Gynecologic cancers: Part. I--Risk factors

Gynecologic cancers will account for approximately 81,000 new cases of cancer this year. Although much is known about the risk factors for cervical, ovarian, and endometrial cancers, less is known about vaginal and vulvar cancer risk factors. Generally, risk factors and associations for gynecologic cancers are behavioral, reproductive, hormonal, and genetic related. Research continues to verify and refute the impact of certain factors. All nurses must be knowledgeable about the risk factors and associations for these cancers.

Death and meaning in a storefront church

Nurses are often uncomfortable in addressing the needs of a spiritual family in times of death and grieving. They frequently find that scientific explanations and even emotional support fail to comfort individuals and families. This study, based in a small Black storefront church, explores the meaning of death and the experience of grieving among the deeply religious church members. Ethnographic description and analysis of life history interviews were employed to analyze these concepts. Church members had a particular way of managing the death of one of their members or the death of a child. They made an attempt to "go on," and they had a strong belief in an afterlife. Church members sometimes experienced visions and visits from "the other side" that supported these beliefs. They had a spiritual manner of comforting those left behind, speaking often of the "homegoing" with acceptance, examining the purpose of the "journey" of one's life, trying to inspire hope, and yet simultaneously preparing for death. Members praised each other for doing all that they could for their loved one. The nurse who cares for a spiritual family needs to carefully assess each family individually, however, s/he may find that the approaches used by the church members in caring for one another are helpful to incorporate into her/his care.

The impact of an ostomy on sexuality

Creation of an ostomy results in physiological and psychological changes that affect sexuality. Major physiological complications for men include erectile dysfunction and ejaculatory difficulties. For women, dyspareunia is the most common physiological complication. The presence of an ostomy can alter a person's body image, which, in turn, influences the desire for sexual activity. Sexuality concerns should be addressed with all patients undergoing ostomy placement. The PLISSIT model, which outlines four stages of interventions used in sexual counseling, can be used to guide nursing care.

Research and oncology nursing practice

OBJECTIVE

To trace the evolution of oncology nursing research and to discuss its contribution to oncology nursing practice and health care.

DATA SOURCES

Articles, textbooks, organizational documents, conference proceedings, and personal communication.

CONCLUSIONS

Placing research in perspective will help suggest where we should go as a nursing specialty to provide excellent cancer care to patients, families, communities, and populations. It will also suggest directions for research priorities and for conceptual, methodologic, and health policy activities.

IMPLICATIONS FOR NURSING PRACTICE

To influence oncology care, it is essential that oncology nurse researchers be responsive to trends that are relevant to both the conduct and utilization of oncology nursing research.

Health policy and legislation: impact on cancer nursing and care

OBJECTIVES

To review policy and legislative initiatives in which nursing has played roles and to provide insight into trends and issues that characterize the policy and political agendas in which oncology nurses can play advocacy roles in the new millennium.

DATA SOURCES

Professional journals, books, newspapers, news magazines, and internet web sites.

CONCLUSIONS

Oncology nurses can offer solutions to the dilemmas posed by fiscal realities, unique American values and expectations, and the complexities of cancer care in the United State's market-based health care system. Oncology nurses must assume roles as health policy specialists.

IMPLICATIONS FOR NURSING PRACTICE

For nurses to gain acceptance in health policy arenas, individual nurses and groups of nurses must become expert in assessing the environment, the interpretation of cues, and the development and implementation of realistic strategies targeting priority health policy and legislative issues.

The minimization to clients of screen-detected breast cancer: a qualitative analysis

Previous research has shown a low incidence of psychological morbidity in women with screen-detected breast cancer when compared to women with symptomatic breast cancer. Farmer et al. suggested that this might be due to the way the diagnosis of breast cancer is given to women with screen-detected disease. In order to test this hypothesis a detailed, in-depth, qualitative study was undertaken. The sample consisted of women with symptomatic breast cancer (n=5), women with screen-detected invasive breast cancer (n=6) and women with screen-detected in-situ breast cancer (n=5). The 'bad news consultations' with the surgeons, and subsequent meetings with the breast care nurses (BCN), were tape recorded. The women were also interviewed in their own homes within 7 days. The results suggested that the women with screen-detected breast cancer received more reassurance than the women with symptomatic breast cancer and that the benefits of breast screening were emphasized by the surgeons and the BCNs. This led to minimization of the significance of screen-detected disease. Women were found to draw on a new conceptual model of early curable breast cancer which appears to be associated with a low incidence of psychological morbidity.

