Penny F. Pierce

Deciding on breast cancer treatment: a description of decision behavior.

The purposes of this study were to describe the unaided decision-making process of women facing treatment for early stage breast cancer and to provide the empirical grounding to develop a conceptual framework for more structured research. A convenience sample of 48 women completed an open-ended interview while they were making a decision. A qualitative analysis of these interviews identified five empirical indicators of decision behavior: (a) perceived salience of alternatives, (b) decision conflict, (c) information seeking, (d) risk awareness, and (e) deliberation. The configurations of these indicators discriminated the decision maker into one of three empirically derived groups. In order of complexity, these are termed Deferrer, Delayer, and Deliberator.

Work–family conflicts of women in the Air Force: their influence on mental health and functioning

This paper examined the effects of work and family stressors and conflicts on Air Force womens mental health and functioning. We analyzed data from a 1993 survey of representative stratified samples of 525 Air Force women from the active duty reserve and guard forces. The analyses of the data are guided by the comprehensive model of work–family conflict that has been tested by Frone, Russell, and Cooper (1992) using a large representative community sample. Structural equation modeling analyses provided support for the work–family conflict model. The analyses also provided support for an extension of the model, which included the separate effects of marital and parental roles on mental health. The extended model demonstrated that job and parental stresses had direct effects on work–family conflicts and that job and marital distress and family–work conflict had an independent adverse effect on mental health. Whereas job and parental involvement had a beneficial effect on distress, they had an adverse effect on work–family conflicts. Copyright

Patient Decision-making Behavior: An Emerging Paradigm for Nursing Science

BackgroundAs healthcare technology and medical therapies proliferate, healthcare providers have more options to offer and patients have more options from which to choose. Active patient participation in healthcare decision making is a relatively new phenomenon that has been born of sociocultural, ethical, and legal influences. Patients, however, often find healthcare decisions bewildering, stressful, and anxiety-provoking. ObjectivesThe purpose of this review is to provide a framework for those interested in pursuing patient decision-making investigations and suggest ways in which current knowledge can be extended to develop a scientific platform upon which to build decision support interventions. MethodLiterature review. DiscussionThis review (a) provides a context for understanding patient decision making; (b) explicates the state of the science of patient decision making; (c) identifies significant theoretical, methodological, and measurement issues; and, (d) identifies gaps in patient decision-making knowledge and propose areas for further investigation.

War-Related Stressors as Predictors of Post-Deployment Health of Air Force Women

INTRODUCTION Little is known about the effects of combat exposure on womens health after service in Operation Iraqi Freedom (OIF). Our purpose was to describe the incidence and nature of physical heath symptoms reported by deployed women to identify problematic areas where early intervention or better surveillance might be directed. METHODS Using a random, stratified sample (theater vs. non-theater; parent vs. non-parent; and military component including active, guard, and reserve members) of 1,114 Air Force women, we provide descriptive statistics, group comparisons, and multiple regression models to identify health concerns and potential predictors of physical health outcomes. RESULTS Findings revealed that those in the reserve/guard forces (vs. active duty) and those in the theater of operations (vs. elsewhere during the same time period) reported greater physical health problems (β = -0.07, p < .05 and β = 0.11, p < .001, respectively). Enlisted women reported poorer general health than officers (β = 0.09, p < .01). Women were more likely to report that their physical health was impacted by OIF if deployed to the theater versus deployment elsewhere (β = 0.16, p < .001) or if they were in the reserve forces (β = -0.11, p < .001). Further, women who were parents or deployed to the theater reported greater interference of physical and emotional problems on their social functioning (β = 0.08, p < .05 and β = 0.08, p < .01, respectively). CONCLUSION Deployment to the theater of operations is significantly associated with physical health outcomes although the severity of the self-reported symptoms is low. Our findings suggest that further investigation is needed to explore the war-related predictors of health among women serving in deployed locations around the world.

Differences Between Women Who Pursued Genetic Testing for Hereditary Breast and Ovarian Cancer and Their At-Risk Relatives Who Did Not

PURPOSE/OBJECTIVES To (a) examine differences in appraisals of hereditary breast and ovarian cancer (HBOC), psychological distress, family environment, and decisional conflict between women who pursued genetic testing and their at-risk relatives who did not, and (b) examine correlations among appraisals of HBOC, psychological distress, family environment, and decisional conflict regarding genetic testing in these two cohorts of women. DESIGN Descriptive, cross-sectional cohort study. SETTING Two clinics affiliated with a major research university in the midwestern United States. SAMPLE 372 women aged 18 years and older. 200 pursued genetic testing for BRCA1 and BRCA2 mutations (probands) and 172 of their female relatives who had a greater than 10% prior probability of being a mutation carrier but had not pursued testing. METHODS After providing informed consent, probands and relatives were mailed self-administered questionnaires. MAIN RESEARCH VARIABLES Perceived risk, knowledge of HBOC risk factors and modes of gene inheritance, perceived severity, perceived controllability, psychological distress, family relationships, family communication, and decisional conflict about genetic testing. FINDINGS T tests revealed that probands perceived higher risk and had more psychological distress associated with breast cancer. Probands had more knowledge regarding risk factors and gene inheritance, and greater decisional conflict regarding genetic testing. Relatives reported higher perceived severity and controllability. No differences were observed in family relationships and family communication between probands and relatives. Pearson correlations revealed different patterns in knowledge, perceived controllability, family relationships, and decisional conflict between probands and relatives. CONCLUSIONS Significant differences exist between women who pursue genetic testing and those who do not. The family environment influences adjustment to HBOC and decisions about genetic testing. IMPLICATIONS FOR NURSING Enhancing the family communication process about HBOC can provide informational and emotional support to high-risk women and promote decision making about genetic testing.

