Effect of Digital Health Coaching on Self-Efficacy and Patient Reported Outcomes in Individuals with Acute Myeloid and Chronic Lymphocytic Leukemia: A Pilot Randomized Controlled Trial.

Introduction Promotion of self-efficacy can enhance engagement with healthcare and treatment adherence in patients with cancer. We report the outcomes of a pilot trial of a digital health coach intervention in patients with leukemia with the aim of improving self-efficacy. Methods Adult patients with newly diagnosed acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) were randomized 1:1 to a digital health coach intervention or standard of care. The primary outcome of self-efficacy was measured by the Cancer Behavior Inventory (CBI) score. Results One-hundred and forty-seven patients (37 AML, 110 CLL) were enrolled from July 2020 to December 2022. In the AML cohort, there was a mean increase in CBI score of 7.03 in the digital health coaching arm compared to a mean decrease of -3.57 in the control arm at 30 days (p=0.219). There were no significant associations between the intervention and other patient reported outcomes for patients with CLL. Conclusion There were numerical, but not statistically significant increases in self-efficacy metrics in AML patients who received digital health coaching. Although this trial was underpowered due to enrollment limitations during a pandemic, digital health coaching may provide benefit to patients with hematologic malignancy and warrants further investigation.

Consensus Building to Identify Nursing Research Priorities Among Oncology Nurses: A Delphi Study in a National Cancer Institute-Designated Comprehensive Cancer Center.

BACKGROUND: To advance oncology nursing science and clinical practice, researchers and clinicians must understand the important real-world concerns of nurses who provide direct care to people with cancer or manage processes that support patient care. OBJECTIVE: This study developed a comprehensive compendium of real-world concerns among oncology nurses and built consensus regarding their importance. METHODS: Using Delphi survey methodology, this prospective, descriptive study was performed in 3 phases: (1) identification of experts, defined as registered nurses (RNs) employed within a comprehensive cancer center; (2) qualitative content analysis of 353 responses from 267 RNs who responded to the question, "What do you see as nursing research concerns, problems, and/or issues on your unit or in your work environment that needs to be studied?"; and (3) rating the importance of 62 research themes identified from the qualitative content analysis (n = 247 RNs). RESULTS: The top research priority was patient safety followed by patient education, oncologic emergencies, patient expectations and adherence with care, team communication, patient psychosocial needs, patient-reported outcomes and quality of life, healthcare team burnout, workload, and nurse burnout. CONCLUSIONS: The findings support the nursing discipline's fundamental focus on patient safety, the top-rated nursing research priority, along with other patient-related and work environment issues. IMPLICATIONS FOR PRACTICE: Oncology nursing is complex and complicated. This study identified and prioritized the real-world concerns, issues, and problems of oncology RNs who provide direct care or manage the processes that support care, supporting the need to focus on patient-related and work environment research.

Palliative care referral criteria and outcomes in cancer and heart failure: a systematic review of literature.

BACKGROUND: Cardiotoxicity resulting in heart failure (HF) is among the most dreaded complications of cancer therapy and can significantly impact morbidity and mortality. Leading professional societies in cardiology and oncology recommend improved access to hospice and palliative care (PC) for patients with cancer and advanced HF. However, there is a paucity of published literature on the use of PC in cardio-oncology, particularly in patients with HF and a concurrent diagnosis of cancer. AIMS: To identify existing criteria for referral to and early integration of PC in the management of cases of patients with cancer and patients with HF, and to identify assessments of outcomes of PC intervention that overlap between patients with cancer and patients with HF. DESIGN: Systematic literature review on PC in patients with HF and in patients with cancer. DATA SOURCES: Databases including Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science from January 2009 to September 2020. RESULTS: Sixteen studies of PC in cancer and 14 studies of PC in HF were identified after screening of the 8647 retrieved citations. Cancer and HF share similarities in their patient-reported symptoms, quality of life, symptom burden, social support needs, readmission rates, and mortality. CONCLUSION: The literature supports the integration of PC into oncology and cardiology practices, which has shown significant benefit to patients, caregivers, and the healthcare system alike. Incorporating PC in cardio-oncology, particularly in the management of HF in patients with cancer, as early as at diagnosis, will enable patients, family members, and healthcare professionals to make informed decisions about various treatments and end-of-life care and provide an opportunity for patients to participate in the decisions about how they will spend their final days.

Validation of the Spanish version of the MD Anderson symptom inventory - heart failure (MDASI-HF-Spanish) module.

