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Hulett JM, Spotts RA, Narkthong N, Scott SD. Massage therapy for hospital-based nurses: A proof-of-concept study. Complement Ther Clin Pract 2024; 55:101846. [PMID: 38484434 DOI: 10.1016/j.ctcp.2024.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Jennifer M Hulett
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA; Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA.
| | - Ruth Anne Spotts
- Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA
| | - Natsayakarn Narkthong
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA; Prince of Songkla University, Songkhla, Thailand
| | - Susan D Scott
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA; University of Missouri Health Care, Columbia, MO, USA
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Sperling EL, Hulett JM, Sherwin LB, Thompson S, Bettencourt BA. The effect of mindfulness interventions on stress in medical students: A systematic review and meta-analysis. PLoS One 2023; 18:e0286387. [PMID: 37796866 PMCID: PMC10553303 DOI: 10.1371/journal.pone.0286387] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/16/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Medical students have high levels of stress, which is associated with higher incidents of burnout, depression, and suicide compared to age-matched peers. Mindfulness practices have been shown to reduce stress among medical students. PURPOSE The purpose of this systematic review and meta-analysis was to examine if mindfulness interventions have an overall effect on stress outcomes in the high-stress population of medical students globally, particularly given the wide variety of interventions. Any intervention designed to promote mindfulness was included. METHODS A comprehensive literature search was completed to include multiple databases, ancestry, and hand-searching and 35 studies were included. Standardized mean difference effect sizes (ES) were synthesized across studies using a random-effects model for changes in stress levels in medical students ≥ 18. Moderator analyses were performed to explore variations in effects by participant and intervention characteristics. RESULTS Mindfulness interventions significantly improved stress among medical students in both the two-arm studies (d = 0.370, k = 19, n = 2,199, 95% CI 0.239-0.501, p < .001) and one-arm pre-post studies (d = 0.291, k = 30, n = 18 (two cohorts from Dyrbye et al), 95% CI 0.127-0.455, p = 0.001). Moderator analyses found trends in less hours and less required practice resulted in better improvement in stress. CONCLUSIONS This study further confirms that despite a wide variety of mindfulness interventions for medical students around the world, they produce an overall small-to-moderate effect on stress reduction. Future research looking at the most effective protocols for high-stress medical students would be beneficial.
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Affiliation(s)
- Edie L. Sperling
- Medical Anatomical Sciences, College of Osteopathic Medicine of the Pacific–Northwest, Western University of Health Sciences, Lebanon, Oregon, United States of America
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, United States of America
| | - Jennifer M. Hulett
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, United States of America
- Ellis Fischel Cancer Center, University of Missouri, Columbia, Missouri, United States of America
| | - LeeAnne B. Sherwin
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, United States of America
| | - Sarah Thompson
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, United States of America
| | - B. Ann Bettencourt
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States of America
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Sperling EL, Hulett JM, Sherwin LB, Thompson S, Bettencourt BA. Prevalence, characteristics and measurement of somatic symptoms related to mental health in medical students: a scoping review. Ann Med 2023; 55:2242781. [PMID: 37552776 PMCID: PMC10411307 DOI: 10.1080/07853890.2023.2242781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Somatic symptoms related to mental health in medical students are under-researched, with nothing on the topic being published in the United States in over three decades. This scoping review is the first of its kind to explore the prevalence, type and severity of somatic symptoms induced by stress, anxiety, depression and burnout amongst medical students, with the objective of describing the significance and breadth of this issue. METHODS PRISMA-ScR guidelines were used to guide this review. A comprehensive search was performed of 22 databases, followed by bibliographic and hand searching. Inclusion criteria were published, peer-reviewed articles with a sample of medical students and at least one measure of somatic symptoms related to mental health, in English or with an English-language translation. Excluded were review, companion and editorial articles. Coding was done by an experienced coder trained in systematic review techniques. Two authors reviewed each article. RESULTS Twenty-nine articles met inclusion criteria, representing 16 countries, 31 schools/teaching hospitals and 9,887 medical students. The prevalence of somatic symptoms ranged from 5.7 to 80.1%, and somatic symptoms were overwhelmingly found to be significantly correlated with mental ill-health. Somatic symptoms included back pain, neck pain, headaches, sleep disturbances and functional gastrointestinal disorders. Eleven different outcome measures were used, with varying degrees of validity and reliability, which were compared and assessed. CONCLUSIONS Somatic symptoms appear strongly correlated with mental ill-health in medical students, and are likely highly prevalent. This review highlights the need for further research on somatic symptoms of mental ill-health in medical students, particularly in the United States, and the addition of larger, multi-institutional cohorts to expand our understanding of prevalence, incidence and inciting factors of somatic symptoms. Longitudinal studies tracking somatic symptoms' effect on career trajectory and professional burnout levels are also needed. Finally, future research should explore interventions for reducing physical symptom burden in medical students.
