Unfolding parental knowledge, attitudes, and beliefs toward palliative care for children with cancer.

BACKGROUND: Parents' views toward pediatric palliative care (PPC) remain underexplored, especially in low/middle-income countries where care relies heavily on families. A better understanding of parents' perspectives would inform strategies to support PPC integration into the care of children with cancer. This multicenter study aimed to examine knowledge, attitudes, and beliefs toward PPC among parents of children with cancer in Lebanon to uncover areas for improvement and determine associated factors. METHODS: Using a quantitative cross-sectional descriptive design, 105 primary caregivers (RR = 95.4%) were recruited during the child's visit to one of three pediatric oncology centers in Lebanon. Data were collected through structured interviews using questionnaire items newly developed or taken from validated tools. Data were analyzed using descriptive statistics, correlational analysis, and multiple linear regression. RESULTS: Only 18/105 participants (17.1%) had heard about PPC and 2% had accurate information about it. When given a brief description, more than 90% endorsed PPC and recommended its integration upon the child's diagnosis. Respectively, "Religious and spiritual engagement" and "Overwhelming negative emotions" were the most cited facilitators and barriers to integrating PPC. Knowledge, attitudes, and beliefs were significantly associated with several demographic and clinical factors such as education level, number of persons living with the child, child's symptom count, and pain score. CONCLUSION: This research is among the very first studies conducted to examine parents' perspectives toward PPC for children with cancer in Lebanon. Study findings inform future directions to promote PPC in limited-resource settings through expanded research, policy, education, and practice initiatives.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Nursing and midwifery research activity in Arab countries from 1950 to 2017.

BACKGROUND: Nursing and midwifery research activity is an important indicator of the quality of healthcare services and the status of nursing profession. The main aim of this study was to assess the research activity in nursing and midwifery field in Arab countries. METHOD: The current study implemented bibliometric method using Scopus database. The search strategy used country affiliation or journal name or keywords as a strategy to retrieve the required documents. The study period was from 1950 to2017. Analysis included a presentation of bibliometric indicators and VOSviewer mapping of the retrieved data. RESULT: 2935 documents were retrieved making up less than 1% of global nursing and midwifery research output. Of the retrieved documents, 25% were published in high rank (first quartile = Q1) journals. The majority (56.7%) of the retrieved documents were published in the last five years of the study period. The retrieved documents received an average of 6.9 citations per document with an h-index of 47. The total number of authors who took part in publishing the retrieved documents was 10,572, giving an average of 3.6 authors per article. Jordan ranked first in research output. Researchers from Jordan took part in over than one third (1023; 34.9%) of the retrieved documents. Lebanon (35.5%) ranked first in the percentage of documents published in Q1 journals. The United Arab Emirates ranked first in the percentage (67.4%) of publications with international authors. The most active journal involved in publishing nursing research from Arab countries was Life Science Journal (158; 5.4%). The University of Jordan was the most productive institution while the American University of Beirut ranked first in the percentage (36.9%) of documents published in Q1 journals. Author keyword analysis and10 most cited articles showed that non-communicable diseases and nursing education were the focus of nursing research in Arab countries. CONCLUSIONS: Nursing and midwifery research activity in Arab countries has dramatically increased especially over the past five years. Despite this, nursing research is still in its infancy, lagging in quantity and quality compared to developed countries.

Cross-cultural adaptation and validation of the STarT Back Tool for Arabic speaking adults with low back pain in Saudi Arabia.

