The meaning of spirituality and spiritual well-being among Thai breast cancer patients:A qualitative study

Context: Spirituality is the essence of a human being. Patients who have good spiritual well-being (SWB) will also have better quality of life. However, health-care providers usually under-assess this aspect due to lack of practical guideline. In Thailand, the validated survey came from a different cultural background and was heavily based on Buddhism approach. Aims: The aim of the study is to assess the meaning of spirituality and SWB in Thai breast cancer patients in Southern Thailand where people have more diverse cultural and religious background. Settings and Design: Descriptive qualitative phenomenology design. Subjects and Methods: In-depth interview with stratified purposive sampling method. The interviews took place in the oncology outpatient unit department and participants' home. Inclusion criteria were being diagnosed with breast cancer, age over 18 years old, able to communicate in Thai, has a Palliative Performance Scale more than 50, and was not diagnosed with any psychological disorder. Statistical Analysis Used: Descriptive statistic. Results: From October 2016 to February 2018, 16 women joined the study. Three themes emerged with five subthemes: (1) feeling life worthwhile, (2) sense of belonging in the community, and (3) feeling connected to the nature. Conclusions: For Thai women, who have breast cancer, their spirituality focuses on family, mainly their children. They also have better SWB if they have good family relationship, social support, or feeling connected with nature or higher being in a religious or nonreligious way. Future survey design needs to be broader in a secular view and on another perspective rather than the religious approach

Body image transformation after breast cancer diagnosis and treatment in southern Thai women

Objective: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. Methods: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods. Results: Participants’ body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization. Conclusion: The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process

Utilising Card Game to Promote Advance Care Planning in Thailand:An Innovative Approach

Background/aims: Advance Care Planning (ACP) enables individual to conceptualise and express their preferences of care in the case of future incapacitation or towards end-of-life. The ACP uptake and its awareness remain low amongst healthcare professionals and the public in Thailand. Peaceful Death, a community driven organisation, seeks to raise ACP awareness and increases its uptake through the use of the Life Unlocking Care Game. The card game empowers the lived experience of people, facilitates the socially constructed experience and tacit knowledge around death and dying, is culturally appropriate and empowers ACP discussion and documentation that goes beyond end-of-life care as well as medical care preferences for Thais.Methods: From 2018-2020, Peaceful Death conducted three-day online training with ACP facilitators, focusing on communication skills and how to facilitate the card game session. Facilitators were also introduced to Baojai book, a jargon-free booklet that allows individuals to record their advance directive thus making it legally-binding. After the training, facilitators went to their communities and led the card game session initiatives for the public. Online survey were sent and 4 focus groups were conducted to evaluate the impact of the training programme.Results: Nine cohorts of facilitators were trained. 107/283 participants completed the online survey and 22 joined the focus groups. In total, the trained participants reached out to 26993 people. Of which, 15,555 joined the ACP sessions and 9,588 subsequently completed their advance directives. Team reflexivity indicates the card game to be appropriate in Thai context due to its i) cultural appropriateness that addresses relational autonomy; ii) normalisation of ACP conversation in a non-threatening environment.Conclusions: This project demonstrates a wide-scale training of ACP in a resource-limited setting. Findings resonated with Thai palliative care policies that aim to implement ACP nation-wide and should be further utilised

Utilising Card Game to Promote Advance Care Planning in Thailand:An Innovative Approach

Background/aims: Advance Care Planning (ACP) enables individual to conceptualise and express their preferences of care in the case of future incapacitation or towards end-of-life. The ACP uptake and its awareness remain low amongst healthcare professionals and the public in Thailand. Peaceful Death, a community driven organisation, seeks to raise ACP awareness and increases its uptake through the use of the Life Unlocking Care Game. The card game empowers the lived experience of people, facilitates the socially constructed experience and tacit knowledge around death and dying, is culturally appropriate and empowers ACP discussion and documentation that goes beyond end-of-life care as well as medical care preferences for Thais.Methods: From 2018-2020, Peaceful Death conducted three-day online training with ACP facilitators, focusing on communication skills and how to facilitate the card game session. Facilitators were also introduced to Baojai book, a jargon-free booklet that allows individuals to record their advance directive thus making it legally-binding. After the training, facilitators went to their communities and led the card game session initiatives for the public. Online survey were sent and 4 focus groups were conducted to evaluate the impact of the training programme.Results: Nine cohorts of facilitators were trained. 107/283 participants completed the online survey and 22 joined the focus groups. In total, the trained participants reached out to 26993 people. Of which, 15,555 joined the ACP sessions and 9,588 subsequently completed their advance directives. Team reflexivity indicates the card game to be appropriate in Thai context due to its i) cultural appropriateness that addresses relational autonomy; ii) normalisation of ACP conversation in a non-threatening environment.Conclusions: This project demonstrates a wide-scale training of ACP in a resource-limited setting. Findings resonated with Thai palliative care policies that aim to implement ACP nation-wide and should be further utilised

Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST):A Mixed Method Study

Background: It seems unclear why people living with breast cancer choose to receive medical cannabis-related content from social media. Thus, the extent to which patients access cannabis-related information from social media and the quality of the content on the platforms needs evaluation.Objective: We analyzed the factors determining the quality of cannabis-related content for breast cancer care on social media platforms and the characteristics of bad quality cannabis-related content on social media platforms accessed and consumed by Thai breast cancer survivors following its legalization in 2019.Methods: A mixed methods study was conducted between November 2020 and May 2022. A breast cancer survivor support group was involved in this study throughout. The group identified content related to medical cannabis by using social media platforms. The content was categorized based on i) content creator(s), ii) platforms, iii) content category, and iv) upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Content was classified as ‘good’ or ‘bad’, based on expert ratings. The inter-observer reliability of the QUEST was analyzed. Youden index was used as the cutoff point for QUEST. Statistical significance was set at p < 0.05. Fairclough’s Critical Discourse Analysis was undertaken to examine the underlying discourses around bad quality content.Results: Sixty-two cannabis-related items were evaluated. Content sources were categorized as news channels (33.9%), government (25.8%), healthcare providers (19.4%), and alternative medicine providers (19.4%). Most content (48.4%) were uploaded to YouTube and other websites (29.7%). Of these, 36.5% (27 contents) were news or generic cannabis advertisements. Some (12%) content had no identifiable date. The inter-observer correlation of QUEST scores was 0.86 (p<0.05). The mean QUEST score was 12.1±7.6. Contents were considered ‘good’ when the experts’ rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between good and bad content quality were 81.2% and 97.5%, respectively. Content creator was the only significant factor between ‘good’ and ‘bad’ quality content. Bad quality content were primarily created by alternative medicine providers and news channels. Two discourses were identified: i) advocacy for the normalization of cannabis use and ii) romanticization of cannabis as a panacea. These discourses overly normalize and romanticize the use of cannabis, with attention on indications of cannabis use, instructions for cannabis use, and promotion of medical cannabis, without discussions on the contraindications and side-effects of cannabis. Conclusions: The varying quality of medical cannabis information on social media accessed and shared by Thai breast cancer survivors is concerning. Given that content creators are the sole predictive factors of good content quality, the findings call the Thai government to consider placing restrictive regulations and control over cannabis content creators. Clinical Trial: N

Evaluating Cannabis Information Quality for Thai Breast Cancer Survivors Using QUEST:A Mixed-method study

Background/aims: To evaluate the quality of medical cannabis (MC) content on social media platforms accessed by Thai breast cancer survivors post its legalization in 2019.Methods: A Mixed-method study was conducted with engagement with a breast cancer survivor support group throughout. They identified MC contents accessed by breast cancer survivors via social media platforms. The contents were categorized based on the i) content creators; ii) platforms used and iii) content category. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess the quality of the content, scoring between 0 to 28 and classified them as ‘good’ or ‘bad’ based on expert ratings. The inter-observer reliability was analyzed. Youden index was used as the cut-point and a p value &lt; 0.05 was deemed statistically significant. Fairclough’s Critical Discourse Analysis was subsequently undertaken to explore discourses within the ‘bad’ quality contents.Results: 64 contents were evaluated, with categorizations revealing 33.9% from news channels, 25.8% governmental sources, 19.4% healthcare providers, and 19.4% alternative medicine providers. The majority were uploaded on YouTube (48.4%). The inter-observer correlation of QUEST scores was significant at 0.86 (p&lt;0.05), with a mean score of 12.1±7.6. Content was deemed ‘good’ with an expert rating over 3 and a QUEST score threshold of 15, achieving 81.2% sensitivity and 97.5% specificity. The content creator was the sole significant factor distinguishing between ‘good’ and ‘bad’ quality. Two discourses were identified: i) Normalization of cannabis and ii) The romanticization of cannabis as a panacea. Both affirm the use of MC without discussing its contraindications and adverse effects.Conclusions: A notable variance of MC information accessed amongst Thai breast cancer survivors is concerning. Findings urge regulatory interventions by the Thai government to implement stringent regulations and controls over cannabis content creators to safeguard information quality and public health.<br/