Elisabeth Coyne

Holding it all together: Breast cancer and its impact on life for younger women

Abstract While breast cancer is often associated with older women, in the year 2000, 25% of new breast cancer diagnoses in Australia affected young women. An interpretive study using in-depth interviews provided valuable insight into the lived experiences of six young Queensland women living with breast cancer.This paper presents data from the study with a particular focus on young women and the impact it has on their social situation and their family. The young women in this study found a diagnosis of breast cancer traumatic and their responses were heightened as they sought to understand why at such a young age. For the younger woman a diagnosis of breast cancer is likely to cause not only emotional distress but concerns relating to motherhood, family and fertility. In many respects younger women having greater responsibility for the well being of others in their family and in the provision of stability for everyday family life face a tough reality than older women with breast cancer.This study identified that a specialist breast care nurse is an important resource.

Undergraduate Nursing Students' Placement in Speciality Clinical Areas: Understanding the Concerns of the Student and Registered Nurse

Introduction: Student nurses in Australia are regularly placed in acute clinical areas providing them with clinical experience to link theory with real patient situations. Specialist clinical areas such as day oncology and renal dialysis often exclude students on the basis that their clinical area may not be able to meet normal clinical expectations, including holistic care of four to six patients with minimal direction from the registered nurse. However, specialist clinical areas provide students with unique learning experiences. This paper reports on an evaluation of speciality clinical placements for student nurses with an aim to increase our understanding of this type of placement. Methods: Semi-structured audiotaped interviews were undertaken with 7 third year final semester students and 13 registered nurses working with the third year students. All interviews were transcribed and a thematic analysis conducted. Findings: Key themes from the students and registered nurses were knowledge and preparedness for specialist placement, team work and being included and customising learning needs. Conclusion: Speciality placements provide a valuable experience for the undergraduate nurse including opportunities to see excellence in team work, communication and assessment as well as identifying future intention to become an oncology or renal specialist nurse.

Trust and quality of life: A cross-sectional study of young women:

Background: Trust is increasingly identified as a psychosocial determinant of well-being. However the relationship between trust and well-being outcomes has not been comprehensively examined, particularly in socially and economically transitioning countries such as Iran and among young women. Aims: This cross-sectional study examined the association between trust and the quality of life of young Iranian women. Methods: A total of 391 young Iranian women aged between 18 and 35 years (M: 27.3, standard deviation (SD): 4.8) were recruited through cluster convenience sampling to participate in this cross-sectional study. The measures used included the ‘Trust scale’ adapted from the British General Household Survey (GHS) Social Capital scale, and the Persian version of the WHOQOL-BREF (World Health Organization Quality of Life questionnaire - brief version). Results: The participants (n = 391, mean age of 27 years) reported a relatively low level of trust. For the participants, trust was positively associated with better quality of life (r = .24, p value: .01). The findings also showed that there is a significant difference between socio-demographic factors such as the level of religiosity, occupation and income with the domains of trust. Conclusion: Policies are needed to improve participation and reciprocity at the level of individuals and informal social groups, including local to broader communities in order to increase the sense of community belonging, improving trust and consequently quality of life.

Perceived control and self-efficacy, subjective well-being and lifestyle behaviours in young Iranian women

This study examined whether young Iranian women’s perceived control and self-efficacy, as a component of cognitive social capital, predicts health and well-being. A total of 391 women aged between 18 and 35 years completed a survey including scales measuring control and self-efficacy and health outcomes including quality of life, satisfaction with life and lifestyle behaviours. Statistical analyses indicated that participants had low perceived control and influence over community affairs together with high perceived control over their personal lives. Multiple regression analyses indicated the predictive role of control and self-efficacy for well-being outcomes suggesting the potential role for health interventions targeting control and self-efficacy.

A qualitative exploration of oncology nurses' family assessment practices in Denmark and Australia.

BackgroundThe nurses’ ability to provide supportive care to the patient and the family is influenced by their family assessment skills, which provide them with understanding of the family needs and strengths. When a patient is diagnosed with cancer, it is the family who provides the long-term support for the patient, and nurses need to understand the family needs in order to provide holistic care.ObjectiveThe objective of the present study is to understand the factors that influence nurses’ family assessment practices in adult oncology setting in Denmark and Australia.MethodsAn interpretive qualitative study was conducted guided by the family systems theory. Focus groups were completed with 62 nurses working in adult oncology areas in Denmark and Australia. A thematic analysis and a computer-generated concept mapping were completed to identify themes within the data.ResultsOverall, the nurses valued family as part of the patient care and worked to understand the family concerns. However, the family assessment process was unstructured and did not enable holistic family support. Nurses from both countries discussed that experience and ability to engage with the family influenced the nurse’s role in family assessment.ConclusionThis study identified that nurses value family as part of patient care, however struggle to assess and support families during oncology care. There is a need for a structured assessment approach and education on family assessment, which could be used across the two countries and possibly internationally.

