Designing and facilitating class discussion in an Internet class.

Designing a replacement for face-to-face classroom discussion is a major consideration in the development of an Internet course, whether the course is completely new or a redesign of an existing course. The experiences of four faculty members who were involved in developing courses for a baccalaureate completion program for RNs taught entirely on the Internet will be used to illustrate key issues in designing andfacilitating on-line discussion.

Pregnancy and breast cancer.

Pregnancy-associated breast cancer (PABC) and pregnancy subsequent to breast cancer are two areas of concern facing women of childbearing age. The current approach to the management of PABC is to treat the cancer with some modification because of the pregnancy. The clinical management of both PABC and pregnancy occurring after breast cancer in young survivors, with emphasis on issues in clinical decision making, clinical management, and client education and support, are addressed.

Quality of life, survivorship, and psychosocial adjustment of young women with breast cancer after breast-conserving surgery and radiation therapy.

PURPOSE/OBJECTIVES: To examine changes in quality of life (QOL), psychosocial adjustment, and survivorship issues over time of women younger than 45 years who underwent breast-conserving surgery and radiation therapy (RT) for breast cancer. DESIGN: Repeated measures, longitudinal design. METHODS: Data were collected at four time points: start of RT, midpoint of RT, end of RT, and six months after RT. Three instruments were used to collect data: Quality-of-Life Index, Psychosocial Adjustment to Illness Scale, and the newly developed Adaptation to Survivorship Experience. Subjects also participated in an indepth interview at the start of RT. SETTING: A large radiation oncology department located in an urban teaching hospital in the Northeast United States. SAMPLE: 23 women with newly diagnosed stage I or II breast cancer who were starting RT following breast-conserving surgery, with a mean age of 37.8 years (range = 25-45 years). MAIN RESEARCH VARIABLES: QOL, psychosocial adjustment, and adaptation to survivorship experience. FINDINGS: Although subjects adjusted their lives to accommodate RT, QOL declined from the start of RT to midpoint, with gradual improvement reported six months later. Social and sexual adjustment declined from start of RT to six months later. Negative perceptions of the survivorship experience and worry about cancer increased from the start of RT to six months later. CONCLUSIONS: Young women with breast cancer experience changes in QOL, psychosocial adjustment, and adaptation to survivorship issues during RT. Changes may not reflect what is observed in clinical practice. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be aware of changes in QOL, psychosocial adjustment, and survivorship to better understand and support young women during RT.

The meaning of quality of life in cancer survivorship.

PURPOSE/OBJECTIVES: To describe the meaning of quality of life (QOL) in long-term cancer survivors, to validate inductively derived QOL themes, and to identify and cluster over-arching themes across long-term cancer survivors. DESIGN: Qualitative study that was part of a larger, cross-sectional survey. SETTING/SAMPLE: 687 (57% response) cancer survivors at an average of 6.7 years after diagnosis. In the sample, 81% were female (with a mean age of 49.6 years), 72% were college educated, 63% were married, and 49% worked full time. METHODS: Mailed survey of three open-ended questions and standard QOL tools. A QOL conceptual model was used to frame the research study, describe the QOL responses of the participants, and explore the meaning of cancer survivorship. Content analysis was used to answer the research questions. Data collection and analysis occurred sequentially. MAIN RESEARCH CONCEPTS: Meaning, QOL cancer survivorship. FINDINGS: 25 of 30 inductively derived QOL themes were validated in this study of long-term cancer survivors; 107 additional QOL themes were identified and clustered into 11 over-arching themes across the entire data set. Over-arching themes included struggle between independence-dependence, balance, wholeness, life purpose, reclaiming life, multiple losses, having control, altered meaning of health, and surviving cancer from a family perspective. IMPLICATIONS FOR NURSING PRACTICE: The meaning of QOL in long-term cancer survivors is multifaceted and complex. CONCLUSIONS: Nurses can use this broader conception of QOL in breast cancer survivors to help patients prepare for and cope with adjustments.

Balancing demands of cancer surveillance among survivors of thyroid cancer.

