Anaesthesia-related cognitive dysfunction following cardiothoracic surgery in late middle-age and younger adults: A scoping review.

AIM: This review aimed to evaluate factors associated with anaesthesia-related postoperative cognitive dysfunction (POCD) among adults younger than 65 years who underwent cardiothoracic surgeries. STUDY DESIGN: A systematic keyword search, following the scoping review framework, was performed in the PubMed and CINAHL databases. Original English-language studies that included adults younger than 65 years and addressed cognitive function after surgery along with anaesthesia management were included. Retrospective studies, animal research and in vitro and in vivo studies were excluded. RESULTS: Twenty-three articles were included (65.2% interventional studies). All studies lacked theoretical or conceptual frameworks. Ketamine's neuroprotective potential is questionable, and intravenous lidocaine may be considered a possible early agent for preventing POCD, but long-term effectiveness is uncertain. Compared to inhalational anaesthesia, total intravenous anaesthesia (TIVA) may be related to a decreased incidence of POCD. Variation in POCD assessment impacted the lack of homogeneity in obtained data. Moreover, the shorter-term timing of POCD evaluation such as in early days after surgery could be greatly influenced by medication and delirium. CONCLUSION: Although strategies such as TIVA, the use of neuroprotective anaesthetics and comprehensive preoperative assessments are suggested to prevent POCD, this multifactorial phenomenon cannot be explicitly attributed solely to anaesthetics or anaesthesia-related techniques. Use of standardized, reliable and valid tools for POCD assessment is encouraged for cross-study comparison. RELEVANCE TO CLINICAL PRACTICE: Nurses and certified nurse anaesthetists must be aware of risk factors for postoperative delirium and POCD so they can assess patients before and after surgery. Patients and caregivers need to be educated about cognitive changes after surgery and advised to report them to their health care provider if they occur.

Predictive factors associated with death depression in women with breast cancer.

A cross-sectional study with a convenience sample of 241 patients with breast cancer was conducted to investigate death depression and its explanatory factors in Iranian women who were diagnosed and undergoing treatment for breast cancer. Patients with significantly higher death depression were those who were housewives (ß = 0.6, p = 0.016), unskilled workers (ß = 15.8, p = 0.002), and retired (ß = 13.1, p = 0.002) as compared with those who were professionally employed with higher socio-economic status (ß = 17.4, p = 0.002); and those receiving combination therapy as compared to surgery only (ß = 6.3, p = 0.02). For patients with higher spiritual health scores, death depression was significantly lower (ß = -0.2, p < 0.001).

Factors affecting medication beliefs among patients newly prescribed oral oncolytic agents.

BACKGROUND: Prescribing oral oncolytic agents (OAs) for advanced cancers is increasing. AIMS: To explore changes in medication beliefs and the effects of symptom severity, cognitive effectiveness and depressive symptoms on medication beliefs over 12 weeks. METHODS: Secondary analysis of a randomized controlled trial, testing an intervention to promote symptom management and adherence [N = 230]. Questionnaires evaluated medication beliefs, symptom severity, depressive symptoms, and cognitive effectiveness. Linear mixed effects models were used for analyses. RESULTS: OA Necessity beliefs increased over time (mean difference 0.0112, SE = 0.055, p 0.04). Concern beliefs did not change and were lower for advanced cancers (-0.193, SE = 0.067, p < 0.01).Depressive symptoms were related to decreased Necessity beliefs (-0.012, SE = 0.005, p = 0.02), but not Concern beliefs. Medication beliefs were not associated with symptom severity or cognitive effectiveness. CONCLUSION: Patients with advanced cancer hold different medication beliefs compared to earlier staged cancers, lending insight into potential outcomes beyond adherence.

The Relationship Between Religious Orientation and Death Anxiety in Iranian Muslim Patients with Cancer: The Mediating Role of Hope.

Cancers are globally prevalent often life-threatening diseases that carry an immense psychological burden such as death anxiety. Thus, identifying protective psychological factors affecting death anxiety in individuals with cancer is of strong relevance. This study investigated the potential mediating role of hope in the relationship between religious orientation and death anxiety in Iranian patients with cancer. A cross-sectional design was used to evaluate death anxiety, hope, and religious orientation in a convenience sample of 320 patients (age range 18-89 years) with cancer. Measures included demographic factors, health characteristics, and validated instruments of the study constructs. Path analysis was used to evaluate mediation models. The findings indicated a direct path from intrinsic religious orientation (ß = - 0.122, p < 0.001) to death anxiety and a direct path from hope (ß = - 0.258, p < 0.001) to death anxiety. However, when hope was introduced as a mediating variable, the relationship between intrinsic religious orientation and death anxiety became non-significant (ß = 0.001, p = 0.983). In this study, hope largely explained the relationship between intrinsic religiosity and death anxiety. In countries such as Iran where religiosity is an important psychological construct, greater hope among the more intrinsically religious may help to explain why more deeply religious persons experience less anxiety.

