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Aim To increase the knowledge of the frequency and intensity of symptoms and the treatment interventions in older palliative cancer patients. Background Research on symptoms and the treatment modalities in older palliative cancer patients is scarce. Insight into these aspects is needed to enable healthcare professionals to alleviate the burden. Design A cross-sectional study. Methods Four hundred hospitalized older palliative cancer patients participated in the study between March 2013 - February 2015. Two validated instruments were used to assess 40 symptoms in multiple domains and collect data on the treatment modalities in older palliative cancer patients. Results Patients reported on average approximately 14 symptoms. Dry mouth, physical fatigue, lack of energy, lack of appetite and difficulty moving outside were the most prevalent. Psychological pain, psychological fatigue, lack of willpower, lack of energy and physical fatigue were reported as intensive. On average, 5·15 disciplines were consulted per patient. Few patients were referred to a palliative support team, spiritual consultant or psychologist. Patients received a variety of interventions to increase life expectancy and alleviate symptoms and the side effects of treatment. The occurrence of symptoms was associated with different clinical and treatment variables such as having a geriatric risk profile. Conclusions Older patients receiving palliative cancer care are confronted with multiple symptoms. Psychological symptoms are more often reported as intensive. Greater attention should be given to the early referral of patients to palliative care teams, assessment and management of multiple symptoms, particularly psychological symptoms.

Background: Despite an enhanced interest and evolution in pain management, prevalence remains high. Interventions to optimize pain-related care can only be effective if barriers are identified and accounted for. Aim: To assess pain intensity and examine its association with patient- (including health literacy defined in this study as “requiring help to read health information”), nurse-, and system-related (including social capital defined as “the importance of network and norms at work”) barriers/facilitators to pain management. Methods: A two-center, cross-sectional study was performed between October 2012 and April 2013. The study included patients and nurses of 39 noncritical wards of two hospitals in Belgium. Patients who were 18 years of age or older and without impaired cognition or consciousness were eligible to take part. All nurses working in the included ward were invited to participate. Pain intensity and patient-related barriers were collected by a structured and standardized questionnaire, completed in dialogue with the patient. Nurses completed the questionnaire on the nurse- and system-related barriers and the social capital scale. Multilevel analysis was used to analyze the data because of the hierarchical structure of the data. Results: The average pain of all patients across all wards on a 0–10 scale was 2.2 (SD = 3.6). The multilevel analysis indicates that pain intensity can be explained by variables at patient and ward levels. A significant independent association was found between higher pain intensity and younger age, receiving pain medication, the conviction of patients that pain medication does not improve pain, inadequate health literacy in patients, nurses without advanced education, and nurse’s concerns about side effects. Social capital did not emerge as predictor of pain intensity. Discussion: Patient and nurse level factors should be taken into account in hospitals when setting up strategies to improve pain management.

Purpose To develop and validate an instrument to collect data on symptoms (frequency/intensity) in older palliative cancer patients. Methods A four-phase instrument development and validation study was performed. A preliminary version of the instrument was developed through a literature review. Face- and content validity were assessed in a Delphi-procedure with eleven experts. Cognitive interviewing with 24 older cancer patients was performed to enhance content validity of the instrument. Test–retest was performed to assess the stability. Results An 40-item instrument was developed. The Assessment Symptoms Palliative Elderly (ASPE) collects data on frequency and intensity of 24 physical, 10 psychological, 3 functional, 1 spiritual and 2 social symptoms. Content validity was excellent (I-CVI 81.8%–100.0% and S-CVI 92.9%). Cognitive interviewing allowed to improve the content validity. Test–retest showed substantial to almost perfect agreement for 87.5% of the items. No item had poor or fair agreement. Conclusion This study resulted in the development of the ASPE which reflects good properties for face- and content validity and reliability. Cognitive interviewing has a valuable contribution in the validation process. The instrument can be used to gain insight in symptoms in older palliative cancer patients.

