Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review.

BACKGROUND: Cancer is a disease that mostly affects older adults. Treatment adherence is crucial to obtain optimal outcomes such as cure or improvement in quality of life. Older adults have numerous comorbidites as well as cognitive and sensory impairments that may affect adherence. The aim of this systematic review was to examine factors that influence adherence to cancer treatment in older adults with cancer. PATIENTS AND METHODS: Systematic review of the literature published between inception of the databases and February 2013. English, Dutch, French and German-language articles reporting cross-sectional or longitudinal, intervention or observational studies of cancer treatment adherence were included. Data sources included MEDLINE, EMBASE, PsychINFO, Cumulative Index to Nursing and Allied Health (CINAHL), Web of Science, ASSIA, Ageline, Allied and Complementary Medicine (AMED), SocAbstracts and the Cochrane Library. Two reviewers reviewed abstracts and abstracted data using standardized forms. Study quality was assessed using the Mixed Methods Appraisal Tool 2011. RESULTS: Twenty-two manuscripts were identified reporting on 18 unique studies. The quality of most studies was good. Most studies focused on women with breast cancer and adherence to adjuvant hormonal therapy. More than half of the studies used data from administrative or clinical databases or chart reviews. The adherence rate varied from 52% to 100%. Only one qualitative study asked older adults about reasons for non-adherence. Factors associated with non-adherence varied widely across studies. CONCLUSION: Non-adherence was common across studies but little is known about the factors influencing non-adherence. More research is needed to investigate why older adults choose to adhere or not adhere to their treatment regimens taking into account their multimorbidity.

A systematic review of unmet needs of newly diagnosed older cancer patients undergoing active cancer treatment.

PURPOSE: The aim of this study is to systematically review evidence with regard to answering the following questions: (1) What are the unmet care needs of older persons diagnosed with cancer who are undergoing active cancer treatment? (2) What are the predictors of unmet needs of older persons while undergoing active cancer treatment? METHODS: A systematic review of the literature published between January 1996 and December 2010 was completed. Manuscripts could be published in English, French, Dutch, or German searching the Medline, Embase, Psychinfo, Cinahl, and the Cochrane Library databases. The literature search was performed by two researchers with the assistance of a university librarian. Abstracts were reviewed by two reviewers for inclusion. RESULTS: Thirty studies were included. A significant proportion of newly-diagnosed patients undergoing cancer treatment had unmet needs, ranging from 15 to 93%. The most common needs varied by study but included psychological needs, information needs, and needs in the physical domain. Most studies showed that the level of unmet needs was highest after diagnosis and start of treatment and decreased over time. Predictors of unmet needs included: younger age, female gender, depression, physical symptoms, marital status, treatment type, income, and education. CONCLUSIONS: The level of unmet needs in newly diagnosed older cancer patients after the start of treatment is high, and the most common needs are psychological and information needs. More research is needed which would focus on the needs of older adults with comorbid conditions, and how these comorbid conditions influence the level of unmet needs.

Impact of nursing on hospital patient mortality: a focused review and related policy implications.

Understanding the determinants of patient mortality can lead to the development of strategies that reduce mortality and prevent unnecessary death. This paper synthesizes the body of published research that explores determinants of mortality for patients who have experienced acute care hospitalization. Fifteen research manuscripts were found to meet the selection criteria through an electronic search in MEDLINE and CINAHL (1986-2004). Seven categories of determinants of mortality were found: nurse-physician relationships, nurse staffing characteristics, physician characteristics, professional practice environment, nurse experience, registered nurse educational preparation, and clinical nursing support. Implications and recommendations for improving quality and safety in hospital care are discussed.

Nursing-related determinants of 30-day mortality for hospitalized patients.

