Mary E. Johnson

Impacting Quality of Life for Patients With Advanced Cancer With a Structured Multidisciplinary Intervention: A Randomized Controlled Trial

PURPOSE The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer. PATIENTS AND METHODS Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27. RESULTS Of the 103 participants, overall QOL at week 4 was maintained by the patients in the intervention (n = 49), whereas QOL at week 4 significantly decreased for patients in the control group (n = 54). This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group (P = .009). Intervention participants maintained their QOL, and controls gradually returned to baseline by the end of the 6-month follow-up period. CONCLUSION Although intervention participants maintained and actually improved their QOL during radiation therapy, control participants experienced a significant decrease in their QOL. Thus, a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment.

The Well-Being and Personal Wellness Promotion Strategies of Medical Oncologists in the North Central Cancer Treatment Group

Purpose: The well-being of oncologists is important to the well-being of their patients. While much is known about oncologist distress, little is known about oncologist well-being. We set out to evaluate oncologist well-being and the personal wellness promotion strategies used by oncologists. Patients and Methods: We performed a cross-sectional survey of medical oncologists in the North Central Cancer Treatment Group using a validated instrument to measure quality of life. Study-specific questions explored stressors, wellness promotion strategies and career satisfaction. Results: Of 241 responding oncologists (response rate 61%), 121 (50%) reported high overall well-being. Being age 50 or younger (57 vs. 41%; p = 0.01), male (53 vs. 31%; p = 0.01) and working 60 h or less per week (50 vs. 33%; p = 0.005) were associated with increased overall well-being on bivariate analysis. Ratings of the importance of a number of personal wellness promotion strategies differed for oncologists with high well-being compared with those without high well-being. Developing an approach/philosophy to dealing with death and end-of-life care, using recreation/hobbies/exercise, taking a positive outlook and incorporating a philosophy of balance between personal and professional life were all rated as substantially more important wellness strategies by oncologists with high well-being (p values <0.001). Oncologists with high overall well-being also reported greater career satisfaction. Conclusion: Half of medical oncologists experience high overall well-being. Use of specific personal wellness promotion strategies appears to be associated with oncologist well-being. Further investigations of the prevalence, promotion, causes, inequities and clinical impact of physician well-being are needed.

Quality of life of caregivers of patients with advanced-stage cancer.

There has been much research documenting the impact of having a loved one diagnosed with advanced cancer, but little is known about how to reduce care-giver burden. In this randomized controlled trial, the authors examined the potential relationship of an advanced cancer patient’s participation in an 8-session, structured, multidisciplinary intervention on the care-giver’s burden and quality of life (QOL). Although the patients randomly assigned to the intervention (n = 54) demonstrated improved QOL compared to the control condition (n = 49) participants (P < .05), there was no evidence that improving the patient’s QOL made an impact on the caregiver’s level of burden or the care-giver’s QOL. Further investigation is warranted in this area, including interventions specifically designed and targeted to both reduce caregiver burden and to improve caregiver QOL.

Therapeutic exercise during outpatient radiation therapy for advanced cancer: Feasibility and impact on physical well-being.

Cheville AL, Girardi J, Clark MM, Rummans TA, Pittelkow T, Brown P, Hanson J, Atherton P, Johnson ME, Sloan JA, Gamble G: Therapeutic exercise during outpatient radiation therapy for advanced cancer: Feasibility and impact on physical well-being. Objective:To characterize the feasibility of delivering a structured physical therapy (PT) program as part of a multidisciplinary intervention to patients undergoing outpatient radiation therapy for advanced cancer. Design:A single-blinded, randomized, controlled trial at a quaternary medical center outpatient clinic. One hundred three adults undergoing radiation therapy for advanced cancer with prognoses ≥6 mos and 5-yr survival estimates ≤50% were randomized to usual care or participation in eight 90-min, multidisciplinary interventional sessions with 30 mins of each session devoted to PT. PT consisted of truncal and limb isodynamic strengthening targeting major upper- and lower-limb muscle groups as well as education and provision with instructional materials. Physical well-being and fatigue were assessed with Linear Analog Scale of Assessment. The Profile of Mood States-Short form, including Fatigue-Inertia and Vigor-Activity subscales, was also administered. Results:PT session attendance was 89.3%. Relative to baseline, mean physical well-being Linear Analog Self Assessment scores at week 4 improved in the intervention group, 0.4 (SD, 23.6), and declined significantly in the control group, −10.0 (SD, 21.5) (P = 0.02). Fatigue and vigor were not significantly different between the groups. All intergroup differences had resolved at 8 and 27 wks. Baseline characteristics were not associated with the magnitude or direction of change in outcomes related to physical functioning. Conclusions:Delivery of a standardized resistive exercise PT intervention is feasible during outpatient radiation therapy and is associated with preserved physical well-being. However, benefits were not sustained, and fatigue was not affected.

Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer

Psychosocial interventions often address only 1 domain of quality of life (QOL), are offered to patients with early‐stage cancer, do not include the caregiver, and are delivered after cancer treatment has been completed.

Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: A randomized controlled trial

OBJECTIVE To examine the potential impact of elderly age on response to participation in a structured, multidisciplinary quality-of-life (QOL) intervention for patients with advanced cancer undergoing radiation therapy. METHODS Study design was a randomized stratified, two group, controlled clinical trial in the setting of a tertiary care comprehensive cancer center. Subjects with newly diagnosed cancer and an estimated 5-year survival rate of 0%-50% who required radiation therapy were recruited and randomly assigned to either an intervention group or a standard care group. The intervention consisted of eight 90-min sessions designed to address the five QOL domains of cognitive, physical, emotional, spiritual, and social functioning. QOL was measured using Spitzer uniscale and linear analogue self-assessment (LASA) at baseline and weeks 4, 8, and 27. RESULTS Of the 103 study participants, 33 were geriatric (65 years or older), of which 16 (mean age 72.4 years) received the intervention and 17 (mean age 71.4 years) were assigned to the standard medical care. The geriatric participants who completed the intervention had higher QOL scores at baseline, at week 4 and at week 8, compared to the control participants. SIGNIFICANCE OF RESULTS Our results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention. Therefore, geriatric individuals should not be excluded from participating in a cancer QOL intervention, and, in fact, elderly age may be an indicator of strong response to a QOL intervention. Future research should further explore this finding.

Predicting patients' expectations of hospital chaplains: a multisite survey.

OBJECTIVE To identify patient expectations regarding chaplain visitation, characteristics of patients who want to be visited by a chaplain, and what patients deem important when a chaplain visits. PARTICIPANTS AND METHODS Three weeks after discharge, 4500 eligible medical and surgical patients from hospitals in Minnesota, Arizona, and Florida were surveyed by mail to collect demographic information and expectations regarding chaplain visitation. The survey was conducted during the following time periods: Minnesota participants, April 6 until April 25, 2006; Arizona participants, October 16, 2008, until January 13, 2009; Florida participants, October 16, 2008, until January 20, 2009. Categorical variables were summarized with frequencies or percentages. Associations between responses and site were examined using χ(2) tests. Multivariate logistic regression was used to assess the likelihood of wanting chaplain visitation on the basis of patient demographics and perceived importance of reasons for chaplain visitation. RESULTS About one-third of those surveyed responded from each site. Most were male, married, aged 56 years or older, and Protestant or Catholic. Of the respondents, nearly 70% reported wanting chaplain visitation, 43% were visited, and 81% indicated that visitation was important. The strongest predictor of wanting chaplain visitation was denomination vs no indicated religious affiliation (Catholic: odds ratio [OR], 8.11; 95% confidence interval [CI], 4.49-14.64; P<.001; evangelical Protestant: OR, 4.95; 95% CI, 2.74-8.91; P<.001; mainline Protestant: OR, 4.34; 95% CI, 2.58-7.29; P<.001). Being female was a weak predictor (OR, 1.48; 95% CI, 1.05-2.09; P=.03), as was site. Among the reasons given by respondents for wanting chaplain visitation, the most important were that chaplains served as reminders of Gods care and presence (OR, 4.37; 95% CI, 2.58-7.40; P<.001) and that they provided prayer or scripture reading (OR, 2.54; 95% CI, 1.53-4.20; P<.001). CONCLUSION The results of this study suggest the importance medical and surgical patients place on being visited by a chaplain while they are hospitalized. Those who valued chaplains because they reminded them of Gods care and presence and/or because they prayed or read scripture with them were more likely to desire a visit. Our results also suggest that being religiously affiliated is a very strong predictor of wanting chaplain visitation.

