S. Hughes

Self-care burden, stress appraisal, and mood among persons receiving radiotherapy.

This study was undertaken to describe the self-care burden (SCB) of persons receiving radiation as outpatients, to identify factors contributing to SCB, and to test a model of the effects of SCB, symptom distress, and appraisal of illness on mood. The subjects were 72 adults with cancer who had been in treatment an average of 4 weeks. Fatigue was reported to be the most distressing symptom. Among health deviation self-care tasks, coming for treatment was the most demanding, and self-treatment, such as administering medications, was the most difficult. Universal self-care activities most disrupted by treatment were social and recreational activities. Path analysis revealed that dependency was the primary predictor of health deviation SCB, while symptom distress was the best predictor of universal SCB. Universal SCB and family hardiness were the best predictors of appraisal scores. Symptom distress and somatic mood were highly correlated, suggesting collinearity between these factors. Four variables—appraisal, symptom distress, family hardiness, and health deviation SCB—explained 55% of the variance in affective mood scores. Theoretical and clinical implications are discussed.

A Randomized Trial of a Representational Intervention to Decrease Cancer Pain (RIDcancerPain)

OBJECTIVE Based on theories regarding cognitive representations of illness and processes of conceptual change, a representational intervention to decrease cancer pain (RIDcancerPain) was developed and its efficacy tested. DESIGN A two-group RCT (RIDcancerPain versus control) with outcome and mediating variables assessed at baseline (T1) and 1 and 2 months later (T2 and T3). Subjects were 176 adults with pain related to metastatic cancer. MAIN OUTCOME MEASURES Outcome variables were two pain severity measures (BPI and TPQM), pain interference with life, and overall quality of life. Mediating variables were attitudinal barriers to pain management and coping (medication use). RESULTS One hundred and fifty subjects completed the study. Subjects in RIDcancerPain (T1-T2 and T1-T3) showed greater decreases in Barrier scores than those in control. Subjects in RIDcancerPain (T1-T3) showed greater decreases in pain severity than those in control. Change in Barriers scores mediated the effect of RIDcancerPain on pain severity. CONCLUSION RIDcancerPain was efficacious with respect to some outcomes. Further work is needed to strengthen it.

Concerns About Pain Management Among Adolescents With Cancer: Developing the Adolescent Barriers Questionnaire

Investigators have examined barriers to pain management in adults with cancer, but these patient-related barriers have rarely been studied in adolescents. This article summarizes 2 studies used in the development and initial psychometric testing of the Adolescent Barriers Questionnaire (ABQ). Building on the Barriers Questionnaire-II, the ABQ is designed to measure the extent to which adolescents with cancer have concerns about reporting pain and using analgesics. Study 1 was a qualitative study investigating pain management concerns of 5 adolescents with cancer. Concerns emerged that could potentially impede pain management such as fear of addiction and worry about communicating pain to parents and providers. Each of the adolescents revealed at least 1 concern about pain management or held fatalistic beliefs that cancer pain cannot be relieved. In study 2, content validity of the preliminary ABQ (52 items assessing 13 barrier sub-scales) was assessed by 2 panels, adolescents with cancer and clinicians. Based on results, the ABQ was modified to contain 45 items that assess 11 barriers. Further examination of barriers in adolescents with cancer is warranted.

Creating Individualized Symptom Management Goals and Strategies for Cancer-related Fatigue for Patients With Recurrent Ovarian Cancer

Background: Cancer-related fatigue (CRF) is one of the most common symptoms among women with recurrent ovarian cancer, yet it remains extremely difficult to manage. Symptom management typically requires patients to set goals and strategies to manage their CRF, but little is known about how to create individualized CRF symptom management goals and strategies. Objective: The aim of this study was to describe cancer patients’ goals and strategies for managing CRF along with their process of individualizing both. Methods: This study is a qualitative analysis with supportive quantitative description of a Web-based symptom management randomized clinical trial, the WRITE (Written Representational Intervention to Ease) Symptoms study. Researchers conducted a content analysis on 47 participants’ CRF symptom care plans to identify common themes in participants’ goals, categorize strategies, and describe the individualization process. Results: Four general themes were identified among participants’ CRF goals: (1) enjoying time with friends and family, (2) doing the things I enjoy, (3) having energy to be physically active, and (4) keeping up with what I need to do. Cancer-related fatigue strategies were categorized into 13 groups including conserving energy, increasing activity, and talking with healthcare providers. A multistep individualization process resulted in personally meaningful strategies. Conclusions: The process by which participants individualized their CRF strategies consisted of identifying, confirming, testing, and evaluating different CRF strategies and resulted in refined, specific, and individualized strategies intended to eventually ensure participants achieve their goal. Implications for Practice: Clinicians can assist patients in individualizing their CRF goals and strategies. Individualization of CRF goals and strategies assists patients in visualizing how improving CRF will impact their life.

Conducting Intervention Research Through the Cancer Information Service: A Feasibility Study

PURPOSE/OBJECTIVES To determine the feasibility of conducting trials of educational interventions regarding pain and quality of life (QOL) with people who call the National Cancer Institutes Cancer Information Service (CIS). DESIGN Descriptive. SETTING North Central CIS, located at the University of Wisconsin Comprehensive Cancer Center in Madison. SAMPLE Callers to the North Central CIS who self-identified as people diagnosed with cancer or as family members or friends of people diagnosed with cancer were eligible. 102 people with cancer and 103 significant others answered questions concerning the feasibility of a pain study, and 101 significant others completed questions about the feasibility of a QOL study. METHODS Eligible CIS callers were invited at the end of usual service to participate in a research study. Those who agreed were asked structured questions regarding pain or QOL. MAIN RESEARCH VARIABLES Response rate, length of time to complete recruitment, concerns about reporting pain and using analgesics, concerns about QOL, demographic variables, and willingness to join a hypothetical study. FINDINGS The majority of callers had concerns about pain and QOL, and the vast majority (78%-89%) of participants indicated a willingness to join a future educational intervention study. CONCLUSIONS Using subjects recruited through CIS, conducting trials of brief telephone interventions designed to help patients overcome barriers to pain management or assist families in addressing QOL concerns may be feasible. IMPLICATIONS FOR NURSING Researchers may wish to consider the opportunities afforded by collaborating with CIS colleagues in planning and conducting studies of educational interventions.