Feasibility and face validity of two patient reported outcome measures for nausea: Preferences of children with cancer.

PURPOSE: To optimize recognition and management of nausea in children with cancer using patient reported outcome measures (PROMs) and to identify preferences of children with cancer regarding two validated tools: the Baxter Retching Faces (BARF) scale and the Pediatric Nausea Assessment Tool (PeNAT). DESIGN AND METHODS: This quantitative descriptive cross-sectional study (n = 34) used bespoke questionnaires to measure feasibility and face validity of the BARF and the PeNAT. Feasibility included the items: understanding, ease of use, and communication. Face validity was studied in terms of the degree in which the faces of both PROMs corresponded with children's feelings of nausea. A descriptive and comparative analysis of the data was performed. RESULTS: Both the BARF and the PeNAT were rated by the children as feasible, and no significant differences were found. However, regarding the item communication, the PeNAT did not reach the cut-off value (≥80% of all children scored neutral, agree or totally agree on the Likert scale). Regarding face validity, only the BARF reached the cut-off value and corresponded significantly better with children's feelings of nausea than the PeNAT. CONCLUSION: According to children with cancer, only the BARF is both feasible and meets criteria for face validity. Therefore, the BARF is recommended as a PROM for reporting nausea in children with cancer. However, possible differences between age groups should be taken into account for future research. PRACTICE IMPLICATIONS: This study will help health care professionals in making a patient-centered and informed choice when using a PROM for measuring nausea in children with cancer.

A cross-sectional study on Chinese oncology nurses' knowledge of bone health among cancer patients.

OBJECTIVE: To understand the knowledge status, obstacle factors, and management confidence of oncology nurses on the bone health of cancer patients, and in addition to provide reference for establishing bone health knowledge training system for oncology nurses and guiding them to manage bone health of cancer patients. METHODS: A total of 602 nurses engaged in oncology nursing in 6 hospitals in Hebei Province were selected by cluster sampling, and an online anonymous survey was conducted by sending questionnaires to oncology nurses from the Hebei Cancer Prevention and Control Association. The questionnaire was developed by the study team. There are 4 parts, namely general information, nurses' role and job responsibilities, knowledge of skeletal-related events (SREs) and cancer treatment-induced bone loss (CTIBL), and understanding and confidence in bone health management, for a total of 33 questions. RESULTS: Thirty-seven percent of oncology nurses received training on bone health and other related contents; 40.48% of oncology nurses used domestic and foreign guidelines when managing patients with bone metastases or CTIBL. Only approximately one-third of oncology nurses had confidence in managing the side effects of bone metastases and bone modification drugs and identifying patients at risk of CTIBL and fracture; only 33.04% of oncology nurses believed that weight-bearing exercise can prevent bone loss; less than 50% of oncology nurses believed that aromatase inhibitor therapy, ovarian suppression therapy, androgen deprivation therapy, and low body weight were risk factors for pathological fractures. The reasons that hindered oncology nurses from optimizing the management of patients with bone metastases and understanding the preventive measures and risk factors for bone loss mainly included lack of relevant knowledge training, lack of understanding of effective intervention measures, and lack of training and professionalism of specialized nurses, including insufficient development time and guidelines for clinical nursing practice. CONCLUSION: Managers must continuously improve the training system of oncology nurses, enrich the content of training pertaining to bone health for cancer patients, formulate clinical nursing practice guidelines, and give oncology nurses more time for professional development.

Dying at "home" - a qualitative study of end-of-life care in rural Northern Norway from the perspective of health care professionals.

