Current attitudes and practice of American Society of Clinical Oncology-member clinical oncologists regarding cancer prevention and control.

PURPOSE AND METHODS: A nationwide needs assessment survey including a validated Cancer Prevention and Early Detection Attitude Inventory of 1,500 randomly selected American Society of Clinical Oncology (ASCO)-member clinical oncologists was conducted via a 67-item, mailed questionnaire to assess practice and attitudes regarding cancer prevention and control. RESULTS: Responses of 729 physicians from 48 states representing medical (57%), radiation (17%), surgical (16%), and pediatric oncology (6%), and hematology/other (4%) fields were obtained. Except for ambivalence regarding an important role for diet in cancer causation, cancer prevention and control recommendations were widely endorsed despite skepticism about their impact on reducing deaths from cancer. Surprisingly, a significantly (P less than .001) more favorable attitude for cancer prevention and control issues was found in physicians with greater than 20 years practice compared with younger oncology colleagues, as measured by a 22-item Cancer Prevention and Early Detection Attitude Inventory. Among all physicians, participation in cancer therapy trials exceeded that in cancer prevention and control trials (91% v 27%, P less than .01). Formal instruction during postgraduate training in cancer screening (34%) or prevention (23%) was received by few oncologists; nonetheless, 69% considered themselves a resource for cancer prevention and control issues in their practice communities. Of potential barriers to cancer prevention and control activity, only lack of patients without cancer (53%) and difficulty in including such activity economically into clinical practice (65%) were majority selections. Importantly, 64% agreed they could "motivate their patients to change lifestyle to reduce cancer risk." CONCLUSION: Clinical oncologists may represent a potential resource for implementation of cancer prevention and control objectives if economically feasible models for their use in practice settings can be identified.

Determinants of health-promoting lifestyle in ambulatory cancer patients.

The Health Promotion Model was tested as an explanatory framework for health-promoting lifestyle in a sample of 385 ambulatory cancer patients undergoing treatment in 13 clinical sites in the midwestern United States. The aim of this study was to determine the extent to which cognitive/perceptual and modifying variables identified in the Health Promotion Model explain the occurrence of health-promoting behaviors in adults with cancer. A secondary aim was to determine the potential of illness-specific cognitive/perceptual and modifying variables for further explaining the occurrence of health-promoting behaviors in adults with cancer. Multiple regression analyses revealed that 23.5% of the variance in health-promoting lifestyle was explained by the model cognitive/perceptual variables definition of health, perceived health status and perceived control of health and the modifying variables education, income, age and employment. When illness-specific variables were included in the analysis, initial reaction to the diagnosis of cancer was found to be a significant contributor to the regression. Study results support the importance of both general health-related and cancer-specific cognitive/perceptual factors in explaining the occurrence of health-enhancing behaviors among ambulatory cancer patients; these factors may therefore be suitable targets for interventions to encourage adoption of healthy lifestyles.

The epidemiology and primary prevention of gastric and esophageal cancer. A worldwide perspective.

This article examines the epidemiology and primary prevention of gastric and esophageal cancer throughout the world. Although both of these cancers have low incidence rates in many Westernized countries, they rank as foremost among all cancers in a number of developing countries. Risk factors, early signs and symptoms, and early detection procedures are discussed. Primary prevention of both stomach and esophageal cancer involves changing selected lifestyle variables: decreased alcohol intake, cessation of smoking, and decreased intake of dried, smoked, and salted foods. The nursing role in the primary prevention of stomach and esophageal cancer involves (a) familiarity with the known and hypothesized risk factors, (b) developing community-based patient education programs that are culturally relevant, simple, practical, and cost-effective, (c) working with other disciplines in prevention and early detection programs, and (d) lobbying governmental agencies to encourage their involvement in primary prevention of these cancers.

A worldwide perspective on the epidemiology and primary prevention of liver cancer.

Liver cancer is one of the ten most common cancers in the world with a pronounced geographic variation. The incidence of hepatocellular cancer is low in the Western countries compared to the high prevalence in South Africa, Asia, and the Pacific Islands. Risk factors, early signs and symptoms, and the strategies for early detection are discussed. Primary prevention involves conducting mass immunization for hepatitis B virus in endemic countries along with education programs to improve food hygiene, decreasing alcohol intake, using sterile implements for immunizations and injections, smoking cessation, avoiding unnecessary blood transfusions and screening of blood for transfusions.

Cancer prevention education in developing countries: toward a model for nurse educators.

The National Cancer Institute, United States of America, funded a series of continuing education courses in cancer prevention between 1986 and 1994 for nurses from developing countries. The purpose of this program was to stimulate interest and facilitate an increase in the participants' knowledge of primary and secondary cancer prevention. The long-term objectives were to increase the number of nurses, internationally, prepared to engage in the prevention and the early detection of cancer in their countries, to expand the international cancer nursing network, and to have these nurses ultimately play a role in reducing the incidence of cancer in developing countries. More than 50 nations were represented. Participants were chosen for their demonstrated ability to influence nursing education and practice in their country. They completed a demographic data sheet, an attitude inventory, a program evaluation and pre- and postconference activities surveys. Before and after attending the conference, participants were asked to identify anticipated problems and obstacles to their goal achievement. These problems included a lack of screening facilities and a lack of primary prevention services. Although numerous differences existed in their education, experience, and personal attributes, the participants voiced common problems with cancer prevention programs. Results from the postconference survey showed a substantial increase in cancer-related activities conducted by the participants. Activities included an increase in cancer content in nursing education programs, an increase in public and professional presentations on cancer prevention, and improvement in the delivery of cancer care.

