Helen Y.L. Chan

Quality of life and most prevalent unmet needs of Chinese breast cancer survivors at one year after cancer treatment

PURPOSE This study aims to examine the supportive care needs of Chinese breast cancer survivors, and investigate the relationships with participant characteristics and quality of life. METHODS A total of 163 participants were recruited from a local public hospital and completed a self-administered questionnaire: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy. RESULTS The five most commonly reported unmet needs were all in the health system information domain (range: 55-63%), and the majority (84%) reported at least one unmet need in relation to information on healthcare. Stepwise multivariable regression analyses revealed that the time spent on travelling from home to hospital, receiving hormonal therapy, and physical and psychological unmet needs were independently associated with poorer quality of life among the participants. CONCLUSIONS Breast cancer survivors perceive various unmet needs, and health system information is the most common one. Those who have more unmet needs in the physical and psychological domains were more likely to perceive a poorer quality of life.

Colorectal cancer screening behaviour and associated factors among Chinese aged 50 and above in Hong Kong – A population-based survey

PURPOSE This study reports the uptake rate of colorectal cancer screening among Chinese people aged 50 or above and the identified factors associated with the likelihood of undergoing such screening. METHODS A cross-sectional population-based telephone survey was conducted in Hong Kong during the period 2 to 28 May 2007. The survey covered demographics, perceived health status and susceptibility to cancer, utilisation of complementary medicine, family history of cancer and cancer screening behaviour. RESULTS The survey was completed by 2004 Hong Kong Chinese residents aged 50 or older (response rate = 66.6%). The uptake rate of a fecal occult blood test and a colonoscopy was 12% and 19% respectively. Factors associated with colorectal cancer screening behaviour included: male participants, ex-smokers, with cancer or other serious disease, a family history of cancer, perceived health status fair or poor, regular visits to a doctor to look after health, and utilisation of complementary medicine. CONCLUSIONS The uptake rate of this study population was low though an increasing trend did appear. Heath education and promotion programmes may focus on these identified factors to facilitate colorectal cancer screening in a Chinese population.

The perceptions and experiences of nurses and bereaved families towards bereavement care in an oncology unit

BackgroundExisting bereavement literature focuses on the care provided in palliative care units or community settings. However, nurses in oncology units are in a unique position to provide bereavement care, which is care extended to the families after the death of cancer patients. This study aimed to explore the perceptions and experiences of bereavement care among nurses and bereaved family members in an oncology unit in Hong Kong.MethodSemi-structured qualitative interviews were carried out in one oncology unit in Hong Kong with 15 nurses and ten bereaved family members. All interviews were audiotaped, transcribed verbatim and analysed by using qualitative content analysis.ResultsAmong the bereaved family members, three themes emerged: being informed, being supported and being with the patient before and after the patient’s death. Among the oncology nurses, however, the three identified themes were: elements of good bereavement care, emotional response in providing bereavement care and educational needs in the provision of bereavement care. Comparatively, the experiences of and the opinions on bereavement care identified by the bereaved were more specific than those identified by the nurses.ConclusionThe findings revealed that there is room for improvement in current bereavement care. Family members were committed to patient care and they expressed their need for more involvement in the patient care, which could result in a positive impact on their grief and loss experience. Nurses were committed to quality care, and they expressed their need for more training on knowledge, skills and attitudes to improve their readiness and competencies in the provision of bereavement care.

Readiness of Chinese frail old age home residents towards end-of-life care decision making

AIMS To identify different approaches to end-of-life care decision-making among Chinese frail old age home residents. BACKGROUND Advance care planning has been recently introduced to older people, family members and health care providers in the local community with the intention of better preparing them for end-of-life care. However, promoting the concept is challenging as the customary beliefs and previous research findings provide little reassurance that Chinese frail older people are ready for this potentially sensitive discussion. DESIGN Qualitative study. METHOD Semi-structured interviews were used to evaluate the process of advance care planning and the readiness of the participants for such planning. RESULTS The findings revealed five approaches towards end-of-life care decision-making among the frail old age home residents: holding on to life, planning ahead, weighing benefits, avoiding and deferring. CONCLUSIONS The various approaches to end-of-life care decision-making, which affect the older persons level of engagement in advance care planning, are largely related to individual personal values, beliefs and experiences. The level of readiness of frail residents for advance care planning can be explained as a continuum and has to be interpreted in the personal context. RELEVANCE TO CLINICAL PRACTICE The purpose of identifying various approaches is not to be able to screen for individuals who are more likely to undertake advance care planning. Rather, it is to provide insights into the different responses among frail older people with regard to advance care planning and hence the possible ways of devising a specific emphasis and strategies for engaging individuals in the planning process.