Objectives To investigate what published research reveals about the views and experiences of oncology health workers when caring for ethnic minority patients. Design Systematic review of qualitative and quantitative studies. Data sources The following databases were systematically screened: PubMed, CINAHL, Web of Science, and AnthroSource. Reference lists were checked for additional articles. Review methods Empirical studies or systematic reviews (1/2000 to 12/2013) were included if they concerned the oncology setting and the views or experiences of healthcare workers and care users belonging to an ethnic or cultural minority group. The methodological quality of each individual study was assessed using the Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies. Results Eighteen publications met the inclusion criteria. Thirteen articles had a qualitative, four a quantitative, and one a mixed methods design. The results in the individual studies were heterogeneous. Most studies reported challenges or barriers when caring for ethnic minority patients, whereas fewer than half of the articles discussed facilitating factors and opportunities. Oncology health workers participating in the included studies sought to provide professional standards of care and tried to adapt care to the needs of ethnic minority patients. However, they experienced formidable communication barriers and they feared doing things that might be considered culturally insensitive. The organizational aspects of care for the oncology patient appeared to have a significant influence on how healthcare providers view and experience oncology care for ethnic minority patients. Conclusions Views and experiences of participating oncology health workers were characterized by a willingness to provide proper care for ethnic minority patients, but this was hampered by a tangle of interrelated issues such as linguistic barriers, fear and uncertainty, and assumptions about cultural matters. Organizational aspects were shown to be a strong influence on healthcare workers caring for ethnic minority patients. Due to methodological limitations of the included studies, conclusions should be viewed with caution.

Introduction Pressure ulcers impose a substantial financial burden. The need for high-quality health care while expenditures are constrained entails the interest to calculate the cost of preventing and treating pressure ulcers and their impact on patients, healthcare, and society. Objectives The aim of this paper is to provide insight into the cost of pressure ulcer prevention and treatment in an adult population. Methods A systematic literature review was performed to conform the Cochrane Collaboration guidelines for systematic reviews. The search strategy contained index terms and key words related to pressure ulcers and cost. The search was performed in Medline, CINAHL, Web of Science, The Cochrane Library, Embase, and EconLit covering articles up to September 2013. Reference lists and conference abstracts were screened. Articles were eligible if they reported on direct medical cost of pressure ulcer prevention or treatment, and provided national cost estimates, cost per patient, or cost per patient per day. The Consensus on Health Economic Criteria checklist was used to assess methodological quality of the included studies. Results In total, 2542 records were retrieved. After assessing eligibility, 17 articles were included. Five articles reported on both the cost of prevention and treatment, three articles reported on cost of prevention, and nine articles reported on the cost of pressure ulcer treatment. All articles were published between 2001 and 2013. Cost of pressure ulcer prevention per patient per day varied between 2.65 € to 87.57 € across all settings. Cost of pressure ulcer treatment per patient per day ranged from 1.71 € to 470.49 € across different settings. The methodological heterogeneity among studies was considerable, and encompassed differences regarding type of health economic design, perspective, cost components, and health outcomes. Conclusions Cost of pressure ulcer prevention and treatment differed considerable between studies. Although the cost to provide pressure ulcer prevention to patients at risk can importantly impact health care services' budgets, the costs to treat a severe pressure ulcer were found to be substantially higher. Methodological heterogeneity among studies identified the need to use available, and study design-specific methodological guidelines to conduct health economic studies, and the need for additional pressure ulcer specific recommendations.

Background Evidence on the differences in symptom patterns between older palliative cancer and non-cancer patients is lacking. The purpose of the study was to determine the differences in symptoms between older hospitalised palliative cancer and non-cancer patients. Methods A secondary analysis of two multi-centre cross-sectional studies was performed. A validated instrument was used to assess the frequency and intensity of 40 symptoms in older hospitalised palliative cancer patients (n = 100) and older palliative non-cancer patients (n = 100). The data were collected between March 2013 and June 2015. Differences between groups were measured statistically. Results Overall, similarities in symptom patterns were observed between cancer and non-cancer patients. Some minor differences were detected between the groups. Non-cancer patients experienced significantly more physical symptoms and functional dependence than cancer patients. Patients with cancer experienced higher levels of frequency and intensity of psychological symptoms compared to non-cancer patients. Conclusions Healthcare professionals should be aware of the high occurrence of symptoms in both cancer and non-cancer patients, and they should be educated about the systematic assessment of symptoms in multiple domains by accounting for the occurrence of generic symptoms and disease-specific symptoms.

