Family Members Of Cancer Patients Research Articles

Intrathecal drug delivery systems for cancer pain: A retrospective analysis at a single tertiary medical center in China

ObjectiveIntrathecal drug delivery systems (IDDS) have been clinically applied to treat refractory cancer-related pain for years. In this study, we demonstrate the current clinical practice and outcomes of IDDS for cancer pain management over a 3-year period at a single tertiary medical center in China. MethodsPatients who received IDDS implantation for cancer-related pain from 2021 to 2023 were identified. The electronic medical records of all eligible patients were retrospectively reviewed for study data including baseline characteristics, IDDS variables and postoperative clinical outcomes. ResultsA total of 96 consecutive individuals were identified for analysis and complete follow-up information was available in 72 patients with a follow-up rate of 75 %. Patients were 49.0 % female with a mean age of 62 ± 10 years. The top five cancer types in IDDS population were lung (34.4 %), colorectal (17.7 %), pancreatic (11.5 %), breast (5.2 %) and liver (4.2 %) cancer. The median duration from cancer diagnosis to IDDS implantation was 24 months (interquartile range [IQR] 12–48 months) and from pain onset to IDDS implantation was 6 months (IQR 2–12 months). In addition, the median oral morphine equivalents (OME) daily dose was 290 mg (IQR 100–632 mg). Mean NRS was 7.5 ± 0.8 before implantation and decreased to an average of 3.0 ± 1.1 after IDDS (p < 0.001). Median overall survival after IDDS implantation was 3 months (IQR 2–6 months). Overall, 75 % family members of cancer patients were satisfied with IDDS in relieving cancer pain. ConclusionIDDS therapy is a valuable option for patients suffering from cancer pain. More and more cancer pain patients receive IDDS to treat pain during the 3-year study period.

A Randomized Trial of Two Remote Health Care Delivery Models on the Uptake of Genetic Testing and Impact on Patient-Reported Psychological Outcomes in Families With Pancreatic Cancer: The Genetic Education, Risk Assessment, and Testing (GENERATE) Study

Background and AimsGenetic testing uptake for cancer susceptibility in family members of cancer patients is suboptimal. Among relatives of pancreatic ductal adenocarcinoma (PDAC) patients, The GENetic Education, Risk Assessment, and TEsting (GENERATE) study evaluated two online genetic education/testing delivery models and their impact on patient-reported psychological outcomes (PRPOs). MethodsEligible participants had ≥1 first-degree relative with PDAC, or ≥1 first-/second-degree relative with PDAC with a known pathogenic germline variant in one of thirteen PDAC predisposition genes. Participants were randomized by family, between 5/8/2019-6/1/2021. Arm 1 participants underwent a remote interactive telemedicine session and online genetic education. Arm 2 participants were offered online genetic education only. All participants were offered germline testing. The primary outcome was genetic testing uptake, compared by permutation tests and mixed-effects logistic regression models. We hypothesized that Arm 1 participants would have a higher genetic testing uptake than Arm 2. Validated surveys were administered to assess patient-reported anxiety, depression, and cancer worry at baseline and 3-months post-intervention. Results424 families were randomized, including 601 participants (n=296 Arm 1; n=305 Arm 2), 90% of whom completed genetic testing (Arm 1 (87%); Arm 2 (93%), p=0.014). Arm 1 participants were significantly less likely to complete genetic testing compared to Arm 2 (adjusted ratio (Arm1/Arm2) 0.90, 95% confidence interval 0.78-0.98). Among participants who completed PRPO questionnaires (Arm 1 (n=194); Arm 2 (n=206)), the intervention did not impact mean anxiety, depression or cancer worry scores. ConclusionsRemote genetic education and testing can be a successful and complementary option for delivering genetics care.

