Carmen WH Chan

Previous literatures on young adult survivors of childhood cancer show inconsistent findings with regards to their psychological distress and health-related quality of life (HRQOL). Much of the available data focus on negative patient outcomes following cancer treatments prescribed from 1970 to 1990. In the present study, HRQOL and psychological distress of young adult survivors in Hong Kong was examined. It focused on subjects who had received cancer treatments prescribed in the last two decades. A structured telephone survey was conducted with 614 eligible survivors and 208 sibling controls in Hong Kong. The survivors reported significantly lower mean scores in physical role and functioning, whereas their mental, social, and psychological well-being was similar to that of their sibling controls. Being female, older age, longer survival time, and specific cancer diagnoses were the factors associated with poorer physical and mental adaptation. HRQOL was negatively correlated with ps...

Objectives
The review aims to identify available evidence related to the effects of dignity therapy on dignity, psychological well‐being, and quality of life (QoL) among patients with cancer under palliative care.

Methods
Thirteen electronic databases were searched for published articles in English or Chinese from inception to May 2018. Methodological rigour was assessed through the Joanna Briggs Institute (JBI) checklist for randomised controlled trials and quasi‐experimental studies. Sufficient data from four trials were statistically pooled with Review Manager; otherwise, a narrative summary was used.

Results
Ten articles describing eight studies met the selection criteria and were included in the review. None of the studies met all JBI checklist criteria. Meta‐analysis results revealed that dignity therapy significantly improved dignity‐related distress in existential distress domain (mean differences [MD]: −0.26, 95% CI, −0.50 to −0.02, .03) and social support domain (MD: −0.23, 95% CI, −0.39 to −0.07, .004), but nonsignificant improved depression and anxiety. Narrative summaries indicated that dignity therapy exerted positive effects on patients' dignity, psychological well‐being, and QoL.

Conclusions
Dignity therapy is a promising approach to improve psychological well‐being among patients with cancer under palliative care. However, the effects of dignity therapy on dignity and QoL are inconsistent. Further extensive studies should measure the impact of dignity therapy through qualitative and quantitative approaches to establish outcomes in psychological well‐being. Studies with sensitivity to the cultural context within which dignity therapy applied should be conducted to explore its effects on patients with cancer at the early stages of illness trajectory.

Advance directives (AD) can be used for the communication of healthcare decisions that may be required in the future when individuals have lost their capacity to make such decisions. The aim of this study is to examine the prevalence, perception, and predictors of AD completion in the Hong Kong general population with a diverse culture. Through random-digit dialing, a population-based telephone survey was conducted with participants aged 18 or above. Socio-demographic characteristics, self-perception and health status, prevalence of AD, and perceptions related to AD were assessed. The acceptance on completing AD was measured by the summed score on the level of agreement in making AD. In total, 2002 participants completed the survey, with only 0.5% having made AD. However, the majority of those who had heard about AD had made or intended to make AD (80.2%). Multivariable regression analysis showed that being religious, being optimistic, and agreeing to respect patients’ wishes are independently associated with higher AD acceptance. Being a student is associated with lower AD acceptance. The extremely low completion rate of AD, but high acceptance of AD urges for more active promotion of AD to the public and education on end-of-life care among university students.

Postoperative ileus is a common and often life-threatening gastrointestinal complication with few management methods available for patients. Integrating acupressure into perioperative care promises to bring benefits into preventing postoperative ileus. This systematic review and meta-analysis aims to evaluate the efficacy of acupressure in identifying the signs and symptoms of postoperative ileus among patients undergoing abdominal surgery. The MEDLINE, EMBASE, Web of Science, CINAHL, China Journal Net and Wanfang databases were searched for high-quality RCTs using keywords such as acupressure, postoperative ileus, abdominal surgery, etc. A total of six studies ([Formula: see text]) were included in this review and meta-analysis. The quality of the literature was found to be uniformly moderate by the Effective Public Health Practice Project (EPHPP) assessment tool. The results of meta-analyses revealed that acupressure could significantly reduce risks for postoperative nausea (OR 0.52, 95% CI 0.39-0.70, [Formula: see text]) and vomiting (OR 0.54, 95% CI 0.39-0.75, [Formula: see text]) compared with the control group, without significant heterogeneity among studies. Meta-analysis of the need for antiemetic drugs suggested that the OR was 0.39 (95% CI 0.20-0.78, [Formula: see text]) with significant heterogeneity among studies. Our results suggested that acupressure might be effective in reducing the incidence of postoperative nausea and vomiting and the need for antiemetic drugs among patients undergoing abdominal surgery. Considering the substantial risk of bias in the articles included, future high-quality RCTs with a rigorous methodology are desirable to provide solid evidence. Furthermore, other signs and symptoms of postoperative ileus should be explored in future.

Under-screening may increase the risk of cervical cancer in middle-aged women. This study aimed to investigate cervical cancer screening behaviour and its predictors among women aged 50 years or above. A population-based sample of 959 women was recruited by telephone from domestic households in Hong Kong, using random methods, and a structured questionnaire developed to survey participants. Multivariable logistic regressions were performed to examine the factors independently associated with cervical screening behaviour. Nearly half the sample (48%) had never had a cervical smear test. Multivariable analyses showed that age, educational level, marital status, family history of cancer, smoking status, use of complementary therapy, recommendation from health professionals, and believing that regular visits to a doctor or a Chinese herbalist were good for their health were predictors of cervical screening behaviour. Misconceptions concerned with menopause may reduce women’s perceived susceptibility to cervical cancer, especially if they are 50 or above, and exert a negative effect on their screening behaviour. Healthcare professionals should actively approach these high-risk groups–older unmarried women, smokers, those less educated and who are generally not much concerned with their health.

Globally, colorectal cancer (CRC) is the third most common form of cancer. The development of effective chemopreventive strategies to reduce CRC incidence is therefore of paramount importance. Over the past decade, research has indicated the potential of rice bran, a byproduct of rice milling, in CRC chemoprevention. This was recently suggested to be partly attributable to modification in the composition of intestinal microbiota when rice bran was ingested. Indeed, previous studies have reported changes in the population size of certain bacterial species, or microbial dysbiosis, in the intestines of CRC patients and animal models. Rice bran intake was shown to reverse such changes through the manipulation of the population of health-promoting bacteria in the intestine. The present review first provides an overview of evidence on the link between microbial dysbiosis and CRC carcinogenesis and describes the molecular events associated with that link. Thereafter, there is a summary of current data on the effect of rice bran intake on the composition of intestinal microbiota in human and animal models. The article also highlights the need for further studies on the inter-relationship between rice bran intake, the composition of intestinal microbiota and CRC prevention.

