Literature review and development of pictorial action plan to promote self-management of chronic obstructive pulmonary disease.

OBJECTIVE: This study aimed to review relevant literature and develop a pictorial action plan (PAP) to enhance self-management among older patients with chronic obstructive pulmonary disease (COPD). METHODS: In Stage 1, an integrative review was conducted to identify key elements of respiratory self-management action plans. In Stage 2, cartoon pictograms with plain descriptions were designed. In Stage 3, the PAP was validated by 40 older patients with COPD and an expert panel. RESULTS: While the eight included studies demonstrated positive effects on knowledge and quality of life, key elements identified included: traffic light motif, plain and explicit language, and several action plan topics. The final PAP comprises three traffic light-coloured zones and 24 pictograms that introduce self-management strategies for normal, decreasing, and severely decreased airflow. After revising the cartoon characters, all of the pictograms received guessability ratings above 70% and acceptable mean translucency ratings. DISCUSSION: The integrative review provides evidence about the effectiveness and key elements of PAPs. The PAP developed was found to be valid and feasible for use among older patients with chronic respiratory conditions. PRACTICE IMPLICATIONS: This study offered an example of translating evidence into patient education practice to enhance self-management in older patients with COPD.

Financial well-being as a mediator of the relationship between multimorbidity and health-related quality of life in people with cancer.

BACKGROUND: It is unknown whether financial well-being mediates the impact of multimorbidity on the health-related quality of life (HRQoL) of cancer patients. METHODS: Participants were recruited from three outpatient oncology clinics of Hong Kong public hospitals. Multimorbidity was assessed using the Charlson Comorbidity Index. Financial well-being, the mediator of the association between multimorbidity and HRQoL outcomes, was assessed using the Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy. The HRQoL outcomes were assessed using the Functional Assessment of Cancer Therapy - General (FACT-G) and its four sub-dimensions. Mediation analyses were conducted using SPSS PROCESS v4.1. RESULTS: Six-hundred and forty cancer patients participated in the study. Multimorbidity had a direct effect on FACT-G scores independent of financial well-being (ß for path c' = -0.752, p < 0.001). In addition, multimorbidity had an indirect effect on FACT-G scores through its effect on financial well-being (ß for path a = -0.517, p < 0.05; ß for path b = 0.785, p < 0.001). Even after adjustments were made for the covariates, the indirect effect of multimorbidity on FACT-G via financial well-being remained significant, accounting for 38.0% of the overall effect, indicating partial mediation. Although there were no statistically significant associations between multimorbidity, social well-being, and emotional well-being, the indirect effects of multimorbidity on physical and functional well-being through financial well-being remained significant. CONCLUSIONS: Poor financial well-being attributable to multimorbidity partially mediates the direct impact of chronic conditions on HRQoL in Chinese cancer patients, particularly their physical and functional well-being.

The Feasibility and Acceptability of a Needs-Oriented Psychoeducational Intervention Among Caregivers of Adolescent and Young Adult Cancer Patients: A Pilot Randomized Controlled Trial.

BACKGROUND: Little is known about the psychoeducational interventions for caregivers of adolescent and young adult (AYA) cancer patients. OBJECTIVE: To evaluate the feasibility and acceptability of a needs-oriented psychoeducational intervention among caregivers of AYA cancer patients. METHODS: In this 2-arm (parallel-group), pilot randomized controlled trial, participants were randomized to the intervention or control group. Participants in the control group received usual care, whereas those in the intervention group received a needs-oriented psychoeducational intervention via WeChat as well as the usual care. Feasibility was evaluated on recruitment, attrition, and adherence rates and the data collection process. Acceptability was assessed based on participants' satisfaction with and perceived usefulness of the intervention, collected using a questionnaire. In addition, a semistructured interview was conducted to explore their experiences. RESULTS: Twenty-four caregivers of AYA cancer patients were recruited, with a consent rate of 61.5%. The attrition and response rates 5 weeks after baseline were 8.3% and 91.7%. Among the 12 participants in the intervention group, 10 (83.3%) completed all of the 5 weekly sessions. Most of the participants were satisfied with the program and perceived its usefulness. The semistructured interviews revealed 3 major categories: facilitators of participation, perception of the intervention, and perceived benefits. CONCLUSIONS: The needs-oriented psychoeducational intervention delivered through WeChat is feasible for and acceptable to caregivers of AYA cancer patients. A full-scale study is warranted to examine the effects of this intervention on caregivers' health outcomes. IMPLICATIONS FOR PRACTICE: The WeChat-based, needs-oriented psychoeducational intervention may be beneficial to improve caregivers' health outcomes.

