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Biomedical subjects

J Post-White

Publications and source records attributed to J Post-White.

16 recordsLinked to original sources
PubMed2001

Pain, mood disturbance, and quality of life in patients with multiple myeloma.

PURPOSE/OBJECTIVES: To determine the levels of pain intensity and pain interference in patients with multiple myeloma, the relationship between pain and mood disturbance, and factors that influence quality of life (QOL). DESIGN: Descriptive correlational mailed survey. SETTING: A private tertiary institution in the Midwest. SAMPLE: Convenience sample of 346 adult patients with multiple myeloma identified through an institutional database, 206 of whom responded to the surveys. METHODS: Mailed, self-administered questionnaires: Brief Pain Inventory Short Form, Profile of Mood States, QOL Scale (Cancer Patient Version), and a demographic tool. Treatment details were obtained from the database on subjects consenting to participate. MAIN RESEARCH VARIABLES: Pain intensity, pain interference, psychologic functioning, and QOL. FINDINGS: 29% (n = 60) of subjects reported moderate to severe pain intensity. Significant associations were found between pain intensity and mood disturbance scores. As pain interference increased, so did levels of mood disturbance. A joint predictive model explained 74.6% of the variability in total QOL scores. CONCLUSIONS: Cancer pain remains undertreated, and patients with myeloma are no exception. Pain and mood disturbance scores were significant predictors of QOL in this group of patients. Subjects with multiple myeloma reported higher levels of mood disturbance than patients with cancer from other studies. IMPLICATIONS FOR NURSING PRACTICE: The oncology nurse is in a key position to facilitate ongoing, adequate pain and psychosocial assessment of patients with myeloma. Further study is needed to determine if control of pain and mood disturbance factors has a positive effect on the various domains of QOL.

Adult↗
PubMed1998

Recruitment for complementary/alternative medicine trials: who participates after breast cancer.

BACKGROUND: Despite the popularity and widespread practice of complementary/alternative medicine (CAM), researchers may face problems accruing patients to randomized clinical trials, considered the gold standard of biomedical research. Strict exclusion criteria and barriers to participation may limit accrual. Inadequate numbers of subjects decrease the ability of studies to detect an effect that exists and generalize their findings. This article describes the recruitment experience of a CAM trial, details reasons for non-participation, and contrasts participants and non-participants on demographic, clinical, and treatment-related variables. METHODS: Women who were Houston area residents and spoke English, had primary breast cancer (excluding Stage IV), and were 1 to 30 months posttreatment with no steroids, tamoxifen, substance abuse, psychiatric or heart disease, or immune deficiency were eligible. The enrollment process involved three contacts (i.e. introductory letter and brochure, telephone calls, and reminder post cards). Potential participants were told that the study would require blood samples (30 cc) to assess immune function; psychosocial measures to assess emotional well-being, quality-of-life, social support, and coping strategies; and possible assignment to six weekly support or imagery sessions. Factors influencing recruitment and reasons for non-participation were assessed by stratified analysis and multivariate logistic regression. RESULTS: Of 158 eligible participants, 30% (N = 47) consented to participate. Primary reasons for non-participation included work/childcare (33.3%), transportation/travel (30.6%), and lack of interest (24.3%). Participants were more likely to be 40-54 years of age versus younger or older, divorced/separated, and able to pay some/all medical expenses. Divorced or separated women appeared to be more likely to participate, regardless of financial status. CONCLUSIONS: Researchers must assess the impact of exclusion criteria on accrual and recognize the special needs of their target population. Although age, marital status, and pay status were the strongest predictors of participation, these factors are not amenable to intervention. Based on this study, researchers might boost accrual by providing interventions available during the day and evening to accommodate working women, child care services, transportation, or reimbursement for travel costs.

Adult↗
PubMed1997

Improving cancer pain management in communities: main results from a randomized controlled trial.

The purpose of this randomized controlled community trial is to evaluate the effects of a community intervention utilizing opinion leaders and educational strategies on the cancer pain management knowledge, attitudes, and the practices of physicians and nurses, and cancer pain reported by patients. Six Minnesota communities participated in the study. The three communities randomized to the intervention received educational programs over 15 months. The clinical community opinion leaders participated in a minifellowship, developed community task forces, and interacted with their peers. This strategy was reinforced with community outreach programs, clinical practice guidelines, educational materials, and media events. The primary study end point was patients' pain intensity score. Comparing intervention to control communities, pain prevalence declined slightly, pain management index improved slightly, pain intensity scores increased slightly, patient and family attitude scores did not change, and physicians' and nurses' knowledge and attitude scores improved slightly. None of these changes, however, reached statistical significance. Participation in at least one intervention program improved physicians' and nurses' knowledge and attitude scores that approached statistical significance. Our results suggest that community opinion leaders combined with other educational programs may improve cancer pain management, but this strategy requires further study. The results suggest that more intense intervention application may be effective. Effective strategies to improve cancer pain management remain elusive.

