The Enhancing Connections Program: a six-state randomized clinical trial of a cancer parenting program.

OBJECTIVE: The purpose of this study was to test the efficacy of a cancer parenting program for child rearing mothers with breast cancer, the Enhancing Connections Program. Primary goals were to decrease maternal depressed mood and anxiety, improve parenting quality, parenting skills and confidence, and enhance the child's behavioral-emotional adjustment to maternal breast cancer. METHOD: A total of 176 mothers diagnosed within 6 months with Stage 0 to Stage III breast cancer and their 8- to 12-year-old child were recruited from medical providers in 6 states: Washington, California, Pennsylvania, Minnesota, Arizona, and Indiana. After consenting and obtaining baseline measures, study participants were randomized into experimental or control groups. Experimental mothers received 5, 1-hr educational counseling sessions at 2-week intervals; controls received a booklet and phone call on communicating and supporting their child about the mother's cancer. Outcomes were assessed at 2 and 12 months. RESULTS: Compared to controls, at 2 months experimental mothers significantly improved on depressed mood and parenting skills; experimental children improved on behavioral-emotional adjustment: total behavior problems, externalizing problems, and anxiety/depressed mood significantly declined. At 1 year, experimental children remained significantly less depressed than controls on both mother- and child-reported measures. The intervention failed to significantly affect parenting self-efficacy or maternal anxiety. CONCLUSIONS: The Enhancing Connections Program benefitted mothers and children in specific areas and warrants refinement and further testing.

Concept analysis of good death in terminally ill patients.

The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers' evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient's dignity, family presence, family support, and communication among patient, family, and health care providers.

Experience of newly diagnosed patients with sarcoma receiving chemotherapy.

PURPOSE/OBJECTIVES: To examine symptom distress and quality of life (QOL) in newly diagnosed patients with sarcoma receiving chemotherapy. DESIGN: Pilot study; descriptive, quantitative. SETTING: Urban community cancer center in the northeastern United States. SAMPLE: 11 newly diagnosed patients with sarcoma. METHODS: Participants completed the Edmonton Symptom Assessment Scale and the Functional Assessment of Cancer Therapy-General at baseline and on days 1, 15, and 21 of their chemotherapy treatment. MAIN RESEARCH VARIABLES: Symptom distress and QOL. FINDINGS: Fatigue was the most prevalent and pervasive symptom. Anxiety, well-being, lack of appetite, drowsiness, and depression were the most commonly reported symptoms during chemotherapy. QOL was negatively affected. The lowest mean score reported was for functional well-being. Outcome profiles for symptom distress increased over time, whereas QOL profiles decreased over time. Exploratory analyses of age, race, sex, and diagnosis group suggested differences that warrant further study. CONCLUSIONS: Overall, increasing symptom distress and reduced QOL over time were reported by patients with sarcoma during chemotherapy. Exploratory analysis by demographic variables and treatment group suggested the need for further research of predictors for symptom distress and QOL. IMPLICATIONS FOR NURSING: Clinical and research implications included the need for better understanding about symptom distress and QOL predictors in patients with sarcoma, as well as the evaluation of interventions directed to address this population's specific needs.

Knowledge, attitudes, and practice behaviors of oncology advanced practice nurses regarding advanced care planning for patients with cancer.

PURPOSE/OBJECTIVES: To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses' (APNs') knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs' knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning. DESIGN: Descriptive, cross-sectional, pilot survey study. SETTING: The eastern United States. SAMPLE: 300 oncology APNs. METHODS: Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey's attitudinal and practice behavior portions. MAIN RESEARCH VARIABLES: Respondents' demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice. FINDINGS: Exploratory factor analysis yielded a five-factor solution from the survey's attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients' and families' as well as physicians' reluctance to discuss advanced care planning. CONCLUSIONS: The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine. IMPLICATIONS FOR NURSING: Validly assessing oncology APNs' knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes.

The meanings of and attitudes about cancer pain among African Americans.

PURPOSE/OBJECTIVES: To describe the meaning of cancer pain and attitudes in dealing with cancer pain among a group of African Americans with cancer. RESEARCH APPROACH: Qualitative descriptive design. SETTING: Three outpatient medical oncology clinics in the mid-Atlantic region. PARTICIPANTS: Purposive sample of 35 self-identified African Americans older than age 18 and diagnosed with solid tumors, with self-reported cancer-related pain lasting at least one month in duration and no major surgery in the previous three months. METHODOLOGIC APPROACH: In-depth, semistructured, taped-recorded interviews were transcribed verbatim and analyzed. Initial codes were categorized into meaningful themes, and the data were analyzed until no new themes emerged. FINDINGS: Cancer pain was articulated by participants in terms of its physical, emotional, and existential dimensions. Themes related to cancer and pain remained intertwined. Some participants viewed pain as a signal of underlying disease progression and described it as a monitoring strategy for staying ahead of their cancer. Stoicism, faith, and finding meaning in the cancer pain experience emerged as main themes in participants dealing with cancer pain. CONCLUSIONS: The findings suggest that perceived meanings and interpretations of the nature of cancer pain, its causes, and consequences may be important in shaping participants' pain treatment negotiations with providers. Understanding patient-level factors is crucial to fully comprehend pain treatment disparities. INTERPRETATION: Providers must assume a more proactive role in assessing physical, emotional, and existential dimensions of cancer pain, improving trust and communication, and identifying educational and behavioral interventions for African American patients and families to optimize pain treatment outcomes.

