A brief intervention to minimize psychosexual morbidity in dyads coping with breast cancer.

PURPOSE/OBJECTIVES: To develop and evaluate the feasibility of a brief intervention to attenuate the incidence of psychosexual morbidity within the dyad secondary to the diagnosis and treatment of breast cancer. DESIGN: Quasiexperimental, including intervention and treatment-as-usual comparison groups. SETTING: Breast clinic of a comprehensive cancer center in the Midwest United States. SAMPLE: 65 recently diagnosed breast cancer survivors who were pre- or perimenopausal and aged 20-55 years, and their partners. METHODS: Three intervention sessions were delivered based on a manual developed for the study. Twenty-five dyads received treatment as usual, 26 dyads received a face-to-face intervention, and 14 dyads received the same intervention by telephone. Questionnaires were completed at baseline, following completion of the intervention, six months postintervention, and from the comparison group at equivalent data points. MAIN RESEARCH VARIABLES: Intimacy, sexual functioning, and dyadic adjustment. FINDINGS: About 98% of dyads completed all intervention sessions, with an equal level of satisfaction among those in the telephone and face-to-face groups. Interesting trends in differences between the intervention and comparison groups on the relationship variables of intimacy, sexual functioning, and dyadic adjustment were obtained; however, given the sample size, power was not sufficient to reach statistical significance. CONCLUSIONS: The intervention is feasible and acceptable for dyads comfortable discussing their relationship. Intervention by telephone was demonstrated to be as effective as the face-to-face mode of delivery. IMPLICATIONS FOR NURSING: Nurses need to provide an opportunity for women to discuss problems they are experiencing relative to sexuality, intimacy, and body image.

A concept analysis: assuming responsibility for self-care among adolescents with type 1 diabetes.

PURPOSE: This concept analysis clarifies "assuming responsibility for self-care" by adolescents with type 1 diabetes. METHODS: Walker and Avant's (2005) methodology guided the analysis. RESULTS: Assuming responsibility for self-care was defined as a process specific to diabetes within the context of development. It is daily, gradual, individualized to person, and unique to the task. The goal is ownership that involves autonomy in behaviors and decision-making. PRACTICE IMPLICATIONS: Adolescents with type 1 diabetes need to be assessed for assuming responsibility for self-care. This achievement has implications for adolescents' diabetes management, short- and long-term health, and psychosocial quality of life.

Uncertainty in adolescents and young adults with cancer.

PURPOSE/OBJECTIVES: To describe uncertainty in three groups of adolescents and young adults with cancer at specific times in their cancer experience: newly diagnosed, diagnosed one to four years, and diagnosed five or more years. DESIGN: Descriptive, cross-sectional, comparative. SETTING: Six pediatric oncology centers in North America. SAMPLE: 193 adolescents and young adult cancer survivors aged 11-22 years, able to read English, with no central nervous system disease. METHODS: A booklet of questionnaires was completed during a clinic visit or hospitalization. Uncertainty was measured using Mishel's Uncertainty in Illness Scale. MAIN RESEARCH VARIABLES: Uncertainty and time since diagnosis. FINDINGS: No significant differences were found in the overall level of uncertainty among the three time-since-diagnosis groups; however, analysis of variance on individual items detected significant group differences for 8 of the 33 items. Newly diagnosed survivors had significantly higher uncertainty for future pain, the unpredictable illness course, staff responsibilities, and concerns about when they would be able to care for themselves. Survivors five or more years from diagnosis had significantly higher uncertainty related to knowing what was wrong, and they had more unanswered questions and higher uncertainty compared to the two other groups about the probability of successful treatment. All of the survivors had high uncertainty about the multiple meanings of communication from doctors. CONCLUSIONS: The overall level of uncertainty remained unchanged across the survivorship continuum, but differences existed in specific concerns. IMPLICATIONS FOR NURSING: Uncertainty is important to consider far beyond the treatment period, particularly assessment of information needs and acknowledgment of inherent uncertainty throughout cancer survivorship.

Social support and adolescent cancer survivors: A review of the literature.

With survival rates increasing dramatically in pediatric cancer, concern has increasingly focused on the psychosocial aspects of the cancer experience. Clearly, the experience of a cancer diagnosis and treatment of cancer places high demands on the coping of adolescents. Research has shown social support to be effective in decreasing stress and enhancing coping in adolescents facing such demands. A review and critical analysis of studies of social support in adolescent cancer survivors was conducted. The seventeen studies were mainly descriptive and exploratory in nature with social support examined for a number of outcome variables in eight of the studies. Findings from this review indicate that support from parents (especially the mother) and friends were extremely important and that the adolescents were satisfied with family support. Support from friends was described as less satisfactory. Methodological concerns of the reviewed studies include small samples and a lack of consistency in the instruments used to assess social support. Future studies of social support for adolescent cancer survivors should include larger samples to determine gender, age group, and ethnic differences and to allow the examination of social support theoretical models specific to the developmental and chronic illness situation of these adolescents.

Coping in adolescents with cancer: a review of the literature.

The dual challenge of normal adolescent development combined with a diagnosis places high demands on the coping of adolescents with cancer (AWC). A review was conducted to synthesize and critique studies of coping in AWC. Findings from this review indicated inconsistent results for developmental and gender differences as well as associations of coping with distress. A number of limitations were associated with these studies, including the use of small samples, lack of consistency in the conceptualization of coping and instruments, and limited knowledge helpful to inform intervention research to improve effective coping in AWC. Future studies are needed to address these limitations.

Meeting the challenges of social work research in long term care.

As the number of long-term care (LTC) residents increases, issues related to quality of care and quality of life will continue to be of concern. Research in this area is clearly needed, yet it presents a variety of challenges related to the nature of the institutional setting and the compromised functional status of residents. The social work calling to give voice to those who are least heard and most needy demands that we rise to these challenges. Based on the authors' experiences in conducting research in LTC, three types of challenges are identified and discussed: institutional, participant, and research design. Recommendations for addressing these challenges are offered.