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Provision of palliative care to patients with advanced chronic diseases or old populations is suboptimal, which results in unnecessary suffering of and burden to patients, caregivers, and society. Low self-efficacy in palliative care among nurses is a factor affecting suboptimal utilization of palliative care. Poor knowledge is a factor affecting low self-efficacy in palliative care of nurses. Attitudes may contribute to the relationship between knowledge and self-efficacy in palliative care, but these relationships have been rarely examined in nurses. This study aimed to determine whether nurses' attitudes moderate the relationship between knowledge and self-efficacy in palliative care. In a cross-sectional, correlational study, online or offline survey on self-efficacy, knowledge, attitudes, and covariates was conducted from 282 nurses in South Korea. PROCESS v4.1 for SPSS was used to address the study aim. Higher levels of knowledge (p =.048) and attitudes (p <.001), and the interaction term of knowledge and attitudes (p =.025) were significantly associated with higher levels of self-efficacy (F = 6.12, p <.001, R2 =.152), indicating the moderating effects of attitudes. The relationships between higher levels of knowledge and self-efficacy were significant only in nurses with highly and moderately positive attitudes (R2 change =.016, F = 5.11, p =.025), but not nurses with lack of positive attitudes. Our results supported the moderating role of nurses' attitudes in the relationship between knowledge and self-efficacy. To improve self-efficacy in palliative care in nurses, improvement in knowledge and facilitation of positive attitudes are needed. [ABSTRACT FROM AUTHOR]

Background: The relationships of patient factors and caregiver contribution to patients' self-care to different types of self-care have been rarely examined in Korean patients with heart failure. Objective: The aim of this study was to examine patient (ie, age, depressive symptoms, and self-care confidence) and caregiver (ie, caregiver contribution to self-care maintenance and self-care management, and caregiver confidence in contributing to self-care) factors related to different types of self-care (ie, self-care maintenance, symptom perception, and self-care management) and self-care confidence in Korean patients with heart failure. Methods: In this cross-sectional, correlational study, data from 41 pairs of patients (mean age, 68.0 years) and caregivers (mean age, 54.1 years) were collected and analyzed using multiple regression. Results: Higher levels of self-care confidence in patients were related to higher levels of self-care maintenance in patients. Higher levels of self-care confidence in patients were related to higher levels of symptom perception. Higher levels of self-care confidence in patients and caregiver contribution to self-care maintenance were related to higher levels of self-care management. Less severe depressive symptoms in patients and higher levels of caregiver confidence in contributing to self-care were related to higher levels of self-care confidence. Conclusion: Different patient and caregiver factors were related to different types of self-care and self-care confidence in Korean patients, but patients' self-care confidence was related to all types of self-care. Clinicians and researchers need to develop and deliver effective interventions to both patients and their caregivers to improve patients' self-care confidence and, in turn, self-care, considering different factors associated with each type of self-care. [ABSTRACT FROM AUTHOR]

Background: The extent to which cognitive function differs between patients who receive implantable cardioverter-defibrillator (ICD) therapy and patients with heart failure (HF) who do not receive ICD therapy remains to be elucidated. Objectives: The aim of this study was to compare the cognitive function between patients with primary or secondary ICDs and patients with HF without an ICD. Methods : This descriptive, comparative study included 116 patients who received ICDs and 74 patients with HF who did not receive ICDs. Patients underwent neuropsychological assessment for general cognition, memory, and executive function. Results : Immediate recall memory loss (18.9%) occurred more often in patients with HF without an ICD than in patients with primary (3.1%) and secondary (7.1%) ICDs (P =.018). After adjusting for age and education, delayed recall memory of patients with HF without ICDs was significantly worse than that of patients with primary ICDs (4.0 vs 6.5; P <.001), whereas delayed recall memory of patients with primary ICDs was better than that of patients with secondary ICDs (6.0 vs 6.5; P =.006). Executive function of patients with HF without ICDs was significantly worse than that of patients with primary (35 vs 58 seconds; P <.001) and secondary (28 vs 58 seconds; P =.0012) ICDs. Conclusions : Patients with ICDs, regardless of primary or secondary indication, had less impairment of memory and executive function than patients with HF without ICDs, implying that ICD therapy did not interfere with cognitive performance. Cognitive screening as a part of routine care could be helpful for identifying impairment and implementing early cognitive training, especially in patients with HF. [ABSTRACT FROM AUTHOR]

Introduction: Data-based research has rarely addressed advance directives (ADs) in community-dwelling Korean cancer survivors. The purpose of this study was to examine the relationship between AD treatment choices and decisional conflicts among low-income, home-based cancer management recipients. Method: This study uses a cross-sectional, correlational design. The cancer survivors completed the questionnaires (Korean-Advance Directive model and Decisional Conflict Scale). Results: Among the 103 participants (average age 67.92 years), 56.3% had solid cancer. Hospice care was the most desired (68.9%), followed by hemodialysis (18.4%), cardiopulmonary resuscitation/ventilation support (15.5% for each), and chemotherapy (12.6%). Patients who were older, unmarried, unemployed, or underweight/obese; lived alone; or had lower education experienced greater decisional conflicts. In the multivariate analyses, no hospice preference was associated with greater decisional conflicts (t = −2.63, p =.01). Discussion: Early integration of AD discussion with the nurse-led, home-based service for this vulnerable population could serve as a liaison for quality and continuity of cancer survivorship care. [ABSTRACT FROM AUTHOR]

Background: Cognitive decline, which often occurs in heart failure, is likely to decrease health-related quality of life and increase morbidity and mortality (major events), but it has been scantly addressed. Aims: To examine whether baseline cognitive domains of global cognition, memory and executive function predict baseline health-related quality of life and 15-month major events among patients with heart failure. Methods: This prospective study included 117 patients (mean age 65.5 ± 9.42 years; men 58.1%; New York Heart Association class III/IV 25.6%), who completed questionnaires, including neuropsychological testing for cognitive evaluation, depressive symptoms, self-care and health-related quality of life measures. Their 15-month major events were extracted from medical record reviews. Results: Approximately one-third of the sample had cognitive impairment. Forty-one patients (35.0%) experienced major events. Patients with major events had significantly worse memory (immediate recall memory 13.9 vs. 11.5, P =0.030; delayed recall memory 4.3 vs. 3.1, P =0.014) and reduced executive function (trail-making test A 28.1 vs. 38.0 seconds, P =0.031). After controlling for age, sex, heart failure severity and comorbidity, memory loss with depressive symptoms was associated with worse health-related quality of life, and odds ratios of experiencing major events increased only with reduced cognitive function in global cognition and executive function. Conclusion: Cognitive function is an important factor for health-related quality of life and major events, and memory loss – worsened health-related quality of life and poor executive function was more likely to increase the risk of major events. Future studies should consider both cognitive function and depressive symptoms when designing heart failure interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]