Urology Resident Training With an Unexpected Patient Death Scenario: Experiential Learning With High Fidelity Simulation

PURPOSE Communicating unexpected news of a patient death is rarely encountered in urology. We evaluated resident performance during an unexpected patient death scenario involving high fidelity simulation. We also studied simulation as a tool to teach and assess nontechnical skills in urology. MATERIALS AND METHODS An unexpected patient death scenario was developed at a simulation center using high fidelity mannequins, urology residents, critical care fellows, nurses, hospital chaplains and actors. Scenario objectives addressed Accreditation Council for Graduate Medical Education core competencies. The 19 urology residents in training years 2 to 6 participated in the scenario. Performance was evaluated using 5-point Likert scale questionnaires and checklists completed by residents, faculty and actors. RESULTS Overall resident performance was satisfactory in the simulation scenario. Verification of code status was identified as an area requiring improvement. Euphemisms for death were more commonly used in the initial delivery (16 residents or 84.2%) than the preferred words died or death (3 or 15.8%). After completing the scenario the perceived competency of residents increased from 73.7% before to 94.7% after the scenario. In addition, all residents agreed that the simulation experience was useful and overall realistic, and it should be part of the training curriculum. CONCLUSIONS Evaluation of urology resident performance was possible during an unexpected patient death scenario. Upon completion of the scenario perceived competency of the simulation task was increased. High fidelity simulation was found to be an effective method for teaching and assessing the acquisition of nontechnical skills. All residents agreed that the simulation was useful and should be included in urological training.

Centering prayer for women receiving chemotherapy for recurrent ovarian cancer: a pilot study.

PURPOSE/OBJECTIVES To explore the feasibility of implementing centering prayer in chemotherapy treatment and assess its influence on mood, spiritual well-being, and quality of life in women with recurrent ovarian cancer. DESIGN Descriptive pilot study. SETTING Outpatient chemotherapy treatment suite in a large cancer center in the midwestern United States. SAMPLE A convenience sample of 10 women receiving outpatient chemotherapy for recurrent ovarian cancer. METHODS A centering prayer teacher led participants through three one-hour sessions over nine weeks. Data were collected prior to the first session, at the conclusion of the final session, and at three and six months after the final session. MAIN RESEARCH VARIABLES Feasibility and influence of centering prayer on mood, spiritual well-being, and quality of life. FINDINGS Most participants identified centering prayer as beneficial. Emotional well-being, anxiety, depression, and faith scores showed improvement. CONCLUSIONS Centering prayer can potentially benefit women with recurrent ovarian cancer. Additional research is needed to assess its feasibility and effectiveness. IMPLICATIONS FOR NURSING Nurses may promote or suggest centering prayer as a feasible intervention for the psychological and spiritual adjustment of patients with recurrent ovarian cancer.

Stories of breast cancer through art.

PURPOSE/OBJECTIVES To describe the use of an art exhibit, created in response to breast cancer survivor stories, and additional supplementary activities to increase cancer awareness and provide support to those with cancer. DATA SOURCES Published articles and books, personal experiences. DATA SYNTHESIS Art has been used to educate and promote the expression of emotions. Using an art exhibit as the central feature, a planning committee composed of staff members and volunteers developed a repertoire of activities to improve cancer awareness and provide support to cancer survivors. Visitor and staff reactions to the event were profound. CONCLUSIONS Art can capture the most intimate and personal aspects of the cancer experience. This event was a novel and effective way to increase awareness about the cancer experience. The event brought together patients, family members, friends, staff members, and the community and facilitated new partnerships to help people with cancer. IMPLICATIONS FOR NURSING Nurses are well equipped to direct the therapeutic use of art and support the potential reactions of viewers. Nurses can promote the benefit of art exhibits for cancer education, support, and awareness and use their knowledge and skills in planning and implementing supplementary activities.