دکتر مریم رسولی

Despite medical advancements and treatment development, children with cancer experience a wide range of symptoms related to the disease and treatment side effects. Providing palliative care is essential to improve the quality of life for both the child and the family. Given limited available resources, cost-effective service packages can address this need.

This study aimed to develop an essential palliative care package for children with cancer in Iran.

The study was under Health System Research and employed an exploratory mixed method design in three phases. The initial stage involved two sub-studies including a review of literature and a qualitative study. In the subsequent phases, the package draft was compiled and validated using the Delphi technique with input from 12 experts.

The essential palliative care package for children with cancer comprised two main components: INPUT, including dimensions related to medicine, human resources, equipment, and service delivery setting. INTERVENTION, encompasses physical, psychological, social, spiritual symptom management, and growth and development.

Customized for Iran's social and cultural context, this essential service package provides safe, efficient, convenient, and affordable care. Physicians and nurses with primary training can integrate it into primary care including home care, emphasizing the importance of palliative care.

Context: 

The review of palliative care (PC) policies was introduced as one of the four main components of the WHO PC strategy. Considering that eastern Meditranian region countries (EMRCs) has made efforts to establish and develop PC in recent years, coordinated data collection provides a clearer picture of needs, challenges, and barriers at the regional level.

The aim of this study was to analyze PC policies related to cancer in the EMRCs.

A scoping review was conducted and reported following the PRISMA extension guidelines for scoping reviews (PRISMA-ScR). Scopus, Medline, Embase, ScienceDirect, PubMed, Web of Science, Google Scholar, and ProQuest were searched to identify relevant articles published in English and no limit time considered PC related policies in EMRCs. A Walt and Gilson model (context, content, process and actors) was used as a framework for analyzing and summarizing findings

Out of the 43 papers included in this study, 38 (88.37%) were journal articles. The studies covered countries such as Egypt, Jordan, Saudi Arabia, Lebanon, Cyprus, Oman, United Arab Emirates, Palestine, and Iran. The extracted policies were classified into leadership and commitment of policy makers, affordable access (in context), providing integrated patient-family oriented services, improving the quality of care, creating the possibility of information-sharing (in content), Focus/invest in specialized training, capacity building in society (in process), and involve all stakeholders (in actors).

The results of the present study provide a clear picture of how policies are made in the field of PC design and development in EMRCs. Before establishing such a system, it is essential to consider a wide range of economic, social, cultural, and political factors, mainly included in the four axes of Walt and Gilson's policy triangle. The results of this research can be used in policy making, design and formulation, as well as in decisions related to PC system programs.

Since family caregivers play an important role in providing care for patients in need of palliative care, it is important to focus on and examine their care ability in fulfilling the expected roles. Therefore, this study aimed to performa psychometric evaluation of the Caring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale (CAFCPNPCS).

Methods & Materials: 

The present study is methodological research that evaluates the psychometric characteristics of the CAFCPNPCS bymeasuring face validity, content validity, construct validity (confirmatory factor analysis and divergent validity), and internal consistency in 412 family caregivers of the patients in need of palliative care, who were selected through convenient sampling. The datawere analyzed using SPSS 24 andLISREL8.8.

According to the confirmatory factor analysis, the 5-factor model with 31 items was confirmedwiththe valuesRMSEA=0.05,CFI=0.95, andGFI=0.88.The divergent validitywas measured by the estimation of the correlation between the caring ability score with the care burden score (which was measured by Zarit Burden Interview) of the family caregivers of the patients in need of palliative care. Cronbach's alpha (α) was reported to be 0.85 for the whole scale and 0.781-0.852 for other dimensions.

CAFCPNPCSis a valid and reliable tool that can evaluate the caring ability of the family caregivers of patients in need of palliative care. Based on the results, it is recommended to utilize this scale to determine these caregivers’ ability to provide care and to examine the effectiveness of interventions to improve the dimensions of their caring ability.

Nausea and vomiting are among the most common side effects of chemotherapy, and despite using pharmaceutical treatments, no desired outcome has yet been achieved in this regard. Therefore, using non-pharmacological techniques has been recommended.

The present study examined the effect of overshadowing on chemotherapy-induced nausea and vomiting in children with leukemia.

