Decision support computer program for cancer pain management

Decreasing menopausal symptoms of Asian American breast cancer survivors through a technology-based information and coaching/support program

OBJECTIVE

One of the most prevalent and distressing symptoms after breast cancer treatment is menopausal symptoms. Asian American breast cancer survivors have lower quality of life and often receive inadequate management of menopausal symptoms compared to other racial/ethnic groups. Technology-based programs could be a solution to fill the gap in care. The purpose of this study was to test the efficacy of a technology-based information and coaching/support program on menopausal symptoms of Asian American breast cancer survivors.

METHODS

This study adopted a randomized pretest/post-test group design among 91 Asian American breast cancer survivors (42 in an intervention group who used the program and the American Cancer Society Web site and 49 in a control group who used only the American Cancer Society Web site). The intervention was a theory-driven and culturally tailored intervention program that aimed to provide information and coaching/support using computers and mobile devices. Multiple instruments were used to measure background characteristics and menopausal symptoms at pretest, post 1-month, and post 3 months. An intent-to-treat linear mixed-model growth curve analysis was used to analyze the data.

RESULTS

The intervention group showed a significant decrease in the distress scores of menopausal symptoms over time: physical (β = -0.07, P = 0.08), psychological (β = -0.13, P = 0.05), psychosomatic (β = -0.17, P = 0.06), and total symptoms (β = -0.19, P = 0.01). Theory-based variables including attitudes, social influences, and self-efficacy partially mediated the impact of the intervention on the distress scores of menopausal symptoms (P < 0.10).

CONCLUSIONS

The program was effective in alleviating menopausal symptoms of Asian American breast cancer survivors.

Factors of accepting pain management decision support systems by nurse anesthetists

BACKGROUND

Pain management is a critical but complex issue for the relief of acute pain, particularly for postoperative pain and severe pain in cancer patients. It also plays important roles in promoting quality of care. The introduction of pain management decision support systems (PM-DSS) is considered a potential solution for addressing the complex problems encountered in pain management. This study aims to investigate factors affecting acceptance of PM-DSS from a nurse anesthetist perspective.

METHODS

A questionnaire survey was conducted to collect data from nurse anesthetists in a case hospital. A total of 113 questionnaires were distributed, and 101 complete copies were returned, indicating a valid response rate of 89.3%. Collected data were analyzed by structure equation modeling using the partial least square tool.

RESULTS

The results show that perceived information quality (γ=.451, p<.001), computer self-efficacy (γ=.315, p<.01), and organizational structure (γ=.210, p<.05), both significantly impact nurse anesthetists' perceived usefulness of PM-DSS. Information quality (γ=.267, p<.05) significantly impacts nurse anesthetists' perceptions of PM-DSS ease of use. Furthermore, both perceived ease of use (β=.436, p<.001, R(2)=.487) and perceived usefulness (β=.443, p<.001, R(2)=.646) significantly affected nurse anesthetists' PM-DSS acceptance (R2=.640). Thus, the critical role of information quality in the development of clinical decision support system is demonstrated.

CONCLUSIONS

The findings of this study enable hospital managers to understand the important considerations for nurse anesthetists in accepting PM-DSS, particularly for the issues related to the improvement of information quality, perceived usefulness and perceived ease of use of the system. In addition, the results also provide useful suggestions for designers and implementers of PM-DSS in improving system development.

The DSCP-CA: a decision support computer program--cancer pain management

The purpose of this study was to develop a decision support system using fuzzy logic that would support nurses' decisions about cancer pain management, especially for ethnic minority cancer patients. The study had two phases: (1) data collection and (2) development of the decision support computer program. In the data collection phase, an Internet survey of 428 cancer patients and four ethnic-specific online forums (about 30 participants per forum) were conducted to gather data on the cancer pain experience of the four major ethnic groups in the United States. The development phase included two components: (1) development of three modules, including a knowledge base module, a decision module, and a self-adaptation module; and (2) a 3-month evaluation of the decision support computer program by oncology nurses and subsequent incorporation of their feedback into the program. The Internet survey and online forum data were processed into fuzzy and crisp data sets, and ethnic-specific algorithms for the decision module were developed. Using the self-adaptation module, the decision support computer program was further refined as additional data were processed. Then, the decision support computer program was further developed by adding additional components suggested by the oncology nurses.

