Preferences in surgical waiting area amenities.

The purpose of this needs assessment was to determine which waiting area amenities family members deem important to make them comfortable when waiting for news about surgical patients. A literature review was conducted, perioperative staff members were interviewed and surveyed, and family members were interviewed and surveyed. The findings indicate that family members have preferences for specific amenities. Items of highest importance include the service of a surgical nurse coordinator and a private room for consulting with physicians. Items of average importance include beepers and educational materials about the procedure. Items of least importance include a food cart and soft music.

Consent form heterogeneity in cancer trials: the cooperative group and institutional review board gap.

BACKGROUND: Cooperative group (CG) provided consent forms (CGP-CFs) undergo re-review and revision by local institutional review boards (IRB) before institutional approval. We compared the relative readability and length of IRB-approved consent forms (IRB-CFs) used at seven academic institutions with their corresponding CGP-CFs. We also assessed the variability of these metrics across our institutions. METHODS: This study included 197 consent forms (CFs) from 56 CG trials that were open in at least two of the participating institutions. The Flesch Reading Ease Score (FRES), the Flesch-Kincaid Grade Level (FKGL), and document length were collected on all CFs. Unpaired t test was used to compare length and readability of CGP-CF with the IRB-CF. Analysis of variance and Bonferroni-Dunn tests were used to assess interinstitutional variability in readability for all IRB-CFs. All statistical tests were two-sided. RESULTS: IRB-CFs were statistically significantly longer than CGP-CFs (mean number of pages = 17 vs 13; P < .001). Mean FKGLs were higher (10.3 vs 9.4; P < .0001) and the mean FRESs were lower (53.1 vs 57.1; P < .0001) for IRB-CFs compared with CGP-CFs. Readability varied statistically significantly between institutions for all sections of the IRB-CF (P < .0001). Finalized IRB-CFs for identical clinical trials at different institutions demonstrated substantial heterogeneity of readability and length. CONCLUSIONS: As CFs progress from National Cancer Institute (NCI)-sponsored CGs to local IRBs, they seem to become longer and less readable. Interinstitutional heterogeneity in CF readability is substantial and widespread. More consistent adherence to CGP-CFs based on the newly revised NCI CF template with minimal modification by local IRBs should help simplify and standardize CFs used in cancer clinical trials.

A randomized controlled trial of a cardiopulmonary resuscitation video in advance care planning for progressive pancreas and hepatobiliary cancer patients.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is an important advance directive (AD) topic in patients with progressive cancer; however such discussions are challenging. OBJECTIVE: This study investigates whether video educational information about CPR engenders broader advance care planning (ACP) discourse. METHODS: Patients with progressive pancreas or hepatobiliary cancer were randomized to an educational CPR video or a similar CPR narrative. The primary end-point was the difference in ACP documentation one month posttest between arms. Secondary end-points included study impressions; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation; and longitudinal patient outcomes. RESULTS: Fifty-six subjects were consented and analyzed. Rates of ACP documentation (either formal ADs or documented discussions) were 40% in the video arm (12/30) compared to 15% in the narrative arm (4/26), OR=3.6 [95% CI: 0.9-18.0], p=0.07. Post-intervention knowledge was higher in both arms. Posttest, preferences for CPR had changed in the video arm but not in the narrative arm. Preferences regarding mechanical ventilation did not change in either arm. The majority of subjects in both arms reported the information as helpful and comfortable to discuss, and they recommended it to others. More deaths occurred in the video arm compared to the narrative arm, and more subjects died in hospice settings in the video arm. CONCLUSIONS: This pilot randomized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects. This trend, as well as other video effects, is the subject of ongoing study.

The case for development of a new test of health literacy.

