Cynthia Chernecky

Challenges of Recruitment and Retention in Multisite Clinical Research

This article reviews recruitment and retention issues in a multisite, multistate (California, New York, Connecticut, Georgia, Alabama) 6-month prospective cross-sectional study focused on quality of life among 230 women with lung cancer. Recruitment of women into clinical trials and their retention are important, yet understudied. To date, few articles have described the challenges associated with recruiting women with lung cancer to participate in clinical research. Data from this trial were used to investigate the most effective strategies for recruitment across sites, to identify the most common reasons for refusal and attrition, and to identify challenges and potential solutions to recruitment and retention issues associated with multisite clinical research studies. Strategies for recruitment included letters from physicians, posters, announcements in community support groups, and newspaper and radio advertisements. Three sites allowed the researchers to contact potential participants directly, whereas 2 sites required the potential participants to contact the researchers for further information. Enrollment included 63% of the women eligible for the study (n = 230). The most common reasons for refusal were health limitations (n = 60), lack of interest (n = 46), and inconvenience (n = 16). The most common reasons for attrition (24% of the sample) were death (n = 21) and severity of illness (n = 13). Challenges related to recruitment and retention varied by geographic location.

Use of Complementary and Alternative Medicine Therapies to Control Symptoms in Women Living With Lung Cancer

Complementary and alternative medicine (CAM) use by cancer patients, especially women, is increasing. However, CAM use among patients with lung cancer, who have been reported to have the highest symptom burden, is poorly documented. This study describes types and frequencies of specific CAM therapies used by women with lung cancer to manage symptoms, and examines differences in demographic and clinical characteristics between CAM users and non-CAM users. Participants included 189 women with non-small cell lung cancer and ≥1 of 8 symptoms. Six CAM therapies, used to control symptoms, were assessed, including herbs, tea, acupuncture, massage, meditation, and prayer. Forty-four percent (84 women) used CAM therapies, including prayer (34.9%), meditation (11.6%), tea (11.6%), herbs (9.0%), massage (6.9%), and acupuncture (2.6%). Complementary and alternative medicine use was greatest for difficulty breathing and pain (54.8% each), with prayer the most commonly used CAM for all symptoms. Significant differences (P < .05) were found for age (t = 2.24), symptom frequency (t = −3.02), and geographic location (&khgr;2 = 7.51). Women who were younger, experienced more symptoms, and lived on the West Coast or South (vs Northeast) were more likely to use CAM. We found that CAM use is variable by symptom and may be an indicator of symptom burden. Our results provide important initial data regarding CAM use for managing symptoms by women with lung cancer.

A Symptom Cluster and Sentinel Symptom Experienced by Women With Lung Cancer

PURPOSE/OBJECTIVES To determine the symptom experience and a sentinel symptom and to describe the relationship of participant characteristics with symptom clusters. DESIGN Prospective, correlational study. SETTING Clinical sites in five U.S. states. SAMPLE 196 women six months to five years after non-small cell lung cancer diagnosis. METHODS Symptoms were measured during the past day and past four weeks. Symptom clusters were described using a novel dummy coding approach. MAIN RESEARCH VARIABLES Symptom occurrence and severity, demographic and clinical characteristics, health status factors, and meaning of illness. FINDINGS About 98% of women experienced three or more symptoms in the past day. The most common symptoms reported by more than 80% of the women were fatigue, shortness of breath, anorexia, cough, and pain, with fatigue and shortness of breath rated as most severe. Sleep problems, concentration problems, and weight loss also were reported during the past four weeks. A five-symptom cluster including fatigue, shortness of breath, cough, pain, and anorexia was reported by 64% of women. Pain was identified as a sentinel symptom for that cluster. CONCLUSIONS Most women experienced at least three symptoms in the past day, and a five-symptom cluster occurred frequently and continued post-treatment. IMPLICATIONS FOR NURSING Women who participated in the study were, on average, two years postdiagnosis, but most experienced three or more symptoms well past treatment; therefore, vigilant ongoing clinical assessment of these women is essential. A co-occurring sentinel symptom used as a clinical indicator for the presence of a symptom cluster may be useful for clinical assessment.