Retraining programme for older patients undergoing peritoneal dialysis: A randomised controlled trial.

BACKGROUND: Peritonitis is a common cause of hospitalisation and death among patients undergoing peritoneal dialysis. Periodic retraining is recommended to prevent peritonitis, especially in older adults. OBJECTIVES: We evaluated the effectiveness of a retraining programme for reducing peritonitis and exit site infection rates in older adults on peritoneal dialysis. The cost-benefit ratio was also calculated. DESIGN: A two-arm prospective randomised controlled trial. PARTICIPANTS: One hundred and thirty patients aged 55 years or older were recruited. Participants were randomly assigned to the intervention or control group. While both groups received usual care, the intervention group received a retraining programme (a knowledge and practical assessment and a one-on-one retraining session) 90 days after starting home-based continuous ambulatory peritoneal dialysis therapy. MEASUREMENTS: The outcomes included peritonitis rate, exit site infection rate and direct medical costs at 180, 270, and 360 days after starting home-based continuous ambulatory peritoneal dialysis therapy. RESULTS: No significant differences were found in the baseline characteristics between groups. The peritonitis rates were 0.11 episodes per patient-year in the intervention group versus 0.13 in the control group. The incidence of exit site infection was 20.0% in the intervention group and 12.3% in the control group. The cost-benefit ratio of retraining was 1:9.6. None of the results were statistically significant. CONCLUSIONS: The absence of statistical significance may be partly explained by the premature termination of the study. Large-scale multi-centre trials are warranted to examine the effectiveness of retraining. The timing and long-term effects of retraining also need to be examined.

Unmet needs, anxiety, depression, and quality of life among caregivers of adolescents and young adults with cancer: A cross-sectional study.

Objective: To assess unmet needs, anxiety, depression, and quality of life of caregivers of adolescents and young adults with cancer and examine their associations. Methods: A total of 282 caregivers of adolescents and young adults with cancer were recruited by convenience sampling at a tertiary cancer hospital in Chinese Mainland. The participants' unmet needs, anxiety, depression, and quality of life were assessed using self-reported questionnaires. Hierarchical regression analyses were conducted to examine associations between unmet needs and health outcomes. Results: The five most prevalent high unmet needs were related to 'worries about future' and 'information', including dealing with not knowing what lies in the future (n â€‹= â€‹161, 57.1%), dealing with worry about the cancer getting worse (n â€‹= â€‹151, 53.5%), dealing with worry about the cancer coming back (n â€‹= â€‹147, 52.1%), finding information about complementary or alternative therapies (n â€‹= â€‹137, 48.6%), and finding information about the long-term side effects of treatments and medicines (n â€‹= â€‹126, 44.7%). Around 40% of the caregivers reported moderate to severe anxiety and depression. After adjusting for sociodemographic and clinical characteristics, personal and emotional needs, healthcare access and continuity, and financial needs remained significantly associated with anxiety, depression, or quality of life. Conclusions: Nurses need to be aware of the unmet needs of caregivers of adolescents and young adults with cancer. More effort is needed to identify services and interventions that address the unmet needs, particularly personal and emotional, healthcare access and continuity, and financial needs, to improve the caregivers' health outcomes.

Psychometric validation of the Chinese version of the M. D. Anderson Symptom Inventory-Head and Neck Module in patients with nasopharyngeal carcinoma.

