Awaiting diagnosis of breast cancer: strategies of enduring for preserving self.

PURPOSE/OBJECTIVES: To explicate the emotional experiences of women undergoing breast cancer diagnosis who are waiting for the results of breast biopsy. RESEARCH APPROACH: Glaserian Grounded Theory. SETTING: Urban area in western Canada. PARTICIPANTS: 37 women aged 32-76 years. The breast cancer diagnosis was positive for 11 women, negative for 24 women, and two results were unclear. METHODOLOGIC APPROACH: Unstructured, recorded telephone interviews. FINDINGS: Undergoing breast cancer diagnosis is a profoundly distressing experience dictated by diagnostic processes and procedures. Women rapidly transitioned from wellness to frightening phases of facing cancer to continuing terror during the testing phase. While waiting to hear results, women controlled their emotions, which enabled them to get through the experience and highlighted the protective function of enduring and its necessity for survival. The basic social psychological process, preserving self, is the outcome of enduring. CONCLUSIONS: A mid-range theory, Awaiting Diagnosis: Enduring for Preserving Self, was developed. This theory explicates the emotional responses of women who were undergoing diagnosis for breast cancer and provides a theoretical behavioral basis for responding to cues and signals of suffering. INTERPRETATION: The Praxis Theory of Suffering enables nurses to recognize and respond according to the behaviors of suffering, and to endure with healthy, adaptive, and normalizing behaviors that enable preserving self.

A randomized trial comparing two low-intensity psychological interventions for distressed patients with cancer and their caregivers.

PURPOSE/OBJECTIVES: To compare the effectiveness of two low-intensity approaches for distressed patients with cancer and caregivers who had called cancer helplines seeking support. Baseline distress was hypothesized as a moderator of intervention effect. DESIGN: Randomized trial. SETTING: Community-based cancer helplines in Queensland and New South Wales, Australia. SAMPLE: 354 patients with cancer and 336 caregivers. METHODS: Participants were randomized to either a single session of nurse-led self-management intervention or a five-session psychologist cognitive behavioral intervention delivered by telephone. Assessments were undertaken at baseline (preintervention) and at 3, 6, and 12 months. MAIN RESEARCH VARIABLES: Psychological and cancer-specific distress and post-traumatic growth. FINDINGS: No significant moderation by baseline cancer-specific distress was noted. For low-education patients, only the psychologist intervention was associated with a significant drop in distress. For all other participants, distress decreased over time in both arms with small to large effect sizes (Cohen's ds = 0.05-0.82). Post-traumatic growth increased over time for all participants (Cohen's ds = 0.6-0.64). CONCLUSIONS: Many distressed patients with cancer and their caregivers may benefit significantly from a single session of a nurse psychoeducation intervention that can be delivered remotely by telephone and supported by self-management materials. Research is needed to develop an algorithm that moves beyond the use of distress as the only indicator for referral to specialist psychological services. Survivors and caregivers with low education and low literacy may require more in-depth and targeted support. IMPLICATIONS FOR NURSING: Brief nurse psychoeducation and stress management for cancer survivors and caregivers should be considered as part of a tiered approach to psychosocial care.

Psychologic and biologic factors associated with fatigue in patients with persistent radiculopathy.

Fatigue is a common symptom associated with neuropathic pain (NP) and can have negative consequences on psychosocial functioning, physical endurance, and quality of life. Recent evidence indicates that immune activation modulated through the increased release of proinflammatory cytokines can predict fatigue in some patient populations. Although earlier studies have shown that immune activation is a pathophysiologic feature of NP, there have been no studies to examine the relationship between immune activation and fatigue in persons with NP. Therefore, the purpose of this exploratory study was to: 1) determine the relationships among fatigue, pain, psychosocial factors, and selected biologic markers of immune activation (interleukin [IL] 6 and soluble IL-6 receptor [sIL-6R]) in participants with persistent radiculopathy; and 2) determine the differences in these variables based on fatigue severity. Participants (n = 80) were classified according to their level of fatigue as low (27.5%), moderate (32.5%), or high (40%), and significant differences were found between fatigue categories (p = .001). Multivariate analyses of variance revealed that individuals with moderate to high levels of fatigue differed from those with the lowest levels of fatigue in psychologic distress, depressive symptoms, IL-6, and sIL-6R, whereas the differences between moderate and high levels of fatigue were significant for psychologic distress and sIL-6R only. The findings suggest that immune activation affects fatigue severity and possibly other behavioral responses, offering important information when providing care to patients with persistent radiculopathy. The integration of biobehavioral nursing interventions in pain management may have a greater impact on quality of life than treatment focused only on pain.

