Do Patients Regret Having Received Systemic Treatment for Advanced Non-Small Cell Lung Cancer: A Prospective Evaluation.

BACKGROUND: Thousands of patients annually receive treatment for advanced non-small cell lung cancer (NSCLC), but little is known about their views on the decision to receive that treatment, or regret. This trial prospectively evaluated the incidence of regret and whether baseline characteristics, patient decision-making parameters, or clinical progress early in the treatment course predicts regret. MATERIALS AND METHODS: Patients receiving systemic treatment for advanced NSCLC completed every 3-week patient reported outcome (PRO) assessment using the electronic Lung Cancer Symptom Scale (eLCSS-QL), including the 3-Item Global Index (3-IGI; assessing overall distress, activities, and quality of life [QL]). A prespecified secondary aim was to determine the frequency of regret evaluated at 3 months after starting treatment. Patients were randomized to usual care or enhanced care (which included use of the DecisionKEYS decision aid). RESULTS: Of 164 patients entered, 160 received treatment and 142 were evaluable for regret. In total, 11.5% of patients and 9% of their supporters expressed regret. Baseline characteristics did not predict regret; regret was rarely expressed by those who had a less than 20% decline or improvement in the 3-IGI PRO score after two treatment cycles. In contrast, when asked if they would make the same decision again, only 1% not having a 20% 3-IGI decline expressed regret, versus 14% with a 3-IGI decline (p = .01). CONCLUSION: The majority of patients having regret were identified early using the PRO 3-IGI of the eLCSS-QL measure. Identifying patients at risk for regret allows for interventions, including frank discussions of progress and goals early in the treatment course, which could address regret in patients and their supporters. IMPLICATIONS FOR PRACTICE: This report documents prospectively, for the first time, the incidence of treatment-related regret in patients with advanced lung cancer and outlines that risk of regret is associated with patient-determined worsening health status early in the course of treatment. Identifying patients at risk for regret early in treatment (before the third cycle of treatment) appears to be crucial. Counseling at that time should include a discussion of consideration of treatment change and the reason for this change.

Exploring the challenges of medical/nursing tasks in home care experienced by caregivers of older adults with dementia: An integrative review.

AIMS: To examine prevalence, types, challenges and the impact of medical/nursing tasks (MNT) on caregivers of older adults with dementia. BACKGROUND: Medical/nursing tasks have been perceived as a professional healthcare role; however, research shows that many caregivers of older adults with dementia perform those tasks in the home, such as giving injections, tube feedings or operation of medical equipment. Little is known about the caregivers' challenges in engaging in these MNT. DESIGN: Integrative review. METHODS: Ovid MEDLINE, CINAHL, PsycINFO and Web of Science databases were searched to explore MNT among caregivers of older adults with dementia who lived in a community setting. Four quantitative and nine qualitative studies published between 1980-2018 were included. Overall, process of the review was guided by PRISMA. RESULTS: About 67% of U.S. caregivers of older adults with dementia performed MNT, including managing multiple medications, wound care and nutritional management. Care recipients' cognitive impairment complicated the provision of those tasks due to their limited cognitive functioning, behavioural changes, comorbidities and complex medication regimen. Insufficient information and training from healthcare professionals as well as caregivers' age and their own health problems made performance of those tasks even more challenging. As a result, caregivers frequently suffered from emotional distress such as worrying, anxiety and sleep disturbance. CONCLUSIONS: Medical/nursing tasks have become one of the daily tasks of caregivers of older adults with dementia within the home. However, the tasks are difficult and complicated, and inadequate support from healthcare professionals may compromise the caregivers' well-being. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should provide education and should be aware of caregivers' needs related to MNT. Structured-medical information, skill-based instructions and hands-on training may be beneficial to decrease the caregivers' distress from MNT.

Increased adoption of smoke-free policies on campuses with schools of nursing.

