Assessing the needs of patients with breast cancer and their families across various treatment phases using a Latent Dirichlet Allocation model: a text-mining approach to online health communities.

PURPOSE: This study aimed to assess the different needs of patients with breast cancer and their families in online health communities at different treatment phases using a Latent Dirichlet Allocation (LDA) model. METHODS: Using Python, breast cancer-related posts were collected from two online health communities: patient-to-patient and patient-to-doctor. After data cleaning, eligible posts were categorized based on the treatment phase. Subsequently, an LDA model identifying the distinct need-related topics for each phase of treatment, including data preprocessing and LDA topic modeling, was established. Additionally, the demographic and interactive features of the posts were manually analyzed. RESULTS: We collected 84,043 posts, of which 9504 posts were included after data cleaning. Early diagnosis and rehabilitation treatment phases had the highest and lowest number of posts, respectively. LDA identified 11 topics: three in the initial diagnosis phase and two in each of the remaining treatment phases. The topics included disease outcomes, diagnosis analysis, treatment information, and emotional support in the initial diagnosis phase; surgical options and outcomes, postoperative care, and treatment planning in the perioperative treatment phase; treatment options and costs, side effects management, and disease prognosis assessment in the non-operative treatment phase; diagnosis and treatment options, disease prognosis, and emotional support in the relapse and metastasis treatment phase; and follow-up and recurrence concerns, physical symptoms, and lifestyle adjustments in the rehabilitation treatment phase. CONCLUSION: The needs of patients with breast cancer and their families differ across various phases of cancer therapy. Therefore, specific information or emotional assistance should be tailored to each phase of treatment based on the unique needs of patients and their families.

Simplified Chinese version of the PROMIS Pediatric-25 profile: A validation study among cancer children.

PURPOSE: Pediatric cancer is a significant health concern in China, and evaluating the impact of cancer and its treatment on the well-being of young patients is essential for both clinical care and research purposes. This study aimed to psychometrically validate the Patient-reported Outcomes Measurement Information System Pediatric-25 Profile (PROMIS-Pediatric-25) among Chinese children with cancer. DESIGN AND METHODS: We enrolled a group of 114 children living with cancer between the ages of 8 and 17. Each participant completed questionnaires that covered sociodemographic and clinical information and the PROMIS-Pediatric-25. The floor and ceiling effect was examined. Cronbach's alpha and split-half coefficient were examined to determine the reliability. Factor structure was explored by factor analysis. Three assumptions of Rasch model-based item response theory (IRT) were assessed. Differential item functioning (DIF) was investigated concerning factors of gender, diagnosis, and treatment stage. RESULTS: The floor or ceiling effects were detected for six domains. The reliability was found to be excellent. Furthermore, the factor structure of these six domains was validated. Our analysis confirmed that the assumptions required for IRT were met with acceptable unidimensionality, local independence, and good monotonicity. Additionally, we observed measurement equivalence, with outstanding levels of DIF across factors such as gender, diagnosis, and treatment stage. CONCLUSION: PROMIS-Pediatric 25 is a highly reliable and valid instrument for evaluating key domains of health-related quality of life in Chinese pediatric cancer patients. PRACTICE IMPLICATION: Nursing practice could engage the PROMIS-Pediatric 25 for accurate and quick children symptom and function assessment.

Psychometric properties of the Chinese version of the functional assessment of chronic illness therapy-fatigue (FACIT-F) among patients with breast cancer.

