Using Demographics to Predict Palliative Care Access in Inpatient Facilities in Rural North Carolina.

PURPOSE: For individuals with cancer, palliative care improves quality of life, mood, and survival. Rural residents experience limited access to palliative care. In eastern North Carolina, a rural area, little is known about access to inpatient cancer-related palliative care. This study describes access to inpatient palliative care and developed a predictive model of who was most likely to be admitted to an inpatient facility without a palliative care provider. METHODS: A descriptive, exploratory design was used to examine demographics, clinical variables, and inpatient admissions from 2017 and 2018, in a major regional teaching hospital system that included 8 hospitals (7 rural hospitals). Descriptive statistics and a binary logistic regression were used to analyze data. FINDINGS: The mean age was 62.2 years (N = 2,161, range: 18-88, SD = 15.52): 49.4% were female, 54% lived in a rural county, and 44.4% were black. The outlying rural hospitals, with no palliative care providers on staff, had 388 admissions (18%). Only gender (P = .0128), county (P < .0001), and age (P < .05) contributed to the logistic model. The predicted probability of being admitted to an inpatient facility with a palliative care provider is higher for younger males living in urban counties. That probability decreases with age regardless of the gender or type of county. CONCLUSIONS: These findings highlight the limited availability of inpatient palliative care for those with cancer. Women, older adults, and rural residents are more likely to be admitted to 1 of the 7 rural hospitals with no palliative care provider on staff.

Dimensions of Distress in Lung Cancer.

OBJECTIVES: To (a) compare the domains of distress between patients who were distressed and patients who were not distressed and (b) examine the relationship between the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients (DT-PL) and the Hospital Anxiety and Depression Scale (HADS) in individuals with advanced lung cancer. SAMPLE & SETTING: Individuals with advanced lung cancer receiving chemotherapy were recruited from a comprehensive cancer center in the southeastern United States. METHODS & VARIABLES: A cross-sectional, descriptive, exploratory design was used. Individuals with lung cancer completed the DT-PL and the HADS. Data were analyzed using descriptive statistics, t tests, and chi-square analysis. RESULTS: Significant differences were found between the nondistressed group and the clinically distressed group in three domains of distress. IMPLICATIONS FOR NURSING: Distress in individuals with advanced lung cancer goes beyond psychological stressors and includes family problems and physical problems.

Social media as a recruitment method to reach a diverse sample of bereaved parents.

BACKGROUND: Recruiting a diverse group of parents who are grieving the loss of a child into research is challenging. Social media users represent all demographic groups in the United States. Online platforms, such as Facebook and Twitter, may be one potential method to reach and recruit a diverse group of bereaved parents. To our knowledge, this is the first known article to describe social media as a recruitment mechanism for bereaved parents. PURPOSE: The purpose of this paper is to describe 1) how the social media platforms of Facebook and Twitter were used to recruit bereaved parents into a cross-sectional, online survey, and 2) the effectiveness of social media as a recruitment tool for this population. CONCLUSIONS: Social media has the potential to be an effective recruitment tool to reach a diverse group of users. More research is needed, however, to determine the best methods to reach fathers as well as racial and ethnic minorities.

Stigma and Quality of Life in Patients With Advanced Lung Cancer.

OBJECTIVES: To identify groups of participants with high and low levels of stigma and to examine the influence of stigma on social support, social constraints, symptom severity, symptom interference, and quality of life (QOL). SAMPLE & SETTING: 62 individuals with lung cancer were identified and recruited from a comprehensive cancer center in the southeastern United States. METHODS & VARIABLES: Participants completed a questionnaire that included demographic information and measures of stigma, symptom severity and interference, social support, social constraints, and QOL. IBM SPSS Statistics TwoStep Cluster Analysis was used to identify high- and low-stigma groups. Independent sample t tests were used to compare differences between the groups. RESULTS: 22 participants had a high level of stigma; they had significantly higher symptom severity on feeling distressed, problems remembering things, and feeling sad, and greater symptom interference related to mood, relations with others, and enjoyment of life. Participants also had significantly higher levels of social support and lower social constraints. Stigma was significantly related to lower levels of QOL. IMPLICATIONS FOR NURSING: Nurses should be aware that stigma may influence various factors throughout the disease trajectory; they can privately assess individuals with lung cancer for access to social supports, feelings of stigma, and QOL, and make appropriate referrals as needed.

Health Disparities in Hospice Utilization and Length of Stay in a Diverse Population With Lung Cancer.

