A Mixed-Methods Study of Unmet Supportive Care Needs Among Head and Neck Cancer Survivors.

BACKGROUND: Head and neck cancer (HNC) survivors face increasing challenges to adjust to the diagnosis and late effects of treatment. Identifying unmet needs among HNC survivors is therefore important to provide a comprehensive supportive care service for them. OBJECTIVE: The aim of this study was to examine the unmet supportive care needs (SCNs) of HNC survivors in the first year after treatment. METHODS: An explanatory sequential mixed-method design with 2 phases was used. In the quantitative phase, standardized questionnaires were administered to 285 Chinese HNC survivors to solicit their demographic and clinical characteristics, unmet SCNs, and access to various support services. In the qualitative phase, individual semistructured interviews were conducted with 53 participants to explore their unmet needs in more detail. RESULTS: The most prevalent unmet SCNs among the survivors were in the health system and information domain. Five categories of unmet needs emerged from the interview data: physical, psychological, health system and information, patient care and support, and sexuality. The findings reflect the inadequacy of the healthcare services for these survivors. CONCLUSION: Chinese HNC survivors experienced a variety of unmet SCNs, particularly in the areas of symptom management and healthcare system and information provision. IMPLICATIONS FOR PRACTICE: The study provides insights that can (1) inform future service development, including regular symptom identification and management, improvements in communication, and counseling services and (2) identify the specific needs of these survivors as the basis for tailoring care to meet their needs.

A Theory-Based and Culturally Aligned Training Program on Breast and Cervical Cancer Prevention for South Asian Community Health Workers: A Feasibility Study.

BACKGROUND: Cancer screening uptake among South Asian ethnic minorities is reported to be relatively low. An outreach program, led by community health workers (CHWs), may increase the minority group's awareness of the importance of cancer screening. OBJECTIVE: The aim of this study was to assess the feasibility and effectiveness of a theory-based, culturally sensitive program to train South Asian women in Hong Kong as CHWs. METHODS: A CHW training program, guided by the Empowerment Model and the Health Belief Model, was developed and implemented. Its feasibility was evaluated through the recruitment of South Asian women to the program and their satisfaction with it. Its effectiveness was assessed by a test of knowledge, the participants' self-efficacy and competence, and their readiness to work as CHWs. RESULTS: Five South Asian women were recruited to the training program. Outcomes included increased participants' knowledge of cancer and improved self-efficacy and competence in working as CHWs. All participants were highly satisfied with the program, although the addition of practical sessions in the South Asian community was suggested as a further improvement. CONCLUSION: It seems to be feasible to train South Asian CHWs to deliver interventions to promote their peers' awareness of breast and cervical cancer prevention, although challenges exist in recruitment of trainees. More hands-on practical opportunities as CHWs would likely increase their effectiveness. IMPLICATIONS FOR PRACTICE: The theoretical framework of our CHW training program and the incorporated cultural components could be useful for the development of future programs for training South Asian CHWs in delivering interventions on cancer prevention.

A Review of Psychoeducational Interventions to Improve Sexual Functioning, Quality of Life, and Psychological Outcomes in Gynecological Cancer Patients.

BACKGROUND: Psychoeducational interventions are recommended for use with clinical gynecological cancer patients to improve their patient care outcomes. However, the evidence of their effectiveness is far from conclusive. OBJECTIVE: The objective of this study was to identify the best available research evidence related to the effects of psychoeducational interventions on sexual functioning, quality of life, and psychological outcomes in gynecological cancer patients. METHODS: A systematic search was conducted to identify English and Chinese articles from the inception of the databases to April 2012 and included 13 English databases and 7 Chinese databases. Gray literature or unpublished studies were also searched. RESULTS: A total of 11 studies involving 975 gynecological cancer patients were included in the review. Meta-analysis results for 4 comparable studies indicated that psychoeducational interventions were effective in treating depressive symptoms among gynecological cancer patients (standardized mean difference = -0.80; 95% confidence interval, -1.05 to -0.54), whereas information provision significantly improved the mental aspect of quality of life (standardized mean difference = -0.41; 95% confidence interval, -0.74 to -0.08). With regard to sexual functioning, psychoeducational interventions appeared to have benefits in improving the sexual life of patients. CONCLUSIONS: Findings confirm the effectiveness of psychoeducational interventions on depressive symptoms and mental aspect of the quality of life in gynecological cancer patients. IMPLICATIONS FOR PRACTICE: The authors discuss the implications of review findings for the effective design of psychoeducational interventions including components, provider, provision time frame, and duration for clinical practice, as well as psychoeducational intervention research.

A feasibility study of a psychoeducational intervention program for gynecological cancer patients.

