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Biomedical subjects

L Kristjanson

Publications and source records attributed to L Kristjanson.

At least 19 recordsLinked to original sources
PubMed2006

Adverse effects to quality of life arising from treatment can recover with intermittent androgen suppression in men with prostate cancer.

Health-related quality of life (HQOL) research is a means of broadening the assessment of treatment effects. This longitudinal study investigated the dynamic change to quality of life (QOL) and testosterone dependant physiology in men commencing an intermittent maximal androgen blockade program (IMAB). Two hundred and fifty men were accrued to the multi-centre study of IMAB (Flutamide 250 mg TDS, Leuprolide 22.5 mg depot) ceasing treatment after 9 months if PSA <4 ng/ml, and restarting when PSA >20 ng/ml. QOL was assessed every 3 months for 30 months using the EORTC QLQ-C30 and EORTC QLQ-PR25 module. Data completion for the whole study was 90%. At baseline, our cohort was less symptomatic and had better function than the EORTC reference cohort, which may be related to a shift in clinical practice with time. Testosterone suppression (AS) lead to a significant reduction in global HQOL and deterioration in most function and symptom scales. During the off period, there was a trend of progressive improvement in HQOL that paralleled testosterone recovery but was slower than the rate of deterioration during the treatment phase. Maximum recovery of HQOL occurred most frequently by months 9-12. Testosterone recovery was slower and less complete in older men, and lead to concomitant poorer HOQL recovery. Whilst the magnitude of mean change to scale scores was small, there was a consistent and simultaneous deterioration during maximal androgen blockade (MAB) and improvement during androgen recovery. Older men are more likely to show an impaired testosterone recovery, and this was paralleled by a slower HQOL recovery. Newer methods of analysis to describe results in a way that has meaning to the individual patient are warranted.

Aged↗
PubMed2006

Critical review of complementary therapies in haemato-oncology.

There is evidence of the increasing use of complementary and alternative medicine by Australians diagnosed with cancer. Given the increasing desire of cancer patients to use complementary and alternative medicine, it is important that clinicians have a good understanding of the evidence available in this field. This critical review aims to provide an overview of the current evidence pertaining to a range of complementary therapies that are used in a supportive role in the treatment of cancer patients. Treatment methods considered are acupuncture, music therapy, massage and touch therapies and psychological interventions. The efficacy of these complementary therapies in terms of improvement in symptoms and quality of life is examined. Evidence that relates to an effect on immune function and survival is also investigated.

Australia↗
PubMed2001

Dyspnea in cancer patients: prevalence and associated factors.

The objectives of this study were to determine the prevalence of dyspnea in the general cancer population, the intensity of the symptom as perceived by the patient, and the patient characteristics associated with the presence of dyspnea. Nine hundred and twenty-three cancer outpatients completed visual analogue scales (VAS) and verbal rating scales (VRS-D) to assess the intensity of their dyspnea. Baseline data included variables that were known covariates of dyspnea. Forty-six percent of the patients had some shortness of breath. Only 4% had a diagnosis of lung cancer and 5.4% lung metastases. Risk factors found to be significantly related to the presence of dyspnea were history of smoking; asthma or chronic obstructive pulmonary disease (COPD); lung irradiation; or a history of exposure to asbestos, coal dust, cotton dust or grain dust (P values from 0.001 to 0.038). The prevalence of dyspnea was strongly related to the number of risk factors a patient had (P < 0.0001). The VAS and VRS-D were significantly correlated, establishing concurrent validity for the VRS-D.

Canada↗
PubMed2001

Stories about breast cancer in Australian women's magazines: information sources for risk, early detection and treatment.

Sixty articles in five Australian women's magazines were analyzed for journalistic qualities, metaphors, narrative features and accuracy of clinical facts related to risk, early detection and treatment of breast cancer. The stories were features, news features or soft news stories. The stories reflected the 'good news' editorial style of women's magazines. A dominant theme in the stories was that early detection of breast cancer is crucial and equals survival. While there were few inaccuracies in the stories, there was little detail of treatment modalities, an emphasis on lifestyle as a risk factor and a prevailing message that a genetic history of breast cancer means you will get it. A major implication of the findings is that nurses, who provide information to women, must be aware of the goals of journalists and the educational power of narrative logic of stories in women's magazines.

