International Journal of Environmental Research and Public Health
This study examined the pandemic measures taken by nursing leaders to cope with COVID-19 at a nur... more This study examined the pandemic measures taken by nursing leaders to cope with COVID-19 at a nursing home in Singapore. The pandemic has affected over 215 countries, sparking a series of containment and pandemic measures by governments and healthcare organizations worldwide. Long-term care facilities are especially vulnerable to the pandemic, but little has been reported about the nursing homes’ measures in handling the pandemic. The present study used Morley’s (2014) three-stage critical reflection method to review meeting minutes, organizational emails, and government advisories on the COVID-19 pandemic measures undertaken by nursing leaders at a nursing home in Singapore between January and June 2020. The pandemic measures were broadly classified into four groups: (1) infection surveillance and containment measures; (2) ensuring continuity in clinical care and operational support; (3) resource and administrative coordination; and (4) staff training and development. Nurses have p...
Introduction The evolution of colorectal screening has made headway with continual efforts global... more Introduction The evolution of colorectal screening has made headway with continual efforts globally to increase screening rates for colonoscopy-naïve patients. However, little has been done to encourage repeat colonoscopies after the initial scope despite recommendations to repeat colonoscopy every 10 years, with the uptake rates of repeat colonoscopy remaining abysmal at 22%. Methods Previously, a qualitative systematic review evaluated the barriers and facilitators patients faced in their decisions to undergo colonoscopy, analyzing articles from Medline, Embase, CINAHL, PsycINFO and Web of Science. Key findings from articles which highlighted factors influencing patients’ decisions to return for repeat colonoscopies were summarized. Results Three articles were identified in the search. Facilitators for repeat colonoscopy included patients’ assurance garnered from fostered trust in the patient–provider relationship, their intrinsic motivations from fear of cancer and an innate appr...
Purpose To (1) examine the communication difficulties nurses experience when providing end-of-lif... more Purpose To (1) examine the communication difficulties nurses experience when providing end-of-life (EOL) care, (2) establish the correlation between communication difficulties across various stakeholders and (3) determine the impact sociodemographic factors has on the communication difficulties experienced. Methods 124/178 (69.7%) nurses from oncology wards of a tertiary hospital were recruited. Sociodemographic survey and three validated subscales: Communication with Patient and Family (CPF), Explanation to Family (EF) and Reassessment of Current Treatment and Nursing Care (RCTNC) were used to collect the data. Data were analysed with Independent Samples T test, One-Way Analysis of Variance and Pearson’s correlation coefficient. Results Mean score was highest for CPF (8.75 ± 2.24) and lowest for RCTNC (6.32 ± 2.26). Positive correlations were found between CPF with EF ( r = 0.613, p < 0.001), CPF with RCTNC ( r = 0.243, p = 0.007) and EF with RCTNC ( r = 0.370, p < 0.001). Age ( p = 0.048), years of experience ( p = 0.001), religion ( p = 0.034) and EOL care training received ( p = 0.040) were significant factors for CPF subscale while age ( p = 0.011), years of experience ( p = 0.001), educational qualification ( p = 0.003) and EOL care training received ( p = 0.026) were the significant factors for EF subscale. Conclusion Nurses experienced more communication difficulties with patients and families than with the healthcare team. When nurses experience communication difficulties with the healthcare team, they also tend to experience communication difficulties with patients and families and when providing explanations to families. Nurses experienced greater communication difficulties when they are younger, are non-graduates, have less years of experience, adopted a religion or did not receive training in EOL care. Trial registration Clinical Trials.gov Identifier: 2019/00680 (Domain Specific Review Board)
OBJECTIVES Colonoscopy is integral in the early detection of colorectal cancer (CRC), be it for s... more OBJECTIVES Colonoscopy is integral in the early detection of colorectal cancer (CRC), be it for screening, diagnostic or therapeutic intentions. Despite the presence of multiple screening modalities, colonoscopy remains integral in providing a definitive CRC diagnosis. However, uptake rates remain low worldwide with minimal understanding towards stakeholders' perspectives. This systematic review is the first to outline the barriers and facilitators faced by providers and patients in receiving colonoscopy specifically. METHODS Using PRISMA guidelines, our systematic review consolidates findings from Medline, Embase, CINAHL, PsycINFO and Web of Science Core collection. All perceptions of healthcare providers and screening participants aged 45 and above towards colonoscopy were included. RESULTS Forty-five articles were included in our review. Five major analytical themes were identified - procedural perceptions, personal experiences, thoughts and concerns, societal influences, doctor-patient relationship and healthcare system. The discrepancies in knowledge between patients and providers have evidently reduced in the present decade, potentially attributable to the rising influence of social media. The sharing of providers' personal experiences, involvement of patients' family in colonoscopy recommendations and propagation of patients' positive recounts were also more apparent in the past compared to the present decade, highlighting the need to reevaluate the balance between medical confidentiality and personal touch. Additionally, Asian patients were reportedly more apathetic towards CRC diagnosis due to their strong belief in destiny, a crucial association consistent with present studies. CONCLUSION This study highlights pertinent gaps in our healthcare system, providing crucial groundwork for interventions to be enacted in engendering higher colonoscopy uptake rates.
