We are delighted to continue the Academic Express section, which aims to facilitate academic exchanges and further the development of oncology nursing. In every issue, we present ground-breaking research contributions from esteemed members in the field.

In this issue, we are privileged to feature a transformative study led by Associate Professor Bruno Magalhães from the University of Trás-os-Montes and Alto Douro (UTAD), Portugal. His phenomenological research, "Bridging the Care Divide: Family Caregivers' Journeys in Palliative Transition and Imperatives for Oncology Nursing", illuminates the complex realities of transitioning palliative care from hospital to home settings through the lens of family caregivers.

We are deeply honored to contribute to the International Society of Nurses in Cancer Care (ISNCC) website by sharing insights from our recent phenomenological study: "Family perceptions of the transition from hospital to home palliative care." Given that cancer was the predominant diagnosis among the patients whose families participated in our research, our findings hold critical relevance for oncology nursing practice globally.

The study, conducted in Portugal, aimed to explore the profound lived experiences of family caregivers as they navigate the critical shift of palliative care responsibility from the structured hospital environment to the intimacy and complexity of home.

The Essence of the Caregiving Experience

Our analysis revealed that this transition is characterized by a mix of profound moral commitment and systemic fragility. Caring is primarily driven by love, duty, and reciprocity. However, this commitment coexists with intense feelings of helplessness, exhaustion, and deep insecurity due to the inevitability of disease progression.

Three essential themes emerged from the caregivers’ narratives: Emotional and Relational Experience of the Family Member, Family’s Challenges and Adaptation, and Support for the Family.

A particularly salient finding was the tension between the family’s dedication and their profound sense of being unprepared. Caregivers often felt abruptly responsible for complex tasks—such as mobilizing, hygiene, or administering medication—without prior formal training or clear guidance from the institutions. The lack of technical knowledge was a significant source of stress, leading families to resort to "self-directed learning" (trial and error or searching the internet) to manage daily care.

Critical Implications for Oncology Nursing Worldwide

These experiences highlight concrete areas where oncology nurses can act as crucial agents in supporting families during the end-of-life continuum:

1.Mandate Structured Transition Programs: Nurses must implement formalized, practical training programs before hospital discharge. These programs should include supervised sessions on specific technical tasks (e.g., symptom management, mobility techniques) to boost caregiver confidence and reduce anxiety about "doing something wrong".

2. Prioritize Emotional and Psychological Support: Recognizing the high levels of burden, stress, and anticipatory grief reported by caregivers is essential. Oncology nurses must proactively identify signs of exhaustion (burnout) and facilitate timely access to emotional support strategies, such as psychological counseling or support groups.

3. Ensure Seamless Continuity of Care: The contrast between continuous hospital support and limited home resources causes immense insecurity. The presence and responsiveness of community palliative care teams (PCHSTs) emerged as a critical factor for family safety and validation. Nurses must advocate for, and ensure, clear and coordinated referral pathways to strengthen community support structures.

In conclusion, our study confirms the urgent need to recognize the family as the unit of care. By investing in caregiver empowerment, continuous support, and coordinated systems, oncology nurses can ensure that the transition to home palliative care is safe, sustainable, and truly compassionate for both the person with cancer and their devoted family.

References:

Cruz, S., Magalhães, B., & Fernandes, C. (2025). Family perceptions of the transition from hospital to home palliative care: a phenomenological study. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 33(11), 1014. https://doi.org/10.1007/s00520-025-10069-9

Associate Professor Bruno Magalhães 

PhD, DNSc, MPH, CMSRN, RN

We are delighted to continue the Academic Express section, which aims to facilitate academic exchanges and further the development of oncology nursing. In every issue, we present ground-breaking research contributions from esteemed members in the field.

In this issue, we are privileged to feature an innovative study led by Dr. Yongfeng CHEN from The Chinese University of Hong Kong, in collaboration with Professor Marques Shek Nam NG and Professor Carmen Wing Han CHAN. Their research, titled "Exploring the Role of Medication Perceptions in Adherence to Oral Anticancer Agents among Patients with Gastrointestinal Tract Cancer", unveils critical psychological determinants of treatment adherence through a pioneering mixed-methods approach.

