Enhancing Cancer Pain Self-Management: A Holistic Supporting Model.

Introduction: Pain self-management is crucial in reducing pain intensity and improving the quality of life for cancer patients. By acquiring self-management skills, patients can actively participate in managing their pain. Objective: The objective of this study was to develop a grounded theory-based model to assist cancer patients in enhancing their pain self-management. Methods: This qualitative research was conducted in two stages from 2019 to 2021. The initial phase utilized a grounded theory approach to explore the process of pain self-management in cancer patients. Following Corbin and Strauss' analytical method, a grounded theory of pain management in cancer patients was identified. Subsequently, Walker and Avant's theory synthesis strategy was employed to construct a practical model that provides support for patients in managing their pain. Results: Within the conceptual framework, this study developed the "Holistic Supporting from Pain Self-Management" model. This supportive model consists of three main components: (1) enhancing pain self-management skills in cancer patients and their families, (2) empowering physicians and nurses in pain management for cancer patients, and (3) improving the organizational structure for pain management in cancer patients. Conclusion: The Holistic Supporting from Pain Self-Management model emphasizes the importance of addressing all dimensions of cancer pain, including physical, functional, psychosocial, cultural, and spiritual aspects, to effectively manage pain in cancer patients. This model addresses the needs of patients, healthcare providers, and the healthcare system, aiming to enhance and support pain self-management.

Blaming in women with breast cancer subjected to intimate partner violence: A hermeneutic phenomenological study.

Objective: The present study was conducted to determine the blaming experiences of women with breast cancer subjected to intimate partner violence (IPV). Methods: This hermeneutic phenomenological study explored blaming experiences of women with breast cancer subjected to IPV. Nine women with a mean age of 47.5 years referred to oncology hospitals in Tabriz (Iran) were interviewed using semi-structured in-depth interviews. Data analysis was performed based on Van Manen's thematic analysis method. Results: The main theme emerged from the data is "blaming as a shifting cognitive judgment" with three subthemes of patient blaming partner, partner blaming patient, and self-blame. Conclusions: The findings of the present study revealed that cognitive judgment shifting could be emerged as different types of blaming in the patients with breast cancer exposed to IPV. It is suggested that oncology nurses heed the psychological needs of women with breast cancer through holistic nursing considering couple and family-centered care.

Pain Self-management Strategies in Patients With Cancer: A Qualitative Study.

Successful pain management in patients with cancer is a significant challenge, and paying more attention to patients' experiences of pain self-management strategies has particular importance. This study aimed to explore pain self-management strategies in Iranian patients with cancer. This qualitative study was conducted on 14 patients with cancer. Data were collected using semistructured interviews and analyzed through the Graneheim and Lundman content analysis approach. Two main categories emerged from data analysis: (1) psychological pain self-management strategies, and (2) behavioral pain self-management strategies. Psychological strategies included pain distraction techniques, spiritual tendencies, increasing social interactions and support networks, pain tolerance and self-control, and resistance to pain. Behavioral strategies included massage and touch, heat and cold therapy, opium (Taryak in Persian) and tobacco use, herbal and home remedies, and proper diet.

Patients' Experiences of Cancer Pain: A Descriptive Qualitative Study.

OBJECTIVE: The aim of this study was to explore the cancer pain experiences of Iranian patients. DESIGN: A qualitative descriptive design was used. METHODS: This qualitative descriptive study was performed on 17 participants between December 2020 and September 2021. Data were collected using semistructured interviews and analyzed by Graneheim and Lundman's content analysis method. RESULTS: Three main categories emerged in relation to patients' experiences of cancer pain. Categories included (1) characteristics of cancer pain, (2) pain self-management strategies, and (3) influence of pain on patient and her/his family. CONCLUSIONS: Most patients believe that pain is God's will, and family members, doctors, and nurses can assist patients cope with pain by respecting this belief and supporting spiritual healing. Strengthening pain management strategies, expanding social networks, and convincing the patients that they are not an interruption to their families can all help patients maintain their fighting spirit and pain tolerance. To provide holistic care, healthcare providers, particularly nurses, should consider the physical, sociocultural, and spiritual aspects of cancer pain.

Intimate partner violence in women with breast and gynaecologic cancers: A systematic review.

