Showing papers in "Oncology Nursing Forum in 1995"

The effects of psychoeducational care provided to adults with cancer: meta-analysis of 116 studies.

Abstract: Purpose/objectives To determine how educational and psychosocial care provided to adults with cancer affects seven outcomes--anxiety, depression, mood, nausea, vomiting, pain, and knowledge. Design Meta-analysis. Sample 116 intervention studies. A standardized mean difference between a treatment and control group (i.e., an effect-size value) was calculated for 98 studies; for 18 additional studies, it was only possible to code the direction of treatment effect (i.e., whether the treatment or control group had a higher score). Most analyses were limited to the 98 studies from which an effect-size value was obtainable. These studies were published between 1976 and 1993 and were based on data obtained from 5,326 patients with cancer. Methods A comprehensive literature search yielded more than 20,000 potentially relevant citations that were reviewed. Study, subject, treatment, and outcome characteristics of the studies meeting selection criteria were coded. Main research variables Manner of subject assignment to treatment condition; type of control group; publication form; type of psychoeducational care; and the outcomes of anxiety, depression, mood, nausea, vomiting, pain, and knowledge. Findings Statistically significant, beneficial effects were found in relation to all seven of the outcomes. Three threats to validity were examined and were not found to be a problem related to the outcomes examined. Conclusions Psychoeducational care was found to benefit adults with cancer in relation to anxiety, depression, mood, nausea, vomiting, pain, and knowledge. Differentiating among the effectiveness of various types of psychoeducational care was problematic. To maximize the utility of this knowledge for clinicians, more research is needed to evaluate the relative effectiveness of different types of psychoeducational care. Implications for nursing practice A strong research base has established the beneficial effects of psychoeducational care. Clinicians should examine their practice to determine if research-based psychoeducational care is being used sufficiently.

Quality of life in long-term cancer survivors.

Abstract: Purpose/objectives To describe the quality of life (QOL) of long-term cancer survivors Design Descriptive, mailed survey Setting Membership of the National Coalition for Cancer Survivorship (NCCS), which is a nonprofit, peer-support network for people living with cancer Sample 687 (57%) of the 1,200 members of NCCS completed the survey The mean age of the sample was 496 years; 81% were female The predominant cancer diagnoses were breast (43%), lymphoma (9%), ovarian (8%), and Hodgkin's disease (8%) Methods Mailed survey using three instruments: a demographic tool, the Quality of Life-Cancer Survivors (QOL-CS) tool, and the Functional Assessment of Cancer Therapy-General (FACT-G) tool Main research variables Subscale and individual items of QOL including physical, psychological, social, and spiritual well-being Findings Results include areas of positive effects for cancer survivors and continued demands of survivorship Based on scoring of 0 (worst outcome) to 10 (best outcome), cancer survivors' mean QOL-CS subscores were 588 for psychological well-being, 659 for spiritual well-being, 662 for social well-being, and 778 for physical well-being Several demographic factors (eg, evidence of active disease; female gender; presence of spouse/partner or children; length of time since diagnosis; income) had significant influence on QOL Conclusions Cancer survivors experienced altered lives and had needs related to fear of recurrence and facing the spiritual aspects of having survived a life-threatening illness Implications for nursing practice The growing population of cancer survivors has long-term needs for nursing care that address multidimensional aspects of QOL

Information and decision-making preferences of men with prostate cancer.

Abstract: Purpose/objectives To determine whether a relationship exists between preferences for involvement in decision making and type of information in patients with cancer. Design Survey, correlational. Setting Community urology clinic in Winnipeg, Manitoba, Canada. Sample Convenience sample of 57 men (mean age of 71 years). Methods Subjects completed a card sort to elicit their preferred role in treatment decision making. A two-part questionnaire measured the type and amount of information preferred. Findings The majority (57.9%) of men preferred a passive decision-making role. Information on disease advancement, likelihood of cure, and types of treatment available were the three preferred categories of information. Men in the collaborative group and those who wanted their physician to make treatment decisions-only after seriously considering their opinions-also wanted significantly more information in these three categories. Married men ranked self-care information as significantly less important than did single men. Information preferences were similar regardless of preferred decision-making role. Conclusions Although the majority of men in this sample wanted their physician to make final treatment decisions, they did want to be informed. Information preferences were similar to other groups of patients with cancer. Future clinical studies are required to determine if providing these men with more information will enable them to assume a more active decision-making role. Implications for nursing practice Given the small variance in decision-making and information preferences accounted for by sociodemographic and treatment/disease-related factors, individual assessment of these preferences remains the best clinical approach.

Cancer fatalism among elderly Caucasians and African Americans.

