Polly Mazanec

Hospice utilization and end-of-life care decision making of African Americans

Multiple, complex factors influence end-of-life (EOL) decisions for all persons. In the African American population, these factors include history of disparities and discrimination in health care, which may affect the individual and the family, family system beliefs, values, and practices, and health care system issues. Family dynamics have an especially important role in treatment decisions for loved ones with advanced disease. A family systems framework can guide the clinicians in appreciating care needs and preferences at EOL. Understanding why so many African Americans choose aggressive and often burdensome care, even at the expense of suffering, is important for communication about options at the EOL and the delivery of quality care at the EOL.

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers

Objective:To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. Design:A single-group descriptive longitudinal correlational study. Setting:Medical, surgical, and neurological ICUs in a large tertiary care university hospital. Patients:Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient’s fifth day in the ICU. Interventions:None. Measurements and Main Results:Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing posttraumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p = 0.01) and emotion-focused (p < 0.01) coping decreased over time while avoidant coping (p = 0.20) use remained stable. Coping strategies 30 days after hospitalization (R2 = 0.50, p < 0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2 = 0.30, p = 0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of posttraumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity. Conclusions:Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients.

A new model of palliative care for oncology patients with advanced disease

Advances in oncology treatment have prompted the need for a new model of palliative care. The Cancer Support Team, formerly known as the Safe Conduct Team, of the Ireland Cancer Center practices under a new model that emphasizes the variable timing of palliative care needs of patients and families across the cancer disease trajectory. This new model assumes that palliative care is offered in conjunction and as a component of disease-oriented care, but unlike previous models, it does not follow a linear pattern of use. Care needs fluctuate throughout the course of life-limiting disease. In addition, this new model recognizes that as current cancer treatment options improve quantity and quality of life, patient goals of care often include appropriate disease-oriented treatment near the end of life, prohibiting enrollment in hospice based on Medicare regulations. This model of palliative care ensures that oncology patients and families will receive an interdisciplinary plan of care based on their goals and preferences, even if they do not choose hospice care or do not qualify for the hospice benefit.

Lack of Communication and Control: Experiences of Distance Caregivers of Parents With Advanced Cancer

PURPOSE/OBJECTIVES To explore the new and complex phenomenon of distance caregiving in the advanced cancer population. RESEARCH APPROACH Qualitative. SETTING A large comprehensive cancer center in the midwestern region of the United States. PARTICIPANTS 14 distance caregivers of parents with advanced cancer. METHODOLOGIC APPROACH Patients with advanced lung, gastrointestinal, and gynecologic malignancies consented to have their distance caregiving adult children contacted to participate in the study. Responses to three open-ended questions guided the tape-recorded telephone interviews with the distance caregivers. Following transcription, content analysis with inductive coding was performed. FINDINGS Two major themes, communication and control, and five subthemes, benefits and burdens of distance caregiving, dealing with uncertainty, direct action through information seeking, protecting, and staying connected, emerged from the data. CONCLUSIONS Distance caregivers experience some of the same stressors that local caregivers of patients with cancer experience. In addition, they have unique psychosocial needs related to the burden of geographic distance. INTERPRETATION Distance caregivers could benefit from nursing interventions targeted at their unique needs. Innovative interventions using Web-based computer technology for improved communication, as well as supportive care interventions, may be helpful.

Transdisciplinary Pain Management: A Holistic Approach

Pain management is the responsibility of all members of the hospice team. A transdisciplinary model of holistic pain assessment and management engages all disciplines in pain screening, management, and documentation. The nursing role in this model emphasizes detailed holistic assessment, pharmacolog

Oncologic Emergencies New Decade, New Perspectives

The picture of oncologic emergencies in the intensive care unit has changed over the past decade. The classic emergencies, that is, superior vena cava syndrome, spinal cord compression, tumor lysis syndrome and life-threatening hypercalcemia, are now routinely managed on the general oncology unit or in an outpatient setting. Vigilant monitoring for early signs of complications, proactive interventions to prevent complications, and aggressive management account for this change. Currently, emergent conditions that necessitate intensive care unit admission or transfer in the patient with cancer include respiratory failure, cardiac emergencies, hemorrhagic events and coagulopathies, sepsis, and hemodynamic instability. This article will present the current evidence-based management of these conditions, a brief summary of classic oncologic emergencies, and the role of the critical care nurse in meeting the multidimensional needs of the patient and family during the life-threatening episode, based on Ferrells quality of life model.

CARES: AACN's New Competencies and Recommendations for Educating Undergraduate Nursing Students to Improve Palliative Care

Nurses spend the most time of any health care professional caring for patients and families dealing with the challenges of serious illness. The demand for nursing expertise in palliative care is growing as more people are living with chronic, life-limiting illnesses. Nursing faculty must prepare future nurses to meet this demand. The new American Association of Colleges of Nursing Palliative Competencies And Recommendations for Educating undergraduate nursing Students document, released February 2016, identifies the 17 competencies that all undergraduate nursing students should achieve by the time of graduation. This historic document is a revision of the 1998 American Association of Colleges of Nursing Peaceful Death document and is now the guiding framework for undergraduate nursing education. In an effort to support nursing faculty and prepare nursing students to deliver quality palliative care, an innovative, interactive on-line undergraduate End-of-Life Nursing Education Consortium (ELNEC) curriculum is under development and will be released in January 2017. This new curriculum will meet the competencies and recommendations for achieving those competencies outlined in the Competencies And Recommendations for Educating undergraduate nursing Students document.

Integrating palliative care into active cancer treatment.

OBJECTIVES To describe the evidence that palliative care, provided concurrently with disease-modifying treatment early in the course of a cancer diagnosis, can improve quality of life, length of survival, symptom burden, mood, and utilization of health services. DATA SOURCES Current research, the National Consensus Guidelines for Quality Palliative Care, and the American Society of Clinical Oncology Provisional Opinion on Integrating Palliative Care into Standard Oncology Care. CONCLUSION Despite recommendations and evidence, only a subset of cancer centers and community-based oncology clinics currently implement palliative care into ambulatory disease-focused cancer care. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses can improve access by becoming knowledgeable about generalist palliative care and by advocating for local and national practice change.

Distance Caregiving a Parent With Cancer

OBJECTIVE To discuss the new phenomenon of distance caregiving, with an emphasis on the experience of adult children providing distance caregiving to a parent with cancer. DATA SOURCES Literature review and author research. CONCLUSION Although the research is limited, it forms the foundation for beginning to describe the phenomenon and the associated psychosocial burdens that distance caregivers are struggling with. IMPLICATIONS FOR NURSING PRACTICE With the growing population of distance caregivers, it is important for nurses to address these burdens. Interventions for clinical practice are recommended.

Advances in oncology care: Targeted therapies

The start of the 21st century has produced advances in cancer care that have improved both survival rates and quality of life for many persons diagnosed with cancer. Targeted therapy has given new hope for controlling cancer as a chronic illness. Alone, or in combination with traditional therapies such as surgery, radiation, and/or chemotherapy, this new form of therapy targets malignant cells, halting tumor growth and the potential metastatic spread of disease. Toxicities are limited, but some are serious and may require intensive care. It is imperative for the experienced critical care nurse to have an understanding of these new treatment options and those on the horizon, as these therapies are the future of cancer care. Whereas in previous decades, patients with cancer may not have survived an intensive care admission for treatment complications or advanced disease, many patients now are recovering from life-threatening events, continuing treatment for their disease, and going on to live meaningful, good-quality lives.