Kathi Mooney

CERVICAL CANCER BELIEFS AND PAP TEST SCREENING PRACTICES AMONG CHINESE AMERICAN IMMIGRANTS

PURPOSE/OBJECTIVES To examine beliefs and Pap test utilization among Chinese American women, the largest Asian female population in the United States. RESEARCH APPROACH Cross-sectional descriptive, correlational study. SETTING Metropolitan areas of Portland, OR. PARTICIPANTS 100 foreign-born Chinese women aged 40 years and older. METHODOLOGIC APPROACH Three questionnaires were modified, translated, combined, and pretested. Participants completed the self-administered questionnaire in a group setting. MAIN RESEARCH VARIABLES Utilization of Pap test screening, health beliefs, and cultural and sociodemographic variables. FINDINGS Sixty-eight percent reported having a Pap test within the prior three years (adherence), and 84% reported ever having a Pap test. The odds of Pap test use and adherence decreased with increasing age. Women with insurance or a regular healthcare provider had better odds of Pap test use and adherence. Older age, older age when a participant moved to the United States, and increased modesty were negatively associated with ever having had a Pap test. CONCLUSIONS Age and cultural beliefs influence Pap test use and adherence. The strength of provider recommendation and healthcare access as predictors suggest areas for interventions designed to increase screening for cervical cancer. INTERPRETATION Nurses play a vital role in preventive health care, especially with the growing number of advanced practice nurses delivering primary care. Primary healthcare providers should be reminded of their influential role in increasing adherence to cancer screening. Further health policy action is necessary to extend screening coverage to those who do not have adequate health insurance.

Delay in diagnostic testing after abnormal mammography in low-income women

PURPOSE/OBJECTIVES To identify factors associated with diagnostic delay after an incomplete or abnormal mammogram among women participating in a state mammography screening program. RESEARCH APPROACH Retrospective case-control design using bivariate and multivariate logistic regression analyses to explore the associations between age, race, ethnicity, marital status, breast cancer history, and self-reported breast symptoms and delay. SETTING A statewide program of free screening mammography for women who are under- or uninsured. PARTICIPANTS 11,460 women enrolled in a free, statewide screening program from 2002-2006. METHODOLOGIC APPROACH Using the Tennessee Breast and Cervical Cancer Screening Program database, further analyses were conducted. MAIN RESEARCH VARIABLES The outcome measure was delay in completion of all diagnostic tests and was defined as women who did not complete testing within 60 days. FINDINGS Thirty-seven percent of women required follow-up, and of a subset used in the analysis, 30% experienced delay of more than 60 days. Controlling for marital status, age, and breast cancer history, women who experienced delay were more likely to be African American versus Caucasian (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.13, 1.85) or Hispanic (OR = 0.72, 95% CI = 0.55, 0.93) and to have self-reported breast symptoms (OR = 1.50, 95% CI = 1.27, 1.77). CONCLUSIONS In a sample of women with low income needing mammography follow-up, delay was associated with three intrapersonal variables, potentially reducing the effectiveness of mammography screening for women who were African American, or Hispanic, or had self-reported breast symptoms. INTERPRETATION Nurses providing cancer screening examinations are uniquely positioned to assess the knowledge, beliefs, and resources of women using the program and to navigate women through barriers to completion. Knowledge of factors associated with delay is valuable for planning interventions and allocating program resources.

The Association of Chemotherapy-Induced Peripheral Neuropathy Symptoms and the Risk of Falling.

IMPORTANCE Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of neurotoxic chemotherapy resulting in pain, sensory loss, and decreased quality of life. Few studies have prospectively examined the relationship between sensory neuropathy symptoms, falls, and fall-related injuries for patients receiving neurotoxic chemotherapy. OBJECTIVE To determine the association between the symptoms of CIPN and the risk of falls for patients receiving neurotoxic chemotherapy. DESIGN, SETTING, AND PARTICIPANTS In this secondary analysis of a prospective study, 116 patients with breast, ovarian, or lung cancer who were beginning neurotoxic chemotherapy with a taxane or platinum agent were recruited from oncology clinics. These patients would call a novel automated telephone system daily for 1 full course of chemotherapy. The telephone system (SymptomCare@Home) used a series of relevant CIPN questions to track symptoms on a 0 to 10 ordinal scale and contained a questionnaire about falls. Those reporting a numbness and tingling severity score of 3 or greater for at least 10 days were considered to have significant CIPN symptoms and were compared with those patients who did not. Data analysis was performed in November 2015. EXPOSURE Chemotherapy with a neurotoxic taxane or platinum agent. MAIN OUTCOMES AND MEASURES Patient-reported falls or near falls and fall-related injuries. The hypothesis was generated after data collection but prior to data analysis. RESULTS Of the 116 patients who started neurotoxic chemotherapy (mean [SD] age was 55.5 [11.9] years, and 109 [94.0%] were female), 32 met the predetermined criteria for CIPN symptoms. The mean duration of follow-up was 62 days, with 51 telephone calls completed per participant. Seventy-four falls or near falls were reported. The participants with CIPN symptoms were nearly 3 times more likely to report a fall or near fall than the participants without CIPN symptoms (hazard ratio, 2.67 [95% CI, 1.62-4.41]; P < .001). The participants with CIPN symptoms were more likely than the participants without CIPN symptoms to obtain medical care for falls (8 of 32 participants with CIPN symptoms [25.0%] vs 6 of 84 participants without CIPN symptoms [7.1%]; P = .01). CONCLUSIONS AND RELEVANCE These findings suggest that the sensory symptoms of CIPN are an indicator of an increased risk of falling and an increased use of health care resources. This study demonstrates the utility of a novel telephone-based system to track neuropathy symptoms. Careful monitoring and coaching of patients receiving neurotoxic chemotherapy for new sensory symptoms may facilitate more effective fall prevention strategies.

