Purpose: This study aimed to investigate the performance and difficulties of outpatient nurses engaging in prognosis of patients with metastatic/recurrent breast cancer who have multiple symptoms and are undergoing outpatient pharmacotherapy.

Methods: Semi-structured interviews were conducted with six nurses working in the department of outpatient breast surgical oncology or outpatient chemotherapy in two facilities in Tokyo. Data from the interviews were analyzed qualitatively and inductively.

Results: The practice of outpatient nurses engaging in prognosis of patients with metastatic/recurrent breast cancer who have multiple symptoms and are undergoing outpatient pharmacotherapy consisted of “clarification of core symptoms based on the cluster of physical pain,” “organization of priority care with the aim of continuation of home care,” and “accompanying patients/family members from time of notice of recurrence to period of consciousness of death.” The difficulty of outpatient nurses engaging in prognosis of patients with metastatic/recurrent breast cancer who have multiple symptoms and are undergoing outpatient pharmacotherapy consisted of “confusion regarding facing a patient who has received bad news,” “difficulty in predicting sudden changes in patients who are physically and mentally vulnerable,” and “dealing with a patient facing death and family members who are upset.”

Discussion and Conclusion: We inferred that outpatient nurses sorted patients’ multiple symptoms and determination of care strategies in a circular manner within the limited waiting time for medical examination. Some of the practical difficulties faced by outpatient nurses were problems regarding the effective implementation of outpatient end-of-life discussions for patients during the transitional phase to palliative care-oriented medical care and the cooperation between outpatient and home nursing for the continuation of home care for patients. Based on these findings, we recommend the creation of a specific set of guidelines for outpatient nursing support to better perform prognosis of patients with metastatic/recurrent breast cancer during pharmacotherapy.

This study aimed to clarify the process experience by cancer patients who are unemployed after a cancer diagnosis, and to investigate the appropriate nursing support for them. Data were collected by assessing medical records, nonparticipant observation, and face-to-face interviews with ten working-age cancer patients who were unemployed after their diagnosis; qualitative and descriptive analyses were carried out by Sandelowski’s method.

The result was that the types of experience were categorized as follows: “hoping to continue working despite the physical symptoms due to cancer treatment”; “facing cancer treatment’s physical changes, and am distressed that I cannot deal with them”; “would like to consult about work, but cannot find anyone with whom to do that”; “worried about the economic situation after unemployment”; and “decided whether to continue working based on the opinion of family and colleagues.” It was clear that if the relationships between these categories show a temporal sequence, the following three processes occur from cancer diagnosis until unemployment: (i) phase with cancer treatment and working; (ii) phase with difficulties combining cancer treatment and work; and (iii) phase of deciding to quit work.

Nursing support for working-age cancer patients must include the following: (i) supporting patients’ own decision-making about work to enable them to make their own decisions; (ii) supporting to alleviate distress; (iii) providing information appropriate to patients’ own situations and statuses; and (iv) liaison with specialists about financial issues.

Objectives: The objective of the study is to clarify the experiences and management strategies of cancer pain in elderly patients with cancer under home health care.

Methods: Using Dodd's （2001 model of symptom management as the conceptual framework, we collected data from elderly patients with cancer pain through a semi-structured interview and performed content analysis.

Results: We identified the following six categories of cancer pain experiences: 1) experiencing pain as long as one has cancer, 2) being aware of pain limiting independence in daily life, 3) learning the pattern of pain fluctuations during daily life, 4) experiencing failure makes one stay in one’s comfort zone, 5) failing to use analgesics as instructed, and 6) learning the effects of analgesics gradually during daily life activities. In addition, we identified the following seven categories of cancer pain management strategies for elderly cancer patients: 1) continuing to search for and try pain management methods that appear successful based on their own physical sensations, 2) asking for help when it seems impossible to manage on their own, 3) changing previous perspectives and methods and finding something enjoyable to do, 4) taking care of themselves based on their own physical sensations as a pain prevention indicator, 5) trying to communicate with their own physician about pain, 6) experiencing an inability to communicate with their physician because of not being able to describe the pain exactly the way that it is felt, and 7) leaving it to their physician.

