Purpose: The purpose of the present systematic review was to develop a practice guideline to inform health care providers about screening, assessment, and effective management of cancer-related fatigue (CRF) in adults. Methods: The internationally endorsed adapte methodology was used to develop a practice guideline for pan-Canadian use. A systematic search of the literature identified a broad range of evidence: clinical practice guidelines, systematic reviews, and other guidance documents on the screening, assessment, and management of CRF. The search included MEDLINE, EMBASE, CINAHL, the Cochrane Library, and other guideline and data sources to December 2009. Results: Two clinical practice guidelines were identified for adaptation. Seven guidance documents and four systematic reviews also provided supplementary evidence to inform guideline recommendations. Health professionals across Canada provided expert feedback on the adapted recommendations in the practice guideline and algorithm through a participatory external review process. Conclusions: Practice guidelines can facilitate the adoption of evidence-based assessment and interventions for adult cancer patients experiencing fatigue. Development of an algorithm to guide decision-making in practice may also foster the uptake of a guideline into routine care.

The frequency, nature, context, and caregivers' reactions to aggressive behavior in 213 dementia patients residing in the community was studied. Aggression was reported in 57.2% of the patients and in 10.6% of the caregivers. Predictors of patient aggression were greater frequency of behavior and memory problems, premorbid aggression, and a more troubled premorbid social relationship between patient and caregiver. Patient aggression predicted the decision to discontinue home care.

Background: Little research has focused on implementation of electronic Patient Reported Outcomes (e-PROs) for meaningful use in patient management in 'real-world' oncology practices. Our quality improvement collaborative used multi-faceted implementation strategies including audit and feedback, disease-site champions and practice coaching, core training of clinicians in a person-centered clinical method for use of e-PROs in shared treatment planning and patient activation, ongoing educational outreach and shared collaborative learnings to facilitate integration of e-PROs data in multi-sites in Ontario and Quebec, Canada for personalized management of generic and targeted symptoms of pain, fatigue, and emotional distress (depression, anxiety). Patients and methods: We used a mixed-methods (qualitative and quantitative data) program evaluation design to assess process/implementation outcomes including e-PROs completion rates, acceptability/use from the perspective of patients/clinicians, and patient experience (surveys, qualitative focus groups). We secondarily explored impact on symptom severity, patient activation and healthcare utilization (Ontario sites only) comparing a pre/post population cohort not exposed/exposed to our implementation intervention using Mann Whitney U tests. We hypothesized that the iPEHOC intervention would result in a reduction in symptom severity, healthcare utilization, and higher patient activation. We also identified key implementation strategies that sites perceived as most valuable to uptake and any barriers.

A framework that has been found useful in research on young adults, Deci and Ryan's self-determination theory [1, 2], is suggested as a promising direction for research on motivation in later life. The theory proposes the existence of four types of motivation (intrinsic, self-determined extrinsic, nonself-determined extrinsic, and amotivation) which are assumed to have varying consequences for adaptation and well-being. A previously published French measure of motivational styles which is known to be reliable and valid was translated into English and was tested on seventy-seven nursing home residents (aged 60 to 98 years). It was found that the four motivational styles can be reliably measured; that the intercorrelations between the motivational styles are consistent with theoretical predictions; and that the four types of motivation are related to other important aspects of the lives of elderly people in a theoretically meaningful manner. Suggestions are made for further research using self-determination theory and the present scales.

Cancer patients and their families face multiple psychosocial challenges when coping with illness, including emotional distress. The inability to detect and respond appropriately to these needs lead to greater suffering. Consistent with the philosophy of comprehensive care, innovative psychosocial oncology programs need to be created in meeting these complex needs. The purpose of this short communication is to share the experience of developing a new Psychosocial Oncology Program at the McGill University Health Centre in Montreal, Canada. Various challenges and lessons have been learned in the process and are described in this report.