Knowledge and Practice Behaviors Toward the Care of the Dying Among Chinese Oncology Nurses: A Cross-Sectional Survey.

The quality of care provided to patients with cancer at the end of their lives remains unsatisfactory, especially during their last days and hours of life. This study aimed to investigate knowledge and practice behaviors of oncology nurses in relation to the care of the dying and to analyze the influencing factors. A convenience sample of 222 oncology nurses was recruited from 14 hospitals in Beijing, China, in January 2022. These nurses completed an online survey that included a demographic and work characteristics questionnaire and knowledge and practice behavior questionnaires regarding the care needs of dying cancer patients. The self-perceived knowledge and practice behavior of oncology nurses toward the care of the dying were found to be moderate. However, their understanding of airway management, restlessness, and delirium management was insufficient. In addition, their ability to effectively communicate recommendations for discontinuing unnecessary procedures, medications, treatments, and monitoring was inadequate. Nurses' previous end-of-life care education and experience of caring for dying patients influenced their knowledge. Nurses' practice settings, experience of caring for dying patients, and their knowledge were key factors in shaping their behaviors. Providing targeted continuing education for nurses in hospital settings and exploring the nursing pathway may be important ways to bridge their knowledge gap and enhance their practice behaviors toward caring for dying patients.

Corrigendum to "Evaluation of a whole process management model based on an information system for cancer patients with pain: A prospective nonrandomized controlled study" [Asia-Pacific J Oncol Nurs 9 (2022) 88-96].

[This corrects the article DOI: 10.1016/j.apjon.2021.12.017.].

Evaluation of a whole process management model based on an information system for cancer patients with pain: A prospective nonrandomized controlled study.

Objective: The aim of this study was to evaluate the effects of whole process management model interventions based on information system benefits reported by patients with cancer pain. Methods: We performed a quantitative, prospective nonrandomized controlled design from June to October 2020. A total of 124 cancer patients with pain were enrolled. Patients in the experimental group received a whole process management model intervention based on an information system compared to the control group who received routine cancer pain management. Data were collected at baseline and after a four-week follow-up, acting as a test-retest control. The primary outcome was pain management quality, which was measured using the American Pain Society Patient Outcome Questionnaire-Chinese version (APS-POQ-C). Secondary outcomes were patient-related attitudinal barriers and analgesic adherence. The Barrier Questionnaire (BQ) and a single-item questionnaire were used. Chi-square tests were used to compare the pain intensity and analgesic adherence, independent sample t-test and Mann-Whitney U test were performed to test the differences in the pain management quality and patient-related attitudinal barriers between control and experimental groups. Results: Baseline characteristics and outcomes of the participants did not differ significantly (P â€‹> â€‹0.05). Primary outcomes were changes in four aspect of the quality of pain management (APS-POQ-C) between the two groups (P â€‹< â€‹0.05). Patients in the whole process management group reported significantly better pain control and perception of care than the control group. With respect to secondary endpoints, a significant difference in favor of the experimental group was found for barriers (P â€‹< â€‹0.05) and medication adherence (60.0% vs. 40.0%; P â€‹< â€‹0.05) after the interventions. Conclusions: The whole process management of patients with cancer pain effectively improves patient-reported quality of pain management, reduces patient-perceived barriers, enhances patient adherence to analgesic drugs and is worthy of clinical application.

Effectiveness of palliative care simulation in newly hired oncology nurses' training.