AIM: The current study aimed to systematically review the data obtained from studies on women with breast and gynaecologic cancers subjected to Intimate Partner Violence (IPV). DESIGN: Systematic review without meta-analysis. DATA SOURCES: PubMed, ProQuest, Google Scholar, Scopus, Web of Science; databases were searched without time limit. REVIEW METHOD: The PRISMA model was guided the systematic literature search using Boolean keywords and operators. PICO statement was used to develop a question of this review. Studies examining women with breast and gynaecologic cancers subjected to IPV were included in the study after the quality of the articles was reviewed. RESULTS: Eight studies that met the inclusion criteria and were conducted between 2000 and 2021 were included in the study. CONCLUSIONS: Studies confirm the effect of IPV on the severity and consequences of breast and gynaecologic cancers. Having a history of IPV can indirectly lead to breast and gynaecologic cancers. On the other hand, women suffering from IPV are more likely than other women to delay screening or not perform screening for cancer. IMPACT: The dimensions and nature of violence and the disclosure or non-disclosure of violence in vulnerable women are strongly affected by society's culture. Therefore, researchers need to have sufficient knowledge of the culture and social factors governing the community to achieve reliable findings related to IPV in qualitative, quantitative, and psychometric studies and the design of IPV assessment tools. It is recommended that IPV screening teams, that is, multidisciplinary teams of trained physicians, nurses and social workers, participate in two-way screening programmes: IPV screening for women with gynaecological cancer and screening for gynaecological cancer in women with IPV.

Caring Needs of Cancer Patients from the Perspective of Home Care Nurses: A Qualitative Study.

OBJECTIVE: Cancer is the third leading cause of death in Iran. Todays, caregiving to patients with cancer is shifting towards home based care, and home care needs from a caregiver's perspective can help improve the patient care. This qualitative study aimed to examine the home care needs of cancer patients from the perspective of home care nurses. METHODS: This is a qualitative descriptive study carried out at home care centers in the northwest of Iran. A total of 15 participants were recruited through purposive sampling and underwent face-to-face semi-structured interviews. Data were analyzed through Conventional content analysis method in MAXQDA software.  Measures of trustworthiness were established throughout the study using Lincoln and Guba's (1985) criteria (dependability, credibility, transferability, and confirmability). RESULTS: Data analysis resulted in the extraction of four main categories including physical needs (pain relief, gastrointestinal problems including nausea and anorexia and nutritional problems, lethargy, wound care), psychological support (need for hope and emotional support), educational needs (need for information and self-care) and financial support (service insurance coverage, charity support). To promote these patients home care, insurance coverage of nursing home care services was emphasized by the participants. CONCLUSION: Various aspects of cancer patients home care needs were identified. Interdisciplinary home-based palliative care collaboration is needed to address their physical, psychological, and moral needs.

Barriers to cancer pain management from the perspective of patients: A qualitative study.

AIM: The aim of this study was to explore the barriers to effective pain management in Iranian people with cancer. DESIGN: A qualitative descriptive design was used. METHODS: This qualitative descriptive study was performed on 14 people with cancer. Data were collected using semi-structured interviews and analysed by Graneheim and Lundman's content analysis method. RESULTS: Four main categories emerged in relation to barriers to pain management from the perspective of people with cancer. Categories included 1) accepting and enduring divine pain, 2) negative attitudes towards the effectiveness of analgesics, 3) patients' low knowledge of pain self-management methods and 4) neglected pain management. Barriers to pain management are multidimensional in nature consisting of patients, healthcare providers and system components. Therefore, attempts should be focused on the education of patients and healthcare providers about pain management and eliminating the shortcomings of the healthcare system.

Home Care Nurses' Attitude Towards and Knowledge of Home Palliative Care in Iran: A Cross-Sectional Study.

BACKGROUND: Chronic and cancer diseases are expected to rise with the growing population of the elderly in the world. Home palliative care might be a possible solution for improving these patients' quality of life; therefore, the present study sets out to investigate home care nurses' attitude towards and knowledge of home palliative care. MATERIALS AND METHODS: This is a descriptive cross-sectional study (2018-19), in which 168 home care nurses and nursing assistants in East Azerbaijan Province (Iran) were included (2018). The questionnaire used was specifically designed by Shimizu et al. in 2016 for determining the nurses' attitude towards and knowledge of home care. Data analysis was carried out using descriptive and inferential statistics (T-test and ANOVA). RESULTS: In this study, 95 (56.60%) and 113 (67.90%) of the participants were found to have negative attitudes and limited knowledge, respectively. The other participants seemed to have neutral attitudes towards and average knowledge of home palliative care. The Mean (SD) attitude score on terminal home care was estimated 2.33 (0.83), and the knowledge score on dying care was calculated 41.76%, which were the lowest in comparison with the scores of other dimensions. CONCLUSIONS: The home care nurses' attitude towards and knowledge of home palliative care were found to be negative and limited, respectively, which underscores the need to endeavor to improve the attitude towards home care and the knowledge of dying care.

