The concept of spirituality in the context of Chinese patients with cancer: A scoping review.

AIM: To elucidate how the concept of spirituality has been addressed in studies with Chinese people with cancer. DESIGN: A scoping review. METHODS: Patterns in conceptual definitions of spirituality and indicators for measuring spirituality were analysed. DATA SOURCES (INCLUDE SEARCH DATES): Literature published from inception to August 2022 was searched in five electronic databases (CINAHL, PubMed, Web of Science, PsycINFO and a Chinese database). RESULTS: Using data from 10 qualitative studies, a new taxonomy of concepts of spirituality among Chinese people with cancer was derived, consisting of four categories: Creation of meaning, Connection, Transcendence and Existence. A total of 12 instruments developed outside of Chinese contexts and used to measure dimensions of spirituality across 27 quantitative studies were compared to the taxonomy developed in this review, and patterns were identified according to the dimensions of spirituality. Several instruments required modifications or additional explanations in questions regarding God/Higher Power and religion. CONCLUSION: The four categories of spirituality classified in the current review are considered universal across all cultural contexts. Spirituality is multidimensional and functional concept, and the components of the instruments differed depending on which dimension of spirituality was being measured. IMPACT: The findings of this study suggest that for measuring spirituality in research and clinical settings with Chinese people with cancer, it is important to use culturally appropriate scales that are consistent with the dimensions of spirituality being measured. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Even instruments developed outside of the Chinese context could be used for Chinese people with cancer if appropriately selected for their intended use. REPORTING METHOD: This paper adheres to the EQUATOR guidelines and has no direct patient or public contribution.

Ensuring reliability and cultural validity of the Indonesian version of the Quality Of Life Index for patients with cancer.

The objective of this study was to translate the Ferrans and Powers Quality of Life Index (QLI) into the Indonesian language, considering its cultural and functional appropriateness, and to evaluate its psychometric properties by testing the reliability and validity. A committee approach was conducted to create the Indonesian version of the QLI (QLI-Id) and cognitive interviewing with 15 patients with cancer was conducted to identify potential problems or errors in answering the QLI-Id. A cross-sectional descriptive study was carried out using 236 responses to the QLI-Id questionnaire from patients with cancer; 62 of whom completed the same questionnaire twice within a 3-week interval to verify stability reliability. Confirmatory factor analysis results supported construct validity with model fit statistics for the original single-factor and four-factor structure of the QLI (corresponding to the QLI's total score and four subscale scores, respectively) with some rearrangement of the items within each subscale. Reliability for the total QLI-Id scale was supported by McDonald's Omega of 0.92 and the intraclass/intrasubject correlation coefficient at two time points of 0.86. The strong correlation between the QLI-Id total and the Satisfaction with Life Scale scores and the overall health/QOL domain of the EORTC QLQ-C30 (both r = 0.73) supported its construct validity. This study provides evidence for the reliability and validity of the QLI-Id as an instrument to measure the impact of cancer on the overall QOL of Indonesian patients.

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.

Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy.

BACKGROUND: Breast cancer is the most common diagnosis and the leading cause of cancer death among women worldwide and ranks first among Asian and Taiwanese women. Cancer-related fatigue (CRF) affects patients' functioning significantly. AIMS: The aim of this study was to examine changes in cancer-related fatigue (CRF) and related factors among women with breast cancer undergoing a single chemotherapy, and to identify predictors of CRF's change over the course of the chemotherapy cycle. METHODS: Four self-report questionnaires were administered to assess CRF, sleep quality, depression and anxiety, and symptom distress. Heart rate variability (HRV) was assessed to evaluate autonomic nervous system activation related to CRF. Data were collected four times: (1) before initiation of the single chemotherapy cycle (T0), (2) after completion of the single cycle (T1), (3) 1 week post-chemo (T2), and (4) 3 weeks post-chemo (T3). Repeated measurement of variance and generalized estimating equations (GEE) were conducted to estimate the trajectories and predictors. RESULTS: One-hundred women with breast cancer (mean age 50.4 ± 9.42) participated. CRF (F = 7.46), sleep quality (F = 2.74), symptom distress (F = 9.99), anxiety (F = 5.72), and depression (F = 4.14) varied significantly over the single cycle of chemotherapy (p < .001), which the trajectories showed exacerbating at T2. HRV indicated a higher variation only on the day of injection (T0, T1). Results of the GEE revealed that anxiety, depression, and symptom distress were predictors of CRF's change over the single cycle of chemotherapy. LINKING EVIDENCE TO ACTION: CRF worsens at 1 week after a chemotherapy injection among Taiwanese women with breast cancer. Based on the risk predictors in CRF that included anxiety, depression, and symptom distress, multistrategy CRF-alleviating interventions should be provided prior to chemotherapy and targeted at the most disturbed period, that is, 1 week after injection.

