Existing psychological supportive care interventions for cervical cancer patients: a systematic review and meta-analysis.

Cervical cancer patients commonly experience psychological supportive care needs, necessitating diverse interventions to enhance psychological well-being and alleviate physical symptoms. This systematic review, covering English-published articles from January 1999 to April 2023, assessed the impact of psychological supportive care interventions on anxiety and depression. Twenty-Six studies, including 11,638 patients, were analyzed, comprising randomized controlled trials; quasi-experimental, and pre-post-test designs from PubMed; Science Direct; Wiley online library; Google Scholar; Cochrane Library; and JSTOR. The extraction of data was done by two independent authors and a third independent author checked the data extraction. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020 statement was adopted. The population, intervention, comparator, and outcomes (PICO) search strategy was applied. Effective Public Health Practice Project (EPHPP) tool was used to assess the quality of selected articles. Various interventions, such as psychological nursing, exercise, counselling, psycho-curative approaches, peer and family education, psychotherapy, and medication, were identified. Two studies incorporated homework sessions, predominantly administered by nursing staff. Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were commonly used instruments. Statistical analysis revealed a significant difference in anxiety and depression scores between treatment and control groups (p < 0.005) post-intervention across all studies. A subsequent meta-analysis of eight homogeneous studies, utilizing a random-effects model, showed a moderate-to-high overall effect size (1.35, 95% CI: 0.75 to 1.94), indicating a statistically significant positive impact. Various studies exhibited variability in effect sizes ranging from low to high. While the meta-analysis included 936 participants, the forest plot visually represents individual study effect sizes and the combined effect size. Preliminary evidence supports the positive impact of psychological supportive care interventions on cervical cancer outcomes, urging further research, especially exploring long-term effects and employing rigorous study designs.

Knowledge level and constructs of the theory of planned behaviour (TPB) to the practice of unsafe abortion among postnatal mothers attending Mkonze health center, Dodoma Region, Tanzania.

BACKGROUND: Unsafe abortion is now a global agenda because 45% of all global abortions are unsafe, and 97% are occurring in developing countries. In Tanzania, one million reproductive-aged women face unplanned pregnancies per year, and 39% end up with abortion. About 16% of maternal deaths are reported per year in Tanzania, and unsafe abortion takes the second position. There are several efforts to prevent and intervene unsafe abortions, such as equipping healthcare facilities across all levels of healthcare, approval of Misoprostol use, establishment of comprehensive post-abortion care (PAC), revising policy guidelines and standards, provision of emergency contraceptives, and capacity building of healthcare providers. There is little documentation about how the constructs of the theory of planned behaviour, knowledge, and sociodemographics influence the practice of abortion. OBJECTIVES: To assess the association of knowledge level, sociodemographic characteristics, and constructs of the theory of planned behaviour (TPB) to the practice of unsafe abortion among postnatal mothers at Mkonze Health Center in the Dodoma region. METHODOLOGY: It is an analytical cross-sectional study design conducted in Dodoma-Tanzania and involved 206 postnatal women. A validated questionnaire was used and analysis was performed in the Statistical Package for the Social Sciences (SPSS), through descriptive and inferential statistics. RESULTS: The practice of unsafe abortion in the current study is 28/206 (13.6%), influenced bytheir lower educational level and being single women. It was found that the majority had adequate knowledge of unsafe abortion 129 (62.6%), positive attitude 130 (63.1%), good subjective norms 113 (54.9%), and positive perceived behavioral control111 (53.9%). Knowledge, attitude, subjective norms, and perceived behavioral control were not significantly associated with the practice of unsafe abortion. CONCLUSION: The majority of the respondents had high knowledge, attitudes, subjective norms, and perceived behavior control on unsafe abortion. This is an indicator that the implemented initiatives are effective. Maintaining the ongoing effort and improving strategies are promising to mitigate the burden of unsafe abortion. Future research needs to find out hidden factors associated with attitude and how health beliefs might influence someone's attitude towards unsafe abortion.

Assessment of supportive care needs among cervical cancer patients under treatment in Nepal: a cross-sectional study.

