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1.  Inner conflict in patients receiving oral anticancer agents: a qualitative study 
BMJ Open  2015;5(4):e006699.
To explore the experiences of patients receiving oral anticancer agents.
A qualitative study using semistructured interviews with a grounded theory approach.
A university hospital in Japan.
14 patients with gastric cancer who managed their cancer with oral anticancer agents.
Patients with cancer experienced inner conflict between rational belief and emotional resistance to taking medication due to confrontation with cancer, doubt regarding efficacy and concerns over potential harm attached to use of the agent. Although they perceived themselves as being adherent to medication, they reported partial non-adherent behaviours. The patients reassessed their lives through the experience of inner conflict and, ultimately, they recognised their role in medication therapy.
Patients with cancer experienced inner conflict, in which considerable emotional resistance to taking their medication affected their occasional non-adherent behaviours. In patient-centred care, it is imperative that healthcare providers understand patients’ inner conflict and inconsistency between their subjective view and behaviour to support patient adherence.
PMCID: PMC4401846  PMID: 25872938
2.  Current nursing practice for patients on oral chemotherapy: a multicenter survey in Japan 
BMC Research Notes  2014;7:259.
With a paradigm shift toward a chronic care model in cancer, the issue of adherence is becoming increasingly important in oncology.
We mailed two self-reported surveys on current nursing practices for patients on oral chemotherapy to all 309 designated cancer centers and 141 large general hospitals in Japan. The first survey was based on a nurse-based questionnaire containing 40 items concerning nurse’s characteristics, nurse staffing at workplace, general nursing care for new patients on oral chemotherapy and those with refilled prescriptions, follow-up, and system-based approach. The second survey was based on a patient-based questionnaire containing 10 items about patient characteristics and adherence-related nursing practice for 249 patients taking oral chemotherapy of 903 systematically sampled. We used multivariate logistic regression to identify factors that were associated with adherence-related nursing practices.
A total of 62 nurses (mean age: 41.5 years) from 62 hospitals who consented participated in the both nurse-based survey and patient-based survey about 249 patients. The results of nurse-based survey indicated that practices varied, but nurses were less likely to ask adherence-related questions of patients with refilled prescriptions than of new patients. The results of patient-based survey found that questions on side effects, discussions about barriers to achieving balance between treatment and daily life activities, and medication management were all significantly related to the question about unused medicines. Logistic regression revealed that adherence-related nursing practices were associated with the nurse’s background, type of treatment, and healthcare system-related factors. Patient orientation on oral chemotherapy, interdisciplinary learning, and having a system-based approach for detecting prescription errors were identified as healthcare system-related factors.
A more systematic approach must be developed to ensure patients receive safe and effective oral chemotherapy, while nurses should play significant roles in patient education and monitoring.
PMCID: PMC4002555  PMID: 24758498
Oral chemotherapy; Medication adherence; Compliance; Interdisciplinary care; Medication management
3.  Guided Self-Help for Prevention of Depression and Anxiety in Women with Breast Cancer 
ISRN Nursing  2012;2012:716367.
Depression and anxiety are prevalent in women with breast cancer. We developed a self-help kit as a self-learning package of necessary preparatory information (basic knowledge on chemotherapy, side effects, and problem-solving skills). We provided an oncology nurse-guided self-help kit with a cognitive behavioral therapy approach to 46 women with breast cancer in the intervention group and usual care to 36 in the control group in outpatient chemotherapy settings. The oncology nurse monitored and facilitated the patient's progress using the diary during the patient's chemotherapy. We also provided professional-led support group programs. Depression, anxiety, and quality of life were measured at baseline, 1 week, 3 months, and 6 months. The chi-square test and t were used to examine differences between the two groups, and repeated measures analysis of variance was used to test the effects of the intervention on the measures over time. All depression and anxiety scores were improved in both the intervention and control groups, but there were no significant differences between the two groups. Further studies are needed to evaluate the effectiveness of an oncology nurse-guided self-help approach for cancer patients.
PMCID: PMC3488404  PMID: 23150835
4.  Preconditions for successful guideline implementation: perceptions of oncology nurses 
BMC Nursing  2011;10:23.
Although evidence-based guidelines are important for improving the quality of patient care, implementation in practice is below expectations. With the recent focus on team care, guidelines are intended to promote the integration of care across multiple disciplines. We conducted an exploratory study to understand oncology nurses' perceptions of guideline implementation and to learn their views on how their experiences affected the implementation.
A qualitative study was used with focus group interviews. We collected data from 11 nurses with more than 5 years of oncology nursing experience in Japan. The data were analyzed using grounded theory.
Results of the analysis identified "preconditions for successful guideline implementation" as a core category. There were 4 categories (goal congruence, equal partnership, professional self-development and user-friendliness) and 11 subcategories related to organizational, multidisciplinary, individual, and guideline levels.
Although the guidelines were viewed as important, they were not fully implemented in practice. There are preconditions at the organizational, multidisciplinary, individual, and guideline levels that must be met if an organization is to successfully implement the guideline in clinical settings. Prioritizing strategies by focusing on these preconditions will help to facilitate successful guideline implementation.
PMCID: PMC3247822  PMID: 22067513
5.  Information Sharing and Case Conference Among the Multidisciplinary Team Improve Patients’ Perceptions of Care 
The Open Nursing Journal  2011;5:79-85.
As the advent of genomic technology accelerates personalized medicine and complex care, multidisciplinary care is essential for management of breast cancer.
To assess whether healthcare delivery systems are related to patients’ perceptions of care in breast cancer treatment institutions.
We conducted a cross-sectional nationwide study of breast cancer treatment institutions approved by the Japanese Breast Cancer Society in Japan. From 128 of the 457 institutions, 1,206 patients were included in the analysis. Each patient completed a questionnaire regarding perceptions of care that consisted of a multidisciplinary care subscale and a patient-centered care subscale.
Multiple regression analysis revealed that the multidisciplinary care subscale was significantly related to implementation of patient-based medical record system that was paper-based (p<0.05). The results of the secondary analysis showed a significant relationship between the interdepartmental medical record system and the patient’s perception of multidisciplinary care (p<0.05) and patient-centered care (p<0.05). When a multidisciplinary case conference took place regularly or multidisciplinary viewpoints were incorporated into the conference records, the conference had a significantly higher correlation with both subscales (p<0.001).
Integrated patient-based information and regular multidisciplinary case conferences that include records of viewpoints from different professionals improve patients’ perceptions of comprehensive breast cancer care.
PMCID: PMC3227867  PMID: 22135715
Breast cancer; multidisciplinary care; electronic medical record; patient perception; patient satisfaction; multidisciplinary case conference.

Results 1-5 (5)