The diary as a means of understanding the quality of life of persons with cancer receiving home nursing care

Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial

CONTEXT

Breathlessness, fatigue, and anxiety are distressing symptoms for patients with advanced lung cancer. Usually managed as isolated symptoms, they often can occur simultaneously. Previous research often has addressed management of discrete symptoms rather than considering them as a cluster, which, in reality, is the situation faced by patients.

OBJECTIVES

This study aimed to examine the effectiveness of a psychoeducational intervention (PEI) on the symptom cluster of anxiety, breathlessness, and fatigue, compared with usual care.

METHODS

A pretest/post-test, two-group, randomized, controlled trial was conducted. Education on symptom management and coaching in the use of progressive muscle relaxation were delivered to patients one week prior to commencing radiotherapy (RT), and repeated three weeks after beginning RT. Symptom data were collected at four time points: prior to the intervention, three weeks, six weeks, and 12 weeks postintervention.

RESULTS

One hundred forty lung cancer patients receiving palliative RT were recruited from a publicly funded hospital in Hong Kong. Doubly multivariate analysis of variance revealed a significant difference (time×group interaction effect, P=0.003) over time between the PEI and usual care control group on the pattern of change of the symptom cluster. Significant effects on the patterns of changes in breathlessness (P=0.002), fatigue (P=0.011), anxiety (P=0.001), and functional ability (P=0.000) also were found.

CONCLUSION

PEI is a promising treatment for relieving the symptom cluster and each of the individually assessed symptoms. More effort needs to be directed at studying impact of interventions on common symptom clusters.

Symptom-monitoring behaviors of rural cancer patients and survivors

GOALS OF WORK

Symptom monitoring is described among rural cancer patients and survivors with comparison across study variables.

MATERIALS AND METHODS

An anonymous survey was mailed to adult cancer patients and survivors. Sampling was via a cancer center serving a region of a US rural-frontier state. Symptom monitoring was measured as keeping written track of symptoms, side effects, trends in how one is feeling, and/or limits to what one can do.

MAIN RESULTS

Useable response rate was 60.4% (134/222). Respondents were on average 62.3 years old, 53.0% were female, and 52.3% had earned less than a college degree. Breast (30.6%) and prostate (28.4%) cancers were most common. Symptom monitoring was reported and confirmed via tracking means, by 32.1% of respondents. Symptom monitoring was associated with "shared" or "passive" symptom management decisions, keeping written track of questions to ask providers and answers received, report of fatigue, and having received the suggestion or advice on how to monitor. Symptom monitoring was not associated with age, education, sex, number of symptoms, or being given something with which to monitor.

CONCLUSIONS

Symptom monitoring apart from intervention appears common among rural cancer patients and survivors. Findings support using multi-dimensional ways to inquire of, and refer to, such behavior. Data show symptom monitoring is more common among those suffering cancer-related fatigue, indicating opportunities for intervention to optimize monitoring for improved outcomes. Findings also suggest symptom-monitoring patients may rely on, or interact more with, providers regarding symptom management.

An assessment of the feasibility and utility of the MS Symptom and Impact Diary (MSSID)

The Multiple Sclerosis Symptom and Impact Diary (MSSID) was developed to provide a more comprehensive assessment of the impact of multiple sclerosis (MS) on HRQoL for use in clinical practice. This paper reports on an assessment of its feasibility and utility in two outpatient samples of people with MS (n = 13 and n = 63) using quantitative and qualitative methods. The response rate in study 2 was 82% and 83% of days were fully completed. Most respondents found the MSSID easy to understand and got into the habit of completing it. Missing items increased over time and those who experienced a relapse had more missing items than those who did not but there was no difference in the number of missed days. Some respondents found completing the MSSID enabled them to manage their lives more effectively and provided useful information to their neurologist. It is concluded that the MSSID is feasible for people with MS to complete and some may find the MSSID helpful as a tool to monitor their condition. Further research is needed to examine clinicians' perceptions of the feasibility and utility of the MSSID within clinical practice.

Development, feasibility and compliance of a web-based system for very frequent QOL and symptom home self-assessment after hematopoietic stem cell transplantation

We believe that many adverse events following hematopoietic stem cell transplantation (HSCT), particularly relapse and chronic graft-versus-host disease (CGVHD), are preceded by a subclinical period of development that is accessible by frequent psychometric assessment. Documenting these associations could improve future clinical care by extending the potential window for intervention. However, conventional methods of assessing quantity of lite (QOL) in patients in their homes, typically by mailed self-assessment questionnaires, are impractical for very frequent administration. We have developed and implemented a web-based system for measuring short-term (dynamic) changes in QOL by employing brief, online, daily QOL assessments and more extensive, monthly online assessments from patients' homes. Here we report the feasibility of collecting very frequent patient home self-assessments of QOL via the web for a 52 week participation period; we detail incidence of home web access, accrual, compliance, and satisfaction with the system in an HSCT patient sample. We also describe our integrated web-systems for administering patient recruitment, scheduling, monitoring, and analysis. Our results suggest that very frequent routine collection of QOL outcomes is entirely feasible using our web-based home assessment tool, with good patient compliance and high user satisfaction. We believe our methodology shows great promise for use with other cancer and health populations.

