How to come to terms with facing death: a qualitative study examining the experiences of patients with terminal Cancer.

BACKGROUND: Cancer patients who have reached the terminal stage despite attempts at treatment are likely to experience various problems, particularly as they encounter increasing difficulty in doing what they were able to do easily, and their physical symptoms increase as the disease advances. The purpose of this study is to explore how terminal cancer patients who have not clearly expressed a depressed mood or intense grief manage their feelings associated with anxiety and depression. METHODS: Eleven terminally ill patients with cancer who were receiving symptom-relieving treatment at home or in palliative care units were interviewed. Interviews were generally conducted weekly, two to five times for each participant. In total, 33 interviews were conducted, and the overall interview time was 2027 min. Data were analyzed via qualitative methods. RESULTS: The following five themes were extracted regarding the experience of managing feelings associated with anxiety and depression when facing death: "I have to accept that I have developed cancer," "I have to accept the undeniable approach of my own death," "I have to accept my need for assistance," "I have to accept this unsatisfactory circumstance" and "I have to accept this as my destiny and an outcome of my life." CONCLUSION: The present study revealed key themes related to how patients come to terms with their impending death. Nurses are required to comprehend the patients' complicated mental patterns that are expressed in their daily languages. Furthermore, the findings clarify the necessity for nurses to help patients understand the acceptance of a terminal disease state during a patient's final days.

[The Necessity and the Current Status of Safe Handling of Anticancer Drugs].

Number of people who handle anticancer drugs in their profession is increasing. Anticancer drugs, which are hazardous drugs(HD), exert cytocidal effects on cancer cells, but many have also been shown to have mutagenicity, teratogenicity and carcinogenicity; therefore, safe handling of anticancer drugs is necessary. In July 2015, the first Japanese guidelines for exposure control measures, namely, the "Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs", were published jointly by 3 societies. Our guideline is the creation of the Japanese Society of Cancer Nursing(JSCN), Japanese Society of Medical Oncology(JSMO)and Japanese Society of Pharmaceutical Oncology(JASPO)and has a historical significance. This paper states the necessity of safe handling of anticancer drugs, Japan's recent movement of safe handling, the introduction of joint guidelines of safe handling of anticancer drugs, and new movement of safe handling of USP chapter 800 in the United States.

The validity and reliability of the Korean version of the Cancer-chemotherapy Concerns Rating Scale.

OBJECTIVE: The Cancer-chemotherapy Concerns Rating Scale was developed in Japan for outpatients undergoing chemotherapy, and its validity and reliability have been reported. The purpose of the study was to test the reliability and validity of the Korean version of the Cancer-chemotherapy Concerns Rating Scale. METHODS: The questionnaire was filled out by 199 cancer patients, who were currently undergoing outpatient chemotherapy. The data were analyzed using exploratory factor analysis with Promax Rotation to determine the factor construct validity. The reliability of the Cancer-chemotherapy Concerns Rating Scale was investigated by Cronbach's alpha and the Spearman Brown coefficient. RESULTS: Four factors were obtained and the overall structure was similar to that of the Japanese version; reorganization of daily life, self-existence, disease progress, and social and economic concerns. Cronbach's alpha for the total scale was 0.91 and the Spearman Brown coefficient was 0.85. CONCLUSIONS: We found that the Korean version of the Cancer-chemotherapy Concerns Rating Scale could be clinically useful. It could provide health-care providers with information useful to understand the psychological state of patients undergoing outpatient chemotherapy.

Experiences of Adolescent Daughters in Beginning to Live With Their Mothers' Cancer: A Qualitative Study.

This study reveals the experiences of adolescent daughters who are beginning to live with their mothers' cancer diagnosis. Participants were 14 adolescent daughters who were either junior or senior high school students when their mothers were diagnosed with breast cancer. We analyzed semi-structured interviews using content analysis. Using interview data, four categories were created from 23 subcategories and 183 codes: (1) using trial and error to attempt to steady their minds against upset and anxiety; (2) minimizing the effect on their own school life and future; (3) moving forward with the help and support of those around them; and (4) advancing together with their family to protect and take care of their mother. As supporters, we must understand adolescent daughters' experiences in living with their mothers' cancer. Open communication with an important outside individual is essential in promoting adolescent daughters' ability to obtain support and live with their mothers' cancer.