In this clinical trial study, participants were 70 children aged 3 - 18 years admitted to the Oncology Department of Mofid hospital in Tehran, Iran, and were randomly assigned to 2 intervention and control groups. A flavored candy was given to each child in the intervention group 10 minutes before the start of chemotherapy. This process was repeated during 3 rounds of chemotherapy. The severity of nausea was measured with the Baxter Animated Retching Faces Scale. The frequency of vomiting was measured using a checklist in both groups 10 minutes before and immediately after chemotherapy. The data were analyzed with SPSS software (version 25).

The data revealed no statistically significant difference in the severity of nausea in the first and second chemotherapy rounds between the intervention and control groups (P > 0.05). However, there was a significant difference in the third chemotherapy round between the 2 groups (P < 0.05). The severity of nausea and frequency of vomiting in 3 chemotherapy rounds was not significant (P > 0.05).

The results indicated that overshadowing was not effective in reducing the severity of nausea and frequency of vomiting. Further studies are needed to determine the potential effects of this technique on gastrointestinal symptoms, including nausea and vomiting.

Prenatal diagnosis of fetal anomalies leads to parental psychological stress and decision-making challenges to continue or terminate pregnancy. Continuing pregnancy despite fetal anomaly can cause confusion, anxiety and depression in parents, so it seems necessary to be aware of their needs and appropriately respond to them. This study was conducted to exploring experiences about Continuation Pregnancy despite fetal anomaly in the socio-cultural context of Iran.
Qualitative exploratory descriptive study, 35 participants including 15 pregnant women with Life-Limiting fetal anomaly diagnosis, 5 family members and 15 perinatal care providers were selected purposefully. Data were gathered by individual interview and were written, important phrases were coded, by grouping same codes, main and sub categories were extracted.
In this study, 4 main categories, each with a number of subcategories were extracted. The main categories included: “mental health counseling, support parents to accept and cope with event, ethical consideration during end-of-life care of baby, providing perinatal palliative care)”.
The results showed that parents who forcibly or voluntarily continue pregnancy after a wearing of fetal anomalies, have extensive care needs during pregnancy and after birth that are not sufficiently met. Therefore, it seems that a comprehensive service package of perinatal palliative care appropriate for Iran socio- cultural context is necessary.

 Multiple sclerosis (MS) is one of the most common chronic progressive neurological diseases. It is the non-traumatic cause of neurological disability in adults. This disease increases the patient’s need for care due to the progressive course of disease that intensifies the symptoms over time. Family caregivers of these patients have different challenges and needs for caregiving. The present study aims to investigate the supportive needs of family caregivers of patients with MS in Iran.

This is a qualitative study conducted in MS Association of Isfahan, Iran in 2018-2019 for 8 months. Participants were selected by a purposive sampling method who included 8 patients, 13 family caregivers, and 4 treatment staff. Semi-structured interviews were used to survey the supportive needs of caregivers. Interviews took about 30-60 minutes. Sampling and data collection were saturated after 25 interviews. We used Guba and Lincoln’s criteria (credibility, dependability, transferability, and conformability) to evaluate and validate the data. The contract content analysis technique was used to analyze the data.

 The results of analysis yielded 795 initial codes. After merging these codes based on common features, 562 codes were remained. The supportive needs of family caregivers of MS patients were presented in three main categories (creating interaction opportunities to reduce isolation, empathetic interaction with peers and treatment staff, and financial support) and nine sub-categories.

Most of the family caregivers of MS patients in Iran do not receive adequate social and systemic supports from health care providers and do not have access to support resources. Policymakers and health caregivers should provide the required supporting programs for these caregivers so that they can optimally play their role in caregiving MS patients, especially at home, while receiving appropriate social and systemic supports.

Adherence to the treatment regimen is among the behaviors, which predict the successful control of the disease and decrease its intensity and negative consequences, which is influenced by several factors. The patient’s beliefs and attitudes toward the disease are effective factors in disease management and adherence to treatment, and spiritual health is one of these influential variables.

The aim of this study was to determine the mediating role of spiritual health in adherence to treatment in patients with cancer.

