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Galaznik A, Trask P, Dudley W. Assessment of early and late symptom toxicity in a real-world cancer treatment population using the PRO-CTCAE. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18663 Background: The FDA’s Draft Guidance for Core Patient-Reported Outcomes (PROs) in Cancer Clinical Trials, recommends assessment of disease-related symptoms, symptomatic adverse events, overall side effect impact, physical function, and role function. This guidance also recommends that core PROs be assessed more frequently within the first few treatment cycles. The NCI’s PRO Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is a system to evaluate symptomatic toxicity. The objective of this study is to assess the utility of frequent assessment early in treatment, using PRO-CTCAE measures for symptom monitoring. Methods: The patient cohort (n = 248) was derived from users of PROmpt®, an application for remote patient reporting and provider symptom management, employed in routine care in 30+ integrated cancer treatment centers. Patients were enrolled (9/20-10/21) at treatment initiation. Baseline characteristics were assessed by survey and review of patient EMR records. PRO-CTCAE derived surveys of 14 core symptoms (pain, shortness-of-breath, nausea, diarrhea, sadness, anxiety, constipation, fever, neuropathy, insomnia, urinary problems, decreased appetite, fatigue and mouth sores) were administered weekly. Patients who completed surveys in weeks 1 – 3 AND weeks 9 – 11 were selected for analysis (n = 75), with weekly incidences calculated for these windows. Differences were tested using dependent measures T-test. Exploratory analysis of differences by gender, frailty status, and tumor type were also performed. Results: Overall cohort was predominantly female (86.7%), with mean age 59.6 yrs. Subjects with baseline multi-dimensional geriatric assessments (MGA), were 73% fit, 24.3% intermediate and 2.7% frail. The majority of symptoms (11 of 14) showed directional decline over time, with 6 trending towards significance (p < / = 0.10). Increases, however, were statistically significant for neuropathy(p = 0.01) and directional for shortness-of-breath (p = 0.10) and mouth sores (p = 0.32). Conclusions: Findings support recommendations for frequent, early assessment, with weekly surveys showing higher symptom incidence for most items compared with later assessment. Observation of late symptom increases support continued, regular monitoring for timely management of emerging symptoms with continued treatment.
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Galaznik A, Dudley W, Coombs N. Recurring event survival analyses: A methodological approach to model recurring event data in cancer patients receiving multiple lines of therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18693 Background: In cancer treatment, patients often receive multiple rounds of treatment, or Lines of Therapy (LoT). The time between start of a LOT and change to a new LOT is an important outcome in clinical oncology, for understanding disease progression and anticipating response to further treatment. Research questions may focus on the associations between duration of an LOT (the dependent variable) and independent variables of interest, such as time-invariant demographic (gender, age, race) and clinical factors (comorbidities, stage of disease) as well as time-varying factors such as Patient Reported Outcomes (PRO’s), resource utilization, and adverse events. These associations can be tested empirically with traditional “survival analyses”, more generally known as time-to-event when there is a single event (such as 5-year survival). The analyses, however, may become more complex when patients experience more than one LOT. This is due to the possibility that the Time-to-Events may be correlated within an individual patient, similarly to how outcome variables are correlated in other repeated measures designs. If this correlation is not captured in the modeling, the validity of parameters estimates may be in doubt. Thus, it is important to analyze the data using methods which account for the within-person correlation among LOT durations through the use of “Recurring Event” survival analyses. Methods: This methodological presentation will report an example of a real world “Recurring Event” analysis in a study of Multiple Myeloma patients who received one or more than one LOT. The study data set was derived from users of PROmpt®, an application for remote patient reporting and provider symptom management. Patient characteristics and treatment history were assessed by survey and review of patient EMR records. 80 patients were identified, with a treatment history of receiving between 1 and 19 LOT’s (mean = 5.2). Time invariant predictors are age, gender, and frailty (employing the Modified Geriatric Assessment). Time varying variables are the incidence of hematological and non-hematological toxicities. Results: The presentation will provide: an overview of how to interpret the model parameters, a discussion of the data structure required by the modeling, and a series of results in which LOT durations are analyzed as first independent and then when modeled as a “Recurring Event” analysis. The results are examined across different modeling strategies to illustrate a model testing approach, as well as to quantitatively demonstrate the impact on survival analysis results when incorporating “recurring event” methodology. Conclusions: The intent of the presentation is to alert researchers to the need to analyze Time-To-Event models using a recurring event framework when patients experience recurring events in order to produce valid and generalizable parameters.