BACKGROUND: Fatigue is the most frequent and distressing symptom affecting the physical, cognitive, and affective domains of breast cancer patients. The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) has been widely used in patients with chronic diseases and has shown satisfactory reliability and validity. This study aimed to examine the psychometric properties of the FACIT-F among Chinese patients with breast cancer. METHODS: Using a convenience sampling method, a cross-sectional survey (January 2020 and September 2022) was used with patients recruited from two tertiary hospitals in Shanghai, Mainland China, and a total of 597 patients completed a demographic information questionnaire, the FACIT-F and the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B). Convergent validity was estimated by calculating the Pearson correlation coefficient of the FACIT-F with the FACT-B. Measurement invariance across age was performed by examining differential item functioning (DIF) across age groups (≤ 60 and > 60 years). The internal consistency and split-half reliability were performed for reliability analysis. Unidimensionality of the scale was evaluated by the principal component analysis by Rasch analysis. Additionally, Rasch analysis was performed for item difficulty levels, and an item-person map was used. RESULTS: No floor/ceiling effects were observed for the FACIT-F. Moderate correlations were found between FACIT-F and FACT-B (r = - 0.342, p < 0.01). Most items showed an absence of DIF regarding age, except for one item. In addition, the FACIT-F showed acceptable internal consistency. Principal component analysis of Rasch residuals showed that the proportion of variance explained by the FACIT-F was 53.3%, and the outfit mean square statistics for the items ranged from 0.68 to 1.90 and the infit MNSQ from 0.63 to 1.73. Additionally, an acceptable response between items and persons was found. CONCLUSIONS: The findings indicate that the Chinese version of the FACIT-F is a valid tool for the measurement of fatigue in breast cancer patients.

Identification of age differences in cancer-related symptoms in women undergoing chemotherapy for breast cancer in China.

BACKGROUND: Both contextual and cancer-related factors could be identified as causes of the interindividual variability observed for symptoms experienced during breast cancer treatment with chemotherapy. Understanding age differences and the predictors of latent class memberships for symptom heterogeneity could contribute to personalized interventions. This study aimed to identify the role of age differences on cancer-related symptoms in women undergoing chemotherapy for breast cancer in China. METHODS: A cross­sectional survey was conducted among patients with breast cancer in three tertiary hospitals in central China between August 2020 to December 2021. The outcomes of this study included sociodemographic and clinical characteristics, Patient-Reported Outcomes Measurement Information System (PROMIS)-57 and PROMIS-cognitive function short form scores. RESULTS: A total of 761 patients were included, with a mean age of 48.5 (SD = 11.8). Similar scores were observed across age groups for all symptoms except for fatigue and sleep disturbance domains. The most central symptoms varied among each group, and were fatigue, depression, and pain interference for the young-aged, middle-aged, and elderly-aged groups, respectively. In the young-aged group, patients without health insurance (OR = 0.30, P = 0.048) and in the fourth round of chemotherapy or above (OR = 0.33, P = 0.005) were more likely to belong to low symptom classes. In the middle-aged group, patients in menopause (OR = 3.58, P = 0.001) were more likely to belong to high symptom classes. In the elderly-aged group, patients with complications (OR = 7.40, P = 0.003) tended to belong to the high anxiety, depression, and pain interference classes. CONCLUSIONS: Findings from this study indicated that there is age-specific heterogeneity of symptoms present for Chinese women being treated for breast cancer with chemotherapy. Tailored intervention should consider the impact of age to reduce patients' symptom burdens.

Validation of the simplified Chinese version of PROMIS Parent Proxy-25 Profile in parents of children with cancer.

PURPOSE: To determine the psychometric properties of the Patient-reported Outcomes Measurement Information System Parent Proxy-25 Profile (PROMIS-25) in a sample of Chinese parents of children with cancer. DESIGN AND METHODS: A cross-sectional sample (N = 148) of parents with children aged 5-17 years living with cancer was recruited. Each participant completed sociodemographic and clinical questionnaires and PROMIS-25. The flooring and ceiling effects were calculated. Reliability was determined by the Cronbach's alpha and split-half coefficient. Factor structure was examined by factor analysis. Model fit and graphical plots were assessed to test the assumptions of Rasch model-based item response theory (IRT). Differential item functioning (DIF) was assessed in terms of gender, age, and treatment stage. RESULTS: PROMIS-25 demonstrated some flooring and ceiling effect, excellent reliability (Cronbach's α > 0.7 for all six domains), and the six-domain factor structure was supported. The IRT assumptions were met in terms of unidimensionality, local independence, monotonicity, and measurement equivalence with acceptable DIF in terms of gender, age, diagnosis, and treatment stage. CONCLUSION: PROMIS-25 is a highly reliable and valid instrument for evaluating children with cancer that assesses important health-related quality of life domains of child cancer. PRACTICE IMPLICATION: Chinese parents of children with cancer and healthcare providers could use PROMIS-25 to assess the symptoms of children.