Objective: The Chinese version of the M. D. Anderson Symptom Inventory-Head and Neck Module (MDASI-HN-C) has been linguistically validated. However, its psychometric properties have not been established yet. The purpose of the study was to psychometrically validate the MDASI-HN-C in patients with nasopharyngeal carcinoma (NPC). Methods: 130 Chinese NPC patients who were undergoing radiotherapy (RT) participated in this cross-sectional study. The content, convergent, and construct validity of the MDASI-HN-C were examined. The reliability of the instrument was tested by examining the internal consistency and test-retest reliability. Results: Cronbach's α coefficients ranged from 0.85 to 0.91 for the three subscales of the MDASI-HN-C. The 3-day test-retest reliability was acceptable with intraclass correlation coefficients (ICC) ranged from 0.52 to 0.71. The scale content validity index (S-CVI) was satisfactory (0.97). Subscale scores of the MDASI-HN-C were negatively correlated with the total score of the Chinese version of the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-H&N-C) as hypothesized (r â€‹= â€‹-0.484 to -0.563, all P â€‹< â€‹0.01). Exploratory factor analysis (EFA) revealed two factors for the 13 core and another two for the nine HNC-specific items. Only one factor was generated for the six interference items. Conclusions: The MDASI-HN-C shows desirable psychometric properties for evaluating symptom burden in NPC patients, which can be used in both clinical and research contexts.

Needs assessment instruments for family caregivers of cancer patients receiving palliative care: a systematic review.

PURPOSE: Family caregivers of palliative cancer patients experience various supportive care needs. Appropriate self-reported instruments with robust psychological properties are required to identify these needs of family caregivers. Therefore, we conducted a systematic review to identify self-reported supportive care needs assessment instruments for family caregivers of palliative cancer patients and assess their contents, psychometric properties, and applicability. METHODS: Systematic searches were conducted in six English databases and four Chinese databases from inception to October 2020 and updated in June 2021. The instruments identified were evaluated using an 18-item checklist consisting of six domains: conceptual model, content validity, reliability, construct validity, scoring and interpretation, and respondent burden and presentation. RESULTS: Six articles, describing four self-reported needs assessment instruments, were included in the review. These instruments varied significantly in terms of contents, constructs, scoring methods, and applicability. Three of these instruments were developed to assess the comprehensive supportive care needs of family caregivers, while one was specifically developed to assess the spiritual needs of family caregivers. With respect to psychometric properties, none of the instruments identified met all the criteria. Three major shortcomings were identified, namely, lack of longitudinal validity, lack of a strategy for interpreting missing data, and lack of a description of the literacy level required to understand the questions. Additionally, the instrument development processes assessed in this study lacked qualitative elements. CONCLUSIONS: End-users need to consider contents, psychometric properties, and applicability when choosing an appropriate needs assessment instrument according to individual purpose and context. Further evaluation or development of needs assessment for the family caregivers of palliative cancer patients is needed, with a particular emphasis on caregivers' perspectives.

Effectiveness of psychoeducational interventions among caregivers of patients with cancer: A systematic review and meta-analysis.

