Profiles of women's adjustment after cancer based on sexual and psychosocial wellbeing: results of a cluster analysis.

BACKGROUND: Sexual wellbeing is a critical yet often overlooked aspect of overall wellbeing for women across cancer diagnoses. OBJECTIVE: We identified profiles of women cancer survivors by sexual and psychosocial outcomes and compared groups for differences in relevant outcomes and individual characteristics. METHODS: Partnered women treated for cancer (n = 226; M age = 51.1 (12.6); 54% breast cancer; 86% White) completed a cross-sectional survey assessing sexual and psychosocial wellbeing. K-means cluster analysis modeled subgroups (clusters) with similar response patterns on measures of sexual wellbeing (sexual function, distress, sexual communication, and self-efficacy for communication), psychosocial wellbeing (quality of life (QOL), anxiety and depressive symptoms), and time since treatment. ANOVAs with Tukey post-hoc analyses and chi-square analyses tested cluster mean differences. RESULTS: Three distinct clusters of women differed by levels of adjustment in sexual and psychosocial wellbeing: higher-adjustment (32.7%), intermediate (37.6%), and lower-adjustment (29.6%). Significant differences among the clusters were found for all outcomes, with largest effect sizes for sexual distress (η2p = 0.66), sexual communication (η2p = 0.51), sexual satisfaction (η2p = 0.44), and anxiety and self-efficacy for communication (η2p = 0.32). The intermediate adjustment group was characterized by lower adjustment on measures of sexual and relationship function, and better adjustment on measures of QOL and mood. CONCLUSIONS: Findings suggest that for women cancer survivors, measures of sexual and psychosocial wellbeing can model distinct profiles to inform targeted interventions to meet women's needs. Evidence-based targeted interventions could lead to better sexual function, and ultimately to better QOL and overall wellbeing. IMPLICATIONS FOR PRACTICE: A stepped intervention approach to sexual health care for women with cancer, where content and format depend on degree of sexual and psychosocial adjustment after cancer, may be most appropriate. Interdisciplinary teams may address sexual, emotional, and relationship functioning.

Challenges of Cognitive Interviewing in Sensitive Health Topic Research.

BACKGROUND: Cognitive interviewing is a qualitative methodology for generating valid, reliable patient-centered outcome measures. There are challenges inherent in research on sensitive topics that require thoughtful approach by the scientist for data collection methods, analysis, and interpretation. OBJECTIVE: The purpose of this article is to provide principles of cognitive interviewing for sensitive health topics. METHODS: We review the challenges inherent in cognitive interviewing for sensitive topics scale development. We illustrate adaptations to general cognitive interviewing for sensitive topics through the presentation and analysis of a research exemplar. RESULTS: Researchers must consider threats to quality of sensitive topic data collection and potential harms to participants and researchers. We provide specific examples of how these risks were mitigated in a sensitive topic scale development study. DISCUSSION: Unique challenges of cognitive interviewing for sensitive health topics can be addressed with a well-planned data collection strategy, anticipating participant safety concerns, and consideration to researcher well-being.

The Self-Efficacy to Communicate about Sex and Intimacy (SECSI) scale: psychometric assessment in women treated for cancer.

PURPOSE: The purpose of this study was to conduct a preliminary validation of the psychometric performance of the newly developed Self-Efficacy to Communicate about Sex and Intimacy (SECSI) scale in a sample of women treated for cancer. METHODS: Partnered women (n = 250) who had received treatment for cancer completed an online survey that included the SECSI scale and measures of health-related quality of life, depression, anxiety, sexual function, sexual distress, self-efficacy for sexual functioning, sexual behaviors, relationship satisfaction, and satisfaction with sexual communication. Sociodemographic and clinical cancer characteristics data were collected. RESULTS: High internal consistency and strong test-retest reliability of the SECSI scale were shown with a Cronbach's alpha coefficient of 0.94 and test-retest reliability of r = 0.82, respectively. Construct validity of the SECSI scale, including discriminant, convergent, and divergent validity, was supported except regarding hypothesized relationships between SECSI scores and participant age and time since treatment. CONCLUSIONS: The SECSI scale is a valid, reliable measure for use with partnered women treated for cancer. Clinicians working with cancer survivors who may be at risk for difficulties communicating about sex and intimacy needs after cancer treatment may use this scale to identify women who would benefit from interventions to increase their confidence to communicate with their partner. The SECSI scale fills an important gap in ability to assess self-efficacy to communicate about sex and intimacy.