Women with lung cancer: quality of life after thoracotomy: a 6-month prospective study.

Background: Data about health-related quality of life (QOL) after surgical treatment for lung cancer are limited. Such information can be valuable in developing appropriate nursing interventions for follow-up care for survivors. Objectives: The purposes of this study were to describe physical and emotional QOL of disease-free female non-small cell lung cancer (NSCLC) survivors and to determine characteristics associated with greater risk for disruptions. Methods: One-hundred-nineteen women surgically treated for NSCLC completed the Short-Form 36 (as a measure of physical and mental QOL) along with health status assessments (including comorbidity, depression, Center for Epidemiologic Studies-Depression Scale, smoking status, and body mass index), dyspnea (Dyspnea Index), meaning of illness, and demographic and clinical information at baseline and 3 and 6 months. Results: On average, the women were 68 years of age, diagnosed 2 years previously, had adenocarcinoma, and were treated surgically with lobectomy. The majority (66%) had comorbid disease, 29% had depressed mood (Center for Epidemiologic Studies-Depression Scale score ≥16), 8% were current smokers, 62% were overweight, 22% had dyspnea (scores ≥2), and 24% had a negative meaning of illness. Physical and emotional QOL scores were comparable to Short-Form 36 norms for older adults and exhibited little change over time. Controlling for time since diagnosis, dyspnea, and depressed mood were strongly related to disruptions in physical and emotional QOL, respectively, across the 6-month study period, with comorbid disease contributing to both models. Conclusion: Depressed mood, comorbidities, and dyspnea were factors related to poorer physical and emotional QOL. Survivors with these characteristics might benefit from greater supportive care. Implications for Practice: Screening for dyspnea, depressed mood, and comorbid illness can identify female survivors at-risk for poorer QOL after surgery.

Tobacco use in women with lung cancer

Background: Smoking cessation after a cancer diagnosis is associated with improved clinical outcomes.Purpose: The aims of this study are to determine smoking prevalence, describe patterns of smoking, identify readiness to quit and cessation strategies, identify factors associated with continued smoking among women with lung cancer, and determine smoking prevalence among household members.Methods: Data were collected through questionnaires and medical record review from 230 women. Smoking was determined through self-report and biochemical verification with urinary cotinine.Results: Eighty-seven percent of women reported ever-smoking, and 37% reported smoking at the time of diagnosis. Ten percent of women were smoking at entry to the study, 13% were smoking at 3 months, and 11% at 6 months. Fifty-five percent of smokers planned a quit attempt within the next month. One third of smokers received cessation assistance at diagnosis, and pharmacotherapy was the most common strategy. Significant factors associated with continued smoking included younger age, depression, and household member smoking. Continued smoking among household members was 21%. Twelve percent of household members changed their smoking behavior; 77% quit smoking, but 12% started smoking.Conclusions: The diagnosis of cancer is a strong motivator for behavioral change, and some patients need additional support to quit smoking. Family members should also be targeted for cessation interventions.

