Prehabilitation in patients with cirrhosis awaiting liver transplantation: protocol of a feasibility study.

INTRODUCTION: Patients with cirrhosis awaiting liver transplantation (LT) are often frail, and malnourished. The period of time on the waitlist provides an opportunity to improve their physical fitness. Prehabilitation appears to improve the physical fitness of patients before major surgery. Little is known about prehabilitation in patients with cirrhosis. The aim of this feasibility study will be to investigate the feasibility, safety, and effectiveness of a multimodal prehabilitation programme in this patient population. METHODS AND ANALYSIS: This is an open-label single-arm feasibility trial recruiting 25 consecutive adult patients with cirrhosis active on the LT waiting list of the McGill University Health Centre (MUHC). Individuals will be excluded based on criteria developed for the safe exercise training in patients with cirrhosis. Enrolled individuals will participate in a multimodal prehabilitation programme conducted at the PeriOperative Programme complex of the MUHC. It includes exercise training with a certified kinesiologist (aerobic and resistance training), nutritional optimisation with a registered dietician and psychological support with a nurse specialist. The exercise training programme is divided into an induction phase with three sessions per week for 4 weeks followed by a maintenance phase with one session every other week for 20 weeks. Aerobic training will be individualised based on result from cardiopulmonary exercise testing (CPET) and will include a high-intensity interval training on a cycle ergometer. Feasibility, adherence and acceptability of the intervention will be assessed. Adverse events will be reviewed before each visit. Changes in exercise capacity (6-minute walk test, CPET, liver frailty index), nutritional status and health-related quality of life will be assessed during the study. Post-transplantation outcomes will be recorded. ETHICS AND DISSEMINATION: The research ethics board of the MUHC has approved this study (2021-7646). Our findings will be submitted for presentation at national and international conferences, and for peer-reviewed publication. TRIAL REGISTRATION NUMBER: NCT05237583.

Reporting quality of randomized controlled trials in prehabilitation: a scoping review.

BACKGROUND: Inadequate study reporting precludes interpretation of findings, pooling of results in meta-analyses, and delays knowledge translation. While prehabilitation interventions aim to enhance candidacy for surgery, to our knowledge, a review of the quality of reporting in prehabilitation has yet to be conducted. Our objective was to determine the extent to which randomized controlled trials (RCTs) of prehabilitation are reported according to methodological and intervention reporting checklists. METHODS: Eligibility criteria: RCTs of unimodal or multimodal prehabilitation interventions. SOURCES OF EVIDENCE: search was conducted in March 2022 using MEDLINE, Embase, PsychINFO, Web of Science, CINAHL, and Cochrane. CHARTING METHODS: identified studies were compared to CONSORT, CERT & Modified CERT, TIDieR, PRESENT, and CONSORT-SPI. An agreement ratio (AR) was defined to evaluate if applicable guideline items were correctly reported. Data were analyzed as frequency (n, %) and mean with standard deviation (SD). RESULTS: We identified 935 unique articles and included 70 trials published from 1994 to 2022. Most prehabilitation programs comprised exercise-only interventions (n = 40, 57%) and were applied before oncologic surgery (n = 32, 46%). The overall mean AR was 57% (SD: 20.9%). The specific mean ARs were as follows: CONSORT: 71% (SD: 16.3%); TIDieR: 62% (SD:17.7%); CERT: 54% (SD: 16.6%); Modified-CERT: 40% (SD:17.8%); PRESENT: 78% (SD: 8.9); and CONSORT-SPI: 47% (SD: 22.1). CONCLUSION: Altogether, existing prehabilitation trials report approximately half of the checklist items recommended by methodological and intervention reporting guidelines. Reporting practices may improve with the development of a reporting checklist specific to prehabilitation interventions.

Assessing the relationship between physical fitness activities, cognitive health, and quality of life among older cancer survivors.

