A COVID-19 screening tool for oncology telephone triage.

PURPOSE: Symptoms associated with COVID-19 infection have made the assessment and triage of cancer patients extremely complicated. The purpose of this paper is to describe the development and implementation of a COVID-19 screening tool for oncology telephone triage. METHODS: An Ambulatory Oncology Clinical Nurse Educator and three faculty members worked on the development of an oncology specific triage tool based on the challenges that oncology nurses were having with the generic COVID triage tool. A thorough search of the published literature, as well as pertinent websites, verified that no screening tool for oncology patients was available. RESULTS: The screening tool met a number of essential criteria: (1) simple and easy to use, (2) included the most common signs and symptoms as knowledge of COVID-19 infection changed, (3) was congruent with the overall screening procedures of the medical center, (4) included questions about risk factors for and environmental exposures related to COVID-19, and (5) assessed patient's current cancer history and treatment status. Over a period of 3 weeks, the content and specific questions on the tool were modified based on information obtained from a variety of sources and feedback from the triage nurses. CONCLUSION: Within 1 month, the tool was developed and implemented in clinical practice. Oncology clinicians can modify this tool to triage patients as well as to screen patients in a variety of outpatient settings (e.g., chemotherapy infusion units, radiation therapy departments). The tool will require updates and modifications based on available resources and individual health care organizations' policies and procedures.

Methodological considerations for the design and implementation of a fully longitudinal mixed methods study.

Growing interest is evident in longitudinal mixed methods research, particularly fully longitudinal mixed methods designs in which both quantitative and qualitative data are collected concurrently for the duration of the study. Fully longitudinal mixed methods designs are particularly relevant for research on dynamic phenomena because of their ability to illuminate both quantitative and qualitative dimensions of change in real time as the phenomenon of interest changes. However, these are complex research designs and their data-intense nature makes them potentially burdensome for study participants, challenging for research teams, and costly for funding agencies. Despite growing use, the methodological literature on fully longitudinal mixed methods research is sparse and little guidance is available for researchers considering this approach. We address this gap by describing our experience with the design and implementation of a fully longitudinal mixed methods study of a dynamic phenomenon, namely, family caregiving during cancer treatment. We describe important questions and key decisions confronted while developing the research proposal, proactive strategies for study implementation, and implementation realities encountered while the study was in progress. On the basis of insights gained through real-world experience, we offer three guiding principles for researchers undertaking such a study. First, align the study design with the nature of the dynamics in the phenomenon of interest. Second, plan from the start when and how the integration of the longitudinal quantitative and qualitative data will occur. Third, employ implementation strategies that take into account the practical aspects of repeated contacts with study participants for an extended period.

Impact of patient symptoms and caregiving tasks on psychological distress in caregivers for head and neck cancer (HNC).

OBJECTIVE: To determine the association of caregiving task burden and patient symptom burden with psychological distress among caregivers of head and neck cancer (HNC) patients. METHODS: Adults with HNC and their primary caregivers were included. Patient symptom burden was assessed with the Vanderbilt Head and Neck Symptom Survey-2.0. Caregiving task burden was quantified as task number and task difficulty/distress using the HNC Caregiving Task Inventory. Psychological distress was measured with the Profile of Mood States-Short Form. Two-step clustering analysis was conducted for patient symptom burden, caregiving task burden, and psychological distress. Associations of the resultant clusters of task burden and patient symptoms with caregiver distress were tested using logistic regressions. RESULTS: Eighty-nine HNC caregivers and 84 patients were included. Among patients, two clusters of symptom burden were found (51% mod-high, 49% low). Among caregivers, two clusters of caregiving task burden (40% mod-high, 60% low) and caregiver psychological distress (40% mod-high, 60% low) were found. Caregivers with mod-high task numbers and task difficulty/distress reported higher levels of psychological distress. After controlling for caregiver number of tasks, respective difficulty/distress, and patient symptom burden, caregiver perceived task difficulty/distress had the strongest association with caregiver psychological distress (adjusted OR = 3.83; 95% CI, 1.0-14.64; P = 0.049). CONCLUSIONS: Psychological distress in HNC caregivers is associated with caregiving task burden, with caregivers experiencing high task difficulty/distress at greatest risk. Further study of the caregiver and task characteristics leading to psychological distress should inform supportive interventions for HNC patients and caregivers.

