Israeli and Chinese partners of women with breast cancer: a cross-cultural view of marital issues.

OBJECTIVE: Cultural nuances may influence the interface between the cancer experience and marital issues, specifically for the partner. Most of the literature has focused on the woman's narrative or couple's adjustment to cancer in general. The purpose of this study was to describe and compare the marital relationship, sexuality, and marital adjustment of Israeli and Chinese husbands of women with breast cancer and the discussion of the health-care team concerning these issues. METHODS: A convenience sample of 50 Chinese and 50 Israeli men, ages of 28-79 years, completed components of the Psychological Adjustment to Illness Scale, the Locke Wallace Adjustment Scale, and a background questionnaire. RESULTS: The majority of husbands were in their first marriage. The average time since diagnosis was 16.7 months. No significant difference was found between the two groups on issues of marital relationship. Significant differences were found between Israeli and Chinese husbands on sexual interest, pleasure, and performance (p<0.05). Israeli husbands reported a significantly higher level of marital adjustment as opposed to the Chinese husbands (p = 0.006). Marital adjustment for both groups was significantly related only to perceived quality of the relationship (p<0.03). CONCLUSIONS: Significant cultural differences were found in sexuality variables with no differences discerned on marital relationship variables. Couple-based interventions for marital issues are a critical component of support for both partners. Culturally sensitive assessment and care of the spouse as well as the woman with breast cancer should be part of a holistic, comprehensive family care plan.

The Various Roles of Oncology Nurse Specialists: An International Perspective.

Ilana Kadmon, PhD, RN was for many years a nurse specialist in Breast Cancer at Hadassah Medical Center, Jerusalem, Israel. From 2016, she started the role of a nurse academic consultant at the nursing division at Hadassah. Her PhD is from The University of Edinburgh, UK. Her research involved psychosocial aspects of breast cancer, and the role of the breast care nurse (BCN). She was a pioneer in developing the post of the BCN in Israel. This position was initially developed by her at Hadassah and initiated by the Israel Cancer Association. Beyond her clinical expertise, at the Hadassah School of Nursing, she lectures and writes in many areas on breast cancer care in general. She served as a board member of the European Oncology Nursing Society, and was also a member of the Editorial Committee of the European Journal of Oncology Nursing. Moreover, she serves as a reviewer for many nursing journals. She was involved in a mutual international collaborative project with nurses in Tianjin, China. She was there for seminars and initiated some cross-cultural research in the area of partners of women with breast cancer, involving both countries. Moreover, she has been invited to Cyprus, Greece Russia, and Turkey to teach and give workshops.

Vulvar and Vaginal Graft versus Host Disease: A Healthcare Clinic Initiative.

OBJECTIVE: In patients receiving bone marrow transplantation (BMT), their mucosa becomes altered and sclerotic changes in the female external genital organs occur. Although a few studies have specifically addressed vulvar and vaginal graft versus host disease (VVGvHD) and its repercussions on the sexual health and quality of life of patients, VVGvHD can be overlooked by health practitioners. The objective of the study is to describe the initiation of a health care clinic specializing in VVGvHD in a general tertiary hospital. METHODS: A VVGvHD clinic was founded as a part of BMT daycare in a joint initiative of the nursing staff and the medical director of the department and a gynecologist specializing in vulva and vaginal disease. Patients were assessed for vulvovaginal symptoms, such as dryness, burning, itching, pain to touch, pain during intercourse, and dysuria. These patients might be subsequently referred to the VVGvHD clinic according to their needs assessed by daycare nurses. Treatment guidelines were developed by the specialist gynecologist. RESULTS: A total of 81 women aged 2-66 years (median age = 38 years) visited the clinic from 2009 to 2015. Of these women, 70 received an allogeneic transplant and 11 underwent autologous transplantation before consultation in our clinic. VVGvHD was detected in 54% of the patients. CONCLUSIONS: The VVGvHD clinic was developed to fulfill the specific needs of female patients who underwent BMT. The pioneer clinic was founded as a joint effort of the multidisciplinary team. Evidence supporting the optimum treatment for this condition is insufficient. This was the main reason for performing this study to explore the clinic that was newly based in Israel. VVGvHD may be a fluctuating condition with frequent deterioration and improvement. Therefore, regular clinical examinations are necessary.