Why We Chose This Research Topic

Oral anticancer agents (OAAs) have transformed cancer care by enabling patients to receive treatments at home. However, this convenience comes with a critical challenge of upkeeping adherence—a global concern across cancer care settings. This challenge is even more pressing in patients with gastrointestinal (GI) tract cancers, who often rely on cytotoxic OAAs administered in long-term, intermittent regimens. Our previous review found a median adherence rate of 68% in this population. Such suboptimal adherence may compromise treatment effectiveness and increases mortality risk.

To address this challenge, we turned to the Common-Sense Model of Self-Regulation (CSM). Unlike traditional frameworks that view patients as passive recipients of care, they are regarded as active problem solvers in the CSM. This model emphasizes that patients’ medication perceptions—both cognitive and emotional responses to medication—shape adherence. While existing studies have focused largely on cognitive responses, our clinical observations revealed that pivotal roles of emotions. Therefore, we conducted a mixed-methods study, integrating quantitative surveys and qualitative interviews, to capture both measurable data and authentic patient voices for building a more comprehensive understanding about how medication perceptions influence adherence.

What We Discovered

Our survey showed that only 58.9% of patients fully adhered to their prescribed OAAs regimens, whereas 25% stopped when they felt worse, 17% forgot doses, and 9% discontinued when they felt better. Patients who fully adhered to OAAs were characterized by significantly lower general harm beliefs and perceived sensitivity to medicine, while significantly higher self-efficacy in managing OAAs. Through patient voices, four major themes emerged:

• Emphasizing the effectiveness of OAAs despite their hazardous nature.
• Experiencing negative emotions in relation to taking OAAs, including concern and reluctance.
• Taking responsibility for routine OAAs management at home.
• Encountering multiple barriers to taking OAAs, including adverse effects,polypharmacy, poor memory, unpleasant drug characteristics, and lack of knowledge about managing OAAs.

By integrating quantitative and qualitative data, we found that:

• Patients with higher general harm beliefs tended to reinforce the hazardous nature of OAAs, resulting in lower adherence.
• Those rated a higher level of sensitivity to medication were more likely to consider sensitivity to the adverse effects of OAAs, thereby presenting lower adherence.
• Those reported a higher level of medication self-efficacy might have a higher possibility of overcoming barriers to taking OAAs and showing better adherence. 

Implications for Cancer Care

Our findings support the application of the CSM in explaining adherence behaviors and offer new insights into effective management of OAAs among patients with GI tract cancer:

• Targeting negative medication perceptions, such as exaggerated harmful or adverse effects of OAAs, to promote adherence.
• Enhancing self-management ability to empower patients to take an active role in managing OAAs and overcoming barriers at home.
• Integrating emotional management strategies, such as addressing concerns and reluctance, in adherence-enhancing programs.
•  Screening for negative medication perceptions, such as harm beliefs and perceived sensitivity to medication, may help identify high-risk patients with non-adherence.

We are committed to supporting patients who manage OAAs at home. Building on this study, we are developing and evaluating a program that addresses medication perceptions and promotes adherence. We welcome your continued engagement with our ongoing research.

References

Chen Y, Ng MSN, Dong B, Chan CWH. "These Drugs Are Going to Save Our Lives" A Mixed Methods Study on the Role of Medication Perceptions in Adherence to Oral Anticancer Agents Among Patients With Gastrointestinal Tract Cancer. Psychooncology. 2025;34(7):e70213. doi: 10.1002/pon.70213.

From left to right: the second author and co-supervisor, Professor Marques Shek Nam NG; the first author and principal investigator, Dr. Yongfeng CHEN; and the corresponding author and supervisor, Professor Carmen Wing Han CHAN

We are delighted to continue the Academic Express section, which aims to facilitate academic exchanges and further the development of oncology nursing. In every issue, we present ground-breaking research contributions from esteemed members in the field. 