Effects of partners together in health intervention on physical activity and healthy eating behaviors: a pilot study.

BACKGROUND: Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. OBJECTIVE: The objective of this feasibility study was to test the Partners Together in Health (PaTH) intervention versus usual care in improving physical activity and healthy eating behaviors in coronary artery bypass graft surgery patients and their spouses. METHODS: An experimental, 2-group (n = 17 couples/group), repeated-measures design was used. Coronary artery bypass surgery patients in both groups participated in phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients did. Spouses in the usual care attended educational classes with patients. It was theorized that "2 persons would be better than 1" at making changes and sticking with them in the long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), at 3 months (post-CR), and at 6 months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. RESULTS: The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and usual care patients or spouses at 3 or 6 months in the number of minutes per week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥150 min/wk at >3 metabolic equivalents). CONCLUSIONS: The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR.

HealthViEWS: mortality study of female US Vietnam era veterans, 1965-2010.

We conducted a retrospective study among 4,734 women who served in the US military in Vietnam (Vietnam cohort), 2,062 women who served in countries near Vietnam (near-Vietnam cohort), and 5,313 nondeployed US military women (US cohort) to evaluate the associations of mortality outcomes with Vietnam War service. Veterans were identified from military records and followed for 40 years through December 31, 2010. Information on underlying causes of death was obtained from death certificates and the National Death Index. Based on 2,743 deaths, all 3 veteran cohorts had lower mortality risk from all causes combined and from several major causes, such as diabetes mellitus, heart disease, chronic obstructive pulmonary disease, and nervous system disease relative to comparable US women. However, excess deaths from motor vehicle accidents were observed in the Vietnam cohort (standardized mortality ratio = 3.67, 95% confidence interval (CI): 2.30, 5.56) and in the US cohort (standardized mortality ratio = 1.91, 95% CI: 1.02, 3.27). More than two-thirds of women in the study were military nurses. Nurses in the Vietnam cohort had a 2-fold higher risk of pancreatic cancer death (adjusted relative risk = 2.07, 95% CI: 1.00, 4.25) and an almost 5-fold higher risk of brain cancer death compared with nurses in the US cohort (adjusted relative risk = 4.61, 95% CI: 1.27, 16.83). Findings of all-cause and motor vehicle accident deaths among female Vietnam veterans were consistent with patterns of postwar mortality risk among other war veterans.

The state of the science of family caregiver-care receiver mutuality: a systematic review.

This review critically examines the current state of the science on the concept of family caregiver-care receiver mutuality, summarizes accomplishments and gaps and identifies directions for future theory development and research. Mutuality between family caregivers and care receivers is of increasing interest to researchers. However, no analysis of the current state of the science of this important concept has been published. Our literature search revealed 34 research articles that met inclusion criteria. The studies were assessed in terms of conceptualization of mutuality, instrument development, populations studied, research designs and methods and findings. Significant scientific progress during the past 30 years includes the development of clear definitions and new instruments, expansion of research beyond the clinical populations in which mutuality was first studied, the use of a variety of research designs, and increasingly sophisticated methods of data analysis. Growing evidence suggests that mutuality is associated with caregiver emotional health outcomes and may decrease over time in the context of chronic illness. Directions for future research include development of new theoretical frameworks grounded in relational theory, development of theory on the dynamics of mutuality over time, exploration of mutuality in diverse cultures and populations, and intervention studies aimed at enhancing mutuality.

Disparities in cancer stage of diagnosis by rurality in California, 2015-2019.

