Lisa Kennedy Sheldon

Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: A systematic review

INTRODUCTION Surgical resection currently is the best available treatment to enhance long-term survival after non-small cell lung cancer (NSCLC). With the anticipated growth in the number of NSCLC survivors diagnosed through computed tomography screening, health-related quality of life (HR-QOL) as an endpoint of treatment will become increasingly important. This article is a systematic review of the literature regarding HR-QOL in patients after surgical treatment. METHODS Three computerized databases (PubMed, Medline, and CINHAL) were used to identify relevant articles. Inclusion criteria were: empirical studies English language, assessment of HR-QOL after surgical treatment for stage I, II, or III NSCLC, and publication prior to January 2012. Data were abstracted and content analyses were used to synthesize the findings. RESULTS Nineteen out of 337 studies were reviewed. The majority of participants (67%) had stable or improved mental HR-QOL at 6-months after surgery. Compared with the general population, however, NSCLC survivors have poorer mental HR-QOL. Compared to pre-surgical status, participants had worse physical function at 6-months after surgery and had decreased physical function up to 2-years after surgery. Pain, fatigue, dyspnea and coughing were the most prevalent symptoms. Increased levels of dyspnea and fatigue persisted for at least 2-years after surgery. Continued smoking, presence of comorbidities, extensive surgical resection, and use of adjuvant therapy were associated with lower HR-QOL. CONCLUSIONS New interventions focused on smoking cessation, improving symptom control and physical function are needed to enhance HR-QOL after lung cancer surgery.

Communication in Oncology Care: The Effectiveness of Skills Training Workshops for Healthcare Providers

Communication skills are the cornerstone of the patientprovider relationship in cancer care. Lack of these skills can diminish patient disclosure, increase patient anxiety, and decrease satisfaction with care. The purpose of this article is to evaluate the literature regarding the effi cacy and outcomes of communication skills training programs for healthcare providers in oncology. Using four databases, the author found 21 research articles about communication skills training programs for healthcare providers in oncology. The majority of published studies involved training programs for experienced clinicians (i.e., physicians, nurses, nurse practitioners, physician assistants) in oncology care. Programs varied in length from 18–105 hours and evaluated communication skills, patient satisfaction and anxiety, and provider confi dence and perceived stress. Specifi c communication skills and provider confi dence were statistically improved in 19 of 21 studies. Follow-up data showed maintenance of some skills and attrition of others. Longer programs with consolidation workshops are seen as more effective.

Putting Evidence Into Practice®: Evidence-Based Interventions for Anxiety

Anxiety is a common form of distress that oncology nurses often observe in their patients. The incidence of anxiety may be as high as 50% in recently diagnosed patients and may persist into survivorship. How nurses respond to patients experiencing distress and anxiety influences further assessment of the patients concerns, identification of anxiety, and the initiation of appropriate interventions. Evidence-based interventions are essential to improving outcomes for patients experiencing anxiety and directing future research. The authors of this article reviewed the evidence of effectiveness for different interventions to reduce anxiety in patients with cancer.

Provider verbal responses to patient distress cues during ambulatory oncology visits.