Eczema is a common skin condition that impairs children's daily life activities and quality of life. Previous research shows that gut microbiome composition plays an important role in the development of eczema. The present review summarizes evidence on environmental factors related to altered gut microbiota in children with eczema. We searched Medline, PubMed, Embase, and the Cochrane database of Systematic Reviews through October 2015. The search strategy focused on articles published in peer-reviewed, English-language journals with no publication year limit. Only original studies and review articles that reported environmental factors on gut microbiome specific to eczema were included in this review. We selected six studies (total 1990 participants) for full review and identified that the composition of gut microbiota specific to eczema could be influenced by the following environmental factors: length of gestation, mode of delivery, type of feeding, method of treatment, number of older siblings, and other lifestyle factors. There has been inconsistent empirical evidence as to the modulatory effects of gut microbiota on immunological functions in children with eczema. Further research on the environmental-host-microbial interaction is needed to develop a strong base of knowledge for the development and implementation of prevention strategies and policies for eczema.

Hong Kong has introduced a senior intake admission scheme which is similar to the US model of credit transfer from community college programmes to university bachelor programmes. The study aimed to assess the outcomes, in terms of generic capabilities, of introducing a senior intake articulation scheme to a bachelor of nursing curriculum in Hong Kong. One hundred and seventy-four nursing students completed and returned the Student Engagement Questionnaire. The senior intake students reported significantly higher scores in creative thinking, active learning, teaching for understanding, feedback to assist learning, and relationship between teachers and students than the mainstream students. Self-managed learning and relationship with other students were positively and significantly related to academic performance. The senior intake students appeared to adjust well in university education. Greater effort should be made to nurture their relationship with other students and a review of the denseness of the mainstream curriculum is warranted.

Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients’ ability to participate in self-management.

Purpose: To examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery.

Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups.

Results: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%.

Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

This study aimed to understand information needs of patients with heart failure from the perspectives of health professionals. The exploratory qualitative study was conducted in 2011. Face-to-face interviews were performed to collect data from 24 health professionals. Data were evaluated through content analysis. Information identified by health professionals as essential for patients' learning included risk factors and symptom management, prognosis, medication and lifestyle adjustment. Factors related to both patients and health professionals were recognized as barriers to information acquisition. Moreover, health professionals provided several recommendations for improving the health condition of patients. Information needs identified by health professionals, as well as actual needs expressed by patients, can be incorporated in health education. The effectiveness of educating patients can be improved by addressing needs perceived by both patients and health professionals.

Lung cancer is ranked first worldwide as one of the main cancers in terms of prevalence and mortality rate. The development of effective treatment strategies against lung cancer is therefore of paramount importance. Traditionally, chemotherapy was employed in the treatment of various cancers. However, the non-specific nature of the actions of chemotherapeutic drugs and the potential for tumors to develop resistance to these drugs may render chemotherapy a less favorable option for cancer treatment. Immunotherapy provides an alternative strategy for this purpose. It involves the utilization of the immune system and the immune effector cells to elicit an immune response to the tumors, thereby eliminating them. Strategies include the administration of pro-inflammatory cytokines for immune stimulation, the removal of immunological checkpoints using monoclonal antibodies, and the use of cancer vaccines to enhance immunity against tumors. This article summarizes the above strategies, highlights the reasons why immunotherapy is superior to chemotherapy for the purpose of tumor removal, and reviews the recent clinical studies comparing the clinical outcomes of patients undergoing immunotherapy and chemotherapy. The article also describes advances in immunotherapeutic strategies for the treatment of lung cancer.

Background: Chinese women rarely undergo regular cervical screening. Women’s decisions about cervical screening may be influenced by their perception of the risk of cervical cancer. Therefore, understanding how women perceive the risk of cervical cancer, how personal risk factors are interpreted, and the influence of cultural issues on cervical screening behavior is important.

Objective: The aim of this study is to understand cervical cancer risk perception and the role of personal risk factors as they influence screening behavior among Chinese women.

Method: An exploratory qualitative research design was used. We conducted semistructured, in-depth interviews of 27 women in Changsha, a medium-size city in Hunan province, China.

Results: Participants identified that cervical cancer had serious consequences, but they distanced themselves psychologically from the disease because they felt that “cervical cancer is a shameful and deadly disease.” Although women identified some of the risk factors for the disease, they had little specific knowledge of human papillomavirus infection, its association with cervical cancer, and the importance of cervical screening.

Conclusion: This study contributes new knowledge to the understanding of cervical screening behavior within a specific social and cultural context. Better efforts should be made to educate Chinese women on the risk of cervical cancer and emphasize that effective cancer treatments are available and that there is a good chance of survival.

Implications for Practice: Nurses working with Chinese women should ensure that the information they provide is culturally sensitive, particularly by acknowledging the normative beliefs of this population group.

Colorectal cancer (CRC) is a major health problem in Asia. It has been reported that the Chinese are more susceptible to CRC than many other ethnic groups. Screening for CRC is a cost-effective prevention and control strategy; however, the screening rates among the Chinese are sub-optimal. We conducted a review to identify the factors associated with CRC screening participation among Chinese people. Twenty-two studies that examined the factors related to CRC screening behaviors among the Chinese were identified through five databases. Seven factors were consistently reported to influence CRC screening behaviors in at least one of the studies: socio-demographic characteristics (educational level, health insurance, and knowledge about CRC and its screening); psychological factors (perceived severity of CRC, susceptibility of having CRC, and barriers to screening); and contact with medical provider (physician recommendation). The evidence base for many of these relationships is quite limited. Furthermore, the associations of many factors, including age, gender, income, cancer worry/fear, and self-efficacy with CRC screening behaviors, were mixed or inconsistent across these studies, thereby indicating that more studies are needed in this area.

Purpose

The prevalence of colorectal cancer (CRC) among older people is high. Screening for CRC presents a cost-effective secondary prevention and control strategy which results in a significant reduction in mortality. This study aims to describe the prevalence of CRC screening and examine its risk factors among Chinese community-dwelling older people guided by a comprehensive model combining Health Belief Model and Extended Parallel Processing Model.

Methods

A descriptive correlational study was conducted. A convenience sample of 240 community-dwelling adults aged ≥60 was recruited in May–July in 2012 in Hong Kong. Participants were asked to complete a questionnaire which collected information on demographic variables, CRC-related psychosocial variables and whether they had a CRC screening in the past 10 years.

Results

Among the participants, 25.4% reported having a CRC screening test. Results of logistic regression analyses indicated that participants with a higher level in cue to action, and lower perceived knowledge barriers and severity-fear were significantly associated with participation in CRC screening. But there were no significant associations between fatalism and cancer fear with screening.

