Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis.

Importance: Mindfulness-based interventions (MBIs), grounded in mindfulness, focus on purposely paying attention to experiences occurring at the present moment without judgment. MBIs are increasingly used by patients with cancer for the reduction of anxiety, but it remains unclear if MBIs reduce anxiety in patients with cancer. Objective: To evaluate the association of MBIs with reductions in the severity of anxiety in patients with cancer. Data Sources: Systematic searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and SCOPUS were conducted from database inception to May 2019 to identify relevant citations. Study Selection: Randomized clinical trials (RCTs) that compared MBI with usual care, waitlist controls, or no intervention for the management of anxiety in cancer patients were included. Two reviewers conducted a blinded screening. Of 101 initially identified studies, 28 met the inclusion criteria. Data Extraction and Synthesis: Two reviewers independently extracted the data. The Cochrane Collaboration risk-of-bias tool was used to assess the quality of RCTs, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Summary effect measures were reported as standardized mean differences (SMDs) and calculated using a random-effects model. Main Outcomes and Measures: Our primary outcome was the measure of severity of short-term anxiety (up to 1-month postintervention); secondary outcomes were the severity of medium-term (1 to ≤6 months postintervention) and long-term (>6 to 12 months postintervention) anxiety, depression, and health-related quality of life of patients and caregivers. Results: This meta-analysis included 28 RCTs enrolling 3053 adults with cancer. None of the trials were conducted in children. Mindfulness was associated with significant reductions in the severity of short-term anxiety (23 trials; 2339 participants; SMD, -0.51; 95% CI, -0.70 to -0.33; I2 = 76%). The association of mindfulness with short-term anxiety did not vary by evaluated patient, intervention, or study characteristics. Mindfulness was also associated with the reduction of medium-term anxiety (9 trials; 965 participants; SMD, -0.43; 95% CI, -0.68 to -0.18; I2 = 66%). No reduction in long-term anxiety was observed (2 trials; 403 participants; SMD, -0.02; 95% CI, -0.38 to 0.34; I2 = 68%). MBIs were associated with a reduction in the severity of depression in the short term (19 trials; 1874 participants; SMD, -0.73; 95% CI; -1.00 to -0.46; I2 = 86%) and the medium term (8 trials; 891 participants; SMD, -0.85; 95% CI, -1.35 to -0.35; I2 = 91%) and improved health-related quality of life in patients in the short term (9 trials; 1108 participants; SMD, 0.51; 95% CI, 0.20 to 0.82; I2 = 82%) and the medium term (5 trials; 771 participants; SMD, 0.29; 95% CI, 0.06 to 0.52; I2 = 57%). Conclusions and Relevance: In this study, MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer. Future trials should explore the long-term association of mindfulness with anxiety and depression in adults with cancer and determine its efficacy in more diverse cancer populations using active controls.

Perspectives of Nunavut patients and families on their cancer and end of life care experiences.

The present study arose from a recognition among service providers that Nunavut patients and families could be better supported during their care journeys by improved understanding of people's experiences of the health-care system. Using a summative approach to content analysis informed by the Piliriqatigiinniq Model for Community Health Research, we conducted in-depth interviews with 10 patients and family members living in Nunavut communities who experienced cancer or end of life care. Results included the following themes: difficulties associated with extensive medical travel; preference for care within the community and for family involvement in care; challenges with communication; challenges with culturally appropriate care; and the value of service providers with strong ties to the community. These themes emphasise the importance of health service capacity building in Nunavut with emphasis on Inuit language and cultural knowledge. They also underscore efforts to improve the quality and consistency of communication among health service providers working in both community and southern referral settings and between service providers and the patients and families they serve.

Supportive care experiences of rural women living with breast cancer: An interpretive descriptive qualitative study.

Breast cancer is the leading cause of female cancer in Canada. However, there is limited research on the health and supportive needs of rural women living with this illness. The purpose of this qualitative study was to arrive at an increased understanding of the supportive care experiences of rural women requiring treatment for invasive breast cancer who reside in rural Manitoba. To explore this phenomenon, an interpretive descriptive qualitative study was completed. Twenty women from four regional health authorities participated in the study. Data were collected using face-to-face, semi-structured interviews and analyzed by content analysis through an interpretative qualitative lens. The findings presented emphasize a holistic overview of the experiences of women living with breast cancer that captured both the positive aspects of living rurally and the described rural challenges. Pragmatic recommendations have been generated from the study findings that have implications for nursing practice and service delivery.

Barriers to information provision regarding breast cancer and its treatment.

