The RAI-PC: an assessment instrument for palliative care in all settings.

Large numbers of persons in most types of healthcare settings have palliative care needs that have considerable impact on their quality of life. Therefore, InterRAI, a multinational consortium of researchers, clinicians, and regulators that uses assessment systems to improve the care of elderly and disabled persons, designed a standardized assessment tool, the Resident Assessment Instrument for Palliative Care (RAI-PC). The RAI-PC can be used for both the design of individual care plans and for case mix and outcomes research. Some elements of this instrument are taken from the resident assessment instrument (RAI) mandated for use in all nursing homes in the United States and widely used throughout the world. The RAI-PC can be used alone or in counjunction with the other assessment tools designed by the InterRAI collaboration: the RAI for homecare (RAI-HC), for acute care (RAI-AC), and for mental health care (RAI-MH). The objective of this study was to field test and carry out reliability studies on the RAI-PC. After appropriate approvals were obtained, the RAI-PC instrument was field tested on 151 persons in three countries in more than five types of settings. Data obtained from 144 of these individuals were analyzed for reliability. The reliability of the instrument was very good, with about 50 percent of the questions having kappa values of 0.8 or higher, and the average kappa value for each of the eight domains ranging from 0.76 to 0.95. The 54 men and 95 women had a mean age of 79 years. Thirty-four percent of individuals suffered pain daily. Eighty percent tired easily; 52 percent were breathless on exertion; and 19 to 53 percent had one or more other symptoms, including change in sleep pattern, dry mouth, nausea and vomiting, anorexia, breathlessness at rest, constipation, and diarrhea. The number of symptoms an individual reported increased as the estimated time until death declined. The "clinician friendly" RAI-PC can be used in multiple sites of care to facilitate both care planning and case mix and outcomes research.

Mexicans and care for the terminally ill: family, hospice, and the church.

The structural barriers to the use of hospice services by minority groups have been widely discussed. The attitudes of these groups are less clearly delineated. A series of focus groups with Mexicans was held in Michigan and Arizona. The participants were between the ages of 45 and 64 or over as well as providers of services to Mexicans. Regardless of length of time in the United States, participants were low on acculturation scores. These groups found important attitudes about the roles of the family, hospice services, and spirituality and the church in providing care to terminally ill individuals.

Work-site cancer screening: a Latino case study.

PURPOSE/OBJECTIVES: To develop a work-site cancer education and detection program targeted for Latino women and evaluate the effectiveness of the program in a firm with a majority of employees from Latino backgrounds. DESIGN: Program implementation and evaluation. SETTING: A Latino-owned industrial firm in Detroit, MI. SAMPLE: 560 of 857 female employees. Among the 202 women who were eligible for mammography, 142 participated in the screening. METHODS: Education and mammography were offered to women employees of Mexican Industries in Michigan. Education programs and mammograms were conducted at the work site. The programs were offered in English and Spanish. MAIN OUTCOME MEASURES: Participation in education and mammography and evaluation of program components. FINDINGS: Pre- and post-tests of knowledge indicated increases in the understanding of breast cancer. Evaluation of the educational program indicated high ratings of the presentations and materials. CONCLUSIONS: Work-site cancer education and detection programs are cost effective in firms where the majority of employees are from one ethnic/racial group and where the programs take into consideration the cultural background of the employees. IMPLICATIONS FOR NURSING PRACTICE: Cancer education and detection programs should consider the possibility of work-site interventions as well as the ethnic/racial background of employees during program development.

Minority recruitment in the prostate cancer prevention trial.

