BACKGROUND:Personalized Stratified Follow-Up (PSFU) is an approach to cancer follow-up involving patients re-accessing care when they need to, rather than attending predetermined appointments. The benefits of this approach are a more personalized experience for patients and increased capacity in clinics. OBJECTIVE:To understand the evidence relating to the experiences of people on PSFU following breast cancer treatment, specifically in terms of the perceptions of people from underserved groups. METHODS:A scoping review of the relevant evidence was conducted. Screening was conducted independently by 2 researchers. Data extracted were charted using a predetermined checklist for summary and analysis. RESULTS:A total of 2728 results were identified through databases; 11 papers were included. Nineteen gray literature resources were also identified. Findings were presented as: (1) key components of PSFU for breast cancer; (2) experiences and perceptions of patients and health professionals in relation to PSFU for breast cancer; (3) suggestions to enhance PSFU; and (4) evidence relating to underserved groups on PSFU for breast cancer. CONCLUSION:Patients on PSFU are generally satisfied with their care and are confident in managing their own condition. Unmet needs include psychological support and re-accessing clinical teams. This review has highlighted that little is known about the experiences of underserved groups. IMPLICATIONS FOR NURSING PRACTICE:Nurses should be aware of the importance of providing patients on PSFU with information about self-examination, signs of recurrence, side effects, and re-accessing the clinical team. PSFU services should be designed to ensure that patients from underserved groups do not experience inequalities in their care.
BACKGROUND:Bell-ringing rituals mark the end of active cancer treatment in oncology settings worldwide. Despite their growing prevalence, their emotional and clinical implications across patients, caregivers, and healthcare professionals remain underexplored. OBJECTIVE:To map and synthesize the available evidence on bell-ringing rituals in cancer care, examining their meanings and implications from the perspectives of patients, informal caregivers, and healthcare professionals. INTERVENTIONS/METHODS:A scoping review was conducted following Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (Open Science Framework protocol: https://doi.org/10.17605/OSF.IO/UCPFV). Five databases (PubMed, Scopus, Embase, CINAHL, and Cochrane Library) were searched from January 1996 to July 2025. Qualitative, quantitative, and mixed-methods studies were eligible. Two independent reviewers performed selection, extraction, and thematic synthesis. RESULTS:Five studies met the inclusion criteria. Four themes emerged: (1) symbolic closure and transition, (2) emotional ambivalence encompassing joy, guilt, and anxiety, (3) visibility, recognition, and disparities, and (4) absence of institutional guidance. While many patients experienced achievement and community, those with ongoing treatments or advanced disease frequently reported exclusion and distress, including posttraumatic stress disorder triggers. CONCLUSIONS:Bell-ringing rituals support meaning-making for some patients but may unintentionally marginalize vulnerable individuals when implemented without adequate assessment. No evidence-based protocols currently exist for patient readiness or cultural appropriateness. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Oncology nurses should conduct preritual readiness assessments and offer individualized symbolic options to protect nonparticipating patients. Findings support inclusive institutional protocols and the integration of ritual literacy into nursing education.
BACKGROUND:Asian American breast cancer survivors face substantial disparities in recurrence rates; however, ethnic differences in breast cancer survivorship remain understudied. OBJECTIVE:To examine the associations between psychosocial factors and breast cancer survivorship, with a focus on ethnic differences among Chinese, Korean, and Japanese Americans. METHODS:This secondary analysis used data from 167 participants in a randomized clinical trial of Asian American breast cancer survivors. Cancer survivorship was measured with the Supportive Care Needs Survey, the Memorial Symptom Assessment Scale, and the Functional Assessment of Cancer Therapy-Breast Cancer. Psychosocial factors included attitudes, self-efficacy, perceived barriers, and social influences. All assessments were administered at baseline, 4-week posttest, and 12-week posttest. Baseline differences across ethnic groups were examined with analysis of variance (ANOVA), post hoc, and chi-square tests. Panel data were analyzed with mixed-effects linear regression models. RESULTS:ANOVA tests indicated that Chinese Americans reported more negative attitudes toward cancer survivorship, whereas Japanese Americans reported lower levels of social influence. Mixed-effects linear regression models showed significant ethnic differences in associations: Compared with Japanese Americans, Chinese Americans exhibited stronger negative associations of cancer survivorship outcomes with a lack of social support and perceived barriers. Among Korean Americans, higher loneliness and lower social influence were associated with greater unmet needs (Supportive Care Needs Survey). CONCLUSION:To address survivorship experiences among Asian American breast cancer survivors, ethnic differences must be considered. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Survivorship care for Asian American breast cancer survivors should incorporate ethnic differences and modifiable psychosocial factors to guide culturally tailored interventions.
