Shiow-Ching Shun

Symptoms, psychological distress, and supportive care needs in lung cancer patients

PurposeThe purpose of this study was to examine the level of symptoms, psychological distress, and supportive care needs and factors related to five unmet need domains in lung cancer patients.MethodsA cross-sectional study of 152 lung cancer patients at a medical center in Taiwan assessed their symptoms, psychological distress, and unmet supportive needs in five major care domains. Logistic regression was applied to examine the related factors of unmet supportive care needs.ResultsIn general, patients had mild-to-moderate levels of symptoms and high prevalence of psychological distress. Regardless of their treatment status, they reported high levels of supportive care needs. The top three need domains were: (1) health system and information, (2) psychological, and (3) patient care and support. Levels of symptoms, anxiety, and depression were the most significant factors in unmet supportive care needs.ConclusionThe effect of symptoms and psychological distress on unmet supportive care needs is substantial. Therefore, a systematic assessment of patients’ distress and care needs is important for clinical lung cancer care. Further intervention consisting of symptom management, continuing counseling, and preparation for transition from active treatment to the follow-up stages are essential in improving quality of care.

Comparison of the Effects of a Supervised Exercise Program and Usual Care in Patients With Colorectal Cancer Undergoing Chemotherapy

Background: Although exercise has been addressed as a promising therapy for cancer adverse effects, few studies have evaluated the beneficial effects of exercise for colorectal cancer (CRC) patients during chemotherapy. Objective: The purpose of this study was to compare the effects of supervised-exercise intervention with those of usual care on cardiorespiratory fitness, muscle strength, fatigue, emotional distress, sleep quality, and quality of life (QoL) in patients with CRC undergoing chemotherapy. Methods: Patients with stage II or III CRC admitted for adjuvant chemotherapy were allocated to either a supervised-exercise group that received a combined aerobic and resistance exercise program or a “usual care” control group for 12 weeks. The outcomes, QoL, muscle strength, cardiorespiratory fitness, emotional distress, physical activity, fatigue, and sleep quality, were assessed at baseline and after intervention. Results: Significant interactions between intervention and time were observed for the role functioning and pain subscales of QoL and physical activity level. The time main effects were significant for the secondary outcomes: hand-grip strength, cardiorespiratory fitness, physical activity level, and physical functioning, role functioning, social functioning, fatigue, and pain subscales of QoL. Conclusion: Compared with usual care, the supervised exercise demonstrated larger effects than usual care on physical activity level and role functioning and pain subscales of QoL. Implications for Practice: Supervised-exercise program is suggested to be incorporated as part of supportive care to promote the cardiorespiratory fitness, muscle strength, physical activity level, and QoL of patients with CRC undergoing chemotherapy.

Validation of EQ-5D in patients with cervical cancer in Taiwan

PurposeThe survival rate of cervical cancer is increasing due to early diagnosis and timely treatment. As a result, the availability of a valid and reliable general HRQoL is important. The purpose of this study was to evaluate the psychometric properties of the EuroQol questionnaire (EQ-5D) in patients with cervical cancer in Taiwan.MethodOutpatients with cervical cancer were recruited from three medical centers across Taiwan. Test–retest reliability and ceiling effect were evaluated. Construct validity including convergent and discriminate validities were examined using the EORTC QLQ C-30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and the clinical indicators of the functional performance assessment using the Karnofsky Performance Scale (KPS) and disease status.ResultsA total of 530 patients completed the questionnaire. The intraclass correlation coefficient for the EQ-5D index was 0.83, and the Cohens kappa values for the EQ-5D dimensions ranged from 0.54 to 0.73. The EQ-5D index and VAS scores were higher for patients with a higher KPS score and disease-free status. The EQ-5D index was strongly correlated with all EORTC QLQ-C30 functioning scales.ConclusionThe EQ-5D questionnaire is reliable and valid for the assessment of health-related quality of life in patients with cervical cancer in Taiwan.

Attributing Variance in Supportive Care Needs during Cancer: Culture-Service, and Individual Differences, before Clinical Factors

