Evaluating a nurse-led narrative interview intervention with cancer patients with a first diagnosis: A feasibility study

Background Patients with chronic mental illness often experience fragmented self-identity and impaired social functioning. The traditional biomedical model has limitations in promoting the reconstruction of patient agency. Narrative medicine provides a humanistic framework for understanding illness experiences through attention, representation, and belonging. Painting art therapy, utilizing nonverbal expression, facilitates the exploration and integration of the self. Existing research predominantly focuses on symptom relief, with limited exploration of art therapy's profound impact on self-identity reconstruction from a narrative medicine perspective. Against this backdrop, this study investigates the effects of painting art therapy on self-identity reconstruction in chronic mental illness patients from a narrative medicine framework. It aims to validate whether painting art therapy integrated with narrative medicine principles can effectively promote self-identity reconstruction in chronic mental illness patients, offering a new pathway for mental health interventions that combines clinical efficacy with humanistic care. Methods Employing a mixed-methods design, the study recruited 60 patients diagnosed with stable chronic schizophrenia or bipolar disorder from a mental health center. Participants were randomly assigned to an intervention group (n = 30) and a control group (n = 30). The intervention group received 12 weeks of narrative medicine-guided art therapy (twice weekly), featuring structured activities such as illness story illustration, emotional symbol creation, and life map integration, supplemented by narrative interviews and reflective discussions. The control group maintained routine rehabilitation activities. Quantitative assessments were conducted using the Sense of Identity Scale (SIS), General Self-Efficacy Scale (GSES), and Symptom Checklist-90 (SCL-90) at baseline, post-intervention, and 3 months post-intervention. Semi-structured interviews were conducted with intervention group participants, and thematic analysis was performed on the textual data. Results Experimental results indicate that following the intervention, the total scores on the self-identity scale were significantly higher in the intervention group than in the control group (68.42 ± 6.31 vs. 58.15 ± 7.24, t = 5.892, p<.001), and their general self-efficacy scores also showed a marked improvement (28.50 ± 4.16 vs. 23.21 ± 4.80, t = 4.576, p<.001). The SCL-90 scale revealed that the intervention group exhibited more significant reductions in depression, anxiety, and interpersonal sensitivity factor scores compared to the control group (all p<.05). Qualitative analysis identified three core themes: “visual reconstruction of illness narratives,” “transformation of trauma symbols,” and “emergence of new self-narratives,” indicating that painting facilitated patients' acceptance of illness experiences and integration of personal life stories. Follow-up data showed stable self-identity scores in the intervention group, with sustained improvement in some indicators. Discussion This study confirms that art therapy grounded in narrative medicine effectively promotes self-identity reconstruction in chronic mental illness patients, yielding sustained effects in enhancing self-efficacy and alleviating psychological symptoms. By facilitating visual storytelling and reflective dialogue, this intervention helps patients transform fragmented illness experiences into coherent life narratives, holding significant clinical and public health implications. Future community mental health rehabilitation services should incorporate such humanities-art integrated intervention strategies. Multicenter, large-scale studies are recommended to validate long-term efficacy and underlying mechanisms, thereby providing evidence to advance holistic and humanized mental health service development.

Narrative medicine is a pedagogical tool for cultivating empathy, communication skills, and humanistic care. The application of narrative medicine methods has several limitations in paediatric training, particularly in China. This pilot study explored the preliminary association between narrative medicine training and the enhancement of empathy and communication skills among Chinese medical students during paediatric endocrinology rotations. Ten undergraduate medical students from Shenzhen University participated in 9.5 weeks of narrative medicine training (11 sessions), which was conducted in small groups during the hospitalization and post-discharge phases. The Jefferson Scale of Empathy and the Doctor-Patient Communication Behaviour Scale were administered before and after the intervention to evaluate the medical students' empathy and communication skills. The differences in the pre-and post-intervention scores were compared using paired t tests. Compared with the baseline scores, the total Jefferson Scale of Empathy scores significantly increased post-intervention (133.10 ± 4.25 vs. 95.97 ± 8.90, P < 0.05), with increases in the scores of 19 items (P < 0.001 after correction for multiple testing). Similarly, compared with the baseline scores, the post-intervention total Doctor-Patient Communication Behaviour Scale scores significantly increased (155.45 ± 5.76 vs. 133.52 ± 3.81, P < 0.05), with all 6 items demonstrating significant increases (P < 0.001 after correction for multiple testing). Although the reported score changes are notable, they should be considered in the context of the study's small sample size, the lack of a comparison group, and the potential influence of confounding factors. Narrative medicine training is associated with the potential to improve empathy and communication skills in paediatric contexts, which provides preliminary evidence for promoting the application of narrative medicine in the humanities training of paediatricians. Given the relatively late introduction of narrative medicine in China, its application in the training of Chinese medical students presents greater prospects and opportunities for the accumulation of more experience.

