Rural living as context: a study of disparities in long-term cancer survivors.

PURPOSE/OBJECTIVES: To explore the impact of rurality on health-related quality-of-life (HRQOL) disparities in rural long-term cancer survivors. DESIGN: Cross-sectional survey. SETTING: Rural-Urban Continuum Codes (RUCC) 7, 8, and 9. SAMPLE: 91 adults at least five years post-treatment. METHODS: Mailed surveys measured HRQOL, self-esteem, and social support. Regression models were estimated to isolate (from self-esteem and social support) the effect of level of rurality on HRQOL. MAIN RESEARCH VARIABLES: HRQOL, self-esteem, social support, and rurality. FINDINGS: No differences in demographic characteristics existed among RUCCs. Survivors residing in RUCCs 7 or 8 tended to be similar in several dimensions of HRQOL. Survivors living in RUCC 7 reported significantly lower social function and greater financial difficulty and number of symptoms compared to survivors in RUCC 9 (the most remote). Self-esteem and social support strongly correlated with HRQOL. CONCLUSIONS: The significant impact of rurality on HRQOL beyond self-esteem and social support suggests its role in explaining cancer survivorship disparities and directing practice. Until additional exploration can identify mechanisms behind rurality's impact, consideration of level of rurality as a potential factor in evaluating survivors' HRQOL outcomes is reasonable. IMPLICATIONS FOR NURSING: Survivor context (e.g., level of rurality) influences HRQOL outcomes. Context or culture-relevant risk minimization and HRQOL optimization nursing practices are indicated.

Addicted to constructs: science in reverse?

Advancement in science requires clarity of constructs.Like other fields in behavioral science, addiction research is being held back by researchers' use of different terms to mean similar things (synonymy) and the same term to mean different things (polysemy). Journals can help researchers to stay focused on novel and significant research questions by challenging new terms introduced without adequate justification and requiring authors to be parsimonious in their use of terms. To support construct lucidity, new modes of thinking about research integration are needed to keep up with the aggregate of relevant research.

A novel quantitative approach to concept analysis: the internomological network.

BACKGROUND: When a construct such as patients' "transition to self-management" of chronic illness is studied by researchers across multiple disciplines, the meaning of key terms can become confused. This results from inherent problems in language where a term can have multiple meanings (polysemy) and different words can mean the same thing (synonymy). OBJECTIVES: The aim of this study was to test a novel quantitative method for clarifying the meaning of constructs by examining the similarity of published contexts in which they are used. METHODS: Published terms related to the concept transition to self-management of chronic illness were analyzed using the internomological network (INN), a type of latent semantic analysis performed to calculate the mathematical relationships between constructs based on the contexts in which researchers use each term. This novel approach was tested by comparing results with those from concept analysis, a best-practice qualitative approach to clarifying meanings of terms. By comparing results of the 2 methods, the best synonyms of transition to self-management, as well as key antecedent, attribute, and consequence terms, were identified. RESULTS: Results from INN analysis were consistent with those from concept analysis. The potential synonyms self-management, transition, and adaptation had the greatest utility. Adaptation was the clearest overall synonym but had lower cross-disciplinary use. The terms coping and readiness had more circumscribed meanings. The INN analysis confirmed key features of transition to self-management and suggested related concepts not found by the previous review. DISCUSSION: The INN analysis is a promising novel methodology that allows researchers to quantify the semantic relationships between constructs. The method works across disciplinary boundaries and may help to integrate the diverse literature on self-management of chronic illness.

Building collaborative scholarship in an academic nursing community.

In this article, authors report one College of Nursing's efforts to address the challenges of multiple academic role expectations by establishing faculty interest groups to promote collaborative scholarship. The background of the project is described in terms of past and recent academic, financial, and environmental influences. Collaborative scholarship is defined. Literature related to faculty productivity, variations in collaborative scholarship within and across disciplines, and incentives to motivate and reward faculty productivity are discussed. An evaluation of one faculty interest group's process is reported. Amey and Brown's Interdisciplinary Collaboration Model dimensions were used to analyze achievements and challenges. Organizational restructuring and disbandment of these groups provided a second opportunity to reflect on lessons learned. One perspective about the process and educational and professional implications of collaborative scholarship that would be of interest to faculty is provided. Lessons learned may inform other faculty facing the same task.

