The dyadic effects of coping and resilience on psychological distress for cancer survivor couples

PURPOSE

This study aimed to examine the actor and partner effects of coping and resilience characteristics on psychological distress in cancer survivors and their spouses and to examine the mediating role of resilience characteristics in the relationship between coping and psychological distress.

METHODS

A total of 91 breast, colorectal, and prostate cancer survivor-spouse dyads were recruited from the University Hospital Registry in Cleveland, Ohio. Standardized questionnaires that assessed psychological distress, reframing and acquiring social support coping, and resilience characteristics were used.

RESULTS

The actor-partner interdependence mediation model demonstrated that the resilience of the survivors and spouses was a strong predictor of their personal psychological distress. Survivors' and spouses' own resilience mediated the association between their reframing coping and psychological distress. However, only the survivor model confirmed the mediating effect of resilience characteristics in the relationship between social support coping and psychological distress. In addition, spouse psychological distress was influenced by survivor resilience, indicating a spouse-partner effect in the relationship between resilience characteristics and psychological distress.

CONCLUSIONS

Our findings provide insight into the relationships between coping, resilience characteristics, and psychological distress at the individual and dyadic levels. Enhancing cancer survivors' and their spouses' positive thoughts and available external resources can improve resilience and, in turn, reduce their psychological distress of couples coping with cancer.

Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand

AIMS

To identify factors associated with patients receiving foot examinations by primary health care nurses.

METHODS

A cross-sectional survey of 287 randomly sampled primary health care nurses, from a total of 1091 in Auckland, completed a postal self-administered questionnaire and telephone interview. Biographical and diabetes management details were collected for 265 diabetes patients consulted by the nurses on a randomly selected day.

RESULTS

A response rate of 86% was achieved. Nurses examined patient's feet in 46% of consultations. Controlling for demographic variables, foot examinations were associated with age, odds ratio (1.25, 95% CI 0.57-2.74) for patients aged 51-65 years and >66 years (2.50, 1.08-5.75) compared with those ≤50 years, consultations by district compared with practice nurses (14.23, 95% CI 3.82-53.05), special programme consultations compared with usual follow-up consults (8.81, 95% CI 2.99-25.93) and length of consultation (1.89, 0.72-4.97) for 15-30 min and (4.45, 95% CI 1.48-13.41) >30 min compared with consultations ≤15 min, or for wound care (2.58, 1.01-6.61).

CONCLUSIONS

Diabetes foot examinations by primary health care nurses varies greatly, and are associated with characteristics of the patient (age, need for wound care) and the consultation (district nurses, diabetes programme and duration).

A survey of prognosis discussions held by health-care providers who request palliative care consultation

BACKGROUND

Patient misunderstandings about prognosis may be related to lack of communication.

AIM

This study aimed to examine prognosis discussions held with hospitalized patients for whom palliative care consultations were requested, and if prognosis discussions did not occur, to explore why not.

DESIGN

This was a survey conducted over the telephone from a convenience sample of health-care providers who requested palliative care consultations. Respondents were asked about whether prognosis had been discussed with the patient and the topics addressed.

PARTICIPANTS

A total of 65 health-care providers who called to request a consultation from the palliative care team in a large academic medical center in the United States.

RESULTS

Of the 65 responses, 45 (69.2%) subjects reported that a prognosis discussion had occurred, while 15 (23.1%) reported that a prognosis discussion had not taken place. Among the surveys reporting a prognosis discussion, a majority of providers responded that most aspects of prognosis were discussed, with the exceptions of life expectancy, survival rates/statistics, and psychosocial concerns. When the prognosis discussion had not occurred, the most common reasons for omitting the prognosis discussion included difficulty in determining prognosis, the perception that the patient already knew his or her prognosis, and the belief that the prognosis discussion was better suited for a different specialty.

CONCLUSIONS

The results of this study highlight the uncertainty that primary team providers in the academic hospital environment have with prognostication, which is a complex process for which this set of providers, composed primarily of medical trainees and nurses, may not have had sufficient training.

