Huda Abu-Saad Huijer

Coping With Breast Cancer: A Phenomenological Study

Background: Breast cancer is the most common malignancy affecting women worldwide. In Lebanon, a country of 4 million people, breast cancer is also the most prevalent type of cancer among Lebanese women. Objective: The purpose of this study was to gain a more in-depth understanding of the coping strategies espoused by Lebanese women with breast cancer. Methods: The study followed purposeful sampling and saturation principles in which 10 female participants diagnosed as having breast cancer were interviewed. Data were analyzed following a hermeneutical process as described by Diekelmann and Ironside (Encyclopedia of Nursing Research. 1998:50-68). Results: Seven main themes and 1 constitutive pattern emerged from the study describing the Lebanese womens coping strategies with breast cancer. The negative stigma of cancer in the Lebanese culture, the role of women in the Lebanese families, and the embedded role of religion in Lebanese society are bases of the differences in the coping strategies of Lebanese women with breast cancer as compared to women with breast cancer from other cultures. Conclusion: These findings cannot be directly generalized, but they could act as a basis for further research on which to base a development of a framework for an approach to care that promotes coping processes in Lebanese women living with breast cancer. Implications for Practice: Nursing and medical staff need to have a better understanding of the individual coping strategies of each woman and its impact on the womans well being; the creation of informal support group is indispensable in helping these women cope with their conditions.

Quality of life in people living with HIV/AIDS in Lebanon.

Abstract The aim of the study was to determine the impact of HIV/AIDS on the quality of life (QoL) in Lebanese adult patients living with HIV/AIDS. The study design was a cross-sectional descriptive survey, using self-administered questionnaires. A convenience sample of 41 Lebanese adults (aged 18 years and above) living with HIV/AIDS was recruited from outpatient departments at two major medical centers in Lebanon. The instruments included the Multidimensional Quality of Life HIV (MQoL-HIV), the HIV Symptom Index and a stigma scale, and a demographic section. The majority of the sample were male and single. The mean age was 38 years (SD=9.93). The mean MQoL-HIV score was 176.85, with the highest scores for the cognitive functioning, social functioning, and medical care; the lowest domain scores were for financial status, sexual functioning, and mental health. A single item measuring overall QoL was rated by 47.5% as neither poor nor good. Mean stigma score was 2.05 (SD=0.62) and mean HIV Symptom Index score was 0.6. Prevalence of symptoms and perceived stigma were negative predictors of QoL, being married was a positive predictor of QoL. The results of this study, which is the first to look at the QoL in people living with HIV/AIDS in Lebanon and the Middle East and North Africa region, showed that these mostly asymptomatic well-functioning individuals reported a fair level of QoL. The strongest determinants of QoL revolved around psychosocial aspects of life, namely social relationships, mental health, and medical care.

Bereaved Parental Evaluation of the Quality of a Palliative Care Program in Lebanon

Palliative care (PC) is important in Pediatric Oncology as more than 20% of children with cancer still die despite modern treatment. As a significant number of children reside in countries with limited resources; more research in PC is needed there. This study aimed at evaluating the quality of care provided to children with cancer at the Childrens Cancer Center of Lebanon (CCCL) during their last month of life as perceived by the bereaved parents.

Quality of life and symptom prevalence as reported by children with cancer in Lebanon

PURPOSE To date, there are no studies on quality of life (QoL) and symptom prevalence reported by pediatric oncology patients in Lebanon. The purpose of this study was to evaluate the QoL, symptom prevalence and symptom management among a sample of pediatric oncology patients. METHODS The study design was cross-sectional. The Pediatric Quality of Life Inventory (PedsQL) cancer module and the Memorial Symptom Assessment Scale were administered in Arabic using face-to-face interviews to a convenience sample of 85 pediatric cancer patients (7-18 years) at a tertiary hospital in Lebanon. RESULTS The mean age of the study group was 12.5 years with leukemia being the most common cancer (43.5%). The lowest scores on the PedsQL subscales were in nausea (score = 64.82; SD = 25.76) and worry (score = 68.14; SD = 30.07), thus indicating more problems in these areas. A comparison based on age showed significant differences in pain and hurt, nausea, and worry. In children (7-12 years), lack of appetite, pain, and nausea were mostly prevalent whereas adolescents (13-18 years) experienced lack of energy, irritability, and pain. In both age groups, pain and nausea were the most frequently treated symptoms. CONCLUSION Overall, the participants had good health-related QoL as indicated by most of the PedsQL subscales. Symptom management was found to be inadequate and in some cases ineffective. More attention should be given to the management of symptoms in general using pharmacological and non-pharmacological techniques. Of particular importance is the importance of providing psychological support to alleviate symptom burden and improve QoL.

Health-related quality of life among breast cancer patients in Lebanon.

