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Context Terminal dyspnea in dying cancer patients is frequent and distressing, and the impact extends to their families. Families are often involved in providing care for terminal dyspnea. Objectives This study aimed to describe various care strategies for terminal dyspnea in cancer patients hospitalized in palliative care units (PCUs), evaluate families’ satisfaction with care for terminal dyspnea, and explore determinants contributing to families’ satisfaction. Methods A nationwide, cross-sectional survey was conducted using a self-reported questionnaire among bereaved families of cancer patients who died in PCUs. The questionnaire consisted of questions on the perceptions of care offered to patients with terminal dyspnea and their families, satisfaction with care for terminal dyspnea, family-perceived intensity of terminal dyspnea, use of oxygen, and background data of patients and families. Results In total, 533 participants (response rate = 54%) returned the completed questionnaires, and 231 reported that their loved one had experienced terminal dyspnea. Dedicated and compassionate care was perceived by 60%–89% of the participants as the strategy provided for patients. Care for family members was perceived by 58%–69% of the participants. Perception of dedicated and compassionate care for patients and that of care for family members were significantly associated with high satisfaction (odds ratio, 95% confidence interval: 8.64, 3.85–19.36 and 15.37, 5.00–47.25, respectively). Conclusion Dedicated and compassionate care may be the essential part of the care for terminal dyspnea. Dedicated and compassionate care for patients and care for family members have a potential of improving the care satisfaction among family caregivers.

Objective: This study aimed to investigate quality of life (QOL) improvement in long-term cancer survivors using complementary therapy (CT) as mind–body practice. Methods: A quasi-experimental study including intervention and control groups was conducted. Participants in the intervention group engaged in CTs, including music therapy, progressive muscle relaxation, and deep-breathing exercises for 8 weeks at home. QOL was evaluated in both the groups using Short Form-8 (SF-8) questionnaire before the experiment and at 4 and 8 weeks after starting the experiment. To examine QOL, we compared SF-8 subscale scores, the physical and mental component summaries of QOL. Results: Cancer survivors were assigned to the intervention and control groups, comprising 69 and 59 individuals. There were no significant differences in QOL between the two groups with low scores, but there was a significant difference in the mental aspect of QOL in 4 weeks, indicating that the intervention group was lower than the control group. Meanwhile, the intervention group tended to experience increased changes in the mental aspect of QOL in 8 weeks compared to 4 weeks, although there was no significant difference. Conclusions: CT did not exhibit an effect on QOL among cancer survivors, especially in 4 weeks. This might have been due to sample size, participants' potential low compliance resulting in an inability to confirm whether the CTs were performed accurately and continuously, and consideration of what CT suited them. Meanwhile, CT may require a longer time to increase QOL. We recommend further studies to address these factors when conducting CT as mind–body practice.

Objective: This study aimed to evaluate the psychometric properties of the Japanese version of the Cancer Survivors' Unmet Needs (CaSUN-J) scale among cancer survivors in Japan. Methods: The CaSUN-J was developed using standardized translation methodology. Content validity was evaluated by a group of experts, and a pilot test was conducted with a convenience sample of 10 cancer patients. A total of 183 Japanese cancer survivors completed the CaSUN-J. The internal consistency of the scale was examined with Cronbach's α. Construct validity was analyzed using correlations with the physical effects, quality of life (QoL), and age. To assess the factorial validity of the CaSUN-J, confirmatory factor analysis (CFA) was performed. Results: The CaSUN-J indicated good readability and high content validity for use as an assessment tool among Japanese cancer survivors. All Cronbach's α coefficients were above the minimum acceptable criterion of ≥0.70. For construct validity, higher physical effect scores, as well as poorer QoL scores and younger patients, were significantly positively associated with higher levels of needs. CFA indicated that the five-factor structure of the CaSUN-J was a good fit to the data. Conclusions: The CaSUN-J can serve as a valid and reliable tool to evaluate unmet needs among Japanese cancer survivors.

