Management of cancer-related fatigue in Taiwan: an evidence-based consensus for screening, assessment and treatment.

BACKGROUND: Cancer-related fatigue is one of the most common and persistent issues experienced by cancer patients. Cancer-related fatigue is a distinct form of fatigue that is subjective, long-lasting and unalleviated by rest or sleep. Studies have shown that almost all cancer patients experience severe fatigue that disrupts the quality of life and physical function, but cancer-related fatigue remains under-addressed in clinical care, and only about half of all patients receive treatment. METHODS: To increase the awareness of cancer-related fatigue and improve current management, the Taiwan Society of Cancer Palliative Medicine and the Taiwan Oncology Nursing Society convened a consensus committee to develop recommendations for the screening, assessment and treatment of cancer-related fatigue. RESULTS: Thirteen consensus recommendations were subsequently developed based on the best available evidence and the clinical experience of committee members. CONCLUSIONS: These recommendations are expected to facilitate the standardization of cancer-related fatigue management across Taiwan and may also serve as a reference for other clinicians.

[A Quality Improvement Project for Reducing Work-Related Stress of Nurses in Converting an Oncology Ward Into a Designated COVID-19 Ward During the COVID-19 Pandemic].

BACKGROUND & PROBLEMS: The community spread of SARS-CoV-2 occurred during the COVID-19 pandemic in May 2021 in Taiwan. Due to the large number of COVID-19 patients, demand for healthcare capacity had also increased. In response to the massive influx of patients with COVID-19 in our hospital, a designated COVID-19 ward was established. In addition, the oncology ward was also quickly transformed into a designated COVID-19 ward that shared staff and work schedules with the originally designed COVID-19 ward during the pandemic period. The process of setting up the ward, training personnel, and providing independent care to COVID-19 patients and the period of professional cooperation with medical staff from the infectious disease ward caused great burden and pressure on nurses. PURPOSE: The objective of this study was to reduce the work-related stress index from 20.2 to 15. RESOLUTION: Cross-training and in-service courses were implemented to assist the oncology nurses to learn nursing care for patients with COVID-19. Five solutions were discussed and implemented in a timely manner. The interventions included the unifying the logistical flows between wards, optimizing ward environments, providing education and training on COVID-19, launching a new communication platform to facilitate discussions and gather various opinions, and implementing flexible scheduling. RESULTS: The stress index score declined from 20.2 to 8.2 on the stress and anxiety to viral epidemics-9 scale. CONCLUSIONS: The findings of this study may be referenced to assist nurses and nursing managers when making preparations to transform oncology wards into designed COVID-19 wards.

Validation of the Smoking Cessation Counseling Scale Chinese Version in Taiwan.

BACKGROUND: Providing tobacco control (TC) and smoking cessation (SC) counseling is an important part of healthcare. An assessment tool to understand healthcare providers' experiences in providing SC counseling may enhance TC. OBJECTIVE: The aims of this study were to (1) translate and develop the Smoking Cessation Counseling Scale-Chinese version (SCCS-C) and (2) evaluate its psychometric properties in Taiwan. METHODS: This is a 2-phase instrument testing study. In the first phase, the SCCS-C was developed and translated. In the second phase, 2 groups of participants were recruited. First, 292 SC educator trainees completed the psychometric assessment measures (internal consistency reliability and construct validity). The 2-week test-retest reliability was assessed in certified TC instructors. RESULTS: The results showed that (1) the SCCS-C has satisfactory content validity and internal consistency reliability with a Cronbach's α of .96; (2) the overall 2-week test-retest reliability was 0.70; (3) instead of the 4-factor structure of the original scale, a 3-factor structure of the SCCS-C was identified by exploratory factor analysis to explain 65.37%; (4) construct validity was supported by significant negative correlations between SCCS-C and barriers regarding TC and positive correlations with counseling, responsibility, and self-efficacy; and (5) discriminant validity was supported by significant differences between SC educator trainees and the certified TC instructors, as well as between those living with or without smokers. CONCLUSIONS: The SCCS-C has satisfactory reliability, test-retest reliability, and construct validity. IMPLICATIONS FOR PRACTICE: The SCCS-C is a valid, reliable instrument for assessing healthcare counseling activities for SC in Taiwan.

