Network analysis for the visualization and analysis of qualitative data.

We present a novel manner in which to visualize the coding of qualitative data that enables representation and analysis of connections between codes using graph theory and network analysis. Network graphs are created from codes applied to a transcript or audio file using the code names and their chronological location. The resulting network is a representation of the coding data that characterizes the interrelations of codes. This approach enables quantification of qualitative codes using network analysis and facilitates examination of associations of network indices with other quantitative variables using common statistical procedures. Here, as a proof of concept, we applied this method to a set of interview transcripts that had been coded in 2 different ways and the resultant network graphs were examined. The creation of network graphs allows researchers an opportunity to view and share their qualitative data in an innovative way that may provide new insights and enhance transparency of the analytical process by which they reach their conclusions. (PsycINFO Database Record

Managing One's Symptoms: A Qualitative Study of Low-Income African Americans With Advanced Cancer.

BACKGROUND: African Americans endure disproportionately high advanced cancer rates and also are disproportionately represented in the lower socioeconomic strata. These individuals work to manage symptoms in order to function and have a satisfactory quality of life. OBJECTIVE: The purpose of this study was to discover what low-income African American adults with advanced cancer do on a day-to-day basis to relieve and manage symptoms. This study viewed the individuals as experts and asked them not what they are told to do, but rather what they actually do. METHODS: A purposive sample of 27 individuals participated in semistructured interviews conducted by 2 research interviewers. This qualitative descriptive approach used content analysis to develop themes to describe symptom self-management. RESULTS: Participants described 2 approaches: making continual adjustments and finding stability through spirituality. In seeking comfort from the distress of their symptoms, they were constantly altering their activities and fine-tuning strategies. They adjusted medical regimens and changed the speed and selection of daily activities, including comfort measures and diet modifications. In contrast, their spirituality was a consistent presence in their lives that provided balance to their unstable symptom experience. CONCLUSIONS: This study illustrates that people with advanced cancer actively engage in multiple complex self-management strategies in response to symptoms. IMPLICATIONS FOR PRACTICE: As providers assess how individuals manage their symptoms, they must find ways to support those efforts. Providers then will recognize the challenges faced by advanced cancer patients in obtaining the best quality of life while managing multiple symptoms, activities, and family responsibilities.

Prioritizing Clinician Wellbeing: The University of Virginia's Compassionate Care Initiative.

BACKGROUND: Working in healthcare is increasingly challenging for nurses, physicians, and other health professionals. Ongoing high stress takes a toll on clinicians and interferes with the quality of their patient care. Fostering clinician wellbeing needs to be a priority; if not, the human and financial consequences are significant. OBJECTIVE: To describe the University of Virginia (UVA) School of Nursing's Compassionate Care Initiative (CCI) as an example of an organizational case study that is engaged in multipronged efforts to cultivate a resilient healthcare workforce committed to high-quality, compassionate, relationship-based care. METHODS: This case report describes the development, implementation, and evaluation of the CCI at UVA. Various elements of the program are reviewed, which include harnessing talents and interests of the larger institution in the establishment of Compassionate Care Ambassadors, outreach to the community, innovative student-specific educational activities, and a national media program. CONCLUSION: The UVA CCI is a successful model of an organizational effort to promote clinician wellbeing and resilience. Aspects from this program can be adapted to other organizations that are committed to addressing this critical issue in US healthcare today.

Personalized integrative oncology: targeted approaches for optimal outcomes: the 11th International Conference of the Society for Integrative Oncology.

The 11th International Conference of the Society for Integrative Oncology (SIO) brought together more than 300 clinicians, researchers, patients, and advocates to hear and interact with world-leading experts about the latest research in the areas of nutrition, exercise, acupuncture, health services research, meditation, and other integrative disciplines. The conference theme, "Personalized Integrative Oncology: Targeted Approaches for Optimal Outcomes," highlighted innovations in personalized medicine and ways this growing field will advance the evolution of individualized integrative cancer care to the next level. This year's conference also featured a clinical track focusing on clinical information for the practicing health care professional. The conference's rigorous schedule included 3 keynotes, 4 plenary sessions, 2 interdisciplinary tumor boards, 5 workshops, 45 concurrent oral sessions, and 106 posters. In addition to the conference theme, keynote and plenary sessions presented topics on stress and cancer, the importance of sleep for cancer patients, epigenetic mechanisms of lifestyle and natural products, recently published Journal of the National Cancer Institute monograph on integrative oncology, SIO's clinical practice guidelines for breast cancer survivors, and a joint session of the American Academy of Hospice and Palliative Medicine and SIO about supportive care and symptom management. This highly successful conference helped further the mission of the SIO to advance evidence-based, comprehensive, integrative health care to improve the lives of people affected by cancer.

Tibetan medicine for cancer: an overview and review of case studies.

