Janet Harden

Couples' experiences with prostate cancer: focus group research.

PURPOSE/OBJECTIVES To explore the experiences of couples living with prostate cancer, the impact of the illness on their quality of life, their ability to manage symptoms, and their suggestions for interventions that would help them to improve their daily experiences. DESIGN Descriptive, qualitative. SETTING Six focus groups were used to obtain the data; two were patient-only groups, two were spouse-caregiver groups, and two were dyad groups. The focus groups were conducted at two comprehensive cancer centers in the midwestern region of the United States. SAMPLE 42 participants: 22 men with prostate cancer and 20 spouse-caregivers. METHODS Focus group discussions were tape-recorded, and the content was analyzed. MAIN RESEARCH VARIABLES Quality of life, symptom experience, and areas for intervention. FINDINGS Four major themes emerged from the data: enduring uncertainty, living with treatment effects, coping with changes, and needing help. CONCLUSIONS Participants had a need for information and support. Both men and spouse-caregivers felt unprepared to manage treatment effects. Symptoms had a broad effect on couples, not just men. Positive effects of the illness, as well as negative effects, emerged from the themes. IMPLICATIONS FOR NURSING Attention needs to be given to methods of providing information and support to couples coping with prostate cancer. Both patients and partners need to be included in discussions about the effect of the illness and treatments so that both can feel more prepared to manage them.

Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure

BACKGROUND Web-based home care monitoring systems can assess medication compliance, health status, quality of life, and physiologic parameters. They may help overcome some of the limitations associated with current congestive heart failure management models. OBJECTIVES This pilot study compared the effects of a self-care and medication compliance device, linked to a Web-based monitoring system, to the effects of usual care alone on compliance with recommended self-care behaviors; medication taking; quality of life; distance walked during a 6-minute walk test; and New York Heart Association Functional Class. We also assessed patient experiences living with the compliance device. METHODS We enrolled 18 patients with Functional Class II-III congestive heart failure in an urban VA Medical Center. The patients were randomized into 2 groups. Group A received usual care plus the compliance device. Group B (controls) received usual care only. Data were collected using the compliance device, the Heart Failure Self-Care Behavior Scale, pill counts, 6-minute walk test, and the Minnesota Living with Heart Failure Questionnaire at baseline and at 3 months follow-up. RESULTS At baseline and at 3 months, there were no differences between the compliance device group and the usual care group in self-care behaviors, pill counts, 6-minute walk-test distance, or Functional Class. However, quality of life improved significantly from baseline to 3-month follow-up (ANOVA, P =.006). This difference was due to an improvement in quality of life for the monitor group (P =.002) but not the usual care only group (P =.113). Patients in the compliance device group had a 94% medication compliance rate, 81% compliance with daily blood pressure monitoring, and 85% compliance with daily weight monitoring as compared to 51% for blood pressure monitoring and 79% for weight monitoring in the usual care group (P = NS). CONCLUSION These are promising pilot results that, if replicated in a larger sample, may significantly improve care and outcomes for patients with heart failure.

A family-based program of care for women with recurrent breast cancer and their family members.

PURPOSE/OBJECTIVES To evaluate the FOCUS Program (family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management), a family-based program of care for women with recurrent breast cancer and their family caregivers. DATA SOURCES Randomized clinical trial. SETTING Midwest region of the United States. DATA SYNTHESIS The family-based program of care consisted of five components: family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management. The program was delivered in three home visits and two follow-up phone calls over a five-month period of time. CONCLUSIONS Patients with recurrent breast cancer and their family members reported high satisfaction with the FOCUS Program. Although the FOCUS Program had a number of strengths, limitations of the program also were identified that need to be addressed in future family-based interventions. IMPLICATIONS FOR NURSING A need exists for family-based programs of care that enable both patients and their family members to manage the multiple demands associated with recurrent breast cancer.

