Embracing midcareer in the tenure system.

Midcareer faculty are the "keystone" of academia. Faculty in midcareer experience an increase or change in responsibilities and expectations as well as reduced support and mentorship usually extended to junior faculty. Nonetheless, midcareer can be an ideal time for re-evaluating and defining one's career path and taking advantage of leadership and service opportunities. Successful navigation of midcareer is essential to ensure nursing faculty remain in the academic setting, contribute to nursing science, and have a satisfying career. In this paper, we present strategies midcareer nurse faculty can consider to maintain balance and advance their careers even during challenging times. These strategies include appraising career goals, maintaining and expanding mentoring relationships, seeking and utilizing opportunities for leadership development, selecting service strategically to advance career goals, preparing for the unexpected, maintaining/expanding scholarly productivity, learning when to say yes or no, embracing lifelong learning, and improving visibility of one's work.

The Prevalence and Types of Complementary and Integrative Health Therapies Used by Caregivers of Patients with Cancer.

OBJECTIVE: To assess rationale for usage and types of complementary and integrative health therapies used as self-care by unpaid cancer caregivers. DATA SOURCES: CINAHL, PubMed, PsycINFO, Embase, and Alt HealthWatch. CONCLUSION: Six articles provide updated information on caregiver preferences and desires relative to use of complementary and integrative health therapies. Findings largely focused on patients; whereas perceptions of caregivers were secondary. IMPLICATIONS FOR NURSING PRACTICE: Given shifts in cancer care from clinics to home, clinicians can increase their effectiveness through a better understanding of the caregiving experience, allowing for delivery of supportive, personalized interventions. Such support may include evidence-based complementary and integrative health therapies for caregivers.

Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Clinical Trial.

IMPORTANCE: Fatigue is a common and debilitating late-term effect of breast cancer that is associated with poor sleep and decreased quality of life, yet therapies remain limited. Acupressure has reduced fatigue in previous small studies, but rigorous clinical trials are needed. OBJECTIVES: To investigate if 6 weeks of 2 types of self-administered acupressure improved fatigue, sleep, and quality of life vs usual care in breast cancer survivors and to determine if changes were sustained during a 4-week washout period. DESIGN, SETTING, AND PARTICIPANTS: Phase 3 randomized, single-blind, clinical trial conducted from March 1, 2011, through October 31, 2014. Women were recruited from the Michigan Tumor Registry. INTERVENTIONS: Randomization (1:1:1) to 6 weeks of daily self-administered relaxing acupressure, stimulating acupressure, or usual care. MAIN OUTCOMES AND MEASURES: The primary outcome was change in the Brief Fatigue Inventory score from baseline to weeks 6 and 10. Secondary analyses were sleep (Pittsburgh Sleep Quality Index) and quality of life (Long-Term Quality of Life Instrument). RESULTS: A total of 424 survivors of stages 0 to III breast cancer who had completed cancer treatments at least 12 months previously were screened, and 288 were randomized, with 270 receiving relaxing acupressure (n = 94), stimulating acupressure (n = 90), or usual care (n = 86). One woman withdrew owing to bruising at the acupoints. At week 6, the percentages of participants who achieved normal fatigue levels (Brief Fatigue Inventory score <4) were 66.2% (49 of 74) in relaxing acupressure, 60.9% (42 of 70) in stimulating acupressure, and 31.3% (26 of 84) in usual care. At week 10, a total of 56.3% (40 of 71) in relaxing acupressure, 60.9% (42 of 69) in stimulating acupressure, and 30.1% (25 of 83) in usual care continued to have normal fatigue. At neither time point were the 2 acupressure groups significantly different. Relaxing acupressure, but not stimulating acupressure, showed significant improvements in sleep quality compared with usual care at week 6, but not at week 10. Only relaxing acupressure significantly improved quality of life vs usual care at weeks 6 and 10. CONCLUSIONS AND RELEVANCE: Both acupressure arms significantly reduced persistent fatigue compared with usual care, but only relaxing acupressure had significant effects on sleep quality and quality of life. Relaxing acupressure offers a possible low-cost option for managing symptoms. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01281904.

Saw Palmetto for Symptom Management During Radiation Therapy for Prostate Cancer.

