Difference in patient's acceptance of early versus late initiation of psychosocial support in breast cancer

The present study was performed to assess the difference in acceptance of psychosocial counseling and resulting benefits between patients with breast cancer with early or late onset. In a prospective randomized controlled study conducted over 6 months, 41 women with a new diagnosis of early breast cancer (group 1) and 43 patients with advanced breast cancer (group 2) received individually tailored psychosocial support and were compared against controls. This therapy was free of charge, and the duration of support was determined by the patients' wishes and needs. Among the patients with new onset of disease acceptance of the psychosocial counseling was high, and these patients experienced significant improvements in their quality of life. In contrast, acceptance of psychosocial counseling was low in the advanced breast cancer group and the therapy did not improve quality of life over the observation period of 6 months. Early psychosocial support in patients with breast cancer meets with a high acceptance rate and improves quality of life.     

Perceptions of patients' self-efficacy for managing pain and lung cancer symptoms: correspondence between patients and family caregivers

This study examined the degree of correspondence between lung cancer patients and their family caregivers in their perceptions of the patients' self-efficacy for managing pain and other symptoms of lung cancer, and the association of this correspondence to demographic, disease, and psychosocial variables. Thirty patients who were newly diagnosed with lung cancer and their primary family caregivers completed telephone interviews assessing the patient's symptoms, the patient's self-efficacy for managing symptoms, the quality of the relationship between the patient and caregiver, patient and caregiver psychological distress, and caregiver strain. Although patients and their caregivers showed a moderate degree of agreement in their perceptions of the patient's self-efficacy for managing pain and other symptoms, there was considerable variability in the degree of congruence. Factors that contributed to lower levels of congruence included low patient-rated self-efficacy, female gender of the patient, high patient psychological distress, and high caregiver strain. Caregivers were about evenly split in their tendency to overestimate versus underestimate the patient's self-efficacy. A poorer quality of relationship between the caregiver and the patient (as rated by the patient), high levels of patient-rated symptoms, and high levels of caregiver strain were associated with caregivers overestimating patient self-efficacy.     

A short-term psychoeducational intervention for patients newly diagnosed with cancer

The psychological and medical problems encountered by cancer patients are numerous and unique. The diagnosis of cancer frequently produces psychological distress. A review of the literature and the authors' clinical and research experience suggest that cancer patients may benefit from a variety of psychological intervention programs. A structured, psychiatric intervention consisting of health education, stress management/behavioral training, coping (including problem-solving techniques), and psychosocial group support offers the greatest potential benefit for patients newly diagnosed or in the early stages of their treatment. Early-stage interventions that encourage active behavioral coping and active cognitive coping rather than avoidance or passive acceptance of the illness can be helpful psychologically. These active behavioral and cognitive coping behaviors, which can be learned, can attenuate the psychological distress caused by stressful illness, decrease the amount of psychosocial adjustment to the illness needed, improve overall quality of life, and may also be associated with longer survical times.Presented at the Symposium Psychotherapeutic Interventions in Cancer Patients, Flims, Switzerland, 12–14 January 1995     

Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: associations with symptoms and distress

This study examined self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their caregivers, and associations between self-efficacy and patient and caregiver adjustment. One hundred and fifty-two patients with early stage lung cancer completed measures of self-efficacy, pain, fatigue, quality of life, depression, and anxiety. Their caregivers completed a measure assessing their self-efficacy for helping the patient manage symptoms and measures of psychological distress and caregiver strain. Analyses indicated that, overall, patients and caregivers were relatively low in self-efficacy for managing pain, symptoms, and function, and that there were significant associations between self-efficacy and adjustment. Patients low in self-efficacy reported significantly higher levels of pain, fatigue, lung cancer symptoms, depression, and anxiety, and significantly worse physical and functional well being, as did patients whose caregivers were low in self-efficacy. When patients and caregivers both had low self-efficacy, patients reported higher levels of anxiety and poorer quality of life than when both were high in self-efficacy. There were also significant associations between patient and caregiver self-efficacy and caregiver adjustment, with lower levels of self-efficacy associated with higher levels of caregiver strain and psychological distress. These preliminary findings raise the possibility that patient and caregiver self-efficacy for managing pain, symptoms, and function may be important factors affecting adjustment, and that interventions targeted at increasing self-efficacy may be useful in this population.     