In this issue, we’ll continue focus on pioneering oncology research from China, featuring a novel multidimensional assessment of adolescent and young adult gynecological cancer patients. Through synchronized actigraphy, circadian chronotyping, and serum inflammatory marker quantification (including TNF-α), this Cancer Nursing (2025) study establishes an objective framework during active treatment.

Our recent publication, “The Level of Psychological Distress Is Associated with Circadian Rhythm, Sleep Quality, and Inflammatory Markers in Adolescent and Young Adults with Gynecological Cancer,” which published in Cancer Nursing, investigates associations between psychological distress, circadian rhythm, sleep quality, and inflammatory markers in adolescent and young adults with gynecological cancer. As researchers and clinicians working with young cancer patients, we are deeply aware of the unique psychosocial and physiological challenges faced by adolescent and young adult (AYA) women with gynecological cancers. This study aimed to explore the interrelationships among circadian rhythm, sleep quality, inflammatory markers, and psychological distress in this vulnerable population.

Why We Chose This Topic

AYA gynecological cancer patients not only confront a life-threatening diagnosis but also face threats to fertility, body image, and sexual health, which can exacerbate psychological distress.
Previous research has shown that circadian disruption, poor sleep, and systemic inflammation are linked to worse mental health in cancer patients, but few studies have focused specifically on AYAs with gynecological cancers. We believed a deeper understanding of these factors could inform more holistic and effective supportive care strategies.

What We Discovered

Our study included 64 AYA gynecological cancer patients in active treatment. We found that the average psychological distress level (4.23 on the Distress Thermometer) exceeded the clinical cutoff, indicating significant psychological burden. Key findings include:

• Patients with high psychological distress were more likely to have evening-type circadian preferences.
• Those with high psychological distress had significantly worse sleep quality, including shorter total sleep time (TST), longer sleep onset latency (SOL), and lower sleep efficiency (SE).
• Inflammatory markers, particularly TNF-α, were elevated in highly distressed patients and positively correlated with psychological distress levels.
• Stepwise regression identified TST, SOL, and TNF-α as significant predictors of psychological distress.

Implications for Cancer Care

Our findings highlight the need for integrated care that addresses both psychological and physiological aspects of health in AYA gynecological cancer patients. Specifically, we recommend:

l  Routine screening for circadian preference and sleep quality using validated tools like MEQ and actigraphy.

l  Early intervention for sleep disturbances through cognitive-behavioral therapy for insomnia (CBT-I), light therapy, or sleep hygiene education.

l  Monitoring inflammatory markers such as TNF-α may help identify patients at risk of severe distress and guide targeted support.

l  Multidisciplinary collaboration among oncologists, nurses, psychologists, and rehabilitation specialists to address the complex needs of these patients.

By addressing circadian rhythm disruption, improving sleep quality, and mitigating inflammation, we can better support the mental health and overall well-being of AYA women with gynecological cancer. This holistic approach is essential not only for improving quality of life but also for enhancing treatment adherence and outcomes.

Source:

Luo, Y., Duan, Y., Zhou, Y., Yi, S., Dai, C., Luo, X., Kang, Y., Wan, Z., Qin, N., Zhou, X., Liu, X., Xie, J., & Cheng, A. S. K. (2025). The Level of Psychological Distress Is Associated With Circadian Rhythm, Sleep Quality, and Inflammatory Markers in Adolescent and Young Adults With Gynecological Cancer. Cancer nursing, 48(5), E289–E295. https://doi.org/10.1097/NCC.0000000000001325

Reference:
Linden, W., Vodermaier, A., Mackenzie, R., & Greig, D. (2012). Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. Journal of affective disorders, 141(2-3), 343–351. https://doi.org/10.1016/j.jad.2012.03.025
Manne, S. L., Myers-Virtue, S., Kissane, D., Ozga, M. L., Kashy, D. A., Rubin, S. C., Rosenblum, N. G., & Heckman, C. J. (2017). Group-based trajectory modeling of fear of disease recurrence among women recently diagnosed with gynecological cancers. Psycho-oncology, 26(11), 1799–1809. https://doi.org/10.1002/pon.4223