The purpose of this study was to further our understanding of the effects of nursing-related hospital variables on 30-day mortality rates for hospitalized patients. A retrospective design was used to test the proposed 30-Day Mortality Model. The sample consisted of 75 acute-care hospitals in the province of Ontario, Canada. To develop hospital mortality rates, 46,941 patients discharged from these hospitals who had a most responsible diagnosis of acute myocardial infarction, stroke, pneumonia, or septicemia were included. To develop hospital-level nursing predictor variables, 3,998 responses to the Ontario Registered Nurse Survey of Hospital Characteristics were also included. The findings support a relationship between lower 30-day mortality and 3 predictors: a richer registered nurse skill mix, more years of experience on the clinical unit, and reported larger number of shifts missed. These findings can be used to predict the effects of hospital changes in nursing skill mix and years of RN experience on patient mortality.

A decentralized admission screening protocol for a geriatric rehabilitation program: does it make a difference?

The purpose of this retrospective evaluation study was to compare outcomes related to two distinct processes for screening people referred for admission to a geriatric rehabilitation program at a chronic care hospital in southern Ontario. Data were collected through chart review and focus group methods. The results were unexpected in that the projected outcomes associated with the newer referral screening process did not materialize. For both referral screening processes, findings are discussed in terms of the percentage of achieved patient rehabilitation goals. The average lengths of patient stay associated with both screening processes were also compared. No statistically significant differences between the two processes were found in terms of either the percentage of goals achieved or the length of patient stay. Focus group sessions were held to elicit team members' perceptions of the effectiveness of each of the referral processes. Participants in the focus groups were supportive of the newer referral screening and admission process although the evidence gathered from the chart review did not demonstrate improvements in patients' length of stay or an increase in the percentage of rehabilitation goals achieved.

Intravenous therapy for women in labor: implementation of a practice change.

BACKGROUND: Intravenous therapy for women in labor has been routinely administered in many North American hospitals since the 1950s. The purpose of this study was to evaluate a change in intravenous therapy practice. METHODS: The evaluation study, using a posttest, quasi-experimental design, examined the responses of women in labor and nurses to a questionnaire. Proxy prestudy cohort data were used for comparison of some patient outcomes. The convenience sample comprised 219 women admitted to the labor and delivery unit of a community hospital in Toronto, Ontario, between August and October 1997. RESULTS: Under the new intravenous therapy protocol, 26 percent of the women in labor did not receive intravenous therapy compared with 100 percent under the old protocol. The primary reasons for therapy were to enable administration of prescribed medication and bolus intravenous administration associated with epidural anesthesia. At the first after-delivery void, 61 percent of study women-65 percent of those who received intravenous therapy and 50 percent of those who received no intravenous therapy-tested negative for ketonuria. All 119 comments from nurses indicated comfort with their judgments related to the initiation of intravenous therapy. CONCLUSIONS: The change in the intravenous therapy protocol was supported by the study findings. Nurses should increase patient education about drinking and eating adequately throughout labor if appropriate, and resuming adequate fluid and food intake as quickly as possible after childbirth.

Evaluation of a partnership model of care delivery involving registered nurses and unlicensed assistive personnel.

The employment of unlicensed personnel in Canadian acute care hospitals has been undertaken without clear evidence of outcomes for patients, caregivers, and hospital organizations. This quasi-experimental evaluation study was completed in a metropolitan Toronto acute care hospital to examine the effects of a new nursing care delivery system which included unlicensed assistive personnel. Most of the expected benefits of the newly implemented nursing care delivery system did not materialize leading to the conclusion that the employment of unlicensed assistive personnel in acute care hospital systems may not offer additional benefits for patients, caregivers, or hospital organizations. The processes and results of this study provide useful information for nurse administrators who are seeking effective and innovative care delivery systems that are designed to optimize patient, caregiver, and hospital outcomes.

Tap in on ear thermometry.

In February 1992, nursing departments at The Mississauga Hospital, a 530-bed community hospital in Southern Ontario, purchased First Temp Genius ear thermometers to replace the electronic predictive thermometers then in use. Ear thermometers collect infrared heat radiation from the ear canal with a probe, then convert the radiation to a temperature reading. Although quick and easy to use with patients of all ages, there are nonetheless some issues concerning their use that still must be addressed.