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Aims: We aimed to test a model in which hope and spiritual well-being acted as protective factors against anxiety and depressive symptoms in childhood cancer patients (CCPs). We hypothesized that hope and spiritual well-being were mutually reinforcing factors that would both reduce anxiety and depressive symptoms., Methods: Using path analysis, the hypothetical model was tested on a cross-sectional sample of 412 Chinese CCPs aged 8-17 years. Self-reported measures were used to obtain data on participants' social and clinical characteristics, spiritual well-being, hope, anxiety and depressive symptoms., Results: The hypothetical model was supported. Results suggested that sex, treatment type and diagnosis predicted spiritual well-being; diagnosis and time since diagnosis predicted hope. Spiritual well-being and hope were mutually predictive and mutually reinforcing, and were both negatively associated with anxiety and depressive symptoms. This model predicted 40% of the variance in spiritual well-being, 37% in hope, 39% in depressive symptoms, and 28% in anxiety., Conclusion: Spiritual well-being and hope were mutually reinforcing and served as protective factors against anxiety and depressive symptoms. These support the value for integrating spiritual and hope elements in developing interventions for CCPs to improve their spiritual and psychological well-being along the disease trajectory., (© 2023 John Wiley & Sons Ltd.)

Hope plays an extremely important role in protecting childhood cancer patients from psychological distress caused by cancer. The availability of a valid and reliable instrument that can accurately assess hope is crucial for the development of interventions to enhance hope among childhood cancer patients. This study aimed to examine the psychometric properties of the Chinese version of the Herth Hope Index (HHI). Chinese childhood cancer patients aged 8-17 years (n = 412) were invited to participate in this cross-sectional study. Participants completed the Chinese translated version of the HHI, the Center for Epidemiology Studies Depression Scale for Children and the Paediatric Quality of Life Inventory 3.0 Cancer Module. Exploratory factor analysis and confirmatory factor analysis were conducted to assess the structural validity of the HHI. Content validity, convergent validity, internal consistency, and test-retest reliability at 2 weeks were also examined. The content validity index for items ranged from 0.8 to 1.0, and that for the scale was 0.9, demonstrating appropriate content validity. There was a positive correlation between HHI and Center for Epidemiology Studies Depression Scale for Children scores and a negative correlation between HHI and Paediatric Quality of Life Inventory 3.0 Cancer Module scores. The results indicated that the Chinese version of the HHI showed reasonable convergent validity and discriminant validity. Exploratory factor analysis yielded a three-factor model, which could explain 82.74% of the total variance. The confirmatory factor analysis results showed that χ 2 /df was 2.20, comparative fit index was 0.98, goodness of fit index was 0.94, and root-mean-square error of approximation was 0.07. Cronbach's alpha was 0.78, indicating good internal consistency. The findings of the study showed that the Chinese version of the HHI (11-item) is a reliable and valid instrument for assessing hope among Chinese childhood cancer patients. Evidence-based interventions can be provided to enhance hope in this population., (© 2023. The Author(s).)