Symptom Burden and quality of life in survivorship: A review of the literature

Background: Cancer has a great impact on the well-being of affected persons and their caregivers long into survivorship. Objective: This article reviews the state of science on the survivorship experience of cancer survivors and caregivers, with a focus on symptom burden and quality of life (QOL) after treatment termination. Methods: The primary databases utilized included PubMed and CINAHL. Search results were limited to human participants, English language, and publications from 2008 to 2013. The articles retrieved included studies of prostate, breast, colorectal, and gynecologic cancers during adulthood. Results: As many as a third of cancer survivors experienced symptoms after treatment cessation equivalent to those experienced during treatment. Fatigue, depression or mood disturbance, sleep disruption, pain, and cognitive limitation were commonly reported by survivors across various malignancies; depression, anxiety, and sleep disturbance affected some caregivers. The studies indicated residual symptoms that extend into survivorship have a great impact on QOL and are associated with disability and healthcare utilization. Younger age, lower socioeconomic status, and increased comorbidities are associated with poorer QOL and higher symptom distress in cancer survivors. Younger age and lower income are associated with greater distress and poorer QOL in caregivers. Conclusions: Survivors and caregivers struggle with symptom burden and diminished QOL long into survivorship. Longitudinal studies are needed to investigate the persistence and severity of symptom burden over time as well as long-term and late effects of these symptoms. Implications for Practice: Interventions designed to help alleviate symptom burden in those most affected are needed.

Developmental life stage and couples' experiences with prostate cancer: A review of the literature

Prostate cancer affects men in all adult life stages. As couples age, they face developmental tasks specific to their age. The combination of disease-related stressors and ongoing developmental changes may negatively affect the dyads adjustment to prostate cancer and, consequently, their quality of life (QOL). In spite of this, a life stage perspective has not been used to understand the impact of diagnosis and treatment on patients and their partners across the aging life span. The purpose of this literature review was to explore the relationship between developmental age and disease-specific issues that may affect a couples QOL as they adapt to a prostate cancer illness. The stages of aging are examined in 3 phases: late middle age (50–64 years); the young-old (65–74); and the old-old (75 years and older). More specifically, these 3 phases were addressed first by presenting the normative developmental challenges of each phase, then disease-related issues from the perspective of the patient, and finally from the perspective of the spousal caregiver. The literature review found that few studies considered age as a relevant factor in the analysis of outcomes of treatment; however, some differences among the groups for both the patient and the caregiver were identified. Ages of participants in the various studies covered a large span of time (50–86 years); consequently, recommendations from these studies do not consider the effect of developmental challenges on the couples ability to adapt to a prostate cancer diagnosis. Knowledge gaps and implications for research using a developmental approach are identified.

The influence of developmental life stage on quality of life in survivors of prostate cancer and their partners

IntroductionAlthough prostate cancer is prevalent, little information is available on how it affects couples’ quality of life (QOL) according to their age cohort. The purpose of this study was to examine how quality of life, self-efficacy and appraisal of the illness experience vary among men with prostate cancer and their partners according to age cohort: middle age (50–64); young-old (65–74); and old-old (75–84). Using an Adult Developmental and Family Stress framework, this study focuses on how normative (developmental stage) and non-normative stressors (prostate cancer) may affect a couples ability to adapt.MethodsA descriptive, comparative design was used to examine age-related differences in quality of life and selected psychosocial variables in 69 men with prostate cancer and their spouses. Cross-sectional data were obtained using standardized instruments with adequate reliability and validity. ANCOVA and MANCOVA were used to determine differences among age groups.ResultsFindings indicated that patients who were ages 65–74 had better QOL and higher self-efficacy than patients ages 50–64 and less negative appraisal of illness than the other two groups. Spouses ages 50–64 reported the most distress related to sexual changes in their husbands. Spouses in both the middle age and old-old group had more bother related to hormone therapy than the young-old spouses.Implications for cancer survivorsFindings suggest that interventions should be tailored to dyads’ developmental life stage. Younger and older prostate cancer survivors and their partners may benefit from tailored interventions designed to improve their quality of life and confidence in managing their treatment outcomes during the survivorship period.

Partners' long-term appraisal of their caregiving experience, marital satisfaction, sexual satisfaction, and quality of life 2 years after prostate cancer treatment.

