Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy.

BACKGROUND: Breast cancer is the most common diagnosis and the leading cause of cancer death among women worldwide and ranks first among Asian and Taiwanese women. Cancer-related fatigue (CRF) affects patients' functioning significantly. AIMS: The aim of this study was to examine changes in cancer-related fatigue (CRF) and related factors among women with breast cancer undergoing a single chemotherapy, and to identify predictors of CRF's change over the course of the chemotherapy cycle. METHODS: Four self-report questionnaires were administered to assess CRF, sleep quality, depression and anxiety, and symptom distress. Heart rate variability (HRV) was assessed to evaluate autonomic nervous system activation related to CRF. Data were collected four times: (1) before initiation of the single chemotherapy cycle (T0), (2) after completion of the single cycle (T1), (3) 1 week post-chemo (T2), and (4) 3 weeks post-chemo (T3). Repeated measurement of variance and generalized estimating equations (GEE) were conducted to estimate the trajectories and predictors. RESULTS: One-hundred women with breast cancer (mean age 50.4 ± 9.42) participated. CRF (F = 7.46), sleep quality (F = 2.74), symptom distress (F = 9.99), anxiety (F = 5.72), and depression (F = 4.14) varied significantly over the single cycle of chemotherapy (p < .001), which the trajectories showed exacerbating at T2. HRV indicated a higher variation only on the day of injection (T0, T1). Results of the GEE revealed that anxiety, depression, and symptom distress were predictors of CRF's change over the single cycle of chemotherapy. LINKING EVIDENCE TO ACTION: CRF worsens at 1 week after a chemotherapy injection among Taiwanese women with breast cancer. Based on the risk predictors in CRF that included anxiety, depression, and symptom distress, multistrategy CRF-alleviating interventions should be provided prior to chemotherapy and targeted at the most disturbed period, that is, 1 week after injection.

Knowledge and comfort related to palliative care among Indonesian primary health care providers.

This study investigated Indonesian primary health care providers' knowledge and comfort towards palliative care. A descriptive cross-sectional design was used. From August 2017 to February 2018, the research team approached 70 primary care centres in the Yogyakarta province of Indonesia and invited health care providers to complete the Palliative Care Quiz for Nursing - Indonesia and describe their comfort in caring for terminally ill patients. Data were obtained from 516 health care providers. The mean (±s.d.) score of palliative care knowledge was low (7.8±3.3 of a possible score of 20). Current comfort level in providing palliative care was also low (1.6±2.7 of a possible score of 10). Only 11.3% of palliative care knowledge was explained by respondents understanding of palliative care definition, their education levels and experience in providing palliative care in hospital. However, 82.9% of provider comfort was explained by their experiences for caring for terminally ill patients in primary healthcare centres, palliative care training and years of work experience in primary healthcare centres. Indonesian evidence-based palliative care standards and guidelines must be established with education offered to all providers.

Long-term effectiveness of an E-based survivorship care plan for breast cancer survivors: A quasi-experimental study.

OBJECTIVE: The purpose of this study was to evaluate the effect of a web-based survivorship care plan (SCP) computerized application (APP): (SCP-A) on women's unmet needs, fear of recurrence, symptom distress, anxiety, depression, and quality of life (QoL). METHODS: Women diagnosed with breast cancer, who had completed their primary treatment but less than 5 years without a sign of recurrence (N = 165) were randomized to a SCP-A or a control group. Self-reported questionnaires were completed by the both groups at baseline (T0), 5 weeks (T1), 3 months (T2), 6 months (T3), and 12 months (T4). RESULTS: Controlling for relevant covariates, mixed effect model analyses revealed a significant decrease in women in the SCP-A group compared to the control group for total unmet needs since T3 (p < .004) and fear of recurrence since T4 (p = .02). Women in the SCP-A group also reported significant improvements in QoL at T4 (p < .001) relative to those in the control group. CONCLUSION: Providing SCP using an information website application for women with breast cancer can decrease unmet needs, fear of recurrence, and improve quality of life during short-term and long-term use. PRACTICE IMPLICATIONS: Web-based information that provides survivorship care plans for breast cancer survivors are beneficial.