BACKGROUND: Cancer rates in rural areas vary by insurance status, socioeconomic status, region, race, and ethnicity. METHODS: California Cancer Registry data (2015-2019) were used to investigate stage of diagnosis by levels of rurality for the five most common cancers. Percent of residents in rural blocks within census tract aggregation zones was categorized into deciles up to 50%. Multivariable logistic regression was used to estimate associations with rurality, with separate models by cancer site, sex, race, and ethnicity (non-Hispanic White and Hispanic). Covariates included individual-level and zone-level factors. RESULTS: Percent of late-stage cancer diagnosis was 28% for female breast, 27% for prostate, 77% for male lung, 71% for female lung, 60% for male colorectal, 59% for female colorectal, 7.8% for male melanoma, and 5.9% for female melanoma. Increasing rurality was significantly associated with increased odds of late-stage cancer diagnosis for female breast cancer (p-trend<0.001), male lung cancer (p-trend<0.001), female lung cancer (p-trend<0.001), and male melanoma (p-trend=0.01), after adjusting for individual-level and zone-level factors. Strength of associations varied by sex and ethnicity. For males with lung cancer, odds of late-stage diagnosis in areas with >50% rural population was 1.24 (95% CI (1.06-1.45)) for non-Hispanic White patients and 2.14 (95% CI (0.86-5.31)) for Hispanic patients, compared to areas with 0% rural residents. CONCLUSIONS: Increasing rurality was associated with increased odds for late-stage diagnosis for breast cancer, lung cancer, and melanoma, with the strength of associations varying across sex and ethnicity. IMPACT: Our findings will inform cancer outreach to these rural subpopulations.

Caregiving demand and difficulty in older adult spousal caregivers after coronary artery bypass surgery.

The purpose of this study was to describe the caregiving demands and difficulties for older adult spousal caregivers of coronary artery bypass (CAB) surgery patients. Caregiving demands and difficulties were measured by the Caregiving Burden Scale. The sample size was 35 caregivers of CAB surgery patients who were, on average, 60 years old and 19 days since hospital discharge. Descriptive analysis revealed that the top four most demanding caregiving activities perceived by spousal caregivers were providing transportation, additional household tasks, providing emotional support, and two tied for fourth: monitoring symptoms and additional tasks outside the home. The top four most difficult caregiving tasks were additional household tasks, providing transportation, and two tied for third: additional tasks outside home and managing behavior problems. Also, caregivers reported experiencing more demands than difficulties. Examining the demanding and difficult caregiving tasks provides information from which to develop and test tailored interventions for caregivers of this population.

Disparities in cancer incidence by rurality in California.

BACKGROUND: Cancer rates in rural areas across the United States have different patterns than in urban areas. This study examines associations between rurality and incidence for the top 5 cancers in California and evaluates whether these associations vary jointly by sex, race, and ethnicity. METHODS: We used 2015-2019 California Cancer Registry data to compare incidence rate ratios (IRRs) and trends for breast, prostate, lung, colorectal, and skin (melanoma) cancers. We leveraged census tract aggregation zones and 7 levels of percentage rural population (0%, >0% to <10%, 10% to <20%, 20% to <30%, 30% to <40%, 40% to <50%, and 50+%). RESULTS: Zones with higher proportions of rural population were significantly associated with lower incidence of female breast cancer and prostate cancer, though the trends were not statistically significant overall. Zones with higher proportions of rural population were significantly associated with higher incidence of lung cancer and melanoma. There were no statistically significant trends for colorectal cancer overall. Comparing areas with 50% and over rural population with areas with 0% rural population, the IRR for lung cancer in Hispanic females was higher (IRR = 1.43, 95% confidence interval [CI] = 1.17 to 1.74) than in Hispanic males (IRR = 0.90, 95% CI = 0.72 to 1.11). Also, in areas with 50% or more rural population, the IRR for melanoma was higher in Hispanic females (IRR = 1.75, 95% CI = 1.23 to 2.45) than non-Hispanic White females (IRR = 0.87, 95% CI = 0.80 to 0.95). CONCLUSIONS: Our findings show that rurality is associated with cancer incidence and underscore the importance of jointly examining rural disparities with sex, race, and ethnicity by cancer site.

Living with atrial fibrillation: a qualitative study.