Impact of a bilingual education intervention on the quality of life of Latina breast cancer survivors.

PURPOSE/OBJECTIVES: To test the effectiveness of a bilingual education intervention to improve the quality of life (QOL) of Latina breast cancer survivors (BCSs) after completing primary treatment for breast cancer. DESIGN: A two-group prospective, longitudinal, randomized, controlled trial. SETTING: An ambulatory-care setting of a designated comprehensive cancer center in southern California. SAMPLE: 52 English- and Spanish-speaking Latina BCSs. METHODS: Women were randomly assigned to the experimental or attention control group and completed measures of QOL, uncertainty, distress, and acculturation at baseline, and at three and six months postintervention. MAIN RESEARCH VARIABLES: QOL, uncertainty, and distress. FINDINGS: After controlling for acculturation, the four dimensions of QOL increased slightly in the groups or remained unchanged without significant group-by-time interaction. The social and psychological well-being subscales had the lowest scores, followed by physical and spiritual well-being. Although the group-by-time interaction was not statistically significant, the post-hoc difference for total QOL between time 2 and time 3 in the experimental group approached significance, with a slight increase in total QOL. CONCLUSIONS: Latina BCSs have multiple survivorship and QOL concerns that might put them at risk for poor QOL. IMPLICATIONS FOR NURSING: More culturally congruent intervention studies are needed to address the paucity of intervention research with Latina BCS. KNOWLEDGE TRANSLATION: Core values must be incorporated in the development of health education programs. Those programs also should be linguistically appropriate and available to non-English-speaking Latinas. In this way, the informational and supportive needs of all BCSs can be met.

Clinical case study: a 4-year-old boy with posterior fossa syndrome after resection of a medulloblastoma.

Posterior fossa syndrome can occur after neurosurgical resections of childhood posterior fossa tumors, such as medulloblastomas. Posterior fossa syndrome is characterized by transient mutism, emotional lability, cognitive deficits, weakness, ataxia, and cranial nerve dysfunction. Symptoms generally appear 1 to 3 days after surgery and persist for months to years. Neuroscience nurses play an integral role in helping affected children and their families through the diagnosis, treatment, and sequelae of this frightening syndrome.

Personality trait and quality of life in colorectal cancer survivors

PURPOSE/OBJECTIVES: To explore the association between quality of life (QOL) and type D personality, which is characterized by the traits of negative affectivity and social inhibition, and to further identify impacts of these traits after controlling for biophysical and psychological factors in colorectal cancer survivors. DESIGN: Cross-sectional and correlational. SETTING: Oncology and surgical outpatient clinics of a medical center in Taiwan. SAMPLE: 124 patients diagnosed with colorectal cancer who had completed active treatment. METHODS: Data were collected using a set of structured questionnaires to explore type D personality, biophysical and psychological factors, and QOL. Their associations were verified with Mann-Whitney U test and Spearman's rho correlation. Significant factors associated with QOL were identified with generalized estimating equations. MAIN RESEARCH VARIABLES: Type D personality and QOL. FINDINGS: Patients with type D personality experienced higher physical and psychological distress than those with non-type D personality. Social inhibition remained an important factor leading to impairment in the mental component of QOL after controlling for other associated factors. Negative affectivity was associated with fatigue intensity and interference of fatigue with life activities. CONCLUSIONS: Personality trait was found to be an important factor associated with QOL. The trait of social inhibition was a significant factor influencing mental aspects of QOL, whereas negative affectivity was associated with fatigue. IMPLICATIONS FOR NURSING: Assessing patients' personality, including negative affectivity and social inhibition, could help nurses to develop supportive groups or social networks for these patients and thereby improve QOL for cancer survivors.

Provider verbal responses to patient distress cues during ambulatory oncology visits.

