青年女性癌症患者生育信息需求及支持的研究进展

随着癌症早期筛查的实施和诊疗方案的不断改进,青年女性癌症患者的转归和预后发生较大改善,其对生育问题关注度日益增加。该文对青年女性癌症患者生育信息需求进行综述,介绍以实施多学科合作的生育咨询、开发生育知识手册、提供生育决策辅助工具为主的3种生育信息支持途径的应用情况,并分别从医护人员、患者层面分析阻碍癌症患者生育信息支持的原因,以期为研制癌症患者生育信息需求评估工具、构建以患者需求为导向的生育信息支持方案提供参考。     

Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service

Purpose

Guidelines recommend screening patients with cancer to identify their rehabilitation needs. To help quantify this area of need and associated workload from an occupational therapy perspective in patients with thoracic cancer, we report the experiences of a dedicated rehabilitation service.

Methods

Consecutive patients were screened soon after diagnosis using items associated with occupational performance in the Sheffield Profile for Assessment and Referral for Care questionnaire. Those reporting predetermined levels of distress underwent a full occupational therapy evaluation; this generated a problem list from which individualised goals and interventions were instigated.

Results

Of 540 patients screened, 273 (51 %) reported levels of distress which warranted a full occupational therapy assessment. Of these, 260 (95 %) reported a total of 681 problems (median of 4 [2–5] per patient). Mostly these lay within the domain of self care (553, 78 %) in the categories of transfers, functional mobility and bathing/showering. A total of 646 goals (median of 2 [1–3] per patient) were formulated, resulting in 652 individual interventions, most frequently the provision of equipment (79 %) or advice (32 %) and referral to another professional/agency (23 %). Patients considered that most goals were achieved (98 %) and that the provision of equipment was useful (97 %).

Conclusions

About half of patients with thoracic cancer screened have occupational therapy needs around the time of diagnosis. Problems are mostly in the area of self-care, with equipment provision the most frequent intervention provided. Future work should examine the efficacy of occupational therapy interventions further.     

Semen preservation in male adolescents and young adults with cancer: one institution's experience

Semen preservation is a feasible procedure for male adolescents and young adults who may become infertile as a result of cancer therapy. Treatment for several pediatric malignancies puts adolescents and young adults at a significant risk for fertility dysfunction. Eligible male adolescents and young adults (N = 32) treated from January 2004 to June 2005 at Cook Children's Medical Center were offered semen preservation at the time of diagnosis or presentation to the center for treatment. Fifteen (47%) young men were successful in semen preservation. Two (6%) adolescents did not participate because of parental refusal. Seven (22%) were too ill, and eight (25%) failed to produce an adequate sample. Several patients were not successful because of time constraints, lack of counseling, and parental anxiety. Efforts for success in semen preservation should include private discussions between nurses and adolescents. In addition, information on infertility needs to be given to families early in the diagnostic phase to provide them with an opportunity to ask questions.     

Personal control and the needs for hope and information among adults diagnosed with cancer

Cancer patients inevitably experience situations in which their sense of personal control is diminished. Identifying the strategies used by these individuals to maintain or regain control can be an important component in the planning of care. This study examined the relationship between levels of perceived personal control and the needs for hope and information among 56 adult cancer patients. Subjects responded to the Needs Assessment Inventory and the Spheres of Control Scales. Data were analyzed using responses from the total group (n = 56), male subjects (n = 23), and female subjects (n = 33). Significant correlations were found between perceived level of control and eight issues related to hope and information-seeking.     

Development of cancer needs questionnaire for parents and carers of adolescents and young adults with cancer

Purpose  

In order to improve the service delivery for the parents and carers of adolescents and young adults (AYAs) with cancer, it is important to develop measures which assess the specific issues and concerns faced by this group. The aims of this study were to describe the development and acceptability of a measure of unmet needs of parents and carers of AYA cancer survivors and to assess the prevalence of unmet needs among the respondents.     