BACKGROUND AND RESEARCH OBJECTIVE: Atrial fibrillation (AF) is a public health burden associated with stroke, cardiomyopathy, and diminished quality of life (QOL). Although surveys suggest that AF impairs physical functioning and mental health, little is known about patients' experiences contributing to those findings. Understanding patients' experiences of living with AF may provide a foundation for interventions to improve QOL. In this qualitative descriptive study, we describe the experience of living with recurrent symptomatic AF from patients' perspectives. SUBJECTS AND METHODS: Seven women and 8 men, recruited from a Midwest medical center, with a mean age of 59.8 (SD, 14.5) years, diagnosed with recurrent symptomatic AF, participated in open-ended interviews. Data were analyzed by qualitative descriptive methods. RESULTS AND CONCLUSIONS: Themes were identified that reveal experiences of living with recurrent symptomatic AF over time and how AF may diminish QOL. Themes included (1) finding the meaning of symptoms, (2) feeling uninformed and unsupported, (3) turning points, (4) steering clear of AF, (5) managing unpredictable and function limiting symptoms, (6) emotional distress, and (7) accommodation to AF tempered with hope for a cure. Participants experienced delays in diagnosis and minimization of their concerns by clinicians and others and did not receive counseling regarding the nature of AF and self-management. Strategies to manage AF and its symptoms were learned through trial and error and were transiently effective. Support for coping with the emotional burden of AF was lacking. Interventions to improve recognition of AF symptoms and promote prompt evaluation and treatment are needed. Psychoeducational programs to teach patients and families about the nature of AF, guide self-management, and address the emotional burden of AF need to be developed and tested.

The Experience of Complex Pain Dynamics in Oncology Outpatients: A Longitudinal Qualitative Analysis.

BACKGROUND: Few qualitative studies of cancer patients' everyday experiences with pain exist within the large body of cancer pain research. Longitudinal qualitative studies are particularly sparse, and no studies have qualitatively described patients' pain experience over time during participation in a self-management intervention. OBJECTIVE: To longitudinally describe patients' pain experiences during a 10-week pain self-management intervention. METHODS: This qualitative study was embedded in a randomized controlled trial of a psychoeducational pain management intervention. The data consisted of transcribed audio recordings of each intervention session. An emergent, interpretive approach was used in this longitudinal qualitative analysis. RESULTS: Forty-two adult patients were included. The analysis revealed the strikingly dynamic nature of individual patient's pain experiences. Multiple facets of pain contributed to its dynamic nature, including pain in changing locations, co-occurring sources of pain, and varying patterns of pain intensity over time. For individual patients, the cumulative effect of these multiple facets resulted in a phenomenon we termed "complex pain dynamics." CONCLUSION: The results contribute to knowledge about the dynamic nature of cancer patients' pain experiences over a relatively short period. They suggest the need for a new paradigm for management of pain in cancer patients and raise questions about the interpretation of randomized controlled trial results in the absence of qualitative data. IMPLICATIONS FOR PRACTICE: Frequent assessments and reassessments of pain are needed in cancer patients with the ongoing development of highly individualized self-management strategies. A large repertoire of interventions is needed to effectively manage pain in cancer patients over time.

A new conceptual model of experiences of aging in place in the United States: Results of a systematic review and meta-ethnography of qualitative studies.

