Sandra L. Spoelstra

Fall Prevention in Hospitals An Integrative Review

This article summarizes research and draws overall conclusions from the body of literature on fall prevention interventions to provide nurse administrators with a basis for developing evidence-based fall prevention programs in the hospital setting. Data are obtained from published studies. Thirteen articles are retrieved that focused on fall interventions in the hospital setting. An analysis is performed based on levels of evidence using an integrative review process. Multifactoral fall prevention intervention programs that included fall-risk assessments, door/bed/patient fall-risk alerts, environmental and equipment modifications, staff and patient safety education, medication management targeted to specific types, and additional assistance with transfer and toileting demonstrate reduction in both falls and fall injuries in hospitalized patients. Hospitals need to reduce falls by using multifactoral fall prevention programs using evidence-based interventions to reduce falls and injuries.

An Intervention to Improve Adherence and Management of Symptoms for Patients Prescribed Oral Chemotherapy Agents: An Exploratory Study

Background: Use of oral chemotherapy agents to treat cancer has increased. Patients are responsible for adhering to complex regimens while managing symptoms from adverse effects of the chemotherapy. Objective: This study examined an intervention to manage symptoms and adherence to oral agents. Methods: A 3-group pilot study determined how an Automated Voice Response (AVR) system alone (n = 40), or the AVR with strategies to manage symptoms and adherence (n = 40), or the AVR with strategies to manage adherence (n = 39) reduced symptom severity and improved adherence. Participants received a Symptom Management Toolkit, completed a baseline interview, and were randomized to receive 8 weekly AVR calls. An exit interview occurred at 10 weeks. Results: Mean age was 59.6 years, with 70% female and 76% white, and 42% were nonadherent, with missed doses increasing with regimen complexity. Symptom severity declined over time in all groups. No difference was found in adherence rates, and higher adherence was related with lower symptom severity across groups. Conclusions: Adherence, a significant clinical problem, can affect efficacy of the cancer treatment. The AVR intervention alone was just as effective as the AVR plus the nurse intervention at promoting adherence and managing symptoms from adverse effects. Implications for Practice: Nurses need to focus on patient education by ensuring patient understanding of oral agent regimen and the need to adhere to the oral agent for efficacious cancer treatment. Nurses can promote the use of medication reminders and self-management of symptoms from adverse effects, to support adherence to the oral agent.

A pilot study of an automated voice response system and nursing intervention to monitor adherence to oral chemotherapy agents.

This study was designed to develop and test a system to monitor adherence with nonhormonal oral chemotherapeutic agents using an automated voice response (AVR) system plus nursing intervention. Participants were patients diagnosed with solid tumor cancers, primarily breast, colon, and lung cancers, who received the Symptom Management Toolkit and participated in an interview for symptom severity, satisfaction, and beliefs about oral agents. Patients received weekly AVR calls, which assessed adherence to oral agents and severity of 15 symptoms. Patients who reported adherence of below 100% of the prescribed oral agents or symptoms of 4 or greater (0-10 scale) for 3 consecutive weeks were called by a nurse for assistance with symptom management and adherence to oral chemotherapy medications. After the 8 weekly AVR calls, patients participated in a follow-up interview and medical record review. Participants were 30 oncology patients who were ambulatory and treated at 2 cancer centers in Midwest United States. The results indicate 23.3% nonadherence rate to oral chemotherapy medications due to symptoms and forgetting to take the medication. An association between symptom management and adherence was found. Symptom severity and beliefs about medications were not significantly different between adherent and nonadherent patients. This pilot study demonstrated the ability to accrue patients for a longitudinal trial and informed intervention design while providing guidance for future interventions and research studies.