Global presence: Usaf aeromedical evacuation and critical care air transport

Flight nursing, whether as an AE nurse or as a CCAT team member, is a demanding profession that extracts tremendous energy, competes with family and recreational time, and sets high expectations. On reflection, however, most crewmembers claim it is the most rewarding experience in their professional life. The opportunity to be a part of history, to provide care and transport to American servicemen and women in times of extreme need, and to accomplish the mission safely despite the circumstances and personal cost is an unparalleled experience and one that hold tremendous pride.

Psychometric testing of the decisional conflict scale: genetic testing hereditary breast and ovarian cancer.

Background:Hereditary breast and ovarian cancer (HBOC) syndrome is attributed mostly to mutations in the Breast Cancer 1 and Breast Cancer 2 genes (BRCA1/2). Mutation carriers of BRCA1/2 genes have significantly higher risk for developing breast cancer compared with the general population (55%-85% vs. 12%) and for developing ovarian cancer (20%-60% vs. 1.5%). The availability of genetic testing enables mutation carriers to make informed decisions about managing their cancer risk (e.g., risk-reducing surgery). However, uptake of testing for HBOC among high-risk individuals is low, indicating the need to better understand and measure the decisional conflict associated with this process. Objective:The aim of this study was to evaluate the reliability and validity of the modified Decisional Conflict Scale for use in decisions associated with genetic testing for HBOC. Methods:This cross-sectional cohort study, recruited women who pursued genetic testing for HBOC in two genetic risk assessment clinics affiliated with a large comprehensive cancer center and one of their female relatives who did not pursue testing. The final sample consisted of 342 women who completed all 16 items of the Decisional Conflict Scale. The psychometric properties of the scale were assessed using tests of reliability and validity, including face, content, construct, contrast, convergent, divergent, and predictive validity. Results:Factor analysis using principal axis factoring with oblimin rotation elicited a three-factor structure: (a) Lack of Knowledge About the Decision (&agr; = .97), (b) Lack of Autonomy in Decision Making (&agr; = .94), and (c) Lack of Confidence in Decision Making (&agr; = .87). These factors explained 82% of the variance in decisional conflict about genetic testing. Cronbachs alpha coefficient was .96. Discussion:The instrument is an important tool for researchers and healthcare providers working with women at risk for HBOC who are deciding whether genetic testing is the right choice for them.

Development of an informational web site for recruiting research participants: process, implementation, and evaluation.

&NA; Internet‐based research is increasing, yet there is little known about recruitment approaches that target the Internet. Investigators have been slow to discuss how to plan, develop, and enhance recruitment using the Internet when well‐concealed or disparate populations, sensitive topics, or qualitative methods are interspersed into the aims of the study. The twofold purpose of this article was to (1) highlight the major steps and strategies undertaken to develop and implement an innovative Web site for recruiting high‐genetic‐risk couples who were considering preimplantation genetic diagnosis use, and (2) present the recruitment results and lessons learned based on enrollment, self‐evaluation, and descriptive data. The Web site was developed using a five‐step process designed by the investigators. A significant step in the process was determining the Web site objectives, which were enacted through contextual and design decisions, and also by incorporating a brief video and study logo into the Web site. The recruitment results indicate that, of the 22 participant couples, ˜82% were recruited via the Internet versus traditional recruitment approaches (ie, clinics, newsletters) and that the majority of couples viewed the Web site prior to enrolling in the study. In conclusion, developing a Web site using the five‐step process can facilitate recruitment.

The meaning of complementary therapy from the perspective of Thai women with breast cancer

A qualitative study based on Heideggerian phenomenology was conducted with 17 Thai women who had survived breast cancer and had utilized at least one type of complementary therapy. The study explored the meaning of such therapy and the data were collected by an in-depth interview, a demographic data-recording form, and a reflective journal. The data were analyzed by using an interpretative process that was described by Cohen, Kahn, and Steeves. Six themes were generated in relation to the meaning of complementary therapy as perceived by the participants: cancer-controlling treatment; mental strengthening; mind and body therapy; self-determination; natural therapy; and conventional therapy integration. The knowledge gained from this study will help health-care providers better understand the role that complementary therapies play in the lives of women whose lives are threatened by cancer. It is important for health-care providers to be more proactive in the culturally sensitive promotion of using complementary therapies based on the womens values and preferences.

En Route Care Patient Safety: Thoughts From the Field

The purpose of this study was to describe the patient safety culture of en route care in the United States Air Force aeromedical evacuation system. Almost 100,000 patients have been transported since 2001. Safety concerns in this unique environment are complex because of the extraordinary demands of multitasking, time urgency, long duty hours, complex handoffs, and multiple stressors of flight. An internet-based survey explored the perceptions and experiences of safety issues among nursing personnel involved throughout the continuum of aeromedical evacuation care. A convenience sample of 236 nurses and medical technicians from settings representing the continuum was studied. Descriptive and nonparametric statistics were used to analyze the quantitative data, and thematic analysis was applied to the qualitative data. Results indicate that over 90% of respondents agree or strongly agree safety is a priority in their unit and that their unit is responsive to patient safety initiatives. Many respondents described safety incidents or near misses, and these have been categorized as personnel physical capability limitations, environmental threats, medication and equipment issues, and care process problems. Results suggest the care of patients during transport is influenced by the safety culture, human factors, training, experience, and communication. Suggestions to address safety issues emerged from the survey data.