Development of the Ways Of Helping Questionnaire: a measure of preferred coping strategies for older African American cancer survivors

A Survey of Emergency Department Quality Improvement Activities: Effective Fast Track Waiting Area Management

This article describes the quality improvement process used to implement a waiting area within fast track. Staff and patient survey data indicated a significant decrease in workload, with a subsequent high satisfaction of both groups following the redesign process.

African American elders' psychological-social-spiritual cultural experiences across serious illness: an integrative literature review through a palliative care lens

Disparities in palliative care for seriously ill African American elders exist because of gaps in knowledge around culturally sensitive psychological, social, and spiritual care. The purpose of this integrative literature review is to summarize the research examining African American elders' psychological, social, and spiritual illness experiences. Of 108 articles, 60 quantitative, 42 qualitative, and 6 mixed methods studies were reviewed. Negative and positive psychological, social, and spiritual experiences were noted. These experiences impacted both the African American elders' quality of life and satisfaction with care. Due to the gaps noted around psychological, social, and spiritual healing and suffering for African American elders, palliative care science should continue exploration of seriously ill African American elders' psychological, social, and spiritual care needs.

African American Elders' Serious Illness Experiences: Narratives of "God Did," "God Will," and "Life Is Better"

The foundation of culturally sensitive patient-centered palliative care is formed from one's social, spiritual, psychological, and physical experiences of serious illness. The purpose of this study was to describe categories and patterns of psychological, social, and spiritual healing from the perspectives of aging seriously ill African American (AA) elders. Using narrative analysis methodology, 13 open-ended interviews were collected. Three main patterns were "prior experiences," "I changed," and "across past, present experiences and future expectations." Themes were categorized within each pattern: been through it . . . made me strong, I thought about . . . others, went down little hills . . . got me down, I grew stronger, changed priorities, do things I never would have done, quit doing, God did and will take care of me, close-knit relationships, and life is better. "Faith" in God helped the aging seriously ill AA elders "overcome things," whether their current illness or other life difficulties.

Development of an "Impact of HIV" Instrument for HIV Survivors

As with cancer survivors, HIV-infected people may have unique physical, psychological, social, and existential challenges over their lifespans, yet no single instrument can assess such challenges. A newly created Impact of HIV Survey, modified from Zebrack's Impact of Cancer Scale, was developed and completed by 356 HIV-infected patients on antiretroviral therapy. Factor analyses confirmed seven scales within 38 items: Health Awareness, Positive Self-Evaluation, Positive Outlook, Value of Relationships, Negative Self-Evaluation-Outlook, Health Anxiety, and Body Changes (Cronbach's alphas range = 0.54-0.93). Participants scored high on health awareness, positive outlook, and value of relationships; high on health worry; and low on body image concerns. Patients with HIV for 15 years and longer tended to have higher positive self-evaluation scores and lower negative self-evaluation-outlook scores compared to those with HIV for a shorter duration. The initial survey version had good internal validity with potential utility in research and clinical care.

A meta-analytic review of religious or spiritual involvement and social health among cancer patients

Religion and spirituality (R/S) play an important role in the daily lives of many cancer patients. There has been great interest in determining whether R/S factors are related to clinically relevant health outcomes. In this meta-analytic review, the authors examined associations between dimensions of R/S and social health (eg, social roles and relationships). A systematic search of the PubMed, PsycINFO, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature databases was conducted, and data were extracted by 4 pairs of investigators. Bivariate associations between specific R/S dimensions and social health outcomes were examined in a meta-analysis using a generalized estimating equation approach. In total, 78 independent samples encompassing 14,277 patients were included in the meta-analysis. Social health was significantly associated with overall R/S (Fisher z effect size = .20; P < .001) and with each of the R/S dimensions (affective R/S effect size = 0.31 [P < .001]; cognitive R/S effect size = .10 [P < .01]; behavioral R/S effect size = .08 [P < .05]; and 'other' R/S effect size = .13 [P < .001]). Within these dimensions, specific variables tied to social health included spiritual well being, spiritual struggle, images of God, R/S beliefs, and composite R/S measures (all P values < .05). None of the demographic or clinical moderating variables examined were significant. Results suggest that several R/S dimensions are modestly associated with patients' capacity to maintain satisfying social roles and relationships in the context of cancer. Further research is needed to examine the temporal nature of these associations and the mechanisms that underlie them.

African American cancer survivors: do cultural factors influence symptom distress?

PURPOSE

The purpose of this study was to examine how the cultural factors, stigma, being strong, and religiosity influence symptom distress in African American cancer survivors.

