Ellyn E. Matthews

Relationships among optimism, well‐being, self‐transcendence, coping, and social support in women during treatment for breast cancer

Objective: The impact of diagnosis and treatment for breast cancer, stressors that affect emotional well‐being, is influenced by several psychosocial factors and the relationships among them. The purpose of this study was to investigate the relationship between optimism and emotional well‐being (EWB) and the individual and combined mediation of this relationship by perceived social support (SS), problem focused coping (PFC), and self‐transcendence in women with breast cancer during radiation therapy.

Adherence to cognitive behavioral therapy for insomnia: A systematic review

Chronic insomnia is a significant public health problem worldwide, and insomnia has considerable personal and social costs associated with serious health conditions, greater healthcare utilization, work absenteeism, and motor-vehicle accidents. Cognitive behavioral therapy for insomnia (CBTI) is an efficacious treatment, yet attrition and suboptimal adherence may diminish its impact. Despite the increasing use of CBTI, surprisingly little attention has been devoted to understanding the role of adherence. This review describes a comprehensive literature search of adherence to CBTI. The search revealed 15 studies that evaluated adherence to CBTI in adults using valid and reliable measures of sleep, and measure of adherence other than study withdrawals. The primary purposes of this review were to 1) synthesize current study characteristics, methodology, adherence rates, contributing factors, and impact on outcomes, 2) discuss measurement issues, and 3) identify future practice and research directions that may lead to improved outcomes. Strong patterns and inconsistencies were identified among the studies, which complicate an evaluation of the role of adherence as a factor and outcome of CBTI success. The importance of standardized adherence and outcome measures is discussed. In light of the importance of adherence to behavior change, this systematic review may better inform future intervention efforts.

Cognitive Behavioral Therapy for Insomnia Outcomes in Women After Primary Breast Cancer Treatment: A Randomized, Controlled Trial

PURPOSE/OBJECTIVESnTo examine the effect of cognitive-behavioral therapy for insomnia (CBTI) on sleep improvement, daytime symptoms, and quality of life (QOL) in breast cancer survivors (BCSs) after cancer treatment.nnnDESIGNnA prospective, longitudinal, randomized, controlled trial.nnnSETTINGnOncology clinics, breast cancer support groups, and communities in Colorado.nnnSAMPLEn56 middle-aged BCSs with chronic insomnia.nnnMETHODSnWomen were randomly assigned to CBTI or behavioral placebo treatment (BPT) and completed measures of sleep, QOL, functioning, fatigue, and mood at baseline, postintervention, and at three- and six-month follow-ups.nnnMAIN RESEARCH VARIABLESnSleep outcomes (e.g., sleep efficiency, sleep latency, total sleep time, wake after sleep onset, number of nightly awakenings); secondary variables included sleep medication use, insomnia severity, QOL, physical function, cognitive function, fatigue, depression, anxiety, and sleep attitudes or knowledge.nnnFINDINGSnSleep efficiency and latency improved more in the CBTI group than the BPT group; this difference was maintained during follow-up. Women in the CBTI group had less subjective insomnia, greater improvements in physical and cognitive functioning, positive sleep attitudes, and increased sleep hygiene knowledge. No group differences in improvement were noted relative to QOL, fatigue, or mood.nnnCONCLUSIONSnNurse-delivered CBTI appears to be beneficial for BCSs sleep latency/efficiency, insomnia severity, functioning, sleep knowledge, and attitudes more than active placebo, with sustained benefit over time.nnnIMPLICATIONS FOR NURSINGnOncology nurses are in a unique position to identify insomnia in cancer survivors. When sleep disturbances become chronic, nurses need to make recommendations and referrals.