The perception of life and death in patients with end-of-life stage cancer: A systematic review of qualitative research.

PURPOSE: This study aims to clarify the perceptions on life and death among patients with the end-of-life stage cancer through a systematic review. METHODS: The search strategy combined MeSH terminology with free text searches, and was applied to the PubMed, CINAHL, Embase, and ICHUSHI (Japan Medical Abstracts Society) databases covering from 2010 to 5/2022. To ensure the quality of the research included, the Critical Appraisal Skills Program Qualitative Studies Checklist was used. Data relating to the perceptions of life and death of patients with the end-of-life stage cancer was extracted and analyzed with reference to qualitative meta-synthesis methods. RESULTS: Ultimately, 50 studies were included. Five themes were derived based on the perceptions of life and death of patients with the end-of-life stage cancer: despair, making sense of death, how to live the rest of life, special feelings for loved ones, and fluctuation. By making sense of death in their own way, and reconciling it with their current situation, patients with the end-of-life stage cancer, even in despair over their impending death, look ahead into the future and their surroundings and consider how they would live the remaining time they have. During this time, the special feelings they have for their loved ones make an impact. CONCLUSIONS: An important new finding from this study lies in the fact that the patients' desire to live as ordinary people who were not patients were expressed as a face that they hid from their families. Further research is needed in low-income countries/regions.

Efficacy of an Algorithm-Based Nursing Intervention to Promote a Balance Between Cancer Patients' Social Roles and Outpatient Treatment: A Quasi-Experimental Study.

BACKGROUND: Cancer patients undergoing treatment are often unable to balance treatment and work because of the time required for care at the hospital and a desire to avoid problems at work. OBJECTIVE: The aim of this study was to elucidate the efficacy of an algorithm-based nursing intervention (ANI) to promote balance between social roles and outpatient treatment in cancer patients. METHODS: Participants were outpatients receiving cancer therapy and randomly assigned to a control or an intervention group, the latter to receive ANI for 2 months. The outcomes were assessed using the Distress and Impact Thermometer and changes in employment status. Data from 54 evaluable participants in each group were analyzed. RESULTS: Distress and Impact Thermometer scores in the intervention group were significantly lower than those in the control group ( P < .001). In addition, 2 months later, 20 participants had resigned from their employment or were on leave in the control group (37.0%); this was twice the number in the intervention group, a significant difference ( χ2 = 4.573, P < .05). Logistic regression analysis showed that the odds ratio in the control group was 3.6 times that of the intervention group of having resigned. CONCLUSION: The ANI appears to have reduced distress and impact scores associated with the course of treatment and to have reduced the likelihood of resignations at 2 months after implementation. IMPLICATIONS FOR PRACTICE: The intervention appears to be effective and may be a new tool for use by outpatient oncology nurses.

Randomized clinical trial quantifying the effectiveness of a self-monitoring intervention in cancer patients with peripheral neuropathy: A quantitative study.

Objective: The aim of this study was to quantitatively evaluate the efficacy of a self-monitoring intervention for the management of persistent chemotherapy-induced peripheral neuropathy (CIPN). Methods: A randomized controlled clinical trial was conducted on 65 outpatients receiving taxane or platinum-based anticancer drugs. Participants were assigned to the control group (CG; n â€‹= â€‹32) or the self-monitoring group (SMG; n â€‹= â€‹33) and followed for 6 weeks. Non-interveners were blinded. Participants in the intervention group self-monitored and recorded. The researchers provided feedback on the recorded symptoms and coping strategies once every 3 weeks. The efficacy of the 6-week self-monitoring intervention was assessed, using various measures, at baseline (T0), 3 weeks (T1), and 6 weeks (T2). Scores of CIPN, Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity, Distress and Impact Thermometer, Self-Efficacy Scale for Advanced Cancer, and Functional Assessment of Cancer Therapy-General of both groups were compared. Safety behavior in daily life was also compared. The study was conducted from August 9, 2017 to March 30, 2020 in outpatient clinics at three hospitals. Analysis was conducted using the t-test, Mann-Whitney U test, χ2 test, and two-way repeated-measures analysis of variance (two-way RMANOVA). Results: No significant differences were noted between the two groups in the CIPN score, the Distress and Impact Thermometer score, and in safety behavior in daily life. The mean Self-Efficacy Scale for Advanced Cancer score at T1 differed between the two groups (CG mean â€‹± â€‹SD: 358.44 â€‹± â€‹109.90; SMG mean â€‹± â€‹SD: 421.21 â€‹± â€‹85.54), which was significantly higher in the SMG (P â€‹= â€‹0.012). Two-way RMANOVA revealed an interaction between the CG and SMG (F â€‹= â€‹5.689, P â€‹= â€‹0.004). Quality of life scores were higher in the SMG than in the CG at T0, T1, and T2. Two-way RMANOVA analysis showed an effect of the intervention (F â€‹= â€‹7.914, P â€‹= â€‹0.007). Conclusions: The self-monitoring intervention maintained the participants' quality of life. This finding suggests its effectiveness in patients with peripheral neuropathy.