PURPOSE/OBJECTIVES To explore healthcare provider cue-responding behaviors to patient cues of distress and socioemotional concerns during ambulatory, on-treatment oncology visits. DESIGN Descriptive secondary analysis of a data set of audio recordings of oncology visits and reports of symptoms and quality of life recorded with an electronic self-report assessment-cancer (ESRA-C) tool. SETTING Comprehensive cancer center, ambulatory care. SAMPLE 31 randomly selected cases from an existing data set (with one used as a training tool) of 590 audio recordings of patient-provider communication. METHODS Patients were placed in Group 1 (n = 20) and Group 2 (n = 10) to explore differences in patient-provider communication and decrease coder bias. Both groups completed the ESRA-C questionnaire prior to the visit. Providers in Group 2 received a printed ESRA-C summary report for use during the visit. Audio files of the visit were coded using the Medical Interview Aural Rating System (MIARS). MAIN RESEARCH VARIABLES Patient cues of distress and provider cue-responding behaviors. FINDINGS Patient cues of distress and socioemotional concerns ranged from 0-13 cues per visit, with a mean of 4.6 cues per visit. Providers acknowledged 57% of patient cues, but only acknowledged and explored 22% of all patient cues. Providers in Group 2 acknowledged patient concerns more often but explored the concerns less frequently. The number of patient cues distanced from by providers was lower in Group 2 and the overall provider score for responsiveness to patient cues of distress was higher, indicating more responsiveness than from Group 1. CONCLUSIONS The use of a summary report of patient concerns may have enhanced provider responsiveness, in general. Distancing behaviors by providers in response to patient verbal cues may indicate a lack of knowledge, time limitations, or a lack of confidence. IMPLICATIONS FOR NURSING To effectively support patients with cancer through active therapy, a greater level of acknowledgment, exploration, and responsive action by providers is indicated. These findings have implications for provider education, with regard to appropriate responses, and for researchers to test methods that best prompt and support effective provider behaviors, ultimately improving patient outcomes.

Prevalence, Predictors, and Same Day Treatment of Positive VIA Enhanced by Digital Cervicography and Histopathology Results in a Cervical Cancer Prevention Program in Cameroon.

Background In 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC). Methods We retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Women’s Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC). Results Of the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000. Conclusions High rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.

Cervical Cancer Screening in Cameroon: Interobserver Agreement on the Interpretation of Digital Cervicography Results.

Objective The World Health Organization recommends visual inspection with acetic acid (VIA) for cervical cancer screening in resource-limited settings. In Cameroon, we use digital cervicography (DC) to capture images of the cervix after VIA. This study evaluated interobserver agreement of DC results, compared DC with histopathologic results, and examined interobserver agreement among screening methods. Method Three observers, blinded to each others interpretations, evaluated 540 DC photographs as follows: (1) negative/positive for acetowhite lesions or cancer and (2) assigned a presumptive diagnosis of histopathologic lesion grade in the 91 cases that had a histopathologic diagnosis. Observer A was the actual screening nurse; B, a reproductive health nurse; C, a gynecologic oncologist; and D, the histopathologic diagnosis. We compared inter-rater agreement of DC impressions among observers A, B, and C, and with D, with Cohen kappas. Results For interpretations of DC, (negative/positive) strengths of agreement of paired observers were the following: A/B, moderate [K, 0.54; 95% confidence interval (CI), 0.47–0.61], A/C, fair (K, 0.37; 95% CI, 0.29–0.44), and B/C, moderate (K, 0.45; 95% CI, 0.37–0.53). For presumptive pathologic grading, strengths of agreement for weighted Ks were as follows: A/B, moderate (K, 0.42; 95% CI, 0.28–0.56); A/C, fair (K, 0.33; 95% CI, 0.20–0.46); B/C, fair (K, 0.54; 95% CI, 0.40–0.67); A/D, moderate (K, 0.59; 95% CI, 0.45–0.74); B/D, moderate (K, 0.58; 95% CI, 0.46–0.70); and C/D, moderate (K, 0.50; 95% CI, 0.37-0.63). Conclusions Interobserver agreement of DC interpretations was mostly moderate among the 3 observers, between them and histopathology, and comparable to that of other visual-based screening methods, i.e., VIA, cytology, or colposcopy.