A qualitative study of caregivers' experiences with newly diagnosed advanced colorectal cancer.

PURPOSE/OBJECTIVES: To report on a descriptive, qualitative study of 14 caregivers of patients newly diagnosed with advanced colorectal cancer. RESEARCH APPROACH: Qualitative. SETTING: One urban ambulatory cancer center in the northeastern United States. PARTICIPANTS: 14 identified caregivers of patients newly diagnosed with stage III or IV colorectal cancer. METHODOLOGIC APPROACH: Semistructured interviews were taped recorded. Interviewers asked participants to describe their experiences caring for a loved one with colorectal cancer. Thematic content analysis with inductive coding was used to code the transcribed interview data. Throughout the data-coding process, emics in each category were compared within and between categories to maximize the fit of participants' data. Categories were reviewed in a final stage of analysis and further organized into domains from which the core category was derived. MAIN RESEARCH VARIABLES: Caregiver experiences of living with a person with colorectal cancer, effect on daily living, coping strategies used, and effect on children. FINDINGS: The coded interview data yielded three domains: Experiencing Total Disruption of My Life, Staying Positive, and Attempting to Keep Family and Children's Routines as Normal as Possible. The core category that explained study participants' caregiving experiences was "balancing caregiving activities and disruptions while dealing positively with daily demands and personal impact." CONCLUSIONS: The dominant experiences of the participants focused on coming to terms with the disease's disruption in their lives, attempting to deal positively with the effect of the disease, and maintaining normalcy in family life. INTERPRETATION: Targeted assessment of caregivers' needs is important in the three dimensions of the study domains. Clinicians who work with caregivers of patients with cancer should offer direct support because caregivers cope with the care of their loved one and struggle with their own distress and with maintaining normal family life. Findings suggest the importance of offering psychosocial support to caregivers and providing guidance to caregivers for support of their children and families.

Salvaging their normal lives: a qualitative study of patients with recently diagnosed advanced colorectal cancer.

PURPOSE/OBJECTIVES: To describe the experiences of patients living with newly diagnosed stage III or IV colorectal cancer. RESEARCH APPROACH: Qualitative; inductive coding methods were used to identify open codes that were analyzed, compared, and grouped into categories. SETTING: An urban ambulatory cancer center in the northeastern United States. PARTICIPANTS: 14 patients newly diagnosed with stage III or stage IV colorectal cancer. METHODOLOGIC APPROACH: Semistructured interviews were recorded on audiotape. Interviewers asked participants to describe their experiences with the diagnosis and treatment of colorectal cancer. Content analysis with inductive coding was used to code the transcribed interview data. Categories were reviewed and organized into larger groupings, from which the core category was derived. MAIN RESEARCH VARIABLES: Experiences of living with a diagnosis of colorectal cancer, impact on daily living, quality of life, coping strategies used, level of preparedness, and impact on children. FINDINGS: The coded interview data yielded six domains: feeling life is disrupted, experiencing physicians, feeling unprepared for everything, rethinking parenting, wondering "why me?," and dealing with it. The core category that explained study participants' experiences with recently diagnosed colorectal cancer was "salvaging their normal lives." CONCLUSIONS: The dominant experience of the study participants focused on four aspects of their illness experience: (a) framing it in ways that enabled them to recreate a semblance of normalcy or of their preillness state, (b) trying to tell children about the illness in stabilizing ways, (c) generating or maintaining a positive outlook no matter what, and (d) concretely managing the distress of the illness and its symptoms. INTERPRETATION: Targeted assessment is important in the six dimensions of the study domains. Clinicians who work with patients with cancer should offer support as patients search for meanings to explain this potentially devastating life event. Teaching active coping strategies as patients with advanced cancer struggle to come to terms with the demands of the disease while attempting to live their lives as fully and as normally as possible is important.

Factors associated with distress in urban residential fire survivors.

PURPOSE: To identify factors associated with recovery in a sample of urban residential fire survivors. DESIGN AND METHODS: 440 survivors, of residential fires were interviewed at approximately 3, 6, and 13 months after the fire to measure psychological distress. A set of factors was identified that correlated with survivors' ability to recover from the fire event. Potential predictors of increased distress were identified. Hypotheses were that participants who were lower in socioeconomic status, who were minority members, who had less social support, who engaged in attributional thinking, and had greater concurrent life stresses would have greater psychological distress in response to a residential fire and would be less able to recover from the fire event. FINDINGS: Distress after fire was high at 3 months and decreased for the majority of participants, although one-third of survivors had higher distress at 13 months than at 3 months. Loss of control and attributional variables had the strongest influence on psychological distress over time. CONCLUSIONS: The findings are consistent with stress-response tendencies expected after a stressful event. A set of predictor variables was identified to help clinicians target survivors at high risk for psychological distress after a residential fire.

Graduate education in oncology nursing for minorities.

BACKGROUND: Cancer statistics reveal disturbing morbidity and mortality rates among minorities, especially African Americans. A program to recruit and train minority nurses as Oncology Advanced Practice Nurses was developed at the University of Pennsylvania School of Nursing. METHODS: Since 1992, 30 African American, five Asian/Pacific Islander, and five Hispanic nurses have been supported during advanced oncology nursing study. RESULTS: Graduates have assumed positions of clinical and academic leadership in oncology nursing. CONCLUSIONS: This project strengthened the ability of a graduate program in oncology nursing to respond to needs related to the education of minority students and to the care of minority populations with cancer.