The Lived Experience of Persons with Terminal Cancer: A Qualitative Study.

This study aims to elucidate the life and death experiences of patients with terminal cancer. The researchers interviewed 18 terminal cancer patients, for a total 3,118 min. A psychophenomenological approach was used for analysis. Three themes were derived: a new appreciation for the gleam of an ordinary life after experiencing extreme suffering, a desire to at least pass away peacefully when sensing impending death, and a desire to remain useful to loved ones and other suffering patients like them. The novelty of this research derives from its finding that life and death are not in conflict and can lead to hope.

Effects of a self-monitoring intervention in breast cancer patients suffering from taste alterations induced by chemotherapy: A randomized, parallel-group controlled trial.

PURPOSE: This study evaluates the effect of a self-monitoring intervention on taste alterations in breast cancer patients undergoing outpatient chemotherapy. METHODS: The study was a randomized controlled trial. Thirty-four participants were divided into two groups: a self-monitoring (SMG) group (n = 17) and a control group (CG) (n = 17). A conceptual framework was developed with reference to the components of self-management, cognitive behavioral therapy, and the concepts of self-monitoring. Interventions were based on this framework. SMGs recorded their taste symptoms as homework and worked with the researcher to set goals and provide feedback four times every three weeks. In the feedback, the researcher actively listened to the SMG about their feelings and coping strategies during the taste changes, and gave approval and praise for these. The implementation period was 9 weeks for each participant; the CG was provided with conventional nursing support. The intervention was evaluated by comparing the items of symptom improvement, quality of life (QOL), and self-efficacy between the groups before and after the start of the intervention using a scale score. Scale scores were also compared for recognition of taste changes, concerns during treatment, distress, and impacts on each treatment day. RESULTS: SMG had significantly lower scores than CG for perceived change in taste (p = 0.009), and there was an interaction with CG (p = 0.008). SMG had also significantly lower scores than CG in concern during treatment (p = 0.015). CONCLUSION: This study showed that a self-monitoring intervention reduced negative cognition of taste alterations and reduced discomfort. The results suggest that the self-monitoring intervention is effective nursing support for chemotherapy-induced taste alterations.

Development and validation of the Total Dyspnea Scale for Cancer Patients.

PURPOSE: This study developed a comprehensive measurement tool for assessing dyspnea in cancer patients and examined its reliability and validity. METHODS: This cross-sectional study included 239 cancer patients with awareness of cancer-related dyspnea from outpatient/inpatient wards of six general hospitals in Japan. Items for the Total Dyspnea Scale for Cancer Patients (TDSC) were developed based on qualitative research and a literature review on patients with dyspnea. Ten cancer experts confirmed the scale's content validity. Factor analysis established construct validity. Internal consistency was analyzed by Cronbach's α. Study variables were the effects of dyspnea, worry, and quality of life. RESULTS: Factor analysis identified 2 factors (11 items): effects on "daily living activities and psychology" and on "social life." Cronbach's α of the whole scale was 0.952 (p < 0.01), confirming high reliability. The scale showed high correlation with existing measures. TDSC can comprehensively and multidimensionally evaluate cancer-related dyspnea. CONCLUSIONS: The TDSC consists of 11 items within two factors. Cronbach's α coefficient of the scale was 0.952 in this study, and thus, an acceptable level of reliability was confirmed. In addition, reference-related validity and discriminant validity were verified and confirmed. In future clinical practice, this scale can be utilized as a useful tool for comprehensively and multidimensionally evaluating cancer-related dyspnea.

