Adventure therapy for child, adolescent, and young adult cancer patients: a systematic review.

PURPOSE: This systematic review aimed to examine the evidence on adventure therapy (AT) intervention for child, adolescent, and young adult (AYA) cancer patients in order to inform the design of future research and clinical practice. METHODS: This review included studies that tested the AT intervention among child and AYA cancer patients. Nine electronic databases (CINAHL, Cochrane Central Register of Controlled Trials, EMBase, Medline via EbscoHost, OpenGrey, PsycInfo, Web of Science, Scopus, and PubMed) were searched for English-language published studies using a quasi-experimental design, one-group pre-test-post-test experimental study design, or randomized controlled trial (RCT) from 1981 to May 2020. The methodological quality of the included studies was evaluated using JBI Critical Appraisal Checklists for RCTs and for Quasi-Experimental Studies by two researchers independently. A narrative synthesis of intervention characteristics and related health-related outcomes was performed. RESULTS: Eight papers from seven studies were included in the review, namely four RCTs, two quasi-experimental study papers, and two one-group pre-test-post-test experimental study papers. Studies varied in the components and duration of AT. Medium to high methodological quality of included studies was noted in all study designs. Results showed the positive effects of AT on the physical activity, fatigue, psychological distress, and quality of life of child and AYA cancer patients. CONCLUSION: AT is a promising intervention that may improve a number of health-related outcomes in child and AYA cancer patients. Evidence-based AT interventions should be developed and incorporated as part of supportive care for the target population.

Identification and evaluation of pharmacists' commonly used drug information sources.

BACKGROUND: Given the rate at which new medications are introduced to the market, as well as the diversity of existing drugs, pharmacists frequently need to consult drug information (DI) sources. Currently, there is a lack of information about pharmacists' needs for and sources of DI in Singapore. OBJECTIVE: To examine where practicing pharmacists in Singapore usually obtain DI and how useful and satisfactory the source is to pharmacists and to determine the kind of drug-related questions pharmacists usually receive. METHODS: An online survey was sent to registered hospital and community pharmacists who were members of the Pharmaceutical Society of Singapore. The survey consisted of questions about the pharmacists' demographics, what DI source they used most often, their satisfaction with that DI source, and how frequently they received various DI questions. RESULTS: A total of 156 pharmacists responded to the survey, for a response rate of 27.4%. The majority (82.7%) of the respondents chose reference texts as their most commonly used DI source; of these, 38.0% used the Drug Information Handbook. Reference texts were mostly rated very comprehensive (34.1%) or somewhat comprehensive (54.3%), whereas Web sites or search engines were mostly rated somewhat comprehensive (69.6%) or brief (21.7%). Most pharmacists believed that the information from reference texts could usually (51.2%) or always (48.8%) be trusted. Community pharmacists received questions on over-the-counter drugs and comparisons of drug efficacy more frequently than did hospital pharmacists (p < 0.001 and p = 0.001, respectively), whereas hospital pharmacists more frequently received questions on pharmacokinetics (p = 0.001). CONCLUSIONS: Most pharmacists in Singapore use reference texts when searching for general DI, and they find these texts more comprehensive and trustworthy than other available sources. The results also show that pharmacists in different settings receive different types of DI questions and have adequate resources to answer general DI questions.

Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases.

GOALS OF WORK: To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers. PATIENTS AND METHODS: Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns. RESULTS: Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice. CONCLUSIONS: Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.