In this descriptive correlational study, the participants were 234 Iranian patients with cancer, who were selected through convenience sampling, admitted to the oncology wards of 9 selected teaching hospitals in the northern, southern, eastern, and western provinces of the country, as well as the capital in 2021. The research instruments included the Demographic and Clinical Information Questionnaire, Spiritual Well-Being Scale, and Morisky Medication Adherence Scale-8. The path analysis was done to determine the factors related to the degree of adherence to treatment, taking into account the mediating role of spiritual health.

The mean age of the participants in the study was 47.27 ± 15.36. The mean scores for spiritual health and adherence to treatment were 76.70 ± 13.75 and 6.47 ± 2.1, respectively. A positive and significant relationship was found between spiritual health and adherence to treatment (P-value < 0.05). The variables of marital status, the time of diagnosis, and being a religious person had a direct effect on spiritual health, and the time of diagnosis indirectly affected treatment adherence.

According to the results, the level of spiritual health and adherence to the treatment in patients with cancer was moderate. In addition, the variable of diagnostic time affected adherence to treatment indirectly. Besides, in examining the factors affecting spiritual health, the findings indicated the effect of the variables “being religious”, “marital status”, and “the time of diagnosis”. In addition to strengthening spiritual health, it is necessary to highlight the need to follow therapeutic diets in these patients. Therefore, it is suggested to consider a program to meet the patients with cancer spiritual needs along with the physical care program.

Changes in the course of diseases, their treatment, and care provision result in the need for a specific type of care known as palliative care. Medical staff’s knowledge and awareness of palliative care is important in this regard.

This study aims to examine the caregivers’ knowledge and awareness of palliative care and to determine the related predictors.

In this cross-sectional study, 277 subjects were selected from among the caregivers working in the selected teaching hospitals in Iran through non-randomized sampling method. The subjects were asked to fill the online questionnaire which consisted of 3 sections including demographic data, knowledge, and attitude toward palliative care. Descriptive, inferential statistics, correlation and regression analyses were performed.

The mean scores of care providers’ attitude and knowledge were 140.90 ± 11.56 and 19.36 ± 2.73 respectively. There was a significant relationships between some variables such as working place, education level, age, palliative care-related working experience, and the necessity to pass training courses and the mean scores of attitude and knowledge.

Since palliative care providers’ level of knowledge and attitude were reported to be moderate, training courses at different levels in the form of clinical courses should be offered with the aim of improving care providers’ skills and scientific abilities. It is essential to include the related topics in the curricula of academic programs.

Spiritual intelligence training, as one dimension of comprehensive care and a means of communicating with a higher power (God), can increase mothers' hope and self-transcendence. This study aimed to determine the impact of spiritual intelligence training on hope and selftranscendence in the mothers of premature neonates hospitalized in the ICU of Fatemieh Hospital, Hamadan. This randomized clinical trial study included 80 mothers with premature neonates hospitalized in the neonatal intensive care unit in Iran in 2019. The permutated block method was used to randomly divide the eligible participants into intervention and control groups. Weekly training sessions were held in a hybrid of virtual and face-to-face formats for eight 90-minute sessions for the intervention group, while the control group did not receive any education. The maternal demographic and neonatal clinical characteristics form, the Hope Scale of Mothers with Premature Neonates, and the Self-Transcendence Scale were used for data gathering. The mean ages of the participants in the intervention and control groups were 30.18±3.76 and 29.38±1.52 years, respectively, and about 45.2% of the neonates were firstborn. The results of repeated-measures ANOVA showed that after spiritual intelligence training, the mean scores of selftranscendence (51.42±1.81) and hope (160.10±7.75) significantly increased in the intervention group (P<0.001). Implications for Practice: It is possible to ensure that mothers provide quality and comprehensive care, allowing them to better perform the parent role, using mechanisms that can increase their hope and self-transcendence.

Traumatic events could be accompanied by positive personal and psychological changes. However, no scale is available to measure these aspects in patients with cancer. Accordingly, this study aimed at designing and evaluating the psychometric properties of the Persian version of the Post-Traumatic Growth Inventory (P-TGI) in patients with cancer.

According to the quantitative findings of our previous study, 9 items were added to the 21 items of P-TGI. After calculating the Content Validity Index (CVI) and Content Validity Ratio (CVR) coefficients, P-PTGI was finalized with 24 items. A total of 272 eligible patients with cancer who were referred to Shahid Ghazi Hospital in East Azerbaijan Province, Iran for follow-up treatment completed the P-PTGI. The instrument was assessed to determine its construct validity using various indices of Confirmatory Factor Analysis (CFA) and standardized lambda (λ) coefficient, followed by further assessment of the discriminant and convergent validities using the Structural Equation Modeling (SEM). LISREL and SPSS were used for data analysis. 