Development and testing of the Attitude Scale for the Dietary Therapy of Hemodialysis Patients.

AIM: To develop an attitude scale regarding the dietary therapy of hemodialysis patients and to examine its reliability and validity. METHODS: An initial item pool of 37 items was extracted from a conceptual model that had been developed in the authors' previous study and the literature was reviewed. An expert panel examined the content validity. A total of 381 Japanese hemodialysis patients then were recruited. Exploratory factor analyses and a confirmatory factor analysis were used to test the construct validity and an item analysis, internal consistency coefficients, and test-retest were used to verify the reliability. RESULTS: The expert panel judged the content validity index to be satisfactory. The data from the final 16 items consisted of three factors (propensity of behavior that is affected by cognition, propensity of behavior that is affected by the food culture, and negative affect that modifies the diet). Regarding the subscales, the Cronbach's coefficient alpha values were confirmed to be reliable, showing medium-to-high internal consistency. The test-retest method confirmed the stability of the scale. CONCLUSION: With the reliability and validity confirmed, it was established that the Attitude Scale for the Dietary Therapy of Hemodialysis Patients described herein is capable of determining the attitude of hemodialysis patients towards their dietary therapy. This scale makes it possible to quantitatively evaluate hemodialysis patients' attitudes toward dietary therapy. The accuracy of the scale needs to be improved by further examining its reliability and validity.

Emotional Responses to Persistent Chemotherapy-induced Peripheral Neuropathy Experienced by Patients with Colorectal Cancer in Japan.

OBJECTIVE: For patients who wish to continue treatment for persistent chemotherapy-induced peripheral neuropathy (PCIPN) while maintaining the quality of life (QOL), the only effective way appears to be the stop-and-go strategy. The objective of the present study was to analyze emotional responses of Japanese patients with colorectal cancer (CRC) experiencing PCIPN for the first time and to consider effective ways of providing supportive nursing care. METHODS: In all, 25 patients with metastatic CRC who had completed more than six courses receiving first-line therapy with modified FOLFOX6 were included. Data were collected through semi-structured interviews. RESULTS: Emotional responses to PCIPN experienced by patients with CRC fell into the following categories: (1) suffering from an inability to cope with the previously unknown sensation of numbness, (2) inability to perform daily living activities activities of daily living [ADL]/instrumental activities of daily living [IADL] independently and feeling fear for physical safety, (3) feeling a sense of relief at being able to live the same life as before, and (4) facing the threat of cancer and tolerating the numbness caused by the life-supporting treatment. Fear, helplessness, dismay and other uncomfortable feelings represented 72.5% of all emotional responses, probably reflecting the lack of effective intervention for PCIPN. CONCLUSIONS: These results suggest that both subjective and objective assessments of PCIPN and proper use of a stop-and-go strategy are essential for treatment continuation and maintenance of patient's QOL; therefore, an integrated approach is desirable.

Salient Features and Outline of the Joint Japanese Guidelines for Safe Handling of Cancer Chemotherapy Drugs.

The purpose of this paper is to introduce the outline and describe the salient features of the "Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs" (hereinafter, "Guideline"), which were published in July 2015. The purpose of this Guideline is to provide guidance to protect against occupational exposure to hazardous drugs (HDs) to all medical personnel involved in cancer chemotherapy, including physicians, pharmacists, and nurses and home health-care providers. The Guideline was developed according to the Medical Information Network Distribution Service guidance for developing clinical practice guidelines, with reference to five authoritative guidelines used worldwide. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ichushi-Web, and Cochrane Central Register of Controlled Trials were used for a systematic search of the literature. Eight clinical questions (CQs) were eventually established, and the strength of recommendation for each CQ is presented based on 867 references. The salient features of the Guideline are that it was jointly developed by three societies (Japanese Society of Cancer Nursing, Japanese Society of Medical Oncology, and Japanese Society of Pharmaceutical Oncology), contains descriptions including the definition of HDs and the concept of hierarchy of controls, and addresses exposure control measures during handling of chemotherapy drugs. Our future task is to collect additional evidence for the recommended exposure control measures and to assess whether publication of the Guideline has led to adherence of measures to prevent occupational exposure.

Development of the Hirai Cancer Fatigue Scale: Testing its reliability and validity.

