Needs Assessments Enhance Patient-Centered Care Quality No abstract available

Validation of the Supportive Care Needs Survey Screening Tool Chinese Version for Patients With Head and Neck Cancer in Taiwan Background The increasing number of cancer survivors and the trend of shifting cancer treatments into outpatient clinics have increased rapidly the supportive care needs of patients with cancer. However, no brief assessment tool is available to screen for these needs. Purpose In this study, we aimed to (a) translate and develop a nine-item Chinese version of the Supportive Care Needs Survey Screening Tool (SCNS-ST9-C) and (b) examine the psychometric properties of this tool in a sample of patients with head and neck cancer (HNC) in Taiwan. Methods In this two-phase instrument validation study, the SCNS-ST9-C was translated and evaluated for content, face validity, and feasibility in Phase I and was examined for internal consistency reliability and construct validity (including factor structure and theoretically supported correlations) on a sample of patients with HNC in Phase II. Results In Phase I, the SCNS-ST9-C was translated and developed by three bilingual doctoral-prepared nurse researchers (Chinese and English). A standardized score system ranging from 0 to 100 was built, with higher scores indicating higher unmet supportive care needs. Good content and face validity were confirmed by five cancer care experts and 20 patients with HNC, respectively. In Phase II, 116 subjects were recruited. A clear four-factor structure, which incorporated one of the original five dimensions (sexuality care needs, with one item) into the dimension of psychological and emotional care needs, was identified using exploratory factor analysis. Good internal consistency reliability for the overall SCNS-ST9-C was supported by a Cronbach's α of .75 and its four subscales (domains). Good construct validity was also confirmed by the theoretically supported correlations. Better performance status and longer time since treatment completion correlated negatively with the SCNS-ST9-C (i.e., lower unmet care needs), whereas higher distress (anxiety, depression, and symptoms) correlated positively with the SCNS-ST9-C (i.e., greater unmet care needs). Female patients reported higher overall unmet care needs and psychological and emotional care needs and higher scores on the care and support needs subscale than male patients. Conclusions The SCNS-ST9-C is a brief, low-burden, and psychometrically valid instrument that may be applied in ethnically Chinese settings. This tool takes 1–2 minutes to complete. Further testing of the psychometrics of this instrument in different cancer populations is recommended.

A Correlational Study of Skin Toxicity and Quality of Life in Patients With Advanced Lung Cancer Receiving Targeted Therapy Background Oral targeted therapy is increasingly used worldwide to treat patients with advanced lung cancer. The adverse skin toxicity that is associated with treatment with epidermal growth factor receptor inhibitors often results in acneiform rash, dry skin (xerosis), pruritus, and paronychia, which may cause discomfort in patients and affect their quality of life. Purpose This study was designed to explore changes in skin toxicity and quality of life (measured overall by three subscales) as well as the correlation between skin toxicity and overall quality of life over a 3-month period for patients with advanced lung cancer receiving oral targeted therapy. Methods This study used a longitudinal research design. Baseline data were collected before initiating targeted therapy. Data for the effects of targeted therapy on skin toxicity and quality of life were collected at 2, 4, 8, and 12 weeks after therapy initiation. Data on skin toxicity were collected using the Common Terminology Criteria for Adverse Events Version 4.03, and quality of life was measured using the Chinese version of the Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitor-18 questionnaire. Demographic and clinical data were analyzed using descriptive statistics, and Spearman's rank correlation coefficient was used to measure the correlation between skin toxicity and quality of life. Results Thirty-two patients participated in this study. The symptoms of skin toxicity that increased over the 3-month study period included xerosis and paronychia, whereas acneiform rash and pruritus fluctuated during this period. Over the study period, more than 70% of the participants exhibited symptoms of skin toxicity. Skin toxicity was the greatest and quality of life was the lowest, respectively, at the end of the study. All of the symptoms of skin toxicity were significantly correlated with quality of life, although each varied over time (r = .36–.61, p < .05). Conclusions/Implications for Practice The results of this study indicate that healthcare providers should consider the impact of skin toxicity on quality of life in patients with advanced lung cancer who are receiving oral targeted therapy. These findings may be used to design interventional measures for skin and medical care to improve quality of life in patients with advanced lung cancer.

