[Development and Validation of a Dignity in Care Scale of Terminally Ill Patients for Nurses].

PURPOSE: This study aimed to develop an instrument to showcase Dignity in Care of Terminally Ill Patients for Nurses and to examine its validity and reliability. METHODS: A total of 58 preliminary items on dignity in care of terminally ill patients for nurses were selected using content validity analysis and expert opinions on 97 candidate items derived through a literature review and qualitative focus group interviews. Questionnaires were administered to 502 nurses caring for terminally ill cancer patients at hospice and palliative care institutions. The data were analyzed using item analysis, exploratory and confirmatory factor analysis, convergent and discriminant validity, and Pearson correlation for criterion validity, reliability was tested using Cronbach's alpha. RESULTS: The final instrument consisted of 25 items, with four factors identified through confirmatory factor analysis. Four factors-ethical values and moral attitudes, interaction-based communication, maintaining comfort, professional insight and competence-accounted for 61.8% of the total variance. Cronbach's α for total items was .96, and test-retest reliability of intraclass correlation coefficient was .90. CONCLUSION: Since its validity and reliability have been verified through various methods, the Dignity in Care Scale of Terminally Ill Patients for Nurses can be used for develop nursing interventions and improve dignity in care of terminally ill patients.

Development and Evaluation of a Mobile Web-based Food Allergy and Anaphylaxis Management Educational Program for Parents of School-aged Children with Food Allergy: A Randomized Controlled Trial.

PURPOSE: This study aimed to develop a mobile web-based food allergy (FA) and anaphylaxis management educational program for parents of school-aged children with food allergies and evaluate its effectiveness. METHODS: A mobile program was developed based on a web-based teaching-learning system model. Its effectiveness was subsequently evaluated using a parallel, randomized controlled pre- and post-test design. This study included 73 parents of school-aged children with food allergies. These parents were randomly assigned to either the experimental (n = 37) or control (n = 36) groups. The experimental group participated in a 2-week mobile web-based educational program that covered major topics in FA and anaphylaxis management. These topics included an understanding of food allergies and anaphylaxis, learning techniques for using an epinephrine auto-injector, and developing an emergency action plan. An educational booklet was provided to the control group. Participants completed a pre-test and two post-test questionnaires to evaluate the impact of the program. The assessment tools were the Food Allergy Knowledge Test, Food Allergy Self-Efficacy for Parents, and Food Management and Adaptation Scale. The data were analyzed using descriptive statistics, a test of homogeneity for the pre-test, an independent t-test, and repeated measures ANOVA. RESULTS: The experimental group experienced greater improvement in the knowledge of FA (post-intervention t = 14.51, p < .001; 2 weeks post-intervention, t = 16.15, p < .001), FA self-efficacy (post-intervention t = 77.99, p < .001; 2 weeks post-intervention, t = 76.09, p < .001), and practice behavior in FA management (post-intervention t = 28.10, p < .001; 2 weeks post-intervention, t = 27.98, p < .001) after web-based FA education. CONCLUSION: This study revealed improvements in the knowledge, self-efficacy, and practice behaviors of parents regarding FA and anaphylaxis management. Therefore, the mobile web-based educational program can contribute to the effective management of food allergies and anaphylaxis for parents of school-aged children. CRIS registration: KCT0007491.

Changes in Fatigue, Psychological Distress, and Quality of Life After Chemotherapy in Women with Breast Cancer: A Prospective Study.

BACKGROUND: Chemotherapy leads to various symptoms and psychological distress, which contribute to a significant decrease in the quality of life of the patients. OBJECTIVES: The aim of this study was to identify changes and interrelationships in the fatigue-depression-anxiety symptom cluster and quality of life during the cancer care trajectory in women with breast cancer. METHODS: Fifty women participated in the study and completed questionnaires at 3 different times: prechemotherapy, postchemotherapy, and 6 months after the completion of chemotherapy. The assessment tools were the Functional Assessment of Cancer Therapy-Fatigue Scale, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-Breast Cancer version 4 Scale. Data were analyzed using descriptive and repeated-measures analysis of variance statistics. RESULTS: A significant increase in fatigue (F = 41.95, P < .001) and psychological distress (F = 26.55, P < .001) from prechemotherapy to postchemotherapy was noted. Improvement was observed 6 months after the completion of chemotherapy. A positive or negative change in fatigue was associated with the same in psychological distress. Quality of life (F = 65.22, P < .001) also showed similar change patterns as observed with fatigue and psychological distress. Fatigue had a greater impact on quality of life at postchemotherapy, but psychological distress had a greater impact at prechemotherapy and at the 6-month follow-up. CONCLUSION: These results suggest that chemotherapy is highly associated with the fatigue-depression-anxiety symptom cluster and quality of life in women with breast cancer. IMPLICATIONS FOR PRACTICE: Nursing intervention is needed to relieve the intensity of the fatigue-depression-anxiety symptom cluster and thus improve the quality of life of patients undergoing chemotherapy from before treatment to follow-up.