METHODS

This descriptive correlational study was designed using the Sociocultural Stress and Coping Framework. Seventy-seven African American cancer survivors, recruited from oncology clinics and the community in North Carolina, completed a questionnaire that consisted of measures of demographic and illness characteristics, the Perceived Stigma Scale, the Ways of Helping Questionnaire, the Religious Involvement Scale, and the Symptom Distress Scale.

RESULTS

The two cultural factors that were significantly associated with symptom distress were stigma (β = .23, p < .05) and organized religion (β = -.50, p < .05). No significant associations were found between being strong or nonorganized religiosity and symptom distress. The most commonly reported symptoms were fatigue (M = 2.44, SD = 1.20), pain (M = 2.26, SD = 1.43), and insomnia (M = 1.95, SD = 1.25).

CONCLUSIONS

The findings of this study indicate that the cultural factors, stigma, and organized religiosity were significantly associated with symptom distress.

IMPLICATIONS FOR PRACTICE

The results from this study can be used to guide researchers in developing culturally appropriate interventions aimed at alleviating symptom distress in African American cancer survivors.

Psychosocial predictors of depression among older African American patients with cancer

PURPOSE/OBJECTIVES

To determine whether psychosocial factors predict depression among older African American patients with cancer.

DESIGN

A descriptive correlational study.

SETTING

Outpatient oncology clinic of a National Cancer Institute-designated cancer center in the southeastern United States.

SAMPLE

African American patients with cancer aged 50-88 years.

METHODS

Fisher's exact and Wilcoxon rank-sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not. Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates.

MAIN RESEARCH VARIABLES

Religiosity, emotional support, collectivism, perceived stigma, and depression.

FINDINGS

Participants (N = 77) had a mean age of 61 years (SD = 8.4), and a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants who were in the lowest income category, not married, or male had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model.

CONCLUSIONS

Psychosocial factors are important predictors of depression. Emotional support and organized religious activities may represent protective factors against depression, whereas collectivism may increase their risk.

IMPLICATIONS FOR NURSING

Nurses need to be particularly aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance, and lack of emotional support. In addition, the treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment, and side effects so they are empowered to meet support needs.

KNOWLEDGE TRANSLATION

Among older African American patients with cancer, emotional support and reassurance from family and friends that they will not abandon them decreases the likelihood of depressive symptoms and minimizes the impact of stigmatizing responses, but the perception that the illness is placing a strain on the family increases the likelihood of such symptoms. Emotional support likely is a stronger predictor of depressive symptoms than religious service attendance.

Breast cancer and coping among women of color: a systematic review of the literature

Breast cancer is the most commonly diagnosed form of cancer for women regardless of race/ethnicity. Women of color are diagnosed at later stages and experience greater mortality than their White counterparts. However, there has been comparatively little research on coping with breast among racial/ethnic minorities at time of diagnosis, during treatment, or in the course of survivorship. This is despite the fact that research has repeatedly shown that distress can impact disease progression and survival. The questions asked of this systematic literature review include: (1) What is known about coping with breast cancer among major racial/ethnic groups? (2) What are the strengths and gaps in research to date? Over 120 peer-reviewed published studies (1980-2012) were reviewed. A total of 33 met criteria for inclusion including 15 quantitative, 17 qualitative, and 1 mixed methods study. The majority of studies were small sample cross-sectional studies. Only five studies were longitudinal, and two randomized-controlled intervention trials sought to improve coping among survivors. The most common topic in both quantitative and qualitative studies was spirituality and coping among African American breast cancer patients. Thirteen studies included Latinas only or in combination with other groups. Only one quantitative and one qualitative study solely addressed the Asian American population exploring coping and adjustment. In the course of this systematic literature review, we elucidate what is known about coping with breast cancer among racial/ethnic minority women and identify priorities for future research.

Coping skills among African-American breast cancer survivors

Women with a diagnosis of breast cancer, particularly African-American women, face multiple barriers to survival. Although research exists regarding the unique barriers faced by African-American breast cancer survivors, there has been little research into the various coping needs or coping strategies used among African-American women. The purpose of this article is to provide information from an exploratory study of data investigating the coping skills of 30 African-American women diagnosed and treated for breast cancer. Quantitative data was collected via a self-report questionnaire based on the pretest of the Breast Cancer Survivors Toolbox. The study sample was evaluated to determine overall coping skills followed by an analysis of individual categories of coping skills (e.g., communication, information seeking, negotiating, social support systems, cultural norms). Although limited by the non-random sampling technique and self-report, the results of the study support the need for further research regarding the use of interventions and strategies tailored to improve coping skills used by this population.

