Interactive digital tools to support empowerment of people with cancer: a systematic literature review.

PURPOSE: To identify and synthesise interactive digital tools used to support the empowerment of people with cancer and the outcomes of these tools. METHODS: A systematic literature review was conducted using PubMed, CINAHL, Web of Science, Cochrane, Eric, Scopus, and PsycINFO databases in May 2023. Inclusion criteria were patient empowerment as an outcome supported by interactive digital tools expressed in study goal, methods or results, peer-reviewed studies published since 2010 in cancer care. Narrative synthesis was applied, and the quality of the studies was assessed following Joanna Briggs Institute checklists. RESULTS: Out of 1571 records screened, 39 studies published in 2011-2022 with RCT (17), single-arm trial (15), quasi-experimental (1), and qualitative designs (6) were included. A total of 30 interactive digital tools were identified to support empowerment (4) and related aspects, such as self-management (2), coping (4), patient activation (9), and self-efficacy (19). Significant positive effects were found on empowerment (1), self-management (1), coping (1), patient activation (2), and self-efficacy (10). Patient experiences were positive. Interactivity occurred with the tool itself (22), peers (7), or nurses (7), physicians (2), psychologists, (2) or social workers (1). CONCLUSION: Interactive digital tools have been developed extensively in recent years, varying in terms of content and methodology, favouring feasibility and pilot designs. In all of the tools, people with cancer are either active or recipients of information. The research evidence indicates positive outcomes for patient empowerment through interactive digital tools. Thus, even though promising, there still is need for further testing of the tools.

Empowering patient education on self-care activity among patients with colorectal cancer - a research protocol for a randomised trial.

BACKGROUND: Chemotherapy-induced side effects may have a negative effect on nutrition intake, thus increasing the risk of malnutrition and consequently, other serious complications for patients with cancer. The prevalence of malnutrition is common among patients with colorectal cancer. Nurse-led empowering education may have a positive effect on self-care activity in this patient group. Therefore, our purpose is to develop an empowering educational nursing intervention and test its effect on self-care activation and knowledge level among patients with colorectal cancer during chemotherapy. Secondary outcomes are quality of life and risk of malnutrition. METHODS: An interdisciplinary expert group developed a face-to-face empowering educational intervention using teach-back method. A two-arm, single-centre, superiority trial with stratified randomisation (1:1) and pre-post measures will be used to assess the effect of the intervention compared to standard care. Patients (N = 40 + 40) will be recruited in one university hospital outpatient clinic in Finland. Eligibility criteria are adult patients diagnosed with colorectal cancer starting oral fluoropyrimidine or combination chemotherapy treatment. A registered nurse experienced in oncology will deliver the intervention 2 weeks after the first chemotherapy. Outcomes are measured before intervention (M0) and after a two-month follow-up period (M1). DISCUSSION: This study will assess whether nurse-led empowering education using teach-back method is effective on self-care activity among patients with colorectal cancer. If the intervention has a positive effect, it may be implemented into patient education in a corresponding context. TRIAL REGISTRATION: ClinicalTrials.gov : NCT04160650 Registered 12 November 2019 - retrospectively registered.

Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews.

AIMS AND OBJECTIVES: To explore nursing interventions used among patients with cancer and summarise the results of their effectiveness. The ultimate goal was to improve the quality of care and provide best evidence for clinicians to refer to while developing effective nursing interventions. BACKGROUND: Nursing interventions refer to actions that nurses take with the aim of improving the well-being of people with cancer-related health and care needs. A plethora of systematic reviews has been conducted in this research area, although with scattered results. We conducted a comprehensive review to identify and summarise the existing evidence. METHODS: This overview of systematic reviews adheres to the PRISMA guidelines. The PubMed, CINAHL, MEDLINE and Scopus databases were searched. Nine reviews reporting findings from 112 original studies published 2007-2017 met the selection criteria. The results of intervention effectiveness were analysed using descriptive quantification and a narrative summary of the quantitative data. RESULTS: The effectiveness of educational nursing interventions was inconsistent on quality of life (QoL), attitudes, anxiety and distress, but positive on level of knowledge, symptom severity, sleep and uncertainty. Psychosocial nursing interventions had a significant effect on spiritual well-being, meaning of life, fatigue and sleep. Psychological nursing interventions reduced cancer-related fatigue. Nursing interventions supporting patients' coping had a significant impact on anxiety, distress, fatigue, sleep, dyspnoea and functional ability. Activity-based interventions may prevent cancer-related fatigue. CONCLUSIONS: Nursing interventions achieved significant physical and psychological effects on the lives of patients with cancer. Multidimensional nature of interventions by combining different elements reinforces the effect. Priorities for future research include identifying the most beneficial components of these interventions. RELEVANCE TO CLINICAL PRACTICE: Implementation of these nursing interventions into clinical practice is important to improve patients' knowledge and QoL as well as reducing various symptoms and side effects related to cancer and its treatment.

