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The Chinese version of the M. D. Anderson Symptom Inventory-Head and Neck Module (MDASI-HN-C) has been linguistically validated. However, its psychometric properties have not been established yet. The purpose of the study was to psychometrically validate the MDASI-HN-C in patients with nasopharyngeal carcinoma (NPC).130 Chinese NPC patients who were undergoing radiotherapy (RT) participated in this cross-sectional study. The content, convergent, and construct validity of the MDASI-HN-C were examined. The reliability of the instrument was tested by examining the internal consistency and test-retest reliability.Cronbach's α coefficients ranged from 0.85 to 0.91 for the three subscales of the MDASI-HN-C. The 3-day test-retest reliability was acceptable with intraclass correlation coefficients (ICC) ranged from 0.52 to 0.71. The scale content validity index (S-CVI) was satisfactory (0.97). Subscale scores of the MDASI-HN-C were negatively correlated with the total score of the Chinese version of the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-HN-C) as hypothesized (The MDASI-HN-C shows desirable psychometric properties for evaluating symptom burden in NPC patients, which can be used in both clinical and research contexts.

This study aimed to examine the fidelity of intervention delivery and identify precursory factors contributing to the successful delivery and beneficial effects of family-oriented dignity therapy.This was a process evaluation with quantitative and qualitative methods alongside a randomized controlled trial from March to May 2019. Nonparametric statistics were used to analyze how participants' demographics (The fidelity was achieved with minor deviations from the protocol. Higher educational level and higher income were significantly correlated with lower levels of existential distress (H ​= ​12.20,Fidelity and precursory factors that enhance the beneficial effects of family-oriented dignity therapy were identified. Reinforcement strategies, such as using supplementary video, audio, and reading materials; developing a flexible approach to expressing feelings; and exploring lessons and achievements from various perspectives, are recommended for future research to enhance intervention effects.The study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1900020806).

Objective: This article aimed to report the experience of developing a complex nurse-led, theory-driven, and evidence-based educational intervention program intended to manage the nutrition impact symptom cluster experienced by patients with nasopharyngeal carcinoma (NPC) during radiotherapy, based on the Medical Research Council (MRC) framework. Methods: The “development” and “feasibility and piloting” phases of the MRC framework were used to guide the intervention development. The development phase included identifying the evidence base through a systematic review, exploring the relevant and guiding theory to enhance the effectiveness of the intervention and conducting a qualitative study to identify the intervention modelling. For the feasibility and piloting phase, we conducted a pilot study to examine the feasibility and estimate the effectiveness of the intervention. Results: The systematic review revealed that nurse-led educational interventions were used commonly for symptom cluster management, with promising effectiveness. The theoretical foundation was provided by the Theory of Unpleasant Symptoms, which indicates that an educational intervention can help patients to manage symptom cluster by influencing psychological, situational, and physiological factors. The qualitative study further provided contents of the intervention based on the perspectives of NPC patients and health professionals. The resulting program involves a nurse-led, family caregiver involvement, educational intervention with two sessions that uses a booklet as a medium. The pilot study found that conducting the educational intervention program was feasible and it also had some favorable effects on managing the nutrition impact symptom cluster in NPC patients. Conclusions: The MRC framework provided a strong structure with which to develop a complex intervention for nutrition impact symptom cluster management through a theory-driven and evidence-based approach. The evaluation of the intervention, the delivery process and the mediation mechanism of change using a rigorous randomized controlled trial design is recommended.

It is well-documented in the literature that dignity therapy is feasible and effectively improves the end-of-life experience of the terminally ill. In a similar vein, this study aimed to develop and investigate the feasibility of evidence-based and culturally sensitive family-oriented dignity therapy for Chinese patients with lung cancer undergoing chemotherapy.Three phases of the Medical Research Council framework were adopted to guide the development of the novel dignity therapy intervention. It was preliminarily designed based on a qualitative study and a systematic review, Erikson's eighth stage of psychosocial development, and the dignity model. The feasibility and acceptability of the intervention were examined in a pilot randomized controlled trial with 12 recruited dyads of patients and family caregivers.The intervention consists of three face-to-face sessions that facilitate participants' reminiscences and promote their communication. Recruitment and response rates for the feasibility study of the intervention were 92.3% and 75%, respectively. Both patients and family caregivers reported that the intervention alleviated their psychological distress and improved communication.The Medical Research Council framework serves as a useful scientific basis for modifying dignity therapy with a culturally sensitive approach. The results of the feasibility study suggest that the family-oriented dignity therapy intervention is feasible, acceptable and has the potential to enhance the effects of dignity therapy.