Journal Article↗
PubMed2001

Palliative care in Western Australia: an assessment of information and support needs.

Health professionals in rural Western Australia have embraced palliative care, however, to date no information has been available about the issues that face those providing the care. The descriptive study was undertaken to determine what palliative care education and support resources were available to rural health professionals, and to ascertain what further services would be of benefit to their practice. The findings of this study suggests that rural health professionals would welcome increased access to both education and support services when providing palliative care to patients in their communities. Recommendations are made that could enhance the delivery of palliative care education and support to rural Western Australia.

Allied Health Personnel↗
PubMed2000

Models of integrated cancer care: a critique of the literature.

A number of models that integrate care across the hospital-community interface have been developed. Consumers and health care providers who are considering adopting this approach to service delivery need to consider which model is most suitable for implementation in their setting. A comprehensive review of the literature was conducted to identify and describe integrated care delivery models. This article defines five integrated models of care, provides a critical analysis of each model, and evaluates the extent to which claims about the models are supported by clinical reports and empirical findings. Finally, recommendations are made regarding implementation.

Continuity of Patient Care↗
PubMed2000

Palliative care nursing in rural Western Australia.

This article presents the findings of a study of rural palliative care nurses in Western Australia. The number of rural centres in Western Australia offering palliative care services is increasing; however, at present there is little empirical data available about the roles of the nurses involved. This study was undertaken to begin to correct this deficit. The study examined basic social processes associated with the role of rural palliative care nurses, and identifies issues that affect the nurses' professional practice. A modified grounded theory approach was used to form a conceptual framework that describes rural palliative care nursing. Theoretical sampling techniques were used to identify the six palliative care nurses working in rural Western Australia who participated in the study. Data were generated using in-depth interview and participant observation techniques. Constant comparative analysis of the data was employed to allow concepts to emerge from the data. The central theme that developed is the all-consuming nature of the rural palliative care nurse's role. Three subthemes relating to multiple roles, expectations of nurses, and coping strategies are also discussed. This research explored issues that rural palliative care nurses feel are relevant to their professional practice, and it describes the basic social processes inherent in the rural palliative care nurse's role. Recommendations for nursing research, education, administration and clinical practice are presented.

Adaptation, Psychological↗
PubMed1999

[Perception of symptom distress in lung cancer patients: I. Agreement between patients and their caregiving relatives].

This paper employs a comparative descriptive design to compare primary family caregivers' assessment of lung cancer patients' symptom distress with patients' own perceptions of symptom distress in the home setting. The second part describes the results of the qualitative component of this research. A convenience sample of 37 patient-family caregiver dyads completed the McCorkle and Young Symptom Distress Scale (SDS). Family caregivers' global scores were moderately correlated with patients' global scores (r = 0.71; P < 0.001). No significant differences in ratings were found for 10 of the 13 symptoms assessed. Therefore, when the patient is unable to provide a self-report of symptom distress, health-care professionals may seriously consider family caregivers' assessments of patients' symptom distress to be reasonable estimates for at least 10 of the 13 symptoms on the SDS.

Adult↗
PubMed1999

Skin reactions during radiotherapy for breast cancer: the use and impact of topical agents and dressings.

Radiation skin reactions occur in the majority of cases of patients undergoing radiotherapy for breast cancer with varying degrees of severity. Guidelines for skin care and for the use of topical agents and dressings have developed over the years of practice but there is little empirical evidence on which to base a decision for best practice. This paper describes the incidence of radiation skin reactions in a sample of 126 women treated for breast cancer post-lumpectomy. The results show that by the end of whole breast irradiation between 4-8% of patients will have no reaction and less than 10% will have moist desquamation as measured by the RTOG acute scoring system. The majority of patients did not require application of a topical agent during the treatment period. Statistical analysis of relationships between the severity of radiation skin reaction and the use of topical agents found no support for additional healing or preventative benefit. However, these topical agents were found to promote comfort. The use of Fixomull as a protector and potential preventive measure for moist desquamation is described.