Chemotherapy-related cognitive impairment, known as "chemobrain," has been described as a side effect of chemotherapy and is associated with cognitive changes on quality of life especially among older cancer survivors. This longitudinal feasibility study examined the relationship between physical fitness, cognitive health, and quality of life among two groups of older adults: those on chemotherapy, and those who have completed chemotherapy. To assess cognitive health, we used the Montreal Cognitive Assessment and demographic information from the Healthy Brain Questionnaire. For quality of life, we used the McGill Quality of Life assessment. Physical activity was assessed using Metabolic Equivalency Tasks from the Compendium of Physical Activities classification system. t-Tests and regression analyses indicated that at Time 1 those on chemotherapy had lower cognitive health scores than those off chemotherapy. Yet at Time 2, as physical activities increased, cognitive health and quality of life improved for those on chemotherapy. However, those who had completed chemotherapy also benefited from an increase in physical activities over time. The results have implications for health care practitioners in oncology settings to better inform patients of cognitive challenges resulting from chemotherapy and the importance of participation in physical activities. Future research should compare different age groups among a larger sample.

Coping Skills for Oncology Patients: A Practical Guide.

OBJECTIVE: To present a practical how-to guide on implementing a coping skills intervention for patients with cancer facing surgery. DATA SOURCES: A review of the literature on coping and coping skills and on assessing the impact on patients' emotional status. CONCLUSION: Developing and presenting a brief coping skills program is possible within the confines of perioperative preparation for oncology patients. Such coping skills help develop a sense of self-efficacy, personal control, and resilience. Patients are responsive to the program and seem to practice their home assignments in a satisfactory manner. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can implement some of or all of the program with their patients. The coping skills fall under the mandate of a variety of health care professionals and are readily available to present to patients. The preoperative period is a suitable time to engage patients to learn coping skills.

Predicting stress-related problems in long-term breast cancer survivors.

INTRODUCTION: Little is known about the early clinical and psychosocial factors associated with subsequent stress-related problems in breast cancer survivors. METHODS: We used data collected at 3, 7, 11, and 15 months post-diagnosis to predict stress-related problems in 86 breast cancer survivors at 6 years post-diagnosis. We examined two common stress-related problems: (a) emotional distress and (b) intrusion and avoidance. Hypothesized risk factors included perceived stressfulness of the cancer; fear of the future; poor perceived health; initial stress-related problems; avoidance coping; and second cancer experience. Hypothesized protective factors included active coping (seeking social support; positive problem solving); optimism; and social support. RESULTS: Hierarchical multiple regression analyses, controlling for age and education, indicated that positive problem-solving coping at 3 months and emotional distress at 7 months significantly predicted 6-year emotional distress (R(2)=.24, P<.01). Second cancer experience and 3-month intrusion and avoidance significantly predicted 6-year intrusion and avoidance (R(2)=.38, P<.001). In both cases, risk and/or protective factors measured at 11 and 15 months did not add significantly to the regression equations. DISCUSSION/CONCLUSION: Symptoms of intrusion and avoidance should be monitored carefully during the first 3 months following diagnosis because they signal the risk that these symptoms will persist in the long-term. Elevated emotional distress at 7-months post-diagnosis and second-cancer experiences may signal the need for psychosocial intervention. Overreliance on positive problem solving to cope early in the disease trajectory may be detrimental in the longer term.

Comparison of four common stressors across the breast cancer trajectory.

OBJECTIVE: Studies of cancer stressors have typically assessed a limited number of factors using cross-sectional designs. There is little information about aspects of cancer that patients consider most stressful at different points along the disease trajectory. METHODS: Seventy-two breast cancer patients rated the degrees to which they experienced each of four common cancer concerns as stressful during the preceding month at 3, 7, 11, and 15 months, and at 6 years after diagnosis. Stressors included fear of the future; physical limitations; pain; and problems with family or friends due to cancer. RESULTS: Overall, the cancer concerns were rated as not especially stressful, with the exception of fear of the future which was the most stressful of the four concerns on all measurement occasions. Although fear of the future decreased from 3 to 7 months following diagnosis, it remained elevated at all of other time points. Physical limitations and pain were reported to induce equivalent levels of stress and their intensities decreased over time. However, there was a resurgence of the stressfulness of physical limitations and pain at the 6-year follow-up point when women experienced a second cancer during the long-term follow-up period. At all measurement occasions, breast cancer survivors reported very low levels of concern in relation to family and friends. CONCLUSION: Breast cancer can be stressful for years after diagnosis for some women and especially for those who experience a second cancer. Fear of the future is the most pressing target for psychosocial interventions.

Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy.

Existential issues often accompany a diagnosis of cancer and remain one aspect of psychosocial oncology care for which there is a need for focused, empirically tested interventions. This study examined the efficacy of a novel psychological intervention specifically designed to address existential issues through the use of meaning-making coping strategies on psychological adjustment to cancer. Eighty-two breast or colorectal cancer patients were randomly chosen to receive routine care (control group) or up to four sessions that explored the meaning of the emotional responses and cognitive appraisals of each individual's cancer experience within the context of past life events and future goals (experimental group). This paper reports the results from 74 patients who completed and returned pre- and post-test measures for self-esteem, optimism, and self-efficacy. After controlling for baseline scores, the experimental group participants demonstrated significantly higher levels of self-esteem, optimism, and self-efficacy compared to the control group. The results are discussed in light of the theoretical and clinical implications of meaning-making coping in the context of stress and illness.

Strategies to increase research-based practice: interplay with unit culture.

PURPOSE: A major focus of clinical nurse specialist nursing practice is the integration of research findings into practice. The purpose of this study was to describe strategies used to facilitate research utilization (RU) by nurses in a practice setting. DESIGN: This multiple-case study identified the strategies that clinical nurse specialists and master's degree-prepared nurse educators, working collaboratively, used to facilitate RU. SETTING/SAMPLE: The setting included 8 units in 4 sites of a university hospital with all willing nurses participating. METHODS: Open-ended focus groups and individual interviews and observational sessions were conducted using investigator-designed interview guides. Comprehensive qualitative analysis led to identification of categories and themes related to RU and the unit culture that supported it. FINDINGS: Findings demonstrated that strategies to facilitate RU by staff at the unit level included conducting original research, supporting nurses participating in research, assessing and meeting staff learning needs, promoting staff attendance at conferences, stimulating goal-setting for presentations and publications, encouraging and responding to new ideas, questioning practice and stimulating inquiry, capitalizing on expertise in research knowledge and skills, and generating information and material resources. Characteristics of unit culture were linked to varying degrees of success with these strategies. The interplay of strategies with unit culture and research-based practice is described. CONCLUSION: A wide repertoire of strategies is needed to facilitate RU, and the outcome of these strategies is influenced by the unit culture. IMPLICATIONS FOR PRACTICE: Consideration of the findings and the scope of the strategies used by nurses in the study can help clinical nurse specialist and other nursing leaders facilitate the building of practice on research.

Unit culture and research-based nursing practice in acute care.

The purpose of this multiple-case study of research utilization (RU) was to examine whether and how nursing practices in acute-care units are built on research and to identify potential explanations for the observed patterns. Open-ended data were collected from staff nurses and nursing leaders on 8 acute-care units through interviews and observation. RU varied within and across units, but unit culture emerged as the principal factor linked to patterns of RU. Unit-culture themes that formed the links were harmony of research perspective, motivation to learn, goal orientation, creativity, critical inquiry, mutual respect, and maximization of resources. The findings provide a rich description that could serve as a basis for self-assessment of unit culture in inpatient and outpatient acute-care units.

The prevalence of pain in hospitalized patients and resolution over six months.

Pain was assessed in 2415 randomly selected hospitalized patients. Fifty percent of the sample reported pain at the time of the interview, and 67% had experienced pain during the past 24 h. High levels of pain were more frequent in postpartum women, patients with diseases of the musculoskeletal systems and after injury or poisoning, but in all diagnostic categories there were patients whose lowest pain level in the preceding 24 h was moderate or severe. Patients who had undergone a surgical procedure during the past 7 days were more likely to report moderate or severe pain, but 21% of non-surgical patients reported moderate or severe pain. Twenty percent of those with pain reported that it had existed for more than 6 months. Patients reported significant impairment of function and distress as a consequence of pain. Use of analgesic medications was low overall and even lower for non-surgical patients. A decrease in pain over 3 weeks was predicted by pain of shorter duration, a shorter duration of hospitalization in the past year, and if a surgical procedure had been performed. None of these variables predicted pain resolution between 3 weeks and 3 or 6 months. Impairment of function did not increase with continuing pain but distress did. Medication use remained low at follow-up. The data indicate that current strategies to improve pain management need to be critically reviewed.

