European Journal of Oncology Nursing

Editorial Board

2010-09-01

Communication skills training in end of life care – Short of the mark?

Sue Duke — 2010-08-02

Communication has long been a service and education priority in cancer and palliative care and rightly so. It is the means by which we provide information about what is medically possible, explore patient and family concerns and preferences and the vehicle through which the skills of practice and the humanity of care are conveyed. It is also the area of practice that patients and their family are most likely to rate as less than satisfactory; the experience of poor health care communication can have a lasting negative impact on health and future health care experiences. This mismatch between the importance of communication and people’s health care experience often comes to the fore at turning points in a person’s illness. At the end of life, communication around important decisions such as resuscitation and individual care preferences, whilst known as predictors of satisfaction with end of life care (), are not always done well or in a timely way (). As a consequence, patient preferences for their end of life care are unlikely to be known or subsequently met and family members’ bereavement experiences are likely to be influenced by stress, anxiety and depression ().

A longitudinal study about the body image and psychosocial adjustment of breast cancer patients during the course of the disease

Helena Moreira, Maria Cristina Canavarro — 2010-05-24

Abstract: Purpose: The research of body image among breast cancer patients is characterized by some limitations, such as the lack of longitudinal studies or the absence of a multidimensional perspective of body image. This study intends to overcome these limitations, by examining the evolution of body image dimensions (investment, emotions and evaluations) from the period of surgery (T1) to 6-months after the treatment’s ending (T2). It also aims to explore the predictors of body image at T2 and, simultaneously, the predictive role of initial body image to psychosocial adjustment at T2.Methods: A total of 56 breast cancer patients participated in both assessments and completed a battery of instruments that included measures of body image dimensions (appearance investment, self-consciousness of appearance, shame and appearance satisfaction) and psychosocial adjustment (quality of life and emotional distress).Results: Within the dimensions of body image, only shame increased over time. In general, initial levels of investment predicted subsequent body image dimensions and having a mastectomy done was associated with higher shame and lower appearance satisfaction at T2. Initial body image did not predict later adjustment, with the exception of depression, where appearance investment played a relevant role.Conclusions: Our findings contributed to the advance of knowledge in this area, providing relevant data about the evolution of body image dimensions, its predictors and its predictive role on psychosocial adjustment among breast cancer patients. This study also suggested some clinical implications that can assist health professionals to implement strategies focused on body image throughout the disease.

Exploring the information needs of patients with cancer of the rectum

Gloria O'Connor, Vivien Coates, Siobhan O'Neill — 2010-03-17

Abstract: Purpose: The aims of this study were to adapt an instrument to measure the information needs of patients with cancer of the rectum and determine how these information needs were met, using an adapted form of the Toronto Information Needs Questionnaire.Method: The questionnaire was administered in a semi-structured interview with 40 patients who had undergone surgery and treatment for cancer of the rectum in the previous 18 months.Results: The instrument used in this study demonstrated content and construct validity. The results of this study indicated that information needs were high in this patient group. Patients felt that many information needs with ratings of a high level of importance were not adequately addressed. A Wilcoxon Signed Ranks Test comparing the importance of informational needs with how needs were addressed indicated significant negative Z values for 33.9% (n=18) of the items. Patients differed in the information that they required due to differences in treatment plans, treatment outcomes and preferences as to the type of information required.Conclusions: There is a need for individualised information provision for this patient group, provided in sections that can be read in isolation. This would ensure that patients receive information relevant to their treatment plan and the topics which they have identified as being important to them.

Knowledge, attitudes and beliefs of Cypriot nurses on the handling of antineoplastic agents

2010-03-18

Abstract: Background: Antineoplastic agents have been associated with major concerns among health professionals. The objective of our study was to evaluate the knowledge, attitudes and beliefs of Cypriot nurses on their exposure to antineoplastic agents.Methods: A cross-sectional survey using a self-administered questionnaire was distributed among oncology nurses in three hospitals in Nicosia. The questionnaire was originally compiled by Turk et al., in order to evaluate the knowledge, attitudes and safe behaviours of nurses' handling cytotoxic drugs and was translated from Turkish to Greek by two bilingual volunteers.Results: A total of 88 nurses participated in the survey (20 male and 68 female). The mean age of the nurses was 33 years (age range 21–60). The majority of nurses were aware of the potential hazards associated with handling of chemotherapy. The mean score of the participants' knowledge was 79.43 out of 100. Most of the participants reported high levels of compliance with the use of personal protective equipment such as gloves and protective gown (95.4%, and 84.5%) during reconstitution of antineoplastic agents, respectively. Almost all nurses (98.8%) reported use of a safety cabinet during preparation, however only 53.4% reported that they have annual medical checkups and only 33% reported having received specialized training.Conclusion: While the level of knowledge about antineoplastic agents is high among nurses, along with the level of personal protective equipment use, medical surveillance and employee training seems to be lagging behind. Further research may help us identify the reasons for such discrepancy.