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.

Organization of services and nursing care: hospice and palliative medicine

The health care industry is changing and nursing case management is an integral part of restructured care in many institutions. Health care organizations must evaluate services and outcomes. The terminally ill comprise a large portion of patients in any health care delivery system. Hospitals that provide formal cancer care services need to evaluate where palliative care and hospice fit. Shifts in patient care will be evident due to changes in demographics, payor initiatives, and technological advances. Providing care for patients with advanced disease and the role of nursing have evolved over the past 10 years. One important area that has not changed is the passion and caring evident in the nurse's everyday practice.

Attendance at cancer follow-up clinic: does it increase anxiety or provide reassurance for men successfully treated for testicular cancer?

This cross-sectional descriptive study examined the meaning of the cancer follow-up clinic for men who have been successfully treated for testicular cancer. The sample of 62 men were selected using a nonprobability quota sampling method before attendance at a routine testicular cancer follow-up clinic within the Directorate of Clinical Oncology, Western General Hospitals NHS Trust, Edinburgh, Scotland. Subjects were given four instruments to complete immediately before seeing the doctor in the clinic, and two instruments to complete on day 8 after the clinic appointment. Instruments included the State-Trait Anxiety Inventory (STAI), a demographic questionnaire, and two Likert scales adapted for use in the study: the Common Concerns about Testicular Cancer questionnaire and the Psychological Consequences of Screening questionnaire (PCQ). Results demonstrated that men attending the clinic exhibit low levels of anxiety at the points measured, but gain a great deal of reassurance from the clinic visit. Results also demonstrated the areas of concern about testicular cancer and its management that influence anxiety in the follow-up clinic.

Patients' and nurses' assessment of cancer pain

The purpose of this study was to examine hospitalised cancer patients' and nurses' assessment of patients' cancer pain and to compare them. The data were collected from 51 patient-nurse pairs in two hospitals from oncological and medical clinics. Each nurse and patient took part in the study no more than once. The data were collected with a structured interview and the questionnaire. The intensity of pain was measured with a visual analogue scale (VAS) and the Finnish version of the McGill Pain Questionnaire (FPQ). The results showed that the differences between patients' and nurses' assessments were statistically significant for most intensive pain and for acceptable pain. In both cases nurses' assessments of the intensity of pain were lower than patients' assessments. The nurses identified 40 words in the verbal FPQ that the patients used in describing their experiences of pain. The words used most often by patients were agonizing, tender, wave-like and radiant. The word that the nurses used most often was that of intense. Nurses' knowledge about pain medication in general and morphine in particular was clearly associated with the differences observed in estimates of the intensity of pain. Nurses with poor knowledge underestimated the patients' most intensive experiences of pain. The difference was statistically significant.

Dealing with the uncertainty of developing a cancer

Based on a personal experience in a genetic counselling consultation, this article proposes a personal reflection about the different ways in which individuals from high-risk families are living and dealing with the uncertainty of one day developing a cancer. The psychological reactions of the individuals concerned are described before exploring actual issues of genetic testing--such as the reasons for testing--but also technical and familial limits. This paper also presents the limits existing in follow-up and prevention for the carriers of susceptibility genes and insists on the importance of counselling before genetic testing and the necessity of further multidisciplinary research in this field. The original text was presented in French during the Eleventh MASCC International Symposium on Supportive Care in Cancer, at Nice, in February 1999.