PURPOSE: African American men have a higher prostate cancer risk profile than that of other men in the United States. The purpose of this manuscript is to summarize the challenges associated with enrolling and randomizing African American and other minority participants in the Prostate Cancer Prevention Trial (PCPT). METHODS: The PCPT is a randomized trial of finasteride versus placebo for preventing prostate cancer in healthy men age 55 years and older; it is coordinated by the Southwest Oncology Group. The manuscript describes demographic and lifestyle characteristics of the PCPT randomized sample (18,882 men) by four racial and ethnic groups (Caucasian, African American, Hispanic, and other). African American men comprised 4% of the total randomized sample compared to our goal of 8%. Minority recruitment was emphasized through the Study Manual and training that occurred at trial activation. Supplemental minority recruitment activities were initiated a year after study activation and continued through the end of the accrual period. Minority recruitment was emphasized as follows: minority recruitment presentations at PCPT training seminars (held during twice yearly Southwest Oncology Group meetings); distribution of additional minority recruitment materials; engagement of four consultants for minority recruitment; production of a Minority Recruitment Manual; and a small pilot study involving minority outreach recruiters at five PCPT sites. RESULTS: The consultants were helpful in implementing the pilot project and in suggesting and reviewing materials for minority recruitment. The five-site pilot project did not increase either enrollment or randomization of minorities (with a possible exception at one site). CONCLUSIONS: We suggest that a long-term perspective is required for successful recruitment of minority participants in clinical trials. Likewise, extensive minority recruitment efforts must be ready to implement at trial activation.

Outcome of African American men screened for prostate cancer: the Detroit Education and Early Detection Study.

PURPOSE: Will early detection impact on stage of disease and recurrence of prostate cancer in a high risk population? We initiated a community based study to educate and recruit African American men for early diagnosis of prostate cancer, that is the Detroit Education and Early Detection (DEED) study. Our objective was to evaluate our recruitment process for this target population, examine the percentage of organ confined prostate cancer in men undergoing radical prostatectomy and measure recurrence biochemically. MATERIALS AND METHODS: A community based study from February 1993 to February 1995 through the African American churches in metropolitan Detroit was initiated. We compared the early detection group treated with radical prostatectomy to the population presenting to our urological clinic during the same period. We tested and followed 1,105 African American men using the prostate specific antigen blood test. RESULTS: Pathologically organ confined prostate cancer was diagnosed in 11 of 17 men (65%) who underwent radical prostatectomy in the DEED project. Within the clinic population 35% of the African American men were diagnosed with pathologically organ confined prostate cancer. The difference between the 2 populations was statistically significant (p = 0.033). Disease recurred in 1 of 15 (7%) and 39 of 157 (25%) men in the DEED and clinic populations, respectively (p = 0.97). CONCLUSIONS: We demonstrated our ability to recruit African American men into a prostate cancer early detection program. We diagnosed early but clinically significant prostate cancers among African American men with characteristics similar to prostate cancers diagnosed in other early detection studies in which the overwhelming majority of men were white.

Digital rectal examinations and prostate cancer screening: attitudes of African American men.

PURPOSE/OBJECTIVES: To explore the relationship between attitudes toward digital rectal examination (DRE) and participation in prostate cancer screening among African American men. DESIGN: Survey. SETTING: Prostate cancer screenings with a prostate-specific antigen (PSA) blood test held at churches with African American members in Detroit, MI. SAMPLE: 613 African American men between the ages of 40 and 70. METHODS: Self-administered, structured questionnaires examining attitudes toward DRE, past experiences with DRE, and fear of cancer. MAIN OUTCOME MEASURES: Willingness to undergo DRE. FINDINGS: The majority of men who were screened had positive attitudes about DRE. Fear of cancer was associated with negative attitudes toward DRE. DREs were not a deterrent among men who attended the screenings. CONCLUSION: Negative attitudes toward DRE do not necessarily deter African American men from participating in prostate cancer screenings. IMPLICATIONS FOR NURSING PRACTICE: Prostate cancer screening programs should attempt to use both DRE and PSA. More reliable prostate cancer indicators are obtained by incorporating DRE with PSA tests.

Prostate cancer in African American men: increasing knowledge and self-efficacy.