PURPOSE/OBJECTIVES: To explore healthcare provider cue-responding behaviors to patient cues of distress and socioemotional concerns during ambulatory, on-treatment oncology visits. DESIGN: Descriptive secondary analysis of a data set of audio recordings of oncology visits and reports of symptoms and quality of life recorded with an electronic self-report assessment-cancer (ESRA-C) tool. SETTING: Comprehensive cancer center, ambulatory care. SAMPLE: 31 randomly selected cases from an existing data set (with one used as a training tool) of 590 audio recordings of patient-provider communication. METHODS: Patients were placed in Group 1 (n = 20) and Group 2 (n = 10) to explore differences in patient-provider communication and decrease coder bias. Both groups completed the ESRA-C questionnaire prior to the visit. Providers in Group 2 received a printed ESRA-C summary report for use during the visit. Audio files of the visit were coded using the Medical Interview Aural Rating System (MIARS). MAIN RESEARCH VARIABLES: Patient cues of distress and provider cue-responding behaviors. FINDINGS: Patient cues of distress and socioemotional concerns ranged from 0-13 cues per visit, with a mean of 4.6 cues per visit. Providers acknowledged 57% of patient cues, but only acknowledged and explored 22% of all patient cues. Providers in Group 2 acknowledged patient concerns more often but explored the concerns less frequently. The number of patient cues distanced from by providers was lower in Group 2 and the overall provider score for responsiveness to patient cues of distress was higher, indicating more responsiveness than from Group 1. CONCLUSIONS: The use of a summary report of patient concerns may have enhanced provider responsiveness, in general. Distancing behaviors by providers in response to patient verbal cues may indicate a lack of knowledge, time limitations, or a lack of confidence. IMPLICATIONS FOR NURSING: To effectively support patients with cancer through active therapy, a greater level of acknowledgment, exploration, and responsive action by providers is indicated. These findings have implications for provider education, with regard to appropriate responses, and for researchers to test methods that best prompt and support effective provider behaviors, ultimately improving patient outcomes.

The clinical utility of the distress thermometer: a review.

The Distress Thermometer (DT) is a well validated screening tool, demonstrably sensitive and reasonably specific to the construct of distress in cancer. Its brevity makes it ideal to incorporate into a system of distress management. To ascertain how far this idea has been developed in practice, and to support future research, a literature review was undertaken. Medline, CINAHL, PsycINFO, Embase, ASSIA, British Nursing Index, AMED, CCTR, and HMIC were systematically searched. Forty studies were reviewed that examined the function of the DT alone, together with the problem list (PL), and/or other validated measures. The majority of studies validated the DT against other robust measures of distress in order to establish 'caseness' in these populations, and establish factors associated with distress. Many of the studies recommended that further research should test their findings in clinical practice. A small section of the literature focused on the clinical utility of the DT as a facilitator of consultations, and found it to have potential in this regard. It is concluded that there is enough validation research, and in line with the majority of these studies' recommendations, future research should focus on the utility of DT as part of a structured distress management programme.

Determinants of quality of life in patients near the end of life: a longitudinal perspective.

PURPOSE/OBJECTIVES: to describe the quality of life (QOL) of patients near the end of life and to identify determinants of their QOL. DESIGN: descriptive, longitudinal. SETTING: university-affiliated cancer center, two private oncologists' offices, and patients' homes. SAMPLE: 80 patients with either stage IIIb or IV lung cancer newly diagnosed in the previous month or recurrent lung cancer with distant disease. METHODS: patients were interviewed for responses to instruments to assess demographic, physical, psychosocial, and spiritual characteristics. Baseline data were collected at the patients' places of oncology care. Home visits were made for the two-month and four-month data collection points. MAIN RESEARCH VARIABLES: QOL; symptom frequency, severity, and distress; functional status; anxiety; depression. FINDINGS: fifty percent of patients died within five months of their lung cancer diagnosis. Patients reported a relatively high QOL that did not change significantly as they approached the end of life. Symptom distress was the strongest determinant of QOL, followed by symptom severity, symptom frequency, and depression. CONCLUSIONS: QOL was most affected by symptoms experienced in patients with advanced lung cancer, particularly distress associated with symptoms. Interventions for symptom management must be implemented at diagnosis because patients in this population may approach the end of life quickly. IMPLICATIONS FOR NURSING: a routine and thorough symptom assessment is imperative for patients with advanced lung cancer. Attention to symptom distress is important because of its effect on QOL.

Pediatric oncology: the use of cluster analysis to examine maternal concerns.