The field of cancer care still lacks best practices in communication. Few postgraduate training programs offer formal training to develop such skills. The patient partnership has been used in medical education to increase the sensitivity of the subjective experiences of patients. In our Canadian center, residents and patient-partners participated in an educational workshop on communication focusing on patient's narrative. The aim of this pilot qualitative study was to explore the experiences of participants in the workshop. Using theoretical sampling, we recruited 6 residents and 6 patient-partners. Semi-structured interviews were conducted and transcribed. A thematic analysis was performed. From analysis, 4 themes emerged: (1) lack of communication skills training; (2) barriers to effective communication in cancer care; (3) the empathy of patient-partners towards the communication challenges faced by residents; and (4) the participants' reactions to the workshop. Based on our findings, our communication skills workshop centered on narrative medicine and involving patient-partners appears feasible. Future research could study its pedagogical value and the optimal learning environment required.

The effects of acceptance and commitment therapy on the psychological and physical outcomes among cancer patients: A meta-analysis with trial sequential analysis

2033P - HIV, HBV and HCV screening practices in oncology: A cross-sectional interregional survey

Background: Non-Japanese-speaking patients taking medical treatment in Japan face language barriers and lack of language assistance. Language barriers influence all processes from preventive services to treatment, and insufficient communication can affect patient outcomes. Illness perception, which is related to illness-coping behaviors and self-care behaviors, is an important factor for effective treatment, but no studies have investigated the relationship between communication skills and illness perception among non-Japanese-speaking patients.Objective: The purpose of this cross-sectional study was to assess communication skills utilizing ENDCORE, to clarify the relationship between communication skills and illness perception among non-Japanese-speaking patients in Japan, and to identify the impact of language assistance on these factors.Method: A web questionnaire survey was conducted between February and April 2024, targeting 1,904 non-Japanese-speaking patients who had visited medical institutions in Japan. The survey items included basic attributes, purpose of the medical visit, Japanese language proficiency, communication tool, language assistance, communication skills (using ENDCORE), and illness perception (using the Brief Illness Perception Questionnaire; B-IPQ). The Kruskal-Wallis test and Mann-Whitney U test were used to examine factors related to the means of ENDCORE scores and B-IPQ scores, and Spearman’s rank correlation coefficient was used for correlation analysis.Results: The analysis included data for 354 participants. Participants who received language assistance scored lower on communication skills than those who did not receive language assistance, but they reported more positive illness perception. For factors related to ENDCORE means, statistically significant differences were observed for country of origin, residence qualifications, Japanese language proficiency, communication tool, and language assistance. For factors related to the B-IPQ means, statistically significant differences were observed for sex, country of origin, residence qualifications, communication tool, and language assistance. The correlation analysis of ENDCORE and the B-IPQ items showed that the sense of control a person feels they have over their illness (r = 0.201, p < .001), the significance of treatment (r = 0.215, p < .001), and understanding of the illness (r = 0.318, p < .001) were weakly positively correlated.Conclusion: The findings suggest that language assistance for non-Japanese-speaking patients can lead to more beneficial communication between them and their physicians and more positive illness perception for those patients. We also believe that maximizing patients’ communication skills will facilitate more appropriate diagnoses and treatments, improve patients’ coping behaviors, and contribute to patient safety and quality of medical care.

