BackgroundDecision-making in recurrent or metastatic head and neck cancer (HNC) is challenging, often involving high uncertainty and psychological distress.ObjectiveTo identify factors contributing to decisional conflict in patients with recurrent or metastatic HNC.MethodsThis cross-sectional study used convenience sampling to recruit participants from the outpatient department of a cancer center in northern Taiwan between August 2021 and July 2024. The Decisional Conflict Scale (DCS) and the University of Washington Quality of Life Scale (UW-QOL) were used to assess decisional conflict, physical function, and social-emotional function.ResultsA total of 140 patients were recruited. Among them, 78.6% experienced decisional conflict. The main areas of concern were lack of support, ineffective decision-making, unclear values, insufficient information, and uncertainty. Patients with lower education, living alone, with lower family income, with private insurance, or with lower physical and social-emotional functioning were more likely to experience decisional conflict.ConclusionsLower education, living alone, lower family income, private insurance, or lower physical or social-emotional function contribute significantly to decisional conflict in patients with recurrent or metastatic HNC. Healthcare providers should incorporate targeted interventions addressing these factors into the shared decision-making processes to reduce decisional conflict and enhance patient-centered care.

Background The transition to competency is challenging for novice nurses, often leading to stress and turnover. Nurse residency programs enhance clinical skills and improve retention. Competency-Based Education (CBE) advances nurses' development through patient-centered care, critical thinking, and accountability. CBE's competency-driven objectives facilitate effective mentorship. Multidimensional training fosters collaboration and inclusivity, strengthening learning and professional relationships. Objectives This study aimed to develop a multidimensional competency-based approach, highlighting how individualized repeated practice, targeted feedback, and dynamic preceptor-learner interactions enhance skill development and competency acquisition. It evaluated the clinical competence, professional confidence, and passion for nursing of novice nursing practitioners. Design Mixed methods approach. Methods A qualitative descriptive approach with monthly facilitated group discussions explored novice nurses' perceptions of patient care needs and barriers. Findings informed the design of a tailored, multidimensional six-month training program. The program featured interactive sessions with faculty guidance and incorporated classroom instruction, simulated teaching, hands-on practice, and reflective exercises. Professional competence, confidence, passion for nursing, and perceived healthcare team support were assessed quantitatively before and after the intervention. Results A total of one hundred and eighty-three participants were recruited. Quantitative results demonstrated significant improvements in professional competence, confidence, passion for nursing, and perceived healthcare team support (p < 0.05). Qualitative findings indicated that simulation-based learning and structured team support enhanced nurses' confidence, clinical care capability, and engagement. Participants reported high satisfaction with clinical skills simulators and perceived healthcare team support as essential. All participants who completed the program-maintained employment at the one-year follow-up assessment, yielding a 100% retention rate. Conclusions The multidimensional competency-based education program significantly improved novice nurses' clinical competency, professional confidence, and passion. Tailored multidimensional training is essential to prepare novice nurses to tackle clinical challenges and build resilience.

PURPOSE:Patients undergoing treatment for multiple myeloma (MM), a common hematological malignancy, may experience symptom distress, functional decline, fear of disease progression, and poor quality of life (QOL). This study of MM patients aims to assess patient-reported symptom distress, functional impairment, fear of cancer progression, and QOL and to identify factors associated with QOL. METHODS:This cross-sectional study used consecutive sampling to recruit subjects from inpatient wards and the outpatient departments of hematology and chemotherapy at a medical center in northern Taiwan. Patients were assessed via self-reported questionnaires for symptom distress, functional impairment, fear of progression (FoP), and QOL. Descriptive analysis, Pearson's product-moment correlation, multiple regression, independent-samples t-test, and one-way ANOVA were used to analyze the data. RESULTS:A total of 100 MM patients were included in this study. The most common symptoms reported to cause distress during treatment were fatigue, immobility, difficulty defecating, pain, numbness, and insomnia. The greatest level of functional impairment was in the ability to get around. A high level of FoP was reported by 32.0% of the patients. Multiple regression analysis showed that MM patients who had higher performance status, lower symptom distress, and lower FoP were more likely to have higher QOL. These 3 factors accounted for 78.1% of the variance in QOL. CONCLUSION:Performance status was the greatest predictor of overall QOL and of five QOL domains. Patient-centered care programs that address symptom management, resistance training, diet control, and supportive care during treatment can reduce symptoms and FoP and improve the performance status and QOL of MM patients during treatment.