PURPOSE: The purpose of this qualitative study was to explore and describe the demands of long-term cancer surveillance among survivors of thyroid cancer and how these perceived demands influence their quality of life. DESCRIPTION OF STUDY: The sample consisted of 34 participants who had undergone thyroid hormone withdrawal before body scanning for evaluation of cancer recurrence and/or metastatic disease. Participants completed two self-report instruments: 1) a Demographic Data Tool, and 2) three open-ended questions about quality of life during thyroid hormone withdrawal. The participants wrote down their answers to the demographics and open-ended questions. RESULTS: The 34 participants had a mean age of 40 years (range, 22-73 years); 85% were women and 74% were white. All were high school educated, and 32% were college graduates. Sixty-eight percent were married, and 75% were employed either full- or part-time. Participants experienced profound changes in relationship to withdrawal from thyroid hormone medication. These changes in physical well-being coupled with the potential for disease recurrence influenced their psychological and social well-being. Balancing the demands of cancer surveillance (through body scanning and thyroid hormone withdrawal) against day-to-day living had a major influence on perceptions of quality of life. CLINICAL IMPLICATIONS: Study results support other studies and clinical reports that physical symptoms related to thyroid hormone withdrawal were profound, severe, and debilitating. First, participants with thyroid cancer had to learn through their own personal experiences what physical limitations were imposed during the period of surveillance testing. Second, the physical changes and anticipation of body scanning exerted a profound effect on psychological and social well-being. Feelings of loss, anxiety, depression, and loss of concentration were very difficult to endure. Third, given the general characteristics of this population of thyroid cancer survivors who generally are younger and working, the experience of hypothyroidism can have a major impact on work schedules. Individuals who require a large amount of concentrated attention to work tasks may need to modify their work schedules during hypothyroid states. Findings suggest that individuals who are considered "cured" of their disease are a largely forgotten segment of cancer survivors. However, participants in this study continued to inform us of the process of cancer survivorship and the need for exploring quality-of-life concerns, regardless of prognosis.

Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy.

Quality of life (QOL) is an important consideration as patients survive longer with cancer and is an area of increasing interest in patients with thyroid cancer who undergo long-term cancer surveillance. However, there are few disease-specific QOL tools available to evaluate QOL in patients with thyroid cancer. The purposes of this longitudinal, repeated-measures study were to: (1) test a new instrument, the QOL-Thyroid Scale, during thyroid hormone withdrawal; and (2) to evaluate the impact of thyroid hormone withdrawal on patients' perceived changes in quality of life. The sample included 34 subjects (mean age 40 years) undergoing thyroid hormone withdrawal in preparation for scanning procedures. Subjects completed three instruments (demographic data tool, the QOL-Thyroid, and the FACT-G) at four specific time points in relationship to scanning. The results demonstrated that the QOL-Thyroid tool is a reliable and valid measure of QOL. Cronbach's alpha coefficient of r = .78 between QOL-Thyroid and FACT-G indicated good concurrent validity. Second, the impact of thyroid hormone withdrawal on QOL showed significant changes in physical, psychological, and social well-being across the four testing points. The greatest changes occurred between peak hormone withdrawal and thyroxine (T4) therapy. While it is generally known that patients suffer troublesome physical symptoms relating to thyroid hormone withdrawal, the negative psychological, family, and work sequelae are less apparent. In conclusion, the QOL-Thyroid is a reliable and valid measure for use in evaluating patients undergoing scanning procedures and may be used to identify and target teaching and support for high-risk areas in patients lives that are negatively affected by hormone withdrawal.

Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer.

PURPOSES/OBJECTIVES: To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidenced by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate. DESIGN: Experimental, two-group pretest, post-test. SETTING: Two university teaching hospital outpatient radiation therapy departments. SAMPLE: 46 women beginning a six-week program of radiation therapy for early stage breast cancer. METHODS: Following random assignment, subjects in the exercise group maintained an individualized, self-paced, home-based walking exercise program throughout treatment. The control group received usual care. Dependent variables were measured prior to and at the end of radiation therapy. In addition, symptoms were assessed at the end of three weeks of treatment. MAIN RESEARCH VARIABLES: Participation in the walking exercise program, physical functioning fatigue, emotional distress, and difficulty sleeping. FINDINGS: Hypothesis testing by multivariate analysis of covariance, with pretest scores as covariates, indicated significant differences between groups on outcome measures (p < 0.001). The exercise group scored significantly higher than the usual care group on physical functioning (p = 0.003) and symptom intensity, particularly fatigue, anxiety, and difficulty sleeping. Fatigue was the most frequent and intense subjective symptom reported. CONCLUSIONS: A self-paced, home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy. IMPLICATIONS FOR NURSING PRACTICE: Nurse-prescribed and -monitored exercise is an effective, convenient, and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment.

Quality of life in women with ovarian cancer.

Despite growing interest in quality of life (QOL) as an important variable in nursing and health care, little research focuses on QOL in women with ovarian cancer (OVCA). The purpose of this study was to examine QOL in OVCA survivors. The convenience sample consisted of 152 women in all disease stages. Quantitative data were collected using the QOL-Cancer Survivors tool and a demographic sheet. Qualitative data were collected by asking participants to write their definitions and experiences of QOL since their diagnosis. Reliability and validity of all data and findings were established. Findings reveal that QOL is moderately high for this group of cancer survivors, despite some specific negative facets of the illness and treatment experience. Qualitative analysis elaborates the four domains of Ferrell's QOL model: physical, psychological, social, and spiritual well-being. Qualitative data also reflect the complexity of the cancer experience.