The purpose of this study was to develop a cancer radiation therapy nursing quality evaluation index for cancer patients receiving radiation therapy of external irradiation. A cancer radiation therapy nursing quality evaluation index draft was developed based on a literature review and it was modified based on the consideration of qualitative content validity by an expert panel. In addition, we conducted a questionnaire survey about the relevance and importance of the items on 128 [nurses certified in radiation therapy,] and quantitatively examined the content validity using the Item-level Content Validity Index（I―CVI） and Scale’s Content Validity Index（S―CVI/Ave）. As a result, a cancer radiation therapy nursing quality evaluation index was composed of 4 components: “Decision support for treatment selection”, “The provision of safe and comfortable treatment”, “Support to enhance self-care” and “Support to live true to oneself with cancer”; 15 level items, and 62 items. All items reach 0.78 or more in I―CVI acceptance criteria, overall quality evaluation index, components, and the level items were ensured to be 0.90 or more in the S―CVI / Ave. We have developed a cancer radiotherapy nursing quality evaluation index with sufficient content validity. Cancer radiation therapy nursing quality evaluation indexes were developed, and practiced care can be self evaluated which leads to the appropriate setting of goals for improving the problem. Furthermore, the indexes can be used as an educational tool for the training of nurses, and can help achieve the maintenance and support of the education system． Abstract

The purpose of this study was to develop a cancer radiation therapy nursing quality evaluation index for cancer patients receiving radiation therapy of external irradiation. A cancer radiation therapy nursing quality evaluation index draft was developed based on a literature review and it was modified based on the consideration of qualitative content validity by an expert panel. In addition, we conducted a questionnaire survey about the relevance and importance of the items on 128 [nurses certified in radiation therapy,] and quantitatively examined the content validity using the Item-level Content Validity Index（I―CVI） and Scale’s Content Validity Index（S―CVI/Ave）. As a result, a cancer radiation therapy nursing quality evaluation index was composed of 4 components: “Decision support for treatment selection”, “The provision of safe and comfortable treatment”, “Support to enhance self-care” and “Support to live true to oneself with cancer”; 15 level items, and 62 items. All items reach 0.78 or more in I―CVI acceptance criteria, overall quality evaluation index, components, and the level items were en sured to be 0.90 or more in the S―CVI / Ave. We have developed a cancer radiotherapy nursing quality evaluation index with sufficient content validity. Cancer radiation therapy nursing quality evaluation indexes were developed, and practiced care can be selfevaluated which leads to the appropriate setting of goals for improving the problem. Furthermore, the indexes can be used as an educational tool for the training of nurses, and can help achieve the maintenance and support of the education system．

Abstract

In this study, we aimed to develop evaluation criteria for patient reported outcomes on the side effects of can cer chemotherapy, and to make these criteria available to patients. We developed criteria based on 13 side effects with versatility, and these were evaluated by medical staff and patients. We then examined the usefulness of these criteria in clinical practice, and considered including further side effects within the criteria. In the first stage, we developed a draft based on a review of existing literature. Physicians involved in the treatment of cancer patients (i.e., specialists) checked the draft twice (first check, 86 specialists; second check, 224 specialists). In the second stage, we interviewed 20 patients and refined the draft based on the interview findings. In the third stage, we asked 40 specialists to examine if the draftʼs expressions and classifications were appropriate. We then obtained a consensus from specialists and completed the evaluation criteria for side effects, which included 13 items for the evaluation of four phases (Grades 0 to 3). We interviewed 20 patients (median age, 65 years) and extracted the following 4 categories: “a review and pre diction of side effects”, “physical condition management”, “communication with medical staff”, and “difficulties in recording data”. The development of these criteria was useful to patients for managing their physical condition and promoting communication with medical staff, and to medical staff for appreciating the impact of side effects and providing ap propriate supportive care. We were able to find further side effects for inclusion within the criteria, including those which patients were both reluctant and eager to suggest. We then devised appropriate ways to evaluate each side effect.