食管癌患者不同知情程度对照顾者生活质量的影响

目的:探讨食管癌患者的知情状况对照顾者生活质量的影响。方法:随机选取200例食管癌患者及其照顾者,嘱其填写自制的知情度问卷、生存质量问卷,然后对所得资料进行统计学分析。结果:200例患者中,68例(34%)为完全知情,92例(41%)为部分知情,40例(25%)为完全不知情。照顾者是否选择告知患者病情真相与照顾者受教育的程度有关(rs=0.89,P=0.007)。三组不同知情状况患者的照顾者,其生理机能、躯体疼痛、一般健康状况、精力和精神健康总体生活质量的差异均有统计学意义(P0.05)。结论:食管癌患者对疾病的知情程度对其照顾者有很大影响,采取适当的方式、方法,提高患者对疾病的知情度,有助于提高其照顾者的生活质量。     

Developing Effective Cancer Pain Education Programs

Pain is prevalent, burdensome, and undertreated in individuals with cancer across the disease trajectory. Providing patients and family caregivers with psychosocial support and education to manage cancer pain is a core component of quality care that can result in significant clinical benefit. In this review, we: (1) outline an approach for developing and assessing the effectiveness of education programs for adults with cancer pain; (2) discuss considerations for tailoring programs to the needs of diverse populations and those with limited health literacy skills; (3) describe the resource needs and costs of developing a program; (4) highlight innovative approaches to cancer pain education. We conclude with recommendations for future research and the next generation of educational interventions.     

Perceptual consistency of pain and quality of life between hospice cancer patients and family caregivers: a pilot study

AIMS: Clinicians usually adjust medical management based on caregivers' observation when caring for seriously ill or cognitive-impaired patients. The purpose of this study is to research the differences in perceptual congruence of patients and caregivers when assessing patients' global pain (GP) and quality of life (QOL) in a hospice ward. METHODS: From July 2002 to June 2004, hospice inpatients and their family caregivers were invited to participate in this study at a medical centre in Southern Taiwan. The survey was cross-sectional, incorporating patients' bio-psycho-social factors so as to understand their impacts on patients' pain perception and QOL. The bio-psycho-social factors included biological pain, physical dependence, financial difficulty, anxiety over family, existential meaning of life, uncontrolled outcome of disease and insufficient emotional support. RESULTS: Fifty-eight patient/caregiver dyads were recruited in the study. The mean of patients' self-reported GP was higher than caregivers' rating (5.9 +/- 1.7 vs. 5.1 +/- 1.9, p < 0.05); however, the score of patients' QOL was lower in the patients than in the caregivers (6.9 +/- 1.6 vs. 7.9 +/- 1.4, p < 0.001). The result of regression analyses showed that 'biological pain', 'religion' and 'gender' were independent variables for patients' GP; however, 'biological pain' and 'gender' were factors for patients' QOL. No psychosocial factor was revealed as a factor in patient's perception of GP or QOL in this survey. CONCLUSION: This study indicates that caregivers have the propensity to under-rate patients' pain and overvalue QOL; moreover, 'religion' and 'gender' influence patients' perception near the end-of-life. Therefore, reassessment and proper holistic approach are important in hospice care.     

Symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal cancer

This study aims to describe symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal tract (GIT) cancer, and to identify the extent to which demographic, physical, and psychosocial factors predict their quality of life. A convenience sample of 146 newly diagnosed GIT cancer patients recruited from 3 major hospitals in Shanghai completed a self-report questionnaire. The questionnaire was designed to obtain demographic and medical data and measures of symptoms, psychological distress, social support, health-related quality of life (HRQoL), and global quality of life (GQoL). Measures developed in English were translated into Chinese using the procedure advocated by WHO. The results showed that the most common signs and symptoms reported were fatigue, pain, and weight loss; 28% of the patients were depressed; and overall, patients had a moderate quality of life. Comparative analyses found some difference on measures for demographic and diagnostic subgroups. Depression, symptom distress, and social support accounted for 44% of the total variance for HRQoL, while perceived financial difficulty and symptom distress accounted for 20% of the total variance for GQoL. Findings from this research give insights into the importance of quality of life assessment, symptom management, and intervention to improve the quality of life of Chinese cancer patients. It also raises questions about measures of quality of life that are culturally relevant.     

Is There a Role for Palliative Services and Supportive Care in Managing Advanced Penile Cancer?

ObjectivesWe aim to review the benefits of palliative care, describe why a palliative approach to care is needed for patients with advanced penile squamous cell carcinoma and propose ways in which oncology nurses can improve access to and provision of palliative care.Data SourcesA review of the literature was performed and identified a range of randomized trials and systematic reviews regarding the benefits of palliative care in this patient group. Cohort studies of patients with penile cancer were used to describe the psychosocial and physical disease burden of penile cancer.ConclusionThroughout each phase of penile cancer and its treatment, oncology nurses can engage in care that goes beyond cancer-directed treatments to address the whole person, thereby improving quality of life by delivering person-centered palliative care in line with individual needs.Implications for Nursing PracticeOncology nurses are in key positions to explore many concerns that patients with penile cancer have for themselves or their caregivers. Through speaking directly with patients and caregivers, oncology nurses can uncover sources of distress, assess for unmet needs, and advocate for improved primary palliative care or early referral to specialty palliative care teams.     

Dealing With the Unthinkable: Bladder and Colorectal Cancer Patients’ and Informal Caregivers’ Unmet Needs and Challenges in Life After Ostomies

ObjectivesWe examined patient and informal caregiver unmet needs to identify areas for targeted supportive care interventions and programs to enhance both patient and informal caregiver experience.Data SourcesA total of 30 patients who underwent ostomy surgeries for bladder or colorectal cancers and 13 informal caregivers participated in the study. Patients were enrolled at the Icahn School of Medicine at Mount Sinai between 2017 and 2018. Qualitative data were collected by individual interviews, audiotaped, and transcribed verbatim. Transcribed data were iteratively analyzed using Atlas.ti to explore patient and caregiver unmet needs.ResultsPatients and informal caregivers reported having insufficient psychological preparation for ostomy surgeries, and very limited hands-on training on stoma care and utility of stomal appliances. Unmet psychological needs related to depression, anxiety, and distress caused by changes in body image and sexual, urinary, and bowel function were reported. Patients and caregivers also reported significant patient medical needs in the acute postoperative period including pain, fatigue, sleep disturbance, inflammation, and complications resulting in hospital readmissions. Colorectal cancer patients specifically experienced significant challenges with changes in diet and nutrition that contributed to ostomy care burden. Both patients and caregivers recommended seeking psychological and social support to enhance both patient and caregiver emotional adjustment to life after ostomies.ConclusionMeeting patient and informal caregiver unmet informational and supportive care needs is imperative to improve their quality of life and adjustment.Implications for Nursing PracticeAn effective supportive care plan should be designed and utilized in clinical care to improve ostomy patients’ and caregivers’ outcomes.     