Knowledge of colorectal cancer among older persons.

Cancer screening is a national health priority, especially for colorectal cancer, the second leading cause of death due to cancer in the United States. The researchers measured colorectal cancer knowledge among 211 older Americans. A quasiexperimental pretest-posttest two-by-two factorial design was used to test the effect of knowledge on participation in fecal occult blood screening. The American Cancer Society's colorectal cancer educational slide-tape presentation served as the basis for all of the educational programs. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data. One-half of the participants had incomes below the poverty level. Almost one-half the subjects in the study sample stated that they had not received any information about colorectal cancer within the past year. Caucasians had more knowledge of colorectal cancer than African Americans [F(1, 78) = 7.92, p < 0.01] and persons with higher income had more knowledge than persons with less income [F(2, 76) = 3.01, p = 0.05]. Subjects showed significant increases in colorectal cancer knowledge 6 days after the colorectal cancer education program [t(79) = 2.59, p = 0.01] and this increased knowledge was a predictor of participation in free fecal occult blood screening [chi 2(1, n = 164) = 5.34, p = 0.02].

Screening for prostate cancer in asymptomatic men: clinical, legal, and ethical implications.

PURPOSE/OBJECTIVES: To describe the opposing recommendations of the major medical organizations related to screening for prostate cancer and to explore the impact of these opposing recommendations on advanced practice nurses (APNs) who are in a position to decide who gets screened and when. DATA SOURCES: Published medical, legal, and economic articles, published legal verdicts and settlements, case law, and news reports. DATA SYNTHESIS: The national recommendations for screening for prostate cancer are conflicting and have legal, economic, and ethical implications for healthcare practitioners. Both the current early diagnostic tests, age- and race-based prostate specific antigen ranges, and the resultant treatment have significant problems and further contribute to the national controversy about whether to screen asymptomatic men. Lack of coverage for early detection of prostate cancer by many managed-care plans and Medicare also contribute to the dilemma practitioners face. However, electing not to screen "at-risk" men may subject APNs to charges of negligence or other legal theories. CONCLUSIONS: Present recommendations by the leading national medical, cancer, and policy organizations related to prostate cancer screening are contradictory. Adding to this national quagmire is the lack of financial support from Medicare and most health maintenance organization plans to pay for early detection of prostate cancer. These conflicting recommendations place APNs in a legally and ethically precarious position. APNs and nurses with patient education responsibilities should individualize decision-making and counsel their asymptomatic patients who may be at risk for prostate cancer about the benefits and complications of screening. IMPLICATIONS FOR NURSING PRACTICE: Considering the multiple implications of the decision to screen for prostate cancer, counseling patients who may be at risk for the disease and involving them and their spouses may be the best approach in deciding whether to screen for prostate cancer in asymptomatic men.

Cancer prevention and screening activities reported by African-American nurses.

PURPOSE/OBJECTIVES: To describe the cancer prevention and screening activities of African-American nurses prior to their participation in a national workshop on cancer prevention and screening. The hypothesis tested was that African-American nurses would describe few prevention and screening behaviors. DESIGN: 18-month, longitudinal, descriptive study. SETTING: National survey. SAMPLE: 360 African-American nurses who applied for participation in a National Cancer Institute/Oncology Nursing Society workshop received study questionnaires. One hundred forty-six questionnaires were returned. The final sample was 64 nurses citing involvement in prevention/screening activities. METHODS: Self-administered quantitative/qualitative questionnaire mailed to nurses two weeks prior to the workshop. Quantitative data analyzed using descriptive statistics; a clustering technique was used to categorize responses emerging from qualitative data. MAIN RESEARCH VARIABLE: Cancer prevention and screening activities of African-American nurses six months prior to the workshop. FINDINGS: Respondents reported involvement in 11 categories (618 prevention/screening activities), predominantly in those of life-style (86%), education (77%), and clinical screening (58%). Respondents practiced 64% of the activities on a voluntary basis. Respondents provided prevention/screening education to more than 8,900 community members. CONCLUSION: African-American nurses favorably influence cancer prevention and screening beliefs and practices of clients in their communities. IMPLICATIONS FOR NURSING PRACTICE: A survey approach can describe cancer prevention/screening behaviors of African-American nurses. These nurses are an effective resource for community education.

Nurse documentation: not done or worse, done the wrong way--Part I.