Barriers to home-based palliative care in people with cancer: A qualitative study of the perspective of caregivers.

Aim: To investigate the barriers to home-based palliative care for cancer patients from professional caregivers' experiences. Design: A qualitative study. Method: This is a descriptive-qualitative study carried out in the community-based care. Twenty-three participants took part in this study. Data were collected through semi-structured interviews. Results: Data analysis led to the identification of three category of barriers including the lack of instructions (the lack of clinical practice guidelines, the ambiguity of tariffs and the lack of insurance coverage), family desperation (family views of prognosis, distrust and poverty) and lack of professionalism (limited knowledge, the use of amateur nurses and siloed care). Developing a care protocol and providing resources support contribute to the development of home-based palliative care. Moreover, the education of families and training courses for nurses must be fostered.

Palliative Care Models for Cancer Patients: Learning for Planning in Nursing (Review).

Cancer is the second cause of mortality in the world. Increased incidence of cancer and its growing trend have drawn attention to care for these patients. Palliative care is a solution for improving the quality of cancer care. However, only 14% of cancer patients in the world are receiving palliative care and most nurses lack the adequate knowledge and education to implement different palliative care models for cancer patients. This review of the literature intended to identify the palliative care models used by nurses for cancer patients as well as the similarities and differences between these models. Databases such as PubMed, ProQuest, google scholar, and CINAHL were searched, and experimental studies that presented palliative care models for cancer patients that nurses were involved were selected. From a total of articles selected by searching the databases, 16 experimental articles were selected. These articles presented 12 palliative care models that involved nurses and participants were cancer patients. The palliative care models presented in the experimental articles were based on hospice, hospital, home care, ambulatory, community, pediatric, spirituality, early, family, telehealth, dignity, and integrated. It was found out that several palliative care nursing models for cancer patients can be employed by nurses as they are the key agents in the provision of palliative care. The collaborative nature of the models, their positive consequences for patients being common components of models, and the implementation of the models considering the disease trajectory were among their distinctions.

A Qualitative Study on Cancer Care Burden: Experiences of Iranian Family Caregivers.

The aim of this study was to explore the experiences of Iranian family caregivers with regard to the burden of caregiving. This is in the context of illuminating and identifying the experiences of family members from different contextual perspectives. In this qualitative study, purposive sampling was conducted in 2016. Data were collected using semistructured interviews and were analyzed using content analysis. Data analysis identified 4 categories and 8 subcategories: (1) burnout (physical problems and psychoemotional stress), (2) role conflict (balancing caring roles and family responsibilities; failure in professional or educational roles), (3) health system tensions (inadequate support from health professionals; ignorance of family members in health structure), and (4) social challenges of cancer (economic burden; taboo of cancer). In conclusion, nurses need to provide individualized support and counseling that address the sources of burden. This highlights the benefit of training health care professionals to provide culturally sensitive support based on family caregivers' needs and circumstances.

Going Forward Lightening the Shadow of Cancer: Experiences of Family Caregivers Toward Empowerment.

This qualitative study was conducted to explore the empowerment experiences of family caregivers of patients with cancer. Empowerment consisted of 3 main categories: (1) seeking tranquility with the help of religious beliefs, (2) developing a positive attitude, and (3) restoring control over the situation. Results may help nurses for planning spiritual and supportive care.

Family support liaison in the witnessed resuscitation: A phenomenology study.