Assessing fatigue and self-care strategies in patients receiving radiotherapy for non-small cell lung cancer

Lung cancer represents a major public health problem worldwide (ISD 2000) with approximately 80% of patients presenting with locally advanced or metastatic disease. Treatment is essentially palliative; therefore, symptom management is important. This paper describes the findings from a prospective study of fatigue in newly diagnosed patients with non-small cell lung cancer. Fifty-three patients undergoing radical or high-dose palliative radiotherapy for Stage I, II and III disease were recruited to the study. Patients completed a structured health diary throughout radiotherapy and for up to 1 month post-treatment. Tape-recorded interviews were conducted with a sub-sample (n=11) to explore the nature of fatigue. Complete data sets were available on 46 patients. Consistent with current literature, the study findings demonstrated the progressive nature of this symptom throughout treatment; however, the levels of distress reported and interference with daily living were not found to be as overwhelming in this group of patients as the literature thus far suggests.

The usefulness of a daily pain management diary for outpatients with cancer-related pain

PURPOSE/OBJECTIVES

To describe the usefulness of daily pain management diaries to outpatients with cancer who participated in a randomized clinical trial of the PRO-SELF Pain Control Program.

DESIGN

Randomized clinical trial in which a daily pain management diary was used for data collection in the control group and for data collection and nurse coaching regarding the pain management program in the intervention group.

SETTING

Seven outpatient oncology settings.

SAMPLE

155 patients with pain from bone metastases and 90 family caregivers.

METHODS

Content and statistical analysis of audiotaped answers to a semistructured questionnaire.

MAIN RESEARCH VARIABLES

Patients' and family caregivers' perceptions of the usefulness of a daily pain management diary; specific ways in which the diary was used.

FINDINGS

Patients in both the intervention (75%) and control groups (73%) found the diary useful. The diary was used to heighten awareness of pain, guide pain management behavior, enhance a sense of control, and facilitate communication. Family caregivers in both groups also reported that the diary was useful.

CONCLUSIONS

The completion of a daily pain management diary is useful to patients and family caregivers and may function as an intervention for self-care.

IMPLICATIONS FOR NURSING

Research-based evidence supports the importance of using a daily pain management diary in clinical practice.

Recovery trajectory of unpartnered elders after myocardial infarction: an analysis of daily diaries

The study reported here analyzed daily diary entries of unpartnered elders after myocardial infarction (MI) to gain perspective into their recovery. A total of 33 diaries were included as part of the qualitative analysis of the larger study referred to above. Diary content was evaluated through qualitative descriptive analysis. Six categories--activities of daily living, exercise practices, social support, symptom reporting, healthcare activities, and health-related expenses--were identified from the diaries. Results suggest that recovering, unpartnered MI elders have a need to return to a familiar lifestyle. Moreover, a few differences and similarities based on gender were found. In the rehabilitation setting, nurses should recognize the need for elders to return to normal activities, the importance of social support, the acknowledgement of gender differences, and the potential cost burden for these patients. Diaries were a valuable tool with which to uncover information about the recovery trajectory of unpartnered elders after MI.

Quality of life in cancer care: patients' experiences and nurses' contribution

People with cancer experience great changes in their lives. Disease, treatment and prognosis affect their quality of life. The aim of this literature review was to ascertain how the illness affects patients' quality of life and to what extent nurses can influence or improve this experience. Twenty-two research articles were reviewed, the majority of which were qualitative in nature, studies that allow patients to portray their experiences in their own words. The concept of quality of life was defined as consisting of well-being in four core domains, psychological, social, physical and spiritual. It was found that patients' quality of life is affected in all four core domains and that these domains are overlapping and interdependent. The qualitative data also highlighted that each patient's experience is unique to that patient. Nurses have to be aware of this and remain sensitive to the individual patient's needs. Few of the articles reviewed examined nursing care from the patient's point of view. Tentative conclusions were that nurses can improve patients' quality of life by ensuring they are competent in daily practice, by giving patients a feeling of security and by treating them with respect as individuals and human beings.

