Sue P. Heiney

Operationalization of community-based participatory research principles: Assessment of the National Cancer Institute's Community Network Programs

OBJECTIVES We examined how National Cancer Institute-funded Community Network Programs (CNPs) operationalized principles of community-based participatory research (CBPR). METHODS We reviewed the literature and extant CBPR measurement tools. On the basis of that review, we developed a 27-item questionnaire for CNPs to self-assess their operationalization of 9 CBPR principles. Our team comprised representatives of 9 of the National Cancer Institutes 25 CNPs. RESULTS Of the 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles of recognizing community as a unit of identity, building on community strengths, facilitating colearning, embracing iterative processes in developing community capacity, and achieving a balance between data generation and intervention. CNPs varied in the extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging the community in research dissemination, and striving for sustainability. CONCLUSIONS Although the development of assessment tools in this field is in its infancy, our findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.

The Effects of Group Therapy on Siblings of Pediatric Oncology Patients

The stress and psychological difficulties of siblings of children with cancer is well documented. Siblings must cope with a myriad of emotions, isolation from the family, and many changes in daily life. Therefore, a need exists to determine the effects of psychosocial interventions on siblings of cancer patients. The support group is one psychosocial intervention that has been suggested as a method to relieve stress and enhance coping. A quasi-experimental design was selected to determine the effects of participation in a support group on the social adjustment of siblings of children with cancer. Conclusions suggest that a support group provides siblings with the opportunity to decrease their sense of isolation, ventilate negative feelings, and learn from each other. Additionally, descriptive data suggest a need for ongoing follow-up with siblings to help them manage the stresses emerging from the impact of the diagnosis and treatment on the family. Implications of this study suggest that nurses should organize support groups for siblings and/or refer them to existing groups. Also, this study suggests the need to work with siblings and educate parents regarding sibling concerns.

Efficacy of therapeutic Group by telephone for women with breast cancer

A pilot study was conducted to test the efficacy of a therapeutic group by telephone conference call for women with breast cancer. Sixty-six women with stage I or stage II breast cancer consented to participate in the study. Participants were randomly assigned to a usual psychosocial care or intervention group, using a permuted block method. Only 2 of 68 patients dropped out of the study, which included 27% African Americans. Assessments at 3 time periods (pretest, immediately after the intervention, and 3 months after the group ended) included evaluation of quality of life (QOL), mood, and immune function. t tests were performed to determine if differences on important variables existed at pretest. The intervention group had worse QOL and mood scores than did the control group on the pretests. A mixed-model repeated-measures procedure controlling for pretest differences was used to analyze data. A significant Group by Time interaction was found for spiritual well-being and mood. These differences were not in the expected direction. The intervention group showed improvement in QOL and mood during the intervention, but showed decompensation following the intervention. Conversely, the control group demonstrated stable or declining scores. This intervention is feasible and practical for women with breast cancer, especially African American participants. The puzzling results suggest several areas for future research, including a better conceptual fit with outcome measures, increasing dosage, and exploration of the value of emotional expression.

A diet, physical activity, and stress reduction intervention in men with rising prostate-specific antigen after treatment for prostate cancer.

BACKGROUND Nearly 35% of men treated for prostate cancer (PrCA) will experience biochemically defined recurrence, noted by a rise in PSA, within 10 years of definitive therapy. Diet, physical activity, and stress reduction may affect tumor promotion and disease progression. METHODS A randomized trial of an intensive diet, physical activity, and meditation intervention was conducted in men with rising post-treatment PSA after definitive treatment for PrCA. Intention-to-treat methods were used to compare usual care to the intervention in 47 men with complete data. Signal detection methods were used to identify dietary factors associated with PSA change. RESULTS The intervention and control groups did not differ statistically on any demographic or disease-related factor. Although the intervention group experienced decreases of 39% in intakes of saturated fatty acid (SFA as percent of total calories) (p<0.0001) and 12% in total energy intake (218 kcal/day, p<0.05)], no difference in PSA change was observed by intervention status. Signal detection methods indicated that in men increasing their consumption of fruit, 56% experienced no rise in PSA (vs. 29% in men who did not increase their fruit intake). Among men who increased fruit and fiber intakes, PSA increased in 83% of participants who also increased saturated fatty acid intake (vs. 44% in participants who decreased or maintained saturated fatty acid intake). CONCLUSION Results are discussed in the context of conventional treatment strategies that were more aggressive when this study was being conducted in the mid-2000s. Positive health changes in a number of lifestyle parameters were observed with the intervention, and both increased fruit and reduced saturated fat intakes were associated with maintaining PSA levels in men with biochemically recurrent disease.

