Patients' and Clinicians' Perceptions of the Clinical Utility of Predictive Risk Models for Chemotherapy-Related Symptom Management: Qualitative Exploration Using Focus Groups and Interviews.

BACKGROUND: Interest in the application of predictive risk models (PRMs) in health care to identify people most likely to experience disease and treatment-related complications is increasing. In cancer care, these techniques are focused primarily on the prediction of survival or life-threatening toxicities (eg, febrile neutropenia). Fewer studies focus on the use of PRMs for symptoms or supportive care needs. The application of PRMs to chemotherapy-related symptoms (CRS) would enable earlier identification and initiation of prompt, personalized, and tailored interventions. While some PRMs exist for CRS, few were translated into clinical practice, and human factors associated with their use were not reported. OBJECTIVE: We aim to explore patients' and clinicians' perspectives of the utility and real-world application of PRMs to improve the management of CRS. METHODS: Focus groups (N=10) and interviews (N=5) were conducted with patients (N=28) and clinicians (N=26) across 5 European countries. Interactions were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS: Both clinicians and patients recognized the value of having individualized risk predictions for CRS and appreciated how this type of information would facilitate the provision of tailored preventative treatments or supportive care interactions. However, cautious and skeptical attitudes toward the use of PRMs in clinical care were noted by both groups, particularly in relationship to the uncertainty regarding how the information would be generated. Visualization and presentation of PRM information in a usable and useful format for both patients and clinicians was identified as a challenge to their successful implementation in clinical care. CONCLUSIONS: Findings from this study provide information on clinicians' and patients' perspectives on the clinical use of PRMs for the management of CRS. These international perspectives are important because they provide insight into the risks and benefits of using PRMs to evaluate CRS. In addition, they highlight the need to find ways to more effectively present and use this information in clinical practice. Further research that explores the best ways to incorporate this type of information while maintaining the human side of care is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081.

Evaluating cancer related fatigue during treatment according to children's, adolescents' and parents' perspectives in a sample of Greek young patients.

INTRODUCTION: Cancer related fatigue in children and adolescents has received limited clinical attention. The aim of the study is to assess the change in fatigue scores during cancer treatment according to children's, adolescents' and parents' perspectives and to describe the possible causes of fatigue from children's, adolescents' and parents' view. PATIENTS AND METHODS: The sample consisted of 40 children aged 7-12 years old, 29 adolescents aged 13-15 years old with cancer and one of their parents. Three measurements were performed for the evaluation of cancer related fatigue. Three versions of the instrument for the assessment of fatigue in pediatric patients with cancer were used: "The Child Fatigue Scale" (CFS), "The Adolescent Fatigue Scale" (AFS) and "The Parent Fatigue Scale" (PFS). The survey was performed from March 2003 till October 2006. RESULTS: Children (F=6.85, p=0.00), adolescents (F=4.15, p=0.03) and parents (F=3.98, p=0.02) reported a statistically significant increase in fatigue scores during their treatment. The hospital environment was assessed as the most contributing factor of fatigue by the three groups. CONCLUSIONS: Cancer treatment was found significantly to increase children's fatigue levels. Medical procedures and the hospital environment seemed to be major causative factors of the fatigue experienced by young patients with cancer during their treatment.

Transformations of self: a phenomenological investigation into the lived experience of survivors of critical illness.

Based on the hermeneutical, phenomenological perspective, this study explored the lived experience of individuals with a past hospitalization in an intensive care unit, with focus on their dreams. The purpose was to explore how it is to have been critically ill. Dreams are the language of the unconscious and can symbolically convey meanings. Eight participants recounted their experiences with critical illness through semi-structured phenomenological interviews and dream-telling. An interplay between the 'factual-external' world and the 'internal' world appeared to be the basis of their perception of the situation. Participants' narratives were immensely rich in symbols of transformation, transcendence and rebirth. Transformations in perception, in lived-body, and in lived time and space were some of the themes emerging as part of both conscious and dreaming experiences. Attitudes towards death were altered, and elements of heightened spirituality were evident in the aftermath of critical illness. Critical illness was conceptualized as a 'cocooning phase' leading to transformation of self, spiritual arousal and personal growth. Nurses may be able to alleviate suffering by supporting this process while in the ICU, as well as after discharge.