According to the results of goodness-of-fit indicators, the 5-dimensional, 24-item P-PTGI model was acceptable. Considering that the values of average variance extracted (AVE=0.53-0.75) were greater than the square of correlation coefficients between the 5 dimensions of P-PTGI, discriminant validity was approved. The convergent validity of the tool was confirmed according to the high lambda standard coefficients (0.50-0.93) between items and their related factors. Additionally, alpha coefficients for 5 dimensions of P-PTGI ranged from 0.84 to 0.93 which confirmed the consistency of the tool.

This study revealed that P-PTGI, with 24 items and 5 dimensions, is a valid and reliable tool for assessing PTG in Iranian patients with cancer.

 Due to the growing prevalence of cancer globally, the disease is considered one of the most important sources of stress, disability, and reduced life satisfaction. Although life satisfaction is supposed to be a relatively stable psychological construct, it may change in response to life events. Life-satisfaction is the assessment of the quality of life according to one’s chosen criteria.

 The purpose of this research is the psychometric evaluation of the Persian version of “Brief Multidimensional Life Satisfaction Scale” (BMLSS) in Iranian patients with cancer.

 The present study was a methodological research, during which the BMLSS was translated and the Farsi version was validated for patients with cancer.

 The fit indices of confirmatory factor analysis confirmed the dual dimension of the BMLSS. Regarding the convergent validity of the BMLSS, the total score of the instrument had a positive and significant relationship with age and the sense of religiosity. Cronbach's alpha and Intraclass Correlation were calculated.

 The findings indicated that this Persian version has good validity and reliability and can be used as a comprehensive instrument in Iran.

Providing palliative care (PC) is increasing by the increase in the number of people with life-threatening diseases and determined the benefits of these services in the community. Access to palliative care is a patient’s rights and ethical responsibility. Thus it is necessary to integrate into all level of the health system, including the primary health care. This study was conducted to assess the requirements for the integration of PC into the primary health care.

It was a document analysis, carried out through conventional content analysis and 10 national documents on PC, released by governmental organizations from 2010. The 4-step Scott method was used for the data validity and the coding process was done utilizing MAXQDA 10 software.

Base on the data analysis, we identified the “requirements of the integration of PC into the primary health care”, was of 4 main categories and 12 sub-categories. The categories include “principles and basics”, “legislation and policy-making”, “the establishment of PC system” and “the need for civil support”, which were extracted by reviewing the documents.

PC is believed to be in its early stages in the Iranian health system. Therefore, universal access to these services requires their provision at the community level. Thus, it is recommended that the principles and basics of PC in the country be explained and then, the necessary infrastructures of this integration be provided with the cooperation of governmental organizations, NGOs, and charities, through proper policy making.

Background:

 Due to the increased survival of children with chronic and complex diseases, transferring a part of care provision to home and harnessing the family’s potential with the aim of shortening the length of stay and returning the child to the safe and familiar atmosphere of the family can affect the health system and the family. This study aimed to evaluate the cost-effectiveness of home-based palliative care for children with complex health care needs based on the literature review.

After selecting the keywords related to the research question, by examining MeSH, EMTREE and the experts’ opinions mentioned in articles, searching the databases PubMed/Medline, EMBASE, Scopus and Web of Science was done through a combination of them.

Finally, 11 studies met the inclusion criteria, which were investigated in three groups of methodological features, economic outcomes and indirect outcomes. The reviewed studies were of medium to high quality. Eight were cohort studies, one pre-post study, and 2 economic evaluation studies. Studiesshowed that the decrease in the costs of home-based palliative care for the children in need of special health care, although little, was the result of either reduced hospital stay or the decreased number of hospitalizations. 

Conclusion:

 In order to set up pediatric palliative care services in Iran, considering the cultural atmosphere and the limited resources of the health system, attention should be paid to the cost effectiveness of care settings and the provided services, and measures should be taken in order to improve the situation of the children with special care needs, based on social conditions.