BACKGROUND: Family-witnessed resuscitation remains controversial among clinicians from implementation to practice and there are a number of countries, such as Iran, where that is considered a low priority. OBJECTIVE: To explore the lived experience of resuscitation team members with the presence of the patient's family during resuscitation. DESIGN: The hermeneutic phenomenology. SETTINGS: The emergency departments and critical care units of 6 tertiary hospitals in Tabriz, Iran. PARTICIPANTS: There were potentially 380 nurses and physicians working in the emergency departments and acute care settings of 6 tertiary hospitals in Tabriz. A purposive sample of these nurses and physicians was used to recruit participants who had at least 2 years of experience, had experienced an actual family witnessed resuscitation event, and wanted to participate. The sample size was determined according to data saturation. Data collection ended when the data were considered rich and varied enough to illuminate the phenomenon, and no new themes emerged following the interview of 12 nurses and 8 physicians. METHODS: Semi-structured, face- to- face interviews were held with the participants over a period of 6 months (April 2015 to September 2015), and Van Manen's method of data analysis was adopted. RESULTS: Three main themes emerged from the data analysis, including 'Futile resuscitation', 'Family support liaison', and 'Influence on team's performance'. A further 9 sub-themes emerged under the 3 main themes, which included 'futile resuscitation in end-stage cancer patients', 'when a patient dies', 'young patients', 'care of the elderly', 'accountable person', 'family supporter', 'no influence', 'positive influence', and 'negative influence'. CONCLUSIONS: Participants noted both positive and negative experiences of having family members present during cardiopulmonary resuscitation. Welltrained and expert resuscitation team members are less likely to be stressed in the presence of family. A family support liaison would act to decrease family anxiety levels and to de-escalate any potentially aggressive person during the resuscitation. It is recommended that an experienced health care professional be designated to be responsible for explaining the process of resuscitation to the patient's family.

Determinants of mammography adoption among iranian women: What are the differences in the cognitive factors by the stages of test adoption?

Our aim in this cross-sectional study was to investigate the predictors of the stages of change in mammography adoption (MA) based on Health Belief Model among Iranian women. Through multistage cluster sampling, we recruited and interviewed 1131 women older than 40. After statistical adjustment for other risk factors, perceived barriers (OR D 0.84, 95% CI D .81-.87) and benefits (OR D 1.17, 95% CI D 1.11-1.24) were significant predictors for MA. Majority of the women were in the pre-contemplation and contemplation stages of change for MA. Our findings are informative for the development of targeted interventions to foster MA among women.

A Comparative Study on the Meaning in Life of Patients with Cancer and Their Family Members.

Introduction: The overwhelming effects of cancer could be catastrophic for the patients and their family members, putting them at risk of experiencing uncertainty, loss, and an interruption in life. Also, it can influence their sense of meaning, a fundamental need equated with the purpose in life. Accordingly, this study aimed to compare the meaning in life (MiL) of patients with cancer and their family members. Methods: This descriptive comparative study was conducted on 400 patients with cancer and their family members admitted to university hospitals in Tabriz and Ardebil provinces, Iran. The participants were sampled conveniently and the Life Evaluation Questionnaire (LEQ) were used for collecting data analyzed through descriptive and inferential statistics in SPSS ver. 13 Software. Results: The mean score for the MiL of the patients with cancer and their family members was 119 (16.92) and 146.2 (17.07), respectively. There was a significant difference between patients with cancer and their family members in terms of MiL. Conclusion: The MiL of patients with cancer is lower than that of their family members, which indicates the need for further attention to the psychological processes and their modification in Iranian healthcare systems.

The Effects of a Patient-Caregiver Education and Follow-Up Program on the Breast Cancer Caregiver Strain Index.

BACKGROUND: In recent years, the caregiving responsibilities of cancer patients' family members have increased dramatically. Reducing caregiver strain and burden supports the mission of professional nursing. OBJECTIVES: The aim of this study was to determine and compare the caregiver strain index scores of breast cancer informal caregivers, before and after a patient-caregiver educational and telephone follow-up program. PATIENTS AND METHODS: This is an experimental two-group design study. Participants were recruited from an outpatient chemotherapy unit of the largest hematology and oncology research center in Northwest Iran. Thirty patient-caregiver pairs were randomly allocated to intervention and control groups. The intervention group received 2 face-to-face education sessions at bedside and 4 subsequent telephone follow-up sessions. The control group received routine care. Pre and post tests were administered in both groups pre and post intervention. To analyze the data, SPSS (13th version) software was used. RESULTS: The caregiver strain index decreased significantly in the intervention group after the patient-caregiver education and follow-up (P < 0.001), while the control group's scores did not change (P = 0.04). CONCLUSIONS: It appears that the patient-caregiver education and follow-up program had a beneficial effect on the caregiver strain index compared to the usual care.

Awareness and Attitude of Nurses in Regard to Providing Hospice Care.

