Effect of Auricular Acupressure in Management of Constipation in Palliative Care Patients.

Objectives: This experimental randomized-controlled study was performed to define the efficacy of auricular acupressure (AA) in the management of constipation developing in palliative care patients. Methods: According to the pre-prepared randomization list, 44 patients were included in the experimental group and 46 patients were included in the control group. Routine clinical treatment and care implementation were maintained in the patients in both groups. AA was performed for 4 weeks in patients in the experimental group. During the study, to determine the complaints of the patients regarding constipation, the information in the daily patient chart was examined at least 5 times by interviewing with the patient/patient's relative in the clinic and/or via phone call, and the results were recorded in the patient chart and data collection forms. The independent variable of the study is AA application, and the dependent variables are constipation and quality of life. Results: It was determined that there was no statistically significant difference between the daily defecation frequency of the 2 groups during the first 11 days. However, after the 12th day, the daily stool frequency of the experimental group was higher compared to the control group and this difference obtained between the 2 groups was statistically significantly different. AA was effective in decreasing laxative use. Conclusion: This intervention increased stool frequency, reduced physical and psychosocial symptoms, anxieties, and improved stool satisfaction and it was an effective approach to improving the quality of life. It is recommended that the daily use of AA should be evaluated. The healthcare providers including nurses, patients, and patient relatives should be trained regarding AA.

Effects of a Mindfulness-Based Stress Reduction Program on Stress, Depression, and Psychological Well-being in Patients With Cancer: A Single-Blinded Randomized Controlled Trial.

BACKGROUND: A mindfulness-based stress reduction program combined with music therapy is one of the interventions designed to help patients cope with stress and depression. OBJECTIVE: The aim of this study was to examine the effects of an online mindfulness-based stress reduction program combined with music therapy on stress, depression, and psychological well-being in adult patients with cancer. METHODS: This study was a single-blinded, prospective, randomized-controlled experimental design. One hundred twenty cancer patients were recruited (60 each in the intervention and control groups). Patients in the intervention group received a 10-day mindfulness-based stress reduction program combined with music therapy. Stress was measured with the State Trait Anxiety Inventory-State, psychological well-being was measured with the Psychological Well-being Scale, and depression was measured with the Beck Depression Inventory at baseline and the end of the study. RESULTS: The intervention group showed significantly lower stress and depression scores than the control group in the total scores at 10 days ( P < .05). The intervention group had significantly higher scores in the psychological well-being ( P < .001) than the control group at 10 days. Intragroup comparison of the stress and depression scores showed that posttest score of the intervention group was significantly lower than its pretest score ( P < .05). CONCLUSION: Mindfulness-based stress reduction program combined with music therapy reduced the levels of stress and depressive symptoms and improved psychological well-being in cancer patients. IMPLICATIONS FOR PRACTICE: A nurse-led mindfulness-based stress reduction program combined with music therapy is an innovative and effective psychological intervention that may be integrated with regular patient care for adults receiving treatment of cancer.

The effect of warm salt water foot bath on the management of chemotherapy-induced fatigue.

PURPOSE: Several studies have shown that the warm water bath can be a beneficial approach in the management of fatigue. This experimental study was conducted to evaluate the effect of warm salt water foot bath in the management of chemotherapy-induced fatigue. METHODS: This randomized controlled trial was perfomed between November 2017-February 2018. Seventy five patients who experienced moderate or higher level chemotherapy related fatigue were randomly assigned to the intervention or control group. A training booklet about chemotherapy-induced fatigue was given to all patients. In addition, the experimental group performed 20 min warm salt water footbath for a week. The primary outcome was the change in fatigue level over 7 days after chemotherapy. The secondary outcome was the difference in physical, affective, emotional, and cognitive fatigue scores of patients. RESULTS: The level of fatigue was grade 2 and grade 3 for 65.3% and 33.3% of patients, respectively. There was no statistically significant difference between groups regarding the mean of total fatigue score before and after bath (p > 0.05). However, the amount of decrease observed in the experimental group was found to be statistically significantly higher than the control group (p = 0.012; p < 0.05). In addition; the score in behavioral/severity, sensory, affective and cognitive dimensions related to fatigue decreased in the experimental group but did not decrease in the control group. CONCLUSION: This study shown that warm salt water footbath can be an effective approach in enhancing fatigue related quality of life cancer patients. More studies should be conducted to assess the effectiveness of this intervention.