The scoring systems evaluate neonatal outcomes based on perinatal factors in the Neonatal Intense Course Unit (NICU). This study aimed to predict mortality risk in preterm neonates for the first time, using the Clinical Risk Index for Babies (CRIB II). This cross-sectional, descriptive-analytical, longitudinal study was conducted on 344 preterm neonates with the gestational age of 23-32 weeks and birth weight of 500-1500 g in a referral center in Tehran, Iran, from winter 2016 to spring 2017. Some neonatal variables were completed within the first 12 h of life, and the final scores were calculated based on CRIB II. Then, the correlation of these variables with mortality outcome was evaluated using logistic regression. Sensitivity, specificity, and positive and negative values were also calculated via SPSS software (version 23). According to the results, 253 (73.57%) neonates, including 122 girls (48%), survived in the first 24 h after birth. The total CRIB II score in the surviving neonates was 6.1±2.6. The area under the receiver operating characteristic curve was estimated at 0.84 with the cut-off point of 8.5. In addition, the sensitivity, specificity, positive predictive value, and negative predictive value of the CRIB II system were obtained as 75%, 78%, 55%, and 89.5%, respectively. The results revealed a significant correlation between the CRIB II score and mortality outcome. In this regard, an increase in the CRIB score coincided with a 0.67 increase in the risk of death (OR=1.671, p <0.001). Implications for Practice: Based on the findings of the present study,CRIB II can be concluded to be an appropriate scoring system. Consequently, the result of this tool can be used for routine investigations.

Premature birth and hospitalization in Neonatal Intensive Care Units (NICUs) is a critical issue for parents, especially mothers. The present study aimed to investigate the effect of spiritual care on hope and self-transcendence in mothers with premature newborns hospitalized in the NICUs. This quasi-experimental, single-group study was conducted using time series analysis. The sample consisted of 30 mothers with premature neonates hospitalized in Shahid Beheshti Hospital, Maraqeh, Iran. The participants were selected through a convenience sampling method following the inclusion criteria. The data were collected using the demographic characteristic forms of mothers and the clinical status of infants, as well as the hope and self-transcendence scales of the mothers with premature neonates admitted to the NICU. The data were analyzed in SPSS software (version 19) through descriptive statistics (i.e., frequency distribution, mean and standard deviation) and repeated measures analysis of variance (ANOVA). The findings show a significant difference among the pre-test, post-test, and follow-up stages in terms of the mean scores of hope and self-transcendence using repeated measure ANOVA (P<0.001). Moreover, in examining the effect of spiritual care on hope and self-transcendence in mothers, the results of repeated measures ANOVA showed that there was a difference among the pre-test, post-test and follow-up stages in terms of the mean scores of mothers’ hope, (P<0.001, F=53.133, and Eta-squared=0.639). Moreover, a significant difference was observed among the pre-test, post-test, and follow-up phases regarding the mean scores of self-transcendence (P<0.001, F=131.239, and Eta-squared=0.814). Since spirituality can lead to an increase in hope and self-transcendence of mothers with premature infants hospitalized in the NICUs, this approach can be used as an appropriate intervention method to help improve their adaptation and peace of mind. Therefore, barriers to providing these types of care and managing them must be identified so that nurses in the NICUs can use them.

COVID-19 pandemic has led to serious challenges in nursing homes around the world. In addition to age-related conditions, living in nursing homes are more likely to be infected with COVID-19 due to the use of shared living space, gathering in common dining and recreational areas, and limited technical and human resources. Nurses play an important role in meeting the complex needs of the elderly in the crisis and it is essential to use specialist nurses for addressing the physical and psychological needs of this high-risk population. In this crisis, the lack of geriatric nurses in nursing homes in Iran causes problems such as the rapid spread of infection, lack of access to quarantine and proper prevention, and further infection of patients and caregivers. These specialist nurses could take many responsibilities in a special condition such as the provision of specialized courses for other care providers who are working in these facilities to prevent the complications of being affecting by the disease. Therefore, it is recommended to prioritize the employment of specialist geriatric nurses, support staff more, and use appropriate technologies to minimize contact with patients, effectively train volunteers in the programs of these centers. It also Necessary to formulate and implement strict regulations and guidelines by these nurses to prevent, rapid diagnosis, and infection control, personal protection, meeting, and isolation of residents of nursing homes.

