Marjorie Wells

Use of Complementary and Alternative Medicine Therapies to Control Symptoms in Women Living With Lung Cancer

Complementary and alternative medicine (CAM) use by cancer patients, especially women, is increasing. However, CAM use among patients with lung cancer, who have been reported to have the highest symptom burden, is poorly documented. This study describes types and frequencies of specific CAM therapies used by women with lung cancer to manage symptoms, and examines differences in demographic and clinical characteristics between CAM users and non-CAM users. Participants included 189 women with non-small cell lung cancer and ≥1 of 8 symptoms. Six CAM therapies, used to control symptoms, were assessed, including herbs, tea, acupuncture, massage, meditation, and prayer. Forty-four percent (84 women) used CAM therapies, including prayer (34.9%), meditation (11.6%), tea (11.6%), herbs (9.0%), massage (6.9%), and acupuncture (2.6%). Complementary and alternative medicine use was greatest for difficulty breathing and pain (54.8% each), with prayer the most commonly used CAM for all symptoms. Significant differences (P < .05) were found for age (t = 2.24), symptom frequency (t = −3.02), and geographic location (&khgr;2 = 7.51). Women who were younger, experienced more symptoms, and lived on the West Coast or South (vs Northeast) were more likely to use CAM. We found that CAM use is variable by symptom and may be an indicator of symptom burden. Our results provide important initial data regarding CAM use for managing symptoms by women with lung cancer.

Nursing research in smoking cessation: a listing of the literature, 1996-2005.

A listing of publications related to nurses and tobacco is posted on the Tobacco Free Nurses Web site (www.tobaccofreenurses.org). For this conference, a chronological listing of the numbers and type of data-based articles that focused on nursing involvement in tobacco cessation published since 1996, the year of the first publication of the Agency for Health Care Policy and Research, Clinical Practice Guideline #18, through 2005 was developed. One hundred and seventy-five data-based papers that met the criteria, that is, the paper focused on smoking cessation and involved nurses, were identified. Most (88%) articles were exclusively focused on cessation. Research designs included experimental (38%), quasi-experimental (24%), descriptive-quantitative (25%), descriptive-qualitative (8%), meta-analyses (2%), and secondary analyses and systematic reviews (each 1%). The number of articles that focused on nursing involvement in tobacco cessation has increased eight fold in the past 10 years, from less than 5 articles published in 1996 to more than 40 published in 2005. The minority (35%) of data-based articles that focused on nurses and tobacco cessation were published in nursing journals.

Increasing Nursing Referral to Telephone Quitlines for Smoking Cessation Using a Web-Based Program

Background:Smokers who make a quit attempt during hospitalization have improved long-term abstinence if they receive follow-up support, including via a telephone quitline, a free resource in the United States. Smokers are referred infrequently to this resource by healthcare providers. Objective:The aim of this study was to evaluate the impact of a Web-based educational program (Helping Smokers Quit) on translating the Treating Tobacco Use and Dependence Clinical Practice Guideline: 2008 Update into practice. Using a Web-based survey, frequency of nurses’ self-reported referral of smokers to a quitline and performance of the components of a smoking cessation intervention (the 5As: Ask, Advise, Assess, Assist, Arrange) was compared with self-reported performance among nurses who received printed educational materials (control group) at 6 months. Methods:Nurses from 30 (n = 15 control and n = 15 intervention) randomly selected and assigned hospitals from California, Indiana, and West Virginia participated. Both groups received a toolkit of materials including a state quitline card and access to the Tobacco Free Nurses Web site; the intervention group had additional access to a project-specific Web page and the opportunity to attend a webinar. Only nurses who completed baseline and 6-month surveys were included in the analysis. Mean improvement of the 5As and refer scores and logistic regressions of consistent (usually or always) referral to a quitline were used to examine differences over time by group. Results:Pre–post data were collected for 333 nurses (209 intervention, 124 control). Mean improvement was significantly higher in Advise, Assess, Assist, Arrange, and Referral to a Quitline for the Help Smokers Quit group. Nurses in the control group significantly improved in Advise and Referral to a Quitline. Consistent referral was most likely in the intervention group (OR = 1.74, 95% CI [1.11, 2.72]), especially among those who viewed the webinar (OR = 2.34, 95% CI [1.03, 4.23]). Discussion:After 6 months, nurses in the intervention group had significant improvement in the frequency of interventions and consistency of referral of smokers to the quitline. The improvement of nurses’ referral to the quitline among the control group who only received printed materials demonstrates that both are effective strategies in increasing awareness of this resource.

Tobacco Cessation Practices and Attitudes Among Nurses in the Czech Republic.

Background: Tobacco is the leading cause of cancer in the Czech Republic. More than one-third of the population older than 15 years smokes, including many nurses. Most smokers want to quit, but the extent of nurses’ involvement in tobacco cessation is unknown. Objective: The purposes of this study are to describe the frequency of nurses’ interventions in helping smokers quit, examine their attitudes and skills, and explore the relationship of nurses’ smoking status to level of intervention. Methods: A convenience sample of nurses in the Czech Republic completed a survey about their frequency of interventions according to the 5As for tobacco dependence treatment (ie, ask, advise, assess, assist, arrange), their attitudes and perceived skills, and their smoking status (never, former, current). Results: A total of 157 nurses completed the survey; 26% “always” or “usually” assisted patients with smoking cessation. Few (22%) reported that nurses could play an important role in helping patients quit, and 65% rated their ability to help smokers quit as “fair/poor.” Nurse who smoked (30%) were less likely to consistently assess smoking status or arrange for follow-up support. Conclusion: Few nurses in the Czech Republic consistently provide smoking cessation support to patients, have the skills to do so, or view this role as an important part of their role. Implications for Practice: To reduce tobacco-related cancers in the Czech Republic, capacity-building efforts are needed to enhance nurses’ skills and confidence in providing smoking cessation interventions. Support is also need to help nurses who smoke quit.

Impact of Online Education on Nurses’ Delivery of Smoking Cessation Interventions With Implications for Evidence‐Based Practice

BACKGROUND Tobacco use is the leading cause of preventable disease and death in Europe and worldwide. Nurses, if properly educated, can contribute to decreasing the burden of tobacco use in the region by helping smokers quit smoking. AIMS To assess: (a) the feasibility of an online program to educate nurses in Czech Republic and Poland on evidence-based smoking cessation interventions for patients and (b) self-reported changes in practices related to consistently (usually or always) providing smoking cessation interventions to smokers, before and 3 months after participation in the program. METHODS A prospective single-group pre-post design. RESULTS A total of 280 nurses from Czech Republic and 156 from Poland completed baseline and follow-up surveys. At 3 months, nurses were significantly more likely to provide smoking cessation interventions to patients who smoke and refer patients for cessation services (p < .01). Nurses significantly improved their views about the importance of nursing involvement in tobacco control. IMPLICATIONS FOR PRACTICE Education about tobacco control can make a difference in clinical practice, but ongoing support is needed to maintain these changes. Health system changes can also facilitate the expectation that delivering evidence-based smoking cessation interventions should be routine nursing care. LINKING EVIDENCE TO ACTION Educating nurses on cessation interventions and tobacco control is pivotal to decrease tobacco-related disparities, disease, and death. Online methods provide an accessible way to reach a large number of nurses.