Background Several studies reported poor to moderate agreement between patient- and nurse-reported pain assessment. Many of these studies focused on a specific patient group. So far, no study studied the level of agreement in the assessment of patient-related barriers between patients and nurses. Aims The aim of the study was to identify if nurses and patients equally assessed pain intensity and patient-related barriers to pain management in hospitalised patients. Design A cross-sectional study was performed in two hospitals. Participants Inclusion criteria for patients were: (1) being at least 18 years; (2) understanding the Dutch language; and (3) giving informed consent. All nurses responsible for the participating patients and present at the time of the survey were invited to participate. Methods Data were collected between October 2012 - April 2013. Patients and nurses completed the Numeric Rating Scale to measure pain intensity. Patient-related barriers to pain management were measured using the barriers to pain assessment and management scale developed by Elcigil et al. (2011). Results A moderate agreement between patients and nurses was found for the assessment of pain intensity. Multiple logistic regressions showed a significant association between pain intensity reported by patients and the under-, over- and adequate estimation of pain by nurses. Nurses significantly underrated the belief patients had regarding pain management. Conclusions Nurses should be educated about these beliefs and should be encouraged to actively explore patient-related barriers to pain management with their individual patients. Routine pain assessments should also be encouraged and should be explained to patients. This article is protected by copyright. All rights reserved.

The aim of this analysis was to identify the association between inconti- nence-associated dermatitis (IAD), its most important etiologic factors (incontinence and moisture), and pressure ulcers (PUs). A systematic review and meta-analysis were performed. We searched Medline, Embase, CINAHL, Web of Science, and the Cochrane Library for relevant papers dating through March 15, 2013. Fifty-eight studies were included. Measures of relative effect at the univariate level were meta- analyzed. In most studies (86%), a significant association between variables of inter- est was found, with pooled odds ratios of PUs in univariate models between 1.92 (95% CI 1.54-2.38) for urinary incontinence and 4.99 (95% CI 2.62-9.50) for double incontinence (p

Context Symptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care. Objectives The objective of this systematic review was to search and synthesize the prevalence figures of symptoms in older palliative care patients with cancer. Methods A systematic search through multiple databases and other sources was conducted from 2002 until April 2012. The methodological quality was evaluated. All steps were performed by two independent reviewers. A meta-analysis was performed to pool the prevalence of symptoms. Results Seventeen studies were included in this systematic review. Thirty-two symptoms were identified. The prevalence of these symptoms ranged from 3.5% to 77.8%. The most prevalent symptoms were fatigue, excretory symptoms, urinary incontinence, asthenia, pain, constipation, and anxiety and occurred in at least 50% of patients. Conclusion There is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.

Review questions/objective The overall aim of this systematic review will be to find and synthesise the best available evidence regarding the prevalence of symptoms in elderly persons with incurable cancer. The following questions will be addressed: 1. Which symptoms do elderly people with incurable cancer experience? 2. What is the point prevalence of the identified symptoms in the elderly with incurable cancer? 3. Is there a difference in the prevalence of symptoms in different subgroups (subgroups such as, but not limited to, cancer stage and cancer type)? Inclusion criteria Type of participants This review will consider studies including adults older than 65 years and suffering from incurable cancer. All quantitative studies with reported data that are appropriate for the estimation of the prevalence of interest for this review will be included. Consideration will be given to ensuring the inclusion of studies with an appropriate sample size for the estimation of prevalence. Type of outcomes Studies reporting on the point prevalence of symptoms (physical, psychological, social, spiritual) or reporting a proportion or number of patients with the symptom will be considered for inclusion. In intervention studies in which symptoms are possibly affected by that intervention, only baseline measurements will be used.

Introduction: Since sleep is found to be a fundamental part in experiencing quality of life and health it is of importance that nurses and other health care personnel strive to improve sleep and pr ...

Aim To evaluate the effectiveness of an e-learning course compared with a face-to-face lecture on medication calculation. Background The current knowledge on medication calculation of nursing students and nurses is insufficient to provide safe care. Design A stratified-clustered quasi-experimental study. Methods A random selection of nursing schools were allocated to the e-learning course (intervention group) (seven schools; 189 students) or face-to-face lecture (control group) (six schools, 222 students). Students in both groups completed a validated medication calculation test (maximum score: 16) prior to the course (T0), immediately after the course (T1) and 3 months later (T2). A linear mixed model was used for data analysis. Results Medication calculation skills improved significantly more by the face-to-face lecture than e-learning course. Students in both groups significantly improved in medication calculation skills immediately after the course (T1) and 3 months later. The results flattened at T2 with a significant decline in the intervention group between T1 and T2 and a non-significant decline in the control group. Based on a subgroup analysis, improvement in medication calculation skills at T2 could only be observed in vocational-level (sub degree) nursing students receiving a face-to-face course. Conclusions Both medication calculation courses had a positive effect on medication calculation skills. Students receiving traditional face-to-face lecture improved significantly more than the students receiving the e-learning course.