Abstract P6-08-14: Meeting needs and expectations of breast cancer survivors: Learning from patients through a survey method

Introduction: Oncology patients have many needs throughout the care continuum. Identification of the most salient needs is critical in program planning in an environment where resources are limited. Choices for programming should be based on information regarding survivors’ perceived needs and their usage of services provided by the cancer center and in the community. We developed a survey to assess needs of patients seen at our Cancer Center. The purpose of the project was to establish the feasibility of the method in the population, identify needs, use these as a basis to develop programs to meet the needs, and establish a baseline for future needs assessments.

Methods: Previous U.S. cancer patient needs surveys were used as a background to create survey questions for cancer survivors using a quality of life framework. The scope of the survey was expanded based on feedback from Cancer Center leaders and Patent and Family Advisory Committee members. IRB approval was obtained and surveys were mailed to patients seen within 2 years at our sites. After eliciting demographic data, questions sought information about the performance of the cancer team and patient preferences for learning styles and what resources were used. Patients were asked by whom they preferred follow-up care to be given. Specific questions on the physical, emotional, social and spiritual effects of cancer were sought. Breast cancer respondents were compared to respondents with other types of cancer.

Results: 1005 of 2750 (37%) mailed surveys were returned; 518 (51.5%) were from breast cancer survivors. Of the breast cancer survivors, mean age was 64 (range 30-94); 82% were Caucasian, 15% African-American; 62% were married; 50% were retired; 24% remained on treatment, 14% <2 years, 29% 2-5 years, 33% >5 years after treatment. Slightly more than half used non-hospital (57%) or hospital (54%) resources. Most commonly used non-hospital resource was internet (34%); most commonly used hospital resource was information from the health care team (36%). One year after treatment 90% preferred follow-up care from primary oncology team (vs. primary care physician or other). While there was concordance that “attention to my physical needs” was excellent for 76% and this was “important” for 94%, only 46% rated “attention to my emotional needs” as excellent with this was “important” for 84%. Fear of cancer recurrence was the greatest concern for patients and had not significantly resolved for the respondents >5 years after treatment. Breast cancer patients differed significantly from patients with other types of cancer having less fatigue (p<0.001), more issues with sexual intimacy (p = 0.001), more interest in obtaining genetic counseling (p = 0.001) and more fear of developing a new cancer (p = 0.01).

Conclusions: This method of assessment was feasible (with a project cost of $7000), was completed in two years and can be used as a baseline. As a result of this survey our Cancer Center created an educational print resource describing our supportive oncology programs, implemented an end of treatment distress screening tool piloted with breast cancer patients, and provided staff education regarding patient needs and intervention tools.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-14.

Contribution by primary health nurses and general practitioners to the Diabetes Annual Review (Get Checked) programme in Auckland, New Zealand

AIM

To describe primary health care (practice and specialist) nurses involvement in the government-funded annual diabetes review 'Get Checked' programme and the division of care between nurses and general practitioners in Auckland, New Zealand.

METHOD

Of the total 911 practice and specialist nurses identified and working in the greater Auckland region, 276 (30%) were randomly selected and invited to undertake a self-administered questionnaire and telephone interview in 2006-8.

RESULTS

An 86% response rate was achieved. Over 60% of practice nurses and over half of specialist nurses participate in 'Get Checked' reviews. Of those nurses, 40% of practice and 70% specialist nurses, reported completing over half of the total number of 'Get Checked' reviews at their practice. Of the nurses sampled who work in general practice (n=198), 38% reported that 'nurses mostly complete' the reviews, 45% stated that 'nurses and doctors equally complete' them and 17% reported that only 'doctors' did so. For the nurses who reported that 'nurses and doctors equally complete' the reviews (n=89), most nurses undertake blood pressure measurements (90%), weigh patients (88%), give lifestyle advice (87%), examine patient's feet (73%), and 44% carried out the complete review of the patients they consult.

CONCLUSION

These findings show the 'Get Checked' programme was successful in engaging practice and community-based specialist nurses in the community management of diabetes and has revealed positive relationships between nurses and doctors, extended roles for nurses and the importance of engaging nurses in the design of health care programmes.

