Spiritual Interventions Among Pediatric Patients With Cancer: A Systematic Review And Meta-Analysis.

CONTEXT: Although spiritual intervention is crucial in the care of childhood cancer patients (CCPs), its effectiveness has not yet been systematically evaluated. OBJECTIVES: To determine the effectiveness of existing spiritual interventions on psychological, spiritual outcomes, and quality of life (QoL) in CCPs. METHODS: We searched eight databases to identify relevant randomized controlled trials and quasi-experimental studies. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Results were either synthesized in a systematic narrative synthesis or a meta-analysis using a random effects model, where appropriate. The pooled treatment effect was estimated using the standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS: Twelve studies with 576 CCPs were included. Eight studies showed a high risk of bias. The overall effect of existing spiritual interventions on QoL (Z = 1.05, SMD = 0.64, 95%CI = -0.15 to 1.83, P = 0.29), anxiety (Z = 1.11, SMD = -0.83, 95%CI = -2.30 to 0.64, P = 0.28) and depressive symptoms (Z = 1.06, SMD = -0.49, 95%CI = -1.40 to 0.42, P = 0.12) were statistically nonsignificant. The nonsignificant findings could be attributed to the high heterogeneity among the included studies (QoL: I2 = 85%; anxiety: I2 = 90%; depressive symptoms: I2 = 58%). CONCLUSION: Evidence to support the positive effects of existing spiritual interventions on psychological and spiritual outcomes and QoL in CCPs is insufficient. Future studies should adopt a more rigorous design and unify the outcome measures to reduce the risk of bias and heterogeneity, respectively.

Effectiveness of Computerized Cognitive Training on Working Memory in Pediatric Cancer Survivors: A Systematic Review and Meta-analysis.

BACKGROUND: Interactive features of computerized cognitive training (CCT) may enhance adherence to training, providing a relatively low-cost intervention. A robust systematic review on the effectiveness of CCT for improving working memory (WM) among pediatric survivors with cancer is lacking. OBJECTIVE: To summarize the available evidence and determine the effectiveness of CCT for WM among pediatric survivors with cancer. INTERVENTIONS/METHODS: Five databases were searched. The Effective Public Health Practice Project was used to assess the study quality. ReviewerManager was used. The primary outcome was WM performance. Secondary outcomes included processing speed, attention, intervention adherence, and number of adverse events. RESULTS: Six studies were included. Regarding overall quality, 1 study was weak, and 5 studies were moderate. Five studies reported a significant improvement of WM postintervention (P < .05). The meta-analysis of Cogmed interventions on symbolic WM revealed a significant difference between groups (vs placebo), with an overall pooled effect size of 0.71 (95% confidence interval, 0.02-1.41; P = .04). Two and 4 studies investigated the effects of CCT on processing speed and attention, respectively, with conflicting results. Four studies reported adherence of 80% or greater. Two studies reported no adverse events. CONCLUSIONS: Computerized cognitive training using Cogmed has a significant positive effect on WM. The effects of CCT on processing speed and attention remain inconclusive. IMPLICATIONS FOR PRACTICE: More rigorous trials should be conducted to elucidate the cognitive effects of CCT, particularly processing speed and attention, in the pediatric population with cancer. Further studies should consider combining CCT with other existing interventions to strengthen their effectiveness.

Symptom Burden of Children with Cancer and Parental Quality of Life: The Mediating Role of Parental Stress.

BACKGROUND: The aim of this study was to investigate the association between children's reported symptom burden and their parents' quality of life, and whether parents' perceived stress mediates this relationship. METHOD: this was a cross-sectional quantitative research study. Convenience sampling was used to recruit 80 pairs of parents and their children with cancer. Advanced statistical methods were used to analyse the mediating effects of parental stress between children's symptom burden and parents' quality of life. RESULTS: The results showed that parental stress was the mediator in the relationship between children's reported symptom burden and their parents' quality of life. CONCLUSIONS: Symptom burden was prevalent in Chinese children with cancer living in the community. Children's symptom burden is an important factor in predicting parental stress level, which simultaneously and directly lower parents' quality of life. The evidence in this study enlarges the knowledge base about the mediating effect of parental stress on the association between the symptom burden of children with cancer and their parents' quality of life. This evidence is crucial in paving the way for the development of interventions that improve the parental quality of life through stress-reduction programs.

Utilization of the Youth Quitline as an opportunity for an undergraduate nursing students to deliver smoking cessation counseling as their clinical placement: An implementation of a service-learning model.

