Laurel Northouse

Quality of Life and Satisfaction with Outcome among Prostate-Cancer Survivors

BACKGROUND We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners. METHODS We prospectively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy. We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome. RESULTS Adjuvant hormone therapy was associated with worse outcomes across multiple quality-of-life domains among patients receiving brachytherapy or radiotherapy. Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures. After prostatectomy, urinary incontinence was observed, but urinary irritation and obstruction improved, particularly in patients with large prostates. No treatment-related deaths occurred; serious adverse events were rare. Treatment-related symptoms were exacerbated by obesity, a large prostate size, a high prostate-specific antigen score, and older age. Black patients reported lower satisfaction with the degree of overall treatment outcomes. Changes in quality of life were significantly associated with the degree of outcome satisfaction among patients and their spouses or partners. CONCLUSIONS Each prostate-cancer treatment was associated with a distinct pattern of change in quality-of-life domains related to urinary, sexual, bowel, and hormonal function. These changes influenced satisfaction with treatment outcomes among patients and their spouses or partners.

Randomized clinical trial of a family intervention for prostate cancer patients and their spouses

Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family‐based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self‐efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses.

Coping strategies and quality of life in women with advanced breast cancer and their family caregivers

Coping with advanced breast cancer is a challenge for both women and their family caregivers. The primary purposes of this study were to compare coping strategies used by patients with advanced breast cancer and their family caregivers and to examine how those strategies related to patient and caregiver quality of life. The sample consisted of 189 patient-family member dyads with advanced breast cancer. Profile analysis showed that patients reported greater use of emotional support, religion, positive reframing, distraction, venting, and humor coping while family members reported greater use of alcohol/drug coping. Regression analyses showed that among both patients and family caregivers, active coping was associated with higher quality of life and avoidant coping was associated with lower quality of life. In addition, the patient’s level of symptom distress moderated the relationship between coping and quality of life. The negative relationship between family caregivers’ avoidant coping strategies and family caregivers’ mental quality of life was strongest when patients had low levels of symptom distress and weakest when patients had high levels of symptom distress.

Cancer and the family: Strategies to assist spouses

Research that has been conducted with spouses of cancer patients documents the nature of their stress, the duration of their stress, and the concerns that they confront over the course of the illness. A variety of intervention strategies have been used to assist spouses in dealing with the stressful effects of cancer. Two major categories of intervention strategies are providing information and offering support.

The quality of life of African American women with breast cancer

The objectives of this study were to describe the quality of life of African American women with breast cancer and test a model of factors that may affect their quality of life. A stress-coping framework that included person (demographics, current concerns, and optimism), social resources (family functioning), and illness-related factors (symptom distress, medical characteristics), as well as appraisal of illness and quality of life, was used to guide this exploratory, cross-sectional study. Participants included 98 African American women who were approximately 4 years postdiagnosis. The women reported a fairly high quality of life, were generally optimistic, and had effective family functioning. Although symptom distress was generally low, a sizable number of women reported problems with energy loss, sleep disturbances, and pain. The model explained 75% of the variance in quality of life, with appraisal, family functioning, symptom distress, and recurrence status each explaining a significant amount of the variance. Current concerns had an indirect effect on quality of life that was mediated by appraisal. These findings underscore the importance of helping women foster a positive appraisal of their illness, manage current concerns, maintain family functioning, and reduce symptom distress, because each of these factors indirectly or directly affects their quality of life.

The Impact of Caregiving on the Psychological Well-Being of Family Caregivers and Cancer Patients

OBJECTIVES To provide an overview of patient and caregiver emotional distress; examine the sources of their distress, review evidence-based interventions that can reduce distress, and provide guidelines for assessment and intervention. DATA SOURCES Peer-reviewed publications. CONCLUSION There is a significant, reciprocal relationship between patient and caregiver emotional distress. Sources of distress vary by phase of illness. Evidence-based interventions can reduce distress and anxiety, but often are not implemented in practice. IMPLICATIONS FOR NURSING PRACTICE Nurses need to assess patients and family caregivers for distress and intervene to reduce distress by fostering patient-caregiver teamwork, communication, and self-care; providing information; and referring to resources as needed.

Putting Evidence Into Practice®: Nursing Assessment and Interventions to Reduce Family Caregiver Strain and Burden

Family caregiving often is associated with multiple rewards, yet the diversity and intensity of caregiving roles also can result in caregiver strain and burden. Using interventions to reduce the strain and burden on caregivers of patients with cancer is an important role nurses play. This article is a critical review and synthesis of the evidence regarding assessment tools and interventions aimed at reducing caregiver strain and burden in the oncology population. Although the striking finding is the limited number of interventions targeted toward oncology caregivers, suggestions from the literature are offered to support and promote healthy outcomes for family caregivers.

Helping families of patients with cancer

PURPOSE/OBJECTIVES To discuss the impact of cancer on families of patients with cancer. DATA SOURCES National reports on caregiving and research articles related to cancer and families. DATA SYNTHESIS Family caregivers are the bedrock of chronic care in the United States. They provide an enormous amount of unpaid care that is often invisible. Cancer can affect the emotional, social, physical, and spiritual well-being of family members. CONCLUSIONS Family intervention research can have a positive effect on patient and family caregiver outcomes. More intervention research with families is needed that is theoretically based, uses randomized clinical trial designs, and uses instruments that are sensitive to intervention effects. IMPLICATIONS FOR NURSING Although family intervention research is limited, descriptive and exploratory research has identified protective factors and risk factors that need to be addressed in clinical practice.

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.

Caring for caregivers and patients: Research and clinical priorities for informal cancer caregiving.

Informal/family caregivers are a fundamental source of care for cancer patients in the United States, yet the population of caregivers and their tasks, psychosocial needs, and health outcomes are not well understood. Changes in the nature of cancer care and its delivery, along with the growing population of survivors and their caregivers, warrant increased attention to the roles and demands of caregiving. This article reviews current evidence presented at a 2‐day meeting examining the state of the science of informal cancer caregiving that was convened by the National Cancer Institute and the National Institute of Nursing Research. The meeting sought to define who is an informal cancer caregiver, summarize the state of the science in informal cancer caregiving, and describe both the kinds of interventions developed to address caregiving challenges and the various outcomes used to evaluate their impact. This article offers recommendations for moving science forward in 4 areas: 1) improving the estimation of the prevalence and burden of informal cancer caregiving; 2) advancing the development of interventions designed to improve outcomes for cancer patients, caregivers, and patient‐caregiver dyads; 3) generating and testing strategies for integrating caregivers into formal health care settings; and 4) promoting the use of technology to support informal cancer caregivers. Cancer 2016;122:1987–95.