OBJECTIVES: The purpose of this systematic review was to synthesize the evidence on experiences of aging in place in the United States. DESIGN: Systematic review and meta-ethnography of qualitative studies. DATA SOURCES: We searched six bibliographic databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, Sociological Abstracts), with no limits on publication date. Eligible studies reported peer-reviewed qualitative research on experiences of aging in place in the United States with full-text available in English. REVIEW METHODS: Three reviewers independently used Covidence software to screen titles and abstracts followed by full texts. We assessed quality and risk of bias using a modified version of the Joanna Briggs Institute Checklist for Qualitative Research. Qualitative data analysis was conducted using meta-ethnography, following Noblit and Hare's seven-step method of translation and synthesis to generate a novel conceptual model. RESULTS: Of 2659 papers screened, 37 unique studies were eligible for inclusion, reported in 38 publications. The studies were conducted in 16 states and published between 1994 and 2018. The included samples represented 1199 participants in total, with mean ages ranging from 48 to 91 years. The gender of the samples ranged from 20% to 100% female, with a median of 77%. One-third of the included studies did not report participants' race/ethnicity, and half of the remaining study samples were at least 90% white; however, 20% of the studies focused exclusively on experiences of racial/ethnic minority older adults. Using meta-ethnography, we developed a new conceptual model of aging in place in the United States as a dynamic process of balancing threats and agency in relation to experiences of identity, connectedness, and place. We found that people aging in place were engaged in significant work to cope with unpredictable needs and challenges by changing their mindset, adapting their home environment to accommodate new needs, and finding different ways to connect with important people in their lives. Agency was shaped by resources and restrictions on choice, and where threats to aging in place outweighed an individual's sense of agency, the consequences included feelings of uncertainty, isolation, and dislocation. CONCLUSIONS: To the best of our knowledge, this is the first systematic review of qualitative studies to evaluate experiences of aging in place in the United States. The findings of our meta-ethnographic synthesis led to the development of a new conceptual model of aging in place highlighting the dynamic tensions involved in balancing threats and agency.

Initial psychometric testing of the Head and Neck Cancer Patient Self-Management Inventory (HNC-PSMI).

PURPOSE: Head and neck cancer (HNC) and its treatment are associated with significant symptom burden and functional impairment. HNC patients must engage in intensive and complex self-management protocols to minimize acute and late treatment effects. Self-management among HNC patients is understudied due to the limited availability of disease-specific self-management measures. This article describes the initial psychometric testing of the HNC Patient Self-Management Inventory (HNC-PSMI), an instrument that characterizes self-management tasks in the HNC population. METHOD: A cross-sectional survey design was used. One hundred HNC patients completed the HNC-PSMI, the Vanderbilt Head and Neck Cancer Symptom Survey plus General Symptom Survey, and the Profile of Mood States-Short Form. To evaluate the psychometric properties of the HNC-PSMI, the relevance of items, internal consistency of domain item responses, and the direction and strength of associations between domain scores and other measures were examined. RESULTS: There was variability both in the number of self-management tasks performed overall and in each domain as well as in the reported difficulty completing those tasks. Kuder-Richardson values for domains with > 3 items ranged from 0.61 to 0.86. Hypothesized associations were supported. CONCLUSIONS: Overall, the psychometric properties for the HNC-PSMI were acceptable. The HNC-PSMI can be used to advance an understanding of self-management requirements and challenges in HNC patients.

A Longitudinal Study of Predictors of Constipation Severity in Oncology Outpatients With Unrelieved Pain.

CONTEXT: Although constipation is a common symptom in oncology patients, it often goes unrecognized and untreated. In addition, little is known about characteristics associated with interindividual differences in constipation severity. OBJECTIVES: To describe prevalence, characteristics, and management of constipation; evaluate interindividual differences in constipation severity over 10 weeks; and identify demographic, clinical, and symptom characteristics associated with higher constipation severity scores. METHODS: In this prospective, longitudinal study, 175 oncology patients with unrelieved pain were recruited from eight outpatient cancer settings in the U.S. Patients completed demographic and symptom questionnaires at enrollment. Constipation severity was evaluated over 10 weeks using the Constipation Assessment Scale (CAS). Hierarchical linear modeling was used to identify characteristics associated with higher CAS scores. RESULTS: At enrollment, 70.1% of the patients reported constipation [i.e., CAS score of >2; mean CAS score: 3.72 (±3.11)]. While over the first week of the study patients used one to two constipation treatments per day, a large amount of interindividual variability was found in CAS scores. Higher percentage of days with no bowel movement, higher number of constipation treatments, higher state anxiety scores, and higher analgesic side effects scores were associated with higher CAS scores at enrollment. Higher percentage of days with no bowel movement was associated with interindividual differences in the trajectories of constipation. CONCLUSION: Our findings underscore the high prevalence of and large amount of interindividual variability in constipation severity. The characteristics associated with worse CAS scores can assist clinicians to identify high-risk patients and initiate prompt interventions.