Li, L., Duan, Y., Sun, Q., Xiao, P., Wang, L., He, S., Liu, X., Zhou, J., Xie, J., & Cheng, A. S. K. (2021). Relationship of Circadian Rhythm and Psychological Health in Adolescents and Young Adults With Cancer. Cancer nursing, 44(6), E659–E669. https://doi.org/10.1097/NCC.0000000000000971

Irwin, M. R., Olmstead, R. E., Ganz, P. A., & Haque, R. (2013). Sleep disturbance, inflammation and depression risk in cancer survivors. Brain, behavior, and immunity, 30 Suppl(Suppl), S58–S67. https://doi.org/10.1016/j.bbi.2012.05.002

Nursing Department, The Third Xiangya Hospital (Jianfei Xie)

We are honored to continue the Academic Express initiative, a cornerstone platform for disseminating transformative research that shapes the future of cancer care worldwide. In this issue, we present a reflective commentary by Dr. Dorothy N.S. Chan (Chair, ISNCC Knowledge Development Committee), her doctoral student Ms. Jennifer Zhang and her team on their pioneering study: "Multicomponent Self-Management Intervention for Cancer Patients with Pain". Responding to the universal crisis of unrelieved cancer pain—where patients may view suffering as inevitable or even contemplate suicide—this research delivers a breakthrough multicomponent self-management intervention (MSMI) integrating mHealth technology. The PainManager app achieved remarkable 95.8% retention, demonstrating scalable solutions to bridge critical gaps in outpatient pain management.

We are honored to share reflections on our recent research, "Multicomponent Self-Management Intervention for Cancer Patients with Pain: A Pilot Randomized Controlled Study." Our decision to focus on cancer pain management emerged from firsthand observations of the profound challenges patients endure throughout their cancer journeys. Pain disrupts not only physical comfort but also emotional and psychological well-being. In China, we have encountered cancer patients who endured unrelieved pain, and patients who believe suffering is an inevitable part of cancer. Despite advances in medical treatment, many individuals still experience inadequate pain relief, particularly during the transition to outpatient care. This highlights the urgent need for effective self-management strategies that empower patients and improve their quality of life.

Through this study, we gained valuable insights into the importance of a holistic approach to pain management. A systematic review revealed that while existing self-management interventions offer benefits, they often lack a comprehensive framework addressing the multifaceted nature of pain. Synthesizing data from multiple randomized controlled trials allowed us to develop a novel multicomponent self-management intervention (MSMI) that integrates education, assessment, ongoing support, and lifestyle adjustments—all essential components for improving outcomes in cancer patients experiencing pain.

One of the most rewarding aspects of our research was the incorporation of mHealth technology via the PainManager app. Our findings highlight its potential to bridge the gap between patients and healthcare providers, fostering a collaborative approach to pain management. The app not only improved communication but also promoted engagement and adherence to self-management strategies. Positive participant feedback emphasized its practical value and potential for broader implementation in cancer care.

Our pilot study, which included 23 participants, demonstrated high feasibility with a 95.8% retention rate and strong acceptability. Although preliminary analyses showed modest effects on several outcomes, we observed a moderate positive effect on medication adherence—a key challenge in pain management. Participant interviews provided invaluable feedback, noting the app’s convenience and benefits while also identifying areas for refinement, such as streamlining questionnaires. These findings are not an endpoint but a critical foundation, underscoring the need for a larger-scale study to validate and optimize the intervention’s efficacy.

We believe nursing practice can greatly benefit from these insights. Equipping patients with the tools and knowledge to manage their pain fosters independence and strengthens the nurse-patient relationship. As we continue to explore innovative ways to address the complex needs of cancer patients, we hope our research encourages further exploration in the vital field of self-management interventions.

In conclusion, conducting this study has reaffirmed our commitment to improving cancer care. We invite our colleagues in oncology nursing to embrace the possibilities offered by evidence-based, technology-integrated interventions. Together, we can make meaningful strides toward alleviating cancer pain and enhancing the quality of life for patients worldwide.