Cancer support and resource needs among African American older adults

Older African Americans face substantial barriers to state-of-the-art cancer care. Implementing culturally appropriate support throughout cancer therapy is critical to improving cancer outcomes and quality of life for this vulnerable population. The purpose of this study was to obtain experiential data regarding cancer diagnosis and treatment, and analyze survivors' recommendations regarding treatment-related needs, psychosocial support, and strategies and resources. Four main issues emerged from the study: (a) the need for more health-related and cancer-specific education, (b) the importance of faith and spirituality, (c) the availability of support, and (d) participants' difficulty identifying and articulating financial needs. Few participants reported requesting or receiving assistance (financial or otherwise) outside of the family during their cancer experience. However, treatment-related medication costs posed a significant hardship for many.

Case management needs of older and elderly cancer survivors

PURPOSE/OBJECTIVES

The purpose of this study was to examine the case management needs of older and elderly adults. The specific aim was to describe the results of a survey distributed to cancer survivors, asking them to respond to questions about their specific needs. The survey targeted the physical, psychosocial, social, and spiritual needs.

PRIMARY PRACTICE SETTING

Outpatient setting, outreach program.

FINDINGS/CONCLUSIONS

Fatigue, fear of reoccurrence, and sleep disturbances were of the greatest concern to the older and elderly cancer survivor.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Case managers dealing with elderly cancer survivors can target these needs in terms of transitions from inpatient to outpatient care and beyond into the survivorship period.

Needs of low-income african american cancer survivors: multifaceted and practical

This study aimed to identify the needs of low-income, African American cancer survivors in an urban setting. Data were collected from semi-structured interviews conducted with cancer survivors (n = 12), caregivers (n = 10), professionals (n = 10), and surveys from town hall meetings (n = 80). The major needs identified, across all groups, included a diverse array of practical needs including transportation, financial and job assistance, childcare, self-care assistance, more education and lifestyle information when diagnosed as well as after diagnosis, better post treatment plan, and more need for social support. They identified the ideal resource center as being located within the survivor's neighborhood and would provide a range of medically specific support as well as recreational services. Being of limited economic means has a host of implications for those diagnosed with cancer and for their family members. Participants suggested that needs for cancer survivors have to take into account a complexity of factors including culture, family, and especially economic implications.

Coping profiles common to older African American cancer survivors: relationships with quality of life

CONTEXT

Cancer survivors use distinct sets of coping behaviors that vary in their associations with psychological health and quality of life. However, existing research has largely focused on Caucasian and middle-class subjects.

OBJECTIVES

This study explores whether clusters with differing coping profiles could be identified among older African American cancer survivors and whether these profiles varied on cultural factors and physical, psychological, and relationship well-being.

METHODS

Four hundred forty-nine older African American cancer survivors recruited from outpatient oncology clinics completed a questionnaire booklet containing the Ways of Helping Questionnaire (WHQ), the Brief Index of Race-Related Stress, the Religious Involvement Scale, Mutuality Scale, and the Short Form-12 Health Survey Questionnaire. A k-means cluster analysis was conducted using the WHQ.

RESULTS

Four distinct coping profiles were identified and labeled as high coping, low encouraging healthy behaviors, low coping, and strong/distracting behaviors. Coping profiles were associated with participant's gender, age, and living-alone status. Controlling for these demographic differences, the coping profiles were associated with religiosity; experiences with racism; and physical, psychological, and relationship well-being.

CONCLUSIONS

The findings from this study lend support for examining coping profiles and health outcomes among African American cancer survivors. This research also suggests that these profiles vary on cultural factors. This information should prove useful to researchers as they develop culturally appropriate interventions for this underserved population.

Predictors of depression among older African American cancer patients

BACKGROUND

Depression is becoming an increasing concern in cancer patients because of its impact on quality of life. Although risk factors of having depression have been examined in the literature, there has been no research examining these factors in older African American cancer patients.

OBJECTIVE

This study explores the demographic and illness-related risk factors in older African American cancer patients.

METHODS

Two hundred eighty-three patients were recruited from outpatient oncology clinics. These older African American patients completed a questionnaire that included the Geriatric Depression Scale as well as sociodemographic characteristics and medical information. chi2 Tests, trend tests, and logistic regression were used to identify the demographic and illness-related factors that predict depression in the sample.

RESULTS

The overall prevalence of depression in the sample was 27.2%. Younger age (<65 years), employment status, proximity to family, and multiple symptoms due to cancer or treatment were independent predictors of depression.

CONCLUSION

This study represents the first attempt to describe the risk factors of depression within older African American cancer patients. Findings indicate a high prevalence of depression in African American cancer patients which can be attributed to identifiable risk factors.

IMPLICATIONS FOR PRACTICE

An understanding of the risk factors associated with depression can be used to identify those cancer patients at risk for depression and initiate early interventions to improve psychological outcomes and lessen the potential burden of cancer on these patients.