Despite contributing to the control of hormone receptor-positive breast cancer, a highly prevalent cancer type, endocrine therapy affects patients’ cognitive function. We aimed to identify cognitive decline following the start of endocrine therapy using patient-reported measures and investigate factors associated with cognitive difficulties. This cross-sectional survey used a self-administered, anonymous questionnaire. The participants were 876 patients with breast cancer who experienced subjective cognitive difficulties after starting endocrine therapy. Our sample was recruited from 11 patient advocacy groups, 5 clinics, and 2 hospitals in Japan. The questionnaire assessed subjective cognitive difficulties (30 items), psychological well-being, demographic and clinical information, and other subjective symptoms. Of 510 (58.2%) responses, we analyzed 405 (46.2%) questionnaires. Exploratory factor analysis identified three factors of cognitive difficulties: Factor 1, “difficulties in manipulating memory and language;” Factor 2, “difficulties in processing multiple pieces of information;” and Factor 3, “difficulties in maintaining attention and concentration.” Factor 1 was the most common type, and it was significantly related to the treatment characteristics of endocrine therapy. Multivariate logistic regression analysis revealed that fewer household members, a history of breast surgery, more severe menopausal symptoms, and greater psychological distress were significantly associated with cognitive difficulties. As cognitive difficulties increased, the proportion of participants suspected to have psychological disorders increased significantly. Patients treated with endocrine therapy for breast cancer experience intricately intertwined impairments in several domains of cognitive function. They have an increased risk of psychological disorders corresponding to the degree of subjective cognitive function.

Purpose Practicing self-care behaviors is important for patients with gastrointestinal cancer undergoing outpatient chemotherapy. Knowledge of personality traits may be useful in providing individualized support that can improve self-care behaviors. Therefore, we assessed the association between personality traits and self-care behaviors in these patients. Methods This cross-sectional study was conducted among patients who received intravenous chemotherapy at a designated regional cancer hospital between June 2020 and October 2020. A self-administered survey was conducted among these patients using the Japanese version of the Ten Item Personality Inventory and a 29-item questionnaire to assess self-care behaviors. Association between the scores of the personality traits and frequency of each self-care behavior was analyzed using the Spearman's rank correlation coefficient. Results In total, 53 responses were obtained from 57 participants, of which 52 valid responses were included in the analysis. Openness and conscientiousness were personality traits significantly associated with multiple self-care behaviors. High degree of openness, characterized by the ability to tackle new situations, had a moderately significant positive correlation with adjustment of exercise (ρ = 0.49, pρ = 0.40, pρ = 0.30, p=0.03) and confirmation of inspection results (ρ = 0.39, p

Decision making regarding the place of end-of-life (EOL) care is an important issue for patients with terminal cancer and their families. It often requires surrogate decision making, which can be a burden on families.To explore the burden on the family of patients dying from cancer related to the decisions they made about the place of EOL care and investigate the factors affecting this burden.This was a cross-sectional mail survey using a self-administered questionnaire. Participants were 700 bereaved family members of patients with cancer from 133 palliative care units in Japan. The questionnaire covered decisional burdens, depression, grief, and the decision-making process.Participants experienced emotional pressure as the highest burden. Participants with a high decisional burden reported significantly higher scores for depression and grief (both P 0.001). Multiple regression analyses revealed that higher burden was associated with selecting a place of EOL care that differed from that desired by participants (P 0.001) and patients (P = 0.034), decision making without knowing the patient's wishes and values (P 0.001) and without participants sharing their wishes and values with the patient's doctors and/or nurses (P = 0.022), and making the decision because of a due date for discharge from a former facility or hospital (P = 0.005).Decision making regarding the place of EOL care was recalled as burdensome for family decision makers. An early decision-making process that incorporates sharing patients' and family members' values that are relevant to the desired place of EOL care is important.

