Darlene Mood

Randomized clinical trial of a family intervention for prostate cancer patients and their spouses

Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family‐based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self‐efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses.

Coping strategies and quality of life in women with advanced breast cancer and their family caregivers

Coping with advanced breast cancer is a challenge for both women and their family caregivers. The primary purposes of this study were to compare coping strategies used by patients with advanced breast cancer and their family caregivers and to examine how those strategies related to patient and caregiver quality of life. The sample consisted of 189 patient-family member dyads with advanced breast cancer. Profile analysis showed that patients reported greater use of emotional support, religion, positive reframing, distraction, venting, and humor coping while family members reported greater use of alcohol/drug coping. Regression analyses showed that among both patients and family caregivers, active coping was associated with higher quality of life and avoidant coping was associated with lower quality of life. In addition, the patient’s level of symptom distress moderated the relationship between coping and quality of life. The negative relationship between family caregivers’ avoidant coping strategies and family caregivers’ mental quality of life was strongest when patients had low levels of symptom distress and weakest when patients had high levels of symptom distress.

Couples' experiences with prostate cancer: focus group research.

PURPOSE/OBJECTIVES To explore the experiences of couples living with prostate cancer, the impact of the illness on their quality of life, their ability to manage symptoms, and their suggestions for interventions that would help them to improve their daily experiences. DESIGN Descriptive, qualitative. SETTING Six focus groups were used to obtain the data; two were patient-only groups, two were spouse-caregiver groups, and two were dyad groups. The focus groups were conducted at two comprehensive cancer centers in the midwestern region of the United States. SAMPLE 42 participants: 22 men with prostate cancer and 20 spouse-caregivers. METHODS Focus group discussions were tape-recorded, and the content was analyzed. MAIN RESEARCH VARIABLES Quality of life, symptom experience, and areas for intervention. FINDINGS Four major themes emerged from the data: enduring uncertainty, living with treatment effects, coping with changes, and needing help. CONCLUSIONS Participants had a need for information and support. Both men and spouse-caregivers felt unprepared to manage treatment effects. Symptoms had a broad effect on couples, not just men. Positive effects of the illness, as well as negative effects, emerged from the themes. IMPLICATIONS FOR NURSING Attention needs to be given to methods of providing information and support to couples coping with prostate cancer. Both patients and partners need to be included in discussions about the effect of the illness and treatments so that both can feel more prepared to manage them.

The quality of life of African American women with breast cancer

The objectives of this study were to describe the quality of life of African American women with breast cancer and test a model of factors that may affect their quality of life. A stress-coping framework that included person (demographics, current concerns, and optimism), social resources (family functioning), and illness-related factors (symptom distress, medical characteristics), as well as appraisal of illness and quality of life, was used to guide this exploratory, cross-sectional study. Participants included 98 African American women who were approximately 4 years postdiagnosis. The women reported a fairly high quality of life, were generally optimistic, and had effective family functioning. Although symptom distress was generally low, a sizable number of women reported problems with energy loss, sleep disturbances, and pain. The model explained 75% of the variance in quality of life, with appraisal, family functioning, symptom distress, and recurrence status each explaining a significant amount of the variance. Current concerns had an indirect effect on quality of life that was mediated by appraisal. These findings underscore the importance of helping women foster a positive appraisal of their illness, manage current concerns, maintain family functioning, and reduce symptom distress, because each of these factors indirectly or directly affects their quality of life.

Functions and preferred methods of receiving information related to radiotherapy. Perceptions of patients with cancer.

A convenience sample of 83 patients with cancer were interviewed before and/or after a full course of radiotherapy, with 36 patients interviewed both times, to determine their perceptions about the functions served by the information received from standard care personnel Patients indicated the preferred sources of receiving information. The results indicate that information served three main functions. Active participation was the most frequently cited function, followed by anxiety reduction and preparation. There was no difference by gender, age, education, or socio economic status (SES) in type of functions cited. Disadvantages in receiving information were rarely cited but included receiving bad news and inaccurate or vague information. Many stated that they nevertheless still wanted the information. Verbal communication, especially from the physician, followed by written material, was the most popular choice for receiving information at pretreatment. Written material was more frequently cited as the preferred type of information at posttreatment. Nurses were mentioned as an information source more frequently at posttreatment than at pretreatment. Implications of the findings for practitioners working with patients with cancer are discussed. Patients with cancer.

