R. Brian Giesler

When Comparisons Arise

People acquire information about their abilities by comparison, and research suggests that people restrict such comparisons to those whom they consider sources of diagnostic information. We suggest that diagnosticity is often considered only after comparisons are made and that people do not fail to make nondiagnostic comparisons so much as they mentally undo them. In 2 studies, participants made nondiagnostic comparisons even when they knew they should not, and quickly unmade them when they were able. These results suggest that social comparisons may be relatively spontaneous, effortless, and unintentional reactions to the performances of others and that they may occur even when people consider such reactions logically inappropriate.

Self-Verification in Clinical Depression: The Desire for Negative Evaluation

Do clinically depressed individuals seek favorable or unfavorable information about the self? Self-verification theory makes the counterintuitive prediction that depressed individuals solicit feedback that confirms their negative self-views. To test this prediction, participants were classified on the basis of a structured clinical interview and self-report measures into high-esteem, low self-esteem, and depressed groups. All participants were offered a choice between receiving favorable or unfavorable feedback; 82% of the depressed participants chose the unfavorable feedback, compared to 64% of the low self-esteem participants and 25% of the high self-esteem participants. Additional evidence indicated that depressed individuals also failed to exploit fully an opportunity to acquire favorable evaluations that were self-verifying. The authors discuss how seeking negative evaluations and failing to seek favorable evaluations may help maintain depression.

Improving the quality of life of patients with prostate carcinoma: a randomized trial testing the efficacy of a nurse-driven intervention.

Treatments for clinically localized prostate carcinoma are accompanied by sexual, urinary, and bowel dysfunction and other sequelae that can result in significant distress and reduced well being. Methods capable of improving quality of life are needed that can be integrated into clinical practice. To address this need, a nurse‐driven, cancer care intervention was developed and tested.

Quality of life of African American breast cancer survivors: how much do we know?

Women affected by breast cancer experience an array of quality-of-life issues that affect their daily living in both short-term and long-term survivorship. Because African American women experience disparities in breast cancer survival, their quality-of-life concerns may paint a different picture from those of other racial and ethnic groups. To gain a better understanding of quality of life in African American women breast cancer survivors, we conducted a review, using an adaptation of Brenners quality-of-life proximal-distal continuum, of studies that have investigated these womens experiences and associated variables. Twenty-six studies, qualitative and quantitative, were reviewed that identified both deficits and positive outcomes of breast cancer treatment and sequelae, including physical, emotional, social, and patient-provider problems as well as heightened spirituality and positive growth. Although overall global quality of life was favorable in both African American and white survivors, differences existed in the nature and extent of deficits between these 2 survivor groups. Nursing implications of this review point to the need for further rigorous research and wide dissemination of results. Recommendations for practice include tailoring assessments and interventions within the context of the lives of African American women breast cancer survivors.

A trial for comparing methods for eliciting treatment preferences from men with advanced prostate cancer: results from the initial visit.

Objective.The objective of this study was to evaluate the convergent validity of 3 types of utility measures: standard gamble, time tradeoff, and rating scale. Research Design.A prospective cohort of 120 men with advanced prostate cancer were first asked to rank order 8 health states, and then utility values were obtained from each participant for each of the 8 health states through 2 of the 3 techniques evaluated (standard gamble, time tradeoff and rating scale). Participants were randomly assigned to 1 of 3 possible pairs of techniques. The validity of the 3 methods, as measured by the convergence and raw score differences of the techniques, was assessed with ANOVA. The ability of the techniques to differentiate health states was determined. The inconsistencies between rankings and utility values were also measured. Proportions of illogical utility responses were assessed as the percent of times when states with more symptoms were given higher or equal utility values than states with fewer symptoms. Results.There were significant differences in raw scores between techniques, but the values were correlated across health states. Utility values were often inconsistent with the rank order of health states. In addition, utility assessment did not differentiate the health states as well as the rank order. Furthermore, utility values were often illogical in that states with more symptoms received equal or higher utility values than states with fewer symptoms. Conclusions.Use of the utility techniques in cost-effectiveness analysis and decision making has been widely recommended. The results of this study raise serious questions as to the validity and usefulness of the measures.