Nurse managers' perceptions and experiences of caring behavior for clinical nurses: a multicenter survey.

BACKGROUND: Humanistic care management is a necessary measure to improve the motivation and initiative of clinical nurses and is the foundation to improve the quality of nursing. Understanding the current status and identifying the influencing factors that promote or hinder humanistic care behaviors is essential. This study investigated the current status and experiences of nurse managers' caring behaviors toward clinical nurses. METHODS: We conducted a mixed-methods study with an explanatory sequential design. A survey on the nurse managers' caring behaviors in 101 hospitals from 23 provinces and four municipalities in China was investigated (n = 2022). Then, semi-structured interviews were conducted to obtain information about the participants' experiences associated with the performance of caring behaviors (n = 27). RESULTS: Survey data demonstrated that the nurse managers' overall caring behaviors were moderately good. The total scoring rate was 88.55%, and the overall score was 161.19 ± 20.68. Qualitative data revealed that the capacity of nurse managers and clinical nurses, opportunity, and motivation to implement humanistic care are key influencing factors of caring behaviors. CONCLUSIONS: The results suggested that intrinsic motivation, organizational support, and the humanistic care capabilities of clinical nurses and nurse managers are vital to implementing care behaviors. Thus, successful humanistic care management requires a concerted effort at the individual and organizational levels.

Validity and reliability of the Chinese version of the Patient-Reported Outcomes Measurement Information System adult profile-57 (PROMIS-57).

BACKGROUND: The PROMIS-57 is a commonly used self-reported instrument to solve the lack of generalizable and universal measures required to evaluate common symptoms and functions from patients' perspectives. This study aimed to translate the PROMIS-57 into Chinese and psychometrically test the translated instrument on patients with breast cancer. METHODS: Translation, cross­cultural adaptation, and psychometric evaluation of the instrument were performed from June 2020 to June 2021. Eligible patients were recruited and completed the PROMIS-57, Functional Assessment of Cancer Therapy-Breast (FACT-B), and a sociodemographic questionnaire. RESULTS: Data from 602 patients with a mean age of 48.83 years were analyzed. Most domains in the PROMIS-57 showed an absence of floor and ceiling effects. Multi-trait scaling analysis demonstrated acceptable convergent and discriminant validity. The correlations between the PROMIS-57 scores and the selected FACT-B scores supported the criterion validity via the Pearson correlation test. Measurement invariance was supported by the absence of differential item functioning for most items. Cronbach's α of the domains ranged from 0.85-0.95. The unidimensional factor structure of all domains was supported using confirmatory factor analyses. Additionally, most items showed acceptable item information curves and item characteristics curve matrices. CONCLUSION: The Chinese version of the PROMIS-57 was found to be a reliable and valid tool for assessing common symptoms and functions among patients with breast cancer.

Psychometric evaluation of the PROMIS social function short forms in Chinese patients with breast cancer.

