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.

Evaluation of job stress and quality of life in individuals returning to work after cancer treatment.

PURPOSE: The aim of this study was to investigate the impact of work life on work stress and quality of life in cancer patients returning to work after treatment. METHODS: This descriptive cross-sectional study was conducted between January 2021 and June 2021 with 302 cancer patients who ad registered at the oncology outpatient clinic of a university hospital and had started or continued work after treatment. Data were collected using a personal information questionnaire, the Perceived Work Stress Scale, and the EORTC QLQ-C30. Results with p < 0.05 were considered statistically significant. RESULTS: The mean age of the patients was 44.97 ± 10.08 years. They were predominantly women, had a diagnosis of breast cancer, and had received chemotherapy. The patients' perceived work stress score was 2.10 ± 0.68 (level D) and the EORTC QLQ-C30 score was 65.95 ± 20.11. Women, participants who were worried about their jobs, those who worked >36 months after cancer treatment, public and private sector workers, those who considered leaving their jobs after cancer treatment, and those who considered changing jobs had higher work stress scores. CONCLUSIONS: The results of this study suggest that perceived work stress negatively affects the quality of life in individuals returning to work after cancer treatment. Therefore, individuals should be supported in returning to work and subsequent phases, and future should focus on the concepts of rehabilitation and return to work.

The Effect of Coffee in the Prevention of Oral Mucositis Associated with Head and Neck Radiotherapy.

AIM: This study investigates the effect of coffee on the management of oral mucositis associated with head and neck radiotherapy. METHOD: Twenty-nine patients who underwent radiotherapy for the first time due to head and neck cancer between March 2019 and February 2020 were included in the experimental study. One cup/day of Turkish coffee (6 mg) was given to the patients in the intervention group every day for 3 weeks from the first day of radiotherapy. Data monitoring of both groups was performed once a week for 3 weeks. RESULTS: Most of the patients participating in the study were at local stage (65.2%), and 72.4% underwent head and neck radiotherapy with the diagnosis of nasopharynx and larynx cancer. Although the development rate of oral mucositis was lower in the intervention group, no statistically significant difference was determined (p > 0.05). In the repeated follow-up, the quality of life scores was found to be similar in both groups. CONCLUSION: We concluded that coffee application is not an effective approach in the prevention of oral mucositis associated with head and neck radiotherapy. Further studies with larger sample sizes are needed to determine the prophylactic effect of coffee in the management of oral mucositis.

Development of Cancer Palliative Care in Turkey.

Palliative care is an important component of integrated, person-centered health care. It can be provided alone or in combination with the patient's medical treatment, not only by the palliative care team but also by the healthcare team caring for the patient. The concept of palliative care was developed in 2010 along with the establishment of the National Cancer Control Program in Turkey, and today there are many palliative care units, especially in metropolitan hospitals, that provide comprehensive palliative care. One-third of patients who come to the palliative care unit for treatment of pain, malnutrition, and respiratory problems are cancer patients. The care needs of all patients presenting to the palliative care unit are assessed, and a multidisciplinary team plans comprehensive palliative care for patients. Theoretical and practical patient care training is provided by palliative care nurses for family members or caregivers. Considering the burden of cancer as well as the increasing life expectancy at birth, it can be stated that the actual need for palliative care in Turkey will be much greater in the near future.

"I don't Want to Die Alone" Nurses' Perception of Ageism: A Qualitative Study.

The aim of the study was to learn the perceptions and thoughts of nurses with whom older patients interact constantly. In this research, semi-structured interview was used. In a research hospital in Istanbul between March-June 2019, 16 volunteers were included in the study. Researchers led individual semi-structured interviews regarding nurses' perceptions, how they overcame those challenges, and need and expectations aging care (dying patients). All interviews were analysed using thematic analysis methods and synthesized into major themes. The research was planned based on the 32-item checklist (COREQ) guideline. Nurses (N = 16) reported three themes: (i) ageing perceptions (ii) care for dying patients, (iii) expectations and five subthemes emerged in this study. It is understood that nurses have a positive perception of ageing. In addition, nurses have expectations from the state (financial support, gerontology service etc.) and society (respectful, understanding etc.) to reduce the difficulties they experience while caring for dying patient.