Assessing women's sexuality after cancer therapy: checking assumptions with the focus group technique

Cancer and cancer therapies impair sexual health in a multitude of ways. The promotion of sexual health is therefore vital for preserving quality of life and is an integral part of total or holistic cancer management. Nursing, to provide holistic care, requires research that is meaningful to patients as well as the profession to develop educational and interventional studies to promote sexual health and coping. To obtain meaningful research data instruments that are reliable, valid, and pertinent to patients' needs are required. Several sexual functioning instruments were reviewed for this study and found to be lacking in either a conceptual foundation or psychometric validation. Without a defined conceptual framework, authors of the instruments must have made certain assumptions regarding what women undergoing cancer therapy experience and what they perceive as important. To check these assumptions before assessing women's sexuality after cancer therapies in a larger study, a pilot study was designed to compare what women experience and perceive as important regarding their sexuality with what is assessed in several currently available research instruments, using the focus group technique. Based on the focus group findings, current sexual functioning questionnaires may be lacking in pertinent areas of concern for women treated for breast or gynecologic malignancies. Better conceptual foundations may help future questionnaire design. Self-regulation theory may provide an acceptable conceptual framework from which to develop a sexual functioning questionnaire.

Pain in adult recipients of blood or marrow transplant

Severe pain is a problem for most bone marrow transplant (BMT) recipients. The purpose of this descriptive study was to describe the pain experience of adults undergoing autologous BMT, allogeneic BMT, or peripheral blood stem cell transplant. The sample consisted of 20 adults, 21 to 54 years of age. Using investigator-developed structured interview guides, investigators interviewed each participant four times: on the day of transplant, then at 3-weekly intervals. Investigators used a content analysis approach when analyzing data. During the first interview, 18 participants said that they were told to expect mouth sores during BMT, yet only six said that they actually expected to experience mouth sores during BMT. During successive interviews, 13 reported mouth sores. Eight other pain sites were reported. Participants reported that their tolerance of mild, moderate, and severe pain decreased over 2 weeks, and they named a wide variety of factors that caused or relieved pain. Ten said that they used nonpharmacologic techniques to feel more comfortable. Seven said that their BMT pain was worse or more difficult than they had expected. Overall pain ratings ranged from 0 to 8 on a 0 to 10 scale, M = 4.5. Five said the side effects of analgesics bothered them more than their pain. Most of them said a pain-rating scale was useful. Three weeks post-BMT, seven said they still experienced pain. Implications for clinical practice, research, and education are discussed.

Body image, decision making, and breast cancer treatment

This study was performed to describe women's satisfaction with body image before and 8 weeks after the surgical treatment of breast cancer compared with women without breast cancer. Additional aims were to describe women's perceived participation in decisions regarding choice of surgical procedure to treat their breast cancer, and postoperative satisfaction with their breast cancer treatment, as well as to explore factors influencing women's decisions regarding choice of surgical procedure. The design was prospective with a descriptive, comparative design. The convenience sample included 31 women with breast cancer from an urban breast health center, and 30 women without breast cancer from the community. The majority were college educated, white, ranging in age from 29-82 years. Women with breast cancer completed instruments before and 8 weeks after surgery. Women without breast cancer completed the instruments two times 8 weeks apart. Three instruments measuring body image satisfaction were used. Participation in treatment decision-making, having a treatment choice, and posttreatment satisfaction, along with a description of important factors in decision making, were measured with open and closed-ended questions. During the study period, women with breast cancer experienced a significant decrease in satisfaction with body image after surgery (p < .004). Satisfaction with body image remained constant in the women without breast cancer. Most (94%) of the women with breast cancer reported participating in treatment decisions about the type of surgical procedure used to treat their breast cancer, had a treatment choice (77%), and were moderately to very satisfied with the outcome of their surgeries (94%). Qualitative data results suggest that women's treatment decisions were based on their perceptions of "survival," that is, which type of surgery offered the best chance for long-term survival. These data suggest that satisfaction with body image is disturbed by surgery for breast cancer despite active participation in decisions regarding selection of treatment or postoperative satisfaction with type of surgical treatment received. These outcomes suggest that women need assistance in adjusting to alterations in body image from nurses and the need for research to describe effective interventions. Future studies of body image and breast cancer treatment should be conducted with larger samples, and at different points after surgery to determine the effects of mastectomy and breast-conserving surgery on the body image of breast cancer survivors over time.