Non-Hodgkins’s lymphoma (NHL) patients’ body mass index (BMI), information needs, and self-efficacy to manage illness vary over the course of treatment and are correlated to their physical and psychological health. The purpose of this study was to assess BMI, performance status, information needs, and self-efficacy to manage illness, and study their effects on symptom distress and anxiety in patients with NHL. This prospective longitudinal study recruited NHL patients from a medical center in Northern Taiwan. A total of 47 NHL patients were followed before treatment (T0), at 6 weeks after beginning treatment (T1), and at 15 weeks after beginning treatment (T2). Generalized estimating equation analysis was used to examine the factors associated with symptom distress and anxiety. Self-efficacy to manage illness increased from T0 to T2 and was lowest at T0. Symptom distress slightly increased from T0 to T1 and then decreased at T2. Anxiety and information needs decreased from T0 to T2 and were highest at T0. Less symptom distress was associated with less anxiety, higher information needs, and higher self-efficacy to manage illness. Greater anxiety was associated with greater symptom distress, higher information needs, and less self-efficacy to manage illness. Information needs and self-efficacy to manage illness were important factors influencing symptom distress and anxiety in patients with NHL. Healthcare professionals should provide patient-centered education as part of pre-treatment care to facilitate self-care, empower self-efficacy to manage illness, and improve symptom distress and anxiety.

Background/purpose Social function and employment are vital to the quality of life in head and neck cancer (HNC) survivors. This study aimed to (1) assess the status of social difficulties (including getting along with others, social participation and unemployment); (2) examine their associations with the University of Washington Quality of Life Questionnaire (UW-QOL); and (3) establish UW-QOL cut-off points for identifying social difficulties after primary treatment. Materials and methods The cross-sectional study was conducted at a medical center in Taiwan, involving HNC survivors under 65 years who completed primary treatments. Data collection included the UW-QOL, the “getting along” and “social participation” subscales of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), employment status, and demographic and clinical characteristics. Results A total of 164 HNC survivors was recruited. Among them, 49.4 % reported difficulty in social participation, 20.7 % had difficulty getting along with others, and 25.6 % were unemployed. UW-QOL scores were highly correlated with the two social function subscales and significantly differed between employed and unemployed individuals. UW-QOL cut-off scores indicating mild to severe difficulty were 75.0, 73.3, and 63.9 for social participation; 63.9, 60.8, and 58.5 for getting along; and 76.8 for unemployment. Conclusion The study showed that social difficulties are a concern for HNC survivors. Importantly, the study provides strong evidence to support that UW-QOL can be used to concurrently assess for QOL and the main social difficulties through the cut-off points in UWQOL.

Purpose Nasopharyngeal carcinoma (NPC) patients may experience symptom distress and depression during and after radiation therapy, which negatively impacts quality of life (QOL). We sought to identify trajectories of symptom distress, depression, social support, and QOL in patients with NPC receiving intensity-modulated radiation therapy (IMRT) vs intensity-modulated proton therapy (IMPT). Methods A multicenter prospective longitudinal study recruited NPC patients from two leading medical centers in Taiwan. The 121 NPC patients were followed from before RT (T0), at 4 weeks after beginning RT (T1), at 6 weeks of RT or the end of treatment (T2), and at 4 weeks post-RT (T3). Generalized estimating equation analysis was used to identify the factors related to QOL. Results Patients’ symptom distress and depression increased from T0, peaked at T2, and decreased at T3. Physical-QOL and psychosocial-QOL decreased from T0 to T2, then increased by T3. Patients who had early-stage cancer, received a lower RT dose, had less symptom distress, and had less depression were more likely to have better QOL. Greater physical-QOL was associated with IMPT receipt, higher education level, early cancer stage, lower radiation dose, less symptom distress, and less depression. Patients who had good physical performance, received a lower radiation dose, had less symptom distress, and had less depression were more likely to have better psychosocial-QOL. Conclusion Radiation dose, symptom distress, and depression were the most important factors affecting QOL in patients with NPC. Understanding the factors associated with the trajectory of QOL can guide care during radiation treatment.