BACKGROUND: The diagnosis of breast cancer and the subsequent treatment undermine patients' participation in social activities. This study aimed to carry out a cross-cultural adaption and analysis of the construct validity and reliability of the Chinese version of the PROMIS social function short forms in patients with breast cancer. METHODS: This study utilized a cross-sectional research design, and was registered in the Chinese Clinical Trial Registry (ChiCTR2000035439). After a standardized cross-cultural adaption process, a psychometric evaluation was performed of the Chinese version of the PROMIS social function short forms. Using convenience sampling, eligible patients with breast cancer from tertiary hospitals in China were enrolled from January 2019 to July 2020. Participants completed the sociodemographic information questionnaire, the PROMIS social function short forms, the Functional Assessment of Cancer Therapy-Breast, the PROMIS emotional support short form and the PROMIS anxiety short form. RESULTS: Data were collected from a sample of 633 patients whose mean age was 48.1 years. The measures showed an absence of floor and ceiling effects. Regarding construct validity, the results of confirmatory factor analysis supported the original two-factor structure of the PROMIS social function short forms. In addition, the measures were found to have acceptable known-group validity, measurement invariance, and convergent and discriminate validity. Regarding reliability, the Cronbach's α was high for all items (> 0.70). CONCLUSION: The Chinese version of the PROMIS social function short forms was demonstrated to be a valid and reliable measure for the assessment of social function in Chinese patients with breast cancer. Additional psychometric evaluation is needed to draw firm conclusions.

Distinct dyadic coping profiles in Chinese couples with breast cancer.

PURPOSE: Conceptualizing cancer as a dyadic stress provides new insight into how stress impacts couples with breast cancer. The present study aimed to identify subgroups with distinct dyadic coping profiles in a sample of Chinese couples with breast cancer and to determine how these subgroups differed in terms of demographic and clinical characteristics in addition to marital adjustment outcomes. METHODS: Using convenience sampling, a cross-sectional survey was conducted. Couples with breast cancer completed the general information questionnaire, the Dyadic Coping Inventory, and the Locke-Wollance Marital Adjustment Test. The modeling was performed using a latent profile analysis to identify the dyadic coping subgroups. Parametric and nonparametric tests were applied to examine between-group differences across the identified classes. RESULTS: The analytical results supported a three-class solution of dyadic coping groups: high (27.4%), medium (32.2%), and low (40.4%). Between-group differences were found in educational background, number of children, postoperative time, and type of surgery. CONCLUSION: Most couples reported low levels of dyadic coping. The couples with an educational level of primary school or below, with one child or who were childless, and who had undergone breast preservation surgery within the past year were more likely to belong to the low dyadic coping group. When supporting couples with breast cancer, it is essential to assess several demographic and clinical risk factors in addition to the marital adjustment level to identify high-risk subgroups that warrant intervention.

Profiles of instrumental, emotional, and informational support in Chinese breast cancer patients undergoing chemotherapy: a latent class analysis.

BACKGROUND: To date, few studies have assessed social relationships in patients with breast cancer during their chemotherapy process. This study aimed to explore profiles of instrumental, emotional, and informational support in Chinese breast cancer patients undergoing chemotherapy. METHODS: In a cross-sectional study performed between September 2018 and September 2020 in China, 638 patients with breast cancer completed demographic information questionnaires, the PROMIS-Social Relationships Short Forms, the PROMIS-Anxiety Short Form, and the PROMIS-Depression Short Form. Analysis of variance and chi-square tests were performed to examine between-group differences in demographic characteristics, anxiety, and depression outcomes across the identified latent classes. Multinomial logistic regression was performed to identify the correlation of significant variables among the identified classes. RESULTS: Three profiles of social relationships were identified: Class 1-low social relationships group (14.3%), Class 2-high instrumental support, medium emotional and informational support group (24.6%), and Class 3-high social relationships group (61.1%). The findings revealed the heterogeneity of instrumental, emotional, and informational support in Chinese breast cancer patients undergoing chemotherapy, which was significantly correlated with educational background, monthly family income, health insurance, and employment status. Additionally, patients with low instrumental, emotional, and informational support were more likely to report high levels of anxiety and depression. CONCLUSIONS: When conducting interventions to promote social relationships during the chemotherapy process, healthcare providers should consider the sociodemographic characteristics, anxiety levels, and depression symptoms of patients with breast cancer and identify high-risk patients for tailored interventions.

Physical activity in the context of advanced breast cancer: An integrative review.

