Bakgrund: Cancer kan uppstå i diverse delar av kroppen. Cancervården använder sig av två faser. Den kurativa fasen där målet är att patienten ska bli botad samt den palliativa fasen där vårdinriktningen är palliativ och sjukdomen inte längre går att bota. Patienter med cancer kan leva flera år i en tidig palliativ fas där behandlings målet är att fördröja sjukdomsförloppet. Därefter träder den sena palliativa fasen in där fokusering på välbefinnande och smärtlindring är huvudändamål. Det är i skiftet mellan de olika faserna som brytpunktssamtalet främst äger rum. Sjuksköterskor kan ha en betydande roll i processen kring brytpunktssamtal. Syfte: Syftet med denna litteraturstudie var att undersöka och sammanställa sjuksköterskors upplevelser och erfarenheter av brytpunktsamtal hos patienter med cancer Metod: En litteraturstudie med systematisk översikt. Tio artiklar med kvalitativ ansats kvalitégranskades och sammanställdes genom innehållsanalys. Resultat: Resultatet identifierades till tre huvudteman; Upplevelser och erfarenheter kring samverkan med patient och läkare, relationer i anknytning till brytpunktssamtal och sjuksköterskans upplevelser av hopp. Sjuksköterskor upplevde att samverkan med läkare samt tydlig kommunikation med patient var av vikt. Relationen till patienter och närstående var en faktor som sjuksköterskor upplevde fanns med i brytpunktssamtalet. Hopp var en känsla som identifierades hos sjuksköterskor under brytpunktssamtal. Konklusion: Sjuksköterskor kan i samband med brytpunktssamtal med både för och nackdelar hamna i kläm mellan patienter och läkare. Sjuksköterskor är i behov av tydlig information i anknytning till brytpunktssamtal för att kunna bistå patienter och samverka inom det multidisciplinära teamet runt patienten. Sjuksköterskor oroar sig över att beröva hopp från patienter genom att diskutera och besvara frågor kring sämre prognoser. / Background: Cancer can occur in different areas of the human body. Cancer care consists of two different phases. The curative phase when the goal is to cure the patient and the palliative phase when cure is no longer possible and the goal changes to comfort care. Patients with cancer can live for several years in the early stages of palliative care when the goal is to prolong the patient’s life and slow down the progression of the disease. When prolonging life is no longer possible the late palliative phase sets in and the goal of care is to make the patient comfortable and to manage symptoms of the disease. It is in between these phases the discussion called breaking point takes place. Nurses have a meaningful role in the process around breaking point. Purpose: The purpose of this study is to explore and compile nurses’ experiences of discussion around breaking point with patients with cancer. Method: A systematic literature review. Ten articles with qualitative approach were graded and compiled through content analysis. Result: The results was identified into three main themes; Nurses experience of cooperation between physicians and patients, relationship within breaking point and the nurses experience of hope. Nurses experienced that cooperation with doctors and evident communication with patients was important. The relationship with patients and relatives was an element that was present during breaking point conversation according to nurses. Hope was an emotion that was identified among nurses during breaking point conversations. Conclusion: Nurses can in relation to the discussion around breaking point get stuck in the middle between patients and the physicians which has both advantages and disadvantages. Nurses can through their work with the patient establish a relationship that involves confidence between the patient and the nurse. This relationship can benefit everyone involved in the breaking point discussion. Nurses are concerned about depriving their patients of hope when talking about their worsening prognosis.

