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The acceptability and feasibility of an educational programme on cervical cancer prevention in Chinese- and non-Chinese-speaking female adolescent students in secondary schools

January 5th, 2021 in International News

Authors: Ms. Jenny YS Chan (Undergraduate Nursing Student), Dr. Dorothy NS Chan (RN, PhD), and Dr. Winnie KW So (RN, PhD) from The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong

Cervical cancer is commonly affecting women globally and in Hong Kong (Hong Kong Cancer Registry, 2019; International Agency for Research on Cancer, 2016). Cervical cancer is majorly caused by the Human Papillomavirus (HPV) (Centre for Health Protection, 2018). Fortunately, the risk of having cervical cancer could be significantly lowered especially in females aged below 24 through HPV vaccination (Department of Health, 2018). Despite the effectiveness of vaccines, the uptake rate is generally low. A previous survey revealed that only around 12% of the secondary school students had received HPV vaccination (Family Planning Association, 2017). To boost vaccination uptake, some schools have organized educational programmes about HPV vaccination (Yuen, Lee, Chan, Tran, & Sayko, 2018). However, students who attended these programmes are mostly local Chinese speaking (CS) students, missing out the non-Chinese speaking (NCS) students (a group rapidly expanding in the past decades) (Census & Statistics Department, 2017). In view of the phenomenon, non-Chinese speaking students should have equal opportunities in accessing HPV vaccination and obtaining relevant knowledge to maintain health.

Therefore, we designed a one-group pretest and posttest study to examine the acceptability and feasibility in implementing an educational programme on cervical cancer prevention in a secondary school with CS and NCS students. We also aim to improve participants’ knowledge about cervical cancer and HPV vaccines, and their intention to vaccination. The programme was conducted in March to April 2019. It had two major parts: a 40-minute health talk and a 40-minute tutorial.  In the health talk, we introduced what cervical cancer was and emphasized on how to prevent it. While in the tutorial, we emphasized on introducing HPV vaccination and explaining myths about it to the participants through an interactive matching game. A health booklet about cervical cancer and HPV vaccination was then distributed and discussed. All teaching material was adjusted in a culturally sensitive way, for instance, simple sketching and laymen terms were used instead of detailed anatomical pictures and medical jargons, to minimize events of embarrassment.

A total of 27 grade 10-11 CS (n=11) and NCS (n=16) girls were recruited. Most of the students were satisfied with the programme and agreed that the programme content was easily understood. All NCS and most CS students reported that the programme was very good and interesting. It was noticed that there was a positive change in participants’ knowledge towards HPV vaccine and an apparent increase in intention after the programme.

Reflecting in this project, it succeeded in proving the feasibility of implementing such educational programmes for CS and NCS school-aged girls. At first, we were quite worried about the responses, however, it turned out that most participants were satisfied with the programme. However, we only evaluated the immediate intention of participants, there were no actual follow-up verifications in the change of HPV vaccine uptake rate. In the future, we would hope to conduct follow-up verification studies to enhance the impact of this programme and further expand the scope of the programme to more secondary schools with NCS students in Hong Kong.

References:

Census and Statistics Department. (2017). 2016 Population By-census. Thematic report: Ethnic minorities. Retrieved from https://www.statistics.gov.hk/pub/B11201002016XXXXB0100.pdf

Centre for Health Protection (2018). Joint Consensus Recommendation on the Use of 9-valent Human Papillomavirus Vaccine in Prevention of Cervical Cancer in Hong Kong. Retrieved from https://www.chp.gov.hk/files/pdf/joint_consensus_recommendation_on_the_use_of_9_valent_human_papillomavirus_vaccine_in_prevention_of_cervical_cancer_in_hong_.pdf

Department of Health (2018). Human Papillomavirus (HPV) Vaccine. Retrieved from https://www.cervicalscreening.gov.hk/english/hum/hum_ccv.html

Hong Kong Cancer Registry, Hospital Authority (2019). Leading cancer sites in Hong Kong 2017. Retrieved from https://www3.ha.org.hk/cancereg/pdf/top10/rank_2017.pdf