BACKGROUNDS: The perceived supportive care needs (SCNs) of cancer patients are essential components of a care program. The first step in planning and intervening for supportive care is the proper identification of the SCNs of cancer patients. Cervical cancer (CC) is the most prevalent cancer among Nepali women. The authors assess SCNs and their predictors among CC patients under treatment by using a validated Nepali version supportive care need survey short form (SCNS- SF 34 N). METHODS: This descriptive cross-sectional study was conducted in 5 cancer treatment hospitals in Nepal. A culturally adapted and psychometrically validated Nepali version SCNS -SF- 34 N was completed by a convenience sample of 218 CC patients. Data were analyzed by using descriptive (frequency, percentage, mean, median) and inferential (Chi-square P-value and binary logistic regression analysis) statistics. RESULTS: The study showed that 99% of the respondents were in need of some level (low, moderate, high) of supportive care. The psychological domain, physical daily living, health system information, patient care support and sexuality domain ranked from first to fifth for SCNs with mean and standard deviations 70.29 ± 18.84, 63.25 ± 23.15, 57.90 ± 21.11, 56.46 ± 21.92 and 46.06 ± 34.16, respectively. Binary logistic regression found causal association between SCNs and variables "occupation (p-value = 0.007), and type of hospital (p-value = 0.000)" at a 95% confidence level. CONCLUSION: Nepali CC patients perceive and experience many unmet SCNs, with psychological SCNs being the first priority. It is essential that the SCNs of patients may need to be known by their close family members, care providers, CC related program. so that they can offer intervention as per patients' needs.

The supportive care needs survey short form 34 (SCNS-SF34): translation and cultural adaptation into the Nepali language among patients with cervical cancer in Nepal.

BACKGROUND: A questionnaire developed in one language must be translated and adapted when it will be used with patients speaking a different language and care should be taken to maintain equivalence between the source language (SL) version and its translated version. The objective of this study was to test the linguistic and cultural validity of a Nepali language version of the Supportive Care Need Survey - Short Form 34 (SCNS-SF34) used with the Nepali population. METHODS: Translation of the SCNS-SF34 was carried out by following Beaton's guidelines and Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) by a research team. The translated version was administered to patients with cervical cancer in Nepal. The following steps were performed as part of the study: translation, content validity assessment, reliability assessment and measurement of errors. RESULTS: The study reports item content validity (I-CVI) was > 0.78 and scale content validity (S-CVI) was - 0.89, 0.91 and 0.90 respectively in semantic, cultural, and conceptual aspects. The study found a content validity ratio (CVR) of 0.9 to 1, Cronbach's α of 0.90, correlation significant at the 0.01 level (2-tailed), and clarity of the questionnaire at 91.29%. The standard error of measurement (SEM) and small detectable changes (SDC) for overall care need scores were measured 2.70 and 7.47 respectively. All items were accepted as per the original SCNS-SF34. Following the respondents' suggestions, simpler Nepali words were chosen in some items to replace the words in the preliminary Nepali version of SCNS-SF34. CONCLUSION: Preliminary findings show that the Nepali translation of SCNS-SF34 is practical and applicable to the Nepali population. Financial supportive care needs, supportive care for caretakers and problems during patient hospital stays are essential to include in the questionnaire to further explore supportive care needs.

The distinct experience of supportive care needs among cervical cancer patients: A qualitative study.

INTRODUCTION: Patients with cervical cancer report experiencing physical, psychological, economic, and social problems daily. An exploration of supportive care needs is important for patients and their families to cope with diagnosis, treatment, recovery or even death. OBJECTIVE: This study explores the perceived supportive care needs of Nepali patients with cervical cancer who are undergoing cancer treatment. METHODS: A descriptive qualitative research design was utilized with semi-structured interviews to probe patients with cervical cancer's supportive care needs. The study was conducted at a cancer-specific hospital in Nepal. Purposive sampling was used to recruit 30 patients with cervical cancer. Qualitative thematic analysis techniques were employed to identify the supportive care needs of Nepalese patients with cervical cancer. RESULTS: Supportive care needs were identified with five main themes and sixteen sub-themes: 1) psychological trauma (regret on delaying medical consultation, fear of disease, death and dying, ambivalence about the future and treatment, feeling of loss, caring/rearing of children, feeling and burden to partner/family); 2) financial distress (loss of income and challenges with treatment costs); 3) sexual disharmony; 4) physical dependency on others for day-to-day care and; 5) hunger for information (cause of disease, prognosis of disease, dietary counseling, and information on sexuality). CONCLUSION: Recognizing the supportive care needs of patients with cervical cancer during treatment by health care professional and family members is vital to facilitate optimal care at the hospital and home for overall improvement in the patient's quality of life. Acknowledgment that the expensive treatment regime creates an economic and psychological burden for the patients.