Effectiveness of a Pre-emptive Preoperative Belladonna and Opium Suppository on Postoperative Urgency and Pain After Ureteroscopy.

PURPOSE: Postoperative ureteroscopy patients can develop bladder spasms, complaints of pain, and the urgent need to void during emergence from anesthesia. Discomfort leads to patient agitation, resulting in a risk to patient safety. The purpose of this study was to determine the effectiveness of a preemptive preoperative belladonna and opium (B + O) suppository on postoperative bladder comfort, narcotic requirements, and length of stay of ureteroscopy patients. DESIGN: A prospective double-blind study was conducted. METHODS: Fifty adult outpatients scheduled for ureteroscopy were assigned to routine care or a B + O suppository immediately after anesthesia induction. Urinary urgency and pain were assessed every 15 minutes. FINDINGS: Urgency significantly decreased in the B+O group, with less than half reporting urgency at discharge. CONCLUSIONS: Pre-emptive preoperative administration of a B + O suppository before ureteroscopy results in decreased urinary urgency during the postoperative recovery. Pre-emptive preoperative interventions can result in positive outcomes before discharge.

Longitudinal psychosocial adjustment of women to human papillomavirus infection.

AIM: The aim of this study was to examine the psychosocial adjustment trajectory, focusing on psychological distress, sexual relationships and healthcare information, and factors which have an impact on adjustment on receiving a positive diagnosis of human papillomavirus infection. BACKGROUND: Human papillomavirus is a common sexually transmitted infection in females. To date, knowledge of the longitudinal psychosocial response to the diagnosis of human papillomavirus is limited. DESIGN: A prospective longitudinal design was conducted with a convenience sample. METHODS: Women aged 20-65 years old were followed at one, 6 and 12 months after a diagnosis of HPV. Participants completed measures of initial emotional distress and followed up psychosocial adjustment. A mixed-effects model was applied to analyse the longitudinal changes in psychosocial adjustment. RESULTS: Seventy human papillomavirus positive women participated in the study with nearly 20% of the women reporting emotional distress during their first visit. Mixed-effects model analyses showed that a trajectory of psychosocial adjustment in healthcare orientation, sexual relationship and psychosocial distress occur from one to 6 months after HPV diagnosis. However, a declining trend from 6 to 12 months was significant in healthcare orientation. Initial emotional distress was associated with changes in psychological adjustment. CONCLUSIONS: Psychosocial adjustment to human papillomavirus was worse at 1 month compared with 6 and 12 months after diagnosis. Healthcare providers should offer health information and psychosocial support to women according to their disease progression.

Fear of Recurrence as a Predictor of Care Needs for Long-Term Breast Cancer Survivors.

BACKGROUND: The improved survival rate for breast cancer has increased the number of women living with the diagnosis for more than 5 years. Limited studies have focused on the care needs for long-term healthy survivors of breast cancer. OBJECTIVE: The aims of this study were to understand the care needs of long-term breast cancer survivors and identify related factors that influence these needs. METHODS: A convenience sampling with a correlational study design was used. Women at least 20 years old, who were given a diagnosis of breast cancer at least 5 years, were recruited from 2 hospital clinics in southern Taiwan. A self-administered questionnaire measuring cancer survivors' unmet needs was administered after obtaining informed consent. Binary logistic regression was used to examine variables associated with unmet care needs. RESULTS: Of the 192 women participating, the highest unmet needs related to existential survivorship. The most frequently endorsed unmet need was for an ongoing case manager. Fear of recurrence was associated with 3 aspects including existential survivorship, comprehensive cancer, and quality-of-life unmet needs (odds ratio, 1.14-1.21). CONCLUSIONS: Even 5 years after the diagnosis and completion of therapy, women continue to report unmet needs. Evaluating women's fear of recurrence to identify high-risk women with unmet needs is critical to providing quality care. IMPLICATION FOR PRACTICE: Developing appropriate survivorship care programs combined with managing concerns regarding recurrence by a nursing case manager is needed.