Background: Psychological problems are common in cancer patients. For the purpose of planning psycho-oncological interventions and services tailored to the specific needs of different cancer patient populations, it is necessary to know to what extent psychological problems meet the criteria of mental disorders. The purpose of this study was to estimate the 12-month and lifetime prevalence rates of mental disorders in cancer patients. Methods: A representative sample of patients with different tumour entities and tumour stages (n = 2,141) in outpatient, inpatient and rehabilitation settings underwent the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). Results: The overall 12-month prevalence for any mental disorder was 39.4% (95% CI: 37.3–41.5), that for anxiety disorders was 15.8% (95% CI: 14.4–17.4), 12.5% (95% CI: 11.3–14.0) for mood disorders, 9.5% (95% CI: 8.3–10.9) for somatoform disorders, 7.3% (95% CI: 6.2–8.5) for nicotine dependence, 3.7% (95% CI: 3.0–4.6) for disorders due to general medical condition, and 1.1% (95% CI: 0.7–1.6) for alcohol abuse or dependence. Lifetime prevalence for any mental disorder was 56.3% (95% CI 54.1–58.6), that for anxiety disorders was 24.1% (95% CI: 22.3–25.9), 20.5% (95% CI: 18.9–22.3) for mood disorders, 19.9% (95% CI: 18.3–21.7) for somatoform disorders, 18.2% (95% CI: 16.6–20.0) for nicotine dependence, 6.4% (95% CI: 5.4–7.6) for alcohol abuse or dependence, 4.6% (95% CI: 3.8–5.6) for disorders due to general medical condition, and 0.2% (95% CI: 0.1–0.6) for eating disorders. Conclusions: Mental disorders are highly prevalent in cancer patients, indicating the need for provision of continuous psycho-oncological support from inpatient to outpatient care, leading to an appropriate allocation of direct personnel and other resources.

Please read the abstract in the section 00front of this document Please cite as follows: Opperman JA, 2002, Die emosionele belewenis van 'n beenmurgoorplanting : 'n Maatskaplike Werk perspektief, MA dissertation, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd- 07252005-110248/ > / Dissertation (MA (Social Work))--University of Pretoria, 2002. / Social Work and Criminology / MA (Social Work) / unrestricted

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13222号 / 論医博第2169号 / 新制||医||1033(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 松村 由美, 教授 森田 智視 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Existing research on health disparities in breast cancer is heavily focused on outcomes for poor or low-income women. Little is known about the experience of privately insured Black breast cancer patients that have moderate to high SES. As a result, the present study was conducted to learn more about their experiences. It examines differences in physician prescribing of two breast cancer pain treatments, peripheral nerve block (PNB) and opioids, for Black and White women with like levels of health insurance coverage and socioeconomic status (SES). Three specific questions are addressed: 1. What, if any, race-based disparities exist in usage of PNBs at time of total mastectomy? 2. What, if any, race based disparities exist in the prescription of opioids for postoperative pain following total mastectomy? 3. What, if any, changes have occurred in the frequency of orders placed for PNBs and prescription opioids over time, to treat postoperative pain resulting from mastectomy? A cross-sectional designed was used relying on an existing national dataset, Optum Clinformatics Data Mart. The study period was January 1, 2012, through December 31, 2019. Study results revealed that while moderate to higher SES Black women have equitable access to PNB and opioids - a kind of shield from long established physician bias against Black women – this protection is quite porous. They still do not have open and ready access to PNB as a more advanced pain treatment. Nor do they have assurance that they are protected from the overprescribing of opioids, a class of drugs with serious and well-known safety risks. Therefore, on the surface, it appears that equity and racial inclusion are hallmarks of physician prescribing of postoperative breast cancer pain treatment. However, further interrogation reveals that ‘separate and somewhat equal’ is a more accurate characterization of their prescribing practices, based both on race and SES.