Trajectories of fatigue in family caregivers of patients undergoing radiation therapy for prostate cancer.

Predictors of and trajectories for evening and morning fatigue were evaluated in family caregivers of oncology patients using hierarchical linear modeling. Evening fatigue trajectory fit a quadratic model. Predictors included baseline sleep disturbances in family caregivers and baseline evening fatigue in patients. Morning fatigue trajectory fit a linear model. Predictors were baseline trait anxiety, levels of perceived family support, and baseline morning fatigue in patients. Findings suggest considerable inter-individual variability in the trajectories of evening and morning fatigue. Evaluating family caregivers for sleep disturbance, anxiety, and poor family support, as well as high levels of patient fatigue, could identify those family caregivers at highest risk for sustained fatigue trajectories.

Understanding Functional Communication in Head and Neck Cancer Survivors Using a Mixed Methods Design.

BACKGROUND: Functional communication, defined as everyday communication with family and friends, at work, and in the community, is an important but understudied concept in the head and neck cancer (HNC) survivor population. OBJECTIVE: The aim of this study was to better understand functional communication by using a mixed methods approach. METHODS: Head and neck cancer survivors participated in semistructured interviews and completed self-report questionnaires assessing multiple aspects of well-being and health-related quality of life (HRQOL). These qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated. RESULTS: Survivors' perceptions of functional communication ranged from "Communication is good" to "Communication has changed" to "Communication is difficult." Using these qualitative results, survivors were categorized into 3 mutually exclusive groups. Clinically meaningful cut points were exceeded on measures of depressive symptoms (18%), state (40%) and trait (54%) anxiety, and pain (18%). Health-related quality of life scores were moderate to high for the sample as a whole. Statistically significant group differences were found only on the HNC-specific measure of HRQOL. A surprising finding was that the lowest mean score on social function was in the "Communication has changed" group. This group perceived changes in speech and voice that bothered them when communicating in social situations, although their speech was clear to a listener. CONCLUSION: An underrecognized subpopulation of HNC survivors may exist, whose day-to-day functional communication has changed in ways that impact their relationships and sense of self. IMPLICATIONS FOR PRACTICE: Clinical identification of this subpopulation and provision of appropriate interventions are essential to facilitate optimal HRQOL after HNC treatment.

Experiences of aging in place in the United States: protocol for a systematic review and meta-ethnography of qualitative studies.

BACKGROUND: By 2035, older adults will outnumber children for the first time in the United States (US). In light of its aging population, the US has supported services focused on enabling older adults to continue living in their current homes, a model commonly described as "aging in place." The lived experience of aging in place is not well documented in existing systematic reviews. The aims of this systematic review are to synthesize and evaluate the existing qualitative evidence on experiences of aging in place in the US and identify knowledge gaps and directions for future studies. METHODS: Six electronic bibliographic databases (PubMed, PsycINFO, CINAHL, Web of Science, EMBASE, and Sociological Abstracts) will be searched. Studies presenting qualitative data on the experiences of older adults currently aging in place in the US will be included. Covidence software will be used to screen studies and extract data. The Joanna Briggs Institute checklist for qualitative research will be used to assess quality and risk of bias of included studies. We will use meta-ethnography, following the method described by Noblit and Hare, to synthesize and evaluate the results of the included studies. DISCUSSION: To the best of our knowledge, this is the first systematic review to integrate and synthesize the findings of qualitative studies of aging in place focusing on older adults in the US. The findings of this review will provide in-depth knowledge on lived experiences of aging in place and address important gaps in existing work. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO): CRD42018102847.

Couples' Experiences With Healthy Lifestyle Behaviors After Cardiac Rehabilitation.

