Showing papers in "Oncology Nursing Forum in 1999"

The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue.

Abstract: Purpose/objectives To identify indicators involving circadian activity/rest cycles associated with higher levels of cancer-related fatigue (CRF) during the first three chemotherapy cycles after surgery for stage I/II breast cancer. Design Prospective, descriptive, repeated measures. Setting Midwestern oncology clinics and subjects' homes. Sample 72 women, ages 33-69 and free of unstable chronic illnesses, entered the study. Complete data were obtained from 30-47 subjects at each time. Methods CRF was measured using the Piper Fatigue Scale at the start and midpoint of each chemotherapy cycle. Circadian activity/rest indicators were obtained using Mini-Motionlogger wrist actigraphs for 96 hours at the start of each treatment and for 72 hours at the midpoint of each chemotherapy cycle. Main research variables Fatigue and circadian activity/rest indicators. Findings Women who were less active and had increased night awakenings reported higher CRF levels at all three cycle midpoints, with the strongest association being number of night awakenings. During the third chemotherapy cycle, women who were less active during the day, took more naps, and spent more time resting during a 24-hour period experienced higher CRF. Conclusions Women whose sleep is disrupted at cycle midpoints are at risk for CRF. The cumulative effects of less daytime activity, more daytime sleep, and night awakenings are associated with higher CRF levels. Implications for nursing practice Assessment of CRF and night awakenings at the midpoints of each chemotherapy cycle and development of nursing interventions to promote daytime activity and nighttime rest are key to managing fatigue and preventing loss of biologic rhythmicity.

The Index of Nausea, Vomiting, and Retching: a new format of the lndex of Nausea and Vomiting.

Abstract: Purpose/objectives To determine the reliability of the Index of Nausea, Vomiting, and Retching (INVR), a new format of the Rhodes Index of Nausea and Vomiting Form 2 (INV-2). Design and setting A parallel form study was conducted at a large, Midwestern teaching hospital and a cancer center. Sample Convenience sample of 159 subjects: 40 obstetrical, 60 oncological, 59 medical/surgical. Methods Two instruments, the INVR and the INV-2, were administered approximately 30-60 minutes apart. One-half of the subjects completed the INVR first, and the other half completed the INV-2 first. Main outcome measures Equivalency measures of reliability correlation coefficients for both instruments. Findings A high rate of agreement was found in the responses between the two forms. In cases of clear disagreement, the responses to the INVR were more frequently consistent than the responses to the original form. Conclusions INVR has tested reliability and is more user friendly for the patient and the healthcare provider. Implications for nursing practice Nurses have a focal role in managing symptoms. Managing nausea, vomiting, and retching requires excellent assessment skills of the patient's personal symptom experience and knowledge of pharmacology. Efficient, cost-saving assessments require accurate self-report instruments that permit patients to quantify their symptom experiences. The INVR can provide a scientific base from which to prescribe and teach patients and may improve their quality of life. Reliable and valid self-reporting instruments are essential for managing these adverse symptoms.

Breast cancer screening and African American women: fear, fatalism, and silence.

Abstract: Purpose/objectives To explore the beliefs, attitudes, and practices related to breast cancer and breast cancer screening among low- and middle-income African American women. Design Qualitative study using focus group methodology. Sample/setting 26 African American women, age 40-65, selected from three employment groups, recruited from a community-based center and a local teacher's union in a moderate-sized urban area. Methods Three 90-minute focus group discussions exploring breast cancer beliefs, attitudes, and practices were audiotaped, transcribed verbatim, and analyzed using thematic context analysis techniques. Findings When breast cancer was discussed, fear was the predominant feeling expressed in all groups. This fear was a primary reason not to engage in breast cancer screening. Unemployed women and service workers emphasized the role of violence in causing breast cancer, whereas teachers discussed injury and sex as causing breast cancer. All participants stressed that breast cancer is seldom discussed within the African American community. Teachers added that this secrecy within the African American community leads to breast cancer being viewed as a white woman's disease. Conclusions Despite initiatives promoting breast cancer awareness. African American women still hold misconceptions regarding the etiology of breast cancer and fatalistic perspectives regarding breast cancer outcomes, perhaps because breast cancer is discussed infrequently. Because pain, fear, and fatalism were discussed in all groups, future research should address the influence of these factors to increase screening behaviors. Implications for nursing practice Because unemployed women, service workers, and teachers differed in their beliefs about breast cancer and breast cancer screening, nurses must be mindful of the need to tailor Interventions to address the needs of both low- and middle-income African American women.

Taste changes experienced by patients receiving chemotherapy.

Abstract: Purpose/objectives To increase knowledge about the nature, frequency, and quality-of-life (QOL) effects associated with taste changes after chemotherapy. Design Cross-sectional, descriptive. Setting 11 outpatient urban and suburban oncology centers. Sample 284 adults who had received at least two chemotherapy cycles. Methods Patients completed a taste change questionnaire and the Functional Assessment of Cancer Therapy-General, and nurses collected demographic and disease-related information. Descriptive statistics, Spearman correlations, chi-square, Mann-Whitney, and Kruskal-Wallis one-way analysis of variance were calculated. Findings Taste changes were frequent and at least moderately severe for many patients, who often reported dry mouth, decreased appetite, nausea, and vomiting. Cisplatin and doxorubicin were the agents most likely to be related to severe taste changes and to have caused greater distress from taste changes, which also were associated with decreased QOL. Oncology nurses and physicians rarely discussed taste changes with patients, who often tried changing the ways they seasoned their food. Conclusions Taste changes are a frequent and significant problem for patients receiving chemotherapy and have negative effects on patients' QOL. Oncology nurses and physicians typically do not offer self-management suggestions to patients. IMPLICATIONS FOR NURSING RESEARCH AND PRACTICE: Repeated-measures research may provide a clearer understanding of chemotherapy-associated taste changes over time. Studies to examine strategies suggested from this and other research as well as clinical literature may determine which self-care interventions are most useful. Nurses should inform patients that taste changes may occur following chemotherapy, provide self-management information, and assess for related problems that could increase chemotherapy morbidity.