Enhancing Palliative Care With Mindful Touch: Impact of a Manual and Movement Therapy Training Program in an International Multidisciplinary Integrative Oncology Setting.

CONTEXT: Manual and movement therapies (MMTs) play a central role in the integrative oncology setting, significantly improving patients' quality of life (QOL). Despite research supporting the effectiveness and safety of these modalities, most oncology health care providers (HCPs) lack any MMT training. OBJECTIVES: In this study, we examine the impact of an MMT-based integrative oncology training program with the participation of an international and multidisciplinary group of oncology HCPs. The feasibility of implementing these skills in palliative cancer care is examined. METHODS: A three-day evidence-based hands-on teaching program was designed to train oncology HCPs working in supportive cancer care MMT modalities from traditional Chinese and anthroposophic medicine. Prequalitative and postqualitative assessments of the trainees' narratives were analyzed using ATLAS.Ti software (Scientific Software Development GmbH, Berlin, Germany) for systematic coding. RESULTS: The training program was attended by 30 participants from Israel (15), Germany (7), Italy (6), Turkey (1), and Cyprus (1). The group included 13 nurses, 10 physicians, 6 complementary/integrative HCPs, and 1 psycho-oncologist. The pretraining expectations that were met at post-training included gaining knowledge and practical QOL-oriented skills, which could be implemented in the palliative and supportive care setting. A significant change in the attitude of trainees to touch therapy was also identified, with respondents seeing MMTs promoting patient-centered palliative care, including nonverbal communication. CONCLUSION: An MMT training program for oncology HCPs for QOL-related indications is both feasible and likely to be implemented in palliative and supportive cancer care. Nonspecific effects of MMTs were also recognized for their ability to facilitate patient-centered care.

The Effect of Lotus Position on Dyspnoea Management in Intensive Care Unit.

OBJECTIVE: To determine the effect of lotus position on dyspnea management. METHODS: The case-control study was conducted from June to November 2016 at a training and research hospital in Istanbul, Turkey, and comprised patients with lung disease in an intensive care unit. The patients were divided into an experimental group who were exposed to lotus position for dyspnoea management, while the control group was subjected to Orthopnoeic position. Data was collected using a patient description form, and the Medical Research Council Scale. Respiratory rate, oxygen saturation, heart rate and blood pressure for all subjects were noted. SPSS 22 was used for data analysis. RESULTS: Of the 35 subjects, 17(48.5%) were cases and 18(51.4%) were controls. The overall mean age was 61.48±15.51 years. There was a significant improvement in the intra-group respiratory rate, oxygen saturation, heart rate and systolic blood pressure in both groups (p<0.05). Patients in both groups were similar in their vital signs both before and after the intervention (p>0.05). CONCLUSIONS: Both lotus and Orthopnoeic positions significantly improved dyspnoea-related variables, and lotus position was as effective as Orthopnoeic position.

The Effect of Lavender Oil on Sleep Quality and Vital Signs in Palliative Care: A Randomized Clinical Trial.