BACKGROUND: The STarT Back Tool (Subgrouping for Targeted Treatment; SBT) was developed and validated in the United Kingdom for adults with non-specific low back pain (LBP) to provide risk stratification groups. An Arabic version has not yet been developed. Consequently, our objectives were: First, to cross-culturally adapt the SBT for use in Arabic speaking adults (SBT-Ar) with LBP. Second, to assess the face, content and construct validity of SBT-Ar against relevant reference standards. METHODS: This was a prospective, cross-sectional study carried out in the outpatient department in a tertiary care hospital. A total of 59 participants (aged 18-60) with LBP able to read Arabic completed the questionnaire. SBT cross-cultural adaptation was performed according to published guidelines. Face and content validity were explored by individual interviews. Construct validity was assessed using pre-hypothesized correlations with relevant reference standards. RESULTS: Following 48 individual interviews the SBT final version was reached and demonstrated face and content validity. The SBT-Ar total score and psychosocial sub-scale had acceptable internal consistency and no redundancy (Cronbach α = 0.7). Moderate Spearman's correlations were found between the SBT-Ar total score and reference standards (Arabic Pain Numeric Rating Scale NRS-Ar r = 0.50 and Arabic Oswestry Disability Index ODI-ar r = 0.51). As expected the SBT-Ar psychosocial subscale had medium to high correlations with the psychosocial reference measures (Arabic Fear-Avoidance Beliefs Questionnaire Physical Activity FABQPA-Ar r = 0.41, Arabic Hospital Anxiety and Depression Scale-Anxiety HADSA-Ar r = 0.58, Arabic Hospital Anxiety and Depression Scale-Depression HADSD-Ar r = 0.45 and Arabic Pain Catastrophizing Scale PCSAr r = 0.69).The SBT-Ar showed no significant floor or ceiling effects. CONCLUSION: This study culturally adapted and preliminary validated SBT into Arabic. STUDY DESIGN: Prospective, Cross-sectional.

Symptom prevalence and management in older adult patients in Lebanon.

OBJECTIVE: The purpose of this study is to explore symptoms and the effectiveness of their management in older adult palliative care candidates in Lebanon. The aims of this study were to: (1) determine symptom prevalence in Lebanese older adults who qualify for palliative care; (2) identify the severity and distress of symptoms; (3) identify the prevalence of symptom management and its efficacy; and (4) explore the relationship between overall symptom burden and its correlates. METHOD: This study uses an observational cross-sectional design using convenience sampling (N = 203) to recruit older adults qualifying for palliative care from three major medical centers in Lebanon. RESULT: The mean age of the sample was 78.61 years. The most prevalent symptoms were lack of energy (93.5%), worrying (83.2%), and pain (71.4%). Psychological symptoms had the highest mean scores, preceded only by the physical symptoms and lack of energy. The most treated symptoms were physical with pain having the highest treatment prevalence (91%). Although psychological symptoms were the most burdensome, they were poorly treated. Multiple regression analysis showed that symptom scores had significant positive associations with financial status, social functioning, and comorbidities; there was a negative association with age. SIGNIFICANCE OF RESULTS: Lack of energy and psychological symptoms were the most prevalent, with the latter having the highest mean total symptom scores. Treatment was poor for psychological symptoms and effective for physical ones. Associations were found between age, comorbidity, financial problems, social functioning, and total physical and psychological mean symptom burden scores. More attention needs to be given to psychological symptoms and their management among older adults receiving palliative care.

Delphi Survey of Clinical Nursing and Midwifery Research Priorities in the Eastern Mediterranean Region.

PURPOSE: As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region. DESIGN: A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016. METHODS: Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau. FINDINGS: Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections. CONCLUSIONS: Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives. CLINICAL RELEVANCE: Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally.

Incorporating gerontological content in the nursing curriculum. The case of AUB School of Nursing.

In Lebanon, the proportion of older adults (over 65 years) is on the rise. This rise is associated with increased morbidity rates and the need for age-specific medical and nursing care. The number of nurses specializing in geriatric care remains very small despite the increased need for this specialty. The nursing curriculum at the Hariri School of Nursing at the American University of Beirut (AUB) has integrated gerontological content in both undergraduate and graduate programs as an essential step to prepare future nurses for the care of the growing population of older adults and consequently to support the health care system. In line with the essential competencies proposed by the American Association of Colleges of Nursing (AACN), the school of nursing at AUB is preparing entry level and advanced practice nurses to care for the geriatric population. Furthermore, developing specialists in the field of gerontology and launching an interdisciplinary graduate program on 'Care of the Older Adult' is more and more becoming a desired development for the future.

Validation of the Arabic version of the EORTC quality of life questionnaire among cancer patients in Lebanon.