PURPOSE: The purpose of this study was to develop the Hirai Cancer Fatigue Scale (HCFS) to assess the fatigue experienced by cancer patients, and to verify its reliability and validity. METHODS: Based on qualitative research about the perception of fatigue by Japanese cancer patients, we developed a questionnaire. The content validity was confirmed by 5 expert oncology nurses and 5 oncologists. 281 Japanese cancer patients participated in this study. Construct validity was analyzed using factor analysis, and internal consistency was analyzed using Cronbach's α coefficient. RESULTS: A 15-item scale with 3 dimensions, "physical/mental sensation", "activity-related sensation" and "cognitive sensation," was developed by factor analysis. This scale had an overall Cronbach's α coefficient of .943 and a test-retest reliability coefficient of r = .820 (p < 0.01), confirming the high reliability of the scale. The correlation coefficient was r = .759 (p < 0.01) between HCFS and abridged Profile of Mood States-Fatigue (POMS-F), and r = .763 (p < 0.01) between HCFS and Cancer Fatigue Scale (CFS), both showing high correlations and confirming criterion-related validity. CONCLUSION: HCFS enables reliable and valid evaluation of Japanese cancer patients' fatigue. Use of the HCFS would assist in convenient self-evaluation of fatigue, and would allow information to be effectively provided to healthcare professionals. It could also be used for outcome evaluation in an intervention study.

Development and validation of a chemotherapy-induced taste alteration scale.

PURPOSE/OBJECTIVES: To develop an instrument to assess the specific symptoms of chemotherapy-induced taste alterations. DESIGN: Cross-sectional study. SETTING: Two outpatient chemotherapy centers in Kanto, Japan. SAMPLE: Convenience sample of 214 adult patients with chemotherapy-induced taste alterations. METHODS: Items on the chemotherapy-induced taste alteration scale (CiTAS) were developed by a qualitative study of patients with taste alterations, and the content validity of each item was assessed by a panel of specialized oncology nurses. Data were analyzed for item consistency using Cronbach alpha and construct validity using factor analysis. MAIN RESEARCH VARIABLES: Taste alterations, symptoms of discomfort, and impact of taste alterations on daily life. FINDINGS: An 18-item scale was developed with four dimensions identified through factor analysis: decline in basic taste, discomfort, phantogeusia and parageusia, and general taste alterations. The scale demonstrated excellent reliability (Cronbach alpha = 0.9) and test-retest reliability (r = 0.94, p < 0.001, n = 28), as well as good validity, which was indicated by its strong correlation with a visual analog scale of the impact of taste alterations on daily life (r = 0.62, p < 0.001) and by negative correlations with Short Form-8 quality-of-life measures (physical component summary, r = -0.33; mental component summary, r = -0.47). CONCLUSIONS: The CiTAS enabled valid, reliable measurement of specific symptoms of chemotherapy-induced taste alterations. The CiTAS has potential as a clinical tool and also could be used as a measure of chemotherapy-induced taste alterations in future studies. KNOWLEDGE TRANSLATION: The CiTAS may help evaluate the effectiveness of interventions to reduce the symptoms of taste alterations, such as administering zinc and self-care strategies.

Empirical analysis of content of support in regional intractable disease consultation.

AIM: The purpose of this research is to study the content of support provided by nurses who were employed in a regional intractable disease consultation project. METHODS: The content of support was classified using records of 943 consultations with intractable disease patients and their families conducted over a 5 year period in a regional intractable disease consultation project in one prefecture of Japan as the subject of analysis. The number of recording units in respective categories was compared. RESULTS: A total of 1276 recording units were extracted from the data and organized into two major categories, eight minor categories, and 24 subcategories. The major category [Support for problem solving by patients' and their families' own efforts] comprised four minor categories, which have the aims of respect of the independence of the patient and patient's family and support for the solution of problems. The major category [Coordination with support division] comprised four minor categories, as support for problems which are difficult for the patient and their family to solve. CONCLUSION: The distinctive features of regional intractable disease consultations conducted by nurses are support from the combined viewpoints of medical care and everyday life, specialized support based on the features of the patient's disease, and coordination with close support persons. In education for nurses who are to be employed in this field, it is necessary to develop competence in responding to the specialized support needs of intractable diseases and coordination of support persons.