Exploring the influence of Traditional Chinese Medicine on self-care among Chinese cancer patients.

PURPOSE: The aim of this study was to explore the influence of traditional Chinese medicine (TCM) on self-care among Chinese cancer patients. METHODS: This was an exploratory qualitative study. A purposive sample of thirty cancer patients who were currently undergoing either chemotherapy or radiotherapy was interviewed. Qualitative content analysis was conducted for data analysis. RESULTS: Two core categories were emerged from their accounts of experiences with practising TCM-supported self-care activities: perceived beneficial effects and concerns about undesirable effects. The perceived beneficial effects of these self-care activities were mainly stemmed from the traditional beliefs in TCM, which included: strengthening the "origin", removing toxins, and mind-soothing. Concerns about undesirable effects of these self-care activities were raised due to lack of knowledge and unpleasant experience with these self-care activities. CONCLUSION: The findings revealed that the philosophy of TCM had been deeply integrated by Chinese cancer patients into their self-care. While Western medicine is the mainstream cancer treatment, Chinese cancer patients also practised various TCM-supported self-care activities. However, they were perplexed about the effects of these self-care activities. They could not ascertain whether the perceived benefits were just due to their own belief in the TCM philosophy, and their lack of knowledge in this aspect and unpleasant experience further confused them. Nurses have to be proactive in identifying the unique health-deviation self-care requisites of their clients in a culturally sensitive manner, explore how their self-care experience affects their wellbeing and treatment compliance, and be prepared to clarify misconceptions about their conditions and progress.

Uptake of prostate cancer screening and associated factors among Chinese men aged 50 or more: a population-based survey.

OBJECTIVE: To investigate the uptake rate of prostate specific antigen (PSA) testing among Hong Kong Chinese males aged 50 or above, and identify factors associated with the likelihood of undergoing a PSA test. METHODS: A population-based telephone survey was conducted in Hong Kong in 2007. The survey covered demographic information, perceived health status, use of complementary therapy, cancer screening behavior, perceived susceptibility to cancer and family history of cancer. Descriptive statistics, percentages and logistic regression analysis were used for data analysis. RESULTS: A total of 1,002 men aged 50 or above took part in the study (response rate =67%), and the uptake rate of PSA testing was found to be 10%. Employment status, use of complementary therapy, perceiving regular visits to a doctor as good for health and the recommendations of health professionals were significant factors associated with PSA testing. CONCLUSION: The uptake rate of PSA testing in the study population was very low. Among all the factors identified, recommendations from health professionals had the strongest association with the uptake of PSA testing, and they should therefore take an active role in educating this population about cancer prevention and detection.

The dynamic process of adherence to a renal therapeutic regimen: perspectives of patients undergoing continuous ambulatory peritoneal dialysis.

BACKGROUND: The nature of end-stage renal disease and the need for continuous ambulatory peritoneal dialysis require patients to manage various aspects of the disease, its symptoms and treatment. After attending a training programme, patients are expected to adhere to the renal therapeutic regimen and manage their disease with the knowledge and skills learned. While patients are the stakeholders of their health and related behaviour, their perceptions of adherence and how they adhere to their renal therapeutic regimen remains unexplored. AIMS: To understand adherence from patients' perspectives and to describe changes in adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis. DESIGN: This study used a mixed methods design with two phases - a survey in phase I and semi-structured interviews in phase II. This paper presents phase II of the study. SETTINGS: The study was conducted at a renal unit of an acute hospital in Hong Kong. PARTICIPANTS: Based on the phase I survey results, maximum variation sampling was employed to purposively recruit 36 participants of different genders (18 males, 18 females), ages (35-76 years), and lengths of dialysis experience (11-103 months) for the phase II interviews. METHODS: Data were collected by tape-recorded semi-structured interviews. Content analysis was employed to analyse the transcribed data. Data collection and analysis were conducted simultaneously. FINDINGS: Adherence was a dynamic process with three stages. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2-6 months of dialysis, participants entered the stage of subsequent adherence, when they adopted selective adherence through experimenting, monitoring and making continuous adjustments. The stage of long-term adherence commenced after 3-5 years of dialysis, when participants were able to assimilate the modified therapeutic regimen into everyday life. CONCLUSIONS: The process of adherence was dynamic as there were fluctuations at each stage of the participants' adherence. With reference to each stage identified, nursing interventions can be developed to help patients achieve smooth transition throughout all the stages.

Gender differences in the use of colorectal cancer tests among older Chinese adults.

