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Background:\ud \ud Ensuring adequate knowledge about palliative care and positive attitudes towards death and dying are crucial educational aspects when preparing undergraduate nursing students to respond effectively to the complexities of care for people affected by a progressive, life-limiting illness. In undergraduate nursing education in Greece, the level of students' attained knowledge and developed attitudes towards palliative and end-of-life care remain unknown.\ud Purpose:\ud \ud To investigate undergraduate nursing students' knowledge about palliative care and attitudes towards death and end-of-life care, and explore demographic and academic factors as potential moderators of student knowledge and attitudes.\ud Methods:\ud \ud We conducted a descriptive, cross-sectional, questionnaire-based survey. We recruited 2nd, 3rd and 4th year undergraduate nursing students from the country's two University Faculties. Participants completed a demographic form, the Palliative Care Quiz for Nursing (PCQN), and the Frommelt Attitudes Towards Care of the Dying (FATCOD) questionnaire.\ud Results:\ud \ud The final sample was 529 students (response rate = 87.6%). Mean total PCQN scores revealed low levels of knowledge. Knowledge about pain/symptom management and psychosocial/spiritual care was insufficient. Mean total FATCOD scores indicated positive, liberal and supportive attitudes towards end-of-life care, with 60% of respondents keen to care for a dying person and their family. We noted less positive attitudes mainly in relation to student comfort with the care of a dying person and his/her imminent death. Academic parameters (year of study) and student demographic characteristics (older age) were the most significant moderators of both knowledge and attitudes. Greater knowledge about palliative care was a relatively weak, yet significant, predictor of more liberal attitudes towards care of the dying.\ud Conclusion:\ud \ud Our findings suggest that structured courses in palliative care can be a core part of undergraduate nursing education. Specific attention could be given to such areas patient-health professional communication, misconceptions and biases towards death and dying, and comfort in caring for the dying in order to prepare student nurses to psychologically deal with the sensitive and challenging process of death and dying.

Objective To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. Design Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. Setting Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. Participants 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin’s disease, or non-Hodgkin’s lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. Intervention Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. Main outcome measures The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy—General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory—Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). Results For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference −0.15, 95% confidence interval −0.19 to −0.12; P Conclusions Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A “medium” Cohen’s effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients’ symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. Trial registration Clinicaltrials.gov NCT02356081 .

Background: Advances in research and technology coupled with an increased cancer incidence and prevalence have resulted in significant expansion of cancer nurse role, in order to meet the growing demands and expectations of people affected by cancer (PABC). Cancer nurses are also tasked with delivering an increasing number of complex interventions as a result of ongoing clinical trials in cancer research. However much of this innovation is undocumented, and we have little insight about the nature of novel interventions currently being designed or delivered by cancer nurses. Objectives: To identify and synthesise the available evidence from clinical trials on interventions delivered or facilitated by cancer nurses. Data sources and review methods: A systematic review of randomised controlled trials (RCT), quasi-RCTs and controlled before and after studies (CBA) of cancer nursing interventions aimed at improving the experience and outcomes of PABC. Ten electronic databases (CENTRAL, MEDLINE, AMED, CINAHL, EMBASE, Epistemonikos, CDSR, DARE, HTA, WHO ICTRP) were searched between 01 January 2000 and 31 May 2016. No language restrictions were applied. Bibliographies of selected studies and relevant Cochrane reviews were also hand-searched. Interventions delivered by cancer nurses were classified according to the OMAHA System. Heat maps were used to highlight the volume of evidence available for different cancer groups, intervention types and stage of cancer care continuum. Results: The search identified 22,450 records; we screened 16,169 abstracts and considered 925 full papers, of which 214 studies (247,550 participants) were included in the evidence synthesis. The majority of studies were conducted in Europe (n = 79) and USA (n = 74). Interventions were delivered across the cancer continuum from prevention and risk reduction to survivorship, with the majority of interventions delivered during the treatment phase (n = 137). Most studies (131/214) had a teaching, guidance or counselling component. Cancer nurse interventions were targeted at primarily breast, prostate or multiple cancers. No studies were conducted in brain, sarcoma or other rare cancer types. The majority of the studies (n = 153) were nurse-led and delivered by specialist cancer nurses (n = 74) or advanced cancer nurses (n = 29), although the quality of reporting was poor. Conclusions: To the best of our knowledge, this is the first review to synthesise evidence from intervention studies across the entire cancer spectrum. As such, this work provides new insights into the nature of the contribution that cancer nurses have made to evidence-based innovations, as well as highlighting areas in which cancer nursing trials can be developed in the future. This project is jointly funded by the European Oncology Nursing Society (EONS) and the European Cancer Organisation (ECCO).