International Agency for Research on Cancer. (2016). Cancer fact sheets: Cervical cancer. Retrieved from http://gco.iarc.fr/today/data/pdf/fact-sheets/cancers/cancer-fact-sheets-16.pdf

The Family Planning Association of Hong Kong (2017). Press releases: Report of Youth Sexuality Study 2017. Retrieved from https://www.famplan.org.hk/en/media-centre/press-releases/detail/fpahk-report-on-youth-sexuality-study

Yuen, W.W.Y., Li, A., Chan, P.K.S., Trans, L., & Sayko, E. (2018). Uptake of human papillomavirus (HPV) vaccination in Hong Kong: Facilitators and barriers among adolescent girls and their parents. PLoS One, 13(3), e0194159.

2020 Chinese Conference on Oncology (CCO) Cancer Nursing Forum Successfully Held

December 30th, 2020 in Editorial Office, International News

Authors: Zhenqi Lu, Yongyi Chen, Xiaoju Zhang
Institutions: Cancer Nursing Committee of Chinese Anti-Cancer Association

The Cancer Nursing Forum, organized by the Cancer Nursing Committee of Chinese Conference on Oncology (CCO), was successfully held in Guangzhou, China on November 14, 2020. The Forum had drawn nearly 500 participants expertise at cancer nursing from across the country to celebrate and advance the development of the oncology nursing profession.

The keynote speaker Dr. Yumei Wang, director of Shengjing Hospital of China Medical University, showcased a speech about the topic of “Palliative Care – Guarding the Dignity of Life of Cancer Patients”. Palliative care requires a professional team, thus Dr. Wang believes her team work with the purpose of “Influence life with life, warm the heart with heart” can bring dignity to more patients. Then, Professor Changrong Yuan, another keynote speaker from School of Nursing, Fudan University, emphasized the importance of Patient-Reported Outcome (PRO) in the process of cancer care. Patient-Reported Outcomes come directly from patients’ self-reports on their health status, functional status, and treatment feelings, which can evaluate patients’ status more efficiently and comprehensively. The third speaker, Tong Yingge, a professor of School of Medicine, Hangzhou Normal University, introduced the application of five pain assessment tools. She exemplified specific clinical cases to demonstrate how to form the structural elements, process elements and outcome elements of pain management in cancer patients. After that, Professor Qian Lu, coming from the School of Nursing, Peking University, presented the method to construct a risk prediction model and an early warning model of breast cancer-related lymphedema (BRCL). She aimed to achieve the early screening of BRCL with the help of models and machine learning methods.

Director of Cancer Nursing Committee of Chinese Anti-Cancer Association: Zhenqi Lu
Huiying Qin, Director of Nursing Department of Sun Yat-sen University Cancer Center
Director of Nursing Department of Sun Yat-sen University Cancer Center: Huiying Qin
2020 Chinese Conference on Oncology (CCO) Cancer Nursing Forum
A scene from the 2020 Chinese Conference on Oncology (CCO) Cancer Nursing Forum

As to distinctive management, Li Liu, deputy director of Sun Yat-sen University Cancer Center, established the “Internet-Nursing Service” platform. By organizing standard training and giving management in the whole process, Liu attempted to meet patients’ needs with limited medical resources and achieve the integration of medical and nursing services in the community. Besides, Lijun Chen, director of Guangxi Medical University Affiliated Tumor Hospital, displayed a cancer follow-up information system subsequently. She set up a professional follow-up team and carried out standard follow-up practice. In addition, Zhimin Liu, a head nurse of The Fourth Hospital of Hebei Medical University and Hebei Cancer Hospital introduced the diversified management of “the warm sun studio” in the medical oncology department. The project combined with their own characteristics and showed the humanistic care in various forms.

At this conference, eight excellent representatives were selected from 1,983 manuscript submissions, to share their views on how to promote cancer patient care, improve the quality of life, and deepen the meaning of cancer care.