BACKGROUND Disruptive behavior can harm high-quality care and is prevalent in many Western public... more BACKGROUND Disruptive behavior can harm high-quality care and is prevalent in many Western public health systems despite increasing spotlight on it. Comparatively less knowledge about it is available in Asia, a region commonly associated with high-power distance, which may limit its effectiveness in addressing disruptive behavior. PURPOSE The aim of this study was to develop a comprehensive framework for tackling disruptive behavior among health care professionals in a public health system. METHODOLOGY A nationwide cross-sectional study relying on the Nurse-Physician Relationship Survey was conducted in Singapore. Four hundred eighty-six public health care professionals responded. RESULTS Two hundred ninety-eight doctors (95.5%) and 163 nurses (93.7%) had witnessed a form of disruptive behavior. Doctors observed disruptive behavior committed by other doctors and nurses much more frequently than did nurses. Doctors made stronger associations between disruptive behavior and negative employee outcomes and between disruptive behavior and negative patient outcomes. Qualitative analyses of participants' open-ended answers produced a multipronged three-dimensional approach for tackling disruptive behavior: (a) deterrent measures, (b) development of knowledge and skills, and (c) demonstration of organizational commitment through proper norms, empathizing with staff, and structural reforms. PRACTICE IMPLICATIONS Disruptive behavior is a multifaceted problem requiring a multipronged approach. Our three-dimensional framework is a comprehensive approach for giving health care professionals the capability, opportunity, and motivation to address disruptive behavior effectively.
Objective This study was conducted to better understand the pervasive gender barriers obstructing... more Objective This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. Methods Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. Results Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, ...
Objective This study was conducted to better understand the pervasive gender barriers obstructing... more Objective This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. Methods Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. Results Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, ...
Background Clinical nursing education provides opportunities for students to learn in multiple pa... more Background Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students’ clinical learning to enhance their clinical competencies. Objective This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors’ clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. Methods A quasi-experimental single-group pretest a...