BACKGROUND: Many of the needs of caregivers of patients with cancer are unmet, particularly their informational and psychological needs. Psychoeducational interventions that focus on providing caregivers with information, and on meeting their emotional and psychosocial needs, may therefore be effective. OBJECTIVE: To evaluate the effectiveness of psychoeducational interventions on the outcomes of caregivers of patients with cancer and identify characteristics of effective psychoeducational interventions. DESIGN: A systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: The databases of PubMed, Embase, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature Complete, the British Nursing Index, PsycINFO, Ovid Emcare, Scopus, Chinese Journal Net, and Wan Fang Data were searched in December 2020. Clinical trial registers, related websites and reference lists of included studies were also examined. REVIEW METHODS: The Cochrane Risk of Bias Tool was used to appraise the quality of included studies. Meta-analysis was conducted, and narrative syntheses were performed where meta-analysis was inappropriate. RESULTS: Fourteen articles describing 12 studies were included. The results of the meta-analysis showed that psychoeducational interventions have short-term (immediately post-intervention) positive effects on relieving anxiety [SMD: -0.50, 95%CI: (-0.97, -0.02), p = 0.04], depression [SMD: -0.54, 95%CI: (-0.76, -0.32), p < 0.00001] and caregiver burden [SMD: -0.57, 95%CI: (-0.87, -0.27), p = 0.0002] and improving their quality of life [SMD: 0.42, 95%CI: (0.23, 0.62), p < 0.0001) and self-efficacy [SMD: 0.31, 95%CI: (0.09, 0.53), p = 0.006] in the caregivers of patients with cancer. They also showed long-term (at least 3 months post-intervention) positive effects on improving physical health [SMD: 0.26, 95%CI: (0.05, 0.47), p = 0.02]. The types of psychoeducational interventions varied in the 12 studies. However, the main contents of effective psychoeducational interventions included tasks related to health care provisions for patients, caregiver self-care and stress management, and relationship and coping skills. In general, most studies had short follow-up periods and involved caregivers of older patients with cancer (>40 years old). CONCLUSIONS: Psychoeducational interventions may have short-term desirable effects on caregivers' anxiety, depression, quality of life, burden and self-efficacy and long-term desirable effects on physical health. Individual psychoeducational intervention varied in contents, delivery mode, dosage and format. Research is needed to further specify the optimal combination of contents. Further high-quality RCTs are warranted, with longer follow-up periods, for caregivers of patients with cancer, especially caregivers of younger patients with cancer.

Psychological Wellbeing and Associated Factors Among Ethnic Minorities During the COVID-19 Pandemic.

This study assessed the psychological wellbeing and its associated factors amongst ethnic minorities during the coronavirus disease 2019 (COVID-19) pandemic. A total of 310 Hong Kong South Asians aged 41.3 (SD 13.7) years completed an anonymous online survey between July 2020 and February 2021. The results showed an overall moderate level of stress and high levels of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms amongst South Asian minorities. Multivariable regression analyses suggested that being single/divorced, following Hinduism or other non-Muslim religions, having lower perceived knowledge of COVID-19 and having worried about losing job were significant predictors of higher levels of depression, anxiety and/or stress; additionally, being male, having a low monthly household income, having worried about losing job and healthcare collapse were significant predictors of a higher level of PTSD symptoms. The findings suggest an urgent need to alleviate the psychological impacts of the COVID-19 pandemic on ethnic minorities, specifically for those most vulnerable to these impacts.

Discrepancies between nurses' current and perceived necessary practices of family-centred care for hospitalised children and their families: A cross-sectional study.

PURPOSE: This study investigated (1) the discrepancies between the nurses' current and perceived necessary practices of family-centred care (FCC), and (2) the nurses' demographic characteristics associated with current and perceived necessary practices of FCC for hospitalised children and their families in Malawi. DESIGN AND METHODS: A cross-sectional study involving 444 nurses was conducted. The Family-Centred Care Questionnaire-Revised was used to examine the discrepancies between the nurses' current and perceived necessary practices of FCC. Univariate and multivariate statistical analyses were performed to identify the nurses' demographic characteristics associated with current and perceived necessary practices of FCC. RESULTS: The total mean score of the nurses' current practices of FCC (M = 34.78, SD = 7.06) was significantly lower than that of the nurses' practices of FCC that were perceived as necessary (M = 38.63, SD = 5.60, p < 0.001). The nurses who were over 40 years of age (regression coefficient, ß = 9.162, p = 0.014), had a postgraduate qualification (ß = 23.314, p < 0.001), were separated or widowed (ß = 9.661, p = 0.029), had a Tumbuka cultural background (ß = 12.984, p < 0.001), were Seventh-day Adventist members (ß = 8.863, p = 0.026), and worked in mission hospitals (ß = 16.401, p = 0.021) were more likely to implement current practices of FCC. Conversely, the nurses who were members of the Moslem, Buddhist, or Hindi religious denomination (ß = 6.587, p = 0.040), had a Tonga or Ngonde cultural background (ß = 6.625, p = 0.046), and were nurse midwife technicians (ß = -23.528, p = 0.012) were more likely to implement practices of FCC that they perceived as necessary. CONCLUSION: Significant differences between the nurses' current and perceived necessary practices of FCC suggested that there were barriers to implementing necessary practices of FCC. The nurses' cultural and religious backgrounds were predictors of current practices of FCC, and this finding could direct the future development and testing of FCC interventions in Malawi. PRACTICE IMPLICATIONS: Continued educational activities and research on the factors that contributed to the discrepancies between the nurses' current and perceived necessary practices of FCC and their impact on FCC in Malawi are critical.