Implementing a multidisciplinary approach for older adults with Cancer: geriatric oncology in practice.

BACKGROUND: Evidence-based practice in geriatric oncology is growing, and national initiatives have focused on expanding cancer care and research to improve health outcomes for older adults. However, there are still gaps between knowledge and practice for older adults with cancer. MAIN TEXT: Here we provide a detailed methodology of geriatric oncology care delivery within a single institution. The Cancer and Aging Resiliency (CARE) clinic is a multidisciplinary approach for implementing geriatric-driven health care for older adults with cancer. The CARE clinic was developed as a direct response to recommendations targeting key multifactorial geriatric health conditions (e.g. falls, nutritional deficits, sensory loss, cognitive impairment, frailty, multiple chronic conditions, and functional status). The multidisciplinary team assesses and delivers a comprehensive set of recommendations, all in one clinic visit, to minimize burden on the patient and the caregiver. The CARE clinic consultative model is a novel approach integrating cancer subspecialties with geriatric oncology healthcare delivery. CONCLUSIONS: Older adults with cancer have unique needs that are independent of routine oncology care. The CARE clinic model provides specific assessments and interventions to improve health outcomes among older adults with cancer.

A Congregation Transition of Care Program Using Faith Community Nurses and Volunteer Faith-Based Nurses.

Transition of Care Models can reduce the 30-day hospital readmission rate up to 67% by offering coordination and continuity of care. The purpose of this project was to evaluate a Congregation Transition of Care (CTOC) program in faith-based communities with the use of a faith community nurse and volunteer faith-based registered nurses. Descriptive statistics were used to describe findings, revealing a CTOC program can be effective in reducing 30-day readmissions in the faith community.

Trauma-informed care: Insights from a Q-methodology study of advanced practice registered nursing students.

BACKGROUND: Trauma-informed care (TIC) aims to create a safe and supportive healthcare environment that empowers patients and cultivates understanding of the role trauma plays in short-term and long-term health. TIC also has the potential to improve health outcomes and foster clinician wellness. Nurse educators must design evidence-based instruction to develop advanced practice registered nurses (APRNs) who deliver high-quality TIC while also protecting their own wellbeing. OBJECTIVES: To identify patterns in subjective viewpoints about TIC among APRN students and describe how those patterns influence their learning experience in an advanced health assessment course. DESIGN: Q methodology was used to explore student perceptions of TIC. SETTING: A virtual advanced health assessment course at a large, midwestern university in the United States. PARTICIPANTS: Ninety-five APRN students from six specialty APRN programs. METHODS: Students completed an online Q-sort activity by ranking 32 TIC statements according to how well the statements aligned with their own perspectives. Q-sorts were analyzed using factor analysis and narrative responses to open-ended questions. RESULTS: Four factors were extracted that revealed different student viewpoints on TIC and their learning experiences: Comfortable/Confident Learners, Uncomfortable/Apprehensive Learners, Empathetic/Hesitant Learners, and Inexperienced/Uncertain Learners. CONCLUSIONS: All students acknowledged the need to learn about TIC to implement it effectively in practice. It is important for faculty to understand the potential range of divergent student viewpoints about TIC and acknowledge, accept, and support students who have anxiety related to learning about TIC.

Enhancing Pediatric Mental Health Care in an Outpatient Primary Care Setting Using the Keep Your Children/Yourself Safe and Secure (KySS) Program: A Multidisciplinary Quality Improvement Project.

INTRODUCTION: This project aimed to enhance access to pediatric mental primary health care. METHOD: The Keep Your Children/Yourself Safe and Secure (KySS) training was offered to a multidisciplinary team at a Federally Qualified Health Clinic in the Midwest United States. Confidence was measured using the Healthcare Provider Confidence Scale (HPCS). Frequencies of visits and mental health referrals were compared preintervention/postintervention. HPCS scores were compared using Wilcoxon rank-sum and Cohen's d. RESULTS: Referrals in 2022 were greater than in 2020 but less than in 2021 (p = .25). The total number of visits declined from 431 in 2021 to 385 in 2022. HPCS (n = 9) scores trended higher following the KySS Program in prescribing and general positive beliefs. DISCUSSION: Referrals to mental health providers increased, although not significantly. The number of mental health visits varied between 2020-2022. Provider confidence was not significantly affected, whereas beliefs in prescribing did increase significantly. More work is necessary to understand the impact of delivery to a multidisciplinary team.