BACKGROUND: This study was conducted to determine the effect of lavender oil on sleep quality and vital signs in palliative care patients. METHODS: We examined 68 patients in a palliative care unit. Vital signs of all the patients were assessed, and also their sleep quality was evaluated using the Richards-Campbell Sleep Questionnaire. Lavender was applied to patients in the experimental group. During the intervention, vital signs of the patients were monitored at 4-h intervals throughout the night, and sleep quality was evaluated during the morning. The same evaluation processes were performed for the control group. RESULTS: It was observed in the evaluation that lavender application did not affect the vital signs of the patients but it ensured a deeper sleep on the 2nd day after the intervention, facilitated their falling asleep and sleeping again when they were awakened and enhanced sleep quality (p < 0.05). Also, this application decreased the awakening frequency on the 1st and 2nd days and enhanced overall sleep quality (p < 0.05) after the intervention. CONCLUSIONS: Lavender has no effect on the vital signs of palliative care patients but is an effective and reliable approach to enhance their sleep quality.

The efficacy of abdominal massage in managing opioid-induced constipation.

PURPOSE: This study was conducted to determine the effects of abdominal massage in managing opioid-induced constipation. METHODS: Designed as a randomized controlled trial, this study was conducted between February 2017 and January 2018 with the participation of 204 patients who had complaints of opioid-induced constipation. The experimental and control group, each of which included 102 patients, were randomised using a previously prepared randomization checklist. Patients in the experimental group were given a 15-min video-guided abdominal massage training by the researcher, and the patients in this group were asked to perform abdominal massage for 4 weeks, twice a day, 30 min after breakfast and dinner. In the control group, the standard approach of the clinic was applied. A patient data form, the Defecation Diary, Visual Analogue Scale, and Patient Assessment of Constipation Quality of Life Questionnaire were used to the study. RESULTS: The data from the study showed that abdominal massage decreased the severity of constipation, the feeling of incomplete bowel emptying, the severity of straining, the severity of anal pain, and bloating (p < 0.05), provided better stool consistency (p < 0.05) and increased the number of defecations as well as quality of life scores (p < 0.05). CONCLUSION: The abdominal massage application increased the number of defecations by 13% and was an effective approach for managing opioid-induced constipation symptoms.

Human Development Index and its association with staff spiritual care provision: a Middle Eastern oncology study.

BACKGROUND: Although staff spiritual care provision plays a key role in patient-centered care, there is insufficient information on international variance in attitudes toward spiritual care and its actual provision. METHODS: A cross-sectional survey of the attitudes of Middle Eastern oncology physicians and nurses toward eight examples of staff provision of spiritual care: two questionnaire items concerned prayer, while six items related to applied information gathering, such as spiritual history taking, referrals, and encouraging patients in their spirituality. In addition, respondents reported on spiritual care provision for their last three advanced cancer patients. RESULTS: Seven hundred seventy responses were received from 14 countries (25% from countries with very high Human Development Index (HDI), 41% high, 29% medium, 5% low). Over 63% of respondents positively viewed the six applied information gathering items, while significantly more, over 76%, did so among respondents from very high HDI countries (p value range, p < 0.001 to p = 0.01). Even though only 42-45% overall were positively inclined toward praying with patients, respondents in lower HDI countries expressed more positive views (p < 0.001). In interaction analysis, HDI proved to be the single strongest factor associated with five of eight spiritual care examples (p < 0.001 for all). Significantly, the Middle Eastern respondents in our study actually provided actual spiritual care to 47% of their most recent advanced cancer patients, compared to only 27% in a parallel American study, with the key difference identified being HDI. CONCLUSIONS: A country's development level is a key factor influencing attitudes toward spiritual care and its actual provision. Respondents from lower ranking HDI countries proved relatively more likely to provide spiritual care and to have positive attitudes toward praying with patients. In contrast, respondents from countries with higher HDI levels had relatively more positive attitudes toward spiritual care interventions that involved gathering information applicable to patient care.

Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses.

OBJECTIVE: When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with "unrealized potential" for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it. METHOD: We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Reflexology in the management of chemotherapy induced peripheral neuropathy: A pilot randomized controlled trial.

