Dauna Crooks

Psychosocial adjustment in women with breast cancer

There is a plethora of studies investigating psychosocial adjustment in women with breast cancer, its correlates, clinical course, and prognosis. These studies have been conducted with varying degrees of methodologic rigor. An assessment has been made of the quality of this existing evidence to identify from the best evidence the factors which predict the adjustment status of women with breast cancer. Studies have been reviewed, using methodologic standards for the critical appraisal of studies on prognosis, developed by Sackett and colleagues in the Department of Clinical Epidemiology and Biostatistics at McMaster University (Hamilton, Ontario, Canada). Few of the studies investigating psychosocial adjustment of women with breast cancer meet all of the criteria for reviewing studies of clinical course and prognosis. This review focuses the direction and methodologic rigor required in future investigations. In particular, studies are needed that employ prospective designs and that deliberately measure or control for the extraneous prognostic variables that may affect adjustment. Future investigations need to incorporate adequate precision in measurement so that measures of the psychosocial variables are objective, reliable, and valid.

Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions.

This paper reviews the current literature concerning the prevalence and incidence of depression in the general population and within the population of people living with cancer where depression is defined using current standards and guidelines. Reviews of recent work where the treatment of depression was the focus of study are also presented. Finally, studies that have specifically addressed the psychological treatment of depression among cancer patients are critically reviewed. Suggestions for practice guideline development of psychological interventions are offered based on the review. Copyright

A New Perspective on Competencies for Self-Directed Learning

In baccalaureate in nursing programs, self-directed methods of education have been used for many decades. A major goal of this type of approach to education is to provide students with the necessary competencies to become lifelong learners. Students must be exposed to self-directed learning competencies to obtain the knowledge, skills, and attributes unique to their personal and professional growth. It has been proposed that six competencies are required for students to become self-directed learners: self-assessment of learning gaps; evaluation of self and others; reflection; information management; critical thinking; and critical appraisal. Each of these skills are not mutually exclusive but are interrelated in such a way that students use all or a combination of them simultaneously to direct and control their learning.

Self-Directed Learning: Faculty and Student Perceptions

This article reports the results of a qualitative study that explored faculty and student perceptions of self-directed learning (SDL) and investigated factors that facilitate or impede it. This study was conducted at McMaster University with faculty and students in a 4-year undergraduate nursing program. Data were collected from 47 faculty and 17 students by means of focus groups that were audiotaped and transcribed. Content analysis was conducted to identify common themes in faculty and student transcripts. The themes that emerged provide insight into the educational strategy of self-directed learning and can be summarized by the following major points: (1) commitment to SDL requires students and faculty to understand the value of empowering learners to take increased responsibility for decisions related to learning; (2) students engaged in self-directed learning undergo a transformation that begins with negative feelings (i.e., confusion, frustration, and dissatisfaction) and ends with confidence and skills for lifelong learning; and (3) faculty development is important to ensure high levels of competency in facilitating self-directed learning.

Factors that influence the recruitment of patients to Phase III studies in oncology: the perspective of the clinical research associate.

The multiple determinants of a patients decision to enter into a clinical trial have been explored largely from the perspectives of patients and their physicians. Little research has involved clinical research associates (CRAs) formally, despite their central role in the process of recruitment. The current study was initiated to explore the factors that influence the decision of patients with cancer regarding clinical trial entry, specifically from the perspective of the CRA.

Development of professional confidence by post diploma baccalaureate nursing students

Professional confidence should be nurtured in a caring nursing curriculum, however there is a lack of clarity as to what confidence means, how it is perceived by students, and what educators can do to instill professional confidence in nursing students. A qualitative study using focus groups was conducted to explore the components of professional confidence as perceived by diploma-prepared registered nurses enrolled in a two-year student-centered, problem-based baccalaureate degree program. Students identified professional confidence as developing through a two-phase process. During the first phase, Becoming Informed, students reported acquiring knowledge, theory and critical thinking in the supportive environment of small tutorial groups, which in turn enabled them to examine nursing practice and defend decisions with clarity and confidence. In Finding a Voice of My Own they clearly articulated an evidence-based nursing position in both academic and clinical environments with a sense of ownership and congruence with their own values. Each phase was further composed of four processes: feeling, knowing, doing and reflecting. When supported through these phases, students felt prepared (i.e. confident) to assume broader roles in health care. Post diploma programs should acknowledge and build on the skills and abilities nurses bring to the educational setting, yet challenge learners to develop critical self appraisal.

The Initial Health Assessment: an intervention to identify the supportive care needs of cancer patients

BackgroundThe first step in effective supportive care delivery is an assessment of patient needs. The Initial Health Assessment Form (IHA) was developed to aid clinicians in recognition and documentation of a patients supportive care needs during their first visit to a comprehensive cancer centre. The purpose of this study was to determine the relative effectiveness of this instrument as compared to routine practice.MethodsA before-after study was performed. Charts of consecutive patients with newly diagnosed cancer attending the Hamilton Regional Cancer Centre were selected randomly. Each chart was reviewed to determine the documentation at the initial patient assessment of 22 supportive care items under eight domains of need: physical, psychological, daily living, social, financial, informational, special needs and personal resources. The pre-intervention evaluation (T1) occurred over a 3-month period followed by the introduction of the IHA into clinical practice. Three months after its introduction, the post-intervention (T2) evaluation took place over the ensuing 3 months.ResultsA total of 306 charts were evaluated (153 each in T1 and T2). Patients from the two time periods were comparable with respect to background demographic variables. Introduction of the IHA increased the mean documentation of supportive care needs and resources from 26% in T1 to 49% in T2 (p=0.001). Significant improvements were found in all domains of need. Despite improvements, documentation of assessment continued to remain low for daily living, social, financial, and informational needs.ConclusionsThe IHA improved documentation of supportive care needs and resources. There is still room for improvement.

Development of an instrument to assess individual student performance in small group tutorials.

Recognizing the need for a valid and reliable method to assess individual tutorial performance in a problem-based learning curriculum, we developed a 31-item instrument from theoretical frameworks and items used elsewhere. A scale was developed for each of three broad learning domains: self-directed learning (SDL), critical thinking (CT), and group process (GP). The instrument demonstrated high internal consistency (SDL = .88, CT = .90, GP = .83) on a sample of 18 tutors and 167 students. Tutor-student interrater reliability coefficients were estimated to be low (SDL = .16, CT = .18, GP = .14) due to lack of variance on the response scale. The instrument showed high correlation (r = .82) with other forms of summative evaluation. In its current form, this standardized and validated instrument is unreliable in differentiating strong from weak tutorial performance but can have a steering effect on student tutorial behaviors. The process of instrument development has general application to other educational programs.