Strengths and resources used by Australian and Danish adult patients and their family caregivers during treatment for cancer

PURPOSE Family plays an essential role in supporting the patient with cancer, however, relatively little attention has been given to understanding the strengths and resources of the family unit across different settings and countries. This study aims to investigate the strengths and resources of patients and family members in Australia and Denmark. METHODS Using a descriptive, cross-sectional design, 232 patient and family participants from inpatient and outpatient oncology services in Australia and Denmark completed paper based surveys that included the Family Hardiness Index (FHI) and Family Crisis Orientated Personal Evaluation Scales (F-COPES), together with demographic and health information. RESULTS The familys appraisal of the cancer and ways the family worked together predicted the level of external resources used to manage their circumstances. CONCLUSION After a cancer diagnosis patients and family respond in different ways related to their family functioning. There is a need for nurses to work closely with the family to understand their strengths and resources, and tailor support and information for family to promote optimal patient outcomes.

I-Kiribati nursing graduates experience of transition from university to residential aged care facilities in Australia

OBJECTIVE To explore the experience of international nursing graduates from Kiribati transitioning into practice in RACFs, upon completion of their bachelor of nursing degree in Australia. DESIGN This study used an interpretive phenomenology design with two focus groups. A thematic analysis of the transcripts from the focus groups generated themes relating to the graduates personal journey through transition. SETTING This study was conducted with graduates working in residential aged care facilities [RACF]. SUBJECTS I-Kiribati nursing graduates (N=6) who have been practicing for 1year in RACF. RESULTS The experience of transition for the I-Kiribati graduates related to challenges faced during this time. Three themes were developed from the analysis: being unsure of expectations, understanding responsibilities of practice, and stepping up to the RN role. The influence of culture was apparent within the three themes. CONCLUSION Overall, the transition to RACFs for the participants was difficult; however, students described increased confidence to work through professional and cultural challenges. They became more reliant on their own knowledge and skills as they matured as practitioners. Recommendations for improving the transition experience include transitional support and educational workshops related specifically to working in RACF. Tailoring workshops to the specific needs of international graduate nurses would assist their transition in relation to cultural differences.

Strategies to successfully recruit and engage clinical nurses as participants in qualitative clinical research

Background: Research conducted in the clinical area promotes the delivery of evidence-based patient care. Involving nurses as participants in research is considered essential to link patient care with evidence-based interventions. However recruitment is influenced by nurses’ competing demands and understanding engagement strategies may assist future research. Aim: This reflective analysis aimed to understand influencing factors and strategies that support successful recruitment nurses in clinical research. Method: A reflective analysis of research notes and focus group data from research with oncology nurses was completed. Results: This research identified that gaining support from key staff, understanding work constraints and developing a rapport with nurses is important. Establishing clear relevance and benefits of the research and being flexible with research requirements enabled nurses to participate in the research. Conclusion: Clear information and a willingness to accommodate the demands and dynamic nature of the environment, ensures ongoing support and engagement of nurses in the clinical setting as participants in research.

Danish and Australian families have the same supportive care needs during cancer treatment – an international study

Background: Oral mucositis (OM) is a common debiliating adverse effect following high dose chemotherapy prior to bone marrow transplantation. OM often interferes with food intake and lead to malnutrition, weight loss and impaired quality of life. These adverse effects may require intravenous morphine for pain alleviation, Although uncomfortable to the patient, oral cryotherapy with ice chips has been shown to reduce the grade and extent of OM. Purpose: The purpose of the present study is to evaluate whether an intraoral cooling device has the same effectiveness as ice chips when it comes to cooling the oral mucosa. Method: Five healthy volunteers (mean age 36.2 years) chewed ice under surveillance for 30 minutes. Before the start of and immediately after the termination of the ice chewing, the intraoral mucosal temperature was measured using a modified thermometer. The same protocol was used to asses the cooling efficacy obtained by the newly developed intraoral device. Results: No statistical significant differences in cooling of teh oral mucosa (p=0.12) were obtained. The mean surface temperature following cooling was 25.7 degrees Celcius with ice chips and 24.7 degrees Celcius with the cooling device. Conclucion: The cooling device is as effective as ice chips in terms of cooling the oral mucosa. The next step in this research is to use the cooling devise to establish the highest surface temperature of the oral mucosa, during infusion of chemotherapy, that will still result in prevention of oral mucositis.Introduction Lifestyle interventions might be useful in the management of adverse effects of androgen deprivation therapy (ADT) in men with prostate cancer. Objectives To examine the effects of dietary and exercise interventions on quality of life (QoL), metabolic risk factors and androgen deficiency symptoms in men with prostate cancer undergoing ADT. Methods CINAHL, Cochrane library, Medline and PsychINFO were searched to identify randomised controlled trials published from January, 2004 to October, 2014. Data extraction and methodological quality assessment was independently conducted by two reviewers. Meta-analysis was conducted using RevMan® 5.3.5. Results Of 2183 articles retrieved, 11 studies met the inclusion criteria and had low risk of bias.Nine studies evaluated exercise (resistance and/or aerobic and/or counselling) and three evaluated dietary supplementation. Median sample size =79 (33–121) and median intervention duration was 12 weeks (12–24). Exercise improved QoL measures (SMD 0.26, 95%CI −0.01 to 0.53) but not body composition, metabolic risk or vasomotor symptoms. Qualitative analysis indicated soy (or isoflavone) supplementation did not improve vasomotor symptoms; however, may improve QoL. Conclusions Few studies have evaluated the efficacy of lifestyle interventions in the management of adverse effects of ADT. We found inconclusive results for exercise in improving QoL and negative results for other outcomes. For soy-based products, we found negative results for modifying vasomotor symptoms and inconclusive results for improving QoL. Future work should investigate the best mode of exercise for improving QoL and other interventions such as dietary counselling should be investigated for their potential to modify these outcomes.