Nurses' recognition of depression in their patients with cancer.

Abstract: Purpose/objectives To determine the degree to which nurses recognize levels of depressive symptoms in their patients with cancer and to describe patient characteristics that influence the accuracy of nurses' perceptions of depressive symptoms. Design Descriptive, prospective correlational design. Setting 25 community-based ambulatory oncology clinics affiliated with Community Cancer Care of Indiana. Sample 40 clinic nurses rated the depression levels of 1,109 patients. Methods Patients completed the Zung Self-Rating Depression Scale (ZSDS) prior to their medical oncology clinic appointment. Nurses rated their patients' level of depressive symptoms, anxiety, and pain on a 0-10 numerical scale along with determining a performance status score. Main research variables Patient-rated depression and the nurse depression rating. Findings The most frequent agreement between nurses and patients was observed when patients reported little or no depressive symptoms. They were only concordant 29% and 14% of the time in the mild and moderate/severe ranges, respectively. Nurses' ratings were influenced most by patients' endorsement of frequent and obvious mood symptoms and nurse ratings of patients' anxiety and pain. Conclusions A marked tendency existed to underestimate the level of depressive symptoms in patients who were more severely depressed. Nurses' ratings were most influenced by symptoms such as crying, depressed mood, and medical factors that are useful but perhaps not the most reliable indicators of depression in this population. Implications for nursing practice Nurse assessment of depression might be improved if greater emphasis were placed on the more diagnostically reliable symptoms of depression and if screening tools for depression were incorporated into nursing practice.

Analysis of end-of-life content in nursing textbooks.

Abstract: Purpose/objectives To determine the amount and types of content regarding pain and end-of-life (EOL) care included in major textbooks used in nursing education. Design Descriptive. Sample 50 texts (45,683 pages) selected from a potential of more than 700 texts. Methods Content analysis and quantification of nine essential areas of EOL care content present in the texts. Main research variables Nine areas of EOL care: palliative care defined; quality of life, pain; other symptom assessment/management; communication with dying patients and families; role/needs of family caregivers in EOL care; death; issues of policy, ethics, and law; and bereavement. Findings Only 2% of the overall content and 1.4% of chapters in nursing texts were related to EOL care. Based on the analysis, many deficiencies were identified in the texts, including inaccurate information and a lack of information regarding critical EOL topics. Conclusions Nursing texts contain limited content regarding EOL care. Increased attention to this area is essential in preparing nurses to care for patients at EOL. Implications for nursing practice Nursing practice is based on the foundation of nursing education. Changes in nursing school curriculum and provision of continuing education for practicing nurses are essential for improved EOL care.

An intervention to decrease cancer fatalism among rural elders.

Abstract: Purpose/objectives To evaluate the effectiveness of a video intervention in decreasing cancer fatalism, increasing knowledge of colorectal cancer, and increasing participation in fecal-occult blood testing (FOBT). Design Repeated measures, pretest/post-test. Setting Senior citizen centers in a rural southern state. Sample Individuals were selected and assigned to the study group based on the center they attended. Centers were selected and assigned randomly to an intervention (n = 42) or control (n = 28) group. The age of the participants ranged from 52-92 years (X = 75). Methods Pretest measures included the Powe Fatalism inventory, the Colorectal Cancer Knowledge Questionnaire, and the Demographic Data Questionnaire. The intervention group viewed the Medical University of South Carolina's video Telling the Story ... To Live is God's Will, and the control group viewed the American Cancer Society (ACS) video Colorectal Cancer: The Cancer No One Talks About. Hemoccult II kits were distributed to both groups at no cost. Post-test data were collected using the Powe Fatalism Inventory and the Colorectal Cancer Knowledge Questionnaire. Main research variables Cancer fatalism, knowledge of colorectal cancer, and participation in FOBT. Findings People who viewed the intervention video had a greater decrease in cancer fatalism scores and a greater increase in knowledge of colorectal cancer scores than the control group. Both groups had greater than 60% participation in FOBT. Conclusions Telling the Story ... To Live is God's Will is an effective, self-contained, cost-effective intervention to decrease cancer fatalism and increase knowledge of colorectal cancer. The video was as effective as the ACS video on colorectal cancer in increasing participation in FOBT among rural elders. But, because Telling the Story ... To Live is God's Will also decreases cancer fatalism and increases knowledge, the potential exists for the increased screening behaviors to be maintained over time. Implications for nursing practice Showing the video in waiting areas of community health centers to facilitate the discussion of colorectal cancer and cancer screening with the healthcare professional is a possibility. Nursing students may benefit from using the video as a model for the integration of beliefs and attitudes in developing culturally appropriate, community-based interventions. More research is needed to determine if the positive outcomes of the intervention (i.e., decreased cancer fatalism, increased knowledge, increased participation in colorectal cancer screening) can be maintained over time.

The meaning of quality of life in cancer survivorship.

