Emotional experiences across the cancer journey: A psycho-oncological perspective for patients, caregivers, and oncology nurses.

Rates of burnout and compassion fatigue among oncology nurses are rising, and the emotional impact of the work increases the risk. This study examined how oncology nurses describe the evolution of emotions from first significant patient loss through cumulative patient death. To explore the emotional evolution of being an oncology nurse. Semistructured interviews with 7 oncology nurses. Thematic analysis was used to analyze the data. Participant's mean age was 41.3 years, with 13.9 years of nursing experience and 10.6 years of oncology experience. One metatheme, "riding the roller coaster," described the overall emotional experience of the nurses. Three subthemes, "all in and then," "finding your way," and "impact on self," further outlined the process taken to cope with workplace emotions. Oncology nurses are frequently exposed to loss and suffering. Findings from this study suggest that new nurses are underprepared for the emotional experience of being an oncology nurse. Further, they define their emotional boundaries in isolation and without guidance on how to develop healthy coping skills. Changing the culture of silence around mental health and well-being among healthcare professionals can provide space for important conversations to occur. Oncology nurses have few resources to teach them how to cope with the emotions experienced while caring for oncology patients. These findings suggest that alternative approaches to the traditional bereavement programs and innovative interventions offered to new oncology nurses within their first few years are needed.

“New Normal” Home Chemotherapy in Thailand: How the Challenging Roles of Nurses Are Changing?

BackgroundAlthough videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses’ ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey.ObjectiveThis study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs).MethodsIn this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis.ResultsMost patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present.ConclusionsPerson-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines.International Registered Report Identifier (IRRID)RR2-10.2196/27940

The landscape of cancer care is evolving. Oncology nursing continues to develop and respond to the changing needs of patients with cancer and their families. There is limited understanding of what it means to be an oncology nurse, as well as the factors that facilitate or hinder being an oncology nurse. This study used an interpretive phenomenological approach. Six nurses from two in-patient units in a tertiary care teaching facility were interviewed. The overarching theme, Investing to Make a Difference, reflected how oncology nurses invested in building relationships with patients and their family members and invested in themselves by developing their knowledge and skills and, eventually, their identities as oncology nurses. In turn, these investments enhanced their role, and were seen to make a difference in the lives of patients and their family members by supporting them through the cancer journey. Implications of these findings for oncology nursing are highlighted as they relate to nursing practice, education, research, and leadership.

New year greetings from the Editor-in-Chief of the Asia–Pacific Journal of Oncology Nursing

Oncology nurses have frequent contact with oncology patients during their cancer journey. This long-term, recurrent contact can impact the health and well-being of the nurse through the development of compassion fatigue (CF). To identify what contributes to CF and what individual, interpersonal, and organizational factors mitigate CF among oncology nurses caring for adult patients. A scoping review framework by Arksey and O'Malley guided this review. Electronic databases were searched for relevant studies. A blinded screening process was undertaken by the authors using the following inclusion criteria: English language published from January 2011 to December 2021, primary research peer-reviewed studies, and focusing on CF within oncology nurses caring for adult patients in any practice setting. Nineteen studies (21 articles) were identified. The review found nurses' personal beliefs around nursing care being provided, and personality traits of psychological inflexibility, neuroticism, passive coping, and avoidance contributed to CF. Workplace conflict and lack of a healthy work-life balance also contributed to CF. However, nurses' personal resilience, ability to positively reflect upon their work, a supportive team environment, and continuing education were found to mitigate CF. Levels of CF vary among oncology nurses caring for adult patients. Oncology nurses may benefit from personal and organizational resources aimed at improving oncology nurses' professional quality of life while decreasing CF. Consideration and future research of effective interventions are needed to sustain a future health workforce and mitigate CF among oncology nurses.

Perspectives of oncology nurses on peer support for patients with cancer.

The purpose of this study was to understand the perception of oncology nurses and how it is related to cancer rehabilitation in Korea. A qualitative study with three focus groups consisting of 6-8 Korean oncology nurses (n = 21) was conducted. The interviews were thematically analyzed. Two main themes for the attributes of cancer rehabilitation were "comprehensive activities of nurses" and "active involvement of survivors." Six subthemes from the oncology nurses' care experiences were identified: "incorporating partnership and sharing feelings," "fulfilling individualized needs," "providing timely and practical support," "enhancing internal strength with optimistic mindset," "regaining functional independence," and "getting family members in." The findings suggest that oncology nurses can play a key role in rehabilitation for cancer survivors. Nursing interventions focused on comprehensive activities of nurses as well as active involvement of survivors can be effective in enhancing cancer survivors' strength and resilience in order to lead a healthy life. Oncology nurses need to be taught a psychosocial intervention based on individualized assessment and family partnership for cancer survivors.