BACKGROUND: Lung cancer is the leading cause of cancer deaths globally. Individuals are diagnosed at an advanced stage with limited life expectancy. OBJECTIVES: To explore potential health disparities in hospice utilization and length of stay (LOS) in a diverse sample of patients with lung cancer. METHODS: Demographic and clinical information as well as data for hospice utilization and LOS was extracted from electronic health records. Data were analyzed using descriptive statistics, χ2 tests, and an analysis of variance test. RESULTS: Data from 242 patients were analyzed. In the sample, 33% (n = 80) were Black and 51% (n = 124) lived in a rural county. At the time of data collection, 67% of the sample was deceased and 36% (n = 86) chose to enroll in hospice. No disparities were found for race, age, gender, or rural/urban dwellers in hospice enrollment. No disparities were found for race, gender, or rural/urban dwellers for hospice LOS. Age was associated with hospice LOS ( P = .004). Those who were older were more likely to have a longer LOS. CONCLUSION: Hospice utilization and LOS were low for all groups with lung cancer in a geographically and racially diverse region of the United States. Given the rates of mortality in lung cancer, discussions about the goals and benefits of hospice care may be beneficial and should be part of an ongoing dialogue throughout the disease trajectory.

An Evaluation of a Rural Community-Based Breast Education and Navigation Program: Highlights and Lessons Learned.

Cancer has become the leading cause of death in North Carolina (NC) (North Carolina DHHS, State Center for Health Statistics 2015) and the eastern region of North Carolina (ENC) has experienced greater cancer mortality than the remainder of the state. The Pitt County Breast Wellness Initiative-Education (PCBWI-E) provides culturally tailored breast cancer education and navigation to screening services for uninsured/underinsured women in Pitt and Edgecombe Counties in ENC. PCBWI-E created a network of 23 lay breast health educators, and has educated 735 women on breast health and breast cancer screening guidelines. Navigation services have been provided to 365 women, of which 299 were given breast health assessments, 193 were recommended for a mammogram, and 138 were screened. We have identified five lessons learned to share in the successful implementation of a community-based breast cancer screening intervention: (1) community partnerships are critical for successful community-based cancer screening interventions; (2) assuring access to free or low-cost screening and appropriate follow-up should precede interventions to promote increased use of breast cancer screening; (3) the reduction of system-based barriers is effective in increasing cancer screening; (4) culturally tailored interventions can overcome barriers to screening for diverse racial/ethnic and socioeconomic groups; and (5) multi-component interventions that include multiple community health strategies are effective in increasing screening.

Post-Treatment Symptoms of Pain, Anxiety, Sleep Disturbance, and Fatigue in Breast Cancer Survivors.

BACKGROUND: In part because of improvements in early detection and treatment, the number of breast cancer survivors is increasing. After treatment, however, breast cancer survivors often experience distressing symptoms, including pain, sleep disturbance, anxiety, and fatigue; at the same time, they have less frequent contact with health care providers. Pain commonly co-occurs with other symptoms and the combination of symptoms contribute to the amount of distress experienced by survivors. Previous studies of post-treatment symptoms include primarily urban and white women. AIMS: The purpose of this study was to describe the post-treatment cluster of symptoms, to examine the correlations among these symptoms, and to examine the role pain intensity may play in understanding the variation in sleep disturbance, fatigue, and anxiety in a racially diverse sample of rural breast cancer survivors. DESIGN: The theoretical framework for this descriptive correlational study was the theory of unpleasant symptoms. SETTINGS: Outpatient university-affiliated cancer clinic. PARTICIPANTS/SUBJECTS: Forty women who were between 6 months and 5 years post breast cancer diagnosis. METHODS: Participants completed the following self-report instruments: Patient Reported Outcomes Measurement Information System of pain intensity, pain interference, anxiety, and sleep disturbance and the Piper Fatigue Short Form 12. RESULTS: The average age of participants was 58 years, and 57.5% were black. Most women reported sleep disturbance (78%), pain interference (68%), and pain intensity (63%) above the national average for an American adult. Black women reported higher pain intensity than whites. There were moderate to strong correlations among the symptoms (range r = 0.35-0.89). CONCLUSIONS: Nurses and health care providers in primary care settings need to screen for symptoms, and nursing interventions are needed to assist breast cancer survivors to manage distressing symptoms.

Nursing care, delirium, and pain management for the hospitalized older adult.

Delirium is a reversible cognitive disorder that has a rapid onset. Delirium risk factors include older age, severity of illness, poorer baseline functional status, comorbid medical conditions, and dementia. There are adverse consequences of delirium, including increased length of stay and increased mortality. Therefore, it is important for nurses to identify clients at risk and prevent and manage delirium in the hospitalized older client. Once high-risk clients are identified, prevention strategies may be used to reduce the incidence. Examples of prevention strategies include providing glasses and working hearing aids and effective pain management. This article discusses various assessment instruments that detect the presence of delirium. With this information, nurses are better equipped to evaluate the best assessment options for their work setting. Early detection is crucial to reduce the adverse consequences of delirium. Once a client is found to be experiencing delirium, a treatment plan can be established using both nonpharmacologic and pharmacologic interventions. In addition, the identification and the correction of etiologies of delirium can shorten the course of delirium.