BACKGROUND:Young adult childhood cancer survivors (YA CCSs) may experience posttraumatic growth (PTG), yet little is known about how neighborhood-level social determinants influence PTG. Posttraumatic stress may also shape PTG, but its mediating role in the relationship between neighborhood deprivation and PTG remains unclear. OBJECTIVE:To examine associations between neighborhood deprivation and PTG among YA CCSs and determine whether posttraumatic stress mediates these associations. METHODS:This cross-sectional study included 121 YA CCSs. Neighborhood deprivation was measured using the Area Deprivation Index (ADI) and the Environmental Justice Index (EJI). PTG and posttraumatic stress were assessed using the Posttraumatic Growth Inventory and the Impact of Event Scale-Revised. Linear regression examined associations between neighborhood deprivation and PTG. The MEDCURVE macro tested curvilinear mediation. RESULTS:Participants were mostly non-Hispanic White (71%) with a mean age of 19.4 years. Higher ADI scores were associated with greater PTG (B = 0.36, 95% confidence interval [CI], 0.17-0.55). Total EJI and its Social and Health Vulnerability subscale were positively associated with PTG. Posttraumatic stress curvilinearly mediated the ADI-PTG association, with stronger mediation in less deprived neighborhoods (B = 0.11, 95% CI, 0.02-0.30) and weaker mediation in more deprived neighborhoods (B = 0.07, 95% CI, 0.02-0.17). Similar mediation was observed for the EJI Social Vulnerability subscale. CONCLUSIONS:Greater neighborhood deprivation was associated with higher PTG in YA CCSs. Posttraumatic stress mediated this association, with its influence varying across neighborhood conditions. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Findings support personalized interventions addressing socioecological environments and psychological determinants.
BACKGROUND:Physical activity (PA) alleviates the symptoms of breast cancer survivors and improves their spouses' wellness. Nevertheless, insufficient dyadic PA behavior among patient-spouse dyads constrains their PA levels. OBJECTIVES:To evaluate the feasibility, acceptability, and preliminary efficacy of a dyadic PA behavioral promotion program for breast cancer survivors during chemotherapy and their spouses. METHODS:Fifteen patient-spouse dyads from a tertiary general hospital were enrolled in this single-arm pilot study and received an 8-session dyadic PA behavioral promotion intervention across 2 chemotherapy cycles. The feasibility, acceptability, and preliminary efficacy of the intervention were evaluated using t tests or Wilcoxon signed-rank tests, and effect sizes were calculated to estimate intervention effects. RESULTS:Rates of recruitment (57.69%), retention (73.33%), and participation (84.71%) indicated good feasibility, and the high overall satisfaction score (4.85 ± 0.36), together with participant feedback, demonstrated high acceptability. PA levels (both P < .05, d = 0.71, d = 0.67) and marital intimacy (P < .01, d = 1.22; P < .05, d = 0.94) were significantly improved in both patients and their spouses. In addition, patients' quality of life was significantly improved (P < .05, d = 0.91), and spouses' sleep disturbance was reduced (P < .05, d = 0.75). CONCLUSIONS:The dyadic PA behavioral promotion program was feasible and acceptable and may help improve PA levels and reduce symptom burden. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Dyadic PA promotion interventions can be integrated into routine supportive care to enhance physical and mental well-being and health-promoting behaviors among patients and their spouses.