Quality of life (QOL), supportive care, and spirituality in hematopoietic stem cell transplant (HSCT) patients.

For many patients, a hematopoietic stem cell transplant (HSCT) can be challenging to physical and emotional health. Supportive care needs can be overwhelming for many patients and families. The purpose of this study was to evaluate the effect of quality of life (QOL), spiritual well-being, and supportive care resources post-HSCT. This descriptive, repeated-measures study included people over the age of 18 years undergoing HSCT for any cancer diagnosis. The Functional Assessment in Cancer Therapy--Bone Marrow Transplant scale, the Functional Assessment of Chronic Illness Therapy--Spiritual--12 scale, and a resource questionnaire were administered prior to HSCT and following HSCT at 30, 60, 90, and 180 days. Three groups of HSCT patients were examined: allogeneic, autologous, and overall. Data analysis included descriptive statistics and correlations. In the sample (n = 159), the autologous HSCT group reported the highest QOL scores. Spirituality scores increased for the autologous HSCT group at 90 days, but decreased for the overall and allogeneic groups. The type of supportive care resources most used were information from the physician and nurse, the Leukemia and Lymphoma Society Support as the most used form of support group, and Faith, Prayer and Spiritual Healing. QOL and spiritual well-being scores correlated best at 180 days (6 months) for autologous and allogeneic patients.

Prediction of Malnutrition and the Relationships Among Pain, Function, Depression, and Cancer Stage in Older Women With Breast Cancer.

BACKGROUND: Older women diagnosed with breast cancer are at risk for malnutrition. OBJECTIVES: This article aims to evaluate the relationships among cancer stage, pain, functional status, depression, and malnutrition, and to determine whether these symptoms predict nutritional status. METHODS: This cross-sectional study included women (N = 72) aged 70 years or older diagnosed with breast cancer at an academic medical center in the midwestern United States. The Timed Up and Go Test, Activities of Daily Living Scale, Numeric Pain Rating Scale, Geriatric Depression Scale, and Mini Nutritional Assessment were used. Demographic characteristics were evaluated using descriptive statistics. Bivariate and point-biserial correlations and linear regressions were used. FINDINGS: Participants' Mini Nutritional Assessment scores were significantly related to cancer stage, pain, depression, and Activities of Daily Living Scale scores.

Resilience in Older Adults Diagnosed With Cancer and Receiving Chemotherapy.

BACKGROUND: Resilience is the capacity for physical and emotional recovery from stressful events like cancer diagnosis and treatment. OBJECTIVES: The objectives of this study were to review existing literature to understand and illustrate ways to assess and manage resilience when providing holistic care to older adults with cancer. METHODS: A review of the literature was conducted with a focus on assessment, management, and preservation of resilience in older adults with cancer. FINDINGS: Interventions to support resilience include managing problems that occur in the areas of nutrition, exercise, social support, cognition, functional status, and emotion. Cell cycle arrest using pharmacologic agents may provide a novel proactive approach to protect resilience from deteriorating during chemotherapy to treat cancer. The oncology nurse can assess and manage resilience. which can lead to better treatment outcomes.

Serious Illness Conversation Training for Inpatient Medical Oncology Advanced Practice Providers: A Quality Improvement Project.

Background: Hospitalized advanced cancer patients and their families are inadequately informed about their cancer diagnosis and prognosis, which limits educated and reasonable decision-making for their care and end-of-life planning. Objectives: The primary objective of this evidence-based project was to enhance serious illness conversations (SICs) with advanced cancer patients by providing advanced practice providers (APP) training and to increase the frequency of SIC documentation in the electronic medical record (EMR). Methods: SIC training included a 45-minute Zoom video recording and 30-minute discussion groups. Advanced practice providers' beliefs and self-efficacy were measured pre- and post-training via a survey. Prior training was queried in the pre-survey. Data from APP discussion groups were summarized and themes identified. Serious illness conversation documentation frequency was measured. Pre- and post-survey differences were assessed using Wilcoxon rank sum tests. Findings: 19 inpatient medical oncology nurse practitioners and 6 physician assistants participated. Many reported little formal training yet are engaging in SICs regularly. Scores on both the belief and self-efficacy survey sections were high prior to training and did not significantly change following training. Despite the high pre-survey scores, many of the APPs verbalized the need for more training to improve their confidence and to learn SIC communication skills. Training significantly improved the APP's ability to manage their own emotions and be present. This indicates a trend toward improved APP comfort with SICs. Accessible documentation in the EMR increased with training.