Using a psychosocial registry as a data source for nurses

Nurses at the bedside strive to base their practice on the best available information derived from evidence. However, issues related to patient care often arise for which evidence is either difficult to attain or not available. This can be particularly true for nurses who care for patients with diverse diagnoses because most studies focus on patients with a single cancer diagnosis. For example, evidence about quality of life (QOL) as perceived by the patient is a concern for clinicians but is of particular importance to nurses at the bedside. A great deal of study has been performed on the QOL of patients with cancer; however, most of these reports focus on narrow or limited samples, typically one specific cancer type. Having access to a registry that enrolls patients with diverse types of cancer and collects QOL data could be very useful to practicing bedside nurses.

Facilitating enrollment in a Cancer Registry through modified consent procedures: a pilot study

Research registries are increasingly important in medical research and are essential to the mission of cancer centers. However, designing enrollment and data collection procedures that are consistent with ethical norms and regulatory requirements yet are efficient and cost effective is a major challenge. Current standard consent forms can be a barrier to enrollment because of their length, multiple components, and technical language. We pilot tested an IRB-approved registry booklet and simplified one-page, tiered consent form, allowing for choice of extent of participation. The booklet was mailed to patients with breast cancer as part of their routine information packet prior to the first clinic appointment. A research nurse met with 27 patients at initial treatment to review the booklet, answer questions, obtain informed consent, and collect quality of life data. The consent rate was 78% with 21 patients enrolling in the study. Twelve of the 21 patients (57%) did not read the booklet prior to the visit. The 9 patients (43%) who had read the booklet prior to arrival found it easy to understand. The multi-stage, simplified consent process and data collection were acceptable to these patients and readily integrated into clinical operations. An easy-to-read registry booklet may be an effective guide for discussion, but in-person consent procedures and further testing of the approach are required.

Characteristics of nurses providing diabetes community and outpatient care in Auckland

INTRODUCTION

There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training.

AIM

To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand.

METHOD

Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008.

RESULTS

Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued.

DISCUSSION

These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access.

Characteristics of nurses providing diabetes community and outpatient care in Auckland

INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006–2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access. KEYWORDS: Community health nursing; diabetes mellitus; internet; nurses; primary health care

How have long-term survivors coped with living with HIV?

With advances in HIV treatment, more individuals have grown older with the disease. Little is known about factors that have helped these survivors manage everyday life with HIV. In this exploratory, qualitative study, we asked, "What has helped survivors cope with challenges of living long term with HIV?" Participants were recruited from a convenience sample of persons living with HIV who obtained treatment at a specialty HIV clinic; 16 long-term survivors of HIV were interviewed. Mean age was 50.13 (SD = 8.30) years; mean time from diagnosis was 16.75 (SD = 5.98) years. Results were broadly dichotomized as coping mechanisms and social supports. Three themes characterized coping mechanisms: disease coping, practical coping, and emotional coping. Social supports included themes of family, friends, professionals, peer groups, and pets. In particular, the power of patient-professional relationships and meanings derived from religion/spirituality were considered by a majority of participants to be influential factors.

Child oral health concerns amongst parents and primary care givers in a Sure Start local programme

AIM

To conduct an oral health promotion needs assessment amongst parents and primary care givers of pre-school children in a South East London Sure Start Local Programme (SSLP).

OBJECTIVE

To explore the oral health concerns and oral health literacy with regard to children's oral health amongst parents and primary care givers in a South East London SSLP.

DESIGN

A qualitative study using four in-depth focus groups with a purposive sample of 20 participants. Data were analysed using the framework method.

RESULTS

The SSLP was identified as an important source of information, support and social interaction for participants. Participants rated the informal networks of the programme as equally authoritative as other formal sources of information. Oral health concerns included: introducing healthy eating, establishing tooth brushing, teething and access to dental care. While participants had adequate knowledge of how to prevent oral disease they cited many barriers to acting on their knowledge which included: parents' tiredness, lack of confidence in parenting skills, confusing information, widespread availability of sugary foods and drinks, and lack of local child friendly dentists. Parenting skills and the social support provided by the SSLP appeared to be integral to the introduction of positive oral health behaviours.

CONCLUSIONS

SSLPs were seen as a trusted source of support and information for carers of pre-school children. Integration of oral health promotion into SSLPs has the potential to tap into early interventions which tackle the wider support needs of carers of pre-school children while also supporting the development of positive oral health behaviours.