Use of complementary and alternative medicine by patients with urologic cancer: a prospective study at a single Japanese institution

Objectives We prospectively evaluated the prevalence and predictors of complementary medicine (CAM) use among Japanese patients with urologic cancer 1 year after diagnosis.Patients and methods A total of 349 patients with newly diagnosed urologic cancer answered a self-administered questionnaire on CAM use 1 year after diagnosis. General-health-related quality of life (GHQL) of the patients was also assessed at diagnosis and 1 year after diagnosis using the Medical Outcome Study Short Form-36 (SF-36). The overall prevalence, types of CAM used, and costs of CAM were assessed. The effects of several variables including GHQL at baseline and 1 year after treatment on the prevalence of use of CAM were evaluated.Results A total of 164 respondents (47%) admitted using some type of CAM, of which 73 (45%) had used multiple types. Health food, in particular extract from Agaricus blazei, was the most common type of CAM used. CAM users had significantly lower scores for social function, general health perception, and vitality domains than CAM non-users 1 year after diagnosis. This tendency was more marked in users of multiple types of CAM.Conclusions Health food, including extract from A. blazei, was the most commonly used CAM in Japan. The prevalence of CAM use did not differ between patients with prostate cancer and those with urologic cancer other than prostrate cancer. CAM users, especially those who used multiple types of CAM, had lower GHQL scores than non-users of CAM.     

Meeting the information needs of women with breast cancer: Piloting a nurse-led intervention

This study evaluated a telephone intervention, administered by specialist breast care nurses, that aimed to meet the information needs of women with breast cancer. The intervention was developed from previous work that examined priority information needs. Participants were allocated to a telephone intervention (n = 67) or control group (n = 68). Data were collected by means of semi-structured interviews with participants at two time points (3 months and 8-12 months post-diagnosis) and focused on patient satisfaction with sources of information, information needs and psychological morbidity. Interviews were also conducted with breast care nurses to ascertain their views on administering the intervention. The intervention group reported fewer physical problems at Time 2 and were more likely to have had their information needs met than women in the control group. The control group were more likely to utilise media sources of information at Time 2 whereas women in the intervention group reported breast care nurses as their most prominent source of information. There were no significant differences in psychological morbidity between the two study groups. The findings indicate that the intervention is a feasible and acceptable approach to meeting the information needs of women with breast cancer. Further research is required to evaluate the intervention in a randomised controlled trial.     

Information needs and sources of information for women with breast cancer: a follow-up study

This paper reports a study which examined the specific information needs and sources of information for 105 women with breast cancer at two time points, the time of diagnosis and a mean of 21 months from diagnosis At diagnosis the priority information needs concerned survival issues Further from diagnosis survival issues were still a concern, but information about the risk to family members of getting breast cancer showed a significant increase in importance Information about sexual attractiveness was ranked last at both the newly diagnosed and follow-up stages Information sources at the time of diagnosis centred around the specialist breast care service, while further from diagnosis few professional or voluntary sector sources were utilized, with women receiving most of their information from media sources such as women's magazines The relevance of these findings for nurses and other health care professionals is discussed     

Patient and carer needs following a cancer-related hospital admission: the importance of referral to the district nursing service

BACKGROUND: Despite 30 years of research attention, discharge planning and district nurse (DN) referral remain problematic and few cancer-related publications exist. With shorter hospitalizations, discharged cancer patients and their carers may experience unmet needs for assessment, information and support. Although DN referral might enable patient/carer needs to be met, the DN role lacks clarity. AIM: To investigate the needs of people with cancer, and their lay carers during discharge from hospital to home, and identify the role of DNs in meeting these needs. METHOD: In this qualitative study, 71 pre- and postdischarge interviews were performed with cancer patients and (where possible) their carers. Predischarge interviews focused on expectations and postdischarge interviews on experiences of discharge and aftercare. Interview tapes were transcribed and analysed thematically. RESULTS: Interviewees anticipated few aftercare needs during predischarge interviews but described met and unmet needs during postdischarge interviews. Unmet needs of those referred and not referred to the district nursing service were similar. Patients and carers had unmet needs for psychological support related to nutrition. Carers, especially those not resident with and not related to patients, had informational needs. Even very elderly, ill and isolated patients felt that other people had greater needs than their own and many thought that DNs only performed physical tasks. CONCLUSION: All cancer patients discharged from hospital might be referred to a DN for ongoing assessment of needs. However, to ensure optimal results, the DN role needs to be clarified and public perceptions altered. Further research on psychological aspects of nutrition and the needs of carers not resident with/not related to patients is necessary.