A Research Agenda for Gero-Oncology Nursing

The association between the mental health disorders, substance abuse, and tobacco use with head & neck cancer stage at diagnosis

PURPOSE

Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system.

METHODS

This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59 years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use.

CONCLUSIONS

The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.

Maximizing Nurse Scientist Role Potential in Health Care Organizations

Before Magnet designation, nurse scientists functioned primarily in academia. The Magnet model's emphasis on new knowledge required that health care organizations demonstrate knowledge generation to achieve and sustain designation. The nurse scientist role definition and function within health care organizations continues to evolve, which contributes to a lack of clarity about who and how nurses generate new knowledge. The purpose of this scoping review was to (1) identify nurse scientist role components in the context of 2 theoretical models (Thompson's Knowledge Brokering Model and Edward's Research Appreciation, Accessibility, and Application Model), (2) explore the strengths and barriers associated with existing nurse scientist practice models in US health care organizations, and (3) describe a unique, expanded practice model applied within Stanford Health Care's Office of Research and its implications for building new knowledge and innovation capacity with recommendations for ongoing role development.

Supporting older adults with chemotherapy treatment: A mixed methods exploration of cancer caregivers' experiences and outcomes

PURPOSE

Due to delivery of chemotherapy being mostly in ambulatory care settings, support of people with cancer relies heavily on caregivers (e.g. relatives). Whilst cancer caregiver research has been flourishing, there has been little focus on the specific experiences of caregivers of older people (>70yrs) with cancer, and little considerations of cultural influences on their experiences. This study explored caregiver experiences and outcomes in the geriatric oncology context in Switzerland.

METHODS

Sequential mixed-methods design, comprising a) cross-sectional survey (n = 86/RR52%; age range 37-85) and b) interviews (n = 19) to explore experiences of caregivers of older people (mean age in yrs 74.6 (sd 4.3) with cancer, and factors related to caregivers' psychological morbidity and health related quality of life (HrQoL).

RESULTS

Caregivers reported a median of three moderate/high unmet needs (range 0-41) and 44% reported clinically significant psychological morbidity. Demographics (caregiver age, gender, and marital status), caregiving tasks (physical, psycho-emotional, social and/or treatment related care), unmet needs and caregiver burden collectively explained between 20 and 57% of variance in caregiver psychological morbidity and HRQoL. Two main themes emerged from interviews: "Being a caregiver and doing caregiving" and "Living through the situation." These indicated that caregiver roles are multiple and fluid, and identified responsibilities not previously reported outside of palliative care settings, such as thinking about and planning for death and dying.

CONCLUSIONS

Caregiving for an older person with cancer can have detrimental impacts on caregivers' wellbeing and quality of life. Consideration needs to be given to the particular needs of caregivers in geriatric oncology settings. Their support needs appear different to those of their counterparts caring for younger people with cancer, notably related to spiritual needs; this may in part relate to possible differences arising from caregivers themselves being older.