Development and Validation of a Dignity in Care Scale of Terminally Ill Patients for Nurses

Purpose@#This study aimed to develop an instrument to showcase Dignity in Care of Terminally Ill Patients for Nurses and to examine its validity and reliability. @*Methods@#A total of 58 preliminary items on dignity in care of terminally ill patients for nurses were selected using content validity analysis and expert opinions on 97 candidate items derived through a literature review and qualitative focus group interviews.Questionnaires were administered to 502 nurses caring for terminally ill cancer patients at hospice and palliative care institutions. The data were analyzed using item analysis, exploratory and confirmatory factor analysis, convergent and discriminant validity, and Pearson correlation for criterion validity, reliability was tested using Cronbach’s alpha. @*Results@#The final instrument consisted of 25 items, with four factors identified through confirmatory factor analysis. Four factors-ethical values and moral attitudes, interaction-based communication, main-taining comfort, professional insight and competence–accounted for 61.8% of the total variance. Cronbach’s ⍺ for total items was .96, andtest-retest reliability of intraclass correlation coefficient was .90. @*Conclusion@#Since its validity and reliability have been verified through various methods, the Dignity in Care Scale of Terminally Ill Patients for Nurses can be used for develop nursing interventions and improve dignity in care of terminally ill patients.

The development and effects of a nursing education program for hyperglycemia patient care using standardized patients for nursing students / 한국간호교육학회지

Purpose@#This study aimed to evaluate the effects of a nursing education program for hyperglycemia patient care using standardized patients. @*Methods@#This study used a nonequivalent control group pre-test and post-test non-synchronized design. A total of 50 senior university nursing students who had completed an adult nursing course participated in this study (experimental group, n=24; control group, n=26). This nursing education program was developed according to the stages of analysis, design, development, implementation, and evaluation. The collected data were analyzed using χ2-test, Fisher’s exact test, independent t-test, paired t-test, and repeated measure ANOVA. @*Results@#Significant differences were shown between the experimental and control groups in clinical performance ability (F=277.41, p<.001), communication skills (F=47.18, p<.001), self-efficacy (F=3.81, p=.031), and learning satisfaction (t=2.25, p=.033). Problem-solving ability was not statistically significant between the groups. @*Conclusion@#The nursing education program for hyperglycemia patient care using standardized patients was effective in improving nursing students’ clinical performance ability, communication skills, and learning satisfaction. Therefore, it is proposed that the education program developed in this study be used as part of an education program to enhance nursing students’ abilities in caring for hyperglycemia patients.

Development and Evaluation of a Mobile Web-based Food Allergy and Anaphylaxis Management Educational Program for Parents of School-aged Children with Food Allergy: A Randomized Controlled Trial

Purpose@#This study aimed to develop a mobile web-based food allergy (FA) and anaphylaxis management educational program for parents of school-aged children with food allergies and evaluate its effectiveness. @*Methods@#A mobile program was developed based on a web-based teaching-learning system model. Its effectiveness was subsequently evaluated using a parallel, randomized controlled pre- and post-test design. This study included 73 parents of school-aged children with food allergies. These parents were randomly assigned to either the experimental (n ¼ 37) or control (n ¼ 36) groups. The experimental group participated in a 2-week mobile web-based educational program that covered major topics in FA and anaphylaxis management. These topics included an understanding of food allergies and anaphylaxis, learning techniques for using an epinephrine auto-injector, and developing an emergency action plan. An educational booklet was provided to the control group. Participants completed a pre-test and two posttest questionnaires to evaluate the impact of the program. The assessment tools were the Food Allergy Knowledge Test, Food Allergy Self-Efficacy for Parents, and Food Management and Adaptation Scale. The data were analyzed using descriptive statistics, a test of homogeneity for the pre-test, an independent ttest, and repeated measures ANOVA. @*Results@#The experimental group experienced greater improvement in the knowledge of FA (postintervention t ¼ 14.51, p < .001; 2 weeks post-intervention, t ¼ 16.15, p < .001), FA self-efficacy (postintervention t ¼ 77.99, p < .001; 2 weeks post-intervention, t ¼ 76.09, p < .001), and practice behavior in FA management (post-intervention t ¼ 28.10, p < .001; 2 weeks post-intervention, t ¼ 27.98, p < .001) after web-based FA education. @*Conclusion@#This study revealed improvements in the knowledge, self-efficacy, and practice behaviors of parents regarding FA and anaphylaxis management. Therefore, the mobile web-based educational program can contribute to the effective management of food allergies and anaphylaxis for parents of schoolaged children. CRIS registration: KCT0007491.