Comparative evaluation of five needleless intravenous connectors

AIM The purpose of this study was to evaluate in vitro differences of colony forming units (CFUs), of four different bacteria (Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli), over 4 days, using bovine blood, in five intravenous needleless connectors (three negative, one positive, one zero). BACKGROUND Availability of colony forming units creates a definitive environment for bloodstream infections and occlusions. Protection of the intraluminal pathway is one important way to help eliminate occlusions and catheter-related bloodstream infections and utilization of best available product(s) will aid in best patient outcomes. METHODS Five different connectors evaluated in 2009 by an independent laboratory for in vitro differences about colony forming units of four different organisms over 4 days. RESULTS The Q-Syte™ performed poorly on all organisms (P<0·0001). The MaxPlus(®) Clear and MicroCLAVE(®) fluctuated between high colony forming units (28·15 & 56·55 respectively) and zero colony forming units. The TKO™Clave(®) stayed increased (high of 50·8 colony forming units). The RyMed-5001(®) performed the best with very low colony forming units (2·25 CFUs to zero). CONCLUSIONS Non-antimicrobial connectors differ on colony forming unit counts in vitro for four types of bacteria. Connectors with most colony forming units to least colony forming units included the Q-Syte™, TKO™Clave(®), MicroCLAVE(®), MaxPlus(®) Clear and RyMed-5001(®). Connectors are one statistically significant variable (50%) in the development of occlusions and infections. Staff nurses, managers, infection control specialists and vascular access specialists in all settings need to use technologies that invoke the least patient harm. The RyMed-5001(®) connector best protects the intraluminal pathway from bacteria compared with four other commonly used connectors in vitro.

Implementation of an intravenous medication infusion pump system: implications for nursing.

AIM To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. BACKGROUND Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. METHODS Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. RESULTS Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. CONCLUSIONS It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. IMPLICATIONS FOR NURSING MANAGEMENT Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses.

Temporal differences in coping, mood and stress with chemotherapy.

This longitudinal study examined relations among mood, coping, perceived stress, and side effects from chemotherapy in 50 individuals with stages III and IV adenocarcinoma of the lung over four consecutive combination chemotherapy courses. Results indicated that perceived stress was moderately high only at the time of pretreatment, and four coping strategies were used: seeking social support, planful problem solving, self-control, and positive reappraisal. No relations existed between coping strategies and side effects from chemotherapy, coping and perceived stress, mood and side effects, and perceived stress and side effects. Seven side effects occurred: leukopenia, decreased activity, nausea, loss of appetite, fatigue, constipation, and taste changes. In summary, receiving chemotherapy is stressful at the time of pretreatment, so nursing interventions need to be concentrated at that point.

Caring for Patients With Cancer Through Nursing Knowledge of IV Connectors

Knowledge about the three different types of IV connectors (negative, positive, and neutral) is imperative to cancer care as specific and distinct interventions can help prevent occlusions and catheter-related bloodstream infections that can lead to increased morbidity with infections and loss of treatment time and mortality. Nurses have responsibilities associated with nursing research, education, and evidence-based practice that should support the outcomes of best patient care when using IV connectors.

Assessing coughing and wheezing in lung cancer: a pilot study.

PURPOSE/OBJECTIVES To establish reliability and validity of two self-report questionnaires, the Lung Cancer Cough Questionnaire and the Lung Cancer Wheezing Questionnaire. DESIGN Prospective, exploratory pilot study. SETTING Clinical oncology settings in the southern United States. SAMPLE 31 adult women with lung cancer. METHODS Content validity of both questionnaires was assessed through a comprehensive literature review and an expert judge panel. Concurrent validity was established by Spearman rank correlation coefficients and Wil-coxon Rank Sum tests with items from other valid tools. Test-retest reliability was assessed by percent agreement, kappa, paired t tests, and correlations. Internal consistency was determined by Cronbachs alpha. MAIN RESEARCH VARIABLES Cough, wheeze. FINDINGS Cronbachs alpha showed excellent internal consistency and percent agreement, and kappa showed similarity of item responses across test-retest administrations. Nonsignificant paired t tests indicated similar mean scores, and significant test-retest correlations supported test-retest reliability. CONCLUSIONS Preliminary testing indicates good reliability and validity for both questionnaires. Both instruments can identify people with problems of coughing and wheezing and have the potential for monitoring these symptoms over time and determining effectiveness of interventions. IMPLICATIONS FOR NURSING Assessment of coughing and wheezing is an important component of monitoring respiratory symptoms of lung cancer. Both of these symptoms can be amenable to interventions. Further research is needed to confirm psychometrics and sensitivity of these tools.