Taiwanese family members’ bereavement experience following an expected death: a systematic review and narrative synthesis

BackgroundBereavement experience is shaped by cultural and social contexts. No systematically constructed reviews were identified to explore the bereavement experience for people who are influenced by Chinese culture valuing filial piety and mutual dependence. This review aimed to systematically review the bereavement experience of Taiwanese family members living in Taiwan following an expected death.MethodsMEDLINE, PsycINFO, CINAHL, China Academic Journal Database, and Chinese Electronic Periodical Services were searched with no date restrictions from inception to 20 October 2022. The methodological rigour of studies was assessed using Hawker’s appraisal tool. A narrative synthesis approach using Popay’s work was employed to synthesise the findings of the studies. Studies investigating Taiwanese family members’ bereavement experiences were included. We excluded papers studying bereavement through the death of a child.ResultsSearches retrieved 12,735 articles (after de-duplication), 17 of which met the inclusion criteria and were included for synthesis: English [9] and Chinese [8], published between 2006 and 2021. The studies varied in quality with scores ranging from 22 to 33 out of 36. The studies differed in the relationship between participants and the deceased, the bereaved time frames, and the definitions of bereavement. Most studies focussed on family members of cancer patients receiving specialist palliative care. Three bereavement theories and four tools were used. Risk factors of bereavement outcomes included family members feeling less prepared for death and deaths where palliative sedative therapy was used. Protective factors were higher caregiving burden and longer caregiving periods. Four themes regarding Taiwanese bereavement experience were generated: multiple impacts of death; problem-based coping strategies; importance of maintaining connections; influential religious beliefs and rituals.ConclusionContinuing the relationship with the deceased is a key element of Taiwanese bereavement experience and it is influenced by religious and cultural beliefs. Suppressing or hiding emotions during bereavement to connect with the deceased and maintain harmonious relationships needs to be acknowledged as culturally acceptable and encouraged by some religions in Taiwan. The findings could be potentially relevant for other Chinese populations, predominantly Buddhist countries or other East Asian societies. The role of preparing for death in bereavement outcomes is little understood and requires further research.

Abstract A005: The development of a bioethically sensitive education video: Addressing the barriers to African Americans’ and Hispanics’ participation in clinical and genomic research through digital animation

Abstract Introduction: Research advances on effective methods to prevent, diagnose and treat cancer continue to emerge through clinical and genomic research. To ensure the results from these research studies help those who need it most, a diverse population needs to enroll. Despite guidance from authorities, such as the National Institutes of Health, most clinical trial and genomic research participants identify as White. At the participant level, mistrust of research, unawareness of research opportunities and gaps in bioethical knowledge about clinical trials and genomic research remain proven barriers to participating, especially among African Americans (AA) and Hispanics. With the development and access to technology, digital delivery of salient and tailored health education may provide innovative pathways to increase representation of AA and Hispanics in research. Methods: Members from the NCI-funded Partnerships to Advance Cancer Health Equity (PACHE) including experts from the community, healthcare, biomedical research and public health, such as oncologists, cancer geneticists, behavioral scientists and bioethicists collaborated on all phases. A design lab with experience synthesizing complex health messages into brief animations was contracted. The goal was to utilize existing educational resources from the National Cancer Institute and the National Human Genome Research Institute to create a tailored message to address AA's and Hispanics’ beliefs, values and bioethical concerns related to participation in clinical and genomic research. Models of behavior change and communication theories were leveraged to frame key components of the message, which then informed the animated video. Results: Development of the video consisted of six iterative phases: 1) writing sessions; 2) storyboarding; 3) animating; 4) screening/revisions; 5) acceptability testing; 6) finalization. In the last two steps, the video was presented to family members of cancer patients, cancer survivors and community members who provided quantitative and qualitative feedback which informed further edits. The final animated video is approximately five minutes in length and covers several topics including the goal of clinical research, disparities in clinical trials and genomic research participation, genomic research regulations and the purpose of a biobank. Supporting imagery to emphasize specific concepts, such as racial disparities in research, was dispersed throughout the video. A voiceover emphasized key bioethical concepts, including how research participation is safe and voluntary. When possible, characters were designed to resemble the targeted viewing audience. Discussion: Increasing AA and Hispanic participation in clinical and genomic research is imperative to achieving health equity. Tailored messages via short videos may assist in addressing the barriers and facilitators towards research participation and increase intentions to enroll in trials. Future research will evaluate the efficacy of the video through a multi-level framework in real-world settings. Citation Format: Victoria Churchill, Yu-Mei Schoenberger, Vivian L Carter, Windy Dean-Colomb, Roland Matthews, Desiree Rivers, Stephen O Sodeke, Jamirah Chevrin, Brian Rivers. The development of a bioethically sensitive education video: Addressing the barriers to African Americans’ and Hispanics’ participation in clinical and genomic research through digital animation [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A005.