The Experience of Chemotherapy Related Cognitive Impairment in Patients with Cancer

Purpose@#This study was conducted to explore the experiences of adult cancer patients living with Chemotherapy-Related Cognitive Impairment (CRCI). @*Methods@#Data were collected by using in-depth and audio-recorded interviews with seven patients of colorectal, stomach, and breast cancer. The participants were asked to describe their CRCI experience. The data were analyzed according to Colaizzi’s method for phenomenological analysis. @*Results@#Three-theme clusters and six themes emerged: (1) Foggy daily life: brain health impairment; “I feel different from my usual self: cognitive impairment,” “Lost daily activities: work-related tasks affected,” (2) Struggle to retain memories; “Tried using all strategies I could to recall my memories,” “Need for concern and therapeutic communication,” (3) Expectation of a whole body: hope to live; “Expectations for cognitive rehabilitation,” “Reorganizing daily life.” @*Conclusion@#These results showed that patients did not consider CRCI important until symptoms affected daily activities and workrelated tasks and tried to use self-management strategies to manage CRCI. A two-way exchange of information between patients and health professionals can help patients understand and prepare for CRCI in dealing with symptoms.

Posttraumatic Growth and Health Promotion Behavior in Patients with Cancer:The Mediating Effect of Spiritual Well-Being

Purpose@#This study is a descriptive correlation research to test the mediating effect of spiritual well-being in the relationship between posttraumatic growth and health promotion behaviors of cancer patients. @*Methods@#The data were collected from 145 cancer patients of three hospitals. The instruments were Posttraumatic Growth Inventory, Health-Promoting Lifestyle Profile, and Spiritual Well-Being Scale. Data were analyzed using descriptive statistics, correlation, and multiple regression using Baron and Kenny’s steps for mediation. @*Results@#The mean score for posttraumatic growth was 3.57. The mean score was 2.98 for health promotion behaviors. The mean score for spiritual well-being was 2.96. There were significant correlations among the variables, posttraumatic growth, health promotion behaviors, and spiritual well-being. Spiritual well-being was directly affected by posttraumatic growth (Adj R2 =25). Health promotion behaviors were directly affected by posttraumatic growth (Adj R2=26). Posttraumatic growth and spiritual well-being affected health promotion behaviors (Adj R2 =31). Spiritual well-being had a partial mediating effect (β=.25, p<.001) on the relationship between posttraumatic growth and health promotion behaviors (Sobel test: Z=2.84, p<.001). @*Conclusion@#Based on the findings of this study, nursing intervention programs focusing on managing posttraumatic growth and increasing spiritual wellbeing are highly recommended to improve health promotion behaviors in cancer patients.

Posttraumatic Growth and Health Promotion Behavior in Patients with Cancer:The Mediating Effect of Spiritual Well-Being

Purpose@#This study is a descriptive correlation research to test the mediating effect of spiritual well-being in the relationship between posttraumatic growth and health promotion behaviors of cancer patients. @*Methods@#The data were collected from 145 cancer patients of three hospitals. The instruments were Posttraumatic Growth Inventory, Health-Promoting Lifestyle Profile, and Spiritual Well-Being Scale. Data were analyzed using descriptive statistics, correlation, and multiple regression using Baron and Kenny’s steps for mediation. @*Results@#The mean score for posttraumatic growth was 3.57. The mean score was 2.98 for health promotion behaviors. The mean score for spiritual well-being was 2.96. There were significant correlations among the variables, posttraumatic growth, health promotion behaviors, and spiritual well-being. Spiritual well-being was directly affected by posttraumatic growth (Adj R2 =25). Health promotion behaviors were directly affected by posttraumatic growth (Adj R2=26). Posttraumatic growth and spiritual well-being affected health promotion behaviors (Adj R2 =31). Spiritual well-being had a partial mediating effect (β=.25, p<.001) on the relationship between posttraumatic growth and health promotion behaviors (Sobel test: Z=2.84, p<.001). @*Conclusion@#Based on the findings of this study, nursing intervention programs focusing on managing posttraumatic growth and increasing spiritual wellbeing are highly recommended to improve health promotion behaviors in cancer patients.

