Understanding Functional Communication in Head and Neck Cancer Survivors Using a Mixed Methods Design.

BACKGROUND: Functional communication, defined as everyday communication with family and friends, at work, and in the community, is an important but understudied concept in the head and neck cancer (HNC) survivor population. OBJECTIVE: The aim of this study was to better understand functional communication by using a mixed methods approach. METHODS: Head and neck cancer survivors participated in semistructured interviews and completed self-report questionnaires assessing multiple aspects of well-being and health-related quality of life (HRQOL). These qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated. RESULTS: Survivors' perceptions of functional communication ranged from "Communication is good" to "Communication has changed" to "Communication is difficult." Using these qualitative results, survivors were categorized into 3 mutually exclusive groups. Clinically meaningful cut points were exceeded on measures of depressive symptoms (18%), state (40%) and trait (54%) anxiety, and pain (18%). Health-related quality of life scores were moderate to high for the sample as a whole. Statistically significant group differences were found only on the HNC-specific measure of HRQOL. A surprising finding was that the lowest mean score on social function was in the "Communication has changed" group. This group perceived changes in speech and voice that bothered them when communicating in social situations, although their speech was clear to a listener. CONCLUSION: An underrecognized subpopulation of HNC survivors may exist, whose day-to-day functional communication has changed in ways that impact their relationships and sense of self. IMPLICATIONS FOR PRACTICE: Clinical identification of this subpopulation and provision of appropriate interventions are essential to facilitate optimal HRQOL after HNC treatment.

Perceived Self-Efficacy: A Concept Analysis for Symptom Management in Patients With Cancer
.

BACKGROUND: Perceived self-efficacy (PSE) for symptom management plays a key role in outcomes for patients with cancer, such as quality of life, functional status, symptom distress, and healthcare use. Definition of the concept is necessary for use in research and to guide the development of interventions to facilitate PSE for symptom management in patients with cancer.
. OBJECTIVES: This analysis will describe the concept of PSE for symptom management in patients with cancer.
. METHODS: A database search was performed for related publications from 2006-2016. Landmark publications published prior to 2006 that informed the concept analysis were included.
. FINDINGS: Greater PSE for symptom management predicts improved performance outcomes, including functional health status, cognitive function, and disease status. Clarification of the concept of PSE for symptom management will accelerate the progress of self-management research and allow for comparison of research data and intervention development.

Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care.

The U.S. population is plagued by physical inactivity, lack of cardiorespiratory fitness, and sedentary lifestyles, all of which are strongly associated with the emerging epidemic of chronic disease. The time is right to incorporate physical activity assessment and promotion into health care in a manner that engages clinicians and patients. In April 2015, the American College of Sports Medicine and Kaiser Permanente convened a joint consensus meeting of subject matter experts from stakeholder organizations to discuss the development and implementation of a physical activity vital sign (PAVS) to be obtained and recorded at every medical visit for every patient. This statement represents a summary of the discussion, recommendations, and next steps developed during the consensus meeting. Foremost, it is a "call to action" for current and future clinicians and the health care community to implement a PAVS in daily practice with every patient.

Global cardiovascular disease prevention: a call to action for nursing executive summary.

The global epidemic of cardiovascular disease (CVD) calls for multidisciplinary and multiprofessional approaches to the management of this condition, with strategic emphasis on prevention, treatment, and control. In addition, there is increasing recognition that effective prevention and management of CVD requires a diverse workforce skilled in the social, environmental, and policy determinants of health. Nowhere are these approaches and strategies brought together and more closely aligned than in the field of preventive cardiovascular nursing. This executive summary of "Global Cardiovascular Prevention: A Call to Action for Nursing" includes key points from the 6 papers written by the Preventive Cardiovascular Nurses Association and published in July-August 2011 as a supplement to the Journal of Cardiovascular Nursing and the European Journal of Cardiovascular Nursing. This supplement addresses innovative efforts to stem the current global epidemic of CVD and emphasizes the need for effective team-based interventions for lifestyle and behavior changes across the life span. Social solutions, strategies for working with key players to develop interactive models, as well as coordinated multilevel policies, partnerships, and programs that are culturally relevant and context specific are examined. Such approaches are urgently needed to reduce death and disability from CVD in the United States and globally. Nurse leaders and other members of the healthcare team are well positioned internationally to meet these challenges.

A population-based case-control study of extreme summer temperature and birth defects.

BACKGROUND: Although hyperthermia is a recognized animal teratogen and maternal fever has been associated with birth defects in humans, data on the relationship between high environmental temperatures and birth defects are limited. OBJECTIVE: To determine whether pregnancies are potentially vulnerable to the weather extremes anticipated with climate change, we evaluated the relationship between extreme summer temperature and the occurrence of birth defects. METHODS: We performed a population-based case-control study by linking the New York State Congenital Malformations Registry to birth certificates for the years 1992-2006. We selected nonmalformed infants from a 10% random sample of live births as controls. We assigned meteorologic data based on maternal residence at birth, summarized universal apparent temperature (UAT; degrees Fahrenheit) across the critical period of embryogenesis, and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) with multivariable logistic regression, controlling for confounders available on the birth certificate. RESULTS: Among 6,422 cases and 59,328 controls that shared at least 1 week of the critical period in summer, a 5-degree increase in mean daily minimum UAT was significantly associated with congenital cataracts (aOR = 1.51; 95% CI: 1.14, 1.99). Congenital cataracts were significantly associated with all ambient temperature indicators as well: heat wave, number of heat waves, and number of days above the 90th percentile. Inconsistent associations with a subset of temperature indicators were observed for renal agenesis/hypoplasia (positive) and anophthalmia/microphthalmia and gastroschisis (negative). CONCLUSIONS: We found positive and consistent associations between multiple heat indicators during the relevant developmental window and congenital cataracts which should be confirmed with other data sources.