Need for Improvement in Death Pronouncements in Palliative Care Units.

Death pronouncement is an important moment that can impact a family's bereavement process; however, necessary improvements in physicians' behavior during death pronouncement remain unclear. To explore whether the lack of certain behaviors by the physician was associated with a perceived need for improving death pronouncement for advanced cancer patients in palliative care units (PCUs). This study was a secondary analysis of a nationwide multicenter questionnaire survey conducted in 2018 that targeted bereaved family members of cancer patients who died in PCUs. We performed univariate analysis to investigate the need to improve behavior toward death pronouncement. We performed bivariate analysis to investigate the relationship among the need for improvement in behavior toward death pronouncement, physician attribution (primary responsible physician, a member of the same team, and another physician), and nine specific behaviors. Four hundred twenty-two questionnaires (64.2%) were returned. We analyzed 356 responses and found that 32.5% perceived the need to improve death pronouncement. Lack of certain behaviors at death pronouncement, especially not explicitly explaining the cause of death to family members (odds ratio: 11.89, p < 0.001), were positively associated with the need for improvement. There were significant differences among the types of physician attribution regarding the need for improvement (primary responsible physician vs. a member of the same team vs. another physician [15.1% vs. 42.6% vs. 45.7%, p < 0.001]). There was a significant positive association between the lack of certain behaviors toward death pronouncement and the need for improvement. The major lack of behavior toward death pronouncement was not explicitly explaining the cause of death to family members and not calling out to the patient before beginning the patient's examination.

Psychometric properties of the Arabic version of the good death inventory (GDI-A) questionnaire tested on Palestinian family members of deceased adult cancer patients

BackgroundDespite the importance of understanding the concept of good death (GD) from different cultural perspectives, it has not been assessed in Arab communities because of the unavailability of validated instruments. This study aimed to evaluate the psychometric properties of the Arabic version of the Good Death Inventory (GDI-A) questionnaire used among Palestinian bereaved family members of cancer patients. MethodsA cross-sectional methodological study was applied. An online survey was adopted as a data collection method. The online survey was delivered through Qualtrics and posted in cancer and health-related social media groups on Facebook, the most commonly utilized social media platform in Palestine. A convenient and snowball sampling of 285 family members of deceased adult cancer patients was adopted. The participants were asked to complete GDI online survey. A confirmatory factor analysis (CFA), content validity, and internal consistency reliability were assessed. ResultsParticipants showed a good perspective about death (M = 300.01, SD = 31.09). Significant differences in GDI-A total score were reported with the “patient’s relationship with family” (M = 303.02, SD = 31.42), F(2, 282) = 7.787, p = .001, “educational level” (M = 305.97, SD = 28.38), F(4, 280) = 3.685, p = .006, and “member’s relationship with the patient” (M = 311.74, SD = 16.57), F(5, 279) = 3.125, p = .009. The Arabic version scale-level content validity index and the scale-level content validity index-universal agreement were 0.96 and 0.85, respectively. Factor analysis with a varimax rotation matrix revealed that 16 factors explained 76.08% of the variance. ConclusionThis study provides the literature with an Arabic questionnaire for understanding the concept of a GD from the perspective of bereaved families. The GDI Arabic translated version is a psychometrically robust instrument with satisfactory measurement, which can be used for evaluating a GD among bereaved families.

The Functioning of Hospice in the Perception of Family Members of Cancer Surgery and Hospice Patients