Comparative study of exclusive breastfeeding practice among employed mothers and housewives in Tanzania.

BACKGROUND: Exclusive breastfeeding (EBF) is a global concern as it is associated with infant protection against gastrointestinal infections, reduces newborn mortality and prevents a child from becoming overweight or obese. Even though some studies have reported high EBF practices among housewives compared to employed mothers, the influences of practices among the two groups are little documented. OBJECTIVES: The study aimed at comparing the EBF among employed mothers and housewives in Tanzania. METHODOLOGY: The study was a facility-based comparative cross-sectional study, with a sample size of 246 mothers of children less than 6 months. Convenience sampling was used to select participants. Data were collected by using a validated questionnaire and analyzed by Statistical Package for Social Science, version 23, through descriptive statistics (frequency, proportion and mean) and inferential statistics (Chi-square test (χ2) and binary logistic regression). RESULTS: The findings show that 106 (80.9%) of housewives had good EBF compared to 78 (67.8%) employed mothers, which was a significant difference (χ2 = 5.57; P = 0.019). One hundred and seven (81.7%) housewives had adequate knowledge of EBF compared to 84 (73%) employed mothers, but the knowledge between them was not significantly different (χ2 = 2.63; P = 0.071). For employed mothers, only age was significantly associated with EBF (χ2 = 39.49; P = 0.006), while for housewives, none of the sociodemographic characteristics was significantly associated with EBF. CONCLUSION: EBF practice was higher among housewives as compared to employed mothers. Age was significantly associated with good practice of EBF among employed mothers. The effort should be strengthened to help employed mothers aged below 28 years to practice EBF. Different programs and approaches that are developed and implemented should target this age group to increase the rate of EBF.

The Effect of Peer-Led Navigation Approach as a Form of Task Shifting in Promoting Cervical Cancer Screening Knowledge, Intention, and Practices Among Urban Women in Tanzania: A Randomized Controlled Trial.

BACKGROUND: Even though the government's priorities in preventing cervical cancer are implemented in urban areas, the screening rate remains unsatisfactory at 6%, compared to 70% recommended by the world health organization. The ongoing public health education has not resulted in sufficient screening rates. The study aims to assess peer-led navigation (PLNav) in promoting cervical cancer screening knowledge, intention, and practices among urban women in Tanzania. Since PLNav is the form of task shifting, it involves delegating cervical-cancer-related tasks from healthcare professionals to community health workers (CHWs). METHODS: It is a community-based randomized controlled trial conducted in Dar es Salaam in Tanzania March-Sept 2020. The PLNav involved the CHWs delivering health education, counselling and navigation assistance to community women (COMW). The CHWs help women who have never undergone cervical cancer screening (CCS) and those who have undergone CCS but with a precancerous cervical lesion to overcome screening barriers. The data related to PLNav were analyzed by descriptive statistics, an independent-samples t-test, repeated measures ANOVA and linear regression. RESULTS: The repeated measures ANOVA across time showed that PLNav intervention on mean knowledge score changes was statistically significant in the intervention group compared with the control group's usual care, [F (1, 43) = 56.9, P < .001]. At the six-month follow-up, 32 (72.7%) out of 44 participants from the intervention group had screened for cervical cancer, and only one participant (2.3%) from the control group screened. The PLNav intervention on CCS uptake changes was statistically significant in the intervention group compared with usual care in the control group [F (1, 43) = 100.4, P < .001]. The effect of time on CCS uptake in the intervention and control groups was statistically significant [F (1.64, 70.62) = 73.4, P < .001]. CONCLUSION: Peer-led navigation (PLNav) was effective in promoting cervical cancer screening knowledge, intention, and uptake.

