Association between pregnancy intention and preconception health behaviors.

BACKGROUND: Female adolescent and young adult (AYA) cancer survivors face higher infertility and pregnancy risks than peers with no cancer history. Preconception health behaviors such as physical activity (PA), tobacco smoking, and alcohol intake influence reproductive outcomes. In general populations, pregnancy intention is positively associated with healthy preconception behaviors, but it has not been studied among AYA survivors. The authors hypothesized that higher pregnancy intention would be associated with healthier behaviors, especially among AYA survivors with perceived infertility risk. METHODS: A cross-sectional analysis was conducted with data collected between 2013 and 2017 from 1071 female AYA survivors aged 18 to 39 years who had completed their primary cancer treatment and enrolled in an ovarian function study. Self-reported intention dimensions were measured as a pregnancy intention score (PIS) and trying now to become pregnant. Multivariable linear (PA), binary (smoking), and ordinal (alcohol use) logistic regressions were used to estimate associations between intentions and preconception behaviors, with adjustments made for demographic and cancer characteristics. Effect modification by perceived infertility risk was assessed. RESULTS: The mean PIS was 1.1 (SD, 0.77) on a 0 to 2 scale (2 = high intention), and 8.9% were attempting pregnancy now. A higher PIS was associated with increased PA (ß, 0.08; 95% CI, 0.11-1.04), whereas ambivalence in pregnancy intention was associated with lower alcohol consumption (odds ratio, 0.72; 95% CI, 0.55-0.95). Pregnancy intentions were not associated with smoking. Perceived infertility risk strengthened the relationship between PIS and PA (P < .05). CONCLUSIONS: Pregnancy intentions were associated with some healthier preconception behaviors in AYA survivors. Medical professionals caring for AYA survivors may consider pregnancy intention screening to guide conversations on preconception health.

The effects of a multicomponent intervention program on clinical outcomes associated with falls in healthy older adults.

BACKGROUND: Multicomponent intervention programs have been shown to be effective in reducing risk factors associated with falls, but the primary target population of these interventions is often low-functioning older adults. AIMS: The purpose of this study was to investigate the effectiveness of a multicomponent intervention program focusing on balance and muscle strength for independently functioning community-dwelling older adults. METHODS: Fifty-three independently functioning older adults, aged 80.09 ± 6.62 years, participated in a group exercise class (conducted 2 times/week for 8 weeks) emphasizing balance. Outcome measures were balance performance using the Fullerton Advanced Balance (FAB) scale and muscle strength using the Senior Fitness Test (SFT). RESULTS: The intervention improved balance (P < 0.001), and older adults who were classified as having high fall risks based on the FAB scores at pre-testing improved more than older adults who were classified as having low fall risks (P = 0.017). As a result, 22 participants transitioned from a high fall risk group at pre-testing to a low fall risk group at post-testing (P < 0.001). The intervention also enhanced both upper and lower muscle extremity strength based on SFT results (P < 0.001) regardless of participants' classification of fall risk status. CONCLUSIONS AND DISCUSSION: The multicomponent intervention conducted two times per week for 8 weeks was effective in improving balance and enhancing muscle strength of independently functioning older adults. The results underscore the importance of providing fall prevention interventions to healthy older adults, a population often not a target of balance interventions.

Engaging patients with radiation related skin discomfort in self-care.

BACKGROUND: Patients receiving radiation to the breast can suffer painful, moist desquamation of the axilla and inframammary fold. Intensity of skin reactions will vary with each individual and be dependent on the total dose of radiation, treatment volume, daily fraction size, energy and type of radiation, as well as other personal factors (Gosselin, 2010). Treatment-related skin reactions make it difficult for women to wear clothing and undergarments comfortably and to perform daily activities. InterDry AG is a textile dressing with an antimicrobial complex that wicks away excess moisture and reduces friction, itching, and burning. Despite showing highly beneficial properties, there is no current published evidence indicating the utility of InterDry Ag for radiation skin reactions. PURPOSE: This project evaluated the potential utility of InterDry Ag dressing to relieve discomfort of skin reactions for breast cancer patients undergoing radiation treatment. METHODS: A descriptive design was employed to better understand the effectiveness of InterDry Ag dressing in reducing side effects of radiation treatment of the breast for women. Twenty eligible participants consented to participate. A radiation oncology nurse evaluated its effect every five days, utilizing a skin assessment questionnaire developed by the nursing team from clinical observations. RESULTS: A personalized skin care regimen was developed with each patient's feedback. A trusting relationship was developed between the nurse and patient by building rapport that indicated nursing care support. Some women began sharing their emotional stressors with nurses, as well as the physical pain they were experiencing due to the skin reactions. This observation resulted in provision of additional resources for women and engaging them in self-care using a patient-centred approach.