AIMS: To describe and synthesize diverse empirical evidence regarding physical activity (PA) in the context of advanced breast cancer (ABC). DESIGN: Integrative review guided by the work of Whittemore and Knafl (2005). DATA SOURCES: Six electronic databases were systematically searched to identify relevant literature published between January 2007-June 2019. REVIEW METHODS: Abstracts of papers that met the inclusion criteria were reviewed by two researchers and full texts of eligible papers were assessed. Data were extracted by two independent researchers and inter-rater reliability of data extraction established. Quality of papers was evaluated using the Mixed Methods Appraisal Tool. Data were organized according to comprehensive thematic analysis and the biobehavioural model for the study of exercise interventions. RESULTS: Of the 532 abstracts, 18 studies met the inclusion criteria which included six randomized controlled trials, one quantitative non-randomized study, seven quantitative descriptive studies, three mixed method studies and one qualitative study. Results from studies enrolled fell into four domains: PA performance and its influence on survival; barriers and preferences for PA; interventions to enhance PA; perceived benefits of PA from qualitative feedback. CONCLUSION: Evidence suggests that ABC patients are physically inactive. Main barriers of PA are less aerobic fitness and heavy symptom burden. Simple, tailored and specialist-supervised PA is preferred by ABC patients. Form of joint self-instructed and group accompanying is advocated as well. PA intervention programmes identified in this review vary on type, intensity, duration and frequency, while generally, are found to be feasible, safe and beneficial to patients' physical and psychosocial well-being. IMPACT: The results propose tailored, supervised, group-based PA programmes are in urgent need for ABC patients. Clinical professionals should manage more feasible and safer PA interventions to help improve patients' overall health. More research with rigorous methodology design is warranted to explore PA's effect on long-term health outcomes.

Identification and Characteristics of the Three Subgroups of Pain in Chinese Children and Adolescents with Cancer.

PURPOSE: Pain is a distressing symptom for children and adolescents with cancer and is experienced by individuals differently. This study sought to determine subgroups according to their pain experiences, and how demographic, clinical, and quality of life (QOL)-related characteristics might differ across subgroups. DESIGN AND METHODS: This cross-sectional study recruited 187 pediatric patients with cancer aged 8 to 17 years old and asked them to complete measures of pain intensity, pain duration, pain interference and pain control using the Chinese translation of the validated questionnaire from the Pain Squad app, as well as 7 PROMIS measures assessing QOL-related outcomes. Latent profile analysis (LPA) was used to identify latent subgroups. RESULTS: Three subgroups of children were identified: low-pain/low-duration (69.5%), moderate-pain/high-duration (19.8%), and high-pain/moderate-duration (10.7%). Hospitalized children were more likely to be in the moderate-pain/high-duration subgroup. Children in the high-pain/moderate-duration subgroup were more likely to be cared for by unemployed caregivers. Scores on depressive symptoms (p = 0.002), anger (p < 0.001), anxiety (p = 0.045), fatigue (p = 0.044), and mobility (p = 0.008) questionnaire were significantly worse in the high-pain/moderate-duration subgroup than the other two subgroup. PRACTICE IMPLICATIONS: This study provides a scientific foundation for further studies exploring predictive factors related to pain experiences. More targeted treatment strategies targeting the specific characteristics of each subgroup will help improve patients' QOL and use of medical resources. CONCLUSIONS: The 3 identified pain subgroups demonstrate the heterogeneity in pain experiences among pediatric patients with cancer. Knowledge of these subgroups can assist clinicians in better identifying and targeting pain treatment for children with cancer.

Patterns of sexual health in patients with breast cancer in China: a latent class analysis.

