The Impact of Hematologic Cancer and Its Treatment on Physical Activity Level and Quality of Life Among Children in Mainland China: A Descriptive Study Background The effects of hematologic cancer and its treatment on Chinese children’s physical activity level and quality of life (QoL) remain unclear despite numerous studies conducted in Western countries and Hong Kong. Objective The aim of this study was to examine the effects of hematologic cancer and its treatment on the physical activity level and QoL among Chinese children. Methods A cross-sectional study was conducted. One hundred twenty-five children who were admitted for treatment of hematologic cancer and 243 healthy counterparts of similar age participated in this study. All participants were asked to complete the Chinese University of Hong Kong: Physical Activity Rating for Children and Youth and Pediatric Quality of Life Inventory. The children with hematologic cancer also completed a therapy-related symptom checklist. Results There were statistically significant differences in the mean physical activity and QoL between children with hematologic cancer and their healthy counterparts. Multiple regression analyses showed that physical activity levels and the adverse effects of hematologic cancer treatment had statistically significant effects on the children’s QoL. Conclusions Physical activity level and QoL in children with hematologic cancer were both lower than those in their healthy counterparts. Implications for Practice This study provides further evidence that hematologic cancer and the adverse effects of its treatment have negative effects on Chinese children’s QoL. Although a lack of physical activity is deeply embedded in Chinese culture, nurses should take a proactive role in effecting change by educating parents about the benefits to their children’s physiologic and psychological well-being of physical activity during and after treatment. RESEARCH AWARD No abstract available

The Easier, the Better: Truth of Measurement No abstract available

Chinese Version of Pediatric Patient-Reported Outcomes Measurement Information System Short Form Measures: Reliability, Validity, and Factorial Structure Assessment in Children With Cancer in China Background The Pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to measure symptoms and functions of children with a variety of chronic diseases. As the Chinese version of pediatric PROMIS (C-Ped-PROMIS) measures was developed, the measurement properties of C-Ped-PROMIS have not been demonstrated. Objective The aim of this study was to examine the reliability, validity, and factorial structure of the C-Ped-PROMIS measures in children with cancer in China. Methods A total of 272 children and adolescents were recruited from 3 hospitals in China. The 8 C-Ped-PROMIS measures and Pediatric Quality of Life Inventory General Core Module and Cancer Module were administered in a cross-sectional design. Known-group validity, concurrent validity, and item and scale reliability of these 8 measures were examined by using SPSS 21.0, and factorial structures were tested by using confirmatory factor analysis with Mplus 7.1. Results All 8 C-Ped-PROMIS measures showed good known-group validity as hypothesized (P < .05) and good concurrent validity measured by significant correlations with the Pediatric Quality of Life Inventory General Core Module and Cancer Module; the correlation coefficients ranged from r = 0.519 to r = 0.655, except for peer relationship with r = 0.255 and r = 0.136, respectively. The Cronbach's α of C-Ped-PROMIS ranged from .758 to .910, and model-estimated scale reliabilities ranged from 0.740 to 0.905. The confirmatory factor analysis models of each measure fit data very well. Conclusions All 8 C-Ped-PROMIS measures have a valid factorial structure as theoretically defined with good reliability and validity. Implications for Practice The C-Ped-PROMIS can be readily used to measure symptoms and functions of children and adolescents with cancer in China.

Interrelatedness of Distress Among Chinese-Speaking Patients and Family Caregivers Background Cancer is a family disease, affecting the individual patient and the family. For Chinese patients and their families in Canada, adjusting to cancer may be particularly distressing when culture and language are not congruent with the mainstream model of care delivery. Objective In view of the limited research on the cancer experience of Chinese families, this study aims to examine the interrelatedness of patients and family caregivers' distress among a Chinese-speaking cancer population in Canada. Methods Semi-structured interviews were conducted with a purposive sample of 10 Chinese-speaking cancer patients and 6 family caregivers. Qualitative analysis of the interview data was conducted to construct cross-cutting themes regarding the experiences of distress after a cancer diagnosis. Results Four overarching themes emerged from the analysis: (1) misconception about cancer, (2) tensions in disclosure, (3) patient and family caregiver distress, and (4) concealing emotion in patient and family caregiver. Notably, the interrelatedness of patients and family caregivers' distress was highlighted, as patients and family caregivers both sought to regulate their own emotions to protect one another's mental well-being. Conclusion The study provides insights into the distress of living with cancer and the impact on family relationships. Understanding the patients and family members' cultural and social contexts also provides the foundation for patient- and family-centered care. Implications for Practice Healthcare professionals can provide culturally appropriate care by recognizing the needs, values, and beliefs of cancer patients and their families. Furthermore, the patient–family-caregiver dyad needs to be considered as the unit of care.

