Application of the ConNECT Framework to achieve digital health equity.

BACKGROUND: The emphasis on digital technology and informatics in health care (digital health) has introduced innovative ways to deliver health care and engage populations in health research. However, inadequate attention to the development and implementation of digital health interventions can exacerbate health disparities. PURPOSE: We applied the transdisciplinary ConNECT Framework principles within the context of digital health, with an aim to describe strategies to achieve digital health equity. METHODS: We described the five ConNECT principles of (a) integrating context, (b) fostering a norm of inclusion, (c) ensuring equitable diffusion of innovations, (d) harnessing communication technology, and (e) prioritizing specialized training within the framework of achieving digital health equity. FINDINGS AND DISCUSSION: We describe proactive, actionable strategies for the systematic application of the ConNECT Framework principles to address digital health equity. Recommendations to reduce the digital health divide in nursing research and practice are also described.

Fatigue-related symptom clusters and functional status of older adults in hospice.

BACKGROUND: Fatigue is frequently co-existing with other symptoms and is highly prevalent among patients with cancer and geriatric population. There was a lack of knowledge that focus on fatigue clusters in older adults with cancer in hospice care. OBJECTIVES: To identify fatigue-related symptom clusters in older adult hospice patients and discover to what extent fatigue-related symptom clusters predict functional status while controlling for depression. METHOD: This was a cross-sectional study in a sample of 519 older adult hospice patients with cancer, who completed the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression, Boston Short Form Scale, and the Palliative Performance Scale. Data from a multi-center symptom trial were extracted for this secondary analysis using exploratory factor analysis and hierarchical multiple regression analysis. RESULTS: Data from 519 patients (78 ± 7 years) with terminal cancer who received hospice care under home healthcare services revealed that 39% of the participants experienced fatigue-related symptom clusters (lack of energy, feeling drowsy, and lack of appetite). The fatigue cluster was significantly associated positively with depression (r = 0.253, p < 0.01), and negatively with functional status (r = -0.117, p < 0.01) and was a strong predictor of participants' low functional status. Furthermore, depression made a significant contribution to this predictive relationship. CONCLUSION: Older adult hospice patients with cancer experienced various concurrent symptoms. The fatigue-specific symptom cluster was identified significantly associated with depression and predicted functional status. Fatigue should be routinely monitored in older adults, especially among hospice cancer patients, to help reduce psychological distress and prevent functional decline.

A Review and Conceptual Analysis of Cancer Pain Self-Management.

OBJECTIVES: In this concept analysis article, we will clarify the concept "self-management of cancer pain" by identifying related antecedents, attributes, and consequences to further refine the conceptual and operational definitions of the concept. DESIGN: A review was conducted. REVIEW/ANALYSIS METHODS: The Walker and Avant method was used for this concept analysis. DATA SOURCES: CINAHL, PubMed, and PsycInfo were searched systemically.A total of eight studies on "self-management of cancer pain or self-care of cancer pain" published between 2004 and 2019 were identified. RESULTS: Attributes for self-management of cancer pain include self-efficacy, integration of methods for pain relief into daily life, decision-making related to pain management, process for solving pain-related issues, and initiation of interactions with healthcare professionals. Antecedents include knowledge regarding pain assessment and management, cognitive abilities, motivation, undergoing pain treatment, patient education and counseling, social support, and accountability from all parties involved. Consequences include pain control, improved quality of life, and increased opioid intake. CONCLUSIONS: Self-management of cancer pain was reported to be a self-regulation process with the aim to encourage patients to use skills attained through development of self-efficacy, so they can actively participate in their pain management. This outcome may enhance their quality of life by decreasing their pain, depression, and anxiety and increasing the availability of social support.

Feasibility of the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors.

OBJECTIVE: The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement. METHODS: A single group, pre-posttest design was implemented among female stages 0-III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress-reducing intervention that combines sitting and walking meditation, body scan, and yoga and is designed to deliver weekly 2-hour sessions for 6 weeks using an iPad. RESULTS: The mean age of the 15 enrolled BCS was 57 years; one participant was non-Hispanic black, and 14 were non-Hispanic white. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post-mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue, and quality of life (P's < .05). Effect sizes for improvements of multiple symptoms ranged from medium to large. CONCLUSIONS: These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer.

Validation of the Spanish version of the Cancer Symptom Scale in Hispanic cancer patients.