Changes in Chemotherapy-induced Peripheral Neuropathy, Sleep Quality, and Quality of Life following Chemotherapy in Stomach Cancer Patients: a Prospective Study

Purpose@#The purpose of this study was to identify the changes of chemotherapy induced peripheral neuropathy (CIPN), sleep quality, and quality of life and their interrelationships following chemotherapy. @*Methods@#A sample of 52 patients who had been diagnosed with stomach cancer receiving oxaliplatin containing chemotherapy were included in a prospective longitudinal study. The assessment tools were Chemotherapy-induced Peripheral Neuropathy 20, Pittsburgh Sleep Quality Index, and EORTC Quality of Life- Cancer. The data were collected at three time points: pre-chemotherapy, post-chemotherapy, and three months after the completion of chemotherapy, using questionnaires given between June 2017 and March 2019. Data were analyzed using descriptive statistics, repeated measures analysis of variance, and multiple regression analysis. @*Results@#Post-chemotherapy, 19.2% of patients complained of CIPN and 21.2% exhibited CIPN at three-month follow-up. Repeated measures ANOVA showed a significant increase in CIPN after chemotherapy and it remained high at three-month follow-up (F = 39.90, p< .001). Functional quality of life (F = 8.23, p< .001) and symptom quality of life (F = 7.88, p= .001) also showed significant decreases after chemotherapy, and symptom quality of life remained low at three-month follow-up. However, for sleep quality, no significant main effect of time point was shown. CIPN and sleep quality were a factor influencing quality of life with an explanatory power of 48.3% at post-chemotherapy and 65.3% at three-month follow up. @*Conclusion@#These results suggest that chemotherapy is highly associated with CIPN and symptoms affecting quality of life in cancer patients. Nursing intervention is needed to monitor and relieve these symptoms of patients during the cancer care trajectory.

Effects of Nursing Workplace Spirituality and Self-efficacy on the Patient Safety Management Activities of Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to examine the effects of nursing workplace spirituality and self-efficacy on patient safety management activities of nurses. METHODS: A purposive sample of 212 nurses from two general hospitals was recruited for the cross-sectional survey design. During March and April, 2017, data were collected through structured self-administered questionnaires. The assessment tools were Patient Safety Management Activities Scale, Nursing Workplace Spirituality Scale and Self-efficacy Scale. Data were analyzed using descriptive statistics, t-test, one way ANOVA, Pearson correlation coefficients, and hierachical multiple regression analyses with SPSS 22.0 and AMOS 22.0 programs. RESULTS: The mean score for patient safety management activities by nurses was 4.29. A mean score of 4.49 was found for nursing workplace spirituality and a mean of 3.43 for the degree of self-efficacy. The results of the hierarchical multiple analysis revealed that self-efficacy (β=.31, p<.001) and nursing workplace spirituality (β=.27, p<.001) were predictive of patient safety management activities (R2=.18, p<.001). CONCLUSION: These results suggest that self-efficacy and nursing workplace spirituality are highly associated with patient safety management activities by nurses. Intervention programs are needed to promote self-efficacy as well as nursing workplace spirituality.

A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients / 간호학회지

PURPOSE: This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model. METHODS: The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs. RESULTS: The modified model was a good fit for the data. The model fit indices were χ2=423.18 (p<.001), χ2/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=−.51, p=.001), symptom experiences (β=−.27, p=.001), menopausal symptoms (β=−.22, p=.008), and chemotherapy-related cognitive impairment (β=−.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%. CONCLUSION: These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.