Age Changes and Suicidal Activity in Iran Over the Past Decade: A Systematic Review and Meta-Analysis.

This review study fills an important gap by aiming to determine the age changes in attempted and completed suicide in Iran during the past decade. A systematic review of related articles in international and Iranian databases from January 2008 to January 2020 was first conducted and relevant studies were extracted based on established criteria. Results showed that the mean age of suicide in Iran is 29.8 (range 27.7 - 31.8) years old for men and 27.4 (range 25.8 - 28.9) for women (P < 0.0001). The youngest and oldest populations of completed suicide belong to eastern and central regions of the country respectively. Findings imply the critical importance of increasing awareness through educational programs and public health campaigns to increase awareness and reduce suicidal behavior in Iran.

A path analysis model of spiritual well-being and quality of life in Iranian cancer patients: a mediating role of hope.

PURPOSE: Maintenance of quality of life (QOL) is vital for adaptation to life-threatening and chronic illnesses such as cancer. Therefore, the evaluation and strengthening of personal psychological resources that support QOL for patients with cancer is paramount. This study investigated the potential mediating role of hope in the relationship between spiritual well-being and QOL in Iranian cancer patients. METHODS: A correlational predictive design was used with 200 patients with varying types and stage of cancer. Demographic and health characteristic surveys, spiritual well-being (SWB), adult hope, and EORTC QLQ-c30 scales were used for measuring the study constructs. Path analysis modeling was used to determine mediation relationships. RESULTS: Patients' QOL was affected by SWB and hope. Religious (ß = 0.205, p = 0.002) and existential (ß = 0.286, p < 0.001) SWB dimensions and hope (ß = 0.263, p < 0.001) improved QOL scores. The presence of hope partially mediated the relationship between SWB and QOL. CONCLUSION: Quality of life was directly affected by SWB and was further improved by the presence of hope. The study suggests that maintenance of hope is essential to QOL in Iranian patients with cancer.

Spirituality and quality of life in women with breast cancer: The role of hope and educational attainment.

OBJECTIVE: This study investigated relationships among spirituality, hope, and overall quality of life in Muslim women with breast cancer in Malaysia. METHOD: A cross-sectional descriptive design with a convenience sample of 145 Malay patients was used. The mediating role of hope in the relationship between spirituality and quality of life as well as the moderating effect of education level on the spirituality hope link were examined. RESULTS: Participants with higher self-reported spirituality reported more hope (b = 6.345, p < 0.001) and higher levels of quality of life (b = 1.065, p < 0.001). Higher educational attainment weakened relationships between spirituality and hope (b = -1.460, p < 0.001). SIGNIFICANCE OF RESULTS: The role of advanced education in contributing to lessened hope in relation to spirituality emphasizes the importance of skilled and personalized spiritual counseling in the respective socio-cultural religious context.

The Relationship Between Spirituality Dimensions and Death Anxiety among Iranian Veterans: Partial Least Squares Structural Equation Modeling Approach.

The purpose of the present study was to examine the relationship among spiritual intelligence, spiritual well-being and death anxiety among Iranian veterans. In this predictive correlational study, 211 veterans completed King and DeCicco's Spiritual Intelligence Scale, Paloutzian and Ellison's Spiritual Well-being Scale and Templer's Death Anxiety Scale-Extended. After confirming the reliability of the constructs using intra-class correlation coefficient, partial least squares structural equation modeling method was utilized to assess the impact of spiritual well-being and spiritual intelligence on death anxiety. This study found a significant positive relationship between spiritual intelligence and death anxiety after controlling for the effects of age, education level and disability. However, there was a significant negative relationship between spiritual well-being and death anxiety among Iranian veterans. Negative relationships were found between spiritual well-being and death anxiety among Iranian veterans. However, spiritual intelligence had a positive impact on death anxiety.

A Cross-Cultural Evaluation of the Construct Validity of Templer's Death Anxiety Scale: A Systematic Review.