Cohort Studies↗
PubMed1997

Coping, life attitudes, and immune responses to imagery and group support after breast cancer treatment.

BACKGROUND: The pilot study used clinical trial methodology to differentiate the effects of imagery and support on coping, life attitudes, immune function, quality of life, and emotional well-being after breast cancer. METHODS: Women (N = 47) who completed treatment for primary breast cancer, excluding stage IV, were randomly assigned to standard care (n = 15) or six weekly support (n = 16) or imagery (n = 16) sessions. Self-report measures included Ways of Coping-Cancer, Life Attitude Profile, Quality of Life (FACT-B), Profile of Mood States, and Functional Support. Immune measures included natural killer cell activity, plasma neopterin, interferon-gamma, interleukins 1 alpha, 1 beta, and 2, and beta-endorphin levels. Differences between groups over time were tested using general linear models, adjusted for pretest score and covariates (age, stage, and months posttreatment). RESULTS: For all women, interferon-gamma increased, neopterin decreased, quality of life improved, and natural killer activity remained unchanged. Compared with standard care, both interventions improved coping skills (seeking support) and perceived social support, and tended to enhance meaning in life. Support boosted overall coping and death acceptance. When comparing imagery with support, imagery participants tended to have less stress, increased vigor, and improved functional and social quality of life. CONCLUSION: Although imagery reduced stress and improved quality of life, both imagery and support improved coping, attitudes, and perception of support. The clinical implications of these changes warrant further testing.

Adaptation, Psychological↗
PubMed1997

How healthcare professionals contribute to hope in patients with cancer.

PURPOSE/OBJECTIVES: To explore whether healthcare professionals influence the level of hope in patients with cancer and, if so, how they influence their hope. DESIGN: Descriptive, qualitative design. SETTING: An adult hematology/oncology unit in the upper midwestern United States. SAMPLE: Thirty-two men and women receiving active or supportive treatment or palliative care for cancer. METHODS: Semistructured interviews conducted in the participants' hospital rooms. Ten investigators and two consultants transcribed and analyzed the interview data using content analysis. They identified themes and subthemes that described healthcare professionals' roles. MAIN RESEARCH VARIABLES: Healthcare professionals' contributions to hope as described by patients with cancer. FINDINGS: Healthcare professionals positively and negatively influenced hope in this sample. Hope was facilitated by being present, giving information, and demonstrating caring behaviors. Negative influences on hope primarily concerned the way in which healthcare professionals gave information. CONCLUSION: Healthcare professionals do influence patients' perceptions of their hope. Although most nursing actions are hope enhancing, nurses can reduce a patient's sense of hope if information provided or attitude toward the patient is insensitive or disrespectful. IMPLICATIONS FOR NURSING PRACTICE: Nurses can increase patients' hope by being present, taking time to talk, and being helpful. They must provide information and answer questions in a compassionate, positive, honest, and respectful manner. Caring behaviors such as thoughtful gestures, showing warmth and genuineness, and being friendly and polite also increase patients' hope.

Adaptation, Psychological↗
PubMed1996

The immune system.

OBJECTIVE: To explain the role of the immune system in cancer control and its response to environmental and perceived stressors. DATA SOURCES: Review articles, research studies, and book chapters related to immunology and the immune system. CONCLUSIONS: The immune system responds to foreign pathogens and cancer cells by activating specific and nonspecific immune responses. The goal of immunotherapy is to enhance these responses to control the growth of cancer cells. Knowledge of the influence of stress on immune and cytokine response is evolving. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of the principles of immunology, the immune response to cancer, the role of cytokines in mediating immune response, and the influence of stress on immune and cytokine response will help nurses provide quality care to patients receiving biological agents.

Antibody Formation↗
PubMed1995

Physician knowledge and attitudes about cancer pain management: a survey from the Minnesota cancer pain project.

The purposes of the study were to determine the knowledge and attitudes about cancer pain management (CPM) among practicing physicians in six Minnesota communities and to determine the physician-related barriers to optimal CPM. Eligible community physicians were surveyed by telephone. The study analyzed responses of 145 physicians (response rate, 87%). The majority of the physicians were primary care specialists (73%). Significant knowledge deficits were identified in nine of 14 CPM principles, but inappropriate attitudes were found in only two of nine CPM concepts. Medical specialty had the strongest influence on knowledge and attitudes, with primary care physicians having significantly better outcomes than surgeons or medical subspecialists. Effective education strategies must address knowledge deficits, attitudes, and motivations of the relevant peer group influencing physicians, as well as those of individual physicians. The Minnesota Cancer Pain Project is testing strategies to enhance CPM by physicians and improve patient outcomes.