Intensified primary cancer care: a randomized study of home care nurse contacts

Newly diagnosed cancer patients (n=527) were randomised to intensified primary care or a control group. Intensified primary care comprised routines to improve general practitioners' and home care nurses' possibilities to support and monitor patients, i.e. increased information from specialist care, education and supervision in cancer care. The aims of this paper are to evaluate the effects of intensified primary care on cancer patients' home care nurse contacts, and to study if patients' use of home care services 6 months after diagnosis can be predicted. The intervention resulted in a marked increase of follow-up contacts. About 90% of intensified primary care patients reported such contacts, compared to 26% of control patients. The results indicate that standard care does not routinely include follow-up contacts, not even for the oldest (80+ years) or those with advanced disease. Only 27% and 36% of these groups of control patients reported follow-ups. Logistic regression analysis identified intensified primary care as the strongest predictor for reporting a continuing contact 6 months after diagnosis. Intensified primary care patients were 14 times more likely than controls to report a such contact. The strongest predictor of a continuing contact in the intensified primary care group was high age. Patients with advanced disease were more likely than patients with non-advanced disease to report a continuing contact, and living in a rural district was positively associated with reporting a contact. A majority of the patients (70%) assessed the time for the first contact as the 'right time' and estimated that the nurse gave expected support to a very large or large extent (67%). The results suggest that routines like those implemented through intensified primary care may be an effective strategy to increase the accessibility and continuity of care, especially for elderly people and for patients with a need for long-term contacts.

The hidden experience of radiotherapy to the head and neck: a qualitative study of patients after completion of treatment

Only a small proportion of cancer patients undergo radical radiotherapy to the head and neck, but their needs are particularly complex. Radiation reactions often exacerbate existing functional difficulties and may severely limit 'normal' life. Few existing studies examine what happens when radiotherapy is over, yet this is the time when reactions are at their peak and day to day links with the hospital are severed. This naturalistic inquiry uses a combination of methods to explore the experiences of 12 patients after completion of radiotherapy to the head and neck. The impact of radiotherapy and the profound disruption to daily life is shown by the uncertainty and unpredictability of symptoms, the waiting, ambiguity and loss of self integrity which occurs throughout this time. Despite considerable physical and emotional trauma, patients showed remarkable resilience and a profound reluctance to ask for help. The findings demand that we re-examine our styles of communication, and consider how well we give information and listen to what is really happening. It is imperative that we provide greater consistency and continuity of care during radiotherapy, recognize the impact of the whole experience and respond to the post-treatment needs of this unique patient group.

Perceptions of symptom distress in lung cancer patients: I. Congruence between patients and primary family caregivers

Part I of this two-part paper employs a comparative design to compare primary family caregivers' assessments of lung cancer patients' symptom distress with patients' own perceptions of symptom distress in the home setting. Part II describes the results of the qualitative component of this research. A convenience sample of 37 patient-family caregiver dyads completed the McCorkle and Young Symptom Distress Scale (SDS). Family caregivers' global scores were moderately correlated with patients' global scores (r = 0.71; P < 0.001). No significant differences in ratings were found for ten of the 13 symptoms assessed. Therefore, when the patient is unable to provide a self-report of symptom distress, health-care professionals may seriously consider family caregivers' assessments of patients' symptom distress to be reasonable estimates for at least ten of the 13 symptoms on the SDS.

Patients' perceptions of their education needs in the first six weeks following discharge after cardiac surgery

The aim of this study was to discover what information and support patients feel they need in the 6-week rehabilitation period following discharge after cardiac surgery. It was undertaken at the request of the hospital multidisciplinary cardiac rehabilitation team to enable them to plan a package of information to meet those needs. It was a local study aiming to gain insight into the patients' own views by asking them to keep a diary over the 6-week period and then take part in an unstructured interview when they returned for their 6-week out-patient appointment. The analysis of the respondents' comments gave an insight into their whole experience of the first 6 weeks following discharge. The themes which emerged were wide-ranging and were grouped under the headings of the early discharge needs of pain relief and sleep promotion, psychological needs, practical needs and community support. To take the study forward, several recommendations were made to improve the rehabilitation experience. These included additions to the literature and patient education sessions, and changes to ensure a smoother transition into the community. The findings also suggest the need for improvements in and further research into the whole area of the psychological preparation for discharge after cardiac surgery.

Health diaries in nursing research and practice

Health diaries have been used in research and clinical practice to examine the daily symptoms of healthy and ill people, responses to symptoms, and efficacy of symptom response. This article describes current uses of health diaries in nursing research and practice, the types of typical health diaries, factors affecting the quality of diary data, and the costs and analytic issues related to health diaries. The implications of health diaries for nursing education, practice, and research are considered.

The use of the diary as a data collection technique

The initiation of a research project requires many decisions, not the least of which is the selection of a method for data collection. This decision is, in large measure, guided by the nature of the research question which generally prescribes the selection of a strategy for data collection from among an array of possible alternatives. This article addresses the use of a diary for data collection. Although diaries have traditionally been used in social science and health research, their use in nursing research is more recent. The article begins with a brief discussion of the rationale for using the diary to gather data in a study of personal and professional caregiving. A brief review of the use of diaries in previous studies follows, along with a description of the use of a diary in the caregiving study and a discussion of the possible threats to high quality data as well as measures used to ensure the collection of high quality data. The article concludes with a discussion of the strengths and weaknesses of the diary and makes recommendations regarding its use in nursing research.