Rebecca H. Lehto

Death anxiety: an analysis of an evolving concept.

This article identifies defining attributes, antecedents, and consequences of the concept of death anxiety using Rodgers (2000) evolutionary method of concept analysis. The literature on death anxiety was systematically reviewed for the years 1980–2007. Articles were summarized and coded. Inductive data analyses resulted in defining attributes (emotion, cognitive, experiential, developmental, sociocultural shaping, and source of motivation), antecedents (stressful environments and the experience of unpredictable circumstances, diagnosis of a life-threatening illness or the experience of a life-threatening event, and experiences with death and dying), and consequences (adaptive and maladaptive presentations). Results are important because little systematic inquiry of death anxiety exists in nursing literature.

Factors influencing prostate cancer screening in african american men

African American men have the highest prostate cancer incidence and mortality rates worldwide, but have lower screening rates compared with Caucasian men. The purpose of the study was to identify social ecological factors that affect screening behaviors in African American men, knowledge that could be integral to the design of culturally appropriate interventions. The exploratory study included 60 African American males recruited from the greater Detroit metropolitan area. Social ecological variables examined included age, marital status, presence of health insurance, education, health values and behaviors, physician trust, and perceived stress coping (John Henryism). Analyses included descriptives, chi-square tests, one-way ANOVAs, and logistic regression. Findings concluded that a parsimonious model consisting of two variables (age and health values) was predictive. African American males, ≥50 years, with higher positive health values were more likely to obtain screening. Findings imply the importance of health values and targeted educational and screening interventions for younger African American men.

Worry and the formation of cognitive representations of illness in individuals undergoing surgery for suspected lung cancer.

Worry involving repetitive thoughts about threats and concerns is prevalent when confronted with a life-threatening illness such as cancer. Worry may contribute to the formation of negative cognitive representations of illness that can have a detrimental effect on behavioral and adaptive outcomes. The study examined for the first time (a) the relationship between worry and early formation of cognitive representations of illness in individuals with suspected lung cancer over the presurgical and postsurgical period and (b) associations between worry and anxiety, sex, age, and educational level. Correlational statistical analyses were used to assess worry and cognitive representations in 42 individuals before lung surgery and again 3 weeks postsurgery. Higher worry was significantly related to more threatening content in multiple illness domains. Repeated-measures analysis of variance using high- and low-worry strata showed significant interactions between worry and time on certain illness domains indicating that high worry was associated with increased threat and negative contents in cognitive representations of illness over time. Multiple regression analyses showed that trait anxiety was the only significant predictor of worry in a regression model including age, sex, education, and anxiety before surgery. Findings suggest that higher worry at time of diagnosis is associated with the development of negative and more threatening contents in cognitive representations of illness in individuals with suspected lung cancer.

Patient views on smoking, lung cancer, and stigma: A focus group perspective

PURPOSE Patients with lung cancer, the leading cause of cancer death, are shown to have high levels of psychological distress and poorer quality of life as compared to patients with other cancer types. The purpose of this paper is to describe patient focus group discussions about the lung cancer experience in relation to perceived stigmatization, smoking behaviors, and illness causes; and to discuss implications of these findings relative to the role of the nurse as a patient advocate. METHODS AND SAMPLE Eleven adult lung cancer patients participated in audio taped focus group sessions. Discussion questions probed patient perceptions of lung cancer challenges and adaptation issues. RESULTS Six primary themes from the qualitative analysis included: 1) societal attitudes; 2) institutional practices and experiences; 3) negative thoughts and emotions such as guilt, self-blame and self-deprecation, regret, and anger; 4) actual stigmatization experiences; 5) smoking cessation: personal choices versus addiction; and 6) causal attributions. CONCLUSIONS Patients with lung cancer uniquely experience an added burden from developing an illness that the public recognizes is directly associated with smoking behaviors. Stigmatization and smoking related concerns are of high importance. Oncology nurses must be at the forefront in ensuring that patients with lung cancer do not experience additional burden from perceptions that they somehow deserve and need to defend why they have the illness that they are facing.

Identifying Primary Concerns in Patients Newly Diagnosed With Lung Cancer

PURPOSE/OBJECTIVES To compare illness concerns before and after surgery in patients newly diagnosed with early-stage lung cancer, and to determine whether perceived healthcare environment factors were associated with reduced concerns and cancer-related worry. DESIGN Participants completed a semistructured interview using the conceptual content cognitive map (3CM) method. Important concepts were identified in a spatial array representative of a cognitive map of the illness. SETTING A comprehensive cancer center and a Veterans Affairs medical center in the midwestern United States. SAMPLE 34 men (n=22) and women (n=12), aged 47-83 years (X=65, SD=10), with newly diagnosed lung cancer were interviewed at the time of diagnosis and again three to four weeks after surgery. METHODS Content and frequency analysis and descriptive statistics were used to characterize the data. Correlation studies and paired t tests were used to determine relationships among the main study variables. MAIN RESEARCH VARIABLES Illness perceptions, worry, and health environment experience. FINDINGS Twelve primary content domains were identified pre- and postoperatively (seven negative and five positive). Cancer-related worry was related to negative content and to fears both before and after surgery. Positive health environment perceptions were related to positive content after surgery. CONCLUSIONS The findings demonstrate important areas of concern that can be targeted to reduce psychological distress and promote adaptation. IMPLICATIONS FOR NURSING The willingness of nurses to identify concerns, assist patients to participate in care, and identify strategies to manage unresolved issues early in the treatment trajectory is integral to optimize long-term adjustment.