The integrated team approach to the care of the patient with cardiovascular disease.

Cardiovascular disease (CVD) is a costly, worldwide problem with significant annual morbidity and mortality. Guideline-based primary and secondary prevention is effective in preventing and controlling CVD. Such prevention must be implemented by an integrated team of physician-directed health professionals, during both the inpatient and the outpatient phases of care. Appropriate team members may include, but are not limited to, nurses, advanced practice nurses, physician assistants, dietitians, physical therapists, psychologists, pharmacists, cardiac fellows, exercise physiologists, and case managers. During the acute phase of care, various teams are activated as appropriate to specific needs of the patient in the medical (invasive and noninvasive) and surgical specialties. The outpatient phase varies with diagnosis and condition of the patient and team members are involved as needed. An integrated team effort is essential to the best care for each patient regarding individual management and will assure that evidence-based guidelines, in both treatment and secondary prevention, are implemented.

Association of summer temperatures with hospital admissions for renal diseases in New York State: a case-crossover study.

This study assessed the association between high temperatures and increased odds of hospitalization for renal diseases that, to date, has been examined in only a small number of studies. A case-crossover design was used to study 147,885 hospital admissions with renal diagnoses during July and August, 1991-2004, in New York State. Regional temperature, humidity, and barometric pressure data from automated monitors were used as exposure indicators. By use of time-stratified referent selection and conditional logistic regression analysis, an overall 9% increase in odds of hospitalization for acute renal failure per 5°F (2.78°C) was found for mean temperature at a 1-day lag (odds ratio = 1.09, 95% confidence interval: 1.07, 1.12). The results suggest increased susceptibility to hospitalization for acute renal failure for blacks, Hispanics, people aged 25-44 years, and those in the lowest income quartile. The odds varied geographically with the largest associations found in the more urban regions. Increased odds of hospitalization were also found for urinary tract infections, renal calculi, lower urinary calculi, and other lower urinary tract disorders. The findings can help to identify vulnerable subpopulations and to inform decisions and policies regarding adaptation strategies and heat-warning systems.

The cancer family caregiving experience: an updated and expanded conceptual model.

OBJECTIVE: The decade from 2000 to 2010 was an era of tremendous growth in family caregiving research specific to the cancer population. This research has implications for how cancer family caregiving is conceptualized, yet the most recent comprehensive model of cancer family caregiving was published ten years ago. Our objective was to develop an updated and expanded comprehensive model of the cancer family caregiving experience, derived from concepts and variables used in research during the past ten years. METHODS: A conceptual model was developed based on cancer family caregiving research published from 2000 to 2010. RESULTS: Our updated and expanded model has three main elements: 1) the stress process, 2) contextual factors, and 3) the cancer trajectory. Emerging ways of conceptualizing the relationships between and within model elements are addressed, as well as an emerging focus on caregiver-patient dyads as the unit of analysis. CONCLUSIONS: Cancer family caregiving research has grown dramatically since 2000 resulting in a greatly expanded conceptual landscape. This updated and expanded model of the cancer family caregiving experience synthesizes the conceptual implications of an international body of work and demonstrates tremendous progress in how cancer family caregiving research is conceptualized.

A blessing and a curse: head and neck cancer survivors' experiences.

BACKGROUND: Head and neck cancer (HNC) survivors often exhibit late symptoms or adverse effects of treatment that may severely disrupt their ability to speak, eat, breathe, and associate with others. Research has focused on survival and quality of life associated with treatment and/or stage of cancer. Although research shows communication problems in 50% of survivors, few studies have assessed functional speech, and none describe HNC survivor perspectives on speech or communication more broadly. OBJECTIVE: The purpose of this study was to describe survivors' experience of communication during and after treatment. METHODS: A phenomenological, descriptive, and interpretive research method was used to study 39 HNC survivors. Interviews included open-ended questions about their communication experiences. Researchers conducted line-by-line coding, identified theme labels, and compared themes in all interviews. Procedures to ensure scientific rigor included data validation and consensus. RESULTS: Intertwined positive/negative aspects of communication were described. Two major themes were identified: "change in communication," which included functional aspects of communication, and "going deeper into life," which included the positive aspects of the process. CONCLUSIONS: This study is the first to describe day-to-day communication experiences from the perspective of HNC survivors. The deeply personal aspects of communication included functional and existential themes far beyond the ability to speak. For these participants, deeper change came from their experience and was carried forward in their lives. IMPLICATIONS FOR PRACTICE: Survivors benefited from support and understanding offered by family, friends, and healthcare professionals. This difficult situation served as a catalyst for deeper human change.

Coping styles, health status and advance care planning in patients with hematologic malignancies.

This study evaluated whether measures of psychological well-being, including coping style, are associated with advance care planning (ACP). Data were from the Hematology Communications Study (HEMA-COMM), a prospective observational study of physician-patient communication in patients with hematologic malignancies. ACP was defined as having a living will, having a health care proxy, discussing life support with family or friends and discussing life support with a doctor or nurse. A total of 293 patients participated: only 45 (15%) had all the elements of ACP; 215 (73%) had at least one element of ACP, while 33 (11%) did not engage in ACP. In multivariate analysis, specific coping styles but not other measures of psychosocial well-being were associated with having written ACP. Verbal ACP was associated with patient-reported health and physician estimate of life expectancy. Our study suggests that tailoring ACP discussions to a patient's coping style may increase engagement in ACP.

Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives.

Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.