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1.  [No title available] 
PMCID: PMC4295204  PMID: 19444078
2.  Feasibility and Acceptability of the PROMIS Measures in Children and Adolescents in Active Cancer Treatment and Survivorship 
Cancer nursing  2014;37(1):10.1097/NCC.0b013e3182a0e23d.
Background
Patient-reported outcomes (PROs) related to symptoms, function, and quality of life during and following cancer treatment can guide care for pediatric cancer patients. To advance the science of PROs, the National Institutes of Health funded the Patient Reported Outcomes Measurement Information System (PROMIS).
Objective
To assess feasibility and acceptability of the PROMIS pediatric measures, as defined by enrollment and attrition rates as well as missingness by measure, item, participant, and assessment time point.
Methods
8-to-18 year olds participated in two studies: PROMIS I, a cross-sectional study of children in active cancer treatment or survivorship, and PROMIS II, a longitudinal study with 3 assessment time points for children receiving curative treatment.
Results
PROMIS I (n=200) and PROMIS II (n=94) had enrollment rates of 92.5% and 89.7%, respectively. For PROMIS I, measure missingness was acceptable (8% missed any measures) and was not related to other study variables. For PROMIS II, measure missingness was minimal (0.8%), and item-level missingness was relatively low. In general, items that were skipped asked about experiences that participants had not encountered in the past 7 days.
Conclusions
In both studies, the PROMIS instruments demonstrated good feasibility and acceptability among pediatric cancer patients. Overall, we had high enrollment, low attrition, and acceptable rates of measure and item missingness.
Implications for Practice
Our results demonstrate that PROMIS measures are acceptable to 8-to-18 year-olds in different points of cancer care and feasible for use in pediatric cancer inpatient and outpatient settings.
doi:10.1097/NCC.0b013e3182a0e23d
PMCID: PMC3859798  PMID: 24036439
3.  A Labor of Love 
Cancer nursing  2013;36(6):474-483.
Background
Evidence suggests that emotional distress and objective demands of cancer caregiving are comparable to those of dementia caregiving, yet little research has focused on the physical health of cancer caregivers. Whether the stress leads directly to changes in health or whether the stress leads to changes in health behaviors, which in turn affect health, has not been systematically examined.
Objective
The objective of this study was to review the research literature regarding changes in health behaviors associated with caring for an individual with cancer.
Methods
Literature was reviewed from multiple databases including CINAHL (Cumulative Index to Nursing and Allied Health Literature), CINAHL Plus, PsycNET, PubMed, SCOPUS, EMBASE, and Web of Science. Key words included “health behavior,” “health promotion,” ”caregivers/caregiving,” “cancer/oncology,” “diet/nutrition,” “exercise/physical activity,” “stress management,” “smoking” and “alcohol.” Studies were included if they involved informal adult caregivers and at least 1 behavior associated with a healthy lifestyle. Of the 866 studies identified, 8 met the criteria.
Results
Studies revealed conflicting information, with some suggesting deleterious changes in behaviors, whereas others found the changes protective.
Conclusions
The lack of uniformity of terminology and conflicting findings make it difficult to conclude the impact of the caregiving experience on the health behaviors of cancer caregivers. Something is placing caregivers at risk for illness and early death, but the mechanisms behind the risk and the role of unhealthy behaviors are not clear.
Implications for Practice
At a minimum, cancer caregivers should be screened for behavior changes and disease risk. Developing standardized measures for future research including controlled, longitudinal studies is needed.
doi:10.1097/NCC.0b013e3182747b75
PMCID: PMC4196265  PMID: 23132126
Burden; Cancer; Caregivers; Health behaviors; Screening; Stress
4.  Measuring Vincristine-Induced Peripheral Neuropathy in Children with Acute Lymphoblastic Leukemia 
Cancer nursing  2013;36(5):E49-E60.
Background
Vincristine-induced peripheral neuropathy (VIPN) is difficult to quantify in children.
Objective
The study objective was to examine the reliability, validity, and clinical feasibility of several VIPN measures for use in children with acute lymphoblastic leukemia.
Interventions/Methods
Children (N = 65) aged 1–18 years receiving vincristine at four academic centers participated in the study. Baseline and pre-vincristine VIPN assessments were obtained using the Total Neuropathy Score-Pediatric Vincristine (TNS-PV), the National Cancer Institute Common Terminology Criteria for Adverse Events, the Balis grading scale, and the FACES pain scale. TNS-PV scores (n = 806) were obtained over 15 weeks. Blood was obtained at several time-points to quantify pharmacokinetic parameters.