Background Accurate detection of symptoms is essential in palliative care. Identification of clustering of symptom is valuable to develop target interventions. This area is largely understudied in older palliative cancer patients. Objectives To identify symptom clustering in older palliative cancer patients, and patient groups based on the clustering of symptoms, and to evaluate the difference in functional dependence and experiencing life as not meaningful between the identified patient groups. Design A cross-sectional study. Setting Geriatric and non-geriatric wards of seven acute care hospitals. Participants 400 palliative cancer patients aged 65 years and older. Methods Symptoms were collected using a validated instrument which assesses physical, psychological, functional, social, and existential symptoms by means of a structured interview with a researcher. An agglomerative hierarchical clustering analysis was used to analyse the data. Results The cluster analysis revealed five groups of symptoms: (1) urological and gastrointestinal symptoms, and their treatment complications, (2) psychological and existential symptoms, (3) pain, constipation, sleeplessness and airway problems, (4) functionality problems, and (5) fatigue-related symptoms. Three patient groups were identified: (1) symptom-free group, (2) physical discomfort group, and (3) physical and psychological discomfort group. In the last group, significant more patients had a geriatric risk profile and less of them received chemotherapy. Patients in this group were more often functionally dependent and experienced their life as not meaningful. Conclusion Five groups of symptoms were identified. Three patient groups were identified which reported different levels of functionality and experiencing life as meaningful. Healthcare professionals should be triggered to detect symptom clusters and be alert to the presence of the other symptoms in the cluster when identifying one symptom. They should also be alert to patients with a geriatric risk profile because of their higher risk of experiencing physical and psychological symptoms and the influence these symptoms have on being functionally dependent and experiencing life as not meaningful.

Purpose/Objectives: To evaluate the level of agreement of symptom assessment among older adult palliative patients with cancer, nurses, and patients’ proxies. Design: A cross-sectional study. Setting: Two general hospitals in Flanders, Belgium. Sample: 120 palliative patients with cancer, aged 65 years and older. Methods: A validated 36-item instrument developed to assess physical, psychological, functional, social, and existential symptoms in older palliative patients with cancer was independently completed by patients, the nurses, and proxies. Main Research Variables: Frequency and intensity of 36 symptoms. Findings: The study indicates that nurses and proxies tend to underestimate physical and social symptoms and overestimate psychological, functional, and existential symptoms. Agreement scores between patients and nurses and patients and proxies were only significantly different in 39% and 20% of the cases, respectively. Higher intraclass correlation coefficients were measured between patients and proxies compared to patients and nurses. Agreement was associated with demographic and clinical factors, such as gender and prognosis. Conclusions: This study indicates discrepancies among patient, nurse, and proxy in the assessment of symptoms. Implications for Nursing: Patients should be encouraged to report their true experiences. Nurses and proxies should be taught to recognize and assess symptoms and to communicate about them with patients.

The aim of this analysis was to identify the association between incontinence-associated dermatitis (IAD), its most important etiologic factors (incontinence and moisture), and pressure ulcers (PUs). A systematic review and meta-analysis were performed. We searched Medline, Embase, CINAHL, Web of Science, and the Cochrane Library for relevant papers dating through March 15, 2013. Fifty-eight studies were included. Measures of relative effect at the univariate level were meta-analyzed. In most studies (86%), a significant association between variables of interest was found, with pooled odds ratios of PUs in univariate models between 1.92 (95% CI 1.54-2.38) for urinary incontinence and 4.99 (95% CI 2.62-9.50) for double incontinence (p .05). This evidence indicates an association between IAD, its most important etiological factors, and PUs. Methodological issues should be considered when interpreting the results of this review.

