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Biomedical subjects

Susan C McMillan

Publications and source records attributed to Susan C McMillan.

15 recordsLinked to original sources
PubMed2006

Impact of coping skills intervention with family caregivers of hospice patients with cancer: a randomized clinical trial.

BACKGROUND: Family caregivers for cancer patients experience high levels of stress and burden and diminished quality of life (QOL). Interventions to improve coping skills of caregivers have been shown to be effective with other populations, but their impact has not been assessed in the difficult context of hospice care. The purpose of this study was to determine whether hospice plus a coping skill training intervention improved family caregivers' QOL, burden, coping, and mastery, compared with hospice plus emotional support, and usual hospice care. METHODS: A three group randomized controlled trial was conducted including baseline, 16 day, and 30 day assessments conducted from March 1999 to May 2003. The sample consisted of 354 family caregivers of community dwelling hospice patients with advanced cancer. Patient/caregiver dyads were randomly divided into three groups, including a control group (n = 109) who received standard hospice care, a group (n = 109) who received standard hospice care plus three supportive visits, and a group (n = 111) who received standard care plus three visits to teach a coping skills intervention. Primary outcomes included caregiver QOL, caregiver burden due to patient symptoms, caregiver burden due to tasks, and caregiver mastery. RESULTS: At the 30-day follow-up, the coping skills intervention led to significantly greater improvement in caregiver QOL (estimate = -0.16, standard error [SE] = 0.07, P = 0.03), burden of patient symptoms (estimate = 0.28, SE = 0.07, P < 0.001), and caregiving task burden (estimate = -0.01, SE = 0.01, P = 0.038) than did the other two conditions. None of the groups showed significant change in overall caregiving mastery, caregiver mastery specific to caregiving tasks, problem-focused or emotion-focused coping. CONCLUSIONS: The coping skills intervention was effective in improving caregiver QOL, reducing burden related to patients' symptoms, and caregiving tasks compared with hospice care alone or hospice plus emotional support. Structured caregiver skill-training interventions for caregivers are promising even in the difficult environment of end-of-life care and for families already receiving benefits of hospice care.

Adaptation, Psychological↗
PubMed2006

Methodological issues in the recruitment of cancer pain patients and their caregivers.

Published pain management guidelines recommend that caregivers of cancer pain patients be provided pain management education, but little is known about the utility of providing such information. This study examined recruitment and retention of cancer pain patients and caregivers for a randomized clinical trial that provided psychoeducation and stress management training to caregivers. Of 397 patient/caregiver dyads screened, only 22 (5.5%) were study eligible, consented to participate, and completed the study. A variety of problems hampered successful participation, including a high proportion of non-cancer-related pain syndromes among patients, a high proportion of patients without caregivers, and participants' perception of study burden. Results suggest that researchers should recruit from a broad patient base and limit study burden on participants.

Adult↗
PubMed2006

Interpersonal factors predict increased desire for hastened death in late-stage cancer patients.

BACKGROUND: Cancer patients at the end of life sometimes express a wish that death would come quickly, but this desire for hastened death (DHD) remains little understood. Relationships with spousal caregivers may play a role in patients' DHD. PURPOSE: This study examined factors that could predict an increase in the DHD in late-stage cancer patients over the course of 4 months, including marital and caregiving variables that have not previously been examined. METHOD: Patients completed the Schedule of Attitudes Toward Hastened Death and other measures, including the Dyadic Adjustment Scale. Caregivers were asked how many hours they spent weekly in caregiving activities and completed the Caregiver Demands Scale. Approximately 4 months later, DHD was reassessed in surviving patients. RESULTS: Sixty caregiver/patient dyads completed all measures. Desire for hastened death was generally low at both assessments; however, more depression and greater dyadic adjustment reported by patients, and more hours spent in caregiving activities by spouses, each independently predicted increased DHD in patients at the Time 2 assessment. CONCLUSIONS: Findings suggest that issues related to spousal caregivers play an important role in the course of DHD in cancer patients at the end of life.

Aged↗
PubMed2005

Training pain resource nurses: changes in their knowledge and attitudes.

PURPOSE/OBJECTIVES: To determine the changes in knowledge and attitudes of pain resource nurses (PRNs) as a result of an intensive pain management course. DESIGN: Pre- and post-test design. SETTING: A Veterans Administration hospital in the southeastern United States. SAMPLE: 18 RNs from multiple units where care is provided for veterans with cancer. METHODS: The PRNs were tested before and after a 32-hour intensive pain management course. MAIN RESEARCH VARIABLES: Knowledge about pain management, attitudes toward pain management, and attitudes toward patients in pain. FINDINGS: Significant improvements were found in pain knowledge and attitudes toward patients in pain. Improvements in attitudes toward pain management approached significance. CONCLUSIONS: The improvements in scores not only supported the effectiveness of the course but also provided additional evidence of the validity of the assessment instruments. IMPLICATIONS FOR NURSING: Courses such as this should be offered in other settings to encourage practicing nurses to provide better care to patients in pain and to serve as role models for their peers.

Adult↗
PubMed2005

Pain resource nurses: believing the patients, and believing in themselves.