JBI Database of Systematic Reviews and Implementation Reports, 2011
Background Breast cancer is the most common cancer in women. With increasing numbers of women sur... more Background Breast cancer is the most common cancer in women. With increasing numbers of women surviving breast cancer, there is a need to move beyond the traditional ways of evaluating clinical outcomes and include patient-based outcomes such as the quality of life.Objectives To integrate and summarise the best evidence related to the quality of life of women diagnosed with breast cancer during and up to ten years after treatment for breast cancer. Types of participants: Adult women (over the age of 18 years) diagnosed with breast cancer who are or have received treatment for breast cancer in the last ten years (i.e. surgery, chemotherapy, radiation therapy and/or hormonal therapy). The quality of life of women diagnosed with breast cancer during and up to ten years after treatment. Women with breast cancer from both developed and developing countries.Types of studies: Studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory and ethnography, action research and feminist research.Search strategy The search sought to find both published and unpublished studies between 1990 and 2010, limited to the English language. Eleven electronic databases were searched including CINAHL, PubMed, Scopus and PsycArticles.Methodological quality Methodological quality was assessed independently by two reviewers using a standardised critical appraisal instrument from the Joanna Briggs Institute.Data extraction Qualitative data were extracted from the included studies using a standardised data extraction tool from the Joanna Briggs Institute. A total of 42 findings from seven qualitative studies were extracted and rated as unequivocal or credible. Eleven categories were produced. Three synthesised findings were generated based on the meta-aggregation of the categories: (1) &amp;amp;amp;amp;amp;amp;amp;amp;quot;effective care for patients will be achieved if clinicians are aware of the impact of breast cancer and its treatment on the physical and psychosocial domains of women&amp;amp;amp;amp;amp;amp;amp;amp;#39;s quality of life&amp;amp;amp;amp;amp;amp;amp;amp;quot;; (2) &amp;amp;amp;amp;amp;amp;amp;amp;quot;for effective patient-centred care, clinicians must be cognisant of the ways breast cancer and its treatment modalities affect social relationships&amp;amp;amp;amp;amp;amp;amp;amp;quot;; (3) &amp;amp;amp;amp;amp;amp;amp;amp;quot;clinicians should be aware that women use religion and spirituality to cope with breast cancer treatment and improve their quality of life&amp;amp;amp;amp;amp;amp;amp;amp;quot;. This review concludes that the breast cancer diagnosis and its treatment can have a significant effect on several domains of women&amp;amp;amp;amp;amp;amp;amp;amp;#39;s quality of life. Healthcare providers caring for patients need to be well informed about each individual woman&amp;amp;amp;amp;amp;amp;amp;amp;#39;s physical and psychosocial concerns and be cognisant that any attempt to offer support must be targeted to meet the specific challenges faced by each individual woman. Support and guidance could be provided by healthcare providers through the use of counselling services, psycho-education and organisation of support groups. Elements of counselling and psycho-education should include, when appropriate, joint sessions with the woman&amp;amp;amp;amp;amp;amp;amp;amp;#39;s spouse/partner. As spirituality emerged as a coping mechanism, it is important that women be able to nurture their spiritual relationship in an environment which is supportive. The lack of studies within the Asian context indicates that further research is warranted to examine the impact of breast cancer and its treatment on the quality of life of women from diverse multi-ethnic populations. Further research into self-help strategies to improve the psychosocial well-being of women with breast cancer is warranted.It is noted that when faced with adversity, women seek comfort in religion and spirituality and a study into the relationship between spirituality and quality of life, as well as the effect of culture and religion on the quality of life, is warranted.
JBI Database of Systematic Reviews and Implementation Reports, 2010
Breast cancer is one of the most common cancers worldwide, and anxiety is a psychological morbidi... more Breast cancer is one of the most common cancers worldwide, and anxiety is a psychological morbidity that is inevitable. Many researchers have investigated its prevalence and detrimental effects, yet little is known when comparing the different breast cancer treatments. A systematic review of all available literature was indicated to encourage better understanding of anxiety in patients undergoing treatment for breast cancer. This review aimed to determine the best available evidence on the level of anxiety among women with breast cancer undergoing/had undergone cancer treatment(s), and factor(s) contributing to anxiety in these treatment modalities. Types of participants Women with breast cancer of stage 0 to stage IIIA breast cancer, over and equal to 21 and below the age of 65 years of age.Types of intervention Women who were undergoing/had undergone cancer treatment restricted to chemotherapy, radiotherapy, surgery or combined treatments, and were without other medical co morbidities.Types of outcomes A variety of outcome measures were used to assess anxiety in the included papers. Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory were mostly used.Types of studies This review considered quantitative papers (randomized control trials, descriptive studies and systematic review) that fulfilled both requirements: SEARCH STRATEGY: The search sought to gather data from published and unpublished studies conducted between 1990 and 2010. An initial search on CINAHL and Medline was done to identify relevant search terms. A search strategy was then developed, using MeSH headings and keywords. Following databases were searched: CINAHL; PubMed; ScienceDirect; PsycINFO; Cochrane Database of Systematic Review; Scopus; Wiley Interscience and PsycARTICLES. Two reviewers independently assessed the eligibility of the papers for inclusion. Eighteen papers were selected based on relevance, and underwent assessment for methodological quality using MAStARI. Eleven research papers that met the level of methodological standard were included into the review. Both reviewers came to the same consensus on the included and excluded papers. Due to the methodological heterogeneity of the included papers, a meta-analysis was not possible. The studies were hence presented in narrative summary. Anxiety seems to be ubiquitous, presenting itself in all treatment types for breast cancer. Anxiety level in breast cancer women who underwent chemotherapy was highest before the first chemotherapy infusion, mediated by age and trait anxiety. Radiotherapy regimes did not affect anxiety level in radiotherapy-treated patients, and most research concluded that anxiety level was higher among women who underwent mastectomy than breast conservation therapy. When compared, patients who underwent chemotherapy were more anxious. The prevalence and intensity of anxiety has been shown to be pronounced among the three treatments. Chemotherapy, as compared to other treatments, has shown to be associated with a higher anxiety level. With the prevalence, intensity and correlated factors of anxiety identified through this review, future research may investigate the interventions that could help alleviate anxiety among these patients. Anxiety is prevalent in women with breast cancer undergoing treatment, especially those undergoing chemotherapy. Healthcare professionals should pay greater attention to identify cues of anxiety in patients and prevent/alleviate it.
The authors aim to examine the impact of demographic changes, socioeconomic inequality, and the a... more The authors aim to examine the impact of demographic changes, socioeconomic inequality, and the availability of health care resources on life expectancy in Singapore, Malaysia, and Thailand. This is a cross-country study collecting annual data from 3 Southeast Asian countries from 1980 to 2008. Life expectancy is the dependent variable with demographics, socioeconomic status, and health care resources as the 3 main determinants. A structural equation model is used, and results show that the availability of more health care resources and higher levels of socioeconomic advantages are more likely to increase life expectancy. In contrast, demographic changes are more likely to increase life expectancy by way of health care resources. The authors suggest that more effort should be taken to expand and improve the coverage of health care programs to alleviate regional differences in health care use and improve the overall health status of people in these 3 Southeast Asian countries.
International Journal of Environmental Research and Public Health
This study examined the pandemic measures taken by nursing leaders to cope with COVID-19 at a nur... more This study examined the pandemic measures taken by nursing leaders to cope with COVID-19 at a nursing home in Singapore. The pandemic has affected over 215 countries, sparking a series of containment and pandemic measures by governments and healthcare organizations worldwide. Long-term care facilities are especially vulnerable to the pandemic, but little has been reported about the nursing homes’ measures in handling the pandemic. The present study used Morley’s (2014) three-stage critical reflection method to review meeting minutes, organizational emails, and government advisories on the COVID-19 pandemic measures undertaken by nursing leaders at a nursing home in Singapore between January and June 2020. The pandemic measures were broadly classified into four groups: (1) infection surveillance and containment measures; (2) ensuring continuity in clinical care and operational support; (3) resource and administrative coordination; and (4) staff training and development. Nurses have p...
Introduction The evolution of colorectal screening has made headway with continual efforts global... more Introduction The evolution of colorectal screening has made headway with continual efforts globally to increase screening rates for colonoscopy-naïve patients. However, little has been done to encourage repeat colonoscopies after the initial scope despite recommendations to repeat colonoscopy every 10 years, with the uptake rates of repeat colonoscopy remaining abysmal at 22%. Methods Previously, a qualitative systematic review evaluated the barriers and facilitators patients faced in their decisions to undergo colonoscopy, analyzing articles from Medline, Embase, CINAHL, PsycINFO and Web of Science. Key findings from articles which highlighted factors influencing patients’ decisions to return for repeat colonoscopies were summarized. Results Three articles were identified in the search. Facilitators for repeat colonoscopy included patients’ assurance garnered from fostered trust in the patient–provider relationship, their intrinsic motivations from fear of cancer and an innate appr...