Tai chi qigong as a means to improve night-time sleep quality among older adults with cognitive impairment: a pilot randomized controlled trial.

Purpose Age-related cognitivee decline is a growing public health concern worldwide. More than a quarter of adults with cognitive impairment experience sleep disturbance. The objective of this pilot study was to evaluate the preliminary effects of tai chi qigong (TCQ) on improving the night-time sleep quality of older adults with cognitive impairment. Participants Older adults with cognitive impairment who complain of sleep disturbance. Methods A randomized controlled trial with two groups. Fifty-two subjects were recruited from two district elderly community centers and randomly assigned to either the TCQ group (n=27) or the control group (n=25). The intervention group received TCQ training consisting of two 60-minute sessions each week for 2 months. The control group was advised to maintain their usual activities. Sleep quality was measured by the Chinese Pittsburgh Sleep Quality Index. Quality of life was measured by Short-form 12, cognitive functions measured by mini-mental state examination, and subjective memory deficits measured by the memory inventory for Chinese. Results Data were collected at baseline, 2 months, and 6 months. Significant results were noted at 6 months in the Chinese Pittsburgh Sleep Quality Index global score (P=0.004), sleep duration (P=0.003), habitual sleep efficiency (P=0.002), and the Short-form 12 mental health component (P<0.001). The TCQ participants reported better sleep quality and a better (quality of life) mental health component than the control group. Conclusion TCQ can be considered a useful nonpharmacological approach for improving sleep quality in older adults with cognitive impairment. Clinical trial registration CUHK_CCT00448 (https://www2.ccrb.cuhk.edu.hk/registry/public/287).

Uptake of prostate cancer screening and associated factors among Chinese men aged 50 or more: a population-based survey

Objective To investigate the uptake rate of prostate specific antigen (PSA) testing among Hong Kong Chinese males aged 50 or above, and identify factors associated with the likelihood of undergoing a PSA test. Methods A population-based telephone survey was conducted in Hong Kong in 2007. The survey covered demographic information, perceived health status, use of complementary therapy, cancer screening behavior, perceived susceptibility to cancer and family history of cancer. Descriptive statistics, percentages and logistic regression analysis were used for data analysis. Results A total of 1,002 men aged 50 or above took part in the study (response rate =67%), and the uptake rate of PSA testing was found to be 10%. Employment status, use of complementary therapy, perceiving regular visits to a doctor as good for health and the recommendations of health professionals were significant factors associated with PSA testing. Conclusion The uptake rate of PSA testing in the study population was very low. Among all the factors identified, recommendations from health professionals had the strongest association with the uptake of PSA testing, and they should therefore take an active role in educating this population about cancer prevention and detection.

Feasibility of psychoeducational interventions in managing chemotherapy-associated nausea and vomiting (CANV) in pediatric oncology patients.

PURPOSE Childhood cancer patients often suffer from Chemotheraphy-Associated Nausea and Vomiting (CANV). To alleviate CANV, relaxation techniques and patient education were combined to develop a multidimensional psychoeducational intervention package. The aim of this pilot study was to assess the feasibility of the two major components, namely, (1) relaxation, and (2) patient education, of a psychoeducational intervention, prior to the commencement of the main study. METHODS A pre-test-post-test control group design was adopted. Twenty patients were allocated equally to the relaxation group (10 participants) and to the educational group (10 participants). Twenty historical matched control cases were identified to form the control groups. Besides, a process evaluation was adopted to assess the feasibility of the study. RESULTS In relation to episodes of vomiting on day 3, a significant difference was detected from the results (X(2) = 8.54, p = 0.036), in that fewer patients in the relaxation group experienced vomiting. A significant difference was not found in both the use of antiemetics and body weight between the groups. All subjects in the intervention groups adhered to the intervention and completed the questionnaire without difficulty. Patients and parents perceived the intervention as being moderately useful. CONCLUSIONS Although the beneficial effect of relaxation and education in alleviating CANV was not well-supported statistically, the findings from descriptive data suggest that these interventions promoted the intake of antiemetics as a preventive method. Both interventions and instruments were well-received by the patients and also by their parents.