Palliative care in Poland is for all dying people and their families to have timely access to quality care services. The study aimed to assess the perception of the role of hospice care by families of patients treated in oncological surgery departments and hospices. The study included 211 family members of cancer patients, comprising 108 family members of cancer surgery patients (Group I) and 103 hospice patients (Group II). The study used a diagnostic survey method with a proprietary questionnaire. 74.9% of people in Group I and 84.6% in Group II experienced positive associations with hospice care. 86% of respondents from Group I believed that hospice is a place where patients can die with dignity, while 68.3% of those from Group II believed it is where patients receive professional care. 56.7% from Group I and 65.4% from Group II did not feel anxious about hospice care. According to 68.6% of people in Group I, informing the patient that he or she is in hospice as well as about his or her disease should depend on the patient's condition. In the opinion of 75% of Group II, the patient should always be informed. In Group I (68.3%) and Group II (91.5%), the dominant opinion was that the family should take part in the care and treatment of the patient. 78.4% of respondents in Group I and 96.4% in Group II recommend hospice to other families. Most families of cancer patients from both the oncological surgery departments (Group I) and hospice (Group II) had positive first associations with hospice care. However, families from Group II had more critical remarks on hospice functioning.

Being sick to a cancer patient: pathways of delay in help seeking and diagnosis of cancer in India.

There is evidence that cancer mortality and morbidity could be reduced when the disease is diagnosed and treated at an early stage. The paper examines the pathways of delay of cancer diagnosis in an Indian setting. It draws on a qualitative study conducted among cancer survivors and family members of cancer patients in the city of Bengaluru, South India. The results show that a substantial part of the delay occurred at the stage of initial formal help seeking wherein patient and family-led, disease-related and systemic factors together played a major role. Patient-led factors included trivialisation and normalisation of symptoms as part of general fatigue and aging; unrealistic risk perceptions that linked causality of cancer merely to heredity and behavioural risk factors; fear of being diagnosed as cancer patient; gender related reasons including family's gender performance expectation, lower agency of women to seek help and lower prioratisation of women's health in the household and access related issues including financial constraints and unavailability of specialised hospitals nearby. Disease-related factors included the presence of comorbidity, cancer's mimicking of symptoms of other diseases and absence of distinguishable symptoms at the initial stage for certain types of cancers. The practitioner-led and system-led factors such as trivialisation of symptoms by general practitioners, non cancer-specific referrals, and lack of cancer screening facilities accounted for a major part of delay after the formal help seeking. The paper argues that the mere knowledge of cancer symptoms did not always lead to early diagnosis due to the interplay of these factors. The ongoing cancer prevention and control interventions in India need to be informed of these micro level factors while developing strategies to prevent avoidable delays in cancer diagnosis.

"You nearly feel a little bit like you've less right to grieve": a qualitative study on the impact of cancer on adult siblings.

Family members of cancer patients experience a range of challenges and are impacted in various ways by cancer. To our knowledge, the impact of cancer on adult siblings has yet to be explored. Sibling relationships are one of the longest relationships individuals have across the lifespan. Thus, the current study sought to investigate the perspectives of siblings of those who previously had cancer. Ten participants were recruited using purposive sampling. A qualitative, cross-sectional design was implemented with both virtual and in-person semi-structured interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis. The researchers identified five themes relating to both the impact of cancer on siblings and the supports they received: changes in family relationships, sibling's grief is forgotten, benefits of social support networks, supporting their sibling and caregiving and self-support. Cancer organizations and support services should focus on signposting services for siblings in order to ensure they can access support. Further research is needed with siblings to gain greater insight into what supports siblings feel are available for them to access, whether there are any for them to access or how supports can be improved. The provision of appropriate psychological support for siblings of cancer patients will ensure they can provide optimal support and care to their siblings. This will in turn benefit cancer patients along their cancer trajectory as adequate support from their caregivers will enhance their quality of life.

Abstract A029: A randomized study of two Strategies of remote Genetic Education, Risk Assessment, and Testing (GENERATE) for family members of patients with pancreatic cancer