PURPOSE: The current experimental study aimed to evaluate the effectiveness of reflexology on the management of symptoms and functions of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients. METHOD: This study was conducted as a randomized controlled trial in 60 patients (30 experimental and 30 control patients) who had chemotherapy-induced Grade II-IV peripheral neuropathy complaints from July 2013 to November 2015. Data were collected using the patient identification form, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy (EORTC-CIPN-20) form, and BPI (used for related chemotherapy-induced peripheral neuropathy symptoms). RESULTS: The majority of the patients were being treated for gastrointestinal or breast cancer and were primarily receiving Eloxatine- or taxane-based treatment. It was found that reflexology applications did not lead to differences in either group in terms of peripheral neuropathy severity and incidence (p > 0.05) and only led to improvement in sensory functions in the experimental group (p < 0.05). CONCLUSIONS: It was determined that reflexology is not an effective method in the management of patients' activity levels, walking ability etc. and motor, autonomic functions related CIPN, but reflexology is effective method in the management of patients' sensory functions related CIPN. Key Words: Peripheral neuropathy, reflexology, chemotherapy, EORTC QLQ-CIPN-20, BPI.

Effectiveness of Black Mulberry Molasses in Prevention of Radiotherapy-Induced Oral Mucositis: A Randomized Controlled Study in Head and Neck Cancer Patients.

OBJECTIVES: Radiation-induced oral mucositis is one of the problems experienced by 70%-80% of patients receiving radiation therapy (RT). This randomized controlled trial assessed the effectiveness of black mulberry molasses in the prevention of oral mucositis in head and neck cancer patients receiving RT. INTERVENTIONS AND OUTCOME MEASURES: Eighty head and neck cancer patients scheduled to undergo RT to the oropharyngeal mucosa were randomly assigned to receive RT (42) or RT plus mulberry molasses (38). The research data were collected with a Patient Description Form, Common Terminology Criteria for Adverse Events, version 4.0, an Oral Assessment Guide, and the University of Washington Quality of Life Assessment Questionnaire. RESULTS: The incidence and severity of oral mucositis were lower in the black mulberry molasses group. However, black mulberry molasses usage was an only independent and significant factor in prevention of mucositis [HR 0.63 (%95 GI 0.40-0.98)]. There were no differences between the quality of life scores of experimental and control groups. CONCLUSIONS: This randomized controlled study showed that black mulberry molasses usage is an effective intervention in the prevention of the radiation-induced mucositis of head and neck cancer patients. However, to confirm these results, further studies are needed.

Effects of Distant Reiki On Pain, Anxiety and Fatigue in Oncology Patients in Turkey: A Pilot Study.

BACKGROUND: Fatigue, stress and pain are common symptoms among cancer patients, affecting the quality of life. The purpose of the present study was to determine the effect of distant Reiki on pain, anxiety and fatigue in oncology patients. MATERIALS AND METHODS: Participants in the control group received usual medical and nursing care during their stay. The intervention group received usual care plus five distant Reiki sessions, one each night for 30 min. A face to face interview was performed and patient personal and illness related characteristics were evaluated using the Patient Characteristics form. Pain, stress and fatigue were evaluated according to a numeric rating scale. RESULTS: The experimental group was predominantly composed of women (71.4%), married individuals (40%), and primary school graduates (40%). The control group was predominantly male (72.7%), married (60%), and primary school graduates (60%). The control group demonstrated greater levels of pain (p=0.002), stress (p=0.001) and fatigue (p=0.001). The Reiki group pain score (p<0.0001), stress score (p<0.001) and fatigue score were also significantly lower. CONCLUSIONS: The results of this study indicate that Reiki may decreasepain, anxiety and fatigue in oncology patients.

Effect of Reiki on symptom management in oncology.

Reiki is a form of energy therapy in which the therapist, with or without light touch, is believed to access universal energy sources that can strengthen the body's ability to heal itself, reduce inflammation, and relieve pain and stress. There is currently no licensing for Reiki nor, given its apparent low risk, is there likely to be. Reiki appears to be generally safe, and serious adverse effects have not been reported. So in this article provides coverage of how to use Reiki in oncology services.