Objective: The aim of the study was to evaluate the effectiveness of palliative care simulations with standardized patients in improving the knowledge, skill performance, and critical thinking of newly hired oncology nurses. Methods: By convenience sampling, 59 newly hired oncology nurses in 2019 were enrolled as control group and 50 in 2020 as simulation group at a grade-A tertiary cancer hospital. Simulation group accepted theory (3 sessions) and simulation teaching includes three representative scenarios (6 sessions) in palliative care: pain management, special scenario communication, and turn over. Control group accepted traditional theory and skill teaching (9 sessions). Then both groups underwent four weeks clinical practice. The knowledge score was assessed by knowledge questionnaires, skill performance by standardized clinical evaluations, and critical thinking by the California Critical Thinking Disposition Inventory in both groups before and after intervention. The satisfaction of two groups was assessed by the learning satisfaction scale. Analysis of variance was conducted among the two groups by SPSS20.0. A difference was considered significant when P â€‹< â€‹0.05. Results: After intervention, the simulation group was significantly greater in knowledge of pain management (t â€‹= â€‹-7.560, P â€‹< â€‹0.001), and knowledge of special scenario communication (Z â€‹= â€‹5.031, P â€‹< â€‹0.001), as well as the skill score of turnover (Z â€‹= â€‹2.808, P â€‹= â€‹0.005) than the control group. The critical-thinking score was also significantly greater in the simulation group (Z â€‹= â€‹6.229, P â€‹< â€‹0.001). The simulation group had higher satisfaction (Z â€‹= â€‹5.144，P â€‹< â€‹0.001). Conclusions: Palliative care simulation with standardized patients can improve newly hired oncology nurses' knowledge, skill performance, and critical thinking and satisfaction of teaching. It would be an effective strategy to train newly hired oncology nurses.

Preferences for a good death: a cross-sectional survey in advanced cancer patients.

OBJECTIVE: The aim of this study was to describe preferences for a good death among Chinese patients with advanced cancer and then to explore factors contributing to their preferences including patient demographics and disease variables. METHODS: A convenience sample of 275 patients with advanced cancer was recruited from a tertiary cancer hospital in Beijing, China, between February and December 2017. A Chinese version of the Good Death Inventory (GDI) was used to measure patients' preferences for dying and death. Besides, data were collected using a multi-itemed questionnaire focusing on demographic and disease characteristics of patients. RESULTS: Of the 275 questionnaires returned, 248 responses were analysed (effective response rate 90.2%). According to the total scores for each of the 20 domains, the five most important domains of a good death were: good relationship with family (19.80±2.39), independence (19.66±2.56), maintaining hope and pleasure (19.56±2.55), good relationship with medical staff (18.92±3.73), not being a burden to others (18.89±3.30). Patients' characteristics including age, educational status, religious belief, medical payment types, family economic status, past experiences of the death of others, the period since cancer diagnosis, past experiences of hospitalisation and subjective physical condition influenced their preferences for a good death (all p<0.05). CONCLUSIONS: We had an in-depth knowledge and understanding of their preferences for good death among Chinese patients with advanced cancer. Meanwhile, we found some patients' factors contributed to different preferences for a good death. These findings have the potential to guide hospice care services aimed at achieving a good death for patients with advanced cancer.

Relationship Between Anticipatory Grief and Communication Avoidance in Chinese Caregivers of Patients With Advanced Cancer.

BACKGROUND: Anticipatory grief (AG) and its relationship with communication avoidance in Chinese caregivers of patients with advanced cancer have not been previously examined. An association between AG and communication avoidance could provide important insights to Chinese caregivers worthwhile to be investigated. OBJECTIVES: The aims of this study were to evaluate AG and communication avoidance with patients among Chinese caregivers of patients with advanced cancer and to identify their relationship. METHODS: A cross-sectional study was conducted with a convenience sample of caregivers of patients with advanced cancer practicing at an academic cancer hospital. The participants completed the Anticipatory Grief Scale (AGS) and the Caregivers' Communication With Patients About Illness and Death scale. RESULTS: Of the 256 participants, the mean age was 49.10 (SD, 12.87) years, and 63.28% of participants were female. The mean AGS score was 88.05 (SD, 18.42). The AGS subscales in descending order of scores were feeling of loss, sadness, decreased ability to function at usual tasks, anxiety, anger, guilt, and irritability. The mean Caregivers' Communication With Patients About Illness and Death score was 3.60 (SD, 1.13). In the multiple linear regression, AG severity was significantly, positively correlated with communication avoidance. Old age, low education level, religious belief, low income, and living with the patient, spouse, parents, and child implied severe AG. CONCLUSIONS: Chinese caregivers of patients with advanced cancer reported a high AG and poor communication with patients about illness and death. Less communication was related to more severe AG. IMPLICATIONS FOR PRACTICE: Healthcare professionals should pay attention to AG severity and communication of caregivers of patients with advanced cancer to explore the suitable clinical intervention.