PURPOSE: Women with breast cancer require information about their cancer and its treatment during the process of treatment decision-making, yet it is unclear if there are barriers to information support. This study explores the experience of making treatment decisions in breast cancer, paying particular attention to the barriers experienced to the provision of information. METHODS: Using a grounded theory methodology, semi-structured interviews were conducted with 22 women with invasive breast cancer exploring the experience of treatment decision-making. Data was organized using ATLAS.ti software and analyzed using constant comparisons. RESULTS: Analysis of the data showed that barriers to cancer and treatment information include intrapersonal and interpersonal communication challenges (emotional distress, patient-provider communication, "making it personal," access to information) which reside at different levels of the breast cancer experience (individual, dyad, group, organization). A model is provided to depict this experience. CONCLUSIONS: Women want information about their cancer and its treatment and experience barriers to information provision at various levels. Satisfactory information provision cannot occur without addressing barriers at every level. Utilizing interprofessional models of care may minimize existing barriers to information provision and empower patients to make satisfying treatment decisions that are consistent with their individual wishes.

The psychosocial experiences of women with breast cancer across the lifespan: a systematic review.

OBJECTIVE: To summarize the psychosocial experience of women with breast cancer from a lifespan perspective by examining the findings of qualitative studies. METHODS: A meta-aggregate review of 24 qualitative studies was undertaken. To be included, studies must include women with a breast cancer diagnosis and focus on younger or older women (as defined by the study), or compare a psychosocial issue across the lifespan. Eight databases were searched systematically. RESULTS: Study participants ranged in age from 26 to 91 years. Sixteen studies focused on younger women, six focused on older women, and two included women across the lifespan. A total of 155 findings were extracted from the studies and were aggregated into 11 categories. These were synthesized into four synthesized findings: (a) dealing with cancer, (b) the importance of caring, (c) the aftermath of cancer, and (d) fertility and infertility. CONCLUSIONS: Further research is required to explore these findings, and to examine the needs of older women in particular. Delineating the similarities and differences in the needs of women across the lifespan will inform the development of psychosocial interventions for all women with breast cancer.

Childhood brain cancer and its psychosocial impact on survivors and their parents: A qualitative thematic synthesis.

PURPOSE: The multiple late-effects experienced by survivors of childhood brain tumors, are not only a source of great distress for survivors, but also for their parents and siblings. The aim of this review is to systematically identify and synthesize qualitative evidence on how survivors of childhood brain tumors and their parents experience life after surviving childhood brain tumors. METHODS: Based on literature search in seven databases, 10 qualitative studies, published between 2004 and 2014 were included. RESULTS: Surviving a childhood brain tumor was experienced as paradox for survivors and their parents. While parents and survivors celebrated making it through the cancer experience, they nonetheless encountered a world with loss and new challenges. In short, the experience of survival was a bittersweet experience for survivors and their parents. Survivors and their parents experienced change that included living with uncertainty, intensification of the parenting role, a changing social world, a different way of being, and the need for additional help. CONCLUSION: Results from this synthesis reinforce that surviving a childhood brain tumor should be viewed as a point on a continuum of living with a brain tumor. Psychosocial effects of surviving brain cancer affect the entire family unit. A need for psychosocial support is evident, although development of such supports necessitates a more full understanding of challenges face by the child affected, their parents, and siblings. The limitations noted in this synthesis reinforce that more qualitative research is needed in this subject area.

Using a supportive care framework to understand and improve palliative care among cancer patients in Africa.

OBJECTIVE: Cancer incidence and mortality are increasing in Africa, which is leading to greater demands for palliative care. There has been little progress in terms of research, pain management, and policies related to palliative care. Palliative care in Africa is scarce and scattered, with most African nations lacking the basic services. To address these needs, a guiding framework that identifies care needs and directs palliative care services could be utilized. Therefore, using the supportive care framework developed by Fitch (Fitch, 2009), we here review the literature on palliative care for patients diagnosed with cancer in Africa and make recommendations for improvement. METHOD: The PubMed, Scopus, CINAHL, Web of Science, Embase, PsycINFO, Social Sciences Citation Index, and Medline databases were searched. Some 25 English articles on research from African countries published between 2004 and 2014 were selected and reviewed. The reviewed literature was analyzed and presented using the domains of the supportive care framework. RESULTS: Palliative care patients with cancer in Africa, their families, and caregivers experience increasing psychological, physical, social, spiritual, emotional, informational, and practical needs. Care needs are often inadequately addressed because of a lack of awareness as well as deficient and scattered palliative care services and resources. In addition, there is sparse research, education, and policies that address the dire situation in palliative care. SIGNIFICANCE OF RESULTS: Our review findings add to the existing body of knowledge demonstrating that palliative care patients with cancer in Africa experience disturbing care needs in all domains of the supportive care framework. To better assess and address these needs, holistic palliative care that is multidomain and multi-professional could be utilized. This approach needs to be individualized and to offer better access to services and information. In addition, research, education, and policies around palliative care for cancer patients in Africa could be more comprehensive if they were based on the domains of the supportive care framework.