Psychological distress and cancer survival: a follow-up 10 years after diagnosis.

OBJECTIVE: This study tested the predictive role of psychological distress in cancer survival, while attempting to overcome several important methodological and statistical limitations that have clouded the issue. METHODS: Measures collected on a range of emotional and cognitive factors in the early postdiagnostic period and at 4-month intervals up to 15 months after diagnosis were used to predict survival time up to 10 years among 205 cancer patients heterogeneous in disease site, status, and progression. RESULTS: With the use of both baseline and repeated measures, depressive symptomology was the most consistent psychological predictor of shortened survival time, after controlling for several known demographic and medical risk factors. CONCLUSIONS: Given the importance of depressive symptoms to cancer survival, discussion focuses on the possible mechanisms mediating this relationship, the importance of psychological screening of cancer patients, and need for further research.

Nucare, a coping skills training intervention for oncology patients and families: participants' motivations and expectations.

This study looks at the relationship between intention, self-efficacy, and beliefs as components of readiness to learn in a population dealing with a cancer diagnosis who attended the Nucare program, a coping skills training intervention. The subjects completed a short questionnaire and/or participated in a focus group as part of the intervention. We found a positive relationship between participants finding the intervention useful and their levels of self-efficacy and beliefs in their ability to change their coping strategies. Understanding that patients believe that coping is important to their well-being helps nurses plan interventions to teach and promote the use of coping skills to patients and families. Nucare may be selected as a useful guide to practice.

The impact of a multimedia informational intervention on psychosocial adjustment among individuals with newly diagnosed breast or prostate cancer: a feasibility study.

OBJECTIVE: To examine the impact of an 8-week cancer multimedia informational intervention on health-related outcomes among individuals newly diagnosed with cancer. METHODS: Using a pre-/post-quasi-experimental design, participants with breast or prostate cancer (n=250) were conveniently recruited from four oncology ambulatory clinics and completed questionnaires at three points (enrolment, 1-2 weeks post-intervention, and 3 months later). RESULTS: Repeated-measure analyses showed that, when compared to controls, the intervention significantly improved satisfaction with cancer information over time for women (p<.001), prevented deterioration in functional quality of life (p=.030) and marginally improved perceived oncologist informational support (p=.051). There were no significant differences in psychosocial adjustment among men. Unlike previously suggested, the intervention did not have a differential impact according to levels of personal resources (self-esteem, mastery, and optimism). However, for all outcomes and regardless of group, participants high in personal resources reported better adjustment across time. CONCLUSION: Even though the hypotheses were only partially supported, the findings provide preliminary evidence that multimedia interventions can be supportive. PRACTICE IMPLICATIONS: With increasing numbers of new cancer diagnoses, cancer survivors and more limited health care resources, further research is needed to evaluate potential benefits of health information technology in providing support to individuals facing cancer.

Emotional distress impacts fear of the future among breast cancer survivors not the reverse.

INTRODUCTION: Fear of the future is one of the most stressful aspects of having cancer. Research to date has conceptualized fear of the future as a precursor of distress or stress-response symptoms. Yet it is equally plausible that distress would predict increased fear of the future or that they would have a reciprocal influence on each other. The purpose of the present study was to examine the bidirectional relations between fear of the future and distress as well as intrusion and avoidance among breast cancer survivors at 3, 7, 11, and 15 months after diagnosis. METHODS: We used a bivariate latent difference score model for dynamic change to examine these bidirectional relationships among 146 early-stage breast cancer survivors. Using Lisrel version 8.80, we examined four models testing different hypothesized relationships between fear of the future and distress and intrusion and avoidance. RESULTS: Based on model fit evaluation, our data shows that decreases in distress over time lead to a reduction of fear of the future but that changes in fear do not lead to changes in distress. On the other hand, there is no relationship between changes in fear of the future and intrusion and avoidance over time. DISCUSSION: Ongoing fear of the future does not appear to be a necessary condition for the development of stress-response symptoms. IMPLICATIONS FOR CANCER SURVIVORS: Future studies need to explore the role of distressing emotions in the development and exacerbation of fear of the future among cancer survivors.

