Process of inner change in advanced age: a qualitative study of older adults in their early 90 s.

BACKGROUND: The number of nonagenarians is growing globally. The promotion of mental wellbeing is increasingly important. The aim of this study was to explore mental wellbeing and psychological experiences of older adults in their early 90 s who were living at home. METHODS: We conducted a qualitative study using semi-structured face-to-face interviews with 20 older adults in their early 90 s. A thematic analysis, according to Braun and Clarke, was used to analyze data. RESULTS: An inner process of older adults in their early 90 s was revealed; its three themes were the "reality of aging," "seeking emptiness of the mind," and "still moving on." Older adults in this study experienced functional decline, regret, and loneliness. They were tired of life and nearly gave up. Emptying their minds helped them reset their attitudes and find a way to move on. After realizing that negative thinking did not help anything, they focused on what they could do and their daily routines. Perceived social usefulness validated participants' self-worth. However, a few were consistently active without negative perceptions of aging. CONCLUSION: Understanding the psychological process and mental wellbeing in later life aids in the development of practical healthcare policies to assist the growing oldest-old population in cope with age-related challenges and improve their mental wellbeing.

Impact of a web-based educational program on Japanese nurses tobacco cessation practice and attitudes in oncology settings.

PURPOSE: To evaluate the effects of a short web-based educational program on Japanese nurses' self-reported attitudes toward tobacco cessation and their use of interventions to help smokers to quit. DESIGN: Prospective, single-group design with a pre-educational survey, a short web-based educational program, and a follow-up survey at 3 months. METHODS: Clinical nurses were asked to view two prerecorded webcasts about helping smokers quit. They completed two online surveys, one at baseline and one at a 3-month follow-up. Generalized linear models were used to determine changes in nurses' self-reported routine practice after the study intervention. FINDINGS: A total of 1401 nurses responded to the baseline survey, 678 of whom completed the follow-up survey. Compared with baseline, nurses at follow-up were more likely to advise smokers to quit (odds ratio [OR] = 1.45, 95% confidence interval [CI: 1.15, 1.82]), assess patients' interest in quitting (OR = 1.46, 95% CI [1.01, 1.04]), and assist patients with smoking cessation (OR = 1.34, 95% CI [1.04, 1.72]). However, the proportion of nurses who consistently recommended resources for tobacco cessation did not significantly improve at follow-up. CONCLUSIONS: This study provides preliminary evidence that a web-based educational program can increase nurses' implementation of tobacco dependence interventions in cancer care practice. Sustaining these educational efforts could increase nurses' involvement in providing these interventions, encourage nurses to refer patients to cessation resources, and support nurses' attitudes towards their role in smoking cessation. CLINICAL RELEVANCE: Our short web-based educational program can increase nurses' use of tobacco-dependence interventions in cancer care practice. This role can be enhanced with additional information about existing cessation resources that nurses could use to refer patients for support post-discharge. Japanese nurses, when properly educated, are willing and significant contributors to promote tobacco use cessation for cancer patients. The contribution can be facilitated through nursing care protocol that integrate tobacco use cessation interventions within evidence-based cancer care approaches.

Characteristics of taste alterations in people receiving taxane-based chemotherapy and their association with appetite, weight, and quality of life.

PURPOSE: There is limited evidence on the effect of chemotherapy-associated taste alteration. This study aimed to evaluate taste alteration characteristics in patients receiving taxane-based chemotherapy and investigate the association of taste alterations with appetite, weight, quality of life (QOL), and adverse events. METHODS: This cross-sectional study evaluated 100 patients receiving paclitaxel, docetaxel, or nab-paclitaxel as monotherapy or combination therapy. Taste alterations were evaluated using taste recognition thresholds and severity and symptom scales. Taste recognition thresholds, symptoms, appetite, weight, and adverse events were compared between patients with and without taste alterations, and logistic regression analysis was performed to identify risk factors. RESULTS: Of the 100 patients, 59% reported taste alterations. We found significantly elevated taste recognition thresholds (hypogeusia) for sweet, sour, and bitter tastes in the taste alteration group receiving nab-paclitaxel (p = 0.022, 0.020, and 0.039, respectively). The taste alteration group reported general taste alterations, decline in basic taste, and decreased appetite. Neither weight nor QOL was associated with taste alterations. Docetaxel therapy, previous chemotherapy, dry mouth, and peripheral neuropathy were significantly associated with taste alterations. CONCLUSIONS: Almost 60% of patients receiving taxane-based regimens, especially docetaxel, reported taste alterations. Taste alteration affected the patient's appetite but did not affect the weight or QOL. Docetaxel therapy, previous chemotherapy, dry mouth, and peripheral neuropathy were independent risk factors for taste alterations.