Results
Cronbach’s alpha for a reduced TNS-PV scale was 0.84. TNS-PV scores correlated with cumulative vincristine dosage (r = 0.53, p = 0.01), pharmacokinetic parameters (r = 0.41, p = 0.05), and grading scale scores (r = 0.46 – 0.52; p = 0.01). FACES scores correlated with the TNS-PV neuropathic pain item (r = 0.48; p = 0.01), and were attainable in all ages. A 2-item V-Rex score (vibration and reflex items) was the most responsive to change (es 0.65, p < 0.001). TNS-PV scores were attainable in 95% of children ≥ 6 years.
Conclusions
The TNS-PV is reliable and valid for measuring VIPN. It is sensitive to change over time (15 weeks) and feasible for use in children ≥ 6 years of age.
Implications for Practice
The TNS-PV may be a useful tool for assessing vincristine toxicity in children with acute lymphoblastic leukemia.
doi:10.1097/NCC.0b013e318299ad23
PMCID: PMC3951303  PMID: 23842524
5.  Symptom Distress in Older Adults Following Cancer Surgery 
Cancer nursing  2013;36(4):10.1097/NCC.0b013e31826dd517.
Background
Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults’ symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes.
Objective
We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients ages 65 and older diagnosed with thoracic, digestive, gynecologic, and genitourinary cancers.
Methods
Secondary analysis using combined subsets of data from five nurse-directed intervention clinical trials targeting patients post-surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline, 3, and 6 months.
Results
A multivariable analysis, using Generalized Estimating Equations, showed symptom distress was significantly less at 3 and 6 months (3 months: p<0.001, 6 months: p=0.002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all p<0.05). Participants ages 75 and older reported increased symptom distress over time compared with those ages 65 to 69 (p<0.05).
Conclusions
Age, type of cancer, comorbidities, mental health, and function may influence older adults’ symptom distress following cancer surgery.
Implications for Practice
Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, worse mental health, decreased function, and ages 75 and older may prevent morbidity and improve outcomes of older adults following surgery.
doi:10.1097/NCC.0b013e31826dd517
PMCID: PMC3818245  PMID: 23047803
Cancer; Surgery; Older; Symptom Distress
6.  Personal Financial Effects of Multiple Myeloma and its Treatment 
Cancer nursing  2013;36(4):301-308.
Background
Improvements in some treatment programs for multiple myeloma (MM) are increasing survival. As patients live longer with MM as a chronic disease, the personal financial effects of MM treatment become a serious concern.
Objective
The objective of this study was to identify the personal financial effects of MM and its treatment in five areas: employment, disability, health/medical and life insurance, retirement, and out-of-pocket expenses.
Methods
We mailed a questionnaire about financial issues to 1015 patients who had received intensive treatment for MM at the study site. Data analysis included descriptive statistics and comparisons using independent t-tests.
Results
Our sample (n=762; mean age 61, SD 9.26), experienced issues with employment (66% employed at diagnosis and treatment; 33% employed at questionnaire time), disability (35% applied), health/medical and life insurance (29% lost coverage and 8% changed coverage), retirement (13% retired during treatment), and out-of-pocket expenses (36% of income in first treatment year and 28% of income during most recent 12 months).
Conclusions
Issues of employment, disability, health insurance, retirement, and out-of-pocket costs for treatment are major challenges for patients.
Implications for Practice
In the midst of assessing physical needs during clinical trials for chemotherapy and stem cell transplants, health care providers must keep sight of patients' personal financial needs so that we can intervene promptly with referrals to social work, rehabilitation therapy, and other health care professions to help patients decrease the personal financial effects of MM and its treatment.
doi:10.1097/NCC.0b013e3182693522
PMCID: PMC3973128  PMID: 23047800
7.  ResearchTracking: Monitoring Gender and Ethnic Minority Recruitment and Retention in Cancer Symptom Studies 
Cancer nursing  2013;36(3):E1-E6.
Background
Recruiting and retaining participants for clinical trials, particularly women and ethnic minorities, is challenging. Studies are lacking, however, in which investigators examine gender and ethnic differences in research processes. Such information is important for findings to adequately represent the available population.
Objective
The study aim was to examine study recruitment processes (referral, eligibility, consent/enrollment) and study retention (completion) for gender and ethnic differences.
Methods
A descriptive comparative analysis of data from two randomized clinical trials focused on cancer outpatients with pain and/or fatigue. A computerized ResearchTracking software allowed documentation of recruitment and retention effort outcomes..