Causal Attributions in Individuals With Suspected Lung Cancer: Relationships to Illness Coherence and Emotional Responses

Causal-attribution theory focuses on the human need to understand, give meaning to, and ascribe causation to unexpected and unfortunate life events. The aim of the current study was to examine causal attributions among men and women newly diagnosed with suspected lung cancer and to determine the relationships between causal attributions, perceptions of illness coherence, and emotional responses to the illness before and following surgery. Causal attributions were measured by the 16-item Cause scale of the Illness Perception Questionnaire—Revised (IPQ-R). The 42 participants ranged in age from 37 to 83 years and had a broad educational background. Findings demonstrated that individual perceptions of cause were multifactorial, and the most commonly cited cause was personal smoking behaviors. The study suggests that although participants largely viewed themselves as at least somewhat responsible for their illness, in general, they assumed smoking behaviors were contributory in the context of several competing hypotheses. J Am Psychiatr Nurses Assoc, 2007; 13(2), 109-115.

The Experience of Death Anxiety in Iranian War Veterans: A Phenomenology Study

Recognition of death anxiety experienced by patients who have survived violence and threats to life during war is of strong importance in delivery of best care for veterans experiencing health stressors. The aim of the study was to explore the death anxiety experience of veterans from the Iran–Iraq war. Using a phenomenological approach, 11 war veterans were interviewed related to death anxiety experiences. Four major themes included afterlife fears; alienated farewell; ambiguous separation; and physical dissolution. Patients who have been exposed to death trauma in the battlefield may carry added burden from unique cognitions and fears related to personal death.

The Challenge of Existential Issues in Acute Care: Nursing Considerations for the Patient With a New Diagnosis of Lung Cancer

A new diagnosis of lung cancer is a highly threatening experience that raises personally relevant existential issues and brings death-related thoughts and concerns to mind. Those issues can be very disturbing to patients, leading to distress and potentially to a lowered quality of life. The purpose of this article is to present to the practicing oncology nurse the types of existential and death-related concerns that patients with a new diagnosis of lung cancer may have. In addition, the article identifies practical strategies and resources for oncology nurses who can help patients accept and manage the normal but often distressing responses to a life-threatening diagnosis.

Death Concerns Among Individuals Newly Diagnosed with Lung Cancer

Confronting the reality of death is an important challenge for individuals facing life-threatening illness such as lung cancer, the leading cause of cancer death. Few studies, however, document the nature of death-related concerns in individuals newly diagnosed with lung cancer. The aims of this exploratory study were to examine unsolicited death-related concerns among newly diagnosed individuals, and to determine if age, gender, marital status, stage of disease, type of treatment, presence of comorbid conditions, and veteran status were related to extent of death concerns. A mixed-method approach was used to examine death concerns in 73 individuals newly diagnosed with non-small cell lung cancer. Seven categories related to death were identified: psychological preparation, time left, impact, behavioral preparation, acceptance, cancer death experiences, and post-death. Stage of disease and veteran status were factors that were related to increased numbers of death-related content. Findings demonstrate that death concerns are varied, primarily negative, and are relevant to the person facing a new lung cancer diagnosis, thus highlighting the importance for health care providers to assess, discuss, and listen for death concerns in the acute care setting.

Perioperative Warming in Surgical Patients A Comparison of Interventions

The four arm study investigates how use of a preoperative forced-air warming blanket and adjustment of ambient surgical room temperature may contribute to prevention of perioperative hypothermia. Active warming interventions may prevent the drop in core temperature that occur as a result of surgical anesthesia. Core body temperatures from a convenience sample of 220 adult surgical patients were sequentially monitored in the preoperative, intraoperative, and post-anesthesia care units (PACU) while receiving: (a) routine surgical care, (b) application of preoperative forced-air warming blanket, (c) application of preoperative forced-air warming blanket with adjustment of ambient surgical room temperatures, or (d) adjustment of ambient surgical room temperature only. Sample characteristics were evenly distributed among the four groups. There were no statistical differences in PACU core body temperatures. The application of forced-air warming blankets and room temperature adjustment interventions were not more effective than current practice in preventing perioperative hypothermia.