Adult Cancer Patients' Perceptions of Factors That Influence Hospital Admissions.

PURPOSE/AIMS: To explore cancer patients' perceptions of factors that influence hospital readmissions. DESIGN: A cross-sectional, prospective design was employed utilizing a 1-time survey and brief interviews to measure patients' perceptions and unplanned hospital admissions. METHODS AND VARIABLES: The principal investigator collected data from medical record review, the Hospital Admission Survey, and interviews to measure patient characteristics and perceptions of influencing factors that contributed to an unplanned hospital admission upon admission. Data were analyzed using descriptive statistics to categorize patient perceptions of influencing factors of unplanned hospital admissions. RESULTS: The top reasons for admission were symptoms of uncontrolled gastrointestinal, pain, fever, and respiratory problems. The majority perceived the admission was unavoidable and wanted to avoid an admission. Perceived influencing factors were related to survey categories of 1) communication (ie, cannot reach physician anytime, cannot get a next-day appointment, medical problems are out of control, advised to go to the emergency department) and 2) home environment (ie, unable to adequately manage symptoms at home and hospital admission is the best place for care). Other survey categories of patient education and palliative care were not perceived as influencing or contributing factors. CONCLUSIONS: These findings highlight opportunities for clinical nurse specialists to target these vulnerable patients and provide expert consultation to address potential barriers and gaps in utilization of appropriate supportive services that may reduce unplanned hospital admissions.

Learning Needs of Women Who Undergo Robotic Versus Open Gynecologic Surgery.

OBJECTIVES: To compare the learning needs of women undergoing robotic versus open (laparotomy) gynecologic surgery for benign and cancerous conditions. DESIGN: Descriptive exploratory study. SETTING: A tertiary care hospital in Orlando, Florida. PARTICIPANTS: Women undergoing gynecologic surgery (N = 226; n = 71 laparotomy and n = 155 robotic). METHODS: All consenting procedures and data collection occurred in two study visits. Instruments included a demographics questionnaire and the Patient Learning Needs Scale. Bivariable sociodemographic and clinical differences between surgical groups were assessed with Pearson's chi-square test. Multiple linear regression was used to assess differences in total Patient Learning Needs Scale scores and subscores between surgical groups and to evaluate the association of demographic and clinical variables with total Patient Learning Needs Scale scores within surgical groups. RESULTS: White and non-Hispanic women were more likely to receive robotic surgery. Women who underwent robotic surgery were more likely to ambulate and have their first oral intake on the day of surgery. Women in the robotic surgery group were also significantly more likely to have a hospital length of stay of 1 day or less (90.3% vs. 4.2%, p < .001). At discharge, participants in the robotic surgery group had significantly more learning needs overall (179.67 vs. 159.66, p < .001) and for the subscales of Medication, Activities of Daily Living, Feelings Related to Condition, Treatment/Complications, Quality of Life, and Skin Care than participants in the laparotomy group. For women in the robotic surgery group, those with a hospital length of stay longer than 1 day had significantly greater learning needs. For women in the laparotomy group, Asian women had greater learning needs than White women. CONCLUSION: Participants who underwent robotic gynecologic surgery had greater learning needs than those who underwent laparotomy. Nurses and other health care providers may perceive robotic surgery as a less invasive procedure with fewer adverse effects, shorter length of stay, and faster recovery that requires fewer postoperative care instructions.

Transition from treatment to survivorship: effects of a psychoeducational intervention on quality of life in breast cancer survivors.

PURPOSE/OBJECTIVES: To examine the effectiveness of a psychoeducational intervention on quality of life (QOL) in breast cancer survivors in post-treatment survivorship. DESIGN: A randomized controlled trial. SETTING: An academic center collaborating with a regional cancer center in the southeastern United States. SAMPLE: 256 breast cancer survivors. METHODS: Women were randomly assigned to the experimental or wait control group. The Breast Cancer Education Intervention (BCEI) study was delivered in three face-to-face sessions and five monthly follow-up sessions (three by telephone and two in person). The control group received four monthly attention control telephone calls and the BCEI at month 6. Data were collected at baseline, three and six months after the BCEI for the experimental group, and one month after the BCEI (at month 7) for the wait control group. MAIN RESEARCH VARIABLES: Primary endpoints were overall QOL and physical, psychological, social, and spiritual well-being. FINDINGS: No differences in QOL were reported at baseline between groups. The experimental group reported improved QOL at three months, whereas the wait control group reported a significant decline in QOL. The experimental group reported continued maintenance of QOL at six months. Although the wait control group reported improved QOL at six months, significant differences continued to exist between the groups. CONCLUSIONS: The BCEI was an effective intervention in improving QOL during the first year of breast cancer survivorship. Treatment effects were durable over time. IMPLICATIONS FOR NURSING: Post-treatment survivorship has not been empirically studied to a large degree. The BCEI is one of the few interventions demonstrating effectiveness among survivors after primary treatment, suggesting that oncology nurses may be uniquely positioned to provide safe passage using education and support.