Fundamental Elements in Training Patient Navigators and Their Involvement in Promoting Public Cervical Cancer Screening Knowledge and Practices: A Systematic Review.

BACKGROUND: Cervical cancer screening remains unsatisfactory in some regions due to hindrances. This study aims to explore fundamental elements in training patient navigators and their involvement in promoting screening knowledge and practices. METHODS: This systematic review study included only English published articles between 2014 and 2019 from PubMed/Medline, EBSCO, Science Direct, and Wiley online library. RESULTS: Healthcare professionals trained patient navigators in 3 days regarding screening basics, along with group discussions and role-plays. They delivered effective health education and navigation assistance. CONCLUSION: The group education session facilitated by patient navigators, coupled with navigation care, resulted in a high screening rate.

The effect of cognitive behavioral therapy on the quality of life of breast cancer patients: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Several lines of clinical research support the efficacy of Cognitive behavioral therapy (CBT) with a large number of population and various disease conditions, however, the true effects of CBT interventions on Quality of Life of breast cancer patients remain unknown. The aim of the study was to evaluate the effect of Cognitive Behavioral Therapy on the Quality of Life of breast cancer patients. METHODS: A systematic review of articles published using Web of Science (1950-January 2020); Medline via EBSCO (1992-January 2020); Science direct via ELSEVIER (1996-January 2020); SCOPUS (2004-January 2020); and PubMed (1946-January 2020 excluding Medline from 1992-January 2020) were included. Additional studies were included after  checking reference lists of all relevant studies; searching ongoing trials and research registers and manual search. Data extraction was conducted by two independent authors and a third independent author checked the data extraction. The PRISMA statement was adopted. RESULT: Eleven Randomized controlled trials (RCT) with 1690 breast cancer patients were included in this review. The overall effect size of cognitive behavioral therapy on QoL of breast cancer patients was medium 0.39 (95% CI 0.12-0.66, P < 0.00001, I2 = 83%). Five studies had shown statistically significant improvement in functional and symptoms scales in the treatment group than the control group. CONCLUSION: CBT is effective in improving the Quality of Life of breast cancer patients. In future research, further randomized controlled trials with adequate randomization, allocation concealment, and appropriate blinding may be needed.

Predictors of uptake of cervical cancer screening among women in Urban Tanzania: community-based cross-sectional study.

OBJECTIVES: The proportion of women screened for cervical cancer in Tanzania remains small at 6-21%. Even though some studies have been conducted to address barriers, the screening uptake remains low, which denotes the presence of unidentified barriers. The main objective of this study is to assess the predictors in the uptake of cervical cancer screening (CCS) among women in Tanzania. METHODS: This is a community-based cross-sectional study conducted to obtain quantitative data through validated questionnaires to assess predictors of CCS. RESULTS: 1013 (91.8%) of the respondents had not been screened for cervical cancer. Three predictors of CCS were identified in this study; screening intention, health beliefs, and knowledge level. 600 (54.4%) of respondents had no screening intention. 552 (50%) had negative health beliefs, and 585 (53%) had inadequate knowledge of cervical cancer and CCS. Respondents who had no intention to screen were 0.482 (AOR) times less likely to uptake CCS (P = 0.002; 95% CI: 0.305, 0.761). CONCLUSIONS: The ongoing community-awareness raising campaigns should be coupled with community knowledge-raising campaign, and there should be an establishing of peer-supporting screening programs in communities.

The current status of nurses-doctors collaboration in clinical decision and its outcome in Tanzania.

AIM: The aim of this study was to establish the current level of collaboration between nurses and medical doctors (MDs) in the making of clinical decisions. DESIGN: Descriptive qualitative design was applied in this study. METHODS: Semi-structured interviews were conducted to collect qualitative data. Contents were arranged according to their similarities, whereas content analysis was used to identify explanatory themes. RESULTS: Nurses feel disrespected when medical doctors (MDs) ignore their opinions. The impression of lower level of education of nurses is seen as a cause to their opinions been ignored by the medical doctors. Nurses sometimes adhere to the instructions of MDs, but on other times, they carry on with their own proposed treatment. IMPLICATIONS FOR NURSING PRACTICES: Involvement of nurses in clinical decisions will enable nurses to effectively advocate for patients.