Supportive Care Needs of Patients With Lung Cancer in Mainland China: A Cross-Sectional Study Background The diagnosis and treatment of lung cancer necessitate a variety of supportive care needs. To our knowledge, no studies have been conducted that target specifically the supportive care needs of patients with lung cancer in Mainland China. Cross-cultural studies indicate that supportive care needs vary by cultural background. Thus, it is necessary to investigate the supportive care needs of patients with lung cancer in the cultural context of China. Purpose This study aimed to describe the level of supportive care required by patients with lung cancer in China and to examine the relationships between supportive care needs and demographic factors and between supportive care needs and treatment variables. Methods A cross-sectional descriptive study design was adopted. Five hundred fifty-four patients with lung cancer were recruited using a convenience sampling method from inpatient departments in four tertiary teaching hospitals that are affiliated with a medical university in Anhui Province, China. The Nursing Professional Social Support Needs Scale and background information list were used as the data collection instruments. A Wilcoxon rank sum test and a Kruskal–Wallis rank sum test were conducted to examine the differences among the professional supportive care needs of patients of different demographic characteristics and under different treatment conditions. Results Participants self-reported the highest scores in the domain of informational needs (M = 3.67, interquartile range = 1.25). The most common supportive care need was “to be cared for by nurses with skilled venipuncture techniques.” There were significant differences in needs across different genders, age groups, educational levels, and income levels (p < .05). Patients with metastasis and other illnesses had greater supportive care needs in terms of total and subscale scores in Stages III and IV (p < .05). Conclusions Patients with serious diseases and heavy socioeconomic burdens have greater supportive care needs. Therefore, healthcare providers should improve their awareness and expertise to identify the needs of their patients and to provide supportive care to patients with lung cancer. In addition, patients with high supportive care needs should be identified.

The Development of a Standardized Framework for Primary Nurse Specialists in Diabetes Care in China: A Delphi Study Background: The number of patients with diabetes has been increasing rapidly according to a 2017 report by the International Diabetes Federation. Diabetes has become one of the most challenging public health problems, and there will be an estimated 143 million patients with diabetes in China by 2035. This puts considerable pressure on nurses who specialize in the care of patients with diabetes in China and increases related social and financial burdens. Clinical practice has proven that strengthening the core competencies of nurses and establishing an evaluation system of core competencies improve both healthcare quality and patient quality of life. However, no core-competence system framework currently addresses the unique characteristics of nurses in China. Purposes: The purpose of this study was to construct a core-competence system framework for primary nurse specialists in diabetes care. Methods: A brainstorming approach was conducted that worked to conceptualize the core competencies of nurse specialists in diabetes care in China. Next, a study group organized this information and conducted a seminar; 50 experts and patients with diabetes were invited to develop the first draft of the framework. Afterward, 50 experts were selected to participate in the Delphi survey. Most indicators were retained after a three-round Delphi process, and the superiority chart was used to determine the weights of the six dimensions. Results: Forty-seven experts completed the consultation. The experts' rate of response ranged from 94% to 100%, the authority coefficient was .91, and the Kendall's coefficients of concordance in Grades 1–3 were .793, .418, and .542, respectively. An increasingly detailed, three-grade system framework was developed, including six first-grade indicators (diabetes professional knowledge, diabetes-related knowledge, communication skills and health education ability, specialized skills, clinical judgment, and specialty development capacity), 23 second-grade indicators, and 87 third-grade indicators. The weights of the six first-grade indicators were .221, .149, .192, .209, .160, and .069, respectively. Conclusions: The core-competence system framework includes six core competencies, which represent the main characteristics of primary nurse specialists in diabetes care who are highly recommended by experts. It is important to keep in mind that this is only a theoretical framework and thus must be further tested in clinical practice settings in China.