Background: Partners of men treated for prostate cancer report more emotional distress associated with a diagnosis of prostate cancer than the men report; the duration of distress for partners is seldom examined. Objectives: The purpose of this study was to determine the long-term effects of prostate cancer treatment on partners’ appraisal of their caregiving experience, marital satisfaction, sexual satisfaction, and quality of life (QOL) and factors related to these variables. Methods: This exploratory study evaluated QOL among spouses of prostate cancer survivors at 24 months after treatment. Partners completed a battery of self-report questionnaires in a computer-assisted telephone interview. Results: The sample consisted of 121 partners with average age of 60 years. There was a significant relationship between partners’ perceptions of bother about the man’s treatment outcomes and negative appraisal of their caregiving experience and poorer QOL. Younger partners who had a more negative appraisal of caregiving also had significantly worse QOL. Conclusions: Men’s treatment outcomes continued to bother the partner and resulted in more negative appraisal and lower QOL 2 years after initial prostate cancer treatment. Younger partners may be at greater risk of poorer QOL outcomes especially if they have a more negative view of their caregiving experience. Implications for Practice: Findings support prior research indicating that prostate cancer affects not only the person diagnosed with the disease but also his partner. Partners may benefit from tailored interventions designed to decrease negative appraisal and improve symptom management and QOL during the survivorship period.

Faculty and student experiences with Web-based discussion groups in a large lecture setting.

The exchange of ideas in a discussion format is a more effective way of developing critical thinking in students than a traditional lecture format. Although research has shown that discussion groups are more effective for developing skills in application, analysis, and synthesis of content, it is difficult to implement in a large lecture setting. The author discusses how computer discussion groups were incorporated into a class of 117 nursing students.

The experiences of unpartnered men with prostate cancer: a qualitative analysis.

PurposeThe purpose of this study was to examine how men without partners make decisions about prostate cancer treatment, manage treatment side effects, and obtain information and support.BackgroundIn 2009, it was projected that over 230,000 men were diagnosed with prostate cancer. While treatment options vary, these options result in changes within the man that can affect his quality of life. Research has shown that often spouses play a central role in men’s choice of treatment and in maintaining men’s quality of life. In addition, spouses are the major providers of emotional support and physical care. However, little is known about how men without partners cope with prostate cancer. Prior research seldom addresses how diagnosis and treatment for prostate cancer affects the quality of life of men without partners.MethodsBecause very little is known about the needs of men without partners managing prostate cancer, qualitative analysis of data obtained during semi-structure interviews provided respondents with an opportunity to share the lived experience of prostate cancer. A semi-structured interview was conducted with selected, consenting men. The sample was drawn from the ongoing R01 study of men with prostate cancer (PROSTQA).ResultsThe sample for this study included 17 unpartnered prostate cancer survivors. The ages of participants ranged from 47 to 72 with a mean age of 63. The participants had between zero and two co-morbidities with an average of one co-morbidity per participant. The sample was 82% Caucasian and 17% Black. A total of 35% of the participants reported “some college” (n = 6), 30% graduated from college (n = 5), and 23% went to graduate school (n = 4). One participant reported that he was a high school graduate and one had less than a high school education. Five themes emerged from the data: going it alone, diagnosis and prostate cancer treatment decision-making, sources of information and support, the aftermath of prostate cancer, and coping strategies.ConclusionsThis study provides information about unpartnered men’s prostate cancer experience. This information will help health care professionals to meet the needs of unpartnered more effectively and help them to assist men as they adapt to living with this chronic illness.

Getting to Normal: Women's Experiences Self-Managing Their Perceived Blood Pressure Changes.

Background:In the United States, nearly 25% of all women older than 20 years have hypertension (HTN). Nearly 30% to 50% of persons with HTN experience symptoms attributed to high blood pressure (BP). Women with hypertensive symptoms may connect their symptoms to perceived BP changes and may be using their perceptions about BP changes to guide their HTN self-management. There is limited research about perceived BP changes or their use in self-management. Objective:The purpose of this qualitative study is to describe the experiences of women with HTN self-managing their perceived BP changes. Methods:van Manen’s phenomenology methodology and method guided the inquiry. Women with HTN who believed they could tell when their BP changed based on their symptoms were recruited from community settings and were interviewed once with a semistructured guide. Interviews were digitally recorded and professionally transcribed. Textual data were analyzed using thematic analysis to identify major themes. Results:Seven black and 6 white women comprised the study sample. Participants were middle aged (mean [SD], 50.5 [9.62] years), were experienced in living with HTN (mean [SD],10.76 [9.50] years), had at least a high school education, and had a limited annual income (93% <