Caring for and about cancer patients: identifying the meaning of the phenomenon "caring" through narratives

For several decades nurses have been using the terms "caring" and "nursing." Caring, considered to be a universal phenomenon, has been seen as a nursing term, including all aspects of delivering nursing care to patients. Ten registered nurses selected from hematologic, oncologic, and lung medicine wards were asked to narrate one situation in which they had been able to supply good caring and one situation wherein they had not been able to provide good caring for the patient. To identify the meaning of the caring phenomenon as experienced and expressed by nurses working with patients who have cancer, a qualitative analysis using phenomenologic hermeneutics was used. The narrated interviews, tape-recorded and transcribed verbatim, were analyzed, and a theme was interpreted: developing and maintaining a helping-trusting interpersonal relationship. Five subthemes also were identified: creating an interaction with the patient and the next of kin, acting to satisfy the needs of the patient and next of kin, feeling frustration in the role of caring, being affected by time aspects, and developing self and acquiring insight. It is in caring that nurses and patients connect with one another, are fulfilled, and experience growth. If they work actively with this perspective, nurses will feel fulfilled, not frustrated.

The relationship of rural persons' multidimensional health locus of control to knowledge of cancer, cancer myths, and cancer danger signs

The purpose of the study was to determine if a relationship exists between multidimensional health locus of control and knowledge of breast cancer, prostate cancer, cancer myths, and danger signs. A descriptive correlational design was used. A convenience sample of 78 rural men and 79 rural women participated in the study. Participants completed three questionnaires: (a) the Cancer Danger Signs Questionnaire, (b) the Cancer Myths Questionnaire, (c) the Prostate Cancer Knowledge Test (completed by the men) and the Breast Cancer Knowledge Test (completed by the women). Results indicated that an internal score on the Multidimensional Health Locus of Control (MHLOC) scale did not predict knowledge of breast cancer in women, prostate cancer in men, cancer myths, or danger signs. Women who scored high on the Powerful Others subscale of the MHLOC had statistically significant high scores on knowledge of breast cancer, but not on cancer myths and danger signs. The MHLOC and its subscales did not predict knowledge of prostate cancer, cancer myths, or cancer danger signs for the male participants. The implications of these results for rural nursing practice and their relationship to previous research are discussed.

Principles of radiotherapy and radiobiology

OBJECTIVES

To review the current state of knowledge of radiation physics and radiobiology, combined modality treatments, the use of radiosensitizers and radioprotectors, new developments in radiation therapy, radiation safety principles, and the implications of radiation in advanced nursing practices.

DATA SOURCES

Research and review articles, oncology nursing textbooks, and physics and medical oncology textbooks.

CONCLUSIONS

Radiation therapy is an important entity in the treatment of cancer, used alone or in combination with surgery and/or chemotherapy. Research continues to grow in the use of radiation therapy to control cancer, spare surrounding normal tissue, and reduce acute long-term toxicity.

IMPLICATIONS FOR NURSING PRACTICE

An understanding of radiobiology and physics will assist oncology nurses in providing proper education to the patient and managing radiation-induced side effects.

Patterns of care in radiation oncology

OBJECTIVES

To provide an overview of the Patterns of Care Study (PCS) in radiation oncology and to discuss the progress and impact of the PCS on clinical practice.

DATA SOURCES

Research studies and review articles.

CONCLUSIONS

The PCS has demonstrated tremendous impact on the delivery of radiation oncology services in the United States. The PCS surveys the discipline of radiation oncology to determine quality of care and provide outcome data to enhance the delivery of radiation treatment in diverse settings.

NURSING IMPLICATIONS

Radiation oncology nurses occupy a pivotal place in the quest to promote quality clinical care. A knowledge base about the activities of the PCSs and the integration of nursing participation in future studies has the potential to enhance patient care.