Ensuring use of valid and reliable scales for evaluating death anxiety that are relevant to the cultural context where they are applied is essential. The purpose of the study was to conduct a systematic review of the psychometric properties of Templer's Death Anxiety Scale (DAS) across cultures. PubMed, Scopus, Web of Knowledge, SID, and Magiran databases were systematically searched for studies published between 1970 and 2017 using Mesh terms. Two independent researchers used Quality Assessment of Diagnostic Accuracy Studies and Checklist of Standards for Reporting of Diagnostic Accuracy to evaluate study quality. Included studies were conducted in Iran, United States, Italy, China, Egypt, Spain, and Australia. Overall study quality was acceptable in 15 evaluated articles. However, findings demonstrated that two (one study), three (seven studies), four (four studies), and five factors (three studies) were extracted across the respective studies. Confirmatory concurrent validity was assessed in two studies. While Templer's DAS has stood the test of time as a commonly used index of capturing the conscious experience of death anxiety, there are psychometric inconsistencies in identified factor solutions across cultures. Findings emphasize the need for continued evaluation of how the DAS is translated in specific countries with assessment in relation to other death construct tools.

Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review.

BACKGROUND: When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life. MATERIALS AND METHODS: Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment. FINDINGS: 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. CONCLUSION: Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries.

How adverse events and permanent medication stoppages affect changes in patients' beliefs about oral antineoplastic agents.

BACKGROUND: Patients with advanced cancer often experience adverse events related to oral antineoplastic agents (OAAs) and permanent OAA medication stoppages, yet it is unknown how these factors impact medication beliefs. Such beliefs about OAA therapy may lend insight into decisions about continued cancer treatment near the end of life. PURPOSE: To explore relationships that adverse events and permanent OAA stoppages have on medication beliefs during the first 12 weeks following new OAA initiation. DESIGN: A secondary data analysis from a National Cancer Institute-funded randomized controlled trial testing an intervention to promote symptom management and OAA adherence. SETTING/SUBJECTS: Patients ≥ 21 years of age initiating a new course of OAA medication were recruited from six United States Comprehensive Cancer Centers. This analysis was based on a subset of patients with advanced disease (N = 60). MEASUREMENTS: Beliefs about Medicine Questionnaire, Common Terminology Criteria for Adverse Events, and medical records of permanent OAA stoppages. RESULTS: Significant decline in beliefs regarding the necessity of OAA medications existed between patients experiencing three or more adverse events and those experiencing a permanent OAA stoppage. CONCLUSIONS: Beliefs about the necessity of OAA medication change when physicians stop OAA medication or the patient experiences three or more adverse events. Concern regarding OAA medication did not change in response to medication stoppage or adverse events for this sample. Perhaps, patients with advanced cancers may be more accepting of adverse events that occur along the treatment trajectory and are not concerned about OAA medication once it is stopped. Findings suggest the importance of physicians' discussions of adverse events and decisions to permanently stop OAA medication as a means of transitioning to a new phase of cancer care that may include palliative or hospice considerations, given that beliefs about medication necessity are changing during these threats to cancer treatment.

Conceptualisation of medication beliefs among patients with advanced cancer receiving oral oncolytic agents using a theory derivation approach.

OBJECTIVE: This paper describes a derived model that provides a conceptual framework for understanding medication beliefs among patients with advanced cancer receiving oral oncolytic agents. METHODS: Theory derivation was used to (a) examine the phenomenon of medication beliefs in cross-disciplinary research; (b) select a parent theory for derivation; (c) identify parent theory concepts and/or structure to use in derivation; and (d) redefine parent theory concepts and structure to create a derived model. RESULTS: Medication beliefs are shaped by previous experiences, including cognitive and emotional factors, past health and illness encounters, and medication-taking behaviours. Medication beliefs are defined within a larger mental model of illness representation for which medication was prescribed. Individuals independently hold both positive and negative medication beliefs at the same time. This distinction is critical to understanding how dichotomous components of medication beliefs change over time as they are influenced by varying treatment-related factors. CONCLUSION: This paper contributes to conceptual knowledge regarding the phenomenon of medication beliefs and their impact on health behaviour. Findings can support oncology interventions to improve patient outcomes including medication adherence.

Religious coping and death depression in Iranian patients with cancer: relationships to disease stage.