Changes in chemotherapy-induced peripheral neuropathy, disturbance in activities of daily living, and depression following chemotherapy in patients with colorectal cancer: A prospective study.

PURPOSE: This study was conducted to identify the changes in oxaliplatin-induced peripheral neuropathy (OIPN), disturbance in activities of daily living (ADL), and depression and their interrelationships during the cancer care trajectory in colorectal cancer patients. METHODS: Eighty-six subjects participated in the study and completed the questionnaire at three time points: pre-chemotherapy, undergoing chemotherapy, and 3 months after the completion of chemotherapy. The assessment tools were Chemotherapy-Induced Peripheral Neuropathy 20 for OIPN, Chemotherapy-Induced Peripheral Neuropathy Assessment Tool to measure disturbances in ADL, and Hospital Anxiety and Depression Scale for depression. Data were analyzed using descriptive statistics and repeated-measures analysis of variance. RESULTS: While undergoing chemotherapy, 37.2% of the patients complained of OIPN and 32.6% exhibited OIPN at 3-month follow-up. Repeated-measures analysis of variance showed a significant increase in OIPN after chemotherapy, which remained high at the 3-month follow-up. The most frequent symptom of OIPN was "tingling feeling in the hand and foot," and the second was "impotence." Disturbance in ADL by OIPN and depression showed similar patterns as OIPN. The mean score for disturbance in ADL of OIPN was 48.58. The mean score was 7.36 for depression, with a prevalence of 23.5%. There were significant correlations among the three variables, suggesting that OIPN may be casual in the OIPN- disturbance in ADL-depression symptom interrelationships. CONCLUSION: These results suggest that chemotherapy is highly associated with OIPN, disturbance in ADL by OIPN, and depression in colorectal cancer patients. Nursing intervention is needed to relieve depression as well as OIPN in patients undergoing chemotherapy.

[A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients].

PURPOSE: This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model. METHODS: The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs. RESULTS: The modified model was a good fit for the data. The model fit indices were χ²=423.18 (p<.001), χ²/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (ß=.38, p=.002), depression and anxiety (ß=.25, p=.002), and symptom experiences (ß=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (ß=-.51, p=.001), symptom experiences (ß=-.27, p=.001), menopausal symptoms (ß=-.22, p=.008), and chemotherapy-related cognitive impairment (ß=-.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%. CONCLUSION: These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.

[Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis].

PURPOSE: This study was conducted to evaluate the effectiveness of non-pharmacologic interventions in chemotherapy-induced peripheral neuropathy (CIPN). METHODS: PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean databases (Until August 2017) were searched. The main search strategy combined terms for peripheral neuropathy and presence of neoplasms. The risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies and the Risk of Bias Assessment tool for non-randomized studies. To estimate the effect size, a meta-analysis of the studies was performed using the Rev Man 5.3 program of the Cochrane Library random-effects models were used in the analyses. RESULTS: Twenty-two studies with a total of 954 participants met the inclusion criteria. Of the 22 studies, 12 were used to estimate the effect size of the non-pharmacologic interventions. The non-pharmacologic interventions used in patients with CIPN were exercise, acupuncture, massage, and foot bath. The acupuncture significantly reduced CIPN symptoms and signs (d=-0.71) and CIPN pain (d=-0.73) (p<.001). Massage and foot bath were also effective in reducing CIPN symptoms (d=-0.68; 95% CI=-1.05, -0.30; p<.001; I²=19%).Exercises were effective in improving muscle strength and endurance(d=-0.55) and quality of life (d=-2.96), but they were not significantly effective in improving CIPN. CONCLUSION: Although these results provide little evidence of the effectiveness of acupuncture, massage, and foot bath in the treatment of CIPN, they suggest that these interventions can reduce CIPN symptoms in patients with cancer. However, the findings of this study should be interpreted with caution as there is a relative lack of data in this field, and additional well-designed studies are needed. PROSPERO registration: CRD42017076278.

