Information needs and preference for information of women with breast cancer over a first course of radiation therapy

The study assessed the information needs of women receiving a course of radiation therapy (RT) for breast cancer and the relationship between information needs and preference for information. Thirty-three women were interviewed during the first (T1), third (T2), and last week of RT (T3), and one month later (T4) using the Toronto Informational Needs Questionnaire--Breast Cancer and the Information Subscale of the Health Opinion Survey. Information need scores were high and did not differ significantly across time. Information need and preference for information were correlated only at T1. Findings indicate that women with breast cancer receiving RT have high information needs and preference for information may not be a meaningful indicator of their desire for information. Health care providers need to assess the women's information needs frequently and be prepared to offer on-going educational support.

Fatigue in women with breast cancer receiving radiation therapy

Fatigue is a common complaint of individuals receiving treatment for cancer. There is a dearth of rigorous research investigating the clinical course and prognosis of fatigue over the course of radiation therapy. Seventy six patients with breast cancer receiving external radiation therapy were followed longitudinally from the onset of treatment to 6 months post-treatment. Fatigue significantly increased over the course of treatment, was highest at the last week of treatment, and returned to pretreatment levels by 3 months after treatment. Fatigue was not influenced by the patient's age, stage of disease, time since surgery, weight, and length of time since diagnosis. Fatigue was significantly related to symptom distress, psychologic distress, and self-reported fatigue relief strategies. The most frequently reported self-relief strategies were "sit" and "sleep." Fatigue had a negative impact on the patient's quality of life. Impairment in quality of life was evident by the end of treatment, with improvement by 3 and 6 months after treatment. The second week through to the last week of radiation therapy are critical times to target interventions for the management of fatigue. The amelioration of concomitant symptoms is a supportive approach that might be helpful. Self-help strategies focusing on the cessation of activity and increasing rest were reported as successful by patients.

The information needs at time of hospital discharge of male and female patients who have undergone coronary artery bypass grafting: a pilot study

OBJECTIVE

To compare the information needs 24 to 48 hours before hospital discharge of male and female patients who have undergone first-time coronary artery bypass surgery.

DESIGN

Cross-sectional, descriptive-comparative.

SETTING

Teaching hospital in a city in central Canada.

SAMPLE

The sample consisted of 20 men and 20 women who had undergone elective coronary artery bypass surgery for the first time.

INSTRUMENTS

Patient Learning Needs Scale and open-ended question.

RESULTS

No differences were found in information needs between men and women. The highest areas of information needs included: treatment and complications, activities, medications, and enhancing quality of life.

CONCLUSION

Men and women have similar information needs after coronary artery bypass surgery. They both want information concerning treatment and complications, activities of living, enhancing their quality of life, and medications.

Uncertainty, symptom distress, and information needs after surgery for cancer of the colon

The purpose of this study was to determine the relationships between uncertainty, symptom distress, and discharge information needs in individuals after a colon resection for cancer. The theoretical framework for the study was derived from Lazarus and Folkman's stress, appraisal, and coping model, and Mishel's theory of uncertainty in illness. Uncertainty was measured by the Mishel Uncertainty Illness Scale (MUIS); symptom distress of pain, fatigue, constipation, diarrhea and loss of appetite by visual analogue scales; and discharge information needs by the Patient Learning Need Scale (PLNS). Forty individuals with a first diagnosis of cancer were interviewed after surgical resection of colon cancer. The study results indicated that they had moderate levels of uncertainty, low levels of symptom distress, and a moderate number of discharge information needs. Information related to treatment, complications, and activities of living were identified as highly important. An increase in uncertainty was significantly associated with an increase in discharge information needs. Increased attention to information needs at discharge may decrease an individual's level of uncertainty and facilitate the transition from hospital to home.

Influence of symptoms, lung function, mood, and social support on level of functioning of patients with COPD

To explain how symptoms, lung function, mood, and social support affect level of functioning, patients (N = 143) with chronic obstructive pulmonary disease (COPD) completed measures assessing their symptoms (Bronchitis-Emphysema Symptom Checklist), mood (Profile of Mood States), social support (Personal Resource Questionnaire), and functioning (Sickness Impact Profile). Those who were receiving oxygen therapy (n = 52) had significantly lower FEV1 scores and experienced significantly poorer functioning than those who were not receiving oxygen therapy (n = 91). Results of path analyses indicated that symptoms and mood directly, and social support indirectly, influenced the functioning of those who were not receiving oxygen. For those who were receiving oxygen, only symptoms directly, and FEV1 indirectly, influenced their functioning. These models need to be confirmed using other samples of patients with COPD.

Predictors of functioning of patients with chronic obstructive pulmonary disease

OBJECTIVE

To determine the extent to which mood, symptoms, lung function, and social support of patients with chronic obstructive pulmonary disease (COPD) predicted their level of functioning over a 30-month period.

DESIGN

Prospective, longitudinal.

SETTING

The homes of patients living in or adjacent to metropolitan Toronto.