Tamoxifen is commonly prescribed for preventing recurrence in patients with breast cancer. However, the responses of the patients on tamoxifen treatment are variable. Cytochrome P450 genetic variants have been reported to have a significant impact on the clinical outcomes of tamoxifen treatment but no tangible conclusion can be made up till now. The present review attempts to provide a comprehensive review on the associative relationship between genetic polymorphisms in cytochrome P450 enzymes and survival in breast cancer patients on adjuvant tamoxifen therapy. The literature search was conducted using five databases, resulting in the inclusion of 58 studies in the review. An appraisal of the reporting quality of the included studies was conducted using the assessment tool from the Effective Public Health Practice Project (EPHPP). Meta-analyses were performed on CYP2D6 studies using Review Manager 5.3 software. For other studies, descriptive analyses were performed. The results of meta-analyses demonstrated that shorter overall survival, disease-free survival and relapse-free survival were found in the patients with decreased metabolisers when compared to normal metabolisers. The findings also showed that varying and conflicting results were reported by the included studies. The possible explanations for the variable results are discussed in this review.

Background Nursing research training is important for the improvement of nursing research competence of clinical nurses. High-quality development is crucial for a good nursing research training program. Therefore, the objectives of this study are: (1) To develop a blended emergent research training program for clinical nurses based on a needs assessment and related theoretical framework; (2) To describe and discuss the uses and advantages of the ADDIE model (Analyze, Design, Develop, Implement, Evaluate) in the instructional design and potential benefits of the blended emergent teaching method. Methods This intervention development study adopted mixed-methods design. The ADDIE model (Analyze, Design, Develop, Implement, Evaluate) was followed to develop the research training program for clinical nurses based on the limitations of current nursing research training programs, the needs of clinical nurses, and the theoretical foundation of blended emergent teaching. Results In this study, a theoretical framework of blended emergent teaching was constructed to provide theoretical guidance for the development of training program. Following the ADDIE model, a blended emergent research training program for clinical nurses to improve nursing research competence was developed based on the needs of clinical nurses and the theoretical framework of blended emergent teaching. Conclusions The nominal group technique could effectively identify learners’ common needs and priorities. The ADDIE model is a valuable process model to guide the development of a blended emergent training program. Blended emergent teaching is a promising methodology for improving the learner’s learning initiative and educational outcomes. More empirical studies are needed to further evaluate the blended emergent teaching to promote the development of related theories and practice in nursing education.

Background: Antenatal depression is a severe public health problem. Many studies support the concept that neuroticism, social support, and sleep quality are closely related to antenatal depression. However, there is little evidence concerning the influencing pathways of these variables on antenatal depression. The aim of this study is to investigate the pathways from neuroticism, social support, and sleep quality to antenatal depression during the third trimester of pregnancy. Methods: A cross-sectional study design was used. A total of 773 eligible women in the third trimester of pregnancy submitted valid questionnaires from June 2016 to April 2017. Instruments with good reliability and validity were used to measure neuroticism, social support, sleep quality, and antenatal depression. Structural equation modeling was used to explore the pathways from neuroticism, social support, and sleep quality to antenatal depression during the third trimester of pregnancy. Results: Antenatal depression is shown to be positively correlated with neuroticism and negatively correlated with social support and sleep quality. Neuroticism is shown to have a direct effect and indirect effects through social support and sleep quality on antenatal depression. Conclusions: Neuroticism influences antenatal depression directly and indirectly. Social support and sleep quality are the mediators of the indirect relationship between neuroticism and antenatal depression. Our results suggest that a personality test offered to all pregnant women could help detect a vulnerability to depression, whereupon intervention in the domains of sleep and social support could prove preventive.

