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Objective: To study the resources available for cancer patients once referred for fertility preservation., Materials and Methods: Cross-sectional study clinics that are members of the Society for Assisted Reproductive Technology assess support for fertility preservation., Results: Surveys were distributed to a total of 1135 members at 394 Society for Assisted Reproductive Technology clinics. Responses were received from 99 individuals representing a total of 84 unique clinics (21.3%). Most clinics (76%) are able to see new cancer patients within 24 to 48 hours after a referral. Clinics most commonly offer oocyte freezing and embryo freezing (96% and 98%, respectively), with a significantly smaller portion of clinics offering ovarian tissue freezing (26%). Although most clinics offer fertility preservation for breast cancer, hematologic cancers and ovarian cancer, only 31% of clinics offer fertility preservation for pediatric premenarchal cancers. Clinics that receive >20 referrals from oncology centers annually are more likely to be in the Northeast and have an academic affiliation. These clinics are more likely to provide support for patients during their cancer treatment, more likely to have long-term follow-up with cancer patients and similarly more likely to have cancer patients return to take advantage of their treatment., Conclusions: There are significant geographic and clinic variations in support for fertility preservation. Clinics overall are able to expeditiously see patients to avoid delays in oncologic treatment. Clinics that provide additional support and long-term care tend to have a larger oncologic volume and have more patients who utilize their fertility treatment upon completion of cancer therapy.

Background: Empirical data suggest that life review is an effective psychospiritual intervention. However, it has not been applied to Chinese patients with advanced cancer, and its effects on this population remain unknown., Objective: The aim of the study was to determine the effect of a life review program on quality of life among Chinese patients with advanced cancer., Methods: In this prospective randomized controlled trial, a total of 80 patients were randomly assigned to the life review program group and the control group. The 3-weekly life review program included reviewing a life and formulating a life review booklet. Outcome data were assessed by a collector who was blinded to group assignment before and immediately after the program and at a 3-week follow-up., Results: Significantly better scores in overall quality of life, support, negative emotions, sense of alienation, existential distress, and value of life were found in the life review group immediately after the program and at the 3-week follow-up., Conclusion: This study provides additional data on the potential role of a life review in improving quality of life, particularly psychospiritual well being; it also indicates that the life review program could enable Chinese patients with advanced cancer to express their views on life and death., Implications for Practice: The life review program offers advanced cancer patients an opportunity to integrate their whole life experiences and discuss end-of-life issues, which lays the ground for further active intervention in their psychospiritual distress. The program could be integrated into daily home care to enhance the psychospiritual well-being of Chinese patients with advanced cancer.

This study aimed to examine the quality of life (QOL) of patients with advanced cancer in Hong Kong. Ninety participants were recruited from the oncology ward of the study hospital. They responded to a 28-item, 8-subscale multidimensional questionnaire and a single-item scale that measured QOL in a face-to-face interview. Participation in health care decisions, food-related concerns, and existential distress were some QOL concerns that require health care professionals' attention. Walking ability predicted the level of QOL in certain QOL domains that surfaces patients' need for rehabilitation. That the QOL domain value of life was the most important domain that predicted overall QOL calls for meaning-of-life interventions for palliative care.

Purpose/objectives: To develop the Meaning of Life Intervention in response to the need for brief and meaning-focused interventions in palliative care and to establish potential effect sizes for future full-scale randomized, controlled trials., Design: A randomized, controlled trial conducted to pilot test the Meaning of Life Intervention., Setting: A 68-bed oncology inpatient ward in an urban acute general hospital in Hong Kong., Sample: 84 patients with advanced-stage cancer. Fifty-eight completed the study., Methods: Assessments of outcome variables were conducted at baseline and one day and two weeks after the intervention. Patients were randomly allocated to the intervention group or the control group. Repeated measures analysis of covariance were conducted to assess the impact of the Meaning of Life Intervention on participants' quality of life., Main Research Variables: The primary outcome was quality of life and was measured by the Quality-of-Life Concerns in the End-of-Life (QOLC-E) questionnaire and with a single-item scale on global quality of life. The eight subscales of the QOLC-E served as secondary outcomes., Findings: Statistically significant main effects were noted for the group in the QOLC-E questionnaire total score, the single-item scale on global quality of life, and the existential distress subscale of the QOLC-E questionnaire. The effects represented a medium effect size., Conclusions: The results of this pilot study show that the Meaning of Life Intervention can improve quality of life, particularly existential distress., Implications for Nursing: The Meaning of Life Intervention represents a potentially effective and efficient intervention that is feasible for implementation by nursing staff for patients with advanced-stage cancer in a palliative care setting.