Aims and objectives: The aim of this study was to explore the associations between patients' gender, education, health status in relation to assessments of patient-centred quality and individuality in care and trust in nurses for those

Purpose The purpose of the eSMART (Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology) study is to evaluate the use of mobile phone technology to manage chemotherapy-related toxicities (CRTs) in people with breast cancer (BC), colorectal cancer (CRC), Hodgkin's lymphoma (HL), and non-Hodgkin lymphoma (NHL)) across multiple European sites. One key objective was to review the published and grey literature on assessment and management of CRTs among patients receiving primary chemotherapy for BC, CRC, HL, and NHL to ensure that ASyMS remained evidence-based and reflected current and local practice. Methods Three electronic databases were searched for English papers, with abstracts available from 01/01/2004-05/04/2014. For the grey literature, relevant clinical practice guidelines (CPGs)/evidence-based resources (EBRs) from the main international cancer organisations were reviewed as were symptom management (SM) protocols from the sites. Results After full-text screening, 27 publications were included. The majority (n = 14) addressed fatigue and focused on BC patients. Relevant CPGs/EBRs were found for fatigue (n = 4), nausea/vomiting (n = 5), mucositis (n = 4), peripheral neuropathy (n = 3), diarrhoea (n = 2), constipation (n = 2), febrile neutropenia/infection (n = 7), palmar plantar erythrodysesthesia (PPE) (n = 1), and pain (n = 4). SM protocols were provided by >40% of the clinical sites. Conclusions A need exists for empirical research on SM for PPE, diarrhoea, and constipation. Research is needed on the efficacy of self-care strategies in patients with BC, CRC, HL, and NHL. In general, consistency exists across CPGs/EBRs and local guidelines on the assessment and management of common CRTs.

Introduction/Background The integration of palliative care into standard gynecologic oncology care, in developed countries, is considered to be associated with cost-savings, longer survival, lower symptom burden, and better quality of life for patients and caregivers. ‘GALILEE’ is the first comprehensive Palliative Care Unit in Greece. The aim of the study is to characterize symptom prevalence and identify operational metrics in patients with gynecologic cancer, cared at home by an interdisciplinary palliative care team Methodology Retrospective analysis of all women, with gynecologic cancers, cared from 01.03.2015- 31.12.2018, by ‘GALILEE’ was performed. Electronic patient records were reviewed for demographics, disease characteristics and end of life discussions. Performance status was measured by the Palliative Performance Scale (PPS) and symptom burden by the Edmonton Symptom Assessment System (ESAS). Results Out of 520 patients cared in the same time period, only 42 (8)%) were identified with gynecologic cancers. Their median age was 68,5 years (range, 44–94). The majority had ovarian cancer (47,6%). Half of the patients were admitted during first line treatment. Only two patients (4,7%) were referred by their gynecologic oncologist. Median time in care was 97,5 (5–2151) days. At study entry, most patients (61%) had a good performance status (PPS>50%), while the most common disease-related symptoms were pain (78,6%), fatigue (54,8%), nausea (52,4%), anxiety (45,2%) and depression (31%). 43,9% of the patients had no emergency admission to the hospital, 42,8% of patients died of their disease and 50% were supported to die at home. In the last 2 weeks of life 7,1% of patients were receiving chemotherapy and 31% had a hospital admission. Upon admission, only 23,8% of patients were aware of the diagnosis and 11,9% of the prognosis. Conclusion Gynecologic oncology outpatients have a high symptom burden and information needs and could thus profit by concurrent provision of palliative care, early on their disease trajectory. Disclosure Nothing to disclose

Aims The aims of this paper are to explore the role of cross-disciplinary knowledge exchange and integration in advancing the science of unfinished nursing care and to offer preliminary guidance for theory development activities for this growing international community of scholars. Background Unfinished nursing care, also known as missed care or rationed care is a highly prevalent problem with negative consequences for patients, nurses and healthcare organizations around the world. It presents as a `wicked' sustainability problem resulting from structural obstacles to effective resource allocation that have been resistant to conventional solutions. Research activity related to this problem is on the rise internationally but is hindered by inconsistencies in conceptualizations of the problem and lack of robust theory development around the phenomenon. A unified conceptual framework is needed to focus scholarly activities and facilitate advancement of a robust science of unfinished nursing care. Design Discussion paper. Data Sources This discussion paper is based on our own experiences in international and interdisciplinary research partnerships related to unfinished nursing care. These experiences are placed in the context of both classic and current literature related to the evolution of scientific knowledge. Implications for Nursing The problem of unfinished nursing care crosses multiple scientific disciplines. It is imperative that the community of scholars interested in solving this wicked problem engage in meaningful cross-disciplinary knowledge integration and move towards transdisciplinarity. Conclusion Metatheorizing guided by structuration theory should be considered as a strategy to promote transdiciplinarity around the problem of unfinished nursing care.

Effective symptom management is a critical component of cancer treatment. Computational tools that predict the course and severity of these symptoms have the potential to assist oncology clinicians to personalize the patient’s treatment regimen more efficiently and provide more aggressive and timely interventions. Three common and inter-related symptoms in cancer patients are depression, anxiety, and sleep disturbance. In this paper, we elaborate on the efficiency of Support Vector Regression (SVR) and Non-linear Canonical Correlation Analysis by Neural Networks (n-CCA) to predict the severity of the aforementioned symptoms between two different time points during a cycle of chemotherapy (CTX). Our results demonstrate that these two methods produced equivalent results for all three symptoms. These types of predictive models can be used to identify high risk patients, educate patients about their symptom experience, and improve the timing of pre-emptive and personalized symptom management interventions.

BACKGROUND There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. OBJECTIVE This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone–based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. METHODS There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. RESULTS The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. CONCLUSIONS Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries.