Purpose To (1) examine the communication difficulties nurses experience when providing end-of-lif... more Purpose To (1) examine the communication difficulties nurses experience when providing end-of-life (EOL) care, (2) establish the correlation between communication difficulties across various stakeholders and (3) determine the impact sociodemographic factors has on the communication difficulties experienced. Methods 124/178 (69.7%) nurses from oncology wards of a tertiary hospital were recruited. Sociodemographic survey and three validated subscales: Communication with Patient and Family (CPF), Explanation to Family (EF) and Reassessment of Current Treatment and Nursing Care (RCTNC) were used to collect the data. Data were analysed with Independent Samples T test, One-Way Analysis of Variance and Pearson’s correlation coefficient. Results Mean score was highest for CPF (8.75 ± 2.24) and lowest for RCTNC (6.32 ± 2.26). Positive correlations were found between CPF with EF ( r = 0.613, p < 0.001), CPF with RCTNC ( r = 0.243, p = 0.007) and EF with RCTNC ( r = 0.370, p < 0.001). Age ( p = 0.048), years of experience ( p = 0.001), religion ( p = 0.034) and EOL care training received ( p = 0.040) were significant factors for CPF subscale while age ( p = 0.011), years of experience ( p = 0.001), educational qualification ( p = 0.003) and EOL care training received ( p = 0.026) were the significant factors for EF subscale. Conclusion Nurses experienced more communication difficulties with patients and families than with the healthcare team. When nurses experience communication difficulties with the healthcare team, they also tend to experience communication difficulties with patients and families and when providing explanations to families. Nurses experienced greater communication difficulties when they are younger, are non-graduates, have less years of experience, adopted a religion or did not receive training in EOL care. Trial registration Clinical Trials.gov Identifier: 2019/00680 (Domain Specific Review Board)
OBJECTIVES Colonoscopy is integral in the early detection of colorectal cancer (CRC), be it for s... more OBJECTIVES Colonoscopy is integral in the early detection of colorectal cancer (CRC), be it for screening, diagnostic or therapeutic intentions. Despite the presence of multiple screening modalities, colonoscopy remains integral in providing a definitive CRC diagnosis. However, uptake rates remain low worldwide with minimal understanding towards stakeholders' perspectives. This systematic review is the first to outline the barriers and facilitators faced by providers and patients in receiving colonoscopy specifically. METHODS Using PRISMA guidelines, our systematic review consolidates findings from Medline, Embase, CINAHL, PsycINFO and Web of Science Core collection. All perceptions of healthcare providers and screening participants aged 45 and above towards colonoscopy were included. RESULTS Forty-five articles were included in our review. Five major analytical themes were identified - procedural perceptions, personal experiences, thoughts and concerns, societal influences, doctor-patient relationship and healthcare system. The discrepancies in knowledge between patients and providers have evidently reduced in the present decade, potentially attributable to the rising influence of social media. The sharing of providers' personal experiences, involvement of patients' family in colonoscopy recommendations and propagation of patients' positive recounts were also more apparent in the past compared to the present decade, highlighting the need to reevaluate the balance between medical confidentiality and personal touch. Additionally, Asian patients were reportedly more apathetic towards CRC diagnosis due to their strong belief in destiny, a crucial association consistent with present studies. CONCLUSION This study highlights pertinent gaps in our healthcare system, providing crucial groundwork for interventions to be enacted in engendering higher colonoscopy uptake rates.
BACKGROUND Disruptive behavior can harm high-quality care and is prevalent in many Western public... more BACKGROUND Disruptive behavior can harm high-quality care and is prevalent in many Western public health systems despite increasing spotlight on it. Comparatively less knowledge about it is available in Asia, a region commonly associated with high-power distance, which may limit its effectiveness in addressing disruptive behavior. PURPOSE The aim of this study was to develop a comprehensive framework for tackling disruptive behavior among health care professionals in a public health system. METHODOLOGY A nationwide cross-sectional study relying on the Nurse-Physician Relationship Survey was conducted in Singapore. Four hundred eighty-six public health care professionals responded. RESULTS Two hundred ninety-eight doctors (95.5%) and 163 nurses (93.7%) had witnessed a form of disruptive behavior. Doctors observed disruptive behavior committed by other doctors and nurses much more frequently than did nurses. Doctors made stronger associations between disruptive behavior and negative employee outcomes and between disruptive behavior and negative patient outcomes. Qualitative analyses of participants' open-ended answers produced a multipronged three-dimensional approach for tackling disruptive behavior: (a) deterrent measures, (b) development of knowledge and skills, and (c) demonstration of organizational commitment through proper norms, empathizing with staff, and structural reforms. PRACTICE IMPLICATIONS Disruptive behavior is a multifaceted problem requiring a multipronged approach. Our three-dimensional framework is a comprehensive approach for giving health care professionals the capability, opportunity, and motivation to address disruptive behavior effectively.