SUBJECTS

Seventy-one patients (48 men and 23 women) with COPD who had a forced expiratory volume in 1 second less than 50% of predicted (FEV1 < 50%) and who spoke English. They ranged in age from 43 to 81 years (mean 66.37 years).

OUTCOME MEASURES

The patients' level of functioning at the final data collection visit, 30 months after the initial measure.

INSTRUMENTS

At both data collection visits patients completed measures of mood (negative mood scales of the Profile of Mood States), symptoms (Bronchitis-Emphysema Symptom Checklist), social support (Personal Resource Questionnaire), and functioning (Sickness Impact Profile).

RESULTS

Data were analyzed by use of multiple regression analysis. From measures taken at the initial visit (T1), the best predictors of patients' functioning at 30 months (T2) were their functioning at T1, symptoms, FEV1, and age. Together these accounted for 70% of the variance in the final functioning scores, with initial functioning scores accounting for 51% of the variance. The most prevalent symptoms were dyspnea and fatigue, and both were highly correlated with functioning scores 30 months later.

CONCLUSIONS

In this study, symptoms, FEV1, and age are predictive of functioning in patients with COPD over a 30-month time frame. However, only 50% of the 143 patients recruited into the study completed it. Therefore caution needs to be exercised when the results are applied to other patients with COPD.

Fatigue-reducing strategies used by patients receiving treatment for cancer

In order to determine which strategies are most effective in relieving fatigue of women undergoing treatment for cancer, women receiving either chemotherapy (n = 45) or radiation therapy (n = 54) were interviewed twice to determine their level of fatigue and the effectiveness of the strategies they used to relieve their fatigue. The subjects were interviewed either at the start and mid-point of any cycle of chemotherapy, or at the beginning and end of a 5- or 6-week course of radiation therapy. At each interview, the subjects completed the Pearson Byars Fatigue Feeling Checklist and the Fatigue Relief Scale. At the second interview, the patients were significantly more fatigued than they had been at the first interview (p < 0.0001). The more effective the fatigue-relieving strategies at the second interview, the less fatigue experienced by the women (p < 0.0001). At both interviews, subjects used similar strategies to relieve their fatigue. Sleep and exercise were among the most effective strategies. However, there was a wide range of scores for each strategy used, indicating variability among subjects as to the effectiveness of the strategy. The results of the study provide nurses with some guidance as to strategies they might suggest to patients who experience fatigue.

The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals

Fatigue can be a prevalent and serious problem for the individual with cancer and can negatively impact on the individual's quality of life. Little is known about the prevalence of clinical fatigue among patients with cancer and how the fatigue cancer patient's experience compares with the fatigue people experience as a function of their normal daily activities. This study, which utilized a control group, investigated the prevalence of fatigue among patients receiving treatment with radiotherapy (n = 54) and chemotherapy (n =47) over two measurement points. The level of fatigue experienced by cancer patients was compared with the level of fatigue experienced by apparently healthy auxiliary staff (n = 53) working at three cancer treatment facilities. There were no differences in the mean level of fatigue experienced by cancer patients and the mean level experienced by healthy controls before the start of cancer treatment. However, cancer patients experienced a significant increase in fatigue over a 5- or 6-week course of radiotherapy and 14 days after treatment with chemotherapy, and these increases were significantly greater than the fatigue reported by healthy control subjects. The midpoint of the Pearson Byars Fatigue Feeling Checklist was accepted as a crude measure of clinical fatigue and was found to be significantly different from the mean level of fatigue reported by healthy controls. The prevalence of fatigue among patients after undergoing cancer treatment was determined to be 61%. Fatigue in cancer patients was found to covary with weight, symptom distress, mood disturbance, and alterations in usual functional activities. The best predictors of fatigue in the patient sample were their symptom distress and mood disturbance. Symptom distress and fatigue were significant predictors of impairment in functional activities related to illness. Implications for practice and future research are discussed.

Women with breast cancer: their quality of life following a course of radiation therapy

The study assessed the quality of life of 53 women who had a lumpectomy or other breast-conserving surgery for breast cancer followed by radiation therapy. The women were interviewed a mean of 7 weeks after the course of radiation therapy regarding their functioning, emotional distress, and symptoms. Functioning was measured by the Sickness Impact Profile, emotional distress by the Profile of Mood States, and symptoms by the Symptom Distress Scale. Although the women were not experiencing many changes in their usual activities, were not distressed emotionally, and were experiencing very few symptoms, they were experiencing fatigue. Those who experienced the most fatigue had the most symptoms and the poorest level of functioning.