BACKGROUND Nurses' caring behaviors are central in the quality of care of patients undergoing sophisticated chemotherapy protocols. However, there is a scarcity of research regarding these behaviors in non-Anglo-Saxon countries. OBJECTIVE The aim of this study was to explore caring behaviors that nurses perceive as important in caring for patients in Greece receiving chemotherapy. METHODS We used a mixed-methods design, including a survey in 7 oncology wards in 3 cancer hospitals in Attica, Greece, and a subsequent qualitative focus group investigation. Caring behaviors were explored through the Caring Behavior Inventory 24 and content analysis of 3 focus group interviews. RESULTS A sample of 72 nurses (response rate, 68.5%) were surveyed, and 18 nurses participated in the focus groups. "Knowledge/skills" (5 [SD, 0.7]) was the most important caring behaviors. No significant associations with nurses' characteristics were noted, except for higher scores in caring behaviors in participants who were married (P < .02). Six caring-related categories emerged from the qualitative analysis: "the concept of care," "respect," "nurse-patients' connection," "empathy," "fear of cancer," and "nurses' professional role." Moreover, they stressed barriers they faced in each category. CONCLUSIONS Integrated quantitative and qualitative data concur that operational tasks are central in Greek nurses' caring behaviors. In addition, qualitative findings highlighted those skills equipping nurses to provide holistic individualized care in a hectic care environment. IMPLICATIONS FOR PRACTICE Supporting nurses in attaining excellence in technical skills and in meaningfully engaging with patients receiving chemotherapy is essential in the realization of their caring role. These should be priorities for continuing education and practice improvement initiatives.

Background: Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses' professional and moral values. Objective: To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses. Design, data sources and methods: A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis. Results: Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients' daily care needs, prioritising work by essential tasks and participating in priority setting for patients' access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient's situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses' moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise. Conclusions: Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.

Aim: To identify, appraise and synthesize the available evidence relating to the value and impact of cancer nursing on patient experience and outcomes. Background: There is a growing body of literature that recognizes the importance and contribution of cancer nurses, however, a comprehensive review examining how cancer nurses have an impact on care quality, patient outcomes and overall experience of cancer, as well as cost of services across the entire cancer spectrum is lacking. Design: A systematic review and meta-analysis using Cochrane methods. Methods: We will systematically search 10 electronic databases from 2000, with pre-determined search terms. No language restrictions will be applied. We will include all randomized and controlled before-and-after studies that compare cancer nursing interventions to a standard care or no intervention. Two reviewers will independently assess the eligibility of the studies and appraise methodological quality using the Cochrane Risk of Bias tool. Disagreements will be resolved by discussion and may involve a third reviewer if necessary. Data from included studies will be extracted in accordance with the Template for intervention Description and Replication reporting guidelines. Missing data will be actively sought from all trialists. Data will be synthesized in evidence tables and narrative to answer three key questions. If sufficient data are available, we will perform meta-analyses. Discussion: This review will allow us to systematically assess the impact of cancer nursing on patient care and experience. This evidence will be used to determine implications for clinical practice and used to inform future programme and policy decisions in Europe. This project is jointly funded by the European Oncology Nursing Society (EONS) and the European CanCer Organisation (ECCO).

Purpose The aim of this study was to investigate the effectiveness of an educational intervention on home nursing care plans based on NANDA, Nursing Interventions Classification, and Nursing Outcomes Classification for registered nurses working at primary healthcare settings in Greece. Methods This is a quasi-experimental study without a control group. The sample consisted of 19 registered nurses. The study tool was a questionnaire administered pre- and post-educational intervention. Findings The intervention improved their skills on nursing diagnoses' nomination, proper formulation, and individualization of defining characteristics, but it did not improve them in desired outcomes formulation. Conclusions A significant effect of an educational intervention on nursing care plans was demonstrated. Implications for Nursing Practice Nurses' knowledge and attitudes are important for understanding and integrating documentation within the nursing process.

As patients are different, only one way of delivering care is neither appropriate nor efficient. Care needs to be tailored according to individual characteristics in more general and extents to include individualized nursing care. Individualized care has a positive impact on patient outcomes and is therefore worth of studies and implementation in clinical practice. The aim of this study was to describe and compare hospitalized cancer patients' perceptions of individualized care, controlled by their socio-demographic characteristics, in four European countries. The quality of individualized nursing care was represented by hospitalized patients' perceptions of the (1) nurses' support of individuality and (2) receipt of individuality as measured by the two-part Individualized Care Scale (ICS). Patients' socio-demographic characteristicsincluded education, age, gender, type of hospital admission, previous hospitalization, and hospital length of stay. Data (n=599) were collected in Cyprus (n=150), Finland (n=158), Greece (n=150) and Sweden (n=141). Multivariate analysis of variance models were constructed. The main effect of country on perceptions of individualized care was analyzed using socio-demographic characteristics as covariates. The level of support of individuality was reported as moderate and receipt of individuality on care as good. The assessments were generally the highest by the respondents in Sweden and the lowest in Greece. Shortcomings in the individualized nursing care were found based on patients' assessments. This study revealed some between-country differences in patients' perceptions of care individualization, controlled by the sample characteristics, and allows the researcher to further analyze the possible reasons for these differences whether conceptual, differences due to the education, clinical practice or organization of nursing care and services

Purpose: Although, within cancer nursing the concept of caring is central, there are limited studies comparing nurses', patients' and caregivers' views of care, especially in non-Anglo-Saxonic cultures. We explored and compared perceptions of caring behaviours by cancer patients, their caregivers, and nurses in Greece, as well as associations with demographic variables. Methods: A descriptive correlational study with cross-sectional comparisons was conducted in three cancer hospitals in Attica, with a convenience sample of 138 patients receiving chemotherapy and their family caregivers and 72 nurses. Participants completed the Caring Behaviour Inventory-24 (CBI-24). Results: All groups perceived "Knowledge and skill" as the most important CBI sub-scale. There were no statistically significant differences between patients' and caregivers' perceptions of care. Overall, nurses rated their caring behaviours lower than patients and caregivers (. p