Aims: The aim of this study was to elicit patients' perceptions of their participation in a life review programme for Chinese patients with advanced cancer., Background: Empirical data have supported the suggestion that a life review is an effective psycho-spiritual intervention, particularly with older people. However, no life review programmes have been specifically designed for Chinese patients with advanced cancer, and their views on the life review therefore remain unknown., Design: This study was a descriptive qualitative design., Method: In-depth individual interviews were conducted with a sample of 26 patients with advanced cancer receiving home-based palliative care from a hospice after the completion of the programme., Results: The six categories identified in the analysis were as follows: (1) accepting one's unique life; (2) feelings of emotional relief; (3) bolstering a sense of meaning in life; (4) leaving a personal legacy; (5) making future orientations; and (6) barriers to a life review., Conclusion: Our life review programme is non-invasive care intervention for improving the psycho-spiritual well-being of Chinese patients with advanced cancer and helping them to prepare for death. This programme not only provides Chinese nurses with a new approach to meeting the unique needs of patients approaching death but also poses a challenge to customary beliefs about death, which is considered a social taboo in China., Relevance to Clinical Practice: The life review programme can be integrated into the usual care arrangements to enhance the psycho-spiritual well-being of Chinese patients with advanced cancer. Nurses should be aware of the challenges involved in the process of conducting a life review., (© 2011 Blackwell Publishing Ltd.)

Objective: To assess the attitudes of the general U.S. population toward the use of IVF to assist adults with a history of cancer or human immunodeficiency virus (HIV)., Design: Cross-sectional survey study., Setting: Online., Patient(s): A total of 1,183 adult men and women across the U.S., Intervention(s): Questionnaire consisting of multiple-choice and open-ended questions., Main Outcome Measure(s): Attitudes toward IVF for cancer and HIV patients., Result(s): A total of 82% supported IVF for cancer patients compared with 38% for HIV patients. The most common reasons for support was the anticipation of normal life expectancies and a belief in the universal right to have children, although nearly twice as many participants believed this to be a "right" for cancer patients than for HIV patients. Young respondent ages, higher educational attainment, Jewish religion, and a personal history of infertility were associated with higher likelihood of support. Lower education level, higher annual household income, and having children were predictors of discordance in support of IVF for cancer versus HIV patients., Conclusion(s): Despite advancements in the treatment of cancer and HIV, which have allowed patients to have longer life expectancies and improved chances of parenthood, there is significant disparity in the support of providing IVF to these patient groups., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Aim: This paper is a report of an exploration of the phenomenon of existential distress in patients with advanced cancer from the perspectives of healthcare professionals., Background: Existential distress is an important concern in patients with advanced cancer; it affects their well-being and needs to be addressed in the provision of holistic care., Method: Focus groups were conducted from November 2008 to February 2009 with physicians, nurses, social workers, occupational therapists, physiotherapists, and chaplains working in a palliative care unit that served patients with advanced cancer in Hong Kong. Data collection and analysis were guided by the grounded theory approach. All categories were saturated when five focus groups had been held with a total number of 23 participants., Findings: We found three causal conditions of existential distress: anticipation of a negative future, failure to engage in meaningful activities and relationships, and having regrets. Three basic (caring, relating and knowing) and six specific (positive feedback, religious support, new experiences, task setting, exploring alternatives and relationship reconciliation) intervening strategies were identified. Whether the intervening strategies would be effective would depend on patients' openness and readiness; healthcare professionals' self-awareness, hopefulness, and interest in knowing the patients; and a trusting relationship between patients and healthcare professionals. A sense of peace in patients was considered a consequence of successful interventions., Conclusion: This paper acknowledges the lack of an accepted conceptual framework of existential distress in patients with advanced cancer. It is based on healthcare professionals' views, and further studies from the perspectives of patients and their families are needed.