BACKGROUND: In 2015, the majority of U.S. American Association of Colleges of Nursing (AACN)-accredited schools of nursing resided on campuses without smoke-free policies. PURPOSE: To determine the presence of smoke-free policies at AACN-accredited after resolutions from AACN and the American Academy of Nursing, and the creation of online resources. METHODS: Smoke-free policies (2015-2017) were determined through listings on the ANRF College Campus Policy Database© and survey responses from nursing deans. RESULTS: Smoke-free policies for 689 schools of nursing increased from 36% in 2015 to 91% in 2017. There were no significant differences by nursing program types or geographic area. Twenty percent of deans reported using the resources, with over 1700-page views. CONCLUSION: Smoke-free policies increased after support from two national nursing organizations. Learning in a smoke-free environment should be an expectation for nursing students to protect their own health, and to support their future critical role in tobacco control.

Enhancing evaluation of sarcopenia in patients with non-small cell lung cancer (NSCLC) by assessing skeletal muscle index (SMI) at the first lumbar (L1) level on routine chest computed tomography (CT).

PURPOSE: Ongoing cancer cachexia trials evaluate sarcopenia by skeletal muscle index (SMI) at the L3 vertebrae level, commonly used as a standard. Routine chest CT institutional protocols widely differ in including L3. We investigated whether SMI at L1 assessment, rather than L3, would be reliable and more practicable for non-small cell lung cancer (NSCLC). METHODS: NSCLC patients with routine CT chest had SMI measurements performed at L1 using Slice-O-Matic software. Accuracy of including L1 level, imaging quality, and ability to detect sarcopenia was collected and correlation of L1 SMI with body mass index (BMI) was performed. RESULTS: Thirty-seven patients with NSCLC (73 CT assessments) were enlisted at three institutions. Characteristics: 47% female; medians: age 59, KPS 80%; BMI 25.49, weight 72.97 kg, SMI 59.24. Sarcopenia was detected in 14.7% of patients; 20% had sarcopenic obesity. Of the 73 CTs, 94.5% included L1 (95% CI 86.6-98.5%). Three images (4%) were difficult to evaluate. Inclusion of L1 was similar among the three participating institutions (90.4 to 96.7% inclusion). BMI correlation with SMI was weak (r = 0.329). CONCLUSIONS: SMI assessment at L1 is achievable in patients with NSCLC receiving routine chest CT, with 96% having acceptable quality evaluations. Similar to results previously reported at L3, BMI showed poor correlation and low sensitivity to detect muscle mass loss. The use of CT at L1 is reliable and presents the opportunity for easier patient evaluation of sarcopenia in patients with lung cancer without the need for additional testing or radiation exposure.

Content validity and electronic PRO (ePRO) usability of the Lung Cancer Symptom Scale-Mesothelioma (LCSS-Meso) in mesothelioma patients.

PURPOSE: Obtaining qualitative data directly from the patient perspective enhances the content validity of patient-reported outcome (PRO) instruments. The objective of this qualitative study was to evaluate the content validity of the Lung Cancer Symptom Scale for Mesothelioma (LCSS-Meso) and its usability on an electronic device. METHODS: A cross-sectional methodological study, using a qualitative approach, was conducted among patients recruited from four clinical sites. The primary target population included patients with pleural mesothelioma; data were also collected from patients with peritoneal mesothelioma on an exploratory basis. Semi-structured interviews were conducted consisting of concept elicitation, cognitive interviewing, and evaluation of electronic patient-reported outcome (ePRO) usability. RESULTS: Participants (n = 21) were interviewed in person (n = 9) or by telephone (n = 12); 71% were male with a mean age of 69 years (SD = 14). The most common signs and symptoms experienced by participants with pleural mesothelioma (n = 18) were shortness of breath, fluid build-up, pain, fatigue, coughing, and appetite loss. The most commonly described symptoms for those with peritoneal mesothelioma (n = 4) were bloating, changes in appetite, fatigue, fluid build-up, shortness of breath, and pain. Participants with pleural mesothelioma commonly described symptoms assessed by the LCSS-Meso in language consistent with the questionnaire and a majority understood and easily completed each of the items. The ePRO version was easy to use, and there was no evidence that the electronic formatting changed the way participants responded to the questions. CONCLUSIONS: Results support the content validity of the LCSS-Meso and the usability of the electronic format for use in assessing symptoms among patients with pleural mesothelioma.

Understanding End-of-Life Decision-Making Terminology Among African American Older Adults.

