Redefining Competencies for Nurse Anesthesia Education--Integrating Emotional Intelligence Assessment and Training into a Nurse Anesthesia DNP Program.

We present an overview of best practices for integrating emotional intelligence into a nurse anesthesia educational program. We first cover a brief history of the importance of emotional intelligence to the healthcare, nursing, and nurse anesthesia fields and then present the processes we undertook to integrate emotional intelligence holistically into our curriculum.

Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research.

The process of cerebral vessels regulating constant cerebral blood flow over a wide range of systemic arterial pressures is termed cerebral autoregulation (CA). Static and dynamic autoregulation are two types of CA measurement techniques, with the main difference between these measures relating to the time scale used. Static autoregulation looks at the long-term change in blood pressures, while dynamic autoregulation looks at the immediate change. Techniques that provide regularly updating measures are referred to as continuous, whereas intermittent techniques take a single at point in time. However, a technique being continuous or intermittent is not implied by if the technique measures autoregulation statically or dynamically. This narrative review outlines technical aspects of non-invasive and minimally-invasive modalities along with providing details on the non-invasive and minimally-invasive measurement techniques used for CA assessment. These non-invasive techniques include neuroimaging methods, transcranial Doppler, and near-infrared spectroscopy while the minimally-invasive techniques include positron emission tomography along with magnetic resonance imaging and radiography methods. Further, the advantages and limitations are discussed along with how these methods are used to assess CA. At the end, the clinical considerations regarding these various techniques are highlighted.

Unintentional weight loss, its associated burden, and perceived weight status in people with cancer.

PURPOSE: Unintentional weight loss (UWL) is a prevalent problem in people with cancer and is associated with poorer psychosocial outcomes. A gap exists in understanding whether and how perceived and/or weight status impacts experiences of UWL. Thus, we sought to examine subjective experiences of UWL in people with cancer, and whether perceived and/or actual weight status impacts these experiences. METHODS: Participants were recruited through Cancer Support Community's Cancer Experience Registry® and related networks. Participants completed an online survey that included the FAACT Anorexia-Cachexia subscale, and 19 items that captured six themes related to "beliefs and concerns" (positive beliefs, psychosocial impact, physical impact, cancer outcomes, self-esteem, relationships with others). Perceived weight status (PWS) was assessed using a single item. Body mass index (BMI) was calculated using self-reported weight and height measurements. RESULTS: Of 326 respondents, 114 reported experiencing UWL. Over one-third misperceived their weight, with 29% perceiving weight status as below their BMI status. UWL in those with perceived weight status of overweight/obese was associated with positive beliefs. However, being underweight by BMI or perceiving oneself as underweight were both associated with greater concerns about weight loss. Perceived weight status of underweight compared to normal or overweight/obese weight status was associated with poorer psychosocial well-being, personal control, self-esteem, and relationships with others. CONCLUSION: In people with cancer, perceived weight status, rather than BMI, had greater impact on negative "beliefs and concerns" about UWL. Findings suggest assessment of both perceived and actual BMI to address the impact of UWL on psychosocial wellbeing.

Sociodemographic inequalities in barriers to cancer pain management: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II).

OBJECTIVE: Research has increasingly documented sociodemographic inequalities in the assessment and management of cancer-related pain. Most studies have focused on racial/ethnic disparities, while less is known about the impact of other sociodemographic factors, including age and education. We analyzed data from a large, national, population-based study of cancer survivors to examine the influence of sociodemographic factors, and physical and mental health comorbidities on barriers to cancer pain management. METHODS: The study included data from 4707 cancer survivors in the American Cancer Society's Study of Cancer Survivors-II, who reported experiencing pain from their cancer. A multilevel, socioecological, conceptual framework was used to generate a list of 15 barriers to pain management, representing patient, provider, and system levels. Separate multivariable logistic regressions for each barrier identified sociodemographic and health-related inequalities in cancer pain management, controlling for years since diagnosis, disease stage, and cancer treatment. RESULTS: Two-thirds of survivors reported at least 1 barrier to pain management. While patient-related barriers were most common, the greatest disparities were noted in provider- and system-level barriers. Specifically, inequalities by race/ethnicity, education, age, and physical and mental health comorbidities were observed. CONCLUSION: Findings indicate survivors who were nonwhite, less educated, older, and/or burdened by comorbidities were most adversely affected. Future efforts in research, clinical practice, and policy should identify and/or implement new strategies to address sociodemographic inequalities in cancer pain management.