The study’s aim was to evaluate the agreement between patients’ and nurses’ ratings of patients’ health-related quality of life (HRQoL) and to identify factors that affect their level of agreement. A total of 150 home health care cancer patients from Greece and all nurses ( N = 5) who worked in the home health care units completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 (EORTC QLQ-C30). Intraclass correlation coefficients varied between .45 and .87, indicating a moderate to excellent agreement. Median absolute difference on QLQ-C30 scores ranged from 0.00 to 16.66 points on the 0 to 100 scale. Cohen’s d varied between −0.15 and 0.59. Nurses’ higher educational level was associated with greater agreement ( p = .05). Nurses assessed lower the QoL of patients who were completely disabled than the patients themselves did ( p = .005). Our findings suggest that Greek home health care nurses estimate patients’ QoL in a reliable and valid way.

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Context Risk profiling of oncology patients based on their symptom experience assists clinicians to provide more personalizedsymptom managementinterventions. Recent findings suggest that oncology patients with distinct symptom profiles can be identified using a variety of analytic methods. Objectives The objective of this study was to evaluate the concordance between the number and types of subgroups of patients with distinct symptom profiles usinglatent class analysisand K-modes analysis. Methods Using data on the occurrence of 25 symptoms from the MemorialSymptom AssessmentScale, that 1329 patients completed prior to their next dose of chemotherapy (CTX), Cohen'skappa coefficientwas used to evaluate for concordance between the two analytic methods. For both latent class analysis and K-modes, differences among the subgroups in demographic, clinical, and symptom characteristics, as well as quality of life outcomes were determined using parametric andnonparametric statistics. Results Using both analytic methods, four subgroups of patients with distinct symptom profiles were identified (i.e., all low, moderate physical and lower psychological, moderate physical and higher Psychological, and all high). The percent agreement between the two methods was 75.32%, which suggests a moderate level of agreement. In both analyses, patients in the all high group were significantly younger and had a highercomorbidityprofile, worse Memorial Symptom Assessment Scale subscale scores, and poorer QOL outcomes. Conclusion Both analytic methods can be used to identify subgroups of oncology patients with distinct symptom profiles. Additional research is needed to determine which analytic methods and which dimension of the symptom experience provide the most sensitive and specific risk profiles.

To explore and compare cancer patients' perceptions on the quality of nursing care in four European countries.Data were collected in Cyprus, Finland, Greece and Sweden. The sample comprised 596 hospitalized cancer patients. The quality of nursing care was measured using the "Oncology Patients' Perceptions of the Quality of Nursing Care Scale" (OPPQNCS). Patient characteristics were also collected. Analysis of variance was used to examine the effects of country on the perceptions of the quality of nursing care.Patients' age ranged from 18 to 86 years, and 58% were male. The comparison of cancer patients' perceptions regarding the quality of nursing care between the four countries showed a statistically significant difference in the total OPPQNCS scores (p0.001) as well as in the subscales responsiveness (p0.001), individualization (p0.001), coordination (p0.001) and proficiency (p0.001). The Cronbach's alpha coefficient for the OPPQNCS ranged between 0.89 and 0.95. A multivariate analysis of variance for the OPPQNCS controlled by respondents' demographic characteristics revealed that only the patient's country was significantly related with the patients' perceptions of quality care.Quality of nursing care as perceived by cancer patients was high, but differed between the four countries. The impact of the clinical status of cancer patients on the quality of nursing care and managerial factors such as staffing/nursing care delivery models that influence the ability of nurses to offer high quality care should also be explored by more focused studies.

Purpose The purpose of this study was to examine psychometric properties of three translated versions of the Trust in Nurses Scale (TNS) and cancer patients’ perceptions of trust in nurses in a sample of cancer patients from four European countries. Methods A cross-sectional, cross-cultural, multi-site survey design was used. The data were collected with the Trust in Nurses Scale from patients with different types of malignancies in 17 units within five clinical sites (n = 599) between 09/2012 and 06/2014. Data were analyzed using descriptive and inferential statistics, multivariate methods and psychometrics using exploratory factor analysis, Cronbach's alpha coefficients, item analysis and Rasch analysis. Results The psychometric properties of the data were consistent in all countries. Within the exploratory factor analysis the principal component analysis supported the one component structure (unidimensionality) of the TNS. The internal consistency reliability was acceptable. The Rasch analysis supported the unidimensionality of the TNS cross-culturally. All items of the TNS demonstrated acceptable goodness-of-fit to the Rasch model. Cancer patients trusted nurses to a great extent although between-country differences were found. Conclusions The Trust in Nurses Scale proved to be a valid and reliable tool for measuring patients’ trust in nurses in oncological settings in international contexts.

