The effects of nursing care guided by self-regulation theory on coping with radiation therapy.

PURPOSE/OBJECTIVES: To test the hypotheses that preparatory informational interventions based on self-regulation theory delivered to radiation therapy (RT) recipients by staff nurses would reduce disruption in patients' usual life activities and have a positive effect on the moods of patients who tended to have pessimistic expectations about outcomes. DESIGN: A quasi-experimental design with repeated measures. SETTING: University-affiliated RT department. SAMPLE: 226 patients receiving RT for breast or prostate cancer. METHODS: The control-group patients received the nursing care that was the standard of practice before the experimental interventions were introduced. The experimental-group patients received theory-based interventions four different times from staff nurses. Patient data were collected by interview four different times. MAIN RESEARCH VARIABLES: Type of nursing interventions generated, optimistic or pessimistic expectations about outcomes (Life Orientation Test), amount of disruption in usual life activities (Sickness Impact Profile), and moods (Bi-Polar Profile of Mood States). FINDINGS: The patients who received the self-regulation theory-based nursing interventions experienced less disruption in their usual life activities during and following RT. Among the patients who tended to be pessimistic, those who received the theory-based interventions had a more positive mood than those who did not receive the interventions. IMPLICATIONS FOR NURSING PRACTICE: Staff nurses should use self-regulation theory-based interventions to help patients cope with RT.

Side effects and quality of life in patients receiving high-dose rate brachytherapy.

PURPOSE/OBJECTIVES: To describe the side effects and changes in quality of life (QOL) in patients receiving high-dose rate (HDR) brachytherapy. DESIGN: Descriptive, repeated measures. SETTING: A radiation therapy department in a large university setting. SAMPLE: Nine patients receiving HDR brachytherapy to the bronchus and 18 patients receiving HDR brachytherapy for gynecologic cancer. METHODS: Patient self-administered questionnaires and chart review. MAIN RESEARCH VARIABLES: Side effects and QOL. FINDINGS: Patients receiving gynecologic treatments experienced fatigue, diarrhea, urinary frequency, and urinary burning. Few changes occurred in QOL over time. Patients receiving bronchial treatments experienced cough, fatigue, shortness of breath, and difficulty swallowing. A decline in physical functioning occurred in the QOL measures over time. CONCLUSIONS: Patients receiving HDR brachytherapy experience similar side effects as patients receiving external beam radiation to the same site. Patients receiving treatment to the bronchus did not show improved QOL after treatment. IMPLICATIONS FOR NURSING PRACTICE: This data can be used in teaching patients about the experience of receiving HDR brachytherapy, planning symptom management for these patients, planning future research exploring the relationship between side effects and QOL, further documenting the side effects of HDR brachytherapy, and examining the efficacy of nursing interventions for side effects.

Results of a patient education project using a touch-screen computer.

PURPOSE: The purpose of this project was to increase use of the Physician Data Query and Patient Information File services of the National Cancer Institute in a clinical setting. OVERVIEW: A patient education demonstration project was conducted at the University of Rochester Cancer Center using a touch-screen computer program called CancerHelp. Two computers were purchased, one stationed in the Patient Library at the University of Rochester Cancer Center and one circulated to three affiliated hospitals. Demographic information was asked at the beginning of the program and an evaluation was elicited at the end of the program. All information was given voluntarily; users of the system could bypass the questions if they wished. The computer program was very well received by patients and their families. The program was used 1758 times over 6 months. CLINICAL IMPLICATIONS: A touch-screen computer program can be an effective method for distributing cancer information.

Patients' use of prevention behaviors in managing side effects related to chemotherapy.

PURPOSE/OBJECTIVES: To describe the use of prevention and early detection behaviors related to the side effects of chemotherapy. DESIGN: Cross-sectional, descriptive, and secondary analysis. SETTING: A large university hospital and university-affiliated community hospital. SAMPLE: 46 adult patients with cancer starting a cycle of IV chemotherapy who were predominantly white, married, and female. METHODS: Self-report utilizing a 17-item, self-administered prevention and early detection questionnaire called the Prevention Behaviors Questionnaire (PBQ); questionnaires were completed two days and five days after treatment. MAIN RESEARCH VARIABLE: Prevention and early detection behaviors. FINDINGS: Patients reported using an average of 8.8 prevention behaviors two days after chemotherapy and 9.2 behaviors five days after chemotherapy. "Tried to think more positively" was the most frequently used behavior. Internal consistency and test-retest correlation coefficients on the questionnaire were calculated to be 0.81 and 0.78, respectively. CONCLUSIONS: The PBQ had adequate internal consistency and test-retest reliability. Patients reported using many prevention and detection behaviors, although very little is known about the efficacy of these behaviors in reducing or preventing the side effects of chemotherapy. IMPLICATIONS FOR CLINICAL PRACTICE: This exploratory study does not have direct implications for practice but identifies an area for future research that may affect what nurses teach patients and how they assist patients to cope with treatment.

A comparison of patient-reported side effects among three chemotherapy regimens for breast cancer.

Patient's perceptions of side effects and the influence of treatment on daily activities are important considerations in choosing a chemotherapy regimen. However, there are no studies comparing patients' experiences with three commonly used chemotherapy regimens for breast cancer. The authors compared the patient-reported side effects and disruption in usual activities for cyclophosphamide and fluorouracil combined with methotrexate (CMF), doxorubicin (CAF), or mitoxantrone (CNF) in 86 women receiving treatment for breast cancer. The incidence and severity of side effects and disruption in usual activities were recorded by patients in a self-care diary (SCD) 2 and 5 days after the first and second drug cycles. Patients reported a mean of 3.2 to 4.9 side effects at each point in time. Fatigue, nausea, anorexia, taste changes, and headache were the most frequently reported side effects and did not differ in incidence among the three drug regimens. When repeated measures analysis of covariance was conducted using mean substitution for missing data and controlling for stage of disease, women receiving CAF reported more severe nausea than women receiving CMF or CNF (P < 0.05). Fatigue was significant for time; however, a distinct clinical pattern of fatigue was not apparent. Patients reported moderate levels of disruption in activities of daily living, with those receiving CAF having greater disruption. There was no difference among treatment groups in reports of overall disruption in activities. These data on patient reported experiences with side effects of chemotherapy can be used to prepare patients for specific side effects of treatment and facilitate symptom management.

Measuring mouth moisture: a case study in instrument development.

This paper describes the process through which an instrument for measuring mouth moisture was developed. The need to create a means of quantifying mouth moisture was realized while planning studies of oral care. Nursing texts assert that one indicator of successful oral care is "moist mucous membranes," and research on oral care typically names mouth moisture as an outcome variable. Yet the measures used in nursing research to assess mouth moisture have been characterized by imprecision, questionable reliability, and disregard for congruence between conceptual and operational definitions. The paper begins by critiquing the instruments commonly used in mouth care research to assess moisture. Next, the methodical process of building ideas to construct a new instrument is described. Finally, the trials that were conducted to arrive at the instrument's final design, estimates of reliability and validity, and a procedure for use that would preserve the integrity of the instrument are discussed.