Decision-Making Styles and Levels of Involvement Concerning Breast Reconstructive Surgery: An Israeli Study.

PURPOSE/OBJECTIVES: To address decision-making styles among breast cancer survivors considering breast reconstruction.
. DESIGN: A primary analysis of a cross-sectional sample among survivors who chose to have breast reconstruction to examine correlations among patient age, decision-making style, and the level of involvement of decision making.
. SETTING: Hadassah Medical Center in Jerusalem, Israel.
. SAMPLE: 70 women who had undergone breast reconstruction surgery in the past five years.
. METHODS: Participants completed decision-making style and demographic questionnaires and an assessment of their level of involvement in the decision-making process. 
. MAIN RESEARCH VARIABLES: Level of involvement in decision making, decision-making model between provider and patient, and decision-making styles were examined.
. FINDINGS: No correlation was found between four main decision-making styles and patient age or the extent of patient decision-making involvement and age. A statistically significant correlation was found between the level of involvement in decision making and the decision-making style of the patient.
. CONCLUSIONS: Nurses should assess patient decision-making styles to ensure maximum patient involvement in the decision-making process based on personal desires regardless of age.
. IMPLICATIONS FOR NURSING: Nurses working in breast cancer care must address the decision-making process of patients diagnosed with breast cancer, including the choice to undergo breast reconstruction after mastectomy. Nurses should understand the complex factors that influence a woman's decision-making style to best help with the decision.

Israeli breast care nurses as a learning organization.

This article will look at the theory of a Learning Organization as described by Senge and the Israeli Breast Care Nurses as an example. A description of the theory of a Learning Organization, the role of the Breast Care Nurses in Israel and the relation between the two will be described. Since 1996, the role of the Breast Care Nurse was founded in Israel. At that time, the role with its importance was very hard to be recognized by the health care team and other professionals of the multidisciplinary team for breast cancer patients. Since the role was initiated, it had been developing all over Israel through the support given by the Israel Cancer Association. As a learning organization, the Breast Care Nurses have a few goals: To learn to give patients the most updated and relevant information; to be a part and be seen as equal as the other members of the multidisciplinary team for breast cancer patients; to have knowledge which empowers them as a working group; to enable to teach students, mainly nursing students, in basic and further education and to help continually teach a new generation of nurses. This learning organization involves some formal and informal education. Although oncology nurses do much of the ideas we have described, we suggest using a strict model to help in implementing a Learning Organization. Future research can examine the outcomes of a Learning Organization on oncology nursing.

Being a legal guardian - the nursing perspective.

BACKGROUND: Surrogate decision making is common in public healthcare worldwide. In Israel any incompetent adult patient requires a Legal Guardian (LG), appointed by the court, for approval of invasive none-life saving procedures. Usually, the LG is a close family member of the patient. Nurses are the most available healthcare providers to the families and the LG during the process of appointment and afterwards. The patient's family is often anxious or even depressed, and thus the perceptions and behavior of nurses charged with providing support are crucial. In a previous study based on interviews of LGs we found that the most difficult issues for the LGs were decision related issues, family related issues and appointment bureaucracy issues. OBJECTIVE: To qualitatively assess nurses attitudes regarding the difficulties that families and LGs face during and after appointments and to compare the findings to previously accessed LG attitudes. RESEARCH DESIGN: After IRB approval, demographic and semi-structured questionnaires were used to assess the attitudes of a convenience sample of 34 nurses who were participating in a critical care training course (41 % of the respondents were from the ICU, 47 % from medical or surgical wards, and 12 % from other departments at secondary and tertiary hospitals in Israel.) regarding LGs difficulties. After reading and analyzing the responses provided by the nurses, the authors categorized the pertinent topics raised using content analysis. Nurses' perceptions were also compared to those of LGs reported in previous research by the authors. RESULTS: Three main themes emerged: 1. Decision related issues; namely coping with the complexity of end of life decision issues; 2. Family related issues; namely, family dynamics related to the various decisions regarding LG identity and patient care; and 3. Bureaucracy issues; namely, the formal process related to LG appointment and decisions. Regarding the first two themes, the feelings of the nurse respondents were quite similar to those of LG respondents from our earlier research. The third theme - bureaucracy issues - was never mentioned by the nurses, as opposed to LGs who mentioned it frequently. This suggests that the nurses did not consider it to be an important issue. CONCLUSIONS: The difficulties of decision making as well as family support and responsibility of LGs are well known by nurses. The appointment and bureaucracy issues were neglected by nurses, although they are very important to the LGs. Improvement of this parameter of care is needed. Possible directions for improvement include raising awareness of nurses regarding the appointment process and alleviation of bureaucracy. Further research is required to identify appropriate strategies for improving these aspects of care.

