Elisabeth Patiraki

Complementary and alternative medicine use in breast cancer patients in Europe

Complementary and alternative medicine (CAM) has gained popularity among cancer patients in the past years. For this study, CAM includes any group of health care systems, practices or products that are not considered to be part of conventional medicine at present (National Center for Complementary and Alternative Medicine). The present study assessed patterns of CAM use in breast cancer patients in Europe. The study used a descriptive cross-sectional design, and data were collected through a 27-item questionnaire. The sample, which was part of a larger study, consisted of 282 breast cancer patients from 11 countries in Europe. Among participants, 44.7% used CAM since their diagnosis of cancer. The most common therapies used included herbal medicine (46.4%) and medicinal teas, relaxation techniques, spiritual therapies, homeopathy and vitamins/minerals. Younger patients with higher education and who had received combination treatments for their cancer in the past were more likely to use CAM. High levels of satisfaction were reported, with only 6.5% of the women reporting no benefits from the CAM used. Main sources of information about CAM were mostly friends/family and the media. Findings suggested that a high proportion of breast cancer patients used CAM, which may have implications for the clinical management of these patients.

Nurses’ knowledge, attitudes, and practices regarding provision of sexual health care in patients with cancer: critical review of the evidence

BackgroundThe 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 workThe 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 methodsA critical review of the literature was conducted over a period of three decades and 18 original research articles were retrieved and analyzed.ResultsA 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.ConclusionsThe 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.

Surgical Patient Satisfaction as an Outcome of Nurses’ Caring Behaviors: A Descriptive and Correlational Study in Six European Countries

Purpose: Theoretically, patient satisfaction is correlated with nursing care, but there is not sufficient evidence to support it. The aim of this study was to address three research questions: (a) What is the correlation between caring as perceived by patients and patient satisfaction? (b) Are there differences across various countries on the correlation on caring as perceived by patients and patient satisfaction? (c) Do caring behaviors affect patient satisfaction? Design: A multicenter correlational design was adopted involving surgical patients from six European countries: Cyprus, Czech Republic, Greece, Finland, Hungary, and Italy. Methods: A convenience sample of 1,565 patients was recruited in autumn 2009. The short version of the Caring Behaviours Inventory (CBI; 24 items) and Patient Satisfaction Scale (PSS; 11 items) were used. Data analysis included descriptive statistics, as well as correlation analysis and stepwise multiple regression, to examine relations between caring behaviors and patient satisfaction. Findings: According to the patients involved, nurses performed caring behaviors between very frequently (score = 5) and always (score = 6). Patient satisfaction with nursing care was also high, between satisfied (score = 3) and very satisfied (score = 4). A positive correlation emerged between CBI and PPS (r= 0.66, p < .01) ranging between countries from 0.27 to 0.85 (Czech Republic r= 0.27, Cyprus r= 0.76, Finland r= 0.71, Greece r= 0.85, Hungary r= 0.63, and Italy r= 0.45 [p < .01]). Among the CBI dimensions, “connectedness” mainly explains patient satisfaction (R2= 0.404, p < .001), followed by “assurance” (R2= 0.032, p < .001) and “respectful” (R2= 0.005, p < .001). Conclusions: Caring behaviors enacted by nurses determine a consistent proportion of patient satisfaction. This association between them suggests several implications for nursing education, practice, and management. Clinical Relevance: The results may be utilized by policymakers, nurse ward managers, nurse educators, and clinical nurses as a background for taking appropriate measures to improve nursing care provided, thereby enhancing patient satisfaction.

Moral Professional Personhood: ethical reflections during initial clinical encounters in nursing education

Moral agency is an important constituent of the nursing role. We explored issues of ethical development in Greek nursing students during clinical practice at the beginning of their studies. Specifically, we aimed to explore students’ lived experience of ethics, and their perceptions and understanding of encountered ethical conflicts through phenomenological analysis of written narratives. The process of developing an awareness of personal values through empathizing with patients was identified as the core theme of the students’ experience. Six more common themes were identified. Development of the students’ moral awareness was conceptualized as a set of stages, commencing with empathizing with patients and nurses, moving on to taking a moral stand and, finally, concluding by becoming aware of their personal values and showing evidence of an emerging professional moral personhood. The notions of empathy, caring and emotion were in evidence throughout the students’ experience. Implications for practice and nurse education are discussed.

Patients’ and nurses’ perceptions of respect and human presence through caring behaviours: A comparative study:

Although respect and human presence are frequently reported in nursing literature, these are poorly defined within a nursing context. The aim of this study was to examine the differences, if any, in the perceived frequency of respect and human presence in the clinical care, between nurses and patients. A convenience sample of 1537 patients and 1148 nurses from six European countries (Cyprus, Czech Republic, Finland, Greece, Hungary and Italy) participated in this study during autumn 2009. The six-point Likert-type Caring Behaviours Inventory-24 questionnaire was used for gathering appropriate data. The findings showed statistically significant differences of nurses’ and patients’ perception of frequency on respect and human presence. These findings provide a better understanding of caring behaviours that convey respect and assurance of human presence to persons behind the patients and may contribute to close gaps in knowledge regarding patients’ expectations.

