Background Sleep disruption is a prevalent symptom reported by survivors of childhood cancer. However, there is no validated instrument for assessing this symptom in this population group. To bridge the literature gap, this study translated and adapted the Pittsburgh Sleep Quality Index (PSQI) for Hong Kong Chinese cancer survivors and examined its psychometric properties and factor structure. Methods A convenience sample of 402 Hong Kong Chinese childhood cancer survivors aged 6–18 years were asked to complete the Chinese version of the PSQI, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Fatigue Scale-Child (FS-C)/Fatigue Scale-Adolescent (FS-A), and Pediatric Quality of Life Inventory (PedsQL). To assess known-group validity, 50 pediatric cancer patients and 50 healthy counterparts were recruited. A sample of 40 children were invited to respond by phone to the PSQI 2 weeks later to assess test–retest reliability. A cutoff score for the translated PSQI used with the survivors was determined using receiver operating characteristic analysis. Results The Chinese version of the PSQI had a Cronbach alpha of 0.71, with an intraclass correlation coefficient of 0.90. Childhood cancer survivors showed significantly lower mean PSQI scores than children with cancer, and significantly higher mean scores than healthy counterparts. This reflected that childhood cancer survivors had a better sleep quality than children with cancer, but a poorer sleep quality than healthy counterparts. We observed positive correlations between PSQI and CES-DC scores and between PSQI and FS-A/FS-C scores, but a negative correlation between PSQI and PedsQL scores. The results supported that the Chinese version of the PSQI showed convergent validity. Confirmatory factor analysis showed that the translated PSQI data best fit a three-factor model. The best cutoff score to detect insomnia was 5, with a sensitivity of 0.81 and specificity of 0.70. Conclusion The Chinese version of the PSQI is a reliable and valid instrument to assess subjective sleep quality among Hong Kong Chinese childhood cancer survivors. The validated PSQI could be used in clinical settings to provide early assessments for sleep disruption. Appropriate interventions can therefore be provided to minimize its associated long-term healthcare cost. Trial registration This study was registered in ClinicalTrials.gov with the reference number NCT03858218.

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Key Points Question Can brief motivational interviewing delivered via mobile instant messaging promote regular physical activity in children who have survived cancer? Findings In this randomized clinical trial involving 161 children who survived cancer and their caregivers, brief motivational interviewing delivered via instant messaging significantly increased physical activity levels, reduced cancer-related fatigue, and improved handgrip strength and quality of life during a 12-month study period. Moderate to vigorous physical activity levels in intervention participants increased by 72.8%, compared with 6.3% in controls. Meaning The intervention used in this randomized clinical trial was effective in promoting regular physical activity in children who survived cancer; further investigation is warranted to enhance long-term sustainability of the intervention effect.

Background: Timely and effective communication about end-of-life issues, including conversations about prognosis and goals of care, are extremely beneficial to terminally ill patients and their families. However, given the context, healthcare professionals may find it challenging to initiate and facilitate such conversations. Hence, it is critical to improving the available communication strategies to enhance end-of-life communication practices. Aim: To summarise the end-of-life communication strategies recommended for healthcare professionals, identify research gaps and inform future research. Design: A scoping review performed in accordance with the Arksey and O’Malley framework. Data sources: A literature search was conducted between January 1990 and January 2022 using PubMed, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library and China National Knowledge Infrastructure databases and Google, Google Scholar and ProQuest Dissertations & Theses Global. Studies that described recommended end-of-life communication strategies for healthcare professionals were included. Results: Fifty-nine documents were included. Seven themes of communication strategies were found: (a) preparation; (b) exploration and assessment; (c) family involvement; (d) provision and tailoring of information; (e) empathic emotional responses; (f) reframing and revisiting the goals of care; and (g) conversation closure. Conclusions: The themes of communication strategies found in this review provide a framework to integrally promote end-of-life communication. Our results will help inform healthcare professionals, thereby promoting the development of specialised training and education on end-of-life communication.

Purpose This study aimed to examine the interrelationships among resilience, way of coping, psychological well-being, and quality of life among Chinese parents of children with cancer, and identify factors associated with their quality of life. Methods A cross-sectional study was conducted with 119 Chinese parents (primary caregivers) of children with cancer at the Hong Kong Children’s Hospital between January 2020 and March 2022. Parents’ resilience level, way of coping, depressive symptoms, state anxiety scores, perceived social support, and quality of life were assessed. Results Participating parents (N = 119) included 98 mothers (82.4%) and 11 parents were from single-parent families (9.2%). Almost half (47.9%) of the parents were potentially at risk for depression. The results showed that participants from single-parent families reported statistically significantly lower levels of resilience (P < .001), more depressive symptoms (P < .001), and poorer quality of life (P < .001) than those who lived with their partners (married). In addition, parents who adopted problem-focused coping strategies reported statistically significantly higher levels of resilience (P < .001), fewer depressive symptoms (P < .001), and better quality of life (P < .001) than those who adopted emotion-focused coping strategies. A multiple regression analysis revealed that resilience (P < .001) was associated with quality of life among parents of children with cancer. Conclusions This study provides further support that resilience is an important factor associated with quality of life among parents of children with cancer. Assessing resilience in these parents is an important prerequisite for designing appropriate psychological interventions to increase their resilience and enhance their psychological well-being and quality of life.