Background Studies using the Supportive Care Needs Survey (SCNS) report high levels of unmet supportive care needs (SCNs) in psychological and less-so physical & daily living domains, interpreted as reflecting disease/treatment-coping deficits. However, service and culture differences may account for unmet SCNs variability. We explored if service and culture differences better account for observed SCNs patterns. Methods Hong Kong (n = 180), Taiwanese (n = 263) and Japanese (n = 109) CRC patients’ top 10 ranked SCNS-34 items were contrasted. Mean SCNS-34 domain scores were compared by sample and treatment status, then adjusted for sample composition, disease stage and treatment status using multivariate hierarchical regression. Results All samples were assessed at comparable time-points. SCNs were most prevalent among Japanese and least among Taiwanese patients. Japanese patients emphasized Psychological (domain mean = 40.73) and Health systems and information (HSI) (38.61) SCN domains, whereas Taiwanese and Hong Kong patients emphasized HSI (27.41; 32.92) and Patient care & support (PCS) (19.70; 18.38) SCN domains. Mean Psychological domain scores differed: Hong Kong = 9.72, Taiwan = 17.84 and Japan = 40.73 (p<0.03–0.001, Bonferroni). Other SCN domains differed only between Chinese and Japanese samples (all p<0.001). Treatment status differentiated Taiwanese more starkly than Hong Kong patients. After adjustment, sample origin accounted for most variance in SCN domain scores (p<0.001), followed by age (p = 0.01–0.001) and employment status (p = 0.01–0.001). Treatment status and Disease stage, though retained, accounted for least variance. Overall accounted variance remained low. Conclusions Health service and/or cultural influences, age and occupation differences, and less so clinical factors, differentially account for significant variation in published studies of SCNs.

Patient-Related Barriers to Fatigue Communication in Cancer Patients Receiving Active Treatment

OBJECTIVE To explore barriers to reporting fatigue in cancer patients receiving active treatment and the significant factors associated with those barriers from fatigue characteristics (i.e., intensity, duration, and interference with daily life), to demographic characteristics and disease/treatment variables. METHODS Patients with various types of cancer (n = 288) were recruited from an outpatient chemotherapy center, and from seven oncology and hematology units in a teaching hospital in northern Taiwan. Data were collected using the Fatigue Management Barriers Questionnaire to explore barriers to fatigue communication. RESULTS Fear of distracting the doctor was rated as the highest barrier of reporting fatigue. The degree of fatigue interference with daily life by patients was associated with the willingness to report fatigue. Patients with gastrointestinal cancer experienced more barriers to reporting fatigue than those with hematological cancer. Patients without religion perceived the highest level of barriers to fatigue communication. Outpatients had higher levels of concern than inpatients. CONCLUSIONS Discussion with patients about their high level of perceived fatigue barriers before implementing patient education is recommended. Assessing fatigue interference with daily life and identifying factors associated with barriers to reporting fatigue (i.e., type of cancer, religion, and the setting for receiving treatment) are suggested in order to provide better fatigue management in clinical settings.

Predictors and Patterns of Chronic Pain Three Months after Cardiac Surgery in Taiwan

OBJECTIVES Clinicians and researchers have a very limited understanding of how acute pain after cardiac surgery may develop into chronic pain. The aims of this study were to describe the pattern of pain during the first 3 months after cardiac surgery and to examine the predictors of surgery-related chronic pain. DESIGN A prospective panel study was conducted to monitor changes in worst and average pain intensity before and during the first 3 months following cardiac surgery in a sample of Taiwanese patients. Fifty-three patients who underwent a midsternotomy rated pain intensity before surgery and at postoperative days 7, 10, 30, and 90. The participants also rated beliefs about opioid use, and their medical records were reviewed to document opioid use during the first week after surgery. RESULTS The patients who reported chronic pain 90 days following surgery showed an unusual pattern of an increase in pain from 10 to 30 days after surgery. Higher worst pain intensity ratings at 30 days following surgery and more negative beliefs in opioid use were both associated with a greater likelihood of reporting chronic pain at 3 months. CONCLUSION Patients reporting a pattern of increasing pain starting about 10 days after surgery and holding negative beliefs about opioid use are at risk of developing chronic pain and may require more careful monitoring and pain treatment. The possible benefits of interventions that minimize pain during the weeks after surgery and that alter negative beliefs about opioid use should be examined in future research.

Psychometric Assessment of the Chinese Version of the Supportive Care Needs Survey Short-Form (SCNS-SF34-C) among Hong Kong and Taiwanese Chinese Colorectal Cancer Patients

Background Accurate assessment of unmet supportive care needs is essential for optimal cancer patient care. This study used confirmatory factor analysis (CFA) to test the known factor structures of the short form of Supportive Care Need Survey (SCNS-34) in Hong Kong and Taiwan Chinese patients diagnosed with colorectal cancer (CRC). Methods 360 Hong Kong and 263 Taiwanese Chinese CRC patients completed the Chinese version of SCNS-SF34. Comparative measures (patient satisfaction, anxiety, depression, and symptom distress) tested convergent validity while known group differences were examined to test discriminant validity. Results The original 5-factor and recent 4-factor models of the SCNS demonstrated poor data fit using CFA in both Hong Kong and Taiwan samples. Subsequently a modified five-factor model with correlated residuals demonstrated acceptable fit in both samples. Correlations demonstrated convergent and divergent validity and known group differences were observed. Conclusions While the five-factor model demonstrated a better fit for data from Chinese colorectal cancer patients, some of the items within its domain overlapped, suggesting item redundancy. The five-factor model showed good psychometric properties in these samples but also suggests conceptualization of unmet supportive care needs are currently inadequate.

