Meredith Wallace Kazer

Perception of cancer and inconsistency in medical information are associated with decisional conflict: a pilot study of men with prostate cancer who undergo active surveillance.

Study Type – Therapy (case series)

Psychosocial aspects of active surveillance.

Purpose of review To summarize the literature on psychosocial responses to active surveillance as well as educational and support strategies to promote adherence. Recent findings There are two prevalent responses among men undergoing active surveillance; anxiety and uncertainty. The education of a patient about low-risk prostate cancer as well as the inquiry by the physician into patients priorities and goals with respect to their prostate cancer diagnosis provide opportunities to facilitate a collaborative relationship between the physician and the patient. Supplemental support services for men undergoing active surveillance, including support groups and Internet-based interventions continue to be researched in relation to their role in promoting adherence to active surveillance. Summary Active surveillance continues to remain a highly valued management approach for men with early stage prostate cancer. However, it is suggested that the psychosocial burden of living with prostate cancer plays a substantial role in adherence to active surveillance and outcomes of men with the disease. Effective clinician education and counseling, as well as the referral for supplemental support services must be implemented and documented in future research studies and clinical practice.

An Internet Intervention for Management of Uncertainty During Active Surveillance for Prostate Cancer

PURPOSE/OBJECTIVES To provide preliminary data on an Internet intervention that incorporates cognitive reframing and self-management strategies to help older men undergoing active surveillance (AS) self-manage disease-related issues and improve quality of life (QOL). DESIGN Single-subject design. SETTING Two participating urologic practices at major academic medical centers in the northeastern United States. SAMPLE 9 patients undergoing AS. METHODS Baseline data were compared to data immediately after completion of the intervention and five weeks later. Telephone interviews were used to determine overall feasibility as well as the ease of use, user friendliness, and acceptability of the intervention in patients undergoing AS. MAIN RESEARCH VARIABLES Self-efficacy, uncertainty, and QOL. FINDINGS The results revealed change between baseline (time 1) and intervention completion (time 2) in the majority of variables, with a return toward baseline after the intervention (time 3). Ten of the 12 measures of intervention acceptability were met. The results showed positive trends in the impact of the intervention and good overall acceptability. CONCLUSIONS The results of this pilot study will lead to further research aimed at helping men manage issues related to AS and improve QOL. IMPLICATIONS FOR NURSING The intervention may reduce the overtreatment of prostate cancer in men who are clinically appropriate for this management option.

The role of spiritual nursing interventions on improved outcomes in older adults with dementia.

Dementia is a devastating condition that takes a toll on all involved. This integrative literature review focuses on the role of spirituality/spiritual nursing interventions in the improved health outcomes of older adults with dementia. Dementia treatments are constantly being explored and current findings are promising. Older persons with dementia, respond best to holistic care that includes the spiritual aspects of their lives. Not only is attention to spirituality beneficial to the patient, but to caregivers and nurses/healthcare providers as well. Research indicates that the memory needed to explore ones spirituality may be spared the effects of dementia. This preservation of memory allows older adults with dementia to benefit from spiritual nursing interventions, especially music and rituals. However, further investigation examining the phenomenon of spiritual interventions as treatment is warranted.

The experiences of unpartnered men with prostate cancer: a qualitative analysis.

PurposeThe purpose of this study was to examine how men without partners make decisions about prostate cancer treatment, manage treatment side effects, and obtain information and support.BackgroundIn 2009, it was projected that over 230,000 men were diagnosed with prostate cancer. While treatment options vary, these options result in changes within the man that can affect his quality of life. Research has shown that often spouses play a central role in men’s choice of treatment and in maintaining men’s quality of life. In addition, spouses are the major providers of emotional support and physical care. However, little is known about how men without partners cope with prostate cancer. Prior research seldom addresses how diagnosis and treatment for prostate cancer affects the quality of life of men without partners.MethodsBecause very little is known about the needs of men without partners managing prostate cancer, qualitative analysis of data obtained during semi-structure interviews provided respondents with an opportunity to share the lived experience of prostate cancer. A semi-structured interview was conducted with selected, consenting men. The sample was drawn from the ongoing R01 study of men with prostate cancer (PROSTQA).ResultsThe sample for this study included 17 unpartnered prostate cancer survivors. The ages of participants ranged from 47 to 72 with a mean age of 63. The participants had between zero and two co-morbidities with an average of one co-morbidity per participant. The sample was 82% Caucasian and 17% Black. A total of 35% of the participants reported “some college” (n = 6), 30% graduated from college (n = 5), and 23% went to graduate school (n = 4). One participant reported that he was a high school graduate and one had less than a high school education. Five themes emerged from the data: going it alone, diagnosis and prostate cancer treatment decision-making, sources of information and support, the aftermath of prostate cancer, and coping strategies.ConclusionsThis study provides information about unpartnered men’s prostate cancer experience. This information will help health care professionals to meet the needs of unpartnered more effectively and help them to assist men as they adapt to living with this chronic illness.