The purpose of the current study was to examine understanding of end-of-life (EOL) decision-making terminology among family caregivers of African American older adults with dementia. This qualitative descriptive study was part of a larger mixed-methods study from which a subset of caregivers (n = 18) completed interviews. Data were analyzed using descriptive statistics and content analyses guided by methods of qualitative analysis. Caregiver interpretation of EOL decision-making terminology varied between associations before and/or after death. EOL decision making was most often a family decision, based on past experiences, and included reliance on resources such as faith or spirituality and health care providers. Patients and families attach meaning to health care terms that should be aligned with health care providers' understanding of those terms. Results provide insight to improve EOL decision making in this population via tailored interventions for patients, families, and health care providers. [Journal of Gerontological Nursing, 44(2), 33-40.].

Post-Transfer Predictors of Poor Outcomes in Pediatric Renal Transplant Recipients.

The aims of this study were twofold: 1) to describe the post-transfer (defined as from pediatric to adult providers) incidence of predictors (medication nonadherence, acute rejection, and change in kidney function), as well as outcomes (graft loss) for adolescent and young adult kidney transplant recipients during a three-year post-transfer follow-up period; and 2) to identify variables to monitor these predictors, in the form of a clinical profile, so providers can promote early intervention for these medically at-risk adolescents. National data were used to describe predictors and outcomes for 250 youth (16 to 25 years old) three years after transfer of care. These predictors were combined with previous literature to develop a preliminary clinical profile. Using an evidence-based clinical profile with predictors for graft loss by a dedicated healthcare professional as a transition coordinator will assist in identifying those at risk for poor outcomes after transfer.

Risk Factors for Graft Loss in Pediatric Renal Transplant Recipients After Transfer of Care.

BACKGROUND: Improvements in transplantation have increased the survival of children after kidney transplantation. These patients have complex needs, and the current medical system is not prepared to effectively transfer the care of these individuals from pediatric to adult health-care systems. Too often, transfer occurs during moments of crisis and is associated with poor outcomes. OBJECTIVE: The aim of this study was to use a national database, the Scientific Registry of Transplant Recipients, to test the hypothesis that the increased risk of graft loss after transfer of care (from pediatric to adult services) for young adult kidney transplant recipients over a 2- to 3-year posttransfer follow-up period was related to these posttransfer risk factors (medication noncompliance, acute rejection, insurance status). DESIGN: A retrospective, longitudinal, correlational design using secondary data was used to evaluate the transfer of care of 250 kidney transplant recipients (ages 16-25). RESULTS: Seventy-seven (30.8%) individuals lost their graft within 3 years after transfer of care. Medication noncompliance, acute rejection, and serum creatinine >2.0 mg/dL at transfer were significant predictors of graft loss after accounting for multiple other factors. CONCLUSION: These individuals are at risk for graft loss after transfer of care and may benefit from increased personalized care during this risky period.

Few U.S. schools of nursing on campuses with smoke-free policies: A Call for Action.

INTRODUCTION: Tobacco remains the leading cause of preventable death in the United States. Recognizing that smoke-free policies can significantly reduce tobacco-related morbidity and mortality by preventing exposure to second-hand smoke and increasing quit rates, members of the Tobacco Control Subgroup of the American Academy of Nursing's (AAN) Health Behavior Expert Panel launched a health policy initiative entitled the Smoke-Free Campus Policy for Schools of Nursing Campaign. Designed as a two-phased initiative, the Campaign is a Call to Action to increase smoke-free policies on campuses with Schools of Nursing across the United States by 2020. METHODS: Phase I of the AAN Campaign included a cross-sectional study using secondary data analysis to describe the presence of smoke-free policies on campuses of Schools of Nursing across the United States. A list of colleges and universities with smoke-free policies maintained by the Americans for Nonsmokers Rights Foundation in January 2015 was accessed to conduct the analysis. Schools of Nursing granting baccalaureate and graduate nursing degrees were included. Descriptive statistics were obtained for Schools of Nursing by region of the country and by highest level of nursing degree program of study at each institution. RESULTS: Smoke-free policies of 689 Schools of Nursing were examined. Of these, 442 (64%) did not have 100% smoke-free policies on their campuses. A greater percentage of nursing schools without a smoke-free policy were located in the Northeast (114, 79%) and West (70, 73%). Nearly half (57, 46%) of the Schools of Nursing with a PhD/DNS program had a smoke-free policy in place compared with all other degree program levels (BS/BSN: 69, 35%; MS/MSN: 83, 35%; DNP: 38, 30%). CONCLUSIONS: With only 247 (36%) of Schools of Nursing on campuses with comprehensive smoke-free policies, more must be performed to promote healthy learning and working environments for nursing students, staff, and faculty. As public health advocates, nursing leaders in Schools of Nursing have a moral and ethical imperative to advance tobacco control on college campuses to meet the American College Health Association goals for smoke-free/tobacco-free environments.