Discussions: Learning safe ranges from experiences of failure and continuing to try methods that seem successful are active strategies that elderly patients with cancer developed to maintain an independent lifestyle at home, where there is limited contact with medical professionals, and the strategies should be supported.

The purpose of this study was to gain insights into the relationship between chemotherapy-induced peripheral neuropathy (CIPN), physical activity, and health-related quality of life (HRQOL) in breast cancer patients who received taxane-based chemotherapy. We conducted a cross-sectional, observational study on 43 breast cancer patients who underwent taxane-based chemotherapy. Information on demographics, CIPN (Ntx subscale), HRQOL (FACT-G), physical activity (IPAQ-SF), and psychological distress (K6) was collected through self-administered questionnaires. Data of clinical characteristics were extracted from the patients' medical records. Correlation analysis revealed a significant positive correlation between CIPN and HRQOL (r = 0.55, p < 0.001), physical well-being (r = 0.72, p < 0.001), emotional well-being (r = 0.41, p < 0.01), and functional well-being (r = 0.47, p < 0.01) but not physical activity. There was no significant correlation between physical activity and HRQOL. Among the 19 patients with severe symptoms of CIPN, an analysis of physical activity showed that 7 (36.8%) were inactive and 12 (63.2%) were active. Hence, CIPN significantly affects the HRQOL of breast cancer patients. Additionally, some patients perform physical activity according to their individual roles and environment by managing and enduring the symptoms of CIPN. Nurses should recognize the impact of CIPN on patients’ everyday lives, adequately assess the CIPN symptoms, evaluate the influence of CIPN on patients’ physical activity levels, and counsel patients accordingly. Additionally it is necessary to consider patients individually how to perform physical activity safely, especially when experiencing CIPN.

[Objective] To identify difficulties other than aphonia faced by patients who have undergone laryngectomy as a surgical procedure commonly required in total laryngectomy and hypopharyngolaryngo-cervical esophagectomy, such difficulties were predicted based on morphological and functional changes related to the procedure. Furthermore, changes in the degrees of these difficulties with time after surgery and solutions in each case were examined.

[Methods] A questionnaire survey was conducted, involving 1,602 laryngectomy patients, and responses were obtained from 799 (response rate: 49.9%). Statistical and content analyses were performed.

[Results] The difficulties faced by these patients in daily life after discharge were explained by the following 3 factors and 15 subfactors: [Factor I: permanent tracheostomy and breathing]: 2) difficulty carrying heavy things, 8) frequent water in the tracheostomy when taking a bath or shower, 11) frequent foreign objects in the tracheostomy, 12) dry airways, 13) frequent bleeding from the tracheostomy, 14) frequent phlegm, and 15) skin erosion around the tracheostomy, [Factor II: meals and excretion]: 3) difficulty straining when excreting, 4) difficulty blowing on hot foods to cool them, 5) difficulty eating noodles and soups, 6) frequent belching and flatulence, 7) frequent choking on solid foods, and 10) hyposmia; and [Factor III: physical activities] 1) difficulty running with maximal effort and 9) limitations in physical activities, such as swimming. The degrees of difficulties represented by Subfactors 3)-5), 8), and 14) decreased with time after surgery. To resolve these difficulties, approaches to manage aphonia, the permanent tracheostomy, phlegm, meals, constipation, and overall daily life were suggested.

[Discussion] The solutions to 1) 9) and 10) were not suggested. For a problem to continue irrespective of passed years after an operation, establishment of educational method is needed.

The purpose of this study is to clarify the components and influencing factors of nursing support on Advanced Care Planning (ACP) for cancer patients.

A questionnaire was developed based on ACP concept analysis and interview surveys. It consisted of nine items related to personal attributes, 55 items regarding ACP support, and 11 items about nurses’ recognition of ACP. Hospitals and stations for visiting nurse services were randomly selected nationwide, and 147 of them consented to participate in this research. The questionnaire was sent to nurses at the organizations with no less than five years of experience and collected via mail individually. Between June 1 and September 30, 2018, 1,354 copies of the questionnaire were distributed. 798 responses (response rate of 58.9%) were received, and 780 of them were valid (effective response rate of 97.7%). Factor analysis and multiple regression analysis were employed to analyze the data.