Educational Intervention to Enhance Nursing Comfort With Advance Care Planning and Documentation.

The objectives of this quality improvement project were to increase documentation of advance care planning (ACP) in the electronic health record (EHR) and improve nurses' self-reported comfort during discussions about end-o.

Falls in persons with chemotherapy-induced peripheral neuropathy.

PURPOSE: The purpose of this study was to evaluate possible risk factors for falls in a group of patients with chemotherapy-induced peripheral neuropathy (CIPN). METHODS: This prospective, descriptive study included persons receiving paclitaxel, docetaxel, oxaliplatin, or cispatin who reported at least one symptom of CIPN. Each patient was invited to complete the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) and a demographic data questionnaire. Data were analyzed using descriptive statistics and logistic regression. RESULTS: In this sample (n = 109), fallers (n = 21) had higher doses of chemotherapy(p = 0.045), more neuropathic symptoms (p = 0.016), higher scores on the symptom experience (p = 0.005) and interference items (=0.001) on the CIPNAT, more severe muscle weakness (p < 0.001) and loss of balance (p < 0.001), and higher interference with walking(p < 0.001) and driving (p = 0.022). Patients who received taxanes were more likely to have fallen than patients who received platinum-based chemotherapy (p = 0.022). No significant differences in age or disease stage between fallers and non-fallers were present. Severity of loss of balance and cycle number was independently associated with falling. CONCLUSIONS: This study demonstrates that the risk of falls increases with each cycle of chemotherapy and that patients receiving taxanes may be at greater risk of falls than patients receiving neurotoxic platinum-based drugs. Patients who report muscle weakness and loss of balance or say that their symptoms interfere with walking or driving may be at a higher risk of falls.

Perceptions of shared governance among nurses at a midwestern hospital.

Shared governance is a model of nursing leadership that drives practice. The purpose of this project was to determine whether nursing education, work experience, certification, employment position, setting (inpatient/ambulatory), participation in shared governance, and age were related and predictive of scores on the Index of Professional Nursing Governance (IPNG). The significance was to provide a basis on which to enhance a nursing shared governance model resulting in enhanced patient care. This prospective, cross-sectional study included nurses in any type of nursing role and with any level of educational preparation. An analysis of variance was employed to identify strength of relationships among the categorical or ordinal variables and regression models for the continuous variables. General linear models were used to identify the variables most predictive of IPNG scores. Of the 98 participants, most (96%) were women, 58% were bachelor's prepared, and 80% were staff nurses. The mean IPNG score was 186.5. No significant relationships were found among demographic measures and IPNG scores. A reported role in shared governance, when combined with work setting (inpatient or ambulatory), was predictive of IPNG scores. Nurses who worked in the inpatient setting reported higher mean IPNG scores.

Influence of Patient Functional Status and Depression on Strain in Caregivers.

BACKGROUND: Individuals who provide care to older adult women with breast cancer can experience distressing caregiver strain. OBJECTIVES: The purpose of this study was to determine whether functional status and depression in older adult women with breast cancer relates to strain in their caregivers. Relationships among caregiver characteristics and strain were also evaluated. METHODS: This multivariate, cross-sectional study used activities of daily living, instrumental activities of daily living, Timed Up and Go Test, Geriatric Depression Scale, and Modified Caregiver Strain Index (MCSI). Statistical analyses included Wilcoxon rank-sum tests and Spearman rank correlations. Logistic regression was used to predict MCSI scores. FINDINGS: Patient Timed Up and Go Test and Geriatric Depression Scale scores had the greatest impact on MCSI, with lower function and greater depression associated with increased caregiver strain. Advanced disease was associated with increased caregiver strain. When cancer stage is controlled for, caregiver employment is associated with increased strain.

The Complexity of Educating Acute Care Nurses on Opioid Use Disorder: A Quality Improvement Project.