A report on mutual projects related to breast cancer nursing between Israel and China.

Breast cancer is a major concern in women's health in the western world, and is now receiving more and more attention also in the East. In China, for example, where the incidence of breast cancer was very low, there has been a rapid increase of the disease since the last few years. This report describes how a collaborative nursing project between the Hadassah Medical Organization and the Tianjin Cancer Institute and Hospital was initiated, planned and implemented.

Symptoms of hormonal therapy and social support: Is there a connection? Comparison of symptom severity, symptom interference and social support among breast cancer patients receiving and not receiving adjuvant hormonal treatment.

BACKGROUND: Although there has been a significant reduction in mortality, breast cancer is the most frequent cancer among women worldwide. This decline in mortality has created a significant survivor population that must manage the post curative treatment phase, in order to have an increased quality of life and well-being. This study examined the relationship between symptom interference and severity with the perception of social support in the lives of women receiving or not receiving, hormonal therapy after initial treatment. METHODS AND SAMPLE: Participants completed symptom severity and interference questionnaires, (MDASI and BCPT), a social support survey (MSPSS) and demographic and comorbidity questionnaires. RESULTS: Of the 210 women participants, higher symptom severity correlated with unemployment, living alone or being religious. Participants who were currently taking hormonal treatment (n = 84), reported a significant negative correlation between symptom severity, measured by MDASI, and social support (p = 0.006). Consequently, as symptom severity increased, perceived social support decreased. In the BCPT assessment, decreased cognitive functioning (p < 0.05), pain (p < 0.05), bladder dysfunction (p = 0.001), and reduced self-image (p < 0.01) were significantly negatively correlated with social support for those participants currently taking hormonal therapy. Participants who had not previously received hormonal therapy (n = 64), cognitive dysfunction and bladder dysfunction were negatively correlated with social support. Women with preexisting heart or pulmonary dysfunction and arthritis reported statistically significant higher levels of symptom severity and decreased perceptions of social support. CONCLUSIONS: Identifying socio-demographic variables and comorbidities that affect hormonal therapy symptom burden is essential for offering adequate support for breast cancer survivors.

Perceptions of Israeli women with breast cancer regarding the role of the Breast Care Nurse throughout all stages of treatment: a multi center study.

PURPOSE OF THE RESEARCH: The role of the Breast Care Nurse (BCN) is well established in Israel. The purpose of this study is to examine the impact of the BCN on Israeli women with breast cancer at all stages of disease from diagnosis, through treatment and follow-up. METHODS: This was a descriptive multi-center study on 321 women with non-metastatic breast cancer who completed their treatment <5 years before. Data collection took place in seven institutions in Israel, both in hospital and in the community. The women completed two questionnaires: a demographic questionnaire and the Ipswitch Patient Questionnaire looking at various aspects of care. Also included was one qualitative open question. Data analysis was performed checking for outliers and illogical observations. KEY RESULTS: In most areas investigated the women perceived the overall contribution of the BCN as very high, with 87% reporting a general contribution of very high or high. It was found that 53% of the women received information about the position from the nurse herself. In 61.3% of the cases, initial contact with the BCN was made at the time of diagnosis. The qualitative findings concerning the open question are also reported. CONCLUSIONS: According to the perceptions of women with breast cancer in Israel, BCN support is an important part of the patient's ability to manage their diagnosis and related care. The multi-disciplinary breast cancer team should incorporate BCN specialists as part of their holistic care.