AIM: To assess the validity of the translated Spanish Cancer Symptom Scale. BACKGROUND: Instruments to facilitate comprehensive and objective assessments of the cancer symptom experience in underrepresented populations are essential. METHODS: The Cancer Symptom Scale was translated into Spanish, and a back translation was conducted. During June 2016, a sample of 121 Hispanic Puerto Rican patients with any cancer diagnosis, all undergoing cancer treatments, completed four paper surveys. A subgroup of 15 patients agreed to complete the Spanish Cancer Symptom Scale a second time after a short delay of 1 to 2 hours. Construct validity and reliability (internal consistency via Cronbach alpha and test-retest reliability) was evaluated. RESULTS: All the Intensity Items of the Spanish Cancer Symptom Scale correlated significantly with the matched items on the MD Anderson Symptom Inventory. In a subgroup of 77 participants, each Cancer Symptom Scale subscale total of scores correlated significantly with the total scores from the Functional Assessment of Cancer Therapy-General. Discriminant validity was demonstrated between those receiving chemotherapy and those from post treatment. The Spanish Cancer Symptom Scale internal consistency reliability was 0.98. CONCLUSION: The Spanish Cancer Symptom Scale has excellent evidence of validity and reliability for assessing cancer-therapy-related symptoms.

Nurses' experiences of communicating with hospitalized, suddenly speechless patients.

We used a qualitative focus group design to explore the experiences and challenges of nurses who work with hospitalized patients experiencing the sudden inability to verbalize their needs, also known as sudden speechlessness. In response to open-ended questions in facilitated focus groups, 18 nurses discussed issues around the care and communication needs of suddenly speechless (SS) patients. Nurses identified multiple, commonly occurring communication challenges when caring for SS patients. They believed these challenges led to poorer recognition of patient needs, with the potential for compromised patient care. Nurses described how the lack of reliable strategies to facilitate communication sometimes resulted in negative patient outcomes, including unmet psychosocial needs and the potential that informed consent and educational issues were being inadequately addressed for the SS patients. Even experienced nurses indicated ongoing problems in communicating with SS patients, despite using a multitude of strategies, leaving many to deal with issues of frustration and role conflict.

Telehealth Interventions in Head and Neck Cancer Patients: A Systematic Review.

BACKGROUND: Head and neck cancer (HNC) and its treatments often result in adverse effects that impair a patient's quality of life. Although intensive rehabilitative strategies can be used, their applicability can be limited due to patient-specific and socioeconomic barriers. Telehealth interventions represent a possible novel approach to increase access to these services and improve posttreatment quality of life in the HNC population. OBJECTIVE: The objective of this systematic review was to identify studies investigating telemedicine-based interventions for HNC patients to determine whether there is a consensus concerning the cost-effectiveness, clinical utility, and accessibility of this model for rehabilitation. METHODS: PubMed, EMBASE, Web of Science, and CINAHL were used to identify literature without time limit for publication. A critical appraisal of individual sources was conducted by 2 reviewers. Sixteen studies met inclusion criteria. RESULTS: Studies related to telehealth interventions in the HNC population are limited. Salient themes included feasibility of telehealth as an intervention, effects on self-management and knowledge, impact on quality of life, physical and psychiatric symptoms, and cost. CONCLUSION: Although the current literature presents promising data, indicating that telehealth interventions may be both effective and cost-efficient in the management of HNC patients, more research is needed to definitively elucidate their role in management. IMPLICATIONS FOR PRACTICE: Telehealth interventions are valuable for clinicians as an alternative to expand access to care across the cancer continuum, to strengthen patients' knowledge and consequently their self-management, and to provide continuity of services as well as for remote monitoring of symptoms and response to treatment.

Caregiver burden in caregivers of patients with advanced stage cancer: A concept analysis.