BACKGROUND: 'Most patients want to die at home' is a familiar statement in palliative care. The rate of home deaths is therefore often used as a success criterion. However, providing palliative care and enabling patients to die at home in rural and remote areas may be challenging due to limited health care resources and geographical factors. In this study we explored health care professionals' experiences and reflections on providing palliative care to patients at the end of life in rural Northern Norway. METHODS: This is a qualitative focus group and interview study in rural Northern Norway including 52 health care professionals. Five uni-professional focus group discussions were followed by five interprofessional focus group discussions and six individual interviews. Transcripts were analysed thematically. RESULTS: Health care professionals did their utmost to fulfil patients' wishes to die at home. They described pros and cons of providing palliative care in rural communities, especially their dual roles as health care professionals and neighbours, friends or even relatives of patients. Continuity and carers' important contributions were underlined. When home death was considered difficult or impossible, nurses expressed a pragmatic attitude, and the concept of home was extended to include 'home place' in the form of local health care facilities. CONCLUSIONS: Providing palliative care in patients' homes is professionally and ethically challenging, and health care professionals' dual roles in rural areas may lead to additional pressure. These factors need to be considered and addressed in discussions of the organization of care. Nurses' pragmatic attitude when transfer to a local health care facility was necessary underlines the importance of building on local knowledge and collaboration. Systematic use of advance care planning may be one way of facilitating discussions between patients, family carers and health care professionals with the aim of achieving mutual understanding of what is feasible in a rural context.

The prevalence, related factors and interventions of oncology nurses' burnout in different continents: A systematic review and meta-analysis.

BACKGROUND: Burnout is a significant occupational problem among oncology nurses, affecting their physical and mental health and the quality of medical care. Besides, there is a gradually increasing trend that we should pay more attention to. OBJECTIVES: To investigate the prevalence, influencing factors and interventions of oncology nurses' burnout among different continents. DESIGN: Systematic review and meta-analysis. DATA SOURCES: English literature in PubMed, EMBASE, MEDLINE/EBSCOhost, CINAHL Complete and Web and of Science were searched before 1 March 2022. RESULTS: Twenty studies included 5904 oncology nurses in this review. Meta-analysis was performed in 19 of the studies. First, the pooled mean scores estimate for emotional exhaustion (EE) was 22.13 (95% CI: 19.69-24.58), depersonalization (DP) was 6.89 (95% CI: 5.67-8.10) and personal accomplishment (PA) was 32.86 (95% CI: 29.34-36.37). A high level of burnout was defined as a high level of EE (score ≥ 27), a high level of DP (score ≥ 10), and a low level of PA (score ≤ 33). Of these, 36.40% of nurses reported high EE, 28.26% reported high DP and 28.68% reported low levels of PA. Furthermore, there are differences in the prevalence, influencing factors and intervention measures of burnout among oncology nurses in different regions. The highest pooled mean scores for EE and DP were found in Asia. And the highest pooled mean scores for PA were found in the Americas. The factors that influence burnout among Asian oncology nurses are mostly personal-related factors such as empathy and personality traits, while the factors that influence burnout among European oncology nurses are work-related factors. This review included three intervention studies from Europe and the Americas, with fewer intervention studies on burnout in oncology nurses in Asia. CONCLUSION: Oncology nurses in Asia had the highest pooled mean scores for EE and DP, and the highest mean scores for the PA pool in the Americas. There are regional differences in the prevalence and factors influencing burnout among oncology nurses, but there are few interventions for it. Therefore, future interventions should be developed to address the differences that exist in different regions. RELEVANCE TO CLINICAL PRACTICE: Burnout among oncology nurses in different regions is a concern, and this review may provide a reference for managers to target interventions to alleviate burnout among oncology nurses.

Effectiveness of oncology nurse navigator on the incidence of postoperative pulmonary complications in gastric cancer patients undergoing radical gastrectomy.