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study is to advance theoretical understanding of how an adolescent with incurable cancer prepares for end-of-life (EOL). A theoretical model was developed to link awareness, acceptance, and willingness to take action to EOL preparedness (knowledge about EOL, acknowledgement of grief and emotion, identification of the meaning of death and spirituality, and conceptualization of personal plan) and communication about EOL preferences and priorities; and to determine impact on quality of life (QOL). Method: Case study research method was used to guide data collection and analyses on two adolescent cases across two time points. The theoretically-based model was developed prior to data collection and based on research studies conducted in adult and pediatric EOL literature. Multiple sources of data were collected and triangulated to assess relationships between qualitative and quantitative data. Through an iterative process of pattern matching, data were compared to constructs in the conceptual model for both across cases, and across time. Results: Results indicate awareness (cognitive recognition of incurable prognosis) and acceptance (emotional acknowledgement of incurable prognosis) are both fluid concepts and varied within each time point and across time. Contextual factors (demographic, environmental, personal, and social support characteristics) influenced awareness, EOL preparedness, and willingness to take action; and directly influenced QOL. Level of awareness influenced involvement in EOL preparedness. Information preference and willingness to engage in discussions regarding knowledge about EOL were incongruent with actual knowledge about EOL. Adolescents demonstrated a willingness to discuss potential disease progression in order to conceptualize an EOL advanced care plan regardless of emotional acceptance of incurable prognosis. In contrast, acknowledgment of grief and emotions, and identification of the meaning of death and spirituality were related to acceptance of incurable prognosis and further determined conceptualization of immediate EOL priorities. Social constraint or lack of ability to discuss prognosis, was identified as an important construct that influenced communications. Implications: This study provides increased theoretical understanding of how adolescents living with advanced cancer confront EOL. Insight led to theory modification and expansion which may serve as a guide for future research to assist clinicians caring for adolescents living with incurable cancer. Victoria L. Champion, PhD, RN, FAAN, Chair

Bakgrund: Cancer kan avsevärt påverka en individs sexuella hälsa på olika nivåer; biologiskt, psykologiskt och socialt. World Health Organization (WHO) definierar sexuell hälsa som ett välbefinnande som omfattar fysiska, emotionella, mentala och sociala aspekter av sexualiteten. Sjuksköterskans kärnkompetenser inkluderar personcentrerad omvårdnad, vilket innebär att se hela individen och beakta deras andliga, existentiella, sociala och psykiska behov lika mycket som de fysiska. Att inte inkludera sexuell hälsa kan leda till en bristfällig helhetsbild av patientens behov. Patienter känner ett behov av att diskutera sin sexuella hälsa och framhåller bristen på initiativ från sjuksköterskor att inleda dessa samtal. Det råder en tvåvägs-tabu kring sexuell hälsa vilket försvårar kommunikationen. Genom att förstå sjuksköterskans perspektiv kan denna studie bidra med insikter som kan förbättra vårdpraxis och utbildning inom detta område. Syfte: Studien syftade till att undersöka sjuksköterskors upplevelse av samtal med cancerpatienter. Metod: Litteraturstudie som sammanställt och analyserat resultat från empiriska studier med kvalitativ ansats. Vetenskapliga artiklar inhämtades från CINAHL, en databas med inriktning på omvårdnad och medicin. Studien baseras på semistrukturerade intervjuer, publicerade mellan år 2000–2023, utan geografisk avgränsning. Resultaten: Vid analysen identifierades tre olika huvudkategorier av betydelse för sjuksköterskans upplevelse av samtal om sexuell hälsa; Individuella faktorer, Sociala faktorer och Organisatoriska kulturer och barriärer. Därifrån utformades ytterligare åtta subkategorier. Konklusion: Sjuksköterskor upplever diverse hinder i kommunikationen om sexuell hälsa med cancerpatienter. Ämnet upplevs pinsamt och känsligt att röra vid. Det finns en osäkerhet i hur man initierar samtalet, dock uppger vissa sjuksköterskor samtalsstrategier som normaliserar samtalet vilket hjälper patienter att våga öppna upp sig. Patientens personliga egenskaper, såsom ålder, könstillhörighet, civilstånd, sexuell läggning och språk, påverkade sjuksköterskans tillvägagångssätt i samtalet och om samtalet ens skulle äga rum. Organisatoriska hinder som tidsbrist och överdriven byråkrati skapar en diskrepans mellan förväntningar och möjligheter inom vården.

