Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors

Older breast cancer survivors' symptom beliefs

PURPOSE/OBJECTIVES

To use Leventhal's Common Sense Model (CSM) to describe older breast cancer survivors' symptom representations, symptom management strategies, and perceived barriers to symptom management.

DESIGN

A secondary analysis was conducted using data from three pilot studies that tested a theory-based intervention to improve symptom management in older breast cancer survivors.

SETTING

Advanced practice nurses conducted open-ended interviews with older breast cancer survivors either in their homes or via telephone.

SAMPLE

Participants were recruited from the community, an oncology clinic, and a state tumor registry. The women (N = 61, X age = 69.5) were an average of 4.7 years after breast cancer diagnosis and reported an average of 17 symptoms.

METHODS

Content analysis was conducted with field notes taken during baseline interviews.

MAIN RESEARCH VARIABLES

Symptom representations, symptom management strategies, and perceived barriers to symptom management.

FINDINGS

Women described their symptoms as chronic, incurable, and uncontrollable, with multiple causes (usually not aging) and numerous negative consequences. Women described an average of six symptom management strategies, most typically self-care. The most frequent barrier to symptom management was communicating with healthcare providers.

CONCLUSIONS

The CSM is a useful framework for understanding the symptom beliefs of older breast cancer survivors.

IMPLICATIONS FOR NURSING

Addressing women's beliefs and barriers may result in better communication with healthcare providers and more effective interventions for symptom management.

An individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors: three pilot studies

PURPOSE/OBJECTIVES

To test the feasibility and acceptability of an individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors and test the short-term effects of an IRIS on symptom distress.

DESIGN

Two small randomized clinical trials and one pre-experimental study.

SETTING

Oncology clinic and community.

SAMPLE

41 women with breast cancer (aged 65 years and older) in pilot study 1, 20 in pilot study 2, and 21 in pilot study 3.

METHODS

In pilot study 1, women were randomized to the IRIS or usual care control. In pilot study 2, women were randomized to the IRIS or delayed IRIS (wait list) control. In pilot study 3, all women received the IRIS by telephone. Measures were collected at baseline, postintervention, and follow-up (up to four months).

MAIN RESEARCH VARIABLES

Feasibility, acceptability, symptom distress, symptom management behaviors, symptom management barriers, and quality of life.

FINDINGS

Across three pilot studies, 76% of eligible women participated, 95% completed the study, 88% reported the study was helpful, and 91% were satisfied with the study. Some measures of symptom distress decreased significantly after the IRIS, but quality of life was stable. Women in the IRIS group changed their symptom management behaviors more than controls.

CONCLUSIONS

Preliminary evidence supports the need for and feasibility of an IRIS.

IMPLICATIONS FOR NURSING

Nurses may help older breast cancer survivors manage their numerous chronic symptoms more effectively by assessing women's beliefs about their symptoms and their current symptom management strategies.

Nurse responsiveness to cancer patient expressions of emotion

OBJECTIVE

This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient.

METHODS

This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness.

RESULTS

Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness.

CONCLUSION

Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse-patient communication, has implications for interventional studies.

PRACTICE IMPLICATIONS

Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.

Application of a model of social information processing to nursing theory: how nurses respond to patients

AIM

This paper is a report of a study to assess the applicability of a theoretical model of social information processing in expanding a nursing theory addressing how nurses respond to patients.

BACKGROUND

Nursing communication affects patient outcomes such as anxiety, adherence to treatments and satisfaction with care. Orlando's theory of nursing process describes nurses' reactions to patients' behaviour as generating a perception, thought and feeling in the nurse and then action by the nurse. A model of social information processing describes the sequential steps in the cognitive processes used to respond to social cues and may be useful in describing the nursing process.

METHODS

Cognitive interviews were conducted in 2006 with a convenience sample of 5 nurses in the United States of America. The data were interpreted using the Crick and Dodge model of social information processing.

FINDINGS

Themes arising from cognitive interviews validated concepts of the nursing theory and the constructs of the model of social information processing. The interviews revealed that the support of peers was an additional construct involved in the development of communication skills, creation of a database and enhancement of self-efficacy.

CONCLUSION

Models of social information processing enhance understanding of the process of how nurses respond to patients and further develop nursing theories further. In combination, the theories are useful in developing research into nurse-patient communication. Future research based on the expansion of nursing theory may identify effective and culturally appropriate nurse response patterns to specific patient interactions with implications for nursing care and patient outcomes.

A mixed-method evaluation of nurse-led community-based supportive cancer care

GOALS OF WORK

The study purpose was to evaluate a nurse-led supportive care clinical case management program in the community using multi-methods to delineate care processes prior to outcome evaluation.

MATERIALS AND METHODS

Multiple data sources including program service records, chart reviews and interviews with nurses and key interdisciplinary informants were used to identify population served (coverage and reach), processes of care (implementation), and providers' perceptions of the effectiveness of the nurse-led program (reaction).

MAIN RESULTS

The program provided care to over 700 cancer patients in a 1-year period. Nurse-led support interventions were focused on direct care inclusive of teaching/coaching for symptom management, counseling and support, and mobilization of services through system navigation based on an initial comprehensive assessment of supportive care needs.

CONCLUSIONS

Nurse-led models of supportive care have the potential to reduce unmet supportive care needs, improve continuity of care, and overall health-related quality of life that should be tested in future trials.

Communication with breast cancer survivors

Breast cancer survivors must manage chronic side effects of original treatment. To manage these symptoms, communication must include both biomedical and contextual lifestyle factors. Sixty breast cancer survivors and 6 providers were recruited to test a conceptual model developed from uncertainty in illness theory and the dimensions of a patient-centered relationship. Visits were audio-taped, then coded using the Measure of Patient-Centered Communication (Brown, Stewart, & Ryan, 2001). Consultations were found to be 52% patient-centered. Chi-square Automatic Interaction Detection (CHAID) analysis showed that survivor self-reported fatigue level and conversation about symptoms were associated with survivor uncertainty, mood state, and survivor perception of patient-centered communication. Survivors may want to discuss persistent symptom concerns with providers, due to concerns about recurrence, and discuss lifestyle contextual concerns with others.