BACKGROUND: Management of postoperative pulmonary complications (PPCs) can be challenging in gastric cancer patients undergoing radical gastrectomy and is always associated with poor prognosis. Even though oncology nurse navigator (ONN) provide effective and critical individualized care to patients, little is known about their impact on the occurrence of PPCs in gastric cancer patients. This study aimed to determine whether ONN decreases the incidence of PPCs in gastric cancer patients. METHODS: This was a retrospective review in which data for gastric cancer patients at one centre was evaluated before and after an ONN hired. An ONN was introduced to patients at their initial visit to manage pulmonary complications throughout treatment. The research was conducted from 1 August 2020 to 31 January 2022. The study participants were divided into the non-ONN group (from 1 August 2020 to 31 January 2021) and the ONN group (from 1 August 2021 to 31 January 2022). The incidence and severity of PPCs between the groups were then compared. RESULTS: ONN significantly decreased the incidence of PPCs (15.0% vs. 9.8%) (OR = 2.532(95% CI: 1.087-3.378, P = 0.045)), but there was no significant difference in the components of PPCs including pleural effusion, atelectasis, respiratory infection, and pneumothorax. The severity of PPCs was also significantly higher in the non-ONN group (p = 0.020). No significant statistical difference was observed for the major pulmonary complications ([Formula: see text] 3) between the two groups (p = 0.286). CONCLUSIONS: Role of ONN significantly decrease the incidence of PPCs in gastric cancer patients undergoing radical gastrectomy.

Documenting patients' and providers' preferences when proposing a randomized controlled trial: a qualitative exploration.

BACKGROUND: With advances in cancer diagnosis and treatment, women with early-stage breast cancer (ESBC) are living longer, increasing the number of patients receiving post-treatment follow-up care. Best-practice survivorship models recommend transitioning ESBC patients from oncology-provider (OP) care to community-based care. While developing materials for a future randomized controlled trial (RCT) to test the feasibility of a nurse-led Telephone Survivorship Clinic (TSC) for a smooth transition of ESBC survivors to follow-up care, we explored patients' and OPs' reactions to several of our proposed methods. METHODS: We used a qualitative study design with thematic analysis and a two-pronged approach. We interviewed OPs, seeking feedback on ways to recruit their ESBC patients for the trial, and ESBC patients, seeking input on a questionnaire package assessing outcomes and processes in the trial. RESULTS: OPs identified facilitators and barriers and offered suggestions for study design and recruitment process improvement. Facilitators included the novelty and utility of the study and simplicity of methods; barriers included lack of coordination between treating and discharging clinicians, time constraints, language barriers, motivation, and using a paper-based referral letter. OPs suggested using a combination of electronic and paper referral letters and supporting clinicians to help with recruitment. Patient advisors reported satisfaction with the content and length of the assessment package. However, they questioned the relevance of some questions (childhood trauma) while adding questions about trust in physicians and proximity to primary-care providers. CONCLUSIONS: OPs and patient advisors rated our methods for the proposed trial highly for their simplicity and relevance then suggested changes. These findings document processes that could be effective for cancer-patient recruitment in survivorship clinical trials.

Thai oncology nurses' perspectives toward survivorship care plan components and implementation for colorectal cancer survivors.

PURPOSE: To describe oncology nurses' perspectives regarding survivorship care plan (SCP) components and implementation for colorectal cancer (CRC) survivors in Thailand. METHODS: A cross-sectional, descriptive online study was conducted between October and November 2020. Thai oncology nurses were recruited using Facebook and the Line application. Study participants (n = 160) rated the usefulness of four standard SCP components (treatment summaries, surveillance, late/long-term effects, and health promotion and psychosocial needs; n = 23 items) and gave input on the implementation of SCPs in clinical practice (n = 11 items). Data were analyzed using descriptive statistics. RESULTS: Most oncology nurses supported providing CRC survivors with SCPs (93.2%) and felt that SCPs were an important part of their practice (93.7%). Nurses rated all four SCP components as "very useful," including treatment summaries (76.4%), surveillance (81.9%), late/long-term effects (85.7%), and health behavior and psychosocial concerns (80.2%). In terms of implementation, most nurses indicated that oncologists should prepare (84.4%) and provide SCPs (95%), but 61.9% and 69.4% of nurses, respectively, also believed that they should perform these tasks. In addition, most nurses indicated that they should play a significant role in the ongoing management of CRC survivors (95.7%) and that evidence-based surveillance guidelines are needed (96.2%). CONCLUSION: Oncology nurses believed that the four SCP components were helpful to the long-term management of CRC survivors, supported SCP provision, and expressed their perceived responsibilities for preparing and delivering SCPs. The findings suggested opportunities for oncology nurses to play a significant role in developing and implementing SCPs. However, additional efforts are needed to expand nurses' roles in survivorship care and establish practice guidelines that will facilitate integration of SCPs into nursing practice.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study.