Abstract Background: Uptake of genetic testing for cancer susceptibility in family members of cancer patients is suboptimal. The GENetic Education, Risk Assessment, and TEsting (GENERATE) study evaluated two strategies of remote genetic education and testing in relatives of pancreatic ductal adenocarcinoma (PDAC) patients. Methods: Eligible participants had: a first-degree relative with PDAC or had a known pathogenic germline variant (PGV) in one of thirteen PDAC predisposition genes (APC, ATM, BRCA1, BRCA2, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, or TP53) and a first- or second-degree relative with PDAC. Participants were cluster-randomized by family into one of two arms. Arm 1 included an interactive telemedicine session with a genetic counselor, followed by genetic testing at a commercial laboratory. Arm 2 involved remote online genetic education and testing at the commercial laboratory without the interactive session. The primary outcome was uptake of genetic testing across study arms, which was compared by permutation tests and mixed-effects logistic regression models. Results: Between 5/8/2019 and 6/1/2021, 424 families were randomized, including 601 participants (n=296 Arm 1; n=305 Arm 2). The uptake of genetic testing was 87% (257/296) in Arm 1 and 93% (284/305) in Arm 2 (p=0.014). Participants in Arm 1 were significantly less likely to obtain genetic testing compared to Arm 2 (Adjusted ratio [Arm1/Arm2] 0.90, 95% confidence interval 0.78-0.98). BRCA2, ATM, CDKN2A and PALB2 were the most common PDAC susceptibility genes in which PGVs were identified. Conclusions: Remote methods of genetic education and testing are successful alternatives to traditional germline susceptibility testing. Citation Format: Nicolette J. Rodriguez, C. Sloane Furniss, Matthew B. Yurgelun, Chinedu Ukaegbu, Pamela E. Constantinou, Ileana Fortes, Alyson Caruso, Alison N. Schwartz, Jill E. Stopfer, Meghan Underhill-Blazey, Barbara Kenner, Scott H. Nelson, Sydney Okumura, Alicia Y. Zhou, Tara B. Coffin, Hajime Uno, Miki Horiguchi, Allyson J. Ocean, Florencia McAllister, Andrew M. Lowy, Scott M. Lippman, Alison P. Klein, Lisa Madlensky, Gloria M. Petersen, Judy E. Garber, Michael G. Goggins, Anirban Maitra, Sapna Syngal. A randomized study of two Strategies of remote Genetic Education, Risk Assessment, and Testing (GENERATE) for family members of patients with pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A029.

Patients’ and oncologists’ perceptions towards the discussion on high-cost innovative cancer therapies: findings from a qualitative study

ObjectivesIn the last decades, innovative technologies for cancer treatment were developed rapidly. In most cases, their price is high, with no funding offered by public health systems. The present study...

Grief reactions of family members after the death of cancer patients: a phenomenological study

Introduction. The death of a family member due to cancer is one of the most stressful events of life. The purpose of the present study was to investigate lived experiences of family members grieving after the death of their relatives from cancer in Iran. Material and methods. A phenomenological study was performed. The seven-stage process of data analysis was employed. The study was conducted in two hospitals that have oncology wards in Tehran, Iran. We interviewed 14 bereaved family members. Participants went through semi-structured, in-depth, and face-to-face interviews. Results. Study participants’ lived experiences were classified into 2 main themes including ‘grief management’ and ‘evaluating death’. ‘Grief management’ had two subthemes: ‘cultural adaptation to death’ and ‘emotional reactions’. ‘Evaluating death’ also had two subthemes: ‘good death’ and ‘bad death’. One constitutive pattern `families' effort to accept the cancer patient's death' was identified. Conclusions. According to our findings, family members of cancer patients require more supportive programs such as supportive care. Our study indicated the need for culture-based care for the bereaved family members of cancer patients.

Study on the Conduction Analysis and Blocking Intervention Scheme of Emotional Disorders between Cancer Patients and Their Families.

