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 feasibility study on using tablet personal computers for self-reported symptom assessment in newly diagnosed lung cancer patients.

AIM: The study aimed to assess the feasibility and acceptability of an innovative tablet-assisted self-reported symptom assessment among newly diagnosed lung cancer patients. BACKGROUND: Routine symptom assessment for lung cancer patients in a fast-paced clinical environment is demanding. Mobile health technology offers a potential platform for symptom assessment and paves the way for tailored self-care intervention. DESIGN: A feasibility study using a mixed method design. METHOD: A convenience sample of 10 newly diagnosed lung cancer patients used tablet personal computers to self-report common symptoms: dyspnoea, fatigue, pain, and anxiety. A nurse reviewed the assessment results and provided tailored educational interventions. Acceptability was evaluated by the Electronic Self-Report Assessment-Cancer. Semi-structured interviews were conducted to explore the patients' perceptions of this symptom assessment method. Data were collected from January to March 2016. RESULTS: An Electronic Self-Report Assessment-Cancer mean score of 23.5 (SD 2.7) showed moderate acceptance of the assessment method. Participants found this approach user-friendly and helpful in identifying their symptoms and they gained awareness and better understanding of them. CONCLUSION: Tablet-assisted symptom assessment is a feasible method that can be further tested in busy clinical settings to assess symptom burden and identify individual needs for tailoring symptom management plans.

Evaluating the direct economic burden of health care-associated infections among patients with colorectal cancer surgery in China.

BACKGROUND: Little is known about the direct economic burden associated with health care-associated infection (HAI) in patients undergoing colorectal cancer surgery in China. This study aims to fill this knowledge gap. METHODS: This study was a prospective monitoring case-control study. The direct economic burden was presented as the median of the 1:1 pair differences of various hospitalization fees and hospital length of stay. Wilcoxon signed-rank tests were used to explore the differences in the direct economic burden. RESULTS: Out of 448 patients, 38 had acquired HAIs, with the infection incidence being 8.93%. The total direct economic burden of HAIs was $1,589.30 (P <.05). Among various infection sites, deep surgical site infection had the highest direct economic burden of $8,654.44, followed by multisite infections ($5,946.52). When it comes to various hospitalization costs, the cost for Western medicine ($846.13) constituted the highest proportion of economic burden followed by treatment cost ($145.73) and bed charge ($126.75). On average, the length of hospital stay in the infection group was 6 days longer than that in the control group (P <.05). CONCLUSIONS: HAI was associated with considerable economic burden for patients who underwent colorectal cancer surgery in China. The study highlights the necessity of taking effective measures to decrease incidence of HAIs to reduce economic burden.

Quality of life in head and neck cancer survivors at 1 year after treatment: the mediating role of unmet supportive care needs.

PURPOSE: The aim of the study was to test a hypothesised model that supportive care needs (SCNs) have a mediating effect on the relationship between characteristics of (Chinese) head and neck cancer (HNC) survivors and their quality of life (QoL). METHODS: A total of 285 Chinese HNC survivors who had finished cancer treatment 1 year earlier completed a self-reported survey covering demographic and clinical characteristics, the Chinese version of the Short-Form Supportive Care Needs Questionnaire (SCNS-SF34-C), the supplementary module of access to healthcare and ancillary support services and the Functional Assessment of Cancer Therapy for Head and Neck Cancer (FACT-H&N). RESULTS: The final path model showed that optimism, educational level, any coexisting disease, number of somatic symptoms, household income, eating ability, support from others, whether the cancer is under control or not and travelling time from home to hospital have direct or indirect effects, or both, on the QoL of HNC survivors, by way of unmet SCNs in the psychological, physical and/or health system information domains, which account for 64 % of the variance in the total FACT-H&N score. CONCLUSIONS: Our study demonstrated the mediating effects of SCNs in the association between HNC survivors and their QoL. Early needs assessment may help healthcare professionals to identify the actual needs of these survivors, and providing the information that HNC survivors want is a significant factor in meeting their psychological needs and thereby improving their overall QoL.