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Wujcik D, Papadantonakis N, Wall SA, Kasner MT, JAMY OMERHASSAN, Dudley W, Ingram SA, Lawhon V, Son UI, Dudley M. Integrating touchscreen-based geriatric assessment and frailty screening for adults with acute myelogenous leukemia to drive personalized treatment decisions. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24030 Background: AML is a disease of older adults, with median age of 68 years at presentation. NCCN guidelines suggest comprehensive geriatric assessments (GA) be included in clinical practice to guide treatment decisions. Utility of GA in older AML patients in a real-world environment is not yet established. We tested the feasibility of using a modified GA (mGA), administered by patient self-report on a touchscreen computer, real-time use and utility by clinicians and the correlation of mGA results on treatment decision-making. Methods: Sixty-two patients were recruited from three sites to complete a tablet-based mGA screening at a treatment decision-making time point. The mGA consists of the Frailty Index (FI) that includes four domains: age, activities of daily living, instrumental ADLs, and comorbidities. Falls within the past 6 months and patient reported health interference with function are also assessed. Results are displayed for the clinician to inform the treatment discussion. Results: Participants were mean age 73 years (range 61-88), 63% male, and 90% white. Frailty Index result was 32% fit, 40% intermediate, and 28% frail. Providers were asked the fit/frailty status prior to seeing the results of the mGA. Of 53 provider responses, there was 57% (n=30) provider concordance with the mGA result; 9% (n=5) said fit when mGA said intermediate and 17% (n=9) said intermediate when mGA said frail. When asked their goals of care, nearly all (n=60, 97%) patients agreed with the statement “my cancer is curable”, yet 30% (n=19) disagreed the treatment goal was to get rid of all the cancer. Nearly half (n=30) indicated they want to make treatment decisions together with the provider rather than provider or patient making decision alone. 73% (45/62) of patients were satisfied with the ease of using the survey and took an average 16.3 minutes to complete. Patient self-reported presence/severity of eight symptoms at baseline (see Table). Conclusions: A simple electronic tool may provide valuable insight into patient understanding of disease to better tailor patient-provider discussion and treatment decision-making. Providers overestimated fitness 26% of the time. Final results will be presented to include the outcome at 3 months by Frailty Index. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - UI Son
- Ohio State University, Columbus, OH
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Wujcik D, Mehta AN, Corona R, Cook F, Dudley M, Dudley W. Use of a patient-preferences shared-decision-making encounter tool in clinical practice for patients with non-Hodgkin’s lymphoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24192 Background: Non-Hodgkin lymphoma (NHL) is the fourth leading cause of cancer in the United States with 77,240 new cases and 19,940 deaths annually. Treatment options are numerous and driven by patient’s molecular profile, risk, preferences/goals, and ability to tolerate treatment. Aligning physician-patient goals of care and integrating patient preferences into a shared-decision making (SDM) model allows patients and providers to select treatment consistent with medical science and personalized to each patient. This project evaluates feasibility of a patient preferences (PP) SDM encounter tool using technology to facilitate SDM at treatment decision (TD) for patients with NHL. Methods: To date, 45 patients with NHL at a TD making point were recruited from two sites to complete a tablet-based PPSDM encounter tool. The tool includes questions about needs, decision making preferences, values and goals of care. Results are reviewed by the provider and used to facilitate SDM in treatment selection during the clinical encounter. Patients also completed measures to assess satisfaction with the TD, patient activation, and perceived achievement of desired role in SDM at 3 weeks and 3 months post TD. Results: Participants are mean age 66 years (range 23-86), 53% male, and 98% white. 47% (n = 45) preferred that their doctor share responsibility with them when deciding which treatment was best for them. 69% said they would like to make the TD together with family and close friends and 69% agreed that their spouse was the most important person in helping make a TD. 51% said spirituality did not play a part in their TD. When asked how they liked to get medical information, 67% said they wanted all the facts, but not the prognosis. 87% said they had identified a medical surrogate to make decisions, yet 31% had an advanced directive on file. 64% agreed their cancer was curable and 84% agreed that a treatment goal was to get rid of all cancer. 73% of providers used the PPSDM results in conversation with the patient and 53% indicated their patient management changed based on the PPSDM results. There was 24% concordance between patient and provider perception of how TD were made. Conclusions: Collecting patient preferences, values, and care goals prior to the clinical visit using technology is feasible in busy clinics. Although most providers used the PPSDM results and over half changed their management plan, there was low concordance between patient and provider perceptions. Final analysis will include 3 week and 3 month measures of patient activation and satisfaction.