IntroductionPromoting the quality of death and achieving a good death is one of the most important goals of palliative care in cancer care. Few studies synthesised views of patients with cancer on the notion of a good death and its associated factors. By eliciting the core elements of a good death, the review aims to identify potential unmet needs of patients with cancer and reveal their common values and care preferences at the end of life. The review also has the potential to inform the development of guidelines for clinical care and shared decision-making in palliative care practice.Methods and analysisA qualitative systematic review will be conducted and reported according to the Joanna Briggs Institute (JBI) methodology for systematic review and synthesis of qualitative data and the Preferred Reporting Items for Systematic Review and Meta-Analysis. Comprehensive search will be performed in six English and two Chinese databases from inception to 30 April 2022 to retrieve relevant qualitative articles focusing on the notion of a good death from the perspective of patients with cancer. Data will be extracted using the JBI standardised data extraction tool for qualitative research. The quality of the included studies will be critically appraised using the JBI Qualitative Assessment and Review Instrument. Data extraction and quality appraisal will be conducted by two reviewers independently. A meta-aggregative approach and narrative summary will be used to synthesise data.Ethics and disseminationEthical approval is not needed. We will disseminate the findings through international conferences related to cancer care or palliative care. The final review will be submitted and published in a peer-reviewed journal.PROSPERO registration numberCRD42021266629.

Physical activity (PA) has declined in China due to urbanization in the past two decades. Evidence-based programs are good approaches to promote PA, but are limited in China. Adopting existing programs can be a viable option. Prior to that, readiness assessment is needed. This study aimed to assess community readiness levels for disseminating evidence-based PA programs to older adults in Changsha, China. In-person interviews were conducted with 33 participants of five districts in Changsha to assess the community readiness level in five dimensions: community knowledge of efforts, community climate, community knowledge about the issue, leadership and resources. Data was transcribed, reviewed and compared with an anchored rating scale to provide a stage of readiness score ranging from 1 (no awareness) to 9 (high level of community ownership). Participants included 14 community staff, 13 older adults, four community leaders and three health professionals. The top three barriers to disseminating PA programs were lack of appropriate locations, funding and instructors. The top three resources were availability of indoor space, chairs and loudspeakers. Community leadership was the highest-rated readiness dimension (3.3 out of 9) followed by community climate (3.2), community knowledge of efforts (3.1) and resources (2.8); knowledge about the issue scored the lowest (2.7). The overall community stage readiness score of Changsha was 3.0 out of 9. The stage of readiness for communities in Changsha, China is ‘vague awareness’. Developing strategies to improve community readiness levels may increase evidence-based PA program dissemination in Changsha, China.

To synthesize the characteristics and effects of couple-based intervention on sexuality and the quality of life (QOL) of cancer patients and their intimate partners and its implications for future research and practice. A systematic review and meta-analysis of randomized and non-randomized controlled studies of interventions was conducted in nine English databases and two Chinese databases, with identification of related studies published in English and Chinese. The quality of the studies was assessed using the tools of the Effective Public Health Practice Project. A total of 33 articles were identified for systematic review and 23 articles were identified for meta-analysis. For patients, the effect size was 0.42 (Hedges’s g, 95% CI = 0.05–0.78, p = 0.03) for physical health. For partners, the effect size was 0.52 (Hedges’s g, 95% CI = 0.06–0.98, p = 0.03) for sexual relationships. However, moderate to high heterogeneity was reported. Effects on sexual function, sexual self-concept, and mental health for couples were not significant. Couple-based interventions had small to medium-sized effects on physical health for cancer patients. Partners could derive medium effects for improvement in sexual relationships from couple-based intervention. Future research should pay more attention to sexual self-concept in cancer patients and target types of cancer that are more likely to compromise sexuality and QOL. The systematic review and meta-analysis has been registered in PROSPERO with registration number: CRD42019119047.

Aim To explore challenges that Chinese head nurses confront on financial management from the perspective of different levels of nursing and non-nursing managers and to provide contemporary nurse managers with suitable supports. Methods Eighteen nursing leaders in different levels were divided into two groups: Junior Leadership Group (head nurses) and Senior Leadership Group (nurse coordinator, nurse executive, and vice-president of the hospital). All the subjects were invited to participate in a semi-structured interview. The interviews were audio-taped and transcribed, and data were analyzed using a comparative content approach. Results The four following challenges that head nurses confront on financial management practice were identified from the research findings: 1) lack of intrinsic motivation; 2) insufficient training and education on financial management and nursing economics; 3) desires for cross-uniting communication and cooperation; 4) insufficient reference managerial tool. Conclusions The confusion confronted by head nurses in Changsha include three aspects: managerial roles, managerial training, and managerial tools. Cooperative management model, evidence-based management training, and data-driven tools will contribute to improving the financial management capacity of nurse managers.