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Affiliation(s)
- Edie L. Sperling
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
- College of Osteopathic Medicine of the Pacific-Northwest, Western University of Health Sciences, Lebanon, OR, USA
| | - Jennifer M. Hulett
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
- Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA
| | | | - Sarah Thompson
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Hulett JM, Mele C, Kim J, Narkthong N, Schomberg T, Greaves J, Bormann JE, Heiney SP. Acceptability of the Mantram Repetition Program to Reduce Stress in Adolescent Survivors of Pediatric Cancer or Brain Tumors. J Adolesc Young Adult Oncol 2022; 12:275-279. [PMID: 35749707 DOI: 10.1089/jayao.2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A mixed-methods approach was used to explore the acceptability of the Mantram Repetition Program (MRP) to reduce stress in adolescents with a history of pediatric cancer or brain tumor. Five male participants diagnosed at ages 1-14 years and currently, ages 13-18 years, completed assessments of stress, anxiety, and sleep disturbance and were interviewed about the acceptability of a mantram repetition intervention. Adolescent survivors reported low to moderate levels of stress, anxiety, and sleep disturbance. Data indicate that the MRP is acceptable among adolescent survivors of pediatric cancer and brain tumors, and face-to-face intervention delivery is preferred.
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Affiliation(s)
- Jennifer M Hulett
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Cheryl Mele
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jeongsuk Kim
- School of Social Work, University of South Florida, Sarasota, Florida, USA
| | | | - Takara Schomberg
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Jenna Greaves
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Jill E Bormann
- Beyster Institute of Nursing Research, Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, USA
| | - Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
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Hulett JM, Johnstone B, Millspaugh RJ, Millspaugh JJ. Personality and Spirituality as Predictors of Mental Health and Salivary Alpha-Amylase Activity in Breast Cancer Survivors. Oncol Nurs Forum 2022; 49:307-314. [PMID: 35788735 DOI: 10.1188/22.onf.307-314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine the relative predictive validity of personality and spirituality for mental health and salivary alpha-amylase (sAA) in breast cancer (BC) survivors. SAMPLE & SETTING 23 BC survivors participated in a single-group, cross-sectional study. METHODS & VARIABLES Predictor variables included personality and spiritual variables. Outcome variables included subjective physical and mental health outcomes and sAA, a neuroimmune biomarker. RESULTS Hierarchical regressions indicated that (a) conscientiousness and forgiveness independently predict 38% and 11% of variance in mental health scores, respectively; and (b) conscientiousness and forgiveness independently predict 15% and 24% of the variance in sAA, respectively. Consistent with psychoneuroimmunology theory, personality and spiritual variables independently influence subjective mental health and neuroimmune activity in BC survivors. IMPLICATIONS FOR NURSING Nurses should be aware of BC survivors' personality characteristics and spiritual dispositions so that distinct interventions can be offered to promote mental health and reduce stress-related neuroimmune inflammation.
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Hulett JM, Fessele KL, Clayton MF, Eaton LH. Rigor and Reproducibility: A Systematic Review of Salivary Cortisol Sampling and Reporting Parameters Used in Cancer Survivorship Research. Biol Res Nurs 2019; 21:318-334. [PMID: 30857393 DOI: 10.1177/1099800419835321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Salivary cortisol is a commonly used biomarker in cancer survivorship research; however, variations in sampling protocols and parameter reporting limit comparisons across studies. Standardized practices to provide rigor and reproducibility of diurnal salivary cortisol sampling and reporting are not well established. Previous systematic reviews examining relationships between diurnal salivary cortisol and clinical outcomes have resulted in mixed findings. It remains unclear which sampling protocols and reporting parameters offer the greatest utility for clinical research. This review examines diurnal salivary cortisol sampling protocols and reporting parameters to evaluate whether a standardized approach is recommended. A comprehensive search of intervention studies among adult cancer survivors including diurnal salivary cortisol resulted in 30 articles for review. Sampling protocols ranged from 1 to 4 days with the majority of studies sampling cortisol for 2 days. Sampling instances ranged from 2 to 7 times per day, with the majority collecting at 4 time points per day. Diurnal cortisol slope and cortisol awakening response (CAR) were the most commonly reported parameters associated with clinical outcomes. Flattened cortisol slopes, blunted CARs, and elevated evening cortisol concentrations were associated with poorer psychosocial and physiological outcomes. Based on our review, we propose that a rigorous, standardized diurnal salivary cortisol sampling protocol should include sampling at key diurnal times across ≥3 consecutive days to report diurnal cortisol parameters (i.e., CAR and slope) and objective measures of participant protocol adherence. Diminishing budgetary resources and efforts to minimize participant burden dictate the importance of standardized cortisol sampling protocols and reporting parameters.