PURPOSE/OBJECTIVES: To review the need for reading assessments for patients with cancer, review existing reading assessment tools, and make a case for a new tool specific to patients with cancer. DATA SOURCES: Published articles, experiences, and discussions with published authors in the field of literacy. DATA SYNTHESIS: Valid and reliable tools that assess word recognition and comprehension exist for general use in health care. Word-recognition tests do not always predict comprehension, and a commonly used comprehension test has sections assessing only very low, second year of high school, and graduate-level skills. CONCLUSIONS: A new tool, developed specifically for patients with cancer, may better capture reading ability and comprehension. It is being evaluated for use in a clinical setting. IMPLICATIONS FOR NURSING: If nurses know their patients' reading levels, they can plan more effectively for teaching self-care and discussing decision making. Outcomes related to health and satisfaction may improve if poor readers are given materials they can understand.

Creating a CD-ROM program for cancer-related patient education.

PURPOSE/OBJECTIVES: To describe the process of developing a cancer-related patient and family education CD-ROM program and initial evaluation results. DATA SOURCES: Published research, theory, practice, and personal experience. DATA SYNTHESIS: CD-ROM programs can be far more comprehensive than the booklets and videotapes used more commonly in patient education. Developing CD-ROM programs requires funding, organizational skills, access to content experts, and a team composed of people who have the varied skills required for a finished multimedia product. The time frame for CD-ROM production is often longer than that of other patient-education formats. Published reports and this institution's experience confirm that patients accept this medium. Evaluation to date suggests that CD-ROMs may be more useful to patients and their families than any other single information source. CONCLUSIONS: CD-ROM technology is more expensive than videotapes and booklets, but it allows for greater depth of content and may satisfy a broader range of educational needs than other media. Funding often can be obtained through foundations and with unrestricted educational grants from pharmaceutical companies. IMPLICATIONS FOR NURSING: Nurses can lead multidisciplinary teams to produce CD-ROMs for their patient populations. These programs can be used before a patient has a first consultation to introduce a cancer or treatment and anytime during cancer diagnosis and treatment. They can reinforce one-on-one teaching or provide greater depth of content than ever could be provided in individualized teaching sessions. They can facilitate patients' self-directed learning and may allow nurses and doctors to teach on a different level. These programs also can complement patients' Internet searches either by creating a solid foundation for further investigation or by confirming the reliability of information gained through a variety of Internet sources.

A perioperative nurse liaison program: CNS interventions for cancer patients and their families.

Cancer surgery causes stress and anxiety for families and patients. Knowing that communication between family and health care professionals is traditionally fragmented during the perioperative period, Memorial Sloan-Kettering Cancer Center developed a family-centered program to improve information exchange. This article describes the Perioperative Clinical Nurse Specialist program and the process by which ongoing communication of clinical information and psychosocial support for waiting relatives occurs. Good communication during the preoperative, intraoperative, and postoperative period is characteristic of quality care at a critical time. The subject program serves to bridge the gap in the continuum of perioperative care.

Online cancer patient education: evaluating usability and content.

PURPOSE: Two patient education CD-ROMs were converted to a web-based environment. This article reports on users' evaluations of the programs' usability and content. DESCRIPTION OF EVALUATION: Subscribers to a center's web newsletter were asked to view one of two web programs and to complete a survey. The first 150 respondents were offered a free patient education CD-ROM of their choice, but users continued to respond to the survey even after a notice stated that 150 responses were received. A total of 301 surveys were completed (Colorectal Cancer Program 168; Chemotherapy Program 133). RESULTS: Sixty-eight percent of Colorectal Cancer Program respondents and 50% of Chemotherapy Program respondents considered the program to be more useful or much more useful than any other source of information on the topic. A majority of users for both programs preferred to view the information on the Internet rather than on CD-ROM. Many users reported trouble accessing certain segments of the media. Common complaints included the inability to open video or audio clips and the length of time needed for each page to load, despite a high-speed Internet connection. CLINICAL IMPLICATIONS: Internet use is high, with 60% of US households reporting having used the Internet to search for health information. However, little is known about user satisfaction with specific sites and what about them users like or do not like. It is hoped that these and other user evaluations will help web site authors and developers improve their sites.