BACKGROUND: Although videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses' ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey. OBJECTIVE: This study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs). METHODS: In this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis. RESULTS: Most patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present. CONCLUSIONS: Person-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/27940.

[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.

Improving nurses' performance in the safe handling of antineoplastic agents: a quasi-experimental study.

BACKGROUND: The safe and standard handling of antineoplastic drugs can reduce the effects of occupational exposure and promote safe behaviors in nurses. Thus, the present study aimed to determine the effects ofstandard guidelines education on the safe handling of antineoplastic drugs among oncologynurses in Ardabil, Iran. METHODS: Thequasi-experimental study with a one-group pretest-posttest design was performed among 32 nursesworking in the oncology wards of two educational hospitals in Ardabil city, during 2020. Allthe nurses in the wards who met the inclusion criteria participated in the study. The data were collectedby usinga demographic information form and nurses'knowledge assessment questionnaire regardingthe standard guidelines for working with antineoplastic drugs, and a standard checklist for examiningtheir performance in this regard. Subsequently, they were analyzed by descriptive (mean and standard deviation) and inferential statistics (t-test)and Pearson's correlation coefficient) in SPSS 22. RESULTS: The mean and standard deviation of the knowledge and performance scores of the oncology nurses was59.56±6.41and 18.96±2.54 respectively, which changed to 66±4.82 and 32.03±2.45 respectively three months after training. The results of the t-test represented a statistically significant difference between the level of knowledge and performance before and after the intervention (P=0.001). CONCLUSIONS: Based on the results, the standard guidelines education improved the nurses' knowledge and performance on the safe handling of antineoplastic drugs in the chemotherapy wards. Therefore, it is advised to increase the awareness of the oncology nurses in this regard in the planning and policy-making ofhealthcare centers.

Oncology clinic nurses' attitudes and perceptions regarding implementation of routine fall assessment and fall risk screening: A survey study.

Falls in older adults with cancer are often under-recognized and under-reported. The objective of this study was to explore oncology clinic nurses' willingness and perceived barriers to implement routine falls assessment and falls screening in their practice. Nurses working in outpatient oncology clinics were invited to complete an online survey. Data were analyzed using descriptive statistics and sorted into thematic categories. The majority of respondents indicated willingness to routinely ask older patients about falls (85.7%) and screen for fall risks (73.5%). The main reasons for unwillingness included: belief that patients report falls on their own, lack of time, and lack of support staff. Findings from this study show many oncology nurses believe in the importance of routine fall assessment and screening and are willing to implement them routinely, although falls are not routinely asked about or assessed. Future work should explore strategies to address barriers nurses face given the implications of falls amongst this vulnerable population.

The importance of understanding burnout: an oncology nurse perspective.

The challenges presented by the global COVID-19 pandemic have intensified the stressors placed on nurses, leading to burnout. Oncology nurse burnout is likely to be an increasingly significant issue for cancer services as the true cost of the pandemic is revealed. Delays in diagnosis and treatment of cancers are reported widely, inevitably leading to poor prognosis and more aggressive treatments for patients. Gaining a better understanding of oncology nurse burnout, its prevalence and causes as well as strategies to reduce or prevent it will help to improve patient care and support staff wellbeing during and after the pandemic. Methodology: A search of the literature related to oncology nurse burnout, covering North America and Europe over 5 years (August 2014-January 2020), resulted in 31 articles for review. None of the studies were carried out in the UK, suggesting a need for robust investigations into oncology nurse burnout in the British health service. Summary: The prevalence of burnout among oncology nurses before the COVID-19 outbreak appeared to be high and is likely to have increased as a result of the pandemic. However, the studies investigating oncology nurse burnout are small and cross-sectional, with low-quality methods. The literature suggests the major causes of burnout arise in the workplace, particularly aspects of the environment that prevent nurses from working according to their values. Although burnout is frequently attributed to workplace factors, interventions remain focused on individuals' coping mechanisms and rarely on the workplace factors that are known to cause it.