Building international research capacity: Exploring oncology nurses family assessment practices

Background - Primary brain tumours are rare among adults, but patients often experience physical, cognitive, neurological and psychosocial morbidity. Research has documented high rates of unmet supportive care needs among subgroups, such as patients receiving specific treatments or those receiving palliative care, but the needs of patients in the period soon after diagnosis are not known. Aim - To describe the unmet supportive care needs of adults recently diagnosed with primary brain tumours and change in needs over the early diagnosis/treatment period. Methods - A representative population-based sample of 40 patients was recruited approximately three months after diagnosis through a state cancer registry in Queensland, Australia. Patients or carer proxies completed surveys of supportive care needs in six domains (physical/daily living, psychological, patient care and support, sexuality, health system and information needs, and brain tumour-specific needs) at baseline and three months later. Mean supportive care needs scores (scale 0-100, with higher scores indicating higher levels of need) were calculated and compared over time. Results - The highest mean supportive care needs score at each time point was for physical needs (baseline 47.9, SD 26.3), closely followed by psychological needs (baseline 45.8, SD 35.6). Mean scores for other domains ranged from 30.4 to 37.9. Mean scores in all domains except for sexuality significantly declined over time, with the greatest decline for the patient care and support needs domain (mean 15.9 point decrease). Conclusions - Adults with primary brain tumours experience high levels of unmet physical and psychological needs early in the disease trajectory. However, levels of needs, particularly for patient care, decline over time, perhaps with the completion of primary treatments. Further research is needed to confirm these findings in a larger sample and investigate reasons for the decline seen.Programme/Policy Process: Once a VHL develops its activities through a cooperative network of institutions which are users and producers of information, it was essential to structure such a network within the field of cancer control and develop a governance model that could allow its sustainable operation. The model is composed of Executive Secretary, Advisory Committee, Executive Committee and Responsibility Matrix. The institutions which are part of this collaborative network have been selected in order to represent the regional diversity present in Brazil and also the diverse profiles of institutions related to cancer control, such as research, academia, government, scientific societies and organizations representing patients.Background: Smoking rates in Aboriginal Australians are gradually reducing in some age groups, but not for people in the peak reproductive years.¹ Smoking cessation is vital for cancer prevention.² Many regional programs avoid the use of threat messages when targeting Australian Aboriginal smokers.³ Aim: To assess, for the first time, the responses of Aboriginal smokers, 18–45 years, to Risk Behaviour Diagnosis scales (RBD)⁴ and intentions to quit smoking, including gender differences. Methods: We interviewed 121 Aboriginal smokers, using a structured questionnaire including adapted RBD scales. The RBD measured perceived threat (susceptibility and severity of threat) and perceived efficacy (self-efficacy and response efficacy) on Likert scales. Intentions to quit were assessed. Scales were recoded into high-low responses. Face validity was assessed via an Aboriginal panel, and scales assessed for reliability. Chi-square tests investigated the associations between intention to quit, efficacy/threat and gender. Results: Among men, intention to quit was associated with perceived efficacy (X² = 15.23;df = 1; p < 0.0001), but not with perceived threat. For women, intention to quit was neither associated with efficacy nor threat. Both genders were more likely to have high intention to quit, with high efficacy and high threat (n = 54;45%:maleX² = 12.6;df = 1; p < 0.001:femaleX²= 5.6;df = 1; p < 0.05). There was no difference in intention to quit with low efficacy-high threat for either gender (n = 39;32%). In contrast, all of the men with low threat-high efficacy (n = 5;4%) intended to quit, whereas all of the women with low threat-low efficacy (n = 6;5%) intended to quit. Conclusions: High-perceived threat was associated with high intention to quit smoking only when perceived efficacy was high. Gender differences may be a consideration. The RBD scales could be used to tailor messages to the level of efficacy and threat in clinical consultations, and in regional programs. All Aboriginal Australian smokers may benefit from increased efficacy to quit smoking.Abstract presented at the 2014 World Cancer Congress, 3-6 December 2014, Melbourne, Australia