Impact of a breast cancer care RN-coordinator program on patients' distress level.

The purpose of this study was to determine whether patients receiving navigation supportive care from a Breast Cancer Care Coordinator (BCCC), prior to initial oncology consultation at a British Columbia Cancer Agency, Abbotsford Centre (BCCA-AC), demonstrated different levels of anxiety and depression from those not receiving such support at the same BCCA centre. A retrospective review of the Psychological Screen for Cancer (PSSCAN) scores of new breast cancer patients seen for oncology consultation for the control cohort (receiving usual care) were compared to PSSCAN scores of those who had received care from a BCCC prior to the oncology consultation (the study cohort). A total of 91 PSSCANs were reviewed in the study, with 54 belonging to the treatment group and 37 to the control group. PSSCAN scores for anxiety and depression did not show significant differences between the two groups.

Application of the Extended Health Control Belief Model to Predict Hepatitis A and B Vaccinations.

BACKGROUND: Adult vaccination compliance rates vary according to sample and type of vaccine administered (influenza, pneumococcal). This study looked at vaccination of a community sample of low-income, minority adults. METHODS: Nurses offered free vaccination for hepatitis A and B in the form of the combined Twinrix vaccine to adults on a walk-in basis. In addition to dosing information, participants completed the Risk Behavior Assessment, the Coping Strategies Indicator and the Cardiovascular Risk Assessment. Skaff's extended Health Belief Model was used as the theoretical framework. Count regression was used to model receipt of one, two, or three doses. RESULTS: The majority of participants were male with a mean age of 40 years. The distribution of doses was: 173 individuals (27.6%) received one dose only, 261 (41.7%) received two doses, and 191 (30.5%) received three doses of vaccine. The multivariate count regression model including being male, having previously been told by a health care provider that one has syphilis, having severe negative emotions, and perceived social support were associated with participants' receiving fewer doses of hepatitis vaccine. A greater problem-solving score was associated with a higher number of vaccine doses received. CONCLUSION: Despite free vaccinations offered in an easily accessible community setting, the majority of participants failed to complete the hepatitis vaccine series. More effort is needed to get adult men to participate in hepatitis vaccination clinics. Additional research is necessary to understand barriers other than cost to adults receiving vaccination.

An evaluation report of the nurse navigator services for the breast cancer support program.

The purpose of this quality improvement project was to evaluate the effectiveness of breast cancer care support provided by breast cancer care navigators (BCCN) for women attending the breast health clinic (BHC). This evaluative process examined patients' satisfaction with the nurse navigator program that focused on addressing breast cancer patients' informational needs, emotional support, and guidance through the cancer trajectory. A survey approach using Likert-type scales and open-ended questions was utilized to gather data. Patients seen at the BHC between July 2011 and July 2013 were sent the surveys by mail. The 154 responses constituted a 69% response rate. More than 90% of participants understood the information provided by the BCCN and were satisfied with the information that had been received. Psychosocial support from patient/family counselling services at the agency and in the community were among the most common request for resources. Recommendations include contacting patients directly after their initial meeting at the clinic and at least once after their treatments began, to ensure continuity and support. BCCN role was identified as being valuable with a positive effect on patients' experience.

Horizontal hostility and verbal violence between nurses in the perinatal arena of health care.

The goal of this US study was to determine the frequency of horizontal violence in a perinatal service and its effect on patient outcomes. A 24-question survey instrument was completed online by 63 nurses. The results indicated that labour and delivery wards experience a higher frequency of horizontal violence than other units in the perinatal service. They also showed that the mother and baby unit demonstrates a higher frequency of recipient or victim behaviours. A relationship between horizontal violence and ineffective communication, as well as a relationship between horizontal violence and poor patient outcomes or near misses, was demonstrated.

Cultural Adaptation and Validation of the Punjabi Version of EPIC.