Changes of Cognitive Function and Fatigue following Chemotherapy in Patients with Gastrointestinal Cancer: A Prospective Controlled Study

PURPOSE: This study was to identify changes in cognitive function and fatigue following chemotherapy in patients with stomach or colorectal cancer. METHODS: Of the participants, 67 underwent adjuvant chemotherapy, while 66 healthy participants made up the comparison group. Three assessment tools were used: 1) the Korean Mini-Mental State Examination; 2) Everyday Cognition; 3) Functional Assessment of Chronic Illness Therapy-Fatigue. The questionnaires were administered in three stages, before chemotherapy, towards the end of chemotherapy, and 6 months after the final chemotherapy session. Data were analyzed using descriptive statistics and repeated measures analysis of variance (RM ANOVA). RESULTS: At the post-chemotherapy stage, 38.8% of the patients who underwent adjuvant chemotherapy complained of subjective cognitive impairment and reported greater difficulty in the cognitive domains of attention and concentration, memory, and executive function. RM ANOVA revealed a significant decline in cognitive function after chemotherapy. However, improvement was observed six months after the completion of chemotherapy (F=42.68, p< .001). Cancer-related fatigue also showed similar patterns as observed in the case of cognitive function (F=44.76, p< .001). CONCLUSION: Chemotherapy was associated with increased cognitive decline and fatigue in cancer patients with cancer. Nursing intervention programs need to be developed to counteract cognitive decline and fatigue in patients undergoing chemotherapy.

The Experience of Chemotherapy-induced Peripheral Neuropathy in People with Cancer

PURPOSE: The purpose of this study was to explore the experiences of adult cancer patients living with chemotherapy induced peripheral neuropathy (CIPN). METHODS: Data were collected from January 2018 to April 2018 through in-depth interviews with nine patients of colorectal and breast cancer. The main question was, ‘What is your experience living with CIPN such as tingling and/or numbness?’. The data were analyzed using Colaizzi's phenomenological method. RESULTS: Three theme clusters and six themes emerged: (1) unusual body change; ‘experience of unusual distressing symptoms’, ‘daily activities and functioning affected’, (2) CIPN: a less important risk; ‘CIPN: a distressing and have to endure’, ‘lack of concern and therapeutic communication’, (3) struggle for distressing CIPN through trial and error; ‘try all the remedies that can do’, ‘getting used to distressing CIPN’. CONCLUSION: These results showed that patients did not consider CIPN important until symptoms affected daily activities and QOL. They then tried self-management strategies to deal with CIPN through trial and error. A two-way exchange of information between patients and health professionals could help patients understand CIPN and deal with symptoms if they occur.

A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients

PURPOSE@#This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model.@*METHODS@#The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs.@*RESULTS@#The modified model was a good fit for the data. The model fit indices were χ2=423.18 (p<.001), χ2/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=−.51, p=.001), symptom experiences (β=−.27, p=.001), menopausal symptoms (β=−.22, p=.008), and chemotherapy-related cognitive impairment (β=−.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%.@*CONCLUSION@#These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.

Changes of Cognitive Function and Depression following Chemotherapy in Women with Breast Cancer: A Prospective Study

PURPOSE: This study was done to identify the changes of cognitive function and depression following Chemotherapy in women with breast cancer. METHODS: Fifty patients participated in the study and completed the questionnaire at three-time points: pre-chemotherapy, post-chemotherapy, and six months after the completion of chemotherapy. The assessment tools were: everyday cognition, the Montreal Cognitive Assessment, and the Hospital Anxiety and Depression Scale. Data were analyzed using descriptive statistics and repeated measures analysis of variance. RESULTS: Immediately after chemotherapy, 52.0% of patients complained of subjective cognitive decline and reported greater difficulty in the cognitive domains of attention, memory, and visuospatial abilities. At six-month follow-up, 24.0% of patients exhibited mild cognitive decline. Repeated measures ANOVA showed a significant decline in cognitive function after chemotherapy. However, improvement was observed 6 months after the completion of chemotherapy. Depression showed similar patterns to cognitive function. Higher cognitive decline scores were significantly correlated with higher depression (r=.33, p=.020). CONCLUSION: These results suggest that chemotherapy is highly associated with cognitive decline and depression in women with breast cancer. Nursing intervention is needed to relieve depression as well as cognitive decline in patients undergoing chemotherapy.

Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis

PURPOSE: This study was conducted to evaluate the effectiveness of non-pharmacologic interventions in chemotherapy-induced peripheral neuropathy (CIPN). METHODS: PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean databases (Until August 2017) were searched. The main search strategy combined terms for peripheral neuropathy and presence of neoplasms. The risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies and the Risk of Bias Assessment tool for non-randomized studies. To estimate the effect size, a meta-analysis of the studies was performed using the Rev Man 5.3 program of the Cochrane Library random-effects models were used in the analyses. RESULTS: Twenty-two studies with a total of 954 participants met the inclusion criteria. Of the 22 studies, 12 were used to estimate the effect size of the non-pharmacologic interventions. The non-pharmacologic interventions used in patients with CIPN were exercise, acupuncture, massage, and foot bath. The acupuncture significantly reduced CIPN symptoms and signs (d=+0.71) and CIPN pain (d=+0.73) (p < .001). Massage and foot bath were also effective in reducing CIPN symptoms (d=+0.68; 95% CI=+1.05, +0.30; p < .001; I2=19%).Exercises were effective in improving muscle strength and endurance(d=+0.55) and quality of life (d=+2.96), but they were not significantly effective in improving CIPN. CONCLUSION: Although these results provide little evidence of the effectiveness of acupuncture, massage, and foot bath in the treatment of CIPN, they suggest that these interventions can reduce CIPN symptoms in patients with cancer. However, the findings of this study should be interpreted with caution as there is a relative lack of data in this field, and additional well-designed studies are needed. PROSPERO registration: CRD42017076278.

Effect of Cancer Symptoms and Fatigue on Chemotherapy-related Cognitive Impairment and Depression in People with Gastrointestinal Cancer

PURPOSE: The purpose of this study was to test a hypothetical model of chemotherapy-related cognitive impairment (CRCI) and depression in people with gastrointestinal cancer. METHODS: A purposive sample of 198 patients undergoing chemotherapy was recruited from November 2014 to July 2015. The instruments were Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module. Data were analyzed using descriptive statistics, correlation, and path analysis. RESULTS: CRCI was directly affected by cancer symptoms (β=.19, p=.004) and fatigue (β=.56, p<.001)(R²=47.2%). Depression was directly affected by fatigue (β=.48, p<.001) and CRCI (β=.27, p<.001). However, The impact of cancer symptoms on depression was confirmed through the mediating effect of CRCI. CONCLUSION: Results indicate that in patients with gastrointestinal cancer undergoing chemotherapy along with the direct physiologic effects (fatigue, symptoms) of cancer treatment may have altered cognitive function leading to depression.

Chemotherapy-related Cognitive Impairment and Quality of Life in People with Colon Cancer: The Mediating Effect of Psychological Distress

PURPOSE: The purpose of this study was to test the mediating effect of psychological distress in the relationship between chemotherapy related cognitive impairment (CRCI) and quality of life (QOL) in people with cancer. METHODS: A purposive sample of 130 patients undergoing chemotherapy was recruited for the cross-sectional survey design. Data were collected from November 2014 to June 2015. The instruments were K-MMSE (Korean Mini-Mental State Examination), Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). Data were analyzed using descriptive statistics, correlation, and multiple regression using Baron and Kenny steps for mediation. RESULTS: The mean score for objective cognitive function was 27.95 and 69.32 for perceived cognitive decline. Overall quality of life was 91.74. The mean score was 17.52 for psychological distress. The prevalence was 56.2% for anxiety and 63.1% for depression, and 20.0% for CRCI. There were significant correlations among the variables, objective cognitive function and self-reported cognitive decline, psychological distress, and quality of life. Psychological distress was directly affected by CRCI. (R2=29%). QOL was directly affected by CRCI. Psychological distress and CRCI effected QOL (R2=43%). Psychological distress had a partial mediating effect (beta= -.56, p <.001) in the relationship between self-reported cognitive decline and quality of life (Sobel test: Z= -5.08, p <.001). CONCLUSION: Based on the findings of this study, nursing intervention programs focusing on managing cognitive decline, and decreasing psychological distress are highly recommended to improve quality of life in cancer patients.