Communication About Symptoms and Quality of Life Issues in Patients With Cancer: Provider Perceptions

This study used qualitative data collection and analysis methods to describe provider perceptions of addressing patient-initiated communication about common or sensitive symptom and quality of life issues (SQIs) in oncology. Eligible participants were health care providers who had participated in a larger trial testing a patient-centered technology to assess cancer SQIs and support self-care. Audio-recorded vignettes were simulated based on recorded clinic visits from the larger trial and presented during semi-structured cognitive interviews with each participant. Transcripts of the interviews were content analyzed. Twelve providers participated. Participants’ responses included four themes: the institutional and clinical context, the complexity of addressing SQIs, strategies used to understand SQIs, and creating a plan to address SQIs. Participants felt that approaching SQIs inside and outside of the clinic required ongoing communication within a multidisciplinary team both to gather information and manage the SQI. Forming a relationship with the patient was one strategy to facilitate assessing SQIs. Most participants expressed a need for guidance about effective SQI communication. Providers perceived approaching SQIs as a routine part of interdisciplinary clinical care. The specific symptom and the complexity of its management influenced the process of assessing and managing SQIs. Findings have implications for institutional processes, training, evaluation, and program development.

Promoting Cancer Nursing Education, Training, and Research in Countries in Transition

Nurses are the majority of the healthcare workforce globally and have the most contact with people at risk for or living after a cancer diagnosis. Cancer care, including prevention, screening, treatment, and survivorship and symptom management and palliative care, and survivorship issues, is provided by nurses. This is especially true in countries in transition where access to specialty personnel, resources, and training may be limited by conflict, economic factors, or geographical and/or technological isolation. Promoting equity in cancer care and reducing the global cancer burden necessitates specialty training for nurses in cancer care to include evidence-based, best practices across continuum of care. Global partnerships between countries, organizations, and academic institutions are one way to address specialty training in oncology nursing. Technology such as web-based resources and mobile health technology affords opportunities for distance training and consultation regardless of borders. Globalization of oncology nursing is needed to implement new, international initiatives and improve cancer care and control.

Breast Cancer Survivors and Sexuality: A Review of the Literature Concerning Sexual Functioning, Assessment Tools, and Evidence-Based Interventions.

BACKGROUND Most breast cancer survivors (BCSs) experience sexual dysfunction from treatment-induced hormonal changes, making sexual assessment an important component of survivorship care. However, because many oncology healthcare providers do not perform such assessment, a number of BCSs endure unidentified sexual dysfunction. Barriers to assessment faced by providers must be identified, and further research should examine the perspectives of BCSs and their partners regarding preferences for sexual assessment and interventions. OBJECTIVES The purpose of this literature review was to explore tools used to assess sexual functioning and evidence-based interventions used to treat sexual dysfunction in BCSs. METHODS Articles published from 2003-2013 that reported on the effects of breast cancer and its treatment on sexual functioning in BCSs and located through online database searches (PubMed, the Cochrane Library, MEDLINE, CINAHL) were reviewed. FINDINGS Sexual dysfunction is a common problem among BCSs. Using various assessment tools, providers should regularly assess sexual functioning in BCSs during and after treatment to improve quality of life for BCSs and their partners.

Pediatric Pain Assessment by Drawn Faces Scales: A Review

Pediatric pain assessment is a significant issue yet the topic is understudied. Unique challenges, namely reporting biases, are present when assessing pain in children. The aim of this review of the literature is to increase awareness of biases when assessing pain in children, suggest changes in practice, and state priorities for future research. Five computerized databases were searched to identify original research pertaining to the use of drawn faces scales for pediatric pain assessment. Twelve studies met inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines provided a framework for this review. Relevant articles were identified and data were extracted from the studies. Content analyses were then used to synthesize the findings. The age of a child being assessed contributed to biases in pain assessment. Drawn faces scales may provide inaccurate pain assessment results if a child has difficulty separating the feelings of pain and mood. Smiling faces on pain assessment scales may lead to overestimation of pain intensity. Nurses should consider biases when selecting and implementing a drawn faces pain assessment tool and when planning pain management interventions. An increase in the use of technology in pediatric pain assessment practices may provide opportunities to implement individualized pain assessment in practice. Further research is needed to determine the most reliable methods for pediatric pain assessment including the use of technology. Evidence would assist nurses in determining the best tool to assess each child based on cognitive abilities and developmental level.