BACKGROUND: With earlier prostate cancer (PCa) diagnosis and increased survivorship, post-treatment quality of life (QoL) has become increasingly important. The Expanded Prostate Cancer Index Composite (EPIC) is a widely adopted QoL instrument for PCa. We aimed to create a Punjabi version of EPIC to further research in the Punjabi-speaking population. METHODS: A prototype of the Punjabi version of EPIC was created by forward-backward translations and revision. After concluding the cultural adaptation phase by interviewing 15 participants, a pilot version was created. Validation of the pilot version was performed by having 72 participants complete the Punjabi EPIC and another commonly used QoL instrument, the EORTC QLQ-c30, twice within a 4-week period. Test retest reliability (Pearson's correlations and difference distribution) and internal consistency (Cronbach's alpha) were measured using SAS version 9.4. RESULTS: Modifications were needed for the prototype Punjabi version after forward-backward translations. Cultural adaptation has highlighted a few issues including syntax and terminology.  Test-retest reliability of the Urinary, Bowel, Sexual and Hormone domains were 0.88, 0.91, 0.91, and 0.95, respectively, and subscale correlations ranged from 0.75 to 0.93. Internal consistency for domains and subscales was good except for Sexual Domain. Performance of EPIC is comparable, and in some cases, slightly better than validated Punjabi version of EORTC QLQ-C30. CONCLUSIONS: The EPIC questionnaire was successfully translated into Punjabi and was culturally adapted.  The resultant Punjabi version has high reliability and validity and will be an important tool for QoL research in the Punjabi population. EPIC was successfully translated, culturally adapted, and validated with high reliability and validity into Punjabi. It will be a valuable QoL tool for physicians in clinical and research settings, and for patients in decision-making.

Perceived and Objective Fertility Risk Among Female Survivors of Adolescent and Young Adult Cancer.

Importance: Fertility is important to many survivors of adolescent and young adult (AYA) cancer, yet data on this population's fertility perceptions and their alignment with objective infertility risk are scant. Objective: To assess whether estimated treatment gonadotoxicity and posttreatment menstrual pattern are associated with higher infertility risk perception. Design, Setting, and Participants: This retrospective cohort study included female young adult survivors of cancer diagnosed between ages 15 and 39 years were recruited between March 25, 2015, and September 24, 2018, from 2 state cancer registries, social media, and clinician referrals to participate in a study of posttreatment ovarian function. Data analysis occurred between March 1 and September 1, 2022. Exposures: Participants reported their menstrual pattern. Estimated treatment gonadotoxicity was ascertained through medical record review. Main Outcomes and Measures: Participants reported infertility risk perception and were categorized as increased risk (feeling less fertile or unable to become pregnant) or no increased risk (feeling more or as fertile) compared with female individuals their age. Objective infertility risk was determined by estimated gonadotoxicity, menstrual pattern, and ovarian reserve testing of self-collected dried blood spots. Multivariable logistic regression identified factors associated with perceived infertility and underestimation or overestimation of infertility risk. Results: This study included 785 female participants with a mean (SD) age of 33.2 (4.8) years at enrollment and 25.9 (5.7) years at diagnosis. Most participants self-identified their race and ethnicity as White (585 [74.5%]) and non-Hispanic (628 [78.7%]). Most participants (483 [61.5%]) perceived a higher risk of infertility compared with female participants their age. Prior exposure to moderate- or high-gonadotoxicity treatments was associated with higher odds of perceiving increased infertility risk compared with exposure to low-gonadotoxicity treatments (adjusted odds ratio [AOR], 2.73 [95% CI, 1.87-3.97] and 15.39 [95% CI, 5.52-42.96], respectively). Amenorrhea and irregular cycles were associated with higher odds of perceiving increased infertility risk (AOR, 3.98 [95% CI, 2.13-7.41] and 1.69 [95% CI, 1.19-2.40], respectively). Perceived infertility risk had minimal agreement with objective risk (κ = 0.19). Multiparity (AOR, 4.17 [95% CI, 2.61-6.64]) was associated with increased odds of underestimation, while older age (AOR, 0.94 [95% CI, 0.89-0.98]), endocrine comorbidity (AOR, 0.35 [95% CI, 0.18-0.69]), and prior infertility (AOR, 0.16 [95% CI, 0.07-0.38]) were associated with lower odds of underestimation. Multiparity (AOR, 0.48 [95% CI, 0.27-0.86]), breast cancer (AOR, 0.38 [95% CI, 0.20-0.73]), and skin cancer (AOR, 0.24 [95% CI, 0.11-0.51]) were associated with lower odds of overestimation. Conclusions and Relevance: In this cohort study, survivors of AYA cancer had high rates of perceiving increased infertility risk but frequently overestimated or underestimated their risk. These findings suggest that counseling on infertility risk throughout survivorship may reduce misalignment between perceptions and actual risk, decrease fertility-related psychological distress, and inform family planning decisions.