PURPOSE: The study investigated relationships among the extent of disease, religious coping, and death depression in Iranian patients with cancer. METHOD: A descriptive cross-sectional study was conducted with a convenience sample of 482 Iranian cancer patients. Participants completed demographic and health, death depression, and religious coping surveys. RESULTS: After controlling for demographic and health characteristics, positive and negative religious coping behaviors were significantly related to the experience of death depression. There was an interaction effect between negative religious coping and extent of disease with significant positive relationships to the experience of death depression. CONCLUSIONS: Negative religious coping was found to be more closely associated with death depression in patients with earlier stage disease than those with advanced stages of cancer in this sample of patients with cancer from Iran. Findings support assessing patients for use of religious coping strategies. Muslim patients who are religiously alienated and have existential anguish may be vulnerable and need heightened support following diagnosis and during treatment of early stage cancer.

Development and psychometric evaluation of a Persian version of the Death Depression Scale-Revised: a cross-cultural adaptation for patients with advanced cancer.

OBJECTIVE: The surfacing of thoughts and depressive affect associated with the prospect of death are prevalent among patients with advanced cancer. Because death cognitions and associated negative affect occur along an adaptive-less adaptive continuum, it is essential that valid and reliable instruments are available to measure death depression. The present study aimed to determine the psychometric properties of the Death Depression Scale among Iranian patients with advanced cancer. METHODS: About 497 cancer patients completed a Persian version of the 21-item Death Depression Scale-Revised. The face, content and construct validity of the scale were ascertained. Reliability was also assessed using internal consistency, construct reliability and intra-class correlation coefficient (ICC). RESULTS: Construct validity determined one factor with an eigenvalue greater than 1. The model had a good fit (χ2 (179, N = 248) = 520.345, P < 0.001; χ2/df = 2.907, CFI = 0.916, TLI = 0.902, IFI = 0.917, SRMR = 0.049 and RMSEA = 0.088 (90% confidence interval = 0.079-0.097)) with all factors loadings greater than 0.5 and statistically significant. The internal consistency, construct reliability and ICC were greater than 0.70. Convergent validity of the scale was demonstrated. CONCLUSIONS: Findings revealed that the Persian version of the Death Depression Scale-Revised is valid and reliable, and may be used to assess and evaluate death depression in Iranian patients with advanced cancer.

Relationship Between Fear of Cancer Recurrence and Quality of Life in Patients Undergoing Active Cancer Treatment: The Mediating Role of Social Support.

INTRODUCTION: Socio-psychological factors such as fear of recurrence and presence of social support may affect quality of life (QOL) of cancer patients. Identifying mediating factors that impact QOL are crucial for targeting vulnerability in patients undergoing cancer treatments. The study purpose was therefore to determine relationships between presence of fear of cancer recurrence and QOL of patients, with the mediating role of social support. METHODS: A predictive correlational design was used to conduct the study with 300 patients with cancer who were undergoing chemotherapy, radiotherapy, or surgery at two medical centers in Tehran. Measures included a demographic information form, the Fear of Cancer Recurrence Inventory (FCRI), the European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30), and the Multidimensional Scale of Perceived Social Support (MSPSS). Data analyses included descriptives, and path analysis analyses. RESULTS: Higher fear of cancer recurrence predicted lower QOL (ß = -0.60, p < 0.001). Moreover, individuals with lower fear of cancer recurrence also perceived higher social support (ß = 0.32, p < 0.001). Additionally, individuals with higher perceived social support also reported better QOL (ß = 0.30, p < 0.001). CONCLUSION: Perceived social support plays a significant mediating role in the relationship between the fear of cancer recurrence and QOL in patients undergoing active cancer treatment. Enhancing social support among cancer patients may contribute to enhanced QOL, and as does reducing fears associated with disease recurrence.

The Relationship between Religious Well-Being, Existential Well-Being, Fear of Progression and Quality of Life in Patients with Cancer: The Mediating Role of Hope.

BACKGROUND: A cancer diagnosis can be psychologically challenging to individuals due to perceptions that the disease is potentially incurable truncating life expectancy. The purpose of the study was to examine the relationships among religious well-being, existential well-being, fear of progression and quality of life in Iranian patients with cancer and to evaluate the potential mediating role of hope on these relationships. METHODS: This study with predictive cross-sectional design was done in 2023. Data was gathered from 398 patients with cancer that was selected with accessible sampling method from cancer center of Mazandaran university of medical sciences (Sari, Iran). Study constructs included the religious and existential wellbeing, cancer fear of progression, Snyder Hope, and quality of life. Analysis of a Moment Structures (AMOS) software (v27) was utilized for all study analyses. Covariance based-structural equation modeling (SEM) was used to assess the mediating role of hope. RESULTS: The mean age of patients with cancer was 49.14 (SD = 16.16). The results of the direct effect showed a significant positive relationship between religious well-being and hope (B = 0.164, p < .001), and between hope and quality of life (B = 0.212, p < 0.001). Also, significant negative relationship between fear of progression and hope (B = -0.147, p < 0.05) was founded. CONCLUSION: A significant positive relationship between hope and quality of life, as well as religious well-being and hope, suggests the influential effects of hope and religious well-being on improving quality of life in patients with cancer. Negative relationships between fear of progression and hope conclude that managing fear of progression may be an important factor in increasing hope and improving quality of life in patients with cancer.