Health-related quality of life in ovarian cancer survivors: Results from the American Cancer Society's Study of Cancer Survivors - I.

OBJECTIVE: There are limited data on outcomes and predictors of health-related quality of life (HRQOL) of ovarian cancer survivors. Therefore, we examined the trajectory and predictors of HRQOL one- and two-years post-diagnosis in this population. METHODS: 365 ovarian cancer survivors, a subset of participants in the longitudinal American Cancer Society's Study of Cancer Survivors-I, completed questionnaires at one-year post-diagnosis on sociodemographics, clinical factors, and HRQOL (SF-36). 284 women had HRQOL data at two-years post-diagnosis. In this secondary data analysis, we examined HRQOL at both time points, changes in HRQOL and predictors of HRQOL with univariate and multivariate linear regression. RESULTS: Mean mental and physical HRQOL scores one-year post-diagnosis were 49.37 (SD±11.59) and 45.96 (SD±10.89), respectively. Older age, lower income, higher disease stage, more comorbidities and greater symptom burden were associated with poorer physical functioning one year post-diagnosis. Younger age, higher stage, having an existing mental health issue, greater symptom burden, and not receiving chemotherapy were associated with poorer mental functioning. Disease recurrence between one- and two-years post-diagnosis and greater symptom burden were predictors of declining physical functioning from one- to two-years post-diagnosis. Mental functioning did not change significantly between assessments. CONCLUSIONS: Overall mental and physical functioning of these ovarian cancer survivors was similar to the general population. However, lower HRQOL was associated with a number of variables, including disease recurrence, treatment status, symptom burden, age, and number of comorbidities. These findings can help health care providers identify survivors who may benefit from relevant interventions.

American Cancer Society Head and Neck Cancer Survivorship Care Guideline.

Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.

Health information needs and preferences in relation to survivorship care plans of long-term cancer survivors in the American Cancer Society's Study of Cancer Survivors-I.

PURPOSE: Survivorship care plans (SCPs) provide cancer patients and health care providers with a treatment summary and outline of recommended medical follow-up. Few studies have investigated the information needs and preferred sources among long-term cancer survivors. METHODS: Cancer survivors of the ten most common cancers enrolled in the longitudinal Study of Cancer Survivors-I (SCS-I) completed a survey 9 years post-diagnosis (n = 3138); at time of diagnosis of the SCS-I cohort, SCPs were not considered usual care. We assessed participants' current desire and preferred sources for information across ten SCP items and evaluated factors associated with information need 9 years after diagnosis. RESULTS: The proportion of long-term cancer survivors endorsing a need for cancer and health information 9 years post-diagnosis ranged from 43 % (cancer screening) to 9 % (consequences of cancer on ability to work). Print media and personalized reading materials were the most preferred information sources. Younger age, higher education, race other than non-Hispanic white, later cancer stage, having breast cancer, having ≥2 comorbidities, and self-reporting poor health were associated with greater informational need (p < 0.05). CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS: Long-term cancer survivors continue to report health information needs for most SCP items and would prefer a print format; however, level of need differs by socio-demographic and cancer characteristics. Cancer survivors who did not previously receive a SCP may still benefit from receiving SCP content, and strategies for enabling dissemination to long-term survivors warrant further investigation.

Reference values of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being: a report from the American Cancer Society's studies of cancer survivors.

