Colorectal Cancer Screening Practices Among Texas Nurse Practitioners and Physician Assistants.

The purpose of this study was two-fold: (1) To describe and compare Texas Nurse Practitioners' and Physician Assistants' knowledge and use of current screening guidelines for individuals at varying risk for colorectal cancer and (2) to compare their recommendations for referral for genetic counseling for persons at increased risk for colorectal or endometrial cancer. The study used a descriptive correlational comparative design. A self-administered web-based survey was sent to the members of the Texas Nurse Practitioner Association and the Texas Academy of Physician Assistants. The questionnaire consisted of 44 items categorized in three domains: demographics, knowledge of national guidelines for risk-stratified colorectal cancer (CRC) screening, and referral for genetic counseling and CRC-screening practices. Data were collected from July through October 2014. More than 75% of the survey respondents reported confidence in their knowledge of the lifetime risk of colorectal cancer and the recommendations for screening in the average-risk adult. Fifty-one percent of both groups reported that they were familiar with Lynch syndrome; however, the nurse practitioners had a lower awareness of the lifetime risk of colorectal cancer associated with Lynch syndrome compared to the physician assistants. Only 34.1% of the nurse practitioners and 23.5% of the physician assistants were aware of the lifetime risk of developing endometrial cancer diagnosed before 60 years of age in women with Lynch syndrome, and only 39.6% of the physician assistants and 40% of the nurse practitioners reported performing a three-generation family history of cancer as a risk assessment. Less than 50% of the respondents would refer a patient with a personal or family history of colorectal or endometrial cancer diagnosed before the age of 60 years for genetic counseling. Nurse practitioners and physician assistants in primary care need more formal and continuing education in risk-stratified screening and referral for genetic counseling in adults at increased risk for colorectal cancer. The academic curricula of both disciplines need to include more content on genetic and genomic influences on the pathophysiology of colorectal cancer and the role of this information for screening and personalized treatment.

A Pilot Study of Proinflammatory Cytokines and Fatigue in Women With Breast Cancer During Chemotherapy.

BACKGROUND: Fatigue remains a prevalent, persistent, and debilitating side effect of chemotherapy for stage I and II breast cancer patients. Severity of fatigue varies among patients. Evidence suggests that proinflammatory cytokines contribute to the development of fatigue. OBJECTIVE: The aim of this study is to investigate predictors of fatigue and cytokine levels in women undergoing chemotherapy for stage I or II breast cancer. METHODS: Piper Fatigue Scales and blood samples for interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were collected at baseline and days 7, 14, and 21 for each chemotherapy cycle. Descriptive statistics, general linear mixed models, and graphic analysis were used to analyze the data. RESULTS: The predominantly white convenience sample was composed of 11 women with stage I or II breast cancer who were 37 to 72 years old (mean, 52 years). Predictors of fatigue were type of chemotherapy drugs, time, and IL-6 levels. A predictor of IL-6 and TNF-α levels was whether chemotherapy was administered at the visit. Type of chemotherapy significantly predicted TNF-α levels. Fatigue patterns were characterized by chaotic pattern of peaks and troughs unique to each woman. CONCLUSIONS: Women with stage I and II breast cancer experienced variability in the severity of fatigue and levels of IL-6 and TNF-α throughout their treatment trajectories. The presence and role of genetic variants related to cancer-related fatigue may explain the individual variation and warrant further research. IMPLICATIONS FOR PRACTICE: These findings highlight the importance of symptom assessments including fatigue at each clinic visit and individualized interventions throughout the cancer trajectory.

Frailty: an indication for palliative care.

Chronological age alone does not determine the vulnerability or frailty of an older adult.Frailty can, however, profoundly affect the quality of an older adult's life. Frail adults could benefit from palliative care provided by an interdisciplinary team. The principles of palliative care apply to any population that could benefit from a comprehensive, person-centered plan of care from the time of diagnosis through the illness trajectory. This article presents a conceptual overview of frailty and describes its clinical presentation and treatment options, including palliative care, an intervention used by gerontological nurses to improve the quality of life for frail older adults.

Dispelling myths about palliative care and older adults.

OBJECTIVES: To explore the myths about palliative care and older adults with cancer. DATA SOURCES: Research literature and review articles. CONCLUSION: Several myths about older adults exist: older adults are the same as younger adults, older adults are all the same, and optimizing function and quality of life are not important outcomes. Little research has focused on older adults receiving palliative care and their families. IMPLICATIONS FOR NURSING PRACTICE: The Oncology Nursing Society and Geriatric Oncology Consortium published the Joint Position Statement on Cancer Care in Older Adults acknowledging the unique needs of older adults with cancer. Application of this statement may be helpful in guiding inquiry and practice in the care for older adults receiving palliative care.

Palliative care update for gastroenterology nurses.

Changing demographics, specifically an aging population associated with an increase of chronic and terminal illness, have highlighted the need for palliative or comfort care in nursing from the time of diagnosis through the dying process. Palliative or comfort care is now on the national healthcare agenda. The purpose of this article is to provide an update on selected palliative care and end-of-life issues and resources related to practice, education, research, and policy for gastroenterology nurses. In addition, selecting one of the suggested resources to review on a regular basis will provide the reader with a strategy for keeping up-to-date in palliative and end-of-life care.

Long-term care nurses' knowledge of end-of-life care.

Long-term care (LTC) facilities usually contract with hospice agencies to provide palliative (comfort) care to their terminally ill residents, yet only 1% of nursing home residents enroll in hospice care. Integrating hospice services with nursing home services presents many challenges. One of the most critical challenges is the lack of education in palliative care among physicians, licensed nurses, and certified nursing assistants in LTC settings. A study of 164 licensed nurses from 24 LTC facilities in north central Texas found deficiencies in their knowledge of palliative care. The mean score on the Palliative Care Quiz for Nursing was 12.3 of a possible 20 (62%, SD = 2.7). Implications for practice include a critical need for in-service education on end-of-life content for practicing LTC nurses and integration of such content in all curricula for future nurses.