Anticipatory Grief among Chinese Family Caregivers of Patients with Advanced Cancer: A Cross-Sectional Study.

OBJECTIVE: The objective of this study was to explore the interrelationship between anticipatory grief (AG), caregiver burden, communication, preparation for death, and coping style. METHODS: A convenience sample of 256 Chinese family caregivers of patients with advanced cancer were recruited from an academic cancer hospital between April 2018 and May 2019. This cross-sectional survey included the AG Scale, caregiver burden (Caregiver Reaction Assessment), communication (Caregivers' Communication with Patients about Illness and Death Scale), preparation for death, and coping style (Simplified Coping Style Questionnaire). Structural equation modeling tested the interrelation between them. RESULTS: The final model fitted the data acceptably (χ2 = 25.79, degrees of freedom = 17, P = 0.08, root mean square error of approximation = 0.05, goodness-of-fit index [GFI] = 0.98, adjusted GFI [AGFI] = 0.95, parsimony GFI [PGFI] = 0.46, normed fit index = 0.94, comparative fit index = 0.98). Poor communication contributed to less preparation for death and caregiver burden, which further aggravate AG. Communication was positively associated with AG. In addition, communication and positive coping style interacted to further influence caregiver burden. CONCLUSIONS: Preliminary results supported the model and showed that poor communication, less preparation for death, and caregiver burden contributed to AG while positive coping alleviated AG. Findings suggest the need for further studies to explore effective intervention for communication, preparation for death, burden, and coping style of caregivers to ultimately alleviate AG.

Validation of the Constipation Risk Assessment Scale (CRAS) in Chinese cancer patients.

PURPOSE: The Constipation Risk Assessment Scale (CRAS) is a valid tool for predicting the risk of developing constipation. This study aimed to translate the CRAS into Chinese and evaluate its psychometric properties in Chinese cancer patients. METHOD: The CRAS was translated into Chinese following standard forward- and back-translation procedures. Scale and item indices were calculated for content validity (S-CVI; I-CVI). In total, 175 cancer patients were assessed with the CRAS on the first day of antitumour treatment, of whom 145 were submitted to the predictive validity test, and their defecation pattern, stool consistency, and ease of defecation were assessed for one week. A receiver operating characteristic (ROC) curve was used to describe the prediction accuracy of CRAS-C for constipation. Reliability was evaluated by means of an interrater reliability test using the intraclass correlation coefficient (ICC) in 30 patients. RESULTS: The S-CVI was 0.99, and for each item, the I-CVI was 0.80-1.00. The area under the curve of CRAS-C was 0.722 (95% CI, 0.631-0.812). A CRAS-C score ≥11 indicated a high constipation risk, and a score <11 indicated a low constipation risk. The sensitivity and specificity were 0.887 (95% CI, 0.763-0.953) and 0.500 (95% CI, 0.376-0.624), respectively, and the positive predictive value and negative predictive value were 0.588 (95% CI, 0.472-0.695) and 0.846 (95% CI, 0.688-0.936), respectively. The ICC between the two raters for the total CRAS-C score was 0.963, and the ICC in the four subscales was 0.843-0.955. CONCLUSIONS: The CRAS-C demonstrated favourable content validity, predictive validity and interrater reliability. It can be used in the identification of subjects at risk of constipation and the development of constipation prevention programmes in Chinese cancer patients.

The Knowledge and Attitude Towards Advance Care Planning Among Chinese Patients with Advanced Cancer.