Conclusions

The prevalence of CRC screening was low in Hong Kong Chinese community-dwelling elders. A number of modifiable factors associated with CRC screening were identified which provides specific targets for interventions. This study also adds to the knowledge regarding the associations between fatalism and fear with CRC screening behaviors among Chinese older people.

Purpose
The purpose of the study was to translate the M.D. Anderson Symptom Inventory-Heart Failure (MDASI-HF), a specific instrument to assess symptoms in cancer patients with concurrent heart failure (HF), into Mandarin Chinese and to examine its psychometric properties in Chinese cancer patients.

Design
A translation and psychometric evaluation design was used.

Methods
The translation of the MDASI-HF into Mandarin Chinese followed Brislin's model with the four steps: translation, monolingual assessment, backward translation, and comparison. The Chinese version MDASI-HF was tested among 135 cancer patients with concurrent HF from a cancer hospital in Tianjin, China. Psychometric properties of content validity, internal consistency, test–retest reliability, concurrent validity, and sensitivity of the instrument were evaluated.

Findings
The Cronbach's α was .913 for the core items, .835 for the HF items, and .897 for the interference items. The test–retest reliability was satisfactory with intra-class coefficients >.9 and content validity index was .94. The Chinese version MDASI-HF was significantly correlated with the Eastern Cooperative Oncology Group performance grade (correlation coefficients .456–.600) and the New York Heart Association classification (correlation coefficients .477–.631), indicating the established concurrent validity of the translated instrument.

Conclusions
The Chinese version MDASI-HF is a valid and reliable instrument to assess the symptoms of Chinese cancer patients with concurrent HF.

Clinical Relevance
Symptom assessment and management play important roles in cancer rehabilitation. The Chinese version MDASI-HF can assist appropriate and timely symptom assessment in cancer patients with concurrent HF and can promote communication between health care professionals and patients. Based on the assessment, the rehabilitation team could provide effective symptom management, evaluate the effectiveness of interventions, and improve patients' quality of life.

Background: Managing symptom clusters instead of single symptoms could be more beneficial in cancer care. Psychoeducational intervention (PEI) has been highlighted as a promising symptom intervention, but the effect of PEI in the management of cancer symptom clusters remains unknown.

Objective: The aim of this study was to evaluate the effectiveness of PEI on managing symptom clusters in patients with cancer.

Methods: Six databases were searched, together with hand searching, to identify eligible randomized controlled trials from the year 2001 to July 2014. Data selection, quality appraisal of studies, and data extraction were conducted independently by 2 reviewers. Data were synthesized by use of a systematic narrative approach, and meta-analysis was conducted when this was possible.

Results: Four eligible studies involving 343 cancer patients were included in the review. The methodological quality of the studies was generally fair. Symptom clusters seemed to improve with the provision of PEI. Meta-analysis shows significant improvement in functional performance.

Conclusions: The evidence that PEI could alleviate cancer symptom clusters is encouraging but inconclusive in this review. Future well-designed investigations testing some commonly used PEI such as progressive muscle relaxation and patient education on various types of cancer symptom clusters are warranted.

Implications for Practice: This review suggests a promising role of PEI in managing cancer symptom clusters. Healthcare providers should increase their awareness of managing symptom clusters using PEI to yield more effective and efficient cancer care.

Background:
Colorectal cancer (CRC) is one of the most common cancers. This study aimed to compare the uptake of CRC testing in the general public and in ethnic minorities in Hong Kong.

Materials and Methods:
This cross-sectional survey covered 2,327 South Asian and Chinese adults aged over 50, recruited from two separate studies. A structured questionnaires were administered by research staff over the telephone or in faceto-face interviews.

Results:
The uptake rate of CRC testing among South Asians was significantly lower than that of the general population in Hong Kong. Factors associated with the uptake rate were health professional’s recommendation, perception of regular visits to doctor, use of complementary therapy, ethnicity, perceived susceptibility to cancer, presence of chronic illness, and education level. In addition, a significant interaction (p<0.05) between ethnicity and health professionals’ recommendations was found, after adjustment for the main independent factors identified.

Conclusions:
Older people with lower educational attainment, without chronic illness and those have lower perceived susceptibility to cancer may be targeted for CRC testing promotion in the society. In addition, health professionals can play a highly influential role in promoting such testing, particularly among ethnic minorities.

AIM: To evaluate existing evidence for the association between different type of brassiere exposures and the risk of breast cancer.

METHODS: Ovid Medline, CINAHL, Cochrane Data Base of Systematic Reviews, Pubmed, Scopus, Proquest, Sciencedirect, Wiley Online Library, WanFang Data, Hong Kong Index to Chinese Periodicals, China Journal Net, Chinese Medical Current Contents, Chinese Biomedical Literature Database, China Academic Journals Full-Text database, Taiwan Electronic Periodical Services and HyRead; reference lists of published studies; original research studies published in English or Chinese examining the association between type and duration of brassiere-wearing and breast cancer risk. Data were abstracted by a first reviewer and verified by a second. Study quality was rated according to predefined criteria. “Fair” or “good” quality studies were included. Results were summarised by meta-analysis whenever adequate material was available.

RESULTS: Twelve case-control studies were included in the review. Meta-analysis showed brassiere wearing during sleep was associated with a two times of increased odds.

CONCLUSION: The present review demonstrates insufficient evidence to establish a positive association between the duration and type of brassiere wearing and breast cancer. Further research is essential; specifically, a large-scale epidemiological study of a better design is needed to examine the association between various forms of brassiere exposure in detail and breast cancer risk, with adequate control of confounding variables.

BACKGROUND:
Psychoeducational interventions are recommended for use with clinical gynecological cancer patients to improve their patient care outcomes. However, the evidence of their effectiveness is far from conclusive.

OBJECTIVE:
The objective of this study was to identify the best available research evidence related to the effects of psychoeducational interventions on sexual functioning, quality of life, and psychological outcomes in gynecological cancer patients.

METHODS:
A systematic search was conducted to identify English and Chinese articles from the inception of the databases to April 2012 and included 13 English databases and 7 Chinese databases. Gray literature or unpublished studies were also searched.

RESULTS:
A total of 11 studies involving 975 gynecological cancer patients were included in the review. Meta-analysis results for 4 comparable studies indicated that psychoeducational interventions were effective in treating depressive symptoms among gynecological cancer patients (standardized mean difference = -0.80; 95% confidence interval, -1.05 to -0.54), whereas information provision significantly improved the mental aspect of quality of life (standardized mean difference = -0.41; 95% confidence interval, -0.74 to -0.08). With regard to sexual functioning, psychoeducational interventions appeared to have benefits in improving the sexual life of patients.

CONCLUSIONS:
Findings confirm the effectiveness of psychoeducational interventions on depressive symptoms and mental aspect of the quality of life in gynecological cancer patients.

