IMPACT-ICU: A Relevant Sustainable Program for Military Institutions.

The IMPACT-ICU program provides staff with tools that make difficult palliative conversations easier; introduces the "3 conversations," incorporates role-play activities, and provides for continued coaching. This program is highly relevant to the military health system, which typically lacks a specialized palliative care service. It is easily transferable to any environment to include austere locations as well as other disparate health care institutions. Although titled IMPACT-ICU, it uses communication skills that are appropriate for any difficult conversation in any situation, which makes it appropriate for empowering all multidisciplinary team members in any work area.

Capturing the financial hardship of cancer in military adolescent and young adult patients: A conceptual framework.

OBJECTIVE: Examine whether an existing conceptual framework for understanding financial hardship following a cancer diagnosis captures experiences among military adolescent and young adult (AYA) patients. METHODOLOGICAL APPROACH: Investigators conducted focus groups and key informant interviews (n = 24) with active-duty military AYA cancer patients, their spouses, cancer care providers, and commanders at a military medical center and military post. FINDINGS: Content analysis and thematic abstraction revealed that military AYA cancer patients' experiences of financial hardship occur within material, psychosocial, and behavioral domains that are situated within the contextual influences of AYA development and military culture. Subsequently, investigators constructed an expanded conceptual framework for understanding the financial hardship of cancer to capture these contexts. CONCLUSION: Differentiating experiences of financial hardship into material, psychosocial, and behavioral domains situated within life course development and occupational culture contexts, may inform development of interventions with aspects of financial hardship most impacted by cancer care.

Oncology expressive arts: providing a window to reflect on a stressful experience.

PURPOSE: Evaluate changes in mood, perceived need for help, and task enjoyment after participation in a one-time Oncology on Canvas expressive arts workshop intervention. METHODS: Mixed methods design. Sample: military-veteran oncology survivors and their adult `ohana (family members, caregivers, friends, healthcare providers, volunteers). Measurement tools: Emotion Thermometers, Multiple Affect Adjective Checklist-Revised, Task Enjoyment Question, semi-structured interviews, and self-reflective narratives. Colaizzi's Phenomenological Method was used to conduct a thematic analysis. FINDINGS: Significant improvements in mood, increased task enjoyment, and decreased perceived need for help, with continued effects for up to 30-60 days post-intervention. CONCLUSIONS: A one-time expressive arts workshop intervention can provide a window for oncology survivors and their adult `ohana to reflect on a stressful experience. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: Psychosocial healthcare providers (APRNs, nurse educators, LCSWs, psychologists) who are not professional art therapists can effectively implement expressive arts workshops as a cost-effective intervention for oncology survivors and their `ohana.

Perceived Impact of Participation in a One-Time Expressive Arts Workshop.

INTRODUCTION: This 2015 study examined the use of art to express the experience of the cancer journey of military cancer patients/cancer survivors, family and friends, caregivers, volunteers, and staff members through a one-time art-making workshop, administered by non-art therapists.Using art to express a medical/cancer journey may give participants, who cannot express their feelings in words, the ability to articulate their experience through art that looks at the creative process rather than the end result - expressive art. MATERIALS AND METHODS: This mixed methods study examined the use of art to express the cancer journey of participants. Twenty-eight adults participated in a one-time expressive arts workshop conducted by non-professional art therapists at a military medical center. The five domains of the Emotion Thermometer were analyzed to determine if the pre-event and post-event assessment results would differ. The Silver Drawing Test and Draw-a-Story assessment tools were used to identify emotions and attitudinal stance on six separate five-point scales. A qualitative analysis was done using the phenomenological method of the post-interviews that facilitated open expression to identify themes. RESULTS: A significant difference was found between the pre-event and post-event analyses using the Emotion Thermometer, with post-assessment results revealing lower levels in the three domains of distress, anxiety, and depression. The Silver Drawing Test and Draw-a-Story were analyzed for six components using a five-point scale, with the highest scores being content/meaning, ability to combine, and creativity. A qualitative analysis was done using the phenomenological method; post-interviews provided information to categorize the experience into four key themes: environment, connection, emotions, and discoveries. CONCLUSIONS: Using art to express one's journey through cancer allows participants to articulate that journey "beyond language." This mixed methods study was administered by five non-professional art therapists with three having no expressive arts background. This study established that an expressive arts workshop can effectively be conducted by non-professional art therapists. The team of non-professional art therapists, who facilitated this one-time art-making workshop, demonstrated that a military member's stress can be decreased by giving them "a voice" through expressive art.

Addressing sexual dysfunction in colorectal cancer survivorship care.

Despite the high prevalence of sexual dysfunction in survivors of colorectal cancer, studies have shown that patients and providers rarely discuss how these symptoms may be influencing overall quality of life. The type and severity of symptoms of sexual dysfunction can vary greatly depending on the type of colorectal cancer and treatment, and assessment of sexual dysfunction is key to understanding how patients may be affected by these symptoms. Although patients would like to discuss these issues with their provider, they are often reluctant to ask questions about sexual functioning during appointments. Likewise, health care providers may hesitate to address sexual dysfunction due to time limitations or lack of knowledge regarding treatment of sexual problems. Health care providers can facilitate discussion of sexual dysfunction by (I) assessing sexual functioning throughout treatment; (II) initiating discussions about symptoms of sexual dysfunction at each appointment; and (III) maintaining adequate referral resources for treatment of sexual dysfunction.

Psychosocial issues in colorectal cancer survivorship: the top ten questions patients may not be asking.

Advances in colorectal cancer screening and treatment have increased survivorship significantly in recent years. This has led to an increased emphasis on the need for continuing patient care long after cancer treatment is completed. Colorectal cancer survivors may face a number of psychosocial issues following treatment, including cancer-related distress, adjustment to physical changes following treatment, and challenges related to returning to work. Although there are many resources available to assist with these challenges, many patients may not seek this information from their providers during follow-up care visits. This article highlights some of the most common patient concerns related to survivorship in colorectal cancer and serves as a reminder to ask about these concerns throughout the course of treatment and follow-up care.