Gerald Bennett

Depression in men with prostate cancer

PURPOSE/OBJECTIVES To summarize the current empirical knowledge base on depression in men with prostate cancer to inform psychosocial supportive care interventions for this population and chart directions for future research. DATA SOURCES Reports in English of quantitative studies that included measures of depression or mood in samples of men with prostate cancer published from 1988-2004. DATA SYNTHESIS Nurse researchers are playing a key role in establishing the scientific knowledge base upon which a better understanding of the relative importance of depression in men with prostate cancer will emerge. This review indicates that (a) predictable risk factors exist for depression among men with prostate cancer, (b) different prostate cancer treatments do not tend to be associated with differential outcomes in depression or mood, and (c) overall, men with prostate cancer report fewer depressive symptoms than women with breast cancer. CONCLUSIONS The small body of research addressing depression in men with prostate cancer is methodologically inadequate to estimate the overall prevalence of depression among men with prostate cancer and determine the clinical significance of psychoeducational interventions targeting depression or mood in this population. IMPLICATIONS FOR NURSING Nurses can use current knowledge to identify men with prostate cancer who are most at risk for depression. Evidence supporting the benefit of psychoeducational interventions for depression in other cancer populations (e.g., women with breast cancer) may be applicable to men with prostate cancer.

The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: A multi-center randomized trial ☆

OBJECTIVE The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice. METHODS A randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored. RESULTS A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate -3.61; (confidence interval, -7.01, 0.22), and values clarity (estimate -3.57; confidence interval (-5.85,-1.30). Borderline effect was seen for the total decisional conflict score (estimate -1.75; confidence interval (-3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated. CONCLUSION The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences.

Moderate drinking in women: a concept analysis.

This analysis clarifies the concept of moderate drinking in women. The literature reflects a variety of definitions of moderate drinking and refers largely to drinking in men. Several strategies for concept analysis suggested by Walker and Avant (1995) resulted in the formulation of a theoretical definition of moderate drinking in women applicable to practice and research. The defining attributes of womens moderate drinking in contemporary U.S. culture include (1) minimization of risks of alcohol-related problems, (2) a desire for any potential health benefits, (3) deliberate adoption of personal drinking guidelines based on some knowledge of the effects of alcohol, (4) control of when and how much alcohol is consumed, (5) sensitization to special drinking considerations faced by women, and (6) having at least one interpersonal relationship with another moderate drinker.

Moderate Drinking and Women's Health: Highlights from the Research Literature

In 1996, for the first time, the U.S. government recognized in its Dietary Guidelines for Americans that moderate drinking may have health benefits.’ It is understandable that some nurses and other health professionals may find the dissemination of information about the health benefits of moderate drinking to be at odds with the federal government’s longstanding policy to educate the public about the health hazards associated with drinking. Although not without controversy, the policy decision to include information about the possible health benefits of moderate drinking in the Guidelines is a direct result of an increasing body of scientific evidence supporting a positive relationship between moderate consumption of alcohol and some standard indicators of health. Most research on moderate drinking and health has been conducted with men as subjects. However, recent studies have demonstrated differences in men’s and women’s response to alcohol. The purpose of this article is to identify and review major studies that elucidate the relationship between moderate drinking and women’s health. The nursing responsibility to provide women with health counseling relevant to alcohol use and abuse is best informed by a familiarity with the research literature. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines social drinkers as “those for whom drinking produces no serious longterm health or social consequences and cessation of alcohol use poses no problem”2, p. 1. Moderate drinking is usually defined as a form of social drinking that is regulated by a self-imposed drinking limit. Moderate drinking was defined by the Dietary Guidelines for Americans as not more than one drink per day for women and two drinks per day or less for men. ’ Several researcher^^-^ also define moderate drinking for women as one drink or 14 g or less of alcohol per day. The lower level of alcohol consumption recommended for women as compared with men is based on typical differences in body weight, indications that women are more susceptible than men to toxic effects, and concerns regarding the possible increased risk of breast cancer. Pregnant women and those who are breast-feeding are advised not to drink at aL6 Women’s alcohol use varies according to age, marital status, educational level, and number of social roles a woman fulfills. Married women drink less than divorced, separated, or single women. Widows also consume less than these group^.^^^ Women in the 21 to 34 age group have the highest rates of alcohol consumption, with higher rates of episodic drinking, intoxication, and drinking-related problem~.~*~-’~ Although more women with higher educational levels are moderate drinkers, women with lower educational levels are at higher risk for drinking-related problem^.^*^*^^^ The number of social roles a woman fulfills affects drinking behavior. Multiple roles may reduce alcohol intake, as family roles and employment increase self-esteem and social support while decreasing opportunity. 14* l5 Studies indicate that there are numerous risks and benefits associated with moderate drinking in women. The cardiovascular effects, effects on estradiol levels, bone marrow density, and breast cancer are the main points of interest of the studies reviewed.

m the Guest Editors

As the Reagan years ended, the uncertain future hung like a temperature inversion over Americas substantial prosperity. The economy was enjoying the centurys longest peacetime recovery cycle. But economic power and riches were realigning around the world, and the two most striking economic groups of 1989 represented a stark contradiction: billionaire and the homeless. Prophecies for the future were just as mixed. (Kevin Phillips, 1990, p. 3)

Consultant to a National Demonstration Program

Gerald Bennett, Ph.D., R.N. is an Associate Professor, Department of Mental Health-Psychiatric Nursing, School of Nursing, Medical College of Georgia in Augusta. Since 1989 he has been a consultant to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Homeless Demonstration and Evaluation Branch and ROW Sciences, Inc. in Rockville, Maryland. Professional appointments and memberships include the American Nurses Association Task Force on Drug and Alcohol Abuse, the American Public Health Association’s Section on Alcohol Tobacco and Other Drugs, and the National Nurses Society on Addictions. He is the coeditor for the second edition of the text Substance Abuse recently published by Delmar. Dr. Bennett has 12 years experience in teaching, writing, and conducting research on health and social aspects of recovery from alcohol and other drug abuse. Since 1986 his work has focused on low-income and homeless populations. The Stewart B . McKinney Homeless Assistance Act, signed into law in July 1987, authorized new programs to address the many service needs of homeless people. Under the authority of the McKinney Act, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) developed and implemented a national grant program designed to evaluate innovative alcohol and other drug abuse treatment approaches for homeless people. In May 1988, nine demonstration grants were awarded on a competitive basis to community-based public and nonprofit entities across the nation. These projects were completed in 1991. The national evaluation for the demonstration grant projects will be completed and available in 1992. The Congress authorized additional funding under the McKinney Act for NIAAA to initiate another national demonstration program in 1991. This program consists of three-year cooperative agreements to fourteen research demonstration projects. The cooperative agreement projects address at least three common research objectives: (1) reduction of the consumption of alcohol and other drugs, (2) improvement in levels of shelter and residential stability, and (3) improvement in economic and employment status. Dr. Bennett’s comments in this interview are solely his own views and opinions and do not constitute an endorsement, real or implied, by the National Institute on Alcohol Abuse and Alcoholism. Dr. Bennett is a private consultant and as such does not speak for the NIAAA Homeless Evaluation and Demonstration Branch.

Substance Abuse A Significant Factor in the Plight of the Homeless

While variation is expected nationwide, at Rikers, nurses receive salaries competitive with other major hospitals in the New York metropolitan area. Health and education benefits, such as tuition reimbursement, are also comparable. Prison nursing affords the same opportunities for ongoing learning in continuing education programs and opportunities to work with and instruct students. Nursing students from Columbia, Lehman, and York College are regularly placed at the Rikers health facilities.