PURPOSE/OBJECTIVES: To focus on nursing documentation and expanding technologies (e.g., facsimile, telephone, e-mail, computer charting) that offer different ways to record, deliver, and receive patient records and avoid nursing liability for inadequate or inaccurate documentation. DATA SOURCES: Nursing, non-nursing healthcare, legal journals, case law, and related Internet sources. DATA SYNTHESIS: To avoid liability for inadequate or inaccurate documentation, nurses must be aware of the major issues involved in documentation litigation. New technology is altering how healthcare documentation is done and raising new confidentiality issues. CONCLUSIONS: Nurses should follow their facility's guidelines and principles for documentation of patient care, especially when using more advanced technologies. IMPLICATIONS FOR NURSING PRACTICE: Educating nurses about the principles of documentation and the importance of implementing risk-reduction practices will help guard against liability and ultimately improve patient care.

Nurse documentation: not done or worse, done the wrong way--Part II.

PURPOSE/OBJECTIVES: To focus on nursing documentation and how it can lead to a malpractice lawsuit. DATA SOURCES: Nursing, non-nursing healthcare and legal journals, case law, and related Internet sources. DATA SYNTHESIS: To avoid liability for inadequate or inaccurate documentation, nurses must be aware of how their documentation can either lead to a malpractice claim or actually decrease their chances of ever being named in a malpractice lawsuit. Malpractice cases often are decided based on documentation. The only viable way to defend against allegations of professional negligence is accurate and complete patient charting or defensive documentation. CONCLUSIONS: By examining case law involving inadequate or inaccurate documentation, nurses will be able to effectively adopt documentation practices or policies to decrease potential litigation. IMPLICATIONS FOR NURSING PRACTICE: Educating nurses about the principles of documentation and the importance of implementing risk-reduction practices will help guard against liability and ultimately improve patient care.

A national survey of certified, recertified, and noncertified oncology nurses: comparisons and contrasts.

PURPOSE/OBJECTIVES: To explore opinions about the OCN credential, the ways in which it was obtained and retained, and the extent to which it is valued by employers. DESIGN: A descriptive comparison study using a cross-sectional survey design. SAMPLE: Questionnaires were mailed to a nationwide sample of 2,429 RN members of the Oncology Nursing Society; 1,217 (50%) surveys were returned. The majority of respondents were female, 30-49 years of age. Caucasian, and had practiced nursing for more than 11 years. MAIN RESEARCH VARIABLES: Certification status, work role characteristics, preparation strategies for the certification examination, and motivation for obtaining certification. FINDINGS: Oncology nurses recognize the importance and value of OCN certification. The primary reasons oncology nurses obtain and retain certification include the desire for personal achievement, professional growth, and development. OCNs were more likely to work in a setting where the employer supports professional development through continuing nursing education. IMPLICATIONS FOR NURSING PRACTICE: Because health care is increasingly delivered in ambulatory/home settings and the population is aging, oncology certification needs to be encouraged among nurses who work in these settings or with geriatric populations. Certified nurses tended to experience more job satisfaction than noncertified nurses.

Relationships between certification and job perceptions of oncology nurses.

PURPOSE/OBJECTIVES: To explore relationships between oncology nursing certification and oncology nurses' job perceptions. DESIGN: Descriptive, correlational. SETTING: Questionnaire mailed to homes of Oncology Nursing Society (ONS) members. SAMPLE: 703 certified and 514 noncertified ONS members (N = 1,217; 50% response rate). METHODS: Data were collected using survey methods and grouped by respondents' certification status for statistical analysis. MAIN RESEARCH VARIABLES: Certification, group cohesion, organizational commitment, and job satisfaction. FINDINGS: Certification was weakly correlated with cohesion, commitment, and satisfaction. Work setting, rather than certification, accounted for differences in job perceptions. Job perceptions were most positive in settings characterized by a high percentage of patients with cancer (> 75%), a high percentage of RNs (> or = 80%), and monetary support for continuing education. CONCLUSIONS: The hypothesis that oncology nurses' certification status is associated with job perceptions that are valued by employers was not supported. IMPLICATIONS FOR NURSING PRACTICE: Nurses' job perceptions have been linked to control over nursing practice and participation in organizational and clinical decision making. Managerial strategies that empower certified nurses to practice with more autonomy and participate in decisions that affect patient care should be emphasized.

Neurofibromatosis.

The two types of neurofibromatosis are NF-1 and NF-2. Both cause abnormal cell growth in the central and peripheral nervous system. Each disease is inherited as an autosomal dominant trait, thus each child of an affected parent has a 50% chance of inheriting the disorder. Because there is no cure for either type of NF and treatment consists of amelioration of clinical symptoms, genetic counseling is the only preventive approach to this disease.

Cancer prevention and early detection in ethnically diverse populations.

Providing cancer screening to the diverse minority subgroups of the United States is a challenge. In order to effectively screen the African American, Hispanic, Asian/Pacific Islander, Native American, Native Alaskan, and Native Hawaiian populations, cancer screening methods must be ethically and culturally based. Nurses must also strive make preventive care accessible to the underserved.

Evaluating written patient education materials.

Evaluation, the last component in the process of patient education, is the most frequently omitted step in producing informative material. Yet, it is essential that program/material evaluation be conducted to determine the impact and success or failure of the program or material. It is vital to be aware of this need and possess knowledge about types of evaluation and those areas that must be included to provide a comprehensive evaluation.