INTRODUCTION: Tibetan medicine (TM) is a whole systems medical approach that has had growing interest in the West. However, minimal research, particularly with cancer, has been conducted. The purpose of this article is to provide an overview of TM and describe a clinical case review study to obtain preliminary evidence of TM's safety and effect on patients treated for cancer or hematologic disorders. METHODS: A retrospective case review was conducted in India and cases met the following inclusion criteria: (a) confirmed diagnosis of cancer or hematologic disorder by standard Western biomedical diagnostic tests, (b) either treated exclusively with TM or received insufficient Western treatment followed by TM and (c) were in remission or had stable disease at least 2 years after start of TM. RESULTS: Three cases were identified, 1 solid tumor and 2 hematologic diseases: Case 1--poorly to moderately differentiated adenocarcinoma of the stomach, positive lymph nodes and mucosal infiltration, with clear scans and excellent quality of life 29 months later ; Case 2--chronic myelogenous leukemia with normalization of hematologic labs within 3 months of starting TM and stable 4 years later; and Case 3--red cell aplasia improved significantly and reversed dependence on blood transfusions with TM. None of the cases experienced demonstrable adverse effects from TM. CONCLUSIONS: This limited case review found TM to be safe and have positive effects on quality of life and disease regression and remission in patients with cancer and blood disorders. Further exploration and investigation using rigorous methods is warranted.

Mindfulness meditation lowers muscle sympathetic nerve activity and blood pressure in African-American males with chronic kidney disease.

Mindfulness meditation (MM) is a stress-reduction technique that may have real biological effects on hemodynamics but has never previously been tested in chronic kidney disease (CKD) patients. In addition, the mechanisms underlying the potential blood pressure (BP)-lowering effects of MM are unknown. We sought to determine whether MM acutely lowers BP in CKD patients, and whether these hemodynamic changes are mediated by a reduction in sympathetic nerve activity. In 15 hypertensive African-American (AA) males with CKD, we conducted a randomized, crossover study in which participants underwent 14 min of MM or 14 min of BP education (control intervention) during two separate random-order study visits. Muscle sympathetic nerve activity (MSNA), beat-to-beat arterial BP, heart rate (HR), and respiratory rate (RR) were continuously measured at baseline and during each intervention. A subset had a third study visit to undergo controlled breathing (CB) to determine whether a reduction in RR alone was sufficient in exacting hemodynamic changes. We observed a significantly greater reduction in systolic BP, diastolic BP, mean arterial pressure, and HR, as well as a significantly greater reduction in MSNA, during MM compared with the control intervention. Participants had a significantly lower RR during MM; however, in contrast to MM, CB alone did not reduce BP, HR, or MSNA. MM acutely lowers BP and HR in AA males with hypertensive CKD, and these hemodynamic effects may be mediated by a reduction in sympathetic nerve activity. RR is significantly lower during MM, but CB alone without concomitant meditation does not acutely alter hemodynamics or sympathetic activity in CKD.

Cultural humility: essential foundation for clinical researchers.

Cultural humility is a process of self-reflection and discovery in order to build honest and trustworthy relationships. It offers promise for researchers to understand and eliminate health disparities, a continual and disturbing problem necessitating attention and action on many levels. This paper presents a discussion of the process of cultural humility and its important role in research to better understand the perspectives and context of the researcher and the research participant. We discern cultural humility from similar concepts, specifically cultural competence and reflexivity. We will also explore ways to cultivate cultural humility in the context of human subjects research. Mindfulness is one approach that can be helpful in enhancing awareness of self and others in this process. With a foundation in cultural humility, nurse researchers and other investigators can implement meaningful and ethical projects to better address health disparities.

Touch, Caring, and Cancer: randomized controlled trial of a multimedia caregiver education program.

PURPOSE: A randomized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home. METHODS: A multilingual 78-min DVD and 66-page manual were produced for homebased instruction. Content addresses attitudes and communication about touch in cancer, psychological preparation for giving and receiving touch, safety precautions, massage techniques for comfort and relaxation, acupressure for specific cancer-related symptoms, and practice in the home setting. Materials were produced in English, Spanish, and Chinese versions. A community-based multiethnic sample of 97 adult patient/caregiver dyads was randomized to experimental (massage) or attention control (reading) groups for 4 weeks. Massage dyads received the program and instructions to practice at least three times per week, while control caregivers read to their patients for the same frequency. Self-report instruments assessed change in symptom severity, quality of life, perceived stress, and caregiver attitudes. RESULTS: Significant reductions in all symptoms occurred for patients after both activities: 12-28 % reductions after reading vs. 29-44 % after massage. Massage caregivers showed significant gains in confidence, comfort, and self-efficacy using touch and massage as forms of caregiving. CONCLUSIONS: Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain, depression, and other symptoms. Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress.