The factor analysis yielded the following seven factors as the components of nursing support for cancer patients in ACP: “appropriate sharing of information through dialogue,” “exploration of patients’ wishes for their end of life,” “arrangements for end of life,” “advocacy of patients’ wishes,” “understanding of how patients have lived,” “reflecting patients’ values regarding care,” and “continuous effort.” The multiple regression analysis demonstrated that the following factors had a positive effect on nursing practice in ACP: “nurses’ recognition of the need to confirm patients’ intentions for future treatment and care repeatedly based on the assumption that their feelings can fluctuate,” “the number of times attending ACP training,” “stations for visiting nurse services,” and “establishment of the ACP system.” In contrast, the following factors had a negative impact: “outpatient services,” “inadequate knowledge about ACP,” and “lack of communication skills.”

The purpose of this study was to identify resilience phases and elements in the social life of patients with primary rectal cancer after low anterior resection as well as how they went through the process. The participants were 12 outpatients who had undergone low anterior resection without stoma formation less than three years before. A semi-structured interview was performed, and the data was analyzed qualitatively and descriptively. The following four elements of resilience were extracted from the data. The first phase began with “persistent recognition of unacceptably changed reality after low anterior resection,” and this element linked to the second phase, “activating self-healing power to make a positive meaning.” Then, these elements led to the third phase indicating a progression of recovery “leading oneself to a healthier life in harmony with a reintegrated self.” Through these processes, the final element, “being able to have self-awareness of newly-acquired internal growth,” was provided as the fourth phase associated with growth. Early post-operative nursing care becomes a reliable form of support for patients to enhance resilience, by sharing negative feelings and focusing on issues recognized by those patients. Thereby, nurses provide support in increasing patients’ mental and physical stability and resistance. In addition, it is important that resilient nurses who are knowledgeable about resilience be involved as a partner in the process of strengthening or discovering potential for resilience in patients.

Objective: We clarified the characteristics and influencing factors of sleep in patients receiving cancer chemotherapy.

Methods: We conducted a self-description survey on the sleep of cancer patients receiving chemotherapy using PSQI-J. Multiple regression analysis was performed using the variable increase method with age, sex, and five items of influencing factors that showed significant differences between the presence or absence of poor sleep based on the total score of PSQI and each variable as independent variables.

Results: Among 64 subjects with average of 56.4 ± 7.2 years, 52 (81.3%) had gastrointestinal cancer and 41 (64.1%) had stage IV cancer. The use of oral medication was 31.3% for analgesics, 37.5% for steroids, and 12.5% for sleeping pills. The PSQI total score was an average of 5.2 ± 2.9 points. Those with poor sleep had 34.4 ± 24.7 minutes for sleep onset time, 5.9 ± 1.2 hours for actual sleep time, and 84.5 ± 12.6% for sleep efficiency with significant differences. Side effect symptoms were peripheral neuropathy in 42.2%, loss of appetite in 37.5%, fatigue in 35.9%, and pain in 17.2%. Patients with pain and taste disorder had short sleep time and poor sleep with statistical significance. Oral administration of steroids and sleeping pills, pain, and taste disorders were extracted as influencing factors of the PSQI total score (adjusted R²= 0.432).

Discussion: In cancer chemotherapy, sleep is likely to be disrupted due to oral administration of steroids, pain, and taste disorders. Sleeping pills are not effective in promoting sleep onset. These analyses suggest that it is necessary to alleviate pain symptoms in patients with poor sleep.

The objective of this study was to clarify the process of living with psychological suffering in patients with postoperative pancreatic cancer. The semi-structured interviews were conducted with 17 patients and the obtained data was analyzed using the modified grounded theory approach. The outcome showed that the subjects were upset at the time of diagnosis, wondering if “my life is over or it is too late”, however they thought “I have no choice but to risk my life with surgery”, and underwent surgery. After surgery they realized『I can live more』, whereas they suffered from both surgery and adjuvant chemotherapy, expressing <my body hurts and I hate my appearance>. Although they said, none was effective and they were scared of <dying hopelessly>.During this time, their emotions were torn between life and death and they suffer, wondering if . This process indicates the state of 【being at the mercy of uncertainty over life and death】. As they actually felt <getting better and being able to eat> over time, they shifted to 『look for a way to escape the suffering on their own』, saying . When realizing and 『I have someone to support me』, they felt.