Ms Jennifer Zhang (in the middle, first author of the article) and her nursing team

Reference:

Zhang, J., Yu, W., Wu, X., Zhang, S., Yang, M., Luo, M., Jiang, J., Mai, M., Ho, L.L.K., & Chan, D.N.S. (2025). Multicomponent self-management intervention for cancer patients with pain: A Pilot randomized controlled study. European Journal of Oncology Nursing, 78, 102964. doi: 10.1016/j.ejon.2025.102964.Multicomponent self-management intervention for cancer patients with pain: A Pilot randomized controlled study.

From June 18 to 21, 2025, the International Conference on Cancer Nursing (ICCN) was successfully held in Adelaide, Australia. The conference was jointly held with the Cancer Nurses Society of Australia (CNSA) with the theme of "Global Voice, Local Actions: from inspiration to implementation". Nearly 1,150 oncology nurses from more than 30 countries and regions attended the conference.

Pre-Congress Symposium (June 18, 2025)

Prof Patsy Yates (ISNCC Past President) and Prof Winnie So (ISNCC President) conducted a pre-conference workshop “Future Ready: Working together to build a sustainable and resilient cancer nursing workforce”. The workshop aimed to explore factors impacting the cancer nursing workforce and considerable strategies to build a sustainable and resilient workforce for the future to drive the best possible outcomes for people at risk of or affected by cancer.

Opening ceremony (June 19, 2025)

The Congress began with a Welcome to Country led by Suzanne Bartlett, Chairperson of conference program committee, and a formal opening from the Hon Chris Picton MP, Minister for Health and Wellbeing.

Plenary Sessions

Plenary Session one: the opening plenary brought together national leaders, personal stories, and global perspectives to launch the Congress theme: Global Voices, Local Actions: From Inspiration to Implementation.

Plenary Session Two: Inspiration to Implementation - Genomics and Lung Cancer Screening, explored how emerging science is transforming cancer care--shaping how to prevent, detect, and treat cancer across diverse populations. The expert panel examined lessons learned from global leaders, barriers to implementation, and strategies for equitable access. The panel also discussed early detection, workforce capability, and the critical role of nurses in supporting at-risk population.

After the plenary session 2, Prof. Winnie So, President of ISNCC, presented a distinguished merit award to Prof Annie Young, an Emerita Professor of Nursing at Warwick Medical School, University of Warwick, UK. This award is offered once every two years in recognition of an outstanding contribution to the international advancement of the science and art of cancer nursing.

Plenary Session Three: Leading with Impact - Palliative Care, Survivorship & Advocacy

This plenary session brought together diverse voices to explore compassionate, equitable, and Patient-Centered care across the cancer continuum—from diagnosis to survivorship and end-of-life care. In the panel discussion, panel exerts explored what equity looks like, how nurses and consumers drive advocacy, and nurse-led leadership is key to system-wide change.

Plenary Session Four: Building Capability - Navigation, Education and Workforce Needs. This session focused on Navigation and Education in cancer care—how they can strengthen the cancer nursing workforce while improving outcomes across the care continuum.

Plenary Session Five: Cecilia Peña was recognized as the recipient of the ISNCC Past President's Award, which is honored to recognize outstanding leadership and contributions to cancer care in low- and middle-income countries. Ceceilia shared her experiences at the Congress, and a message of resilience for nurses working in diverse settings around the world. Then, Dr Tabitha Healey brought the Congress to a close, creating space for reflection, renewal, and resilience -honoring global leadership and prioritizing the emotional wellbeing of cancer nurses.

Thematic parallel sessions

The conference featured nine parallel thematic sessions. These themes encompassed the refugee experience and its impact on cancer nursing practice; fostering local perspectives and regional collaborations in cancer care development; exploring equitable cancer care through nurse - led and consumer - informed innovation; amplifying regional voices; promoting greater involvement of cancer nurses in caring for cancer survivors; leveraging global expertise for local impact in children's palliative care; uniting cancer nurse educators; strengthening oncology nursing partnerships; and examining the COVID-19 pandemic's impact on cancer care provision, including lessons learned and future directions, as presented by ISNCC& EONS.