Older people's experiences of their free will in nursing homes.

BACKGROUND: Older people in institutional care should be allowed to live a meaningful life in a home-like environment consistent with their own free will. Research on actualisation of older people's own free will in nursing home context is scarce. OBJECTIVES: The purpose of this study was to describe older people's experiences of free will, its actualisation, promoters and barriers in nursing homes to improve the ethical quality of care. RESEARCH DESIGN: Fifteen cognitively intact older people over 65 years in four nursing homes in Southern Finland were interviewed. Giorgi's phenomenological method expanded by Perttula was used to analyse the data. ETHICAL CONSIDERATIONS: Chief administrators of each nursing home gave permission to conduct the study. Informants' written informed consent was gained. FINDINGS: Older people described free will as action consistent with their own mind, opportunity to determine own personal matters and holding on to their rights. Own free will was actualised in having control of bedtime, dressing, privacy and social life with relatives. Own free will was not actualised in receiving help when needed, having an impact on meals, hygiene, free movement, meaningful action and social life. Promoters included older people's attitudes, behaviour, health, physical functioning as well as nurses' ethical conduct. Barriers were nurses' unethical attitudes, institution rules, distracting behaviour of other residents, older people's attitudes, physical frailty and dependency. DISCUSSION: Promoting factors of the actualisation of own free will need to be encouraged. Barriers can be influenced by educating nursing staff in client-orientated approach and influencing attitudes of both nurses and older people. CONCLUSION: Results may benefit ethical education and promote the ethical quality of older people's care practice and management.

The effect of nurse-led empowering education on nutrition impact side effects in patients with colorectal cancer undergoing chemotherapy: A randomised trial.

OBJECTIVE: This study assessed the effect of empowering education on patient-reported outcomes and morbidity. METHODS: A randomised controlled trial was conducted on adults with colorectal cancer (43 + 40). The intervention consisted of one-hour empowering patient education on nutrition impact side effects. The effect was compared with standard care. The difference between the groups was analysed pre and post intervention. RESULTS: The change in malnutrition-related knowledge level was higher in the intervention group compared to control group (median 0.0, IQR 1.00 vs median 0.0, IQR 0.0, p = 0.028). Additional contacts with outpatient clinic were fewer in intervention group (median 0.00, IQR 0.00) compared to control group (median 1.00, IQR 2.00, p < 0.001). We did not find a statistically significant difference in the change in activation level, risk of malnutrition and quality of life between the groups. CONCLUSION: Empowering education may affect positively on patients' knowledge level related to malnutrition and reduce the number of additional contacts with health care thus reduce health care costs. PRACTICE IMPLICATIONS: Empowering education may be used in patients with colorectal cancer to improve knowledge and reduce additional contacts with health care. Further research is needed on the effect of empowering education in self-care.

Expectations of patients with colorectal cancer towards nursing care- a thematic analysis.

PURPOSE: The purpose of this study was to explore comprehensively expectations of patients with colorectal cancer towards nursing care in the chemotherapy context. METHODS: A purposive sample of patients with colorectal cancer (n = 15) was interviewed individually at the outpatient clinic in one university hospital chemotherapy unit. The data were analysed with thematic analysis. RESULTS: Three main themes were identified in the data. Firstly, patients expected to be empowered with knowledge of disease process, side effects and their self-management and peer support. Secondly, patients expected to be humanely encountered, which included being encountered with support, compassion and hope. Thirdly, patients expected to be skillfully cared for with systematic assessment, expertise, continuity and advocacy. CONCLUSIONS: Besides reliable knowledge of cancer treatment and care, patients expected the sympathetic presence of a nurse whose professional skills they can trust. The results may be utilised in intervention development by focusing on themes significant to these patients. The results may help nurses to enhance person-centred care as well as to encounter patients according to their expectations.