PURPOSE: Many cardiac patients discontinue heart-healthy eating and physical activity (PA) behaviors in the months following cardiac rehabilitation (CR). Involving the spouse in CR with the patient may be 1 strategy to increase the maintenance of these behaviors after CR. Assisting patients and spouses with the maintenance of healthy eating and PA behavior following CR begins with a better understanding of the couple-focused factors, impacting their experiences with these behaviors. The purpose of this study was to qualitatively examine couple-focused facilitators and barriers to maintaining changes in healthy eating and PA behavior from the perspectives of both cardiac patients and their spouses following phase 2 CR. METHODS: A purposive sample of 11 couples (patients undergoing postcoronary artery bypass graft surgery and their spouses) were selected from a larger randomized control trial. Semistructured, in-person interviews were conducted with patients and their spouses separately following CR. Data were analyzed using line-by-line coding to identify facilitator and barrier themes. RESULTS: Two couple-focused barrier themes emerged: unnegotiated situations and unshared behaviors. Two couple-focused facilitator themes emerged: supportive exchanges and partnerships. CONCLUSION: These findings will help guide interventions targeting changes in diet and PA behavior in both patients and their spouses through minimizing unnegotiated situations, fostering supportive exchanges, and creating a partnership for the couple to work together on shared diet and PA goals. Targeting both patients and their spouses may be an innovative and effective way to intervene to increase adherence to healthy eating and PA behaviors post-CR.

Differences in the prevalence and severity of side effects based on type of analgesic prescription in patients with chronic cancer pain.

An understanding of the relationship between the type of analgesic prescription and the prevalence and severity of side effects is crucial in making appropriate treatment decisions. The purposes of this study were to determine if there were differences in the prevalence of side effects among four different types of analgesic prescriptions (i.e., no opioid, only an as needed (PRN) opioid, only an around-the-clock (ATC) opioid, or an ATC+PRN opioid); to determine if there were differences in the severity of side effects among the four prescription groups; and to determine the relationships between the total dose of opioid analgesic medication prescribed and taken and the severity of side effects. As part of a larger study, 174 cancer patients with bone metastasis reported their analgesic use and the prevalence and severity of 11 side effects. Significant differences (P<0.05) were found in prevalence rates for seven of the side effects among the four prescription groups. The highest prevalence rates were found in the only ATC and ATC+PRN groups. Significant differences were found in the severity scores for five of the side effects, with the highest severity scores reported by patients in the only ATC and ATC+PRN groups. Significant positive correlations were found between the severity of six of the side effects and the total dose of opioid prescribed and taken. Risk factors for analgesic-induced side effects are ATC and ATC+PRN prescription types and higher doses of opioid analgesics.

Mutuality and preparedness moderate the effects of caregiving demand on cancer family caregiver outcomes.

BACKGROUND: Family caregiving researchers have explored the moderating or stress-buffering effects of variables such as coping and social support. However, the quality of the family caregiver-patient relationship and preparedness for caregiving have received little attention as potential moderators. OBJECTIVE: To explore whether relationship quality and preparedness moderate the effects of caregiving demand on caregiver outcomes during cancer treatment. METHODS: Eighty-seven family caregivers of patients receiving treatment for cancer completed the Demand and Difficulty subscales of the Caregiving Burden Scale, Mutuality and Preparedness Scales of the Family Care Inventory, and the short form of the Profile of Mood States. Using hierarchical multiple regression analyses, caregiving difficulty and total mood disturbance were regressed on two- and three-way interaction terms for demand, mutuality, and preparedness, controlling for caregiver age and gender, and the simple effect of each independent variable. RESULTS: Negligible effects for two-way interactions were found. However, the three-way interaction between demand, mutuality, and preparedness explained statistically significant variance in both perceived difficulty of caregiving and total mood disturbance. High mutuality in combination with high preparedness protected caregivers from adverse outcomes when demand was high. When either mutuality or preparedness was low, caregivers were at greater risk for negative outcomes when demand was high, but not when demand was low. When both mutuality and preparedness were low, caregivers were at risk for mood disturbance even when demand was low. DISCUSSION: Analysis of three-way interactions provided new theoretical insights into the protective effects of mutuality and preparedness and demonstrated conditions under which caregivers are at increased risk for negative outcomes.