IMPLICATIONS FOR PRACTICE:
The authors discuss the implications of review findings for the effective design of psychoeducational interventions including components, provider, provision time frame, and duration for clinical practice, as well as psychoeducational intervention research.

PURPOSE:
To examine the potential value of a creative art-based activity as a caring modality for promoting holistic well-being among chronic stroke patients, and to explore the feelings and meanings that stroke patients derived from their experience in leisure art-based creative engagement (LACE).

DESIGN:
Qualitative design.

METHOD:
Participants were recruited through purposive and snowball sampling. Individual semi-structured interviews were conducted. Qualitative content analysis was performed. The design and implementation of LACE was guided by Watson's theory of caring.

FINDINGS:
Twenty-four participants completed the study. Four themes emerged from participants' account of experiences with the LACE: (1) appreciation of opportunities, (2) appreciation of self, (3) appreciation of others, and (4) appreciation of life.

CONCLUSION:
From the perspective of the participants, engaging in LACE enhances their sense of enjoyment and self-expression. Furthermore, they perceived LACE as an affirmation of life and an empowering process strengthening their connection and appreciation with the self and others.

CLINICAL RELEVANCE:
This study adds evidence to existing literature on Watson's theory-guided design and implementation of caring initiatives for community rehabilitation and has laid the groundwork for developing further evidence-based research in leisure art-based caring occasions for promoting holistic well-being in stroke rehabilitation.

PURPOSE:
Childhood cancer patients often suffer from Chemotheraphy-Associated Nausea and Vomiting (CANV). To alleviate CANV, relaxation techniques and patient education were combined to develop a multidimensional psychoeducational intervention package. The aim of this pilot study was to assess the feasibility of the two major components, namely, (1) relaxation, and (2) patient education, of a psychoeducational intervention, prior to the commencement of the main study.

METHODS:
A pre-test-post-test control group design was adopted. Twenty patients were allocated equally to the relaxation group (10 participants) and to the educational group (10 participants). Twenty historical matched control cases were identified to form the control groups. Besides, a process evaluation was adopted to assess the feasibility of the study.

RESULTS:
In relation to episodes of vomiting on day 3, a significant difference was detected from the results (X(2) = 8.54, p = 0.036), in that fewer patients in the relaxation group experienced vomiting. A significant difference was not found in both the use of antiemetics and body weight between the groups. All subjects in the intervention groups adhered to the intervention and completed the questionnaire without difficulty. Patients and parents perceived the intervention as being moderately useful.

CONCLUSIONS:
Although the beneficial effect of relaxation and education in alleviating CANV was not well-supported statistically, the findings from descriptive data suggest that these interventions promoted the intake of antiemetics as a preventive method. Both interventions and instruments were well-received by the patients and also by their parents.

PURPOSE:
The aim of the study was to test a hypothesised model that supportive care needs (SCNs) have a mediating effect on the relationship between characteristics of (Chinese) head and neck cancer (HNC) survivors and their quality of life (QoL).

METHODS:
A total of 285 Chinese HNC survivors who had finished cancer treatment 1 year earlier completed a self-reported survey covering demographic and clinical characteristics, the Chinese version of the Short-Form Supportive Care Needs Questionnaire (SCNS-SF34-C), the supplementary module of access to healthcare and ancillary support services and the Functional Assessment of Cancer Therapy for Head and Neck Cancer (FACT-H&N).

RESULTS:
The final path model showed that optimism, educational level, any coexisting disease, number of somatic symptoms, household income, eating ability, support from others, whether the cancer is under control or not and travelling time from home to hospital have direct or indirect effects, or both, on the QoL of HNC survivors, by way of unmet SCNs in the psychological, physical and/or health system information domains, which account for 64 % of the variance in the total FACT-H&N score.

CONCLUSIONS:
Our study demonstrated the mediating effects of SCNs in the association between HNC survivors and their QoL. Early needs assessment may help healthcare professionals to identify the actual needs of these survivors, and providing the information that HNC survivors want is a significant factor in meeting their psychological needs and thereby improving their overall QoL.

Diagnosed with cancer is a traumatic event; it does not only affect the diagnosed patients, but also their caregivers. It brings along negative impacts on biopsychosocial health to the caregivers. Supportive interventions are essential for the caregivers to go through the cancer trajectory. In the past, interventions were being delivered in either face-to-face format or delivering written documents. Although Internet becomes a popular platform for delivering interventions given its substantial growth in usage, the effectiveness of this mode of intervention delivery is unclear. The aim of this review is to review existing literatures regarding efficacy of web-based interventions in psychological outcomes of cancer caregivers. A Literature search was performed in December 2012 from seven databases, including, Ovid MEDLINE, EMBASE, PsycINFO, CINHAL, ERIC, British Nursing Index and EBM Reviews. The following keywords were used in the search but were not limited to “paediatric”, “parent”, “caregiver”, “cancer”, “web-based”, and “psycho education”. Totally 4668 citations were identified, after excluding the duplicated and irrelevant citations; finally six studies were included in this review. A review of the literatures identified that the web-based interventions including either online support group only or a combination of informational website and online support group significantly improved coping skills, in a way reduced anxiety, stress, depression, burden, as well as negative mood and perceived bonding in cancer caregivers. It is concluded that a web-based format as a potential platform for delivering intervention to the caregivers of cancer patients for its unique advantage of easy accessibility, and no geographic or time barriers.

Objectives. To translate the Attitudes of Older People to End of Life
Issues (AEOLI) questionnaire into a Chinese version and to establish
its semantic equivalence, content equivalence, face validity, feasibility,
and reliability.

Methods. The original AEOLI questionnaire was translated into
Chinese using forward and backward translation based on the Brislin
model. Semantic equivalence, content equivalence, face validity,
reliability, and feasibility were established.

Results. The mean equivalence rating of the questionnaire was 90%,
indicating that the Chinese version was a correct reflection of the
English version. The content validity index was 0.83 indicating a high
degree of agreement among the experts about its relevance. Face
validity was assessed in 3 older persons living in nursing homes; the
content of the Chinese AEOLI questionnaire reflected the concepts
that the researcher intended to measure. The test-retest reliability was
conducted in 50 older persons living in nursing homes; the weighted
Kappa statistics were 0.61 to 1.00 (p<0.001), indicating moderate-toexcellent concordance.

Conclusion. The Chinese AEOLI questionnaire is a useful tool to
examine the attitudes of older people towards end-of-life issues in the
Chinese population.

Purpose
Colorectal cancer (CRC) is the most common type of cancer in both men and women, and older adults are more susceptible to this disease. Previous studies suggest that cancer fear may be a key predictor of participation in cancer screening. Yet there is a lack of validated measuring tools of fear relating to CRC for the Chinese older adult population. This study aims to test the psychometric properties of the Chinese version of the Colorectal Cancer Fear Scale (CRCFS), adapting from the Champion's Breast Cancer Fear Scale.

