Frances Marcus Lewis

The family's functioning with newly diagnosed breast cancer in the mother: The development of an explanatory model.

Despite the high rates of breast cancer in the child-rearing mother, there is extremely limited research on the effects of the illness on the children, marriage, and parent-child relationship. The current study tested an explanatory model of family functioning with breast cancer based on data obtained from standardized questionnaires from 80 diagnosed mothers and partners with young school-age children. Path analysis results for data obtained from both the mothers and the partners revealed a similar pattern. More frequently experienced illness demands were associated with higher levels of parental depressed mood which negatively affected the marriage. When the marriage was less well adjusted, it negatively affected the familys coping behavior. Household functioning was positively affected by heightened coping activity and by higher levels of marital adjustment. Children functioned better when the non-ill parent more frequently interacted with them and their families coped more frequently with their problems.

The family's functioning with chronic illness in the mother: The spouse's perspective

While previous research has studied the impact of chronic illness on the patient or spouse, the impact on the marriage, the child, the parent-child relationship, and the familys functioning have been relatively ignored. To date ther is no known study of the impact of a mothers chronic illness on the family. The purpose of the current exploratory study was to test a set of interrelated hypotheses about family functioning with the mothers chronic illness from the spouses perspective based on a family systems perspective. Data were obtained from standardized questionnaires from 48 fathers with young school-age children whose wife had either breast cancer, diabetes, or fibrocystic breast disease. Results of a path analysis revealed that the number of illness demands the father experienced was a significant predictor of his level of depression. More demands resulted in higher depression scores. Marital adjustment was significantly affected by both the fathers level of depression as well as by his wifes type of disease. Spouses of women with breast cancer had significantly higher levels of marital adjustment than did partners of the other women. More depressed spouses had lower levels of marital adjustment. Both illness demands and level of marital adjustment significantly predicted the type of coping behavior the family used. More frequent illness demands and higher levels of marital adjustment were associated with familial introspection, that is, coping behavior characterized by frequent feedback, reflection, and discussion in the family. The quality of the father-child relationship was significantly affected by this type of coping behavior. Families characterized as introspective had fathers who reported more frequent interchange with their children.(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of cancer on the family: A critical analysis of the research literature

Abstract The family, not just the patient, experiences the crisis and impact of cancer. This paper critically reviews the empirical research which examines the effects of cancer on the family. Eleven separate issues are identified and discussed: emotional strain, physical demands, uncertainty, fear of the patient dying, altered roles and lifestyles, finances, ways to comfort the patient, perceived inadequacy of services, existential concerns, sexuality, and non-convergent needs among household members. The paper concludes with the research, clinical, and programmatic implications of these studies.

Clarifying autonomy and accountability in nursing service: part 2.

How can a nursing service convincingly argue for autonomy and accountability without an understanding of the precise meanings of these terms? In this second of two articles exploring the meanings and implications of autonomy and accountability in nursing service, Lewis and Batey arrive at this and other provocative questions. They analyze the concept of accountability and provide selected definitions of the concept by directors of nursing. Their discussion provides insights into the presence or absence of true accountability in nursing organizations and presents issues for further study.

Long-term outcomes of a telephone intervention after an ICD.

Background: The purpose of this study was to determine the long‐term benefits of participating in a structured, 8‐week educational telephone intervention delivered by expert cardiovascular nurses post‐ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self‐efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post‐ICD. This article reports on the 6‐ and 12‐month outcomes of the nursing intervention trial.

Short-term efficacy of a telephone intervention by expert nurses after an implantable cardioverter defibrillator.