Engaging Patients in Research That Involves Meditation: Religious Concerns and Nursing Implications.

BACKGROUND: Studies evaluating the use of meditative practices for supporting symptom management among patients undergoing cancer treatment have increased substantially in recent years. Although meditative practices as adjuncts to promoting health have become mainstream, concerns that such strategies conflict with traditional religious tenets have co-occurred. In the context of a 12-week sequential multiple assignment randomized trial of home-based meditative practices and reflexology delivered to patients with cancer by or with family caregivers to manage symptoms, early attrition was identified in the meditative practices arm. OBJECTIVE: Finding religious concerns were factors contributing to attrition; the purpose is to describe adjustments to the training protocol for study recruiters and interveners when enrolling participants and teaching patient-caregiver dyads meditative practices. METHODS: The training protocol for recruiters and interveners was adapted to address religious concerns related to meditative practices. RESULTS: Since initiation, recruiters and interveners have appreciated the adapted protocol, which has improved their capacity to respond to religious concerns. Participants have responded well to consideration of the practices as mindful movements coordinated with breath. CONCLUSIONS: Given broader application of meditation in symptom management studies, researchers will need to be ready to address religious concerns. It is essential that protocols for introducing meditation are broadly presented to respond to concerns of patients and cancer caregivers regarding perceived conflicts with their specific religious beliefs. IMPLICATIONS FOR PRACTICE: As the provision of integrative care options that include meditation training for patients grows, nurses require awareness of potential barriers and strategies to ameliorate religious concerns.

The Role of Psilocybin-Assisted Psychotherapy to Support Patients With Cancer: A Critical Scoping Review of the Research.

Treatments for addressing psychiatric mental health issues in vulnerable patients with cancer are established. Yet, many patients persist with unrelenting psychological difficulties despite intervention. There is growing interest in the role of psilocybin-assisted psychotherapy for managing treatment-resistant mental health challenges in patients with cancer. Psilocybin is a naturally occurring compound derived from certain mushroom species that can induce entheogenic experiences or an altered state of consciousness. Reed's Self-Transcendence Theory provides a holistic lens to examine existential concerns and mental health in individuals who perceive their illness as potentially life threatening, such as those with cancer. This scoping literature review used Arksey and O'Malley's template to evaluate research examining psilocybin-assisted psychotherapy for patients with cancer. Eight articles met inclusion/exclusion criteria (four quantitative, two mixed methods, and two qualitative). Review findings indicated that the majority of patient experiences were positive, centering on themes of death acceptance, reflection, and broadened spirituality. Although psilocybin-assisted psychotherapy is in early stages of clinical testing, it thus shows promise for carefully screened patients with cancer who have persistent existential suffering. It will be critical for investigators to tailor this emerging intervention to select patients and for clinicians to be engaged in assessment of outcomes and efficacy.

An Evaluation of Natural Environment Interventions for Informal Cancer Caregivers in the Community.

Home-based informal caregiving by friends and family members of patients with cancer is be-coming increasingly common globally with rates continuing to rise. Such caregiving is often emo-tionally and cognitively demanding, resulting in mental exhaustion and high perceived burden. Support for caregivers may be fostered by engagement with the natural environment. Interaction with nature is associated with mental health benefits such as stress reduction and improved well-being. The purpose of this paper was to evaluate the state of the science regarding the use of nat-ural environment interventions to support caregivers of cancer patients in the community. A comprehensive scoping review using the Arksey and O'Malley framework and the Preferred Re-porting Items for Systematic Reviews and Meta-analyses assessed natural environment therapies and mental health outcomes among cancer caregivers. Databases searched included CINAHL, PubMed, Scopus, Cochrane, and Alt HealthWatch. Findings recovered a total of five studies over a 10-year period that met criteria, demonstrating a lack of empirical evidence addressing this po-tential resource to support caregivers. Often, study appraisal was not on nature exposure, but ra-ther other aspects of the projects such as program evaluation, exercise, or complementary thera-pies. Both qualitative and quantitative designs were used but sample sizes were small. Caregivers experienced beneficial results across the various studies and future work could enhance these findings.