Predictors of cognitive decline in people with cancer undergoing chemotherapy.

PURPOSE: The purpose of this study was to investigate the impact of demographic factors, disease/treatment-related factors, and psychological factors on cognitive function. METHOD: A cross-sectional study was conducted. Participants were recruited from the oncology inpatient units of two hospitals. A convenience sample of 175 patients with cancer who underwent chemotherapy were recruited. The Everyday Cognition Scale (ECog), the Korean version of the Mini Mental State Examination (K-MMSE), Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale, Hospital Anxiety and Depression Scale (HADS), and a questionnaire to collect information about demographic, disease, and treatment information were completed. RESULTS: More participants showed a mild decline in cognitive function and self-reported cognitive decline (39.4%) than had objectively confirmed decline (20%). Notably, 53.7-62.9% of the participants showed memory loss and a decline in divided attention. Demographic factors (age, sex), disease/treatment-related factors (chemotherapy cycles, fatigue), and psychological factors (depression) were predictors of cognitive decline in 49.6% of participants. CONCLUSIONS: Old age and cumulative chemotherapy cycles were the main influential factors for objectively confirmed cognitive decline, and fatigue was the most common predictor of self-reported cognitive decline. Depression was one of the predictors of perceived cognitive decline, but it was not significant for objectively measured cognitive function. Thus, treatment-related factors such as fatigue had a greater impact on cognitive decline than psychological factors.

The Effects of Nonpharmacologic Interventions on Cognitive Function in Patients With Cancer: A Meta-Analysis.

PROBLEM IDENTIFICATION: To evaluate the effects of nonpharmacologic interventions on cognitive functioning in adult patients with cancer.
. LITERATURE SEARCH: EMBASE, MEDLINE®, Cochrane Library CENTRAL, CINAHL®, and Korean databases.
. DATA EVALUATION: Cochrane's risk of bias for randomized studies and the RevMan, version 5.3, program of the Cochrane Library were used.
. SYNTHESIS: Fourteen controlled trials with a total of 977 participants met the inclusion criteria. Overall, nonpharmacologic interventions had beneficial effects on subjective cognitive functioning and memory, but not on attention, executive functioning, and verbal ability. In the subgroup analyses by approach type, psychological interventions had a significant effect on perceived cognitive function. 
. CONCLUSIONS: The findings suggest that nonpharmacologic interventions, particularly psychological interventions, may have a positive impact on perceived cognitive functioning and memory in patients with cancer. Additional research with adequate power is required to determine the effectiveness of behavioral intervention as a cognitive rehabilitation strategy.
. IMPLICATIONS FOR PRACTICE: Cognitive function would be most improved in patients with cancer when a multimodal intervention approach (education, retraining, and physical activity) is employed.

[Effect of Cancer Symptoms and Fatigue on Chemotherapy-related Cognitive Impairment and Depression in People with Gastrointestinal Cancer].

PURPOSE: The purpose of this study was to test a hypothetical model of chemotherapy-related cognitive impairment (CRCI) and depression in people with gastrointestinal cancer. METHODS: A purposive sample of 198 patients undergoing chemotherapy was recruited from November 2014 to July 2015. The instruments were Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module. Data were analyzed using descriptive statistics, correlation, and path analysis. RESULTS: CRCI was directly affected by cancer symptoms (ß=.19, p=.004) and fatigue (ß=.56, p<.001)(R²=47.2%). Depression was directly affected by fatigue (ß=.48, p<.001) and CRCI (ß=.27, p<.001). However, The impact of cancer symptoms on depression was confirmed through the mediating effect of CRCI. CONCLUSION: Results indicate that in patients with gastrointestinal cancer undergoing chemotherapy along with the direct physiologic effects (fatigue, symptoms) of cancer treatment may have altered cognitive function leading to depression.

The Effects of Expressive Writing Interventions for Patients With Cancer: A Meta-Analysis.

