So what I'm stressed? A qualitative study examininga caregivers' reactions to emerging biomarkers of stress.

Background: Caregivers of adults with cancer often report significant distress yet remain difficult to engage in supportive services. While the field of Psychosomatic Medicine has continued to identify important markers of physiologic stress, and demonstrated disruption in these markers in caregiver populations, no research has investigated whether biomarker information on caregivers' reaction to stress could impact their willingness to address their ongoing distress. Methods: Here, we report on a qualitative study (N = 17) in which we conducted individual interviews with cancer caregivers to explore their key attitudes towards, and subjective experience of, mock stress biomarker data. A total of 17 caregivers of patients (M age = 56.1 years; SD = 12.3) with primarily metastatic brain tumors (glioblastoma) were interviewed regarding four commercially available biomarkers (telomere length; hair cortisol, activity levels and heart rate variability). Once presented with information about stress biomarkers, caregivers were asked to discuss their subjective reaction as if it was their own data as well as their motivation and willingness to seek support after receiving such information. We identified and extracted relevant themes. Results: Analysis utilizing the framework method revealed four emerging themes. The first theme described caregivers' ability to manage stress and willingness to engage with supportive services. Second, caregivers generally accepted the biomarker data but preferred it to be presented in a specific way. The third theme demonstrated that for some, biomarker data may actually increase their subjective distress (e.g., whether or not something could be done to improve their mental state). The last theme described how biomarkers were generally received as meaningful motivators that could increase caregivers' willingness to engage with supportive services. Conclusions: In addition to the more general identified theme of CG's willingness to engage with additional support, we gained insights into caregivers' reaction to the stress biomarkers presented. Findings will set the stage for the utility of stress biomarker information and whether it influences cancer caregivers' willingness to address their distress and motivation to engage in supportive services.

U.S. nurse practitioners' HIV screening behaviors and health center characteristics.

ABSTRACT: One of the most effective strategies to end the human immunodeficiency virus (HIV) epidemic is HIV screening technologies. Routine HIV screening reaches the first-time tester, people with undiagnosed HIV, and those persons who are in need of frequent retesting due to their ongoing risk. This secondary analysis examined nurse practitioners' (NPs) rates of offering routine HIV screening and health center HIV screening characteristics. A convenience sample of NPs completed either a paper and pencil or an online survey in February 2016. Nurse practitioners responded to several questions about their behaviors and the health center characteristics where they work related to HIV screening. Many NPs (31%) never offer routine HIV screening to patients. Efforts are needed to implement structural changes to increase HIV screening rates among NPs and the health centers where they work. Nurse practitioners, health centers, and the health center policies must align to address the HIV epidemic and implement national HIV screening recommendations.

U.S. Nurse Practitioner Beliefs About Routine HIV Screening: Predicting Behaviors.

HIV is a preventable infection. Effective HIV prevention interventions, which include routine HIV screening, have reduced HIV transmission. As health care providers, nurse practitioners (NPs) have a role in screening for HIV. In this study, we explored NP attitudinal, social normative (expectation and priority), and behavioral control (perceived barriers and facilitators) beliefs that predicted their self-reported HIV screening behaviors. The Theory of Planned Behavior guided the study. Data from 141 NPs were collected through a cross-sectional, paper and pencil survey. Findings revealed that the belief that "my office staff supports routine HIV screening with my patients" predicted HIV screening, whereas the belief that "consent from a parent/guardian should be obtained before screening for HIV in a person younger than 18 years" predicted less HIV screening. Nurse practitioners identified social normative expectations to be most influential in predicting their routine HIV screening behaviors.

HIV screening intentions, behaviors, and practices among nurse practitioners.

BACKGROUND AND PURPOSE: HIV/AIDS is a significant public health issue for individuals living in the United States. Federal agencies and key stakeholders recommend routine HIV/AIDS screening among individuals aged 13-64 of age, yet few studies focus on the nurse practitioner's (NP) perspective. The purpose of this study was to examine routine HIV screening intentions, behaviors, and practices using a national sample of NPs. METHODS: Cross-sectional study utilizing a random sample of 600 NPs from the American Association of Nurse Practitioners™ organization. A total of 141 NPs returned complete responses to the paper and pencil questionnaire and were included in the study. CONCLUSIONS: One-quarter (25%, n = 35) of the NPs reported routine HIV screening behavior. Half (48%, n = 67) reported intentions to increase routine HIV screening in the next year. HIV screening practices were reported as risk-based and patient-initiated among this sample of NPs. IMPLICATIONS FOR PRACTICE: In the U.S. healthcare system, NPs serve as leaders in primary and secondary prevention, screening and identifying individuals who are unaware of their HIV infection. Greater coordinated efforts and new system approaches are needed to help NPs adapt HIV screening recommendations and practice guidelines.