Determining issues of importance for the evaluation of quality of life and patient-reported outcomes in breast cancer: results of a survey of 1072 patients.

Identifying key issues for patients is central to assessing treatment for cancer, especially when evaluating health-related quality of life (QL) and patient-reported outcomes (PROs). This study was conducted to provide enhanced content validity support by incorporating the views of a large number of patients with breast cancer. This methodological study used an anonymous, cross-sectional, electronic web-based survey of 1072 patients with a diagnosis of breast cancer. Patients ranked the importance of 21 issues on a 5-point scale. Issues included general, physical, functional, psychosocial, and summative items. Analysis was also performed by four key factors (age group, time since diagnosis, adjuvant treatment or not, and tumor extent). All of the top five issues rated as either "very important" or "important" were global issues-rather than symptoms-such as maintaining quality of life (ranked in these two highest categories by 99 % of patients), maintaining independence (97 %), and ability to perform normal activities (97 %). The abilities to concentrate and to be able to sleep (97 and 96 %, respectively) were ranked above specific breast cancer symptoms. Specific symptoms included within the top ten highest ranked items were fatigue, depression, anxiety, shortness of breath, and pain. This is the largest analysis of evidence-based data determining support for content validity for QL and PROs provided by patients with breast cancer. While symptoms are important to patients, the survey also demonstrates that PRO measures that only evaluate symptoms are not fully responding to patient-expressed needs. These results provide confidence in the content of quality of life measures for large groups of patients with breast cancer, including the new Breast Cancer Symptom Scale (BCSS) questionnaire.

Analyzing the Usability of the 5-Level Canadian Triage and Acuity Scale By Paramedics in the Prehospital Environment.

INTRODUCTION: ED crowding negatively affects throughput, quality of care, and outcomes. Paramedics do not have an evidence-based, feasible triage instrument to guide classification of patients. No studies have compared the Canadian Triage and Acuity Scale (CTAS) used by prehospital paramedics against the Emergency Severity Index (ESI) used by nurses in the emergency department. This study sought to determine if a relationship exists between paramedics' triage scores and emergency nurses' scores in the emergency department using 2 common 5-level triage instruments, as well as to determine whether either instrument correlates with patient admission. METHODS: CTAS scores determined by paramedics on arrival at the emergency department were compared with the initial ESI scores determined by emergency nurses. Both scores were compared with the patient's disposition status. Data analyses included descriptive statistics, χ(2) statistics, and hierarchical regression analysis. RESULTS: The analysis included 2,222 patients. There was a poor relationship between the CTAS and the ESI at the facility (P = .599, κ = -0.003). The final regression model explained 32.9% of the admission variance (P < .001). The model correctly predicted 61.5% of admissions, with an 82% accuracy rate for all other forms of disposition and an overall model prediction rate of 73.7%. DISCUSSION: Using the CTAS, paramedics can predict admission comparably with nurses using the ESI. However, both instruments showed weakness in over- and under-triage rates. Additional studies are indicated to better understand prehospital paramedic triage and its impact on throughput.

Can a computerized format replace a paper form in PRO and HRQL evaluation? Psychometric testing of the computer-assisted LCSS instrument (eLCSS-QL).