Nursing and fuzzy logic: an integrative review

This study conducted an integrative review investigating how fuzzy logic has been used in research with the participation of nurses. The article search was carried out in the CINAHL, EMBASE, SCOPUS, PubMed and Medline databases, with no limitation on time of publication. Articles written in Portuguese, English and Spanish with themes related to nursing and fuzzy logic with the authorship or participation of nurses were included. The final sample included 21 articles from eight countries. For the purpose of analysis, the articles were distributed into categories: theory, method and model. In nursing, fuzzy logic has significantly contributed to the understanding of subjects related to: imprecision or the need of an expert; as a research method; and in the development of models or decision support systems and hard technologies. The use of fuzzy logic in nursing has shown great potential and represents a vast field for research.

Acculturation and the cancer pain experience

PURPOSE

Using a feminist perspective, the relationship between acculturation and cancer pain experience was explored.

DESIGN

This was a cross-sectional, correlational Internet study among 104 Hispanic and 114 Asian cancer patients. The instruments included both unidimensional and multidimensional cancer pain measures.

FINDINGS

There were significant differences in cancer pain scores by country of birth. Yet there was no significant association of acculturation to cancer pain scores.

DISCUSSION AND CONCLUSIONS

This study indicated inconsistent findings.

IMPLICATIONS FOR PRACTICE

To provide directions for adequate cancer pain management, further studies with a larger number of diverse groups of immigrant cancer patients are needed.

Information technology from novice to expert: implementation implications

AIMS

This paper explores how the Novice-to-Expert Nursing Practice framework can illuminate the challenges of and opportunities in implementing information technology (IT), such as clinical decision support systems (CDSS), in nursing practice.

BACKGROUND

IT implementation in health care is increasing; however, substantial costs and risks remain associated with these projects.

EVALUATION

The theoretical framework of Novice-to-Expert Nursing Practice was applied to current design and implementation literature for CDSS.

KEY ISSUES

Organizational policies and CDSS design affect implementation and user adoption.

CONCLUSIONS

Nursing CDSS can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators can positively influence CDSS function and end-user acceptance by participating in and facilitating staff nurse involvement in IT design, planning and implementation. Specific steps for nurse administrators and managers are included in this paper.

Clinical decision support systems in nursing: synthesis of the science for evidence-based practice

The aim of this article is to present a synthesis of the research literature on the state of nursing science regarding the development, use, and application of clinical decision support systems for the implementation of evidence-based practice in nursing. The authors sought to answer three specific questions in this metasynthesis: (1) What progress has nursing science made regarding the development and use of clinical decision support systems?; (2) What research methods and theoretical models are being applied by nurse researchers in this area?; and (3)Are there evidence-adaptive clinical decision support systems designed specifically to aid nurses' decisions related to evidence-based practice? Of 183 articles, 17 were included in the final analysis, and six were specific for clinical decision support systems to aid nurses in evidence-based practice. Implications for practice are considered, and recommendations for future research are made.

Recruitment of oncology nurses for Internet research: issues and future directions

PURPOSE/OBJECTIVES

To provide future directions for Internet research based on issues raised during the recruitment process of an Internet survey of oncology nurses.

DATA SOURCES

Throughout the research process, the research staff recorded issues as they arose and wrote memos regarding recruitment issues and possible reasons for the issues. Weekly group discussions were conducted, and written records of the discussions were kept. The written memos and records were reviewed, and the content was analyzed.

DATA SYNTHESIS

The recruitment issues included flexibility required, mutual trust, changing Internet dynamics, and potential selection bias.

CONCLUSIONS

As the issues indicated, recruiting nurses for the study only through the Internet did not work well.

IMPLICATIONS FOR NURSING

For future Internet research, the authors suggest using multiple Internet and real settings for recruitment, a variety of strategies, the quota sampling method, and creative motivation strategies.