Family caregiving in cancer pain management

The experience of cancer pain is known to greatly affect family caregivers as well as patients. There are many demands placed on caregivers of cancer patients with pain at home as a result of the shifting of care from the acute setting to the home. These complex demands significantly affect caregiver quality of life. The purpose of this study was to describe the experience of pain management from the perspective of family caregivers of patients with cancer amidst the current healthcare environment. This quasi-experimental study involved 231 family caregivers of patients with cancer pain receiving home care. Family caregivers were assessed in conjunction with a pain education program that provided patient and. family education regarding pain assessment, drug and nondrug interventions. Assessment measures used were the Quality of Life (QOL)-Family Caregiver Tool, Knowledge and Attitudes about Pain (K&A) Tool, and Caregiver Finances Tool. Study findings reveal disruption to family caregiver quality of life in the areas of physical, psychological, social, and spiritual well-being. There is also a continued need for education regarding cancer pain management. Comparison between patients and family caregivers demonstrates that pain impacts both the patient experiencing it and their caregivers.     

Psychological distress and quality of life in hospitalized patients with chronic obstructive pulmonary disease

BACKGROUND: Knowledge of what may influence patients' perceptions of quality of life is essential for improving nursing interventions, but there has been little research on the influence of psychological distress on health status and quality of life among patients with chronic obstructive pulmonary disease. AIM: This paper reports a study whose aim was to examine how disease factors and health status affect psychological distress and subjectively perceived quality of life in patients admitted for an acute exacerbation of chronic obstructive pulmonary disease. METHOD: A convenience sample of 92 inpatients (mean age 69 years) were interviewed using the St George's Respiratory Questionnaire, Hopkins Symptoms Check List (23 item version), and World Health Organization Quality of Life Assessment. Disease variables (disease duration and pulmonary function) and health status were entered in blockwise multivariate regression analyses to examine the relationships between disease variables, psychological distress, and a single item assessment of overall quality of life. RESULTS: The St George's Respiratory Questionnaire Total and Impact subscores showed statistically significant associations with psychological distress. Pulmonary function showed a moderately significant association with subjective perceived quality of life. Pulmonary function and disease duration explained a minor part of the variance in quality of life. Psychological distress had a statistically significant association with quality of life and accounted for 34% of the total 39% variance explained by our model. CONCLUSIONS: The influence of psychological distress on quality of life implies that bringing about change in psychological distress factors may have important consequences for quality of life. The findings should be taken seriously in developing future nursing interventions for this group of patients.     

中青年晚期癌症患者心理痛苦现况分析

目的：调查中青年晚期癌症患者心理痛苦现状及影响因素。方法：采用便利抽样的方法,选取2017年1月至6月住院的284例中青年晚期癌症患者做为研究对象,采用一般资料调查问卷和心理痛苦管理筛查工具（DMSM）对研究对象进行问卷调查,患者入院24小时之内由研究者完成资料的收集。结果：中青年晚期癌症患者心理痛苦得分（3.55±2.70）分,心理痛苦检出率为41.5%;患者人口学特征中性别、家庭月收入对患者心理痛苦程度有影响,心理痛苦问题列表中实际问题得分最高,其次是情绪问题和身体问题,交往问题得分最低,前五位的问题分别是：经济问题（57.7%）、疲乏（32.4%）、无时间经历照顾孩子/老人（28.9%）、担忧（28.9%）、疼痛（24.6%）。结论：中青年晚期癌症患者具有较高的心理痛苦水平,提示在今后的临床工作中医务人员要给予这部分人群更多的关注及心理支持,以降低其心理痛苦水平,改善生活质量。     

The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning

INTRODUCTION: Despite modern advances that have led to improved prognoses and symptom management, a cancer diagnosis continues to evoke images of pain, suffering, and death. DISCUSSION: The current literature suggests that the "existential plight of cancer" refers to what is now commonly known as the "search for meaning" following a cancer experience. Mounting evidence suggests that global meaning-defined as the general sense that one's life has order and purpose-is a key determinant of overall quality of life. It provides the motivation for people with cancer to reengage in life amongst a bewildering array of physical, psychosocial, social, spiritual, and existential changes imposed by the disease. Health care providers are inherently involved in their patients' search for global meaning. Yet, few empirical studies have operationalized how this search can be achieved. CONCLUSION: The meaning-making intervention is presented as one concrete approach to address the normative distress associated with the search for meaning within the context of cancer.     