The role and attitude of senior leaders in promoting group-based community physical activity: a qualitative study.

BACKGROUND: In the context of worldwide public health, it is very important to promote physical activity among the older people. This study explored the roles and attitudes of senior leaders in promoting group-based exercise in their local communities, specifically to determine the level and extent to which to elderly participation was encouraged. METHODS: This study conducted semi-structured face-to-face in-depth interviews and employed a subsequent thematic analysis. Participants included 10 club leaders and five sub-leaders who were working at senior clubs in Fujisawa-city, Kanagawa, Japan, from July to September 2018. RESULTS: Four themes emerged from the interview responses, including "unwavering attitude/conviction in relation to the vision," "leaders must set an example," "a search for balance in delegating responsibilities to members," and "creating and fostering culture and environment of mutual help." Further, each participant outlined several aims, including "achieving healthy longevity for the entire local community," "having older people promote healthy activities among the older people," and "creating a pro-health town." CONCLUSIONS: Findings indicate that policymakers, public health workers, and healthcare providers should recognize the pivotal roles that senior group leaders play in promoting healthy activities for the older people. These efforts should be strongly considered when developing policies and strategies designed to promote overall healthy longevity from a general community perspective.

Validation of the Japanese version of the barriers questionnaire II in cancer pain management: a cross-sectional study.

BACKGROUND: The Barriers Questionnaire II (BQ-II) was developed to assess barriers to effective pain management. In this study, we aimed to assess the reliability and validity of the newly developed Japanese version of the BQ-II (JBQ-II). METHODS: This study used a cross-sectional design. The study was conducted an ambulatory infusion center for cancer in a general hospital in Tokyo, Japan. Participants were 120 Japanese patients with cancer and 21 Japanese health professionals with experience in pain management. Cronbach's alpha coefficient was used to calculate reliability. Test-retest reliability was assessed with Spearman's intra-class correlation coefficient (ICC). Construct, criterion-related, and discriminant validity were assessed using information about pain management, daily life, mental health, and subjective health. RESULTS: The Cronbach's alpha was 0.90 for the JBQ-II, and all ICCs exceeded 0.70 (P < 0.01). Factor analysis showed the JBQ-II had a virtually identical structure to the BQ-II, and path analysis supported the JBQ-II constructs. The JBQ-II was weakly correlated with poor mental state (r = 0.36, P < 0.01). Patients' JBQ-II scores were significantly higher than health professionals' scores. CONCLUSION: The JBQ-II is a valid and reliable measure of patient-related barriers to pain management among Japanese adult patients with cancer.

Correction to: Oncology practitioners' perspectives and practice patterns of post-treatment cancer survivorship care in the Asia-Pacific region: results from the STEP study.

It has been highlighted that the original manuscript [1] contains a typesetting error in the surname of Jesson Butcon. This was incorrectly captured as Jessica Butcon in the original manuscript which has since been updated.

Nurse Counseling for Physical Activity in Patients Undergoing Esophagectomy.

Strong evidence exists regarding multiple benefits of physical activity among cancer patients. Patients undergoing esophagectomy received counseling for physical activity by a nurse and instructions to keep a diary of physical activities before surgery, followed by 2 counseling sessions after surgery. Physical activity, body mass index, psychological distress, and quality of life were measured at baseline, 2-4 weeks, and 3 and 6 months after discharge. Of 29 participants (mean age = 65.9 years), 72.5% underwent thoracoscopic esophagectomy in the prone position with 3-field lymphadectomy. The results of the International Physical Activity Questionnaire indicated that postoperative physical activity returned to nearly preoperative level, and the number of inactive patients gradually decreased by half at 6 months after discharge. Quality of life scores, except those for role function and social function, tended to return to the baseline at 6 months after discharge. Psychological distress measured by the Kessler 6 remained lower than the baseline, whereas the mean score of body mass index gradually declined after discharge. Patients undergoing esophagectomy and receiving nurse counseling can return to preoperative physical activity level in their daily lives after surgery. Nurses should integrate physical activity promotion into cancer care.