Hope is considered a coping strategy as well as a factor that enhances quality of life for patients with advanced cancer. Most studies on the meaning of hope are from the patients' perspective. However, the health-care professionals' view is also important since it may affect their practice. This study explored the meaning of hope to patients with advanced cancer from health-care professionals' perspective. This was a qualitative study that used a hermeneutic phenomenological approach. Five focus group interviews were conducted with 23 participants including physicians, nurses, social workers, occupational therapists, chaplains, and a physiotherapist working in the palliative care unit of a hospital in Hong Kong. Data analysis revealed four themes: expected hopelessness, a dynamic process of hope, hope-fostering strategies, and peace as the ultimate hope. It appears that health-care professionals' hopefulness contributes to the hopefulness of patients. Opportunities to reflect on their values, beliefs, and experience may help health-care professionals enhance their ability to foster hope in patients.

Aim: This article reports a study to examine the meaning of hope from the perspective of Chinese advanced cancer patients in Hong Kong., Methods: Semi-structured interviews were conducted with a convenience sample of advanced cancer patients recruited from the palliative care unit of a local hospital. Data were saturated after 17 participants were interviewed. Qualitative content analysis was adopted to analyse the data., Findings: Hope as experienced by the participants was found to consist of five components: living a normal life, social support, actively letting go of control, reconciliation between life and death, and wellbeing of significant others., Conclusions: While hope is related to the wellbeing of patients with advanced cancer, successful palliative care partly depends on an awareness of the importance of hope in the end-of-life context and cultural sensitivity to the meanings behind it from the patients' own perspective.

Aims: The aims of the study were to develop an understanding of caring in nursing from the perspective of cancer patients and attempt to identify the concept of caring in the Chinese cultural context., Background: Caring as a concept remains elusive, the acceptable definitions of the term care have not been reached. The expressions, processes and patterns of caring vary among cultures, but there is a lack of Chinese culture-based study about caring in nursing., Methods: A qualitative research design was used and 20 cancer patients were interviewed using a semi-structured interview guide. A qualitative content analysis was used to identify themes in the data., Results: Three themes emerged from the data, which suggested that caring is delivering care in an holistic way: nurses' caring attitudes and their professional responsibility for providing emotional support, nurses' professional knowledge and their professional responsibility for providing informational support and nurses' professional skills and their professional responsibility for providing practical support. The caring behaviour of nurses as perceived by cancer patients involved the provision of emotional, informational, and practical support and help based on patients' needs. A model of caring in nursing was formulated., Conclusions: Caring in nursing as perceived by cancer patients involves nurses having qualified professional knowledge, attitudes and skills in oncology and providing the informational, emotional and practical supports and help required by cancer patients., Relevance to Clinical Practice: Caring is manifested in nursing actions through nurse-patient communication process. Patients have their inner expectation for nurses' caring behaviour and attitudes and nurses' performance of caring or uncaring behaviour has a direct influence on the feelings of patients. It is necessary for all nurses to continue improving their oncology professional knowledge, attitudes and skills as well as their abilities of offering informational, emotional and practical support and help for their cancer patients.