Sleep Disturbances and Fatigue in Critically Ill Patients

Sleep disturbances and fatigue are significant problems for critically ill patients. Existing sleep disorders, underlying medical/surgical conditions, environmental factors, stress, medications, and other treatments all contribute to a patients inability to sleep. Sleep disturbance and debilitating fatigue that originate during acute illness may continue months after discharge from intensive care units (ICUs). If these issues are unrecognized, lack of treatment may contribute to chronic sleep problems, impaired quality of life, and incomplete rehabilitation. A multidisciplinary approach that incorporates assessment of sleep disturbances and fatigue, environmental controls, appropriate pharmacologic management, and educational and behavioral interventions is necessary to reduce the impact of sleep disturbances and fatigue in ICU patients. Nurses are well positioned to identify issues in their own units that prevent effective patient sleep. This article will discuss the literature related to the occurrence, etiology, and risk factors of sleep disturbance and fatigue and describe assessment and management options in critically ill adults.

Breast cancer and symptom clusters during radiotherapy.

Background: Symptom clusters assessment shifts the clinical focus from a specific symptom to the patient’s experience as a whole. Few studies have examined breast cancer symptom clusters during treatment, and fewer studies have addressed symptom clusters during radiation therapy (RT). The theoretical underpinning of this study is the Symptoms Experience Model. Research is needed to identify antecedents and consequences of cancer-related symptom clusters. Objective: The present study was intended to determine the clustering of symptoms during RT in women with breast cancer and significant correlations among the symptoms, individual characteristics, and mood. Methods: A secondary data analysis from a descriptive correlational study of 93 women at weeks 3 to 7 of RT from centers in the mid-Atlantic region of the United States, Symptom Distress Scale, the subscales of the Positive and Negative Affect Scale, Life Orientation Test, and Self-transcendence Scale were completed. Results: Confirmatory factor analysis revealed symptoms grouped into 3 distinct clusters: pain-insomnia-fatigue, cognitive disturbance-outlook, and gastrointestinal. The pain-insomnia-fatigue and cognitive disturbance-outlook clusters were associated with individual characteristics, optimism, self-transcendence, and positive and negative mood. The gastrointestinal cluster correlated significantly only with positive mood. Conclusions: This study provides insight into symptoms that group together and the relationship of symptom clusters to antecedents and mood. Implications for Practice: These findings underscore the need to define and standardize the measurement of symptom clusters and understand variability in concurrent symptoms. Attention to symptom clusters shifts the clinical focus from a specific symptom to the patient’s experience as a whole and helps identify the most effective interventions.

Predictors of adherence to a behavioral therapy sleep intervention during breast cancer chemotherapy

BackgroundThis study’s purpose was twofold: (1) to establish adherence rates to a behavioral therapy (BT) sleep intervention and (2) to identify psychological and physical symptom predictors of adherence to the intervention in women undergoing breast cancer chemotherapy.MethodsA randomized controlled trial began 48xa0h before the first of four chemotherapy treatments. Women with stages I–IIIA breast cancer (nu2009=u2009113) received a BT sleep intervention composed of stimulus control, modified sleep restriction (MSR), relaxation therapy (RT), and sleep hygiene counseling components. A BT plan was developed by a research nurse and each participant, reinforced on dayxa08, and repeated for chemotherapy cycles 2, 3, and 4. Adherence to the BT plan was measured daily; total adherence score was computed at each chemotherapy cycle by combining adherence estimates of all BT plan components. Psychological and physical symptoms over the past 7xa0days were measured 2xa0days prior to and 7xa0days after each chemotherapy treatment.ResultsTotal adherence rates to the BT plan were 51–52% at all four treatments but adherence varied by component. Sleep disturbance, pain, and anxiety significantly decreased whereas depression significantly increased across chemotherapy. Structural equation modeling revealed a good model fit with decreasing sleep disturbances (0.409) and increasing depression (−0.711) contributing to lower total adherence rates. Increasing depression predicted lower MSR adherence (−0.203) and decreasing sleep disturbances predicted lower RT adherence (1.220).ConclusionsSleep disturbance and depression significantly impacted adherence rates during chemotherapy. Results warrant attention when promoting adherence to BT sleep interventions during chemotherapy treatment.

Randomizing research participants: promoting balance and concealment in small samples.