Objectives Cancer treatment can impair fertility. The aim of this review was to investigate (1) fertility information needs, receipt and provision, (2) fertility information preferences, and (3) factors associated with receiving/providing fertility information. Cancer patients' and professional caregivers' perspectives were considered. Design Mixed-methods systematic review. Data sources Six electronic databases (PubMed, Web of Science, CINAHL, CRD, Embase) were systematically screened to retrieve articles published between January 2001 and March 2012. Reference lists and conference abstracts were checked for additional publications. Review methods The principles outlined in the Cochrane Handbook for Systematic Reviews of Intervention were applied. Publications were included if they explored fertility-related information/communication in cancer patients/survivors of reproductive age or professional caregivers. The Critical Appraisal Skills Programme for Qualitative Studies and the Quality Assessment Tool for Quantitative Studies were used to assess the methodological quality. A standardised form based on the Cochrane guidelines for systematic reviews was used to extract the data. Two independent reviewers performed all methodological steps. Results Of the 1872 papers found, 27 were included in this review. The majority (66–100%) of the cancer patients wanted information about the impact of cancer therapy on fertility. The need and importance were higher in younger and childless patients, and in patients having childbearing plans. The number of patients receiving this information ranged from 0% to 85%. Several factors were associated with the lack of information receipt, including female gender and age 35 years or older. Patients preferred information via an individual consultation. In the diagnostic phase patients needed information about the impact of the treatment on fertility and preservation options. At the end or after the treatment, information needs shifted towards long term effects. Professional caregivers experienced several barriers in providing fertility information, including caregiver-, patient- and institutional-related factors. Nurses in particular, perceived difficulty in providing fertility-related information due to additional barriers associated with limited responsibility and opportunity in fertility information provision. Conclusion Professional caregivers experienced multiple barriers that hinder information provision. Further exploration of the role of Advanced Nurse Practitioners/Midwifes and the development of an evidence based intervention to overcome caregiver-related barriers are recommended to improve information provision.

Objectives Malnutrition is a common problem in the elderly. It is not clear if oral health is associated to malnutrition in this population. The aim of this systematic review is to determine whether an association exists between oral health and malnutrition in the elderly in a long-term care facility. Design Systematic review. Data source Medline, Cochrane and Cinahl were systematically searched for to identify articles published between January 1985 and May 2011. Reference lists were checked for additional publications. Review methods Publications were included if they explored the association between oral health status and malnutrition. As no consensus about terminology was found, a sensitive filter was developed. The methodological quality of the studies was assessed. Two independent reviewers performed all methodological steps. Results Sixteen studies met the criteria for inclusion. Eleven studies used a multivariate approach; nine of these found an association between oral health status and malnutrition. Four studies found a relationship between masticatory problems and malnutrition. Five studies found an association between malnutrition and dental condition, number of oral problems, tongue alteration, problems with saliva flow, and candidiasis. Overall, the methodological quality of the studies was medium. Conclusions Tentative evidence indicates an independent association between oral health status and malnutrition in the elderly residing in a long-term care facility. Caution is needed for the interpretation of these results because of the absence of a gold standard to define and assess malnutrition and oral health status and the presence of methodological limitations throughout the studies.

We examined the interrater reliability of the interRAI AC. An observational study was conducted on 3 geriatric wards. Two trained raters completed independently the interRAI AC between 24 and 48 h after admission. A sample of 100 patients (age 84.5 ± 5.6 years; 45% female) was analyzed. Interrater reliability was tested using observed agreement, kappa coefficients, and intraclass correlation coefficients. The overall kappa median value for nominal items was 0.82 (almost perfect). For items on ordinal level, both the overall weighted kappa median and the intraclass correlation coefficient median were 0.86 (almost perfect). According to conventional cut-offs for interpreting kappa statistics, reliability was almost perfect (K ≥ 0.81) for 60% of all items, substantial (0.60 < K ≤ 0.80) for 26%, moderate (0.41 < K ≤ 0.60) for 10%, and poor (K ≤ 0.40) for 4% of the items. The median observed agreement was 0.89. For 83% of the items, the observed agreement was greater than 0.80. This study showed substantial or almost perfect interrater reliability for 86% of the items. In addition to previous evidence, the current results suggest that the estimates of the interrater reliability of the interRAI AC are acceptable and provide preliminary evidence that the current version is appropriate for clinical application.