The conference assembled plenty of domestic experts in the field of cancer care, showcasing cutting-edge research concepts, academic achievements and discussing the future development of cancer care.

A good end, a good farewell, and a good living

June 23rd, 2020 in International News

Palliative care reflections in the COVID-19 pandemic

Authors: Xuying Li, Yongyi Chen, Boyong Shen, Xianghua Xu
Institutions: Hunan Cancer Hospital

In the late spring, flowers are like brocade, the sun is shining. During the vigorous spring which is full of warm, the cold has passed away! Nothing can stand in the way of spring! But this winter and spring transition in 2020 is destined to be forever engraved in the hearts of all people, becoming an untouchable pain.

The novel coronavirus raged all over the world in hard times. From February 11 to March 22 this year, I had led totally 16 medical health care professionals in the Hunan Medical Team supporting Huanggang City in Hubei Province in China. We were mainly responsible for the treatment of COVID-19 patients. Most of the team members were assigned to the intensive care units. Patients in these areas were in severe and critical condition. Some of them even had no chance to have a farewell with their loved ones before dying. What’s more, in order to avoid transmission of infection, they were immediately put into the body bag for cremation. Their family members couldn’t see them for a last glance. What a pain which cannot be healed for a long time. I often think, as one of the palliative care workers, what can I do for my patients facing inadequate preparation and limited conditions? How to help the terminally ill patients say apologies, gratitude, love, and goodbye to the people they care? How to achieve a good end, a good farewell, and a good living that palliative care advocate?

There was an old lady lived in the ICU, who developed respiratory failure combined COVID-19 and heart failure. She had experienced three rescues and was pulled back from the brink of death each time. Occasionally she woke up, opened her eyes, looked at me, and stared outside the window. I understood that for her, the unfamiliar surroundings, no family’s company, medical staff wearing layers of protective equipment made her afraid and lonely. Considering she was unable to speak on a ventilator, I asked her to express her needs with winks. When I asked her if she wanted a video with her family, she closed her eyes deeply. Then I took the department’s dedicated mobile phone, videoed on her daughter. I told the daughter that her mother’s waking time was less and less, I hoped she could seize the opportunity to talk with her mother and express apologies, gratitude, and love to her. Daughter cried out gently: “Mom, due to the isolation requirement, please forgive me that I can’t do filial piety at your bedside, I will take good care of my brother and maintain a good family order. Your lifetime is toil and did not enjoy a few days of happiness. I feel so regrettable that I often make you angry inside. Please do cooperate with the treatment. We will wait for you forever.” The patient closed her eyes with tears slipped across her face soundlessly.

Two days later, the patient’s heart rate and blood pressure dropped with the blood oxygen couldn’t be measured. She lost her consciousness and was in a coma. The doctor telephoned her daughter once again, told her that it might be hard to save back this time. The daughter said that her mother believed in Buddhism, hope the health care workers could find the bodhisattva’s red rope which was kept in her mom’s duffel bag. She hoped this red rope could be accompanied by her mother until the last moment. I found the red rope and wrapped in the wrist of the patient. The video was linked to the daughter and other family members, her daughter began to cry at the moment. As a nurse expertise at palliative care, I knew it was time for the family members say goodbye to the patient. I reminded the daughter that her mother could still hear what happened although not able to express. Her mother would be fearful and worried if they kept crying. The daughter understood what I meant, and let all the family members said a few words to the patient through video. Finally, the patient passed away in everyone’s memory peacefully. The daughter requested that according to the local custom, she wanted her mother grabbed some money in hand at the last moment, which will be decent. We wiped the body of the patient with water and disinfectant twice, combed her hair, changed new clothes for her. We found 10 RMB in the belongings of the dead and put it into her hand. After the death of nursing, we connected the daughter again. Her daughter tears were streaming down her face and she thanked us through the video when she saw her mother’s tidy hair, serene countenance, clean clothes, as well as the money holding in the hands. She extended her gratitude for all we had done for her mother in this particular period. A brief funeral was arranged. Paramedics bowed collectively to the patient three times with her favourite Buddhist music downloaded online. I burst into tears when the undertaker’s workers transferred her to the funeral home. I said in my heart silently, “There is no pain on the road to life grandma.”