PURPOSE:Head and neck cancer (HNC) patients often suffer from shame and stigma due to treatment limitations or due to societal factors. The purpose of this study was to assess perceived body image, depression, physical and psychosocial function, and self-stigma, as well as to identify factors that predicted shame and stigma in patients with HNC.METHODS:This cross-sectional study recruited 178 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale-Depression Subscale (HADS-Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson's product-moment correlation, and multiple regression.RESULTS:The two top-ranked subscales of shame and stigma were: "speech and social concerns" and "regret". Shame and stigma were positively correlated with a longer time since completion of treatment, more body image concerns, and higher levels of depression. They were negatively correlated with being male and having lower physical function. Multiple regression analysis showed that female gender, a longer time since completing treatment, higher levels of body image concern, greater depression, and less physical function predicted greater shame and stigma. These factors explained 74.7% of the variance in shame and stigma.CONCLUSION:Patients' body image concerns, depression, time since completing treatment, and physical function are associated with shame and stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.

Purpose: (1) To assess the levels of fear of cancer recurrence (FCR), social support, coping styles, and posttraumatic growth; (2) to identify factors associated with posttraumatic growth; and (3) to compare patient and primary caregiver characteristics by level of posttraumatic growth (no-to-little posttraumatic growth vs. moderate-to-high posttraumatic growth) in the primary caregivers of patients with an oncologic emergency.Data Sources: A cross-sectional study design was adopted. Data were collected by convenience sampling of cancer patient-caregiver dyads who experienced an oncologic emergency within the last 6 months at a medical center in northern Taiwan. The patients, who had completed cancer treatment, were in an intensive care unit. They were assessed for disease severity, physical performance, and demographic and clinical characteristics. Primary caregivers were assessed for FCR, social support, coping styles, and posttraumatic growth using a set of questionnaires. We found that 80.8% of primary caregivers reported moderate-to-high posttraumatic growth and 19.2% reported no-to-little posttraumatic growth.Conclusion: Greater posttraumatic growth in primary caregivers was associated with experiencing more patient oncologic emergencies, younger caregiver age, a higher caregiver FCR score, and caregivers' use of active coping behaviors. Caregivers were less likely to report posttraumatic growth if they experienced fewer patient oncologic emergencies, were older, reported lower FCR, and used active coping strategies less frequently. Implications for Nursing Practice: Developing scenario-based simulations to facilitate caregiving for an oncologic emergency and providing psychological counseling to encourage active coping can help primary caregivers recover emotionally from an oncologic emergency and facilitate growth.(c) 2023 Elsevier Inc. All rights reserved.

Objectives: The present study aimed to evaluate the effects of a nurse-led survivorship care program (SCP) on emotional distress, social support, physical health, mental health, and resilience in primary caregivers of patients with advanced head and neck cancer.Data Sources: A randomized controlled trial was conducted. One hundred patient-primary caregiver dyads were randomized into the nurse-led SCP group (experimental) or the usual care group (control). Participants completed a self-reported questionnaire, including measures of emotional distress, social support, physical health, mental health, and resilience. After 6 months, the experimental group reported a significant improve-ment in emotional distress, social support, physical health, mental health, and resilience. Compared with the control group, measures of emotional distress, physical health, overall resilience, and the resilience aspects of equanimity and perseverance improved in the experimental group.Conclusion: An SCP may feasibly help alleviate emotional distress, improve social support, increase physical and mental health, and strengthen resilience in the primary caregivers of patients with head and neck cancer. Health care providers should encourage primary caregivers to join an SCP.Implications for Nursing Practice: The nurse-led SCP can be applied before patients complete treatment, which may increase the positive effect on physical health and adaptation.& COPY; 2023 Elsevier Inc. All rights reserved.