Results
Among the 1,464 referred patients, 612 (42%) were eligible for study participation. Lack of ongoing care at the study settings and English skills were the main reasons for ineligibility. There were no gender differences in consent/enrollment or completion rates. Ethnic minority patients were represented proportionally to the available population (13%) and were equally willing to consent/enroll and complete both studies as their white counterparts, if they were eligible.
Conclusions
Specific strategies to target language eligibility barriers are necessary to increase minority participation.
Implications for Practice
Future studies could include audio-aided tools in their native language to help recruit patients with limited English skills, if the study tools can be validly translated into other languages and are equivalent to English versions. Efforts to educate and garner support of providers could improve enrollment of patients in cancer studies, especially in studies of audio or video-recorded patient-provider interaction.
doi:10.1097/NCC.0b013e31826909a8
PMCID: PMC3639328  PMID: 23051871
8.  Faith Among Low-Income, African American/Black Men Treated for Prostate Cancer 
Cancer nursing  2010;33(6):470-478.
Background
Understanding how low-income, uninsured African American/black men use faith to cope with prostate cancer provides a foundation for the design of culturally appropriate interventions to assist underserved men cope with the disease and its treatment. Previous studies have shown spirituality to be a factor related to health and quality of life, but the process by which faith, as a promoter of action, supports coping merits exploration.
Objective
Our purpose was to describe the use of faith by low-income, uninsured African American/black men in coping with prostate cancer and its treatment and adverse effects.
Methods
We analyzed data from a qualitative study that used in-depth individual interviews involving 18 African American men ranging in ages from 53 to 81 years. Our analysis used grounded theory techniques.
Results
Faith was used by African American men to overcome fear and shock engendered by their initial perceptions of cancer. Faith was placed in God, health care providers, self, and family. Men came to see their prostate cancer experience a new beginning that was achieved through purposeful acceptance or resignation.
Conclusions
Faith was a motivator of and source for action. Faith empowered men to be active participants in their treatment and incorporate treatment outcomes into their lives meaningfully.
Implication
By understanding faith as a source of empowerment for active participation in care, oncology nurses can use men's faith to facilitate reframing of cancer perceptions and to acknowledge the role of men's higher being as part of the team. Studies are needed to determine if this model is relevant across various beliefs and cultures.
doi:10.1097/NCC.0b013e3181e1f7ff
PMCID: PMC3923421  PMID: 20555257
African American/black; Faith; Prostate cancer
9.  Attitudes Toward Participation in Breast Cancer Randomized Clinical Trials in the African American Community 
Cancer nursing  2007;30(4):261-269.
Participation of African Americans in research trials is low. Understanding the perspectives of African American patients toward participation in clinical trials is essential to understanding the disparities in participation rates compared with whites. A qualitative study was conducted to discover attitudes of the African American community regarding willingness to participate in breast cancer screening and randomized clinical trials. Six focus groups consisting of 8 to 11 African American women (N = 58), aged 30 to 65, were recruited from local churches. Focus group sessions involved a 2-hour audiotaped discussion facilitated by 2 moderators. A breast cancer randomized clinical trial involving an experimental breast cancer treatment was discussed to identify the issues related to willingness to participate in such research studies. Six themes surrounding willingness to participate in randomized clinical trials were identified: (1) Significance of the research topic to the individual and/or community; (2) level of trust in the system; (3) understanding of the elements of the trial; (4) preference for “natural treatments” or “religious intervention” over medical care; (5) cost-benefit analysis of incentives and barriers; and (6) openness to risk versus a preference for proven treatments. The majority (80%) expressed willingness or open-mindedness to the idea of participating in the hypothetical trial. Lessons learned from this study support the selection of a culturally diverse research staff and can guide the development of research protocols, recruitment efforts, and clinical procedures that are culturally sensitive and relevant.
doi:10.1097/01.NCC.0000281732.02738.31
PMCID: PMC3908682  PMID: 17666974
African American; Breast cancer; Clinical trials; Focus group study
10.  A Pilot Exploration of Symptom Trajectories in Adolescents with Cancer during Chemotherapy 
Cancer nursing  2013;36(1):60-71.
Background
Chemotherapy is frequently administered in repetitive cycles. Adolescents with cancer suffer from multiple symptoms related to chemotherapy but knowledge of symptom trajectories across a cycle is limited. Examining trajectories over a cycle may reveal key periods to manage symptoms.
Objectives
The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, fatigue, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across one cycle; and examine relationships between variables.
Interventions/Methods
Nine adolescents with cancer within six months of diagnosis participated. Data were collected by surveys, chart review, and biologic measures on days 1 and 2 of the cycle, one week later (nadir), and day 1 of the following cycle. To evaluate the trajectory, a simple random effects repeated measures analysis was computed.