Assessment and Measurement of Adherence to Oral Antineoplastic Agents

OBJECTIVES The increase in oral anticancer medications with complex regimens creates a need to assure that patients are taking therapeutic dosages as prescribed. This article reviews the assessment and measurement of adherence to oral antineoplastic agents. DATA SOURCES Research and journal articles from CINAHL and PubMed. CONCLUSION Assessing and measuring adherence to oral antineoplastics should include three dimensions: the percentage of medications taken, the duration, and the timing of taking the medication. IMPLICATIONS FOR NURSING PRACTICE Clinicians need to conduct ongoing assessment and measurement of adherence to oral antineoplastic agents. This includes eliciting patient report of adherence, pill counts, drug diaries, and pharmacy or medical record audits.

The Challenges of Oral Agents as Antineoplastic Treatments

OBJECTIVES Given the increasing use of oral antineoplastic agents in cancer management, patient adherence is critical to successful treatment outcomes. This article reviews the scope of the problem and issues of adherence to oral antineoplastic agents. DATA SOURCES Research-based and other articles, newsletters, and conference presentations. CONCLUSION Suboptimal adherence to oral antineoplastic agents is a significant clinical problem that may result in disease or treatment complications, adjustment in treatment regimen, disease progression, and premature death. IMPLICATIONS FOR NURSING PRACTICE Healthcare providers need to monitor and facilitate adherence by identifying barriers and implementing strategies to assure adherence, and therefore, improve clinical outcomes.

Do Older Adults With Cancer Fall More Often? A Comparative Analysis of Falls in Those With and Without Cancer

PURPOSE/OBJECTIVES To examine whether a history of cancer increased the likelihood of a fall in community-dwelling older adults, and if cancer type, stage, or time since diagnosis increased falls. DESIGN A longitudinal, retrospective, cohort study. SETTING A home- and community-based waiver program in Michigan. SAMPLE 862 older adults aged 65 years or older with cancer compared to 8,617 older adults without cancer using data from the Minimum Data Set-Home Care and Michigan cancer registry. METHODS Reports of falls were examined for 90-180 days. Generalized estimating equations were used to compare differences between the groups. MAIN RESEARCH VARIABLES Cancer, falls, patient characteristics, comorbidities, medications, pain, weight loss, vision, memory recall, and activities, as well as cancer type, stage, and time since diagnosis. FINDINGS A fall occurred at a rate of 33% in older adults with cancer compared to 29% without cancer (p < 0.00). Those with a history of cancer were more likely to fall than those without cancer (adjusted odds ratio 1.16; 95% confidence interval [1.02, 1.33]; p = 0.03). No differences in fall rates were determined by cancer type or stage, and the odds of a fall did not increase when adding time since cancer diagnosis. CONCLUSIONS The fall rate was higher in older adults with cancer than in older adults without cancer. IMPLICATIONS FOR NURSING Nurses need to assess fall risk and initiate fall prevention measures for older adults at the time of cancer diagnosis. KNOWLEDGE TRANSLATION When caring for older adults with cancer, nurses should be aware of an increased risk for falls. Healthcare staff also should be aware of an increased risk for falls in that population during cancer treatment. Evidence-based fall prevention measures should be included in care plans for older adult cancer survivors.

mHealth SMS text messaging interventions and to promote medication adherence: an integrative review

AIMS AND OBJECTIVES This article is an integrative review of the evidence for mobile health Short Message Service text messages as an innovative and emerging intervention to promote medication adherence. Authors completed this review to draw conclusions and implications towards establishing a scientific foundation for use of text messages to promote medication adherence, thus informing clinical practice. BACKGROUND The World Health Organization has identified medication adherence as a priority global problem. Text messages are emerging as an effective means of improving health behaviours and in some diseases to promote medication adherence. However, a gap in the literature indicates lack of evidence in guiding theories and content of text messages, which should be synthesised prior to use in clinical practice. DESIGN Integrative review. METHODS Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Scopus, the Cochrane Library and PubMed were searched for relevant studies between 2004-2014. Inclusion criteria were (1) implementation of a text-message intervention and (2) medication adherence to a prescribed oral medication as a primary outcome. Articles were assessed for quality of methodology and measures of adherence. An integrative review process was used to perform analysis. RESULTS Thirteen articles meeting the inclusion criteria are included in this review. Nine of 13 studies found adherence rates improved between 15·3-17·8% when using text messages to promote medication adherence. Text messages that were standardised, tailored, one- or two-way and timed either daily to medication regimen, weekly or monthly showed improvement in medication adherence. CONCLUSIONS This review established a scientific basis for text messages as an intervention to improve medication adherence across multiple diseases. Future large rigorous randomised trials are needed to further test text messaging interventions. RELEVANCE TO CLINICAL PRACTICE This review provides clinicians with the state of the science with regard to text messaging interventions that promote medication adherence. A description of intervention components are provided to aid nurses in development of text messages and in translating evidence into practice.