BACKGROUND: Health-related quality of life measures are common in oncology research, trials, and practice. Spiritual well-being has emerged as an important aspect of health-related quality of life and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being; The 12-item Spiritual Well-Being Scale (FACIT-Sp-12) is the most widely used measure of spiritual well-being among those with cancer. However, there is an absence of reference values with which to facilitate the interpretation of scores in research and clinical practice. The objective of the current study was to provide FACIT-Sp-12 reference values from a representative sample of adult cancer survivors. METHODS: As part of the American Cancer Society's Study of Cancer Survivors-II, a national cross-sectional study of cancer survivors (8864 survivors) completed questionnaires assessing demographic characteristics, clinical information, and the FACIT-Sp-12. Scores were calculated and summarized by FACIT-Sp-12 subscale and total scores across age, sex, race/ethnicity, time after treatment, and cancer type. RESULTS: Student t tests for independent samples found that women reported significantly higher FACIT-Sp-12 scores (P<.001). Analyses of variance found significant main effects for FACIT-Sp-12 scores by age (P<.01), race/ethnicity (P<.05), and cancer type (P<.001). Post hoc comparisons revealed that older adults (those aged 60-69 years and 70-79 years) and black non-Hispanic individuals reported the highest FACIT-Sp-12 scores compared with those aged 18 to 39 years (P<.05; Cohen d [an effect size used to indicate the standardized difference between 2 means], 0.20-0.50) and white non-Hispanic individuals (P<.05; Cohen d, 0.02-0.62), respectively. All other significant main effects were small in magnitude (effect size range, 0.001-0.032). CONCLUSIONS: These data will aid in the interpretation of the magnitude and meaning of FACIT-Sp-12 scores, and allow for comparisons of scores across studies.

Current unmet needs of cancer survivors: analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II.

BACKGROUND: Cancer survivors may continue to experience psychosocial and physical needs related to their cancer experience for many years after treatment. The specification of these needs across cancer types and by survivor characteristics may lead to better prevention approaches and clinical responses. Mixed methods were used to examine responses to an open-ended question about current unmet needs from a survey of 2-, 5-, and 10-year cancer survivors. METHODS: Qualitative techniques were used to code themes of unmet needs from open-ended responses. These themes were then examined with quantitative techniques to describe the frequency of unmet needs across disease subgroups and demographic subgroups of survivors. RESULTS: There were 1514 responses to the open-ended question on unmet needs. Respondents ranged in age from 24 to 97 years and included proportionately more women, and 18% were minorities (black and Hispanic). Sixteen themes of unmet needs were identified. The number and type of unmet needs were not associated with the time since cancer treatment. Breast cancer survivors identified more unmet needs than other survivors. Male survivors and especially prostate cancer survivors identified personal control problems as current needs. Older cancer survivors identified fewer unmet needs on average than younger survivors. CONCLUSIONS: This analysis of an open-ended question on unmet needs extends our understanding of how cancer survivors perceive problems related to cancer. How cancer-related needs change over time and differ by sex, race, and ethnicity and how problems with personal control become manifest are areas of inquiry requiring further research.

Peers promoting physical activity among breast cancer survivors: A randomized controlled trial.

OBJECTIVE: Although studies have shown that physical activity (PA) can reduce some treatment-related side effects of breast cancer, there is a need to offer PA programs outside of research settings to reach more cancer survivors. We partnered with the American Cancer Society's Reach to Recovery (RTR) program to train their volunteers (breast cancer survivors) to deliver a 12-week PA intervention to other breast cancer survivors. METHOD: We conducted a randomized controlled trial to compare the PA intervention delivered by RTR volunteers (PA plus RTR) with contact control (RTR control). Eighteen RTR volunteers/coaches (Mage = 54.9 years; Mtime since diagnosis = 7.0 years) delivered the contact control condition or the PA intervention. Seventy-six breast cancer survivors in New England (Mage = 55.6 years; Mtime since diagnosis = 1.1 years) were randomized to 1 of the 2 groups. At baseline, 12 weeks (postintervention), and at 24 weeks, participants wore an accelerometer for 7 days, were interviewed about their PA, and reported their motivational readiness for PA. RESULTS: Adjusted, mixed-effects longitudinal regression models showed significant group differences favoring the PA plus RTR group in minutes of moderate to vigorous PA at 12 weeks (Mdifference = 103 min/week, p < .001) and at 24 weeks (Mdifference = 34.7 min/week, p = .03). Results were corroborated with significant group differences in accelerometer data favoring the PA plus RTR group at both time points. CONCLUSION: Peer volunteers were able to significantly increase PA among cancer survivors relative to contact control. Partnerships with existing volunteer programs can help to widen the reach of behavioral interventions among cancer survivors. (PsycINFO Database Record

An action plan for translating cancer survivorship research into care.