Length of hospital stay (LHS) is the most important and practical indicator in hospitals, which largely reflects the level of hospital performance and activity. It is also an important indicator for resource planning. Moreover, the quality of care can theoretically be related to LHS. The aim of this study was to investigate the relationship between LHS and quality of nursing care in the neonatal intensive care unit (NICU). In this descriptive correlational study, the samples were 205 premature infants hospitalized in the NICU and 80 nurses working in the NICUs of selected hospitals. They were selected based on the inclusion criteria. The data were gathered using the demographics of nurses and neonates through Quality Patient Care Scale (QUALPAC). The data was analyzed in SPSS (version 21) using Spearman correlation coefficient. The results showed that 47.5% of the nurses were within the age range of 29-36 years and 68.8% of nurses had a working experience of 1-5 years. There was an inverse correlation between the neonate's length of stay and the quality of care (r=-0.507, P<0.0001). The findings revealed an inverse relationship between the length of stay and quality of care. By improving the quality of care, we can decrease the LHS.

Medication administration errors are the most common medication errors. One of the most important causes of medication administration errors is a mistake in calculating the dose of medication by nurses. This study was conducted to evaluate the effects of using the Drug Calculation Cards on the amount and type of medication administration errors in the Neonatal Intensive Care Units (NICUs).

This quasi-experimental study was conducted with one-group before-after design to examine the effects of using the Drug Calculation Cards on the amount and type of medication administration errors. Eligible NICU nurses in selected centers affiliated to Qazvin University of Medical Sciences were registered (n = 33) in the study within three months. Then, before intervention data were collected using “medication administration errors reporting” questionnaire. Three months later the intervention (drug calculation card) was done and the same medication administration errors reporting questionnaire was dispersed. The data were entered to the SPSS version 14 and was analyzed using descriptive statistics.

The mean medication administration error during the three months before and three months after the intervention were 12.41 ± 14.48 and 9.62 ± 12.72, respectively, which had a statistically significant difference (P = 0.004).

Using the Drug Calculation Cards by nurses in

Attention to the family care provider needs and their caring power is essential. Since mothers are considered as the child’s main care provider, this study aimed to determine the caring power and its predictors among mothers of children with cancer.
In this descriptive-correlational study, 196 mothers who had a child with cancer were selected through purposive sampling. The data were collected using two questionnaires, namely demographics questionnaire and the care power of the care providers of cancer patient questionnaire. The data were analyzed using SPSS 19 and running descriptive statistics and regression analysis.
The highest average score belonged to dimensions of “effective role play” (44.62 ± 5.28) and “trust” (14 ± 1.67), and the lowest ones respectively belonged to dimensions of “fatigue and resignation” (22.38 ± 6.33), “awareness” (8.46 ± 2.70), and “uncertainty” (12.38 ± 3.50). In addition, variables of educational level (p <0.001), adequacy of family income (p <0.001), and duration of illness (p0.29) were found as predictors of caring power.
The results of this study showed that the caring power of mothers with a child with cancer is favorable. High trust and effective role-play reduced fatigue and resignation of mothers, and low awareness about the provision of care caused uncertainty affecting negatively the care power. In addition, the adequacy of family income, the high level of mother's education, and the reduction in the duration of the disease had a direct impact on care power.

Cancer is considered one of the most important health issues in Iran. Regarding that Iranians have a positive attitude towards complementary medicine; the demand for this type of treatments is increasing. However, those undergoing this treatment often have limited awareness on it. This study aims at determining the perspective of cancer patients on using complementary medicine. In this descriptive study, 176 cancer patients from all over the country were selected by purposeful sampling, according to the inclusion criteria and, then, completed demographic characteristics questionnaire and the Questionnaire on Integrating Complementary Medicine in Oncology Treatment. The data were analyzed, using SPSS software version 20. More than half of the patients used complementary medicine and according to their viewpoints, using herbal medicine was considered their first priority. At the same time, 46% of the research samples consulted with care providers on how to use complementary medicine for cancer treatment. The most frequent referrals to specialists were referrals to complementary medicine experts. The researchers expected complementary medicine to improve their symptoms of anxiety, fatigue, and depression. The use of complementary medicine as a complementary approach in cancer patients can have an impact on the improvement of symptoms, which ultimately enhances the quality of life in patients. Due to the concerns about applying these approaches, it is necessary to train care providers in order to consider the perspective of cancer patients in this regard and to obtain their past medical history.