Objective To analyze the transmission and blocking intervention scheme of emotional disorders between cancer patients and their families. Methods About 150 patients with cancer and 150 family members with mood disorders treated in a tertiary hospital in North China from March 2021 to Octobor2021 were enrolled. The patients were randomly assigned into control group and study group. The control group received routine intervention, and the study group received the diagnosis, intervention, and treatment strategies of doctor-patient-affective disorder. The factors related to the transmission of emotional disorders between cancer patients and their families were analyzed, and the alterations of anxiety, depression, social support, and satisfaction of the two groups were compared under different blocking intervention schemes. Results (1) Univariate analysis indicated that there were significant differences in family age, family income, sex, location of tumor, course of disease, TNM stage, somatic symptoms, and the incidence of anxiety and depression. There exhibited no significant difference between the gender of the family, the years of education of the family, the occupational status of the family, the relationship between the family and the patient, the mode of payment of the patient's medical expenses, the age of the patient, the mode of treatment of the patient, the degree of knowledge of the disease, and the incidence of anxiety and depression (P > 0.05). The anxiety and depression status of relatives were taken as dependent variables, and the age of family members, family income status, sex of patients, location of tumor, course of disease, TNM stage, and physical symptoms of patients were taken as independent variables, and the data were analyzed by Logistic regression analysis. Logistic regression analysis indicated that family income, tumor location, disease course, TNM stage, and somatic symptoms were the risk factors of anxiety and depression in relatives. (2) Comparison of social support status and intergroup, the objective support, subjective support, support utilization, and total score of social support in the study group were higher compared to the control group. In terms of the depression score before intervention, there exhibited no significant difference (P > 0.05), but after intervention, the depression score of the two groups decreased, and the depression score of the study group was lower compared to the control group before intervention, 1 week, 2 weeks, 3 weeks, and 4 weeks after intervention (P < 0.05). In terms of the anxiety score before intervention, there exhibited no significant difference (P > 0.05), but after intervention, the anxiety score of the two groups decreased, and the anxiety score of the study group was lower compared to the control group before intervention, 1 week, 2 weeks, 3 weeks, and 4 weeks after intervention (P < 0.05). Comparison of the satisfaction between the two groups and the study group was very satisfied in 56 cases, satisfactory in 14 cases, and general in 5 cases, and the satisfaction rate was 100.00%. The control group was very satisfied in 35 cases, satisfactory in 23 cases, general in 12 cases, and dissatisfied in 5 cases, and the satisfaction rate was 93.33%. The satisfaction of the study group was higher compared to the control group (P < 0.05). Conclusion Family income, tumor location, course of disease, TNM stage, and somatic symptoms are the risk factors of anxiety and depression in relatives. After establishing the diagnosis, intervention and treatment strategies of doctor-patient-affective disorder, the emotional disorder of family members of cancer patients, is significantly promoted, and the intervention satisfaction is high, so the scheme is worth promoting.

Influence of financial burden on withdrawal or change of cancer treatment in Japan: results of a bereavement survey.

This study aimed to examine the effect of financial burden of cancer treatment from diagnosis to end-of-life on treatment withdrawal or change in Japan. This study was part of a nationwide survey of bereaved family members of cancer patients in Japan (J-HOPE2016 study). Questions regarding withdrawal or change of cancer treatment (stratified according to whether the treatment was recommended by physicians or based on the patients' request), financial difficulties in coping with cancer treatment expenses, and the participants' socioeconomic background were asked. Descriptive analyses were performed, and logistic regression was used to examine the factors related to withdrawal or change of cancer treatment. In total, 510 (60%) questionnaires were returned. Approximately 7.5% of participants reported withdrawal or change of cancer treatment for financial reasons. Financial difficulties in coping with cancer treatment expenses such as using up all or a portion of one's savings (OR = 2.14, 95% CI = 1.14-4.04, p = 0.018/ OR = 3.45, 95% CI = 1.52-7.81, p = 0.003) and subjective financial burden (OR = 2.54, 95% CI = 1.25-5.14, p = 0.010/OR = 3.89, 95% CI = 1.68-9.00, p = 0.002) were significantly related to withdrawal or change of cancer treatment (recommended by physicians/based on patient request). Fewer participants reported withdrawal or change of cancer treatment than in previous studies, which might reflect the characteristics of the Japanese healthcare system. However, there are patients in Japan who withdraw or change cancer treatment for financial reasons. Medical staff should consider financial toxicity as a serious side effect and assist patients in their decision-making regarding treatment while taking into account their socioeconomic backgrounds.