Reliability and validity of the Japanese version of the Quality of Life Index for patients with cancer.

This study was designed to evaluate the psychometric properties of the newly completed Japanese translation of the Ferrans and Powers Quality of Life Index Cancer Version III (QLI). Using a cross-sectional descriptive design, 136 ambulatory patients with gastrointestinal cancer (55 receiving chemotherapy, 76 with stable health status after treatment, and five status not known) completed a questionnaire at a one-time point, and 26 patients (stable health status) completed the questionnaire again 2 weeks later. Internal consistency reliability was supported by Cronbach's α of .96 for the total scale, with subscales ranging from .83 to .93. A test-retest correlation of 0.76 (total scale) provided evidence of stability reliability over a 2-week period, with subscale retest correlations ranging from 0.70 to 0.83. Confirmatory factor analysis showed the same four domains for the Japanese translation as the original QLI, supporting construct validity. We also assessed construct validity by examining the relationships between the Japanese QLI and six other concepts known to be related to the quality of life. As hypothesized, all correlations were moderate and in the expected direction (pain -0.39, anxiety -0.54, depression -0.63, stress -0.51, pain interfering with functioning -0.52, and general health 0.62). This evidence of the reliability and validity of the Japanese translation of the QLI supports its use in research and clinical practice to evaluate the impact of cancer and treatment. This new translation can be used to assess the patient's perspective of their quality of life, both within Japan and in cross-cultural studies with the QLI in other languages.

Attitudinal Barriers to Pain Management and Associated Factors Among Cancer Patients in Mainland China: Implications for Cancer Education.

Attitudinal barriers to pain management are supposed to contribute to the uncontrolled cancer pain in mainland China. The purpose of this study was (1) to investigate the attitudinal barriers to pain management among cancer patients in mainland China, (2) to examine relationships between the attitudinal barriers and patients' pain management conditions in the light of medication adherence and adequacy of analgesic use, and (3) to identify factors associated with the attitudinal barriers. A cross-sectional questionnaire survey, including the Barriers Questionnaire-Chinese (BQ-C) and two scales that measure the medication adherence and the adequacy of analgesic use, was carried out among patients with a variety of cancers. The questionnaires were completed by 246 cancer patients (response rate 94.6%); their mean age was 51.5 years (SD = 11.7). Almost all the patients had various attitudinal barriers to pain management. The mean scores for the total scale and several subscales of the BQ-C were significantly different by the patients' characteristics, the medication adherence, and the adequacy of analgesic use. The associations with these variables for a given subscale, e.g., the subscale regarding concerns about side effects, were different from those for other subscales, e.g., the subscale regarding fatalism that cancer pain is uncontrollable. The findings suggest that a nurse-led educational program in the light of patients' characteristics is required for overcoming the attitudinal barriers to pain management among cancer patients in mainland China.

Acceptability to making a self-assessment using a tablet computer and health-related quality of life in ambulatory breast cancer patients.

Objective: The purpose of this study was to examine patient acceptability to making self-assessments of their health conditions using a tablet computer-based questionnaire and identify associations between acceptability and health-related quality of life (HR-QOL). Methods: This study used a convenience sample of 54 patients with breast cancer being treated in an outpatient setting. Participants made self-assessments using a tablet computer-based questionnaire and upon completion they received a report of their results. The HR-QOL self-assessment questionnaire comprised three standardized instruments. Participants gave interviews and completed a survey at home. A follow-up, paper-based HR-QOL self-assessment was completed one month later. Results: Making a self-assessment with a tablet computer was acceptable to most participants, and several factors were identified to be associated with self-assessment making and patient HR-QOL. Participants' who were experiencing symptoms, interference, deteriorating physical function, and unsatisfactory levels of well-being were more favorably disposed toward making a self-assessment. At the one-month follow-up survey, however, participants' subjective well-being and physical function had decreased on average. Conclusions: Patients found the HR-QOL self-assessments easy to complete in the clinical setting, and those with symptoms were particularly interested in completing the assessment. However, simply providing HR-QOL information to patients only (and not to staff) was insufficient to improve HR-QOL long-term, which decreased for participants over the month following the initial HR-QOL self-assessment. Thus, the findings of this study encourage the integration of HR-QOL self-assessments into clinical care at the time of the clinic visit, so they can be used in real time to improve HR-QOL.