To describe the knowledge and attitude of Chinese patients with advanced cancer towards advanced care planning (ACP), a convenience sample of 275 patients with advanced cancer was recruited from a tertiary cancer hospital in Beijing, China, between February and December 2017. The multi-item questionnaire focused on patients' demographics, disease characteristics and knowledge about and attitude towards ACP and was administered to eligible patients. Descriptive statistics were performed. Most patients had never heard about ACP (82.2%) and had never talked about ACP (83.0%), but only a few (18.3%) were not willing to talk about ACP. A total of 67.8% patients chose to refuse resuscitation attempts or life-sustaining medical interventions, and 70.8% of patients hoped to have surrogate decision makers when they became unconscious. By binary logistic regression analysis, patients who were of greater age, female and living in urban areas preferred to refuse resuscitation attempts or life-sustaining medical interventions (OR = 1.023, P = 0.042; OR = 2.011, P = 0.020; OR = 0.254, P < 0.01); patients who had very rich or rich family economic status preferred to involve surrogate decision makers compared with patients of very poor family economic status (OR = 0.250, P = 0.011). There is a large gap between the knowledge about ACP and the expectation of implementing ACP in Chinese patients with advanced cancer. To develop culturally appropriate and individualized programmes to promote knowledge and implementation in practice of ACP among Chinese patients with advanced cancer and their relatives is still a significant challenge.

Relationships between patient-related attitudinal barriers, analgesic adherence and pain relief in Chinese cancer inpatients.

PURPOSE: The purpose of this study was to evaluate patient-related attitudinal barriers and identify associated factors in Chinese cancer inpatients receiving opioids and to explore relationships between patient-related attitudinal barriers, analgesic adherence and pain relief. METHODS: A cross-sectional study was conducted. A total of 146 participants completed face-to-face surveys, including information about demographics, the Barriers Questionnaire-Chinese (BQ-C), analgesic adherence, average pain and breakthrough pain in the past 24 h. The Mann-Whitney U test and Kruskal-Wallis test were performed to test the differences in the attitudinal barrier scores between the adherence and nonadherence groups, the complete and incomplete pain relief groups and the groups based on demographics. RESULTS: The majority of participants in this study were men (67.8%), over half of all participants were less than 60 years old, gastrointestinal cancer (47.3%) was the most common diagnosis and 59 (40.4%) acquired comprehensive pain education from the last discharge guidance procedure. The total BQ-C mean (SD) score was 1.61 ± 0.94. A total of 87 (59.6%) patients with cancer pain were completely relieved. Most of the patients (73.3%) completely took analgesics by orders. There was no significant difference in the total BQ-C score between the adherence group and the nonadherence group (P > 0.05), but the difference was significant between the complete pain relief group and the incomplete pain relief group (P < 0.05). CONCLUSION: The findings of this study support unsatisfactory pain management and moderate analgesic adherence for Chinese inpatients. It is suggested that patient-related attitudinal barriers do not play an undermining role in pain management by negatively affecting patients' analgesic adherence. Conversely, patients' beliefs are more likely to be shaped by under treatment rather than as a cause.

Nurse-rated good death of Chinese terminally ill patients with cancer: A cross-sectional study.

OBJECTIVE: To explore the good death of terminally ill patients with cancer rated by nurses and identify associated factors in the context of Chinese culture. METHODS: We conducted a cross-sectional, anonymous questionnaire survey. Totally, convenience samples of 122 nurses in charge of 258 patients during their dying period were investigated. The questionnaire consisted nurses' information including demographics and the experience in palliative care, patients' demographic information and disease characteristics, and Good Death Inventory (GDI). RESULTS: Two hundred and fifty-eight (98.10%) analysable questionnaires were obtained. The total good death score was (245.40 ± 36.91), and the last three were "Independence" (7.34 ± 4.26), "Physical and psychological comfort" (8.12 ± 4.70) and "Religious and spiritual comfort" (8.44 ± 4.55); the first three were "Being respected as an individual" (18.31 ± 2.90), "Good relationship with medical staff" (18.26 ± 2.37) and "Natural death" (18.16 ± 3.22). The unit type, treatment patients received during their last 3 months and nurse's training experience in palliative care were associated factors of good death (R2  = 0.135, F = 9.160, p < .001). CONCLUSION: The good death status of terminally ill cancer patients is poor. It's urgent to promote palliative care and strengthen the training about the knowledge and skills to improve the quality of life of the patients, so as to achieve the goal of good death.