BACKGROUND:Patients with lymphoma face profound psychological challenges that extend beyond physical symptomatology. While benefit finding has demonstrated positive effects on cancer adaptation, the temporal progression and underlying mechanisms of this process in lymphoma populations remain inadequately understood. Understanding these processes is essential for developing targeted psychosocial interventions. OBJECTIVE:This study aimed to explore the lived experiences and developmental trajectory of benefit finding among patients with lymphoma and to identify factors facilitating this psychological transformation. METHODS:A phenomenological qualitative design was employed using Colaizzi's seven-step analytical framework. Eighteen patients with lymphoma, aged 24 to 63 years (mean age 38.72 ± 10.97 years), participated in semi-structured in-depth interviews until data saturation was achieved. RESULTS:Thematic analysis revealed four sequential phases characterizing benefit-finding progression: benefit resistance and initial cognitive adaptation disruption, benefit emergence and initial cognitive adaptation formation, benefit construction and positive cognitive adaptation development, and benefit transcendence and cognitive adaptation maturation. Role models emerged as pivotal catalysts for cognitive transformation, while personal breakthroughs and social reintegration facilitated psychological transcendence. CONCLUSIONS:Benefit finding in lymphoma represents a dynamic, phase-specific developmental process grounded in cognitive adaptation mechanisms involving meaning reconstruction, perceived control restoration, and self-enhancement. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Oncology nurses should assess patients' current benefit-finding phase to deliver stage-tailored psychological interventions. Facilitating connections with peer role models and supporting meaning-making activities can accelerate patients' progression toward benefit transcendence and enhanced psychological well-being.
Background: Acute myeloid leukemia (AML) is associated with high complication rates following induction chemotherapy, yet clinicians lack tools that anticipate deterioration and support proactive care. Preliminary predictive modeling using structured electronic health record data and symptoms extracted through natural language processing identified key risk factors for deterioration within 30 days of discharge. How clinicians interpret these risk factors in practice remains unclear. Objective: This study aimed to explore how hematology clinicians understand actionable risk factors for deterioration in AML and how these factors should inform the design of clinical decision support. Interventions/Methods: Seven hematology clinicians—including hematologist-oncologists, a nurse practitioner, and physician assistants—at a Midwestern academic medical center participated in individual or group semistructured interviews. Interview questions addressed perceived risk factors, actionability, and needs for clinical decision support. Data were analyzed using conventional content analysis. Results: Three themes emerged: (1) generic tools do not adequately support the complexity of AML care; (2) actionability is context‑dependent, with both nonmodifiable and modifiable factors influencing discharge decision‑making; and (3) clinical decision support must integrate predictive risk scoring with user‑centered design features such as intuitive displays, timely alerts, and transparency about contributing factors. Conclusions: Clinicians expressed strong support for a clinical decision support tool that anticipates deterioration, provides individualized and interpretable risk alerts, and aligns with existing workflows to reduce preventable complications and readmissions. Implications for Oncology Nursing Practice: Clinical decision support tools that integrate dynamic clinical data with intuitive, workflow‑aligned interfaces may enhance risk communication, strengthen discharge decision‑making, and support proactive monitoring in AML care.