Cancer is a serious threat to human health worldwide. Attention to the quality of life (QoL) of cancer patients is increasingly recognized as an important component of and a fundamental task in cancer care. Recent studies illustrate that resilience is a key biological factor affecting cancer patients' health status and QoL. However, few studies have focused on resilience during medical procedures of cancer patients from the perspective of nursing. In this study, we summarize recent literature exploring the clinical significance of resilience in oncology nursing, propose strategies for cancer care to improve the QoL of patients through interventions on resilience, and focus on emerging theories in oncology nursing. In summary, this will emphasize the importance of resilience in oncology nursing and benefit the clinical practices that improve patients' QoL and reduce the social burden caused by cancer. J. Med. Invest. 70 : 1-6, February, 2023.

Indolent lymphoma is one of the most frequently occurring subtypes of non-Hodgkin lymphoma (NHL). Indolent NHL has a long natural history, and patients will likely receive multiple therapies during the course of their disease. Treatment options are rapidly evolving and, because oncology nurses play a major role in managing patients undergoing treatment for indolent NHL, they need to be aware of the potential adverse effects associated with new therapies that may affect patients in their care. One such agent is bendamustine, which was approved by the U. S. Food and Drug Administration in 2008 for the treatment of relapsed indolent NHL. Oncology nurses are increasingly likely to encounter bendamustine either as monotherapy or in combination with rituximab. Bendamustine is a hybrid agent with both alkylating and purine analog properties, produces a high response rate in patients with indolent NHL, and has manageable side effects that include immunosuppression, gastrointestinal toxicity, and fatigue. Oncology nurses should be familiar with the common side effects so as to provide enhanced care for the patient receiving this agent. This article reviews the safety profile of bendamustine and discusses the implications from a nursing perspective.

Recruiting, retaining, and training oncology nurses is challenging given the stress levels associated with a field with constantly evolving treatments and a need for expertise in death and dying. This research was conducted to assess what is unique about oncology nursing, to identify what motivates oncology nurses to continue working in the specialty, and to determine what sustains them in daily practice. A phenomenologic approach was used to analyze data. Nurses identified three main themes: the importance of vulnerability and thankfulness in patients, the feeling of spirituality associated with oncology practice, and the value of being in the moment and recognizing priorities as meaningful aspects of oncology nursing.

Work engagement in oncology nurses is crucial for improving nurse practice and healthcare outcomes. The study aimed to define and understand work engagement from the perspective of experienced oncology clinical nurses. This qualitative descriptive study used purposive sampling to select 15 oncology nurses from a University Oncology Hospital in Türkiye. Participants had at least 3 years of experience and volunteered for the study. Data were collected through face-to-face interviews using a "Nurse Data Form" and a "Semi-structured Interview Form." The analysis identified six themes and 12 sub-themes. These themes include a sense of engagement, personal resources, organizational resources, professional resources, elements specific to the nature of oncology, and areas that need improvement. Sub-themes indicate that facilitators of work engagement included altruism, job satisfaction, teamwork, and nursing competencies. Nurses may require assistance in caring for patients with high psychosocial demands, long-term care or repetitive hospitalizations. In conclusion, nurses emphasized the facilitating and challenging factors in work engagement in the oncology clinics. This study suggests that oncology nurses' work engagement can be enhanced by empowering them professionally, individually, and organizationally.

Burnout and exhaustion is a frequent problem in oncology nursing. The aim of this study is to evaluate the aspects of oncology nurses about their profession in order to enhance the standards of oncology nursing. This survey was conducted with 70 oncology nurses working at Hacettepe University Oncology Hospital. Data were collected between January-April 2012. Each participant provided a study form comprising questions about sociodemographic information; about difficulties, positive aspects and required skills for oncology nursing; and questions evaluating level of participation and clinical perception of oncology nursing. Mean age of nurses was 29.9 ± 5.7 years. More than half of the participants were married (51.4%) and 30% had at least one child. Percent of nurses working in oncology for their entire work life was 75.8%. Most frequently expressed difficulties were exhaustion (58.6%), coping with the psychological problems of the patients (25.7%), and frequent deaths (24.3%); positive aspects were satisfaction (37.1%), changing the perceptions about life (30%), and empathy (14.3%); and required skills were patience (60%), empathy (57.1%), and experience (50%). For difficulties of oncology nursing, 28.3% of difficulties could be attributed to job-related factors, 30.3% to patient-related factors, and 77% of difficulties to individual factors. The independent predictors of participation level of the nurses were self-thoughts of skills and positive aspects of oncology nursing. According to the findings of this study, nurses declared that working with cancer patients increase burnout, they are insufficient in managing work stress and giving psychological care to patients, but their job satisfaction, clinical skills and awareness regarding priorities of life has increased.