Ensnared by positivity: A constructivist perspective on ‘being positive’ in cancer care

May McCreaddie, Sheila Payne, Katherine Froggatt — 2010-04-26

Abstract: Background: The concept of ‘positive thinking’ emerged in cancer care in the 1990s. The usefulness of this approach in cancer care is under increasing scrutiny with existing research, definitions and approaches debated. Nurses may wish to judiciously examine the debate in context and consider its relevance in relation to their experience and clinical practice.Purpose: To offer a constructivist perspective on ‘being positive’ we extract data from a constructivist grounded theory study on humour in healthcare interactions in order to identify implications for practice and future research.Methods: We offer three areas for consideration. First, we briefly review the emergence of ‘positive thinking’ within cancer care. Second, we present data from a grounded theory study on humour in healthcare interactions to highlight the prevalence of this discourse in cancer care and its contested domains. We conclude with implications for practice and future research.Findings: Patients actively seek meaningful and therapeutic interactions with healthcare staff and ‘being positive’ may be part of that process. Being positive has multiple meanings at different time-points for different people at different stages of their cancer journey. Patients may become ensnared by positivity through its uncritical acceptance and enactment.Conclusion: Positive thinking does not exist in isolation but as part of a complex, dynamic, multi-faceted patient persona enacted to varying degrees in situated healthcare interactions. Nurses need to be aware of the potential multiplicity of meanings in interactions and be able (and willing) to respond appropriately.

Analysis of causal models of diet for patients with head and neck cancer receiving radiation therapy

Norimasa Ogama, Sumie Suzuki, Yoko Yasui, Katumi Azenishi, Yasuko Shimizu — 2010-06-28

Abstract: Purpose: This study seeks to establish causal models of diet which maintain the appetite of head and neck cancer patients receiving radiation therapy.Sample and methods: We collected data from 208 patients at two radiation doses, 30/50 Gy, using a questionnaire on appetite and analyzed the items using structural equation modeling.Results: In the causal model for 30 Gy, we established a path using the four intervening variables “ease of consuming foods in smooth forms,” “ease of consuming foods with a chewable texture and suitable temperature,” “ease of consuming lightly seasoned foods with a flavorful smell,” and “overall ease of consuming a given meal” from the temporal relationship between “dietary preferences” and “maintaining appetite while caring for the oral cavity.” In the causal model for 50 Gy, we established a path between “ease of consuming foods with a mild temperature and smell,” and “maintaining appetite while caring for the oral cavity” using the four intervening variables “ease of consuming foods that are easy to swallow,” “ease of consuming foods that dissolve well in the mouth,” “ease of consuming foods with a mild taste,” and “overall ease of consuming a given meal.” The goodness of fit indices for both models were above 0.85 for both the goodness of fit index (GFI) and adjusted GFI (AGFI), and less than 0.08 for root mean square error of approximation (RMSEA), indicating a satisfactory goodness of fit.Conclusions: Food characteristics help to maintain patient appetite at cumulative radiation doses of 30/50 Gy.

End-of-life needs as perceived by terminally ill older adult patients, family and staff

Merav Ben Natan, Doron Garfinkel, Irit Shachar — 2010-06-28

Abstract: Purpose of the study: A comparison of inpatient end-of-life needs as perceived by terminally ill older adult patients, family, physicians and nurses, is lacking. This study aimed to compare the importance attributed to different end-of-life needs by terminally ill older adult patients in long-term care facilities, their families and care providers (physicians and nurses).Method: This descriptive, cross-sectional study recruited a convenience sample of 451 subjects, including 73 terminally ill older adult patients, 58 family members, 71 physicians and 249 nurses, from two Israeli geriatric centers.Results: This study found a high congruence between the staff and terminally ill older adults and their families regarding most needs identified as important to dying people. The five needs identified as most important by all subjects were: not suffering pain, having no difficulty breathing, maintaining dignity, having someone who listens, and receiving adequate nursing care. The results of this survey suggest that for terminally ill older adult patients and their families, physical care is crucial. In contrast, nurses attribute higher significance to spiritual needs, but this finding may be affected by the fact that the rate of religiosity among nurses was much higher than among all other research groups.Conclusions: Identifying terminally ill older adults’ end-of-life needs may enable nurses and physicians to modify and improve end-of-life care. This could result in a substantial decrease in suffering amongst nursing home terminally ill older adult patients and their families.

