Background: Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have explored the symptom networks of multidimensional symptom experiences in cancer survivors. The objectives of this study were to generate symptom networks of multidimensional symptom experiences in cancer survivors and explore the centrality indices and density in these symptom networksMethods: Data from 1065 cancer survivors were obtained from the Shanghai CANcer Survivor (SCANS) Report. The MD Anderson Symptom Inventory was used to assess the prevalence and severity of 13 cancer‐related symptoms. We constructed contemporaneous networks with all 13 symptoms after controlling for covariates.Results: Distress (r_s = 9.18, r_c = 0.06), sadness (r_s = 9.05, r_c = 0.06), and lack of appetite (r_s = 9.04, r_c = 0.06) had the largest values for strength and closeness. The density of the “less than 5 years” network was significantly different from that of the “5–10 years” and “over 10 years” networks (p < 0.001). We found that while fatigue was the most severe symptom in cancer survivorship, the centrality of fatigue was lower than that of the majority of other symptoms.Conclusion: Our study demonstrates the need for the assessment of centrality indices and network density as an essential component of cancer care, especially for survivors with <5 years of survivorship. Future studies are warranted to develop dynamic symptom networks and trajectories of centrality indices in longitudinal data to explore causality among symptoms and markers of interventions.

Objective: The aim of this study is to synthesise evidence for the experiences and perceptions of incivility during clinical education of nursing students. Design: We used a meta-aggregation approach to conduct a systematic review of qualitative studies. Data sources: Published and unpublished papers from 1990 until 13 January 2018 were searched using electronic databases, including CINAHL, PubMed (MEDLINE), ProQuest Central, ProQuest Education Journals, ProQuest XML-Dissertations and Theses, Web of Science, Embase, EBSCO Discovery Service and PsycINFO. The search for unpublished studies included the Open Grey collection, conference proceedings and the Deep Blue Library. Eligibility criteria: We included qualitative studies that focused on nursing students' perceptions and experiences of incivility from faculty during their clinical education. Data extraction and synthesis: Two reviewers independently appraised the methodological quality and extracted relevant data from each included study. Meta-aggregation was used to synthesise the data. Results: A total of 3397 studies was returned from the search strategies. Eighteen studies fulfilled the inclusion criteria and were included in the meta-synthesis. Six synthesised findings were identified, covering features of incivility, manifestations of incivility, contributing factors, impacts on students, coping strategies and suggestions. Conclusions: The results showed experiences of incivility during clinical education. However, the confidence was low for all synthesised findings. We suggest that nursing students should try to cope positively with incivility. Nurse managers and clinical preceptors should be aware of the prevalence and impact of incivility and implement policies and strategies to reduce incivility towards nursing students. Hospitals and universities should have an immediate response person or system to help nursing students confronting incivility and create an open communication environment.

Background: Endocrine therapy-related symptoms are associated with early discontinuation and quality of life among breast cancer survivors. Although previous studies have examined these symptoms and clinical covariates, little is known about the interactions among different symptoms and correlates. This study aimed to explore the complex relationship of endocrine therapy-related symptoms and to identify the core symptoms among breast cancer patients.Methods: This is a secondary data analysis conducted based on a multicenter cross-sectional study of 613 breast cancer patients in China. All participants completed the 19-item Chinese version of the Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES). Multivariate linear regression analysis was performed to identify significant factors. A contemporaneous network with 15 frequently occurring symptoms was constructed after controlling for age, payment, use of aromatase inhibitors, and history of surgery. Network comparison tests were used to assess differences in network structure across demographic and treatment characteristics.Results: All 613 participants were female, with an average age of 49 years (SD = 9.4). The average duration of endocrine therapy was 3.6 years (SD = 2.3) and the average symptom score was 18.99 (SD = 11.43). Irritability (n = 512, 83.52%) and mood swings (n = 498, 81.24%) were the most prevalent symptoms. Lost interest in sex (mean = 1.95, SD = 1.39) and joint pain (mean = 1.57, SD = 1.18) were the most severe symptoms. The edges in the clusters of emotional symptoms (“irritability-mood swings”), vasomotor symptoms (“hot flashes-cold sweats-night sweats”), vaginal symptoms (“vaginal discharge-vaginal itching”), sexual symptoms (“pain or discomfort with intercourse-lost interest in sex-vaginal dryness”), and neurological symptoms (“headaches-dizziness”) were the thickest in the network. There were no significant differences in network structure (P = 0.088), and global strength (P = 0.330) across treatment types (selective estrogen receptor modulators vs. aromatase inhibitors). Based on an evaluation of the centrality indices, irritability and mood swings appeared to be structurally important nodes after adjusting for the clinical covariates and after performing subgroup comparisons.Conclusion: Endocrine therapy-related symptoms are frequently reported issues among breast cancer patients. Our findings demonstrated that developing targeted interventions focused on emotional symptoms may relieve the overall symptom burden for breast cancer patients during endocrine therapy.