Provision of supportive spiritual care for hepatopancreatic cancer patients: an unmet need?

BACKGROUND: Among patients with a serious cancer diagnosis, like hepatopancreatic (HP) cancer, spiritual distress needs to be addressed, as these psychosocial-spiritual symptoms are often more burdensome than some physical symptoms. The objective of the current study was to characterize supportive spiritual care utilization among patients with HP cancers. METHODS: Patients with HP cancer were identified from the electronic medical record at a large comprehensive cancer center; data on patients with breast/prostate cancer (non-HP) were collected for comparison. Associations between patient characteristics and receipt of supportive spiritual care were evaluated within the overall sample and end-of-life subsample. RESULTS: Among 8,961 individuals (nHP=1,419, nnon-HP =7,542), 51.7% of HP patients utilized supportive spiritual care versus 19.8% of non-HP patients (p<0.001). Younger age and religious identity were associated with receiving spiritual care (p<0.001). HP patients had higher odds of receiving spiritual care versus non-HP patients (OR 2.41, 95%CI: 2.10, 2.78). Within the end-of-life subsample, HP patients more frequently received spiritual care to "accept their illness" (39.5% vs. 22.5%, p<0.001), while non-HP patients needed support to "define their purpose in life" (13.1% vs. 4.5%, p=0.001). DISCUSSION: Supportive spiritual care was important to a large subset of HP patients and should be integrated into their care.

Characterizing Pastoral Care Utilization by Cancer Patients.

PURPOSE: To assess the rate of and characterize the utilization of pastoral care (PC) among patients on their cancer treatment trajectory. METHODS: Patients included in the present study were diagnosed with cancer 01/2015-08/2019 at The Ohio State Wexner Medical Center-The James. To determine which patient demographic and clinical factors were independently associated with PC utilization, a multivariable logistic regression was performed. RESULTS: A total of 14,322 patients were included in the study and 5,166 (36.1%) had at least one visit with PC. Cancers such as brain (n = 232, 4.5% vs. n = 159, 1.7%), liver/pancreas (n = 733, 14.2% vs. 686, 7.5%), and lung (n = 1,288 vs. 24.9% vs. n = 1,113, 12.2%) were more commonly noted among patients who utilized PC services (all p < 0.001). Furthermore, compared with patients diagnosed with Stage 1 cancer, patients with more advanced disease stages had higher odds of utilizing PC services (Stage III: OR 2.37, 95% CI 2.07-2.70; Stage IV OR 2.31, 95% CI: 2.04-2.61; both p < 0.05). Interestingly, patients who had a DNR order had a markedly higher odds (OR 4.18, 95%CI 3.76-4.65, p < 0.001) of utilizing PC services. DISCUSSION: One in three patients with cancer utilized PC services. Patients with more severe prognoses and individuals with a DNR order were more likely to utilize PC. The data suggest that PC services are an important resource for many patients and should be integrated into the treatment approach for cancer.

Supplementing teacher knowledge using web-based Intelligent Tutoring System for the Text Structure Strategy to improve content area reading comprehension with fourth- and fifth-grade struggling readers.

The effects of teaching the text structure strategy using a web-based Intelligent Tutoring System for the Text Structure Strategy (ITSS) were examined with fourth- and fifth-grade children scoring below the 25th percentile on comprehension measures using the Gray Silent Reading Test (GSRT) and researcher designed assessment from 130 fourth-grade and 130 fifth-grade classrooms. The ITSS was designed to teach students how to select and encode strategic memory from expository texts. The system provides modelling, practice, assessment, scaffolding, and feedback to learners on identifying signalling words, summarizing, making inferences, generating elaborations, and monitoring comprehension. A large scale randomized controlled trial was conducted with 130 fourth-grade and 130 fifth-grade classrooms. Students completed GSRT- and researcher-designed measures of reading comprehension at pretest and posttests. An analysis of fourth-grade students using ITSS who scores less than the 25th percentile on the GSRT pretest showed small but meaningful effect sized on the posttests. The fifth-grade students in ITSS, who scored less than the 25% percentile on the GSRT pretest, showed the highest effect sizes (moderate to large effects) on the standardized test scores on the posttests.

Preparing nurses to intervene in the tobacco epidemic: Developing a model for faculty development and curriculum redesign.