PURPOSE: The study aimed to explore the gender difference in using colorectal cancer (CRC) tests among Chinese aged 50 years or over. METHODS: A cross-sectional study was conducted in 2004 Chinese older adults through anonymous telephone survey which covered socio-demographic variables, health status, use of complementary therapy, health-related perceptions and use of CRC tests. RESULTS: The uptake rate of flexible sigmoidoscopy (FS)/colonoscopy was 14% for males and 10% for females, with males significantly more likely to have had the test after adjusting for their differences in socio-demographics, health status, use of complementary therapies, health-related perceptions and recommendation received from health professionals (adjusted OR = 1.5, 95% CI: 1.1-2.0, p = 0.005). The uptake of fecal occult blood test was nearly the same (19%) for both genders. Further interaction analyses indicates that the effect of a family history of cancer on the uptake of a FS/colonoscopy is significantly weaker in males than in females (the interaction odds ratio = 0.4, 95% CI: 0.2-0.8, p = 0.011), whereas a male perceived that visiting a doctor is good for health will be more likely to have an uptake of a FS/colonoscopy than a female with such perception (the interaction odds ratio = 2.1, 95% CI: 1.1-3.8, p = 0.018). CONCLUSIONS: The uptake of CRC tests was low in this average-risk population. More effort is needed to educate the public about the importance and benefits of CRC tests. In view of the gender differences in some determinants of FS/colonoscopy uptake, particular attention should be given to develop gender-specific strategies to improve the rate.

Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study.

AIM: This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. BACKGROUND: Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. METHODS: A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. RESULTS: The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. CONCLUSION: The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.

Baccalaureate nursing students' perceptions of peer assessment of individual contributions to a group project: a case study.

A group project is a common method of assessment in higher education worldwide. The use of an adjunct peer assessment (PA) scheme as a means to award marks for individual student contributions to a group project has increased. However, nursing students' perceptions of PA have not been well studied. This paper examines baccalaureate nursing students' perceptions of PA in assessing individual contributions to a group project. Using a case study design with both quantitative (an anonymous survey with 123 students), and qualitative methods (six focus group interviews with 21 students), data were collected from students in a baccalaureate nursing programme. Merging of quantitative and qualitative findings indicated that students overall had positive perceptions of PA, especially its ability to reduce 'free-riding'. However, students also had some interpersonal and operational concerns about the PA implementation process. Based on the findings, we recommend: (1) further developing students' abilities to assess the contributions of others to the task and relationship functions in group work; and (2) adopting a confidential online system for submission of PA forms.

Quality of life and its predictors among Hong Kong Chinese patients with diabetes.

AIM: To adapt, cross-culturally, an established quality of life (QoL) scale for Hong Kong Chinese patients with diabetes; to measure their QoL and to identify the predictors of QoL in this population. BACKGROUND: Healthcare providers are called on to assess and enhance the QoL of patients with diabetes. However, there is a lack of empirical QoL data pertaining to such individuals in China. METHODS: The diabetes-specific QoL scale (DQoL) developed by Jacobson and the Diabetes Control and Complications Trial research group was cross-culturally adapted for use in a sample of 206 Hong Kong Chinese patients recruited from a diabetes specialist outpatient clinic. Demographic and clinical data were also collected. RESULTS: The cross-cultural adaptation process produced a Hong Kong Chinese version of the DQoL scale with 37 items (HKC-DQoL-37) that demonstrated good internal consistency (alpha = 0.87) and acceptable test-retest validity (ICC 0.70, 95% CI 0.36-0.87). Discriminant validity was confirmed by comparing QoL scores between patients with and without insulin treatment. The QoL status of this sample (Mean = 2.2, SD = 0.5) is similar to that of Chinese immigrants and Caucasians in North America. Multiple regression analyses identified four predictors of poor QoL: (i) younger age, (ii) with diabetes complications, (iii) with admission due to hypoglycaemia, (iv) on insulin treatment. CONCLUSIONS: Findings provide preliminary evidence on the validity and reliability of the HKC-DQoL-37. The four predictors of poor DQoL in Hong Kong Chinese patients are consistent with those identified in the West. RELEVANCE TO CLINICAL PRACTICE: Understanding these predictors of poor QoL could help nurses and others to design and deliver appropriate interventions to these patients.

Experience of Hong Kong patients awaiting kidney transplantation in mainland China.