Recommendations for spiritual care in cancer patients: a clinical practice guideline for oncology nurses in Iran.

BACKGROUND: In spite of the necessity of implementing spiritual care practices for cancer patients, there is no clear process in this regard in palliative care programs of the health system of countries. The present study was designed with the aim of developing a clinical practice guideline of spiritual care in cancer patients for oncology nurses in the current context. METHODS: This is a multi-method study which was conducted in five stages within the framework of the National Institute for Health and Care Excellence (NICE) guideline. A research committee consisting of four focal and 16 secondary members was formed. The stages included determining the scope of the study, developing guideline (a qualitative study and a systematic review, triangulation of the data, and producing a preliminary draft), consultation stage (validation of the guideline in three rounds of the Delphi study), as well as revision and publication stages. RESULTS: The clinical guideline of spiritual care with 84 evidence-based recommendations was developed in three main areas, including the human resources, care settings, and the process of spiritual care. CONCLUSIONS: We are hoping by applying this clinical guideline in oncology settings to move towards an integrated spiritual care plan for cancer patients in the context of our health system. Healthcare organizations should support to form spiritual care teams under supervision of the oncology nurses with qualified healthcare providers and a trained clergy. Through holistic care, they can constantly examine the spiritual needs of cancer patients alongside their other needs by focusing on the phases of the nursing process.

Spanish oncology nurses: Assessment and relationship between resilience and emotional labour status.

OBJECTIVE: To investigate nurses' resilience and emotional labour (EL) status in the oncology context as well as to examine the relationship between resilience and EL status. METHODS: Cross-sectional, correlational quantitative design. The selected setting is the oncology centre at a referral and teaching hospital in northern Spain. One hundred and two oncology nurses were included. Socio-demographic data were obtained from a questionnaire. Data for resilience and EL status were drawn from validated Spanish questionnaires. RESULTS: Oncology nurses reported a moderate to high level of resilience and experienced less intense EL. Professional rank was the only factor identified that influenced resilience (p < .05). Gender, educational level, shift work, work department, and oncology work experience were statistically significant when correlated with the EL of oncology nurses (p < .05). There was a positive correlation between resilience and two EL factors (p < .05). CONCLUSIONS: The information gained from this study may raise awareness of the importance of resilience and EL in the nursing profession. It would be important to develop a programme of resilience training and emotional regulation and integrate these programmes into educational systems in order to help enhance nursing students' and clinical nurses' resilience and emotional competency.

Factors affecting knowledge levels of oncology nurses about skin cancer and sun protection.

OBJECTIVE: This is a descriptive, cross-sectional and observational study that determines the factors affecting the knowledge levels of oncology nurses for skin cancer and sun protection. MATERIALS & METHODS: This study was performed on the members of the Turkish Oncology Nursing Association and oncology nurses working in hospitals in Turkey between November 2019 and March 2020. Data were collected by using the Nurse Information Form and Skin Cancer and Sun Knowledge (SCSK) scale. For data analysis, average and percentage calculations and multiple linear regression analyses were used. The significance level was set at p < .05. RESULTS: We found those female nurses who were above 40 years of age and having darker skin tone due to excessive sun exposure, with a family history of skin cancer, and educated on skin cancer, performed better on the SCSK scale. We found a statistically significant difference between the mean scores of skin cancer and sun exposure. Using multiple regression analysis, a model was created based on the relationship between variables. In this model, the personality traits of oncology nurses are responsible for higher (91.1%) knowledge levels on skin cancer and sun exposure. CONCLUSION: In conclusion, it is important to consider factors that will influence an individual's behaviour while developing skin cancer and sun protection programmes.