Effectiveness of mandala coloring in reducing anxiety in women with early-stage breast cancer receiving chemotherapy for the first time.

CONTEXT: Many people with cancer experience fear or anxiety when starting chemotherapy for the first time. Mandala coloring is an art therapy approach commonly used for anti-stress therapy. OBJECTIVE: To assess whether mandala coloring reduces the anxiety experienced by women with early-stage breast cancer during their first chemotherapy session. DESIGN: A quasi-experimental controlled study with pretest/posttest design. SETTING: The study was conducted in the outpatient chemotherapy unit of the Istanbul University Institute of Oncology between March 2017 and May 2018. PARTICIPANTS: Eight-four women with early-stage breast cancer who presented for their first session of chemotherapy were included, 41 in the intervention group and 43 in the control group. INTERVENTION: Patients in the intervention group were asked to color a mandala for 30 min while receiving premedication prior to chemotherapy. No intervention was applied to the control group. MAIN OUTCOME MEASURES: Levels of distress and anxiety were assessed before and after premedication using the distress thermometer and State-Trait Anxiety Inventory. RESULTS: The sample group consisted primarily of women who had primary school education, were married, and were homemakers. Average distress levels were low in both the intervention and control group before premedication, and state anxiety scores did not differ statistically between the groups before or after premedication. However, patients in the intervention group who had high distress levels before premedication showed a significant decrease in state anxiety score after premedication, while patients in the control group showed no decrease.

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.

Evaluation of Factors That Affect COVID-19 Infection in Turkish Society.

AIM: The study aims to determine the risk factors that affect coronavirus-2019 infection in Turkey. METHOD: This descriptive study was performed between October 18, 2020, and November 18, 2020. The online link of the form created on Google forms was sent to the participants' phones. Totally 1104 individuals from different regions of Turkey participated. Logistic regression analysis was performed to detect risk factors of coronavirus-2019 infection. RESULTS: Most of the participants were women and university graduates. All participants except one wore masks, 96.8% paid attention to social distance, and 57.8% did not use public transportation. Of the participants, 9.8% (n = 108) were diagnosed with coronavirus-2019 and 41.5% (n = 458) had a coronavirus-2019-positive relative. The infection risk was higher for those who lived in the Marmara region, who went to work daily (odds ratio = 2.18; 95% CI: 1.18-4.04), who had a coronavirus-2019-positive patient where they lived (odds ratio = 3.44; 95% CI: 1.95-6.05), and who shared items with a coronavirus-2019-positive patient (odds ratio = 4.76; 95% CI: 2.64-8.58). CONCLUSION: Sharing items with a coronavirus-2019-positive patient, living in crowded regions, and going to work daily were the main risk factors of coronavirus-2019 infection in Turkish society.

Evaluating Pain Management Practices for Cancer Patients among Health Professionals: A Global Survey.

Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large.

Determining the symptoms and coping methods of patients at home after hematopoietic stem cell transplantation.

AIM: This descriptive study was conducted to determine symptoms experienced at home in the early period by patients who received hematopoietic stem cell transplantation (HSCT), identify coping behaviors used by the patients in the management of symptoms and assess the quality of life of these patients. METHOD: The study included 200 patients who had received HSCT at a private hospital in Kocaeli in Turkey between October 2017 and November 2018 and been discharged. The data of the study were collected by using a patient information and interview form developed by the researcher, the Memorial Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. RESULTS: The mean age of the patients was approximately 51, 39% (n = 78) of the patients were female, 61% (n = 122) were male, and the vast majority (82%) were married. The three most frequently experienced symptoms among the patients after being discharged were identified as pain (63%), weakness (48%), and loss of appetite (43%). It was found that the vast majority of the patients complied with coping behaviors reported in the literature, but these behaviors were partially effective. Clinical diagnosis, type of transplant, status of re-hospitalization of the being discharged, and number of problems experienced were identified as variables that were significantly effective on the treatment-related symptom experiences and many dimensions of the quality of life of the patients (p < 0.05). CONCLUSION: It was determined that the patients who were included in this study experienced various symptoms on different levels and at different frequencies. Regarding the effectiveness of the approaches used by the patients in coping with the symptoms they experienced, it was determined that the approaches they used to cope with nausea-vomiting, fever and insomnia were effective, and those they used for weight loss and anxiety were ineffective.