PURPOSE OF THE RESEARCH: This study aimed to test the feasibility of implementing a psychoeducational intervention program for gynecological cancer patients. METHODS AND SAMPLE: A single-blinded randomized controlled trial and mixed-method design were used. Study subjects were newly diagnosed gynecological cancer patients with surgery as the first-line treatment. They were randomly assigned to the intervention group, in which a psychoeducational intervention program based on a thematic counseling model was offered, or to the attention control group. Quantitative data on sexual functioning, quality of life, uncertainty, anxiety, depression and social support were collected at recruitment, post-operative and during the in-hospital period, and eight weeks after the operation. Participants in the intervention group and three nurses working in the clinical setting were invited to have semi-structured interviews. KEY RESULTS: Of the 30 eligible subjects, 26 were successfully recruited into the study. Following the psychoeducational intervention program, there was significant improvement in the level of inconsistent information about the illness within the category of uncertainty among participants in the intervention group. In addition, trends towards improvement were demonstrated in quality of life, uncertainty, depression and perceived social support with the provision of the interventions. Qualitative data indicated the interventions were desired and appreciated by the participants, as well as being feasible and practical to implement in Hong Kong clinical settings. CONCLUSIONS: The findings suggest that it is feasible to deliver the psychoeducational intervention program and it may have beneficial effects in gynecological cancer patients. A full-scale study is warranted to confirm the results.

Effects of psychoeducational interventions on sexual functioning, quality of life and psychological outcomes in patients with gynaecological cancer: A systematic review.

BACKGROUND: The diagnosis of gynaecological cancer and the effects of related treatment have adverse effects on sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions are recommended for use in clinical areas for gynaecological cancer patients to improve patient outcomes. However, the evidence for its effectiveness is far from conclusive. Moreover, such interventions are still scarce or even absent in most countries. OBJECTIVES: To identify the best available evidence related to the effectiveness of psychoeducational interventions for gynaecological cancer patients on sexual functioning, quality of life and psychological outcomes. INCLUSION CRITERIA: Randomized controlled trials.Adult women who with a primary gynaecological cancer confirmed by pathology test.Psychoeducational interventions that aimed at enhancing the acceptance of the disease and recovery from the illness and treatment among gynaecological cancer patients.Sexual functioning, quality of life and psychological outcomes including, but not limited to, anxiety, depression, distress, adjustment to illness, mood, self-esteem, uncertainty, and coping. SEARCH STRATEGY: Thirty electronic bibliographic databases in English and Chinese were searched from their inception to April 2012. METHODOLOGICAL QUALITY: The Joanna Briggs Institute Critical Appraisal Checklist for experimental studies was used to critically appraise the methodological quality of studies. DATA COLLECTION: Two reviewers extracted and summarized the details of included studies using the Joanna Briggs Institute data extraction form independently. DATA SYNTHESIS: Quantitative results of comparable studies were pooled in statistical meta-analysis. Standardized mean difference and 95% confidence interval were calculated for the summary effect of continuous data measured by different scales. Results were presented in narrative form where statistical pooling was not appropriate. RESULTS: A total of 11 randomized controlled trials involving 975 gynaecological cancer patients were included. Only four studies were comparable to perform meta-analysis. On the basis of two studies examining the outcome of depression, there was a significant improvement in depressive symptoms (SMD: -0.80; 95% CI: -1.05 to -0.54) among participants in the intervention group in which information provision, cognitive-behavioral therapy and counseling were combined together. On the basis of another two studies examining the outcome of quality of life, there was no significant benefit in physical aspect of quality of life (SMD: -0.12; 95% CI: -0.45 to 0.20; p = 0.46) for the intervention group. Conversely, the control group of information-only therapy demonstrated significant effects on mental aspect of quality of life (SMD: -0.41; 95% CI: -0.74 to -0.08; p = 0.01) compared to those receiving psychoeducational interventions. There were no conclusive findings regarding the effects of psychoeducational interventions on the outcomes of sexual functioning, anxiety, distress, adjustment to illness, mood, self-esteem, uncertainty and coping among the gynaecological cancer patients. CONCLUSIONS: The review demonstrated evidence of positive effects of psychoeducational interventions on gynaecological cancer patients.The review suggested that psychoeducational interventions incorporate all four components, i.e. information provision, cognitive-behavioral therapy, social support and counseling. The format could be individual or group, with or without couple participation. A nurse was preferred to be the ideal provider. Provision time frame should be before the start of the treatment and continued after discharge, and the number of sessions could be four. Each session should be between 30 minutes to one hour long.More well-designed randomized controlled trials are needed to further examine the effects of psychoeducational interventions on psychological outcomes in this group of patients. Due to the diversity of these interventions, the optimal format of each also requires investigation.