Cancer is one of the major health challenges that requires palliative care. Home care is one of the most desirable palliative care models. The implementation of any model of care requires the assessment of the views of the service providers and as nurses represent most of the manpower providing home care, their point of view should be considered. This research aimed at investigating nurses’ views on the feasibility of home palliative care in Iran. In this descriptive study, 196 nurses were selected purposefully from all over Iran and filled out demographic information and the Global Home Health Nursing Care Assessment questionnaires. Data analysis was performed, using SPSS software version 20. According to the opinion of the nurses, in order to provide home palliative care for patients with cancer, there is social acceptability and relative satisfaction regarding access to medications, equipment, and pain management. However, lack of access to end-of-life services and hospices as well as achieving educational opportunities are amongst the most important obstacles to the implementation of this kind of care. By having proper planning to promote home palliative care, using the existing potentials as well as applying functional changes to the nursing curriculum at Bachelor’s level, home palliative care can be developed for patients with cancer.

By acceptance of palliative care as a part of health system of each country and due to increasing prevalence of cancer, special focus on stakeholder’s educational needs is of vital importance so that palliative care services are improved and the quality of life of patients is enhanced. This study was conducted to explore the educational needs of stakeholders of palliative care for cancer patients in Iran.
This qualitative study with 20 semi-structured interviews was conducted from August 2016 to February 2017 in Shohadaye Tajrish and Emam Khomeini Hospitals of Tehran. Participants were selected through purposive sampling and included cancer patients and their family caregivers as well as healthcare providers, experts and policy-makers. The data were analyzed through Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Statements of each main category of the study were summarized in SWOT categorizes.
A total of 546 codes were extracted from the analysis of the interviews and four main categories and four subcategories were identified. The four main identified categories included:”academic education planning”, “workforce education”, “public awareness”, and “patient and caregiver empowerment” that contained our subcategories as follows: “strengths”, “weaknesses”, “opportunities” and “threats” (SWOT).
Meeting the educational needs of the stakeholders of palliative care requires policy-makers to identify the factors leading to strategies that are based on the use of opportunities, the removal of weaknesses, and coping with the threats to which the organization is faced.

The diagnosis of cancer can cause great spiritual crises in persons and affect various aspects of their lives.
This study was conducted to design a psychometric spiritual needs assessment scale of patients with cancer in Iran.
This methodological research was conducted in 2 parts: qualitative and quantitative. Interviews were conducted with 18 patients with cancer who were referred to Imam Khomeini Hospital in Tehran with the maximum diversity of the patients occurring in the qualitative stage for explaining the spiritual needs of patients. The purposive sampling method was applied to this study. The interviews were analysed with the content analysis method, and eventually classes related to patients’ spiritual needs were conducted. Also, the terms of the scale were designed in this way. In the quantitative stage, content validity, formal validity, structure validity (exploratory factor analysis), and convergent validity were evaluated with internal consistency and retests of the scale.
The 4 themes, Connection, Search for Peace, Find Meaning and Purpose, and Achieve Transcendence were extracted from the codes obtained. The intended scale was, then, designed. The content validity index and validity ratio of tools of content validity were determined. Content validity was applied during the assessment of face validity assessment of written comments of experts. In addition, 10 patients were examined on the scale. An exploratory factor analysis indicated the 5 factors of the designed scale. Finally, a scale was obtained with 38 terms in 5 subscales and its scoring was determined in a 6-episode Likert. Cronbach’s alpha for the total scale was estimated 0.81; for the religious dimension, this was 0.88, for meaning and purpose 0.77, for peace 0.70, for connection 0.74, and for support and nationalism 0.67, respectively. The result of the retest was also estimated ICC = 0.89.
The spiritual needs scale in patients with cancer can measure different aspects of spiritual needs and is reliable and valid. It is suggested that the spiritual needs assessment scale of patients with cancer be used in different populations of patients with cancer separated on the basis of sex, age, type of cancer, and stage of the cancer and the spiritual needs of these patients be determined. Also, the designed scale is validated in other places and with different cultural conditions.