Background The elderly (above 65 years) have become the leading population of our society. Their multitude of healthcare chronic problems demands palliative care and therefore Palliative Care problems and needs (PCPN) assessment. Methods A quantitative study using structured questionnaires [PNPC, Mini – Mental State Examination (MMSE), demographic and clinical characteristics] was conducted through December 2018 – February 2019, at internal medicine wards of a public general hospital. Patients with MMSE Results Sample consisted of 150 patients (51% men) with mean age 75.6 years old (SD = 10.1). The cancer diagnosis was 40% mostly colon cancer (38%) and for non-cancer patients hypertension (62.2%). No statistical differences were found between cancer and non cancer patients for the demographic and clinical characteristics (p > 0.05). The mean MMSE scare was 27.2 (SD = 2) in patients with cancer and 27.6 (SD = 1.9) in patients with no cancer (p = 0.313). Significantly greater scores were found on the ADL/IADL (p=.012 - p=.001), A (p=.050 - p=.002), SI (p=.007 - p=.004) and Sp (p=.014 - p=.001) in the cancer group for both problems and needs for care. Additionally, the cancer patients reported statistically significant higher need for professional care for FP (p=.022). No statistically significant differences were found for PS, PI and NI (p>.050). Conclusions Elderly hospitalized cancer patients have more palliative care problems and needs for care at daily living, social, spiritual and financial issues than those with no cancer. Hence, nurses should focus on meeting these needs, based on the principles of PC. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

As a concept, organizational culture is multifaceted and it has been studied in fields ranging from social anthropology to industrial-organizational psychology (Schein, 2010) defined as the set of beliefs, values, behavioral patterns, and assumptions shared by members of an organization (Cooke & Rousseau, 1998; Jacobs & Roodt, 2008; Scott, Mannion, Huw, & Marshall, 2003).Researchers in a variety of academic and professional disciplines have studied organizational culture and its possible impact on performance within organizations' services (Brian, Stanley, Armenakis, & Shook, 2009; Davies, Mannion, Jacobs, Powell, & Marshall, 2007; Freund & Drach-Zahavy, 2007; Xenikou & Simosi, 2006; Zheng, Baiyin, & McLean, 2010).

The Ministry of Health of Cyprus (approval no: Y.Y. 5.14.02.4(2)) and the Cyprus National Bioethics Committee (approval no: EEBK/EΠ/2008/1) reviewed and approved the research protocol as Cyprus was the coordinating country for the research study. Abstract BACKGROUND: Patients' decisional control over care is the ability or power for patients to decide what their involvement will be in healthcare decisions. There is evidence of limited agreement between the perceptions of patients and the perceptions of nurses and/or caregivers with regard to the degree of patient involvement in the planning and performance of their care. AIM: To analyse and compare patients' and nurses' perceptions of patients' decisional control over their own care. METHOD: A multisite cross-sectional comparative survey design was employed. Data were collected from hospitalised surgical inpatients (n = 1315) and their caregivers (n = 960 nurses) in five European countries. The Individualised Care Scale part B was used for collecting data from both the patients and nurses. Ethical standards were followed throughout the study. RESULTS: Significant between-country differences were found between patients and nurses. In all countries, both patients and nurses regarded that decisional control over care had been actualised (ICS-B: M = 3.75-4.47 and 3.48-4.33, respectively), but there were significant differences in their perceptions regarding four of the six items of the decisional control factor of the ICS-B. CONCLUSIONS: The results show that there are disparities between patients' and nurses' perceptions of patient involvement in care, probably due to cultural issues that need further exploration. CLINICAL RELEVANCE: The disparities between patients' and nurses' perceptions on patients' decisional control over their care should be taken into consideration as a potential cause of patient dissatisfaction with nursing care. The study was funded by the Cyprus University of Technology (EX 11/2008).