Supportive care needs of rural individuals living with cancer: A literature review.

Regardless of geographic location, the cancer journey is an extremely difficult experience for both patients and their families. The aim of this literature review is to explore the impact of rural or remote residence on the supportive care needs of individuals living with cancer. This review included ten qualitative, seven quantitative, and six mixed design studies. Data collection, analysis, and evaluation were guided using a multi-domain supportive care framework based on seven domains: physical, emotional, informational, psychological, spiritual, social, and practical (Fitch, 2009). This review will suggest that there are distinct experiences that present both challenges and benefits to individuals living with cancer in rural areas. These findings will be detailed with recommendations, and grounding for future research outlined.

A qualitative study on Canadian youth's perspectives of peers who smoke: an opportunity for health promotion.

BACKGROUND: Peer influence, peer selection, and health risk awareness are factors in smoking among youth. Despite the numerous studies on the social context, social network, and how youth define themselves and their smoking status in relation to tobacco use, qualitative knowledge about the role of smoking within peer relationships from youth themselves is only emerging. In this paper, qualitative findings describing Canadian youth's perspectives and experiences of smoking within the context of peer relationships are presented. METHODS: To examine youth's perceptions, a qualitative research study design was used. Seventy-five Canadian youth aged 11-19 years participated in open-ended interviews, focus groups, and photovoice methods. Data analysis involved several levels of analysis consistent with qualitative research. RESULTS: Youth who smoked were perceived by non-smoking peers as less popular and less socially accepted as represented by the theme: The coolness (not so cool) factor. Non-smoking youth felt that peers who smoked strained relationships and forced them to set boundaries and negotiate friendships as denoted by the theme: Negotiating friendships: Being influenced, but also influencing. Finally, in the theme of Making sense of peers who smoke, youth struggled to understand peers who continued to smoke and why they would start in the first place. CONCLUSIONS: As reinforced in this study, Canadian youth increasingly view smoking as unhealthy and uncool. Moreover, youth report resisting peer influence to smoke and in fact, are now influencing their friends who smoke to quit. The self-empowerment stories of non-smoker youth reinforces the idea that the social meaning of smoking with peers is continuing to change from one where youth accepted and participated in the smoking behaviors of their peers, to an environment where youth's perceptions of personal health is paramount. Findings from this study could be used to guide health promotion and smoking prevention programs and campaigns for youth.

Building the Evidence for Nursing Practice: Learning from a Structured Review of SIOP Abstracts, 2003-2012.

BACKGROUND: The focus of work submitted to an international conference can reflect the changing landscape of a specialty and prove important for identifying trends, uncovering gaps, and providing new directions for nurse-led research and clinical practice. We present an analysis of trends in presentations in the nursing program at the SIOP congress from 2003 to 2012 based on all accepted abstracts. PROCEDURE: A total of 462 abstracts were analyzed. A data extraction form was used to ensure consistency of data retrieved. Paired researchers were assigned 2 years of abstracts for assessment: approximately 80-100 abstracts each. Data were entered into REDCap data management software. RESULTS: Most abstracts came from presenters affiliated with institutions in Europe and North America with a noticeably significant under-representation from developing countries. There was an equal representation of papers focused on empirical research with family members and clinical practice focused on the professional role, although this varied in some years. Analysis of research methodology revealed a predominance of surveys, with a recent increase in qualitative and mixed method studies. Out of all abstracts only 18% were subsequently published. CONCLUSIONS: Gaps have been identified, such as the limited involvement of nurses in developing countries, and lack of studies self-reporting from children. Much needs to be done to promote a greater diversity of research frameworks and more dynamic research designs. The small percentage of abstracts from nurses that are eventually published may hinder translation of the findings into clinical practice.

Building school-based cardiovascular health promotion capacity in youth: a mixed methods study.