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Affiliation(s)
- Jennifer M Hulett
- 1 College of Nursing, University of South Carolina, Columbia, SC, USA
| | | | | | - Linda H Eaton
- 4 School of Nursing & Health Studies, University of Washington, Bothell, Bothell, WA, USA
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Heiney SP, Parker PD, Felder TM, Adams SA, Omofuma OO, Hulett JM. A systematic review of interventions to improve adherence to endocrine therapy. Breast Cancer Res Treat 2018. [PMID: 30387003 DOI: 10.1007/s10549-018-5012-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Adherence to endocrine therapy for hormone positive breast cancer is a significant problem, especially in minority populations. Further, endocrine therapy reduces recurrence and thus mortality. However, little data are available on interventions to improve adherence. The authors conducted a systematic review to examine the impact of interventions, strategies, or approaches aimed to improve endocrine therapy adherence among women with breast cancer. A secondary aim was to determine if interventions had any cultural modifications. METHODS Two of the authors examined articles published between 2006 and 2017 from a wide variety of databases using Covidence systematic review platform. RESULTS In total, 16 eligible studies met criteria for review including 4 randomized controlled trials, 4 retrospective studies, and 8 with various observational designs. Eligible studies used a broad range of definitions for adherence and measured adherence by self-report, medical records, claims data, and combinations of these. All used 80% medication possession ratio as a standard for adherence. Patient information/education was the most frequent intervention strategy but did not demonstrate a significant effect except in one study. Significant results were noted when education was combined with communication strategies. CONCLUSIONS Researchers need a standard definition for adherence and a reliable measure that is feasible to use in a variety of studies. While education may be a necessary component of an intervention, when used alone, it is not a sufficient approach to change behavior.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, School of Medicine, University of South Carolina, 1601 Greene St, Columbia, 29208, SC, USA.
| | | | - Tisha M Felder
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Swann Arp Adams
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Omonefe O Omofuma
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Heiney SP, Parker PD, Felder TM, Adams SA, Omofuma OO, Hulett JM. A systematic review of interventions to improve adherence to endocrine therapy. Breast Cancer Res Treat 2018; 173:499-510. [PMID: 30387003 DOI: 10.1007/s10549-018-5012-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/15/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Adherence to endocrine therapy for hormone positive breast cancer is a significant problem, especially in minority populations. Further, endocrine therapy reduces recurrence and thus mortality. However, little data are available on interventions to improve adherence. The authors conducted a systematic review to examine the impact of interventions, strategies, or approaches aimed to improve endocrine therapy adherence among women with breast cancer. A secondary aim was to determine if interventions had any cultural modifications. METHODS Two of the authors examined articles published between 2006 and 2017 from a wide variety of databases using Covidence systematic review platform. RESULTS In total, 16 eligible studies met criteria for review including 4 randomized controlled trials, 4 retrospective studies, and 8 with various observational designs. Eligible studies used a broad range of definitions for adherence and measured adherence by self-report, medical records, claims data, and combinations of these. All used 80% medication possession ratio as a standard for adherence. Patient information/education was the most frequent intervention strategy but did not demonstrate a significant effect except in one study. Significant results were noted when education was combined with communication strategies. CONCLUSIONS Researchers need a standard definition for adherence and a reliable measure that is feasible to use in a variety of studies. While education may be a necessary component of an intervention, when used alone, it is not a sufficient approach to change behavior.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, School of Medicine, University of South Carolina, 1601 Greene St, Columbia, 29208, SC, USA.
| | | | - Tisha M Felder
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Swann Arp Adams
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Omonefe O Omofuma
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Reblin M, Clayton MF, Xu J, Hulett JM, Latimer S, Donaldson GW, Ellington L. Caregiver, patient, and nurse visit communication patterns in cancer home hospice. Psychooncology 2017; 26:2285-2293. [PMID: 28029712 PMCID: PMC5489378 DOI: 10.1002/pon.4361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/15/2016] [Accepted: 12/23/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies have examined the triadic communication between patients, spouse caregivers, and nurses in the home hospice setting. Thus, little is known about the types of communication patterns that unfold. The goals of the study were to, first, identify common patterns of communication in nurse-patient-caregiver home hospice visits and, second, to identify nurse, caregiver-patient dyad, and visit characteristics that predict visit communication patterns. METHOD Nurses (N = 58) and hospice cancer patient and spouse caregiver dyads (N = 101; 202 individuals) were recruited from 10 hospice agencies. Nurses audio recorded visits to patient/caregiver homes from study enrollment until patient death. All patient, caregiver, and nurse utterances from the audio recordings were coded using an adapted Roter interaction analysis system. Using identified codes, cluster analysis was conducted to identify communication patterns within hospice visits. Logistic regression was used with demographic variables to predict visit communication patterns. RESULTS Six visit communication patterns were identified and were defined largely by 2 dimensions: (1) either the patient, the caregiver, or the patient and caregiver dyad interacting with the nurse and (2) the relatively high or low expression of distress during the visit. Time until death significantly predicted several clusters. CONCLUSION This study leads the way in outlining triadic communication patterns in cancer home hospice visits. Our findings have implications for nursing education, letting future nurses know what to expect, and lays the foundation for future research to determine effectiveness and interventions to improve health care communication.