Aim: This paper reports the findings of a study exploring the experiences and expectations of patients with cancer of supportive communication in the context of Chinese culture., Background: Patients with cancer experience psychological distress, particularly in the initial period after diagnosis. Supportive communication can positively affect their psychological adjustment. Previous studies have reported the functions, contents, types and sources of informational support for patients with cancer in Western studies, but patients from different cultural backgrounds who have cancer might have different preferences in seeking support., Methods: Semi-structured interviews were carried out with a convenience sample of 20 Chinese patients with cancer during 2002. Content analysis was used to identify themes within the data., Findings: Chinese patients with cancer have a substantial need to receive informational and emotional support during the period of their hospitalization. Their support networks include doctors, nurses, family members, relatives and fellow patients. The expectations of support from different sources varied according to the nature of the relationship between patients with cancer and providers of support. Patients were active in seeking information and they perceived communication with doctors, nurses and fellow patients as beneficial. Most would only express emotional needs to their close family members and did not expect healthcare professionals to provide emotional support. However, interviewees perceived the caring behaviours of nurses and the emotional support of fellow patients as two important sources of support., Conclusion: For Chinese patients, coping with illness and misfortune is largely a private and family affair, and most of them did not expect nurses to meet their emotional needs. Nurses should be aware of the type, timing and source of supportive communication that Chinese patients find valuable. This will help them to provide the appropriate support to meet patients' needs.

The aim of this study is to describe the experience and expectations of Chinese cancer patients with regard to the favorable and unfavorable words conveyed by their social support providers. In-depth interviews were conducted with 20 patients with cancer using a qualitative approach, and the data obtained were analyzed using content analysis. The findings indicated that favorable words inspired patients with cancer and raised their hopes. Such words included words expressing positive confirmation of patients' physical condition and mental status, words of encouragement and consolation, discussions of successful cases, information about advanced medical techniques and developments, practical instructions, emotional support from close relatives, confirmation about previous achievements for the family and about one's career, as well as small talk to distract the patient. Unfavorable words were those that weakened the patients' hopes and self-esteem. They included words expressing negative information and pessimistic attitudes, those indicating an overprotective attitude on the part of close relatives, as well as words expressing commiseration, advice, and an underestimation of the patients' suffering without empathy. The findings provide guidelines for nurses to communicate with patients with cancer verbally in a Chinese cultural context, and outline strategies for communication to meet psychologic needs of patients.

Aim: The aim of this paper is to report a study exploring aspects of nurse-patient relationships in the context of palliative care., Background: Although there are numerous studies addressing nurse-patient relationships, little research has focused on these in the context of palliative are. Furthermore, no previous study has examined the relationship in the Chinese context., Methods: Qualitative data were collected from 10 hospice nurses and 10 terminally ill patients by means of open ended unstructured interviews. Respondents were asked to reflect on practices and incidents that would allow an understanding of the meaning of nurse-patient relationships in palliative care., Results: Four major categories emerged from the perspectives of patients and nurses: (1) forming a relationship of trust; (2) being part of the family; (3) refilling with fuel along the journey of living and dying; and (4) enriched experiences. Responses revealed that a relationship of trust is formed, and that nurses are not only regarded as health professionals, but also become part of the family or a good friend. Nurses who develop trusting relationships demonstrate a holistic approach to caring, show their understanding of patients' suffering, are aware of their unvoiced needs, provide comfort without actually being asked, and are reliable, proficient, competent and dedicated in their care., Conclusion: Trust, the achievement of the goals of patients and nurses, caring and reciprocity are important elements of nurse-patient relationships in palliative care. Such relationships not only improve patients' physical and emotional state, but also facilitate their adjustment to their illness, ease pain and can ultimately lead to a good death experience. It is nurses' personal qualities and skills, which are embedded in these relationships, that constitute excellence in nursing care. Nurses also derive satisfaction and are enriched through the relationships.

Among the various chronic diseases, cancer is the leading cause of death in Hong Kong. This article presents the process of how cancer patients are being enabled and strengthened to overcome powerlessness based on the interview findings of 12 participants. Interviews were analyzed using constant comparison. The basic social process of empowerment included finding meaning in life, seeking mastery over illness, and acceptance of illness. This study's unique findings suggest that the process of empowering cancer patients consists of more than giving patients control, choice, or resources, such as knowledge and skills. Nurses have an important role in facilitating patients to find meaning in life, as well as in the transformation of thoughts and attitudes. Nurses' personal qualities and skills embedded in the nurse-patient relationship constitute an important source of empowerment for patients.