Oncology practitioners' perspectives and practice patterns of post-treatment cancer survivorship care in the Asia-Pacific region: results from the STEP study.

BACKGROUND: Most efforts to advance cancer survivorship care have occurred in Western countries. There has been limited research towards gaining a comprehensive understanding of survivorship care provision in the Asia-Pacific region. This study aimed to establish the perceptions of responsibility, confidence, and frequency of survivorship care practices of oncology practitioners and examine their perspectives on factors that impede quality survivorship care. METHODS: A cross-sectional survey of hospital-based oncology practitioners in 10 Asia-Pacific countries was undertaken between May 2015-October 2016. The participating countries included Australia, Hong Kong, China, Japan, South Korea, Thailand, Singapore, India, Myanmar, and The Philippines. The survey was administered using paper-based or online questionnaires via specialist cancer care settings, educational meetings, and professional organisations. RESULTS: In total, 1501 oncology practitioners participated in the study. When comparing the subscales of responsibility perception, frequency and confidence, Australian practitioners had significantly higher ratings than practitioners in Hong Kong, Japan, Thailand, and Singapore (all p < 0.05). Surprisingly, practitioners working in Low- and Mid- Income Countries (LMICs) had higher levels of responsibility perception, confidence and frequencies of delivering survivorship care than those working in High-Income Countries (HICs) (p < 0.001), except for the responsibility perception of care coordination where no difference in scores was observed (p = 0.83). Physicians were more confident in delivering most of the survivorship care interventions compared to nurses and allied-health professionals. Perceived barriers to survivorship care were similar across the HICs and LMICs, with the most highly rated items for all practitioners being lack of time, dedicated educational resources for patients and family members, and evidence-based practice guidelines informing survivorship care. CONCLUSIONS: Different survivorship practices have been observed between HICs and LMICs, Australia and other countries and between the professional disciplines. Future service planning and research efforts should take these findings into account and overcome barriers identified in this study.

Regular group exercise contributes to balanced health in older adults in Japan: a qualitative study.

BACKGROUND: While community-wide interventions to promote physical activity have been encouraged in older adults, evidence of their effectiveness remains limited. We conducted a qualitative study among older adults participating in regular group exercise to understand their perceptions of the physical, mental, and social changes they underwent as a result of the physical activity. METHODS: We conducted a qualitative study with purposeful sampling to explore the experiences of older adults who participated in regular group exercise as part of a community-wide physical activity intervention. Four focus group interviews were conducted between April and June of 2016 at community halls in Fujisawa City. The participants in the focus group interviews were 26 older adults with a mean age of 74.69 years (range: 66-86). The interviews were analysed using the constant comparative method in the grounded theory approach. We used qualitative research software NVivo10® to track the coding and manage the data. RESULTS: The finding 'regular group exercise contributes to balanced health in older adults' emerged as an overarching theme with seven categories (regular group exercise, functional health, active mind, enjoyment, social connectedness, mutual support, and expanding communities). Although the participants perceived that they were aging physically and cognitively, the regular group exercise helped them to improve or maintain their functional health and enjoy their lives. They felt socially connected and experienced a sense of security in the community through caring for others and supporting each other. As the older adults began to seek value beyond individuals, they gradually expanded their communities beyond geographical and generational boundaries. CONCLUSIONS: The participants achieved balanced health in the physical, mental, and social domains through regular group exercise as part of a community-wide physical activity intervention and contributed to expanding communities through social connectedness and mutual support. Health promotion through physical activity is being increasingly emphasized. The study results can help to develop effective physical activity programs for older adults in the community.

A self-directed home yoga programme for women with breast cancer during chemotherapy: A feasibility study.

