New opportunities for nurses as patient advocates.

OBJECTIVES: To define the role of nurses as patient advocates and to explore new strategies for the future. DATA SOURCES: Review articles, research studies, education and communications materials, and personal experience with oncology professionals, patients, and family members. CONCLUSIONS: Cancer nurses' roles in patient advocacy have progressed and grown as the profession of oncology nursing has itself matured. As resources continue to diminish, nurses need to consider the power of their roles as change agents, coordinators, and directors as well as interventionists. IMPLICATIONS FOR NURSING PRACTICE: There are many needs for research in this area as well as new roles for nurses who care for patients. Nurses need to be aware of ongoing research in areas such as health communications and consider partnering with persons in these other disciplines to enhance productivity and to use their time most efficiently.

The cancer information service research consortium: an emerging laboratory for cancer control research.

The Cancer Information Service (CIS) was established in 1975 by the National Cancer Institute (NCI) to provide accurate, up-to-date information about cancer to the nation. Although the CIS has in the past served as a venue for cancer communications research, up until very recently the research capacity of the CIS was underutilized. In 1993, this situation changed dramatically with funding from the NCI to form the Cancer Information Service Research Consortium (CISRC). In this article the CISRC is described for the first time, including its research agenda and administrative structure. Early indications from the CISRC suggest that the CIS can serve as one of the premiere laboratories in the country for cancer communications and cancer control research. Several factors are suggested for the early success of the CISRC in sustaining this collaborative effort with the CIS. The progress that has been made by the CISRC could provide a useful model for other large health information programs to maximize their contributions to behavioral science and health promotion research, as well as to establish their own program of policy-relevant research.

The first 15 years: what has been learned about the Cancer Information Service and the implications for the future.

The Cancer Information Service (CIS) has been in existence for over 15 years. During that period, lessons have been learned that have been used to increase the effectiveness of the network. This paper lists 12 of those lessons, covering issues such as giving sophisticated medical information; reaching diverse target audiences; using the mass media; developing systems needed for quality assurance, research, and information technology; and nurturing a local-national partnership. The paper also discusses major accomplishments of the program and lists recommendations for meeting the challenges to be faced by the CIS in the future.

Outreach programs and their effects within the Cancer Information Service network.

Outreach programs have been part of the Cancer Information Service (CIS) program since its outset. The scope of work of the first two CIS contracts gave broad responsibilities to the local offices for public and professional education, responsibilities that were carried out in a diverse fashion with little national direction. As the National Cancer Institute (NCI) Office of Cancer Communications matured and became more directed, the CIS local offices began successfully to implement programs with the Office of Cancer Communications and through intermediary groups. The Partners in Prevention (PIP) effort, launched by NCI in 1984, was the first major national community education program in which all the CIS offices participated. Shortly after the inception of PIP, however, the outreach personnel were deleted from the CIS contracts, due to budget restrictions. When the outreach component was reinstituted in 1990, the structure of the program changed to a catalytic role, working with local media and intermediary organizations to bring the NCI program messages and materials to targeted audiences and memberships. Under the reconfigured CIS network, the outreach program will serve as a resource to both those community institutions that are funded by NCI and those that are not and will be proactive in intermediary development. This paper details the chronology of the program and presents some of the research issues that need to be addressed in the future.

History of the Cancer Information Service.

The Cancer Information Service (CIS) was established on July 1, 1975, following the mandate of the National Cancer Act of 1971 giving the National Cancer Institute (NCI) new responsibilities for educating the public, patients, and health professionals. Funded under a contract mechanism, the CIS has become one of the longest-running community programs in NCI. The CIS has been able to set up and maintain high-quality service, giving accurate, up-to-date medical information to cancer patients and their families and friends, to health professionals, and to the general public. The CIS network, which has taken more than 5 million calls since its inception, has weathered many changes, both at the national and the local level. Its current call volume, in excess of 500,000 calls per year, makes it one of the most heavily utilized health-related telephone helplines in the country. Using a standardized Call Record Form, data on calls have been recorded consistently since 1983; the dataset now contains information on more than 4.2 million calls. An outreach component that acts as NCI's field arm has been part of the CIS since its inception. The CIS has matured into a stable system that has been reconfigured into 19 regional offices, covering the entire country. These offices run the telephone service and serve as NCI's outreach arm, working with intermediaries to carry out NCI information and education programs in local communities.

Women and cancer.

Cancer will be diagnosed in more than a half a million women this year. Prognosis and curability are associated with the stage of the cancer at diagnosis. If cancer is detected at an early stage, more than 75% of women can expect long-term survival or cure for the most common cancers, excluding lung. Promoting health behaviors that reduce risk and recommending screening tests are critical activities for the practitioner that may affect survival rates and quality of life of women with cancer diagnoses. Risk factors, incidence, presenting symptoms, staging, treatment and 5-year survival rates associated with 12 major cancer sites in women are presented. Diagnosis and survival for minority populations are reviewed, highlighting the need to improve cancer screening and detection for this group of women.

Women's perceptions of early detection in breast cancer: how are we doing?

Breast cancer is a significant risk to many women in the United States. It is also a major cause of death among American women. The National Cancer Institute's Year 2000 breast screening goal is to increase the percentage of women aged 50 to 70 years who have physical examination and mammography to 80%. However, many barriers to screening remain. Providing correct information and education regarding risk and mammography may help to overcome these barriers and achieve this goal.

Future trends in patient education.

The many changes expected in the future will create challenges and opportunities in the field of patient education. The aging population, increased numbers of cancer survivors, minorities and disadvantaged patients, more illiteracy, and the changing health care system are a few of these trends. They will require broad changes in patient education and the way information is provided.

Comparison of nurses' smoking habits: the 1975 DHEW survey and Connecticut nurses, 1981.

In a 1975 study conducted by the Centers for Disease Control, Department of Health, Education, and Welfare, 38.9 percent of the nurses surveyed were smokers--a substantially higher percentage than among women in the general U.S. population and higher than among other groups of health professionals. In a 1981 study of a 3-percent random sample of Connecticut nurses, only 25.5 percent of the nurses reported that they smoked. There are limitations to comparisons of the two studies. The 1975 sample was a national population, and the Connecticut study was limited to nurses in one State and may not reflect the habits and attitudes of this occupational group throughout the country. In the more recent study, however, there appear to be several differences in nurses' smoking habits. A trend toward a decrease in smoking seems to be emerging among nurses. The percentage of smokers among the Connecticut nurses resembles the prevalence in two other recent surveys: 25.8 percent in the American Cancer Society, Rhode Island Division study, and 23.6 percent in the University of Michigan Hospital survey. In the U.S. female population, 29.4 percent of the women are smokers. The percentage of former smokers in both the U.S. and this Connecticut population seems to be rising, and there appears to be a trend toward increasingly larger percentages of former smokers in each successive age group. Smoking more (25 or more cigarettes per day) was reported by 28 percent of the Connecticut nurses compared with 16 percent in the earlier study. Compared with the 1975 sample, significantly fewer Connecticut nurses who smoked agreed that a nurse should set a good example by not smoking and that most cigarette smokers can stop if they want to.