Role of the nurse in patient education and follow-up of people receiving oral chemotherapy treatment: an International survey

PurposeThe aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT.Materials and methodsMultinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries.ResultsFindings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines/protocols, 47% reported not having received any education about oral CT drugs. While 64% report being involved in patient education, 58% of subjects indicated lack of patient education materials that are specific for oral CT agents. Only 27% stated that they gave all necessary information such as when and how to take the drugs, drug safety and storage, side effects, and symptom management. Reasons for not being involved in oral CT education and follow-up included beliefs that the physician plans the oral CT and gives patients necessary instructions (34%), that nurses only see patients who receive intravenous chemotherapy (16%), that nurses have lack of knowledge about oral agents (15%), and belief that physicians are responsible for patient follow-up. The nurses suggested better education and follow-up of patients to include the written patient education materials (33%) and professional education for nurses (30%).ConclusionsFindings revealed the need for professional education for nurses to ensure comprehensive, consistent patient education and development of written materials for patients receiving oral CT treatment.

Testing an instrument measuring Greek nurses' knowledge and attitudes regarding pain.

This pretest–post-test study was conducted to test the construct validity, test–retest reliability, and internal consistency of the Nurses’ Knowledge and Attitudes Survey Regarding Pain with Greek nurses. Forty-six registered nurses were randomly assigned to an expert or nonexpert group. The expert group viewed 4 translated educational videotapes about pain management. The nonexpert group received no pain education. All of the nurses completed a pretest and a post-test using a Greek translation of the Nurses’ Knowledge and Attitudes Survey Regarding Pain, with a time delay of 8 to 12 days between testing. The expert nurses learned significantly more than the nonexpert nurses from pretest to post-test, M = 9.0 and M = 1.5 items, respectively. Expert and nonexpert nurses correctly answered 51.5% and 43.3% of the pretest and 74.6% and 47.2% of the post-test questions, respectively. Test–retest reliability for the 28 nonexpert nurses was r = 0.68, P < .001. Cronbach’s alpha for the entire sample was 0.88 (n = 30) at the post-test. These results contribute to the validity and reliability of the Greek version of the Nurses’ Knowledge and Attitudes Survey Regarding Pain and provide the basis for phase II of the study, which will use the Nurses’ Knowledge and Attitudes Survey Regarding Pain to examine the state of pain management in an anticancer facility in Greece.

Prospective assessment of fatigue and health status in Greek patients with breast cancer undergoing adjuvant radiotherapy.

PURPOSE/OBJECTIVES To describe fatigue in women with breast cancer undergoing radiotherapy and to explore the impact of fatigue on their health status. DESIGN Prospective, descriptive, repeated measures. SETTING A major oncology center, Saint Savvas Cancer Hospital, in Athens, Greece. SAMPLE Consecutive sample of 106 women (mean age = 55 + 12), with histologically confirmed diagnosis for stage I or II breast cancer who were receiving adjuvant radiotherapy for approximately six weeks. METHODS Data were collected with the Revised Piper Fatigue Scale (PFS) and the Short Form-36 (SF-36) Health Survey Scale in the first two days of radiotherapy (T0), during the third week (T1), and during the last week of treatment (T2). MAIN RESEARCH VARIABLES Fatigue, health status. FINDINGS Across-subjects analysis revealed that fatigue increased during radiotherapy in patients with breast cancer regardless of stage, type of surgery, or whether they received chemotherapy (p 0.05). Between-subject analysis revealed that no differences existed in the PFS between different groups (chemotherapy versus no chemotherapy, breast conservation versus mastectomy, stage I versus stage II) at each measurement point. A negative correlation was found between the subscales of the PFS and all of the subscales of the SF-36. CONCLUSIONS Fatigue intensity increased significantly during the course of radiotherapy, and patients experienced a significant deterioration in their overall health status. IMPLICATIONS FOR NURSING Findings contribute to the growing body of evidence regarding fatigue and its impact on health status in Greek patients with breast cancer and provide insights for effective nursing assessment, patient education, and symptom management.

Changes in children's fatigue during the course of treatment for paediatric cancer.

BACKGROUND Fatigue is described as one of the most distressing symptoms of cancer therapy; yet it has received limited clinical attention. Children are suffering from a symptom that is under-diagnosed during their treatment. AIM The aim of this study is: (a) to assess the change in fatigue scores during cancer treatment according to childrens perspectives, and (b) to describe the possible causes of fatigue from childrens points of view. SAMPLE AND METHODS The present study is part of an ongoing prospective study. The research group consisted of 40 (n = 40) children aged 7-12 years with cancer who are being followed up in the oncology clinic of a Greek childrens hospital. After parental consent was obtained, data were collected using the Child Fatigue Scale and a sociodemographic data form. RESULTS The children with cancer reported a statistically significant increase in fatigue scores during their treatment (F = 6.846, P = 0.003). Gender was the only demographic factor associated with a significant increase in the fatigue scores (F = 4.857, P = 0.034). CONCLUSIONS Cancer treatment was found significantly to increase childrens fatigue levels. Medical procedures and the hospital environment seemed to be major causative factors of the fatigue experienced by children with cancer during their treatment.

Where Do Cancer Patients Die in Greece? A Population-Based Study on the Place of Death in 1993 and 2003

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.