Objective This study was conducted to better understand the pervasive gender barriers obstructing... more Objective This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. Methods Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. Results Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, ...
Objective This study was conducted to better understand the pervasive gender barriers obstructing... more Objective This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. Methods Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. Results Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, ...
Background Clinical nursing education provides opportunities for students to learn in multiple pa... more Background Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students’ clinical learning to enhance their clinical competencies. Objective This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors’ clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. Methods A quasi-experimental single-group pretest a...
JBI Database of Systematic Reviews and Implementation Reports, 2011
Background Breast cancer is the most common cancer in women. With increasing numbers of women sur... more Background Breast cancer is the most common cancer in women. With increasing numbers of women surviving breast cancer, there is a need to move beyond the traditional ways of evaluating clinical outcomes and include patient-based outcomes such as the quality of life.Objectives To integrate and summarise the best evidence related to the quality of life of women diagnosed with breast cancer during and up to ten years after treatment for breast cancer. Types of participants: Adult women (over the age of 18 years) diagnosed with breast cancer who are or have received treatment for breast cancer in the last ten years (i.e. surgery, chemotherapy, radiation therapy and/or hormonal therapy). The quality of life of women diagnosed with breast cancer during and up to ten years after treatment. Women with breast cancer from both developed and developing countries.Types of studies: Studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory and ethnography, action research and feminist research.Search strategy The search sought to find both published and unpublished studies between 1990 and 2010, limited to the English language. Eleven electronic databases were searched including CINAHL, PubMed, Scopus and PsycArticles.Methodological quality Methodological quality was assessed independently by two reviewers using a standardised critical appraisal instrument from the Joanna Briggs Institute.Data extraction Qualitative data were extracted from the included studies using a standardised data extraction tool from the Joanna Briggs Institute. A total of 42 findings from seven qualitative studies were extracted and rated as unequivocal or credible. Eleven categories were produced. Three synthesised findings were generated based on the meta-aggregation of the categories: (1) &amp;amp;amp;amp;amp;amp;amp;amp;quot;effective care for patients will be achieved if clinicians are aware of the impact of breast cancer and its treatment on the physical and psychosocial domains of women&amp;amp;amp;amp;amp;amp;amp;amp;#39;s quality of life&amp;amp;amp;amp;amp;amp;amp;amp;quot;; (2) &amp;amp;amp;amp;amp;amp;amp;amp;quot;for effective patient-centred care, clinicians must be cognisant of the ways breast cancer and its treatment modalities affect social relationships&amp;amp;amp;amp;amp;amp;amp;amp;quot;; (3) &amp;amp;amp;amp;amp;amp;amp;amp;quot;clinicians should be aware that women use religion and spirituality to cope with breast cancer treatment and improve their quality of life&amp;amp;amp;amp;amp;amp;amp;amp;quot;. This review concludes that the breast cancer diagnosis and its treatment can have a significant effect on several domains of women&amp;amp;amp;amp;amp;amp;amp;amp;#39;s quality of life. Healthcare providers caring for patients need to be well informed about each individual woman&amp;amp;amp;amp;amp;amp;amp;amp;#39;s physical and psychosocial concerns and be cognisant that any attempt to offer support must be targeted to meet the specific challenges faced by each individual woman. Support and guidance could be provided by healthcare providers through the use of counselling services, psycho-education and organisation of support groups. Elements of counselling and psycho-education should include, when appropriate, joint sessions with the woman&amp;amp;amp;amp;amp;amp;amp;amp;#39;s spouse/partner. As spirituality emerged as a coping mechanism, it is important that women be able to nurture their spiritual relationship in an environment which is supportive. The lack of studies within the Asian context indicates that further research is warranted to examine the impact of breast cancer and its treatment on the quality of life of women from diverse multi-ethnic populations. Further research into self-help strategies to improve the psychosocial well-being of women with breast cancer is warranted.It is noted that when faced with adversity, women seek comfort in religion and spirituality and a study into the relationship between spirituality and quality of life, as well as the effect of culture and religion on the quality of life, is warranted.