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Affiliation(s)
| | | | | | - Felice Cook
- University of Alabama Birmingham, Birmingham, AL
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5
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Eifert EK, Dudley W, Eddy J, Perko M, Adams R. Preliminary Evidence for the Validity of the Family Caregiver Identity Scale. J Appl Gerontol 2020; 40:742-751. [PMID: 31893983 DOI: 10.1177/0733464819896573] [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: 11/15/2022] Open
Abstract
The purpose of this study was to develop and evaluate the Family Caregiver Identity Scale (FCIS), an instrument designed to measure the extent to which an individual identifies with the family caregiver role. The process of instrument development outlined in the Standards for Educational and Psychological Testing was combined with Dillman's four stages of pretesting. This was a multistage, iterative process, including several revisions based on feedback from experts, interviews, and pilot testing. Factor analyses were performed to test the hypothesized model of caregiver identity. A version of the FCIS consisting of 18 items was created and demonstrated initial evidence of validity. The FCIS will enable gerontological professionals to assess caregiver identity. The absence of caregiver identity is a factor in caregivers not accessing support services. This study contributes to the growing body of research connecting caregiver identity and support service utilization by caregivers.
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Affiliation(s)
| | | | - James Eddy
- The University of North Carolina at Greensboro, USA
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Nathwani N, Kurtin SE, Lipe B, Mohile SG, Catamero DD, Wujcik D, Birchard K, Davis A, Dudley W, Stricker CT, Wildes TM. Integrating Touchscreen-Based Geriatric Assessment and Frailty Screening for Adults With Multiple Myeloma to Drive Personalized Treatment Decisions. JCO Oncol Pract 2019; 16:e92-e99. [PMID: 31765266 DOI: 10.1200/jop.19.00208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Geriatric assessment (GA) results predict toxicity/survival in older adults, yet GA is not routinely used in care for patients with multiple myeloma (MM). We tested a tablet-based modified GA (mGA) providing real-time results to clinicians. METHODS One hundred sixty-five patients with MM aged ≥ 65 years facing a treatment decision from 4 sites completed a tablet-based mGA with Katz Activities of Daily Living (ADL), Lawton Instrumental ADL, Charlson Comorbidity Index, and variables from the Cancer and Aging Research Group's Chemotherapy Toxicity Calculator. Providers reviewed the assessment results at the treatment visit. RESULTS Patients were white (72%; n = 86), mean age was 72 years (range, 65-85 years), and averaged 7.71 minutes (range, 2-17 minutes) for survey completion. Providers averaged 3.2 minutes (range, 1-10 minutes) to review mGA results. Using International Myeloma Working Group frailty score, patients were fit (39%; n = 64), intermediate fit (33%; n = 55), or frail (28%; n = 46). Providers selected more aggressive treatments in 16.3% of patients and decreased treatment intensity in 34% of patients; treatment intensification was more common for fit patients and milder treatments for frail patients (χ2 = 20.02; P < .0001). Transplant eligibility significantly correlated with fit status and transplant ineligibility with frail status (P = .004). Outcomes on 144 patients 3 months post study visit showed 19.4% (n = 28) had grade ≥ 3 hematologic toxicities, 38.9% (n = 56) had dose modifications, and 18% (n = 26) had early therapy cessation. CONCLUSION Limited patient time required for survey completion and provider time for results review show mGA can be easily incorporated into clinical workflow. Real-time mGA results indicating fit/frailty status influenced treatment decisions.