Results
The significant trajectories were fatigue (P = 0.003), difficulty sleeping (P = 0.032), and nausea (P = 0.04). Most of the adolescents reported some anticipatory anxiety about receiving chemotherapy. Significant correlations between symptoms and biobehavioral variables included anticipatory anxiety and nausea (P = 0.86, P = 0.003), trait anxiety and fatigue (r = −0.82, P < 0.001), and stress and pain (r = 0.78, P = 0.039).
Conclusions
Multiple symptoms were experienced across the cycle. Three symptoms displayed significant trajectories indicating that patterns of symptoms may be anticipated.
Implications for Practice
Pilot findings suggest monitoring symptoms, stress and anxiety across a cycle is important, not only during chemotherapy administration, but also prior to being admitted for chemotherapy.
doi:10.1097/NCC.0b013e318250da1a
PMCID: PMC3416951  PMID: 22561919
11.  Enhancing Self-Efficacy for Optimized Patient Outcomes through the Theory of Symptom Self-Management 
Cancer nursing  2013;36(1):E16-E26.
Background
In today’s world, greater patient empowerment is imperative since 90 million Americans live with one or more chronic conditions such as cancer. Evidence reveals that healthy behaviors such as effective symptom self-management can prevent or reduce much of the suffering from cancer. Oncology nurses play a pivotal role in developing a symptom self-management plan that is critical to optimizing a patient’s symptom self-management behaviors.
Objective
This article uses exemplars to describe how oncology nurses can apply a tested middle-range theory, the Theory of Symptom Self-Management, to clinical practice by incorporating interventions to increase a patient’s perceived self-efficacy to optimize patient outcomes.
Methods
The Theory of Symptom Self-Management provides a means to understand the dynamic aspects of symptom self-management and provides a tested framework for the development of efficacy enhancing interventions for use by oncology nurses in clinical practice.
Results
Exemplars based on the Theory of Symptom Self-Management that depict how oncology nursing can use perceived self-efficacy enhancing symptom self-management interventions to improve the functional status and quality of life of their patients.
Conclusion
Guided by a theoretical approach, oncology nurses can have a significant positive impact on the lives of their patients by reducing the symptom burden associated with cancer and its treatment.
Implications for Practice
Oncology nurses can partner with their patients to design tailored approaches to symptom self-management. These tailored approaches provide the ability to implement patient specific behaviors that recognize, prevent, relieve, or decrease the timing, intensity, distress, concurrence, and unpleasant quality of symptoms.
doi:10.1097/NCC.0b013e31824a730a
PMCID: PMC3526102  PMID: 22495550
12.  Patterns and Correlates of Missed Nursing Care in Inpatient Oncology Units 
Cancer nursing  2013;36(6):E51-E57.
doi:10.1097/NCC.0b013e318275f552
PMCID: PMC3577984  PMID: 23151503
13.  Living My Family's Story 
Cancer nursing  2012;35(6):493-504.
Background
Based on known or suggested genetic risk factors, a growing number of women now live with knowledge of a potential cancer diagnosis that may never occur. Given this, it is important to understand the meaning of living with high risk for hereditary breast cancer.
Objective
The objective of the study was to explore how women at high risk for hereditary breast cancer (1) form self-identity, (2) apply self-care strategies toward risk, and (3) describe the meaning of care through a high-risk breast program.
Methods
Interpretive hermeneutic phenomenology guided the qualitative research method. Women at high risk for hereditary breast cancer were recruited from a high-risk breast program. Open-ended interview questions focused on experiences living as women managing high risk for breast cancer. Consistent with hermeneutic methodology, the principal investigator led a team to analyze the interview transcripts.
Results
Twenty women participated in in-depth interviews. Analysis revealed that women describe their own identity based on their family story and grieve over actual and potential familial loss. This experience influences self-care strategies, including seeking care from hereditary breast cancer risk experts for early detection and prevention, as well as maintaining a connection for early treatment “when” diagnosis occurs.
Conclusions
Healthy women living with high risk for hereditary breast cancer are living within the context of their family cancer story, which influences how they define themselves and engage in self-care.
Implications for Practice
Findings present important practical, research, and policy information regarding health promotion, psychosocial assessment, and support for women living with this risk.
doi:10.1097/NCC.0b013e31824530fa
PMCID: PMC3635541  PMID: 22544165
Genetics; Hereditary breast; cancer risk; Nursing; Phenomenology
14.  Partners’ Long-term Appraisal of Their Caregiving Experience, Marital Satisfaction, Sexual Satisfaction, and Quality of Life 2 Years After Prostate Cancer Treatment 
Cancer nursing  2013;36(2):10.1097/NCC.0b013e3182567c03.