JBI Database of Systematic Reviews and Implementation Reports, 2010
Breast cancer is one of the most common cancers worldwide, and anxiety is a psychological morbidi... more Breast cancer is one of the most common cancers worldwide, and anxiety is a psychological morbidity that is inevitable. Many researchers have investigated its prevalence and detrimental effects, yet little is known when comparing the different breast cancer treatments. A systematic review of all available literature was indicated to encourage better understanding of anxiety in patients undergoing treatment for breast cancer. This review aimed to determine the best available evidence on the level of anxiety among women with breast cancer undergoing/had undergone cancer treatment(s), and factor(s) contributing to anxiety in these treatment modalities. Types of participants Women with breast cancer of stage 0 to stage IIIA breast cancer, over and equal to 21 and below the age of 65 years of age.Types of intervention Women who were undergoing/had undergone cancer treatment restricted to chemotherapy, radiotherapy, surgery or combined treatments, and were without other medical co morbidities.Types of outcomes A variety of outcome measures were used to assess anxiety in the included papers. Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory were mostly used.Types of studies This review considered quantitative papers (randomized control trials, descriptive studies and systematic review) that fulfilled both requirements: SEARCH STRATEGY: The search sought to gather data from published and unpublished studies conducted between 1990 and 2010. An initial search on CINAHL and Medline was done to identify relevant search terms. A search strategy was then developed, using MeSH headings and keywords. Following databases were searched: CINAHL; PubMed; ScienceDirect; PsycINFO; Cochrane Database of Systematic Review; Scopus; Wiley Interscience and PsycARTICLES. Two reviewers independently assessed the eligibility of the papers for inclusion. Eighteen papers were selected based on relevance, and underwent assessment for methodological quality using MAStARI. Eleven research papers that met the level of methodological standard were included into the review. Both reviewers came to the same consensus on the included and excluded papers. Due to the methodological heterogeneity of the included papers, a meta-analysis was not possible. The studies were hence presented in narrative summary. Anxiety seems to be ubiquitous, presenting itself in all treatment types for breast cancer. Anxiety level in breast cancer women who underwent chemotherapy was highest before the first chemotherapy infusion, mediated by age and trait anxiety. Radiotherapy regimes did not affect anxiety level in radiotherapy-treated patients, and most research concluded that anxiety level was higher among women who underwent mastectomy than breast conservation therapy. When compared, patients who underwent chemotherapy were more anxious. The prevalence and intensity of anxiety has been shown to be pronounced among the three treatments. Chemotherapy, as compared to other treatments, has shown to be associated with a higher anxiety level. With the prevalence, intensity and correlated factors of anxiety identified through this review, future research may investigate the interventions that could help alleviate anxiety among these patients. Anxiety is prevalent in women with breast cancer undergoing treatment, especially those undergoing chemotherapy. Healthcare professionals should pay greater attention to identify cues of anxiety in patients and prevent/alleviate it.
The authors aim to examine the impact of demographic changes, socioeconomic inequality, and the a... more The authors aim to examine the impact of demographic changes, socioeconomic inequality, and the availability of health care resources on life expectancy in Singapore, Malaysia, and Thailand. This is a cross-country study collecting annual data from 3 Southeast Asian countries from 1980 to 2008. Life expectancy is the dependent variable with demographics, socioeconomic status, and health care resources as the 3 main determinants. A structural equation model is used, and results show that the availability of more health care resources and higher levels of socioeconomic advantages are more likely to increase life expectancy. In contrast, demographic changes are more likely to increase life expectancy by way of health care resources. The authors suggest that more effort should be taken to expand and improve the coverage of health care programs to alleviate regional differences in health care use and improve the overall health status of people in these 3 Southeast Asian countries.
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Papers by Kamala Devi