[INTIMACY AND SEXUALITY IN PATIENTS DYING OF CANCER OR COPING WITH INCURABLE ADVANCED CANCER IN THE LIGHT OF END OF LIFE AWARENESS].

INTRODUCTION: A neglected issue in treatment and research is the sexuality of patients dying of cancer, or with incurable advanced cancer. Information is lacking about changes in patients' sexual and intimate life, distress caused by these changes and their interest in discussion. METHODS: The study was conducted through qualitative research based on interviews - analyzed by the constant comparison method. Interviews were held with 35 patients dying of cancer or with incurable cancer. RESULTS: A great variety of findings appeared among interviewees. Some reported absence of essential change in their sexual and intimate life, while many others reported fading of their sexuality, with or without satisfying intimate life. The changes caused various forms of distress. We also found heterogeneity in masturbation habits. A majority of the interviewees mentioned, that raising the issue is important and one third expressed a need to receive sexual consultation. CONCLUSIONS: The connection between two topics perceived as taboo - sex and death, may challenge the palliative team. The team should initiate discussion of the issue as an integral part of the professional intervention related to the process of departure from this world Issues on intimate and sexual life may be relevant for the dying patient. The palliative team has an important role in answering complex needs related to sexuality at the end of life. DISCUSSION: Patients may have different needs related to their intimate and sexual life. Some wish to talk about changes in their sexual function and even to receive treatment, while for others there is no such desire.

Israeli breast care nurses as a learning organization.

This article will look at the theory of a Learning Organization as described by Senge and the Israeli Breast Care Nurses as an example. A description of the theory of a Learning Organization, the role of the Breast Care Nurses in Israel and the relation between the two will be described. Since 1996, the role of the Breast Care Nurse was founded in Israel. At that time, the role with its importance was very hard to be recognized by the health care team and other professionals of the multidisciplinary team for breast cancer patients. Since the role was initiated, it had been developing all over Israel through the support given by the Israel Cancer Association. As a learning organization, the Breast Care Nurses have a few goals: To learn to give patients the most updated and relevant information; to be a part and be seen as equal as the other members of the multidisciplinary team for breast cancer patients; to have knowledge which empowers them as a working group; to enable to teach students, mainly nursing students, in basic and further education and to help continually teach a new generation of nurses. This learning organization involves some formal and informal education. Although oncology nurses do much of the ideas we have described, we suggest using a strict model to help in implementing a Learning Organization. Future research can examine the outcomes of a Learning Organization on oncology nursing.

Evaluating palliative care needs in Middle Eastern countries.

BACKGROUND: Cancer incidence in Middle Eastern countries, most categorized as low- and middle-income, is predicted to double in the next 10 years, greater than in any other part of the world. While progress has been made in cancer diagnosis/treatment, much remains to be done to improve palliative care for the majority of patients with cancer who present with advanced disease. OBJECTIVE: To determine knowledge, beliefs, barriers, and resources regarding palliative care services in Middle Eastern countries and use findings to inform future educational and training activities. DESIGN: Descriptive survey. SETTING/SUBJECTS: Fifteen Middle Eastern countries; convenience sample of 776 nurses (44.3%), physicians (38.3%) and psychosocial, academic, and other health care professionals (17.4%) employed in varied settings. MEASUREMENTS: Palliative care needs assessment. RESULTS: Improved pain management services are key facilitators. Top barriers include lack of designated palliative care beds/services, community awareness, staff training, access to hospice services, and personnel/time. The nonexistence of functioning home-based and hospice services leaves families/providers unable to honor patient wishes. Respondents were least satisfied with discussions around advance directives and wish to learn more about palliative care focusing on communication techniques. Populations requiring special consideration comprise: patients with ethnic diversity, language barriers, and low literacy; pediatric and young adults; and the elderly. CONCLUSIONS: The majority of Middle Eastern patients with cancer are treated in outlying regions; the community is pivotal and must be incorporated into future plans for developing palliative care services. Promoting palliative care education and certification for physicians and nurses is crucial; home-based and hospice services must be sustained.

Perceptions of Israeli women with breast cancer regarding the role of the Breast Care Nurse throughout all stages of treatment: a multi center study.

PURPOSE OF THE RESEARCH: The role of the Breast Care Nurse (BCN) is well established in Israel. The purpose of this study is to examine the impact of the BCN on Israeli women with breast cancer at all stages of disease from diagnosis, through treatment and follow-up. METHODS: This was a descriptive multi-center study on 321 women with non-metastatic breast cancer who completed their treatment <5 years before. Data collection took place in seven institutions in Israel, both in hospital and in the community. The women completed two questionnaires: a demographic questionnaire and the Ipswitch Patient Questionnaire looking at various aspects of care. Also included was one qualitative open question. Data analysis was performed checking for outliers and illogical observations. KEY RESULTS: In most areas investigated the women perceived the overall contribution of the BCN as very high, with 87% reporting a general contribution of very high or high. It was found that 53% of the women received information about the position from the nurse herself. In 61.3% of the cases, initial contact with the BCN was made at the time of diagnosis. The qualitative findings concerning the open question are also reported. CONCLUSIONS: According to the perceptions of women with breast cancer in Israel, BCN support is an important part of the patient's ability to manage their diagnosis and related care. The multi-disciplinary breast cancer team should incorporate BCN specialists as part of their holistic care.

The Israel Cancer Association's role as a volunteer organization in forecasting, establishing, implementing and upgrading palliative care services in Israel.

The Israel Cancer Association has contributed, as a key player, to the establishment and upgrade of palliative care in Israel. The aim of this article is to describe the involvement and contribution of the ICA, as a volunteer organization, from a clinical, educational, legal, and organizational perspective. Another main goal of this survey is to shed light on the palliative care network in Israel, in each one of these infrastructures.