Describing health-related outcomes for couples experiencing prostate cancer: differences and similarities.

PURPOSE/OBJECTIVES: To describe health-related outcomes for couples dealing with prostate cancer before the patient started treatment and 6, 12, and 18 months after treatment. DESIGN: Survey with longitudinal, comparative, and predictive elements. SETTING: Tertiary care nonprofit medical center in the southwestern United States. SAMPLE: A convenience sample of 216 patients treated for prostate cancer and their partners was enrolled. The mean age of patients was 68 years; 64 years for their partners. The average length of marriage was about 35 years. About 75% of patients and more than 50% of partners had at least some college education. METHODS: Study participants completed questionnaires before treatment and 6, 12, and 18 months after treatment. MAIN RESEARCH VARIABLES: Health-related quality of life, health status, and marital satisfaction. FINDINGS: Patients' scores were associated with partners' scores more than 50% of the time throughout the study. Relationship satisfaction was the most strongly related variable between patient and partner. Cross-lag analyses suggest that couples' scores demonstrate a reciprocal pattern of influence between the dyads throughout the study. CONCLUSIONS: Patients' scores were associated with partners' scores on most outcome variables. Both are affected by prostate cancer and the treatment experience. IMPLICATIONS FOR NURSING: Nurses should actively include partners in all information and education sessions connected with prostate cancer treatment and follow-up. In addition, the unique experiences of partners of patients with prostate cancer should be identified and addressed.

Couples surviving prostate cancer: Long-term intimacy needs and concerns following treatment.

Couples surviving prostate cancer face long-term challenges in their relationships as they adapt to chronic illness. Ten couples surviving prostate cancer were brought together in a focus group to discuss their experiences and concerns regarding intimacy in their relationships. During three 30-minute segments, couples described their experiences (a) as couples, (b) as individual men and women in two concurrent break-out groups, and (c) regarding current intimacy and relationship needs. Questions asked of couples focused on (a) the process of being diagnosed and treated for prostate cancer, (b) what the experience was like for them as a couple, (c) what was helpful, harmful, and surprising throughout the experience, (d) what they currently needed most as a couple, and (e) what advice they had for other couples. Findings suggested that men and women think and respond differently to intimacy and relationship challenges that occur as a result of prostate cancer, diagnosis, and treatment. Consequently, healthcare providers in any clinical setting who may interact with prostate cancer survivors must consider the relationship and intimacy needs that are unique to men, women, and couples.

Prostate cancer survivors' and partners' self-reports of health-related quality of life, treatment symptoms, and marital satisfaction 2.5-5.5 years after treatment.

PURPOSE/OBJECTIVES: To describe health-related quality of life (QOL), health status, and marital satisfaction of couples as many as 5.5 years after treatment for prostate cancer. DESIGN: Survey with longitudinal, comparative, and predictive elements. SETTING: A tertiary care nonprofit medical center in the southwestern United States. SAMPLE: Convenience sample of prostate cancer survivors (192 enrolled, 137 completed) and their partners (126 enrolled, 104 completed). Men averaged 70 years of age, women 66. Most men (86%) and women (89%) were white, and 71% had at least some college education. METHODS: Questionnaires were mailed annually. Women were enrolled 3.5 years after their partners were treated. Study participants received separate questionnaire packets. MAIN RESEARCH VARIABLES: Health-related QOL, health status including post-treatment symptoms, and marital satisfaction. FINDINGS: Men's health-related QOL, general physical health, and vitality decreased; urinary and sexual post-treatment symptoms increased. Men were concerned about their sexual functioning although few sought treatment. Couples' health-related QOL and marital satisfaction were associated more closely than their health status. CONCLUSIONS: Regardless of type of treatment, health-related QOL and general health tend to decrease for prostate cancer survivors; men in watchful waiting tended to have poorer health outcomes. Men are concerned about sexual functioning, yet few are taking steps to remedy problems. Couples' health-related QOL and marital satisfaction are linked; however, health status indicators are less associated. IMPLICATIONS FOR NURSING: Nurses are in a key position to assess health-related QOL and sexual functioning concerns for prostate cancer survivors and their partners.