PURPOSE/OBJECTIVES: To evaluate the effects of expressive writing (EW) interventions in patients with cancer.
. DATA SOURCES: Electronic databases searched included both international and Korean databases through January 2015.
. DATA SYNTHESIS: Of the 20 trials that met the eligibility criteria of this review, a meta-analysis was conducted of 14 articles involving 13 randomized and 1 nonrandomized trials with 1,718 patients with cancer. EW interventions were compared with a neutral writing intervention or usual care (no writing). A significant small effect was noted on relieving cancer symptoms; however, the effects on psychological and cognitive outcomes were not significant. When subgroup analysis by control condition was performed, a significant effect on health-related quality of life was found between the EW intervention group and the usual care group. 
. CONCLUSIONS: EW had significant small effects only on cancer symptoms. The findings suggest that the traditional EW intervention protocol may need to be intensified to confirm its effect on patients with cancer.
. IMPLICATIONS FOR NURSING: Current evidence for EW as a nursing intervention for improving physical, psychological, and cognitive outcomes among patients with cancer is promising, but not conclusive.

[Chemotherapy-related Cognitive Impairment and Quality of Life in People with Colon Cancer: The Mediating Effect of Psychological Distress].

PURPOSE: The purpose of this study was to test the mediating effect of psychological distress in the relationship between chemotherapy related cognitive impairment (CRCI) and quality of life (QOL) in people with cancer. METHODS: A purposive sample of 130 patients undergoing chemotherapy was recruited for the cross-sectional survey design. Data were collected from November 2014 to June 2015. The instruments were K-MMSE (Korean Mini-Mental State Examination), Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). Data were analyzed using descriptive statistics, correlation, and multiple regression using Baron and Kenny steps for mediation. RESULTS: The mean score for objective cognitive function was 27.95 and 69.32 for perceived cognitive decline. Overall quality of life was 91.74. The mean score was 17.52 for psychological distress. The prevalence was 56.2% for anxiety and 63.1% for depression, and 20.0% for CRCI. There were significant correlations among the variables, objective cognitive function and self-reported cognitive decline, psychological distress, and quality of life. Psychological distress was directly affected by CRCI. (R²=29%). QOL was directly affected by CRCI. Psychological distress and CRCI effected QOL (R²=43%). Psychological distress had a partial mediating effect (ß=-.56, p<.001) in the relationship between self-reported cognitive decline and quality of life (Sobel test: Z=-5.08, p<.001). CONCLUSION: Based on the findings of this study, nursing intervention programs focusing on managing cognitive decline, and decreasing psychological distress are highly recommended to improve quality of life in cancer patients.

[Disturbance in ADL from Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Cancer Patients: The Mediating Effect of Psychological Distress].

PURPOSE: The purpose of this study was to examine the mediation of psychological distress in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life in order to provide a basis for planning nursing interventions to improve the quality of life in cancer patients. METHODS: A purposive sample of 130 patients treated with chemotherapy were recruited in the cross-sectional survey design. Data were collected using self-report questionnaires. The instruments were the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS: The mean score for disturbance in ADL from chemotherapy induced peripheral neuropathy was 3.30. Overall quality of life was 2.48. The mean score was 1.04 for psychological distress. The prevalence was 35.4% for anxiety and 47.7% for depression. There were significant correlations among the three variables, disturbance in ADL from chemotherapy induced peripheral neuropathy, psychosocial distress, and quality of life. Psychosocial distress had a complete mediating effect (ß=-.74, p<.001) in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life (Sobel test: Z=-6.11, p<.001). CONCLUSION: Based on the findings of this study, nursing intervention programs focusing on disturbance of ADL management, and decrease of psychological distress are highly recommended to improve quality of life in cancer patients.

Effects of the Use of High-Fidelity Human Simulation in Nursing Education: A Meta-Analysis.

BACKGROUND: This study was conducted to evaluate the effects of high-fidelity human simulation (HFHS) on cognitive, affective, and psychomotor outcomes of learning. METHOD: PubMed, Cochrane Library, EMBASE, CINAHL, and Korean databases were searched. The RevMan program was used for analysis. RESULTS: A meta-analysis was conducted of 26 controlled trials, with a total of 2,031 nursing students. The use of HFHS tended to have beneficial effects on cognitive and psychomotor domains of learning. In analysis of cognitive outcomes, the weighted average effect size across studies was -0.97 for problem-solving competency, -0.67 for critical thinking, and -2.15 for clinical judgment. The effect size for clinical competence of the psychomotor domain was -0.81. CONCLUSION: Use of HFHS might positively impact a high level of cognitive skill and clinical skill acquisition. Further research is required to determine the effectiveness of use of HFHS as an educational strategy to improve knowledge acquisition and communication skills.