Background
Partners of men treated for prostate cancer report more emotional distress associated with a diagnosis of prostate cancer than the men report; the duration of distress for partners is seldom examined.
Objectives
The purpose of this study was to determine the long-term effects of prostate cancer treatment on partners’ appraisal of their caregiving experience, marital satisfaction, sexual satisfaction, and quality of life (QOL) and factors related to these variables.
Methods
This exploratory study evaluated QOL among spouses of prostate cancer survivors at 24 months after treatment. Partners completed a battery of self-report questionnaires in a computer-assisted telephone interview.
Results
The sample consisted of 121 partners with average age of 60 years. There was a significant relationship between partners’ perceptions of bother about the man’s treatment outcomes and negative appraisal of their caregiving experience and poorer QOL. Younger partners who had a more negative appraisal of caregiving also had significantly worse QOL.
Conclusions
Men’s treatment outcomes continued to bother the partner and resulted in more negative appraisal and lower QOL 2 years after initial prostate cancer treatment. Younger partners may be at greater risk of poorer QOL outcomes especially if they have a more negative view of their caregiving experience.
Implications for Practice
Findings support prior research indicating that prostate cancer affects not only the person diagnosed with the disease but also his partner. Partners may benefit from tailored interventions designed to decrease negative appraisal and improve symptom management and QOL during the survivorship period.
doi:10.1097/NCC.0b013e3182567c03
PMCID: PMC3814170  PMID: 22728952
Age; Caregivers; Family; Prostate cancer; Quality of life; Spouses
15.  Health-related Quality of Life of African American Breast Cancer Survivors Compared to Healthy African American Women 
Cancer nursing  2012;35(5):337-346.
Background
The diagnosis and treatment of breast cancer can result in an array of late cancer-specific side effects and changes in general well-being. Research has focused on Caucasian samples, limiting our understanding of the unique health-related quality of life outcomes of African American breast cancer survivors (BCS). Even when African American BCS have been targeted, research is limited by small samples and failure to include comparisons of peers without a history of breast cancer.
Objective
The purpose of this study was to compare health-related quality of life of African American women BCS to African American women with no history of breast cancer (control group).
Methods
A total of 140 women (62 BCS and 78 control), ages 18 years or older and 2–10 years post-diagnosis, was recruited from a breast cancer clinic and cancer support groups. Participants provided informed consent and completed a one-time survey based on Brenner’s (1995) proximal-distal health-related quality of life model.
Results
After adjusting for age, education, income, and body mass index, African American BCS experienced more fatigue (p=0.001), worse hot flashes (p<0.001) and worse sleep quality (p<0.001), but more social support from their partner (p=0.028) and more positive change (p=0.001) compared to African American women controls.
Conclusions
Our results suggest that African American women BCS may experience unique health-related outcomes that transcend age, education, socio-economic status and body mass index.
Implications for Practice
Findings suggest the importance of understanding the survivorship experience for particular racial and ethnic subgroups to proactively assess difficulties and plan interventions.
doi:10.1097/NCC.0b013e3182393de3
PMCID: PMC3326198  PMID: 22228394
Health-related Quality of Life; African Americans; Female; Survivors; Breast Neoplasm
16.  Changes in Siblings after the Death of a Child from Cancer 
Cancer nursing  2012;35(5):347-354.
Background
Few studies have examined changes in siblings after the death of a brother or sister, particularly from mother, father, and sibling perspectives within the first year post-death.
Objective
This descriptive study identified and assessed the frequency of changes in siblings after a child's death from cancer.
Methods
Participants were recruited from cancer registries at three hospitals in the U.S. and Canada 3–12 months after the child's death. Thirty-six mothers, 24 fathers, and 39 siblings from 40 families were included. Semi-structured interviews using open-ended questions were conducted with each parent and sibling separately in the home. Content analysis identified emerging themes, and McNemar tests compared frequencies between each paired set of reports (sibling vs. mother, sibling vs. father, mother vs. father).
Results
Sixty-nine percent of participants reported personal changes in siblings (e.g., changes in personality, school work, goals/life perspective, activities/interests). Forty-seven percent noted changes in siblings' relationships with family members and peers. Only 21% of participants reported no changes attributed to the death. Comparisons of frequencies across informants were not significant.
Conclusions
Most siblings experienced changes in multiple areas of their lives after the death of a brother or sister to cancer. Some changes reflected siblings that were positively adapting to the death, while other changes reflected difficulties.