Assessment of Anxiety and Depression and its Association with Socio-demographic Characteristics among Family Caretakers of Cancer Patients

Objective: To find out the frequency of anxiety and depression and its association with socio-demographics characteristics among family caretakers of cancer patients.&#x0D; Methodology: This descriptive cross sectional study of 300 participants was carried out at Dr. Ruth K.M Pfau Civil Hospital and Dow University Hospital, Karachi from December 01, 2020 to January 30, 2021. Before the study ethical approval was taken. The Aga Khan University Anxiety and Depression Scale (AKU-ADS) was used to assess the symptoms among family caregivers of cancer patients. The inclined adult male and female family members of cancer patients who were admitted in Dow University Hospital and Dr. Ruth K.M. Pfau Civil Hospital Karachi was included in this study. The data was analyzed by using SPSS version -21. Frequency analy-&#x0D; sis was performed for demographic variables and chi-square test was also run to check the association of anxiety and depression with socio-demographic characteristics of study participants.&#x0D; Results: Finding of this study revealed that 39% of participants were having anxiety and depression. We found that gender, marital status, age group, educational level and patient’s relationship showed significant p value of &lt;0.001 with anxiety and depression.&#x0D; Conclusion: This study concludes that approximately one third of the study participants suffered from anxiety and depression. The demographic variables contributing to anxiety and depression include age, gender, and marital status, relationship with patient and educational level of the participants.

Psychotherapeutic intervention in the modality of emotional support network with family members of cancer patients as part of the service of a hospital oncology center

The main objective of this research – intervention is focused on promoting the description and characterization of a network of emotional support as a psychotherapeutic model at a cancer hospital setting, led to the relatives of those who are experiencing the phenomenon of cancer.&#x0D; To carry out the work, use was made of the constructionist approach systemic - constructivist, which allowed not only the construction of interactional contexts with the people involved, but also the generation of an experiential and symbolic process of research on the phenomenon. From there, they facilitated understanding, hermeneutics from the perspective the way in which people who had experienced the phenomenon of cancer, senses and social meanings built, family and therapeutic about the different actions in the cancer experience.&#x0D; The research - intervention, took in to consideration the look narrative is based on different epistemological and paradigmatic early systemic perspective. It was conducted at the Hospital of San Ignacio, taking in to account the parameters of research that establishes the Pontificia Universidad Javeriana through the Masters in clinical psychology with systemic approach.&#x0D; Seven conversational narrative scenarios as a support network in which fourteen people, relatives of terminally ill patients and were related Javeriano Cancer Center participated were conducted.&#x0D; Qualitative research and study methodology, from which an experiential, subjective and contextual analysis of the experiences of each person is allowed intervention was used,&#x0D; - to carry out the investigation process. From there, the being able to pick up the different versions of the way in which people lived and meant the phenomenon of cancer, made possible the construction and reconstruction of identity processes of each of the participants, including investigating - intervening in where the therapeutic conversational scenarios, became a process of co-construction of realities and identities.&#x0D; As results evidenced how different family systems able to configure a world of meanings and directions about faith, spirituality and family unity as resilient resources in building worlds from the experience hopeful about cancer phenomenon, taking in to account the organization and reorganization of family dynamics to face a critical moment of life as is the terminal disease one of its members, resulting in drastic changes of meanings, interactions, feelings and painful feelings in the way of a process Hospital.

Effectiveness of Multicomponent Intervention on Quality of Life of Family Caregivers of Cancer Patients.

Objective:The study aimed to determine the effectiveness of the multicomponent intervention on Quality of life (QOL) of family caregivers of cancer patients. Methodology:A Quasi-experimental study with pre and post-test measures was conducted among 200 caregivers of cancer patients selected by convenient sampling technique. The experimental group received the intervention, and no intervention was given for the control group during the study period. The data were collected from family members looking after the cancer patients diagnosed with breast/head & neck cancers and who were in the third and fourth stages of cancer. After the pre-test, provided multicomponent intervention (Pranayama, yogic relaxation, counselling and Education) and a post-test was conducted at the first month & third month. The obtained data were analysed and inferred using descriptive and inferential statistics to compare the outcomes among the groups. Result:Most of the caregivers belong to the age group of 31 to 40 years in the intervention group (31%) and in the control group (35%), 31% of them had their education up to a primary level in both the groups and most of the caregivers were spouses (49%). Regarding the QOL of family members, improvement was noted from baseline 66.66 to 126.82 (3 months) among the intervention group, and in the control group, mean QOL enhanced from 59.77 to 81.97. Repeated measure ANOVA was computed to analyse difference within and between the groups and it showed that the intervention program was efficacious in enhancing the QOL of family caregivers of cancer patients (F (1, 191) =639.02, p=.001). Conclusion: Nurses play a vibrant role in improving the Quality of life of family members of cancer patients since they are mostly involved in providing care. Health care system must ensure that the family members who provide care to the cancer patients receive appropriate teaching programmes on reducing their burden.