Abstract: PURPOSE: To determine the relationship between selected demographic factors (eg, education, income, ethnicity, gender, age) and cancer fatalism DESIGN: Descriptive study SETTING: Randomly selected senior citizen centers in a southern state SAMPLE: The majority of the participants (N = 192) were female African Americans Mean age of participants was 76 years, mean years of education was < or = 8 years, and mean income was below $6,500 per year METHODS: Demographic data was collected and Powe Fatalism Inventory was completed in face-to-face interviews MAIN RESEARCH VARIABLES: Education, income, ethnicity, gender, age, and cancer fatalism FINDINGS: Significant negative correlations between cancer fatalism and education and income were found Significant correlations also existed between cancer fatalism and ethnicity and gender Age was not a significant predictor of cancer fatalism CONCLUSIONS: As participants' level of education and income decreased, cancer fatalism scores increased African Americans and females had higher mean cancer fatalism scores Education, income, ethnicity, and gender could be used to predict cancer fatalism scores IMPLICATIONS FOR NURSING PRACTICE: Future research should evaluate the relationship between cancer fatalism and early detection practices

The impact of cancer pain education on family caregivers of elderly patients.

Abstract: Purpose/objectives To examine the impact of pain education on family members providing home care to elderly patients with cancer. Design Quasiexperimental. Setting Homes of selected patients from two California medical centers. Sample Fifty family caregivers of patients experiencing cancer-related pain. Methods The pain education program included three components: pain assessment, pharmacologic interventions, and nonpharmacologic interventions. Patients and their family caregivers were evaluated prior to initiation of the program and at one and three weeks following the interventions. Main research variables Quality of life (QOL); knowledge and attitudes about pain; and caregiver burden. Findings Findings based on measures of QOL and caregiver burden demonstrated the physical and psychological impact of family caregiving and pain management. Comparison between elderly patients with cancer and family caregivers revealed the pain experience's significant impact on family members caring for a loved one in pain. Conclusions The pain education program was effective in improving knowledge and attitudes regarding pain management. Implications for nursing practice Pain management is a priority for nurses, and use of interventions such as structured pain education improves QOL outcomes for elderly patients and their family caregivers.

Reimbursement issues for advanced practice

Abstract: Purpose/objectives To determine what spiritual care practices oncology nurses use. Design Descriptive, cross-sectional survey. Setting Variety of oncology clinical settings from all regions of the United States. Sample Stratified, random sampling of Oncology Nursing Society members who identified themselves as clinicians; 181 out of 700 completed the questionnaires; respondents typically were Christian, caucasian, female, adult inpatient oncology staff nurses. Methods Oncology Nurse Spiritual Care Perspectives Survey and a demographic form were delivered and returned through mailing; questionnaires required up to two hours for completion; respondents were given one month to complete the questionnaires. Main research variables Spiritual care practices/interventions (types and frequency) and indicators of spiritual need. Findings Frequent practices included praying with patients, referring them to chaplains or clergy, providing them with religious materials, serving as a therapeutic presence, and listening and talking to them. Frequency of traditional spiritual care practices differed by variables such as self-reported spirituality, religious service attendance, ethnicity, and education. Identified indicators of spiritual need included anxiety, depression, patient requests, death issues, hopelessness, and withdrawal. Conclusions Oncology nurses provide spiritual care in a variety of ways that often are personal and private, yet they do so infrequently and with some discomfort. Research examining relationships between spiritual care practices and demographic variables is needed. Implications for nursing practice Spiritual care education and resources for clinicians are needed. Data provide examples of interventions for and indicators of spiritual need.

Patient literacy and the readability of written cancer educational materials.

Abstract: PURPOSE/OBJECTIVES The purpose of this study was to determine whether the reading level of educational materials for patients with cancer corresponds to the reading abilities of a sample of patients. A secondary aim was to describe what type of educational materials patients with cancer report as most helpful. DESIGN Descriptive, cross-sectional. SETTING Outpatient oncology clinics at an urban Veterans Affairs Medical Center. SAMPLE A convenience sample of 63 outpatients with cancer. METHODS Investigators used the Word Recognition Achievement Test-Revised Level (WRAT-R2) to measure patients' reading levels. They used the Flesch Index to analyze the reading levels of the booklets that the patients used (14 booklets developed by the American Cancer Society and 16 developed by the National Cancer Institute). Data were analyzed through descriptive statistics and a Wilcoxon signed rank test. MAIN RESEARCH VARIABLES Patient and booklet reading levels. FINDINGS The reading level of 27% of the sample was less than that of all 30 pamphlets (less than a sixth-grade reading level). Seventeen percent of the patients had a reading level between sixth and eighth grades (representing 47% of the pamphlets). Twenty-nine percent of the sample had WRAT scores between 9th and 12th grades (representing 80% of the pamphlets). Only 27% had WRAT scores of the 13th grade and above. Twenty-six percent of the patients preferred written educational materials alone, while 57% of patients desired more than one method of instruction. CONCLUSION Written materials for the education of patients with cancer must be carefully matched to patient reading levels. Written materials may not be the only desirable mode of instruction. IMPLICATIONS FOR NURSING PRACTICE Given the increasing complexity of cancer care, shorter hospital stays, and a shift toward busy ambulatory care centers, nurses need to develop creative, innovative, and comprehensive patient education programs that are understandable to patients and that use multiple types of instruction.