In this way, 【regaining a sense of self-control】 helped them determine to. This study suggests that we should support the patients to relieve physical and psychological pain and to have them feel “getting better at eating”.

The purpose of this study is to clarify how patients with tongue cancer attach meaning to their experiences up through the present after diagnosis and surgery through to the present, and to deepen medical professionals' understanding of patients, as well as to derive suggestions for future nursing practice.

The study's design was a qualitative and descriptive study based on phenomenology: unstructured interviews were conducted with seven participants to collect data, which were analyzed based on a phenomenological method.

As a result of the analysis, four themes were derived from ten meaning units: the difficulty of receiving recognition as a cancer patient before diagnosis, and the need for postoperative determination to protect themselves from the cancer despite already being a patient; regularly experiencing occasions that particularly remind the patient that they have tongue cancer; feeling awkward around other people due to impaired articulation caused by partial or complete removal of the tongue; and starting to try to meet the expectations of the doctor who has worked to cure the disease and to save their life.

These themes represent the patients' feelings and behaviors as they develop and are diagnosed with tongue cancer, beginning with pain in the tongue, their embarrassment at losing their tongue, and their daily lives as tongue cancer patients, trying to adapt socially despite difficulties.

The results suggested the importance of nurses understanding the patients' situations, and the need to assist them in living with acceptance of their status as cancer survivors, becoming accustomed to their new eating methods, and living in society in a way that involves relationships with others.

The purpose of this study was to describe content of regret and how to face the regret in the grief process of bereaved families of cancer patients. The data was collected by semi-structured interview with 11 bereaved families. Interview transcripts were analyzed in a qualitative and inductive manner. As a result, the content of regret was classified into three groups: regret related to life, regret related to death, and regret related to relationships. In the grief process, when the bereaved families remembered the experience with the deceased, they reconsidered the feelings of regret caused by noticing the support of the people around them who connected by the deceased, finding out the meaning of the deceased’s way of life at the end of life, and realizing that they were able to take over thoughts and roles, and therefore began to adapt to the loss. The regret of the bereaved families, which was caused by the bereavement, or the break of the realistic connection, was an important part of the process of remembering and reconsidering the connection with the deceased. And, we suggest the need to provide families of cancer patients with the care focused on the regret at the end of life.

The purpose of this study was to clarify the employment status and characteristics of cervical cancer patients. A cross-sectional observational study was conducted on non-cancerous patients who were within 6 months to less than 6 years since their treatment had begun.

Based on self-administered questionnaires and medical records, we investigated whether the patient was employed or not at the time of cancer diagnosis and the time of the survey, changes in employment, background information, self-esteem, self-efficacy, and dysfunction due to cervical cancer. A comparison was made between groups according to whether or not they were employed at the time of survey.

Of the 127 subjects, 91.3% (116/127) were working at the time of cancer diagnosis. At the time of the survey, an average of 3.2 years (± 1.5) after the start of treatment, 82.7% (105/127) of those employed were working.

Marital status (p = 0.002) and parental status (p < 0.001) were associated with employment status at the time of the survey. 66.3% of those employed at the time of cancer diagnosis and survey had changes in employment after cancer treatment, such as changing jobs or adjusting working hours. Those who had changed employment were significantly more non-regular employees (p = 0.010), and returned to work late (p = 0.013)

For cervical cancer patients, working is financial stability and social interaction. It is necessary to respect the significance of employment and provide employment support including adjustment of the working environment and self-care for dysfunction.

[Objective]: Patients with advanced cancer must make difficult decisions as their disease progresses. End of Life Discussion (EOLD) has been shown to be effective in the decision-making process. However, nurses are not currently able to attend EOLD adequately. Therefore, our aim of this study is to clarify the factors that prevent nurses from attending the EOLD of patients with advanced cancer.

[Methods]: The subjects were eight ward nurses who were engaged in cancer nursing practice at three designated cancer hospitals in A Prefecture. Semi-structured interviews were conducted on the factors preventing their attendance at the EOLD, and the data obtained were analyzed qualitatively and inductively using Krippendorff’s content analysis method.