Administration, Topical↗
PubMed1999

Management of radiation skin reactions: literature review and clinical application.

As many as 95% of patients treated with radiation therapy for cancer will experience a skin reaction. Some reactions are immediate, while others may be later (e.g., months after treatment). Therefore, nurses must be familiar with management of this side effect. This paper reviews current knowledge related to skin reactions from ionizing radiation and recommends guidelines for nursing practice.

Humans↗
PubMed1998

Predicting the severity of radiation skin reactions in women with breast cancer.

PURPOSE/OBJECTIVES: To develop a method of predicting the severity of acute radiation skin reactions. DESIGN: Prospective, descriptive correlational with repeated measures. SETTING: Outpatient radiation oncology department in a metropolitan public teaching hospital in Western Australia. SAMPLE: 126 adult women aged 30-78 receiving postlumpectomy radiation therapy for breast cancer. METHODS: Data about potential predictive factors were collected during the first week of radiation. Weekly observations of the skin reaction using the Radiation Therapy Oncology Group scoring system were recorded throughout treatment with an inter-rater reliability of 0.85. RESULTS: Chi square analysis and t-tests revealed many factors related to severe skin reactions on a univariate level. Logistic regression analysis calculated the relative risk and probability of developing a severe skin reaction. Predictive factors included weight, breast size, lymphocele aspiration, smoking, age, skin cancer, tumor stage, and radiation dose. CONCLUSIONS: In addition to radiation dose, some factors that impair wound healing also contribute to the cause of patient-to-patient variation, thus making it possible to predict who is likely to develop a severe skin reaction. IMPLICATIONS FOR NURSING PRACTICE: The findings will assist in individualizing the assessment, education, and management of women undergoing radiation therapy for breast cancer. Further research could lead to the development of a method of risk assessment for skin reactions for use in radiation therapy nursing.

Adult↗
PubMed1998

Dying to pay: the cost of end-of-life care.

The number of elderly Canadians is likely to double in 20 years, spurring a discussion of end-of-life care. We analyze the literature on the costs of this care and compare cost assessments of different models of palliative care. The cost of treatments for which there is little empirical support is factored into our cost-savings analysis and the methodological limits of cost-analysis studies are also discussed. We conclude that (a) depending upon the model of care, costs of end-of-life care are considerable, (b) costs of care become more expensive with distance from the home setting, (c) cost savings reported in palliative care settings may be a function of nearness to death; (d) family expenses on end-of-life care are substantial and are not factored into most cost-analysis studies, (e) a two-tiered system of palliative home care allows families with higher incomes to afford help in supporting home deaths, and (f) some treatments given to dying patients are costly while yielding little benefit.

Canada↗
PubMed1997

Perceptions of symptom distress in lung cancer patients: II. Behavioral assessment by primary family caregivers.

Literature on assessment of symptom distress has focused primarily on patients' and nurses' perceptions in the hospital setting. To date, no research has examined behavioral measurement and cues that primary family caregivers respond to when assessing patients' level of distress arising from individual symptoms in the home setting. The qualitative data obtained from 37 primary family caregivers of patients with lung cancer was designed to augment quantitative results discussed elsewhere. Content analysis was performed on written responses to an open-ended questionnaire in which family caregivers identified cues that they responded to when assessing patients' distress from symptom items. The results identified the categories of impaired functioning and verbal cues as the most frequent indices of symptom distress. This study documents that certain behavioral measures for assessing symptom distress may be clinically useful to observers. Primary family caregivers are shown in this study to take a limited multidimensional approach in the assessment of patients' distress from symptoms.

Behavior↗
PubMed1997

Perceptions of symptom distress in lung cancer patients: I. Congruence between patients and primary family caregivers.