PURPOSE: The objective of this article was to evaluate the psychometric properties of the translated Lebanese Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 in a sample of adult cancer patients in Lebanon. METHODS: The EORTC QLQ-C30 was translated into Lebanese Arabic and administered to a convenient sample of 200 adult patients diagnosed with cancer at a tertiary care center in Lebanon between 2009 and 2010. The psychometric indices assessed were reliability, multitrait scaling analysis, construct validity, and confirmatory factor analysis. RESULTS: Six out of nine subscales had Cronbach's alpha coefficients above 0.70. Multitrait scaling analysis showed that all item-scale correlation coefficients met the set standards of convergent validity with the exception of item 5 only (95.8 %). In addition, 79.7 % of the item-scale correlation coefficients met the criterion for discriminant validity. In inter-scale correlations, all conceptually related scales had correlation coefficients of ≥ 0.40 with the exception of role functioning and fatigue scales having an undesirable correlation coefficient of -0.76. In known-groups comparison, the instrument differentiated significantly between some of the subscales with respect to education, employment, and age. CFA showed an almost good fit (GFI = 0.87) with respect to our current data set. CONCLUSION: The translated Lebanese Arabic version of the EORTC QLQ-C30 is a reliable and valid instrument that can be used to assess the quality of life of Lebanese cancer patients.

Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide.

CONTEXT: Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal. OBJECTIVES: 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services. METHODS: Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce. RESULTS: Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships. CONCLUSION: An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.

Bereaved parental evaluation of the quality of a palliative care program in Lebanon.

BACKGROUND: Palliative care (PC) is important in Pediatric Oncology as more than 20% of children with cancer still die despite modern treatment. As a significant number of children reside in countries with limited resources; more research in PC is needed there. This study aimed at evaluating the quality of care provided to children with cancer at the Children's Cancer Center of Lebanon (CCCL) during their last month of life as perceived by the bereaved parents. PROCEDURE: Between 2002 and 2007, 76 children with cancer treated at CCCL succumbed to their disease. Twenty-nine of the bereaved parents were interviewed at home about the symptoms and suffering experienced by their children during the last month of life, communication with the healthcare team, quality of care delivered, and recommendations for improving care. RESULTS: Fatigue, anorexia, and pain were the most prevalent symptoms and edema was the most distressing. The overall communication with the healthcare team and the overall quality of care delivered was rated as "very good" to "excellent" by 86.2% and 93.1% of the participants, respectively. Parents suggested improving the organization of care, the communication, and the availability of human and material resources. CONCLUSIONS: This study is the first conducted in Lebanon to evaluate the quality of pediatric palliative care (PPC). The parents' experiences in our country were similar to those described in other countries, religions, and cultures. Significant strengths and weaknesses in the management of the dying children, from the parents' perspective, were uncovered and recommendations for improving practice were made.

Quality of life in people living with HIV/AIDS in Lebanon.

The aim of the study was to determine the impact of HIV/AIDS on the quality of life (QoL) in Lebanese adult patients living with HIV/AIDS. The study design was a cross-sectional descriptive survey, using self-administered questionnaires. A convenience sample of 41 Lebanese adults (aged 18 years and above) living with HIV/AIDS was recruited from outpatient departments at two major medical centers in Lebanon. The instruments included the Multidimensional Quality of Life HIV (MQoL-HIV), the HIV Symptom Index and a stigma scale, and a demographic section. The majority of the sample were male and single. The mean age was 38 years (SD=9.93). The mean MQoL-HIV score was 176.85, with the highest scores for the cognitive functioning, social functioning, and medical care; the lowest domain scores were for financial status, sexual functioning, and mental health. A single item measuring overall QoL was rated by 47.5% as neither poor nor good. Mean stigma score was 2.05 (SD=0.62) and mean HIV Symptom Index score was 0.6. Prevalence of symptoms and perceived stigma were negative predictors of QoL, being married was a positive predictor of QoL. The results of this study, which is the first to look at the QoL in people living with HIV/AIDS in Lebanon and the Middle East and North Africa region, showed that these mostly asymptomatic well-functioning individuals reported a fair level of QoL. The strongest determinants of QoL revolved around psychosocial aspects of life, namely social relationships, mental health, and medical care.

Nurses' attitudes toward the use of the bar-coding medication administration system.