PURPOSE: This study aimed to identify unobserved distinct latent classes/subgroups of breast cancer (BC) patients in China with respect to various sexual health measures and examine the association of the latent membership with individual characteristics. METHODS: In a cross-sectional study, 123 BC patients were analyzed. Their sexual health was measured using the Female Sexual Functioning Index (FSFI). Latent class analysis (LCA) was used to examine the patterns of sexual health in patients. Associations of the latent class membership with individual characteristics were examined using multinomial logistic regression. RESULTS: Three a priori unknown distinct latent classes of patients were identified with respect to the 19 FSFI sexual health measures: 50 patients (41.6%) were classified in class 1 "No Impairment Group," 49 patients (39.4%) in class 2 "Organic Sexual Dysfunction Group," and 24 patients (19.1%) in class 3 "Poor Sexual Health Group." Income and anxiety were positively, whereas disease duration was negatively associated with the likelihood of being in class 2 than in class 1, patients with recurrence of cancer were likely to be in classes 2 and 3. Patients classified in class 3 were more likely to have better prior body image and have more severe menopausal symptoms, whereas less likely to have better post body image and have better partner relationships. CONCLUSION: The findings revealed the heterogeneity of sexual health among BC patients in China and may guide to identify the high-risk patients and enable early intervention.

Development and Pilot Testing a Self-Reported Pediatric PROMIS App for Young Children Aged 5-7 Years.

PURPOSE: The aims of this study are threefold. Firstly, Using the state of science PROMIS (Patient-Reported Outcomes Measurement Information System) methods to develop a smartphone application to monitor the emotional distress for young children aged 5-7 years old; Secondly, to test the usability of this application; and thirdly, to determine the level of agreement between reports by parents and young children's self-report. DESIGN AND METHODS: A multidisciplinary research team, made up of senior pediatric nurses and doctors, software engineers' team, and pediatric health researchers worked together to develop this application. Three phases of stakeholders and user studies were conducted. Phase 1 focused on prototype development; Phase 2 involved cognitive interview and usability testing; Phases 3 focused on the pilot testing of this application. RESULTS: We included the original parent proxy reporting version of Patient Reported Outcome Measurement Information System-emotional distress in the application, as well as self-reporting animated version for young children. After many rounds of modification, all participants felt that this application was easy to use and the animated items were easy to understand for young children aged 5-7 years. Correlations between parents-children reports are significant and moderate, parents underestimated child depression, and overestimated child anger and anxiety compared to child self-report. CONCLUSIONS: This smartphone application and its Web-based administration portal demonstrate good usability and are well accepted by young children aged 5-7 years, which can be used to promote young children's participation when reporting or assessing symptoms of young pediatric patients. PRACTICE IMPLICATIONS: Parent reports cannot be substituted for child reports and evaluations of pediatric patients' perspectives regarding treatment outcomes should be included in pediatric clinic. This animated application can be used as a smart measurement to investigate the symptoms for young children aged 5-7 years, so as to amplify young children's voice in clinical care.

Nurses' Attitudes Toward Internet-Based Home Care: A Survey Study.

Internet-based home care has emerged as a way to relieve the burden of hospitals and meet patients' need for home care. This study aims to explore nurses' attitudes toward Internet-based home care. A cross-sectional online survey was conducted in Ningbo City in China. A self-designed Internet-based home care attitudes questionnaire for nurses (23 items) was used. There were 2039 nurses from 13 hospitals who participated in this online survey. Results reveal that, 1369 nurses (67.1%) were willing to provide Internet-based home care. However, there were significant differences in the attitudes of nurses with different ages (H = 11.86, P = .001), years of work experience (H = 24.257, P = .000), positions (H = 8.850, P = .031), and types of phones (H = 13.096, P = .001). More than 80% of nurses were willing to provide hypodermic and intramuscular injection. But there was a significant difference in the attitudes toward hypodermic injection, intramuscular injection, and pressure ulcer care in nurses with different ages (H = 13.039, P = .005; H = 9.178, P = .027; H = 10.997, P = .012) and a significant difference in the attitudes toward pressure ulcer care in nurses with different years of work experience (H = 15.259, P = .002). Results also indicated that most nurses were worried about their own safety and personal rights protection during Internet-based home care.