IntroductionThe majority of people experience anger at some point in their lives when confronted with unpleasant situations. In social settings, anger can lead to aggressive and hostile in the absence of adequate social competences. Our study aims to examine the moderating role of perceived social competences in the association between psychological distress and anger expression (trait anger, hostility, physical aggression, and verbal aggression) among a sample of Lebanese adults.Methods403 participants above 18 years (the mean age was 24.56 ± 8.46) were enrolled in the cross-sectional study with 73% female participants. The candidates were asked to complete a structured questionnaire including the following scales: (1) Buss–Perry Aggression Questionnaire-Short Form (BPAQ-SF), (2) the Depression Anxiety Stress Scale (DASS-8), (3) Perceived Social Competencies (PSC), and (4) The De Jong-Gierveld Loneliness Scale.ResultsThe interaction psychological distress by perceived social competence was not significantly associated with physical aggression, verbal aggression, or hostility but was significantly associated with anger. After adjusting the results over variables that showed a p <.25 in the bivariate analysis, this association was significant at low (Beta = 0.24; p <.001), moderate (Beta = 0.20; p <.001) and high (Beta = 0.16; p <.001) levels of perceived social competencies, where higher psychological distress was significantly associated with more anger. On another note, with higher perceived social competence, we find a decrease in levels of psychological distress in our sample.ConclusionThis study provided evidence that perceived social competencies such as communication skills, empathy and prosocial behaviors act as moderators in the association between psychological distress and anger. In future works, investigating and building advanced program in order to develop social competences of individuals might prove important. It is crucial to implement such strategies and projects in schools: this educational setting could be fruitful in a way that social skills could be instilled during childhood and anger-aggressive behaviors could be managed throughout adulthood.

BackgroundDelay in diagnosis of cancer may worsen prognosis. The aim of this study is to explore patient-, general practitioner (GP)- and system-related delay in the interval from first cancer symptom to diagnosis and treatment, and to analyse the extent to which delays differ by cancer type.MethodsPopulation-based cohort study conducted in 2004-05 in the County of Aarhus, Denmark (640,000 inhabitants). Data were collected from administrative registries and questionnaires completed by GPs on 2,212 cancer patients newly diagnosed during a 1-year period. Median delay (in days) with interquartile interval (IQI) was the main outcome measure.ResultsMedian total delay was 98 days (IQI 57-168). Most of the total delay stemmed from patient (median 21 days (7-56)) and system delay (median 55 days (32-93)). Median GP delay was 0 (0-2) days. Total delay was shortest among patients with ovarian (median 60 days (45-112)) and breast cancer (median 65 days (39-106)) and longest among patients with prostate (median 130 days (89-254)) and bladder cancer (median 134 days (93-181)).ConclusionSystem delay accounted for a substantial part of the total delay experienced by cancer patients. This points to a need for shortening clinical pathways if possible. A long patient delay calls for research into patient awareness of cancer. For all delay components, special focus should be given to the 4th quartile of patients with the longest time intervals and we need research into the quality of the diagnostic work-up process. We found large variations in delay for different types of cancer. Improvements should therefore target both the population at large and the specific needs associated with individual cancer types and their symptoms.

Background: Constipation affects many patients receiving long-term opioid therapy for cancer pain. Little is known about the nature of psychological distress and the burden associated with this problem. This information may inform the development of effective treatment strategies and ameliorate distress. Aim: The objective was to use qualitative research methods to better understand psychological distress and the burden associated with opioid-induced constipation and its treatment in advanced cancer patients. Design: In this qualitative study, semi-structured interviews explored perceptions of psychological distress and burden from opioid-induced constipation. Interviews were analyzed using a thematic content analysis approach involving descriptive and interpretive coding and identification of recurring themes. Setting/participants: Twelve advanced cancer patients with opioid-induced constipation were recruited from a large urban hospital. Results: Patients experienced various types of negative affect and cognitions associated with opioid-induced constipation. Analyses indicated three major themes: (1) irrational thoughts and educational needs; (2) psychological distress from constipation and (3) the effects of constipation on the decision to use opioid analgesics. Irrational thoughts and educational needs included beliefs that nutrition could improve constipation, the supposition that constipation indicated deteriorating health, and catastrophic beliefs. Psychological distress included depressive symptoms and anticipatory anxiety related to constipation. Decision-making revealed cognitive dissonance about using opioids and conflicting preferences about continuing use. Conclusions: Future investigation of the multiple components of cognitive and affective burden from opioid-induced constipation is warranted. Understanding the varied nature of this burden may improve clinical recognition and assessment and promote more intensive management consistent with the distress it produces.