An integrative curriculum for accelerated nursing education programs.

The number of accelerated baccalaureate and direct-entry master's nursing programs being offered in the United States is increasing. These programs shorten the amount of time to educate entry-level nurses. This article describes one school's curriculum for a direct-entry master's nursing program. A faculty task force developed the curriculum and used the opportunity to change the educational paradigm from traditional pedagogical to a concept student-learning approach. The curriculum design, which integrates nursing content through a conceptual model, and an innovative clinical experience model are described. In addition, the article discusses the successes and challenges of the program encountered during the first 2 years of initiation of the curriculum.

The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer.

This study examined the effect of informational audiotapes on patients' self-care behaviors (SCBs) to manage chemotherapy side effects of fatigue, anxiety, and sleep disturbance. Seventy-one women with breast cancer participated. Thirty-three received audiotapes on SCBs to manage side effects. Three telephone interviews were conducted. Overall, women who received education demonstrated more SCBs, a wider range of SCBs, increased use of SCBs over time, and less anxiety. Nursing time for education in busy clinics is minimal. Patient anxiety in the clinic environment interferes with learning. Audiotapes are an effective tool for use at home, providing for teaching and reinforcement of patient education.

Anxiety and quality of life of women who receive radiation or chemotherapy for breast cancer.

PURPOSE/OBJECTIVES: To examine quality of life (QOL) and anxiety in a sample of women receiving radiation or chemotherapy for breast cancer. DESIGN: Longitudinal, descriptive. SETTING: A cancer center in the southeastern United States. SAMPLE: 48 women participated; 17 received radiation and 31 received chemotherapy. METHODS: The Ferrans and Powers Quality of Life Index (QLI) and Speilberger's State-Trait Anxiety Inventory (STAI) were administered. The QLI was administered at the start of treatment and one year later. The STAI was administered at the start of treatment. The state portion of the STAI also was administered 4 weeks and 12 weeks after the start of treatment. MAIN RESEARCH VARIABLES: QOL and anxiety. FINDINGS: Total QOL improved significantly over time for the entire sample, as did scores on the health/functioning, psychological/spiritual, and family subscales of the QLI. No significant differences existed for total QOL or any subscales by treatment. Trait anxiety was significantly higher for women receiving chemotherapy, and state anxiety was significantly higher at all three measurement times for the women. State anxiety did not decrease significantly over the course of the treatment for either group. Trait anxiety and state anxiety at the start of treatment were significantly negatively correlated with total QLI score and the psychological/spiritual subscale. State anxiety at the start of treatment also was significantly negatively correlated with total QOL and the health/functioning and psychological/spiritual QLI subscales both at the start of treatment and one year later. CONCLUSIONS: QOL improves over time for women who have received radiation or chemotherapy. Women receiving chemotherapy have higher anxiety scores, and higher anxiety at the start of treatment is associated with decreased QOL at the start of treatment and postdiagnosis. IMPLICATIONS FOR NURSING: Nursing interventions to reduce anxiety at the start of treatment, especially for chemotherapy recipients, are indicated. Research also should target methods to reduce anxiety at the start of treatment.

The effect of education in managing side effects in women receiving chemotherapy for treatment of breast cancer.

PURPOSE/OBJECTIVES: To determine the effectiveness of informational audiotapes on self-care behaviors, state anxiety, and use of self-care behaviors; to describe the occurrence and intensity of common side effects in patients with breast cancer. DESIGN: Randomized clinical trial. SETTING: Outpatient chemotherapy clinics operated by a university center in a rural area. SAMPLE: 70 women receiving their first treatment of chemotherapy. METHODS: Subjects completed demographic data and the Spielberger State-Trait Anxiety instrument (stai). The experimental group received two audiotapes. At one and three months, subjects completed the modified nail self-care diary and stai via telephone. MAIN RESEARCH VARIABLES: State anxiety, side-effect severity, and use and efficacy of self-care behaviors. FINDINGS: The most frequent side effects were fatigue, nausea and vomiting, and taste change. The experimental group reported symptom improvements that were not found in the control group. The experimental group increased the use of recommended self-care behaviors, whereas the control group continued to use the same self-care behaviors without effectiveness. State anxiety for both groups diminished over time; however, anxiety in the control group was consistently higher. CONCLUSIONS: Audiotapes are effective teaching tools. Self-care behaviors can be taught and can be effective in managing side effects. Anxiety was high in both groups, but the symptom decreased in the women who received audiotapes and telephone calls. IMPLICATIONS FOR NURSING: Constraints on nurses decrease the length of teaching time available, but audiotapes provide effective teaching and reinforcement of education. Anxiety in clinical environments interferes with patient learning. Teaching effective self-care behaviors enhances patients' independence, comfort, control, and quality of life.