Oral presentation sessions

The oral presentation sessions covered a wide range of topics, such as patient education, the cancer nursing workforce, current challenges and constraints faced by cancer nurses, nurse-led interventions impacting patient outcomes, palliative care, survivorship, nursing education in cancer care, vascular care, supportive care toolkits, Patient-Centered care experiences and support for cancer nurses, as well as patient- centered care research. Scholars, nurse clinicians and leaders worldwide shared their research studies and clinical experiences about the above themes.

Poster presentations: The conference featured hundreds of poster presentations and a lot of themed booths in the exhibition hall, facilitating vibrant academic exchanges among scholars and clinical experts across the world.

Travel grants program

The travel grant program has been established to further the mission and vision of the ISNCC to foster the development of cancer nursing internationally, particularly focuses on supporting nurses from low and middle resource countries. Travel grant recipients are expected to share their experiences and newly acquired knowledge with colleagues following attendance at the International Conference on Cancer Nursing.

Recipients of Travel scholarship

The four-day CNSA-ICCN 2025 Congress successfully concluded, providing a platform for knowledge and experience exchange among cancer nurses globally. Participants gained fruitful insights, enriched knowledge in cancer care, and broadened horizons through the event, which also played a vital role in promoting future global collaboration and professional advancement in cancer nursing.

“Catherine is an outstanding international leader with significant contribution to maximize global cancer nurses' potential in cancer control and care. We are very proud of Cath for being awarded the Member of the Order of Australia (AM)” - Prof Winnie So, ISNCC President

This prestigious national honour recognises Catherine’s significant service to oncology nursing and research. With nearly 30 years of dedicated work as a Clinical Research Nurse in Medical Oncology at Calvary Mater Newcastle, Catherine has made a lasting impact on cancer care in Australia. Since 2010, she has served as the Gastrointestinal Cancer Care Nurse Coordinator for Hunter New England Local Health District.

Catherine is also a passionate leader in nursing professional organisations. In addition to her current role with ISNCC, she was a founding member of the Cancer Nurses Society of Australia (CNSA), contributing to the advancement of cancer nursing nationally and globally.

We are delighted to see Catherine’s outstanding commitment and leadership recognised at the highest level. Congratulations, Catherine!

Ms Catherine Louise Johnson

Reference:

https://www.miragenews.com/aussie-nurses-honored-in-2025-kings-birthday-1474307

The International Society of Nurses in Cancer Care (ISNCC) is proud to celebrate the remarkable achievement of Naomi Oyoe Ohene Oti from Ghana, who has been named the winner of the 2025 Aster Guardians Global Nursing Award. Naomi, an Oncology Nurse Specialist and Head of Nursing at the National Radiotherapy Oncology and Nuclear Medicine Centre, Korle-Bu Teaching Hospital, received this prestigious honor during a grand ceremony held in Dubai, UAE, on May 26, 2025.

The Aster Guardians Global Nursing Award is an international accolade that recognizes the extraordinary contributions of nurses worldwide in areas such as leadership, research, innovation, and community service. Naomi was selected from a remarkable pool of over 100,000 applications spanning 199 countries, rising to the top among ten outstanding finalists.

Naomi’s impact on oncology nursing in Ghana has been transformative. She has pioneered specialized nursing training programs, improved patient care pathways, and championed equitable cancer outcomes in her institution and beyond. Her collaboration with international partners, including the Cross Cancer Institute in Canada, has led to the development of advanced oncology nursing education and professional development programs for nurses in Ghana. Naomi serves on the ISNCC Member Development Committee and has contributed to the development of the AORTIC Oncology Nurse Competencies as well as the oncology nursing content in the 2024 IAEA/WHO Guidance on Setting Up a Comprehensive Cancer Centre.

For her groundbreaking work and dedication, Naomi received a $250,000 prize, underscoring the global importance of her contributions to cancer care and nursing leadership.

ISNCC congratulates Naomi on this well-deserved recognition and is honored to have her as a member of our global community of oncology nursing leaders. Her achievements exemplify the mission and vision of ISNCC — advancing global cancer nursing through excellence in practice, education, research, and leadership.