Effectiveness of an online support program to help female cancer patients manage their health and illness: Protocol for a randomized controlled trial.

Background: The aim of the trial is to evaluate the effectiveness of interventions provided by online support program apps, adopting health-related quality of life (HR-QOL) scores as indicators. Methods: The design is as an open, randomized, parallel-group trial with longitudinal data collection. The subjects will be female cancer patients receiving treatment in a Japanese National Cancer Hospital. Patients assigned to the experimental group will use three apps: an app for them to monitor their own health (monitoring app), an app to assess their understanding of their diagnosis and treatment and their readiness to receive treatment (confirmation app), and an app to address mental health issues (writing app); patients assigned to the control group will use only the monitoring app. At baseline (before patients undergo cancer treatment) and three other times during the study, evaluation indicators will be obtained from three different standardized HR-QOL scales that are incorporated in the monitoring app. The study hypothesis is that at 6 months after patients' baseline health monitoring, patients in the experimental group will have improved HR-QOL as compared with patients in the control group. Conclusion: This study is based on self-regulation theory, so it is important that the online support program works in an efficient way with respect to patients finding and setting their own health-related goals and adapting their behaviors to achieve those goals. Verifying the effectiveness of the combination of the three apps will show that it is a scientifically valid approach to maintaining or improving the HR-QOL of cancer patients.

Ensuring Cultural and Cognitive Integrity in Instrument Translation: Quality of Life Index for Japanese Cancer Patients.

OBJECTIVE: The objective of this paper is to provide a practical illustration of methods useful for translating and testing questionnaire instruments for nursing and healthcare to ensure reliability, validity, and appropriateness for the target culture. METHODS: We present the process used to create the Japanese version of a well-established quality of life (QOL) instrument, originally developed in American English. The Ferrans and Powers Quality of Life Index (QLI)-Cancer Version III was translated into Japanese by a team of bilingual translators and tested using an iterative process involving cognitive interviewing with monolingual Japanese cancer patients. RESULTS: Discussions among the translation team made it possible to find and resolve linguistic, cultural, and practical issues regarding the translation. Problems stemming from question interpretation and information retrieval were resolved through the cognitive interviewing process. One problem related to response editing could not be remedied with altered phrasing, namely a question referring to the respondents' sex lives. This item was retained in the Japanese version of the QLI as an indispensable component of QOL, particularly in a healthcare context. CONCLUSIONS: The final Japanese version captured the intended meaning of the original, and also was culturally appropriate and clearly understood by Japanese cancer patients.

Longitudinal Study on Quality of Life and Psychosocial Conditions in Light of Responses to Illness-Related Information in Postoperative Cancer Patients.

OBJECTIVE: Illness-related information can be significant for cancer patients after gastrointestinal (GI) surgery in terms of their performing adaptive tasks. This study longitudinally investigated the health outcomes of Japanese patients who read a booklet about cancer patients' problems and adaption tasks and evaluated the association between the responses to the booklet and the patients' health outcomes. METHODS: A questionnaire survey about quality of life (QOL), fatigue, anxiety, cognitive plight, and resilience was administered to postoperative patients with GI cancer 1 week after their discharge from hospital and 6 months after surgery. The questionnaires were returned by email. RESULTS: The mean age of the 32 patients at 1 week was 60.9 years; nearly 68.8% of them were men. As a whole, only two variables, QOL and anxiety, were significantly improved at 6 months over those at 1 week. Three statements were taken to gauge the responses to the booklet. In the two-way ANOVA that took QOL and responses to the booklet as independent variables, the post hoc test found that QOL was significantly improved in patients who agreed with the statement "I vaguely understood the content" or "I will deal with my tasks as described in the scenarios" but not in patients who agreed with the statement "The scenarios reflect my situation." The anxiety in patients who agreed with the statement "The scenarios reflect my situation" was high at both survey points. CONCLUSIONS: This study suggests that associations between the responses to the informational booklet and patients' health outcomes partially indicate the directional property of how to support their information usage.

Relationship between the Physical and Psychosocial Conditions of Postoperative Gastrointestinal Cancer Patients and their Responses to an Informational Material.