Implications for practice
Our findings offer guidance to improve aftercare for bereaved siblings and their families. Additional research is needed to further delineate the needs of bereaved siblings and to develop strategies to promote adaptation to loss.
doi:10.1097/NCC.0b013e3182365646
PMCID: PMC3338871  PMID: 22067687
17.  Correlates of Quality of Life among African American and White Cancer Survivors 
Cancer nursing  2012;35(5):355-364.
Background
African Americans continue to suffer disproportionately from cancer morbidity and mortality with emerging evidence suggesting potential quality of life (QOL) disparities in the survivorship period.
Objective
To assess sociodemographic, clinical, and psychosocial factors associated with physical and mental health QOL (PHQOL and MHQOL) among African American and white cancer survivors.
Methods
Patients were recruited from tumor registries. Telephone interviews were conducted with 248 African American and 244 white respondents with a history of breast, prostate, or colorectal cancers. Multivariate regression models were used to assess what factors were associated with PHQOL and MHQOL.
Results
Key racial differences in adjusted analyses included poorer MHQOL scores among African Americans compared to white survivors. Furthermore, race moderated the relationship between perceived social support and MHQOL, where higher social support levels were associated with increased MHQOL among African Americans. Other correlates of QOL impacted racial groups similarly. For example, factors associated with PHQOL scores included being unemployed, uninsured, the presence of medical comorbidities, a longer time since diagnosis and higher levels of cancer related stress appraisals. Factors associated with MHQOL scores included being unemployed, higher levels of daily stress, higher levels of stress associated with the diagnosis, higher levels of education, higher levels of perceived social support, and higher levels of spirituality.
Conclusion
Interventions aimed at increasing social support may have important implications for improving QOL outcomes among African Americans.
Implications for Practice
Measuring and understanding factors associated with QOL have important implications for patient adjustment and clinical decision-making.
doi:10.1097/NCC.0b013e31824131d9
PMCID: PMC3619385  PMID: 22495496
18.  Differences in Pain Location, Intensity and Quality by Pain Pattern in Outpatients with Cancer 
Cancer nursing  2011;34(3):228-237.
Pain pattern represents how the individual’s pain changes temporally with activities or other factors. Understanding pain pattern is important for appropriate timing of pain interventions, but researchers have studied less the temporal aspects of cancer pain than pain location, intensity, and quality parameters. The study purpose was to explore differences in pain location, intensity, and quality by pattern groups in outpatients with cancer. We conducted a comparative, secondary data analysis of data collected from 1994 to 2007. 762 outpatients with cancer had completed the 0-to-10 Pain Intensity Number Scale and the McGill Pain Questionnaire to measure pain location, quality and pattern. From all possible combinations of the three types of pain patterns, we created seven pain pattern groups. The distribution of pain pattern was: pattern-1 (27%); pattern-2 (24%); pattern-3 (8%); pattern-4 (12%); pattern-5 (3%); pattern-6 (18%); and pattern-7 (8%). A statistically significant higher proportion of patients with continuous pain patterns (pattern 1, 4, 5, and 7) reported pain location in two or more sites. Patients with pattern 1, 4, and 7 reported statistically significant, higher worst pain mean scores than patients with pattern 2, 3, and 6 (not continuous descriptors). Patients with pattern7 reported statistically significant, higher mean scores (pain rating index-sensory and total number of words selected) than patients with pattern1, 2, 3, 4, and 6. Using pain pattern groups may help clinicians to understand temporal changes in cancer pain and to provide more effective pain management by recognizing the high risk if the pain is continuous.
doi:10.1097/NCC.0b013e3181faab63
PMCID: PMC3703616  PMID: 21512345
Pain; Pattern; Location; Intensity; Quality; Cancer
19.  The Relationship Between Colorectal Cancer Screening Adherence and Knowledge Among Vulnerable Rural Residents of Appalachian Kentucky 
Cancer Nursing  2012;35(4):288-294.
Background
Colorectal cancer (CRC) is one of the leading causes of cancer related deaths among residents of rural Appalachia. Rates of guideline-consistent CRC screening in Appalachian Kentucky are suboptimal.
Objective
This study sought to determine the relationship between colorectal cancer screening knowledge, specifically regarding recommended screening intervals, and receipt of screening among residents of rural Appalachian Kentucky.
Methods
Residents of Appalachian Kentucky (n=1096) between the ages of 50 and 76 completed a telephone survey including questions on demographics, health history, and knowledge about colorectal cancer screening between November 20, 2009 and April 22, 2010.
Results
While 67% of respondents indicated receiving screenings according to guidelines, respondents also demonstrated significant knowledge deficiencies about screening recommendations. Nearly half of respondents were unable to identify the recommended screening frequency for any of the colorectal cancer screening modalities. Accuracy about the recommended frequency of screening was positively associated with screening adherence.