Falls in the community-dwelling elderly with a history of cancer.

Background: Falls place older adults at risk for injuries, resulting in functional decline, hospitalization, institutionalization, higher healthcare costs, and decreased quality of life. Objective: This study examined community-dwelling elderly to identify if individuals with a history of cancer fall at a higher rate than those without cancer, and if the occurrence of falls was influenced by individual characteristics, symptoms, or function. Methods: This was a retrospective, cross-sectional study, in 2007, examining 7,448 community-dwelling elderly 65 years or older in a state in the Midwest. Fallers were identified based on a diagnosis of cancer, age, sex, race and ethnicity, poor vision, reduced activities of daily living (ADLs), instrumental ADLs, cognition, incontinence, pain, or depression. Results: Findings indicated that 2,125 (28.5%) had at least 1 fall. Of those who fell, 967 (13.0%) had cancer, and 363 (4.9%) with cancer had a fall. Conclusion: Predictors of falls in this population included race, sex, ADLs, incontinence, depression, and pain, all with P <.05. Cancer was not a predictor of falls in this study. Implications for Practice: This study found a high frequency of falls and suggests a predictive model for fall risk in the vulnerable, community-dwelling elderly and will be used to inform future studies.

Issues Related to Overadherence to Oral Chemotherapy or Targeted Agents

Use of oral chemotherapy or targeted agents is shifting how cancer treatment is administered, moving it from supervised office visits to self-administration at home. This study examines issues related to overadherence to oral agents that were noted during a trial conducted by the authors comparing an automated voice system to strategies to reduce symptom severity and improve adherence. Overadherence to oral agents may be a significant clinical problem, occurring more often in patients with complex dosing regimens, and may lead to increased symptom severity from side effects of treatment. Avoiding overadherence may be important for the reduction or prevention of symptoms and potentially life-threatening toxicity. Nurses need to discuss with their patients the importance of the timing of the administration of their oral oncolytic regimen, as well as to provide prompts to assist in self-administration as prescribed so that overadherence can be avoided.

Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment

PurposeThe purpose of this systematic review was to update and expand the existing systematic review with the aim to answer the following questions: (1) How often do older adults (OA)s with cancer fall? (2) What are the predictors of falls in OA with cancer? (3) What is the rate of injurious falls and predictors of injurious falls in OA with cancer? (4) What are the circumstances and outcomes of falls in this population? (5) How do falls in cancer patients affect subsequent cancer treatment?MethodsMedline, Pubmed, Embase, and CINAHL were searched. Eligible studies included clinical trials, cross-sectional, cohort, case-control, and qualitative studies in which the entire sample or a sub-group of the sample were OA aged 60 and above, had cancer, in which falls were examined as a primary or secondary outcome and published in English.ResultsTwenty-seven studies met our inclusion criteria with most involving the outpatient setting. Fall rates and injurious fall rates varied widely. Consistent predictors of falls were prior falls among outpatients and cognitive impairment among inpatients. There were no data on impact of falls on cancer treatment. Data on circumstances of falls were limited.ConclusionFalls and fall-related injuries are common in older cancer patients. However, little is known about circumstances of falls and impact of falls on cancer treatment. Many known fall predictors in community-dwelling OA have not been explored in oncology. More research is needed to address gaps in these areas.