The cross-lagged association between depressive symptoms and health-related quality of life in patients receiving maintenance hemodialysis: a three-wave longitudinal study.

PURPOSE: To examine the cross-lagged relationship between depressive symptoms and health-related quality of life (HRQoL) in patients receiving maintenance hemodialysis. METHODS: A longitudinal, observational study was conducted in two public hospitals in Shanghai, China. The sample consisted of 204 patients at baseline (T1). Of these, 144 completed the 12-month follow-up survey (T2), and 135 completed the 24-month follow-up survey (T3). Depressive symptoms were assessed using the depression subscale of the Hospital Anxiety and Depression Scale, and HRQoL was assessed using the Kidney Disease Quality of Life 36 short form. Cross-lagged path analysis was used to examine the temporal relationship between depressive symptoms and domains of health-related quality of life. RESULTS: Lower levels of three out of five domains of HRQoL (physical functioning, burden of kidney disease, and symptoms of kidney disease) at T1 were associated with increases in depressive symptoms at T2. Moreover, higher depressive symptoms at T2 were associated with decreases in four domains of HRQoL (mental functioning, burden of kidney disease, symptoms of kidney disease, and effects of kidney disease) at T3. CONCLUSIONS: Patients who had poor HRQoL were more likely to report more subsequent depressive symptoms, which in turn predict lower HRQoL over time. It indicates a need to break this cycle in patients receiving maintenance hemodialysis.

Association of single nucleotide polymorphisms of cytochrome P450 enzymes with experience of vasomotor, vaginal and musculoskeletal symptoms among breast cancer patients: a systematic review.

BACKGROUND: Adjuvant endocrine therapies are known to induce undesirable adverse effects such as vasomotor, vaginal and musculoskeletal symptoms among breast cancer patients. Drugs used in these therapies are often metabolised by cytochrome P450 (CYP) enzymes, in which their metabolising activities can be modified by single nucleotide polymorphisms (SNP) in CYP genes and CYP genotypes. This review aims to explore whether SNPs or genotypes of CYP are associated with the occurrence, frequency and severity of vasomotor, vaginal and musculoskeletal symptoms in breast cancer patients on adjuvant endocrine therapies. METHODS: A literature review was conducted using five electronic databases, resulting in the inclusion of 14 eligible studies, and their findings were presented narratively. Selected items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist were used for critical appraisal of the reporting quality of the included studies. RESULTS: Most of the included studies showed that SNPs or genotypes of CYP that modify its metabolising activity have no effect on the occurrence, frequency or severity of vasomotor symptoms, including hot flashes. One study showed no correlation of these genetic variations in CYP with musculoskeletal symptoms, and no data were available on the association between such genetic variations and vaginal symptoms. CONCLUSIONS: Overall, genetic variations in CYP have no effect on the experience of hot flashes among breast cancer patients. We recommend exploration of the link between the active metabolites of chemotherapeutic drugs and the molecules shown to affect the occurrence or severity of hot flashes, and the establishment of the relationship between such genetic variations and patients' experience of musculoskeletal and vaginal symptoms. Subgroup analyses based on patients' duration of adjuvant endocrine therapies in such studies are recommended.

A Dance Program to Manage A Fatigue-Sleep Disturbance-Depression Symptom Cluster among Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Feasibility Study.