BACKGROUND: Essential to building cardiovascular health promotion capacity in youth, which extends into adulthood, are approaches that seek to empower, educate, and support. The Five Cs model of positive youth development (PYD) guided this study. This model represents the ability of youth to develop competence, confidence, connection, character, and caring when given the appropriate resources. The purpose of this two-year school-based feasibility study was to determine if providing a research intervention in the form of education, empowerment, and support build youth's capacity for cardiovascular health promotion. METHODS: A mixed methods case study design was used to evaluate the process, and outcome of a youth-led cardiovascular health promotion program. Twenty-six youth aged 12-13 years from a Canadian middle school took part in the study. Youth participating in this study planned, implemented, and monitored cardiovascular health promotion activities in four areas: smoking, physical inactivity, nutrition and obesity. Qualitative data was collected from the youth participants using three focus groups and individual reflective journals. Quantitative data was collected with the PYD.2, a self-report questionnaire that assesses positive youth development and consists of 5 subscales: character, competence, caring, connection, and confidence. The participants completed the PYD before and after the program to determine if there were any changes in PYD scores after the intervention. The quantitative data was analyzed using paired samples t-tests, and the qualitative data was analyzed using constant comparative analysis. RESULTS: While the PYD scores showed no significant changes, the qualitative findings confirmed that the youth acquired increased awareness and understanding of cardiovascular health promotion initiatives. Four themes emerged from the qualitative data, (1) doing the right thing, (2) wanting to make a change, but feeling constrained, (3) I get it, and (4) The project has changed me! The intervention was found to be acceptable and feasible for the youth participants and their school. CONCLUSIONS: The contributions of this study were twofold. It generated evidence to support integrating positive youth development strategies into cardiovascular health promotion programs. Secondly, this study determined that the research intervention improved the participants' knowledge and attitudes about cardiovascular health and were suitable for further implementation and testing.

Waiting to return to normal: an exploration of family systems intervention in childhood cancer.

The illness suffering of families in childhood cancer is characterized in part by a loss of family normalcy. Hermeneutic phenomenology and family process research methods were used to analyze videotaped family intervention sessions and post-intervention family/clinician interviews. Within this article, some of the findings from the larger doctoral study that focused on the illness suffering of family members and relational, family systems intervention based on the Illness Beliefs Model are described. Although the larger study included findings of family interventions that addressed several aspects of the illness suffering experienced, this article details specific findings related to the theme of the loss of family normalcy and a longing to return home. Family systems intervention practices which facilitated a lessening of illness suffering included the following: offering new interpretations of suffering within a reflecting team, articulating family strength, sensitively acknowledging the illness suffering, and eliciting the experiences of family members in a shared therapeutic conversation.

Cancer prevention in Africa: a review of the literature.

Cancer is an emerging crisis in Africa. Cancer was the seventh leading cause of death in 2004. If not controlled, cancer incidence in Africa is expected to reach 1.28 million cases annually and claim 970,000 lives yearly by 2030. This paper presents a review of the literature on current cancer prevention approaches in Africa, and consists of cancer prevention studies conducted in African countries (e.g. South Africa and Nigeria) from PubMed, Scopus, and CINAHL databases. Common female cancers in Africa are breast and cervical cancer while prostate cancer is the most common neoplasm among African males. Other common cancers are liver, colorectal, and non-Hodgkin's lymphoma. Mortality related to these cancers comes as a result of delays in screening and treatment, unfamiliarity with cancer and cancer prevention, inaccessibility and unaffordability of care, and inefficiency of healthcare systems. Cancer prevention efforts are deficient because many governments lack cancer prevention and control policies. Also contributing to the lack of cancer prevention and control policies are low levels of awareness, scarce human and financial resources, and inadequacy of cancer registries. Overall, governments grapple with limited funds and competing healthcare priorities. As cancer continues to increase in Africa, the need for rigorous interdisciplinary research on cancer etiology and monitoring in Africa has never been timelier. Cost-effective cancer prevention programs, coordination of donor funding, advocacy, and education should be aggressively pursued. The call for more collaborative approaches in research and policy is urgently needed.

Canadian adolescents' perspectives of cancer risk: a qualitative study.

Research examining adolescents' understandings of cancer and cancer risk is limited. Accordingly, we conducted an ethnographic study that sought to extend our limited understanding of Canadian adolescents' perspectives of cancer and cancer prevention including how adolescents conceptualize and understand cancer risk. This article addresses findings specific to adolescents' perspectives of cancer risk. Seventy-five adolescents (11-19 years old) took part in the study. Two individual open-ended interviews were planned for each adolescent with the second interview occurring 4 to 5 weeks after the first interview. The second interview was complemented by the use of photovoice. Four focus groups, composed of the adolescents who took part in the individual interviews, were also conducted. Data analysis involved both thematic and content analysis. Findings revealed that adolescents conceptualized cancer risk in terms of specific risk factors, with lifestyle factors (e.g., smoking, diet/nutrition and physical inactivity) dominating their discourse. Adolescents rationalized risky health behaviours through use of cognitive strategies that included questioning and evaluating risk information, considering the benefits costs of the cancer risk, and downplaying the impact of the cancer risk. Use of these cognitive strategies helped to make cancer risks more acceptable to adolescents. While adolescents felt that cancer could not always be prevented, they did feel it was possible for individuals to delay getting cancer by lowering the impact of cancer risks through making the right choices. Although more research in this area is needed, the findings from this study may help inform cancer prevention and risk communication programmes and policies.