PURPOSE: Caregiver burden is a term used to describe the strain endured by the family member who is providing care for a patient and does not have formal training to do so. Caregiver burden is associated with a lack of self-efficacy, a decrease in the caregiver's quality of life, and high levels of anxiety and depression, that can worsen over time, impacting the well-being of the dyad. Due to the dynamic nature of caregiver burden, the precise understanding of this condition in relation to advanced stage cancer patients has not been fully conceptualized. Clarity of the nature of caregiver burden guides researchers, policy makers, and providers with a better understanding of what is needed to detect who the caregivers are and who is at most risk for severe caregiver burden. METHOD: An electronic search of the literature using PubMed, CINAHL, PsycINFO, and Cochrane Library databases informed the analysis. Quantitative and qualitative studies related to caregiver burden of the cancer patient, published in English between 2000 and 2021 were used. RESULTS: Of the over 20,000 articles initially identified, 19 ultimately met the inclusion criteria. Analysis identified the defining attributes of caregiver burden of the advanced stage cancer patient as: (1) decreased self-efficacy, (2) decreased quality of life, (3) increased anxiety, (4) increased depression, (5) and time sensitivity. Antecedents were identified as predictors of negative outcomes without intervention. Consequences were highlighted for those who are not supported. CONCLUSIONS: Caregiver burden impacts more than 2.8 million informal caregivers in the United States, who are providing complex care to patients with cancer without proper preparation. The conceptual understanding of caregiver burden guides the design of specific interventions to identify and prepare the caregiver for their critical role.

Medical Cannabis as Adjunctive Therapy for Head and Neck Cancer Patients.

The goal of this systematic review was to define a consensus within the current literature regarding the impact/effect of cannabis or cannabinoids on the treatment of patients with head and neck cancer. We conducted a review of PubMed, Embase, and Web of Science databases, using a comprehensive search strategy, focusing on articles relating to head & neck cancer and cannabis/cannabinoids without a time limit for publication. Two, independent reviewers screened articles based on title/abstract and included the ones selected by both. We then conducted a full-text review and excluded all articles which did not meet inclusion criteria. A single reviewer then assessed studies for methodological quality and extracted relevant data using a premade data collection tool. We identified five studies that met inclusion criteria. Studies were of varying quality and the majority investigated recreational cannabis use with only one study reporting dosing across participants. Lack of standardized cannabis exposure presents a wide array of potential confounding variables across the remaining studies. Meta-analysis was not attempted due to variability in reported outcomes. It is impossible to draw any conclusions regarding the benefit or adverse effects of current medical cannabis products in this patient population. The literature regarding the effect of cannabis/cannabinoids on head & neck cancer patients is limited. However, the current lack of evidence does not definitively disprove the efficacy of cannabis. High-quality studies are necessary for physicians to provide advice to patients who are either using or interested in cannabis as an adjunctive treatment.

Communication needs of nonspeaking hospitalized postoperative patients with head and neck cancer.

Treatment of head and neck cancers is often associated with temporary or permanent speech impairments, limiting patients' ability to self-report critical information during the acute care hospitalization period after surgery. Eleven patients unable to speak after head and neck cancer surgery, eight family caregivers, and eight RNs were included in this descriptive pilot study. All participants completed a researcher-developed 5-item survey (from their perspectives) consisting of questions that explored patients' difficulty in communicating, difficult topics to communicate, and individuals with whom patients had difficulty communicating. Study findings emphasized the importance that patients, family caregivers, and nurse assign to the communication of symptoms experienced during the acute postoperative period. In addition, the RN was identified as the health care team member with whom patients had the most communication difficulties. Findings support the participation of patients, family caregivers, and nurses in the selection and implementation of interventions that enhance communication after surgery.

Stress and depression in the context of migration among Haitians in the United States.

Our global communities are becoming increasingly more diverse and interwoven; thus, research that enhances our understanding of the multidimensional relationship between depression and migration among distinct ethnic groups is imperative. This study examined the relationship between migration-related stress and depression and the extent to which that relationship is modified by other factors, through the lens of the stress process model. This cross-sectional pilot study used purposive sampling methods to recruit 76 first-generation Haitian immigrants living in South and West Florida from February 2018-May 2018. Descriptive statistics, bivariate and multiple regressions were utilized to assess associations among migration-related stress (Demands of Immigration Scale), depression (Center for Epidemiological Studies Depression (CESD), Zanmi Lasante Depression Symptom Inventory (ZLDSI)), and key demographic variables. Findings showed a strong positive correlation between migration-related stress and depression (CESD (ß =.606, 95% CI [.296, .556]) and ZLDSI (ß = .624, 95% CI [.242, .440]). Relative to the standardized coefficient, migration-related stress was the strongest predictor of depression after controlling for other predictors. Presence at the 2010 earthquake was the only significant moderator, showing an amplifying effect between migration-related stress and depression (ZLDSI) for those in Haiti during the 2010 earthquake. Consideration of pre-migration factors and the degree of migration-related stress encountered while adapting to life post-migration is critical because they play a significant role in shaping immigrants' depression realities. Community-based services that incorporate or partner with established immigrants to strengthen support for the most vulnerable immigrants early on after migration could serve to mitigate migration-related stressors and facilitate mental health promotion and prevention.