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Affiliation(s)
- Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope National Medical Center, Duarte, CA
| | | | - Brea Lipe
- University of Rochester, Rochester, NY
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Irwin MM, Dudley W, Northouse L, Berry DL, Mallory GA. Oncology Nurses' Knowledge, Confidence, and Practice in Addressing Caregiver Strain and Burden. Oncol Nurs Forum 2019; 45:187-196. [PMID: 29466346 DOI: 10.1188/18.onf.187-196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/17/2022]
Abstract
OBJECTIVES To describe nurses' practices, confidence, and knowledge of evidence-based interventions for cancer caregiver strain and burden and to identify factors that contribute to these aspects.
. SAMPLE & SETTING 2,055 Oncology Nursing Society members completed an emailed survey.
. METHODS & VARIABLES Pooled analysis of survey results. Variables included the baseline nursing assessment, intervention, confidence, knowledge, strategies used, and barriers encountered.
. RESULTS Nurses tend to overestimate the strength of evidence for interventions not shown to be effective and have moderate confidence in assessing and intervening with caregivers. Having been an informal caregiver and having received care from an informal caregiver were associated with higher reported practice and confidence. Major strategies used were referral to social workers and others. Barriers reported were financial, caregiver emotional responses, and distance.
. IMPLICATIONS FOR NURSING An opportunity exists to increase nurses' knowledge and confidence in assessment and intervention with caregivers. Greater use of technology may help nurses overcome some barriers to working with caregivers. Findings can be used to plan continuing education, develop clinical processes, and identify resources nurses need to address strain and burden among informal caregivers.
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Brant J, Blaseg K, Aders K, Oliver D, Gray E, Dudley W. Navigating the Transition From Cancer Care to Primary Care: Assistance of a Survivorship Care Plan. Oncol Nurs Forum 2016; 43:710-719. [DOI: 10.1188/16.onf.710-719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kim HJ, Barsevick AM, Beck SL, Dudley W. Clinical subgroups of a psychoneurologic symptom cluster in women receiving treatment for breast cancer: a secondary analysis. Oncol Nurs Forum 2012; 39:E20-30. [PMID: 22201665 DOI: 10.1188/12.onf.e20-e30] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To investigate clinical subgroups using an empirically identified psychoneurologic symptom cluster (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) and to examine the differences among subgroups in the selected demographic and clinical variables, as well as in patient outcome (i.e., functional performance). DESIGN Secondary analysis. SETTING A university health science center in Salt Lake City, UT, and a National Cancer Institute-designated comprehensive cancer center in Philadelphia, PA. SAMPLE 282 patients with breast cancer undergoing chemotherapy or radiotherapy. METHODS Cluster analyses were conducted to identify subgroups. Multinomial logistic regression and one-way analyses of variance were used to examine the differences among subgroups. MAIN RESEARCH VARIABLES Depressed mood, cognitive disturbance, fatigue, insomnia, pain, and functional performance. FINDINGS Patients were classified into four distinct subgroups based on their symptom cluster experience: all low symptom, high fatigue and low pain, high pain, and all high symptom. Such patient classification patterns were consistent across the treatment trajectory, although group memberships were inconsistent. After initiating treatment, two additional subgroups emerged: high depressed mood and cognitive disturbance, and high fatigue and insomnia. Subgroups differed in physical performance status at baseline, symptom burden, and treatment modality in a relatively consistent pattern across time points. Patients in the all-high-symptom subgroup experienced the most serious limitations in activities across all time points. CONCLUSIONS Patient subgroups exist that share the unique experience of psychoneurologic symptoms. IMPLICATIONS FOR NURSING Findings are useful to determine who needs more intensive symptom management during cancer treatment. Future studies should examine whether specific symptom management strategies are more efficient for certain subgroups.
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Affiliation(s)
- Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul.