BACKGROUND: Smoking is an important modifiable risk factor of morbidities and mortality. Although healthcare professionals play an important role in smoking cessation, their adoption of such practices is relatively low because of inadequate training. To address this issue, we incorporated a service-learning model to operate the Youth Quitline. Undergraduate nursing students were trained and received supervision while delivering smoking cessation counseling through the Youth Quitline as their clinical placement. OBJECTIVES: We evaluated the effectiveness of the placement by assessing students' knowledge, attitudes and practices regarding smoking cessation and tobacco control. DESIGN: One-group pretest-posttest design. SETTING: Youth Quitline. PARTICIPANTS: A total of 61 third-year students in a mental health nursing program. METHODS: Students were required to complete 80 h at the Youth Quitline. The 80 h were divided into 20 sessions; students used four sessions to approach and recruit youth smokers in the community, then provided them with telephone counseling for the rest of the time. Prior to the placement, students attended a 2-day workshop. The outcomes were changes in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control 3 months after the placement compared with baseline. RESULTS: From January-June 2021, students conducted 105 outreach activities to identify 3142 smokers in the community, and provided telephone counseling for 336 smokers via Youth Quitline. Compared with baseline, significant improvements were observed in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control at 3-month follow-up. CONCLUSIONS: The clinical placement improved students' knowledge, attitudes and practices regarding smoking cessation and tobacco control, enhancing their competency in providing support to assist smokers to quit in their future practice. Incorporating the service-learning model in existing community-based services can provide additional venues for nursing students to practice. This is particularly important because many venues have restricted access during the COVID-19 pandemic.

Sleep disruption and its contributing factors in Chinese survivors of childhood cancer: A cross-sectional study.

OBJECTIVES: This study provided information about sleep disruption, particularly its prevalence and severity among Hong Kong Chinese childhood cancer survivors. Additionally, we identified the factors influencing sleep disruption and explored how fatigue, depressive symptoms and physical activity (PA) affect sleep disruption. METHODS: Four hundred two survivors 6-18 years old and 50 age- and gender-matched healthy counterparts were assessed for depressive symptoms, fatigue, PA and subjective sleep quality. Demographic and clinical information were collected. Multiple logistic regression analyses were conducted to identify any factors contributing to poor sleep. RESULTS: Mean scores of depressive symptoms, fatigue for children and that for adolescents, and PA in survivors were 16.1 (SD = 11.1), 24.6 (SD = 10.3), 27.7 (SD = 7.8), and 3.08 (SD = 2.9), respectively. 44.8% of the survivors were poor sleepers, which was more that in healthy counterparts. The three most common sleep problem were prolonged sleep latency (31.9%), daytime dysfunction (23.4%), and sleep disturbance (22.9%). The time since last treatment (children: AOR = 0.54, 95% CI = 0.30-0.96, p = 0.04; adolescents: AOR = 0.80, 95% CI = 0.70-0.92, p < 0.01) and PA levels (children: AOR = 0.46, 95% CI = 0.260-0.82, p = 0.01; adolescents: AOR = 0.70, 95% CI = 0.49-0.98, p = 0.04) were negatively associated with sleep disruption, while depressive symptoms (children: AOR = 1.31, 95% CI = 1.04-1.64, p = 0.02; adolescents: AOR = 1.07, 95% CI = 1.01-1.13, p = 0.03), fatigue (children: AOR = 1.15, 95% CI = 1.00-1.31, p = 0.04; adolescents: AOR = 1.08, 95% CI = 1.02-1.15, p = 0.01), number of treatment received (children: AOR = 16.56, 95% CI = 1.27-216.82, p = 0.03; adolescents: AOR = 7.30, 95% CI = 2.36-22.56, p < 0.01), and co-sleeping (children: AOR = 29.19, 95% CI = 1.65-511.57, p = 0.02; adolescents: AOR = 4.63, 95% CI = 1.22-17.61, p = 0.02) were positively associated with sleep disruption. CONCLUSION: Physical activity made the largest contribution to reduce sleep disruption. It is crucial to advocate for the adoption and maintenance of PA in survivorship.

Psychometric properties of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Hong Kong Chinese childhood cancer survivors.