Prevalence of Depression and Its Influence on the Quality of Life of Jordanians Living in Residential Care Facilities Background As a third-world country experiencing a rise in the elderly population and changes to traditional family structures, improving psychological health is critical to improving quality of life (QoL) in the older adults living in residential care facilities in Jordan. Purpose This study aimed to (a) estimate the prevalence of depression among nursing home (NH) residents in Jordan; (b) measure perceived QoL in these NH residents in the dimensions of mobility, self-care, usual activity, pain and discomfort, and anxiety/depression; and (c) assess the influence of depression on each of these QoL dimensions. Methods This cross-sectional study recruited a convenience sample of 155 participants living in a residential care facility in Jordan. The instruments used included a sociodemographic and clinical questionnaire, the Mini-Mental State Examination, a Geriatric Depression Scale (GDS), and the EuroQol, which is a five-dimension, five-level questionnaire. The data were presented as means, standard deviations, and percentages as well as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results A high prevalence of depression was found in the study population, with 72.3% having a score between 6 and 9 on the GDS, which is suggestive of depression. Moreover, 18.1% scored ≥ 10 on the GDS, which is indicative of a nearly continual state of depression. With regard to the QoL dimensions, 84.5% of the participants reported experiencing pain, 81.9% reported anxiety/depression, 80.6% reported problems performing usual activities, 75.5% reported problems with self-care, and 63.2% reported mobility difficulties. Pain, anxiety, and depression were found to be significantly associated with level of depression (AOR = 2.78 and 95% CI [1.18, 6.57], AOR = 5.81 and 95% CI [2.14, 15.78], and AOR = 4.75 and 95% CI [1.87, 12.07], respectively). Conclusions Depression is common among NH residents in Jordan and is associated significantly with poor QoL. This study yielded empirical data that may be used to develop strategies to enhance or promote the mental health status and QoL of NH residents in Jordan.

The Effect of a Nurse-Led Cognitive Behavioral Protocol on Depressive Symptoms and Coping Strategies of Dementia Caregivers Background Family caregivers of patients with dementia (PWD) often experience depressive symptoms and use poor coping strategies. Cognitive behavioral interventions may enhance positive appraisals of caregiving-related issues and the utilization of active coping strategies among caregivers, which may help prevent caregiver depression. However, there is a shortage of primary, community-based mental health services in China, and little research has been conducted on the effect of nurse-led mental health programs in this population. Purpose This study explored the effect of a nurse-led cognitive behavioral intervention on depressive symptoms and coping strategies among family caregivers of PWD in China. Methods This randomized controlled trial used data from a sample of 112 caregivers screened from 276 potential participants in a city in southeastern China. The sample was randomly assigned to an intervention group (n = 56) and a control group (n = 56). The intervention group received five monthly in-home, nurse-led cognitive behavioral sessions and telephone consultations after each session. The control group received five monthly, short, general conversations with nurse interventionists at the participants' homes, in the hospital, or via telephone. Depressive symptoms, coping strategies, and the demographics of caregiving dyads were collected at Time 1 (baseline), Time 2 (the end of the 5-month intervention), and Time 3 (2-month follow-up). IBM SPSS Statistics Version 19.0 was used for data analysis. Results Eighty-two participants (intervention group: n = 47, control group: n = 35) completed the three evaluations. No significant group differences were found in baseline characteristics between the two groups. The general linear model repeated-measures analysis of variance indicated a significant difference in depressive symptoms and active coping between groups over time, with p < .001 for the interaction between depressive symptoms and groups and p < .01 for the interaction between active coping and groups. A similar result did not occur for passive coping. The t tests further supported a significant interventional effect on participants' depressive symptoms and active coping. Conclusions/Implications for Practice This nurse-led cognitive behavioral intervention was effective in decreasing depressive symptoms and improving active coping among study participants. The findings suggest the improvement of mental health services and social policies in China to support family caregivers of PWD.