[Results]: The subjects were three males and five females with 5-24 years of clinical experience. From the verbatim record, 155 codes, 14 subcategories, and five categories were created. Factors that prevented ward nurses from attending the EOLD were “lack of awareness of the need to attend the EOLD”, “lack of collaboration between health care providers”, “lack of a work system to attend the EOLD”, “lack of role awareness and communication skills in the EOLD”, and “difficulty in engaging with patients’ families according to their characteristics”.

[Discussion]: To promote the attendance of nurses in the EOLD for patients with advanced cancer, the following three solutions are proposed: unified awareness of the need for nurses to attend the EOLD, improved knowledge about the EOLD and communication skills of nurses, and collaboration with the team and experts in difficult cases that may make patients emotional or create ethical conflicts after serious notification.

Objective: This study clarified the relationship between discharge support from ward nurses for the home-care needs of terminal cancer patients (including the associated knowledge/practice/difficulty of palliative care) and predicted nursing practices.

Methods: Participants included nurses from seven facilities (including cancer hospitals) from two prefectures in the Tohoku region. Questionnaires were distributed containing self-assessment scales related to the ward nursing practice with a focus on the home perspective. Retrieved data were subjected to a variety of analysis methods, including descriptive statistics, factor analyses, variable correlations, a model established to determine the level of discharge support according to palliative care knowledge/practice/difficulty, and a covariance analysis on the predicted level of nursing practice.

Results: The survey form was distributed to 338 nurses, and valid responses obtained from 116 nurses were included in the analysis. Results indicated that five factors were related to ward-nursing practices from the home perspective i.e., palliative care practices: Delirium, patient/family-centered care, pain, communication, and share-predicted situations with community health care providers. A valid model with a high-degree index was thus constructed. A total of 58.3% of such practices were explained by the three factors of "practical palliative care practice: Delirium," "practical palliative care practice: Patient/family-centered care," and "share-predicted situations with community health care providers."

Discussion: The two factors of "delivery" and "patient/family-centered care" were directly related to discharge support for required stay-at-home care focusing on the "life" of "patient/family" in the palliative care practice. These two factors are considered highly important.

This study aimed to reveal the state of nursing support provided for patients with sexual dysfunction associated with prostate cancer treatment. Participants were 10 nurses with ≥3 years of experience working in a department for prostate cancer. Semi-structured interviews were conducted to collect data on the nurses' backgrounds and their involvement in caring for patients with sexual dysfunction. The obtained data were analyzed qualitatively and inductively.

The nurses' involvement was broadly divided into the following two attitudes: those who accepted patients with sexual dysfunction and worked towards solving the associated problems and those who did not step in to care for sexual dysfunction in patients with prostate cancer.

The backgrounds of nurses accepting patients with sexual dysfunction and working towards solving their problems included "the attitude of facing a patient's sexual dysfunction regardless of the nurse's own orientation or circumstances," and "mutual support among nurses who listen to and sympathize with the difficulty of involvement." Alternatively, the backgrounds of nurses who did not step in to care for sexual dysfunction in patients with prostate cancer were "the nurse's assumption or indifference to sexual dysfunction [background related to nurses]," "anxiety and fear of telling the medical staff about sexual dysfunction [background related to patients]," and "underdeveloped basic and postgraduate education to care for sexual dysfunction of patients [undeveloped systems]."

To promote adequate nursing support for sexual dysfunction in patients with prostate cancer, several suggestions were provided, such as training experts and establishing a team system to care for patients with sexual dysfunction, creating a workplace culture that considers nurses' feelings about this topic, establishing a systematic education system to address this condition, developing a manual focusing on sexual dysfunction in patients with prostate cancer, and clearly indicating and adhering to ethical and behavioral standards related to sexuality.