Breast cancer: reactions of Israeli men to their wives' diagnosis.

The purpose of this research was to describe Israeli husbands' reactions to their wives' diagnosis of breast cancer. This quantitative, descriptive, preliminary study employed a convenience sample of 20 men and investigated their perception of the information they received, their psychosocial responses, the effects on their marital relationship, and their perceived spousal social support. The study instruments included the Locke Wallace Marital Adjustment Scale, the Psychosocial Adjustment to Illness Scale, and a Social Support Questionnaire. This subject has not been researched in Israel previously. Husbands voiced total trust in the health-care delivery system, even though they reported a need for more information on the disease, treatment, and issues concerning their marital relationship. Husbands had difficulties with their day-to-day activities, and almost half of them cited problems both at work and at home. They described stress, including depression and sleep disturbances. They reported changes in their sexual interest and sexual functioning as well. In general, husbands felt the support of their wives. Husbands whose wives have breast cancer need a network of support to address their specific issues and concerns. The Breast Care Clinical Nurse Specialist is cited as being a pivotal component of such a support network.

Social support as experienced by Chinese and Israeli husbands of women with breast cancer: a comparative study.

The purpose of this research was to compare the experience of social support of Israeli and Chinese husbands of women with breast cancer. Social support was examined from three different sources: wives, friends and family, and the healthcare team. This study is part of a larger descriptive comparative study investigating the husbands' adjustment to their wives' diagnosis of cancer. A convenience sample of 50 husbands from each cultural framework was selected. Support from family and friends and the healthcare team was measured by items from the Social Support Questionnaire (SSQ), the Psychosocial Adjustment to Illness Scales (PAIS) and questions developed by the authors. Israeli husbands reported significantly higher levels of support in all three areas. Chinese husbands were significantly more interested in joining a support group. The results of this study show that culture has an impact on spousal responses to their wives' illness. In developing appropriate breast cancer nursing, nurses need to practice sensitivity and awareness of the cultural differences in order to provide culturally sensitive family oriented nursing care. This study is an ongoing effort of collaboration between nursing professionals from the far east and the middle east.

Knowledge, attitudes and practices of physicians and nurses regarding the link between IVF treatments and breast cancer.

PURPOSE: The ovarian stimulating hormones used in In-Vitro Fertilization may increase the incidence of breast cancer. Little research has been conducted to ascertain health professionals' knowledge or practices regarding this possible connection and if they communicate this risk to their patients. This study described the knowledge, attitudes and practices of doctors and nurses regarding the causative link between In-Vitro Fertilization treatments and breast cancer, and to determine if these health professionals were assessing or communicating this possible risk to their patients. METHOD: Seventy gynecologists and nurses who worked in fertility clinics, had at least one year of experience in fertility and were literate in Hebrew were asked to complete the questionnaires. Ten clinics around the country were contacted and the questionnaires were distributed and collected on the same day. RESULTS: 35 Nurses and 35 gynecologists completed the survey. Although the majority of the physicians (68%) and nurses (69%) thought that there was a possible connection between the hormonal treatment of IVF and breast cancer, physicians were significantly more likely to inform their patients about the connection than were nurses. CONCLUSIONS: There is a gap between the attitudes and practices of both physicians and nurses in communicating possible cancer risk to IVF clients. It would be beneficial to create a standardized risk communication protocol that would include information and guidelines for practice. More research must be conducted in this area, as there is almost no data on possible maternal risk from IVF treatment.