Body composition patterns and breast cancer risk in Chinese women with breast diseases: A latent class analysis.

AIMS: To identify unobserved body composition patterns among Chinese women with breast diseases using latent class analysis (LCA) and to examine the relationship between body composition patterns and breast cancer (BC) risk. DESIGN: A descriptive, cross-sectional study. METHODS: Female patients (N = 1816) with breast diseases were included in the study from April 2016 - March 2017. Body composition measures were done by the bioelectrical impedance analysis. The LCA models were estimated using Mplus 8.1. RESULTS: Four latent classes were identified based on water, protein, minerals and body fat mass: Class 1 - Low Muscle Mass class; Class 2 - High Body Composition class; Class 3 - High Fat class; and Class 4 - Normal Body Composition Class. Classes 2 and 3 are higher risk classes for developing BC compared with the other two classes (p < 0.05). Overall, age is positively associated with the odds of BC development (p < 0.001). However, age effect depends on the body composition patterns. Age effect on the odds of BC was statistically significant only for women who had least body fat mass (Class 1, OR = 1.110, 95% C.I.: 1.084-1.136) or had normal body composition (Class 4, OR = 1.090, 95% C.I.: 1.036-1.147). The effect of age was not statistically significant if women had higher risk body composition (e.g., in Classes 2 or 3). CONCLUSION: Latent Class Analysis is a useful person-centred analytical approach for identification of unobserved patterns of body composition and it could be used to predict the risk of BC and develop personalized interventions for body composition studies.

Influence of physical restraint on delirium of adult patients in ICU: A nested case-control study.

AIMS AND OBJECTIVES: To investigate the impact of physical restraint on delirium of adult patients in intensive care unit. BACKGROUND: Delirium is a common clinical syndrome in intensive care unit, correlated with various adverse clinical outcomes. Physical restraint is a precipitating factor for delirium; however, the effect of physical restraint on delirium, such as duration, number and appliance is still unclear. DESIGN: A nested case-control study. METHODS: A cohort of 593 intensive care unit patients were observed for 12 months, and 447 of them who received physical restraint were included for analysis. Delirium was assessed using the Confusion Assessment Method for the intensive care unit. During hospitalisation in intensive care unit, newly-onset delirium patients (the delirium group), and nondelirium patients of similar age, same gender, and conditions of mechanical ventilation and sedative drug usage (the nondelirium group) were included as the matching criteria. Patient data were acquired by reviewing medical and nursing electronic records. RESULTS: Among the 447 patients that had been physically restrained, 178 (39.8%) developed delirium. Delirium risk in patients with restraint ≥6 days was 26.30 times higher than in those <6 days. Patients who had two and three times of restraint had a 2.38-fold and 3.62-fold higher risk of delirium than those with one time of restraint. However, the appliance, site, time to apply and remove restraint had no effect on the incidence of delirium. CONCLUSIONS: The incidence of delirium is high when patients use physical restraint. Duration and number of restraint are positively related to delirium. Restrictions on the use of restraint in intensive care unit are required to reduce the occurrence of delirium. RELEVANCE TO CLINICAL PRACTICE: To reduce delirium risk of patients in intensive care unit, nurses need to assess the risk of physical restraint and consider alternative measures, thereby to achieve the minimisation of the use of restraint.

Care burden and its predictive factors in parents of newly diagnosed children with acute lymphoblastic leukemia in academic hospitals in China.