Chemotherapy-Induced Peripheral Neuropathy Assessment Tools: A Systematic Review

PROBLEM IDENTIFICATION: Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting chemotherapy toxicity, which has a long-lasting effect and decreases quality of life. Although several tools have been developed to detect CIPN, the study quality, psychometric properties, and practicality of CIPN assessment tools have not been systematically reviewed.
. LITERATURE SEARCH: Electronic searches using keywords were conducted in Medline, PubMed, CINAHL®, and Cochrane Library for articles published from 1980-2015. Eligible studies were included if they involved patients with cancer receiving chemotherapy, provided CIPN assessment tools with psychometric properties, and were published in English.
. DATA EVALUATION: Data were extracted, and study quality was assessed. CIPN tools were evaluated in terms of psychometric properties and practicality.
. SYNTHESIS: A total of 19 studies describing 20 tools were reviewed. The quality of studies varied from strong to weak. The validity ranged from low to high, and the reliability with internal consistency ranged from 0.56-0.96. Poor inter-rater agreement was found. Not all of the tools were deemed practical.
. CONCLUSIONS: Considering the psychometric properties and practicality, two tools (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity [FACT/GOG-Ntx] and Total Neuropathy Score [TNS]) are recommended for assessing CIPN.
. IMPLICATIONS FOR NURSING: Routine assessment of CIPN and choosing appropriate assessment tools are imperative. The FACT/GOG-Ntx and TNS are recommended for clinical use.

Knowledge and beliefs about cervical cancer and human papillomavirus among Taiwanese undergraduate women.

PURPOSE/OBJECTIVES: To assess knowledge and attitudes regarding cervical cancer and human papillomavirus (HPV) among undergraduate women in Taiwan. DESIGN: A descriptive cross-sectional design. SETTING: Five universities in southern Taiwan. SAMPLE: 953 undergraduate women aged 17-36 years. METHODS: The self-administered HPV Belief questionnaire was used to collect data on knowledge and beliefs regarding cervical cancer, Pap testing, and HPV. MAIN RESEARCH VARIABLES: Knowledge, beliefs, cervical cancer, Pap testing, HPV, likelihood of cervical cancer, and HPV infection. FINDINGS: Seventy percent of participants agreed that cervical cancer could be prevented and was a severe disease, and 80% knew the purpose of Pap testing. Forty-nine percent were aware of HPV. Undergraduate women with an awareness of HPV were more likely to be older, studying a health-related major, have a higher class standing, have a personal history of gynecologic visits, and have had a Pap test. Neither family history of gynecologic cancer nor sexual experience predicted HPV awareness, although sexual experience had a significant association with the knowledge and beliefs of cervical cancer. Most of the undergraduate women believed themselves unlikely to acquire cervical cancer or HPV infection. CONCLUSIONS: Undergraduate women in Taiwan have limited knowledge of cervical cancer and HPV. Awareness of the likelihood of HPV infection is low among undergraduate women, even those who are sexually active. IMPLICATIONS FOR NURSING: Educational campaigns focusing on cervical cancer screening and HPV infection are needed, particularly for sexually active undergraduate women.

Health beliefs of Taiwanese women seeking HPV vaccination.

In Taiwan, human papillomavirus (HPV) vaccine is recommended for women aged 9-26 years. The purpose of this study was to examine health beliefs and reasons for HPV vaccination among young adult women (aged 18-26 years), and adult women (aged over 26 years). Women who initiated HPV vaccination were recruited from three hospitals in southern Taiwan. One hundred and eighty-nine subjects completed a questionnaire on health beliefs and reasons for HPV vaccinations. 38% (n=72) of the women who initiated vaccination were over the age of 26. Health beliefs regarding HPV vaccination differ between young adult women and adult women. Recommendations from others (family, health care providers, etc.) are among the main reasons for young adult women to initiate HPV vaccination; while self-awareness of the risk for HPV infection and personal gynecologic diseases are main reasons for adult women to initiate HPV vaccination. Furthermore, women aged 18-26 are more likely than women aged over 26 to consider the cost and availability of vaccination. Media also plays an important role in a woman's decision to seek HPV vaccination.