Evaluation of the caregiving roles and attitudes of nurses during the COVID-19 pandemic.

BACKGROUND: Nurses play a critical role in providing care to patients, in particular, they work in the frontlines in caring for patients with complicated COVID-19 requiring hospitalization. Evaluation of the caregiving roles and attitudes of nurses is critical in the current crisis. Therefore, this study aimed to determine the caregiving roles and attitudes of nurses during the COVID-19 pandemic. METHODS: A quantitative descriptive study was performed with 130 nurses in Turkey. The attitude scale for the caregiving roles of nurses (ASCRNs) was used to collect data. We conducted an online survey between May and November 2020. RESULTS: The mean total score of the participants on the ASCRN was 62.20 ± 18.42. All nurses stated that they were affected by the COVID-19 pandemic. The ASCRN scores of nurses who received training about the COVID-19 pandemic and who thought that the personal protective equipment they used was sufficient had statistically higher scores on the ASCRN (p < .05). CONCLUSION: The results of this study suggested that the COVID-19 pandemic had a negative effect on the caregiving roles and attitudes of the nurses.

Lung Cancer-Related Dyspnea: The Effects of a Handheld Fan on Management of Symptoms.

BACKGROUND: The application of a handheld fan may reduce patients' shortness of breath and increase their activity tolerance by enabling cooling and air flow into the second and third branches of the trigeminal nerve. OBJECTIVES: The aim of the study was to assess the effects of directing a handheld fan toward the face in the management of lung cancer-related dyspnea. METHODS: Using a randomized controlled experimental design, 96 inpatients with lung cancer were evaluated, with the experimental group (n = 49) using a handheld fan to manage dyspnea for 14 days. Dyspnea, respiration rate, oxygen saturation, heart rate, and quality of life were assessed for both groups. FINDINGS: A statistically significant difference was found in dyspnea scores between groups on the first, seventh, and fourteenth days of fan application, and statistically significant differences were found between groups in dyspnea scores, respiration rates, oxygen saturation, heart rate, and quality of life on the fourteenth day of application.

The effect of navigation programme on the management of symptoms related to head and neck radiotherapy.

BACKGROUND: This study aims to determine the effect of navigation programme in the management of symptoms related to head and neck cancer (HNC) radiotherapy. METHODS: This randomized, controlled and experimental study was conducted between November 2018 and March 2020 with the participation of 88 patients with HNC receiving radiotherapy. Referring to the pre-prepared randomization checklist, 41 people were randomized to the experimental group and 47 to the control group. While the standard treatment approaches of the hospital were applied to all patients, the patients in the experimental group were applied an additional nursing navigation program. At the beginning of the navigation program, the patients were given a 30-minute visual training on the first day of radiotherapy and a handbook related to the expected adverse effects. Throughout subsequent seven weeks, the patient continued to be followed up via phone reminders, providing daily counseling and a weekly follow-up. Patient identification form, CTCAE v5.0 toxicity criteria and EORTC QLQ-30, H&N35 assessment questionnaires were used in the study. The first result was the difference observed in quality of life scores at the beginning, middle and end of radiotherapy. RESULTS: Data obtained from the study revealed that the quality of life scores (p < 0.05) improved while the navigation program reduced the severity of symptoms such as mucositis, dysphagia, oral pain and weight loss (p < 0.05). CONCLUSION: It was concluded that navigation programme is an effective approach for patients receiving head and neck radiotherapy. TRIAL REGISTRATION: NCT04857749.

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.

The Impact of the Perception of Chemotherapy-Induced Alopecia on Psychosocial Life.