Individual semi-structured interviews were held with 13 outpatient nurses and 10 visiting nurses to clarify the characteristics outpatient and visiting nurses focus on to determine whether elderly cancer patients undergoing outpatient chemotherapy need visiting nursing. A qualitative content analysis was conducted on the verbatim recordings. Results show the nurses focus on the following characteristics of elderly cancer patients undergoing outpatient chemotherapy deemed to require visiting nursing. In the period from treatment decisions until the outpatient chemotherapy treatment, they are “the existence of factors foreseen to make self-management difficult” and “uncertainty whether family is able to support the elderly cancer patient.” In the period of continued outpatient chemotherapy, characteristics are “difficulty with self-management,” “need to re-examine the direction of treatment and recuperation,” and “a decline in the family’s ability to provide nursing care to a degree that impacts the continuation of treatment.” In the period when continuation of outpatient chemotherapy becomes difficult, the characteristics are “unavoidable decisions on how to spend the rest of the patient’s life” and “limitations on family alone providing care.” This study clarified that outpatient and visiting nurses ascertain an elderly cancer patient’s self-management and the family’s burden to determine who needs visiting nursing. It also indicated that the nurses determine the necessity of introducing visiting nursing while asking elderly cancer patients to consider their lifestyle and life going forward from the period of continued therapy, and concentrating on the patient’s ability to choose the direction of treatment and recuperation on his or her own.

The purpose of this study was to clarify the nursing problems encountered by certified nurse specialists (CNS) and certified nurses (CN) in cancer nursing while providing nursing care to patients with cancer and dementia and their families. Semi-structured interviews were conducted of 11 nursing professionals from 8 facilities. Qualitative analysis of the interview contents revealed the following six problems: [Difficulty in decision support that respects patients receiving treatment], [Difficulty in family support to reduce confusion between cancer and dementia], [Difficulty in adjusting the living environment to suit the patient], [Lack of education of nursing staff who provide nursing care for patients with both cancer and dementia], [Lack of collaboration to utilize expertise in cancer and dementia nursing] and [Difficulty in supporting to ensure patient safety and quality of life (QOL) in cancer treatment]. From the results, it appears that CNS and CN cannot fully understand the patients’ will or intention due to impaired memory/judgment of the latter associated with dementia, and cannot be confident in providing nursing support due to poor evidence of the efficacy of cancer therapy and effects of treatment on the QOL in cancer patients with dementia. They were faced with an ethical dilemma in that too much emphasis on safety measures led to a decrease in the QOL of cancer patients with dementia. The results suggest the importance of improving the quality of cancer nursing provided by nurses inside and outside hospital facilities for patients who are transferred to another treatment/recuperation facility.

This study aimed to examine the challenges faced at work by survivors of gynecological cancer and the factors determining their decision to continue or end their employment. The participants were 26 survivors who had been working when they were initially diagnosed with gynecological cancer. Of these, 20 participants continued employment, while six had ended employment at the time of the study. Semi-structured interviews were conducted for data collection, and Krippendorff’s content analysis method was used to analyze the data.

The results suggested that the challenges for continued employment among survivors of gynecological cancer were “obstacles due to adverse events and the after-effects of treatment”, “difficulty of self-management”, “anxiety about uncertain prospects”, “psychological damage due to changes in self-image and femininity”, and “lack of employment status support by medical staff/institutions”. Furthermore, the factors determining end of employment were “lack of employee support in the workplace”, “anxiety about recurrence”, and “onset of mental illness”. Similarly, the factors determining continuity of employment were “searching for information on adverse events and the after-effects of treatment”, “self-management for adverse events and the after-effects of treatment”, and “disclosure of disease and treatment plans in the workplace”, in addition to the support received through “workplace environments with resources for medical conditions”, “high motivation to work”, and “employment status support by medical staff”. Comprehensive employment support through multi-professional collaboration is necessary for the continued employment of survivors of gynecological cancer. This collaboration should happen primarily with nurses due to their constant involvement in the patients’ life and treatment from the initial diagnosis.

Objective: We aimed to clarify primary breast cancer patients' experiences in explaining the disease to their school-age children to improve the quality of nursing practice in this area.

Methods: Semi-structured interviews were conducted with 13 mothers with primary breast cancer receiving initial treatment, and the obtained data were analyzed using Krippendorff's content analysis.

Results: Primary breast cancer patients' experiences related to explanations of the disease to their children were summarized into 7 categories, including 【experiencing distress due to the necessity of continuously providing such explanations as a mother】, 【considering the child's ability to understand and psychological burden】, and 【realizing the child's mental growth and the development of a favorable mother-child relationship through explanations】.

Discussion: While repeatedly facing distress due to the development of cancer and burden of explaining the disease to their children, the patients judged the children's levels of understanding from the perspective of language conceptualization during the elementary school period and carefully examined how and what to explain to them. After explanation, the patients simultaneously perceived the children's emotional upset, which was expressed through mother-child interactions, and desire to mentally and physically support their mothers, demonstrating that explanation of the disease leads to both the mental growth of children and the development of trust-based mother-child relationships.