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Roter D, Erby L, Hall J, Larson S, Ellington L, Dudley W. Nonverbal sensitivity: consequences for learning and satisfaction in genetic counseling. Health Education 2008. [DOI: 10.1108/09654280810900017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ellington L, Matwin S, Jasti S, Williamson J, Crouch B, Caravati M, Dudley W. Poison control center communication and impact on patient adherence. Clin Toxicol (Phila) 2008; 46:105-9. [PMID: 18259957 DOI: 10.1080/15563650701338914] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This project explored the communication processes associated with poison control center calls. METHODS In this preliminary study, we adapted the Roter Interaction Analysis System to capture staff-caller dialogue. This involved case selection, wherein adherence and non-adherence cases were selected; call linkage to medical records, where case records were linked with voice recordings; and application of Roter Interaction Analysis System to calls. RESULTS Results indicate that communications are predominantly provider-driven. Patient age and percentage of staff partnership statements were significantly associated with adherence at the 0.05 level. Increases in age were associated with decreases in adherence to recommendations (p < 0.001). Increases in percentage of staff partnership statements (over all staff talk) were associated with increases in adherence (p = 0.013). CONCLUSION This line of research could lead to evidence-based guidelines for effective staff-caller communication, increased adherence rates, and improved health outcomes.
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Affiliation(s)
- Lee Ellington
- University of Utah, College of Nursing, Salt Lake City, UT 84112, USA.
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Diefenbach MA, Dudley W. USING GROWTH CURVE MODELING TO EXAMINE QUALITY OF LIFE AMONG PROSTATE CANCER SURVIVORS: RESULTS FROM A 36 MONTHS LONGITUDINAL STUDY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roter D, Ellington L, Erby LH, Larson S, Dudley W. The Genetic Counseling Video Project (GCVP): models of practice. Am J Med Genet C Semin Med Genet 2007; 142C:209-20. [PMID: 16941666 PMCID: PMC2766799 DOI: 10.1002/ajmg.c.30094] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Genetic counseling is conceptualized as having both "teaching" and "counseling" functions; however, little is known about how these functions are articulated in routine practice. This study addresses the question by documenting, on videotape, the practices of a national sample of prenatal and cancer genetic counselors (GCs) providing routine pre-test counseling to simulated clients (SCs). One hundred and seventy-seven GCs recruited at two annual conferences of the National Society of Genetic Counselors (NSGC) were randomly assigned to counsel one of six female SCs of varying ethnicity, with or without a spouse, in their specialty. One hundred and fifty-two videotapes were coded with the Roter Interaction Analysis System (RIAS) and both GCs and SCs completed evaluative questionnaires. Two teaching and two counseling patterns of practice emerged from cluster analysis. The teaching patterns included: (1) clinical teaching (31%) characterized by low psychosocial, emotional and facilitative talk, high levels of clinical exchange, and high verbal dominance; and (2) psycho-educational teaching (27%) characterized by high levels of both clinical and psychosocial exchange, low levels of emotional and facilitative talk, and higher verbal dominance. The counseling patterns included: (1) supportive counseling (33%) characterized by low psychosocial and clinical exchange, high levels of emotional and facilitative talk, and low verbal dominance; and (2) psychosocial counseling (9%) with high emotional and facilitative talk, low clinical and high psychosocial exchange, and the lowest verbal dominance. SCs ratings of satisfaction with communication, the counselor's affective demeanor, and the counselor's use of non-verbal skills were highest for the counseling model sessions. Both the teaching and counseling models seem to be represented in routine practice and predict variation in client satisfaction, affective demeanor, and nonverbal effectiveness.
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Affiliation(s)
- D Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
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Ellington L, Baty BJ, McDonald J, Venne V, Musters A, Roter D, Dudley W, Croyle RT. Exploring genetic counseling communication patterns: the role of teaching and counseling approaches. J Genet Couns 2006; 15:179-89. [PMID: 16770706 DOI: 10.1007/s10897-005-9011-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [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] [Indexed: 10/24/2022]
Abstract
The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.
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Affiliation(s)
- Lee Ellington
- University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, Utah 84112, USA.