Gut microbiota differences in Island Hispanic Puerto Ricans and mainland non-Hispanic whites during chemoradiation for rectal cancer: A pilot study.

PURPOSE: To investigate whether there are differences in diversity, taxonomic composition, and predicted functional pathways of the gut microbiome between Island Hispanic Puerto Ricans (HPR) and mainland non-Hispanic whites (NHW) measured before and at the end of chemo-radiation (CRT) for Rectal Cancer. METHODS: Fifty-six stool samples of newly diagnosed rectal cancer patients (25 HPR and 31 NHW) were amplicon-sequenced during chemo-radiotherapy. 16S rRNA gene data was analyzed using QIIME2, phyloseq, and LEfSe. RESULTS: We observed similar within-sample alpha diversity for HPR and NHW participants during CRT. However, at the end of CRT, several taxa were present at significantly different abundances across both groups. Taxa enriched in the gut of HPR compared to NHW included Muribaculaceae, Prevotella 2 and 7, Gemella, Bacillales Family XI, Catenibacterium, Sutterella, Pasteurellales, and Pasteurellaceae genera, whereas over-represented taxa in NHW participants were Turicibacter and Eubacteriaceae. Significant differences in predicted HPR microbiota functions included pathways for synthesis of L-methionine and degradation of phenylethylamine and phenylacetate. CONCLUSION: In this pilot study, taxonomic analyses and functional predictions of the gut microbiomes suggest greater inflammatory potential in gut microbial functions among HPR rectal cancer patients undergoing CRT compared to that of NHW participants.

Stress Management Intervention to Prevent Post-Intensive Care Syndrome-Family in Patients' Spouses.

BACKGROUND: Post-intensive care syndrome-family (PICS-F) refers to acute and chronic psychological effects of critical care on family members of patients in intensive care units (ICUs). Evidence suggests that increased distress during the ICU stay increases risk of PICS-F. Sensation Awareness Focused Training (SAF-T) is a new, promising stress management intervention, but the feasibility of such training during the ICU stay for family caregivers who are acting as the surrogate decision-maker for patients who are undergoing mechanical ventilation is unknown. OBJECTIVES: To assess feasibility and acceptability of SAF-T to inform a future larger randomized controlled trial. METHODS: This randomized controlled trial of SAF-T (n = 5) versus a control (n = 5) group was conducted at a level 1 trauma center. Participants assigned to SAF-T completed 1 session daily for 3 days. Measures included enrollment rate, data completion rate, acceptability of SAF-T, and symptoms of PICS-F. Scales used included Perceived Stress, Hospital Anxiety and Depression, Impact of Event, and National Institutes of Health Toolbox Emotion Battery. RESULTS: Mean age was 58 (SD, 12) years; 70% of participants were female. Predetermined feasibility criteria were met in enrollment rate (67%), outcome measures completion rate (> 90%), and SAF-T acceptability (100% of doses completed during the ICU stay) without adverse events. Stress scores after SAF-T were significantly lower than scores before SAF-T (z = -3.5, P = .01). CONCLUSIONS: SAF-T intervention during the ICU stay is feasible, acceptable, and may improve family caregivers' post-ICU outcomes. Larger clinical trial to assess the effectiveness of SAF-T in preventing PICS-F seem warranted.

Enhancing the Communication of Suddenly Speechless Critical Care Patients.