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Affiliation(s)
- Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center,
Tampa, FL, USA
| | | | - Jiayun Xu
- College of Nursing, University of Utah, Salt Lake City, UT,
USA
| | | | - Seth Latimer
- College of Nursing, University of Utah, Salt Lake City, UT,
USA
| | - Gary W. Donaldson
- Pain Research Center, Department of Anesthesiology, University of
Utah, Salt Lake City, UT, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT,
USA
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Hulett JM, Armer JM. A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship. Integr Cancer Ther 2016; 15:405-423. [PMID: 27151592 PMCID: PMC5125023 DOI: 10.1177/1534735416636222] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 11/17/2022] Open
Abstract
Objective This is a review of spiritually based interventions (eg, mindfulness-based stress reduction) that utilized psychoneuroimmunological (PNI) outcome measures in breast cancer survivors. Specifically, this review sought to examine the evidence regarding relationships between spiritually based interventions, psychosocial-spiritual outcomes, and biomarker outcomes in breast cancer survivors. Methods A systematic search of 9 online databases was conducted for articles of original research, peer-reviewed, randomized and nonrandomized control trials from 2005-2015. Data were extracted in order to answer selected questions regarding relationships between psychosocial-spiritual and physiological measures utilized in spiritually based interventions. Implications for future spiritually based interventions in breast cancer survivorship are discussed. Results Twenty-two articles were reviewed. Cortisol was the most common PNI biomarker outcome studied. Compared with control groups, intervention groups demonstrated positive mental health outcomes and improved or stable neuroendocrine-immune profiles, although limitations exist. Design methods have improved with regard to increased use of comparison groups compared with previous reviews. There are few spiritually based interventions that specifically measure religious or spiritual constructs. Similarly, there are few existing studies that utilize standardized religious or spiritual measures with PNI outcome measures. Findings suggest that a body of knowledge now exists in support of interventions with mindfulness-breathing-stretching components; furthermore, these interventions appear to offer potential improvement or stabilization of neuroendocrine-immune activity in breast cancer survivors compared to control groups. Conclusion From a PNI perspective, future spiritually based interventions should include standardized measures of religiousness and spirituality in order to understand relationships between and among religiousness, spirituality, and neuroendocrine-immune outcomes. Future research should now focus on determining the minimum dose and duration needed to improve or stabilize neuroendocrine-immune function, as well as diverse setting needs, including home-based practice for survivors who are too ill to travel to group sessions or lack economic resources.
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Armer JM, Hulett JM, Bernas M, Ostby P, Stewart BR, Cormier JN. Best Practice Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-Breast Cancer Lymphedema. Curr Breast Cancer Rep 2013; 5:134-144. [PMID: 26246870 DOI: 10.1007/s12609-013-0105-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Breast cancer-related lymphedema (LE) is a progressive, chronic disease that affects millions of cancer survivors and primarily results from surgical lymphatic vessel/node removal and radiation therapy. Patient education and support for importance of early detection is essential in helping health care providers detect lymphedema early, when there is the best chance to prevent progression. Improved imaging and surgical techniques have decreased the incidence of LE; however, effective risk-reduction and treatment have historically lacked the level of evidence necessary to standardize effective treatment. The purpose of this article is to report an extensive review of literature, including highlighted multidisciplinary studies within the past three years, in order to update best practice guidelines in assessment, risk reduction, management, and surveillance for post-breast cancer lymphedema.
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Affiliation(s)
- Jane M Armer
- Sinclair School of Nursing Director, Nursing Research, Ellis Fischel Cancer Center Director, American Lymphedema Framework Project DC 116.05 Suite 415 EFCC University of Missouri-Columbia Columbia, MO 62011
| | | | | | - Pam Ostby
- Sinclair School of Nursing University of Missouri-Columbia
| | - Bob R Stewart
- College of Education and Sinclair School of Nursing University of Missouri-Columbia
| | - Janice N Cormier
- Departments of Surgical Oncology and Biostatistics The University of Texas MD Anderson Cancer Center Houston, TX
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