Balancing our lives: a study of the married couple's experience with breast cancer recurrence.

Abstract: PURPOSE/OBJECTIVES To examine the married couple's experience with breast cancer recurrence from each partner's own perspective, to describe their mood and martial quality, and to develop an initial explanatory theory of the couple's lived experience with breast cancer recurrence. DESIGN Descriptive, qualitative. SETTING Homes of married couples in the Pacific Northwestern United States. SAMPLES 15 married couples comprised of women diagnosed with recurrent breast cancer and their husbands. The median length of time since recurrence was 10 months. METHODS Structured interviews were conducted in the homes of married couples that met eligibility criteria using an open-ended interview schedule, the Marital Dyad Interview, and two standardized questionnaires-the Spanier Dyadic Adjustment Scale and the Center for Epidemiological Studies Depression Scale. MAIN RESEARCH VARIABLES Lived experience of couples to breast cancer recurrence, depressed mood, and marital adjustment. FINDINGS BALANCING OUR LIVES was the core category that explained how the couples lived with the breast cancer recurrence. Couples actively worked to balance their lives by keeping the breast cancer a background, not a foreground, issue. Although couples talked about managing the daily realities of the woman's breast cancer, not dwelling on the cancer and moving ahead and healing themselves was most important. Balancing Our Lives involved the couples in four major processes: managing the woman's everyday illness, surviving, healing, and preparing for death. Concurrently, one or both members of 60% of the couples scored outside the normative range on either depressed mood or marital adjustment. CONCLUSIONS The couples' ways of managing the breast cancer recurrence through balancing their lives may be facilitating their behavioral functioning but may not be enhancing their mood or marital quality. IMPLICATIONS FOR NURSING PRACTICE The couples' management of recurrence may benefit from additional strategies, including helping them work through sad thoughts or feelings instead of avoiding them; recognizing and supporting each other's views, even when their views differ; and helping them to learn ways to express sad thoughts and feelings without overly dwelling on them.

Differences in pain knowledge and perception of the pain experience between outpatients with cancer and their family caregivers.

Abstract: PURPOSE/OBJECTIVES To determine if knowledge about pain and the perception of the pain experience differ when comparing outpatients experiencing cancer-related pain with their family caregivers. DESIGN Quantitative, descriptive. SETTING Sixteen oncology outpatient settings that are part of the Oncology Nursing Research Network. SAMPLE Eighty-six outpatients with cancer-related pain and their family caregivers. METHODS Patients and their family caregivers were recruited in the outpatient setting and asked to complete a demographic questionnaire and the Pain Experience Scale. The patients also were asked to complete the Karnofsky Performance Scale. MAIN RESEARCH VARIABLES Patients' and their family caregivers' knowledge about pain and their perception of the pain experience. FINDINGS No significant differences in knowledge scores were found between the patients and their family caregivers. A significant difference in the perception of the pain experience was found, with the family caregivers viewing the experience more negatively than the patients did. Family caregivers reported that (a) patients had significantly higher levels of pain compared to patient reports, (b) patients experienced significantly greater distress from their pain than the patients reported for themselves, and (c) family caregivers experienced significantly greater distress from the patients' pain than the patients reported for their caregiver. CONCLUSIONS Outpatients with cancer and their family caregivers possess limited knowledge about pain and pain management and perceive the pain experience differently. IMPLICATIONS FOR NURSING PRACTICE Outpatients and their family caregivers need to be better educated about how to manage cancer-related pain. In addition, to reduce patient and caregiver distress, oncology nurses need to facilitate communication between patients and family caregivers about the pain experience.

The problem of pain in outpatients with breast cancer.

Abstract: Purpose/objectives To determine the prevalence and causes of pain in a group of outpatients with breast cancer and to evaluate the effects of pain on the patient's activities of daily living (ADL), mood, and quality of life (QOL). Design Descriptive and correlational. Setting Sixteen outpatient facilities that are part of the Oncology Nursing Research Network. Sample A convenience sample of 97 outpatients who were actively being treated for breast cancer. Methods Patients completed a demographic questionnaire, a cancer pain questionnaire, the Profile of Mood States, and the Multidimensional Quality of Life Scale--Cancer. Patients' medical records were reviewed. Main research variables Pain intensity, pain duration, changes in ADL, changes in mood, and changes in QOL. Findings Forty-seven percent of the patients with breast cancer reported experiencing cancer-related pain. Patients with cancer-related pain had significantly higher mood disturbance scores and significantly lower QOL scores. Conclusions Pain is a significant problem for outpatients with breast cancer that negatively affects mood, QOL, and functional status. Implications for nursing practice Future research is needed to determine the most effective strategies for treating pain associated with breast cancer. In addition, oncology nurses should perform ongoing assessments of patients' pain and the impact of the pain on various aspects of patients' lives.