Cancer in adolescents and young adults. Psychosocial concerns, coping strategies, and interventions

Adolescent cancer patients present a unique challenge to health care professionals because of the impact of the disease and its treatment on the successful acquisition of age‐appropriate developmental milestones, as well as the psychosocial concerns raised by the illness itself. Understanding normal adolescent development provides a framework for identifying psychosocial concerns, predicting problems, and developing appropriate interventional strategies for adolescents with cancer. A comprehensive support program with specific goals of promoting adjustment to the illness and providing a basis for community reentry by strengthening recognized coping strategies based on identified psychosocial concerns is described as a model.

Racial disparities in breast cancer mortality in a multiethnic cohort in the Southeast.

Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature that examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among breast cancer patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients.

Adolescents with cancer. Sexual and reproductive issues.

Adolescents with cancer are confronted with sexual and reproductive issues at diagnosis, during the entire treatment period, and as long-term survivors. To help the patient cope effectively with his/her concerns, the nurse must understand normal sexual growth and development, current trends in adolescent sexuality, and specific problems arising from diagnosis and treatment. This article discusses an overview of sexuality in the well adolescent, using research findings and anecdotal accounts. The impact of the diagnosis on the adolescents emerging sexual identity is explored in depth. Information is given on the impact of long-term effects on both sexuality and reproduction. Finally, nursing interventions for helping adolescent cancer patients cope with both the impact of diagnosis and late effects are given. These interventions include collaboration with parents, relationship building, assessment, anticipatory guidance, education, and counseling.

Subject recruitment for cancer control studies in an adverse environment.

Subject recruitment in an adverse environment prompted researchers to identify a novel method to gain a different perspective on the problem. Lewins Model of Change was used in a post hoc examination of recruitment strategies from 5 cancer control studies of breast or prostate cancer. Based on this evaluation, driving and restraining forces in recruitment were identified. Lessons learned and recommendations are discussed based on this evaluation. Five categories of restrainers were identified from this evaluation and include sociocultural, institutional, individuals, budget, and study design. Conversely, only 3 categories of drivers were elucidated by the examination: sociocultural, institutional, and individuals. Lessons and recommendations ranged from addressing institutional barriers to capitalizing on public relations. Researchers entering a new environment for recruitment would benefit from using Lewins force field analysis before writing a proposal or implementing a project. This approach better directs energy and resources and enhances the ability of the investigator to maintain a broad, less biased perspective.

Preparing Children to Be Bone Marrow Donors

PURPOSE/OBJECTIVES To review literature regarding children as bone marrow donors and describe the evaluation of an individualized intervention to support children who will be donors for parents or siblings. DATA SOURCE Research studies, abstracts, and clinical reports describing interventions or psychosocial issues related to child donors, parent interviews, and clinical experiences. DATA SYNTHESIS Child marrow donors and caregivers benefit from interventions that illuminate the process and provide psychosocial support. Use of a teaching book enhances intervention and provides a tool for parents to use after transplantation. CONCLUSIONS Psychosocial distress in child marrow donors and parents can be minimized through education and therapeutic interventions. Research is needed to validate the efficacy of interventions and determine whether psychosocial complications are decreased. IMPLICATIONS FOR NURSING Child donors, especially those for parents, should receive support and attention for their unique psychosocial needs.

Sibling grief: A case report

The intensity of sibling grief and the significance of sibling mourning are described in research studies. Yet, nurses caring for dying children may be unaware of these findings and may not offer adequate support to assist siblings in working through grief. This article details one childs perceptions of the loss of a brother and provides rich clinical material for understanding typical sibling responses. The description of the therapy sessions provides a model for working with siblings and demonstrates the value of art as a therapeutic medium. These strategies are useful for nurses working with grieving siblings and may be applicable to other situations in which children experience a significant loss.