Role and skills of the oncology nurse: an observational study.

PURPOSE: The importance of nursing competence arises from its central role in influencing and determining care outcomes. The employment of adequately educated staff, able to base clinical decisions on the best scientific evidence, is one of the components required for delivering high quality nursing care in the oncological field. The aim of this study is to analyze - through the Nurse Competence Scale - the level of competence of nurses working in oncological settings. METHOD: A descriptive study was performed between March and September 2017. The participants were recruited among the nursing staff working in the Day Hospital and the Units of the IRCCS -Regina Elena National Cancer Institute in Rome. The confidentiality and the anonymity of the subjects involved in the study were guaranteed by submitting a socio-cultural data sheet -specifically designed to collect demographic and education data - and the Nurse Competence Scale. RESULTS: The sample included 65 nurses (93%) and 5 head nurses (7%), with a mean age of 41.8 years, predominantly female (80%), who had been working in oncology units for a mean of 17.2 years. The Nurse Competence Scale showed a high level of competence in all dimensions. Moreover, the Chi-Square test allowed to identify the presence of significant associations between the different dimensions of the Nurse Competence Scale and the work experience >15 years and the age > 40 years. CONCLUSIONS: The results of our study show that, even if lacking specific oncology competence, nurses working in oncology care settings have developed a good level of clinical competences. Highlighting the importance of nursing care in the oncology area will increase the demand of both patients and organizations of high quality nursing care, consequently enhancing the nursing profession.

Oncology nurse phone calls halve the risk of reduced dose intensity of immunochemotherapy: results of the randomized FORTIS study in chronic lymphocytic leukemia.

Delivering of > 80% planned relative dose intensity (RDI) of fludarabine-cyclophosphamide-rituximab (FCR) is key to benefit from longer progression free survival (PFS) and survivals in CLL. In this randomized trial, we sought to investigate whether a telephone intervention strategy (called AMA) delivered by an oncology nurse could reduce the risk of RDI < 80% by alleviating adverse events and supporting patients' adherence. Sixty FCR patients were randomized 1:1 for AMA (stratified on Binet stage C). As per guidelines, patients received pegfilgrastim as primary prophylaxis of febrile neutropenia. At the end of therapy, RDI < 80% was reported in 31% of patients, shortening PFS (median 26 months versus not reached, P = 0.021) and OS at 3 years (100 vs 70%, P = 0.0089). Oncology nurse interventions tended to significantly reduce this event (RDI < 80%: 41.4% in non-AMA versus 20.7% in AMA patients (p = 0.09)). By adjusting our logistic regression model on published parameters exposing to RDI < 80%, we found that AMA protected significantly against the risk of reduced RDI (OR = 0.22, IC95% 0.05-0.84, p = 0.04), independently of grade 3/4 neutropenia (< 15% per cycle) and febrile neutropenia (< 5% per cycle) events. As a conclusion, we confirmed that > 20% reduction of FCR dose-intensity was detrimental for PFS/OS, but that oncology nurse interventions reduced the risk of dose concessions.

Factors affecting spiritual care practices of oncology nurses: a qualitative study.

PURPOSE: Spiritual care is a component of the holistic nursing approach. But in practice, nurses face many challenges during the implementation of spirituality care. Thus, the aim of this study was to explore the barriers and facilitators affecting spiritual care practices by oncology nurses. METHODS: This qualitative study was conducted using a conventional content analysis based on semi-structured interviews with 25 participants, including cancer patients and their family members, oncology nurses, physicians, psychologist, and spiritual researcher-therapists. RESULTS: The results showed that the two main themes of the study, "spiritual competency" and "spiritual inefficiency" in healthcare organization, were two major factors in implementing spiritual care practices for cancer patients by oncology nurses. CONCLUSIONS: The findings of this study emphasize the necessity of developing coherent spiritual care programs in hospitals and removing administrative barriers. Teaching spiritual care in nursing courses at schools and continuing education programs for training of healthcare team members are necessary. Likewise, forming a spiritual care team with oncology nurses at the center and defining their members' roles and responsibilities are essential. Hospital managers can also make fruitful steps by establishing a monitoring system and identifying the needs and barriers for spiritual care in oncology settings.