Unmet Supportive Care Needs of Patients With Colorectal Cancer: Significant Differences by Type D Personality

PURPOSE/OBJECTIVES To explore the association between supportive care needs and type D personality, and to identify personality traits, including negative affectivity (NA) and social inhibition (SI), and their influence on the supportive care needs of patients with colorectal cancer (CRC). DESIGN Cross-sectional, correlational survey. SETTING Oncology and surgical outpatient clinics at a medical center in northern Taiwan. SAMPLE 277 patients diagnosed with CRC. METHODS Data were collected using a set of structured questionnaires to measure supportive care needs, symptom distress, anxiety, depression, and personality traits. The associations between type D personality and supportive care needs were verified by the Mann-Whitney U test. The significant roles of personality traits were identified by generalized estimating equations, controlling for biophysical and psychological factors overall, and for the five supportive care domains. MAIN RESEARCH VARIABLES Supportive care needs, type D personality. FINDINGS Patients with CRC reported the most unmet needs in the health system and the information domain. Type D patients had higher needs overall and in most domains, except for sexuality needs. A higher level of NA indicated higher overall and psychological needs. A higher level of SI indicated lower needs in health system and information. CONCLUSIONS The level of unmet supportive care needs of patients with CRC is highly associated with type D personality. The trait of NA alters levels of overall supportive care and psychological needs, and the trait of SI influences needs in health system and information. IMPLICATIONS FOR NURSING Assessing personality traits before providing an education program is highly recommended for patients with cancer. The assessment could improve the quality of personalized education programs and better meet patient needs.

Psychometric evaluation of a Chinese version of the Lee Fatigue Scale-Short Form in women during pregnancy and postpartum.

BACKGROUND Fatigue is among the most prevalent and distressing symptoms in pregnant and postpartum women. Estimating fatigue severity with a psychometrically sound instrument provides the most fundamental information for understanding womens fatigue experience and assessing the need for intervention to improve maternal and infant health outcomes. OBJECTIVES To evaluate the psychometric properties of a Chinese version of the 7-item Lee Fatigue Scale-Short Form (C-LFS-SF) in pregnant and postpartum women. METHODS The study was composed of two phases: translation of the scale into Chinese and examination of content validity, and testing to establish the reliability and validity. A convenience sample of 124 women completed health-related questionnaires, kept a fatigue diary and wore a wrist actigraph for 7 days during the third trimester of pregnancy and within three months postpartum. RESULTS The C-LFS-SF showed satisfactory internal consistency (Cronbachs alpha≥.97) and stability over the 7 days at each time point (intraclass correlation coefficient>.87). Exploratory factor analysis showed that 88-94% of the total variance was explained by the one-factor fatigue model. Significant associations among the C-LFS-SF and actigraphic sleep quantity and quality variables supported adequate construct validity. CONCLUSIONS The C-LFS-SF has satisfactory psychometric properties and is an easy and promising tool for assessing maternal fatigue during routine prenatal and postpartum care. This scale needs to be further tested in a more diverse population of pregnant and postpartum women, like women with high risk pregnancies or with medical conditions.

Multidimensional Pain Inventory-Screening Chinese version (MPI-sC): psychometric testing in terminal cancer patients in Taiwan

IntroductionCancer pain is identified as a multidimensional experience, but relatively few brief instruments are available for assessing the complex pain-related experiences of terminal cancer patients in Taiwan. The purposes of this study were to (1) translate and examine the feasibility and psychometric characteristics of the eight-item Multidimensional Pain Inventory-Screening Chinese (MPI-sC) when used with patients having terminal cancer and (2) apply the MPI-sC to examine multidimensional pain-related experiences of terminal cancer patients in Taiwan.Materials and methodsThe MPI-sC was tested in 106 terminal cancer inpatients at a hospice setting in Taipei.ResultsThe results showed that the MPI-sC has satisfactory face and content validity, feasibility, acceptable internal consistency reliability (overall Cronbach’s alpha of 0.75), and overall support of theoretical assumptions. However, instead of the four-factor structure of the original instrument, we found a three-factor structure (with pain intensity and pain interference merged into one factor) that explained 76.73% of the variance. Close to half the patients (48.1%) had considerable levels of pain interference, and a majority (72.6%) reported not having control in life based on the cut-point of MPI-sC categorization.ConclusionOur results support the brief MPI-sC as a feasible and valid tool for assessing and representing multidimensional pain experiences in terminal cancer patients. The MPI-sC could help clinicians and researchers assess the complex multidimensional pain experiences of terminal cancer patients, including Chinese-speaking cancer populations.