OBJECTIVE: Postoperative patients with gastrointestinal (GI) cancer have multiple adaptation tasks and care needs to improve their quality of life (QOL). Whether their supportive care needs differ according to their physical and psychosocial conditions is unclear. This study investigated patients' (1) physical and psychosocial conditions (QOL, fatigue, anxiety, cognitive plight, and resilience) and (2) responses to an informational booklet describing cancer patients' problems and adaptation tasks, and examined the association between the two factors. METHODS: A questionnaire survey was conducted to postoperative patients with GI cancer. RESULTS: The mean age of the 69 respondents was 63 years; 59.4% of the respondents were men. Nine patients who did not read the booklet showed high fatigue and cognitive plight and low QOL. The patients (36.2%) who chose "I vaguely understood the content" showed low scores for resilience and cognitive plight while those (8.5%) who chose "I will deal with my tasks as described in the scenarios" showed high scores for both of these variables. CONCLUSIONS: The condition of some patients continued to be highly affected by their cancer. In terms of understanding the contents of the booklet, resilience was significant, and cognitive plight did not necessarily have a negative impact. The provision of information by means of a booklet might not be suitable for patients who are highly affected by their cancer. Patients may need additional support to be able to make good use of the information provided in such a booklet.

Psychological Stress and Coping in Recently Discharged Postsurgical Cancer Patients.

OBJECTIVE: Cancer patients and survivors need to cope with various stressful situations and problems even after treatment. In this study, we sought to investigate psychological stress and coping in recently discharged postsurgical cancer patients. METHODS: A mail-in questionnaire survey about stress response, perceived illness-related demands, and coping strategies and styles was administered to postsurgical Japanese cancer patients. The questionnaires were returned a week after the patients' discharge from the hospital. Descriptive and nonparametric statistical analyses were used. RESULTS: Forty-two patients completed the questionnaire; their average age was 58.1 years, and 61.9% were female. The stress response scale-18 (SRS-18) score was lower than that reported among the general population. The proportion of patients who were concentrating coping on social support or positive reappraisal was high. The scores for problem- and emotion-focused coping were nearly identical. SRS-18 scores were weakly correlated with those for emotion-focused coping (r = 0.38, P = 0.014). The demographic data were not significantly associated with any of the stress or coping variables. However, SRS-18 scores for patients who had adjuvant therapy and physical, functional disorders were significantly higher than those for patients who did not (P = 0.004 and P = 0.008, respectively). CONCLUSIONS: Most of the patients had a low-stress response and used appropriate coping strategies. However, the findings suggest that attention must be paid to stress-coping in patients who have a physical, functional disorder as well as in those receiving adjuvant therapy.

Truth disclosure of cancer diagnoses and its influence on bereaved Japanese families.

The purpose of this study was to investigate how patients with cancer and their families are informed of the results of the patients' diagnoses. The bereaved families' assessments and satisfaction with the consequences of their decisions were examined after the patients' deaths. Data were collected from the bereaved families of 53 patients who had died of lung cancer at a Japanese university hospital between January 1994 and December 1997. Data were analyzed by employing descriptive statistics for each factor. Fifty-three bereaved families responded to the questionnaire. The true diagnosis-lung cancer-was disclosed to 15.1% of the patients, whereas 26.4% were told that they were suffering from lung tumors. Other less ominous clinical descriptions were given to 58.5% of the participants. Concerning the bereaved families' responses to the manner in which the decisions had been made on truth disclosure, the average degree of satisfaction was expressed as 3.7 cm on a 5.0-cm scale. An ambiguous expression such as "lung tumor" has been arbitrarily interpreted. However, simple truth disclosure to the patient does not necessarily satisfy a bereaved family. If family members can allay a patient's doubt about the diagnosis, the family's satisfaction may improve.

Adaptation status and related factors at 2 time points after surgery in patients with gastrointestinal tract cancer.

BACKGROUND: The diagnosis of cancer and subsequent surgery represent a life-threatening and stressful experience with several factors relating to the patient's process of adaptation. OBJECTIVE: The purpose of this longitudinal study was to examine adaptation status and related factors in patients who have been diagnosed with and undergone surgery for gastrointestinal tract cancer. METHODS: The survey was administered twice (2 weeks after discharge from the hospital and 6 months after surgery). Twenty-five patients responded to both questionnaires about quality of life (QOL), which was regarded as an index of adaptation status, and illness-related demands, the "why me?" question, sense of coherence (SOC), perceived social support, and disease data. RESULTS: On the second survey, scores about illness-related demands, the "why me?" question, SOC, and QOL, other than the QOL social relationships domain, improved, but scores about perceived social support decreased. A correlation between the "why me?" question and the SOC and the difference in the overall QOL by cancer site were found only on the second survey. Low demands of illness and high SOC predicted high QOL on both surveys. CONCLUSIONS: Except for social relationships, adaptation status 6 months after surgery improved compared with after discharge. The relationships between some variables took on a significant meaning at 6 months after surgery. IMPLICATIONS FOR PRACTICE: Comparisons between 2 time points suggested that most cancer patients had dispositional resilience. Meanwhile, the findings related to social relationships and the relationships between some variables suggested the necessity for professional interventions targeting these factors.