Indicators of survival duration in ovarian cancer and implications for aggressiveness of care

BACKGROUND

Ovarian cancer patients frequently receive chemotherapy near the end of life. The purpose of the current study was to develop indicators that characterize those ovarian cancer patients who have a short life span.

METHODS

The medical charts of deceased epithelial ovarian cancer patients were retrospectively reviewed from 2000 through 2006. All patients received primary debulking surgery and adjuvant chemotherapy. Aggressiveness of cancer care within the last month of life was measured by chemotherapy regimens, emergency room visits, and hospitalizations. Significant clinical events (SCE) were defined as ascites, bowel obstruction, and pleural effusion. Survival quartiles were compared using chi-square and Student t test statistics. Multiple regression analysis was performed using survival duration as a dependent variable.

RESULTS

In all, 113 patients with epithelial ovarian cancer were reviewed. Patients had increased hospitalizations (P < .001) and SCE (P < .001) as they approached the end of life. There was no difference in the pattern of hospitalizations and SCE between the top and bottom survival quartiles. Patients with a shorter survival time had a trend toward increased chemotherapy during their last 3 months of life (P = .057) and had increased overall aggressiveness of care (P = .013). In patients with a disease remission, the length of initial remission time was found to be significant in predicting survival (P < .01). Time to second disease recurrence was also significant in predicting survival time (P < 0.01).

CONCLUSIONS

Patients who received aggressive care did not have improvement in survival. Short disease remissions and increasing hospitalizations with SCE should be indicators of the appropriateness of reducing cure-oriented therapies and increasing palliative interventions.

Donors after cardiac death: validation of identification criteria (DVIC) study for predictors of rapid death

Donation after cardiac death (DCD) is uncommon in part because clinicians cannot prospectively identify patients who are likely to die within 60 min of withdrawal of life-sustaining treatments (LST). UNOS criteria exist but have not been validated. Consecutive patients electively withdrawn from LST at five university-affiliated hospitals were prospectively enrolled. Demographic and treatment characteristics were collected. Chi-square was used to determine risk for death within 60 min and validate the UNOS criteria. A total of 533 patients were enrolled. A total of 28 were excluded from this report due to age <18 years or failure to include time of death. Of 505 (95%) patients, 227 (45%) died within 60 min, 134 (27%) in 1-6 h and 144 (29%) >6 h after withdrawal of LST. A total of 29%, 52%, 65% and 82% of patients with 0,1,2 and 3 UNOS DCD criteria, respectively, died within 60 min of withdrawal of LST. The data validate the UNOS criteria. Patients with no criteria might be excluded from consideration for DCD. Those with more than one criterion are reasonable candidates, while those with a single criterion should be considered if a 50% failure rate for DCD is acceptable.

Transgenic mice that express normal and mutated amelogenins

Amelogenin proteins are secreted by ameloblasts within the enamel organ during tooth development. To better understand the function of the 180-amino-acid amelogenin (M180), and to test the hypothesis that a single proline-to-threonine (P70T) change would lead to an enamel defect similar to amelogenesis imperfecta (AI) in humans, we generated transgenic mice with expression of M180, or M180 with the proline-to-threonine (P70T) mutation, under control of the Amelx gene regulatory regions. M180 teeth had a relatively normal phenotype; however, P70T mineral was abnormally porous, with aprismatic regions similar to those in enamel of male amelogenesis imperfecta patients with an identical mutation. When Amelx null females were mated with P70T transgenic males, offspring developed structures similar to calcifying epithelial odontogenic tumors in humans. The phenotype argues for dominant-negative activity for the P70T amelogenin, and for the robust nature of the process of amelogenesis.

Robotic assisted thoracic surgery for resection of an esophageal cyst

Many centers around the world are now developing robotic surgical programs. The benefit of robotics, particularly in those centers where there is already expertise with minimally invasive surgical techniques, is unclear. We present the case of a 58-year-old man presenting with an esophageal cyst. This was removed using a robotic assisted, VATS (video assisted thoracic surgery) approach. The technical details of the procedure are described. Additionally, a discussion of the relative merits of using a robotic rather than a standard minimally invasive approach is discussed. In a procedure such as the case described, the critical parts of the procedure are focused within a small operative field. We believe that the articulating instrumentation and the 3-dimensional magnified view provided by the robot offers significant advantages over a standard VATS approach.