[Use of Internet resources in nursing: a review]

Resources of Internet system are widely popularized in most of all human activities in the society. This paper aims to identify and to describe major modalities of Internet utilization in nursing areas of Education, Care, and Research. This is a bibliographic review which data source was MEDLINE database, using pertinent descriptors for the focused areas. From referred publications, it was selected 63 articles. Major utilization in Education area is the development of applications to promote distance education; in Patient Education area is the development of applications to make health information available; in Care area are the applications to make care protocols available to promote evidence-based practice, and in Research area is online data collection. It was concluded that nursing is using Internet resources in a satisfactory way, and it has contributed for the profession evolution.

Evaluation of the decision support computer program for cancer pain management

PURPOSE/OBJECTIVES

To evaluate a decision support computer program (DSCP) for cancer pain management.

DESIGN

An Internet intervention study to evaluate the usage profile, accuracy, and acceptance of the DSCP.

SETTING

Internet and community settings.

SAMPLE

122 nurses working with patients with cancer were recruited through the Internet through a convenience sampling method.

METHODS

The instruments included tools for registration and for evaluation of the DSCP. To evaluate the DSCP, the usage profile was measured by counting the total number of cases in which the participants used the DSCP; accuracy was measured by determining whether the decision support from the DSCP was appropriate and accurate; and acceptance was measured using the Questionnaire for User Interaction Satisfaction.

MAIN RESEARCH VARIABLES

Usage profile, accuracy, and acceptance of the DSCP.

FINDINGS

Participants used the DSCP an average of 1.49 times per person (SD = 1.16). Eighty-eight percent of the participants evaluated the DSCP as appropriate and accurate. The mean scores of overall satisfaction in four major areas of the computer program ranged from 7.46-9.69.

CONCLUSIONS

The DSCP could provide accurate and acceptable computerized evidence-based practice guidelines for cancer pain management.

IMPLICATIONS FOR NURSING

The findings suggest that researchers should develop decision support systems in multiple aspects and dimensions of cancer pain experience and that hand-held devices would increase the usability of the DSCP.

Nurses' acceptance of the decision support computer program for cancer pain management

This article describes nurses' acceptance of a decision support computer program for cancer pain management and explores the relationships between the nurses' acceptance and their sociodemographic characteristics. A feminist perspective was used as a theoretical guide for the research process. This was an Internet intervention study among 122 nurses working with cancer patients. Nurses' acceptance of the decision support computer program was measured using the Questionnaire for User Interaction Satisfaction. The data were analyzed using descriptive and inferential statistics, including analysis of variance and correlation analyses. There were significant differences in the total scores of user satisfaction by sex, religion, ethnicity, job title, and specialty. The results suggest that nurses do welcome decision support systems and that nurses' sociodemographic and professional characteristics should be considered in the development of decision support systems.

Recruitment of research participants through the Internet

Despite an increasing amount of Internet research, issues in recruitment for studies in this environment rarely have been discussed. The purpose of this article is to provide some future directions for participant recruitment via the Internet, based on the experiences of recruiting participants for three Internet survey studies. The issues in the recruitment process include those related to low response rates, selected groups of participants, the importance of timing, and potential ethical issues. Based on the discussion of the issues, the following suggestions are proposed for future recruitment through the Internet: use of creative motivation strategies; sensitivity to the gender, ethnicity, and socioeconomic status of potential participants; consideration of the timing of data collection; and sensitivity to potential ethical issues.

Issues in Internet Survey Research Among Cancer Patients

Considering the increasing number of cancer patients who are online, it is clear that the Internet will provide an important research medium and/or setting for oncology nurses in the near future. Despite increasing Internet usage in nursing research and practice, issues in using the Internet among cancer patients as a research tool have rarely been explored and discussed. The purpose of the article is to propose future directions for Internet research among cancer patients based on discussions of practical issues raised in an Internet survey study among 40 online cancer patients. The issues raised through the research process include (a) ethical issues, (b) recruitment issues, (c) issues in Web site development and maintenance, and (d) data entry and analysis issues. On the basis of the discussions of these issues, some future directions for Internet survey studies are proposed, including dealing with ethical issues, getting computer expertise, using motivational strategies, and using national and international approaches.