Recent studies suggest yoga as a promising approach for improving the cognitive function of cancer survivors. We studied whether a self-directed home yoga programme was feasible for patients with breast cancer who were undergoing chemotherapy. Participants' preferences for the type of yoga course and the clinical effects of the programme were also assessed. In this study, 18 women (mean age, 43.9 years) were enrolled (44.7% recruitment rate). Of the participants, 63.6% had stage II cancer and 71.4% received adjuvant chemotherapy. Favourable retention (86%), adherence (94.4%) and acceptability (96.5%) rates were determined. Most (94.4%) of the women practiced the home programme more than twice a week on average. The participants preferred to gradually increase the intensity of the exercises. We only observed improvements in the cognitive aspects of fatigue. No serious adverse events were encountered during the programme. This self-directed home yoga programme was safe and feasible for patients with breast cancer undergoing chemotherapy.

Effects of a nurse-led medication self-management programme in cancer patients: protocol for a mixed-method randomised controlled trial.

BACKGROUND: With the widespread use of orally administered anticancer agents, self-management by cancer patients is inevitable, and adherence to medication is becoming the centre of interest in oncology. METHODS/DESIGN: This mixed-method study is a two-phased approach with a combined quantitative and qualitative design. In the first phase, we will conduct a prospective randomised controlled study to assess the effects of a nurse-led medication self-management programme for patients receiving oral anticancer treatment. Patients with metastatic breast cancer, who have been newly prescribed an oral chemotherapy or a targeted therapy agent will be enrolled in the study. The participants will be randomly assigned to either the medication self-management support programme group (intervention group) or the conventional care group (control group). This will be an open-label study; therefore, neither the patients nor the nurses will be blinded. Nurses will provide patients in the intervention group with information by using the teach-back method, help patients set a goal based on their preferences, and solve problems through follow-up counselling. The primary outcome measure is adherence to medication, to be measured on the basis of the medication possession ratio (MPR), which is the ratio of the number of days of medication supply to the total days at a specified time interval. We hypothesize that the intervention group will have an MPR of ≥90 % that is significantly higher than that of the control group. Secondary outcome measures include self-efficacy, quality of life, psychological distress, severity and interference of symptoms, patient satisfaction, emergency department visits, and hospital admissions. In the second phase, we will conduct focus-group interviews with intervention nurses, and perform a content analysis to understand their role and challenges these nurses will face in the programme while improving patients' medication adherence. DISCUSSION: The present study will be the first Japanese study to evaluate the effects of medication self-management support provided by nurses to patients with metastatic breast cancer who are receiving oral anticancer treatment. The study is characterised by a unique patient-centred approach aiming to help patients manage their medication based on their needs and preferences, with both quantitative and qualitative evaluations. The findings will contribute to the facilitation of medication management in cancer patients. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), Japan, UMIN000016597. (27 February 2015).

Erratum to: Effects of a nurse-led medication self-management programme in cancer patients: protocol for a mixed-method randomised controlled trial.

[This corrects the article DOI: 10.1186/s12912-016-0130-1.].

Are we ready for personalized cancer risk management? The view from breast-care providers.

Personalized medicine, the tailoring of prevention and treatment, is the future of routine clinical practice. This approach has started to appear in genetic testing for predisposition to hereditary breast and ovarian cancer (HBOC). We explored how breast-care providers perceived HBOC risk management, using grounded theory. This study found that the frontline healthcare providers perceived HBOC risk management as still being neglected in breast cancer care. Emerging challenges included treatment priority, hesitancy to deal with sensitive issues, easily missed risks, genetic data not being shared among multidisciplinary professionals, and patients being lost to follow-up. Oncology nurses are ideally placed to facilitate communication and utilization of genetic information among multidisciplinary professionals. Specialized outpatient clinics need to be established to follow up individuals at high risk. There is a need to create a system to meet the future demands of personalized medicine in nursing practice.

Validation of the Japanese version of the Fatigue Barriers Scale (JFBS).