OBJECTIVE: Fatigue, sleep disturbance, and depression (FSD) are highly prevalent among breast cancer (BC) patients undergoing adjuvant chemotherapy, constituting a common symptom cluster (i.e., FSD cluster). Exercise is effective in relieving fatigue, alleviating sleep disturbance, and improving the quality of life (QoL) during adjuvant chemotherapy among these women. Therefore, this study aimed to assess the feasibility and acceptability of a dance program with social support elements for managing this symptom cluster. METHODS: A prospective randomized controlled design combined with a semi-structured interview was utilized. Twenty consented eligible participants were randomly assigned to a dance group or an attention control group after baseline assessment but before chemotherapy. The feasibility of recruitment, retention, intervention, and data collection procedures and the acceptability of exercise modality, hospital-based instruction, and home-based practice were collected by retrieving information from research documents and interviews by the principal investigator 4 weeks after the start of intervention. RESULTS: The recruitment and retention rates were 86.96% and 100.00%, respectively. Participants took about 30-40 min to complete the questionnaire. All the items were comprehensible. The baseline characteristics were comparable between groups, indicating that randomization was successful. The implementation procedure progressed smoothly. Dancing was considered interesting and easy, and participants would like to practice at home. Only minor adjustments would be needed for future studies. CONCLUSIONS: This study demonstrated that the proposed dance program was feasible and acceptable for BC patients in hospital and home settings. A full-scale study is warranted to examine its effects on managing the FSD cluster and promoting QoL.

How patients with cancer experience dignity: An integrative review.

BACKGROUND: A diagnosis of cancer and its treatments can be associated with a prominent issue of loss of dignity or an undermined sense of dignity for patients. Research is increasingly being conducted into how patients with cancer experience dignity, with the aim to build clinical foundations for care that preserves patients' sense of dignity. AIM: This review summarises and synthesises the available empirical literature on the experience of dignity in patients with cancer regarding both the perception of dignity and associated factors. METHOD: An integrative review method was used. A literature search was conducted in 11 databases using the search terms 'dignity' OR 'existential' OR 'existentialism' combined with 'cancer'. The Mixed Methods Appraisal Tool (version 2011) was adopted to appraise the methodological quality of the included studies. RESULTS: Nine qualitative studies and 13 quantitative studies met the selection criteria and were included in the review. The ways that patients with cancer perceived dignity include autonomy/control, respect, self-worth, family connectedness, acceptance, hope/future and God/religious. Factors associated with dignity include demographics, physical and psychosocial distress, experiences of suffering and coping strategies. CONCLUSION: Dignity-conserving care should respect patients' human autonomy to strengthen their sense of self-worth, acceptance, hope, reinforce family connectedness, and foster coping strategies to control the physical, psychosocial factors and experience of sufferings that threaten their sense of dignity.

Identifying a cut-off score for the COST measure to indicate high financial toxicity and low quality of life among cancer patients.

PURPOSE: To identify a cut-off score for the COmprehensive Score for financial Toxicity (COST) to predict a clinical implication of a high level of financial toxicity (FT). METHODS: A total of 640 cancer patients were recruited from three regional hospitals in Hong Kong. They completed a questionnaire comprising the COST measure and the Functional Assessment of Cancer Therapy - General (FACT-G) instrument. The cut-off score for the COST that predicts the lowest quartile of the FACT-G total score was identified by receiver operating characteristic (ROC) analysis. The sample was then stratified by this cut-off score, and characteristics were compared using Fisher's exact, chi-squared or independent sample t-test. RESULTS: The mean scores were 20.1 ± 8.8 for the COST and 71.6 ± 15.5 for the FACT-G. The ROC analysis suggested that the cut-off of 17.5 yielded an acceptable sensitivity and specificity. Characteristics of patients with a higher level of FT included being younger, having a monthly household income of < 10,000 HKD (approximately 1290 USD), being more likely not employed, having stage IV cancer and receiving targeted and/or immunotherapy. In terms of financial support, a higher proportion of these patients had discussed financial issues with health care professionals and had received financial assistance. In addition, fewer of them were covered by private health insurance. CONCLUSION: Our findings suggest a cut-off for the COST that can be used to screen for FT in clinical settings. In addition, while a considerable proportion of high-FT patients received targeted therapy, they often received financial assistance. There is a gap between financial hardship and assistance that warrants attention.