The Joint Venture Model of Knowledge Utilization: a guide for change in nursing.

Knowledge utilization (KU) is an essential component of today's nursing practice and healthcare system. Despite advances in knowledge generation, the gap in knowledge transfer from research to practice continues. KU models have moved beyond factors affecting the individual nurse to a broader perspective that includes the practice environment and the socio-political context. This paper proposes one such theoretical model the Joint Venture Model of Knowledge Utilization (JVMKU). Key components of the JVMKU that emerged from an extensive multidisciplinary review of the literature include leadership, emotional intelligence, person, message, empowered workplace and the socio-political environment. The model has a broad and practical application and is not specific to one type of KU or one population. This paper provides a description of the JVMKU, its development and suggested uses at both local and organizational levels. Nurses in both leadership and point-of-care positions will recognize the concepts identified and will be able to apply this model for KU in their own workplace for assessment of areas requiring strengthening and support.

Meaning-making and psychological adjustment to cancer: development of an intervention and pilot results.

PURPOSE/OBJECTIVES: To develop an intervention that uniquely addresses the existential impact of cancer through meaning-making coping strategies and to explore the intervention's impact on psychological adjustment. DESIGN: Descriptive, qualitative approach to develop the intervention; one-group pre- and post-test design to pilot test the intervention. SETTING: Patients' homes or ambulatory oncology clinics affiliated with a university health center in eastern Canada. SAMPLE: 18 participants who were newly diagnosed in the past three months (n = 14), had completed treatment (n = 1), or were facing recurrence (n = 3) of breast (n = 10) or colorectal (n = 8) cancer. METHODS: Data were collected during interviews using a prototype intervention for trauma patients, and content was analyzed on an ongoing basis to fit the needs of the cancer population. Pretest and post-test questionnaires were administered to determine the intervention's effect. MAIN RESEARCH VARIABLES: Meaning-making intervention (MMI), patients' background variables, disease- or treatment-related symptoms, and psychological adjustment. FINDINGS: The MMI for patients with cancer consisted of as many as four two-hour, individualized sessions and involved the acknowledgment of losses and life threat, the examination of critical past challenges, and plans to stay committed to life goals. At post-test, participants significantly improved in self-esteem and reported a greater sense of security in facing the uncertainty of cancer. CONCLUSIONS: Findings suggest that meaning-making coping can be facilitated and lead to positive psychological outcomes following a cancer diagnosis. IMPLICATIONS FOR NURSING: The MMI offers a potentially effective and structured approach to address and monitor cancer-related existential issues. Findings are useful for designing future randomized, controlled trials.

Comparison of psychosocial outcomes in head and neck cancer patients receiving a coping strategies intervention and control subjects receiving no intervention.

This feasibility study aimed at comparing psychosocial outcomes in head and neck cancer patients receiving the Nucare program with a group of control subjects receiving no intervention. A prospective, nonrandomized study design was used. The Nucare program, a short-term psychoeducational coping strategies intervention, was the test intervention. Control subjects were matched to intervention subjects by cancer stage and time since cancer diagnosis. Outcomes were quality of life and depressive symptoms evaluated at baseline and 3 to 4 months later. One hundred thirty-eight subjects were recruited, and outcome data were available on 101 subjects. At outcome evaluation, compared with their baseline scores, the intervention group had improved physical and social functioning, global quality of life, fatigue, sleep disturbance, and depressive symptoms; the control group showed no changes in quality of life or depressive symptoms. The results suggest that the Nucare program may improve quality of life and reduce depressive symptoms in head and neck cancer patients.

Emotional intelligence: a primal dimension of nursing leadership?

Emotional intelligence, a concept well known in the world of business, is quickly gain ing recognition in the healthcare arena. Described as the primal aspect of leadership, emotional intelligence refers to the ability to monitor and discriminate among emotions, and to use the information to guide thought and action. This paper will explore the theoretical and empirical basis of emotional intelligence and its linkages to leadership. Readers will be informed of the origins and theoretical perspectives regarding emotional intelligence, evidence related to the existence of emotional intelligence, benefits and limitations of the concept and implications for nursing leadership.