Abstract

The aim of this study was to explore the life process of elderly male patients who wished to survive advanced esophageal cancer by undergoing chemoradiotherapy（CRT）. Semistructured and in-depth interviews were conducted with 11 elderly males who were advanced esophageal cancer patients. The data were analyzed using the Modified-Grounded Theory Approach.

The interview results elucidated not just living with the threat of esophageal cancer, but also the process of gaining wisdom for living beyond esophageal cancer. When the participants were informed about their esophageal cancer, they felt that “living with the threat of esophageal cancer” was as if they were close to death. By “communicating with their bodies”, participants living with the threat of esophageal cancer understood that they had to “start making an attempt to survive esophageal cancer”. By thinking of “living one’s life beyond esophageal cancer” instead of “living with the threat of esophageal cancer”, they significantly improved their perception of the overall life process. The subjects disregarded traditional values and hang-ups to “create a new pace of life” and discovered the meaning of life through cancer survival despite the hardships. Consequently, they “took pride in themselves” and changed their perception by “living their life beyond esophageal cancer”.

Nursing care is very important for managing and improving behavioral changes caused by cancer and intense invasive treatments such as CRT. However, nursing from the perspective of cancer survival seeks to increase the patient’s strength to survive cancer, especially focusing on the turning point in the patient’s behavior. Moreover, nursing care helps patients to communicate with their own bodies and start moving forward by themselves.

Abstract

The purpose of this study was to elucidate the inner world of cancer patients, the information that they need and suggestions for nursing care to promote their self care before the start of outpatient external beam radiotherapy. Data were collected using semi-structured interviews with 21 cancer patients before outpatient external beam radiotherapy started, and were analyzed using the method of content analysis by Krippendorff. Information which cancer patients need was classified into 12 themes：“type, appearance time, region and grade of adverse events”, “restrictions on life which outpatient external beam radiotherapy brings about”, “difference from atomic bomb effects”, “objective indicators about anticancer efficacy”, “expense concerning outpatient external beam radiotherapy”, “the experiences of people who received external beam radiotherapy”, etc. The inner world of patients was classified using 16 themes：“threat awareness brought about by aggravation of the disease condition and consciousness of death”, “anxiety over the uncertainty of cancer”, “preparedness for there being no other choices”, “embarrassment originating in the fact of medical treatment which requires a long period of time”, etc. Suggestions are given for nursing care of cancer patients before the start of outpatient external beam radiotherapy, such as ＜prior to the start of treatment providing information about the 12 themes so that cancer patients can feel a sense of personal control over outpatient external beam radiotherapy＞, ＜when patients who underwent multidisciplinary treatment in the past have dissatisfaction about previous treatment, nurses can help to reduce patient dissatisfaction before new medical treatment is started＞.

Abstract

This study has three purposes：（1）To create a questionnaire that will become an index for evaluating psychological adjustment of adult allogeneic hematopoietic cell transplantation survivors；（2）To assess the state of psychological adjustment of subjects using the questionnaire；（3）To clarify how psychological adjustment relates to physical condition and emotional condition. A draft questionnaire was created based on a review of literature and interviews with allogeneic hematopoietic cell transplantation survivors. The draft comprised a total of 27 questions from the 4 subordinate concepts of self‒esteem, self‒affirmative feeling, stability and satisfaction. The draft questionnaire was then used to conduct a study on 69 survivors up to three years after adult allogeneic hematopoietic cell transplantation. As the first step, psychological adjustment questionnaire draft item analysis and factor analysis were conducted. Based on the results of these analyses, the questionnaire was then refined to 16 questions comprising the 4 subordinate concepts of self‒esteem, self‒affirmative feeling, stability and satisfaction. Cronbach’s α coefficient of the refined questionnaire was between 0.72 and 0.88, confirming reliability by internal consistency. A significant correlation was seen between the psychological adjustment questionnaire and SF‒36v2 （r＝0.63，p＜0.01）, confirming concurrent validity. Regarding the relationship between physical condition and the adjustment score obtained by summing the scores of the refined questionnaire, subjects with chronic graft versus host disease （GVHD） had significantly lower psychological adjustment scores（p＝0.026）. In addition, there was a negative correlation between high scores for physical symptoms such as fatigue and low scores for psychological adjustment（r＝－0.58，p＜0.01）. In conclusion, evaluations of the questionnaire developed in this study suggested that, for allogeneic hematopoietic cell transplantation survivors, even in the situation of physical condition or lifestyle change after transplantation, assessing the situation with a sense of self‒affirmation can put them in a psychologically stable state of adjustment. The results have shown that there is correlation between psychological adjustment and QOL.

Abstract

The study objective was to determine dilemmas of nurses when providing terminal care to cancer patients who had been moved to a general ward after the so-called ‘gear change’（switch from positive treatment to mainly palliative care）and methods used for coping with such situations. We conducted semi-structured interviews with 11 nurses providing terminal care to cancer patients transferred to a general ward from university hospital after the gear change, and analyzed the results.