BACKGROUND: The Fatigue Barriers Scale (FBS) is an instrument to identify patient-derived barriers to fatigue management. OBJECTIVE: To assess the reliability and validity of the Japanese version of the FBS (JFBS). METHODS: Participants were 112 cancer patients. Reliability was determined through internal consistency using Cronbach's alpha coefficient and through test-retest reliability using Spearman's intra-class correlation coefficient (ICC). Construct, convergent, criterion-referenced, and concurrent validities were assessed. The Cancer Fatigue Scale (CFS), Patient Fatigue Knowledge Tool (PFKT), and Kessler 6-item distress scale (K6) were used for comparisons. RESULTS: Cronbach's alpha coefficients were 0.74, 0.78, 0.72, and 0.54 for the JFBS total and for each subscale, respectively. All ICCs exceeded 0.65 (P<0.05). The JFBS had a weak negative correlation with the PFKT and a positive correlation with the CFS. The K6 scores showed weak positive correlations with the JFBS total and fatalism subscale scores. CONCLUSIONS: The JFBS can be used to measure fatigue barriers in Japanese people with cancer.

The Role of Nurse on the Treatment Decision Support for Older People with Cancer: A Systematic Review.

Background: The number of older adults with cancer is increasing worldwide. The role of nurses in supporting patients' decision-making is expanding, as this process is fraught with complexity and uncertainty due to comorbidities, frailty, cognitive decline, etc., in older adults with cancer. The aim of this review was to examine the contemporary roles of oncology nurses in the treatment decision-making process in older adults with cancer. Methods: A systematic review of PubMed, CINAHL, and PsycINFO databases was conducted in accordance with PRISMA guidelines. Results: Of the 3029 articles screened, 56 full texts were assessed for eligibility, and 13 were included in the review. We identified three themes regarding nurses' roles in the decision-making process for older adults with cancer: accurate geriatric assessments, provision of available information, and advocacy. Nurses conduct geriatric assessments to identify geriatric syndromes, provide appropriate information, elicit patient preferences, and communicate efficiently with patients and caregivers, promoting physicians. Time constraints were cited as a barrier to fulfilling nurses' roles. Conclusions: The role of nurses is to elicit patients' broader health and social care needs to facilitate patient-centered decision-making, respecting their preferences and values. Further research focusing on the role of nurses that considers diverse cancer types and healthcare systems is needed.

Growth and development of oncology nursing in Asia.

Oncology nursing is increasingly recognized around the world as being vitally important for an effective cancer control system. Granted, there is variation between and among countries/regions regarding the strength and nature of that recognition, but oncology nursing is clearly seen as a specialty practice and as a priority for development in cancer control plans, especially for high resource countries/regions. Many countries/regions are beginning to recognize that nurses are vitally important to their cancer control efforts and nurses require specialized education and infrastructure support to make a substantial contribution. The purpose of this paper is to highlight the growth and development of cancer nursing in Asia. Several brief summaries are presented by nurse leaders in cancer care from several Asian countries/regions. Their descriptions reflect illustrations of the leadership nurses are providing in cancer control practice, education, and research in their respective countries/regions. The illustrations also reflect the potential for future development and growth of oncology nursing as a specialty given the many challenges nurses face across Asia. The development of relevant education programs following basic nursing preparation, the establishment of specialty organizations for oncology nurses, and engagement by nurses in policy activity have been influential factors in the growth of oncology nursing in Asia.

[Cultivating Human Resources in Nursing for Resilient Leadership in Times of Crisis: Focusing on Advanced Nursing Education].

The corona virus disease 2019 (COVID-19) pandemic has revealed an urgent need for a sustainable healthcare system, especially human resource development. Nurses play a front-line role in the prevention of infection and countermeasures for people with health problems in health, medical, and welfare systems, and society demands that their role be further expanded. The education and training programs for nursing professionals are diverse. This study focuses on under-graduate nursing education and post-graduate education, and outlines the development of human resources in nursing for resilient leadership in times of crisis. Under-graduate nursing education is developing and expanding based on the Model Core Curriculum for Nursing Education and the reference standards for quality assurance in nursing education, while assuring the quality. For the advancement of health care and society in times of crisis, it is essential to develop nursing human resources who can respond to crises of life, livelihood, and survival across multiple dimensions. To achieve this, it is necessary for educational institutions, medical institutions, and governmental agencies to strengthen cooperation and collaboration, and to promote the development of human resources who can build a sustainable, equitable, and resilient society.