The effects of simulation-based learning using standardized patients in nursing students: A meta-analysis.

PURPOSE: The aim of this study was to evaluate the effect of simulation-based learning using standardized patients (SPs) on cognitive, affective, and psychomotor domain outcomes of learning in nursing students. METHODS: MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean electronic databases (to June 2014) were searched. The RevMan 5.3 program of the Cochrane library was used for data analysis. RESULTS: A meta-analysis was conducted of 18 controlled trials (4 randomized and 14 non-randomized designs), with a total of 1326 nursing students. Overall, simulation-based learning using SPs appeared to have beneficial effects on the cognitive, affective, and psychomotor domains of learning. In subgroup analysis, use of SPs showed significant effects on knowledge acquisition (d=0.38, p=.05, I(2)=42%), communication skill (d=1.86, p<.001, I(2)=15%), self-efficacy (d=0.61, p<.001, I(2)=6%), learning motivation (d=0.77, p<.001, I(2)=0%) and clinical competence (d=0.72, p<.001, I(2)=0%). Treatment effects on critical thinking (p=.75) and learning satisfaction (p=.43) were not significant. CONCLUSION: The findings of the current study suggest that simulation-based learning using SPs might have a positive impact on self efficacy and learning motivation that affects knowledge and clinical skill acquisition. Therefore, these findings demonstrate that, if integrated appropriately, an SP educational approach can be used in academic settings as an active learning methodology.

[Effects of dignity interventions on psychosocial and existential distress in terminally ill patients: a meta-analysis].

PURPOSE: This study was done to evaluate the effects of dignity interventions on depression, anxiety and meaning of life in terminally ill patients. METHODS: PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and several Korean databases were searched. The main search strategy combined terms indicating dignity intervention, presence of terminal illness and study design. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. Data were analyzed by the RevMan 5.2.11 program of Cochrane Library. RESULTS: Twelve clinical trials met the inclusion criteria with a total of 878 participants. Dignity intervention was conducted for a mean of 2.2 weeks, 2.8 sessions and an average of 48.7 minutes per session. Effect sizes were heterogeneous and subgroup analysis was done. Dignity interventions had a significant effect on depression (ES=-1.05, p<.001, I²=15%) and anxiety (ES=-1.01, p<.001, I²=0). For meaning of life, dignity interventions were effective (ES=-1.64, p=.005) and effect sizes were still heterogeneous. CONCLUSION: Results support findings that dignity interventions can assist terminal ill patients in reducing emotional distress and improving meaning of life. Further well-designed dignity studies will lead to better understanding of the effects of treatments on spiritual well-being.

[Effects of psychosocial interventions on cortisol and immune parameters in patients with cancer: a meta-analysis].

PURPOSE: This study was done to evaluate the effects of psychosocial interventions on cortisol and immune response in adult patients with cancer. METHODS: MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and domestic electronic databases were searched. Twenty controlled trials (11 randomized and 9 non-randomized trials) met the inclusion criteria with a total of 862 participants. Methodological quality was assessed using the Cochrane's Risk of Bias for randomized studies and the Risk of Bias Assessment tool for non randomized studies. Data were analyzed using the RevMan 5.2.11 program of Cochrane library. RESULTS: Overall, study quality was moderate to high. The weighted average effect size across studies was -0.32 (95% CI [-0.56, -0.07], p=.010, I²=45%) for cortisol concentration, -0.62 (95%CI [-0.96,-0.29], p<.001, I²=0%) for T lymphocyte (CD3) and -0.45 (95%CI [-0.74, -0.16], p=.003, I²=0%) for Th lymphocyte (CD4) numbers. Psychosocial interventions were not effective for Tc lymphocyte (CD4), NK cell, monocyte, and cytokine response. CONCLUSION: Although these results provide only small evidence of successful immune modulation, they support the conclusion that psychosocial interventions can assist cancer patients in reducing emotional distress and improving immune response.

The effects of spiritual interventions in patients with cancer: a meta-analysis.