Cultural interrelationships and the lived experience of Pakistani breast cancer patients

Maggi Banning, M. Hassan, S. Faisal, H. Hafeez — 2010-06-28

Abstract: Aim: There is a paucity of British and international literature on the psychological, sociological and cultural correlates of breast health in ethnic minority women.Methods: This two centre qualitative study was part of a larger study that aimed to examine the influence of culture on the lived experience of Pakistani Muslim breast cancer patients. Thirty six patients attending hospital out-patient breast cancer clinics in Lahore, Pakistan and London, UK were recruited to the study. Women were predominantly married, 20–76 years of age with an average of three children. Semi-structured interviews were undertaken. Interview data were analysed using thematic analysis.Results: Five themes emerged: Discovery and reaction to the disease; disclosure to family; developing emotions; emerging reality; long term uncertainty.Conclusions: Data infer that irrespective of city of residence, the cultural attributes of women, breast health awareness and reactions to the diagnosis and treatment are similar. To raise awareness, more focused health education interventions are needed.

Prospective changes of the quality of life for patients newly diagnosed with oral cancer during the acute stage

Hsiu-Fang Lee, Hsueh-Erh Liu — 2010-06-17

Abstract: Purpose of the research: Oral cancer is a common malignant disease in Taiwan. The purpose of this prospective follow-up study was to identify the changes in quality of life for newly diagnosed oral cancer patients during the acute stage.Methods and sample: Subjects were recruited from the outpatient department (OPD) in a medical center located in the northern part of Taiwan. 22 subjects completed both the EORTC QLQ-C30 and the EORTC QLQ-H&N35 at diagnosis, postoperative discharge, and the first postoperative follow-up. In addition, 91% of the subjects received surgery only as their main treatment.Key results: During the three assessments, as measured by the EORTC QLQ-C30, subjects reported that their physical function was much better at diagnosis than at both postoperative discharge and first postoperative follow-up. Their role functioning was much better at diagnosis than at postoperative discharge. Nevertheless, subjects reported better emotional functioning at the first postoperative follow-up than at the other two points of assessment. Only less financial difficulty was reported in the first postoperative follow-up than at diagnosis and postoperative discharge.For QLQ-H&N35, subjects reported that several symptoms (i.e., swallowing) were more severe at postoperative discharge than at diagnosis. Usage of nutritional supplements at first postoperative follow-up was higher than that at diagnosis.Conclusion: Newly diagnosed oral cancer patients reported significant changes in certain domains of both the EORTC QLQ-C30 and QLQ-H&N35. Health professionals need to identify the pattern of changes and to provide supportive care to these new oral cancer patients throughout the treatment process, especially during the planning of discharge.

The validity and reliability of the Turkish version of the Quality of Life Index [QLI] (Cancer version)

Gulbeyaz Can, Zehra Durna, Adnan Aydiner — 2010-05-21

Abstract: Purpose: Quality of life always has become an important concern in the health care of cancer patients. This descriptive study was planned to assess the validity and reliability of the Turkish version of Quality of Life Index – Cancer version in the assessment of the quality of life of lung cancer patients.Method: The validity and reliability of the scale was performed in two phases. Phase I focused on construction of the Turkish version of the instrument and pilot testing. The scale was translated using the back-translation technique. Five nursing experts reviewed the translation for inconsistencies with the original English form. The comprehensiveness and clarity of the scale was assessed with 20 patients. Phase II included factor analysis and psychometric assessment of the scale. The final version of the scale was pretested with 154 cancer patients.Results: According to the recommendations of the expert panel, some items were revised and modified, and the Turkish version of the scale was created. The content validity index (CVI) was 97%. Patients cited that this questionnaire was easy to read and understood. Differently from the original QLI scale, factor analysis was changed the domain of some items. Test–retest coefficients for items were between 0.63 and 0.95 (p < 0.05). The scale showed high internal reliability, Cronbach’s alpha values for domain varied between 0.63 and 0.85 and was 0.89 for the tool.Conclusion: The Turkish version of the QLI was sufficient and suitable tool in evaluating the quality of life of lung cancer patients in Turkey.