PURPOSE/OBJECTIVES: To examine data from mothers whose children have cancer and to identify the characteristics of uncertainty and distress that they reported. The objectives were (a) to use cluster analysis to identify subgroups of maternal uncertainty and distress, (b) to examine whether the subgroups differed based on demographics and children's illness-related variables, and (c) to explore whether mothers in the subgroups differed on quality of life (QOL) and hope. DESIGN: Descriptive, correlational study. SETTING: Pediatric oncology units in northern Taiwan. SAMPLE: 200 mothers of children with cancer. METHODS: Participants completed the Parental Perception of Uncertainty Scale, the Symptom Checklist-35-Revised, the Short-Form 36 Health Survey, the Herth Hope Index, and a demographic questionnaire. Cluster analyses were used to identify subgroups of mothers regarding maternal perceived uncertainty and distress. Differences in demographic variables, disease characteristics, and outcome measures were evaluated with descriptive statistics, analysis of variance, and chi-square analysis. MAIN RESEARCH VARIABLES: Subgroup, maternal uncertainty, distress, QOL, and hope. FINDINGS: Four subgroups were identified by the cluster analyses: high uncertainty and high distress, moderate uncertainty and moderate distress, low uncertainty and low distress, and high uncertainty and low distress. CONCLUSIONS: The subgroup of mothers who reported low uncertainty and low distress reported the highest QOL and hope. IMPLICATIONS FOR NURSING: The findings of this study provide insight for pediatric oncology clinicians and offer issues related to uncertainty, distress, and QOL that such professionals can discuss with the mothers of their patients.

Psychosocial distress in young cancer survivors.

OBJECTIVES: To review existing literature about the psychosocial reactions of cancer patients and provide information about the needs of patients wishing to preserve fertility. DATA SOURCES: Journal articles, research studies. CONCLUSION: The desire for biological parenthood is an important issue for cancer survivors. Patients may not receive accurate, timely information about fertility-sparing options; those not receiving this information are at increased risk for psychological distress. IMPLICATIONS FOR NURSING PRACTICE: Fertility-preservation decisions are complex and a team approach may identify patients at risk for psychological distress and provide opportunities for discussion of psychosocial issues involved. Nurses must be informed about the emotional reactions and informational needs of their patients.

Insomnia, depression, and distress among outpatients with prostate cancer.

Limited information is known about insomnia, depression, and distress in men with prostate cancer. This study explored insomnia and its relationship to depression and distress in this population. Participants (N = 51) were recruited from a Veterans Affairs Medical Center outpatient clinic. Questionnaires included the Insomnia Severity Index, Center for Epidemiologic Studies-Depression Scale, and Impact of Event Scale. Findings indicated that many men had insomnia and depression with a moderate level of distress. Half the men with clinically significant insomnia also had clinically significant depression. Significant relationships were found among insomnia, depression, and distress. Implications for research and practice are offered.

Living with an unfixable heart: a qualitative study exploring the experience of living with advanced heart failure.

BACKGROUND: Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person's point of view as its central focus. AIM: The aim of this study was to describe patients' experiences of living with advanced heart failure. METHODS: The study sample (N=9) consisted of male (N=6) and female (N=3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006. RESULTS: Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence. CONCLUSIONS: The findings suggest that there may be an illogical but enduring ethos of 'cure' pervading health care worker's attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.

A descriptive examination of the impact of sternal scar formation in women.

Formation of abnormal scars is a significant source of morbidity following sternotomy. We undertook a descriptive exploratory mixed methods study of women (n=13) who participated in the Women's Recovery from Sternotomy Trial to examine the: (1) qualitative impact of the cosmetic result of sternotomy, and (2) quantitative association between subjective satisfaction and objective ratings of the sternal scar. Conventional content analysis was used to analyze the data generated from semi-structured interviews. Though the participants appreciated that having the scar was a cost of reaping the benefits of having cardiac surgery, they were not well prepared to learn to live with the scar. The scar was a poignant personal reminder that they had a health problem and underwent a distressing surgery, and it often rendered them feeling less attractive. The scar also had a public presence that they perceived rendered judgment from others. There was little association between the participants' subjective satisfaction (rated on a likert-type scale) and the objective scar rating using the Beausang Clinical Scar Assessment (r=0.348, p=0.294). The subjective perception of the sternal scar is of importance to women. Thus, appropriate preparation, post-operative counseling and support regarding the sternal scar are warranted.