Methods
The CRCFS was developed by altering the wording ‘breast cancer’ to ‘colorectal cancer’. Interviewer-administered surveys were carried out with a convenience sample of 250 community-dwelling adults aged at least 60 years old without a history of cancer. A subsample of 40 participants completed the scale again at one-month.

Results
Confirmatory factor analysis revealed that the one-factor model provided excellent fits to the overall data, and two randomly split samples. Cronbach's alpha of the scale was 0.95 and test-retest reliability was 0.52. Positive and significant correlations of CRC Cancer Fear with CRC-related susceptibility, severity and barriers were observed. A non-linear relationship with benefits was found.

Conclusions
The findings provide support for the psychometric properties of a Chinese version of the Champion Cancer Fear with an adaption to CRC in a sample of community dwelling older Chinese adults. The scale provides a useful tool to assess CRC-related fear, which interventions should address in order to improve screening rates among older Chinese adults.

This study aims to explore the roles and responsibilities of seven newly appointed nurse consultants (NCs) in various clinical specialties in Hong Kong as a pioneer project. Qualitative approaches using direct observation and semi-structured interviews were adopted with two full-day observations on the seven NCs plus 56 semi-structured interviews of NCs, nurses, doctors and patients. Five major NCs’ roles and responsibilities had been identified, namely providing expert practice, initiating service development, leading education, guiding continuous quality improvement (CQI) and conducting research and providing evidence-based practice. The seven NCs within this study have by and large achieved building professional excellence, respect and trust within their own spheres. It is strongly recommended that the NC post be formally established in the new Nurses Career Structure to enable expert clinical nurses to develop a clinical career to contribute to service and patient care to its maximum.

Purpose
This study aims to develop the Chinese version of the Sexual Function after Gynecologic Illness Scale (SFAGIS) and to establish its psychometric properties in Hong Kong Chinese patients with gynecological cancer.

Methods
A Chinese version of SFAGIS was developed using the Brislin model of translation and guidelines for cross-cultural adaptation of scales. The content validity and semantic equivalence were assessed by an expert panel. The translated version of SFAGIS was administered to 150 Hong Kong Chinese women with gynecological cancer to test the scale’s psychometric properties and to assess its feasibility. The convergent validity of the Chinese scale was tested by correlating it with the Chinese version of the sex relations subscale of the Psychosocial Adjustment to Illness Scale Self-Report (PAIS-SR).

Results
The average completion time for the Chinese SFAGIS was 16.2 ± 6.6 min. The internal consistency of the Chinese SFAGIS was 0.93. Test–retest reliability was also high with an interclass correlation coefficient 0.76. A Pearson product–moment correlation found strong correlations among the Chinese SFAGIS and the Chinese version of the sex relations subscale of the PAIS-SR, indicating that both scales measure the same as or has a similar construct.

Conclusions
The Chinese version of SFAGIS is a reliable and valid instrument which can be used in clinical practice and research for assessing sexual function problems in Chinese patients with gynecological cancer and to identify those in need of attention.

Background
The position of nurse consultant (NC) was introduced in Hong Kong by the Hospital Authority in January 2009. Seven NCs were appointed in five clinical specialties: diabetes, renal, wound and stoma care, psychiatrics, and continence. This was a pilot to explore the impact of the introduction of NCs on patient health and service outcomes.

Methods
The present paper describes a historically matched controlled study. A total of 280 patients, 140 in each cohort under NC or non-NC care, participated in the study. The patient health and service outcomes of both cohorts were evaluated and compared: accident and emergency visits, hospital admissions, length of hospital stays, number of acute complications, number of times of treatment or regimen altered by nurses according to patient’s condition, glycated haemoglobin A1c (HbA1c) levels, urea and urea-to-creatinine ratios, and number of wound dressings for patients in corresponding specialty units. A patient satisfaction instrument was also used to assess the NC cohort.

Results
The study showed that patients under NC care had favourable patient health and service outcomes compared with those under non-NC care. The NC cohort also reported a high level of patient satisfaction.

Conclusions
The study demonstrates that the introduction of NCs in specialty units may have a positive impact on patients’ health and service outcomes. The high level of patient satisfaction scores indicates that patients appreciate the care they are receiving with the introduction of NCs.

Purpose of the research
To compare the psychological health and quality of life (QoL) of women with breast cancer, and to determine the relationship between anxiety, depression and QoL during treatment and one year afterwards.

Methods and sample
For this secondary analysis, 269 women undergoing adjuvant therapy for breast cancer, and 148 women with breast cancer who had completed all treatment within the last year completed a self-report questionnaire covering the Hospital Anxiety and Depression Scale-Cantonese/Chinese version, Functional Assessment of Cancer Therapy-General, and demographic and clinical characteristics.

Key results
The ongoing-therapy group showed higher levels of anxiety and depression and lower levels of all QoL dimensions than the post-therapy group. Linear regression results showed that both anxiety and depression were significantly related to physical and functional well-being, while depression was associated with social/family well-being in both groups. In the case of emotional well-being, anxiety had a strong significant association in both groups and depression a significant relationship only in the ongoing-therapy group.

Conclusions
The psychological health of women with breast cancer is affected during and after treatment. Psychological distress in these patients, including anxiety and depression, has independent associations with impaired emotional, functional, physical and social well-being. The results highlight the importance of timely detection of anxiety and depression, and their proper management, during the treatment and survivorship phases of the breast cancer trajectory.

Aim
To describe a study protocol designed to explore the associations among the perceived unmet supportive care needs, quality of life and the demographic and clinical characteristics of head and neck cancer survivors.

Background
The prognoses for people with head and neck cancer are improving with medical advances. However, studies have reported that such cancer survivors experience poor quality of life. Current studies mainly focus on Western populations and there is limited research investigating the needs of head and neck cancer survivors.

Design
A mixed-design method is proposed, which will include two phases. Phase I will use a quantitative cross-sectional design and Phase II a qualitative descriptive approach.

Methods
The participants will be recruited from the outpatient departments of three public hospitals in Hong Kong. In Phase I, a questionnaire will be used to collect demographic and clinical characteristics, supportive care needs, necessary access to various supportive services and quality of life. Semi-structured interviews will be conducted in Phase II. The study is supported by a grant from the Health and Health Services Research Fund, Hong Kong, September 2011.

Discussion
The study will generate in-depth information on the needs of head and neck cancer survivors, to help healthcare professionals allocate resources better and develop new services, which can be more person-centred, to meet the needs of the these survivors.

Background
Social support has been identified as a significant factor positively influencing quality of life (QOL) in breast cancer survivors. However, less is known about whether and how social support remains important among cancer survivors over the course of the survivorship trajectory.