1994 Oncology Nursing Society Research Priorities Survey.

Abstract: PURPOSE/OBJECTIVES: To determine oncology nursing research priorities as well as the type of research needed to address these priorities. DESIGN: Cross-sectional survey design. SETTING: Mail-out survey with return, postage-paid envelope provided. SAMPLE: A random sample of 10% of Oncology Nursing Society (ONS) members who identified patient care as their primary functional area, the ONS leadership group (e.g., Board of Directors, all committee chairs), all doctorally prepared ONS members, and all members of the ONS Advanced Nursing Research Special interest Group (N = 2,178). METHODS: The questionnaire was based on prior ONS Research Surveys and updated to reflect issues or topics that currently are relevant to oncology nurses. MAIN RESEARCH VARIABLES: Priority ranking of 93 research topics organized into seven major categories. FINDINGS: Seven hundred eighty-nine surveys were returned, for a 36% return rate. The top 10 priorities according to the priority index were pain; prevention; quality of life; risk reduction/screening; ethical issues; neutropenia/immunosuppression; patient education; stress, coping, and adaptation; detection; and cost containment. CONCLUSIONS: The top 10 research issues can be used to develop priorities for the direction of research in oncology nursing. IMPLICATIONS FOR NURSING PRACTICE: The findings provide a basis for identifying trends in nursing practice. The fact that prevention, risk reduction, and detection appear in the top 10 suggests that nurses are moving toward a definition of practice that is not limited to managing symptoms of disease. These findings also provide guidance for forming health policy in cancer care.

Skin cancer prevention by parents of young children: health information sources, skin cancer knowledge, and sun-protection practices.

Abstract: Purpose/objectives To describe and evaluate parents' skin cancer prevention knowledge, sun-protection practices for themselves and their children, and use of health information sources. Design Cross-sectional survey. Setting A medium-sized (population 700,000) metropolitan area in the southwestern United States. Sample 205 adults, ages 19-56, with children under age 13. Fifty-three percent of the subjects were female, 72% were Caucasian, 22% were Hispanic, 69% were educated beyond high school, and 80% were married. Methods Adults were recruited from the county's randomly selected Superior Court jury pool. Jurors were approached by a researcher and asked to complete a self-administered questionnaire. Main research variables Parents' levels of sun-protection practices for themselves and their children, skin cancer knowledge, and skin sensitivity to sun; amount of health information parents received from healthcare providers, family and friends, schools, employers, and the media; and parents' perceptions of the information's accuracy, utility, and comprehensibility. Findings Parents are more likely to practice skin cancer prevention for their children than themselves. Parents' own protection is positively related to protection for children. Parents who were knowledgeable about skin cancer prevention received the most information from healthcare providers and family and friends. Parents who more frequently received information from healthcare providers practiced more prevention strategies. Conclusions Parents need to improve their practices of protecting their children from the sun, particularly by limiting their sun exposure and having them wear protective clothing. Implications for nursing practice Nurses in schools, work sites, and healthcare organizations should be active in skin cancer prevention. Nurses can teach parents that children are at risk, encourage parents to teach children to protect themselves, and address barriers to prevention.

Barriers to breast and cervical cancer screening in underserved women of the District of Columbia.

Abstract: PURPOSE/OBJECTIVES To identify barriers to breast and cervical cancer screening services from the perspective of medically underserved women of the District of Columbia (DC) that may influence intentions to perform breast and cervical cancer screening behaviors; to determine any relationship between attitudes and influence of significant others on intended behaviors; and to identify a relationship between the site where services are provided and the underserved women's intentions to engage in screening behaviors. DESIGN Cross-sectional, correlational. SETTING Breast and cervical cancer screening clinics in DC. SAMPLE 339 medically underserved, adult women. METHODS Face-to-face investigator-conducted interviews. MAIN RESEARCH VARIABLES Demographic and contextual variables as well as attitudes and influence of significant others. Intention to have a mammogram or Pap test or perform breast self-examination (BSE) monthly. FINDINGS Intention to have a mammogram was positively related to influence of significant others and negatively related to uncaring healthcare professionals. Intention to have a Pap test had a positive relationship with one's attitude toward the test and with the influence of significant others. Intention to perform BSE was positively related to attitude toward and previous performance of BSE and influence of significant others. No significant relationships were observed between intention to perform screening behaviors and demographic variables. CONCLUSIONS Factors that influence women's attitudes toward screening and intention to perform these behaviors include previous screening behaviors, influence of significant others, and relationships with healthcare professionals. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are well-positioned to develop and test intervention strategies designed to increase access to and compliance with recommended screening guidelines among the medically underserved. Findings from this study potentially could guide development and evaluation of such strategies that are sensitive to this special population.

