Treatment complexity: a description of chemotherapy and supportive care treatment visits in patients with advanced-stage cancer diagnoses.

PURPOSE: Modern chemotherapy regimens are growing increasingly complex, involving lengthy outpatient infusions, and additional visits for supportive care. The treatment of advanced-stage patients is uniquely one of unremitting therapy and varying complexity. The study's purpose was to describe and quantify the dimensions of treatment complexity in terms of chemotherapy (CT) and supportive care (SC) visits. METHODS: Electronic medical records for 121 subjects with stages III and IV cancer were reviewed. Visits were classified as SC and CT types, and actual hours and visit numbers were calculated for a 3-month treatment period. Analysis included descriptive and generalized linear modeling statistics. RESULTS: Subjects ≥65 years spent fewer total hours (M = 18.17 h, SD = 10.17 h, p = 0.04), but experienced more total visits (M = 10.96 visits, SD = 4.65 visits, p = 0.02) than younger subjects. More than 71% of younger patients spent two or more hours per chemotherapy visit, compared to 41.7% of older patients (p = 0.001). Older subjects were more likely to have a SC visit (p = 0.03), but did not differ from younger subjects in SC visit numbers (p = 0.3) or hours (p = 0.6). Females averaged 3.81 more total hours (M = 22. 61 h, SD = 11.06 h, p = 0.055) and had more total visits (M = 10.80 visits, SD = 3.71, p = 0.02) than males. By visit type, women spent twice the hours undergoing SC than males (M = 3.3 vs. 1.5 h, p = 0.051), but genders did not differ in CT visit hours or average length. By diagnosis, colon/esophageal subjects spent more hours in CT visits (M = 21.90 h, SD = 8.60 h, p < 0.01), and lung subjects trended toward spending more hours in SC visits (M = 4.80 h, SD = 8.23 h, p < 0.06). CONCLUSIONS: Advanced-stage cancer patients differed in visit types, hours, and treatment length undergoing CT and SC visits. Age, gender, and diagnosis explained the differences, and this study adds new understanding to the phenomenon of treatment complexity.

Struggling, Adapting, and Holding Each Other Up: A Qualitative Study of Oncology Nurses During the First Year of the COVID-19 Pandemic.

PURPOSE: To explore the experience of oncology nurses during the first year of the COVID-19 pandemic. PARTICIPANTS & SETTING: 21 RNs, advanced practice RNs, and physician associates from inpatient and ambulatory care settings at a comprehensive cancer center in the northeastern United States. METHODOLOGIC APPROACH: A qualitative study using interpretive description was conducted through semistructured interviews. Data were recorded and transcribed verbatim, reviewed for accuracy, and coded into themes following an iterative process of analysis. FINDINGS: The theme of "Doing It Together: Struggling, Adapting, and Holding Each Other Up" describes the experience of oncology nurses during the first year of the COVID-19 pandemic. The following three themes provide further insight: "Struggling With Constant Change and Uncertainty," "Managing Workload Intensity," and "Experiencing Emotional Distress." As the year progressed, "Identifying Benefits and Finding Hope" began to emerge. IMPLICATIONS FOR NURSING: The findings suggest a need for programs to help nurses cope with the continuing effects of the COVID-19 pandemic, mental health and well-being resources, and nursing guidelines for telehealth and relocation to other units.

Optimism, Symptom Distress, Illness Appraisal, and Coping in Patients With Advanced-Stage Cancer Diagnoses Undergoing Chemotherapy Treatment.

PURPOSE/OBJECTIVES: To explore the relationships between optimism, self-efficacy, symptom distress, treatment complexity, illness appraisal, coping, and mood disturbance in patients with advanced-stage cancer.
. DESIGN: Cross-sectional study.
. SETTING: Smilow Cancer Hospital at Yale New Haven in Connecticut, an outpatient comprehensive cancer center.
. SAMPLE: A convenience sample of 121 adult patients with stages III-IV cancer undergoing active chemotherapy.
. METHODS: Participants completed common self-report questionnaires to measure variables. Treatment hours and visits were calculated from data retrieved from medical record review. Mediation and path analysis were conducted to identify direct and indirect pathways from the significant antecedent variables to mood disturbance.
. MAIN RESEARCH VARIABLES: Dispositional optimism, self-efficacy, social support, treatment complexity, symptom distress, illness appraisal, coping, and mood disturbance.
. FINDINGS: Greater optimism and self-efficacy were associated with less negative illness appraisal, less avoidant coping, and decreased mood disturbance. Conversely, greater symptom distress was associated with greater negative illness appraisal, greater avoidant coping, and greater mood disturbance. In the final model, optimism and symptom distress had direct and indirect effects on mood disturbance. Indirect effects were partially mediated by illness appraisal.
. CONCLUSIONS: Mood disturbance resulted from an interaction of disease stressors, personal resources, and cognitive appraisal of illness. Avoidant coping was associated with greater disturbed mood, but neither avoidant nor active coping had a significant effect on mood in the multivariate model. 
. IMPLICATIONS FOR NURSING: Illness appraisal, coping style, and symptom distress are important targets for intervention. Optimism is a beneficial trait and should be included, along with coping style, in comprehensive nursing assessments of patients with cancer.

Describing clinical faculty experiences with patient safety and quality care in acute care settings: A mixed methods study.

BACKGROUND: A major safety initiative in acute care settings across the United States has been to transform hospitals into High Reliability Organizations. The initiative requires developing cognitive awareness, best practices, and infrastructure so that all healthcare providers including clinical faculty are accountable to deliver quality and safe care. OBJECTIVE: To describe the experience of baccalaureate clinical nursing faculty concerning safety and near miss events, in acute care hospital settings. METHODS: A mixed method approach was used to conduct the pilot study. Nurse faculty (n=18) completed study surveys from the Agency for Healthcare Research and Quality (AHRQ) to track patient safety concerns: Incidents; Near misses; or Unsafe conditions, during one academic semester, within 9 different acute care hospitals. Additionally, seven nurse faculty participated in end of the semester focus groups to discuss the semester long experience. RESULTS: Clinical faculty identified a total of 24 patient occurrences: 15 Incidents, 1 Near miss event, and 8 Unsafe conditions. Focus group participants (n=7) described benefits and challenges experienced by nursing clinical faculty and students in relation to the culture of safety in acute care hospital settings. Six themes resulted from the content analysis. CONCLUSIONS: Utilizing nursing clinical faculty and students may add significant value to promoting patient safety and the delivery of quality care, within acute care hospital settings.