Objective: The present study aims to describe fall-related self-efficacy as perceived by patients with chemotherapy-induced peripheral neuropathy (CIPN). The characteristics of patients associated with low perceived self-efficacy of preventing falls were investigated. Methods: A cross-sectional study of four hospitals in Japan. In this study, 100 outpatients who were receiving chemotherapy for cancer and experiencing CIPN were recruited. Participants completed an anonymous, self-administered questionnaire. Self-efficacy was measured with the falling self-efficacy (FSE) scale, and the severity and impact of CIPN was assessed with the Comprehensive Assessment Scale for CIPN in Survivors of Cancer (CAS-CIPN). Data about the demographic information of the patients, cancer diagnosis and treatment, pain and fatigue symptoms, and history of previous falls were collected. Logistic regression analysis was used to assess relationships between variables. Results: A total of 81 (81.0%) participants with CIPN completed the questionnaire. They reported experiencing fear of falling during their daily activities, which include the act of standing up, walking, and using the stairs. Small events, such as unstable postures and uncomfortable situations, affected their confidence of preventing falls. Logistic regression revealed that low FSE scores were significantly associated with female sex (P = 0.022), low body mass index (BMI; P = 0.026), and the CAS-CIPN score (P < 0.001). Conclusions: Female patients with CIPN and low BMI might have an increased need for enhanced fall-related self-efficacy. A comprehensive assessment of CIPN in patients at risk of low FSE scores is likely to be beneficial.

Introduction End-of-life care (EOLC) is necessary for patients who are not expected to live long. Nurses have positive attitudes toward EOLC, but they encounter difficulties in practice. That situation creates conflict, which can affect burnout. It is essential to manage nurses’ conflict about their ability to practice EOLC by enhancing their individual strengths. Focusing on the role of self-compassion may help to prevent burnout related to the conflict about ability to practice EOLC. Objective The study aim was to assess the mediating effect of self-compassion on the association between conflict about ability to practice EOLC and burnout. Methods A correlational study was conducted with emergency department nurses who practiced EOLC. Self-report measures of conflict about ability to practice EOLC, burnout, and self-compassion were obtained. Results Negative aspects of self-compassion mediated the relationship among conflict, emotional exhaustion, and depersonalization (burnout). Self-compassion did not mediate the association between conflict and reduced personal accomplishment (burnout). Conclusions Negative aspects of self-compassion mediated the relationship between conflict and burnout (excluding reduced personal accomplishment). To prevent burnout, it is necessary to screen for nurses with low self-compassion and to provide opportunities to change their cognitive recognition and disclose their conflicts.

While more women with breast cancer survive because of advances in cancer treatment including hormonal therapy, they are at a risk of menopausal symptoms, which can threaten their psychological wellbeing. We examined the effect of menopausal symptoms on women's psychological wellbeing during three different phases of breast cancer: short-term (0-1 years since diagnosis), medium-term (2-5 years), and long-term (more than 5 years). In this cross-sectional study, 425 survivors treated with hormonal therapy were recruited from a convenience sample in Japan and completed an anonymous self-administered questionnaire. Multiple regression analysis revealed that menopausal symptoms significantly contributed to psychological wellbeing in all phases. In long-term survivors, menopausal symptoms were significantly milder; however, the negative effect was prolonged. One in three to four survivors was suspected to have poor psychological wellbeing, irrespective of time. Although the effect of menopausal symptoms on psychological wellbeing has been described in short-term survivors, little is known about the long-term effect. This study examines the effect of menopausal symptoms on psychological wellbeing, thereby providing useful information regarding long-term quality of life.