PURPOSE/OBJECTIVES: To evaluate the effects of a spiritual intervention in patients with cancer. DATA SOURCES: Databases searched included both international electronic databases (MEDLINE® via PubMed, Cochrane Library CENTRAL, EMBASE, and CINAHL®) as well as Korean electronic databases (KMBASE, KOREAMED, RISS, KISS, and NANET) through December 2013. DATA SYNTHESIS: A meta-analysis was conducted of 15 studies involving 14 controlled trials (7 randomized and 7 nonrandomized) with 889 patients with cancer. Spiritual interventions were compared with a usual care control group or other psychosocial interventions. The weighted average effect size across studies was -0.48 (p = 0.006, I2 = 65%) for spiritual well-being, -0.58 (p = 0.02, I2 = 70%) for meaning of life, -0.87 (p = 0.02, I2 = 87%) for anxiety, and -0.62 (p = 0.001, I2 = 73%) for depression. CONCLUSIONS: The findings showed that spiritual interventions had significant but moderate effects on spiritual well-being, meaning of life, and depression. However, the evidence remains weak because of the mixed study design and substantial heterogeneity. IMPLICATIONS FOR NURSING: Oncology nurses increasingly recognize the significance of the spiritual domain of care. The current study indicates that facilitating spiritual awareness and needs may be a worthwhile nursing intervention for patients with cancer.

[Effect of school-based peer leader centered smoking prevention program].

PURPOSE: The purpose of this study was to develop and evaluate a school-based peer leader centered smoking prevention program. METHODS: Non-equivalent control group with a pre/post-test design was used. Students (n=174) in two boys' junior high schools located in D city, Korea participated with 85 being selected for the experimental group and 89 for the control group. Five sessions were given to the experimental group and a 50 minute lecture to the control group. Knowledge, attitude, non-smoking intention, and non-smoking efficacy were measured for the both experimental and control group at two weeks before the program and one month after the program was completed. Data were analyzed using χ²-test, Fisher's exact test, independent t-test and paired t-test with the SPSS 21.0 program. RESULTS: The experimental group showed higher overall knowledge, negative attitude toward smoking, and higher non-smoking intention and efficacy. After receiving the school based peer leader centered smoking prevention program scores for attitude toward smoking and non-smoking efficacy increased in the experimental group were higher than in the control group. CONCLUSION: The school-based peer leader centered smoking prevention program needs longitudinal evaluation, but from this study, there is an indication that this program can be used with junior high school students and effectively change students' attitude toward smoking and promote non-smoking efficacy.

[Meta-analysis of psychosocial interventions to reduce pain in patients with cancer].

PURPOSE: The purpose of this study was to investigate the effects of psychosocial interventions on pain in cancer patients. METHODS: Eight studies published between 1980 and 2012 in Korean and ten studies published between 2002 and 2012 in English met the inclusion criteria with a total of 1539 participants. Methodological quality assessed by Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. The data were analyzed by the RevMan 5.2 program of Cochrane library. RESULTS: Overall, study quality was moderate to high. Effect sizes were heterogeneous and subgroup analysis was done. Cognitive behavioral therapy (CBT) were effective for pain (ES= -0.35; 95% CI= -0.56, -0.13). Pain education studies measured with NRS and VAS were effective for pain (ES= -0.77; 95% CI= -1.01, -0.52). Publication bias was not detected. CONCLUSION: This study support the use of psychosocial interventions administered to cancer patients for their pain management. However, more well-designed studies are needed.

[Meta-analysis of spiritual intervention studies on biological, psychological, and spiritual outcomes].

PURPOSE: The purpose of this study was to evaluate the effectiveness of spiritual intervention studies by examining biological, psychological, and spiritual outcomes. METHODS: From electronic databases 2522 studies were retrieved, of which 21 studies met the inclusion criteria. These studies had 1411 participants. Two authors independently extracted data from the selected studies and assessed the methodological quality. The data were analyzed using the RevMan 5.1 program of the Cochrane library. RESULTS: Overall effect size of spiritual intervention on spiritual and psychological (depression and anxiety) outcomes were moderate (d=-0.65 to d=-0.76, p<.001). The effects on biological outcomes (pain and functional status) ranged from -0.51 to -0.39, respectively. No publication bias was detected as evaluated by a funnel plot. Spiritual intervention had a moderate effect on psychological and spiritual outcomes and a smaller effect on biological outcomes. CONCLUSION: The results of this study suggest that spiritual intervention can relieve depression and anxiety. Further randomized controlled trials studies are needed to evaluate the effects of spiritual intervention on biological outcomes.