Measuring Breast Cancer and Mammography Screening Beliefs Among Chinese American Immigrants

Disparities in breast cancer outcomes persist among Asian American women. Breast cancer is the most commonly diagnosed cancer among Chinese American women. This article describes the psychometric evaluation of an instrument measuring knowledge and beliefs related to breast cancer and screening among Chinese American women aged 40 or older. A sample of 100 foreign-born Chinese American women were recruited from an Asian community. Guided by the health belief model, a questionnaire was adapted from three existing questionnaires. Principal axis factoring analyses yielded a three-factor solution that accounted for 53% of the variance in the breast cancer items and a four-factor solution that accounted for 69% of the variance in the cultural items (Cronbachs alphas = .71—.89). Whereas these findings contribute to the understanding of the psychometric properties of an instrument targeted for Chinese American women, additional research is needed to evaluate its utility and efficacy for other Asian Americans.

Automated home monitoring and management of patient‐reported symptoms during chemotherapy: results of the symptom care at home RCT

Technology‐aided remote interventions for poorly controlled symptoms may improve cancer symptom outcomes. In a randomized controlled trial, the efficacy of an automated symptom management system was tested to determine if it reduced chemotherapy‐related symptoms. Prospectively, 358 patients beginning chemotherapy were randomized to the Symptom Care at Home (SCH) intervention (n = 180) or enhanced usual care (UC) (n = 178). Participants called the automated monitoring system daily reporting severity of 11 symptoms. SCH participants received automated self‐management coaching and nurse practitioner (NP) telephone follow‐up for poorly controlled symptoms. NPs used a guideline‐based decision support system. Primary endpoints were symptom severity across all symptoms, and the number of severe, moderate, mild, and no symptom days. A secondary endpoint was individual symptom severity. Mixed effects linear modeling and negative binominal regressions were used to compare SCH with UC. SCH participants had significantly less symptom severity across all symptoms (P < 0.001). On average, the relative symptom burden reduction for SCH participants was 3.59 severity points (P < 0.001), roughly 43% of UC. With a very rapid treatment benefit, SCH participants had significant reductions in severe (67% less) and moderate (39% less) symptom days compared with UC (both P < 0.001). All individual symptoms, except diarrhea, were significantly lower for SCH participants (P < 0.05). Symptom Care at Home dramatically improved symptom outcomes. These results demonstrate that symptoms can be improved through automated home monitoring and follow‐up to intensify care for poorly controlled symptoms.

Oncology nursing education: Peril and opportunities in the new century

OBJECTIVES To review the historic evolution of oncology nursing education, the health care trends affecting educational programs, and the educational innovations required for the future. DATA SOURCES Articles, textbooks, and professional documents. CONCLUSIONS Oncology nursing education has evolved into a premier model for specialty nursing education. Oncology nursing certification at both the generalist and advanced levels is well recognized. Current trends, however, suggest that some forms of oncology nursing education are on the decline and new and innovative educational approaches need to be considered for the future. IMPLICATIONS FOR NURSING PRACTICE The 21st century will bring new challenges and opportunities for oncology nurse educators to develop new and innovative approaches to prepare oncology nurses to be effective and valued health care providers.

Purchasing oncology services: Summary recommendations

A multidisciplinary panel representing various stakeholders in the health care delivery and oncology services marketplace was convened to develop specific criteria for healthcare purchasers to consider when evaluating the structures and processes of health plans. These rank ordered criteria also can be used by oncologic service providers and health plan designers as a yardstick for the services they offer.

Survivorship, Version 2.2017: Clinical practice guidelines in oncology

Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period.

Observed and self-reported pesticide protective behaviors of Latino migrant and seasonal farmworkers

Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be reduced by pesticide protective behaviors (PPBs). The Environmental Protection Agencys (EPA) Worker Protection Standard (WPS) requires PPBs be taught to farmworkers prior to field work. Studies to date have not utilized observational methods to evaluate the degree to which PPBs are practiced by Latino migrant and seasonal farmworkers in the United States. The purpose of this study was to describe, compare, and contrast observed and self-reported PPBs used by Latino farmworkers; both PPBs that the WPS requires be taught and other PPBs were included. Observed and self-reported data were collected from 71 Latino farmworkers during the 2014 tobacco growing season in North Carolina. Participants were consistent in reporting and using long pants and closed shoes in the field most of the time. In addition, gloves, hats/bandanas, and water-resistant outerwear were frequently observed, although they are not required to be taught by the WPS. Farmworkers reported more long-sleeve (p=.028) and glove use (p=.000) than what was observed. It was uncommon to observe washing behavior before eating or drinking, even when washing supplies were available. Washing behaviors were significantly overreported for hand (p=.000; p=.000) and face (p=.000; p=.058) washing before eating and drinking in the field. This study documents that protective clothing behaviors that the WPS requires be taught, plus a few others are commonly practiced by Latino migrant and seasonal farmworkers, but washing behaviors in the field are not. Targeted strategies to improve washing behaviors in the field are needed.

Survivorship: Fatigue, version 1.2014 - Clinical practice guidelines in oncology

Many posttreatment cancer survivors experience chronic pain, often leading to psychological distress; decreased activity, motivation, and personal interactions; and an overall poor quality of life. This section of the NCCN Guidelines for Survivorship provides screening and management recommendations for pain in survivors. A multidisciplinary approach is recommended, with a combination of pharmacologic treatments, psychosocial and behavioral interventions, physical therapy and exercise, and interventional procedures.