Health-related quality of life of African American breast cancer survivors compared with healthy African American women

Background: The diagnosis and treatment of breast cancer can result in an array of late cancer-specific side effects and changes in general well-being. Research has focused on white samples, limiting our understanding of the unique health-related quality of life outcomes of African American breast cancer survivors (BCSs). Even when African American BCSs have been targeted, research is limited by small samples and failure to include comparisons of peers without a history of breast cancer. Objective: The purpose of this study was to compare health-related quality of life of African American female BCSs with that of African American women with no history of breast cancer (control group). Methods: A total of 140 women (62 BCSs and 78 controls), 18 years or older and 2 to 10 years postdiagnosis, were recruited from a breast cancer clinic and cancer support groups. Participants provided informed consent and completed a 1-time survey based on the proximal-distal health-related quality of life model of Brenner et al (1995). Results: After adjusting for age, education, income, and body mass index, results show that African American BCSs experienced more fatigue (P = .001), worse hot flashes (P < .001), and worse sleep quality (P < .001) but more social support from their partner (P = .028) and more positive change (P = .001) compared with African American female controls. Conclusions: Our results suggest that African American female BCSs may experience unique health-related outcomes that transcend age, education, socioeconomic status, and body mass index. Implications for Practice: Findings suggest the importance of understanding the survivorship experience for particular racial and ethnic subgroups to proactively assess difficulties and plan interventions.

A psychometric analysis of the measurement level of the rating scale, time trade-off, and standard gamble

A fundamental assumption of utility-based analyses is that patient utilities for health states can be measured on an equal-interval scale. This assumption, however, has not been widely examined. The objective of this study was to assess whether the rating scale (RS), standard gamble (SG), and time trade-off (TTO) utility elicitation methods function as equal-interval level scales. We wrote descriptions of eight prostate-cancer-related health states. In interviews with patients who had newly diagnosed, advanced prostate cancer, utilities for the health states were elicited using the RS, SG, and TTO methods. At the time of the study, 77 initial and 73 follow-up interviews had. been conducted with a consecutive sample of 77 participants. Using a Rasch model, the boundaries (Thurstone Thresholds) between four equal score sub-ranges of the raw utilities were mapped onto an equal-interval logit scale. The distance between adjacent thresholds in logit units was calculated to determine whether the raw utilities were equal-interval. None of the utility scales functioned as interval-level scales in our sample. Therefore, since interval-level estimates are assumed in utility-based analyses, doubt is raised regarding the validity of findings from previous analyses based on these scales. Our findings need to be replicated in other contexts, and the practical impact of non-interval measurement on utility-based analyses should be explored. If cost-effectiveness analyses are not found to be robust to violations of the assumption that utilities are interval, serious doubt will be cast upon findings from utility-based analyses and upon the wisdom of expending millions in research dollars on utility-based studies.

Oncology outpatient and provider responses to a computerized symptom assessment system.

PURPOSE/OBJECTIVES To assess patient and provider responses to a computerized symptom assessment system. DESIGN Descriptive, longitudinal study with retrospective, longitudinal medical records review. SETTING University-based National Cancer Institute-designated outpatient cancer center. SAMPLE 80 oncology outpatients receiving chemotherapy, 8 providers, and 30 medical records. METHODS Patients completed the computerized assessment during three chemotherapy follow-up clinic appointments (times 1, 2, and 3). Patient usability was recorded via an observer checklist (ease of use) and the computer (completion time). Patient satisfaction and impact were assessed during telephone interviews two to three days after times 1 and 3 only. Provider usability and impact were assessed at the end of the study using a questionnaire and focus groups, whereas effect on provider documentation was assessed through chart audits. MAIN RESEARCH VARIABLES Patient usability (ease of use, completion time), satisfaction, and impact; provider usability and impact. FINDINGS Patients reported good usability, high satisfaction, and modest impact on discussions with their providers. Providers reported modest usability, modest impact on discussions with patients, and had varied reactions as to how the system affected practice. Documentation of symptoms was largely absent before and after implementation. CONCLUSIONS This system demonstrated good usability and satisfaction but had only a modest impact on symptom-related discussions and no impact on documentation. IMPLICATIONS FOR NURSING A computerized system can help address barriers to symptom assessment but may not improve documentation unless it can be integrated into existing medical records systems.

HOMER as an Acronym for the Scientific Method

Mnemonic strategies, such as acronyms, effectively increase student retention of course material. We present an acronym based on a popular television character to help students remember the basic steps in the scientific method. Our empirical evaluation of the acronym revealed that students found it to be enjoyable, useful, and worthy of use in future courses.