To meet the complex needs of a growing number of cancer survivors, it is essential to accelerate the translation of survivorship research into evidence-based interventions and, as appropriate, recommendations for care that may be implemented in a wide variety of settings. Current progress in translating research into care is stymied, with results of many studies un- or underutilized. To better understand this problem and identify strategies to encourage the translation of survivorship research findings into practice, four agencies (American Cancer Society, Centers for Disease Control and Prevention, LIVE STRONG: Foundation, National Cancer Institute) hosted a meeting in June, 2012, titled: "Biennial Cancer Survivorship Research Conference: Translating Science to Care." Meeting participants concluded that accelerating science into care will require a coordinated, collaborative effort by individuals from diverse settings, including researchers and clinicians, survivors and families, public health professionals, and policy makers. This commentary describes an approach stemming from that meeting to facilitate translating research into care by changing the process of conducting research-improving communication, collaboration, evaluation, and feedback through true and ongoing partnerships. We apply the T0-T4 translational process model to survivorship research and provide illustrations of its use. The resultant framework is intended to orient stakeholders to the role of their work in the translational process and facilitate the transdisciplinary collaboration needed to translate basic discoveries into best practices regarding clinical care, self-care/management, and community programs for cancer survivors. Finally, we discuss barriers to implementing translational survivorship science identified at the meeting, along with future directions to accelerate this process.

Patient-reported outcome measures suitable to assessment of patient navigation.

BACKGROUND: Patient-reported outcomes (PROs) are measures completed by patients to capture outcomes that are meaningful and valued by patients. To help standardize PRO measures in patient navigation research and program evaluation, the Patient-Reported Outcomes Working Group (PROWG) was convened as part of the American Cancer Society's National Patient Navigator Leadership Summit. METHODS: The PROWG consisted of clinicians, researchers, and program managers from a variety of perspectives who developed a set of recommended PRO measures across the cancer continuum (ie, screening, diagnostic follow-up, treatment, survivorship, end of life) as well as those useful for assessing family caregivers. Measures were recommended based on face validity, responsiveness to navigation, reliability, and construct validity in relevant populations. Other considerations included readability, existence of multiple language versions, the existence of norm groups, and respondent burden. RESULTS: The PROWG reached consensus on measures for use in the domains of treatment adherence; perceived barriers to care; satisfaction with cancer care; satisfaction with patient navigation services; working alliance with patient navigator; perceived knowledge/competence/self-efficacy; functional assessment/symptom burden; global quality of life; specific quality-of-life symptoms (eg, depression, anxiety); and perceived cultural competency of the navigator. In domains where validated measures were found lacking, recommendations were made for areas of needed scale development. CONCLUSIONS: These measures should guide research and programmatic evaluation of patient navigation.

Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society's Studies of Cancer Survivors.

BACKGROUND: Few studies have examined risk for severe symptoms during early cancer survivorship. By using baseline data from the American Cancer Society's Study of Cancer Survivors-I, the authors examined cancer survivors with high symptom burden, identified risk factors associated with high symptom burden, and evaluated the impact of high symptom burden on health-related quality of life (HRQoL) 1 year postdiagnosis. METHODS: Participants were enrolled from 11 state cancer registries approximately 1 year after diagnosis and were surveyed by telephone or mail. The outcomes measures used were the Modified Rotterdam Symptom Checklist and the Profile of Mood States-37 (to assess symptom burden) and the Satisfaction with Life Domains Scale-Cancer (to assess HRQoL). RESULTS: Of 4903 survivors, 4512 (92%) reported symptoms related to their cancer and/or its treatment. Two-step clustering yielded 2 subgroups, 1 with low symptom burden (n = 3113) and 1 with high symptom burden (n = 1399). Variables that were associated with high symptom burden included lung cancer (odds ratio [OR], 2.27), metastatic cancer (OR, 2.05), the number of comorbid conditions (OR, 1.76), remaining on active chemotherapy (OR, 1.93), younger age (OR, 2.31), lacking insurance/being underinsured (OR, 1.57), having lower income (OR, 1.61), being unemployed (OR, 1.27), and being less educated (OR, 1.29). Depression, fatigue, and pain had the greatest impact on HRQoL in survivors with high symptom burden, who also had lower HRQoL (P < .0001). CONCLUSIONS: More than 1 in 4 cancer survivors had high symptom burden 1 year postdiagnosis, even after treatment termination. These results indicate a need for continued symptom monitoring and management in early post-treatment survivorship, especially for the underserved.