Vesicant extravasation: myths and realities.

Abstract: Purpose/objectives To provide a comprehensive review of the literature pertinent to the phenomenon of antineoplastic vesicant extravasation within the framework of common misconceptions held by oncology nurses. Data sources National guidelines, published articles in professional specialty journals and proceedings, and the authors' clinical experiences in the care of patients receiving vesicant agents. Data synthesis Antineoplastic vesicant extravasation can result in significant morbidity, severely limiting quality of life for patients with cancer. It also is a liability concern for oncology nurses. Many unanswered questions regarding extravasation exist because the phenomenon is difficult to study in humans and actual extravasation injuries are both sporadic and underreported. The incidence of extravasation from vascular access devices is unknown. Similarly, many recommended management strategies are empirically based. Misconceptions about the nature of extravasation injuries and the manner in which they should be managed contribute to poor patient outcomes and increased liability. Conclusions The disproval of 10 myths regarding the nature and management of vesicant extravasation is an adjunctive step in the translation of existing national guidelines to workable institutional standards and appropriate professional practice. Nursing implications Oncology nurses are in a strategic position to observe the feasibility and efficacy of prevention and management guidelines established at national and local levels. Oncology nurses involved in the administration of antineoplastic vesicant agents are responsible for maintaining a current knowledge base about vesicants and for planning nursing care within the established standards of practice.

The health beliefs and skin cancer prevention practices of Wisconsin dairy farmers.

Abstract: Purpose/objectives To assess and describe health beliefs, level of knowledge about skin cancer, current skin cancer prevention practices, and cues to preventive action of Wisconsin dairy farmers. Design Descriptive survey. Setting Rural Wisconsin. Sample A stratified random sample of 535 male dairy farmers from the Wisconsin Department of Agriculture mailing list; 202 farmers (38%) returned the survey. Methods A survey instrument developed by the researcher was mailed to the farmers. Descriptive statistics were used to analyze data. Main research variables Susceptibility, seriousness, benefits, barriers, current practices, knowledge, and cues to preventive action in regard to skin cancer. Findings Farmers were knowledgeable about skin cancer and felt that they were susceptible, that it was a serious disease, and that protective actions were beneficial; however, they did not practice sun protection. "Too hot to wear" was the most frequent reason given for not wearing protective clothing, and "I forget to wear it" was the most common reason for not using sunscreen. Conclusions Barriers to the use of sunscreen may be the most amenable to intervention. The utility of the Health Belief Model with this population is questioned and may require additional research. Implications for nursing practice Farming-related magazines and newspapers can be used to provide health information. Skin cancer education should be provided at schools, work sites, outpatient clinics, hospitals, and community screening events to remind farmers to practice sun protection.

Quality of life of long-term adult survivors of autologous bone marrow transplantation.

Abstract: PURPOSE/OBJECTIVES To extend the knowledge of quality of life (QOL) of survivors of allogeneic bone marrow transplantation (BMT) to include survivors of autologous BMT. To determine the appropriateness of using a reliable, valid, allogeneic BMT QOL instrument for survivors of autologous BMT. DESIGN Cross-sectional, descriptive, replication survey. SETTING An autologous BMT program in a National Cancer Institute-designated comprehensive cancer center. SAMPLE All survivors of autologous BMT (N = 37) at the center were recruited; 29 survivors participated (85% response rate). METHODS Three mailed questionnaires: the City of Hope quantitative QOL-BMT instrument and qualitative questionnaire and an investigator-developed demographic questionnaire. MAIN RESEARCH VARIABLES QOL, autologous BMT treatment, disease type, age, gender, employment, and date of transplant. FINDINGS Global QOL was high (mean = 8.17 on a 1-10 scale). Most respondents experienced few long-term physical disruptions and had only mild psychological distress. Fatigue, sexuality concerns, and family distress created by the illness were the most negatively rated items. Content, face, and construct validity of the QOL-BMT instrument in the autologous BMT population were acceptable. Overall internal consistency reliability of the tool, as measured by Cronbach's alpha, was 0.82. Themes of uncertainty, concern about relapse, and pain were reported in the qualitative data but not revealed by responses to the QOL-BMT instrument. CONCLUSIONS The majority of survivors of autologous BMT reported few physiologic disruptions and above-average QOL. The City of Hope QOL-BMT instrument had acceptable reliability and validity when adapted for survivors of autologous BMT. Addition of items related to uncertainty, pain, and concern about relapse could further strengthen its validity. IMPLICATIONS FOR NURSING PRACTICE Most survivors of autologous BMT can expect above-average QOL. Incorporating results of QOL evaluation in the informed consent process may help BMT candidates in making the decision to undergo the procedure by providing a more complete picture of life after BMT. However, since a minority of patients will experience continued disruptions in any one of the QOL domains, healthcare providers need to conduct comprehensive follow-up evaluations to determine which patients may need referral to the specialized services of a survivor clinic.