This suggested that by explaining the disease, patients realize the mental growth of their children, who begin to cope with cancer treatment together with them and become their driving force for cancer treatment after explanations, further promoting a favorable mother-child relationship. Based on this study, nursing practice for mothers with cancer should focus on mother-child relationships from initial consultations and continuously support patients to practically reduce the distress they repeatedly face due to the burden of explaining the disease to their children. Information provision, consultation, and support for appropriate explanations from the perspective of language conceptualization may also be important.

This study aimed to understand nursing practices toward caring for adolescent cancer patients, and the difficulties faced by nurses. Semi-structured interviews were conducted with eight members of the Childhood, Adolescents and Young Adult Cancer Nursing SIG (Special Interest Group) in the Japanese Society of Cancer Nursing. The data were analyzed using Krippendorff’s content analysis method.

The results generated four categories. “Understanding cancer and developmental process in adolescents” was at the core of nurses with expertise in caring for adolescents. They were nursing with “an attitude to explore the needs while respecting independence” as they were striving to protect the patients’ rights. Conversely, nurses had “difficulty understanding what patients want in their process of development. ” Nurses shared information among medical professionals to prepare age-appropriate surroundings that encourage autonomy and bridge the disagreements between patients and parents. It was clarified that nurses “support the autonomy of patients living with cancer” after their treatment is completed. Nursing for adolescent cancer patients requires an understanding of the feelings that patients experience during their treatment period. Therefore, in addition to the adult nursing perspective, the pediatric nursing perspective is also necessary. Additionally, supporting the autonomy of adolescent patients living with cancer while caring for them is essential.

We sought to clarify the present state of radiation therapy nursing in cancer patients undergoing external radiation therapy.We conducted a self-administered questionnaire of 1400 nurses involved in radiation therapy nursing. The nurses were asked to describe present state using the “Cancer Radiation Therapy Nursing Quality Evaluation Index”. We received 394 questionnaire responses and we used 349 fully-completed responses as our analysis set. After confirming the reliability and constructive concept validity of the Cancer Radiation Therapy Nursing Quality Evaluation Index, we used the questionnaire responses to analyze constituent factors, respondents’ positions, affiliations, type of facilities, and status of radiation therapy certification.Our findings showed that the respondents could provide nursing care conducive to safe radiation therapy, nursing care that helped patients to make satisfactory therapeutic decisions, and nursing care that facilitated patient self-management, but were unable to sufficiently deliver nursing care for improving quality of life of cancer survivors. Nursing care conducive to safe radiation therapy and that facilitated patient self-management was significantly higher among nurses who worked in radiotherapy departments than among those in hospital wards (P<0.01). All of the factors related to the quality of radiation therapy nursing were significantly higher among the Certified Nurse in Radiation Oncology Nursing than among the general nurses (P<0.01).Our study findings suggested that in order to improve the quality of radiation therapy nursing, nursing education and training must place a greater emphasis on care to improve the daily life of cancer survivors. The overall quality of radiation therapy nursing is expected to be improved by Certified Nurse in Radiation Oncology Nursing acting as role models for their nursing peers in clinical settings, and guiding and consulting with other nurses.

The purpose of this study is to clarify the thoughts, behaviors, and results of by Certified Nurse Specialist in Cancer Nursing (CNS) regarding the content of consultation requests from physicians.

The author conducted semi-structured interviews with four CNSs who were carrying out cancer consultations with physicians. The interview data were compiled and qualitatively and inductively analyzed.

CNSs approach to consultation with physicians consisted of 18 categories. The CNSs thought that “The physicians would request consultation regarding patient-centered care”. CNSs did as follows “Considers relationships to keep the face work of physicians and nurses”, “Trying to solve problems with physicians while understanding the physician’s position”, “Build a system to collaborate with multiple occupations to solve problems”. As a result of the consultation, changes in consulting, such as “The physicians repeatedly request consultation”, clients, consultants, and organizations such as have occurred.