The effects of sense of coherence, demands of illness, and social support on quality of life after surgery in patients with gastrointestinal tract cancer.

PURPOSE/OBJECTIVES: To examine the relationship between quality of life (QOL) as an index of adaptation status and concepts related to self-care skills of patients who have been diagnosed with and undergone surgery for digestive system cancer: sense of coherence (SOC), social support, demands of illness, and the thought "Why me?" DESIGN: Cross-sectional survey. SETTING: General hospitals in Japan. SAMPLE: 60 patients who had been newly diagnosed with digestive system cancer and had undergone surgery. METHODS: Questionnaires were distributed to participants whose discharge date had been determined. The questionnaires were returned through the mail within two weeks of the discharge date. MAIN RESEARCH VARIABLES: QOL, SOC, social support, demands of illness, and the thought "Why me?" FINDINGS: QOL was strongly correlated with SOC and the demands of illness and was moderately correlated with social support. The only variable that was negatively correlated with SOC was the question, "Why me?" SOC and demands of illness accounted for 54% of the variance in QOL; social support was not a significant factor. CONCLUSIONS: This study suggests that SOC is positively correlated with QOL and the demands of illness are negatively correlated with QOL among study participants. IMPLICATIONS FOR NURSING: Nursing interventions focusing on SOC and illness demands may have a significant effect on QOL of patients following cancer surgery.

Experiences of Japanese patients with colorectal cancer during the first six months after surgery.

PURPOSE/OBJECTIVES: To investigate the dynamic experience of patients who recently experienced the stressful situation of being diagnosed with colorectal cancer and undergoing surgery. RESEARCH APPROACH: A qualitative and inductive inquiry. SETTING: General hospitals in Japan. PARTICIPANTS: 12 patients who had undergone colorectal cancer surgery and had been discharged in the previous six months. METHODOLOGIC APPROACH: To inductively elicit the findings from patients' real experiences, interviews and qualitative analysis were used. MAIN RESEARCH VARIABLES: Experience of patients with colorectal cancer. FINDINGS: Three domains that symbolized experiences of patients with colorectal cancer during the first six months after surgery emerged: types of burdens, steps in accepting the cancer diagnosis, and way of living a normal life. Burdens included vulnerability, lack of control, asking for assistance or support, and a "why has this happened to me?" attitude. Way of living a normal life included resisting vulnerability, constructing a daily living routine, and asking for help. CONCLUSIONS: Although patients faced many and varied burdens, they were able to take several actions to gradually accept their cancer diagnoses and resume normal lives. INTERPRETATION: Some of the patients were sincere and skillful in asking for help to live normal lives, but others found that difficult. The present findings are significant in helping nurses provide interventions to enable patients to make use of assistance or support.

Distress of inpatients with terminal cancer in Japanese palliative care units: from the viewpoint of spirituality.

A qualitative study was conducted in an attempt to improve our understanding of the spiritual distress of terminally ill cancer patients in Japan. The subjects were inpatients at four approved palliative care units in Japan. The patients were interviewed and they expressed their own experiences in which spirituality was considered to be identifiable. Literal records of the interviews were analyzed using constant comparative analyses as proposed in relation to the grounded theory approach. The analysis included 11 inpatients and a variety of expressions of distress were obtained. After the conditions of the subjects were evaluated in order to search for common factors related to distress, consciousness of the gap between the patient's aspirations and the present situation were found to cause gap-induced distress. Distress was classified into three categories: distress due to the gap between the present situation and how the individual wanted to live, how the individual wished to die, and the individual's wish to maintain relations with others. The aspirations causing the gap were then interpreted from the viewpoint of spirituality as "anchors in life" for Japanese patients with terminal cancer. It was also revealed that in patients who possessed pictures of how they wished to die as their "anchors in life" and who were in a severe physical condition, distress increased and they became confused after their physical symptoms were relieved following admission to PCU.