CONTEXT: Lower urinary tract symptoms (LUTSs) affect 75%-80% of men undergoing radiation therapy (RT) for prostate cancer. OBJECTIVES: To determine the safety, maximum tolerated dose (MTD), and preliminary efficacy of Serenoa repens commonly known as saw palmetto (SP) for management of LUTS during RT for prostate cancer. METHODS: The dose finding phase used the time-to-event continual reassessment method to evaluate safety of three doses (320, 640, and 960 mg) of SP. Dose-limiting toxicities were assessed for 22 weeks using the Common Terminology Criteria for Adverse Events for nausea, gastritis, and anorexia. The exploratory randomized controlled trial phase assessed preliminary efficacy of the MTD against placebo. The primary outcome of LUTS was measured over 22 weeks using the International Prostate Symptom Score. Additional longitudinal assessments included quality of life measured with the Functional Assessment of Cancer Therapy-Prostate. RESULTS: The dose finding phase was completed by 27 men who reported no dose-limiting toxicities and with 20 participants at the MTD of 960 mg daily. The exploratory randomized controlled trial phase included 21 men, and no statistically significant differences in the International Prostate Symptom Score were observed. The prostate-specific concerns score of the Functional Assessment of Cancer Therapy-Prostate improved in the SP group (P = 0.03). Of 11 men in the placebo group, two received physician-prescribed medications to manage LUTS compared with none of the 10 men in the SP group. CONCLUSION: SP at 960 mg may be a safe herbal supplement, but its efficacy in managing LUTS during RT needs further investigation.

Dyadic recruitment in complementary therapy studies: experience from a clinical trial of caregiver-delivered reflexology.

PURPOSE: As home-based care continues to be a growing trend in health care, involvement of friend and family caregivers in the management of illness becomes essential. However, before nurses can prepare caregivers to engage in various types of care, an evidence base needs to be established via randomized controlled trials (RCTs). Research suggests that recruiting cancer patients and their friend or family caregivers into RCTs presents challenges. The purpose of this paper is to illustrate the barriers to recruitment of patient-caregiver dyads into a RCT of caregiver-delivered reflexology and to recommend strategies to address such barriers. METHODS: This paper reports on a nurse-directed RCT that involved recruitment efforts unique to a caregiver-delivered reflexology protocol for advanced-stage breast cancer patients. Ineligibility due to caregiver-related reasons, consent among eligible patients (out of 551 approached patients), and reasons for refusal were analyzed. RESULTS: Almost one-third of patients were found to be ineligible due to the lack of a caregiver to participate with them and provide this form of social support. Among eligible patients, the consent rate for this dyadic study is much lower than that of previous RCTs of reflexologist-delivered reflexology that enrolled just patients, not dyads. CONCLUSION: Implications for nursing practice and research include addressing the need for greater social support for patients and strategies for problem-solving refusal reasons during study enrollment.

Recruitment and early retention of women with advanced breast cancer in a complementary and alternative medicine trial.

More than 80% of women with breast cancer are now reported to be using complementary and alternative medicine (CAM) therapies during conventional treatment. A randomized clinical trial (RCT) of reflexology with late stage breast cancer patients serves as the data source for this article. The purposes were to investigate: (i) reasons for refusal to participate in a RCT of reflexology; (ii) the differences between those who completed the baseline interview and those who dropped out before baseline; and (iii) the utility of the Palliative Prognostic Score (PPS) as a prognostic screening tool in minimizing early attrition (before baseline) from the trial. Eligible women (N = 400) approached at 12 cancer centers in the Midwest had advanced breast cancer, were on chemotherapy or hormonal therapy, and had a PPS of 11 or less. Comparisons of those who dropped out early (N = 33) to those who stayed in the trial (N = 240) were carried out using Wilcoxon rank, t-, chi-squared and Fisher's exact tests. The reasons of being "too sick" or "overwhelmed" were given by less than 12% of the women who refused to participate. There was a higher early dropout rate among black women compared to other (primarily white) women (P = .01). Cancer recurrence and metastasis, age, and the PPS were not predictive of early retention of women. Specialized techniques may be needed to ensure black women remain in the trial once consented. Women with advanced disease were likely to enter and remain in the trial despite deterioration in health.

Efficacy of an in-home nursing intervention following short-stay breast cancer surgery.

This randomized controlled trial (n = 240) was designed to test the efficacy of a sub-acute home nursing intervention following short-stay surgery for breast cancer. Intervention participants received the in-home nursing protocol, whereas non-intervention participants received agency nursing care or no nursing care. Data, collected via questionnaire, telephone interview, and chart audit, included surgical recovery/self-care knowledge, functional status, anxiety, quality of life (QOL), and health service utilization. There were no significant group differences on postoperative functional status, anxiety, QOL, further surgeries, or complications. Intervention participants were more likely to receive instruction on surgical self-care (p

Physicians and hospice care: attitudes, knowledge, and referrals.

Underutilization of hospice care continues to be a public health issue in the United States. Physician barriers related to incorrect knowledge and unfavorable attitudes have been hypothesized as part of the explanation. We conducted a mail survey of 264 area physicians, obtaining a response rate of 72% (n = 190). The survey examined attitudes toward, knowledge about, and perceptions of benefits and barriers to hospice care. Physicians demonstrated very positive attitudes toward hospice. They had correct knowledge about some aspects of hospice, but were uncertain about correct answers on the majority of items. They had erroneous knowledge on few items. Physicians perceived many benefits to hospice care, and identified patient and family readiness as the major barriers to earlier hospice referrals. Demographic and practice variables were related to responses on few of the survey items. These findings have many implications for outreach strategies for physicians as well as future research.