Integrative oncology imperative for nurses.

OBJECTIVES: To provide an overview of key issues and resources related to complementary and alternative medical (CAM) and integrative approaches in cancer care. DATA SOURCES: Peer-reviewed publications and web sites of professional, federal, and academic institutions and organizations. CONCLUSION: The field of integrative oncology is growing and research evidence in this area is burgeoning. Many cancer patients are using and can benefit from CAM. There are many resources and educational opportunities available to oncology nurses to enhance their CAM knowledge and skills. IMPLICATIONS FOR NURSING PRACTICE: Nurses must keep abreast of the growing evidence in integrative oncology that documents the safety and efficacy of different CAM approaches for cancer patients. It is critical that nurses be aware of reputable resources and legal implications related to use of CAM.

Traditional Chinese Medicine for cancer-related symptoms.

OBJECTIVE: To familiarize oncology nurses about the theory and research related to Traditional Chinese Medicine (TCM) for management of cancer-related symptoms. DATA SOURCES: Peer-reviewed journal articles, TCM texts, professional experience. CONCLUSION: The increasing integration of TCM into mainstream medicine mandates that oncology professionals be familiar with the benefits as well as risks. Clinical research on acupuncture in cancer care is growing and demonstrates it is safe for cancer patients, although results on efficacy across symptoms have been mixed. IMPLICATIONS FOR NURSING PRACTICE: Informed oncology nurses can assist patients by making appropriate referrals to licensed acupuncturists and qualified TCM practitioners to help alleviate unpleasant symptoms associated with cancer and conventional cancer treatment.

"Entering a Clinical Trial: Is it Right for You?": a randomized study of The Clinical Trials Video and its impact on the informed consent process.

PURPOSE: This randomized study was designed to assess the utility of an educational video in preparing cancer patients for decisions about clinical trial participation. The study assessed the effect of the video on patients' understanding and perceptions of clinical trials, its impact on decision making and patient-provider communication, and patients' satisfaction with the video. METHODS: Ninety adults considering cancer clinical trials were randomized to receive (n = 45) or not receive (n = 45) the video. Using the validated Quality of Informed Consent (QuIC), respondents' knowledge about clinical trial participation was assessed. All subjects completed additional questions about satisfaction with the video, decision making, and patient-provider communication. Data were analyzed using the Wilcoxon rank-sum test, regression model, and descriptive statistics. RESULTS: Although intent-to-treat analysis found no significant group differences in objective understanding between those randomized to view or not view the video, the majority of participants reported favorable experiences with regard to watching the video: 85% found the video was an important source of information about clinical trials; 81% felt better prepared to discuss the trial with their physician; 89% of those who watched the video with family indicated that it helped family better understand clinical trials; and 73% indicated it helped family accept their decision about participation. CONCLUSIONS: Although the video did not measurably improve patients' knowledge about clinical trials, it was an important source of information, helped educate families, and enhanced patient communication with their oncology providers.

Compassionate silence in the patient-clinician encounter: a contemplative approach.

In trying to improve clinician communication skills, we have often heard clinicians at every level admonished to "use silence," as if refraining from talking will improve dialogue. Yet we have also noticed that this "just do it," behavior-focused "use" of silence creates a new, different problem: the clinician looks uncomfortable using silence, and worse, generates a palpable atmosphere of unease that feels burdensome to both the patient and clinician. We think that clinicians are largely responsible for the effect of silence in a clinical encounter, and in this article we discuss what makes silence enriching--enabling a kind of communication between clinician and patient that fosters healing. We describe a typology of silences, and describe a type of compassionate silence, derived from contemplative practice, along with the mental qualities that make this type of silence possible.

Early adulthood uprooted: transitoriness in young women with breast cancer.

Young women with breast cancer face a more aggressive disease and lower survival rate compared with those who are older, thereby confronting the potential finitude of life or transitoriness at a time when they are establishing their careers, developing partnerships, and building families. Little is known about the perspectives of young women with breast cancer in how they consider issues of their own mortality. Patients with stage I to III breast cancer aged 39 years and younger who were diagnosed within the last year (N = 16) were included in this qualitative study, which was a secondary analysis of texts written during an expressive writing intervention. Thematic analysis was done by 2 researchers, who reached consensus in coding and theme identification. Nine of the 16 participants (56%) wrote about their mortality (transitoriness). Three themes (being remembered, landscape of emotions and perspectives, and omnipresence of life's finitude) and 10 subthemes were identified from the rich narrative texts. Despite early-stage diagnosis and the beginning phases of adulthood, young women with breast cancer contemplate their mortality and its potential repercussions on their loved ones and their careers. Oncology professionals need to be sensitive to these concerns and provide opportunities for discussion and/or referrals for their young patients as they grapple with such potentially overwhelming issues.