BACKGROUND:Pediatric cancer clinical trials are key to advancing treatment and improving survival rates. However, participation relies on complex family decision-making influenced by emotional, relational, and systemic factors. Understanding these influences is crucial for supporting informed decision-making processes. OBJECTIVE:To synthesize the qualitative evidence on influencers of the decision to pursue treatment in a pediatric cancer clinical trial. METHODS:Following Whittemore and Knafl's framework, databases were systematically searched for qualitative studies on decision-making regarding trial participation in pediatric cancer populations. Twenty-six studies were included. Data were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument tool, appraised with the Critical Appraisal Skills Programme Qualitative Checklist, and synthesized. RESULTS:Included studies examined the perspectives of patients, caregivers, and clinicians. Six main themes emerged: emotional distress and vulnerability, altruism and meaning-making, therapeutic risks and benefits, relationships and power dynamics, communication, and systemic barriers. Families often described trial enrollment as happening during emotional distress, with hope and trust in clinicians sometimes influencing decisions as much as clinical information. Adolescents wanted more involvement but were sometimes sidelined. CONCLUSIONS:Trial decisions are embedded in emotional, relational, and structural contexts that complicate informed consent. Findings highlight tensions between hope and understanding, and voluntariness and trust. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Clinical care should prioritize staged, plain-language, developmentally appropriate trial discussions, active inclusion of adolescents, and proactive attention to logistical burdens. Much existing evidence predates the rise of social media and remains limited to Western contexts. New research must explore digital influences, global experiences, and child-centered methods to better inform equitable, family-centered trial enrollment practices.
BACKGROUND:Decision aids (DAs) have been developed to support decision-making for breast cancer treatments, but evidence regarding their effectiveness remains inconclusive. OBJECTIVES:To systematically identify and synthesize evidence on the effectiveness of DAs for breast cancer treatment on decision conflict, decision regret, shared decision-making (SDM), quality of life (QoL), health-related quality of life (HRQoL), and surgical choices. METHODS:A systematic search across 9 databases from inception to October 2025 included randomized and nonrandomized controlled trials in English or Chinese. Methodological quality was assessed using design-specific tools. Certainty of evidence was evaluated using the GRADE approach. Meta-analyses and narrative syntheses were conducted based on data availability. RESULTS:Forty-eight articles evaluating 46 DAs were included. Pooled analysis suggested that DAs significantly reduce decision conflict (standardized mean difference = -0.70; 95% CI, -0.93 to -0.46) and decision regret (-0.71; -1.03 to -0.40) and improved SDM (0.41; 0.31-0.50) and HRQoL (0.17; 0.05-0.29). However, the effects of DAs on QoL, breast conservation rate, and reconstruction rate remain inconclusive. The study quality varied from low to high risk of bias. The certainty of evidence ranged from very low to moderate, primarily because of substantial heterogeneity. CONCLUSIONS:This review demonstrates significant benefits of DAs in reducing decision conflict and decision regret and in promoting SDM and HRQoL. However, variability in study quality and low certainty of evidence highlight the need for further rigorous investigations. IMPLICATIONS FOR PRACTICE:More rigorous trials and economic evaluations are needed to strengthen the evidence base and validate their cost-effectiveness, ensuring sustainable implementation.
BACKGROUND:Needs and facilitating factors should be identified for children with cancer to receive effective transitional care services during school reintegration. OBJECTIVE:This study examined the experiences of children with leukemia and their parents during the process of returning to school. METHODS:This qualitative research, designed as a descriptive phenomenological study, was based on semistructured, in-depth interviews with children with leukemia and their parents. RESULTS:Three main themes were identified from the analysis for both children and parents: perceived difficulties, comprehensive support needs, and facilitators. For children, the analysis identified 3 main themes. The first theme focused on emotional and behavioral aspects, the process of returning to school, and social life. The second theme highlighted the importance of both academic and social support, while the third emphasized the need for professional guidance and improvements to the school's physical environment. For parents, similar themes emerged: emotional and behavioral aspects, as well as school reentry, formed the first theme; academic support, along with communication and collaboration, constituted the second; and professional support and attention to physical conditions made up the third theme. CONCLUSIONS:The emotional, social, and academic support needs of children with cancer are critical for the successful management of their school reentry. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Oncology nurses should incorporate structured school reentry support into follow-up care, collaborating with families, teachers, and school staff. They should monitor children's anxiety, coping skills, and treatment-related effects, and provide guidance and support to promote smoother school reintegration.