Attitudes of legal guardians in the ICU - a qualitative report.

UNLABELLED: Decision-making in intensive care units (ICUs) is often made by surrogates, since patients are unconscious or incompetent. In Israel, Legal Guardians (LGs), appointed by the court, are required to make these decisions. OBJECTIVE: To qualitatively assess the attitudes of LGs required to make decisions on behalf of their relatives. RESEARCH DESIGN: Demographic and semi-structured questionnaires were used to assess the attitudes of LGs regarding difficulties, positive aspects and areas for improvement with regard to surrogate decision-making. The study sampled sixty-four LGs in two large Israeli hospitals. After reading and analysing the responses provided by the LGs, the authors categorised the pertinent topics raised using a thematic analysis. RESULTS: Themes were: bureaucratic and legal issues, unclear or unknown patient preferences and fear of outcomes. Family and medical staff support was stated as the most beneficial. Suggestions for improvement included alleviation of bureaucracy and improved communication with the medical staff. CONCLUSIONS: The importance of communication and bureaucratic difficulties, making the best decision for the patient and uncertainty regarding decision outcomes were found to be important issue for the LGs. The healthcare team should try and alleviate some of these burdens, mostly by improving communication with relatives, stressing and educating the importance of advance directives. Reporting the problems found in the decision making process of LGs to the legislators in order to revise and simplify the current legal requirements is advised.

Elder women's decision-making in breast cancer care: An Israeli study.

PURPOSE: Much research has examined women's decision-making behaviour in breast cancer care. Patient age has shaped preferences, values, decision style and participation in treatment decisions. The aim of this study was to test the validity of the Michigan Assessment of Decision Style (MADS) (Pierce, 1995) in an older cohort and provide information on decision styles to identify areas of tailored decision support necessary for Israeli women. METHODS: This study examined the decision-making styles of older Israeli women receiving routine mammography screening. Fifty two women over 65 years of age, attending a routine mammography screening, were administered a questionnaire containing demographic information and the MADS to determine hypothetical treatment decision-making. The MADS is a 16-item questionnaire assessing decision-making behaviour by characterizing four factors: avoiding, deferring, information-seeking and deliberation. RESULTS: Age, family history of breast cancer, and having a current mammography were not significantly associated with any of the four MADS factors. Deliberation and Deferring had the highest mean scores, followed closely by Information-Seeking and Avoidance. Correlations among the factors indicate a significant, positive correlation between Deliberation and Information-Seeking and a significant negative correlation between Deliberation and Deferring, consistent with previous studies. CONCLUSIONS: These findings indicate that older Israeli women's decision style is characterized by information seeking and deliberation reflecting a disposition towards engagement. The findings contribute to clinicians' understanding of women's preferences by countering the traditionally accepted stereotype that older women will employ a passive role when faced with an important health care decision.

Training breast care nurses throughout Europe: the EONS postbasic curriculum for breast cancer nursing.

BACKGROUND: The European Parliamentary Group on Breast Cancer and the European Society of Breast Cancer Specialists state that there is a need for EU agreed guidelines on breast care nursing and training. Therefore the European Oncology Nursing Society (EONS) commissioned the development of a post-basic curriculum for breast cancer nursing. PURPOSE: The goal was to define a European curriculum for the training of breast care nurses. METHODS: The curriculum was developed using a variety of sources, including guidelines from a number of European and other countries world wide, relevant literature and input from an expert panel of senior European nurses with expertise in breast care nursing. RESULTS: An English language, European curriculum of breast care nursing was developed at a postbasic level to provide guidance for the training of breast care nurses throughout Europe. Definitions for breast care nurse roles and activities and levels of practice, as well as indicative content are provided. CONCLUSIONS: The training of nurses in breast cancer care should be mandatory and common practice for European countries. To enhance comparability and standard development, the indicative content should be applied in all future post-basic education.

Relationship between severity of symptoms and quality of life in patients with breast cancer receiving adjuvant hormonal therapy.