The needs for men undergoing active surveillance (AS) for prostate cancer: results of a focus group study

Since the emergence of the prostate specific antigen test (PSA) in the 1980s, the rate of prostate cancer diagnosis increased significantly until it finally stabilised in the early part of the 21st century. Currently, prostate cancer is the most prevalent cancer among the US male population. The American Cancer Society 2010 reports that one in every six men will get prostate cancer during his lifetime, but only one in 36 will die of it (http://www.cancer.org). Many of the cancers diagnosed as a result of the PSA are ‘indolent’ tumours associated with low, stable PSA values and low Gleason scores. Autopsy studies have confirmed this and found that many men, who die of other causes, actually had prostate cancers that were not clinically significant and did not play a role in their deaths (Delongchamps et al. 2006). While there are several curative treatments for prostate cancer, the indolent nature of many prostate tumours has led to the urological community to seriously consider that aggressive prostate cancer treatment and associated morbidity do not always result in an increase in lifespan (Klotz 2006). AS involves a vigilant approach to the management of prostate cancer whereby a decision is made to consistently evaluate the status of disease and defer therapy until local progression of the disease is detected. While AS appears to be a cost-effective and logical approach to avoid the adverse effects and high costs of curative treatment, it is highly underused as a management option for early-stage prostate cancer and the needs for this population are virtually unknown. The purpose of this paper is to present the results of the focus groups conducted to determine the psychosocial and educational needs of men undergoing AS for prostate cancer.

Uncertainty and perception of danger among patients undergoing treatment for prostate cancer

Study Type – Therapy (attitude prevalence)

Past, Present, and Future Trends of Master's Education in Nursing

Nurses interested in pursuing careers in advanced practice are now being educated at the doctoral level through new doctorate of nursing practice degree programs. In light of this shift, masters programs for advanced practice nurses are in a tenuous position, and it is questionable whether the remaining masters level educational programs are meeting the needs of consumers, health care institutions, and students. Given the great need for clinical leadership in health care, it is essential to reexamine masters nursing education to ensure that educational institutions are meeting the needs of graduate nursing students, consumers, and health care systems. Research supports that the masters-prepared nurse of the future must be proficient in the development and management of accountable care systems using state-of-the-art technology. In addition, interprofessional models show improvement in health care delivery and health outcomes. The current demands in health care that impact nursing education will be discussed, including the movement toward interprofessional education and the broadened expertise, required of masters-prepared nurses working in an era of health care reform. While academic medical centers are actively advancing toward an interprofessional model, the majority of nurses in this country are educated in private and community settings. This article will examine the move toward interprofessional education at a private university, utilizing clinical partnerships to revise the masters program. The goal of this revision is to empower students with the expertise required in todays health care environment to improve the delivery of care.

Out of the black box: expansion of a theory-based intervention to self-manage the uncertainty associated with active surveillance (AS) for prostate cancer.

Active surveillance (AS) (sometimes referred to as watchful waiting) is an alternative approach to managing low-risk forms of prostate cancer. This management approach allows men to avoid expensive prostate cancer treatments and their well-documented adverse events of erectile dysfunction and incontinence. However, AS is associated with illness uncertainty and reduced quality of life (QOL; Wallace, 2003). An uncertainty management intervention (UMI) was developed by Mishel et al. (2002) to manage uncertainty in women treated for breast cancer and men treated for prostate cancer. However, the UMI was not developed for men undergoing AS for prostate cancer and has not been adequately tested in this population. This article reports on the expansion of a theory-based intervention to manage the uncertainty associated with AS for prostate cancer. Intervention Theory (Sidani & Braden, 1998) is discussed as a framework for revising the UMI intervention for men undergoing AS for prostate cancer (UMI-AS). The article concludes with plans for testing of the expanded intervention and implications for the extended theory.

Geriatric sexual experiences: The seniors tell all

AIM To gain insight into the aging sexual health experiences and concerns of older adults aged 60 years or older. BACKGROUND Despite the prevalence of sexual activity among older adults and the documented health benefits, little is known about how sexual health changes as individuals age. METHODS Participants for this study were recruited through a local senior center and qualitative interviews were conducted. RESULTS Eight older adults (six female, two male) between the ages of 62 and 95 participated in this study. Some participants commented that expression of sexuality changed due to partners health. Some identified less sexual frequency and spontaneity, while others stated that they were now more open with their sexual relationship. Participants stated that they wished their or their partners physicians would discuss their sexual needs. CONCLUSIONS Sexual changes reported by participants in this study were consistent with the research relating sexual health to overall health. The finding that half the sample did not discuss sexual problems with anyone highlights the opportunity for nursing research to further explore this phenomenon.