Abstract

This study aimed to clarify the experiences of women diagnosed with a pre-cancerous cervical lesion during the consultation period and to investigate the nursing support given to these women who were receiving ongoing consultations. Data were collected via participant observation, interviews, and records surveys from 10 partici pants who had a high-grade dysplasia or final diagnosis of cervical cancer. The data were classified into two time periods: from diagnosis of the pre-cancerous lesion to surgical diagnosis, and from surgical diagnosis to final diag nosis. A qualitative analysis was carried out on each period. As a result, the experiences of women diagnosed with a pre-cancerous cervical lesion during the consultation period was classified into seven core categories: feeling confused while in the ambiguous state of having a pre cancerous lesion, taking measures to prevent the progression to cervical cancer, asking for information to estab lish expectations and obtain a sense of ease, feeling upset upon receiving information that threatens oneʼs well being, feeling doubtful and isolated in relationships with others, the supportive presence of others serving as encouragement, and accepting the result of the final diagnosis. The period from the diagnosis of a pre-cancerous lesion to surgical diagnosis involved accepting the reality of the pre-cancerous lesion; however, the period from surgical diagnosis to final diagnosis encompassed obtaining peace of mind after receiving treatment while being confronted with a new threat. Nursing support during the consultation period for women diagnosed with a pre-cancerous cervical lesion is important for helping them to accept and face the reality of the diagnosis of a pre-cancerous lesion or viral infec tion, to help them discuss their fertility and postoperative sexual life with their husband or partner, and to ensure that they have the ability to rebuild their lives.

Abstract

The purpose of this study is to clarify the resilience of cancer patients undergoing chemoradiotherapy. Semi structured interviews were conducted with 6 cancer patients who have been treated with chemoradiotherapy in an inpatient setting. Data collection was performed using a semi-structured interview process and recording sur vey method, and the obtained data were analyzed with reference to the method of qualitative content analysis. As a result, the resilience of cancer patients undergoing chemoradiotherapy was classified into the following 6 categories: “motivation to continue chemoradiotherapy”, “To take responsibility as a patient”, “To acquire ways to relieve pain”, “To accept the chemoradiotherapy and its side effects”, “To protect oneself”, and “To get peer sup port”. This resilience enabled patients to get through the treatment period and achieve complete treatment, with combining an “active capacity to inspire themselves by motivating or assigning a role”, with a “passive capacity to free themselves from the burden and to get help from a peer”. Therefore, we conclude that the required nursing care for patients who undergo chemoradiotherapy is “encour aging patients to continue their treatment, and supporting them in acquiring coping strategies and other support resources.”

Abstract

The purpose of this study was to clarify the recognition by general ward nurses caring for end-of-life cancer patientsʼ families suffering anticipatory grief. Semi-structured interviews were conducted with a total of 12 nurs es working on a general ward, and their accounts were analyzed in a qualitative and inductive manner. These ac counts showed that the nurses placed emphasis on “supporting end-of-life cancer patientsʼ families without re gret”, and recognized the “importance of interpersonal relationships that become the basis for anticipatory grief care”, and the “importance of care that helps to nurture the strength of families suffering distress associated with anticipatory grief”. On the other hand, nurses recognized the “difficulty of providing anticipatory grief care”, and “nursesʼ own regret that remains after patientsʼ death”. The results of our study indicate the need not only to im prove the skills of nurses, such as their communication skills, but also to help them develop the ability to view their own care objectively, and establish systems for providing anticipatory grief care in an organized manner. In addition, in order to promote “growth as a nurse that can be achieved through end-of-life care experience”, which was noted by general ward nurses, we suggest the need to provide them with opportunities to consider life and death, and recognize the significance of their experience of caring for end-of-life cancer patients and their families.

Abstract

The aim of this study was to visualize the decision-making process of patients with newly diagnosed breast cancer, from cancer diagnosis to the time that they tell their elementary school children about their illness, and to discuss the state of nursing support when telling their children about their disease. A semi-structured interview was conducted with 14 patients with newly diagnosed breast cancer who had children in elementary school. A qualitative inductive analysis was performed using a modified grounded theory approach. The process of telling oneʼs child is an experience that involves the patientʼs role and responsibilities as a mother, with the perception that they are the only mother that their children have, along with still being in shock themselves by the cancer diagnosis. This process is affected by factors that encourage or deter them from playing a maternal role. Maintaining the usual communication pattern by taking advantage of their experience in raising children allowed them to convey the information to their children. It is necessary to provide support, in order to identify early on the factors that would encourage them to play a maternal role and also to reinforce encouraging factors. In addition, the results suggested a need to establish a nursing care system to allow the patients to recognize the significance of being a mother, to understand their childrenʼs perception of cancer, and to tell their children about the disease with confidence.

