Development and preliminary testing of the cancer-related fatigue comprehensive assessment scale in cancer survivors.

BACKGROUND: Tailored management of cancer-related fatigue (CRF) is important for effective coping; however, it has been hindered by the lack of a comprehensive tool that assesses both symptoms and treatable influencing factors. AIMS AND OBJECTIVES: The aim was to develop a cancer-related fatigue comprehensive assessment scale (CRF-CAS) and assess its psychometric properties. DESIGN: This was a mixed-method study. METHODS: The study included two phases which were conducted in Zhejiang Province, China. In phase one, a literature search, brainstorming sessions, Delphi studies, cognitive interviews and a pilot study were conducted to construct and revise CRF-CAS indicators. In phase two, a questionnaire-based survey was conducted among cancer survivors. Item analysis was used to select and optimize indicators. Cronbach's α was calculated for reliability analysis. Validity analysis included concurrent validity and structural validity. RESULTS: A 93-item tool was initially constructed. Phase one ended with revision and optimization. The preliminary scale included five dimensions (CRF symptoms, physical activity, cognitive-emotional status, sleep status, nutritional status) and 30 items. The mean item-content validity index (I-CVI) and scale-level CVI universal agreement (S-CVI/UA) were .98, and the adjusted mean values of Kappa for indicators ranged from .91-1, as evaluated by the expert group. The Pearson correlation coefficient between the CRF-CAS and criterion scales ranged from .337-.862. Cronbach's α coefficient ranged from .624-.728. Respondents agreed that the scale was acceptable for administration and that it contributed to decision-making in fatigue management. Confirmatory factor analysis (CFA) indicated that the CRF-CAS fit well. CONCLUSIONS: The construction process of the CRF-CAS, involving panel discussion and expert and participant evaluations, was shown to be scientific and feasible. The CRF-CAS had relatively good validity and reliability in version 5 of its preliminary scale, which requires further improvement in future studies.

Unmet Supportive Care Needs and Associated Factors: a Cross-sectional Survey of Chinese Cancer Survivors.

To assess cancer survivors' unmet supportive care needs and associated factors. Limited evidence is available about the supportive care needs of Chinese cancer survivors to inform future service planning. A cross-sectional survey was conducted (STROBE cross-sectional checklist used for report). Standardized questionnaires were administered to 364 cancer survivors. Using the Supportive Care Framework as conceptual framework, factors concerning individuals' cognitive appraisals of their situation and social resources were examined to explore their association with unmet supportive care needs. The most common unmet supportive care needs included concern about the cancer coming back (51.5%), the need for up-to-date information (49.3%), collaborative management with the medical team (48.8%), and financial support (48.8%). Factors associated with greater strength of unmet supportive care needs included being female, having higher personal support, and higher self-efficacy pertaining to social relationship. Having lower support from family and friends was a contributing factor associated with greater strength of unmet needs in comprehensive cancer care and relationship, as was lower self-efficacy pertaining to uncertainty management associated with greater strength of unmet needs in quality of life, and lower self-efficacy pertaining to health professional interaction associated with greater strength of unmet needs in information. Chinese cancer survivors experience a number of unmet supportive needs. Female and rural cancer survivors, and those with lower social support level and self-efficacy are susceptible to having higher levels of unmet supportive care needs. Consistent information provision and peer support system establishment are two potentially beneficial approaches to meet cancer patients' long-term supportive care needs. Females and rural cancer survivors, those with less support from family and friends, and those with lower self-efficacy in interactions with health professionals and in managing uncertainty are especially at risk for unmet supportive care needs.

[Research Progress of Adaptive Intervention].

Adaptive intervention(AI)is a methodology which dynamically evaluates adaptive variables at decision points and timely adjusts and develops tailored strategies to meet individual needs.The study reviewed the origin and development and elaborated the core elements(including intervention outcomes,intervention options,decision points,tailoring variables,and decision rules)and the classification of AI.Based on the literature,the key points of the design and implementation of AI were prospected,which can provide evidence for the research and development of health behavior intervention.

The effects of Tai Chi on quality of life of cancer survivors: a systematic review and meta-analysis.