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16
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Poynton M, Jasti S, Ellington L, Dudley W, Crouch B, Caravati M, Williamson J. Matching waveform audio files with toxicall data: Record linkage in a poison control center. Stud Health Technol Inform 2006; 122:849. [PMID: 17102421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Analysis of coded communications and electronic patient record data present a unique opportunity for nursing knowledge discovery, the integration of communication content with clinical data. However, joint analysis of coded communications and clinical data depends on the ability to link waveform audio files with patient records. A procedure has been developed to link waveform audio files with Toxicall patient records, using date/time stamps and station identification numbers.
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Affiliation(s)
- Mollie Poynton
- Informatics Faculty, College of Nursing, University of Utah, Salt Lake City, Utah 84112-5880, USA.
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Barsevick AM, Dudley W, Beck S, Sweeney C, Whitmer K, Nail L. A randomized clinical trial of energy conservation for patients with cancer-related fatigue. Cancer 2004; 100:1302-10. [PMID: 15022300 DOI: 10.1002/cncr.20111] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.1] [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] [Indexed: 01/27/2023]
Abstract
BACKGROUND The efficacy of energy conservation and activity management (ECAM) for fatigue reduction and maintenance of functional performance has never been evaluated in adults with cancer who are undergoing treatment. METHODS A randomized clinical trial compared an ECAM intervention with a control intervention focused on nutrition. Individuals initiating chemotherapy, radiotherapy, or concurrent therapy for cancer were randomized to receive either the semistructured ECAM intervention (n = 200) or the control intervention (n = 196). Participants in each group participated in 3 telephone sessions with an oncology nurse during the first 5 weeks of treatment. Data on fatigue and limitation of functioning were obtained before cancer treatment and at two follow-up points that coincided with times of high fatigue for each type of treatment. The outcomes of interest included perception of fatigue and functional performance. RESULTS A repeated-measures analysis of covariance using the type of cancer treatment as a covariate revealed a significant study group-by-time interaction indicating that the ECAM group experienced a greater decrease in fatigue over time compared with the control group (F(2,544) = 4.5; P = 0.01). The intervention was not associated with changes in overall functional performance. CONCLUSIONS Individuals who received the ECAM intervention derived a modest but significant benefit from it. To achieve a more robust clinical benefit from the intervention, it may be necessary to manage other key symptoms in addition to fatigue. Research is needed to examine symptom clusters or combinations associated with negative outcomes as well as combination strategies for symptom management.
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Affiliation(s)
- Andrea M Barsevick
- Nursing Research Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111-2497, USA.
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Abstract
This report summarizes findings related to the psychometric properties (internal consistency and construct validity) of the Pittsburgh Sleep Quality Index (PSQI) and discusses issues related to its use based on data from two clinical studies with diverse samples of cancer patients. Subjects completed a questionnaire that included the PSQI, the Schwartz Cancer Fatigue Scale, and specific demographic, disease, and treatment variables. There were complete data on 170 (of 214) cases in Study 1 and 249 (of 259) cases in Study 2. The Cronbach's alpha for the Global Sleep Quality scale was 0.81 in Study 1 and 0.77 in Study 2 A comparison of Global Sleep Quality in two contrasting groups with low and high fatigue yielded statistically significant differences in both samples. Psychometric evaluation supports its internal consistency reliability and construct validity. However, the scoring is rather cumbersome and raises questions regarding level of measurement and appropriate analysis techniques.
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Affiliation(s)
- Susan L Beck
- University of Utah College of Nursing, Salt Lake City, Utah 84112-5880, USA
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Abstract
The researchers studied the effectiveness of a nursing intervention in promoting adjustment and symptom management in individuals with multiple sclerosis (MS). This was a 4-year longitudinal study to determine whether the 4-week intensive outpatient program was effective in increasing adjustment to MS and if the treatment effect would last over time. A sample of 27 individuals with MS participated in the study. Treatment participants had significant improvements in symptom management at the 4-year follow up. This improvement was attributable to signficant improvements in sleep and fatigue levels. Although adjustment and self-efficacy scores improved in the treatment group over time, this improvement was not superior to the control group. This was anticipated because the behavioral changes would precede improvement in adjustment to life following the diagnosis of MS.