CNSs assessed the consultation requests from physicians, and they worked behind the scenes to maximize the power of multiple occupations. In addition, CNSs has gained the understanding of multiple occupations and organizations by maintaining the face work multiple occupations and visualizing the results of consulting. This has led to general use of CNSs. Additionally, CNSs tried to improve their consultations by reflecting on the previous consultations conducted with multiple occupations.

Purpose: This study examined the current status of and factors associated with clinical competence in specialized palliative care among nurses in palliative care units from the critical thinking and resilience aspects.

Methods: A questionnaire survey was administered to nurses in palliative care units. Clinical competence in specialized palliative care was measured by the core competence required of nurses in charge of specialized palliative care. The questionnaire consisted of clinical competence in specialized palliative care, scales to assess the critical thinking of clinical nurses, the Adolescent Resilience Scale and attributes. Multiple regression analysis was performed with clinical competence in specialized palliative care as a dependent variable.

Results: In all, 1,392 valid responses were obtained (valid response rate: 71%). In terms of the current status of clinical competence in specialized palliative care, nurses scored highly for the items “understand and respect cancer patients and their families just as they are” and “face and support spiritual distress in cancer patients and their families”, but scored low for the items “actively fulfill their roles and responsibilities as a nurse in charge of specialized palliative care”. Six factors were found to be associated with practical competence: “creative thinking”, “logical thinking”, “intuition”, “emotional regulation”, “years of experience in palliative care units”, and “experience of learning palliative care” (adjusted R2 = 0.37).

Discussion: The results regarding the current status of practical competence suggest that nurses respect the values of the patients and their families while showing a high level of awareness of spiritual care, but that there are issues with active engagement in quality improvement. The characteristics of the factors associated with practical competence indicate the importance of: (1) being able to identify the essence of and changes in the palliative care nursing to provide individualized care; (2) being able to reflect and regulate emotions; and (3) repeated practice and learning.

This study aimed to clarify what a “partnership” is between cancer survivors and their family members. This is qualitative descriptive study conducted on 18 participants consisting of 9 pairs, each a first-time cancer treatment survivor and a family member. Data were collected between August 2016 and July 2017 via semi-structured joint interviews between the cancer patient and the family member using an interview guide.

We identified two aspects of the cancer survivor and family member partnership emerged. 1) Re-formation of mutual trust with a deepened understanding of the patient’s involvement with cancer. 2) Working cooperatively to enable living with cancer. Seven core constituent elements of the partnership were identified: (1) A shared understanding of the suffering and trials which only the patient or family members can understand , (2) Not being overly concerned, (3) Providing an emotional boost during hard times , (4) Providing support through reassuring words like “It’s going to be okay”, (5) Making decisions by meeting each other halfway , (6) Surviving treatment by emotionally uniting, (7) Fostering abilities to live and engage with cancer.

The return to an equal relationship of trust via not being overly concerned forms the basis of a partnership between a cancer survivor and family member. To return to this trust, a mutual understanding of the cancer patient’s “suffering and trials which only the individual can understand” is essential. We were able to obtain suggestions a new family image that cancer survivors and family members foster the ability to live and engage with cancer based on the relationship of not being overly concerned. We thought that dyadic intervention-based nursing assistance is needed to promote partnerships between cancer survivors and family members.

The purpose of this study was to clarify the desires of the families of patients with end-stage lung cancer, who receive best supportive care (BSC). Semi-structured interviews using an interview guide were conducted with 10 families of lung cancer patients receiving BSC on acute care wards, and the obtained data were examined using content analysis. The families’ desires were summarized into 4 categories: [desiring to let the patient continue treatment although it is inevitable to discontinue it], [desiring to let the patient spend the last days of his/her life peacefully without pain], [desiring to watch the patient live his/her life in his/her own way until the end], and [desiring to say thank you to the patient for his/her coping]. While regretting the infeasibility of treatment for the patients to continue to live, the families wanted them to spend time peacefully. This represented the families’ desire of “giving priority to patient comfort” such as relief from pain. Explaining that surgery is the only cure, and watching over the patients, who became weak through repeat treatments, was an anticipatory grief process, where the families accepted their deaths little by little. Recognizing such deaths as unavoidable reality, the families desired to support the patients to live their lives in their own ways until the end as “the final duty of family members”, which may have helped the families.

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