中青年晚期癌症患者心理痛苦体验的质性研究

目的：探讨中青年晚期癌症患者心理痛苦体验,为实施全人照顾提供参考依据。方法：采用目的抽样法,抽取2017年5-7月在我院中西医结合科住院的12例中青年晚期癌症患者作为研究对象,所选患者心理痛苦评分（Distress Thermometer,DT）均≥4分,进行深度访谈,采用现象学分析访谈内容,整理提炼主题。结果：生理方面,对患者痛苦最大的前3位症状包括疲乏、疼痛、恶心呕吐;心理方面,主要存在担心、恐惧、病耻感及自我负担感;家庭社会方面,经济问题、无精力照顾孩子和老人、家属过分关心给患者带来很大心理痛苦;灵性方面,患者主要存在失去希望、绝望、自杀意图,怨天尤人,感叹不公,不放心,孤立隔绝等问题。结论：中青年晚期癌症患者存在身、心、社、灵等多方面心理痛苦,医护人员在临床工作中在重视患者症状管理的同时也要关注患者心理痛苦体验并给予针对性心理疏导,做到全人照顾,提高患者终末期生活质量。     

Quality of life and supportive care

 Quality of life and supportive care are complementary concepts in the care of cancer patients. Neither is easy to define. Both have received increasing attention in the medical literature of recent years. From the clinical perspective, supportive care is one means toward the end of improving patients' quality of life. In order to evaluate our degree of success in this endeavour, we must agree on operational definitions of those aspects of care and its outcome we wish to study, then devise, validate and apply appropriate measures. Supportive care covers a variety of topics including symptom control, anti-infective measures, nutritional supplements and psychosocial support. The aspects of quality of life studied include physical, emotional, psychological and (less commonly) spiritual wellbeing. Symptoms influenced by the disease or its treatment are often included in the assessment. Quality of life scales have been used as outcome measures in comparing treatments, and have shown independent prognostic value. This has led several groups to examine the potential of psychosocial interventions aimed at increasing duration of survival by improving quality of life. Quality of life can and should be measured as part of the assessment of the adequacy and effectiveness of supportive care.     

Family caregivers' assessment of symptoms in patients with advanced cancer: concordance with patients and factors affecting accuracy

The purposes of the study were to examine the concordance between patients' and family caregivers' assessments of patients' symptoms, and to identify demographic and psychosocial factors that affect levels of agreement. Sixty-six patients with advanced cancer receiving palliative care, and their primary, informal caregivers assessed patients' symptoms using the Memorial Symptom Assessment Scale (MSAS). Levels of agreement for individual symptoms ranged from poor to excellent (interclass correlation coefficient 0.07-0.75). Analysis of the group means using paired t-tests revealed significant differences for the MSAS subscales (psychological, physical, and general distress index), and for four of the 12 physical symptoms and five of the six psychological symptoms. The magnitude of the observed differences indicated a small to moderate bias for caregivers to overestimate, which was more marked for psychological than for physical symptoms. A number of factors associated with the caregiver (particularly the emotional state, the burden of providing care, and male gender) and the patient (the perception of being a burden to others) were significantly correlated with levels of disparity on some measures. The findings are consistent with the growing body of literature on the validity of proxy respondents' assessments of patients' symptoms.     

我院乳腺外科开展人文护理的实践与成效

目的实现有特色的人性化护理,提高乳腺癌患者的生存质量。方法建立促进全面康复的乳腺癌患者病友会“汝康沙龙”,每季度组织乳腺癌患者聚会活动一次,内容包括：讲解乳腺癌相关知识及对患者进行心理疏导,病友及家属相互介绍抗癌经验及家庭护理心得体会,医、护、患才艺展示等。结果提高了乳腺癌患者生活质量及对护理工作的满意度。结论通过开展乳腺外科人文护理可以提高乳腺癌患者的生活质量。