A model of mother-child coping and adjustment to HIV.

An increasing proportion of newly diagnosed AIDS cases is being reported among African American urban women. Recent research regarding the psychosocial and behavioral impact of a mothers HIV status on her uninfected children as well as a growing body of clinical evidence suggest that these children are extremely vulnerable and at risk for problems in psychosocial adjustment. The present paper reports the results of research designed to examine the pathways by which a mothers HIV-positive status affects the psychosocial adjustment of her uninfected school-age child. The principal predictor variables of the model are family sociodemographic characteristics, social support available to mother and child, HIV-related symptom distress in the mother, coping strategies of both mother and child, emotional distress of the mother, and quality of the parent-child relationship. The dependent variable is the psychosocial adjustment of the child. Data were collected on 147 mother-child dyads using standardized questionnaires and personal interviews. Eighty-six percent of the mothers were African American and over 96% were on public assistance. Structural equation modeling was used to test the proposed model of mother-child coping and adjustment. After adding three paths, the model had a good fit to the data (comparative fit index=0.94; root mean square estimate of error=0.06). Five model constructs accounted for 36% of the variance in child adjustment. The constructs in order of importance were maternal HIV-associated stressors, maternal emotional distress, child social support, child coping, and quality of parent-child relationship.

A family-based program of care for women with recurrent breast cancer and their family members.

PURPOSE/OBJECTIVES To evaluate the FOCUS Program (family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management), a family-based program of care for women with recurrent breast cancer and their family caregivers. DATA SOURCES Randomized clinical trial. SETTING Midwest region of the United States. DATA SYNTHESIS The family-based program of care consisted of five components: family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management. The program was delivered in three home visits and two follow-up phone calls over a five-month period of time. CONCLUSIONS Patients with recurrent breast cancer and their family members reported high satisfaction with the FOCUS Program. Although the FOCUS Program had a number of strengths, limitations of the program also were identified that need to be addressed in future family-based interventions. IMPLICATIONS FOR NURSING A need exists for family-based programs of care that enable both patients and their family members to manage the multiple demands associated with recurrent breast cancer.

Chemotherapy: helping patients to know the drugs they are receiving and their possible side effects.

Two studies were conducted to determine the knowledge cancer patients receiving chemotherapy have about their drugs and to determine the role of the nurse in reviewing chemotherapy information with cancer patients. The first, a descriptive study, sought to determine how much information was retained

Study of dyadic communication in couples managing prostate cancer: a longitudinal perspective

Objective: Cancer patients and partners often report inadequate communication about illness‐related issues, although it is essential for mutual support and informal caregiving. This study examined the patterns of change in dyadic communication between patients with prostate cancer and their partners, and also determined if certain factors affected their communication over time.

An Educational Video to Increase Clinical Trials Enrollment among Lung Cancer Patients

Introduction: Only 3 to 5% of new adult cancer patients participate in clinical trials nationwide. The lack of knowledge and awareness about clinical trials is a significant barrier to clinical trials participation. A randomized trial was conducted to test the effect of an educational video on positively changing patients’ knowledge and attitudes regarding clinical trials and thereby increasing enrollment rates. Methods: Lung cancer patients were randomized to viewing either an 18-minute video about clinical trials before first clinic appointment or to standard care. Participants completed a baseline and 2-week postintervention survey to assess their knowledge and attitudes toward trials participation. Fisher’s exact test tests, t tests, and regression were used to compare patient characteristics and outcomes between arms. Results: Of 145 subjects randomized, 126 (63/arm) satisfied all inclusion criteria and were included in the analysis. A linear regression showed that the video intervention was significantly associated with patients’ self-assessed likelihood to enroll score measured at 2-week follow-up (p = 0.019). Although statistically insignificant, enrollment rates were found to be higher in the intervention arm for therapeutic trials alone (17.5% versus 11.1%) and for therapeutic and nontherapeutic trials combined (25.4% versus 15.9%). Conclusions: The brief educational video seems to be effective in positively changing lung cancer patients’ attitudes about participation in clinical trials. Higher enrollment rates were also observed in the intervention group but the differences did not reach statistical significance. These findings suggest a potential impact of the educational video on clinical trial enrollment; however, larger studies are needed to confirm these findings.