BACKGROUND:Quality of life (QoL) among children with acute lymphoblastic leukemia (ALL) exhibits dynamic changes during various treatment periods. OBJECTIVE:This study explores the longitudinal trends in and determinants of QoL among children with ALL postdiagnosis. METHODS:We conducted this study using repeated measurements with a kernel smoothing mean. We consecutively recruited ALL patients aged 5-18 years and their parental proxies from 3 hospitals in Vietnam. They reported their children's QoL by the PedsQL Generic Core Scales and the PedsQL Cancer Module. RESULTS:We collected a total of 277 repeated assessments for 186 children, and their proxies had a mean age of 38.21 ± 9.01 years. Different age groups experienced distinct QoL problems across various time periods: poor physical functioning (5-7 years: first 5 months; 8-12 years: first year; 13-18 years: second year), pain (5-7 years: first 3 months, 13-18 years: second year), nausea (5-12 years: first 3 months; 13-18 years: second year), procedural anxiety (5-7 years: first 3 months; 8-12 years: first 9 months, 13-18 years: second year), appearance concerns (5-7 years: second year). Duration-to-date, proxy characteristics (education, relationship to the patient) exhibited independent effects on various QoL domains. CONCLUSIONS:Impairments in QoL functioning and problems emerged and changed across different age groups over time. Several factors, including duration to date and proxy characteristics (education, relationship to the patient), were found to be associated with various QoL domains. IMPLICATIONS FOR PRACTICE:A comprehensive program focusing on physical or psychological problems among children with ALL should be developed.
BACKGROUND:Prolonged peripherally inserted central catheter (PICC) use in pediatric patients with hematologic disorders is associated with an elevated risk of central line-associated bloodstream infection (CLABSI), which can lead to poor outcomes and a mortality rate approaching 25%. OBJECTIVE:To evaluate the effectiveness of the PICC-Quality Management System (QMS) in reducing CLABSI and PICC-related complications in pediatric hematologic patients. METHODS:We conducted a single-center, pre-post intervention study including pediatric patients with PICC placement exceeding 48 hours. The 2023 cohort (n = 611) received conventional care, whereas the 2024 cohort (n = 693) received care under the PICC-QMS. Baseline demographics and clinical characteristics were comparable between groups. RESULTS:A total of 1304 patients (mean age ± SD, 9.22 ± 0.11 years; 34.7% female) were analyzed. Compared with conventional care, PICC-QMS implementation was associated with lower CLABSI incidence (22 versus 13 cases; P = .06) and reduced thrombus formation (6 versus 1 case; P = .039). After adjustment for ward type, logistic regression indicated a significantly reduced CLABSI risk in the PICC-QMS group (adjusted odds ratio, 0.46; 95% CI, 0.20-0.90; P = .022). CONCLUSIONS:The PICC-QMS effectively reduces CLABSI incidence in pediatric patients with hematologic disorders, underscoring its value as an infection control strategy. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Standardization, refinement, and continuous monitoring under the PICC-QMS provide a practical, reproducible framework for integrating high-quality PICC care into routine practice, offering a potential reference model for other high-risk populations.
BACKGROUND:Colposcopy has been provided by nurses internationally since the 1970s. A summary of current evidence regarding the outcomes of nurse-led colposcopy has not been published. OBJECTIVE:The aim is to examine existing literature on outcomes of nurse-led colposcopy internationally and identify benefits and limitations for patients and organizations. METHODS:CINHAL, PubMed, and Scopus were searched for literature using keywords. Screening was conducted according to inclusion and exclusion criteria, and relevant studies were included in the review. RESULTS:Eight studies were eligible for inclusion in the review. Half of the included studies (n = 4) were conducted in the United States, while the remaining 4 were undertaken in Bangladesh, Ghana, the Netherlands, and the United Kingdom. Three key topics were identified as benefits of nurse-provided colposcopy, comparison with medical officer-provided colposcopy, and cost-effectiveness and organizational impact. In addition, this review mapped the current levels of education required for nurses to perform colposcopy in each country represented in the included studies. CONCLUSIONS:The review shows that nurses provide colposcopy services in a wide range of settings internationally and to a similar standard to medical officers. Nurse-led colposcopy is not well defined in many of the included studies, and identified gaps in research suggest that further research is needed. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Underserved communities worldwide suffer the burden of gynecological cancers in greater numbers than those in more prosperous communities. This review calls attention to the benefits for patients attending colposcopy provided by nurses and proposes the potential for workforce innovation in resource-poor settings.