[Effects of an Interdisciplinary Care Program on Improving the Return-to-Treatment Rate Among Cancer Patients].

BACKGROUND & PROBLEMS: The return-to-treatment rate is an important indicator of treatment outcome and care effectiveness in cancer patients. The return-to-treatment rates for patients at National Taiwan University Hospital (NTUH) in 2011 and 2012 were 38.5% and 33.3%, respectively. In order to improve the quality of care that is provided to patients, we reviewed NTUH's current clinical case management protocols for handling patients who refused treatment and then identified and resolved the potential problems in these protocols. PURPOSE: To raise the return-to-treatment rate above 45% by 2013. RESOLUTION: We developed four new interventions to improve the return-to-treatment rate. Firstly, we assembled a quality care team that monitored the rates of patient return to treatment on a monthly basis and reminded case managers to follow up with patients regularly. Secondly, we introduced new protocols for case managers that facilitated the ongoing analysis of the reasons that patients elect not to return to treatment. Thirdly, we delivered regular education programs for case managers addressing good quality and quantity care for cancer patients. Finally, we developed an interdisciplinary liaison care program for patients. RESULTS: After implementing these four interventions, the return-to-treatment rate improved to 48% in 2013. CONCLUSIONS: This improvement project demonstrated that integrating an interdisciplinary team, assembling a quality care team, implementing new protocols to help cancer patients who refuse to commence / continue treatment, providing regular education to clinical case managers, and enacting an interdisciplinary care program were all helpful to improving the effectiveness of cancer care services and the return-to-treatment rate of cancer patients.

Communication dysfunction, body image, and symptom severity in postoperative head and neck cancer patients: factors associated with the amount of speaking after treatment.

PURPOSE: The purpose of this study was to determine the relationships of communication dysfunction, body image, and amount of speaking in patients who were treated for head and neck cancers (HNCs). METHODS: This was a cross-sectional study of postoperative HNC patients at the otolaryngology outpatient departments of two leading medical centers in northern Taiwan. Data were collected using questionnaires to assess perceived communication dysfunction, body image, symptom severity, and amount of speaking after treatment. RESULTS: A total of 130 HNC patients were included in the analysis, and 70.8 % of patients reported speaking less after surgery as compared to the period before having HNC surgery. Overall, patients perceived a moderate level of communication dysfunction. Those with higher distress over their body image, higher symptom severity, and with hypopharyngeal and laryngeal cancer reported speaking less. Patients with advanced stage cancer and a tumor in a facial area and those that received reconstructive surgery were more likely to have a negative body image. CONCLUSIONS: Dissatisfaction with body image, greater symptom severity, and hypopharyngeal and laryngeal cancer are predictive of the amount HNC patients speak, as compared with the amount they spoke before having HNC. Clinicians should be aware of and systematically assess communication problems of HNC patients to promote their social function. Further research on interventions that facilitate the development of a positive body image and communication is strongly suggested.

[Nursing care for a lung cancer patient with brain metastasis using the family resiliency model].

This article describes the experience of the author in providing nursing care to a lung cancer patient with brain metastasis who was unable to care for herself. The period of care ran from July 26th to August 7th, 2012. The focus of the article is on the problems of disease adaptation and the coping strategies of the patient and her primary caregivers. The author used the Family Resiliency Model to collect information via physical examination, observation, and interviews. Five major nursing problems were identified in this case: risk of aspiration, self-care deficits, adjustment disorder, caregiver role strain, and family coping ineffectiveness. Based on these problems, the author constructed an individualized care plan to: 1) improve the self-care ability of the patient, 2) enhance the skills of the primary caregiver, 3) recruit the timely assistance of other family members, 4) and reduce the burden of the primary caregiver. The primary goal of this care plan was to promote the quality of life of the patient and her family.

Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan.

Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses' pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7-86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education.