Intention to obtain human papillomavirus vaccination among taiwanese undergraduate women.

BACKGROUND: The human papillomavirus (HPV) vaccine provides an effective strategy against HPV infection, genital warts, and cervical cancer. While the HPV vaccine is available worldwide, acceptance outside of Western countries is unknown. The purpose of the study was to examine health beliefs and intention to obtain the HPV vaccination among undergraduate women in Taiwan. A predictive model of HPV vaccination intention was investigated. METHODS: A convenience sample of 845 female undergraduate students (mean age = 20 years, aged: 17-36 years) recruited from 5 universities located in South Taiwan, provided data. A self-administered questionnaire requested demographic information, gynecologic history, awareness of HPV and the vaccine, health beliefs, and intention to obtain the HPV vaccine. RESULTS: Over 50% of the undergraduate women were aware of HPV and the HPV vaccine. Sixty-three percent of the students reported a high intention to obtain the HPV vaccine. Demographic factors predicting HPV vaccination included: age, family history of gynecologic cancer, personal history of gynecological visit, sexual experience, and awareness of HPV and the HPV vaccine. Health belief factors predicting HPV vaccination included: personal susceptibility of disease, perception of disease severity, attributes of HPV, cost and availability of vaccine, attributes of HPV, and recommendations from others. CONCLUSIONS: Improving undergraduate women's HPV vaccination rate will require educational campaigns, specifically focused on the efficacy, safety, and benefits of the HPV vaccine and the attributes of HPV infection. Targeting incoming students who are not yet sexually active could achieve successful outcomes.

Self-care activities for postdischarge nausea and vomiting.

Postdischarge nausea and vomiting (PDNV) is a serious threat to the recovery of ambulatory surgical patients. Pharmacological interventions available before discharge are not readily available to the patient after discharge; therefore, the activities that patients perform to manage new-onset PDNV may affect their surgical recovery. Assembled from a comprehensive study of PDNV, this paper describes the self-care activities that ambulatory patients use to manage new-onset nausea and vomiting after discharge. The findings have implications for patient education and future research.

The effect of two nursing interventions on the postoperative outcomes of gynecologic laparoscopic patients.

Anecdotal reports support research findings in documenting the high incidence of negative postoperative outcomes after gynecologic (GYN) laparoscopic surgery. Three outcome measures, postoperative pain, postoperative nausea and vomiting (PONV), and length of stay, have received considerable attention. Two nursing interventions frequently suggested for their positive effects are guided imagery and music therapy. An experimental pilot study was conducted to determine the effects of these nursing inventions on postoperative pain, PONV, and length of stay for GYN laparoscopic patients (n = 84). During the perioperative period, patients were randomly assigned to one of 3 interventions: guided imagery audiotapes (GI), music audiotapes (MU), or standard care (C), and outcome measures were evaluated. Results indicated that patients in both the guided imagery and music groups had significantly less pain on PACU discharge to home than the patients in the control group. These findings suggest that both guided imagery and music are effective strategies in improving pain, a difference that becomes apparent when the patient is ready to be discharged. It is possible that these interventions act as distractions in reducing the report of negative postoperative outcomes.

The patient with an implantable cardioverter defibrillator.

Electrophysiologic technology developed over the past 20 years has improved the life expectancy of patients who have survived sudden cardiac death events. Use of an implantable cardioverter defibrillator (ICD) continues to increase as more indications for the device are researched. Patients with ICDs will be cared for in the postanesthesia care unit following cardiac and noncardiac surgery and require PACU nurses to be knowledgeable about this advanced and changing technology as well as provide for emotional and psychological needs.