An educational and screening program for prostate cancer designed to increase knowledge and self-efficacy in African American men was provided in African American churches in a major midwestern city. Modeling was provided by trained lay educators who were African American men previously diagnosed and treated for prostate cancer and who could serve as role models of the desired behaviors. Pretests and posttests developed for this study and provided to the participants were the Prostate Cancer Screening Knowledge Inventory and the Prostate Cancer Screening Self-Efficacy Scale. Paired t tests demonstrated that after completing the church-based intervention, participants had significantly improved knowledge and self-efficacy scores related to prostate cancer screening.

Clinical evaluation of MGI 209, an anesthetic, film-forming agent for relief from painful oral ulcers associated with chemotherapy.

PURPOSE: This open-label, multicenter trial evaluated the efficacy of a mucoadherent, anesthetic medication (MGI 209) for relief from painful oral ulcers associated with cytotoxic chemotherapy. PATIENTS AND METHODS: Twenty-eight eligible cancer patients who had up to five discrete oral ulcers (total area < or = 5 cm2) completed this study. Mean age was 53.5 years (range, 21 to 81). Subjective assessments of oral discomfort before and after an orange juice pain challenge (OJPC), which was measured using a visual analog scale (VAS), and visual estimates of the amount of MGI 209 that remained on treated ulcers were collected at (1) baseline (before MGI 209 treatment); and (2) 30, 60, 120, and 180 minutes posttreatment. RESULTS: Most subjects had low VAS scores (4 or less), which was indicative of oral discomfort, at baseline before and after the OJPC. At 30, 60, 120, and 180 minutes after MGI 209 treatment, most subjects had high VAS scores before and after an OJPC compared with baseline scores, which was indicative of a substantial increase in oral comfort; these differences were statistically significant (P < .0001). Mean percent of MGI 209 estimated to remain on ulcers at the previously mentioned times was 93.7%, 90.3%, 79.6%, and 71.3% of the total amount applied, respectively. CONCLUSION: Benzocaine hydrochloride in combination with the protective, mucoadherent film-coating relieved discomfort for at least 3 hours even with exposure to an irritating beverage. MGI 209 treatment should allow patients with chemotherapy-induced oral ulcers to drink and eat with significantly diminished pain or no pain.

Effects of combined modality therapy of head and neck carcinoma on shoulder and head mobility.

One hundred twenty-six patients were evaluated prospectively for head and shoulder mobility following combined treatment of their advanced head and neck carcinoma. In the absence of a pectoral myocutaneous flap reconstruction, the sacrifice of the spinal accessory nerve does not appear to be deleterious to overall head and shoulder mobility with the exception of shoulder elevation. The addition of the pectoral myocutaneous flap reconstruction negated the shoulder elevation difference between the modified neck dissection and the classical neck dissection. The administration of postoperative radiation therapy appears to decrease the range of motion of both the head and the shoulder by up to 20%. We conclude that head and shoulder mobility following combined modality treatment for patients with head and neck carcinoma appears to be a multifaceted problem involving more than the presence or absence of the accessory nerve and psychosocial considerations. The multifaceted etiology of this problem should be taken into consideration when developing physical and occupational programs directed specifically at this problem.

Combination chemotherapy in advanced gastrointestinal malignancy.

This study compares two combinations of drugs with proven activity in gastrointestinal malignancy. The drugs utilized are 5-fluorouracil (5FU), mitomycin C (Mito C), and 1-(2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (MeCCNU). All 57 patients received 5FU 25 mg/kg as a 24-hour infusion for 5 days every 4 weeks. One group received Mito C 20 mg/m2 IV bolus every 8 weeks. The second group received MeCCNU 150 mg/m2 orally every 8 weeks. These combinations are tolerable, and the toxicities are acceptable. The response to 5FU/Mito C is more efficacious at 47% than 5FU/MeCCNU at 25% in the treatment of evaluable patients with colorectal malignancy.