Reanne Booker

The Relationships Among Physiologic Variables, Quality of Life, and Fatigue in Patients With Multiple Myeloma

PURPOSE/OBJECTIVES To investigate the relationships among physiologic variables, fatigue, and quality of life (QOL) in patients with multiple myeloma. DESIGN Cross-sectional, descriptive, exploratory. SETTING Outpatient ambulatory care clinics at a tertiary oncology center. SAMPLE 56 patients with multiple myeloma were accrued consecutively via nonprobability sampling strategy. METHODS Study participants completed the European Organisation for Research and Treatment of Cancer QLQ-C30 and the Functional Assessment of Cancer Therapy-Fatigue. Physiologic variables and demographic data were collected from patient charts. MAIN RESEARCH VARIABLES Hemoglobin (hgb), C-reactive protein (CRP), fatigue, and QOL. FINDINGS Statistically significant correlations were found among hgb and two measures of fatigue and QOL, as well as among CRP and two measures of fatigue and QOL. Regression analysis revealed that as soon as the effect of CRP was removed, hgb was no longer a significant predictor of fatigue or QOL. CONCLUSIONS Although significant relationships between hgb and fatigue and hgb and QOL were identified, CRP made a significant contribution to predicting the variance in fatigue and QOL, whereas hgb did not. The findings suggest that higher CRP is predictive of greater fatigue and lower QOL. IMPLICATIONS FOR NURSING Nurses play an integral role in the assessment and management of cancer-related fatigue. Greater understanding of the pathophysiology of fatigue may lead to progress in assessment and intervention, with the ultimate goal of reducing cancer-related fatigue and improving QOL.

Patient and healthcare perspectives on the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic: a qualitative study.

Objectives The purpose of this study was to use a qualitative approach to better understand the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic from the perspectives of patients and healthcare providers. Setting Participants were recruited from the bone marrow transplant clinic of a large urban outpatient cancer care centre in western Canada. Participants: Focus groups were conducted with patients (n=7) and healthcare providers (n=9) to explore the importance of addressing spiritual issues across the treatment trajectory and to identify factors associated with effectively addressing these needs. Results Data were analysed using the qualitative approach of latent content analysis. Addressing spiritual issues was understood by patients and healthcare providers, as a core, yet under addressed, component of comprehensive care. Both sets of participants felt that addressing basic spiritual issues was the responsibility of all members of the interdisciplinary team, while recognising the need for specialised and embedded support from a spiritual care professional. While healthcare providers felt that the impact of the illness and treatment had a negative effect on patients’ spiritual well-being, patients felt the opposite. Skills, challenges, key time points and clinical indicators associated with addressing spiritual issues were identified. Conclusions Despite a number of conceptual and clinical challenges associated with addressing spiritual issues patients and their healthcare providers emphasised the importance of an integrated approach whereby basic spiritual issues are addressed by members of the interdisciplinary team and by an embedded spiritual care professional, who in addition also provides specialised support. The identification of clinical issues associated with addressing spiritual needs provides healthcare providers with clinical guidance on how to better integrate this aspect of care into their clinical practice, while also identifying acute incidences when a more targeted and specialised approach may be of benefit.

Fludarabine metabolite level on day zero does not affect outcomes of hematopoietic cell transplantation in patients with normal renal function

Fludarabine metabolite level on day zero does not affect outcomes of hematopoietic cell transplantation in patients with normal renal function

Perspectives on advance care planning in haematopoietic stem cell transplantation: a qualitative study

BACKGROUND Advance care planning (ACP) engagement and completion of advance directives remain low in patients undergoing haematopoietic stem cell transplantation, despite the high risk of treatment-related mortality. AIM To understand the barriers to and facilitators of ACP in haematopoietic stem cell transplantation. METHODS This qualitative study used interpretive description methodology. The researchers conducted audio-recorded semi-structured interviews with participants. The constant comparative method was used to analyse data. RESULTS A total of six patients, five family members and eight clinicians participated in the study. Perceived barriers to ACP included: lack of time, lack of process, lack of understanding of disease/treatment and ACP, need to keep positive and prognostic uncertainty. Potential facilitators of ACP included: early and frequent discussion of ACP, incorporating ACP into routine care, involvement of the multidisciplinary team and framing discussions on ACP as positive. CONCLUSIONS Haematopoietic stem cell transplantation poses unique challenges for patients, families and clinicians when it comes to ACP. Introducing advance care planning as part of standard care and providing ongoing facilitation of ACP, including discussion of disease and treatment expectations at the outset and when complications arise may assist patients and families in recognising how ACP can fit into and enhance their care.