BACKGROUND: Opioid use disorder (OUD) is a public health crisis, yet most acute care nurses are not educated to deliver evidence-based OUD care. Hospitalization provides a unique opportunity to initiate and coordinate OUD care in people presenting for other medical-surgical reasons. The aim of this quality improvement project was to determine the impact of an educational program on self-reported competencies of medical-surgical nurses caring for people with OUD at a large academic medical center in the Midwestern United States. METHOD: Data were collected from two time points using a quality survey examining self-reported nurse competencies related to (a) assessment, (b) intervention, (c) treatment recommendation, (d) resource use, (e) beliefs, and (f) attitudes toward caring for people with OUD. RESULTS: Nurses surveyed before education (T1G1, N = 123) and, after education, those who received the intervention (T2G2, N = 17) and those who did not (T2G3, N = 65) were included. Resource use subscores increased over time (T1G1: x = 3.83, T2G3: x = 4.07, p = .006). Results from the two measurement points found no difference in mean total scores (T1G1: x = 3.53, T2G3: x = 3.63, p = .09). Comparison of mean total scores of nurses who directly received the educational program with those who did not during the second time point showed no improvement (T2G2: x = 3.52, T2G3: x = 3.63, p = .30). CONCLUSIONS: Education alone was insufficient in improving self-reported competencies of medical-surgical nurses caring for people with OUD. Findings can be used to inform efforts to increase nurse knowledge and understanding of OUD and to decrease negative attitudes, stigma, and discriminatory behaviors perpetuating care.

Incorporating a Microlearning Wellness Intervention Into Nursing Student Curricula.

BACKGROUND: Cultivating healthy lifestyle beliefs (HLBs) can result in positive health outcomes for students during their nursing program. PURPOSE: The purpose of the study was to determine the effectiveness of short wellness interventions (microlearning) in nursing courses on reducing stress and anxiety and enhancing HLB. METHODS: Microlearning wellness interventions were offered to graduate and undergraduate nursing students in this cluster randomized intervention study. The Perceived Stress Scale 4, Generalized Anxiety Disorder 7, and Healthy Lifestyle Beliefs Scales were administered. Student perceptions were evaluated using a short answer narrative. RESULTS: The intervention group reported higher HLB (P = .15), lower anxiety (P = .06), and lower stress (P = .06) compared with the control group after adjusting for baseline differences. Student comments were favorable and included enjoying the activities, weight loss success, and mindfulness strategies. CONCLUSIONS: Incorporating wellness interventions into nursing curricula demonstrates a positive trend toward reducing anxiety and stress and improving HLB.

Self-Reported and Performance-Based Evaluations of Functional Status in Older Women With Breast Cancer.

OBJECTIVES: To evaluate self-reported and performance-based functional status (FS) in older women with breast cancer according to stage and time of visit during treatment. SAMPLE & SETTING: 72 women with breast cancer aged 78 years or older and receiving any type of treatment at a midwestern outpatient clinic. METHODS & VARIABLES: FS was evaluated using grip strength, the Index of Activities of Daily Living (ADLs), the instrumental ADLs (IADLs) scale, and the Timed Up and Go Test (TUGT). Mixed models were fit for grip strength and the TUGT, and generalized estimating equations were used to fit binary logistic regressions for the Index of ADLs and the IADLs scale. Continuous FS outcomes were evaluated using means and standard deviations. RESULTS: Cancer stage and time of visit did not affect self-reported or performance-based FS scores. Most participants were considered independent on the Index of ADLs, the IADLs scale, and the TUGT, which did not change significantly between visits. Self-reported measures revealed less impairment. IMPLICATIONS FOR NURSING: Monitoring FS using self-reported and performance-based measures can ensure that older patients receive timely support.

Landmarks in geriatric oncology.

The knowledge of Geriatric Oncology requires some information on her history.Thanks to the effort of investigators throughout the world, embattled but undeterred by the objection of a cautious establishment, geriatric oncology has provided a blueprint for the treatment of the most common form of cancer: cancer in the older person. The history of Geriatric Oncology may be divided in three periods: Prehistory,Past and Contemporay history.

A Quality Improvement Project Using Microlearning to Increase Provider Adherence to Extragenital Sexually Transmitted Infection Screening Guidelines in Men Who Have Sex With Men.

ABSTRACT: The Centers for Disease Control and Prevention (CDC) recommend screening men who have sex with men who are living with HIV for sexually transmitted infections at appropriate extragenital contact sites for bacterial sexually transmitted infections. In an effort to increase provider adherence to CDC recommended guidelines at a Ryan White Clinic, microlearning educational sessions were used. A quality improvement project was designed to determine the rate of provider adherence to CDC guidelines pre/post microlearning sessions. Student t-test was used to compare the number of patients who received urine and extragenital screening to those who received urine-only screening, to before and after the microlearning sessions. The rate of extragenital screening significantly increased after the microlearning sessions (4/460 vs. 70/507, p < .0001). The rate of urine screening remained unchanged (p = 1). Although extragenital screening significantly increased, it remained low. A decision tree in the electronic medical record to prompt providers to screen was developed.