BACKGROUND High incidence rates of breast cancer (BC) emphasize the need to address health-related quality of life (QoL) in this population. The aim of this study was to evaluate the QoL, symptom prevalence and management, functional ability, and quality of care in Lebanese women with BC at a tertiary health care facility. METHODS Cross-sectional descriptive survey targeting Lebanese adults with cancer and using a combination of four instruments: European Organization for Research and treatment of Cancer-Quality of Life Questionnaire, Memorial Symptom Assessment Scale; Barthel Index; Needs at End of life Screening Tool, and a demographic/clinical characteristics section. 89 breast cancer patients participated in the study; data was collected from 2009 to 2010. Descriptive analysis in addition to independent sample t-test, ANOVA, and Pearson r correlation were used for data analysis. RESULTS The most prevalent symptoms were feeling nervous, feeling sad, lack of energy, and pain; symptom management was inadequate; high scores were reported on functional ability, medical care, spirituality, and relationships. Younger, single, and better educated participants who were diagnosed for less than 30 months, had no metastasis, and paid less than

Symptom Prevalence and Management of Cancer Patients in Lebanon

450 dollars per month on medical expenses showed better global health status/QoL. Payments per month for medical expenses, presence of metastasis, time since diagnosis, and type of treatment received were significantly associated with QoL, the different functioning dimensions, and symptoms. CONCLUSION Strategies addressing symptom management in particular psychological symptoms need to be developed and implemented in addition to a holistic multidisciplinary palliative care approach.

Surviving testicular cancer: the Lebanese lived experience.

CONTEXT Cancer patients experience a great number of distressing physical and psychological symptoms. In Lebanon, there are no available data on symptom prevalence and symptom management in adults with cancer. OBJECTIVES The aim of this study was to determine the prevalence of symptoms and the effectiveness of treatment received as reported by patients. METHODS The study used a cross-sectional, descriptive survey design. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Memorial Symptom Assessment Scale were translated to Arabic and used; data were collected from adult Lebanese cancer patients at the American University of Beirut Medical Center. RESULTS A total of 200 cancer patients participated in the study; the majority were female with breast cancer and mean age was 54 years. The cognitive functioning domain of the EORTC QLQ-C30 scale was found to have the highest score and social functioning the lowest. The most prevalent symptom was lack of energy. Nausea and pain were the symptoms most treated. Males reported better quality of life (QoL), physical functioning, and role functioning than females; females reported more fatigue, pain, and appetite loss than males. Higher physical and psychological symptoms were correlated with lower health status, QoL, and functioning. CONCLUSION Although this sample reported a fair QoL and social functioning, many symptoms were highly prevalent and inadequately treated. Symptoms were found to negatively affect QoL and functioning. Based on these results, providing adequate symptom management and social support to Lebanese cancer patients is highly recommended.

Subject independent agitation detection

Background:Testicular cancer is thought to have a great impact on its survivors, yet there has been limited literature on the topic globally and no literature on the topic in Lebanon and the Arab region. Objective:The purpose of this study was to explore the lived experience of Lebanese testicular cancer survivors and gain an in-depth understanding of the psychosexual aspect of their experience. Methods:A hermeneutic phenomenological approach with semistructured digitally recorded interviews and observational field notes was utilized. A purposive sample of Lebanese testicular cancer survivors, aged between 18 and 50 years, in remission for at least 3 years, and willing to share personal information was recruited. Interviews were transcribed verbatim in Arabic. Data saturation was achieved at the seventh interview; a total of eight informants were recruited. The opening question was, “Tell me about your life since you got treated for testicular cancer,” and was followed by probing questions. Two to three weeks after the initial interview, informants were called to validate the investigators’ primary analysis. Results:Six core themes emerged: cancer perception in the Lebanese culture; “do not show, do not tell”; cancer experience is a turning point; fertility, manhood, and relationships; coping with cancer; and preserved aspects of life. Discussion:The findings provide an in-depth understanding of the experience of Lebanese testicular cancer survivors with a focus on the psychosexual aspect of this experience. The results suggest the need to educate patients about testicular cancer and its effect on their fertility.

Pediatric Palliative Care in the Middle East

The need to automate the detection of agitation for dementia patients is a major requirement for caregivers. This research aims at sensing and recognizing negative emotions specifically ldquostressrdquo for patients with dementia. An autonomous multi-sensory device has been developed to achieve automatic assessment of agitation and to control stimulation that will reduce the agitation level automatically. The focus of this paper is the agitation detection algorithm. Three vital signs are monitored for agitation detection: the Heart Rate (HR) the Galvanic Skin Response (GSR) and Skin Temperature (ST). These measures are fed into an SVM based learning machine. Results show accurate detection of agitation, quick adaptation to the subject and a strong correlation between the physiological signals monitored and the emotional states of the subjects. The result is a learning algorithm that is ldquoSubject-Independentrdquo.

Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses

In most Middle Eastern countries pediatric palliative care as a special medical discipline is not as yet in existence. In some countries this specialty is in its infancy, and only in a few countries has it become a recognized specialty and is practiced in the major medical centers. The Middle East, as a region, is seeking support to promote professionals: physicians, nurses, social workers, psychologists, spiritual counselors and art therapists to be well trained and educated in order to initiate such services in pediatric oncology departments in hospitals as well as in the community. It is only recently that Ministries of Health, directors of hospitals and cancer centers, have adopted palliative care, in general, and pediatric palliative care, in particular, as an essential service that deserves the financial and moral support of health providers at all administrative levels. The Middle East Cancer Consortium organizes every year training courses at basic and advanced levels for oncologists (medical, surgical and radiotherapists) pediatric oncologists, anesthesiologists, oncology nurses, pediatric psychologists and social workers, with the goal of enhancing the development of palliative care services in primary, secondary and tertiary levels.