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Abstract
PURPOSE To determine if the reactions of adolescents toward hypothetical situations that can lead to conflict and violence varied by parenting style of their mothers. METHODS This study was part of a larger research project involving adolescents and their mothers participating in a longitudinal HIV-prevention program. Mothers and their adolescents were recruited from a community-based organization (CBO) and interviewed separately. Data were analyzed using the responses of 439 African-American adolescents ranging from ages 11 to 14 years. The responses of adolescents to questions about parenting were used to classify mothers into one of three parenting styles: authoritative, authoritarian, or permissive. The "anticipated reactions to hypothetical situations" scale consists of 11 items with 6 response categories. The six responses were reclassified into three categories ranging from "not at all violent" to "extremely violent." Higher scores indicate more violent reactions to the hypothetical situations. The parenting scale consists of two subscales: a 13-item parental involvement scale and a 13-item parental control scale. Items were rated on a 5-point Likert scale from "strongly disagree" to "strongly agree." Analysis of variance was used to determine if the anticipated reactions of adolescents toward hypothetical situations varied by parenting style of their mothers. RESULTS Adolescent participants who reported a more permissive parenting style expressed more intense negative reactions toward the hypothetical situations that can provoke conflict. Male adolescents also expressed more intense reactions than females to the situations. There was no difference in intensity of reaction by age after controlling for gender and parenting style. CONCLUSIONS Parenting style is associated with adolescents' reactions to hypothetical situations that can provoke conflict. This finding highlights the importance of considering parents and their approach to child-rearing as a factor in the adolescent's ability to react to conflict.
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Affiliation(s)
- Jessica M Miller
- Department of Health Policy and Management, Social and Behavioral Sciences, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.
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O'Neal PV, Grap MJ, Thompson C, Dudley W. Level of dyspnoea experienced in mechanically ventilated adults with and without saline instillation prior to endotracheal suctioning. Intensive Crit Care Nurs 2001; 17:356-63. [PMID: 11853012 DOI: 10.1054/iccn.2001.1604] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to compare the level of dyspnoea with and without the use of 5-cc saline instillation prior to endotracheal suctioning of mechanically ventilated adults. A crossover, quasi-experimental design was used. Seventeen alert, mechanically ventilated adults were asked to rank their level of dyspnoea using the vertical visual analogue scale at specific time intervals surrounding two suctioning events. Saline was randomly assigned to be instilled prior to one of two suctioning episodes. Dyspnoea was ranked immediately after suctioning, and at 10-, 20-, and 30-minute intervals. Data were analyzed using repeated measures analysis of variance with time of measure (immediately after suctioning, 10-, 20-, and 30-minute intervals) and treatment type (with saline versus without saline instillation). The level of dyspnoea based on treatment type (with or without saline) was non-significant. Treatment type by age group interaction was significant (F(1, 15) = 5.41, P = 0.034). The nature of the interaction revealed that older patients (< or = 60 years of age) experienced less dyspnoea without saline prior to suctioning and greater dyspnoea with saline instillation as compared to the younger subjects (<60 years of age). This study documented no beneficial effects of saline. However, it did demonstrate that saline instillation might precipitate a significantly increased level of dyspnoea for up to 10 minutes after suctioning in patients older than 60 years of age. Recommendations based on the results of this study would be to avoid the use of saline instillation prior to suctioning.
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Affiliation(s)
- P V O'Neal
- Division of Nursing and Health Sciences, Gordon College, Barnesville, GA 30204, USA.
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Abstract
PURPOSE This was a test to detect whether a 4-week cognitive behavioral nursing program was effective in increasing adjustment to fibromyalgia (FM) and if the treatment effect would last over time. DESIGN This was a control and treatment group experimental longitudinal study with outcome measures obtained at pretest and every 3 months for 1 year. SAMPLE A sample of 71 subjects continued their participation throughout the first year of the study. FINDINGS Treatment subjects had improved posttreatment adjustment and symptom severity compared to control subjects. When subjects with high pretest psychosocial distress (n = 5) were removed from the analysis, these findings were statistically significant. IMPLICATIONS FOR NURSING PRACTICE The article can provide direction for developing new comprehensive nursing intervention for patients seen with orthopaedic problems. The intervention schedule may help nurses expand their use of interventions for FM patients. Orthopaedic nurses are especially suited for this challenge.