BACKGROUND: Sudden speechlessness is common in critically ill patients who are intubated or have had surgery for head and neck cancer. Sudden inability to speak poses challenges for hospitalized patients because strategies to facilitate communication are often limited and unreliable. OBJECTIVE: To determine the impact of a technology-based communication intervention on patients' perception of communication difficulty, satisfaction with communication methods, and frustration with communication. METHODS: A quasi-experimental, 4-cohort (control and intervention) repeated-measures design was used. Data were collected daily for up to 10 days. Patients in adult critical care units were followed up as they were transferred to other units within the institutions selected for the study. The impact of a technology-based communication system (intervention) was compared with usual care (control). Patients' communication outcomes pertinent to communication with nursing staff that were evaluated included perception of communication ease, satisfaction with methods used for communication, and frustration with communication. RESULTS: Compared with participants in the control group, participants in the intervention group reported lower mean frustration levels (-2.68; SE, 0.17; 95% CI, -3.02 to -2.34; P < .001) and higher mean satisfaction levels (0.59; SE, 0.16; 95% CI, 0.27 to 0.91; P < .001) with use of the communication intervention. Participants in the intervention group reported a consistent increase in perception of communication ease during the hospital stay. CONCLUSIONS: The results facilitated evaluation of a bedside technology-based communication intervention tailored to the needs of suddenly speechless critically ill patients.

Speech impairment in the postoperative head and neck cancer patient: nurses' and patients' perceptions.

Communication between postoperative head and neck cancer patients with speech impairment and their health care providers is challenging. These challenges emerge during a period when the patient must communicate needs related to symptoms such as pain or concerns of significance in the absence of the traditional communication process. Content analysis methods facilitated understanding of the perspective of the postoperative head and neck cancer patient experiencing pain and a speech impairment, and the examination of the nurses' view in the assessment and management of this population. The authors identified self-report of pain as a critical component of pain assessment regardless of the presence of a speech impairment. Significant levels of frustration were associated with the nurses' goal of addressing the pain management needs of the speech impaired and the patients' pursuit of reporting the uniqueness of their pain experience.

Pain measurement in older adults with head and neck cancer and communication impairments.

The ability to communicate the presence of pain by means of verbal and nonverbal communication is crucial to facilitate the assessment of pain. Patients with communication impairment (CI) are limited in their ability to verbally report their pain and, consequently, mechanisms to elicit information about the pain experience must incorporate simple and valid methods to accomplish this goal. Pain measurement and the impact of the pain experience in older adults with CI are areas that have been studied on a limited basis in nursing. This study compared the effectiveness of 3 pain assessment tools in measuring pain intensity in the older adults with head and neck cancer and with CI. Multivariate repeated-measures analysis of variance revealed that there were no significant differences in the mean pain intensity scores when subjects used the Numeric Rating Scale, the Faces Pain Scale, and the Visual Analogue Scale at 3 different time intervals. The highest correlation coefficients between pain measurement tools were identified during the third time when the pain measurement tools were used to rate pain intensity. Subjects identified the Numeric Rating Scale as the preferred method to rate pain intensity. Canonical correlation analysis demonstrated that among the demographic variables evaluated in the study, education explained the largest variance in composite of the pain measurement scales.

Development of a communication intervention to assist hospitalized suddenly speechless patients.

Healthcare staff face significant challenges while caring for hospitalized patients experiencing sudden inability to verbalize their needs (sudden speechlessness). Familiar methods of communication such as non-verbal strategies are limited and often fail to assist suddenly speechless patients (SS) communicate their needs. Consequently, strategies tailored to the needs of hospitalized speechless patients are necessary, and must consider factors intrinsic to the patients and the complexities of the acute care environment. The feasibility and usability of a multi-functional prototype communication system (speech-generating device) tailored to the needs of hospitalized SS patients was evaluated in this pilot study. Adult SS patients admitted to the intensive care setting (n=11) demonstrated independent use of a multi-functional communication system that integrated messages and strategies tailored to the needs of the hospitalized SS patient. Participants reported high satisfaction levels and considered the use of the technology of high importance during an SS event. Additional research should focus on evaluating the impact of technology specific communication interventions on enhancing the communication process between SS patients and healthcare staff.

Prevalence of sudden speechlessness in critical care units.

Sudden speechlessness (SS) is commonly experienced by patients admitted to critical care units. Although literature findings document challenges associated with periods of SS, the prevalence is unknown. The purpose of this study is to determine the prevalence and characteristics of adult SS patients in four critical care units at a university-affiliated tertiary care hospital. Data are collected on 9 randomly selected days over a 4-month period. The daily prevalence of SS ranges from 16% to 24% in each unit. Characteristic data collected includes patient age, gender, medical diagnosis related to SS episode, type of speechlessness, days since SS began, and communication strategies in use. Respiratory intubation related to various clinical diagnoses is the main cause for SS. Use of multiple specific strategies to convey needs during SS periods are identified. Follow-up studies to further define the prevalence of SS in settings beyond the critical care environment are recommended.