BACKGROUND:Betel quid (BQ) chewing is associated with poor oral hygiene, psychological impairment, and acute and long-term addictive effects, resulting in worse oral-related quality of life (OHRQoL). The purpose of this study was to characterize the factors associated with OHRQoL among BQ users receiving oral mucosal screening.METHODS:A cross-sectional study was conducted. Data were collected by random sampling of BQ users who visited outpatient departments receiving oral mucosal screening in a medical center Taiwan. The oral health assessment tool, the state anxiety inventory, the betel quid dependence scale, and the oral health impact profile were used to measure oral health status, anxiety, BQ dependence, and OHRQoL, respectively. Pearson's product-moment coefficient was used to examine the relationship between OHRQoL and the selected independent variables. Independent-samples t-test was used to compare OHRQoL by annual family income, the presence of chronic disease, and BQ dependence. Hierarchical multiple linear regression analysis was used to identify factors associated with OHRQoL.RESULTS:A total of 175 BQ users were surveyed. Factors associated with OHRQoL included oral health status, anxiety, and BQ dependence. BQ users reporting low oral health status, greater anxiety, and more BQ dependence were more likely to have worse OHRQoL.CONCLUSIONS:Poor oral health status, anxiety, and BQ dependence negatively impact on OHRQoL among patients with BQ use receiving oral mucosal screening.

BackgroundsGynaecological cancer survivors may develop lower limb lymphoedema after surgery, which negatively impacts quality of life. The purposes of this study were (1) to assess the levels of symptom distress, depression, body image, and health-related quality of life (HRQoL); (2) to recognize factors associated with HRQoL related in gynaecologic cancer survivors with lower limb lymphoedema.MethodsA cross-sectional study was conducted with convenience sampling of gynaecologic cancer survivors with lower limb lymphoedema. Gynaecologic cancer survivors were assessed for symptom distress, depression, body image, and HRQoL. Multiple regression analysis was conducted to recognize the factors associated with HRQoL. Independent-samples t-test was used to compare symptom distress, depression, body image, and HRQoL by grade of lymphoedema.ResultsThe most common distressing symptoms of lower limb lymphoedema were lower extremity oedema, lower extremity tightness, and lower extremity stiffness. Worse HRQoL was associated with more symptom distress, less satisfaction with body image, a high grade of lymphoedema, and a longer duration of lower limb lymphoedema. These factors explained 76.5% of the variance in HRQoL. Gynaecologic cancer survivors with late grade lymphoedema experienced lower HRQoL and higher levels of symptom distress, depression, and greater dissatisfaction with body image than those who had early grade lymphoedema.ConclusionsSymptom distress had the strongest association with overall HRQoL and with all individual domains of HRQoL, except mental function. These results suggest that educating gynaecologic cancer survivors to assess lower limb lymphoedema-related problems, providing symptom management, and guiding survivors in physical activity to relieve lower extremity discomfort can improve HRQoL.