Perceived informational needs of breast cancer patients receiving radiation therapy after excisional biopsy and axillary node dissection

This study assessed the informational needs of female breast cancer patients receiving radiation therapy after excisional biopsy and axillary node dissection. Two groups of subjects were interviewed: women in the first week of radiation therapy (T1) and women at their first clinic visit after the completion of radiation therapy (T2). A total of 40 women (20 in each group) completed the Informational Needs Questionnaire-Breast Cancer (INQ-BC) to assess their perceived informational need. The INQ-BC assessed the women's informational needs concerning diagnosis, investigative tests, treatment, physical and psychological functioning, family, and available financial resources. All subjects had informational needs on all seven subscales of the INQ-BC. The T1 group had significantly higher scores than did the T2 group. However, for both groups the highest scores were in the Treatment and Physical subscales, suggesting a similarity in the women's informational needs. The results suggest that during the illness experience women seek information about their cancer treatment and related physical care. The results also indicate the importance of assessing the breast cancer patients' perceived informational needs at various points in the treatment continuum.

Bridging the gap between research and clinical practice: a collaborative approach

In nursing, a gap sometimes exists between research and practice. This paper discusses how a group of 11 nurses successfully bridged this gap. The group was composed of nurses from a large teaching hospital, a regional outpatient cancer center, and a university. The result of the group's work over a two-year period was an externally funded research proposal. This paper discusses the strategies that led to the group's success and provides specific recommendations for nurses who want to form similar groups.

Uncertainty in hospitalized patients with chronic obstructive pulmonary disease

The purpose of this study was to describe the perceptions of uncertainty of hospitalized patients with chronic bronchitis and/or emphysema. Fourteen men and 11 women were interviewed. Content analysis of the data yielded three themes of uncertainty, including managing home- and self-care, planning for the future, and the unpredictable course of the illness. Two themes that reflect coping resources also emerged from the data. These were positive thinking, and social support and material resources. The subjects were perceiving uncertainty in relation to their illness and hospitalization, and were endeavouring to manage it through the process of cognitive coping.

Perceived uncertainty, physical symptoms, and negative mood in hospitalized patients with chronic obstructive pulmonary disease

OBJECTIVE

To determine whether perceived uncertainty and physical symptoms were related to negative mood in hospitalized patients with chronic bronchitis and/or emphysema.

DESIGN

Descriptive correlational.

SETTING

Five large teaching hospitals in a city in central Canada.

SUBJECTS

The sample consisted of 15 men and 11 women ranging in age from 53 to 86 years.

INSTRUMENTS

Mishel Uncertainty in Illness Scale; Somatic Scale of the Bronchitis Emphysema Symptom Checklist; and Tension, Depression and Anger Subscales of the Profile of Mood States.

RESULTS

Only the variable of physical symptoms contributed to the negative mood of the subjects with chronic obstructive pulmonary disease, explaining 21% of the variance (p < 0.02). Of the four symptom categories measured (fatigue, dyspnea, congestion, and peripheral-sensory disturbance), only fatigue was a significant predictor (p < 0.006) of negative mood, accounting for 28% of the variance.

CONCLUSION

Negative mood is evidence of impaired coping. The finding that fatigue contributed to negative mood provides support for the theoretic prediction that low energy interferes with an individual's ability to cope with a stressful situation.

Effects of psychological well-being, physical status, and social support on oxygen-dependent COPD patients' level of functioning

Thirty oxygen-dependent patients with chronic obstructive pulmonary disease (COPD) participated in a descriptive correlational study in which investigators examined the relationship between oxygen-dependent COPD patients' psychological well-being, physical status, social support, and level of functioning. Lazarus and Folkman's (1984) theory of psychological stress and coping was used to guide the study. Using multiple regression analysis, physical symptoms had the most predictive power in relation to the level of functioning, accounting for 44.3% of the variance. Among the symptoms, dyspnea had the greatest influence on functioning.

Sickness impact profile: a measure of dysfunction with chronic pain patients

Although chronic pain may affect all facets of a patient's life, there is no generally accepted method of measuring the extent of the disability experienced. This component of a larger study examined changes in usual activities and relationships for patients experiencing chronic nonmalignant pain, in order to understand the impact of pain on an individual's life. The effect of pain intensity and depression on the performance of usual daily activities was assessed by the Sickness Impact Profile (SIP). The sample of 34 subjects, 17 women and 17 men, rated their pain as moderate to severe on a linear analogue scale (mean 64). Thirty percent of subjects were moderately to severely depressed as measured by the Beck Depression Inventory (mean 21). The SIP scores indicated severe disruption in daily activities and relationships for this sample. Significant correlations between the SIP and visual analogue scales measuring coping adequacy and activity levels were interesting and warrant further study.

Factors that predict patients' functioning following treatment for cancer

The study assessed whether the extent of cancer patients' functioning following a course of radiotherapy could be predicted from the amounts of concern, emotional distress, social support and symptoms they had when they began the treatments and from the number of unanticipated experiences they had related to receiving radiotherapy. A sample of 79 patients, 58 with breast cancer and 21 with lung cancer, were interviewed at the beginning and following a course of radiotherapy. When their diagnosis and age were controlled statistically, the only variable which predicted the subject's functioning following the radiotherapy was the amount of emotional distress they experienced when they began the treatments. An examination of the extent to which the individual components of emotional distress contributed to the subjects' functioning revealed that the tension-anxiety component of the emotional distress score was the best predictor of their functioning.