Existential anxiety and growth: an exploration of computerized drawings and perspectives of children and adolescents with cancer.

BACKGROUND: Until now, most existentially focused cancer research has been conducted within adult populations. Only a handful of qualitative investigations have captured the experiences of children with cancer relative to themes such as existential fear and finitude, meaning/meaninglessness, uncertainty, authenticity, and inauthenticity. OBJECTIVE: This article aimed to provide a deeper understanding of the existential challenges faced by children living with cancer. METHODS: An interpretive, descriptive qualitative research approach was used. Thirteen children (8-17 years) undergoing treatment for cancer participated. Children participated in individual open-ended interviews and also had the opportunity to journal their experiences in a computerized drawing tool. RESULTS: The 4 main themes that emerged in relation to the existential challenges experienced by children with cancer included (1) existential worry, (2) existential vacuum, (3) existential longing, and (4) existential growth. The drawing tool within the computer diary was found to be particularly beneficial in assisting children to express the existential challenges that they had previously been unable to articulate in words. CONCLUSION: Children moved between existential anxiety and existential growth within the cancer world. The expressive means of drawing pictures gave children a therapeutic space to explore and work at understanding the existential challenges experienced. IMPLICATIONS FOR PRACTICE: This research provides evidence that the active engagement of children's imaginations through the use of a computer-drawing tool may have significant therapeutic value for children with cancer. As well, the findings support the importance of nurses "being there" for young patients with cancer in their time of despair.

Decision making for mothers with cancer: maintaining the mother-child bond.

PURPOSE: The objective of this study was to explore the process of decision-making in mothers with cancer when they are mothering young children. The purpose of this article is to describe the core category that emerged from the study as well as the conditions precipitating decision making and the consequences of decision making for mothers with cancer. METHODS AND SAMPLE: A qualitative methodology based on the tenets of constructivist grounded theory was used to conduct ten interviews with eight mothers with cancer. KEY RESULTS: Data analysis revealed the core category, the conditions of the decision situation as well as the consequences of decision making. The core category was the meaning that mothers made of decisions, specifically that each decision was made to maintain the mother-child bond. The conditions of the mothers' lives influenced the meaning mothers assigned to decisions. The consequences of decision making were displayed by these mothers through coping strategies to facilitate maintaining the mother-child bond in times of distress. CONCLUSIONS: The conditions of the mothers' lives created a context in which mothers made meaning of decisions. Mothers aimed to maintain their bonds with their children in the decision making process and used various coping strategies as a consequence to distress from decisional situations. The results have implications for future decision making research in cancer care.

Young men with cancer: a literature review.

BACKGROUND: The impacts of cancer on young men are reportedly different from the experiences of others. These impacts may adversely affect the health and the healthcare of young men. OBJECTIVE: The purpose of this article was to conduct a literature review to examine what is known about the experiences of young men with cancer. METHODS: A systematic strategy was used to locate original research that included 4 electronic databases using the search terms men, young men, male, father, parents, and cancer experience. RESULTS: Sixteen studies met the inclusion criteria. Twelve studies used qualitative methodology, and 4 studies used a quantitative method; no mixed-method studies were found. Of the studies reviewed, 6 focused on the experiences of men but not young men aged 20 to 44 years exclusively, 10 studies had male and female respondents. Analysis revealed 5 themes: (1) manhood in question, (2) the good father or not, (3) family and that special bond, (4) silencing cancer talk, and (5) living with uncertainty. CONCLUSIONS: Young men are building resources while creating family bonds, and they identify themselves through their work. Young men with cancer have needs specific to their gender and cohort. IMPLICATIONS FOR PRACTICE: Methodological and conceptual recommendations are presented. This includes conducting research focusing on this cohort and using a life-course perspective. Understanding the overall experience of this cohort will enable the development of clinical interventions for young men with cancer. Supportive care in a nonthreatening environment is needed to help young men cope with the problems described.