway in LMICs. This knowledge could be used as a guide to develop an intervention programme to improve PC. Political influence and support are also required to ensure the sustainability and the provision of high-quality PC.

Factors Impacting on Patient-Centered Communication Skills and Their Opportunities to Be Involved in Decision-making From the Perspective of Patients With Cancer, Informal Caregivers, and/or Healthcare Professionals: A Systematic Review.

BACKGROUND: Active participation of cancer patients and their caregivers in decision-making, along with high-quality communication, is crucial in patient-centered cancer management. Although numerous factors affecting patients' communication and decision-making involvement have been identified, it is still unclear which ones are the most prevalent and critical. OBJECTIVE: To identify factors that contribute to high-quality patient-centered communication and decision-making participation from the perspectives of cancer patients, informal caregivers, and/or healthcare professionals. METHODS: A systematic review was conducted, using 9 databases to retrieve primary research articles published from 2010 to February 17, 2023, updated on December 13, 2023. Methodological quality was assessed using the Mixed Methods Appraisal Tool (version 18). The socioecological model of communication was utilized as analytical framework for summarizing the results. RESULTS: Fifty-two studies were included. The most frequently reported factors were predominantly articulated at the individual, interpersonal, and societal levels. Although the patients' lack of knowledge and limited language proficiency were the frequent patient-level barriers, the perceived lack of knowledge and lack of training of professionals were the crucial and current professional-level barriers, as reported in studies published in 2016 onward. To circumvent these factors, it is critical to enhance professionals' knowledge, communication skills, and patient relationships. CONCLUSIONS: Recognizing barriers and facilitators could help in the development of strategies to overcome these barriers and enhance patient participation in clinical communication. IMPLICATION FOR PRACTICE: The findings could guide the development of programs to enhance patient-professional communication skills. Further cross-cultural studies are needed to understand culture's impact on communication effectiveness and decision-making participation.

Technology-assisted cardiac rehabilitation for coronary heart disease patients with central obesity: a randomized controlled trial.

BACKGROUND: Limited empirical evidence is available regarding the effect of technology-assisted cardiac rehabilitation (TACR) among coronary heart disease (CHD) patients with central obesity. AIM: To determine the effects of 12-week TACR on health outcomes of patients with CHD. DESIGN: Two-arm randomized controlled trial. SETTING: Cardiovascular department of a regional hospital. POPULATION: Coronary heart disease patients with central obesity. METHODS: The study randomized 78 hospitalized CHD patients to receive either the 12-week TACR intervention or usual care. Guided by social cognitive theory, the intervention began with an in-person assessment and orientation session to assess and identify individual risks and familiarize with the e-platform/device before discharge. After discharge, patients were encouraged to visit the interactive CR website for knowledge and skills acquisition, data uploading, use the pedometer for daily step tracking, and interact with peers and professionals via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). RESULTS: Participants in the intervention group showed significant improvement in daily steps at six weeks but not 12 weeks (T1: ß=2713.48, P=0.03; T2:ß=2450.70, P=0.08), weekly sitting minutes (T1: ß=-665.17, P=0.002; T2: ß=-722.29, P=0.02), and total (vigorous, moderate, and walking) exercise at 12-week (ß=-2445.99, P=0.008). Improvement in health-promoting lifestyle profile (T1: ß=24.9, P<0.001; T2: ß=15.50, P<0.001), smoking cessation (T2: ß=-2.28, P<0.04), self-efficacy (T2: ß=0.63, P=0.02), body mass index (T1:ß =-0.97, P=0.03; T2: ß=-0.73, P=0.04) and waist circumferences (T1: ß =-1.97, P=0.003; T2: ß =-3.14, P=0.002) were identified. CONCLUSIONS: Results indicated the effectiveness of the TACR intervention in improving healthy behaviors and anthropometric parameters for CHD patients with central obesity. Individual assessment, collaborative action planning, and ongoing obesity management support should be highlighted in TACR programs for CHD patients. CLINICAL REHABILITATION IMPACT: Central obesity should be assessed and highlighted in TACR intervention as an independent risk factor that requires corresponding behavior change and body fat management.

Oncology nurses' lived experience of caring for patients with advanced cancer in healthcare systems without palliative care services.