Background: In recent years, the shift in cancer services from traditional tertiary care to care delivered within communities has increased the need for patients to engage in self-care activities in order to prevent or reduce the severity of numerous and complex-side effects (McCorkle et al., 2011) and make important health decisions when at home in the absence of clinicians (Butow et al., 2012). The actual degree of engagement in self-management may be dependent on patients’ perceived competence or self-efficacy to perform such activities (Fenlon et al., 2015). Self-efficacy has been defined as “a person’s belief to execute courses of action required to deal with a prospective situation” (Bandura, 1977, 2001). One’s beliefs in their capability to successfully manage tasks and consequently influence situations that impact their lives constitutes a central part of human agency, and can be influenced by performance accomplishments (Bandura, 1989, 2001). Whilst self-efficacy can enable engagement in self-management, actual participation in self-management activities can further increase one’s perceived ability to undertake such activities; it is thus obvious that a bi-directional association between self-management and self-efficacy exists. Supporting a shift in clinical practice with innovative technological systems affords a solution to the increasing demands placed on acute care by enabling the delivery of care in the home and community setting (Basch et al., 2011; Carpenter et al., 2008). Such remote monitoring systems facilitate the provision of clear lines of real-time communication between patients and their health care providers (Basch et al., 2011), and can deliver organised self-management advice tailored to the individual’s clinical characteristics and severity/distress of symptoms of anti-cancer treatment. Aim(s): Funded by the European Union (FP7 programme), a multi-centre European project (the eSMART study) has been designed to investigate the effects of an electronic patient-reported outcomes (ePRO) system, the Advanced Symptom Management System (ASyMS), on patient outcomes including improvement in self-efficacy, symptom management, supportive care needs, psychological status, work presenteeism, and well-being; health system costs; and the current clinical practice. The primary aim of eSMART is to evaluate the short and long term impact of the ASyMS technology on patient reported outcomes in people with breast cancer, colorectal cancer or haematological malignancies receiving first-line chemotherapy. In addition, eSMART will evaluate the cost-benefit of remote patient-monitoring and changes in clinical practice as a result of the application of the ASyMS intervention in different European healthcare settings. The study is currently recruiting patients, thus no data will be available for presentation. This presentation will nonetheless aim to present and discuss the hypothesis that provision of symptom self-management advice may be an important mechanism to improve patient self-efficacy, which may establish a self-sustained cycle where self-care advice provision enables patient self-efficacy and this in turn further increases patient involvement in self-management that can ultimately lead to improved patient outcomes. Method(s)/Results: The current study has been informed by the Medical Research Council Complex Interventions Framework (Anderson, 2008; Craig and Petticrew, 2012; Mackenzie et al., 2010), and the Holistic Framework to improve the Uptake and Impact of e-Health Technologies (van Gemert-Pijnen et al., 2011). The eSMART programme of work comprises two parts that will take place over a period of five years. The first part consists of preparatory work to refine the ASyMS intervention for use in a multi-national context, and concludes with a feasibility testing period to establish the technological readiness of the system prior to its use in the second part. The second part will employ a repeated-measures, parallel-group, stratified randomised controlled trial methodology to demonstrate the effects of the ASyMS intervention in supporting patients who receive chemotherapy treatment through individualised symptom management. The second part will test the short- (i.e. during the treatment phase) and long-term effects (i.e. at one-year follow-up) of the ASyMS intervention versus standard care across the participating countries (Austria, Greece, Ireland, Norway and the UK). The ASyMS intervention comprises use of a mobile phone (i.e. ASyMS patient handset) and a tympanic thermometer. The patient handset will enable participants on the intervention group to enter symptom/temperature data on a dedicated, electronic symptom questionnaire daily and whenever they feel unwell. Upon successful submission of their data, patients will immediately receive automated, evidence-based self-care advice based on their symptom reports. Patients will also have access to a self-care library, symptom graphs (detailing trends in individual symptoms experienced) and contact numbers of care teams and patient support organisations in their country, available within the ASyMS patient handset. Via dedicated tablet PCs, all participants will complete an electronic version of the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer) (Wolf et al., 2005) at baseline; after each CTx; and 3, 6, 9 and 12 months post-chemotherapy treatment. The CASE-Cancer is a validated, 12-item measure that yields scores on three factors: understanding and participating in care, maintaining a positive attitude, and seeking and obtaining information. In accordance with latest recommendations for pragmatic research in healthcare (Oakley et al., 2006; Treweek and Zwarenstein, 2009), the longitudinal nature of the trial will aid to establish sustainability of intervention effects and further stress its benefits when compared to standard care. Conclusions: This anticipatory model of care supports symptom management within the patient’s home, where the early toxicities of chemotherapy can be managed, utilising self-care and local community services. This model is also expected to contribute to the health literacy of patients with cancer in relation to early identification, report and self-management of their most common symptoms. As part of the project’s objectives, we will aim to show improved self-efficacy (as shown by statistically significantly higher self-efficacy scores) during active chemotherapy for breast cancer, colorectal cancer, or haematological malignancies, and/or at one-year follow-up. It is hoped that an enhanced self-efficacy (evidenced by patients’ greater understanding and participation in care, positive attitude, and engagement in seeking health-related information) will in turn enable a smoother rehabilitation process for patients in the post-treatment survivorship period and beyond. EU FP7 Programme Grant agreement No. 602289. Trial registration identifier (clinicaltrials.gov) NCT02356081.

Scand J Caring Sci; 2012; 26; 372–380 Patient satisfaction as an outcome of individualised nursing care Background: The association between individualised nursing care and patient satisfaction has been previously found. However, there is a lack of studies examining this association between individualised care and patient satisfaction in a cross-cultural study. Aims: This study examines the association between individualised care and patient satisfaction in a sample of general surgical patients from five European countries. Methods: A cross-sectional design and survey method were used to collect data from general surgical patients (N = 1315, response rate 78%) in 72 inpatient wards in 26 general acute hospitals’ in 2009 using self-completed questionnaires the Individualised Care Scale and the Patient Satisfaction Scale. Data were analysed using descriptive statistics, Pearson correlation coefficients and multiple stepwise regression analyses. Results: Surgical patients reported that the care they received was only moderately individualised overall, but individuality was taken into account well in patients’ clinical situation and decisional control over care. Patients were satisfied with their care, mostly with the technical aspects of care and least with the information given. There were between-country differences in patients’ perceptions of individuality in care and patient satisfaction. A positive correlation between the level of individualised care received and patient satisfaction was found, confirming that individualised nursing care delivery influences patients’ satisfaction with care and demonstrating that this quality of care indicator might be able to be used as a predictor of patient satisfaction, one outcome of care. Conclusion: The findings of this study strengthen previous results and further reporting the existence of a relationship and the positive correlation between individualised care and patient satisfaction. The results can inform administrative decisions and policy on introducing nursing approaches to care that would increase patient satisfaction.