BACKGROUND: Sleep disruption is a prevalent symptom reported by survivors of childhood cancer. However, there is no validated instrument for assessing this symptom in this population group. To bridge the literature gap, this study translated and adapted the Pittsburgh Sleep Quality Index (PSQI) for Hong Kong Chinese cancer survivors and examined its psychometric properties and factor structure. METHODS: A convenience sample of 402 Hong Kong Chinese childhood cancer survivors aged 6-18 years were asked to complete the Chinese version of the PSQI, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Fatigue Scale-Child (FS-C)/Fatigue Scale-Adolescent (FS-A), and Pediatric Quality of Life Inventory (PedsQL). To assess known-group validity, 50 pediatric cancer patients and 50 healthy counterparts were recruited. A sample of 40 children were invited to respond by phone to the PSQI 2 weeks later to assess test-retest reliability. A cutoff score for the translated PSQI used with the survivors was determined using receiver operating characteristic analysis. RESULTS: The Chinese version of the PSQI had a Cronbach alpha of 0.71, with an intraclass correlation coefficient of 0.90. Childhood cancer survivors showed significantly lower mean PSQI scores than children with cancer, and significantly higher mean scores than healthy counterparts. This reflected that childhood cancer survivors had a better sleep quality than children with cancer, but a poorer sleep quality than healthy counterparts. We observed positive correlations between PSQI and CES-DC scores and between PSQI and FS-A/FS-C scores, but a negative correlation between PSQI and PedsQL scores. The results supported that the Chinese version of the PSQI showed convergent validity. Confirmatory factor analysis showed that the translated PSQI data best fit a three-factor model. The best cutoff score to detect insomnia was 5, with a sensitivity of 0.81 and specificity of 0.70. CONCLUSION: The Chinese version of the PSQI is a reliable and valid instrument to assess subjective sleep quality among Hong Kong Chinese childhood cancer survivors. The validated PSQI could be used in clinical settings to provide early assessments for sleep disruption. Appropriate interventions can therefore be provided to minimize its associated long-term healthcare cost. Trial registration This study was registered in ClinicalTrials.gov with the reference number NCT03858218.

Adventure-based training to enhance resilience and reduce depressive symptoms among juveniles: A randomized controlled trial.

There is growing concern about mental health problems among juveniles. Evidence shows that adventure-based training can reduce depressive symptoms in school children. However, a rigorous empirical investigation of the effectiveness of such training in enhancing resilience among juveniles has not yet been performed. In this study, a randomized controlled trial was conducted to examine the effectiveness of adventure-based training in enhancing resilience and self-esteem and reducing depressive symptoms among juveniles. Secondary school students from grades 7 to 9 (aged 12-16 years) who attended the Integrated Children and Youth Services Centre in a large public housing estate in Hong Kong from December 20, 2018 to November 25, 2019 were invited to participate in this study. We randomly assigned 228 eligible adolescents to an experimental group (n = 115) that received a 2-day/1-night adventure-based training or a placebo control group (n = 113) that received 2 days of leisure activities organized by the Integrated Children and Youth Services Centre. Data were collected at baseline and 3 and 6 months after the corresponding interventions. The primary outcome was resilience at 6 months. The secondary outcomes were depressive symptoms and self-esteem at 6 months. Compared with the placebo control group, the experimental group showed significantly higher resilience (p = 0.001) and fewer depressive symptoms (p = 0.02) at 6 months, and significantly higher self-esteem at 3 months (p = 0.04), but not at 6 months (p = 0.12). However, the generalizability of the findings is limited as we used a convenience sample.

Promoting physical activity among children with cancer through an integrated experiential training programme with coaching: A qualitative study.

OBJECTIVE: The study aim was to investigate how the integrated experiential training programme with coaching could motivate children undergoing cancer treatment to adopt and maintain physical activity. METHODS: A descriptive phenomenological approach was used. A purposive sample of 23 children and their parents participated in one-to-one 25-30-minute semistructured interviews. Interviews were tape-recorded and transcribed. Colaizzi's method of descriptive phenomenological data analysis was used. RESULTS: The integrated programme motivated children with cancer by increasing children's and parents' knowledge of physical activity, enhancing confidence in physical activity and improving physical and psychological well-being. Moreover, the programme provided children with encouragement and psychological support through coach companionship. The programme also facilitated children's participation in physical activity and modified perceptions of physical activity. CONCLUSION: This study addressed a gap in the literature by exploring how an integrated programme promoted and maintained physical activity in childhood cancer patients. PRACTICE IMPLICATIONS: The integrated experiential training programme is feasible and can be easily sustained. Future studies could extend the programme beyond aspects of physical activity to help people change their health practices and maintain a healthy lifestyle.

Helping hospitalized smokers in Hong Kong quit smoking by understanding their risk perception, behaviour, and attitudes related to smoking.