Cancer can have major implications for those who receive a diagnosis, not only as a result of its physical impact, but its emotional one. The emotional impact can not only be distressing in itself, it can also affect behaviour and therefore, has been linked to poorer treatment adherence. The experience of difficult self-directed emotions, such as guilt, shame and disgust have provoked particular interest, particularly due to their association with rejection and avoidance. Therefore, insight into how and when these emotions are experienced within the cancer treatment journey are important to understand, in order that optimum support can be provided. The first paper is a thematic synthesis that explores the emotional experiences of people undergoing cancer treatment with a curative intent. The synthesis is structured by a sequential framework of four key transition points within the cancer journey, and the emotional experiences synthesised within each one. The temporal transition points were: Being diagnosed and facing treatment; Getting rid of cancer; Changed body and stigma; Reflections on the emotional journey having completed treatment. The synthesis demonstrates how emotions and feelings evolve and change in type, frequency and intensity across the curative cancer journey. The second study uses narrative analysis methodology to explore difficult self-directed emotions throughout cancer treatment and into recovery. The analysis focuses on how and when the emotions of disgust, guilt, shame and fear arise, as well as resulting changes to the sense of self. The findings demonstrate how many factors, such as relationships, current stressors, past experiences and resources (personal and systemic) can impact on emotional experiences. The critical appraisal focuses on strengths and weaknesses of the studies, particularly in relational to emotional research considerations more generally.

Introduction Transgender and gender nonconforming (TGNC) patients experience substantial inequities in healthcare delivery and outcomes; barriers include discrimination and inadequate knowledge about TGNC health needs. Qualitative research into TGNC patient experiences, needs, and priorities is important to uncover ways we can improve care for this population; however, this research has lagged behind research regarding cis-gender patients. Little has been studied about TGNC patient experiences with cancer. We hypothesized that being diagnosed with genitourinary (GU) and gynecologic (GYN) cancers may be particularly challenging for TGNC patients who may have dysphoria regarding their pelvic organs. Objective This study aims to understand TGNC patient experiences with GU and GYN cancers. We explored (a) how gender identity impacts the emotional experience of cancer diagnosis and treatment, (b) how gender identity impacts treatment decision making, (c) how interactions with oncology providers have positively and negatively impacted patients’ experiences, and what we can do to better care for this population. Methods Adults identifying as TGNC, diagnosed with cancer of a pelvic organ, were recruited by electronic medical record search. Participants completed an anonymous online survey probing experiences with cancer diagnosis and treatment, the interplay between TGNC identity and GU/GYN cancer, and experiences with providers, with the option to complete an additional interview delving deeper into these topics. Participants were accrued to achieve thematic saturation. Analysis included descriptive statistics, open coding, development of themes, and mixed-methods integration. Results N = 19 patients completed a survey, and n = 15 completed an interview. Patient demographics and cancer details are shown in Table 1. Eleven patients (58%) reported that gender identity influenced their overall cancer journey, and 16 (84%) felt that having cancer in a pelvic organ caused more distress than if the cancer was in an organ unrelated to gender identity. Reasons for distress included fear of provider mistreatment and increased gender dysphoria. For example, an agender patient said that having ovarian cancer “put pressure on me to make quick decisions about my reproductive future that led to a significant increase in misgendering as I chose to have a child while I still could.” Ten patients (53%) reported that their gender identity influenced cancer treatment decisions. Transphobia and mistreatment were reported by six patients (32%); for example, a transmasculine patient with ovarian cancer said, “There was more than one doctor who speculated that my tumor, which produced testosterone, was the cause of my being transgender.” Regarding ways to improve care, patients want their oncologists to ask for pronouns, discuss ways in which cancer treatment may affect management of their gender-affirming therapy or vice versa, and listen to patients’ preferences and priorities. Conclusions For TGNC patients with pelvic-organ cancers, gender identity matters, both for clinical decision making and patients’ emotional experience. There is opportunity for oncology providers to partner with TGNC patients through this particularly challenging journey, to ensure that patients feel safe and supported and can make treatment decisions that align with their gender affirming goals. Disclosure No.