In this study, 24 family caregivers of terminally ill patients participated in in-depth interviews regarding their experiences of giving care. The data were analyzed using grounded theory qualitative method. Commitment emerged as the precondition of the caregiving process. The caregivers did not perceive the work of caring as a burden. Rather, they felt that despite any personal hardships, what they were doing was important to their loved ones and therefore meaningful to them as caregivers. The components of commitment can be described as relational commitment, the act of showing love, and determination. The process of caregiving includes four phases: 1) holding onto hope for a miracle, 2) taking care, 3) preparing for death, and 4) adjusting to another phase of life. A patient-caregiver relationship, Confucian concepts of yi (appropriateness or rightness), and filial duty are reflected in the process of caregiving. Consequences of the process include finding meaning in life and peace of heart and mind. The emotional aspect of the caregiving experience can be described as an intense emotional experience filled with feelings of hope and hopelessness, guilt, fear, and regret. As a result of the caregiving experience, most participants found they have had a change of worldviews and treasure their lives. Findings show a significant need for interventions at each phase of the caregiving process designed to provide effective and culturally sensitive support and affirmation to family members as they care for their loved ones with terminal illnesses.

Caring for dying patients is an essential and major aspect of nursing care. However, previous studies have revealed that nurses felt uncomfortable and inadequate in dealing with the dying patients and their families. This study reports the effectiveness of a problem-based learning approach in death education among a group of registered nurses in Hong Kong. Three problems, with three segmented scenarios related to cancer nursing, were used. Students went through the problem-based learning process and documented their learning throughout the course in journals. A total of 72 sets of journals were collected and analyzed. The strategies of within case and cross-case analysis were employed. The within case analysis explored the learning development of students for each problem. The cross-case analysis compared and contrasted findings of the within case analysis. Three themes have been derived from the findings. They were: nurses acknowledging their emotions in facing death and dying, a need for the nurses to be better equipped in communication and counseling, and a holistic and family-centered approach to care. This study provides evidence showing that problem-based learning is an effective strategy to enhance nurses' self-awareness of death and dying issues, and to stimulate nurses to formulate a plan that addresses the physical, psychological, and social aspects of care. Findings also reveal that nurses need to take into account the particular reactions of death and dying in the Chinese culture when planning care.

The philosophy of empowerment, which is based on the premises that clients must be active, equal and collaborative participants, who are aware and committed to change, has guided research in empowerment interventions. This article reports on a small part of a research study that sought to understand Chinese cancer patients' conceptualization of empowerment. Qualitative delineation of the concept of empowerment by means of in-depth interviews was carried out with 12 Chinese patients with cancer. The findings showed that empowerment is a process whereby patients develop a sense of inner strength through connection with others, including families, friends and health care professionals. It is also a process of transformation through which they actively develop new perspectives by reframing and reinterpreting their illness. Acceptance of illness was shown to result from a realization of a lack of control in the situation, which is then enhanced by the beliefs of Confucianism and Taoism. In the cancer context, personal control comprises both primary and secondary processes. Active involvement, awareness of the situation, partnership, self-determination and self-reliance are important values in empowerment. The concept and therapeutic foundations of empowerment provide ample legitimacy for its vigorous pursuit in nursing.

This study was conducted to identify the process and outcomes of empowerment as experienced by Hong Kong Chinese patients with cancer through participation in cancer self-help groups. The study involved in-depth individual interviews of self-help group members (n = 12) and participant observation of the group meetings over a period of 6 months. The empowered outcomes at a personal level included interconnectedness, confidence and hope, support and affirmation, and a feeling of usefulness. At a social level, expanded social network and opportunities to participate in more activities were reported. Collective efficacy also was demonstrated, although this happened only occasionally through participation in the group. One main theme that runs through the process of participation is empowerment among the members. On the basis of the efficacy demonstrated by self-help groups in this study, nurses should strongly consider referral of patients to such groups. Self-help groups serve as an important resource for patients with cancer in the Hong Kong Chinese community.