Abstract

This study aims to clarify the experience of mothers who raise their children alone after having lost their spouse to cancer. Data was collected through semi-structured interviews conducted with four research partici pants, after which were subjected to analysis based on a qualitative descriptive methodology. The results were di vided into six categories. The experiences of mothers whose partners had passed away were categorized as fol lows: “A sense of isolation as a result of raising the children alone”; “Not wanting to express grief in front of the children”; “Perplexity about how to interact with the children”; “Being helped by the presence of the children”; “Being supported by people around them”; and “Living positively with the children along with the memories of their husband”. Mothers experiencing a sense of isolation at having to raise children alone also felt confused about how to interact with their bereaved children. Feeling that “as long as the children are here, I have to contin ue on as normal,” the mothers felt unable to express their own sorrow and were similarly unable to discuss the fatherʼs death with their children. Conversely, they felt the presence of the children helped them, and the fact that they were making positive attempts to cope was also presented as a notable characteristic. In the course of this experience, it became apparent that these mothers felt buoyed by the assistance provided by those around them. In addition, when children were not clearly informed of their fatherʼs condition, it influenced the grief reaction af ter bereavement. It is therefore required that nurses take care of them so that children can be with their fathers at the end and understand the need for bereavement.This suggests the necessity of support to help mothers and children overcome both the grief of children losing their father and a child-rearing mother losing a husband to cancer.

Abstract

The present study aimed to obtain an insight into nursing practices supporting the life control of outpatients who have undergone transplantation, by clarifying the state of such control among patients who visit a hospital as an outpatient in the early stage after undergoing hematopoietic stem cell transplantation （HSCT）. The study was conducted based on phenomenology in a qualitative and descriptive manner. Semi-structured interviews were held with 18 participants, and the obtained data was analyzed using the descriptive and phenomenological approach of Giorgi. As a result, patientsʼ life control was divided into three major themes comprised of seven themes and 20 subthemes. In addition, we revealed the following concerning the life control of patients who visit a hospital as an outpatient in the early stage after undergoing HSCT: 1） They are deeply concerned about their uncertain circumstances and “re-orienting their lives,” 2） they “lead their lives while maintaining a certain distance from others” and face challenges due to the absence of support for them, and 3） they “balance their own feelings and continue their lives” while trying not to think about their unfavorable prognoses or the possibility of recurrence. The life control of patients was characterized by them predicting their lives, and restraining themselves, while understanding their uncertain circumstances due to various factors, such as graft versus host disease （GVHD） and the possibility of recurrence. The results of our study suggest that nurses can help patients to realize concrete action, and nurses can help outpatients re-orient their lives by viewing their actions through life control. Nurses should also understand that patients have difficulty due to their strict restraints, and support them accordingly.

Abstract

Objective: The purpose of this study was to develop an assessment tool for early detection of depressive states in patients with cancer. Method: The study was approved by the ethics board of the affiliated university. For the assessment tool （AT）, 28 items were developed based on a comprehensive review of the literature and the criteria for major depressive episodes according to the DSM-IV-TR. Content validity was confirmed with a three-round, modified Delphi technique administered to certified nurse specialists in cancer nursing or psychiatric mental health nursing in Japan. Inter-observer reliability was assessed in a pilot study. Item analysis, reliability, and validity were assessed in the main survey. Severity of AT scores was based on the severity of BDI-II scores. Nurses estimated depression severity using the AT for 7 days during day shifts, and patients were asked to use the BDI-II. Sample: The pilot study was conducted with 27 diagnosed cancer patients and 15 nurses, and the main survey was conducted with 377 diagnosed cancer patients and 79 nurses. Result: 1） The AT consisted of 24 items as a result of the literature review, according to the DSM-IV-TR major depressive episode definition, and the modified Delphi technique. 2） The inter-observer concordance rate was 93–100％. 3） Item analysis resulted in 21 final items. 4） A confirmatory factor analysis yielded a GFI of 0.768. The reliability of the AT was confirmed by a Cronbachʼs alpha internal consistency reliability coefficient of 0.932. A significant difference in severity classification between the BDI-II score and AT score （p<0.05） was found. Conclusion: The above findings indicate that the developed AT had content validity, interrater reliability, construct validity, reliability, and criterion-related validity. The subject of the next investigation will establish whether the AT can distinguish the severity of depression.