The implementation of palliative care is never a single kind of thought, nor should be only one mode, but should be based on human nature combined with the actual situation, adjusting measures to local conditions and varying from person to person. In Chinese traditional culture, it is a taboo to talk about death. The sudden epidemic of COVID-19 doesn’t give any psychological preparation to a lot of patients and their family. Numbers of patients had to cease their happy life abruptly and passed away without dying words for their loved ones. For infection control considerations, their family members couldn’t company the patients, which will be the lifelong regret and guilt for the deceased’s families.

Under the global pandemic of COVID-19, the work of palliative care has the work of hospice care has changed. Online communications could be utilized for the family meetings, group consultations, the family visits to reduce regrets between the patients and family members. We could adopt online psychosocial interventions not only to comfort the isolation of emotion but also let the families participate in the patients’ treatment, understand and fulfil the patients’ last wishes. In this process, the medical staff has become the ties between the network platform, patients, and families. Although there are many alternatives for an in-person meet, medical staff is still the biggest source of support for patients and their families. When everyone is scared of COVID-19, in addition to trying our best to rescue patients, all health care workers should do our best to let the deceased rest in peace and reassure the living. In the midst of life and death, it is the shining light of humanity of palliative cares that giving life a warm ferry!

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May 8th is World Ovarian Cancer Day

May 7th, 2020 in Hot Topics, International News

The world faces an unprecedented global health crisis at present, and we’d like to thank all nurses on the front line for your incredibly hard and vital work either looking after people with Covid-19, or patients with other very serious conditions, such as women with ovarian cancer.

The fact that you care so much and are willing and able to undertake such an important role is no surprise to us. We and very many of our patient organisation members know what a key role you play in helping to look after women with ovarian cancer, no matter where they live in the world. Addressing the disparity of nursing roles and utilisation of specialist skills is something we will support you within future, be that fine-tuning and streamlining training across large regions where specialist cancer nurses exist or advocating for the key role that oncology nurses could play in lower and middle-income countries, supporting prevention, screening, early diagnosis, specialist treatment and palliative care.

The wide disparity in roles and interaction with nurses was seen in The Every Woman Study, carried out in 2018 by the World Ovarian Cancer Coalition. 1531 women from 44 countries took part, and during our testing phase, we found it almost impossible to ask a standard set of questions that could be applicable to all, because of the very different duties nurses undertook, and the different levels of interaction with women. The following table showed the wide disparity in nursing contact, in countries where we had more than 40 respondents. Overall 75% of women undergoing treatment for ovarian cancer had some form of contact.

Where nurses are involved in care, on the whole, they are involved in most aspects of care from diagnosis, surgery, chemotherapy, follow up and acting as a contact point. They are more likely to be specialist nurses around the time of chemotherapy (78%), follow up (57%) and answering questions between appointments (60%), than on diagnosis (43%) or at surgery (48%).

Respondents were largely very positive about the role that nurses play in terms of their care, despite the wide variations in tasks and specialisation. Just over half (51.6%) said that nurses were able to provide important continuity of care, and a third of respondents who had nursing care said the nurses were a good source of information on ovarian cancer (35.5%), had more time to spend with them than the doctors (33.8%), we’re able to signpost to other services (31.1%) and that women felt able to ask them questions that they could not ask the doctors (30/8%).

Overall the findings of the Every Woman Study show very wide variations in experiences between and sometimes within countries, and that this provides opportunities to improve the survival and quality of life for women no matter where they are. Similarly, the wide variations in access to and roles of nurses involved in cancer care tell us that much more can be done to strengthen the value nurses bring to the experiences of women with ovarian cancer not just in high but also low and middle-income countries, and that we will support you in this quest as soon as we are all able to focus once again on these matters.

For more information about the Coalition visit www.worldovariancancercoalition.org and to read the Every Woman Study Report click here.