Part I of this two-part paper employs a comparative design to compare primary family caregivers' assessments of lung cancer patients' symptom distress with patients' own perceptions of symptom distress in the home setting. Part II describes the results of the qualitative component of this research. A convenience sample of 37 patient-family caregiver dyads completed the McCorkle and Young Symptom Distress Scale (SDS). Family caregivers' global scores were moderately correlated with patients' global scores (r = 0.71; P < 0.001). No significant differences in ratings were found for ten of the 13 symptoms assessed. Therefore, when the patient is unable to provide a self-report of symptom distress, health-care professionals may seriously consider family caregivers' assessments of patients' symptom distress to be reasonable estimates for at least ten of the 13 symptoms on the SDS.

Adolescent↗
PubMed1997

Development and testing of the ethical reasoning tool (ERT): an instrument to measure the ethical reasoning of nurses.

Ascertaining the thinking of professionals as they are confronted with ethical practice issues is a prerequisite to understanding ethical decision making. Before researchers or educators can examine the effectiveness of various approaches to ethics teaching and learning, there is a need for reliable and valid tools to assess practitioners' cognition. A potential problem with the few measuring instruments currently available is the fact that they ask subjects to rank order existing lists of issues. This says little about an individuals' own thinking about ethical issues and may prompt thinking or responses which would not otherwise have occurred. This paper reports the results of a study to test the psychometric properties of a new instrument, the Ethical Reasoning Tool (ERT) that measures ethical reasoning of nurses. The ERT demonstrates a promising way to reveal unprompted ethical thinking about a practice dilemma, thereby clarifying 'real' versus 'assumed' professional reasoning. The tool allows nurse educators to identify areas of student learning/reasoning deficiency that can be addressed by educational interventions. The ERT also allows nurse educators to evaluate the effectiveness of nursing ethics study units in a trustworthy way.

Adult↗
PubMed1997

Family health and the palliative care trajectory: a cancer research agenda.

This article reviews the published literature related to families of palliative care patients with cancer within the context of the Cancer Control Framework of the National Cancer Institute of Canada. Three themes emerged: 1) the impact of terminal cancer on the family; 2) family functioning--responses to terminal cancer; and 3) quality of palliative care from the family perspective. The most substantial body of research describes family needs, family caregiving burdens, caregiving costs and the impact of the patient's terminal cancer on the health of family members. Small samples, high nonresponse rates, selection biases and a lack of standardized outcome measures have impeded the advancement of knowledge. Method development studies are warranted, including the development of instruments to measure family care constructs. Longitudinal studies to examine the long-term impact of the patient's functional status, mood, symptom distress and quality of life on family members are needed. Research should also explore the effects of family composition, socioeconomic factors, culture and spirituality on families' experiences with terminal illness. Identification of families at risk as well as development and rigorous testing of appropriate interventions should become priorities.

Family Health↗
PubMed1995

Home versus hospital death: assessment of preferences and clinical challenges.

In Canada hospital beds have been reduced in number, and there is increased fiscal pressure for patients with advanced terminal illness to be cared for in their own homes until death. In this issue (see pages 361 to 367) Drs. Ian R. McWhinney and Martin J. Bass and Ms. Vanessa Orr report that people who die at home rather than in hospital are more likely to be cared for by family members other than a spouse and to have the services of a private duty nurse. The literature has shown that health problems of elderly spouses, occupational and other responsibilities of family members, and the physical, psychologic and financial strain of providing home care can make it difficult to honour a terminally ill person's wish to die at home. The findings of McWhinney and colleagues point to the existence of a two-tiered health care system in which those who have access to private duty nursing are able to stay at home to die. Their study also raises three key questions that must be addressed in the assessment of patient preferences as to place of death: Should family members be included in the assessment? How should preferences be measured? and What is an appropriate time frame for such an assessment? Although McWhinney and colleagues identify characteristics of care associated with place of death and underline the need for careful assessment of patient preferences regarding place of death, further research is needed to build on these findings. In the current context of health care reform, we need to examine more closely the type and intensity of services needed to support patients and their families in the final stages of a terminal illness.

Canada↗