Symptom clusters experienced by breast cancer patients at various treatment stages: A systematic review.

Breast cancer patients often experience symptoms that adversely affect their quality of life. It is understood that many of these symptoms tend to cluster together: while they might have different manifestations and occur during different phases of the disease trajectory, the symptoms often have a common aetiology that is a potential target for intervention. Understanding the symptom clusters associated with breast cancer might usefully inform the development of effective care plans for affected patients. The aim of this paper is to provide an updated systematic review of the known symptom clusters among breast cancer patients during and/or after cancer treatment. A search was conducted using five databases for studies reporting symptom clusters among breast cancer patients. The search yielded 32 studies for inclusion. The findings suggest that fatigue-sleep disturbance and psychological symptom cluster (including anxiety, depression, nervousness, irritability, sadness, worry) are the most commonly-reported symptom clusters among breast cancer patients. Further, the composition of symptom clusters tends to change across various stages of cancer treatment. While this review identified some commonalities, the different methodologies used to identify symptom clusters resulted in inconsistencies in symptom cluster identification. It would be useful if future studies could separately examine the symptom clusters that occur in breast cancer patients undergoing a particular treatment type, and use standardised instruments across studies to assess symptoms. The review concludes that further studies could usefully determine the biological pathways associated with various symptom clusters, which would inform the development of effective and efficient symptom management strategies.

Translation and validation of the Traditional Chinese version of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (Version 2).

BACKGROUND: Cancer patients often experience severe financial distress due to the high cost of their treatment, and strategies are needed to objectively measure this financial distress. The COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is one instrument used to measure such financial distress. This study aimed to translate the COST-FACIT (Version 2) [COST-FACIT-v2] instrument into traditional Chinese (COST-FACIT-v2 [TC]) and evaluate its psychometric properties. METHODS: The Functional Assessment of Chronic Illness Therapy (FACIT) translation method was adopted. The translated version was reviewed by an expert panel and by 20 cancer patients for content validity and face validity, respectively, and 640 cancer patients, recruited from three oncology departments, completed the translated scale. Its reliability was evaluated in terms of internal consistency and test-retest reliability. Confirmatory factor analysis has been used to evaluate the one- and two-factor structures of the instrument reported in the literature. The convergent validity was examined by the correlation with health-related quality of life (HRQoL) and psychological distress. Known-group validity was examined by the difference in the COST-FACIT-v2 (TC) total mean score between groups with different income levels and frequency of health care service use. RESULTS: The COST-FACIT-v2 (TC) showed good content and face validity and demonstrated high internal consistency (Cronbach's alpha, 0.86) and acceptable test-retest reliability (intraclass correlation coefficient, 0.71). Confirmatory factor analysis showed that the one- and two-factor structures of the instrument that have been reported in the literature could not be satisfactorily fitted to the data. Psychological distress correlated significantly with the COST-FACIT-v2 (TC) score (r = 0.47; p < 0.001). HRQOL showed a weak to moderate negative correlation with the COST-FACIT-v2 (TC) score (r = - 0.23 to - 0.46; p < 0.001). Significant differences were seen among the COST-FACIT-v2 (TC) scores obtained in groups of different income level and frequency of health care service use. CONCLUSIONS: The COST-FACIT-v2 (TC) showed some desirable psychometric properties to support its validity and reliability for assessing cancer patients' level of financial toxicity.

A review of the prevalence, associated factors and interventions of psychological symptoms among cancer patients in the Chinese Mainland during the COVID-19 pandemic.