Residential segregation and disparities in health-related quality of life among Black and White cancer survivors.

OBJECTIVE: Studies of health-related quality of life (HRQOL) among Black and White cancer survivors have been based on small convenience samples and yielded inconsistent results. We examined Black-White disparities in survivors' HRQOL with a population-based sample, and tested the hypothesis that area-level segregation accounts for those disparities. DESIGN: A sample of survivors of 10 types of cancer was drawn from 11 U.S. state cancer registries and surveyed 12-15 months after diagnosis. The current sample consisted of 5195 survivors (415 Black, 4780 White) who resided in 584 counties. MAIN OUTCOME MEASURES: SF-36 General Health subscale scores were used as the measure of HRQOL. RESULTS: Bivariate results revealed that Black survivors had significantly poorer HRQOL than did White survivors. Multilevel regression including individual-level (gender, age, marital status, education, cancer type, stage at diagnosis, cancer progression, comorbidities, race/ethnicity) and area-level (county segregation and poverty) variables found that HRQOL was poorer among survivors who resided in high-Black-segregated counties, whereas race/ethnicity was no longer significant. CONCLUSION: These findings indicate that Black-White disparities in HRQOL among cancer survivors might be a function, not of race/ethnicity, but of area-level variables associated with race/ethnicity. The strong role of segregation highlights the need for interventions to target Black-segregated areas.

Prevalence and sociodemographic correlates of beliefs regarding cancer risks.

BACKGROUND: Inaccurate beliefs about cancer risk may contribute to unhealthy lifestyle behaviors and poor adherence to recommended screening and prevention guidelines. To address this issue the current study assessed the prevalence and sociodemographic correlates of scientifically unsubstantiated beliefs about cancer risk in a representative sample of the US population. METHODS: Nine hundred fifty-seven US adults with no history of cancer were surveyed by telephone. The survey included 12 statements about cancer risk, risk factors, and prevention that were framed to be contrary to the consensus of current scientific evidence. RESULTS: Participants were inconsistent in their ability to identify the statements as false, and appraisal accuracy was associated with several sociodemographic characteristics. Five of the 12 misconceptions were endorsed as true by at least a quarter of the respondents, and uncertainty was higher than 15% for 7 statements. At the same time, more than two-thirds of the participants were able to identify 7 statements as false and, on average, respondents endorsed fewer than 3 statements as true. Respondents who were male, older, non-White, less educated, and of lower income were most likely to hold inaccurate beliefs. CONCLUSIONS: A notable percentage of the participants in this study hold beliefs about cancer risk at odds with the prevailing scientific evidence. Because the population segments with the least accurate knowledge also bear the greatest burden of cancer, areas for public education and intervention efforts are identified.

The impact of biologics on the quality of life of psoriasis patients and the economics of psoriasis care.

Psoriasis has a tremendous impact on patients' lives, affecting them physically, psychologically, and socially. Thus, it is not merely a cosmetic concern and often warrants appropriately aggressive treatment. Traditional treatments for moderate-to-severe psoriasis include phototherapy, oral retinoids, methotrexate, and cyclosporine. Newer biologics combat the immunologic mechanism responsible for psoriasis and, to date, carry a more favorable side effect profile. We examined the impact on quality of life of biologics and assessed their total direct costs to psoriasis patients. Biologic treatments significantly improve the quality of life of psoriasis patients; however, they cost significantly more than traditional therapies. This difference calls for physicians to weigh the costs and benefits of biologic therapies and compare them to those of traditional treatments when considering care for psoriasis patients.

Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy.

PURPOSE: Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy. The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver. PATIENTS AND METHODS: Four hundred eleven patients about to start chemotherapy were randomly assigned to receive usual psychosocial care only, a professionally administered form of stress management training, or a patient self-administered form of stress management training. Quality-of-life assessments were conducted before randomization and before the second, third, and fourth treatment cycles. Intervention costs were estimated from both payer and societal perspectives. RESULTS: Compared with patients who received usual care only, patients receiving the self-administered intervention reported significantly (P < or = .05) better physical functioning, greater vitality, fewer role limitations because of emotional problems, and better mental health. In contrast, patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only. Costs of the self-administered intervention were estimated to be 66% (from a payer perspective) to 68% (from a societal perspective) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy. CONCLUSION: Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment.