Developing the structure of Japan's cancer survivorship guidelines using an expert panel and modified Delphi method.

PURPOSE: To develop consensus-based components used in the first evidence-based cancer survivorship guidelines in Japan. METHODS: Purposive sampling was used to recruit a panel of experts in oncology clinical practice, nursing, health science, epidemiology, and patient advocacy. The panel engaged in a modified Delphi process to (1) generate consensus related to the definition of survivorship, (2) determine the aim and target users of the guideline, and (3) identify clinical issues for inclusion. A Web-based survey and panel meeting were conducted to obtain the panelists' feedback on the initial draft proposed by the secretariat. Multiple online votes were then completed until all elements of the proposed guidelines reached an approval rate of 80% or higher. Following each round, iterative refinements were made based on all panelists' feedback. RESULTS: Twenty-two experts were enrolled in the panel and participated in four rounds of online voting and two face-to-face meetings. Ultimately, the panel reached consensus on the definition of survivorship, the aim of the guidelines, and target users. Moreover, 11 of the original 17 clinical issues were retained. Finally, the panel selected two priority areas to implement immediately. CONCLUSION: The panel's consensus on the definition of survivorship, aim and target users of the guideline, and 11 clinical issues will serve as a compass for the development of comprehensive cancer survivorship guidelines in Japan. IMPLICATIONS FOR CANCER SURVIVORS: A culturally sensitive consensus approach was developed to improve the long term health and well- being of cancer survivors in Japan.

Interest in a group psychotherapy program among Philippine breast cancer patients and its associated factors.

OBJECTIVE: A wide variety of psychosocial interventions are available for cancer patients, among which group psychotherapy (GPT) programs have made improvements in cancer patients' quality of life, coping abilities, and emotional distress. Few research data are available describing Philippine breast cancer patients' interest in GPT. This study aimed at enumerating the factors that determine Philippine breast cancer patients' interest in a GPT program. METHODS: Patients recruited from the University of Santo Tomas Hospital Benavides Cancer Institute were asked to answer a survey questionnaire about their demographic, clinical, and psychosocial status, as well as whether they would be interested in joining GPT and why. RESULTS: Of 135 patients approached, 123 patients completed the survey. 104 (85%) women indicated interest in GPT. Patients were mostly interested because they wanted to learn coping skills (79%) and gain knowledge or information in dealing with cancer (69%). Patients said they were 'very interested' in learning about cancer recurrence (96%) and treatments (94%). Bivariate analysis showed that compared to the uninterested group, interested patients were younger, more likely to be married, and were more likely to have used complementary therapy for breast cancer. Logistic regression showed that married women were more likely to be interested in GPT (OR 3.30, CI 1.07-10.20). CONCLUSION: There is a potentially high interest in GPT among Philippine breast cancer patients. The attributes of Philippine patients interested in GPT are similar to and yet unique, compared to other populations. Copyright © 2010 John Wiley & Sons, Ltd.

Physicians' attitudes about artificial feeding in older patients with severe cognitive impairment in Japan: a qualitative study.

BACKGROUND: The question of whether to withhold artificial nutrition and hydration (ANH) from severely cognitively impaired older adults has remained nearly unexplored in Japan, where provision of ANH is considered standard care. The objective of this study was to identify and analyze factors related to the decision to provide ANH through percutaneous endoscopic gastrostomy (PEG) in older Japanese adults with severe cognitive impairment. METHODS: Retrospective, in-depth interviews with thirty physicians experienced in the care of older, bed-ridden, non-communicative patients with severe cognitive impairment. Interview content included questions about factors influencing the decision to provide or withhold ANH, concerns and dilemmas concerning ANH and the choice of PEG feeding as an ANH method. The process of data collection and analysis followed the Grounded Theory approach. RESULTS: Data analysis identified five factors that influence Japanese physicians' decision to provide ANH through PEG tubes: (1) the national health insurance system that allows elderly patients to become long-term hospital in-patients; (2) legal barriers with regard to limiting treatment, including the risk of prosecution; (3) emotional barriers, especially abhorrence of death by 'starvation'; (4) cultural values that promote family-oriented end-of-life decision making; and (5) reimbursement-related factors involved in the choice of PEG. However, a small number of physicians did offer patients' families the option of withholding ANH. These physicians shared certain characteristics, such as a different perception of ANH and repeated communication with families concerning end-of-life care. These qualities were found to reduce some of the effects of the factors that favor provision of ANH. CONCLUSION: The framework of Japan's medical-legal system unintentionally provides many physicians an incentive to routinely offer ANH for this patient group through PEG tubes. It seems apparent that end-of-life education should be provided to medical providers in Japan to change the automatic assumption that ANH must be provided.