Cancer survivorship care for post-treatment cancer survivors in Japan: A secondary analysis of a multinational study across Asia-Pacific countries.

Objective: The global understanding of cancer survivorship care leads to optimal care delivery for cancer survivors. This study aimed to assess the perceptions of Japanese oncology nurses regarding cancer survivorship care and explore the factors influencing the provision of survivorship care. Methods: A questionnaire survey of oncology nurses was conducted as part of a multinational, cross-sectional survey. A 29-item measurement scale with four subscales regarding survivorship care was used to assess nurses' perceptions regarding responsibility, confidence, and frequency of practice for cancer survivors. Additionally, we investigated a list of 16 factors influencing the provision of survivorship care. Results: Among 181 oncology nurses, the mean adjusted scores for survivorship care items were 65.6-84.7, 16.8-44.7, and 29.2-47.2 for responsibility, confidence, and frequency, respectively. Significant correlations were observed in the subscales for frequency of care with responsibility (r â€‹= â€‹0.315-0.385, P â€‹< â€‹0.001) and confidence (r â€‹= â€‹0.428-0.572, P â€‹< â€‹0.001). Participants with >10 years of experience in cancer care reported more frequent performance on surveillance than those with ≤ 5 years of experience (P â€‹= â€‹0.03). The major barriers for providing survivorship care by oncology nurses were lack of knowledge and skills (87.8%), lack of time (81.8%), and not seeing the value of survivorship care (79.6%). Conclusions: Oncology nurses face many challenges regarding survivorship care, even though they recognize their responsibility. Educational support for oncology nurses is warranted to overcome impeding factors and improve confidence.

The relationship between work-related outcomes and symptoms in early breast cancer survivors receiving adjuvant endocrine therapy.

Objective: This study examined the relationship between symptom burdens and work-related outcomes, including work participation and overall work impairment (OWI) among breast cancer survivors (BCS) receiving adjuvant endocrine therapy (AET). Methods: This was a cross-sectional study with 140 BCS of working age receiving AET. Data were collected using self-report questionnaires that included an assessment of symptoms and their employment status, and OWI. Data were analyzed using descriptive statistics and multiple logistic regression analysis. Results: A total of 111 (79%) survivors reported being employed at the time of the survey. Symptom burdens were not associated with unemployment. Of the 110 working BCS receiving AET, symptom burdens were significantly related to a higher degree of OWI (OR â€‹= â€‹2.14, 95% CI, 1.58-2.89, P â€‹≤ â€‹0.001). Conclusions: Participating BCS receiving AET continued to work while experiencing symptoms, with survivors who experienced high symptom burdens being negatively affected in their work life. Healthcare providers need to assess and manage symptoms and their impact on work, with the help of employers, to improve the quality of work life of BCS receiving AET.

Preconditions for successful guideline implementation: perceptions of oncology nurses.

BACKGROUND: Although evidence-based guidelines are important for improving the quality of patient care, implementation in practice is below expectations. With the recent focus on team care, guidelines are intended to promote the integration of care across multiple disciplines. We conducted an exploratory study to understand oncology nurses' perceptions of guideline implementation and to learn their views on how their experiences affected the implementation. METHODS: A qualitative study was used with focus group interviews. We collected data from 11 nurses with more than 5 years of oncology nursing experience in Japan. The data were analyzed using grounded theory. RESULTS: Results of the analysis identified "preconditions for successful guideline implementation" as a core category. There were 4 categories (goal congruence, equal partnership, professional self-development and user-friendliness) and 11 subcategories related to organizational, multidisciplinary, individual, and guideline levels. CONCLUSIONS: Although the guidelines were viewed as important, they were not fully implemented in practice. There are preconditions at the organizational, multidisciplinary, individual, and guideline levels that must be met if an organization is to successfully implement the guideline in clinical settings. Prioritizing strategies by focusing on these preconditions will help to facilitate successful guideline implementation.