Six categories were extracted from dilemmas of the nurse. These categories included items such as “there are differences in the perception of the gear change between the medical staff and patients” and “we cannot tell the truth to some patients despite their ability to understand, because their families request that we not tell them.” Seven categories were extracted from the nurses’ methods for coping with these dilemmas. These categories included items such as “coping with their own feelings through consultation and interaction”, “coping with their own feelings by forgetting or giving up”, and “adjusting the situation so that care is given as a team”.

This study revealed that nurses providing terminal care to cancer patients who had been moved to a general ward after the gear change experienced dilemmas when there was a gap in perception of the gear change between medical staff and patients. We found that the dilemmas of these nurses arose because the patients, their families, and medical staff did not share a common goal during the terminal period. Psychological fluctuations of patients and their families due to insufficient perception of their present conditions may underlie this situation. We conclude that in order to cope with these dilemmas, nurses need to coordinate work to facilitate information sharing among patients, doctors and nurses, and support patients in making autonomous efforts to palliate symptoms.

Abstract

Purpose：The purpose of this study was to clarify the characteristics of fatigue in cancer patients. Method：Relevant literature retrieved until August 2011 from four databases：Ichushi Web, CINAHL, MEDLINE, PsycINFO, using search terms, ‘fatigue’ and ‘cancer’ yielded sixty-two articles. Using Rodger’s model of concept analysis, we extracted attributes, antecedents, and consequences of the concept. Results：Four attributes of the concept ‘fatigue in cancer patients’ were identified：1）lack of energy；2）sense of uncertainty；3）uncontrollable；and 4）changeable. Three antecedents were identified：1）characteristics of cancer and pattern of treatments；2）change of internal or external environment；and 3）patients characteristics. Three consequences were identified：1）coping behavior；2）lower quality of life；and 3）reduction of survival time. Discussion and Conclusion：Through concept analysis fatigue in cancer patients was defined as：a sense of uncertainty with lack of energy which produced a sense of uncontrollability resulting from the changeable influences of cancer and its treatment, and the changes of internal or external environments. These results suggest that patients needs accessibility to intervention that enhance physical and psychological symptom management, and maintaining of living functions. Nurses need to identify patterns of fatigue in cancer patients in Japan and build suitable programs that include social support systems.

Abstract

Objective：To evaluate the effect of educational intervention that improves the practice and confidence of nurse educators. In Japan, the Basic Plan to Promote Cancer Control Programs was formulated in 2007 to focus on training medical staff specializing in care of cancer patients. However, there are no specific guidelines for conducting a training program for medical staff. Thus, we created training sessions for nurse educators who run workshops in their institutions. In this study to evaluate the effectiveness of an educational intervention involving the nurse educators that aimed to improve their quality of conducting a workshop for nurses taking care of cancer patients, the ultimate aim of the intervention was to improve the quality of care for cancer patients.

Methods：The educational intervention consisted of a lecture and a group‒work activity in twodays, with a pre‒survey, post‒survey and a 6 months follow‒up survey. The outcome measures were the self‒reported practices about 19 items in the 3 domains of “planning”, “implementation” and “evaluation” of the education process（Cronbach’s α：0.72～0.87） and confidence in planning, implementation and evaluation（4 items, Cronbach’s α：0.93）. A total 102 subjects participated in this study.

Results：All participants completed a pre‒survey and post‒survey, and 94 participants completed a 6 months follow‒up survey. About half of the participants had less than two years’ experience of organizing educational programs in their institution. The self‒reported practices domain score for “training evaluation” including evaluating learning achievement and setting evaluation standards significantly increased from 19.4 to 21.7（p＝0.004, effect size＝0.43）, and the confidence score for development and running of a training session significantly increased from 8.2 to 12.6 soon after training and 10.3 at six months later（p＜0.001, effect size＝0.50）.

Conclusion：Based on self-reporting by participants, the training program improved the practice and confidence of nurse educators. The results suggested that the educational intervention was an effective tool to enable participants to conduct better workshops.

Abstract

The purpose of this research was to interview terminal cancer patients who experienced animal-assisted activity about its effects on their physical well-being and psychological mindset, find out the main effects, and provide suggestions for future nursing practices. In this research, the subjects consisted of six terminal cancer patients who were hospitalized at a palliative care unit. The study data were collected by semi-structured interviews held before and after animal-assisted activity, and observation of participants. The collected data were analyzed using qualitative and descriptive study.

It was clarified that animal-assisted activity physically and psychologically affected the terminal cancer patients. The effects of animal-assisted activity on terminal cancer patientsʼ physical and psychological aspects were “Physical comfort”, “Feeling happiness”, “Receiving natural healing”, “Transferred from hospital room to a comfortable space”, “Satisfying time of peace”, “Sense of freedom”, “Felt the bond between humans and dogs”, “Raised self-respect”, and “Found how to live in the future.”

The results showed that these subjects facing death got a sense of freedom from tremendous pain and enjoyed a time of peace through contact with the dogs. Interacting with the dogs in a family-like atmosphere and creating close relationships clarified that it was worthwhile to introduce terminal cancer patients to animal-assisted activity as an effective complementary alternative medicine to relieve their physical and psychological distresses.