This study determines nurses' attitudes toward bar-coding medication administration system use. Some of the factors underlying the successful use of bar-coding medication administration systems that are viewed as a connotative indicator of users' attitudes were used to gather data that describe the attitudinal basis for system adoption and use decisions in terms of subjective satisfaction. Only 67 nurses in the United States had the chance to respond to the e-questionnaire posted on the CARING list server for the months of June and July 2007. Participants rated their satisfaction with bar-coding medication administration system use based on system functionality, usability, and its positive/negative impact on the nursing practice. Results showed, to some extent, positive attitude, but the image profile draws attention to nurses' concerns for improving certain system characteristics. The high bar-coding medication administration system skills revealed a more negative perception of the system by the nursing staff. The reasons underlying dissatisfaction with bar-coding medication administration use by skillful users are an important source of knowledge that can be helpful for system development as well as system deployment. As a result, strengthening bar-coding medication administration system usability by magnifying its ability to eliminate medication errors and the contributing factors, maximizing system functionality by ascertaining its power as an extra eye in the medication administration process, and impacting the clinical nursing practice positively by being helpful to nurses, speeding up the medication administration process, and being user-friendly can offer a congenial settings for establishing positive attitude toward system use, which in turn leads to successful bar-coding medication administration system use.

Chronic pain in children and adolescents: a review.

Chronic pain in children has been increasing in prevalence and studies have provided evidence that it impacts the functional/physical aspects of the children's life and their psychological and emotional well-being. Family caregivers of children and adolescents with chronic pain suffer a great sense of burden affecting their emotional, social, and family functioning. The problem is also exacerbated by the additional financial burden secondary to increased physician consultation and medication use. A better understanding of pain in children is needed in order to gain insight in the etiology. The aim of the following article is to provide a review of the literature on the prevalence of chronic pain in children and adolescents and the factors associated with it.

Self-care confidence mediates self-care maintenance and management in patients with heart failure.

BACKGROUND: Literature highlights the influence of self-care confidence on self-care in patients with heart failure (HF), but little is known whether it explains the influence of other determinants of self-care. OBJECTIVES: To examine whether confidence explained the associations of social support and HF-knowledge with self-care. METHODS: In a descriptive, correlational study, 100 patients with HF completed questionnaires on self-care, social support, and HF-specific knowledge. Regression analyses were used to examine associations between perceived support and HF-knowledge and self-care. RESULTS: Self-care confidence mediated the association between social support and self-care maintenance (path reduced from Beta = 0.713 to 0.395) and HF-knowledge and maintenance (path reduced from Beta = 2.569 to 1.798) and management (path reduced from Beta = -0.272 to -0.144). CONCLUSION: Self-care confidence explains the influence of social support and knowledge on self-care. Supporting self-care confidence may be a key target for interventions to improve disease management and behaviors in patients with HF.

The Development and Psychometric Validation of an Arabic-Language Version of the Pain Catastrophizing Scale.

Context. The Pain Catastrophizing Scale (PCS) is the most widely used measure of pain-specific catastrophizing. Objectives. The purpose of the present study was to develop and psychometrically evaluate an Arabic-language version of the PCS. Methods. In Study 1, 150 adult chronic nonmalignant pain patients seeking treatment at a hospital setting completed the PCS-A and a number of self-report measures assessing clinical parameters of pain, symptoms of depression, and quality of life. Study 2 employed a cold pressor pain task to examine the PCS-A in a sample of 44 healthy university students. Results. Exploratory factor analyses suggested a two-factor structure. Confirmatory factor analysis comparing the 2-factor model, Sullivan's original 3-factor model, and a 1-factor model based on the total score all provided adequate fit to the data. Cronbach's alpha coefficients across all models met or exceeded accepted standards of reliability. Catastrophizing was associated with higher levels of depression and increased pain intensity and interference. Catastrophizing predicted decreased quality of life, even after controlling for the contribution of gender, employment, depression, and pain interference. PCS-A scores were positively correlated with heightened experimental pain severity and decreased pain tolerance. Conclusion. The present results provide strong support for the psychometric properties of the PCS-A.

Cherishing the past: 100 years of nursing education at the American University of Beirut.

This article describes the foundation and the development of nursing education at the American University of Beirut, the first professional school in the country and the region, across 100 years (1905-2005). It talks about the early years, pioneering achievements (1905-1940), the school's leadership in nursing from 1940 to 1976, the war years from 1976 to 1993, and postwar global vision (1993-2005). Furthermore, it gives special tribute to the dedication and hard work of the founders, Ms. Jane Elizabeth Van Zandt and Ms. Mary Bliss Dale, and all the directors whose endeavors and wisdom have helped the development of the school from diploma to bachelor and master's programs.