Aim
To explore social support and its relationship with QOL in breast cancer survivors in China.

Methods
This was a sequential mixed methods study. In Phase I, 100 breast cancer survivors were surveyed using standardized questionnaires. A multivariate regression analysis was performed to examine the relationship between social support and QOL after controlling for annual household income and length of survivorship. In Phase II, individual in-depth interviews were conducted to understand social support experience from 29 survivors selected from Phase I. Interview data were transcribed and analyzed using qualitative content analysis.

Results
Survivors reported a median support network size of 2.2 persons (interquartile range = 1.2–3.8) and a median support satisfaction score of 5.5 (interquartile range = 5–6). While support satisfaction was found to be associated with QOL, no association was found between support network size and QOL. Interview findings revealed that close family members and peer survivors constituted the major source of breast cancer survivors' support, especially in emotional and informational support aspects. Cultural factors played a role in the perception and utilization of support of the breast cancer survivors.

Conclusions
This study has indicated that support satisfaction is more critical than support network size in influencing various aspects of survivors' QOL through the underlying different types of situation-specific support.

Background
Existing bereavement literature focuses on the care provided in palliative care units or community settings. However, nurses in oncology units are in a unique position to provide bereavement care, which is care extended to the families after the death of cancer patients. This study aimed to explore the perceptions and experiences of bereavement care among nurses and bereaved family members in an oncology unit in Hong Kong.

Method
Semi-structured qualitative interviews were carried out in one oncology unit in Hong Kong with 15 nurses and ten bereaved family members. All interviews were audiotaped, transcribed verbatim and analysed by using qualitative content analysis.

Results
Among the bereaved family members, three themes emerged: being informed, being supported and being with the patient before and after the patient’s death. Among the oncology nurses, however, the three identified themes were: elements of good bereavement care, emotional response in providing bereavement care and educational needs in the provision of bereavement care. Comparatively, the experiences of and the opinions on bereavement care identified by the bereaved were more specific than those identified by the nurses.

Conclusion
The findings revealed that there is room for improvement in current bereavement care. Family members were committed to patient care and they expressed their need for more involvement in the patient care, which could result in a positive impact on their grief and loss experience. Nurses were committed to quality care, and they expressed their need for more training on knowledge, skills and attitudes to improve their readiness and competencies in the provision of bereavement care.

The purpose of this study is to compare health-related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy—General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems.

Purpose
The study aimed to explore the gender difference in using colorectal cancer (CRC) tests among Chinese aged 50 years or over.

Methods
A cross-sectional study was conducted in 2004 Chinese older adults through anonymous telephone survey which covered socio-demographic variables, health status, use of complementary therapy, health-related perceptions and use of CRC tests.

Results
The uptake rate of flexible sigmoidoscopy (FS)/colonoscopy was 14% for males and 10% for females, with males significantly more likely to have had the test after adjusting for their differences in socio-demographics, health status, use of complementary therapies, health-related perceptions and recommendation received from health professionals (adjusted OR = 1.5, 95% CI: 1.1–2.0, p = 0.005). The uptake of fecal occult blood test was nearly the same (19%) for both genders. Further interaction analyses indicates that the effect of a family history of cancer on the uptake of a FS/colonoscopy is significantly weaker in males than in females (the interaction odds ratio = 0.4, 95% CI: 0.2–0.8, p = 0.011), whereas a male perceived that visiting a doctor is good for health will be more likely to have an uptake of a FS/colonoscopy than a female with such perception (the interaction odds ratio = 2.1, 95% CI: 1.1–3.8, p = 0.018).

Conclusions
The uptake of CRC tests was low in this average-risk population. More effort is needed to educate the public about the importance and benefits of CRC tests. In view of the gender differences in some determinants of FS/colonoscopy uptake, particular attention should be given to develop gender-specific strategies to improve the rate.

Aim
To report a study protocol to explore the experience of cancer screening from the perspective of ethnic minorities in Hong Kong

Background
Cancer is a major health problem, but screening can be effective in decreasing the incidence and mortality rates. Providing information on how to participate in recommended preventive measures and on accessibility to these services is a crucial step in promoting healthy behaviour. Ethnic minorities in Western countries are found to be less likely to use preventive services and encounter more barriers in doing so than the general population.

Design
A mixed-method design with two phases has been chosen to meet the aims and objectives of the study, with Phase 1 using a self-reported survey and Phase 2 involving focus-group interviews.

Method
A convenience sample of 1540 South Asians (770 in each gender) will be recruited from community centres for the Phase 1 survey in 2013–2014, of whom 72–96 will be invited to participate in the Phase 2 interviews. The Survey and Behavioural Research Ethics Committee of the local university approved the study in March 2012.

Discussion
The findings will provide detailed information on the use of cancer screening and the barriers that this minority population faces in Hong Kong. The findings will inform the government and policy-makers on the implementation of culture-specific interventions, so as to increase the screening uptake rate of this ethnic minority.

Purpose of the research
This paper adopted Protection Motivation Theory (PMT) to examine Chinese women's knowledge and perceptions of cervical cancer risk and factors influencing their motivation to receive future screening.

Methods and sample
A cross-sectional survey was conducted with 167 Chinese women (142 women were willing to receive a screening in the future and 25 women were not) in 2007 to collect women's socio-demographic information and sexual history, perceptions related to body health and knowledge about cervical cancer and screening, and Protection Motivation Theory measures.

Key results
The majority of women stated they intended to receive future screening and response efficacy was significantly associated with their intention. However, no significant association was observed between sexual history and protection motivation. Using multivariate analysis, cancer in relatives (odds ratio, OR = 9.97, 95% CI [1.44–436.3], p = 0.010), a perception that visiting a doctor regularly is important to health (OR = 9.85, 95% CI [1.61–999.9], p = 0.009)), and ever attending for cervical screening during the previous three years (OR = 3.49, 95% CI [1.23–11.02], p = 0.016) were significantly associated with women' motivation to receive future screening.

Conclusion
The findings of this study highlight the important role of women's beliefs in the value of cervical screening and previous screening experience in motivating them to receive a screening. Education intervention is needed to provide information and raise public awareness about the importance of cervical screening to women's health. Culture-related beliefs and social motivational processes in addition to those specified by PMT need to be addressed.

Background: Although advanced cancer treatments prolong survivors’ lives, a significant proportion experienced poorer health-related quality of life (HRQoL) than general populations. Identifying their needs is essential to develop a health service delivery model to improve patient outcomes.

Objective: The objective of this study was to examine the perceived unmet needs and HRQoL of Chinese cancer survivors who completed treatment less than 1 year ago.