The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study.

PURPOSE: Pregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors. METHODS: A cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18-39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations. RESULTS: Survivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior. CONCLUSIONS: Increasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA. IMPLICATIONS FOR CANCER SURVIVORS: Screening for immediate intentions can identify AYA survivors in need of early preconception health promotion.

Experiences of Using Wearable Continuous Glucose Monitors in Adults With Diabetes: A Qualitative Descriptive Study.

PURPOSE: The purpose of the study was to understand the experiences of adults with diabetes wearing a continuous glucose monitor (CGM). METHODS: This qualitative, descriptive study included 19 adults with type 1 diabetes or type 2 diabetes, who had used the FreeStyle Libre CGM for at least 4 weeks, from an outpatient clinic at a university-affiliated hospital in Korea. Data were collected through in-depth interviews and analyzed using an inductive content analysis approach. RESULTS: The content analysis revealed 3 major themes-navigating glucose level fluctuations, reframing diabetes self-care and improving quality of life, and device improvement and service quality. Participants reported that CGMs offered convenient glucose level monitoring, allowed early response to rapid glucose changes, and facilitated effective patient-clinician communication. Participants expressed concerns about the financial burden and limited services, recommending improvements for devices, consumer services, and health insurance coverage. CONCLUSIONS: Study findings indicated that using wearable CGMs could improve self-care and quality of life in adults with diabetes. Using CGMs could improve patients' understanding of how diabetes self-care management affects real-time glucose levels. Health care providers could support patients' self-care by using device data. Improvements in quality, services, and insurance coverage could increase user satisfaction and promote self-care.

Effect of a Smart Pill Bottle Reminder Intervention on Medication Adherence, Self-efficacy, and Depression in Breast Cancer Survivors.

BACKGROUND: Globally, breast cancer has been identified as the most common cancer among women. The clinical efficacy of adjuvant oral antiestrogen therapy-including tamoxifen and aromatase inhibitors-has been proven to be clinically efficacious for breast cancer survivors. However, medication adherence for these therapies remains suboptimal among breast cancer survivors. OBJECTIVE: The aim of this study was to evaluate the effect of a reminder intervention-a smart pill bottle paired with the Pillsy mobile application-on medication adherence, medication self-efficacy, and depression, among breast cancer survivors who were undergoing oral antiestrogen therapy. METHODS: This study is a randomized controlled trial. Sixty-one women were allocated to an experimental group (n = 31) and the control group (n = 30). The experimental group received the reminder intervention of a smart pill bottle for 4 weeks. Study outcomes were identified as medication adherence, medication self-efficacy, and depression. RESULTS: Fifty-seven women completed the follow-up measurement. Significant differences in favor of the experimental group were noted for medication adherence ( P = .004) and medication self-efficacy ( P = .004). There was no statistically significant difference between the 2 groups with regard to depression ( P = .057). CONCLUSIONS: Reminder intervention using smart pill bottles was effective in improving medication adherence and medication self-efficacy among breast cancer survivors undergoing oral antiestrogen therapy. IMPLICATIONS FOR PRACTICE: A smart pill bottle method of intervention can be a useful reminder strategy to improve medication adherence among breast cancer survivors.

South Asian immigrant women's experiences of being respected within cancer treatment settings.

The purpose of this focused ethnographic inquiry was to examine South Asian immigrant women's experiences and perceptions of respect within health professional-client relationships in the context of a Canadian outpatient treatment clinic. Characteristics of respect described by 11 women interviewed were the meaning of respect, health professional's way of being, their way of attending to the person, and their way of talking. Language, cultural values and beliefs, along with underlying societal, individual and institutional factors that coexist with health professionals' ability to create respect were some of the dimensions that influenced how immigrant women experienced respect. Health professionals' capacity to acknowledge South Asian immigrant women as individuals helped to formulate/construct respect for their individual identities. The need to be respected for 'my social identity' as an immigrant woman with cancer was woven throughout women's stories, illustrated by their personal experiences and perspectives.