PURPOSES: To assess the effects of Tai Chi on quality of life (QOL) of cancer survivors. METHODS: The following databases were searched: PubMed, Cochrane CENTRAL, EBSCO (including MEDLINE, CINAHL, and other databases), ScienceDirect, CNKI, Wangfang Data, and CQVIP until April 25, 2018. Randomized controlled trials (RCTs) published in English or Chinese examining the effects of Tai Chi intervention for cancer survivors were included. The primary outcome was QOL; the secondary outcomes were limb function/muscular strength, immune function indicators, cancer-related fatigue (CRF), and sleep disturbance. Methodological quality was assessed using the Cochrane Risk of Bias tool. Results of RCTs were pooled with mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CI). Quality of evidence for each outcome was assessed with the GRADE system. RESULTS: Twenty-two RCTs were included in this review. Tai Chi improved the physical (SMD 0.34, 95%CI 0.09, 0.59) and mental health (SMD 0.60, 95%CI 0.12, 1.08) domains of quality of life. The intervention improved the limb/muscular function of breast cancer survivors (SMD 1.19, 95%CI 0.63, 1.75) and in mixed samples of cancer survivors reduced the levels of cortisol (MD - 0.09, 95%CI - 0.16, - 0.02), alleviated CRF (SMD - 0.37, 95%CI - 0.70, - 0.04), and promoted sleep (SMD - 0.37, 95%CI - 0.72, - 0.02). CONCLUSION: There is low-level evidence suggesting that Tai Chi improves physical and mental dimensions of QOL and sleep. There is moderate-level evidence suggesting Tai Chi reduces levels of cortisol and CRF and improves limb function. Additional studies with larger sample sizes and with higher-quality RCT designs comparing different regimens of Tai Chi are warranted.

Development and preliminary testing of a questionnaire to measure mobile health information-seeking behaviour in people with cancer.

AIM: The aim of the study was to develop and psychologically test the mobile health information-seeking behaviour (MHISB) questionnaire in people with cancer. DESIGN: Instrument development. METHODS: The study was conducted in three phases in a southeastern city of China from May 2017 to April 2018. In phase one, an item pool was constructed based on a literature review and semistructured interviews. In phase two, expert evaluation and cognitive interviews were used to evaluate the content validity of the questionnaire. In phase three, a cross-sectional study was conducted with people with cancer. Cronbach's α was calculated for reliability analysis. Validity evaluation included content validity and construct validity. RESULTS: The developed MHISB questionnaire has four dimensions (information-seeking frequency, information-seeking self-efficacy, health information evaluation and information-seeking willingness) and 25 items. Psychometric findings were satisfactory and supported the questionnaire's reliability. CONCLUSIONS: The construction process of the MHISB questionnaire was scientific and feasible. The MHISB questionnaire had acceptable validity and reliability, and it requires further improvement in future studies.

Development of mobile health-based self-management support for patients with lung cancer: A stepwise approach.

AIM: To develop self-management support platform on mobile for Chinese patients with lung cancer. DESIGN: A stepwise approach with combination of methods. METHODS: Literature review was carried out to construct preliminary framework and develop detailed content for self-management modules. A semistructured interview was conducted to elicit preference in the content and platform of self-management modules with 15 patients with lung cancer. Delphi study was performed to evaluate and improve the content of modules with 13 experts. A pilot study was conducted to test the mobile health-based self-management support modules with 13 patients with lung cancer. RESULTS: A social network software-based WeChat public account "Symptom Self-Management" for patients with lung cancer was developed and preliminarily tested with positive feedback. Three modules were designed and presented, including symptom management (cancer-related fatigue, cough, dyspnoea, pain, nausea and vomiting), emotion management and role management. CONCLUSION: This study showed that patients with lung cancer have diversified supportive care needs after discharge. A bottom-up and stepwise approach to develop mobile health-based self-management support tool has shown to be feasible and valuable. Theory guidance, user requirement exploration, evidence-based information and expert evaluation are key elements of the process. IMPLICATIONS FOR PRACTICE: The WeChat Public Account "Symptom Self-Management" could be used as sustainable platform to support patients with lung cancer in dealing with common challenges. It provides professional information, self-assessment tools, self-management skills and peer-support platform. Information presented in both text and audio forms enables patients' easy access to the platform.