Women with breast cancer receive support from their partners to deal with the side effects of therapies over the cancer trajectory. Hormonal therapy (HT) is usually given after completing other treatments, and women receiving HT reclaim their normal life. This may lead to changes in support from their partners. Therefore, we explored women’s perceptions of the support provided by their male partners in managing the side effects of adjuvant HT. We conducted semi-structured interviews with 10 women who received HT and recognized their partners as a main source of support. An interview guide was used to explore their experiences of treatment side effects, the contents of support received from their partners, their need for support, and their overall relationship with their partners. Interviews were analysed by content analysis. A theme on how participants perceived support from their partners was formulated as “Support not corresponding to transition to a new treatment” with the following categories: “Shrinking support,” “Primacy of partner,” and “Solitary new treatment.” Participants felt lack of support from their partners because their partners did not understand their experience of the side effects induced by HT. Unlike the side effects of past treatments such as surgery and chemotherapy, side effects of HT cannot be observed and are highly subjective. Their partners often failed to notice these symptoms and provided little support. Nevertheless, participants aimed to accept the existing support without asking for more. They were left alone in the continuing trajectory of breast cancer. After starting HT, women entered a new treatment phase in which less understanding and support was provided by partners. Educational support for couples may enable sharing of subjective symptoms that are not obvious to partners and improve outcomes by facilitating partner engagement and support. Key words: Social support, symptom management, psychological health, cancer nursing, content analysis (Published: 30 November 2015) Citation: Int J Qualitative Stud Health Well-being 2015, 10: 29283 - http://dx.doi.org/10.3402/qhw.v10.29283

Objective This study was performed to clarify the influence of financial conditions on stress in patients with advanced recurrent colorectal cancer undergoing outpatient chemotherapy. Methods A self-administered questionnaire survey was completed by patients with advanced and recurrent colorectal cancer receiving outpatient chemotherapy in five hospitals in the Kansai region. The questionnaire included basic information (age, sex, current employment availability, and subjective financial condition (3 choices)), and the 29-item stress scale from Japanese version of the Mastery of Stress Instrument (5-point scale with a total score of 29-140 points) . Results Responses were received from 76 outpatients (response rate: 95%). The patients’ mean age was 66.6 ± 8.5 years, and they comprised 50 men (65.8%) and 26 jobholders (34.2%). Three patients (3.9%) always had financial leeway (Yutori group), 37 (48.7%) had a satisfactory financial margin (sufficient group), and 36 (47.4%) had no financial margin (marginless group). The mean stress score was 70.0 ± 15.3 points. The stress score was significantly higher in the unemployed group than in the working group. With respect to the patients’ subjective financial condition, the stress score was significantly higher in the marginless group than in the sufficient group. The Yutory group did not differ significantly from any other groups. Discussion and Conclusion Patients with advanced recurrent colorectal cancer undergoing outpatient chemotherapy often follow a long-term treatment course. Therefore, financial problems while undergoing cancer treatment may be a heavy burden. Patients who are unemployed and have no income appear to experience stressful conditions during treatment, such as distress and confusion. These findings suggest the need to provide both mental support and employment support to patients undergoing treatment for cancer. This work was supported by KAKENHI Grant Number A16H055760.

Unfinished business often causes psychological issues after bereavement. Providing care for families of terminally ill patients with cancer to prevent unfinished business is important.To clarify the prevalence and types of unfinished business in families of end-of-life patients with cancer admitted to palliative care units (PCUs), explore depression and grief associated with unfinished business, and explore the factors affecting unfinished business.We conducted a cross-sectional, anonymous, self-report questionnaire survey with 967 bereaved families of patients with cancer admitted to PCUs. The questionnaire assessed the presence or the absence of unfinished business, content of unfinished business, depression, grief, process of preparedness, condition of the family and patient, and the degree of involvement of health care professionals.Questionnaires were sent to 967 families, and 73.0% responded. In total, 26.0% of families had some unfinished business, with improvement of the patient-family relationship being a common type of unfinished business. Families with unfinished business had significantly higher depression and grief scores after bereavement compared with those without. Factors that influenced the presence or the absence of unfinished business were preparedness for the patient's death (P = 0.001), discussion between the patient and family about the disease trajectory and way to spend daily life (P 0.001), good patient-family relationship (P = 0.011), and family and health care professionals considering together the appropriate timing to accomplish the family's wishes (P = 0.021).Many families have unfinished business. Health care professionals should coordinate the appropriate timing for what the family wishes to do, with consideration of family dynamics, including the family's preparedness, communication pattern, and relationships.