BACKGROUND: Caring for patients with advanced cancer is complex and challenging, requiring varied expertise, including symptom management, communication skills, care coordination and emotional resilience. Within existing literature, the lived experiences of oncology nurses are poorly articulated in countries with a lower income where formal palliative care (PC) is absent. AIM: To explore the lived experiences of Gazan oncology nurses who provide care to patients with advanced cancer in healthcare systems, without formal palliative care infrastructure. METHODS: A phenomenological approach was adopted. Semi-structured interviews were conducted between January and April 2022, in the Turkish Palestinian Friendship Hospital. Thematic analysis used the themes (corporeality, relationality, spatiality and temporality) to facilitate reflection on the meaning of participants' lived experiences. RESULTS: Interviews were undertaken with 16 oncology nurses. The experience of the 'erosion of nurses' work when coping with anxious attachments to patients and families' was the overarching theme in nurses' views, characterised by five sub-themes: (1) inadequacy of PC training and resources, (2) serving humanity, (3) pride in their profession, (4) existential distress and the coping strategies used by nurses, and (5) reported stress and anxiety when caring for seriously ill patients and their families. CONCLUSIONS: The study sheds light on the challenges and powerful emotions experienced by oncology nurses who care for patients with advanced cancer, yet lack the necessary PC training and institutional resources. The findings indicate an urgent need for PC training for nurses within the Gazan healthcare system and other lower-income settings. Assessing nurses' emotions and relationships with patients and family caregivers is imperative to enable optimum care for patients with cancer and to foster resilience among their nurses.

Components, Models of Integration, and Outcomes Associated with Palliative/ end-of-Life Care Interventions in the Burn Unit: A Scoping Review.

Objective: To scope the literature to ascertain the components of palliative care (PC) interventions for burn patients, models of integration, and outcomes. Methods: Arksey and O'Malley scoping review design with narrative synthesis was employed and reported following the PRISMA-ScR guidelines. Primary studies reporting PC interventions in the burn unit were considered for inclusion. CINAHL via EBSCO, PubMed, EMBASE via OVID, Web of Science, and gray literature sources were searched from inception to June 2021. Results: Fifteen studies emerging from high-income settings were retained. Data were organized around three concepts: components of palliative/ end of life care in the burn unit; models of integration; and outcomes. The components of interventions based on the Robert Wood Johnson Foundation Critical Care End-of Life Group domains include decision-making, communication, symptom management and comfort care, spiritual support, and emotional and practical support for families. Consultative and integrative models were noted to be the strategies for integrating PC in the burn unit. The outcomes were varied with only few studies reporting healthcare staff related outcomes. Conclusion: PC may have the potential of improving end-of-life care in the burn unit albeit the limited studies and lack of standardized outcomes makes it difficult to draw stronger conclusions regarding what is likely to work best in the burn unit.

A distress thermometer with a cutoff score of ≥ 6 is the optimal point to identify highly distressed patients with advanced cancer stages in resource-limited countries without palliative care services.

Purpose: Although the distress thermometer (DT) scale has been widely validated and used in different cancer types and settings, an optimal cutoff score of DT is not defined to screen advanced cancer patients. The study aimed to define the optimal DT's cutoff score among advanced cancer patients in resource-limited countries without palliative care services and to assess the prevalence and factors associated with psychological distress among this population. Methods: A secondary analysis was performed. Three hundred seventy-nine patients were recruited from Palestine. Participants completed the DT and the Hospital Anxiety and Depression Scale (HADS). Receiver operating characteristic analysis (ROC) was used to define the optimal cutoff score for the DT against HADS-Total ≥15. Multiple logistic regression was utilized for identifying the factors associated with psychological distress of the DT. Results: A DT cutoff score ≥ 6 correctly identified 74% of HADS distress cases and 77% of HADS non-distress cases, with a positive predictive value (PPV) and negative predictive value (NPV) of 97% and 18%, respectively. The prevalence of distress was found to be 70.7%, and the major sources of distress were related to physical (n = 373; 98.4%) and emotional problems (n = 359; 94.7%). Patients with colon (OR = 0.44, 95% CI: 0.31 - 0.62) and lymphoid cancers (OR = 0.41, 95% CI: 0.26 - 0.64) were less likely to have psychological distress than patients with other types of cancer, whereas patients with lung (OR = 1.80, 95% CI: 1.20 - 2.70) and bone cancers (OR = 1.75, 95% CI: 1.14 - 2.68) were more likely to experience it. Conclusion: A cutoff DT score of 6 appeared acceptable and effective for screening distress in patients with advanced cancer stages. Palestinian patients exhibited a high level of distress, and the high prevalence supports the argument of using a DT within the standard delivery of cancer care to identify highly distressed patients. These highly distressed patients should then be involved in a psychological intervention programme.