Lebanese parents' experiences with a child with cancer.

BACKGROUND: The impact of childhood cancer on the family has been studied in different cultures and continues to be an object of study and concern, In Lebanon, a country of 4 million people 282 new pediatric cases of cancer age <20 years diagnosed in 2004 were reported in 2008. OBJECTIVES: The purpose of this study was to explore the experiences of Lebanese families living with a child with cancer. METHOD: The study followed purposeful sampling in which 12 parents (mother or father) of a child with cancer were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironsides (1998). RESULTS: A constitutive pattern "It is a continuous battle" and five themes emerged from the data analysis. Living with the shock of the diagnosis; Alterations in the quality of the family's life; Living with added burdens; Disease impact on the family and sibling dynamics; Living with uncertainty represent the major themes that emerged from the participants' experiences while living with a child with cancer. CONCLUSION: The study contributes to the knowledge that would help health care professionals understand the experiences and challenges that are faced by Lebanese families living with a child with cancer. This awareness would serve as a basis for health care professionals in general and nurses in particular to understand parents' experiences, and offer support, elicit communication of feelings, and examine possibilities for forming a partnership during the challenging course of the child's illness. Supported parents are more likely to provide more effective care to their child with cancer.

Psychometric evaluation of the arabic brief pain inventory in a sample of Lebanese cancer patients.

CONTEXT: Pain is a common complaint in oncology patients, and success in its treatment requires accurate assessment. Thus, assessment tools that are practical, culturally sensitive, and psychometrically sound are needed. OBJECTIVES: The purpose of this study was to evaluate the psychometric properties and cultural sensitivity of the Arabic Brief Pain Inventory (BPI) in a Lebanese sample of cancer patients. The BPI measures the location and severity of pain; pain relief from treatment; and the pain's interference with life. METHODS: The BPI was translated into Arabic. Its cultural sensitivity was evaluated by a panel of experts. This instrument and a visual analogue scale for pain were administered to a convenience sample of 75 adult oncology patients receiving pain treatment. RESULTS: The experts' ratings indicated that the tool was culturally sensitive. The majority of the patient sample (88%) was married, male (78.7%), older than 46 years (56%), and with at least a secondary education (84%). The mean pain intensity rating was 5.3 ± 1.7, with interference ratings of 5.3 ± 2.0 to 7.0 ± 2.5. Most patients (78.4%) reported more than 50% pain relief with treatment. Cronbach alpha coefficients were 0.82 and 0.92 for the severity and interference items, respectively. Factor analysis yielded two factors, replicating the severity and interference dimensions. Correlations between the severity and interference items ranged between 0.25 and 0.57 (P < 0.05). CONCLUSION: The findings support the validity, reliability, and cultural sensitivity of the Arabic BPI in Lebanese oncology patients. This tool can be used to assess pain and improve its management in this population.

Coping with breast cancer: a phenomenological study.

BACKGROUND: Breast cancer is the most common malignancy affecting women worldwide. In Lebanon, a country of 4 million people, breast cancer is also the most prevalent type of cancer among Lebanese women. OBJECTIVE: The purpose of this study was to gain a more in-depth understanding of the coping strategies espoused by Lebanese women with breast cancer. METHODS: The study followed purposeful sampling and saturation principles in which 10 female participants diagnosed as having breast cancer were interviewed. Data were analyzed following a hermeneutical process as described by Diekelmann and Ironside (Encyclopedia of Nursing Research. 1998:50-68). RESULTS: Seven main themes and 1 constitutive pattern emerged from the study describing the Lebanese women's coping strategies with breast cancer. The negative stigma of cancer in the Lebanese culture, the role of women in the Lebanese families, and the embedded role of religion in Lebanese society are bases of the differences in the coping strategies of Lebanese women with breast cancer as compared to women with breast cancer from other cultures. CONCLUSION: These findings cannot be directly generalized, but they could act as a basis for further research on which to base a development of a framework for an approach to care that promotes coping processes in Lebanese women living with breast cancer. IMPLICATIONS FOR PRACTICE: Nursing and medical staff need to have a better understanding of the individual coping strategies of each woman and its impact on the woman's well being; the creation of informal support group is indispensable in helping these women cope with their conditions.