Introduction: Cancer and its treatment affect children's physical, psychological and social well-being throughout the disease trajectory. Spiritual well-being is a fundamental dimension of people's overall health and is considered a source of strength to motivate patients to cope with and adapt to their disease. Appropriate spiritual interventions are important to mitigate the psychological impact of cancer on children, with an ultimate goal of improving their quality of life (QoL) throughout the treatment course. However, the overall effectiveness of spiritual interventions for paediatric patients with cancer remains unclear. This paper describes a protocol to systematically summarise the characteristics of studies related to existing spiritual interventions and synthesise their effectiveness on psychological outcomes and QoL among children with cancer., Methods and Analysis: Ten databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials that meet our inclusion criteria will be included. The primary outcome will be QoL as evaluated by self-reported measures. The secondary outcomes will be self-reported or objectively measured psychological outcomes, including anxiety and depression. Review Manager V.5.3 will be used to synthesise the data, calculate treatment effects, perform any subgroup analyses and assess the risk of bias in included studies., Ethical and Dissemination: The results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Spiritual well-being is the fourth dimension of health, as equally important as physical, mental, and social well-being. The shadow of death associated with cancer triggers children to explore their personal values, meanings, and life goals throughout the illness trajectory, enabling them to identify their unique spiritual needs. Chinese children are generally non-religious, unlike Western children, which affects their spiritual needs. To address the literature gaps, we applied a qualitative, descriptive, phenomenological approach for exploring the spiritual needs of Chinese children hospitalized with cancer. Purposive sampling was conducted in two public hospitals with special wards for pediatric oncology patients in Hunan Province, China. Consequently, 22 children, hospitalized with cancer, were recruited and individually interviewed using a semi-structured interview format. We conducted a thematic analysis of the interview transcripts. Four important themes were identified: the need for self-exploration, inner needs, need for a connection with others, and need for a connection with gods, supernatural powers, and fictional characters. We found that culture significantly influenced the spiritual needs of Chinese children with cancer. Hope was a key factor motivating the children to continue cancer treatment. To address their unique spiritual needs, culturally specific interventions should be developed and incorporated into their care to enhance their spiritual well-being.

Background: The increasing number of cancer patients and inadequate communication in clinics are posing challenges to cancer patients receiving outpatient-based chemotherapy and healthcare providers. A nurse-led care program was proposed as one way of dealing with at least some of these challenges., Objective: The objectives of the pilot study were to assess the feasibility of the subject recruitment, care, and data collection procedures and to explore the acceptability of this program., Methods: A pilot study with a 1-group pretest-posttest design was conducted. Five cancer patients receiving chemotherapy in a chemotherapy day center participated. Each patient had a nurse consultation before chemotherapy and received 2 telephone calls after the first and second cycles of chemotherapy. Four questionnaires were adopted to evaluate the subjects' quality of life, self-efficacy, symptom experiences, and satisfaction with care. Questionnaires were completed before the chemotherapy and after the second cycle. The subjects were also interviewed to understand their comments on the service., Results: The recruitment, care, and data collection procedures were completed smoothly. Slight changes were observed in quality of life and self-efficacy. All 5 subjects were highly satisfied with the care., Conclusions: The nurse-led care program is feasible and acceptable., Implications for Practice: The effect of the nurse-led care program will be evaluated in a single-center, open, randomized controlled trial. If the encouraging results can be confirmed, it may be an effective approach to improving the quality of ambulatory chemotherapy care. It would also shed light on the development of nurse-led care in other areas.

Background: The importance of having nurses address patients' sexuality concerns is emphasized by a growing body of literature. Most relevant studies were conducted in Western cultural settings., Objective: The purpose of this study was to describe Chinese nurses' attitudes and beliefs regarding sexuality care in cancer patients., Methods: A descriptive and correlation design was adopted. Data were collected by an inventory of Sexuality Attitudes and Beliefs Survey., Results: Oncology nurses (n = 199) were recruited from a tumor hospital in China. The study results indicate that most Chinese nurses (76.4%) perceived sexuality as too private an issue to discuss with cancer patients, and 63.8% assumed that most cancer patients lacked interest in sexuality because of their illnesses. The results also show that most nurses (77.9%) did not make time to discuss sexuality issues with patients, and nearly 70% did not feel confident and comfortable discussing cancer patients' sexuality concerns., Conclusion: Helping nurses overcome barriers to addressing patients' sexuality concerns requires a careful assessment of their attitudes and beliefs. This study added insights into Chinese nurses' attitudes and beliefs surrounding the sexuality issues of cancer patients., Implications for Practice: In this study, nurses reported that they were less likely to make time to discuss sexuality issues with cancer patients; thus, future research needs to identify specific factors keeping nurses from incorporating sexuality care into practice. Additionally, most nurses felt less confident and uncomfortable in addressing cancer patients' sexuality concerns. More training related to sexuality care is needed for Chinese nurses.