Abstract: Purpose/objectives To describe the meaning of quality of life (QOL) in long-term cancer survivors, to validate inductively derived QOL themes, and to identify and cluster over-arching themes across long-term cancer survivors. Design Qualitative study that was part of a larger, cross-sectional survey. Setting/sample 687 (57% response) cancer survivors at an average of 6.7 years after diagnosis. In the sample, 81% were female (with a mean age of 49.6 years), 72% were college educated, 63% were married, and 49% worked full time. Methods Mailed survey of three open-ended questions and standard QOL tools. A QOL conceptual model was used to frame the research study, describe the QOL responses of the participants, and explore the meaning of cancer survivorship. Content analysis was used to answer the research questions. Data collection and analysis occurred sequentially. MAIN RESEARCH CONCEPTS: Meaning, QOL cancer survivorship. Findings 25 of 30 inductively derived QOL themes were validated in this study of long-term cancer survivors; 107 additional QOL themes were identified and clustered into 11 over-arching themes across the entire data set. Over-arching themes included struggle between independence-dependence, balance, wholeness, life purpose, reclaiming life, multiple losses, having control, altered meaning of health, and surviving cancer from a family perspective. Implications for nursing practice The meaning of QOL in long-term cancer survivors is multifaceted and complex. Conclusions Nurses can use this broader conception of QOL in breast cancer survivors to help patients prepare for and cope with adjustments.

Does emotional expression make a difference in reactions to breast cancer

Abstract: Purpose/objectives To examine the feasibility of using an emotional expression intervention with patients with cancer and test the hypothesis that emotional expression improves psychosocial adjustment. Design Sequentially randomized pretest/post-test design with repeated measures. Setting Two radiation therapy (RT) facilities. Sample Women completing RT for stage I or II breast cancer, who spoke and read English, were independent in self-care, and provided written consent. Subjects (N = 44) were middle-aged (mean = 53.6 years), Caucasian, married, and well educated. Methods Following a baseline interview, subjects were sequentially randomized to an attentional control group, a single dose, or a three-dose emotional expression writing group. Interventions were administered at the time of completion of RT. Follow-up telephone interviews were completed at 1, 4-6, 16, and 28 weeks post-RT. Main research variables Positive and negative affect, intrusiveness of thoughts, use of avoidant coping, side effect severity, trait negative affectivity, content of written essay, and themes derived from content analysis. Findings A high level of acceptance and completion of emotional expression existed, but no effect of the intervention on psychosocial adjustment was evident. Process measures in the three-dose group changed as expected. No relationship existed between content changes and outcome measures. Conclusions Emotional expression is feasible for patients with cancer, but the efficacy of the intervention in improving mood and decreasing cognitive intrusion and avoidance was not supported. Emotional expression processes were consistent with those seen in other samples and may influence outcomes that were not addressed in this study. Implications for nursing practice More extensive testing is needed, including additional outcome variables. Essays reveal concerns around communication, recurrence, and health behavior changes that should be considered in practice.

The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy.

Abstract: Purpose/objectives To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer. Design Experimental longitudinal, random assignment to groups. Setting Two urban radiation oncology departments. Sample 53 women (26 in the experimental group, 27 in the control group) aged 37-81; 80% European and 10% African American with stage I or II breast cancer about to begin radiation therapy. Methods The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study. The Radiation Therapy Comfort Questionnaire was self-administered at three time points: prior to the introduction of intervention and the beginning of radiation therapy (Time 1), three weeks later (Time 2), and three weeks after completing radiation therapy (Time 3). The State Anxiety Inventory was administered at Time 1 only. Main research variables The effect of use of guided imagery on comfort with anxiety as a control variable. Findings Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group, with the treatment group having higher comfort over time. The data also revealed a significant linear trend in differences between groups. No significant interaction of group and time existed. Conclusions Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer. The intervention was especially salient in the first three weeks of therapy. Implications for nursing practice Guided imagery audiotapes specifically designed for this population were resource effective in terms of cost, personnel, and time.

Side-effects Burden, Psychological Adjustment, and Life Quality in Women With Breast Cancer: Pattern of Association Over Time

Abstract: Purpose/objectives To describe the side-effects burden experienced over time by 53 women who were receiving treatment for breast cancer and to describe the association of side-effects burden with psychological adjustment and life quality. Design Data were drawn from the Self-Help Intervention Project (SHIP), an intervention study designed to test the effectiveness of nursing interventions for women receiving treatment for breast cancer. Setting Subjects were interviewed in their homes or treatment locations three times over a period of four to five months. Sample 53 women randomly assigned to the control group of the SHIP. Methods The researchers collected data after treatment was initiated, six to eight weeks later, and three months after that. Main research variables Side-effects burden, psychological adjustment, and life quality. Findings Fatigue was the most problematic side effect over time. Other problematic side effects included sore arm(s), difficulty sleeping, hair loss, and skin irritation. Significant associations were evident for psychological adjustment with symptom extension and number of side effects at Time 2 and Time 3. Depression burden and anxiety burden were associated significantly with psychological adjustment at all three times. Overall life quality and present life quality was associated negatively with symptom extension and number of side effects at all three times. Fatigue burden was associated negatively with life quality at Time 2 and Time 3 with depression burden and anxiety burden negatively associated with life quality at all three times. Conclusions Over time, evidence showed that negative feelings, in particular depression burden and anxiety burden, persist. Depression burden and anxiety burden each were negatively associated with overall and present life quality at all three times. Implications for nursing practice A need exists for clinically individualized nursing interventions that will reduce the side effects burden of women receiving treatment for breast cancer. Interventions can do much to reduce the perception of illness severity so that psychological adjustment and life quality can be maintained.

