Correlates of Health-Related Quality of Life in a National Sample of Older Adult, Long-Term Survivors of Colorectal Cancer.

BACKGROUND: Most survivors of colorectal cancer (CRC) are older adults who are at high risk of experiencing adverse effects and decreased health-related quality of life (HRQOL) related to cancer and its treatments. OBJECTIVE: This study aimed to describe HRQOL and the demographic and clinical factors associated with HRQOL among older adult, long-term survivors of CRC. METHODS: A sample of older adult, long-term survivors of CRC (N = 14 458) from the Surveillance Epidemiology and End Results-Medicare Health Outcomes Survey dataset was selected. Hierarchical multiple regression was used to analyze the contribution of demographic and clinical variables to HRQOL as measured by the Veterans Rand 12-item scale. RESULTS: The mean respondent age was 79 years with an average time from diagnosis to survey being about 13 years. In the final model, gender, race, education, income, previous radiation treatment, cardiovascular disease, inflammatory bowel disease, depression, pain, fatigue, functional status, and general health perception were all significantly correlated with mental HRQOL (R2 = 0.53). For physical HRQOL, age at diagnosis, race, marital status, education, time since diagnosis, comorbid conditions, depression, pain, fatigue, functional status, and general health perception were all significant correlates (R2 = 0.85). Symptoms were the largest contributors to mental and physical HRQOL, accounting for 43% and 50% of the variance, respectively. CONCLUSION: Pain, depression, and fatigue significantly affect the HRQOL of older adult survivors of CRC, underscoring the need for long-term survivorship care. IMPLICATION FOR PRACTICE: Aggressive symptom assessment and management may be key to improving the HRQOL in this population.

School Shooters: Patterns of Adverse Childhood Experiences, Bullying, and Social Media.

INTRODUCTION: Since 2013 there have been at least 421 recorded incidents of gunfire on school grounds METHOD: This study used a critical review of national and local media news reports of 25 American male school shooter cases from 2013 to 2019. RESULTS: Approximately 88% of school shooters had at least one social media account, and 76% posted disturbing content of guns and threatening messages. Over 72% of shooters had at least one reported adverse childhood experience, and 60% reported being bullied in-person or online DISCUSSION: Professionals who work with adolescents are front-line providers who routinely assess student safety. Social media use is often underassessed, demonstrating a knowledge gap that may reveal insights into the perspective and well-being of adolescents. Inclusion of questions on social media, adverse childhood experiences, and experiences of bullying by pediatric nurses and others may be proactive measures that can help identify, protect, and intervene with at-risk students.

Impact of Exposure to Patient Death or Near Death on Compassion Fatigue in Pediatric Intensive Care Nurses.

BACKGROUND: Compassion fatigue affects up to 40% of health care professionals who work in intensive care settings. Frequent exposure to the death of patients, particularly children, may put nurses at risk for compassion fatigue, but the relation between these is unclear among those working in pediatric intensive care units. OBJECTIVES: To examine the relationship between exposure to the death or near death of a pediatric patient and compassion fatigue, specifically the outcomes of compassion satisfaction, burnout, and secondary traumatic stress. METHODS: Pediatric and neonatal intensive care nurses were surveyed about their exposure to patient death and near-death experiences. They were asked to respond to the Professional Quality of Life Scale, which has 3 subscales that measure compassion satisfaction, burnout, and secondary traumatic stress. Bivariate and multivariate linear regression modeling was used to identify correlates of these outcomes. RESULTS: Of the 65 respondents, 94% were female, 41% were aged 31 to 45 years, and 71% had a bachelor's degree. No significant relationship was found between nurses' experiences of patient death or near death and their compassion satisfaction, burnout, or secondary traumatic stress. Significant correlates of compassion satisfaction and burnout included educational level and an age-experience interaction. CONCLUSIONS: No relationship seems to exist between nurses' experiences of patient death or near death and their compassion satisfaction, burnout, or secondary traumatic stress. Further research is needed to evaluate the impact of educational attainment on nurse outcomes and determine how best to support nurses who are at risk for compassion fatigue.

End-of-life Health-Care Utilization Patterns Among Chronically Ill Older Adults.

Patients with chronic illness are associated with high health-care utilization and this is exacerbated in the end of life, when health-care utilization and costs are highest. Complex Care Management (CCM) is a model of care developed to reduce health-care utilization, while improving patient outcomes. We aimed to examine the relationship between health-care utilization patterns and patient characteristics over time in a sample of older adults enrolled in CCM over the last 2 years of life. Generalized estimating equation models were used. The sample (n = 126) was 52% female with an average age of 85 years. Health-care utilization rose sharply in the last 3 months of life with at least one hospitalization for 67% of participants and an emergency department visit for 23% of participants. In the last 6 months of life, there was an average of 2.17 care transitions per participant. The odds of hospitalization increased by 27% with each time interval ( P < .001). Participants demonstrated 11% greater odds of having a hospitalization for each additional comorbidity ( P = .05). A primary diagnosis of heart failure or coronary artery disease was associated with 21% greater odds of hospitalization over time compared to other primary diagnoses ( P = .017). Females had 70% greater odds of an emergency department visit compared to males ( P = .046). For each additional year of life, the odds of an emergency department visit increased by about 7% ( P < .001). Findings suggest the need for further interventions targeting chronically ill older adults nearing end of life within CCM models.