Conclusions
Enhanced educational approaches have the potential to increase colorectal cancer screening adherence in this population and reduce cancer mortality in this underserved region.
Implications for practice
Nurses play a critical role in patient education, which ultimately may increase screening rates. To fulfill this role, nurses should incorporate current recommendation about CRC screening into educational sessions. Advanced practices nurses in rural settings should also be aware of the increased vulnerability of their patient population and develop strategies to enhance awareness about CRC and the accompanying screening tests.
doi:10.1097/NCC.0b013e31822e7859
PMCID: PMC3248994  PMID: 21946905
20.  Racial Variation in the Cancer Caregiving Experience: A Multi-Site Study of Colorectal and Lung Cancer Caregivers 
Cancer Nursing  2012;35(4):249-256.
Background
Racial disparities are present in all facets of cancer care; however, little is known about the types of racial disparities that exist in the informal support provided to patients.
Objective
This study, part of a larger multi-site study of care recipients with either lung or colorectal cancer and their caregivers, examined the caregiving experiences of African American (AA) and white caregivers.
Intervention/Methods
Caregivers were identified by cancer patients in the Cancer Care Outcomes Research and Surveillance (CanCORS) consortium. Caregivers completed and returned a self-administered, mailed questionnaire that examined their characteristics and experiences. Analysis of covariance (ANCOVA) was used to compare racial groups by objective burden and caregiving resources while controlling for key covariates.
Results
Despite greater preparedness for the caregiving role (p=0.006), AA caregivers reported more weekly hours caregiving than whites (26.5 ± 3.1 vs. 18.0 ± 1.7; p = 0.01). In later phases of caregiving, AAs reported more social support (p = 0.02), more hours caregiving (31.9 ± 3.5 vs. 16.9 ± 1.9; p < .001), and performing more instrumental activities of daily living on behalf of their care recipient (p = 0.021).
Conclusions
Racial disparities in the caregiving experience exist.
Implications for Practice
Nurses play a key role in educating cancer patients and their caregivers on how to effectively cope with, and manage, cancer. Because AA caregivers appear to spend more time in the caregiving role and perform more caregiving tasks, AA caregivers may benefit from nurse interventions tailored to their specific caregiving experience.
doi:10.1097/NCC.0b013e3182330850
PMCID: PMC3326192  PMID: 22088979
21.  Who Will Drop Out & Who Will Drop In, Exercise Adherence in a RCT among Patients Receiving Active Cancer Treatment 
Cancer Nursing  2012;35(4):312-322.
Background
Adherence has significantly affected the efficacy of a randomized clinical trial (RCT) to test exercise interventions.
Objective
To analyze exercise-related adherence patterns among patients receiving active cancer treatment and to identify factors related to exercise adherence and contamination in both the intervention and control groups.
Methods
This is a secondary analysis of data from a RCT of a home-based walking intervention for patients receiving active cancer treatment. Hierarchical Poisson regression analysis was used to identify factors related to exercise adherence and exercise contamination in the exercise intervention and control groups.
Results
A total of 126 patients finished the study. Exercise adherence rate in the intervention group was 32.35%, while exercise contamination rate in the control group was 12.07%. Independent predictors of adherence for the exercise group were baseline physical fitness, pre-treatment fatigue level, treatment-related mood disturbance, and marital status (p < 0.01); past exercise history significantly predicted exercise contamination (p < 0.00) in the control group.
Conclusions
Adherence remains an issue in an exercise RCT among patients on active cancer treatment. Adherence is related to symptom, physical function, and exercise history.
Implications for Practice
Exercise researchers should consider stratifying samples based on pre-treatment variables found to be significantly associated with outcome variables in this study to reduce confounding effects. Oncology clinicians can use the study findings to appropriately tailor strategies to encourage exercise adherence among patients receiving active cancer treatment so that these patients can receive the known benefits of exercise.
doi:10.1097/NCC.0b013e318236a3b3
PMCID: PMC3326216  PMID: 22228393
Exercise; adherence; cancer; treatment; randomized clinical trial
22.  Uncertainty During the Transition From Cancer Patient to Survivor 
Cancer nursing  2009;32(4):E8-E14.