Distressing emotions in female caregivers of people with AIDS, age-related dementias, and advanced-stage cancers.

PURPOSE: To describe and compare the depressive mood, anxiety, anger, and sleep problems of informal female caregivers of people with AIDS, age-related dementias (ARD), and cancer (CA). METHODS: Caregivers recruited from clinics serving people with AIDS, ARD, and CA were interviewed using structured instruments measuring depressive symptoms, anxiety, anger, and sleep problems. Data analysis compared these emotions in the caregivers and related aspects of the caregiving situation to these emotions within each group. FINDINGS: Caregivers did not differ significantly in depressive mood, but did differ in anxiety and anger and sleep problems. Individual items on each scale were compared to provide more descriptive detail. In each group, distressing emotions were significantly related to each other and to sleep problems. CONCLUSIONS: Caregivers of people with AIDS, ARD, and CA experience distressing emotions that may affect their mental and physical health. A comprehensive approach to mental health nursing therapy will best meet the needs of caregivers in relieving their distress.

Effects of a nursing intervention on subjective distress, side effects and quality of life of breast cancer patients receiving curative radiation therapy--a randomized study.

The purpose of this randomized study was to investigate whether a nursing intervention using Orem's self-care theory as a framework would affect subjective distress, side effects and quality of life as perceived by breast cancer patients receiving curative radiation therapy. The intervention consisted of five 30-min sessions once a week during the treatment period and two follow-up sessions after completion of treatment. The experimental group consisted of 67 patients, as did the control group. Measurements were collected five times: at baseline before commencement of treatment, at weeks 3 and 5 (completion of treatment) and follow-up periods of 2 weeks and 3 months. No measurable effect of the nursing intervention was found for side effects or quality of life but nursing intervention proved to have a positive effect in minimizing stress reactions (p = < 0.05). It is suggested that a nursing intervention should be implemented for breast cancer patients receiving curative radiation therapy.

Tratamiento del síndrome de intestino irritable, estudio comparativo / Treatment of the irritated bowel syndrome

El síndrome de intestino irritable es la alteración gastrointestinal más frecuente y se considera que explica del 30 al 50 por ciento de todos los trastornos digestivos que se ven en las clínicas y consulta particular. En últimas fechas se ha recobrado el interés para estudiar la fisiopatología del padecimiento y la terapéutica. Por lo general, el tratamiento es ineficaz, quizá porque no se actúa contra un solo padecimiento y se requiere diversificar el tratamiento. En este estudio se seleccionó a pacientes de la consulta externa de gastroenterología, a los cuales se les diagnosticó síndrome de intestino irritable por exclusión de otras patologías abdominales. Se estudiaron dos grupos de pacientes femeninos; al grupo control se les dio tratamiento médico con base en dieta rica en fibra más procinéticos (metoclopramida 10 mg preparandial), mientras que el grupo en estudio se le dio igualmente tratamiento con base en dieta rica en fibra más procinético (metoclopramida 10 mg preprandial) y psicoterapia grupal. Los criterios en los que se basó el estudio fueron: la evolución de la intensidad de la sintomatología gastrointestinal: dolor abdominal, distensión abdominal, flatulencia y hábitos intestinales. Se observó que a los tres meses de tratamiento, el grupo en estudio mostró un mejoramiento significativo comparado con el grupo control, desapareció la sintomatología por completo en el 85 por ciento de los pacientes mientras que en el grupo control sólo se encotró mejoría en el 11.1 por ciento de los pacientes. Se concluye que el apoyo psiquiátrico es factible y efectivo en pacientes con síndrome de intestino irritable

Hopelessness in the myocardial infarction patient.

Events that cause hopelessness following a myocardial infarction may include coronary heart disease, reality-based misperceptions, lack of future goals and lack of relatedness to others. The susceptibility to hopelessness will depend on how successful the patient has been in accepting previous cardiac-related problems. Once hopelessness occurs, the patient may perceive the future to be limited. Hopelessness centers around seven components: physiological, cognitive, temporal, affective, behavioral, affiliative and contextual loss of hope. This article outlines how hopeless patients may distort their immediate environment and future goals. Methods of identifying hopelessness and intervening with appropriate nursing interventions, which will assist with the management of hopelessness, are described.