Abstract

Actual condition and symptom management of oral complications in patients with hematologic malignancies receiving chemotherapy Purpose: The purpose of this study was to clarify the actual condition of oral complications in patients with hematologic malignancies receiving chemotherapy and how the patient manages the symptoms. Method: The subjects were patients recelivaiving chemotherapy for hematologic malignancies. Semi-structured interviews were conducted with a symptom management model as a conceptual framework, and data was collected on symptomatic experiences and the management of oral complications. We also evaluated oral health condition, quality of life, self-efficacy, and self-care ability. Changes from the 1st week to the 4th week of one course of chemotherapy were analyzed. Results: All 14 subjects experienced some oral complications, with 11 of them experiencing dry mouth and saliva reduction, while 5 had oral mucositis. Many subjects temporarily experienced worsening conditions of their oral cavity, and 2 out of 14 subjects experienced no improvement. Deterioration of OAG scores were observed in subjects with prolonged blood cell depletion, signs of deterioration of physical condition and low self-care ability, and with a high need for medical intervention by medical personnel. The subjectsʼ method of coping with oral complications was strongly influenced by strategies acquired from past experiences of oral problems and their oral care practices, and patients practiced appropriate measures in response to changes in blood cells and the body, such as increasing the amount of mouth rinse when they felt a sense of abnormality in the oral cavity. However, QOL was low overall, as some subjects showed a decline in self-efficacy, and it was found that patients did not feel successful in improving their condition of their oral cavity.

Abstract

This study aimed to clarify the types of dialogues, if held, in support programs for cancer patients who also have children. The contents of dialogues among 24 mothers in the parent–child support program type were included as study data and qualitatively analyzed using an inductive approach. The results of the analysis revealed that through these dialogues, mothers expressed and shared their anxieties associated with cancer and its treatment. They also discussed their troubles as a mother, the understanding of cancer by others, and how to convert the cancer experience to a positive experience. By coming together, cancer patients with children expressed and shared their feelings without any reservations about the treatment and their apprehension of future, their troubles in executing their role as a mother, difficulty experienced by their children/family members and community members in understanding cancer, and their appearance in comparison with other patients affected by the same disease. Having an opportunity to converse with fellow cancer patients in the same circumstances helped them to mutually share their maternal concerns and provided them with a platform offering emotional and informational support.

Abstract

Purpose: To clarify the influence of skin toxicity caused by epidermal growth factor receptor-tyrosine kinase inhibitor treatment on the daily lives of non-small cell lung cancer patients. Method: We conducted a semi-structured interview of nine outpatients who experienced skin toxicity caused by gefitinib or erlotinib. The data was analyzed qualitatively using the Funashima method while referring to analysis by Berelson. Result: We extracted the seven following core-categories relating to what the patients experienced as follows: “physical suffering with pain on the skin surface and itching” and “mental anguish and anxiety about their physical appearance.” They experienced “difficulties in daily life” and “difficulties even after symptomatic treatment” due to the modality of further treatments. In order to “get over anxiety related to skin toxicity deterioration,” they practiced “behaviors to control symptoms.” Thereafter, they needed some information about the symptoms of skin toxicity, support from their family, and knowledge about how to “ask for the necessary support relating to skin toxicity.” Conclusions: Patientsʼ physical suffering due to skin toxicity influencd their social lives. They stopped self-care because it did not alleviate their symptoms. Conversely, some patients, who had a better understanding of skin toxicity, continued self-care. These results suggest that the nursing staff should encourage a shift in patientsʼ perspective about skin toxicity to encourage self-care by informing them about the resolution time of symptoms. Further, after treatment initiation, it is necessary to continue daily assessment of the skin.

Abstract

The need of nursing support for outpatient chemotherapy is increasing with the shift from inpatient to outpatient settings. However, the lack of appropriate nursing support focusing on each patientʼs life-style issues has been pointed out. The purpose of this study was to identify appropriate nursing methods and processes which help chemotherapy patients pursue individually meaningful life–styles. Our study subjects were 14 nurses with 5 years experience or more in clinical practice and 1 year or more （mean: 3.5 ± 1.7 years） in the outpatient chemotherapy unit. Semi-structured interviews were conducted, and the results were analyzed by the modified grounded theory approach. From our results, we noted a core category of “assisting patientsʼ lives according to their own sense of values”. Firstly, the nurses attempted to “sense the usual life-style of the patient”, and then tried to help “each patient maintain their usual life-style as much as possible”. Further, depending on the timing, nurses “expressed understanding of patientʼs unstable feeling”, and served as a “liaison between the professional support” of medical and co-medical staff members. Finally, nurses personally “reflect on the nursing care they provided”. The need for specific nursing processes varied depending on the individual patientʼs condition and feelings. To properly cope with the needs of individual patients receiving outpatient chemotherapy, it is important to comprehensively consider the desired life-style of the patients, taking into account their usual life-styles and physiological effects of the chemotherapy.