This prospective study evaluated the impact that uncertainty has on quality of life as cancer patients end the active phase of their treatment. The transition from patient status to survivor may be a particularly important point in recovery because it may affect how much stress cancer survivors experience. Guided by a within-subjects design framework, 53 cancer patients (predominantly breast cancer) participated in the present study as they approached the end of adjuvant treatment and were followed for 4 months. Distress levels increased the further patients moved away from the end-of-active treatment; however, preceding these ascending scores of distress was a period characterized by little unrest—best described as a “honeymoon” phase. Using hierarchical linear modeling, greater uncertainty 1 month after treatment ended predicted more functional and physical impairment 4 months after the completion of adjuvant treatment. In both cases, uncertainty accounted for nearly 70% of the variance of these changes over time. A period of rest may emerge as active treatment ends, but that it is short-lived, particularly if uncertainty regarding health emerges. Furthermore, uncertainty may a represent a key mechanism (and target for intervention) during the transition from cancer patient to survivor.
doi:10.1097/NCC.0b013e31819f1aab
PMCID: PMC3682664  PMID: 19444082
Cancer survivor; Emotional distress; Quality of life; Uncertainty
23.  Predictors of Breast Examination Practices of Chinese Immigrants 
Cancer nursing  2009;32(1):64-72.
Breast cancer is a significant threat to Chinese women living in the United States. The purposes of this study are, first, to examine the relationships among breast cancer risk knowledge, general cancer beliefs, and breast examination practices and, second, to determine the predictors of breast examination practices among Chinese women in New York. The study offers a descriptive approach that makes use of a correlation cross-sectional survey (N = 135). Five significant predictors are related to breast examination practices as a result of the study findings: age, acculturation, private insurance status, legal status, and length of stay in New York. Findings show that women who have regular breast examinations most likely belong to older generations, as compared with their younger peers. Study findings suggest that healthcare providers must become more culturally sensitive to the practices and needs of Chinese immigrants. Evidently, providing information regarding cancer prevention targeted for female Chinese immigrants can help increase use of cancer screening tests.
doi:10.1097/01.NCC.0000343366.21495.c1
PMCID: PMC3653173  PMID: 19104203
Breast cancer; Breast self-examination (BSE); Chinese immigrants; Clinical breast examination (CBE); Mammogram; New York City
24.  Breast Cancer Knowledge Assessment in Female Chinese Immigrants in New York 
Cancer nursing  2004;27(5):407-412.
The purpose of this study was to examine the relationships between acculturation level and perceptions of health access, Chinese health beliefs, Chinese health practices, and knowledge of breast cancer risk. This descriptive, correlational cross-sectional study used a survey approach. The sample included 135 Chinese women from the New York City metropolitan area. Data were analyzed using correlational techniques and polytomous regression. There were no significant relationships between acculturation and health access, Chinese health beliefs, Chinese health practices, and breast cancer risk knowledge. Only “years of education,” “marital status,” and “household income” significantly predicted breast cancer risk knowledge level. The data indicate that women with a better knowledge of breast cancer risk are twice as likely to have higher income and have more education. The most knowledgeable women are less likely to be married and less likely to have partners compared to least knowledgeable group. Providers need to promote health knowledge and provide information about as well as access to preventive health practices to the immigrant population, given that acculturation to the new dominant society is inevitable.
PMCID: PMC3653178  PMID: 15525869
Acculturation; Breast cancer; Chinese medicine; Immigrants; Knowledge
25.  Perceived Control and Hot Flashes in Treatment-seeking Breast Cancer Survivors and Menopausal Women 
Cancer Nursing  2012;35(3):195-202.
Background
Lower perceived control over hot flashes has been linked to fewer coping strategies, more catastrophizing, and greater hot flash severity and distress in midlife women; yet, this important concept has not yet been studied in breast cancer survivors.
Objective
To explore perceived control over hot flashes and hot flashes in breast cancer survivors compared to midlife women without cancer.
Methods
99 survivors and 138 midlife women completed questionnaires and a prospective, electronic hot flash diary. All data were collected at a baseline assessment prior to randomization in a behavioral intervention study.
Results
Both groups had moderate perceived control over hot flashes. Control was not significantly related to hot flash frequency, but was significantly related to hot flash severity, bother, and interference in both groups. A significantly stronger association between control and hot flash interference was found for survivors than for mid-life women. Survivors using hot flash treatments perceived less control than survivors not using hot flash treatments, whereas the opposite was true in midlife women.
Conclusions
Findings extend our knowledge of perceived control over hot flashes in both survivors and midlife women.
Implications for Practice
Findings emphasize the importance of continued menopausal symptom assessment and management, support the importance of continuing nursing care even for survivors who are already using hot flash treatment, and suggest that nursing interventions aimed at improving perceived control over hot flashes may be more helpful for survivors than for midlife women.
doi:10.1097/NCC.0b013e31822e78eb
PMCID: PMC3248957  PMID: 21946903

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