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Affiliation(s)
- R Wassem
- University of Utah, College of Nursing, Salt Lake City, USA
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Dunbar SB, Kimble LP, Jenkins LS, Hawthorne M, Dudley W, Slemmons M, Langberg JJ. Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation. Depress Anxiety 2000; 9:163-8. [PMID: 10431681 DOI: 10.1002/(sici)1520-6394(1999)9:4<163::aid-da3>3.0.co;2-b] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Life stresses and negative emotions, such as anxiety and depression, are associated with adverse cardiac events, including arrhythmia. Patients undergoing implantation of an automatic internal cardioverter defibrillator provide a unique opportunity to characterize these relationships since all tachyarrhythmia episodes are recorded by the device. OBJECTIVES The purpose of this study was to examine the association of emotional status after internal cardioverter defibrillator (ICD) implantation and subsequent arrhythmia events. METHODS An analysis of data obtained in a prospective longitudinal study of responses to the ICD measured mood disturbance (Profile of Mood States; POMS) before implant and at 1, 3, 6, and 9 months postoperatively. Subjects included 144 men and 32 women with a mean age of 60 +/- 13 years and a mean left ventricular ejection fraction (LVEF) of 33 +/- 12%. Arrhythmia events were measured by self-report of shocks and by ICD device interrogation to obtain the number and type (defibrillation, cardioversion, and antitachycardia pacing) of therapies delivered by the ICD. For each time point, POMS scores of subjects who had arrhythmia events were compared with those who did not. For subjects who had ICD shocks, pre-event and post-event POMS scores were also compared. Multiple logistic regression was used at each time point to determine if clinical, demographic and psychological data could predict arrhythmia events. RESULTS Patients with arrhythmia events had higher POMS scores throughout the 9 months of follow-up. Higher level of mood disturbance (specifically anxiety, fatigue, and confusion) at 1 and 3 months were independent predictors of subsequent arrhythmia events at 3 and 6 months after controlling for LVEF, the presence of coronary artery disease, pre-implant arrhythmia history, and the use of amiodarone and beta-blocking agents. There were no differences in POMS scores before and after ICD shocks, reinforcing the notion that negative emotions were a cause, rather than a consequence, of arrhythmia events. CONCLUSIONS Mood disturbances, such as anxiety, may increase the risk for arrhythmia events after ICD insertion.
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Affiliation(s)
- S B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA.
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Dudley W. The psychological impact of warts on patients' lives. Prof Nurse 1995; 11:99-100. [PMID: 7480061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Warts were for many years associated with witches and magic rituals. Caused by the human papilloma virus, warts are a common dermatological problem. Warts can have devastating psychological effects on patients. It is vital that patients are offered support and advice as well as treatment.
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Dudley W. Selling the safe sun message. Health Visit 1994; 67:394. [PMID: 7995722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
Young and older adults were presented with pictures for study. Their recognition of the information was tested at five retention intervals: immediately, and 48 hr, 1 week, 2 weeks, and 4 weeks later. The main finding of interest was that picture recognition did not show an age-related decline until the 1-week retention interval.
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Affiliation(s)
- D C Park
- Gerontology Center, University of Georgia, Athens 30602
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27
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Abstract
Young and older adults were presented with pictures for study. Their recognition of the information was tested at five retention intervals: immediately, and 48 hr, 1 week, 2 weeks, and 4 weeks later. The main finding of interest was that picture recognition did not show an age-related decline until the 1-week retention interval.
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Affiliation(s)
- D C Park
- Gerontology Center, University of Georgia, Athens 30602
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Dudley W. Premedication and the use of analgesics in pediatric dentistry. Dent Clin North Am 1970; 14:865-74. [PMID: 4248202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Dudley W, Wells PR. What are the indications for the use of tranquilizers in dental practice? Dent Pract (Cincinnati) 1967; 5:5. [PMID: 5232619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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