Cognitive Dysfunction and Its Predictors in Adult Patients With Cancer Receiving Chemotherapy: A Cross-Sectional Correlational Study Background: Chemotherapy-related cognitive dysfunction, one of the most frequently reported symptoms in patients with cancer, has a negative impact on the daily lives of patients. No research has examined cognitive dysfunction and its potential predictors in adult patients with cancer receiving chemotherapy in Saudi Arabia. Purpose: The purpose of this study was to examine the sociodemographic, clinical, and psychological factors associated with cognitive dysfunction in adult patients with cancer receiving chemotherapy. Methods: A cross-sectional correlational study was carried out with a convenience sample of 100 adult patients with cancer receiving chemotherapy at a university teaching hospital in Saudi Arabia. The Montreal Cognitive Assessment, the Hospital Anxiety and Depression Scale, and sociodemographic and clinical surveys were completed by participants. Descriptive statistics and linear regression were used to analyze the data. Results: The data showed that the participants experienced moderate-to-severe cognitive dysfunction. Participants performed poorly in the divided attention and memory cognitive domains. Age, educational level, and depression factors were found to be significant predictors of cognitive dysfunction. Conclusions/Implications for Practice: Cognitive dysfunction is commonly seen in patients with cancer receiving chemotherapy. Chemotherapy, age, and psychological factors increase susceptibility to cognitive dysfunction in adult patients with cancer. Oncology nurses should be aware that patients with cancer may be extremely vulnerable to cognitive dysfunction. Furthermore, age and psychological factors must be considered when developing symptom management and supportive care intervention programs to reduce the incidence of negative cognitive outcomes in this population.

Readiness for Behavior Change in Patients Living With Ischemic Heart Disease Background Readiness for behavioral change may be evaluated by assessing the patient's stage of change, as described in the transtheoretical model. Identifying readiness to change in patients with ischemic heart disease may enhance the effectiveness of interventions that target risk reduction and lifestyle modification. Purpose This study was designed to assess the readiness of patients with ischemic heart disease to change health behaviors as well as to identify the factors that significantly predict this change. Methods A descriptive correlation design approach was adopted, and a convenience sample of 122 patients with ischemic heart disease was recruited from an outpatient cardiac clinic. Readiness for behavioral change was evaluated by assessing the stages of change of the participants, as described in the transtheoretical model. Data on readiness to change were collected using the “readiness for lifestyle change inventory.” Results A total of 62.2% and 43.4% of the participants were in the precontemplation phase of change for “cease smoking” and “be physically active,” respectively; about 33% of the patients were in the maintenance phase for “control weight”; 36.1% were in the maintenance phase for “reduce consumption of high-fat foods”; and 51.6% and 57.4% were in the maintenance phase for “eat fruits and vegetables” and “practice relaxation,” respectively. Participants who were overweight or obese showed higher readiness to practice physical activity, and those with high cholesterol levels showed a higher readiness to reduce the amount of fat in their diet. Higher income was found to predict higher readiness to eat fruits and vegetables. Conclusions Patients are not adequately ready to change their health-related behaviors. Higher cardiovascular risk predicts higher readiness to change health behaviors.

Oral Dysfunction in Patients With Head and Neck Cancer: A Systematic Review Background: Head and neck cancers (HNCs) and their treatment may cause oral function impairment. Purpose: This study was designed to identify oral dysfunction in patients receiving treatment for HNCs using a systematic review. Methods: The PubMed, Embase, and CINAHL databases were searched for studies on oral function impairment in patients receiving treatment for HNCs published between January 2014 and May 2019. Only descriptive, correlational, and interventional quantitative studies that included patients receiving treatment for HNCs who presented with oral dysfunction, were published in English during the aforementioned time frame, and were accessible in full-text versions were selected. Results: Twenty-eight studies (13 cross-sectional, two longitudinal, 12 randomized controlled trial, and one retrospective chart review) fulfilled the inclusion criteria. Oral mucositis, dysphagia, xerostomia, trismus, and chewing and speech problems were the most common oral dysfunctions. Age, cancer stage, tumor location, treatment modalities, treatment status, treatment dose, and pretreatment oral function were factors associated with oral dysfunction. Although individual interventions were shown to improve oral dysfunction, the related evidence was inconclusive. Conclusions/Implications for Practice: Primary HNCs and their treatment significantly deteriorate oral function. A holistic and interdisciplinary approach may maximize oral function.