Learning and support preferences of adult patients with cancer at a comprehensive cancer center.

PURPOSE/OBJECTIVES: To identify content items for an inclusive education curriculum for adult patients with cancer, as well as describe their learning and support preferences, determine the level of information provided to them, and assess the patients' interest in potential new services. DESIGN: Exploratory, descriptive survey research. SETTING: A National Cancer Institute-designated Comprehensive Cancer Center. SAMPLE: All consenting adult patients with cancer who had appointments in the outpatient care setting during a two-week period (N = 1,310). METHODS: A 3-phase study identified core components of an inclusive educational curriculum, conducted structured interviews of patients with cancer, and validated findings in a selected sample. FINDINGS: The surveys were completed and returned by 48% (n = 625) of the patients. The most favored method for learning about all cancer topics was discussions with physicians (66%). Other preferred methods included brochures or booklets provided by physicians or nurses (33%), discussions with nurses (34%), self-selecting print media from information displays (20%), and talking with other patients with cancer (14%). Statistically significant differences in learning preferences were found among subgroups defined by age, gender, and education. CONCLUSIONS: Patients preferred interactive, interpersonal communication with physicians or nurses. In addition, the prevailing method of education delivery for patients with cancer was providing print materials that support and enhance knowledge shared in the patient-healthcare team communication. IMPLICATIONS FOR NURSING: This study confirms the importance of the learning and support preferences of patients with cancer. To implement a successful education program for their patients, nurses must be aware of patients' preferences for learning new information. Time must be set aside for one-on-one communication with patients, and print materials must be easily accessible to healthcare providers to support the patient-education process.

Phase III evaluation of fluoxetine for treatment of hot flashes.

PURPOSE: Hot flashes can be a prominent problem in women with a history of breast cancer. Given concerns regarding the use of hormonal therapies in such patients, other nonhormonal means for treating hot flashes are required. Based on anecdotal information regarding the efficacy of fluoxetine and other newer antidepressants for treating hot flashes, the present trial was developed. PATIENTS AND METHODS: This trial used a double-blinded, randomized, two-period (4 weeks per period), cross-over methodology to study the efficacy of fluoxetine (20 mg/d) for treating hot flashes in women with a history of breast cancer or a concern regarding the use of estrogen (because of breast cancer risk). Eligible patients had to have reported that they averaged at least 14 hot flashes per week; they could have received tamoxifen or raloxifene as long as they were on a stable dose. The major outcome measure was a bivariate construct representing hot flash frequency and hot flash score, analyzed by a classic sums and differences cross-over analysis. RESULTS: Eighty-one randomized women began protocol therapy. By the end of the first treatment period, hot flash scores (frequency x average severity) decreased 50% in the fluoxetine arm versus 36% in the placebo arm. Cross-over analysis demonstrated a significantly greater marked hot flash score improvement with fluoxetine than placebo (P =.02). The results were not adjusted for potential confounding influences, including age and tamoxifen use. The fluoxetine was well tolerated. CONCLUSION: This dose of fluoxetine resulted in a modest improvement in hot flashes.