Aim. The aim of this study was to compare patients’ and nurses’ perceptions of individualised care in five European countries, the Czech Republic, Cyprus, Finland, Greece and Hungary. Background. Individualised nursing care has been studied from both patients’ and nurses’ perspectives, but to date, there are no studies comparing these perspectives internationally. Methods. A cross-sectional comparative survey design was used. Data were collected from nurses (n = 960; response rate, 79%) and patients (n = 1315; response rate, 78%) in 71 surgical units from 26 acute hospitals in 2009. Data were collected using two Individualised Care Scales (ICS-Nurse and ICS-Patient) and analysed statistically using descriptive and inferential statistics. Results. Differences in patients’ and nurses’ assessments of individualised nursing care were found between each country. Nurses, compared with patients, assessed that they supported patient individuality more often. The Meannurses ranged from 3·61 (SD 0·90, Greece)–4·31 (SD 0·53, Hungary), and the Meanpatients ranged from 3·05 (SD 1·09, Greece)–3·79 (SD 1·00, Cyprus). To a large extent, the care provided was individualised as defined by the Meannurses 3·75 (SD 0·92, Greece)–4·36 (SD 0·49, Hungary) and the Meanpatients 3·41 (SD 0·95, Greece)–4·18 (SD 0·79, Cyprus). In Cyprus and Finland, patients’ assessments of the individuality in their care corresponded well with nurses’ assessments. Clear between-country differences in both patients’ and nurses’ assessments were found in both subscales of the ICS. Conclusions. An in-depth analysis of the European between-country differences is required to define the causes of differences that may be due to the differing content of education, the organisation of nursing work, ideology and values assigned to individualised care and health care systems and processes in each country. Relevance to clinical practice. Obtaining both patients’ and nurses’ assessments of individualised care may facilitate the further development of individualised nursing care and be used to help to harmonise European health care processes and nursing care.

papastavrou e., efstathiou g., tsangari h., suhonen r., leino-kilpi h., patiraki e., karlou c., balogh z., palese a., tomietto m., jarosova d. & merkouris a. (2011) A cross-cultural study of the concept of caring through behaviours: patients’ and nurses’ perspectives in six different EU countries. Journal of Advanced Nursing 68(5), 1026–1037. Abstract Aim. This paper is a report of an international study of patients’ and nurses’ perceptions of nurse caring behaviours. Background. Current economic constraints on healthcare systems, demand to increase the quality of care and the incorporation of the consumers’ perspective into care, have created a need to develop a clear understanding of nursing behaviours which convey caring. Patients in different areas of the world report different expectations of nurses’ caring actions when compared to nurses’ views. Method. A descriptive comparative survey design was used to analyse a sample of surgical patients (n = 1659) and their nurses (n = 1195) in 88 wards of 34 hospitals in Cyprus, the Czech Republic, Finland, Greece, Hungary and Italy. Data were collected in autumn 2009 using the Caring Behaviours Inventory-24. Nurses’ and patients’ responses were compared using both inferential and descriptive statistics. Results. Independent samples t-tests showed important differences between nurses’ and patients’ views. Although both groups perceived knowledge and skill as being the most important sub-scale, the nurses’ responses were higher compared to patients (P

Quality of sleep in patients with cancer is regarded as of utmost importance. The aim of the present study was to assess psychometric properties and feasibility of the Greek version of the Pittsburgh Sleep Quality Index (GR-PSQI). Following a “forward–backward” procedure, the scale was translated into Greek. The GR-PSQI was administered as a self-report instrument to 209 consecutive patients with cancer during active-phase chemotherapy treatment. For stability analysis purposes, a subgroup of 60 patients completed the GR-PSQI on two occasions, 14–21 days apart. All participants also completed the Insomnia Severity Index, the Epworth Sleepiness Scale–Greek version, a Sleep Quality–Visual Analogue Scale and the Hospital Anxiety and Depression Scale–Greek version. Validity and reliability analyses were performed for GR-PSQI data. The Chronbach’s alpha for the global GR-PSQI score was 0.76. Test–retest reliability analysis for the global GR-PSQI score yielded a high intra-class correlation coefficient of 0.82 (p

Rationale Translation, adaptation and cross-cultural validation of instruments or scale to measure concepts of interest among different populations can facilitate sharing of knowledge and advance cross-cultural research globally, especially in countries with diverse populations. Aims and objectives This is a two-phase study aiming to: (1) translate, adapt and cross-validate the 24-item English version of Caring Behaviors Inventory into Greek; and (2) evaluate the psychometric properties of the Greek version (CBI-GR). Methods A descriptive correlational design was used to conduct the study. The procedure involved professional translators, committee approach, and a sample of nurses and patients. The psychometric evaluation of the CBI-GR used a sample of 245 Greek and Cypriot medical-surgical nurses. Data analyses comprised internal consistency reliability (Cronbach's alpha coefficient), stability (test–retest) reliability, item analysis and confirmatory factor analysis. Results The Cronbach's alpha for the overall CBI-GR was 0.92 and ranged from 0.76 to 0.87 for the subscales. Correlation coefficients between test and retest for the overall CBI-GR was r = 0.83 and ranged from r = 0.69 to 0.78 for its subscales. Confirmatory factor analysis of the scale supports its four-factor structure and the model indexes were adequate: X2 (239) = 515.54, P

Objectives Nowadays, euthanasia has the meaning of the direct administration of a lethal agent to the patient by another party with a merciful intent after patients' request. Physician assisted suicide refers to the patient intentionally and wilfully ending his or her own life with the assistance of a physician. The objectives of the manuscript were to investigate the opinions of Greek physicians, nurses, lay people and relatives of advanced cancer patients on euthanasia and physician assisted suicide. Methods The final sample consisted of 215 physicians, 250 nurses, 218 relatives and 246 lay people. A survey questionnaire was used concerning issues such as euthanasia and physician assisted suicide. The survey instrument included 13 questions and described issues such as religious and spiritual beliefs, euthanasia, physician assisted suicide and decision-making situations. Results 43.3% physicians and 41.3% relatives would agree in advance that in case of heart and/or respiratory arrest there would not be an effort to revive a terminally ill cancer patient. 20.5% physicians had a request for euthanasia. Significant associations were found between physicians (9.3%), relatives (1.8%, p =0.001) and lay people (3.7%, p =0.020) on their opinions regarding withdrawing treatment. Conclusions The majority of the participants were opposed to euthanasia and physician assisted suicide. However many would agree to the legalization of an advanced cancer patient's hastened death.