As the largest group of health professionals, nurses have a tremendous potential to help curb the tobacco epidemic. However, studies conducted across a range of global settings continue to indicate that both practicing nurses and nursing student have limited knowledge, skills and confidence needed to implement evidence-based tobacco cessation interventions. A contributing factor is the limited inclusion of tobacco control content in nursing curricula. Additionally, there is limited understanding of nurse educators' knowledge and perceptions about teaching tobacco dependence content. This paper presents the Loma Linda University School of Nursing's concurrent experience with both faculty development and curriculum redesign in the area of tobacco dependence prevention and treatment. An internal survey was administered at baseline and at 2-year follow-up to assess faculty's knowledge, perceptions and practices related to teaching tobacco dependence content and skills (n = 42). Faculty and curriculum development strategies and resources utilized, evaluation findings and subsequent lessons learned are described. The findings have implications for nursing programs seeking to enhance their curricula and commitment to ensuring that their graduates are prepared to provide evidence-based tobacco cessation interventions with each patient they encounter.

Factors associated with participation in a prevention trial aimed at reducing biomarkers of breast cancer risk.

OBJECTIVES: Poor enrollment into prevention trials is a major obstacle to the conduct of clinical investigations. This study focuses on cognitive and affective influences on the decision to participate in a clinical trial aimed at reducing biomarkers of breast cancer risk. METHODS: Following a decision to participate or not in a clinical trial focused on reduction of breast cancer risk, women were recruited into the present study. Data were gathered via telephone survey. RESULTS: One hundred healthy women took part in the current study, 72 of whom had participated in the clinical trial, and 28 of whom had declined participation. Women who decided to enroll perceived more benefits and fewer costs, and they experienced more positive emotions and fewer negative emotions. They also made the decision more quickly, more easily, were more satisfied with it, and had fewer regrets than women who declined participation in the clinical trial. CONCLUSIONS: Participants to this clinical trial differed from nonparticipants in terms of antecedents, process, and outcomes of the decision to enroll. PRACTICE IMPLICATIONS: Although obstacles exist, accrual might be improved by greater emphasis on the practical and psychosocial benefits to participants.

A qualitative study of breast cancer treatment decisions: evidence for five decision-making styles.

Being diagnosed with breast cancer requires that women make a number of decisions about their medical treatments. To gain insight into the variety of forces that shape a woman's breast cancer treatment decisions, we conducted semistructured interviews with 44 breast cancer survivors. Through an interpretive analysis, we identified five treatment decision-making styles: (a) medical expert, (b) self-efficacy, (c) relationship embedded, (d) inhibition, and (e) constellation of information, which are differentiated by two dimensions: (a) low versus high information needs and (b) self versus other preferences.

A holistic approach to severe depression: my story.

Given the prevalence of major depressive disorder (MDD) and its significant economic and personal costs to society, families, and those with MDD, and given the frequent failure of contemporary therapeutics to treat MDD, it is imperative that nurses explore holistic approaches to managing MDD. My story provides a case study for how several approaches can be blended to holistically manage MDD. The approach that is effective for me requires faithfully attending to diet, exercise, sunlight, sleep, and spirituality, as well as continuing to receive psychological and social support.

Why older adults make more immediate treatment decisions about cancer than younger adults.

Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making.

Text processing variables predict the readability of everyday documents read by older adults.

A model is presented to predict the readability of documents encountered by older adults. The documents studied are contained in the Educational Testing Service's Test of Basic Skills (1977 edition) and require readers to answer questions about charts (e.g., bus schedules), labels (e.g., plant spray labels and prescriptions), and forms (e.g., tax forms). The components of the model came from theoretical and empirical work on discourse processing and include such factors as discourse structure, emphasis, and position of an answer in a linguistic analysis of the everyday document.A sample of 482 adults from 52 to 93 years of age took the everyday problems test as well as a psychometric ability battery. The correlation was .54 (p < .01) between the readability scores for test items predicted by the model and the percentage of older adults correctly answering those items. In addition, the more difficult test items as identified by the model were correlated more highly with fluid intelligence abilities (figural relations and induction), crystallized intelligence abilities (vocabulary, experiential evaluation), and with memory span.