Adoption of NCLEX-RN for licensure in Canada: Faculty concerns and implications for nursing education.

This paper highlights questions about Canadian nurse regulators' adoption of the U.S.-based NCLEX-RN examination, effective 2015, as the only route to initial registered nurse licensure in all jurisdictions, excluding Quebec. The decision for this change was made by the Canadian Council of Registered Nurses Regulators (CCRNR), an umbrella association of CEO's of provincial regulatory bodies in collaboration with the National Council of State Boards of Nursing (NCSBN). Adoption and implementation of this new policy was accomplished by the Council of each provincial regulatory body. This change, representing the first international adoption of NCLEX-RN, was deemed successful by CCRNR and NCSBN. However, the Canadian Association of Schools of Nursing (CASN) described the decision as unilateral and unwise, questioning the applicability of NCLEX-RN in the Canadian context, citing significant French language translation issues and unacceptable pass rates. Both authors have had extensive academic nursing experience in U.S. and Canada. Both had many conversations with Canadian colleagues who described the impact on nursing education as disastrous. Most of our American colleagues knew nothing about this change, but once informed, expressed some concerns similar to those of their Canadian counterparts. We suggest that international adoption of a US-based examination for initial licensure merits wider discussion by nursing faculty here and abroad.

The Impact of Organizational Factors on Nurses' Knowledge, Perceptions, and Behaviors Around Advance Care Planning.

The objective of this study was to understand the organizational context of nurses' use of advance care plans (ACPs). We use a modified version of Bandera's social cognitive theory model to understand relationships between organizational constructs such as experience with ACPs and satisfaction with organizational support and oncology nurses' knowledge, behaviors, and perceptions around ACPs. The sample included practicing registered nurses with a major focus in oncology who were members of the Oncology Nursing Society in the United States, and nurses at medical hospital or community care settings were included. Institutional review board approval was obtained, and permission was granted from the oncology nursing organization for online surveys. A validated ACP survey was used to measure nurses' experiences and perceptions of working with ACP. Perceptions of ACP by patients, vicarious experience with ACP, direct experience of ACP, having received training, and perceptions of organizational support for ACP were all predictive of total ACP behaviors in the workplace. The final regression model had 3 independent variables and accounted for 33% of the variance in total ACP behaviors. Both vicarious and direct experience with ACP was associated with ACP behaviors in workplaces. This implies the need for more vicarious and direct training experiences, as well as organization support, to build self-efficacy to perform ACP.

Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US-Mexico border region-a qualitative study.

OBJECTIVES: Hospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US-Mexico border region. DESIGN: This qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis. SETTING: The HC programme was situated at a local home health agency, located in rural Southern California, USA. PARTICIPANTS: Twenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study. RESULTS: Conversation about HC as an option was initiated by home healthcare staff (39.3%), followed by physicians (32.1%). Emerging themes related to challenges in utilisation of HC and decision-making included: (1) communication barriers; (2) lack of knowledge/misperception about HC; (3) emotional difficulties, including fear of losing their patient, doubt and uncertainty about the decision, denial and (4) patients are not ready for HC. Facilitators included: (1) patient's known EOL wishes; (2) FCG-physician EOL communication; (3) the patient's deteriorating health and (4) home as the place for death. CONCLUSIONS: HC patients' FCGs in this rural region reported a lack of knowledge or misunderstanding of HC. It is recommended that healthcare providers need to actively engage family members in patient's EOL care planning. Optimal transition to an HC programme can be facilitated when FCGs are informed and have a clear understanding about patients' medical status along with information about HC.

Users' Concerns Related to Online HIV Counseling in South Korea: A Descriptive Qualitative Study.

This qualitative descriptive study was designed to identify HIV-related questions frequently asked by online counseling users seeking professional advice. Data were collected via a public online question/answer counseling website operated by the Gyeonggi-do branch of the Korean Association for AIDS Prevention. Data on users' questions regarding HIV were collected between January 1, 2017, and December 31, 2018. The online questions were then analyzed and divided into codes and categories. From the 559 questions submitted, content analysis identified four major categories related to HIV: (a) HIV testing, (b) self-perceived HIV risk and risky sexual behaviors, (c) positive and negative emotional states, and (d) treatment and prevention. This study indicates that online counseling can be used to provide tailored information related to HIV along with emotional and psychosocial support to reach different subgroups and to provide current information such as the use of pre-exposure prophylaxis for those seeking professional advice.