Parent Psychological and Physical Health Outcomes in Pediatric Hematopoietic Stem Cell Transplantation Background Parents of children undergoing hematopoietic stem cell transplantation (HSCT) are at risk of adverse health outcomes due to their intense caregiver demands. Objective The aim of this study was to describe adverse health outcomes in parents of children who survived an allogeneic HSCT done within the past 1 to 10 years. Methods This cross-sectional study, conducted at a children's hospital in the western United States, enrolled English- and Spanish-speaking parents of children who survived allogeneic HSCT between 2005 and 2015. Outcome measures included Beck Anxiety and Depression Inventories, Perceived Stress and Parent Stress Scales, Physical Symptom Inventory, and Short-Form 36 version 2. Parent scores were compared with normative means. Subsequently, the parent sample was stratified by the amount of time since their child's HSCT for comparison between groups. Results Fifty-four mothers and 7 fathers (n = 61) were enrolled. Global mental health scores were lower for parents in the sample compared with norms (P = .003). Parents in the sample reported moderate anxiety and depression (20% and 23%, respectively), yet reported less parenting stress and superior health outcomes compared with norms (P < .001). Social functioning and general health scores were lower for parents whose children survived an allogeneic HSCT done within the past 1 to 4.99 years (P = .012). Conclusion Parents of survivors of allogeneic HSCT may concurrently experience posttraumatic growth and stress following their child's HSCT. Implications for Practice Health screening and psychological support for parents of children post-HSCT may help to identify parents at risk of adverse outcomes and allow for early, targeted interventions.

Racial Disparities in Cervical Cancer Screening: Implications for Relieving Cervical Cancer Burden in Asian American Pacific Islander Women Background While cervical cancer is considered preventable and the overall Papanicolaou (Pap) test utilization rate has gradually increased in the United States, certain Asian American Pacific Islander (AAPI) women consistently rate lower in Pap test receipt compared with non-Latina whites (NLWs), leading to a higher cervical cancer mortality rate for various AAPI women. Few studies, however, have focused on female AAPI college students' cervical cancer screening behavior in comparison with NLW students. Objective This study aimed to investigate cervical cancer screening behaviors among college-aged females by (1) determining AAPIs' and NLWs' screening rates, (2) assessing their knowledge about Pap tests, and (3) discovering factors associated with Pap test receipt. Andersen's Health Behavioral Model was used as a theoretical framework. Methods Using a simple random sampling strategy, 2270 female students (15% AAPIs, 85% NLWs) completed an online health survey. Results Results indicate AAPI students had significantly lower Pap test knowledge and Pap test receipt rate compared with NLW students. Age, nativity, human papillomavirus vaccination completion, frequency of obstetrician/gynecologist (OB/GYN) visits, and the number of sexual partners were associated with AAPI students' lower rate of Pap test receipt, whereas the Pap test receipt rate for NLW students was influenced by the same factors with the addition of having increased prior knowledge about Pap tests. Conclusion Results show the importance of OB/GYN visits in obtaining Pap tests for AAPI and NLW students. Implication for Practice Health practitioners should pay attention to students' race/ethnicity in their practice and provide corresponding ethnic group–specific preventive care.