BACKGROUND: Awareness and attitudes of nurses regarding end of life care are important factors in providing hospice care. In an extensive literature review, we found no related articles investigating Iranian nurses awareness and attitudes about providing such care. OBJECTIVES: The aims of this study were to investigate the awareness and attitudes of Iranian nurses in providing hospice care. MATERIALS AND METHODS: In this descriptive-correlational study, 240 nurses employed in six educational centers were selected by non-randomized stratified sampling. The data collection instruments included an awareness test and attitudes regarding providing end of life care in hospice questionnaire. The data were analyzed using descriptive statistics and independent sample t-tests, one-way ANOVA, and Pearson correlation tests. RESULTS: The nurses' awareness score was 14.3 out of 29 and 55.7% of them stated that they had not received any education in providing end of life care. Also, by obtaining the score of 91.7 out of 120 the attitudes of participants in providing end of life care in hospices were positive. In addition, the highest attitudes score of nurses were in the dimensions of benefits of implementation and health care team. CONCLUSIONS: Considering low awareness of nurses about end of life care in hospices, continuing education should be provided for them in this regard. Especially, by considering the positive attitude of nurses, providing such programs could help develop hospice care in Iran.

Supportive Care Needs of Iranian Cancer Survivors and Relationships with Social Support.

BACKGROUND: Assessment of supportive care needs of cancer survivors and identifying factors affecting such needs is important for implementation of any supportive care programs. So, the aims of present study were to investigate the supportive care needs of Iranian cancer survivors and relationships with social support. MATERIALS AND METHODS: In this descriptive-correlational study two hundred and fifty cancer survivors participated via convenient sampling methods. The Supportive Care Needs Survey (SCNS-SF34) and Multidimensional Scale of Perceived Social Support (MSPSS) were used for data collection. SPSS software was applied and univariate regression was used for examine relationships of supportive care needs with social support. RESULTS: Participants demonstrated many unmet supportive care needs, especially in health system and information and psychological domains. In addition, participants reported that family members and significant others were their main source of support. Also, social support has a significant correlation with all domains of supportive care needs. CONCLUSIONS: There is an indispensable need for establishment of supportive care programs for Iranian cancer survivors. In addition, family members of family members of such survivors are an important resource to help develop such programs.

Social support and its predictors among Iranian cancer survivors.

BACKGROUND: Social support is an important factor in psycho-social well-being of cancer survivors. There is little information about level of social support and its predictors among cancer survivors in Iran or other Middle Eastern countries. The aims of present study were to determine the social support and its prediction factors among Iranian cancer survivors. MATERIALS AND METHODS: In this descriptive-correlational study 187 cancer patients in one educational center and one private oncology office in northwest of Iran participated using a convenient sampling method. The data collection tool consisted of a researcher-prepared checklist and the Multidimensional Scale of Perceived Social Support Assessment (MSPSS). Data analysis was performed using SPSS statistical software with descriptive statistics and multiple linear regression analysis. RESULTS: The total score of MSPSS was 68 from a possible score between 7 and 84. Participants believed that they received a high level of support from their family members and significant others. Multiple linear regression analysis showed that single and depressed cancer survivors and participants with lower levels of physical activity believed that they received lower levels of social support. CONCLUSIONS: Iranian cancer survivors receive high levels of social support and family members are the most important source of this support. In planning any supportive care program for Iranian cancer survivors this strength should be considered. Especially, single and depressed and patients with lower levels of physical activity need more attention.

The taboo of cancer: the experiences of cancer disclosure by Iranian patients, their family members and physicians.

OBJECTIVE: The objective of this study is to describe the experiences of cancer disclosure by Iranian cancer patients, their family members and physicians. METHODS: Twenty cancer patients, ten family members and eight physicians participated in this study. Data were collected via semi-structured, in-depth interviews and analyzed using qualitative content analysis. RESULTS: Three categories were identified: cancer avoidance, a climate of non-disclosure and mutual concern. The findings demonstrated that cancer is a taboo subject and the word cancer, as well as other indicative terms, was rarely used in daily communication. A climate of non-disclosure predominated because patients were the last to know their diagnosis, they were unaware of their prognosis, and family members and physicians employed strategies to conceal this information. The mutual concern of patients, family members and physicians was the main reason that cancer was not discussed. CONCLUSION: Cancer is a taboo subject in Iran that is maintained and reinforced primarily because of the mutual concern of patients, family members and physicians. The first step to address this taboo and inform cancer patients of their diagnosis would be to understand and help mitigate the individual, family and social consequences of disclosure.