PURPOSE/OBJECTIVES: To describe symptoms and quality of life (QOL) of patients with breast cancer receiving adjuvant hormonal therapy and to examine possible relationships between the two measurements. DESIGN: Descriptive, correlational study. SETTING: An oncology clinic within a tertiary medical center in Israel. SAMPLE: Convenience sample of 132 patients diagnosed with primary breast cancer receiving hormonal therapy. METHODS: Data collection was conducted through the self-administered Functional Assessment of Cancer Therapy endocrine subscale and a sociodemographic and medical information questionnaire. MAIN RESEARCH VARIABLES: QOL and symptoms of hormonal therapy. FINDINGS: Ten symptoms were categorized by more than 20% of the participants as "very much" or "quite a bit." The mean QOL score for the participants was higher than that for a healthy population, although a correlation was found between fewer symptoms and higher QOL. Mood swings and irritability were the symptoms most strongly associated with a decrease in QOL. Patients who exercised had higher QOL scores. CONCLUSIONS: Adjuvant hormonal therapy did not affect the QOL of a majority of patients with primary breast cancer. A reduced number of symptoms indicated a higher QOL. Mood swings and irritability have a negative impact on QOL. IMPLICATIONS FOR NURSING: A need exists to design a program to follow up on hormonal symptoms and the QOL of patients receiving hormonal therapy and to encourage patients to engage in regular exercise.

Social, marital, and sexual adjustment of Israeli men whose wives were diagnosed with breast cancer.

PURPOSE/OBJECTIVES: To explore the psychosocial adjustment of Israeli men whose wives were diagnosed with breast cancer. DESIGN: Descriptive study. SETTING: An urban tertiary medical center. SAMPLE: A convenience sample of 50 Israeli men whose wives had been diagnosed with breast cancer. The average age was 53.8 years. All of the men spoke and wrote Hebrew. METHODS: Husbands completed a demographic and wives' health-related questionnaire, the Social Support Questionnaire to measure social support from their wives, the Psychosocial Adjustment to Illness Scale to measure adjustment to a serious disease of the wives, and the Locke Wallace Marital Adjustment Scale to measure marital and sexual adjustment. MAIN RESEARCH VARIABLES: Psychosocial adjustment, social support, relationships with their partners, and relationships with the healthcare system. FINDINGS: A fifth of the men reported various levels of stress and concern. Half described financial difficulties. Three-quarters of the men noted changes in their relationships. More than a third of the husbands experienced a reduction in communication with their families. All of the men expressed satisfaction with the healthcare system, although some of them expressed a need to receive more information. CONCLUSIONS: Husbands of women with breast cancer grapple with multiple issues on several fronts. They need support and information from the healthcare team even if they do not request it in a timely or direct manner. IMPLICATIONS FOR NURSING: Response to the unspoken needs of men whose wives have breast cancer necessitates education and ongoing staff education to develop strategic support and communication.

Role of the nurse in patient education and follow-up of people receiving oral chemotherapy treatment: an international survey.

PURPOSE: The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. MATERIALS AND METHODS: Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries. RESULTS: Findings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines/protocols, 47% reported not having received any education about oral CT drugs. While 64% report being involved in patient education, 58% of subjects indicated lack of patient education materials that are specific for oral CT agents. Only 27% stated that they gave all necessary information such as when and how to take the drugs, drug safety and storage, side effects, and symptom management. Reasons for not being involved in oral CT education and follow-up included beliefs that the physician plans the oral CT and gives patients necessary instructions (34%), that nurses only see patients who receive intravenous chemotherapy (16%), that nurses have lack of knowledge about oral agents (15%), and belief that physicians are responsible for patient follow-up. The nurses suggested better education and follow-up of patients to include the written patient education materials (33%) and professional education for nurses (30%). CONCLUSIONS: Findings revealed the need for professional education for nurses to ensure comprehensive, consistent patient education and development of written materials for patients receiving oral CT treatment.