The novel coronavirus disease 2019 (COVID-19) has placed tremendous pressure on public health systems across the world. Compared with the healthy population, cancer patients are more prone to developing psychological problems, including depression and anxiety, because of worries about cancer recurrence, cancer symptoms, treatment-related discomfort, a lack of social interaction and the impact on their financial well-being. This paper aimed to identify existing evidence on psychological symptoms and their associated factors among cancer patients in the Chinese Mainland during the COVID-19 pandemic, and on interventions to effectively manage these symptoms. Articles related to the prevalence, the risk factors and interventions of psychological symptoms among cancer patients in the Chinese Mainland during COVID-19 published between December 2019 and August 2020 were searched in two English (PubMed and Embase) and two Chinese (CNKI and Wan Fang Data) databases. A total of 180 studies were identified, and 18 studies were included in the review after removing duplicates and screening for relevancy. The results suggest that patients with cancer in the Chinese Mainland have suffered psychological pressure during COVID-19, with a high prevalence of psychological distress, depression and anxiety reported across most of the reviewed studies. Pandemic-related factors such as treatment discontinuation and worry about being infected are associated with these symptoms. Nurses may help to relieve these symptoms by identifying stressors, providing relevant information through mass and social media and referring patients to specialists for psychological support. However, evidence about treatments and interventions for these symptoms is limited, and additional research is warranted to identify effective interventions to promote resilience in this patient population.

Oral mucositis among Chinese cancer patients receiving chemotherapy: Effects and management strategies.

Oral mucositis is a painful and distressing complication of chemotherapy-induced toxicity in cancer patients that can develop early during the treatment regimen. Previous studies have demonstrated that both oxidative stress and inflammation play a role in the development of the ulceration that is a characteristic of oral mucositis. To date, a few studies have investigated the effect of this complication on the well-being of patients, demonstrating its negative impact on patients' functional ability and quality of life. This effect may entail chemotherapeutic drug dose reduction among patients, in turn reducing their cancer survival rates. Therefore, interventions to address the detrimental effects of oral mucositis on the well-being of cancer patients are required. This review provides an overview of the studies that have examined the negative effects of oral mucositis on Chinese cancer patients undergoing chemotherapy, as well as the interventions shown to be effective in treating this complication, with a focus on interventions utilizing traditional Chinese medicine. Overall, both traditional Chinese medicine-based interventions and interventions involving patient education about effective oral care led by trained nurses were found to be useful in reducing the incidence and severity of oral mucositis among Chinese patients undergoing chemotherapy. Future oral mucositis management plans aiming at effective oral care among cancer patients undergoing chemotherapy should incorporate these types of interventions as integral components to enhance the well-being of these patients.

Treating peritoneal dialysis catheter exit-site granulomas with chlorhexidine swabstick: A pilot study.

BACKGROUND: Silver nitrate cauterisation is the conventional treatment for peritoneal dialysis catheter exit-site granulomas. However, it requires to be performed by nurses, patients often experience pain and chemical burns. Therefore, the appropriateness and applicability of using 2% aqueous chlorhexidine swabstick as an alternative was explored in two nephrology centres in Hong Kong. OBJECTIVE: To examine possibility of conducting full trial using chlorhexidine swabstick compared with silver nitrate. DESIGN: A pilot study. PARTICIPANTS: Fort-four patients with exit-site granulomas were equally, randomly allocated to receive chlorhexidine swabstick or silver nitrate. MEASUREMENTS: Both groups were followed for 6 weeks to evaluate the time of granuloma subsidence and adverse effects. Pain and treatment satisfaction were assessed using numerical rating scale and self-developed questionnaire, respectively. RESULTS: Healing rates were 94.4% (17 of 18) using chlorhexidine swabstick,100% (21 of 21) using silver nitrate (p = 0.46). The mean time of granuloma subsidence was significantly longer when using chlorhexidine swabstick (32.8 days) than silver nitrate (12.3 days, p=0.02). The chlorhexidine swabstick group reported significantly fewer adverse effects (11.1%, 2 of 18, p = 0.01) compared with the silver nitrate group (52.4%, 11 of 21). The chlorhexidine swabstick group had lower mean pain score (0.5 of 11) than the silver nitrate group (2.4 of 11, p < 0.01). The satisfaction scores between the two groups had no substantial difference. CONCLUSION: Chlorhexidine swabstick took long time to remove granulomas but had similar success rate, less pain, fewer adverse effects than silver nitrate. Additional research is warranted to examine the applicability of chlorhexidine swabstick.