Methods: Three hundred seventy-six participants completed a self-report survey: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy: General. Descriptive statistics were used to examine the prevalence of unmet needs. Multivariable logistic regressions were conducted to identify participants’ characteristics that were associated with unmet needs. Multiple linear regression was used to delineate which domains of unmet needs were significantly associated with HRQoL with adjustment for potential confounding factors.

Results: Healthcare information was the most common unmet needs among the survivors. Age, stage of cancer, and remission were significantly associated with 1 or more unmet need domains. Participants with unmet needs in physical, psychological, and patient care domains, on average, have poorer HRQoL.

Conclusions: Chinese cancer survivors have various unmet needs that might have adverse effects on their HRQoL. Younger age, more advanced stages of cancer, and remission were factors contributing to further unmet needs.

Implications for Practice: The results provided useful information on the special needs of survivors that may affect their HRQoL, enabling clinicians to plan better how to allocate existing limited resources to those who most require them.

Background: The diagnosis of gynaecological cancer and the effects of related treatment have adverse effects on sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions are recommended for use in clinical areas for gynaecological cancer patients to improve patient outcomes. However, the evidence for its effectiveness is far from conclusive. Moreover, such interventions are still scarce or even absent in most countries.

Objectives: To identify the best available evidence related to the effectiveness of psychoeducational interventions for gynaecological cancer patients on sexual functioning, quality of life and psychological outcomes.

Inclusion criteria: Types of studies
Randomized controlled trials.

Types of participants
Adult women who with a primary gynaecological cancer confirmed by pathology test.

Types of interventions
Psychoeducational interventions that aimed at enhancing the acceptance of the disease and recovery from the illness and treatment among gynaecological cancer patients.

Types of outcome measures
Sexual functioning, quality of life and psychological outcomes including, but not limited to, anxiety, depression, distress, adjustment to illness, mood, self‐esteem, uncertainty, and coping.

Search strategy: Thirty electronic bibliographic databases in English and Chinese were searched from their inception to April 2012.

Methodological quality: The Joanna Briggs Institute Critical Appraisal Checklist for experimental studies was used to critically appraise the methodological quality of studies.

Data collection: Two reviewers extracted and summarized the details of included studies using the Joanna Briggs Institute data extraction form independently.

Data synthesis: Quantitative results of comparable studies were pooled in statistical meta‐analysis. Standardized mean difference and 95% confidence interval were calculated for the summary effect of continuous data measured by different scales. Results were presented in narrative form where statistical pooling was not appropriate.

Results: A total of 11 randomized controlled trials involving 975 gynaecological cancer patients were included. Only four studies were comparable to perform meta‐analysis. On the basis of two studies examining the outcome of depression, there was a significant improvement in depressive symptoms (SMD: ‐0.80; 95% CI: ‐1.05 to ‐0.54) among participants in the intervention group in which information provision, cognitive‐behavioral therapy and counseling were combined together. On the basis of another two studies examining the outcome of quality of life, there was no significant benefit in physical aspect of quality of life (SMD: ‐0.12; 95% CI: ‐0.45 to 0.20; p = 0.46) for the intervention group. Conversely, the control group of information‐only therapy demonstrated significant effects on mental aspect of quality of life (SMD: ‐0.41; 95% CI: ‐0.74 to ‐0.08; p = 0.01) compared to those receiving psychoeducational interventions. There were no conclusive findings regarding the effects of psychoeducational interventions on the outcomes of sexual functioning, anxiety, distress, adjustment to illness, mood, self‐esteem, uncertainty and coping among the gynaecological cancer patients.

Conclusions: The review demonstrated evidence of positive effects of psychoeducational interventions on gynaecological cancer patients.

Implications for practice
The review suggested that psychoeducational interventions incorporate all four components, i.e. information provision, cognitive‐behavioral therapy, social support and counseling. The format could be individual or group, with or without couple participation. A nurse was preferred to be the ideal provider. Provision time frame should be before the start of the treatment and continued after discharge, and the number of sessions could be four. Each session should be between 30 minutes to one hour long.

Implications for research
More well‐designed randomized controlled trials are needed to further examine the effects of psychoeducational interventions on psychological outcomes in this group of patients. Due to the diversity of these interventions, the optimal format of each also requires investigation.

AIM:
To identify the learning needs of patients with heart failure (HF) in China and to examine the relationships between learning needs and patients' characteristics.

BACKGROUND:
Little information on the learning needs of patients with HF in China is known. Besides, it is important to identify the potential characteristics that may influence patients' perceived learning needs.

METHODS:
This cross-sectional questionnaire survey was conducted in three university affiliated hospitals in Xi'an, Mainland China. A total of 347 HF patients selected by convenience sampling were investigated using the Chinese version of the HF learning needs inventory. Descriptive statistics, independent t-test, Pearson correlation, and one-way analysis of variance were used for data analysis.

RESULTS:
The mean scores rated by Chinese patients with HF were lower than the corresponding scores rated by patients of Western countries. Information on risk factors, prognosis, general HF information and medications were identified as the most important topics while lifestyle modification and psychological factors were regarded as the least important ones. Age negatively correlated with the learning needs on activity (r = -0.125) and prognosis information (r = -0.141). Educational level was significantly related to the learning needs about risk factors.

CONCLUSION:
Patients with HF in China considered most of the topics important for them to learn. Age and educational level were related with the learning needs on only three topics including activity, prognosis information and risk factors.

RELEVANCE TO CLINICAL PRACTICE:
The study findings may be used by health professionals to develop tailored educational programme for patients with HF in China.

BACKGROUND:
The importance of quality-of-life (QoL) research has been recognised over the past two decades in patients with head and neck (H&N) cancer. The aims of this systematic review are to evaluate the QoL status of H&N cancer survivors one year after treatment and to identify the determinants affecting their QoL.

METHODS:
Pubmed, Medline, Scopus, Sciencedirect and CINAHL (2000-2011) were searched for relevant studies, and two of the present authors assessed their methodological quality. The characteristics and main findings of the studies were extracted and reported.

RESULTS:
Thirty-seven studies met the inclusion criteria, and the methodological quality of the majority was moderate to high. While patients of the group in question recover their global QoL by 12 months after treatment, a number of outstanding issues persist - deterioration in physical functioning, fatigue, xerostomia and sticky saliva. Age, cancer site, stage of disease, social support, smoking, feeding tube placement and alcohol consumption are the significant determinants of QoL at 12 months, while gender has little or no influence.

CONCLUSIONS:
Regular assessments should be carried out to monitor physical functioning, degree of fatigue, xerostomia and sticky saliva. Further research is required to develop appropriate and effective interventions to deal with these issues, and thus to promote the patients' QoL.

Background
Theories of health behavior and empirical research highlight the risk perception as a significant factor for people adopting cancer screening. However, screening uptakes and risk perception of cervical cancer in mainland Chinese women remains unknown.