BACKGROUND:Multiple myeloma is a chronic hematological malignancy requiring continuous supportive care. Palliative care (PC) can be delivered through different models, such as consultative and integrative approaches. The subjective meaning patients attribute to these approaches has not been adequately explored. OBJECTIVE:To explore how patients with multiple myeloma experienced a nurse-led integrative PC model integrated within standard hematology practice. INTERVENTIONS/METHODS:Fifteen patients who initially received standard care and later transitioned to nurse-led integrative PC participated in semi-structured, face-to-face interviews after 6 months in the program. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Credibility and trustworthiness were ensured through independent coding, reflexive and analytic memos, peer debriefing, and data saturation. RESULTS:Five themes emerged: redefining PC, relief of symptoms, relational continuity with a dedicated nurse, increased involvement and control, and renewed hope. Patients emphasized the ongoing, relational, and empowering aspects of the nurse-led integrative approach compared with the episodic and reactive nature of standard care. CONCLUSION:Transitioning to nurse-led integrative PC altered patients' perceptions of their treatment. The model provided continuity, emotional stability, and existential meaning in addition to physical symptom relief. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Nurse-led integrative PC can enhance patient experiences by combining symptom management with sustained relational support. Oncology nurses implementing this model may foster greater patient empowerment, hope, and engagement in care, thereby improving quality of life throughout the disease trajectory.
BACKGROUND:In France, individuals newly diagnosed with genetic cancer (probands) inform their relatives (related cases) about the risk of cancer transmission. Participation rates, delays in attending oncogenetic consultations and characteristics of the related cases remain undocumented. OBJECTIVE:This study aimed to (1) assess the proportion of related cases who attend oncogenetic consultation, (2) estimate the delay until related cases attend oncogenetic consultation, and (3) identify factors associated with the use of oncogenetic consultation among related cases. METHODS:Data from 98 probands with hereditary cancer and their 263 related cases were collected from oncogenetic consultations at the University Cancer Institute of Toulouse between 2017 and 2020. Related cases were followed until February 2022. Attendance rates were analyzed using descriptive statistics, while logistic regression and mixed-effects models identified influencing factors. RESULTS:A total of 59% of related cases attended oncogenetic consultation. Among those expected to attend, 50% did so within 374 days, with early attenders presenting within 78 days. After accounting for the family effect, a higher attendance rate was observed among women (odds ratio [OR]men = 0.49 [0.24-0.99]), those with a frequent relationship with their proband (OR65 years = 0.06 [0.01-0.43]). CONCLUSIONS:Improving access to oncogenetic consultation and the dissemination of genetic risk information remains a critical challenge. IMPLICATIONS FOR PRACTICE:In-depth qualitative research is essential to support the development of research aimed at improving health literacy and collaboration between patients and healthcare providers in the context of hereditary cancers.