The ICD is a common therapy for treatment of ventricular arrhythmias and prevention of sudden cardiac death. After ICD therapy, 50% of survivors are known to have significantly elevated anxiety, depression, anger, and fear in getting back to normal physical activities. Despite these problems, few interventions to improve adjustment have been rigorously evaluated within a clinical trial format. This article reports the short‐term efficacy of a structured weekly educational telephone intervention (8 weeks) delivered by expert cardiovascular nurses to recipients of an ICD. To test these effects, a two‐group (n = 84/group) randomized clinical trial design was used with measures at baseline (hospital discharge), 1 month, and 3 months after ICD therapy. The study sample were first time ICD recipients for secondary prevention of sudden cardiac arrest. Primary outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short‐Form Health Survey [SF‐12], ICD shocks), (2) psychological adjustment (State‐Trait Anxiety Inventory [STAI]), Centers for Epidemiologic Studies‐Depression (CES‐D), (3) knowledge (Sudden Cardiac Arrest [SCA] knowledge assessment), and (4) health care use (emergency room visits, outpatient visits, hospitalizations). The intervention group, as compared to the control group, significantly reduced mean PCA symptoms at 1 month (11.3–8.8 vs 9.7–9.3, respectively, P < 0.02), and reduced state anxiety (36.1–31.9 vs 33.1–33.0, respectively, P < 0.08), and enhanced knowledge (21.8–22.4 vs 21.4–21.7, respectively, P < 0.02) at 3 months. The intervention did not significantly impact short‐term health care use. A structured telephone intervention delivered during the first 8 weeks after ICD therapy by expert cardiovascular nurses decreased ICD related physical symptoms and anxiety, and increased SCA knowledge over 3 months.

Using the World Wide Web in health-related intervention research. A review of controlled trials.

A review of published controlled trials was conducted to evaluate components, utility, and efficacy of Web-based healthcare interventions. Nine studies met the established review criteria. Knowledge gains were the most commonly reported significant changes; rarely were there measures or significant changes on behavioral outcomes. Studies varied in format of personal contact with participants, in the structure or sequence of intervention content, and in design features. Dosage was inconsistently measured and process evaluation was relatively absent. Despite limitations, several studies reported significant effects. Based on best evidence-to-date, elements of technologically mediated interventions important to future research are summarized. Taken together, research suggests that Web-based interventions may be an efficacious delivery system, especially for those with chronic conditions amenable to self-management and to those with various limitations to accessing healthcare.

Making the most of the moment: when a child's mother has breast cancer.

The demands and uncertainties associated with adjustments to chronic illness present challenges to maintaining a stable family life. Little has been reported about mother–child relationships within the cancer experience and even less about interventions that may be useful to help these dyads maintain stability. The focus of this article is a pilot study of an intervention addressing the mother–child relationship of women with breast cancer and their school-aged children. A part of the data collection comprised interviews of mothers and fathers to assess their perceptions of the influence of the intervention on the quality of the mother–child relationships after the program. Using inductive content analysis, the fathers’ and mothers’ data were organized into categories, domains, and an explanatory construct, called making the most of the moment. The processes by which the intervention affected the mother–child relationships and implications for professionals who work with families are reported.

Recruitment and retention of families in clinical trials with longitudinal designs.

The Family Home Visitation Program: Nurse as Coach was a 3-year, National Cancer Institute-funded, multisite, randomized trial of a nursing intervention. It tested the effectiveness of an in-home coaching intervention designed to enhance long-term adjustment of breast cancers effect on familyfunctioning. We summarize our recruitment and retention experiences, review accrual and retention issues identified from our experiences and those of other researchers, and suggest 24 specific strategies to maximize sample size in future clinical trial studies. Our target sample consisted of 200 women with early stage breast cancer and their male partners and children. We obtained 313 eligible referrals from 91 sites: 217 participants (69.3%) were accrued, 96families (30.7%) refused, 181 participants (83.4%) were retained, 11 (5.1%) were dropped because of changes in eligibility status or because of scheduling error, and another 25 (11.5%) elected to withdraw.

Psychosocial transitions and the family's work in adjusting to cancer

The family, not just the patient, experiences and attempts to understand the meaning of cancer. The familys adjustment to cancer involves moving through psychosocial transitions in ways that facilitate the meaning of the experience; that maintain the familys ongoing functions; that respond to the illness-related demands; that maintain the self-esteem of the family members; and that foster new arrangements and relationships in the family that are responsive to the contingencies of the illness.