Yingtao Meng, Huiyu Luo

The Oncology Nursing Committee of the Chinese Nursing Association

The China Anti-Cancer Association initiated the 31^st National Cancer Prevention and Control Awareness Week (April 15 to 21, 2025) to promote healthy lifestyles and early screening to the public. The Oncology Nursing Committee of the Chinese Nursing Association and China Anti-Cancer Association Integrated Nursing Committee actively responded to the call and launched "Evidence-Based Healthy Living for Cancer Prevention" campaigns.

Coordinated by the Oncology Nursing Committee, the campaign involved more than 15,000 nurses from 91 institutions across 27 provinces, autonomous regions, and municipalities. A total of 704 face-to-face and online activities were organized successfully, including public lectures/educational seminars and health consultations. The campaign outreached 66 million people, including patients with cancer and their family members, as well as the general public.

During this campaign, oncology nurses actively participated in evidence-based educational seminars and heath consultation sessions  to enhance the public’s awareness of cancer prevention and control. Their efforts demonstrated the value of nursing in reducing the burden of cancer in the nation and achieving the goals of cancerprevention and control under the Healthy China initiative.

We are honoured to present an innovative educational initiative addressing cervical health equity for multicultural youth: “Developing and Implementing an Educational Program for Cervical Health, Healthy Lifestyles, and HPV Vaccination for Female Chinese and Non-Chinese-Speaking Students", co-authored by Dr. Laurie LK Ho and Dr. Dorothy NS Chan from The Nethersole School of Nursing, Chinese University of Hong Kong.

Adopting a healthy lifestyle and receiving Human Papillomavirus (HPV) vaccination are crucial for preventing HPV infections and cervical cancer, making it essential to initiate these practices during adolescence. In Hong Kong, however, there is a lack of focus on promoting cervical health and preventing HPV infections within the secondary school sex education curriculum. While initiatives have primarily targeted Chinese-speaking students, few address the needs of non-Chinese-speaking students. Given Hong Kong’s multicultural society, it is vital that all students, regardless of their linguistic background, have equal access to health information that protects their well-being. Thus, there is a need for an educational program that effectively targets both Chinese and non-Chinese-speaking students in secondary schools.

Reflecting on a recent educational program developed for female Chinese and non-Chinese-speaking students, we aimed to promote cervical health, healthy lifestyles, and HPV vaccination. Creating an effective program required careful planning and cultural sensitivity. Our initiative included a health talk and a tutorial session designed to enhance students’ understanding of HPV, its associated infections, cervical cancer, and preventive measures. The health talk provided foundational knowledge, while the tutorial session focused on addressing myths and misconceptions.

To support these sessions, we developed a variety of educational materials, including PowerPoint presentations, booklets, matching exercises, and case scenarios. The development process followed a multi-step approach. Initially, an outline of the content was created, followed by the selection of different formats to facilitate effective content presentation. Meetings with a graphic designer ensured that graphics were tailored to the interests and comprehension levels of both Chinese and non-Chinese-speaking secondary school girls. Additionally, project team meetings integrated relevant life skills and positive values regarding cervical health and HPV vaccination into the materials.

Successful implementation of the educational program required considering several factors. First, the literacy levels of the students influenced the scope of the health content. Thus, medical jargon was avoided, using simple language, infographics, and cartoons to clarify complex concepts. Bilingual materials were prepared in both Chinese and English to ensure accessibility. Second, the information had to be engaging to stimulate interest in learning. The sequence of materials was finalized: PowerPoint presentations provided knowledge input; booklets served as reminders; interactive matching exercises addressed myths; and scenario-based discussions encouraged practical application of knowledge. Bilingual facilitators guided these discussions, fostering an inclusive environment.

User experience with the educational materials was also paramount. Before implementation, three secondary school girls reviewed the content, providing valuable feedback, especially on sections addressing myths about HPV vaccines. Their insights led to important modifications. Additionally, cultural practices concerning sensitive topics were respected by conducting the program in a female-only classroom setting.