Clinical Competence↗
PubMed1995

The Minnesota Cancer Pain Project: design, methods, and education strategies.

The Minnesota Cancer Pain Project (MCPP) is a community-based research project to test various innovative education strategies for improving cancer pain management (CPM) in Minnesota. The main hypothesis is that community-based, multidisciplinary and integrated education programs can improve CPM and change knowledge, attitudes, and behaviors regarding CPM in cancer patients, their families, and community physicians and nurses. The specific aim of the MCPP is to demonstrate effective methods to improve CPM in communities. The MCPP design is a randomized trial with before- and after-intervention assessments of cancer pain and CPM knowledge, attitudes, and behaviors among cancer patients and their families, physicians, and nurses. The unit of randomization and study is the community, with six Minnesota communities participating in the MCPP. This paper describes the hypotheses, design, methods, and education strategies of the MCPP. Baseline data from the participating communities and the cancer patient sample are reported.

Family↗
PubMed1995

Research methodology in psychoneuroimmunology: rationale and design of the IMAGES-P clinical trial.

Although mental imagery has historically been ignored by the scientific community, it is one of the six most commonly used alternative therapies chosen by cancer patients. Investigations of immune response to psychosocial interventions have been largely anecdotal or quasi-experimental. Although reports of increased survival predominate among cancer patients, few investigators have measured psychological or immunological outcomes to explain the mechanisms that contribute to improved survival. The efficacy of imagery or support groups in patient adaptation (emotionally and physically) to the stresses of cancer, heightened immune function, and improved morbidity and mortality remain uncertain in the absence of objective evidence from randomized, controlled clinical trials. The imagery and group emotional support study pilot (IMAGES-P) is a 12-month feasibility study designed to examine the effect of group support and imagery/relaxation in a randomized, controlled clinical trial, differentiating the effects of these therapy modalities on immune function, quality of life, and the emotional well-being of women who have completed treatment for breast cancer. Secondary aims are to explore the quantitative relationships among emotional well-being, quality of life, and immune function. For this study established clinical trial methodology was used to examine functional immune responses associated with emotional states induced by the therapy interventions. As a pilot study, IMAGES-P will provide direction for future longitudinal studies evaluating the effectiveness of these interventions on emotional well-being and survival.

Breast Neoplasms↗
PubMed1993

Cancer prevention and early detection: nursing students' knowledge, attitudes, personal practices, and teaching.

This study evaluated the impact of an educational workshop on nursing students' knowledge, attitudes, and personal practices regarding cancer prevention and early detection (CP&ED), as well as the effect that it had on their teaching of CP&ED recommendations. Four one-day workshops--which included lectures, small group discussions, and practice of early detection skills--were held in three cities in Minnesota. Students from baccalaureate, associate-degree, and practical nursing programs participated (N = 220). Preworkshop, postworkshop, and six-month follow-up surveys were used to evaluate the knowledge, attitudes, and self-practice of the participants, as well as their teaching of clients, family, friends, and peers. Data were analyzed with matched paired t-tests, chi-square, correlation, and analysis of variance. The postworkshop and six-month follow-up surveys showed improvement in the students' knowledge and attitudes; however, the only self-practice behaviors that changed within six months of the workshop were breast/testicular self-examinations. The results also showed that the students felt more confident and subsequently taught more clients, family, friends, and peers about the CP&ED recommendations. These findings indicate that educating students early in their careers may increase the number of people practicing CP&ED recommendations.

Adult↗
PubMedDate not supplied

Nutrition and cancer: educating the public through a health fair.

Minnesota has a high incidence of dietary-associated cancer, including colorectal, breast, and prostate. To increase public awareness of cancer risks and health benefits of dietary behaviors, the Metro Minnesota Chapter of the Oncology Nursing Society (ONS) participated in a public education health fair. Supported by a Special Project Funding Grant from the ONS, 42 chapter members assisted more than 700 Metro area residents at seven locations to assess and improve their diet according to the American Cancer Society (ACS) guidelines. To evaluate the effectiveness of the project, a postcard survey was sent to 200 (29%) names randomly drawn from raffle entries. Seventy-five surveys were returned (38%). Ninety-five percent found the assessment helpful in evaluating their diet, and 80% made dietary changes in the two weeks following the health fair. Results indicate that nurses should continue to educate the public about the relationship between diet and cancer. Recommendations for further consideration include assessment of long-term effects of the health fair education format and provision of a brochure about ONS. Benefits included community education and ONS member participation in a chapter activity.

Diet↗