Perceived unmet supportive care needs and determinants of quality of life among head and neck cancer survivors: a research protocol.

AIM: To describe a study protocol designed to explore the associations among the perceived unmet supportive care needs, quality of life and the demographic and clinical characteristics of head and neck cancer survivors. BACKGROUND: The prognoses for people with head and neck cancer are improving with medical advances. However, studies have reported that such cancer survivors experience poor quality of life. Current studies mainly focus on Western populations and there is limited research investigating the needs of head and neck cancer survivors. DESIGN: A mixed-design method is proposed, which will include two phases. Phase I will use a quantitative cross-sectional design and Phase II a qualitative descriptive approach. METHODS: The participants will be recruited from the outpatient departments of three public hospitals in Hong Kong. In Phase I, a questionnaire will be used to collect demographic and clinical characteristics, supportive care needs, necessary access to various supportive services and quality of life. Semi-structured interviews will be conducted in Phase II. The study is supported by a grant from the Health and Health Services Research Fund, Hong Kong, September 2011. DISCUSSION: The study will generate in-depth information on the needs of head and neck cancer survivors, to help healthcare professionals allocate resources better and develop new services, which can be more person-centred, to meet the needs of the these survivors.

Perceived unmet needs and health-related quality of life of Chinese cancer survivors at 1 year after treatment.

BACKGROUND: Although advanced cancer treatments prolong survivors' lives, a significant proportion experienced poorer health-related quality of life (HRQoL) than general populations. Identifying their needs is essential to develop a health service delivery model to improve patient outcomes. OBJECTIVE: The objective of this study was to examine the perceived unmet needs and HRQoL of Chinese cancer survivors who completed treatment less than 1 year ago. METHODS: Three hundred seventy-six participants completed a self-report survey: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy: General. Descriptive statistics were used to examine the prevalence of unmet needs. Multivariable logistic regressions were conducted to identify participants' characteristics that were associated with unmet needs. Multiple linear regression was used to delineate which domains of unmet needs were significantly associated with HRQoL with adjustment for potential confounding factors. RESULTS: Healthcare information was the most common unmet needs among the survivors. Age, stage of cancer, and remission were significantly associated with 1 or more unmet need domains. Participants with unmet needs in physical, psychological, and patient care domains, on average, have poorer HRQoL. CONCLUSIONS: Chinese cancer survivors have various unmet needs that might have adverse effects on their HRQoL. Younger age, more advanced stages of cancer, and remission were factors contributing to further unmet needs. IMPLICATIONS FOR PRACTICE: The results provided useful information on the special needs of survivors that may affect their HRQoL, enabling clinicians to plan better how to allocate existing limited resources to those who most require them.

Baccalaureate nursing students' perceptions of peer assessment of individual contributions to a group project: a case study.

A group project is a common method of assessment in higher education worldwide. The use of an adjunct peer assessment (PA) scheme as a means to award marks for individual student contributions to a group project has increased. However, nursing students' perceptions of PA have not been well studied. This paper examines baccalaureate nursing students' perceptions of PA in assessing individual contributions to a group project. Using a case study design with both quantitative (an anonymous survey with 123 students), and qualitative methods (six focus group interviews with 21 students), data were collected from students in a baccalaureate nursing programme. Merging of quantitative and qualitative findings indicated that students overall had positive perceptions of PA, especially its ability to reduce 'free-riding'. However, students also had some interpersonal and operational concerns about the PA implementation process. Based on the findings, we recommend: (1) further developing students' abilities to assess the contributions of others to the task and relationship functions in group work; and (2) adopting a confidential online system for submission of PA forms.

Piloting electronic self report symptom assessment - Cancer (ESRA-C) in Hong Kong: a mixed method approach.