PURPOSE: This trial assessed the ability to enhance health-related quality of life (HRQL) and patient-reported outcome (PRO) evaluation in trials and patient management using computer assistance with a handheld device, called a personal digital assistant. The study assessed ease of use and psychometric properties of this approach, comparing the Lung Cancer Symptom Scale (LCSS) paper form with the electronic (eLCSS-QL). Objectives were to: (1) measure completion times; (2) evaluate acceptability by patients, nurses, and physicians; (3) determine the correlation of the eLCSS-QL with the paper version; and (4) determine the feasibility of using a shorter visual analogue scale (VAS) in the electronic version. PATIENTS AND METHODS: Patients were entered at 12 COMET clinics. All had: (a) stage III or IV non-small cell lung cancer, (b) Karnofsky performance status (KPS) ≥ 60, (c) no prior chemotherapy, and (d) received initial courses of docetaxel + platinum. Of the 148 patients enrolled, characteristics were: men, 57 %; median, KPS 80 %; and median age, 67 years. Of these, 131 patients completed the evaluation form. RESULTS: The eLCSS-QL had excellent acceptance by patients, nurses, and physicians. Patients required 2.2 min (mean) to complete the eLCSS-QL. Reliability coefficients using Cronbach's alpha were high for the paper (0.84) and electronic (0.88) versions. The correlation coefficient between forms was high (0.92). The length of the VAS on the handheld pc (53 mm versus 100 mm on the paper format) resulted in nearly identical scores. CONCLUSIONS: The high acceptance rate by patients and professionals, the rapid completion time, ease of use, and strong psychometric properties confirm that the electronic LCSS (eLCSS-QL) is practical for use in trials and patient management. This study indicates that computer assistance helps overcome barriers associated with evaluating HRQL and PROs.

A theory-based decision aid for patients with cancer: results of feasibility and acceptability testing of DecisionKEYS for cancer.

PURPOSE: Appropriate utilization of treatment is a goal for all patients undergoing cancer treatment. Proper treatment maximizes benefit and limits exposure to unnecessary measures. This report describes findings of the feasibility and acceptability of implementing a short, clinic-based decision aid and presents an in-depth clinical profile of the participants. METHODS: This descriptive study used a prospective, quantitative approach to obtain the feasibility and acceptability of a decision aid (DecisionKEYS for Balancing Choices) for use in clinical settings. It combined results of trials of patients with three different common malignancies. All groups used the same decision aid series. Participants included 80 patients with solid tumors (22 with newly diagnosed breast cancer, 19 with advanced prostate cancer, and 39 with advanced lung cancer) and their 80 supporters as well as their physicians and nurses, for a total of 160 participants and 10 health professionals. RESULTS: The decision aid was highly acceptable to patient and supporter participants in all diagnostic groups. It was feasible for use in clinic settings; the overall value was rated highly. Of six physicians, all found the interactive format with the help of the nurse as feasible and acceptable. Nurses also rated the decision aid favorably. CONCLUSIONS: This intervention provides the opportunity to enhance decision making about cancer treatment and warrants further study including larger and more diverse groups. Strengths of the study included a theoretical grounding, feasibility testing of a practical clinic-based intervention, and summative evaluation of acceptability of the intervention by patient and supporter pairs. Further research also is needed to test the effectiveness of the decision aid in diverse clinical settings and to determine if this intervention can decrease overall costs.

A Decision Aid for Patients With Minimally Suspicious Screening Mammograms: A Pilot Study.

OBJECTIVES: To determine the feasibility and acceptability of using a decision aid (DA) in a breast surgery clinic. SAMPLE & SETTING: 42 patients with minimally suspicious mammograms and two physicians participated in this study at an outpatient breast specialty clinic in Virginia. METHODS & VARIABLES: A quasiexperimental single group pilot study was conducted to determine the feasibility of DecisionKEYS, a theory-based, interactive DA intervention. Patients with minimally suspicious mammogram results chose between breast biopsy or close imaging follow-up. The Decisional Conflict Scale was used to measure decisional conflict. The Decision-Making Quality Scale was used to evaluate the overall decision process. Postintervention physician and patient feedback evaluated feasibility and acceptability. RESULTS: Participants and physicians rated the DA as helpful. Decisional Conflict Scale scores were low before and after the intervention. Physicians reported the DA was feasible for workflow, and the majority reported using the DA in making final recommendations. Management recommendation (breast biopsy, close imaging follow-up) changed in 26 of 42 cases from pre- to postintervention. The majority of participants underwent breast biopsy. IMPLICATIONS FOR NURSING: The feasibility and acceptability of the DA were beneficial to patients and clinic workflow.