AIM: This paper describes the experience of Hong Kong Chinese patients awaiting kidney transplantation in mainland China. BACKGROUND: While travelling to mainland China for kidney transplantation is a controversial issue, there is an increasing trend of Hong Kong Chinese patients with chronic kidney disease seeking this treatment choice, which outnumbers that performed in Hong Kong. Although these patients seek pre- and post-transplantation care from Hong Kong public healthcare system, little is known about their experience during the waiting period. METHODS: This experience is examined in an exploratory qualitative study. In-depth interviews were used to collect data from a purposive sample of 12 kidney recipients. RESULTS: Three major findings are identified: (i) transplant waiting patients may travel to mainland China for transplantation in search of normal life, (ii) they need informational support from their continuing healthcare providers in Hong Kong to make the informed decision and (iii) they perceive a variation of attitudes of nurses and doctors in Hong Kong towards transplantation in mainland China. CONCLUSIONS: This study contributes to the literature by researching patients' perspective. The findings highlight the importance and controversy of addressing these patients' informational needs. While the authors have no inclination for or against travelling to mainland China for transplantation, the findings reveal a tenacious clinical dilemma, which deserves debate in international transplant community and further research to inform the debate. Nurse and doctors in Hong Kong may contribute to the debate by articulating their experience of caring for these patients. RELEVANCE TO CLINICAL PRACTICE: Health information that is readily available for patients scheduled for kidney transplantation in Hong Kong should be made accessible to the whole community of patients with chronic kidney disease. To address the complexity of patients travelling to elsewhere for transplantation and the needs of these patients, provider reticence may be counterproductive.

Psychometric properties of the Chinese version of the diabetes empowerment scale.

Metabolic control is central to positive clinical outcome in patients with diabetes. Empowerment has been linked to metabolic control in this clinical group. The current study sought to determine key psychometric properties of the Chinese version of the Diabetes Empowerment Scale (C-DES) and to explore the relationship of the C-DES sub-scales to metabolic control in 189 patients with a diagnosis of diabetes. Confirmatory factor analysis established that the five sub-scales of the C-DES offered a highly satisfactory fit to the data. Furthermore, C-DES sub-scales were found to have generally acceptable internal consistency and divergent reliability. However, convergent reliability of C-DES sub-scales could not be established against metabolic control. It is concluded that future research needs to address ambiguities in the relationship between empowerment and metabolic control in order to afford patients an evidenced-based treatment package to assure optimal metabolic control.

Translation and validation of the Chinese version of the Gastrointestinal Quality of Life Index in patients with gastric tumor.

OBJECTIVE: Patients with gastric tumor are known to have deterioration in quality of life (QOL) following surgery. However, there is no valid disease-specific self-report QOL measure for clinical practice and research designated for Chinese in Hong Kong. The current study aimed at translating and validating a Chinese version of the Gastrointestinal Quality of Life Index (C-GIQLI) for use in patients with gastric tumors after gastrectomy. METHODS: A translation of the English version of the instrument was performed. The psychometric properties of the C-GIQLI were investigated using internal consistency analysis, correlational analysis, and confirmatory factor analysis in 140 Chinese patients who had undergone surgery for gastric tumor. RESULTS: The C-GIQLI demonstrated good test-retest reliability, internal consistency, and a factor structure consistent with the measurement model of the European version of the instrument. CONCLUSION: The C-GIQLI is recommended as a valid and reliable self-report measure of QOL in patients with gastric tumor after gastrectomy.

Determinants in the development of advanced nursing practice: a case study of primary-care settings in Hong Kong.

Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients' expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes.

Development of a reliable and valid Chinese version of the diabetes empowerment scale.

OBJECTIVE: To translate the Diabetes Empowerment Scale (DES) into Chinese and establish its psychometric properties among Hong Kong Chinese people. RESEARCH DESIGN AND METHODS: A two-stage study design, incorporating qualitative and quantitative components, determined the cultural equivalency and content validity of the translated scale and established the psychometric properties of the Chinese DES (C-DES) in 207 patients. RESULTS: Psychometric analysis supported the reliability and validity of the 20-item Chinese DES (C-DES-20) and five subscales: overcoming barriers (alpha = 0.89), determining suitable methods (alpha = 0.79), achieving goals (alpha = 0.78), obtaining support (alpha = 0.78), and coping (alpha = 0.76). The test-retest reliability of the intraclass correlations was satisfactory when a subsample of 20 patients was tested after a 2-week interval. There was criterion validity between the global scale and metabolic control (HbA(1c)) of respondents with type 2 diabetes (P = 0.03). CONCLUSIONS: The C-DES-20 is a reliable and valid outcome measure for patient education and psychosocial interventions among Hong Kong Chinese people with diabetes.