Randomization is central to rigorous scientific trials. An effective but underutilized approach is urn randomization. To test the ability of urn randomization versus simple randomization to produce balanced groups with small sample sizes, we conducted simulated randomizations: 10 times under sample size scenarios of 20, 40, 60 (group sizes of 10, 20, and 30, respectively), for 30 trials in total. For groups of 20-30, urn surpassed simple randomization in the equal distribution of confounding variables between groups, leading to effects of these variables that were both smaller on average and more consistently close to zero over multiple trials. The urn method is easy to implement and has the advantages of unpredictability of assignment and decreased susceptibility to investigator bias.

Sleep in Mother and Child Dyads During Treatment for Pediatric Acute Lymphoblastic Leukemia

PURPOSE/OBJECTIVESnTo compare the sleep of children with acute lymphoblastic leukemia (ALL) during maintenance treatment with controls and to measure the effect on maternal sleep.nnnDESIGNnComparative, descriptive.nnnSETTINGnPediatric oncology clinic and communities in Colorado.nnnSAMPLEn26 dyads of mothers and children with ALL and matched controls.nnnMETHODSnMothers completed insomnia severity, mood, and stress questionnaires and wore a wrist actigraph, and mothers and children completed a seven-day sleep diary.nnnMAIN RESEARCH VARIABLESnMother and child sleep parameters (e.g., total sleep time, sleep latency, sleep efficiency, awakenings); maternal insomnia severity, mood, and stress; child sleep habits.nnnFINDINGSnMothers of children with ALL reported greater insomnia compared to controls, which was correlated with anxiety, depressive symptoms, and stress. Maternal groups did not differ on diary- and actigraph-measured sleep outcomes; both groups experienced sleep fragmentation. Children with ALL took longer to fall asleep and had more variable sleep patterns.nnnCONCLUSIONSnActigraph and sleep diary data indicated adequate maternal sleep duration and sleep latency. Self-reported insomnia severity in mothers of children with ALL suggested sleep fragmentation that may be undetected by these measures.nnnIMPLICATIONS FOR NURSINGnOncology nurses are in a unique position to identify sleep problems in mothers and children with ALL, which may lead to recommendations for improved sleep and referrals for treatment.

The Impact of Physical Activity on Sleep during Pregnancy: A SecondaryAnalysis

Disturbed sleep is independently associated with adverse pregnancy outcomes. The primary aim of this research which tested Pender’s Model of Health Promotion was to evaluate the contribution of physical activity (PA) to sleep parameters in pregnant women, with pre-pregnant body mass index (BMI) as a confounder. Sleep and physical activity data were drawn from a parent study in which 29 sedentary women in the second trimester were enrolled in an 8-week PA intervention pilot study and randomly assigned to intervention or control group. Steps per day, as measured by pedometer, and sleep parameters (sleep onset latency [SOL], wake time after sleep onset [WASO], sleep duration, and sleep quality), obtained from sleep diaries, were used to evaluate the daily interaction between PA levels and sleep. Hierarchical linear modelling (HLM) was used for analysis, as data were nested within persons. Pre-pregnant BMI contributed negatively to PA levels (p=0.003). PA levels were positively predictive (p=0.037) of sleep onset latency (SOL) and negatively predictive (p=0.01) of sleep quality, demonstrating a negative effect of PA on sleep during pregnancy when measured daily. These results confirm results from the only other published study that looked at daily measures, but contradict findings from other studies that evaluated the PA level-sleep relationship over a week or month. Both PA and sleep are modifiable factors that affect pregnancy outcomes. Further studies are needed to understand the complex relationship between PA, sleep, and weight in pregnancy.

Exercise Guidelines for Adults With Cancer: A Vital Role in Survivorship

Cancer survivors face many challenges as a result of their cancer diagnosis and treatment, most importantly the maintenance of physical well-being. Nurses and other health professionals strive to address the needs of cancer survivors, including providing appropriate health-promotion information for a physically active lifestyle. Cancer survivors are at greater risk for recurrence and for developing second cancers because of treatment effects, unhealthy lifestyle behaviors, or risk factors that contributed to the first cancer. In light of those concerns, guide-lines aimed at understanding and preventing secondary disease, recurrence, and the late and long-term effects of treatment are essential.