Objective To develop a evidence-based and local decision supporting tool for breast reconstruction for breast cancer surgery based on Ottawa decision support framework to guide clinical decision-making and promote the implementation of shared decision-making.Methods Based on Ottawa decision support framework and International Patient Decision Aid Standards 4.0(IPDAS4.0),the initial version of breast reconstructive surgery decision support tool was proposed through a literature review.Eighteen clinical and nursing experts specialised in breast cancer and breast reconstruction were invited to participate in 2 rounds of Delphi consultations and resulted in a revised version of the tool.Following a pilot test involving 5 patients and 5 family members in clinical settings,their feedback was integrated into the revised version to create a final version of the tool.Results The initial version of the tool were developed based on the literature review and evidence synthesis,comprising 7 primary indicators,14 secondary indicators and 49 tertiary indicators.In the first round of consultation on the 3-tier indicators,the average importance scores ranged from 4.06 to 4.94,with coefficients of variation were 0.05-0.22,and proportions of full marks ranged from 0.53 to 0.88.In the second round of consultation on the 3-tier indicators,the average importance scores ranged from 4.71 to 4.94,with coefficients of variation were 0.05-0.15,and proportions of full marks ranged from 0.72 to 1.00.Kendall's W coefficients for the primary,secondary and tertiary indicators in the second round were 0.509,0.437,and 0.425,respectively.The finalised decision support tool for breast cancer and breast reconstruction included 7 primary indicators covering decision evaluation,disease information support,risk and benefit analysis,decision support system,balance value and preference,promotion of decision making,evaluation of decision quality,alongside 14 secondary indicators and 50 tertiary indicators.Clinical trials confirmed the finalised effectiveness of the tool.Conclusion The decision support tool for breast cancer and breast reconstruction which developed on the basis of Ottawa decision support framework demonstrates scientific rigor and clinical value.It provides solutions for breast cancer patients when facing difficulties in making a decision for breast reconstruction surgery.

Objective:To construct a core competency indicator system for oncology advanced practice nurses.Methods:This study is a cross-sectional study. A preliminary draft of the core competency indicator system for oncology advanced practice nurses was developed through literature review and expert group coordination from June to November 2022. The core competency indicator system for oncology advanced practice nurses was established using the Delphi method for expert consultation and the analytic hierarchy process.Results:A total of 54 experts from 11 hospitals and four medical schools in 10 provinces and municipalities directly under the central government across the country were included in two rounds of expert consultation. The effective response rates of the questionnaire were all 100%, with an expert authority coefficient of 0.90, Kendall coordination coefficients of 0.089 to 0.179 and 0.101 to 0.176 ( P<0.01). The final established core competency indicator system for oncology advanced practice nurses included seven primary indicators and 69 secondary indicators. Conclusions:The core competency indicator system for oncology advanced practice nurses is comprehensive and has the characteristics of specialized oncology nursing, and the construction process is scientific and reliable, laying the foundation for future training of oncology advanced practice nurses.

Objective:To investigate the present situation of lymphedema clinics in 60 hospitals and provide reference for the management and development of lymphedema nursing clinic.Methods:Convenience sampling method was used to select 60 hospitals that had set up lymphedema nursing outpatient service. A self-designed questionnaire was conducted for the heads of lymphedema nursing clinics from June 10th 2021 to August 15th, 2021 using electronic questionnaires.Results:Lymphedema clinics had been opened since 2015 and developed rapidly in recent years. The outpatient service mainly took the form of specialized outpatient service for lymphedema, accounted for 61.67%(37/60), and also existed in the form of combined breast rehabilitation, ostomy, catheter maintenance, etc. There was a great difference in the frequency of outpatient service in hospitals, 46.67%(28/60) had outpatient service every day, 36.67% (22/60) had outpatient service only half a day every week. The number of outpatient patients was relatively low, 61.67%(37/60) of the hospitals had no more than 10 patients per week, and only 8.33% (5/60) had more than 50 patients per week. There were only 26 full-time nurses accounted for 14.94%(26/174), and the international lymphedema therapist certification rate was 36.21% (63/174). Training institutions included foreign introduced training programs, domestic and foreign cooperation programs, overseas training and local training, etc. 100.00% (60/60) of the hospitals participating in the survey adopted comprehensive detumescence therapy, combined with auxiliary motor muscle energy binding technology 51.67% (31/60), air wave pressure therapy 48.33% (29/60), traditional Chinese medicine therapy 16.67% (10/60), etc. According to the survey of charging situation, only 14 hospitals accounted for 23.33%(14/60) had special charging, among which 12 hospitals accounted for 20.00%(12/60) had official charging approval.Conclusions:Lymphedema clinics have been developed and the ranks of lymphedema therapists are growing. The relevant departments should strengthen the standard management of lymphedema clinic, clarify the qualifications of visiting personnel, establish the standard of outpatient fees, promote the sustainable development of lymphedema clinic, and finally improve the quality of life of patients with lymphedema.

Objective:To explore the current situation of evidence-based practice competence of masters of nursing specialist at Class Ⅲ hospitals and its influencing factors so as to provide decision-making basis for optimizing the construction and educational management of clinical teaching base for masters of nursing specialist.Methods:From July to October 2021, 141 masters of nursing specialist of Class Ⅲ hospitals in Tianjin were selected as subjects by purposive sampling. All students were investigated with the Chinese version of Evidence Based Practice Evaluation Competence Questionnaire (EBP-COQ) and the Barriers to Research Utilization Scale. Multiple linear regression was used to analyze the influencing factors.Results:Among 141 masters of nursing specialist, the total scores of the EBP-COQ and the Barriers to Research Utilization Scale were 95.35 ± 11.90 and 72.52 ± 26.28 respectively. Multiple linear regression analysis showed that the influencing factors of evidence based practice competence of masters of nursing specialist included the results of availability and the awareness of evidence-based nursing ( r = -2.85, -2.41, both P<0.05). Conclusions:Masters of nursing specialist have the intermediate level of evidence-based practice competence and positive attitudes to evidence based practice, but their evidence-based knowledge and skills need to be improved. Clinical teaching base managers should pay attention to the training of evidence-based nursing practice ability of professional nursing master students, provide more supportive resources and environment, and promote the development of specialty nursing practice.

Objective:To investigate the status quo and influencing factors of unsatisfied needs of patients after radical gastrectomy for gastric cancer through quantitative and qualitative mixed research methods, and to provide reference for the development of effective health management programs in the future.Methods:A total of 297 patients who were hospitalized in Tianjin Medical University Cancer Hospital from January to December 2021 after radical gastretomy were selected as subjects by convenient sampling method. The general data questionnaire and Short-Form Survivor Unmet Needs Survey (SF-SUNS) were used to investigate. Selected 12 patients with gastric cancer by objective sampling method for semi-structured in-depth interview and collate data by Colaizzi 7-step analysis method.Results:The total average score of 297 subjects who did not meet the requirements was (60.91 ± 16.00), which was in the middle level. The average score of each dimension from high to low was: continuous care unmet needs (2.37 ± 0.75) points, work economy unmet needs (2.22 ± 0.65) points, information unmet needs (2.20 ± 0.92) points, emotion unmet needs (1.72 ± 0.60) points. Educational background, main economic source of family and working state were the influencing factors of unmet demand ( t=5.32, -3.59, -3.28, all P<0.05). Qualitative research had extracted four themes: unmet needs for symptom network recognition and accurate symptom management, unmet needs for shared decision participation and disease perception trajectory, unmet needs for dignity maintenance and reconstruction of psychological stress mechanism, and unmet needs for "Internet plus" mobile medical continuous care. Conclusions:The problem of unmet needs of patients after radical gastritis is still prevalent and affected by a variety of factors. It is suggested that medical workers build an effective supportive care system based on the status quo of unmet needs of patients, promote the whole process of multidimensional health management services for patients with gastric cancer, and improve the quality of life.

Objective:To systematically evaluate the effect of couple-centered psychological intervention on breast cancer patients.Methods:Randomized controlled trials published in PubMed, Embase, Web of Science, Scopus, CINAHL, Cochrane Library, JBI, CNKI, Wanfang, Vip and CBM database on the effect of psychological intervention on breast cancer patients with husband and wife as the center were searched by computer. The retrieval time was from the establishment of the database to September 2020. Two reviewer independently conducted literature screening, data extraction and literature quality evaluation according to the inclusion and exclusion criteria, and Meta analysis was carried out using RevMan 5.3 software.Results:A total of 879 patients were included in 11 articles. Meta analysis results showed that the couple-centered psychological intervention not only improved the quality of life, but also improved the anxiety of breast cancer patients ( SMD=1.54, 95% CI 0.22-2.86, P=0.02) and depression ( SMD=1.22, 95% CI 0.12-2.33, P=0.03). Conclusions:After psychological intervention, the anxiety and depression of breast cancer patients were improved and the quality of life was also improved. Due to the inconsistency in the mode, frequency and evaluation index of psychological intervention, more large samples and high-quality studies are needed to further verify the effect of couple-centered psychological intervention on breast cancer patients and spouses centered on husband and wife.

Objective:To explore and describe the experiences of young breast cancer survivors in transitional period, and to provide basis for the development of targeted rehabilitation nursing measures.Methods:This study was guided by phenomenological theory of qualitative research. 14 cases were deeply interviewed using a semi-structured questionnaire. The information of interview was analyzed, sorted, coded in according to Colaizzi′s analysis, and different themes were extracted.Results:6 themes of the experience of young breast cancer survivors in the transitional period were extracted including: trying to return to normal life, persistent side effects of treatment, problems of partnership and fertility, strong sense of insecurity and uncertainty, career planning and unmet needs.Conclusions:Young breast cancer survivors still face pressure from physiological, psychological and social aspects in the transitional period. Nurses can promote their smooth transition and early recovery by strengthening discharge assessment and planning, providing continuous care, paying attention to long-term symptom management, improving their self-care ability, encouraging their spouses to participate in support and other strategies.

Objective:To translate the English version of Families′ Importance in Nursing Care-Nurses Attitudes Scale (FINC-NA) into Chinese,and test the reliability and validity of the scale for initially establishing a Chinese version of FINC-NA.Methods:A total of 661 clinical nurses were tested from Tianjin Medical University Cancer Institute and Hospital using the Chinese version of FINC-NA which was developed through the process of translation,back-translation and cultural adaptation to verify its reliability and validity according to Brislin model.Results:The Chinese version of FINC-NA was extracted for 4 factors by the factor analysis using the maximum orthogonal rotation,the cumulative contribution rate was 61.480%. Cronbach alpha coefficient for the overall scale was 0.918, the split-half reliability coefficient was 0.858.Conclusions:The Chinese version of of FINC-NA has been proved to be reliable and valid which can be used to objectively evaluate the nurses′ attitudes toward families′ importance in nursing care in China.

Objective: To explore the effect of self-efficacy on parenting stress among parents of children with malignant solid tumors. Methods: Totally 100 parents of children with malignant solid tumors were investigated and analyzed by using the general questionnaire, parenting stress Index-Short Form(PSI-SF) and General Self-Efficacy Scale (GSES). Results: The score of general self-efficacy for parents was 1.93±0.54, and the total score of parenting stress was 111.84±13.36. The general self-efficacy and parenting stress scores of parents with malignant solid tumors were significantly negatively correlated with the scores of parental misery, parent-child relationship and difficult children (r=-0.72, -0.65, -0.62 -0.55, all P<0.01). Hierarchical logistic regression analysis indicates that the parenting stress was influenced by self-efficacy, the gender of parents, education level and whether or not on position. Conclusions Self-efficacy is one of the most critical influencing factors on parenting stress of parents.A new approach to improve the self-efficacy is to be achieved to reduce the parenting stress level among parents of children with solid tumors.

Objective To investigate the status of anxiety, depression, fatigue, Body Image and quality of life among post-surgery breast cancer patients undergoing chemotherapy, and explore the relationship between these variables and quality of life. Methods Participants meeting the inclusion and exclusion criteria were investigated by the self-designed general information questionnaire, Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale(SDS), Cancer Fatigue Scale(CFS), Body Image After Breast Cancer Questionnaire (BIBCQ), Functional Assessment of Cancer Therapy-Breast(FACT-B). Statistical analysis included descriptive analysis, variance analysis, correlation and regression analysis. Results Totally 162 participants were investigated. Total score of FACT-B was (91.99 ± 19.90) points, function dimension scored lowest;total score of BIBCQ was (129.49±21.71) points;total score of CFS was (24.42 ± 9.91) points;the percent of anxiety was 12.34％(20/162);the percent of depression was 36.42％(59/162). Score of FACT-B showed differences on religious belief, whether have minor children, family per capita monthly income, ways of medical payment (t=4.882,6.660, F=3.796, 4.771,P<0.05); anxiety, depression, fatigue and body image were all negatively correlated (r=-0.648--0.179, P<0.05);Stepwise regression analysis showed that the effect of whether have minor children, depression, fatigue and body image on sexual function were significant (F=35.641, P<0.01, adjusted R2=0.601). Conclusions All variables significant should be taken into consideration while caring for post-surgery breast cancer patients undergoing chemotherapy, by providing targeted care to relieve symptom burden, paying attention to psychological health. Nursing interventions including health education, image guidance, supportive psychotherapy, mindfulness reduction, exercise guidance and so on could be concerned, to help patients relieve anxiety and depression, improve fatigue, and self image, and improve their overall quality of life.