AIM: To understand the risk perceptions, behaviour, attitudes, and experiences related to smoking among hospitalized Chinese smokers. BACKGROUND: Understanding hospitalized smokers' perceptions of risks associated with smoking, along with their behaviour, attitudes, and smoking-related experiences, is essential prerequisite to design effective interventions to help them quit smoking. DESIGN: A phenomenological research design was adopted. METHODS: A purposive sampling approach was used. Between May 2016-January 2017, 30 hospitalized smokers were invited for an interview. RESULTS: Four themes were generated: (a) associations between perception of illness and smoking; (b) perceived support from healthcare professionals to quit smoking; (c) impact of hospitalization on behaviour, attitudes, and experiences; and (d) perceived barriers to quitting smoking. CONCLUSION: Development of an innovative intervention that helps to demystify misconceptions about smoking through brief interventions and active referrals is recommended to enhance the effectiveness of healthcare professionals promoting smoking cessation for hospitalized smokers. IMPACT: To date, no study examining smoking behaviour among hospitalized patients in Hong Kong has been conducted. Misconceptions about smoking and health, barriers to quitting that outweighed perceived benefits, lack of support from healthcare professionals, and difficulty overcoming withdrawal symptoms or cigarette cravings precluded hospitalized smokers sustaining smoking abstinence after discharge. Smoking is detrimental to physical health. Smoking cessation has beneficial effects on treatment efficacy and prognosis and helps to reduce the economic burden on society from smoking-attributable diseases.

An integrated experiential training programme with coaching to promote physical activity, and reduce fatigue among children with cancer: A randomised controlled trial.

OBJECTIVE: This study examined the effectiveness of an integrated programme in promoting physical activity, reducing fatigue, enhancing physical activity self-efficacy, muscle strength and quality of life among Chinese children with cancer. METHODS: A randomised controlled trial was conducted in a Hong Kong public hospital. Seventy eligible children were randomly assigned to an experimental group (n = 37) or a control group (n = 33). The experimental group received an integrated programme with 28 home visits from coaches over a 6-month period. The control group received a placebo intervention. The primary outcome was fatigue at 9 months (3 months after intervention completion). Secondary outcomes were physical activity levels, physical activity self-efficacy, muscle strength and quality of life at 9 months, assessed at baseline, and 6 and 9 months after starting the intervention. RESULTS: The experimental group reported significantly lower levels of cancer-related fatigue, higher levels of physical activity and physical activity self-efficacy, greater right- and left-hand grip strength and better quality of life than the control group at 9 months. CONCLUSION: The programme is effective and feasible to implement among children with cancer and offers an alternative means of ameliorating the healthcare burden. PRACTICE IMPLICATIONS: Healthcare professionals should build multidisciplinary partnerships to sustain such programmes.

Helping cancer patients quit smoking using brief advice based on risk communication: A randomized controlled trial.

This randomized controlled trial aimed to examine the effectiveness of a smoking cessation intervention using a risk communication approach. A total of 528 smoking cancer patients were randomly allocated either into an intervention group (n = 268) to receive brief advice based on risk communication by a nurse counselor or a control group (n = 260) to receive standard care. Subjects in both groups received a smoking cessation booklet. Patient follow-ups were at 1 week and at 1, 3, 6, 9 and 12 months. No significant differences were found in self-reported point-prevalence 7-day abstinence between the intervention and control groups at 6 months (15.7% vs 16.5%; OR 0.94, 95% CI 0.59-1.50). The rate of at least 50% self-reported reduction of smoking at 6 months, was higher in the intervention group than in the control group (16.8% vs 12.3%; OR 1.43, 95% CI 0.88-2.35). The biochemically validated quit rate at the 6-month follow-up was higher in the intervention group than in the control group (5.2% vs 3.8%; OR 1.38, 95% CI 0.60-3.16). These data suggest that advice based on risk communication was not effective for quitting but improved the rate of smoking reduction among smoking cancer patients.

The impact of cancer and its treatment on physical activity levels and quality of life among young Hong Kong Chinese cancer patients.

PURPOSE: Despite the evidence that regular physical activity can have beneficial effects on the physical and psychological well-being of cancer patients, a review of the literature reveals that a majority of young cancer patients fail to attain the same levels of physical activity that they had before contracting the disease. This study is to examine the impact of cancer and its treatment on the physical activity levels and quality of life of young Hong Kong Chinese cancer patients. METHOD: A cross-sectional study was conducted, with 76 young cancer patients admitted for treatment to a pediatric oncology unit, and another similar age group of 148 healthy counterparts from the two integrated child and youth service centers were invited to join the study. RESULTS: The study found that the current physical activity levels of young cancer patients were markedly reduced when compared with their pre-cancer situation. Moreover, they were significantly less active in performing physical exercise, and reported lower levels of self-efficacy and quality of life than their healthy counterparts. The results of the hierarchical multiple regression analysis showed that physical activity is an important indicator of quality of life among young cancer patients. CONCLUSION: The results provide further evidence that cancer and its treatment have negative effects on physical and psychological well-being and quality of life among young cancer patients. There is an imperative need for healthcare professionals to promote the adoption of regular physical activity among such patients, even during the treatment itself.