Scope of practice of the breast care nurse: A comparison of health professional perspectives

Liz Jones, Lori Leach, Suzanne Chambers, Stefano Occhipinti — 2010-05-21

Abstract: Aim: The Breast Care Nurse (BCN) supports people with breast cancer, co-ordinating services, and providing information and psychosocial support, yet there is ambiguity surrounding the scope of the role, with implications for both BCNs and service provision. The current studies investigated the scope of practice of BCNs from the perspective of both BCNs and other health professionals.Method: In study 1, semi-structured in-depth interviews were conducted with 11 BCNs and 7 other key health professionals (HPs) involved in the care of those with breast cancer. Participants were questioned about the scope of practice of the BCN role and the challenges facing the role. In Study 2, 27 BCNs and 21 HPs then completed a survey asking about the importance of the different elements of practice identified in Study 1, together with the extent to which each aspect of practice was part of the day to day practice of BCNs.Results and conclusion: Provision of information and support to people with breast cancer and their families were identified as core to the role. BCNs and other health professionals differed in their perceptions of both the length and breadth of practice of the BCN, with implications for workload and burnout in BCNs, as well as multidisciplinary team functioning and patient care. Scope of practice also differed across practice contexts.

Breast awareness within an intellectual disability setting

Siobhan Kirby, Josephine Hegarty — 2010-05-21

Abstract: Purpose: This study sought to examine proficiency, motivation and knowledge regarding breast cancer screening and awareness of nurses working within an Intellectual Disability setting. Additionally, the study aimed to examine and establish associations between nurses’ personal and professional breast awareness practices. Breast cancer generally affects women between 50 and 65 years and is one of the principal causes of female deaths. Many women with intellectual disability are placed in the “at risk” age group for developing breast cancer due to increased life expectancy. However, breast cancer screening is much lower in women with intellectual disability compared to the general population.Method: This study adopted a quantitative descriptive design. Data was gathered utilising an adapted version of the Modified Toronto Breast Self-Examination Inventory (MTBSEI).Results: Results reflected that the majority of nurses in this study (n = 105) do not promote breast awareness for women with intellectual disabilities. Further, findings identified deficits in nurses’ personal knowledge, skills and practices with regard to breast awareness and screening.Conclusion: This study identifies the need to support nurses within Intellectual Disability settings with on-going education in relation to breast awareness, in order that breast awareness be promoted in clinical practice.

Best practices in the management of toxicities related to anti-EGFR agents for metastatic colorectal cancer

Jan Ouwerkerk, Christine Boers-Doets — 2010-05-26

Abstract: Purpose: To provide oncology nurses with an overview of the toxicity management associated with the anti-epidermal growth factor receptor (EGFR) monoclonal antibodies cetuximab and panitumumab in patients with metastatic colorectal cancer.Methods: Monoclonal antibodies such as cetuximab and panitumumab that target EGFR have provided patients with metastatic colorectal cancer with effective treatment options. Both antibodies can be used as monotherapy; cetuximab is also approved for use in combination with chemotherapy. We reviewed the literature regarding the signs and symptoms, assessment of severity, and strategies available to prevent and manage adverse events associated with these agents.Key results: This class of therapeutics is associated with an overall acceptable adverse event profile that is distinctly different from conventional chemotherapeutics. In contrast to cytotoxic chemotherapy, which causes myelosuppression, mucositis, and nausea and vomiting, common toxicities reported for anti-EGFR therapy include the more frequent cutaneous toxicities, electrolyte imbalances, and diarrhoea, as well as the less frequent ocular toxicities. Infusion reactions are also observed with the chimerical monoclonal antibody cetuximab.Conclusions: Oncology nurses play a key role in the administration of multi-agent treatment regimens, especially with respect to the identification and management of toxicities, patient education, and patient support. By reducing the incidence and severity of the adverse events associated with anti-EGFR therapy, oncology nurses have the potential to sustain patient adherence to completion of treatment, identify signs and symptoms early, proactively manage adverse events, and provide appropriate treatment interventions, thereby improving patient quality of life.

Noticeboard

2010-07-26

Individual nurses and other health professionals and conference organisers are invited to submit details of conferences, workshops, study days and lectures: Ruud Uitterhoeve, IQ Scientific Institute for Quality of Healthcare, Nursing Science 114, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Academic programmes leading to certificates, diplomas and degrees in the areas of relevance to cancer care will be included in this section at the request of the host institution. The Journal is published in February, April, July, September and December and potential contributors should bear these dates in mind when sending items they wish to be included.

Oncology nursing bibliography

2010-07-23

Differences between women who have and have not undergone breast reconstruction after mastectomy due to breast cancer. FALLBJORK U, KARLSSON S, SALANDER P, RASMUSSEN BH. Acta Oncol 2010;49(2):174–9.