BACKGROUND: The lack of a validated symptom assessment instrument in Spanish for patients with cancer and heart failure (HF) can affect the care and impede the recruitment and participation of Spanish-speaking patients in clinical trials. Spanish is the second most common language spoken by the largest and most rapidly growing racial/ethnic minority group in the United States. To bridge the language barrier and improve symptom management in Spanish-speaking patients with cancer and HF, the MD Anderson Symptom Inventory-Heart Failure (MDASI-HF) was translated to Spanish (MDASI-HF- Spanish). AIM: To validate the MDASI-HF-Spanish symptom assessment instrument. METHODS: Following standard forward and backward translation of the original and previously validated English version of the MDASI-HF, a cognitive debriefing with nine native Spanish speaking participants was conducted to evaluate the participants' understanding and comprehension of the MDASI-HF-Spanish. To examine the comprehensibility, acceptability and psychometric properties of the translated instrument, the MDASI-HF-Spanish was tested in a convenience sample of 50 Spanish speaking patients with a diagnosis of cancer and HF. Evidence for the psychometric validity of the MDASI-HF-Spanish was demonstrated via its internal consistency reliability and known-group validity. RESULTS: Overall, the participants had no problems with the understandability, readability, or number of questions asked. The MDASI-HF-Spanish subscales showed good internal consistency reliability, with a Cronbach's coefficient alpha of 0.94 (13 core cancer symptoms), 0.92 (8 heart failure symptoms), and 0.90 (6 interference items) respectively. The MDASI-HF-Spanish was able to differentiate the functional status between patients based on the New York Heart Association (NYHA) functional classification. CONCLUSIONS: The MDASI-HF-Spanish is linguistically and psychometrically valid with ease of completion, relevance, and comprehensibility among the participants, and it can be a useful tool for clinical management and research purposes.

A quality improvement approach to reducing hospital readmissions in patients with cancer and heart failure.

BACKGROUND: The management of patients with cancer and concurrent heart failure (HF) is challenging. The increased complexity of treatment and the occurrence of multiple overlapping symptoms may lead to frequent hospital admissions, which may result in cancer treatment delays, a diminished quality of life, and an increased financial burden for the patient's family. To provide holistic care to oncology patients with HF, we implemented the Heart Success Program (HSP), a patient-centered, interprofessional collaborative practice, which decreased the 30-day hospital readmission rate for HF diagnosis from 40 to 27%. However, this rate remains higher than that reported for Medicare beneficiaries. AIM: To identify the factors contributing to frequent readmissions, the HSP committee participated in the institution's Clinical Safety and Effectiveness and utilize quality improvement methodologies and tools to decrease hospital readmission for HF. METHODS: The DMAIC (Define, Measure, Analyze, Improve and Control) method was used to guide this quality improvement. Areas considered as having high impact and requiring low effort to address were patient education barriers, lack of documentation clarity, and care provider knowledge gaps about the HSP. We implemented workflow changes, improved clarity with documentation of HF diagnosis, and increase provider knowledge about the HSP. FINDINGS: After 6 months of implementing quality improvement techniques, the 30-day hospital readmission rate for HF patients fell by 23.43% (from 31.7% for the baseline period to 8.27%), exceeding the target project goal of 10%. Our quality improvement method may also be effective in improving the management of patients with cancer and other comorbid conditions.

Incorporation of conjugated linoleic acid into brain lipids is not necessary for conjugated linoleic acid-induced reductions in feed intake or body fat in mice.

Dietary conjugated linoleic acid (CLA) causes reduced feed intake (FI) and body fat (BF). It is unknown, though, if CLA incorporation into tissues, alterations in serum hormones, and/or appetite-regulating neuropeptides are involved. We hypothesized that CLA incorporation into brain lipids would be correlated with changes in appetite-regulating neuropeptide expression and reductions in FI and BF. Male mice (n = 150; 9 weeks old, ICR) received the control diet ad libitum (CON), 2% CLA diet ad libitum (CLA), or control diet pair-fed to the intake of CLA-fed mice for 1, 2, 3, 5, or 7 days. Both FI and body weight were measured daily, and a BF index was calculated. Liver, adipose, and brain fatty acids; serum insulin, leptin, and peptide YY; and arcuate nucleus neuropeptide Y, agouti-related protein, and α-melanocyte-stimulating hormone protein were determined. Mice fed CLA ate less (P < .05) than did the CON on days 1, 2, 3, and 7 but were leaner (P < .05) only on day 7. Mice that received the control diet pair-fed to the intake of CLA-fed mice did not differ in BF from the CON. By days 1 and 2, CLA isomers were incorporated into the liver and adipose but not in the brain. Insulin was increased in CLA-fed mice on days 5 and 7, and leptin was decreased on day 7. Peptide YY and the neuropeptides did not differ. Tissue CLA was not correlated with FI, body weight, or BF but was positively correlated with insulin and negatively correlated with leptin. The reduction in FI is not sufficient to cause the reduction in BF, and tissue CLA accumulation does not appear to be required.