Prevalence and associated factors of psychological distress among Korean cancer patients

281 Differences in coping in parents of pediatric cancer patients and the relation with psychological distress

DESCRIPTION The communication demands expected of today’s engineers and information technology professionals immersed in multicultural global enterprises are unsurpassed. New Media Communication Skills for Engineers and IT Professionals: Trans-National and Trans-Cultural Demands provides new and experienced practitioners, academics, employers, researchers, and students with international examples of best practices in new, as well as traditional, communication skills in increasingly trans-cultural, digitalized, hypertext environments. This book will be a valuable addition to the existing literature and resources in communication skills in both organizational and higher educational settings, giving readers comprehensive insights into the proficient use of a broad range of communication critical for effective professional participation in the globalized and digitized communication environments that characterize current engineering and IT workplaces. The communication demands expected of today’s engineers and information technology (IT) professionals immersed in multicultural global enterprises are unsurpassed. Effective workplace and professional participation does not merely ask but demands proficiency in varied multi-media rich communication skills. Global industries, markets, and professional organisations require graduates who, in order to be work ready, need to be equipped with excellent written and oral communications skills, to be multi-literate in various digital, verbal and written modes of communication, as a baseline rather than optional extra capability. Trans-cultural multi-modal communication skills, now imbued with immense significance, are allied as a powerful and crucial determinant capability highly sought in trans-national and trans-cultural workplaces and professional communities. In the highly multicultural universities and colleges, the development of these skills among both faculty and students also has a direct impact on student learning outcomes as well as on the overall quality and content of educational programs. The acquisition of expertise in transcultural, multi-modal communication skills will greatly enhance the ability of students to apply and transfer their learning into their professional practices in increasingly globalised and demanding workplace settings. However, research indicates a paucity of literature on the types of communication skills increasingly demanded and practiced in 21st century engineering and technology workplaces. Moreover, most of the literature on communication skills that is available is generic in nature, and by aiming at the higher education sector in general, ignores the specific requirements and contexts of the engineering and IT communities of practice. These points to the urgent need to close the performance gap in basic, let alone more sophisticated and technologically enabled communication skills for the engineering and IT professions. Therefore, current evidence points to a distinct need for a comprehensive resource for the learning of traditional as well as new 21st Century, new paradigm digital and trans-cultural communication skills in both workplace and educational settings in engineering and Information Technology. PREFACE The overall objective of this book is to provide a comprehensive resource for new and experienced professionals, as well as students and faculties/academics. All are stakeholders who have to come to grips with new communicative practices in increasingly trans-national, trans-cultural, and digitally-rich contexts. In doing so, the book aims to provide new and experienced practitioners, academics, employers, researchers, and students with international examples of best practices in new as well as traditional communication skills in increasingly trans-cultural, digitalised, hypertext environments. The book consists of 11 scholarly chapter contributions on diverse issues and trends in new media communication skills for engineers and IT professionals. This book will be a valuable addition to the existing literature and resources in communication skills in both organizational and higher educational settings. The book intends to incorporate the views of a wide range of stakeholders: practitioners, professionals, academics, and students. The intention is to give readers comprehensive insights into the proficient use of a broad range of communication skills and tools critical for effective professional participation in the globalised and digitised communication environments that characterise current engineering and IT workplaces.