BACKGROUND:Few studies have explored the combined impact of physical activity (PA), sleep duration, and trouble sleeping on mortality outcomes in patients with cancer. OBJECTIVE:We aimed to investigate the independent and combined prognostic effects of PA and sleep on mortality outcomes among cancer survivors in the United States. METHODS:Using the National Health and Nutrition Examination Survey (2007-2018), data of 2651 cancer survivors were analyzed. Mortality was ascertained using the National Death Index. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate associations. RESULTS:Independent analyses demonstrated reduced mortality risk among survivors with sufficient PA (PA ≥ 600 metabolic equivalent minutes/week) and adequate sleep time (7-9 hours/d), whereas those reporting trouble sleeping showed elevated risk. Joint analyses demonstrated that survivors with sufficient PA and either adequate sleep time or without trouble sleeping had significantly lower all-cause mortality (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.39-0.64; HR: 0.48, 95% CI: 0.37-0.62, respectively) and cancer-specific mortality (HR: 0.56, 95% CI: 0.36-0.86; HR: 0.46, 95% CI: 0.30-0.70, respectively). Importantly, abnormal sleep time (<7 or >9 hours/d) and trouble sleeping were not associated with risk of all-cause or noncancer mortality among individuals who achieved sufficient PA. CONCLUSIONS:The combination of sufficient PA, adequate sleep time, and absence of trouble sleeping reduces mortality risk among cancer survivors. The harms of abnormal sleep time and trouble sleeping were offset by sufficient PA. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Survivorship care should integrate the concurrent assessment and management of PA and sleep.
BACKGROUND:Cancer-related fatigue (CRF) is one of the most prevalent and distressing symptoms among women with breast cancer. The symptoms influence psychological outcomes through functional status and quality of life (QoL). However, whether multidimensional QoL domains mediate the relationship between CRF and mental distress remains unclear. OBJECTIVE:To test a parallel multiple mediation model evaluating the effects of CRF on mental distress through physiological, psychological, social, and environmental QoL domains. METHODS:This cross-sectional study recruited 84 patients with breast cancer receiving postoperative adjuvant therapy in southern Taiwan. Participants completed the Brief Fatigue Inventory-Taiwan Form, World Health Organization Quality of Life-BREF, and Brief Symptom Rating Scale-5. Pearson correlations were calculated, and mediation analyses were tested using a parallel mediation model (PROCESS model 4). RESULTS:CRF was positively associated with mental distress and negatively associated with all QoL domains. Although QoL domains were significantly correlated with mental distress at the bivariate level, none demonstrated significant independent mediation effects in the parallel model. The overall model explained 45% of the variance in mental distress. Findings indicate that CRF exerted a predominantly direct effect rather than operating indirectly through perceived QoL domains. CONCLUSION:Contrary to theoretical expectations, multidimensional QoL domains did not function as mechanistic pathways linking CRF to mental distress. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:These findings highlight CRF as a proximal psychological stressor. Oncology nurses should prioritize systematic fatigue assessment and targeted fatigue management, as mental distress may not be adequately alleviated by improvements in global QoL alone without directly addressing fatigue.
Background:Family caregivers play a crucial, demanding, and often complex role in the care of women with gynecological cancer. However, there is limited evidence focusing on the needs of family caregivers caring for women with gynecological cancer.Objectives:This study aimed to map and summarize the available evidence on family caregivers' experiences and needs when caring for women with gynecological cancer.Methods:A scoping review, using the Askey and O'Malley framework and the Joanna Briggs Institute's methodology, assessed published studies from January 2012 to May 2025 in databases CINAHL, PubMed, Cochrane Library, PsycINFO, ProQuest, SCOPUS, and Web of Science. Inclusion criteria included studies that reported qualitative findings on the needs of family caregivers for women with gynecological cancer. A thematic synthesis, using NVivo software, was used to analyze selected articles.Results:Sixteen studies were included in the review. Eight supportive care needs dimensions for family caregivers of women with gynecological cancer were identified and thematically grouped, including: physical needs, psychological and emotional needs, sexual needs, family or social support needs, healthcare services and facilities' needs, information needs, spiritual needs, and practical needs.Conclusions:This study highlights the importance of further research to better understand the unique needs faced by caregivers in this context.Implications for Practice:Nurses have a vital role in supporting family caregivers by conducting a comprehensive assessment of their needs. Providing holistic care and targeted support can enhance caregivers' quality of life and empower them to fulfill their roles in a sustainable and meaningful way.