Gender differences in the use of colorectal cancer tests among older Chinese adults

PURPOSE The study aimed to explore the gender difference in using colorectal cancer (CRC) tests among Chinese aged 50 years or over. METHODS A cross-sectional study was conducted in 2004 Chinese older adults through anonymous telephone survey which covered socio-demographic variables, health status, use of complementary therapy, health-related perceptions and use of CRC tests. RESULTS The uptake rate of flexible sigmoidoscopy (FS)/colonoscopy was 14% for males and 10% for females, with males significantly more likely to have had the test after adjusting for their differences in socio-demographics, health status, use of complementary therapies, health-related perceptions and recommendation received from health professionals (adjusted OR = 1.5, 95% CI: 1.1-2.0, p = 0.005). The uptake of fecal occult blood test was nearly the same (19%) for both genders. Further interaction analyses indicates that the effect of a family history of cancer on the uptake of a FS/colonoscopy is significantly weaker in males than in females (the interaction odds ratio = 0.4, 95% CI: 0.2-0.8, p = 0.011), whereas a male perceived that visiting a doctor is good for health will be more likely to have an uptake of a FS/colonoscopy than a female with such perception (the interaction odds ratio = 2.1, 95% CI: 1.1-3.8, p = 0.018). CONCLUSIONS The uptake of CRC tests was low in this average-risk population. More effort is needed to educate the public about the importance and benefits of CRC tests. In view of the gender differences in some determinants of FS/colonoscopy uptake, particular attention should be given to develop gender-specific strategies to improve the rate.

INTRAFALLOPIAN EGG REPLACEMENT WITHOUT IVF BACK-UP

The origin of the relation between the GH deficiency and congenital hypothyroidism was thought to lie in the perinatal period. We therefore measured GH concentrations in cord plasma of three newborn babies with congenital thyroid hypoplasia. These infants, detected in the national screen in 1985, were treated from the age of 2 weeks and are currently thriving. 32 healthy babies matched for birthweight and season were the controls. All cord plasma samples were donated by Dr J. Raus (Dr Willems Institute, University Campus, Diepenbeek, Belgium). The mean cord plasma GH concentration in the controls was 20-3 (SE 0-7) ng/ml (range 15-5-35). The levels in the hypothyroid babies were 4-0,4 5, and 63 ng/ml. These decreased GH concentrations suggest fetal GH deficiency in congenital hypothyroidism. To clarify the aetiology we measured GH levels in cord plasma from 2 newborn babies with familial thyroid dyshormonogenesis. In these cases, the TSH levels (400 and 452 mU/1) were similar to those in the babies with thyroid hypoplasia (310, 401, and 593 mU/1). However, their thyroxine levels were higher (6-2 and 7-9 vs 2-3,2-7, and 3-4 ug/dl). The cord plasma GH levels in these 2 cases were normal (16-2 and 18-5 ng/ml), suggesting that the fetal GH deficiency in congenital hypothyroidism is associated with the hypothyroxinaemia and is not due to the hyperthyrotropinaemia. Our cord plasma results indicate that infants under treatment for congenital hypothyroidism have to recover from fetal GH deficiency. The observation of GH deficiency in two children with congenital hypothyroidism treated since early infancy suggests that such patients have a limited GH reserve, a concept which may gain in importance now that the first children with congenital hypothyroidism detected by national screening progress through puberty. In view of the available evidence, we believe it is necessary

Promoting Holistic Well-being in Chronic Stroke Patients Through Leisure Art-based Creative Engagement

Purpose: To examine the potential value of a creative art-based activity as a caring modality for promoting holistic well-being among chronic stroke patients, and to explore the feelings and meanings that stroke patients derived from their experience in leisure art-based creative engagement (LACE). Design: Qualitative design. Method: Participants were recruited through purposive and snowball sampling. Individual semi-structured interviews were conducted. Qualitative content analysis was performed. The design and implementation of LACE was guided by Watson’s theory of caring. Findings: Twenty-four participants completed the study. Four themes emerged from participants’ account of experiences with the LACE: (1) appreciation of opportunities, (2) appreciation of self, (3) appreciation of others, and (4) appreciation of life. Conclusion: From the perspective of the participants, engaging in LACE enhances their sense of enjoyment and self-expression. Furthermore, they perceived LACE as an affirmation of life and an empowering process strengthening their connection and appreciation with the self and others. Clinical Relevance: This study adds evidence to existing literature on Watson’s theory-guided design and implementation of caring initiatives for community rehabilitation and has laid the groundwork for developing further evidencebased research in leisure art-based caring occasions for promoting holistic well-being in stroke rehabilitation.