Health care system changes supporting the development of the nurse practitioner role in Tanzania.

BACKGROUND AND PURPOSE: Accessibility to health care services remains a global challenge, and this has affected the quality of services delivered. This has affected the quality of health care services. Poor accessibility to health care services in Tanzania has hindered the achievements of health care system goals. The development of the nurse practitioner (NP) role has not yet received enough attention to resolve current existing and emerging problems facing the Tanzanian health care system. This study assessed the health care system changes that support the development of the NP role in Tanzania. METHODS: A descriptive, cross-sectional study design was used to collect quantitative data. Purposive and convenience sampling techniques were used to collect data from 237 health care providers using a semi-structured questionnaire. Data were entered into SPSS version 20 and analyzed using descriptive statistics and Chi-square test for independence (Pearson Chi-square, χ). CONCLUSIONS: Although the government of Tanzania has made some improvements in access to health care services, the rural health care facilities still suffer from an extreme shortage of skilled health care providers. This has forced the government to allow medical attendants to treat patients when they are not licensed to do so. The development of the NP role should be able to address the shortage of skilled health care providers in rural health care facilities. IMPLICATIONS FOR PRACTICE: The development of the NP role will improve the accessibility to health care services in rural primary health care facilities.

Health care providers' perceptions regarding fundamental issues to consider prior to launching nurse practitioner training in Tanzania.

BACKGROUND AND PURPOSE: Although the demand for competent health care professionals and better services is high, studies concerning nursing education are not a priority in sub-Saharan African countries, as revealed in limited available records. Strengthening nursing education by establishing proper training models for newly developed advanced practice roles such as "nurse practitioner" (NP) will increase competency in nurses and reduce the shortage of skilled staff within the health care system, thereby enhancing the proper provision of health care services. The main purpose of this research was to investigate fundamental issues that should be considered in the launching of NP training. METHODS: A descriptive qualitative design was used in this study. A nonprobability sampling approach and significantly purposeful sampling were also used to recruit 20 health care providers into the study. Individual face-to-face interviews were conducted on scheduled timings, which required an average of 30 minutes for each interview. Finally, a content analysis was used to identify the themes. CONCLUSION: The current working environment at the rural primary health care facilities is not convenient for the practices of NPs trained at the master's level. Therefore, before the training of NPs, the government and all stakeholders should strive to improve the environment of the facilities including adequate diagnostic equipment and on-time supply of drugs from the store. Institutions aiming to introduce programs for NPs must develop their curriculum based on currently available local and international guidelines. IMPLICATIONS FOR PRACTICE: Adequate preparation before launching an NP training program will be needed to help build a strong training and hence produce competent professionals.

Healthcare Provider Views on Transitioning From Task Shifting to Advanced Practice Nursing in Tanzania.

BACKGROUND: The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shifting-delegation of tasks from professionals to other healthcare team members with less training, such as medical attendants-is practiced, compromising quality of care. Advanced practice nursing is underutilized. OBJECTIVE: The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses. METHODS: A descriptive, qualitative design was used. Purposeful sampling was used to select 20 participants. An in-depth interview guide was used to obtain information. Interviews were conducted in Swahili or English. Content analysis was used to identify themes. RESULTS: Shortage of human resources in rural primary healthcare facilities was identified as a major rationale for implementation of the advanced practice nurse practitioner role because the current health providers in rural health facilities are less trained and doctors are not ready to work in these settings. Opposition from physicians is expected during the course of implementing the nurse practitioner role. Professional bodies and government should reach consensus before the implementation of this role in such a way that they should agree on scope and standards of practice of nurse practitioners in Tanzania. CONCLUSION: Shortage of human resources for health is greater in rural primary healthcare facilities. Task shifting in Tanzania is neither effective nor legally recognized. Transition to advanced practice nursing roles-particularly the nurse practitioner role-can facilitate provision of optimal care. Nurse practitioners should be prepared to work in rural primary healthcare facilities.