This paper uses a qualitative approach to explore quantitative assessment tools and their use in art therapy research with patients with cancer. An archival method was used to gather articles on cancer research which were compiled from peer-reviewed journal articles available online. The author used a systematic analysis to select articles that met the specific research criteria of working with cancer patients in a medical setting, included the implementation of art therapy, and the administration of a pre- and post-test. Twenty-two quantitative assessments fit these criteria. Further exploration was conducted on the five most common assessment tools. These five assessments were further analyzed for emergent themes and characteristics. These common traits were that all of the assessments were self-report questionnaires, four out of five were Likert scales, the assessments were chosen for their accessibility, and many of the research studies were not accessible to a diverse population. It was concluded that these quantitative assessment tools are helpful in art therapy as they contribute towards creating quantifiable results in the research. It may be useful to implement these assessment tools in further art therapy research with cancer patients in order for art therapy to be more frequently employed in medical settings.

L'hormonothérapie (HTX) est un traitement couramment administré chez les hommes atteints d'un cancer de la prostate et qui peut avoir des répercussions sur leur bien-être émotionnel, en incluant une occurrence possible de dépression. Les études qui ont évalué la relation entre l'HTX et le développement de la dépression chez ces patients ont tantôt démontré une telle association et tantôt non. Une explication avancée serait que le cancer de la prostate et ses traitements puissent mener à des altérations dans les niveaux de testosterone et de Cortisol pouvant être associées à la dépression. Cependant, ces études comportaient plusieurs limites méthodologiques dont l'utilisation d'un devis de recherche transversal et l'absence d'un groupe contrôle approprié. La présente thèse compte deux articles empiriques issus de la même étude longitudinale menée auprès de 60 participants traités par radiothérapie seule (n = 32) ou combinée à de l'HTX (n = 28) évalués avant le début des traitements et à sept autres reprises sur une période de 16 mois. Cette thèse visait à répondre aux objectifs principaux suivants : (1) vérifier si l'introduction de l'HTX (et le retrait) de l'HTX étaient associés à une augmentation (et une diminution) des troubles dépressifs et de la sévérité de la dépression; (2) documenter l'évolution des niveaux sanguins de testosterone et de Cortisol dans chacun des groupes; et (3) évaluer la relation entre les niveaux hormonaux de testosterone et de Cortisol et la dépression. Globalement, les résultats obtenus suggèrent que l'HTX a eu un impact mineur sur le développement et la résolution de la dépression chez ces hommes. Par ailleurs, les niveaux de testosterone et de Cortisol ont diminué de façon significative dans les deux groupes de traitement. Néanmoins, la baisse de testosterone dans le groupe qui recevait de l'HTX n'était pas associée significativement à la dépression alors que des scores plus élevés de Cortisol étaient significativement reliés à des niveaux plus importants de dépression, et ce, dans les deux groupes de traitement. Ces résultats contribuent au développement d'une meilleure compréhension de la relation entre les traitements oncologiques, les changements hormonaux et la dépression. Il apparaît maintenant important d'investiguer davantage les différents mécanismes hormonaux et psychologiques sous-jacents au développement de la dépression chez cette population.

Jusqu'à ce jour, très peu de travaux empiriques ont évalué les aspects psychologiques associés au cancer de la prostate. Cette étude transversale vise donc à comparer la prévalence des difficultés psychologiques (i.e., anxiété et dépression), psychophysiologiques (i.e., insomnie, fatigue) et des difficultés sexuelles en fonction de trois modalités de traitement pour le cancer de la prostate (radiothérapie, curiethérapie et prostatectomie radicale) et du temps écoulé depuis le diagnostic. L'échantillon est composé de 861 hommes ayant complété une batterie de questionnaires. Les résultats démontrent que les difficultés sexuelles constituent le problème le plus fréquent suivies de l'insomnie et de l'anxiété. De plus, les symptômes psychologiques et psychophysiologiques restent relativement stables dans le temps alors que les symptômes physiques tendent à se résorber. Enfin, les patients ayant reçu de la radiothérapie ont un risque plus élevé de souffrir d'humeur dépressive, de détresse psychologique globale et de fatigue comparativement aux patients n'ayant pas reçu ce traitement.