Patient's perspectives of living with a precancerous condition: Monoclonal gammopathy of undetermined significance (MGUS).

PURPOSE: The aim of this study was to investigate patient experiences of living with monoclonal gammopathy of undetermined significance (MGUS). Living with a premalignant condition such as MGUS may elicit negative psychosocial effects including increased anxiety and fear of progression to cancer. To date, no study utilising qualitative methodology has explored the lived experiences of MGUS patients. METHODS: Data was collected via two focus groups and six telephone interviews. MGUS patients (n=14) were recruited via nurse-led haematology telephone-clinics in Northern Ireland. Interviews were transcribed verbatim and the data subjected to thematic analysis. OUTCOME: Thematic analysis identified 3 overarching themes; (1) The psychosocial impact of an MGUS diagnosis, (2) Knowledge of MGUS and (3) Experiences of MGUS health services. Patients with MGUS reported experiencing poor psychological adjustment to their condition particularly at the point of diagnosis and approaching follow-up appointments. Feelings of isolation, poor information-provision, increased uncertainty and limited psychosocial support for MGUS patients were also reported. Patients did however reflect positively on their experience of being followed up via nurse-led telephone clinics. CONCLUSIONS: Provision of patient friendly information guides at diagnosis, and additional psychosocial support services such as nurse-led telephone clinics and coordinated patient groups may help MGUS patients adjust better to their diagnosis and in doing so improve quality of life in this patient population.

Infusing Swanson's Theory of caring into an advanced practice nursing model for an infectious diseases anal dysplasia clinic.

The incidence of anal cancer is increasing among HIV-infected men and women. The process of screening for anal dysplasia and the management of abnormal findings are currently and most often based on a medical model. The needs of these patients, however, go well beyond medical care. A more comprehensive and holistic approach to health care is, therefore, required. Given the scope of practice of advanced practice nurses who are involved in the diagnosis and treatment of patients with anal dysplasia, it is appropriate for them to assume leadership roles in addressing the needs of these patients. This article describes the application of a theory of caring to create an advanced practice nursing model of care for HIV-infected men and women in infectious diseases anal dysplasia clinics.

Topical photodynamic therapy: an introduction for nurses.

Non-melanoma skin cancers are the most common cancers in the UK. Although an estimated 50000 cases were registered in 1999 across England and Wales, there is likely to be significant under-reporting of cases. However, the cancer registries do not include pre-cancerous lesions of the skin and therefore the number treated will greatly outnumber the cancers (National Institute for Health and Clinical Excellence, 2006). Topical photodynamic therapy (PDT) is one of several effective treatments for pre-malignant and malignant non-pigmented skin cancers. The treatment is non-invasive and can be administered by nurses in a clinical setting. PDT is a two-step process involving the application of a light-activated substance followed by exposure to light to activate this substance. The treatment results in the elimination of tumour cells while leaving the healthy skin unharmed. This article provides an introduction to PDT for nurses who may in the future be involved in setting up a PDT service within their practice area.

Sexual implications of gynecologic cancer treatments.

Gynecologic cancers affected 81,000 women in 1999. The disease and its associated treatment commonly pose a threat not only to the life of such patients, but also to their sexuality and fertility. These women and their partners require knowledgeable, compassionate care. Effective, holistic nursing care for women experiencing gynecologic cancers requires an understanding of basic concepts of female sexuality, the diagnosis and treatment of gynecologic malignancies, the impact of the disease and its treatment on a woman's sexuality, and ways the nurse can incorporate sexuality issues into practice.

Educating women about early detection of gynecologic cancers using a brochure.

PURPOSE/OBJECTIVES: To develop and evaluate a brochure for educating women about screening for gynecologic cancers. DATA SOURCES: Journal articles and American Cancer Society (ACS) materials. DATA SYNTHESIS: This brochure focuses on early detection (based on ACS guidelines), signs and symptoms, and risk factors for cancers of the cervix, uterus, and ovaries as well as a detailed discussion of the Papanicolaou (Pap) test and the Bethesda System for grading test results. CONCLUSIONS: This brochure has been effective in educating a large number of women about early detection of gynecologic cancers. IMPLICATIONS FOR NURSING PRACTICE: Nurses can use this brochure as an effective adjunct to their public education programs that address early detection of gynecologic cancers.

Knowledge of malignant melanoma and how it relates to clinical practice among nurse practitioners and dermatology and oncology nurses.

Cutaneous malignant melanoma (CMM) is a growing health problem in the United States. This study evaluated nurses' frequency of skin cancer assessment, ability to recognize CMM, knowledge of risk factors and preventive measures, teaching practices, and barriers to skin cancer assessment. The sample (n = 178) consisted of nurse practitioners (NP), oncology nurses (ON), and dermatology nurses (DN). The participants indicated that skin cancer assessment was within their scope of practice but reported frequencies of performance were low. NP scored lower in overall knowledge, although they had received the highest level of formal skin cancer education (p < 0.05). Recognition of melanoma was moderate, with scores of 54-68% for the three groups. Recognition scores for premalignant and benign lesions were lower. Frequency of skin cancer assessment and teaching were higher for DN (p < 0.05). Total knowledge scores were not predictive of teaching practices. Time limitations and inadequate knowledge were barriers that inversely correlated with frequency of skin cancer assessment. Findings suggest that individual CMM knowledge and experience correlated highly with frequency of assessment and teaching. Programs are needed to educate nurses in skin cancer prevention and detection. The broader implications for future research will be presented.

Actinic keratosis and premalignant skin damage.

Because of the prevalence of actinic keratosis and its significance if untreated, dermatology nurses must understand the clinical characteristics, etiologies, and risks of malignant transformation of these lesions.