The efficiency of the acupressure in prevention of the chemotherapy-induced nausea and vomiting.

PURPOSE: This experimental study was planned to assess the efficiency of the acupressure in prevention of the chemotherapy-induced nausea and vomiting (CINV). METHODS: This single-blinded randomized trial was performed at Istanbul University Institute of Oncology between October 2010 and January 2011. The patients, diagnosed with breast, gynecological, or lung cancer treated by doxorubicin-based- or cisplatin-based treatment were included in the study. Taking the consent of the patients, they were divided into experimental (n = 67) and control groups (n = 53) in line with the randomization list prepared before. The patient description form, Rhodes Index of Nausea, Vomiting, and Retching (INVR), and Functional Assessment of Cancer Therapy-General were used in data collection. Non-parametric tests were applied. RESULTS: The patients in the experimental and control groups were identical in terms of sociodemographic features and their conditions. Most of the patients were married (84 %), and some were primary school graduates (41.7 %) and had mid-level income (54.2 %). In nausea-vomiting-retching, experiences of the patients before using a placebo and a real acupressure were identical and similar changes had been observed during 5 days after the treatment. It has been determined that there was no difference between the groups statistically. A similar result has been observed when the impact of acupressure on the subgroups of sociodemographic features and condition were examined, and it has been concluded that real acupressure application cannot increase the quality of life. CONCLUSION: It has been determined that CINV is directly related to the treatment, and acupressure wristband was not an effective approach in preventing CINV.

Complementary and alternative therapies used by Turkish breast cancer patients undergoing chemotherapy.

BACKGROUND: Most breast cancer patients use complementary and alternative medicine (CAM), usually in parallel with their conventional treatments. This study was planned to determine the prevalence and determining factors for use of CAM by breast cancer patients undergoing chemotherapy. PATIENTS AND METHODS: This descriptive study was carried out between October 2010 and May 2011, and included 96 patients at the Istanbul University Institute of Oncology. The Patient Characteristics form and Complementary and Alternative Medicine Scale were used for data collection. Descriptive and non-parametric tests were performed, and logistic regression analysis was used to predict factors affecting CAM use. RESULTS: Praying was the most frequently used form of CAM, and most of the herbal supplements used by patients were harmless. Herbal use was higher among patients who had local disease (relative risk (RR) 4.48%, 95% confidence interval (CI) 1.12-17.95), and worship was more common among those who had not undergone surgery (RR 4.66%, 95% CI 1.64-13.20). CONCLUSION: The CAM approaches used by patients were found to be safe. However, sage and flax seed usage for estrogen-and progesterone-positive patients and exercise for patients with spinal metastasis can be inappropriate approaches. It is important to question and inform patients about CAM use during treatment.

Non-pharmacological interventions used by cancer patients during chemotherapy in Turkey.

PURPOSE: Although there are many non-pharmacological practices being recommended for symptom management, most patients prefer to use pharmacological interventions. This study assesses the non-pharmacological interventions used by cancer patients for symptom management during chemotherapy and the factors affecting its use. METHOD: This study was conducted at the Istanbul University Institute of Oncology, Turkey, with 202 patients. Personal characteristics, illness-related characteristics, symptom severity and non-pharmacological interventions used by the patients were assessed by using Patient Description Form, ECOG and Nightingale Symptom Assessment Scale. RESULTS: Most of the patients in this study were living in Istanbul, 58.4% were women, 78.7% were married and their mean age was 48.82 ± 1.44. Most of the patients experienced different symptoms related to chemotherapy, but only a small number of patients preferred to use and benefited from the non-pharmacological interventions in their symptom management. There were different factors affecting the well-being of the patients, but only being young was found to be an important variable in the use of psychological interventions (OR 3.06 [95% CI 1.17-7.96]). CONCLUSIONS: Physicians remain the central figure in the treatment of cancer patients, so oncologists and oncology nurses should be more proactive and innovative in their patient care, education, and counseling to maximize the use of non-pharmacological interventions that may be helpful in symptom management. Further research evaluating the use and effectiveness of non-pharmacological interventions on symptom management in cancer patients is needed.