After the program, feedback from students indicated that the program was engaging and inspiring, with accessible and useful information. They appreciated the clarity of the materials and the supportive atmosphere fostered by bilingual facilitators.

By offering bilingual resources and fostering an inclusive environment, we equip adolescents with the knowledge to make informed health decisions. This program not only promotes individual well-being but also enhances community health awareness.

Author’s organisation: The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong

Email: longkwanho@cuhk.edu.hk   dorothycns@cuhk.edu.hk

Ahead of World No Tobacco Day, we interviewed Professor William Li,FAAN, to discuss his pioneering work in integrating behavioural science with modern technology to transform smoking cessation support. As a Top 2% Global Scientist (Stanford University) and leader at CUHK’s Nethersole School of Nursing, Professor Li has secured HK$42M+ in grants and published over 200 studies. His team develops innovative interventions—including instant messaging platforms like WhatsApp/WeChat and self-determination theory-based protocols—to empower nurses in delivering personalised cessation guidance. In this interview, he shared how these strategies address challenges in chronic smokers and strengthen nurses’ frontline impact, aligning with global efforts to reduce tobacco-related cancers and healthcare burdens.

Smoking and cancer

Cigarette smoking is the leading preventable cause of premature death and disease, accounting for 8 million deaths annually worldwide, including approximately 1.3 million deaths from exposure to second-hand smoke. Evidence indicates that smoking adversely affects nearly every organ in the body and is linked to various types of cancer. Conversely, quitting smoking can significantly reduce the risks of developing and dying from cancer. For example, the risk of death from lung cancer has been shown to decrease by 30%–50% within 10 years of quitting.

Despite clear evidence that smoking increases mortality, decreases treatment efficacy, and increases the risk of cancer recurrence and the development of new cancers, many cancer patients continue to smoke post-diagnosis. However, quitting smoking after a cancer diagnosis can delay disease progression, decrease treatment side effects, and improve prognosis and quality of life. Therefore, it is crucial for nurses to support cancer patients in quitting smoking to enhance their health.

What are the challenges ahead?

Quitting smoking is extremely difficult, with relapse common due to intolerable withdrawal symptoms. This is especially true among chronic smokers, who often have a long smoking history, high nicotine dependency, and low quit success rates. These individuals are often less responsive to current tobacco control interventions or policies and will ultimately constitute an increasing proportion of remaining smokers in the community. Overcoming this challenge will require innovative and effective smoking cessation strategies, along with tailored advice and support from healthcare professionals.

What can nurses do?

Healthcare professionals have a moral obligation to help smokers quit due to the detrimental effects of smoking on health. Nurses, as frontline clinical staff, spend more time with patients than other healthcare professionals and interact with them across various settings. They play a crucial role in smoking cessation programmes and are uniquely positioned to provide valuable information and encouragement.

However, nursing curricula worldwide often lack comprehensive training on smoking cessation. Additionally, busy schedules can make it difficult for nurses to assist smokers in quitting. Therefore, incorporating smoking cessation training into nursing curricula to empower future nurses to help smokers quit is crucial. Nurse researchers should focus on developing and evaluating effective and cost-efficient smoking cessation interventions.

Technological advancements, such as mobile health apps, web-based platforms, and chatbots, can offer improved solutions to the challenges faced by nurses in promoting smoking cessation. The application of artificial intelligence in healthcare can assist nurses in delivering continuous professional advice and personalised support. By leveraging these strategies, nurses can significantly reduce smoking rates and prevent cancer, ultimately improving public health outcomes globally.

In sum, nurses can play a pivotal role in helping smokers to quit, reducing tobacco-related illnesses and deaths, and improving quality of life. This also protects the public from exposure to second-hand smoke, fostering a healthier environment for future generations. Additionally, it can reduce the economic burden on the healthcare system imposed by smoking and the related diseases, especially cancer. These outcomes will guide smoking cessation policies and boost sustainable development.

The following illustrations depict key components of Prof. Li’s Self-Determination Theory-based interventions, integrating behavioral science to empower nurses in smoking cessation support.