【目的】治療期にある通院中のがん患者を対象に, セルフケア能力を向上させる看護独自の介入プログラムを開発することを目的とした.【方法】参加者15名を対象に, 4週連続の複合的グループ療法を実施し効果検証を行った.【結果】参加者の概要は, 平均年齢56.86±11.52歳, 現病歴平均28.6±18.14カ月であった. 介入前後で, EORTC QLQ-C30 Global health status (p

Aim: The purpose of the study was to identify the actual circumstances of treatment and nursing care for cancer patients during a time of disaster. Methods: The study subjects were 17 nurses working in eight institutions who engaged in nursing activities for cancer patients in the wake of the 1995 Hanshin-Awaji Earthquake at hospitals located in and around the stricken areas. The data were collected through focus group interviews and were analyzed by inductive and qualitative methods to categorize needs. The results were compared with the data categorized by Knowledgeocean, a text-mining tool for analyzing unstructured text in order to examine data validity. Results: The actual circumstances of the treatment and nursing care of cancer patients in disaster situations were divided into three major categories and 10 subcategories. The major categories were: “difficulty in keeping track of patients” undergoing outpatient treatment, “adjustment in treatment” in an effort to continue various therapies for cancer treatment, and “care for patients and their families before and after the last moment” in the case of terminally ill patients. Conclusions: The results suggest that the following issues should be addressed in the future: the need for an information management system for the resumption of interrupted treatment and the transportation of patients, the need for enhancing the self-care ability of cancer patients in ordinary situations so that they can be more self-sufficient in disaster situations, and the need for the creation of a suitable location for dying patients and their families and the development of grief care strategies in disaster situations.

Aim: The aim of this study is to develop a care package to help cancer patients improve their self-care abilities and better prepare for a disaster, so that they can continue treatment and perform symptom management strategies in disaster situations. Methods: In this study, the “Care Package for Cancer Patients in Times of Disaster”, which comprises four pamphlets, was developed through discussions among the eight members of the study group. The care package was produced by making additions and modifications, based on the findings obtained in the above two steps, to the patient education booklets developed in the area of oncology. Results: Of the areas that cancer patients find difficult in times of disaster, the following six were extracted: difficulty in continuing treatment, the possibility of running out of pain medicines and how to store pain medicines, the possibility of not being able to go to a regular hospital, the shortage of stoma-care appliances and other products, the possibility of exposure to infections at a shelter, and the necessity of providing care for cancer patients and their families before and after death. By incorporating these pieces of information, we developed the four pamphlets. These pamphlets are posted on the website for public use. Conclusion: The newly developed pamphlets incorporate information on how to cope with specific situations in times of disaster, based on the findings obtained from the “Survey on Actual Conditions of Treatment and Nursing Care to Cancer Patients in Disaster Situations”.

Dramatic advances have been made in cancer treatment in recent years, enabling patients to leave the hospital more quickly and stay home while still undergoing treatment. As a result, the percentage of outpatients has been on the rise. Healthcare providers engaged in actual outpatient treatment, however, spend so much energy implementing daily procedures safely that they have little time remaining to provide patient education or carry out any other systematic patient support programs. Although self-care generally is believed to be what people do to help themselves, differences exist between Western countries and Japan in the interpretation of self-care. In Japan, obtaining necessary support from the family and friends that one relies on also is viewed as essential. Patients' self-care agency must be assessed if nurses are to make the most of patients' abilities; however, evaluation criteria for that purpose have yet to be established. Development of a method for evaluating the self-care agency of patients receiving chemotherapy on an outpatient basis is needed to ensure further advancement in this area of nursing.