Nurses' attitudes toward death and caring for dying patients.

Abstract: Purpose/objectives To examine possible relationships among the demographic variables of nurses and their attitudes toward death and caring for dying patients. Design Descriptive. Setting A private hospital and Visiting Nurses Association office in an ethnically diverse metropolitan area in the Midwest. Sample 403 nurses, predominantly female (90%) and Caucasian (70%), with a mean age of 41.8 years. Methods Participants completed the Frommelt Attitude Toward Care of the Dying Scale, the Death Attitude Profile-Revised (DAP-R), and a demographic questionnaire. Main research variables Attitudes toward death and caring for dying people. Findings DAP-R scores were related to sex, religious affiliation, and current contact with terminally ill patients. Frommelt scale scores (e.g., showing acceptance of death) were positively related to current contact with dying patients, negatively correlated with two DAP-R subscales (Fear of Death and Death Avoidance), and positively correlated with two other DAP-R subscales (Approach Acceptance and Neutral Acceptance). Conclusions Nurses' attitudes toward death and their current contact with terminally ill patients were predictive of their attitudes toward caring for terminally ill patients. Implications for nursing practice Professionals who are responsible for designing educational programs focused on nurses' attitudes toward caring for terminally ill patients may want to include an assessment of death attitudes and interventions aimed at decreasing negative attitudes and increasing positive attitudes toward death in such programs.

Menopausal symptoms in breast cancer survivors

Abstract: PURPOSE/OBJECTIVES: To examine the prevalence and severity of menopausal symptoms among breast cancer survivors and the relationship between menopausal symptoms and quality of life (QOL). DESIGN: Cross-sectional, descriptive. SETTING: Outpatient breast care center servicing a southeastern city and regional rural areas. SAMPLE: 114 postmenopausal breast cancer survivors with a mean age of 59 years (SD = 10; range = 36-83 years) who were a mean of 34.9 months postcompletion of surgery, radiotherapy, or chemotherapy (SD = 22; range = 4-116 months). METHODS: Telephone interviews were used to assess demographic variables, menopausal status (questions adapted from the Massachusetts Women's Health Study), menopausal symptoms (adapted from the Blatt Menopausal Index), and QOL (SF-12 Health Survey). Disease and treatment information was extracted from medical records and the state cancer registry. MAIN RESEARCH VARIABLES: Menopausal status, menopausal symptoms, and QOL. FINDINGS: The most commonly reported menopausal symptoms (joint pain (77%), feeling tired (75%), trouble sleeping (68%), and hot flashes (66%)) were also the most severe. More than 40% of breast cancer survivors who reported these symptoms rated them as "quite a bit" to "extremely" severe. The total number and severity of symptoms reported was significantly related to the number of years postmenopause but not to time postdiagnosis. Higher prevalence and severity of menopausal symptoms were related to lower physical and emotional QOL. CONCLUSIONS: Menopausal symptoms appear to be a significant problem for breast cancer survivors. IMPLICATIONS FOR NURSING PRACTICE: Nurses can inform women that menopausal symptoms may be experienced following breast cancer treatment and that these symptoms may be more severe than those experienced by healthy women without cancer.

Chemotherapy medication errors: descriptions, severity, and contributing factors.

Abstract: Purpose/objectives To expand the limited body of knowledge of medication errors involving chemotherapy. Design Exploratory, descriptive. Sample 160 (26%) of 620 randomly selected Oncology Nursing Society members employed in direct patient-care positions and 26 nonmembers with chemotherapy administration responsibilities employed in different settings. Methods Mailed investigator-developed questionnaire containing 24 demographic and open-ended questions. Main research variables Nurses' descriptions of the nature and severity of chemotherapy medication errors. Findings Chemotherapy medication errors were reported to have occurred in the workplace of 63% of the respondents, and 140 errors were described. Errors included under- and overdosing, schedule and timing errors, wrong drugs, infusion-rate errors, omission of drugs or hydration, improper preparation of drugs, and chemotherapy given to the wrong patients. Stress, understaffing, lack of experience, and unclear orders were cited as factors believed to contribute to the occurrence of the errors. Most of the errors were reported internally, but only 3% were known to be reported to national reporting databases or drug manufacturers. Conclusions Chemotherapy medication errors are not uncommon and infrequently are reported externally to databases or manufacturers. Implications for nursing practice Risk management strategies to promote safe chemotherapy administration include comprehensive chemotherapy administration training, adherence to basic principles of medication administration, and adequate staffing. Oncology nurses need to know how and when to report chemotherapy medication errors to national databases and drug manufacturers.

Relationship between fatigue and quality of life in patients with glioblastoma multiformae.

Abstract: Purpose/objectives To evaluate changes in fatigue at the time of diagnosis (Time 1) and two weeks after the completion of radiation therapy (Time 2) and to determine the relationship between fatigue and quality of life (QOL) at each time interval in patients with glioblastoma multiformae (GBM). Design Descriptive study to evaluate fatigue and QOL. Setting Neuro-oncology clinic for accrual. Clinic, home, or office for patients interviews. Sample 60 adult patients diagnosed with GBM who received radiation therapy. Methods Participants completed a demographic data sheet, the Profile of Mood States, and the Multidimensional Quality of Life Scale-Cancer Version 2 at both time points. Main research variables Fatigue and QOL. Findings Fatigue significantly increased from Time 1 to Time 2 (t = -2.69, p = 0.009). Increases in fatigue were associated with significant decreases in QOL at Time 1 (r = -0.57) and Time 2 (r = -0.60). Conclusions Patients with GBM experience increases in fatigue after radiation therapy. Increases in fatigue are associated with decreases in almost all aspects of patients' QOL. Implications for nursing practice Nurses must provide patients with information about the occurrence of fatigue during radiation therapy and recommend interventions to deal with this devastating symptom.