Aims. To review evidence on the role of oncology nurses in the provision of information to cancer patients and to delineate evidence-based implications for clinical practice and research. Background. Provision of information is central for the empowerment of patients to participate in their care. There is not enough evidence regarding the nursing role in the information delivery process in cancer patients. Design. Descriptive literature review. Methods. From January 1990–2008, databases searched included Medline, CINAHL, PubMed, CancerLit and the Cochrane Library. Original research articles addressing the role of nurses in information delivery were included. We explored evidence on: (1) the effectiveness of nurses as information providers, (2) the way patients evaluate nurses’ input to information delivery, (3) the extent to which nurses contribute to information delivery to cancer patients and (4) the types of information provided by nurses. Results. The most important findings were: (1) nurses’ role as information providers for cancer patients is prominent, especially after the initiation of treatment, (2) specialist nurses are very effective in providing information, (3) no clear evidence exists on how nurses compare with other health-care professionals as information providers and (4) some evidence exists that patients may prefer nurses as information providers at specific times in their treatment and especially in regards to symptom management. Conclusion. Well-designed studies provide some evidence that nurses are effective as information providers to cancer patients. Specifically, oncology nurses are able to provide information of both high quality and of appropriate quantity and to assist individuals to interpret information provided by others. Relevance to clinical practice. Oncology nurses should be specifically educated and prepared to offer explicit, practical and timely information and they should be trained in interpersonal communication skills, which will increase their ability to comprehend patient information needs.

Several studies have shown that place of death is affected by many parameters. Our objective was to describe for the first time where patients with cancer die in Greece and what has changed between 1993 and 2003. We acquired data on all deaths that were attributed to cancer in Greece in the years 1993 and 2003, and compared these data to the changes in the location of death in the total population. In 1993, approximately 50.7% of men and 50.9% of women cancer patients died in hospital, while in 2003, the respective percentages were 57.3% and 56.1%. The results indicate a trend toward a larger proportion of hospital deaths over this interval. This should be taken under consideration for future planning of end-of-life care in Greece.

BACKGROUND: The experience of living with cancer is associated with a variety of consequences in several central aspects of a patient's quality of life, including intimacy, body image, human relationships, sexuality, and fertility. Despite their importance, incidence, and impact on psychosocial well-being, sexual health care (SHC) is a matter not frequently dealt with by nurses in daily practice. GOALS OF WORK: The purpose of this study was to gather evidence regarding knowledge, attitudes, and behaviors of oncology nurses toward sexual health issues and to identify salient and latent key factors which influence provision of SHC in the context of cancer. MATERIALS AND METHODS: A critical review of the literature was conducted over a period of three decades and 18 original research articles were retrieved and analyzed. RESULTS: A comprehensive data analysis revealed that, although oncology nurses hold relatively liberal attitudes and recognize provision of sexual health care as an important nursing role, they possess limited sexual knowledge and communication skills, while often avoid or fail to effectively respond to patients' sexual concerns. Nine possible influential key factors have been studied: incorrect assumptions toward sexual issues, comfort, sexual knowledge, professional nursing role, patient- and nurse-related issues, work environment-related issues, continuing education activities, and society-related factors. Conflicting findings are reported. CONCLUSIONS: The findings of the present study propose that there is an evident need of dispelling the myths about sexual health in cancer care. Besides, continuing education activities and availability of education materials could assist nurses to adequately address sexual concerns while caring for patients with cancer. Support Care Cancer

The growing interest in the psychological morbidity of patients with cancer has been the major reason for conducting this study. The measurements used were the Beck Depression Inventory, the Beck Hopelessness Scale, the Mini Mental State Examination, the Greek Brief Pain Inventory, and the Spiritual Involvement and Beliefs Scale. The analysis was conducted in 82 patients with advanced cancer. Significant associations were found between pain interference in "mood" and in "enjoyment of life" and hopelessness, as well as between worse pain and pain interference items with depression and cognitive status. Significant correlations were found between hopelessness, depression, and cognitive condition. These findings demonstrate the physical, psychological, and cognitive aspects of patients with cancer.

PurposeThis review aims to outline a systematic approach for the assessment of quality of life in children and adolescents with CHD and to cite its main determinants.MethodsA systematic critical literature search in PubMed, Scopus, and Cinahl databases resulted in 954 papers published after 2000. After the quality assessment, 32 original articles met the inclusion criteria.ResultsMethodological quality of the included studies varied greatly, showing a moderate quality. Impaired quality of life was associated with more severe cardiac lesions. Children with CHD, after cardiac surgery, reported diminished quality of life concerning physical, psycho-social, emotional, and school functioning. The majority of clinical studies showed significant differences among children and their parents’ responses regarding their quality of life, with a tendency of children to report greater quality of life scores than their parents. According to our analysis, concerning children with CHD, the most cited determinants of their quality of life were as follows: (a) parental support; (b) lower socio-economic status; (c) limitations due to physical impairment; (d) sense of coherence; as well as (e) the level of child’s everyday anxiety and depression. These findings suggest that differences in quality of life issues may exist across lesion severities.ConclusionQuality of life in children with CHD should be assessed according to age; severity; therapeutic approach; acceptance of the disease; and personality features. Effective management and early recognition of significant impairments in quality of life could impact clinical outcomes in children with CHD.