PURPOSE: The benefits of utilizing computerized assessment in clinical settings have been reported in studies over the last three decades and more recently in the oncology settings. This study aimed to assess the feasibility and acceptability of using an electronic self report symptom assessment tool among Chinese oncology patients. METHODS AND SAMPLE: The tool, developed by The University of Washington, Distributed Health Assessment and Intervention Research (DHAIR) group was translated into Chinese. The adapted web-based survey platform, the Electronic Self Report Assessment - Cancer (ESRA-C), was tested in a local cancer resource center in Hong Kong. Participants' perceptions of the acceptability and feasibility of the symptom assessment process were assessed using the Acceptability E-scale as well as observation and qualitative interview data. Demographic data were also collected through the touch screen computer system. A convenience sample of 30 (11 male and 19 female) oncology patients was recruited to use the touch-screen computer to assess participants' symptoms using ESRA-C. RESULTS: The acceptability scale indicated moderately high acceptability in each subscale (mean score of 3.32-4.71). On average, participants took 17.5 min (SD: 8.9) to complete the ESRA-C. The qualitative interview data revealed that the majority (25 participants) asserted that the ESRA-C was useful and effective in reporting personal health conditions. CONCLUSIONS: The study suggested that electronic assessment can offer a feasible, attractive, and viable means of implementing regular and comprehensive symptom assessment, which can lead to better symptom management in cancer patients.

Measuring the symptom experience of Chinese cancer patients: a validation of the Chinese version of the memorial symptom assessment scale.

The purpose of this study was to translate the Memorial Symptom Assessment Scale (MSAS) into Chinese and evaluate the psychometric properties of this version. The original MSAS is a 32-item, patient-rated measure that was developed to assess common cancer-related physical and psychological symptoms with respect to frequency, intensity, and distress. In this study, a two-phase design was used. Phase I involved iterative forward-backward translation, testing of content validity (CVI) and a pretest. Phase II established the psychometric properties of the Chinese version MSAS (MSAS-Ch). Results showed that the MSAS-Ch achieved content relevancy CVI of 0.94 and semantic equivalence CVI of 0.94. Pretesting was performed in 10 cancer patients, and the results revealed adequate content coverage and comprehensibility of the MSAS-Ch. A convenience sample of 370 patients undergoing cancer therapy or at the early post-treatment stage was recruited for psychometric evaluation. Confirmatory factor analysis confirmed the construct validity of the MSAS-Ch, with a good fit between the factor structure of the original version and our present sample data (goodness-of-fit indices all above 0.95). The internal consistency reliability of subscales and total MSAS-Ch was moderately high, with Cronbach alpha coefficients ranging from 0.79 to 0.87. The test-retest intraclass correlation results for the subscale and total MSAS-Ch ranged from 0.68 to 0.79. The subscale scores of MSAS-Ch were moderately correlated with the scores on various validation measurements that assessed psychological distress, pain, and health-related quality of life (r = 0.46-0.65, P < 0.01), confirming that they were measurements of similar constructs. The validity of the construct validity was also supported by comparing the MSAS-Ch scores for subpopulations that varied clinically. Inpatients and patients with poorer performance status scored higher on the MSAS-Ch subscale and total scores than outpatients and patients with higher performance status (P < 0.05). Our study shows that the MSAS-Ch has adequate psychometric properties of validity and reliability, and can be used to assess symptoms during cancer therapy and at the early post-treatment stage in Chinese-speaking patients.

The use of placebo in clinical nursing research.

AIMS: This paper reviews placebo and placebo effects and their measurement and application to nursing. Ethical and methodological issues are also discussed. Implications for nursing and recommendations for future study are offered. BACKGROUND: Placebos have been used for decades in clinical trials but discussion about conceptual, methodological and ethical issues has been comparatively scarce. CONCLUSION: It is concluded that true placebo effects are difficult to measure and control and the use of credible placebo is sometimes impractical in clinical nursing research. This leads to the increased use of usual care as a control by researchers. However, more information should be reported in studies that use this approach, including the specification of usual care, its monitoring and patient adherence. RELEVANCE TO CLINICAL PRACTICE: Where its use is considered ethical, safe and feasible, a placebo arm should be included in studies of efficacy to distinguish between active and inactive treatment.