Effect of kefir on the quality of life of patients being treated for colorectal cancer.

PURPOSE/OBJECTIVES: To determine kefir's effect on the prevention of gastrointestinal complaints and quality of life (QOL) in patients being treated for colorectal cancer. DESIGN: Randomized, controlled, prospective, interventional study. SETTING: Istanbul University Oncology Institute in Turkey. SAMPLE: 40 patients, 20 of whom were randomized to the experimental (kefir) arm and 20 who were randomized to the control arm. METHODS: Informed consent to participate in the study was obtained. Before treatment began, demographics, illness-related characteristics, complaints, and QOL of participants were evaluated. During treatment, side effects were evaluated one week after every cycle of therapy. QOL was evaluated after the third and sixth cycles of treatment. MAIN RESEARCH VARIABLES: The effect of kefir on the prevention of gastrointestinal complaints and QOL in patients being treated for colorectal cancer. FINDINGS: Following chemotherapy, the experimental (kefir) group had more treatment-related gastrointestinal complaints but a decrease in sleep disturbance. No difference was found between the two groups for QOL. CONCLUSIONS: Kefir does not prevent or decrease gastrointestinal complaints in patients undergoing chemotherapy for colorectal cancer. Kefir did decrease sleep disturbances in the experimental group. IMPLICATIONS FOR NURSING: Many patients use complementary and alternative medicine during cancer therapy. This study may provide information about the effectiveness of kefir in patients with cancer.

Quality of life and complementary and alternative medicine use among cancer patients in Turkey.

AIM: The purpose of this study was to assess the relationships between quality of life and use of complementary and alternative medicine (CAM) among Turkish cancer patients. METHODS: This cross-sectional study was conducted in Istanbul University Institute of Oncology, Turkey. Two-hundred patients were invited and informed consent was obtained, however 179 cancer patients completed the study. The Patient Characteristics form, The Nightingale Symptom Assessment Scale and The Functional Assessment of Cancer Therapy Scale were used in the evaluation of the patients' characteristics and quality of life. RESULTS: Some form of CAM had been used by 71.5% of the sample. Frequently used CAM methods appeared to be religious practices (68.2%) and only 37.4% of the patients used herbs. However, female patients, single patients, and individuals with metastatic disease and worse quality of life showed a tendency to use CAM more often. More than one-third of our patients began to use CAM immediately after being diagnosed with cancer and factors associated with CAM use varied according to the type of CAM. Although CAM use did not affect the patients' quality of life, logistic regression analysis revealed that gender, type of cancer diagnosis and education level were important factors to be considered in different CAM therapies. CONCLUSION: CAM use is common in cancer patients in Turkey. More discussion about CAM use should take place between patients and health professionals to inform the patients' decisions.

The prevalence and determinants of the use of complementary and alternative medicine in adult Turkish cancer patients.

A study was undertaken to analyze the extent of using complementary alternative medicine (CAM) and to compare sociodemographic and medical characteristics of users and non-users of CAM in Turkish oncology patients. A total of 615 patients with cancer who attended ambulatory patient care units answered the questionnaires. Medical information was reviewed from chart data. Some 291 patients (47.3%) had used at least one type of CAM since the time of initial diagnosis. CAMs almost always consisted of herbal agents (95%). Nettle (Urticae herba) used in conjunction with (88%) or without (56%) various herbal agents were the most popular and prominent CAMs used by patients. Univariate and multivariate comparisons of users and non-users of CAM were performed. In multivariate analysis, female sex (p=0.0006), high income (p=0.0008), advanced stage at diagnosis (p=0.02), and usage of multiple chemotherapy applications (p=0.03) were determined as independent factors for CAM use.