Lymphedema: incidence, pathophysiology, management, and nursing care.

Abstract: Purpose/objectives To review the incidence, pathophysiology, and management of lymphedema and discuss relevant nursing implications. Data sources Published articles, book chapters, and clinical experience. Data synthesis Lymphedema may result from cancer and cancer treatment. Any surgical intervention and radiation therapy can result in interruption and obstruction of the lymph channels. Signs and symptoms of lymphedema include edema, pain, numbness, and limited range of motion. Conclusions Physical and psychological distress may result from lymphedema. Implications for nursing practice Nursing care should focus on patient education that emphasizes risk factors for the development of lymphedema, prevention measures, and self-care activities. Nursing research is needed to determine specific informational needs of the patient, appropriate teaching techniques, and optimal times for delivery of information.

Digital rectal examinations and prostate cancer screening: attitudes of African American men.

Abstract: PURPOSE/OBJECTIVES To explore the relationship between attitudes toward digital rectal examination (DRE) and participation in prostate cancer screening among African American men. DESIGN Survey. SETTING Prostate cancer screenings with a prostate-specific antigen (PSA) blood test held at churches with African American members in Detroit, MI. SAMPLE 613 African American men between the ages of 40 and 70. METHODS Self-administered, structured questionnaires examining attitudes toward DRE, past experiences with DRE, and fear of cancer. MAIN OUTCOME MEASURES Willingness to undergo DRE. FINDINGS The majority of men who were screened had positive attitudes about DRE. Fear of cancer was associated with negative attitudes toward DRE. DREs were not a deterrent among men who attended the screenings. CONCLUSION Negative attitudes toward DRE do not necessarily deter African American men from participating in prostate cancer screenings. IMPLICATIONS FOR NURSING PRACTICE Prostate cancer screening programs should attempt to use both DRE and PSA. More reliable prostate cancer indicators are obtained by incorporating DRE with PSA tests.

Addressing sexual dysfunction following radiation therapy for a gynecologic malignancy.

Abstract: Purpose/objectives To review the aspects of normal sexual response, current incidence of sexual dysfunction following radiation therapy for a gynecologic malignancy, nursing interventions for each symptom that may occur, and nursing research priorities. Data sources Published articles, book chapters, American Cancer Society materials, healthcare professionals working in the field of radiation oncology, and patients. Data synthesis Radiation therapy frequently is the treatment of choice for a gynecologic malignancy. High-dose radiation to the pelvis causes varying degrees of sexual dysfunction because of its effects on the ovaries and vagina. Conclusions Sexual dysfunction resulting from the effects of radiation therapy on the ovaries and vagina can be prevented, minimized, or managed when the nurse is aware of the needs, desires, and expectations of patients receiving this treatment. Implications for nursing practice Sexuality is an important aspect of quality of life that most healthcare professionals do not address. Nursing assessment and practical care strategies for sexual dysfunction can be implemented. Additional nursing research on this subject is warranted.

Assessing and managing venous irritation associated with vinorelbine tartrate (Navelbine)

Abstract: PURPOSES/OBJECTIVES To determine the effect of duration of infusion time on venous irritation in patients receiving vinorelbine tartrate (Navelbine, Burroughs Wellcome Co., Research Triangle Park, NC) in combination with cisplatin or mitomycin. DESIGN Prospective and descriptive. SETTING Five outpatient hematology/oncology units in southern Louisiana and Mississippi. SAMPLE 96 patients receiving vinorelbine in combination with cisplatin or mitomycin through a peripheral vein. METHOD Nurses completed the Venous Irritation Record (VIR), on which they documented the incidence of irritation reactions on the day of infusion as well as 24 hours and one to two weeks later. MAIN RESEARCH VARIABLES Incidence and severity of venous irritation as well as the duration of administration. FINDINGS Significantly lower incidence of venous irritation at 6-10 minute infusion rate was observed (p < 0.05). No difference in incidence was observed when vinorelbine was given with a vesicant (mitomycin) or a nonvesicant (cisplatin) drug. CONCLUSIONS Although venous irritation is a problem associated with peripherally administered vinorelbine, it does not necessitate central line placement. Incidence of this problem can be reduced with a shorter duration of administration. The VIR was feasible, easy to use, and could be adapted for other drugs and other toxicities. The National Cancer Institute Common Toxicity Criteria are not adequate for grading venous irritation reactions. IMPLICATIONS FOR NURSING PRACTICE Vinorelbine should be administered in accordance with the manufacturer's recommendations as a 6-10 minute infusion. Determination of this rate came as a result of clinical nursing research. Nurses involved in clinical trials can and should play a role in describing emergent toxicities and investigating methods to prevent or minimize those toxicities.

Definition and measurement of quality of life in oncology nursing research: review and theoretical implications.

Abstract: PURPOSE To describe oncology nurses' diverse conceptual and operational approaches to the study of quality of life (QOL) by reviewing oncology nursing research of QOL, using principles of theory-building to examine and explain findings, and discussing implications for QOL measurement in research and practice. DATA SOURCES Journal articles published since 1980. DATA SYNTHESIS The use of diverse definitions and measures of QOL reflects the difficulty of operationalizing this abstract and highly individualized concept. A predominant trend in nursing research is the development of multidimensional scales that are disease-specific and include respondent-generated items. CONCLUSIONS Findings reflect a struggle to balance the need for practical, clinically relevant measures of QOL with the equally important need for theoretical integrity and comprehensiveness. IMPLICATIONS FOR NURSING PRACTICE Nurses need to examine carefully their purposes for documenting QOL and the congruence of the evaluation method with patients' perceptions of QOL. This information can guide the choice of methods and enhance the validity of data used to evaluate QOL.

Chemotherapy extravasation: a consequence of fibrin sheath formation around venous access devices.

Abstract: Purpose/objectives To describe, using two case studies, chemotherapy drug extravasation as a consequence of fibrin sheath formation. Data sources Journal articles, textbooks, medical records, and personal experiences. Data synthesis Fibrin sheath formation around venous access devices (VADs) frequently leads to persistent withdrawal occlusion (PWO). While PWO often is easily managed with small doses of thrombolytic therapy (e.g., urokinase), it may result in a more serious complication, such as chemotherapy extravasation. Conclusions Chemotherapy should not be administered through a VAD unless a free-flowing blood return can be demonstrated. Implications for nursing practice Careful nursing assessment of all VADs is important to identify complications such as fibrin sheath formation. To rule out fibrin sheath formation, nurses must obtain catheter dye studies when fibrinolytic therapy fails to restore catheter function.

Breast cancer early detection: differences between African American and white women's health beliefs and detection practices.

Abstract: Purpose/objectives To identify differences in African American and white women's health beliefs and practices regarding early detection of breast cancer. Design and setting Descriptive survey of educators employed by one public school system in one southern state. Sample One hundred seventeen African American and 157 white female professional educators. Methods Subjects completed a survey questionnaire consisting of investigator-developed items and an adapted version of Champion's Health Belief Model Scales. Main outcome measures Reported frequency of use of mammography, clinical breast examination (CBE), and breast self-examination (BSE); health beliefs about these procedures. Findings No significant difference in frequency of use of mammography and CBE was found between the two groups. The difference for BSE frequency approached significance (p = 0.058); African American women had performed BSE significantly more times (p = 0.028) than white women during the preceding 12 months. White women had a significantly higher mean score (p = 0.002) for barriers to mammography. The difference between the two groups for barriers to CBE and control with CBE reached the 0.05 level of significance; in both cases, white women had the higher mean score. No significant difference was found in mean scores for beliefs about BSE. Conclusions The contribution of health beliefs about breast cancer, mammography, CBE, and BSE to frequency of use of these procedures by race remains unclear. Implications Efforts to inform women of the need to adopt an early breast cancer detection program should continue. Additional studies are needed to validate present study findings and to expand the knowledge base for healthcare providers.

Reaching out to the African American community through innovative strategies.

Abstract: Purpose/objectives To describe the University of Pittsburgh Cancer Institute's African American Cancer Program, including innovative strategies that were used, barriers that were encountered, an evaluation of each component, and future directions and implications. Data sources Published articles, references from bibliographies, census data, personal contact, unpublished data. Data synthesis Cancer morbidity and mortality is higher among African Americans than Caucasians. The University of Pittsburgh Cancer Institute pilot-tested four interventions to increase awareness, provide education and early detection opportunities, and overcome barriers to cancer care among African Americans. Conclusion Constant presence, cultural sensitivity, and repetition are necessary to overcome the barriers to increased awareness and behavioral changes in the African American community. A more formalized evaluation component is necessary to draw definitive conclusions. Implications for nursing practice To develop cancer prevention and education programs that meet the unique needs of African Americans, nurses must be aware of barriers and cultural differences.

Relationship of perceived barriers to breast self-examination in women of varying ages and levels of education.