Symptom Trajectories of Adolescents During Hematopoietic Stem Cell Recovery Background Adolescents undergoing allogeneic hematopoietic stem cell transplantation (HSCT) experience multiple symptoms during and after the transplant. These symptoms can increase the need for medical care and reduce the quality of their life. However, little is known about symptom experiences specific to adolescents undergoing HSCT. Objective The primary aim was to describe symptom incidence, severity, and distress trajectories among adolescents from pre-HSCT through 90 days post-HSCT. A secondary aim was to examine the relationship between symptom trajectories and demographic and treatment factors. Methods A repeated-measures design was used for this prospective study. Demographic and treatment information was collected from the medical record. Symptoms were assessed with the Memorial Symptom Assessment Scale 10–18. Symptom trajectories were identified by latent class growth analysis with growth mixture modeling; logistic regression evaluated relationships of demographic and treatment characteristics on the latent classes of symptom trajectories. Results Two distinct latent class trajectories were identified for symptom incidence, severity, and distress. Symptom incidence declined, but symptom severity and distress remained stable. No significant relationships were noted among any demographic or treatment characteristics to any of the symptom trajectories. Conclusions Symptoms persist and remain severe and distressing throughout the first 90 days after HSCT, with pain and lack of energy among the highest in incidence, severity, and distress. Implications for Practice Awareness of symptom trajectories empowers nurses to assess for symptoms throughout the HSCT process and conduct meaningful symptom discussions with their patients.

Quality of Life in Patients With Non–Small Cell Lung Cancer: Structural Equation Modeling Background Quality of life (QOL) is important for cancer patients, even for survival. However, factors affecting QOL of non–small cell lung cancer (NSCLC) patients have not been studied sufficiently. Objective The aims of this study were to understand the relationships among social support, resilience, distress, and symptom and to identify predictors of QOL for NSCLC patients. Methods Participants were 212 adult patients who visited an outpatient department at a tertiary hospital located in Seoul, Korea. Data were collected using self-reported questionnaires and clinical records. Results Social support, resilience, distress, symptom burden, and QOL explained 99.9% of the variance in QOL. Social support was not a significant predictor of distress and QOL, but a significant predictor of resilience. Resilience was a significant predictor of both distress and QOL. Distress was not a significant predictor of QOL, but a significant predictor of symptom burden. Symptom burden was a significant predictor of QOL and had the largest direct effect on QOL. Resilience also had an important impact on QOL because resilience influenced QOL in various paths. Conclusion This study suggests that social support, resilience, distress, and symptom burden are predictors of QOL in an NSCLC population. These predictors had direct and indirect effects on each other and on QOL. Implications for Practice Developing an interventional program to increase resilience and social support as well as to decrease symptom burden and distress may be necessary to improve QOL of NSCLC patients.

A Hermeneutic Interpretation of Nurses’ Experiences of Truth Telling and Harms in Cancer Care in Qatar Background Telling the truth to cancer patients remains under debate in the Middle East, where concealment about diagnosis and prognosis occurs in some cases. Concealment results in challenges for nurses providing care. Objective The aim of this study was to understand nurses’ lived experiences of caring for cancer patients whose cancer diagnosis or prognosis has been withheld from them. Methods Eight nurses from the national cancer center in Qatar were interviewed. The transcripts of the interview texts were interpreted using Gadamer’s hermeneutic approach. Results The interpretations are shaped by understandings of harm. Nurses assessed harm using empathy. Nurses’ empathy was permeated with fears that accompany a cancer diagnosis; the language of cancer is interpreted as a language of fear. It is ideas about harms and evoking patients’ fear that generates nurses’ experiences of complexity, ambiguity, and conflicting feelings regarding truth telling and concealment. The meanings nurses drew from their experiences rested on understandings about love, vulnerability, and opportunities to atone. We interpret nurses’ descriptions of being enmeshed in a web of lies through which multidimensional harms are experienced. The complexities of nurses’ experiences go well beyond the universal concepts of informed consent and patients’ rights. Conclusions Nurses’ experiences reveal insights that likely resonate across other jurisdictions in the Arabic Gulf and other Eastern cultures, where nurses deal with these sensitive issues case by case. Implications for Practice Leaders and health professionals in cancer care in such cultures must establish more nuanced and transparent interdisciplinary approaches to respond to the complexities of truth telling in cancer care.