AIM: This study was planned to evaluate the perception of alopecia as a side effect of chemotherapy, and its effect on the psychosocial life of patients. METHODS: This cross-sectional and descriptive study was carried out at Sisli Hamidiye Etfal Training and Research Hospital, with inpatients in the Radiation Oncology Clinic and outpatients in the Chemotherapy Unit between January 12, 2013 and January 12, 2014. The data for the study were collected by face-to-face interviews using the Patient Identification Form, Disease and Alopecia-Related Features Form, and the Chemotherapy-induced Alopecia Quality of Life Scale, of 213 of the patients who faced chemotherapyinduced alopecia. Descriptive statistics for the statistical evaluation of the data and non-parametric tests such as the Mann-Whitney U-test and the Kruskal-Wallis test for independent group comparisons were used. RESULTS: The study group consisted mostly of elementary school graduates (71.8%), married (74.2%) and female (73.7%) patients residing in Istanbul. A large number of patients stated that they did not have any complaints when their hair began to fall, while a few patients stated that they felt itching. The Chemotherapy-induced Alopecia Quality of Life Scale average scores (23.9 ± 5.4) were found to be low and quality of life of the patients was negatively affected by their alopecia. Also, the impact of alopecia diminished with increasing level of the patient's education. It was found that the alopecia-related quality of life scores were lower for the patients who were already wearing a headscarf before illness, compared to the patients who started to wear a headscarf after illness. CONCLUSION: In conclusion, chemotherapy-induced alopecia is an important problem affecting the psychosocial life of patients.

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 Palliative Care Outcome Scale: Turkish Validity and Reliability Study.

OBJECTIVE: To examine the validity and reliability of the Turkish version of the Palliative Care Outcome Scale (POS). METHODS: This methodological study consisted of 69 patients hospitalized in the palliative care (PC) service of three hospitals between June 2016 and August 2016, 69 carers who undertook continuously primary care of these patients, and 28 staff members working in the PC service and providing care to these patients. The data of the study were collected using the Personal Diagnosis Form, the POS. The scope, structure and criterion validity and internal consistency reliability of the scale were tested. Item analysis, Cronbach's alpha analysis, content validity ratio, confirmatory factor analysis for construct validity, criterion validity, patient validity, and intraclass correlation coefficient for the adaptation of outcomes of patient, carer, and staff groups were conducted. RESULTS: The content validity ratio of the scale was found to be higher than 0.80 for patient, carer, and staff questionnaires. Item-total score correlation coefficients were determined between 0.27 and 0.72 for the items in the patient questionnaire, 0.33-0.67 for the carer questionnaire, and 0.34-0.72 for the staff questionnaire. The Cronbach's alpha reliability coefficients were determined as 0.64 for the patient questionnaire, 0.73 for the carer questionnaire, and 0.68 for the staff questionnaire. CONCLUSIONS: The Turkish version of the POS was determined to be a valid and reliable tool to be used for assessing the needs of PC patients in three dimensions in terms of the perspectives of patient, carer, and staff.

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.

Henna Application in the Prevention of Capecitabine-Induced Hand-Foot Syndrome in Breast and Colorectal Cancer Patients.

AIM: This study investigates the prophylactic effect of henna on the occurrence of hand-foot syndrome (HFS) in patients receiving capecitabine for breast and colorectal cancer. METHOD: This experimental study was carried out between May 2014 and May 2015. In this self-control experimental study, 52 patients with breast and colorectal cancer were included on the first day of capecitabine treatment and had a minimum follow-up of 3 cycles. One hand/foot of each patient constituted the study hand/foot, whereas the others constituted the control. Henna was administered to the study hand/foot on the first day of treatment and application renewed weekly. Development of grade 1-3 toxicity was set as the termination criterion for study. RESULTS: Painful skin changes such as rawness, intumescence and bulla formation, blocking the daily activities or self-care were observed in 26.9% of the patients in the 3rd or 4th cycles of treatment. Development time and severity of skin changes over time did not differ significantly between the study and the control hand/foot. CONCLUSION: Further studies with a larger sample size are needed to conclude on the prophylactic effect of henna in the management of the HFS.