Chemotherapy-induced Peripheral Neuropathy and Depression in Cancer Patients

PURPOSE: The purpose of this study was to assess chemotherapy induced peripheral neuropathy (CIPN) and to examine the relationship between CIPN and depression. METHODS: A purposive sample of 105 patients treated with chemotherapy were recruited in the cross-sectional survey design. Data were collected using self-report questionnaires. The instruments used were the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT) and Hospital Anxiety Depression Scale (HADS). RESULTS: The most frequent suffering symptom of CIPN was 'tingling feeling in the hand and foot'. Of the motor symptoms, 'muscle weakness' was the most frequent symptom and 'muscle or joint aches' was the strongest suffering symptom of CIPN. The mean score for suffering of CIPN was 4.1. The mean score was 1.04 for depression and the prevalence was 48.5%. CIPN was significantly positively correlated with depression (r=.38, p<.001). The result of simple regression analysis revealed that CIPN was predictive of depression (R2=.136, p<.001). CONCLUSION: Based on the findings of this study, nursing intervention programs focusing on CIPN management and alleviating depression are recommended.

Disturbance in ADL from Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Cancer Patients: The Mediating Effect of Psychological Distress

PURPOSE: The purpose of this study was to examine the mediation of psychological distress in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life in order to provide a basis for planning nursing interventions to improve the quality of life in cancer patients. METHODS: A purposive sample of 130 patients treated with chemotherapy were recruited in the cross-sectional survey design. Data were collected using self-report questionnaires. The instruments were the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS: The mean score for disturbance in ADL from chemotherapy induced peripheral neuropathy was 3.30. Overall quality of life was 2.48. The mean score was 1.04 for psychological distress. The prevalence was 35.4% for anxiety and 47.7% for depression. There were significant correlations among the three variables, disturbance in ADL from chemotherapy induced peripheral neuropathy, psychosocial distress, and quality of life. Psychosocial distress had a complete mediating effect (beta= -.74, p <.001) in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life (Sobel test: Z= -6.11, p <.001). CONCLUSION: Based on the findings of this study, nursing intervention programs focusing on disturbance of ADL management, and decrease of psychological distress are highly recommended to improve quality of life in cancer patients.

Effects of Dignity Interventions on Psychosocial and Existential Distress in Terminally ill Patients: A Meta-analysis

PURPOSE: This study was done to evaluate the effects of dignity interventions on depression, anxiety and meaning of life in terminally ill patients. METHODS: PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and several Korean databases were searched. The main search strategy combined terms indicating dignity intervention, presence of terminal illness and study design. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. Data were analyzed by the RevMan 5.2.11 program of Cochrane Library. RESULTS: Twelve clinical trials met the inclusion criteria with a total of 878 participants. Dignity intervention was conducted for a mean of 2.2 weeks, 2.8 sessions and an average of 48.7 minutes per session. Effect sizes were heterogeneous and subgroup analysis was done. Dignity interventions had a significant effect on depression (ES= -1.05, p<.001, I2=15%) and anxiety (ES= -1.01, p<.001, I2=0). For meaning of life, dignity interventions were effective (ES= -1.64, p=.005) and effect sizes were still heterogeneous. CONCLUSION: Results support findings that dignity interventions can assist terminal ill patients in reducing emotional distress and improving meaning of life. Further well-designed dignity studies will lead to better understanding of the effects of treatments on spiritual well-being.

Effects of Psychosocial Interventions on Cortisol and Immune Parameters in Patients with Cancer: A Meta-analysis

PURPOSE: This study was done to evaluate the effects of psychosocial interventions on cortisol and immune response in adult patients with cancer. METHODS: MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and domestic electronic databases were searched. Twenty controlled trials (11 randomized and 9 non-randomized trials) met the inclusion criteria with a total of 862 participants. Methodological quality was assessed using the Cochrane's Risk of Bias for randomized studies and the Risk of Bias Assessment tool for non randomized studies. Data were analyzed using the RevMan 5.2.11 program of Cochrane library. RESULTS: Overall, study quality was moderate to high. The weighted average effect size across studies was -0.32 (95% CI [-0.56, -0.07], p=.010, I2=45%) for cortisol concentration, -0.62 (95%CI [-0.96,-0.29], p<.001, I2=0%) for T lymphocyte (CD3) and -0.45 (95%CI [-0.74, -0.16], p=.003, I2=0%) for Th lymphocyte (CD4) numbers. Psychosocial interventions were not effective for Tc lymphocyte (CD4), NK cell, monocyte, and cytokine response. CONCLUSION: Although these results provide only small evidence of successful immune modulation, they support the conclusion that psychosocial interventions can assist cancer patients in reducing emotional distress and improving immune response.