Fatigue, sleep-wake disturbances, and quality of life in adolescents receiving chemotherapy.

BACKGROUND: Adolescents with cancer experience distressing physical and psychosocial symptoms, especially during treatment. Fatigue and sleep disturbances commonly affect adolescents' quality of life, but little is known about how adolescents experience these symptoms during an early month of chemotherapy. This study measured fatigue, sleep disturbances, and quality of life in 20 adolescents over 1 month while they were receiving chemotherapy. METHODS: Multidimensional fatigue and quality of life were measured weekly with modules from the PedsQL Measurement Model, and sleep disturbances were measured with the General Sleep Disturbance Scale. RESULTS: Adolescents experienced increased severity of fatigue and sleep disturbances during the week after treatment. Common sleep-wake problems included daytime sleepiness, decreased alertness, and poor sleep quality. Fatigue and sleep-wake disturbances were related symptoms, and both symptoms were associated with various domains of quality of life. CONCLUSIONS: Fatigue and sleep-wake disturbances are significant problems for adolescents receiving chemotherapy and negatively affect the quality of life. Clinicians should routinely screen adolescent patients for fatigue and sleep disturbances and intervene to minimize their impact using pharmacologic and nonpharmacologic strategies.

Employing a mobile health decision aid to improve decision-making for patients with advanced prostate cancer and their decision partners/proxies: the CHAMPION randomized controlled trial study design.

BACKGROUND: Metastatic prostate cancer remains a lethal malignancy that warrants novel supportive interventions for patients and their decision partners and proxies. Decision aids have been applied primarily to patients with localized disease, with minimal inclusion of patients with advanced prostate cancer and their decision partners. The use of a community patient navigator (CPN) has been shown to have a positive supportive role in health care, particularly with individuals from minority populations. Research is needed to evaluate decision support interventions tailored to the needs of advanced prostate cancer patients and their decision partners in diverse populations. METHODS: Guided by Janis and Mann's Conflict Model of Decision Making, the Cancer Health Aid to Manage Preferences and Improve Outcomes through Navigation (CHAMPION) is a randomized controlled trial to assess the feasibility and acceptability of a mobile health (mHealth), CPN-administered decision support intervention designed to facilitate communication between patients, their decision partners, and the healthcare team. Adult prostate cancer patients and their decision partners at three mid-Atlantic hospitals in the USA were randomized to receive enhanced usual care or the decision intervention. The CHAMPION intervention includes a theory-based decision-making process tutorial, immediate and health-related quality of life graphical summaries over time (using mHealth), values clarification via a balance sheet procedure with the CPN support during difficult decisions, and facilitated discussions with providers to enhance informed, shared decision-making. DISCUSSION: The CHAMPION intervention is designed to leverage dynamic resources, such as CPN teams, mHealth technology, and theory-based information, to support decision-making for advanced prostate cancer patients and their decision partners. This intervention is intended to engage decision partners in addition to patients and represents a novel, sustainable, and scalable way to build on individual and community strengths. Patients from minority populations, in particular, may face unique challenges during clinical communication. CHAMPION emphasizes the inclusion of decision partners and CPNs as facilitators to help address these barriers to care. Thus, the CHAMPION intervention has the potential to positively impact patient and decision partner well-being by reducing decisional conflict and decision regret related to complex, treatment-based decisions, and to reduce cancer health disparities. Trial registration ClinicalTrials.gov NCT03327103 . Registered on 31 October 2017-retrospectively registered. World Health Organization Trial Registration Data Set included in Supplementary Materials.

The Impact of Performing Medical/Nursing Tasks at Home Among Caregivers of Individuals With Cognitive Impairment.