Aim: To determine the relationship between effective communication and the Quality of Life (QoL) of cancer patients through conducting a Meta-analysis (MA) to quantify and summarize the evidence and present the results of our local findings in the National Center for Cancer Care &amp; Research (NCCCR) of HMC in Qatar. Methods: MA was conducted via searching four online databases including PubMed, Medline, EMBASE and Psych info electronic and grey literature database, ProQuest dissertations. The MA encompassed published cross-sectional, longitudinal studies and a postgraduate PhD dissertation, that investigated the communication among cancer patients on one hand, and health care professionals (HCPs) and health caregivers (HCGs), and their impact in the QoL, on the other hand. Out of 20,796 hits, 204 full-text articles were assessed for eligibility. The final eligible studies were 19 articles that satisfied the inclusion criteria (18 published papers and one PhD dissertation). The quality of encompassed studies was calculated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Comprehensive (CMA) software version 2 was used to perform the MA. The pooled effect size was calculated using the random effect and ANOVAs were performed for moderation analyses for categorical moderators and meta regression analysis for continuous moderators. In addition, publications bias analysis was also performed. The Cochrane software “Review Manager v5.3” was employed to examine the quality of the included studies. Patient perception of physician’s communication skills was compared with the perception of physicians using the American Board of Internal Medicine (ABIM) communication assessment tool and QoL of cancer patients was assessed via FACTG questionnaire. Correlation coefficients of perception of patients were carried out using positive correlation analysis via SPSS V.26. Results: Communication had a significant positive impact on the QoL of cancer patients and a significant association and moderation was observed for the mental component summary (MCS). Furthermore, a significant positive impact of involving Health Caregivers (HCGs) in communication on the QoL of cancer patients was also found. Covariate analysis indicated a true variation in effect sizes between studies and confirmed the existence of inconsistencies among different studies due to the diverse definitions and assessment tools used to measure the outcomes. The heterogeneity assessment offered explanation where possible to the consistencies and diversities between studies. Clinical and design heterogeneities were observed and reported. Our local pilot study in Qatar suggested a significant positive correlation between QoL and patients perception of physicians’ communication skills, r = 0.222, P=0.3. Moreover, our pilot study suggests a significant discrepancy between the patients perceptions &amp; HCP perceptions, of the different communication skills set (Interpersonal, Content, Total Communication Skills). The patients reporting a lower perception 57% vs 86% total communication skills p=0.0028, 58% vs 88% for IP communication skills p=0.0003, and 55% vs 84% for content communication skills p=0.0042. Conclusion: This MA covered a gap that existed in the literature among published systematic reviews and meta-analyses. It confirmed a significant correlation between communication and QoL of cancer patients irrespective of cancer type, age group, culture, gender, prognosis, or year of study. These results were global, transcontinental, and transcultural. It clearly highlighted the significant need to communicate with cancer patients and how much its benefits improve their QoL, as well as medical services. The results can be used to inform policy makers and health practitioners. Future Interventions should take into account these results to improve the communication between health practitioners and cancer patients and the involvement of families in the communication process. The health care system should consider communication as a vital component of providing a holistic patient and family centered care. The umbrella of QoL, provides a clear picture about patients and their families’ conditions and dictates that their communication needs are addressed as part of a standard of care. Furthermore, communication with its wide list of components should undergo a crucial level of studying, researching, critiquing and standardization, so that patients’ right to access a high standard of care is guaranteed across all health care systems. Our local results in Qatar resonate with this MA and raise the attention needed to clinical communication practice.

Increased attention is being given to the psychological impact of climate change, often termed eco-anxiety, which is predicted to increase and be widespread. Despite this, therapists and clients do not frequently discuss this in their sessions. Indirect side-mentions may be made by clients but these are often not opened up for further exploration. This paper outlines findings from narrative interviews with therapists and clients that show both are defended in sessions against potentially overwhelming feelings. A variety of mechanisms including unconscious individual, organisational and social defences are observed. I draw on the concepts of containment, transitional space and the therapeutic third help to understand these dynamics. Findings suggest that therapists need training and to have worked through their own anxieties regarding climate change in order to work effectively and safely with clients around this issue. I conclude that therapy needs to be re-visioned as a psycho-social endeavour. Keywords eco-anxiety, psychotherapy, unconscious defences, social defences, psycho-social methods, thematic analysis, narrative interviews, containment, therapeutic third, transitional space

Based on the results of this review, there is insufficient evidence to validate the effectiveness of family interventions on psychological distress and expressed emotion in family members who live with and care for persons with FEP. In addition, based on the individual primary studies, the implications for practice should be carefully considered.