School-age children's and adolescents' adjustment when a parent has cancer.

Abstract: Purpose/objectives To describe school-age children's and adolescents' adjustment to parental cancer. Design Retrospective population control. Setting Screening cancer registries identified subjects at four Midwestern hospitals, including urban and rural settings of community and tertiary hospitals. All families were interviewed at home one time. Sample A convenience sample of 116 school-age children (6-10 years) and adolescents (11-18 years) living in the home of a parent with cancer. Methods Data were collected using two forms of the Child Behavior Checklist and an investigator-developed demographic form. The ill parent, the partner, and the adolescent rated the adjustment. This study's data were compared with population data, and comparisons were made among raters and with the existing literature. Main research variables School-age children's and adolescents' adjustment. Findings School-age children and adolescents of a parent with cancer have significantly more behavioral problems than were expected. The significant agreement among raters is of a modest magnitude but as strong as rater agreement reported in the literature. Conclusions Most school-age children and adolescents of a parent with cancer are well-adjusted, but a significant subset of youngsters is at risk for behavioral problems. Implications for nursing practice Nurses need to assess ill parents' concerns about their youngsters, provide information to parents, adolescents, and school-age children, and institute appropriate referrals.

Breast cancer screening in relation to access to health services.

Abstract: Purpose/objectives This study examined mammography screening and breast self-examination (BSE) in relation to perceived access to health services to identify persistent barriers to earlier detection. Design Community-based, cross-sectional, survey, and interview. Setting More than 80 nonhealthcare-related, women's group settings in northern California. Sample Convenience sample of 838 black/African American, Latina/Hispanic, and Caucasian/Anglo women varying in age, annual family income, sexual orientation, and educational history. Methods Survey and interview (in English or Spanish) by on-site research assistants facilitating participation of women with limited reading capability. Main research variables Perceived access to services, breast cancer screening behaviors, acculturation and spoken language, habits of use, perceived prejudice in health delivery, available economic resources, and other social and behavioral variables reported elsewhere. Findings Healthcare habits, the perception of prejudicial treatment in health service delivery, spoken language, and three different measures of financial capability explained a large degree of perceived access to services. Perceptions of a lack of access to services were related to decreased mammography screening participation and to decreased BSE behavior. Conclusions Participation in cancer screening depends on real economic access and previous health service delivery experience. BSE behavior may be influenced by lack of money to pay for healthcare services, and experienced prejudice in healthcare delivery appears to have a lasting influence on mammography screening behavior. Implications for nursing practice Tolerance and culturally sensitive service delivery coupled with economic access to both screening and necessary treatment will be vital to eliciting women's complete participation in attaining desired earlier detection goals for breast cancer.

A narrative study of chemotherapy-induced alopecia.

Abstract: Purpose/objectives To describe the experience of alopecia in people undergoing chemotherapy. Design Qualitative. Sample Using announcement flyers, 15 participants (13 women and 2 men) were recruited to participate in audiotaped, in-depth interviews. Method In-depth interviews and narrative analysis of participants' "stories" using a sociolinguistic approach to narrative analysis. Findings Alopecia is a significant and disturbing side effect of chemotherapy. Preparing for hair loss, experiencing hair falling out, realizing an altered sense of self, trying to look normal, being reminded of disease, joking about alopecia, sharing being bald, having problems with wigs, taking control, and experiencing hair growing back emerged as aspects of the experience. Conclusions Understanding the full significance of the experience of alopecia in an individual's everyday life and personal identity is critical to providing support during the course of illness and developing strategies to help clients cope with the difficult changes that occur during cancer treatment. Implications for nursing practice Information about alopecia can help to cognitively prepare the person, but the emotional response to alopecia is difficult to anticipate. Nurses need to create an atmosphere that encourages patients to tell their stories.

Comparison of subjective sleep quality in patients with cancer and healthy subjects.

Abstract: PURPOSE/OBJECTIVES To compare the subjective sleep quality of a group of patients with cancer undergoing treatment and a normative sample of healthy comparison subjects. DESIGN Secondary analysis of data from a single time point in a repeated measures descriptive-correlational study. SAMPLE/SETTING Convenience sample of 15 patients with cancer receiving antineoplastic therapy and admitted to a tertiary university medical center for fever or neutropenia and 52 healthy comparison subjects without sleep disturbances. Although both groups were of similar age, a higher percentage of men comprised the comparison group. METHODS Patients completed the Pittsburgh Sleep Quality Index (PSQI) on the first day of hospitalization to reflect their perceptions of sleep for the month prior to hospitalization. Healthy comparison subject scores on the PSQI were obtained from a published report outlining psychometric properties of the PSQI (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989). MAIN RESEARCH VARIABLES Sleep latency, sleep duration, sleep efficiency, sleep disturbances, medication use, daytime dysfunction, and global sleep quality. FINDINGS Patients with cancer reported significantly poorer overall sleep quality accompanied by more daytime dysfunction. The incidence of specific sleep disturbances, such as snoring and dyspnea, was not different between the groups. CONCLUSIONS This small sample of patients reported significantly poorer sleep quality than an historical comparison group. Specific sleep disturbances commonly seen in the general population were not problematic for the patients with cancer. Limited sample size and use of an historical comparison group need to be considered in interpreting and applying these findings. Additional research is needed to further characterize the nature of sleep problems in patients with cancer. IMPLICATIONS FOR NURSING PRACTICE Nurses need to assess sleep in their patients, including its impact on quality of life and functional status.

Coping strategies and psychological distress in patients with advanced cancer.

Abstract: PURPOSE/OBJECTIVES: To examine the relationship between coping mechanisms and psychological distress in patients with advanced cancer receiving chemotherapy. DESIGN: Descriptive, correlational study. SETTING: Private and public hospitals in New York, NY. SAMPLE: 132 patients, ages 33-83, with advanced breast, ovarian, lung, colorectal, or other cancers. METHODS: Mail survey using the Ways of Coping Inventory-Cancer Version and the Profile of Mood States. MAIN RESEARCH VARIABLES: Coping strategies, psychological distress. FINDINGS: The coping strategies distancing, cognitive escape-avoidance, and behavioral escape-avoidance were related to psychological distress. Distancing was negatively related (r = -0.25) and cognitive escape-avoidance (r = 0.38) and behavioral escape-avoidance (r = 0.38) were positively related to psychological distress (p < 0.01). Collectively, the coping strategies explained 36% of the variance of psychological distress. The most important coping mechanism contributing to overall psychological distress was behavioral escape-avoidance, followed by cognitive escape-avoidance. CONCLUSIONS: Low levels of psychological distress were associated with low levels of cognitive and behavioral escape-avoidance and high levels of distancing. IMPLICATIONS FOR NURSING PRACTICE: Nursing interventions that reduce cognitive and behavioral escape-avoidance and enhance distancing should be tested, through further research, in relation to their ability to decrease psychological distress in patients with advanced cancer.

From theory to practice: designing interventions to reduce fatigue in patients with cancer

Abstract: PURPOSE/OBJECTIVES: To review the evidence available to guide the development of interventions to alleviate cancer-related fatigue. DATA SOURCES: Published fatigue theories and research describing patients' self-care strategies and the efficacy of interventions for the management of fatigue. DATA SYNTHESIS: Fatigue is a pervasive problem for patients with cancer. Without guidance, patients adopt common-sense strategies that generally prove unsuccessful in alleviating fatigue. Theories that identify self-care actions that can reduce fatigue are becoming increasingly sophisticated. A small number of strategies, most notably exercise, has been evaluated. Other interventions--educational, attention-restoring, and psychosocial--have been tested to a lesser extent. The theoretical foundations of these experimental studies frequently are unclear. However, primary evidence is favorable and supports further evaluation. CONCLUSIONS: Passive approaches frequently fail to reduce fatigue in patients with cancer. Alternative approaches based on the growing body of theoretical and research evidence should be adopted. IMPLICATIONS FOR NURSING PRACTICE: Patients require guidance in managing cancer-related fatigue. Nurses need to develop and evaluate relief interventions. Systematic research programs based on sound theoretical premises and previous research will contribute to the growing body of evidence to aid future management of this troublesome symptom.

The effect of an educational intervention on decreasing pain intensity in elderly people with cancer.

Abstract: PURPOSE/OBJECTIVES To determine if an educational intervention related to pain management could decrease pain intensity in elderly people with cancer. DESIGN Quasi-experimental pretest/post-test design. SETTING A private oncology practice in urban west central Florida. SAMPLE 36 subjects who were 65 years of age or older and had a known cancer diagnosis. METHODS Visual Analog Scale (VAS) completed by each subject. Subjects were randomized to an experimental or a control group. Experimental group members watched a 14-minute video produced by the investigator that presented information contained in the booklet "Managing Cancer Pain." Experimental group members also received a copy of the booklet. Control group members received pain management instructions from the office staff. Two weeks later, subjects completed the VAS at two different times on that day and mailed them to the investigator. FINDINGS Analysis of covariance revealed a statistically significant difference in pain intensity between the control group and the experimental group. CONCLUSIONS Pain management in elderly people with cancer has been underrepresented in the literature and minimally studied. This study indicated that an educational intervention aimed at elderly people with cancer was effective and implies that educational interventions should be a central component in prevention and management of cancer pain in the elderly. IMPLICATIONS FOR NURSING PRACTICE Every effort should be made to educate elderly people with cancer on prevention and management of pain. Nurses must take a leading role in identifying and implementing educational strategies for cancer pain management and side effect control for their elderly patients.

The evolving meaning of cancer for long-term survivors of breast cancer.

Abstract: PURPOSE/OBJECTIVES To discover the different meanings of cancer for older women who are long-term survivors of breast cancer. DESIGN Qualitative study using a heuristic approach. SETTING Large metropolitan area in the Midwestern United States. SAMPLE A sample of eight women was obtained using network sampling. The women ranged in age from 65-77 years. Length of survival ranged from 5.5-29 years. Five of the women had been treated with a lumpectomy (four with radiation and chemotherapy and one with radiation only). The three other women had been treated with a simple mastectomy, one of whom also was treated with chemotherapy. METHODS Interviews were conducted in the women's homes. Audiotaped interviews were transcribed and manually coded for patterns and themes. MAIN RESEARCH VARIABLES Meaning of cancer. FINDINGS Three meanings of cancer emerged from the data: (a) cancer as sickness and death, (b) cancer as an obstacle, and (c) cancer as transforming. CONCLUSIONS As the women worked through their cancer experience, their perspectives changed. The meaning of cancer after surviving the disease and its treatment centered around positive, insightful experiences and expansive, renewing interactions with their environment. Further research examining the meaning of cancer is needed to broaden the transferability of the findings to other groups. IMPLICATIONS FOR NURSING PRACTICE Understanding the meaning of cancer for older women who are long-term breast cancer survivors may enhance nurses' sensitivity to survivors' perspectives. Knowledge of survivors' different meanings of cancer may help to paint a new vision of cancer survivorship comprised of potentially positive, transforming experiences.

Cervical cancer screening knowledge, behaviors, and beliefs of Vietnamese women.

Abstract: Purpose/objectives To describe the knowledge, beliefs, and practices of cervical cancer screening of Vietnamese women who have migrated to the United States. Design Exploratory, descriptive. Setting Five Vietnamese churches in southeastern Louisiana. Sample Nonprobability sample of 96 adult Vietnamese migrant women. Methods Data were collected by a bilingual nurse during face-to-face interviews conducted in the language preferred by the subjects (English or Vietnamese). Main research variables Cervical cancer screening knowledge, behaviors, and beliefs. Findings Three fourths of the Vietnamese women interviewed could not correctly explain what a Pap test is used for, and few were aware that the most commonly occurring cancer in Vietnamese females in the United States is cervical cancer. Most believed that their risk of cervical cancer was low. Less than half reported ever having had a Pap test and cited not having a gynecologist, cost, and fear of the test as reasons for not ever having had the test done. Conclusions The number of Vietnamese women who adhere to cervical cancer screening guidelines is low. Cultural beliefs and structural barriers influence the choices that Vietnamese women make regarding Pap test utilization. Implications for nursing practice When planning programs to promote cervical cancer screening, nurses must target those at greatest risk--Vietnamese women. Culturally sensitive educational interventions and cervical cancer screening programs for Vietnamese women are needed to increase Pap test utilization and the early detection of cervical cancer.

Anxiety and directed attention in women awaiting breast cancer surgery.

Abstract: PURPOSE/OBJECTIVES To investigate the relationship between anxiety and directed attention (the ability to focus and concentrate) in women awaiting breast cancer surgery and the potential influence of age and extent of anticipated surgery (breast conservation versus mastectomy) on attentional functioning and anxiety. DESIGN Descriptive, cross-sectional. SAMPLE AND SETTING Convenience sample of 45 women newly diagnosed with localized breast cancer at a Midwestern university medical center. METHODS Subjects were assessed approximately 11 days before surgery using objective measures of attention: Digit Span, the Symbol Digit Modalities Test, the Necker Cube Pattern Control Test, the Attentional Function Index (a subjective measure of effectiveness of attentional functioning), and the Tension-Anxiety subscale of the Profile of Mood States. MAIN RESEARCH VARIABLES Capacity to direct attention, perceived attentional functioning, anxiety level, age, and extent of anticipated breast surgery. FINDINGS Level of anxiety was related inversely (r = -0.63, p or = 55 years) showed overall significantly lowered (p < 0.001) performance on the attentional measures than younger women. CONCLUSIONS Preoperative anxiety is a clinically significant issue in women newly diagnosed with breast cancer regardless of age and extent of anticipated surgery. Higher anxiety requires use of attentional resources and initially may act to reduce perceptions of effectiveness in attentional functioning. Older women who have high anxiety combined with both subjective and objective decline in attentional functioning may be at particularly high risk for attentional fatigue. IMPLICATIONS FOR NURSING PRACTICE Women newly diagnosed with breast cancer may experience not only increased anxiety and associated perceptions of decreased attentional functioning but also a subsequent depletion of attentional reserves as a result of the onset of attentional fatigue. Nurses can assess anxiety in women during the preoperative period and assist them in coping with the psychological and cognitive demands associated with this highly stressful period.

Use of routine and breakthrough analgesia in home care.

Abstract: PURPOSE/OBJECTIVES To describe current use of routine analgesics in home care and the treatment of breakthrough pain. DESIGN Descriptive, companion study. SETTING Homecare agencies in southern California. SAMPLE Convenience sample of 369 patients with cancer participating in a pain-education study. METHODS Data regarding breakthrough pain were derived from the homecare medical records and patient interviews. MAIN RESEARCH VARIABLES Analgesic medications prescribed and used for treatment of routine and breakthrough cancer pain. FINDINGS Results demonstrate discrepancy between recommended pain management in clinical practice guidelines and the actual practice of pain management at home. Deficiencies were found in medications prescribed as well as in actual use by patients. CONCLUSIONS Optimum relief of cancer pain is contingent on adequate treatment of routine and breakthrough pain, including greater use of recommended analgesics in adequate doses and clinical care consistent with clinical practice guidelines. IMPLICATIONS FOR NURSING PRACTICE Breakthrough pain is a common problem affecting the quality of life of patients with cancer. Improved management of breakthrough pain is contingent on accurate pain assessment, optimum use of analgesics, and patient education. Nurses should address the important topic of breakthrough pain as new analgesic drugs and methods of delivery become available.

Capecitabine: nursing implications of a new oral chemotherapeutic agent.

Abstract: Purpose/objectives To describe the new oral chemotherapeutic agent capecitabine (Xeloda, Roche Laboratories Inc., Nutley, NJ) and key concepts driving its development and to delineate the nursing impact of patient-administered, home-based chemotherapies. Data sources Published papers, investigational materials, package inserts, and clinical experience. Data synthesis Capecitabine recently was approved to treat metastatic breast cancer refractory to paclitaxel and anthracycline-containing regimens. Efficacy has been demonstrated. However, although the current regimen is well-tolerated, > or = 40% of patients require dose modification because of grade 2 or greater toxicity, usually hand-foot syndrome or gastrointestinal symptoms. Conclusions Capecitabine frees nurses from infusion-related workload, allowing and demanding a new type and level of patient education. Such education emphasizes compliance with the treatment plan and prevention, timely recognition, and management of toxicities. These practice changes also challenge nurses to advocate for reimbursement of educational practices. Implications for nursing practice Oncology nurses will play more of a central role as use of patient-administered, home-based therapies increases. Nurses must enhance their patient-education and telephone symptom-management skills and help to secure reimbursement for such activities.

Families' awareness of and response to dying.

Abstract: PURPOSE/OBJECTIVES: To explore how family care-givers develop and respond to an awareness that their relative is dying. DESIGN: Qualitative, interpretive. SETTINGS: Four major providers of cancer services in Brisbane, Australia, including a hospital, hospice, homecare nursing service, and oncologist's office. SAMPLE: 20 recently bereaved adult family caregivers (mean age = 48.5): 11 females, 9 males--16 spouses, 2 daughters, and 2 mothers of adults. METHODS: Semistructured interviews transcribed verbatim and content analyzed. MAIN RESEARCH VARIABLE: Developing and responding to an awareness of dying. FINDINGS: Five major themes emerged from the analysis. Two core categories, Being Uncertain and Agonizing, depict the emotional struggles that characterize the process of developing an awareness of dying. Three additional categories-Hoping, Pretending, and Preparing-represent strategies used by family caregivers to manage these emotional struggles. CONCLUSIONS: Developing an awareness of dying is a gradual process for family caregivers. Uncertainty and anguish characterize this process. Several factors contribute to this uncertainty and agony, including interactions with healthcare providers. Family caregivers attempt to manage this developing awareness by hoping, pretending, and preparing for death. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to identify processes to ensure that family caregivers' needs for information and support are given high priority and that supportive interventions identified are based on a sensitive understanding of the experience of the family caregiver. The processes may include assisting family caregivers to maintain hope, sustain social relationships, and make preparations for the death. Further research into how family caregivers use these strategies for managing their developing awareness of dying is required.

The husband's untold account of his wife's breast cancer: a chronologic analysis.

Abstract: Purpose/objectives To identify husbands' perceived needs related to their wives' breast cancer and their view of how they can be helped to deal with the resultant challenges. Design Descriptive, qualitative. Setting Biobehavioral observational laboratory of a large urban research institute. Sample Nine husbands of women diagnosed with early-stage breast cancer, with a mean length of time since diagnosis of 2.4 years. Methods Two focus groups with five participants in the first and four in the second. Focus group questions were designed to facilitate the husbands' reports of their experiences. Main research variables The husbands' view of their lived experience with their wives' breast cancer and challenges across the illness trajectory; the content and process of how best to help them to deal with the challenges. Findings Husbands expressed their own personal and emotional concerns as well as a desire to support their wives. They asked for help to deal with their own personal concerns and to learn strategies to assist their wives with their experiences. Conclusions Husbands' concerns related to their wives' breast cancer changed across the illness trajectory. Husbands' misunderstandings about their own personal emotions hindered their ability to provide support to their wives. Expectations stemming from the male gender role guided husbands' attempts to provide emotional support to their wives that was complicated by an awareness of their inability to meet their wives' needs. Implications for nursing practice An urgent need exists for nurses to adjust individual practices and develop programs that address husbands' concerns in the time frame in which they are experienced. Husbands must be explicitly included as participants in their wives' journey and allowed opportunities to express and deal with personal concerns apart from their wives.

Fatigue in 7- to 12-year-old patients with cancer from the staff perspective: an exploratory study.

Abstract: Purpose/objectives To document and analyze the perspectives of staff members who provide direct care to 7- to 12-year-old patients with cancer regarding the nature and characteristics of fatigue, causes of fatigue, and effective interventions for this population of young patients. Design Exploratory. Settings A pediatric oncology unit at a children's hospital in the southwest and a pediatric research center for childhood catastrophic diseases in the mid-south. Sample A convenience sample of 38 staff members (8 advanced practice nurses, 23 staff nurses, 2 nurses managers, 3 nutritionists, 1 chaplain, and 1 physician) whose experience in pediatric oncology ranged from two months to 23 years. Methods Nine open-ended questions were posed to staff members during focus group sessions. Staff responses were analyzed using content analysis techniques and the Wilson concept analysis technique. Main research variable Staff perceptions of fatigue in 7- to 12-year-old patients with cancer. Findings Fatigue is a state of diminished to complete loss of energy or will that is influenced by environmental, biochemical, personal, cultural, and treatment-related factors. This state, which may be acute, episodic, or chronic, can be accompanied by a changing emotional or mental state. Conclusions Staff perceive fatigue to be a debilitating symptom for these children. When attempting to determine the presence or absence of fatigue, staff primarily compare a child's current state with his or her previous state rather than that of other children. Staff see themselves as having a role in causing and alleviating fatigue in this patient group. Implications for nursing practice Staff can use these findings to help them identify the presence of fatigue in these children and to identify contributing and alleviating factors.