Caregiving for older adults with cognitive impairment can be more difficult as caregivers are required to perform medical/nursing tasks at home. Little is known about medical/nursing tasks and their relationship to caregivers' characteristics and their effects on caregiver burden. Secondary data analyses were conducted with 423 caregivers of individuals with cognitive impairment from the 2015 National Alliance for Caregiving (NAC) and American Association of Retired Persons (AARP) data. In terms of the caregiving context, caregivers who performed medical/nursing tasks lived with the care recipients and provided longer hours of care than caregivers who did not perform medical/nursing tasks. When caregivers delivered medical/nursing tasks, they were 2 times more likely to experience higher levels of caregiver burden. Medical/nursing tasks can exacerbate caregiver burden. Health care providers' explanations of the needs and the benefits of performing medical/nursing tasks, as well as education and training for the tasks, are needed to reduce caregiver burden.

Comparison of two cohorts of medically at-risk adolescents engaging in substance use (cancer survivors and asthmatics): Clinical predictors for monitoring care.

BACKGROUND AND PURPOSE: Medically at-risk adolescents differ in their perception of severity and are vulnerable to substance use because of effects on their medical regimen. The intent in comparing two cohorts, adolescent survivors of cancer and teens with asthma, is to provide clinical predictors to help in monitoring those needing help with substance use decision making. METHODS: Baseline data were obtained from two randomized controlled trials for a decision-making program of research for medically at-risk adolescents. Multivariate analyses were used to identify clinical predictors for poor decision making as well as lifetime and current substance use (smoking, alcohol use, and marijuana use). CONCLUSIONS: Predictors for both cohorts for lifetime and current substance use were increasing age and risk motivation. A significant predictor for both cohorts for poor decision making related to substance use was risk motivation, measured as a more positive attitude for engaging in substance use. Negative modeling by peers and family members had an impact on teen survivors' decision making; but, this was not clear for teens with asthma. IMPLICATIONS FOR PRACTICE: Research is needed comparing other medically at-risk adolescents to determine which cohorts on the substance use spectrum are less resilient to peer and parent modeling, have unrealistic views of their decision-making skills, and need close monitoring and guidance.

Decision-making program for rural adolescents with asthma: a pilot study.

Although a high prevalence of substance use and its adverse effects on the course of the disease have been reported in adolescents with asthma, no studies have attempted to ameliorate the risk through adequate interventions. This pilot study evaluates and supports the feasibility and the effectiveness of a decision-making program in improving decision-making quality and reducing risk motivation over a 6-month study period. Differential effectiveness of the intervention was observed by race and gender. Although the improvement of decision-making quality was observed only in Whites, changes in risk motivation were detected only in non-Whites and girls. No significant reduction in actual substance use behavior was found. The intervention was favorably received by participants. An approach enhancing decision-making quality can be effective in addressing the risk of substance use in adolescent with asthma by altering motivations.

Understanding Advanced Prostate Cancer Decision Making Utilizing an Interactive Decision Aid.

BACKGROUND: Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths among men in the United States. Patients with advanced prostate cancer are vulnerable to difficult treatment decisions because of the nature of their disease. OBJECTIVE: The aims of this study were to describe and understand the lived experience of patients with advanced prostate cancer and their decision partners who utilized an interactive decision aid, DecisionKEYS, to make informed, shared treatment decisions. METHODS: This qualitative study uses a phenomenological approach that included a sample of 35 pairs of patients and their decision partners (16 pairs reflected patients with <6 months since their diagnosis of metastatic castration-resistant prostate cancer; 19 pairs reflected patients with >6 months since their diagnosis of metastatic castration-resistant prostate cancer). Qualitative analysis of semistructured interviews was conducted describing the lived experience of patients with advanced prostate cancer and their decision partners using an interactive decision aid. RESULTS: Three major themes emerged: (1) the decision aid facilitated understanding of treatment options; (2) quality of life was more important than quantity of life; and (3) contact with healthcare providers greatly influenced decisions. CONCLUSIONS: Participants believed the decision aid helped them become more aware of their personal values, assisted in their treatment decision making, and facilitated an interactive patient-healthcare provider relationship. IMPLICATIONS FOR PRACTICE: Decision aids assist patients, decision partners, and healthcare providers make satisfying treatment decisions that affect quality/quantity of life. These findings are important for understanding the experiences of patients who have to make difficult decisions.