Objective:The aim of the study was to evaluate the effects of a return to work (RTW) program on perceived health status, barriers to returning to work, fear of cancer progression, social support, physical function, and psychosocial function in head and neck cancer (HNC) patients.Methods:A randomized controlled trial with repeated measures was conducted. The 70 HNC patients were randomly assigned into two groups: 35 in the experimental group (RTW) and 35 in the control group (usual care). Patients were assessed at four time points: baseline (T0) (6 months after completing treatment), and then at 9-, 12-, and 15-months (T1, T2, and T3, respectively) after completing treatment. Patients completed a self-reported questionnaire, including measures of perceived health status, barriers to returning to work, fear of cancer progression, social support, physical function, and psychosocial function.Results:Patients in the experimental group had significantly greater perceived health status and better psychosocial function compared to those in the control group. Compared to T0, at T4, participants in both groups had significantly lower levels of barriers to returning to work, fear of cancer progression, social support, and higher levels of physical function.Conclusions:The RTW program effectively improved perceived health status and psychosocial function in HNC patients. Survivorship care should include a transitional return-to-work program to help patients transition back to work.Trial registration:NCT04322695.

Abstract Aims: Head and neck cancer (HNC) patients often suffer from stigma after treatment. The purpose of this study was to assess perceived body image, depression, physical function, psychosocial function, and stigma, as well as to identify factors associated with stigma in patients with HNC. Methods: This cross-sectional study recruited 156 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale–Depression Subscale (HADS–Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson’s product-moment correlation, and multiple regression. Results: The two top ranked subscales of stigma were: “speech and social concerns” and “regret”. Stigma was positively correlated with younger age, longer time since the completion of treatment, being employed, body image dissatisfaction, depression, less physical function, and less psychosocial function. Multiple regression analysis showed that higher levels of body image concern, greater depression, a longer time since completing treatment, younger age, and less physical function were associated with greater stigma. These factors explained 69.2% of the variance in stigma. Conclusion: Patients’ body image concerns strongly influence overall stigma as well as each subscale of stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.

AIMS:Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self-management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self-management in patients with type II diabetes mellitus treated with insulin therapy.METHODS:We adopted a cross-sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self-management using the barriers to insulin treatment questionnaire and the partners in health scale.RESULTS:A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self-management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin-related outcomes, no diabetes-related complications, less fear of injection and self-testing, no hypoglycaemia within the previous year, and younger age.CONCLUSION:Insulin therapy injection by patient and no diabetes-related complications were the most common factors associated with overall self-management and with each domain of self-management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self-management.

Purpose Return to work (RTW) is important for survivors of head and neck cancer (HNC). The purposes of the study were to investigate the RTW ratio among HNC survivors and identify factors significantly affecting RTW in this population. Methods A cross-sectional study with consecutive sampling was conducted in a medical center in Taiwan, with 111 patients with HNC who had completed major treatments within 5 years and were employed before their cancer diagnosis enrolled as participants. Cervical range of motion (CROM) functionality, handgrip and hip flexor strength, maximal mouth opening (MMO), selected symptoms, depression, and disease/treatment-related factors were assessed. All of the factors were analyzed using t -test, chi-square test, and multiple logistic regression. Results Less than half (44.1%, n = 49) of the participants had returned to work. The t -test/chi-square test results showed the RTW group to be younger in age and better educated; have better handgrip/hip flexor strength, MMO, and CROM; have less speech difficulty and pain; and have less-advanced cancer than the non-RTW group. Further analysis of the above significant variables by logistic regression revealed early cancer stage, dominant handgrip strength, and less speech difficulty were the robust factors related to RTW. Conclusions The RTW ratio is low in HNC survivors. RTW in HNC survivors is a multifactorial and complicated issue and needs to be further examined. Implications for Cancer Survivors Assessing the factors related to RTW systematically and developing comprehensive interventions and rehabilitation programs to reduce related dysfunctions are necessary to enhance RTW ability in HNC survivors.

Head and neck cancer (HNC) patients who are unable to return to work after completing treatment might face financial loss and reduced self-esteem. The aim of this study was to identify factors influencing a return to work in HNC cancer patients in the first 6 months after treatment. This cross-sectional study examined HNC patients who completed treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Patients were assessed according to psychological distress, patient-perceived health status, barriers to returning to work, and facilitators of returning to work. Of the 106 HNC patients surveyed, 54.7% successfully returned to work. Barriers to returning to work included poor self-perception of health, greater psychological distress, and age ≥50 years. Patients who had higher psychological distress, returned to work after start of the pandemic, or received reconstruction surgery were less likely to experience a positive environment facilitating a return to work.

PURPOSE:After suddenly stopping smoking after an initial oral cancer (OC) diagnosis, patients may restart smoking and nicotine dependence. This study sought to identify factors associated with high nicotine dependence in OC patients who restarted smoking post-treatment.DESIGN:A cross-sectional study.METHODS:A group of 220 OC patients who restarted smoking post-treatment were recruited from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed for nicotine and smoking dependence, physical activity and function, socio-emotional function, social support, and depression.RESULTS:Among patients who restarted smoking after treatment for OC, 75.9% reported low-to-moderate dependence on smoking, while 24.1% reported high nicotine dependence. Factors associated with high nicotine dependence included higher incidence of smoking per day, greater dependence on smoking, less physical activity per week, and poorer social-emotional function. Those highly dependent on nicotine were younger, unmarried, had less education, and had begun smoking earlier than those with low-to-moderate nicotine dependence.CONCLUSIONS:The amount of smoking per day, greater smoking behavioral dependence, less physical activity per week, and worse social-emotional function affected high nicotine dependence.CLINICAL RELEVANCE:Smoking cessation training and counseling for OC patients may help them better control their use of tobacco after treatment.

PURPOSE:To identify factors associated with posttraumatic growth (PTG) of head-and-neck cancer squamous cancer (HNC) patients with oncologic emergencies (OE) within the first six months post-treatment.METHODS:We conducted a cross-sectional study of HNC patients in Taiwan from May 2019 to April 2021 using patient-reported outcomes. Patients were assessed for symptom distress, anxiety, fear of recurrence (FCR), and PTG. Multiple regression analysis was conducted to identify factors associated with PTG. The independent-samples t-test was used to compare PTG and its five specific domains in patients with low FCR, high FCR, low anxiety, and high anxiety.RESULTS:Of the 114 patients surveyed, 46.5% reported little-to-no PTG, and 53.5% had moderate-to-high PTG. Greater PTG was associated with greater FCR, longer time since OE, less anxiety, having a cancer recurrence, and greater educational attainment. These factors explained 38.6% of the variance in PTG.CONCLUSION:A notable proportion of HNC patients with OE-reported PTG but almost half-reported little-to-no PTG. PTG occurred most in the domain of appreciation of life. The study results also suggest that training patients in coping skills and inviting them to group growth experiences can help them increase PTG and cope with cancer-related psychological threats related to OE.

Purpose Spousal caregiving of head and neck cancer (HNC) patients challenges relationship quality and may negatively impact family function. Our purpose was to identify factors associated with family dysfunction in spousal caregivers (SCs) of HNC patients within the first 6 months after treatment. We explored whether patient or SC characteristics differ by level of family dysfunction. Methods We conducted a cross-sectional study of HNC patient-SC dyads in Taiwan from July 2020 to January 2022 using patient-reported outcomes. Patients were assessed using a set of structured questionnaires to measure performance status, demographic and clinical characteristics, physical function, and social-emotional function. SCs were measured on their hardiness, coping styles, spousal relationship, quality of life, and family function. Results Of the 132 dyads surveyed, 62.1% of SCs reported a functional family, 34.8% reported a moderately dysfunctional family, and 3.0% reported a highly dysfunctional family. Patient factors associated with family dysfunction (highly dysfunctional or moderately dysfunctional) included lower family annual income and worse social-emotional function. Associated SC factors were lower hardiness, less use of active coping, and worse spousal relationships. Conclusions Lower family annual income, less patient social-emotional function, less SC hardiness, less SC active coping, and worse SC perceived spousal relationship were associated with perceived family dysfunction. Providing patient-SC dyads with sufficient social resources and problem-solving training may help them positively cope with cancer and enhance family function.