Abstract: PURPOSE/OBJECTIVES: To examine perceived barriers to performing breast self-examination (BSE) in women of varying age groups and education levels and investigate the relationship of age and education to frequency of BSE. DESIGN: Descriptive, retrospective. SETTING: A university nursing center and clerical offices. SAMPLE: Convenience sample of 374 women. METHOD: Subjects were asked to complete Champion's Health Belief Model questionnaire. MAIN RESEARCH VARIABLE: Barriers to BSE practice. FINDINGS: Chi-squares analyses comparing age and education levels to BSE frequency showed no significant differences among groups. Cross tabulations suggested that differences in perception of individual barriers to practice may exist among women of different age groups and education levels. CONCLUSION: Women of varying age groups and education levels responded to individual barrier items differently. IMPLICATIONS FOR NURSING PRACTICE: Young women may need help developing confidence in their BSE technique as well as accurate information to reduce their fears about BSE. Middle-aged women also need this information to reduce their fears and may need help in developing a reminder method for practicing BSE. Older women may benefit from education about BSE's value to them. Less educated women may need information to reduce fear, while women at higher education levels may benefit from help in developing a reminder method.

A professional code of ethics: providing a moral compass for turbulent times.

Abstract: Purposes/objectives To describe the importance of a professional code of ethics and values in guiding and supporting the practice of nurses and to present the proposed Oncology Nursing Society (ONS) Statement of Core Values. Data sources Published articles and books on nursing ethics and bioethics, as well as authors' clinical experiences. Data synthesis Ethical quandaries are commonplace for nurses, and the contemporary context of health care has created new concerns and redefined others. Throughout its history, nursing has been an ethical endeavor, with nurses attempting to sift through complex ethical issues and fulfill their professional responsibilities. A professional code of ethics and values explicates the goals and norms of the profession and provides direction for practice. Conclusion Together, the profession's code of ethics and the proposed ONS Statement of Core Values serve as a resource to guide oncology nurses as they develop an ethically competent practice and confront contemporary ethical challenges. Implications for nursing practice The goal of developing an ethically competent practice, maintaining professional integrity, and rendering quality patient care is of vital concern to oncology nurses. Familiarity with and commitment to the primary ethical precepts and values of the profession are essential to accomplishing this goal.

Advanced practice in oncology nursing: a role delineation study.

Abstract: PURPOSE To identify the elements that comprise the role of the advanced practice oncology nurse. DESIGN Survey. SETTING National. SAMPLE 637 master's-prepared nurses in oncology clinical practice and 619 baccalaureate nurses who were in their first four years of certification as oncology nurses. METHODS Using a 190-item survey composed of five subscales (Direct Caregiver, Consultant, Administrator/Coordinator, Researcher, and Educator) listing advanced practice behaviors, respondents were asked to indicate the frequency with which they performed each behavior and the importance of each behavior to their practice. MAIN RESEARCH VARIABLES The elements of the advanced practice role differentiated from those elements of the role of the nurse who is practicing at the generalist level (i.e., non-master's-prepared). FINDINGS The majority of items showed a significant difference between the the two groups with the greatest similarities in the area of Direct Caregiver and the greatest differences in the areas of Consultant and Researcher. Advanced practice nurses indicated that they performed the behaviors on the Direct Caregiver and Educator subscales most frequently and believed these behaviors to be most important to their practice. CONCLUSION Significant differences exist between the roles of nurses in basic and advanced oncology nursing practice. IMPLICATIONS FOR NURSING PRACTICE The results of the role delineation study have been used to design the blueprint for the Advanced Oncology Nursing Certification Test, to be administered for the first time in April 1995.

Results of a nurse-delivered intervention on proficiency and nodule detection with breast self-examination.

Abstract: PURPOSE/OBJECTIVES To determine group differences in breast self-examination (BSE) frequency, proficiency, and nodule detection as a result of belief and/or informational interventions. DESIGN Prospective, randomized, experimental design using a control group and three intervention groups. Data on outcome measures were collected one year following intervention to determine intervention effect on BSE outcome measures. SAMPLE Women without breast cancer ranging in age from 35-88 years. METHODS Graduate research assistants conducted in-home interviews and completed intervention delivery and data collection using a standardized protocol for each experimental group. Interventions included counseling about beliefs regarding BSE and informational counseling with BSE demonstration. A second in-home interview was conducted one year after the intervention to determine its effect on BSE outcome measures. MAIN RESEARCH VARIABLES Self-recorded frequency, observer-rated proficiency scores, and nodule detection scores. FINDINGS The group receiving both the belief and information interventions had significantly higher frequency (t = 2.22, p < or = 0.05) and higher proficiency scores (t = 3.22, p < or = 0.01) for BSE than the control group. The control group had significantly lower rates than the belief/information group for observed proficiency of BSE (t = 7.72, p < or = 0.01) and for nodule detection (t = 8.91, p < or = 0.01). CONCLUSIONS The intervention consisting of information, BSE demonstration, and follow-up demonstration significantly increased logged frequency, logged proficiency, observed proficiency, and nodule detection one year postintervention. The group receiving both the belief intervention and information intervention demonstrated the highest nodule detection. IMPLICATIONS FOR NURSING PRACTICE BSE teaching should include assessment and discussion about belief toward breast cancer and BSE while providing instruction with return demonstration.