Are family relationships associated with family conflict in advanced cancer patients?

Family conflict during end-of-life care is an important issue for advanced cancer patients and their families, although studies are lacking. We investigated the association between family relationships and family conflict in advanced cancer patients. This study was a secondary analysis of a nationwide multicenter questionnaire survey targeting the bereaved family members of cancer patients who died in palliative care units, general wards, or at home to evaluate the quality of end-of-life care in Japan. A total of 1084 questionnaires (63.0%) were returned and we analyzed a total of 908 responses. In total, 38.0% of family members reported at least one family conflict during end-of-life care, and the most frequent family conflict was "about certain family members not pulling their weight" (23.5%). Multivariate linear analysis revealed family members who asserted their opinions (p<0.001), family assessment device score (p<0.001), worries about family finances during cancer treatment (p<0.001), family members contacted after illness were helpful (p=0.003), female patients (p=0.03), and family with family relationship index ≤7 (p=0.04) were positively associated with the outcome-family conflict (OFC) score. Proxy decision maker was selected by the patient (p=0.003), people listened to families' worries or problems (p=0.003), physician gave sufficient explanation (p=0.003), living will before their illness (p=0.038) and female bereaved family members (p=0.046) were negatively associated with the OFC score. It may be important for health care providers to actively assess the possibility of family conflicts according to family relationships, such as a proxy decision maker having been selected by the patient.

Validation of the Chinese version of the Care Evaluation Scale for measuring the quality of structure and process of end-of-life care from the perspective of bereaved family

BackgroundAssessing the quality of structure and process of end-of-life care can help improve outcomes. There was currently no valid tool for this purpose in Mainland China. The aim of this study is to validate the Chinese version of the Care Evaluation Scale (CES).MethodsFrom January to December 2017, a cross-sectional online survey was conducted among bereaved family members of cancer patients from 10 medical institutes. The reliability of the CES was assessed with Cronbach’s α, and structural validity was evaluated by confirmatory factor analysis. Concurrent validity was tested by examining the correlation between the CES total score and overall satisfaction with end-of-life care, quality of dying and death, and quality of life.ResultsA total of 305 valid responses were analyzed. The average CES score was 70.7 ± 16.4, and the Cronbach’s α of the CES was 0.967 (range: 0.802–0.927 for the 10 domains). The fit indices for the 10-factor model of CES were good(root-mean-square error of approximation, 0.047; comparative fit index, 0.952; Tucker–Lewis index, 0.946; standardized root mean square residual, 0.053). The CES total score was highly correlated with overall satisfaction with medical care (r = 0.775, P < 0.01), and moderately correlated with patients’ quality of life (r = 0.579, P < 0.01) and quality of dying and death (r = 0.570, P < 0.01). In addition, few associations between CES total score and demographic characteristics, except for the family members’ age.Conclusions The Chinese version of the CES is a reliable and valid tool to evaluate the quality of structure and process of end-of-life care for patients with cancer from the perspective of bereaved family in Mainland China.

Unmet need for palliative rehabilitation in inpatient hospices/palliative care units: a nationwide post-bereavement survey.

In end-of-life care, rehabilitation for terminally ill cancer patients is inconsistently provided and rarely discussed. We sought to clarify the prevalence of unmet rehabilitation need for patients admitted to inpatient hospice/palliative care units as perceived by bereaved family members. We conducted a nationwide questionnaire survey of 1001 family members of cancer patients who died at inpatient hospices/palliative care units. For cancer patients who did not receive rehabilitation, we asked if family members perceived that the patient would have wanted rehabilitation intervention. Data were obtained from 416 respondents. Of these, 281 (67.5%) cases received no rehabilitation. The need for physical modalities was the most frequently reported (27.8%; 95% CI: 22.6-33.4), followed by relief of dyspnea (25.6%; 95% CI: 20.6-31.1) and treatment of edema (23.8%; 95% CI: 19.0-29.3). A non-negligible proportion of bereaved families reported unmet need for rehabilitation related to symptom management in inpatient hospices/palliative care units.