PURPOSE: Caring for children with acute lymphoblastic leukemia (ALL) is a distressing experience for parents without medical training. The experience can lead to parents' care burden. This study explored care burden among parents of children with ALL and its related factors. METHODS: A total of 130 parents were surveyed with the Zarit Burden Inventory (ZBI), Perceived Social Support Scale (PSSS), Zung's Self-rating Anxiety Scale (SAS), Zung's Self-rating Depression Scale (SDS), Medical Outcome Study Short Form 36 (SF-36), and a study specific demographic information questionnaire. Independent-samples T test, one-way ANOVA, Pearson correlation analysis and multivariate linear regression analysis (stepwise method), and binomial logistic regression were used in data analysis. RESULTS: The mean score of parents' care burden overall was 37.74 ± 16.57, 17 (13.08%) had little or no burden, 57 (43.85%) had mild-to-moderate burden, 44 (33.84%) had moderate-to-severe burden, and 12 (9.23%) had severe burden. Regression analyses indicated daily care time, anxiety, general health, average monthly family income, social support, and number of co-caregivers were factors associated with care burden. These variables accounted for 51% of the variance in care burden. Other demographic information of parents and children, depression, and other dimensions of SF-36 were not related to care burden. The severe burden level was associated the increase risk of emotional distress compared with little or no burden group (OR = 37.500, 95% CI = 4.515-311.348, P = 0.001). CONCLUSION: The results indicated that care burden in parents of children newly diagnosed with ALL is high. Parents with lower levels of care burden tend to have less daily care time, more co-caregivers, higher income, less anxiety, better general health, and social support. Strategies are needed to help reduce parents' care burden.

The patient-provider discordance in patients' needs assessment: a qualitative study in breast cancer patients receiving oral chemotherapy.

AIMS AND OBJECTIVES: To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy. BACKGROUND: The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient. Home-based care plans will be central to the effective management of these patients. DESIGN: A descriptive qualitative design was used. METHODS: A purposive sample of nine breast cancer patients, four oncologists and four oncology nurses were recruited in Shanghai, China. Semi-structured and in-depth interviews were conducted to collect data. A qualitative content analysis aimed at finding manifest and latent meanings of data was applied to analyse the information. RESULTS: Four themes of needs emerged from the interviews with patients and providers: information/knowledge, communication, social support and symptom management, but patients and providers only agreed on the assessment of symptom and side-effects management needs. Patients want more positive encouraging information from providers, but providers think patients need more information of efficacy and safety. Patients appreciate support from other peer patients with similar experiences, but providers think the support from families and friends are readily available to them. Patients discussed their spiritual needs, while oncologists see the need to improve patient adherence to medication. CONCLUSION: Breast cancer patients differed from their providers in assessment of healthcare needs. Further investigation of the relationships between patient-provider discordance and patient outcomes may guide interventions to improve care for cancer patients receiving oral chemotherapy. RELEVANCE TO CLINICAL PRACTICE: Oncology nurses should develop a holistic home-based care plan by exploring and integrating the discordance of needs assessment of both patients and health providers.

Development of a Smartphone Application to Monitor Pediatric Patient-Reported Outcomes.

Patient-reported outcomes are increasingly emphasized in clinical trials and population health studies. Our research team developed a smartphone app to track patient-reported outcomes of children with chronic diseases. The purpose of this study is to develop a patient-reported outcome reporting app and evaluate its usability. A multidisciplinary research team including health services researchers, pediatric nurses, and software engineers worked collaboratively in developing the patient-reported outcome app and administration portal. Group discussions and several rounds of feedback and modification were used. Ten pediatric patients with cancer, five parents, and two nurses participated in the usability study. We conducted content analyses in app development and usability evaluation. The app collected demographic information and patient-reported outcomes. Patient-reported outcomes were collected by Chinese versions of pediatric Patient-Reported Outcomes Measurement Information System Short Forms and Patient-Reported Outcomes Measurement Information System Parent Proxy Report Scales for Children. Pediatric patients aged 8 to 17 years and parents with a 5- to 7-year-old pediatric child used different age-appropriate questionnaires. The Web-based administration portal helped to manage demographic information, questionnaires, administrators, and survey-conducting organizations. The users liked the app. All participants felt that this app was easy to use and the interfaces were friendly to children. Nurses thought the administration portal interfaces were simple and the data were convenient to download for further analysis. We conclude that the app and its administration portal meet researchers and clinical nurses' demand and have potential to promote patient-reported outcomes in assessing quality of life and symptoms of pediatric patients.