Nurse-rated good death of Chinese terminally ill patients with cancer: A cross-sectional study.

OBJECTIVE: To explore the good death of terminally ill patients with cancer rated by nurses and identify associated factors in the context of Chinese culture. METHODS: We conducted a cross-sectional, anonymous questionnaire survey. Totally, convenience samples of 122 nurses in charge of 258 patients during their dying period were investigated. The questionnaire consisted nurses' information including demographics and the experience in palliative care, patients' demographic information and disease characteristics, and Good Death Inventory (GDI). RESULTS: Two hundred and fifty-eight (98.10%) analysable questionnaires were obtained. The total good death score was (245.40 ± 36.91), and the last three were "Independence" (7.34 ± 4.26), "Physical and psychological comfort" (8.12 ± 4.70) and "Religious and spiritual comfort" (8.44 ± 4.55); the first three were "Being respected as an individual" (18.31 ± 2.90), "Good relationship with medical staff" (18.26 ± 2.37) and "Natural death" (18.16 ± 3.22). The unit type, treatment patients received during their last 3 months and nurse's training experience in palliative care were associated factors of good death (R2  = 0.135, F = 9.160, p < .001). CONCLUSION: The good death status of terminally ill cancer patients is poor. It's urgent to promote palliative care and strengthen the training about the knowledge and skills to improve the quality of life of the patients, so as to achieve the goal of good death.

Breast cancer survivors' experiences of dealing with information during and after adjuvant treatment: A qualitative study.

AIMS AND OBJECTIVES: To describe breast cancer (BC) survivors' experiences of participating in a 2-day educational programme (Breast Cancer School, BCS) and their critical reflection on information received during and after adjuvant treatment. The following research questions guided the study. How do BC survivors experience their participation in an educational programme? How do BC survivors experience the information trajectory during and after adjuvant treatment? BACKGROUND: BC is the most prevalent cancer among women in Norway. BC survivors have a substantial need for information about the disease, treatment and recovery. During the past few years, BC treatment in Norway has changed from inpatient- to outpatient-based treatment. Oncology nurses and oncologists are obliged to provide patients and their families with information, which has necessitated reorganisation of the procedures for providing information. New arenas such as the Breast Cancer School (BCS) offer the opportunity to learn from experts and fellow patients. DESIGN: Qualitative, descriptive design. METHODS: Focus groups with 20 BC survivors after having participated in the BCS were used to enable critical reflection. The COREQ checklist was followed to ensure rigour in the study. RESULTS: Two themes emerged from qualitative analysis: Balancing between the need for and the fear of information and Moving from a safe structure to lonely recovery. We identified differences between BC survivors in diversity, uniqueness and need for information. Continuity and expert knowledge provided by a primary oncology nurse and oncologists were highlighted as important. CONCLUSION: The study reveals the need for information tailored to each BC survivor's unique needs. The BC survivors expressed both the need for and the fear of information. BCS takes both a systematic and individual approach to provide expert information, dialog and the opportunity to meet with fellow patients. The transition from the structure of the treatment to lonely recovery after the most intensive treatment was perceived as unsafe and challenging. BC patients' experiences must be continuously valued and used to improve educational programmes, care and treatment. Oncology nurses play an important part in the information chain and continuity. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of including BC survivors in the design and evaluation of educational programmes. The provision of information and supportive care with continuity between oncology nurses and oncologists through the trajectory of treatment and care is crucial.