Objective
This paper adopted the protection motivation theory (PMT) to examine Chinese women's knowledge and perceptions of cervical cancer risk and factors influencing utilization of cervical screening.

Methods
A self-administered questionnaire was completed by 167 participants in mainland China (79 nonscreened and 88 screened women) in 2007 which consisted of four sections: background information, women's attendance pattern for cervical screening, perceptions related to body health and knowledge about cervical cancer and screening, and PMT measures.

Results
All women considered themselves at low risk of cervical cancer. No significant association was observed between previous screening uptake and PMT variables. Using multivariate analysis, having children, a perception that visiting doctors regularly is important to health, average and high levels of knowledge about cervical screening were significantly associated with having been received screening.

Conclusion
Chinese women demonstrated an unrealistic optimism about their personal risk of cervical cancer. The findings do not support an association between risk perception and screening uptake. In spite of this, current findings revealed some possible factors influencing women's screening behavior. This study highlights the significance of knowledge and culturally-relevant health behavior and beliefs about cervical screening for Chinese women in determining whether or not they receive screening. The promotion of cervical cancer prevention and early detection should be integrated into public education about women's health.

A group project is a common method of assessment in higher education worldwide. The use of an adjunct peer assessment (PA) scheme as a means to award marks for individual student contributions to a group project has increased. However, nursing students' perceptions of PA have not been well studied. This paper examines baccalaureate nursing students' perceptions of PA in assessing individual contributions to a group project. Using a case study design with both quantitative (an anonymous survey with 123 students), and qualitative methods (six focus group interviews with 21 students), data were collected from students in a baccalaureate nursing programme. Merging of quantitative and qualitative findings indicated that students overall had positive perceptions of PA, especially its ability to reduce ‘free-riding’. However, students also had some interpersonal and operational concerns about the PA implementation process. Based on the findings, we recommend: (1) further developing students' abilities to assess the contributions of others to the task and relationship functions in group work; and (2) adopting a confidential online system for submission of PA forms.

Aims.  The aims of this paper were to determine the level of knowledge and attitude of contraception and their relationships among Chinese migrant woman workers.

Background.  Studies on psychosocial variables that lead to reproductive health behaviours among Chinese migrant woman workers in China remain limited.

Design.  A cross-sectional, descriptive and correlational design.

Participants.  One hundred and ninety young woman workers of a factory in Guangdong, a representative city of factory base in mainland China, voluntarily participated in the study with a response rate of 63%.

Methods.  Data were collected through self-administered questionnaires consisting of a socio-demographic sheet, the Contraceptive Knowledge Scale and the Contraceptive Attitude Scale. Pearson product moment correlation coefficient test was employed to examine the relationships between the contraceptive knowledge and attitude, with level of significance set at p < 0·05.

Results.  The Chinese migrant woman workers demonstrated lower contraceptive knowledge and less favourable contraceptive attitude compared with previous studies of adolescents in Taiwan and women seeking abortion in Hong Kong. Although it was a weak correlation, contraceptive knowledge was statistically associated with contraceptive attitudes among the respondents (r = 0·276, p < 0·001). Respondents’ age, education level and working experience were significantly positively correlated with the contraceptive knowledge.

Conclusions.  Young Chinese migrant workers reported in the current study are found to be at higher sexual risk, when compared to the adolescents in Taiwan and Hong Kong women seeking abortion. Early educational intervention for reproductive health in particular contraception and its usage to these young women is indicated.

Relevance to clinical practice.  Migrant woman workers in mainland demonstrated poor knowledge and unfavourable attitudes towards contraception, especially for the younger, single and less educated group. Greater effort is necessary to promote young migrant women’s knowledge and attitude towards contraception and sexual health.

A cross-sectional descriptive design was used in this study to compare the quality of life of younger (<60) and older (≥60) Chinese women undergoing adjuvant therapy for breast cancer. A total of 261 patients completed a self-report survey on their demographic and clinical characteristics, as well as the Functional Assessment of Cancer Therapy for Breast Cancer and the Medical Outcomes Study Social Support Survey-Chinese version. Stepwise regression was used for secondary analysis. Significant differences between the two groups were established in the total score (p = 0.049), and the physical well-being (p = 0.048), emotional well-being (p = 0.014), and breast cancer (p < 0.001) subscales after adjustment for potential confounding variables. The older group had better overall quality of life, physical and emotional well-being, and higher breast cancer subscale scores than the younger group. However, health care professionals need to be aware of the confounding factors identified and of certain cultural values, which may also influence the quality of life of these older patients.

BACKGROUND:
Accurate information and knowledge about cervical cancer and screening importantly influence women's cervical screening participation. Sexual behavior plays a crucial role in human papillomavirus transmission and the subsequent development of cervical cancer. Indeed, the uptake of cervical screening among Chinese women is relatively low compared with other populations.
OBJECTIVE:
To understand women's attendance pattern of cervical screening, knowledge about cervical cancer and screening, and factors influencing their utilization of cervical screening in mainland China.

METHODS:
A cross-sectional survey was conducted to collect women's participation pattern for cervical screening, knowledge about cervical cancer and screening, sociodemographic information and sexual history, and barriers to participating in cervical screening.

RESULTS:
Married women and women who had had their first intercourse after the age of 21 years were significantly more likely to participate in screening. Screened women demonstrated a higher level of knowledge about the cervical screening procedure compared with nonscreened women (P = .002). Also, the scores of individual items such as women's knowledge of cervical screening and risk factors were significantly different between the 2 groups.

CONCLUSION:
The current system of free physical examinations for women in mainland China is a major motivator for women's utilization of cervical screening services. Chinese women's marital status and sexual history influence their screening behavior.

IMPLICATIONS FOR PRACTICE:
Unmarried women who have ever had sex should be encouraged to have cervical screening, and consistent and appropriate information about the preventive nature of cervical screening and risk factors associated with cervical cancer should be provided to the general public.

OBJECTIVE  The study aims to translate the Sexual Function- Vaginal Changes Questionnaire (SVQ) into Chinese and to establish its psychometric properties.

METHODS  A Chinese SVQ was developed by the use of the Brislin model of translation. The content validity and semantic equivalence were assessed by an expert panel. The translated version of SVQ was administered to 75 Hong Kong Chinese women who were suffered from gynecological cancer to test its psychometric properties.

RESULTS  The Chinese version of SVQ was compared to the original study for factor analysis. Internal consistency, item-to-scale correlations and test-retest reliability were high. The convergent and divergent validities supported the Chinese SVQ to be valid.

CONCLUSION  We conclude that the Chinese SVQ appears to be a valid, reliable and feasible disease-specific tool for the assessment of sexual function among Chinese patients.