PURPOSE/OBJECTIVES: To describe the experience of being a pain resource nurse (PRN), discuss the influence of the PRN's role on colleagues and patient care, and explore barriers to the PRN role. DESIGN: Qualitative, exploratory. SETTING: A Veterans Administration hospital in the southeastern United States. SAMPLE: 12 nurses who received advanced training in pain assessment and management attended focus groups approximately one year after assuming the PRN role. METHODS: Two focus group sessions, each with four to eight nurses. Each nurse was asked to describe her experience. Interviews were transcribed verbatim. Data were analyzed using Spradley's domain analysis for discovering processes and themes from the transcribed data. MAIN RESEARCH VARIABLES: The experience of being a PRN, the influence of the PRN on staff and patients, and barriers to the role and pain management. FINDINGS: The key processes that described the PRN experience were Believing the Patients (i.e., an awareness that nurses must have to effectively manage patients' pain) and Believing in Themselves (i.e., the PRNs gained authority as experts in pain management, accepted the responsibility of being champions in pain management, and gave themselves permission to make patients comfortable). CONCLUSIONS: The pain-training course the PRNs received enabled them to practice as confident, credible, and empowered professionals. The awareness that they acquired during the course and the year of practice allowed the PRNs to be patient advocates, role models, and educators. IMPLICATIONS FOR NURSING: The findings of this study indicate a high level of nurse satisfaction with the PRN role. Nurses with an interest and specialized knowledge in pain assessment and management at the unit level may greatly improve patient outcomes.

Adult↗
PubMed2005

Interventions to facilitate family caregiving at the end of life.

Informal family caregivers provide care in a variety of situations, including care for patients receiving active curative treatment for cancer and other life-threatening diseases, for Alzheimer's patients over the long trajectory of their disease, and for hospice patients who are near the end of life. Especially at the end of life, these caregivers are essential because they provide needed help with activities of daily living, medications, eating, transportation, and emotional support, as well as communicating with health care professionals about the patients' condition. As health care increasingly moves out of acute care settings and into homes, the role of the caregiver becomes more critical and the burden becomes heavier. There is a paucity of data regarding which caregivers are at greatest risk for distress and which interventions are likely to relieve that distress. Although both educational and supportive interventions have been tested, including both telephone and face-to-face meetings, it still is not clear which approach is best for which groups of caregivers. Much of the research that has been done has been descriptive and evaluative, and only a very limited number of clinical trials have been conducted with caregivers of patients near the end of life. There is limited evidence about whether caregiver interventions at the end of the patient's life have the potential to provide long-term benefits to caregivers. In addition, issues exist in adapting such interventions to work with culturally diverse populations. Sadly, there appears to be a limited number of investigators doing this important work. More research is needed to provide complete evidence on which to base practice and policy decisions.

Adaptation, Psychological↗
PubMed2003

Hospice patient and caregiver congruence in reporting patients' symptom intensity.

As healthcare increasingly moves out of hospitals, the care of patients with cancer is provided in the community with the help of family caregivers. In many cases, nurses depend on family caregivers to provide assessment data about patients. This makes the accuracy and dependability of the data given by caregivers particularly important. However, it is not clear whether caregivers can accurately and dependably report such subjective data as symptom intensity. The purpose of this project was to evaluate the ability of the primary caregiver to report the symptom intensity of hospice patients with cancer. The sample consisted of 264 newly admitted adult patients with advanced cancer in hospice home care and their primary caregivers. These subjects were part of a large National Institutes of Health (NIH)-funded randomized clinical trial focused on symptom management and quality of life. The patients were alert and oriented. Among the questionnaires completed by both patients and caregivers on admission were numeric rating scales for pain and dyspnea and the Constipation Assessment Scale. All of these scales were designed to describe the patient's symptom intensity. The patient sample was predominantly white (83%) and male (57%), with a mean age of 71.6 years. The caregiver sample was predominantly white (85%) and female (78%), with a mean age of 62 years. The results indicated that caregivers significantly overestimated symptom intensity for all three symptoms (P =.000). Furthermore, the limited variance accounted for by the two sets of scores for each of the symptoms (R2 =.16-.26) indicated much more error in the scores than agreement between patient and caregiver. It appears that family caregivers cannot reliably report patient symptom intensity. Healthcare providers need to train family caregivers in conducting systematic assessments instead of assuming that they understand patient symptoms.

Aged↗
PubMed2002

Pain reports by older hospice cancer patients and family caregivers: the role of cognitive functioning.

PURPOSE: Prior research in nursing homes has shown that cognitive impairment may reduce self-reported pain, but this relation has not been systematically explored among hospice patients. The assessment and treatment of pain is a primary goal of hospice care, and both disease processes and the use of opioid analgesics may lead to cognitive impairment among hospice patients. However, little is known about how cognitive functioning may impact the self-report of pain or the report of care recipient pain by family caregivers. DESIGN AND METHODS: We explored the associations between pain, cognitive functioning, and gender among cancer patients and their family caregivers (N = 176 dyads) during in-home hospice care. This was a cross-sectional, correlational study. RESULTS: Contrary to expectation, care recipients with cognitive impairment reported more intense pain than care recipients with intact cognitive functioning. However, cognitive impairment among care recipients had no impact on the pain report of family caregivers. Care recipient cognitive impairment was related to greater discrepancy in the pain reports of caregivers and care recipients. No gender differences in pain intensity report were found. IMPLICATIONS: Measurement issues and implications for assessing self-reported pain among hospice cancer patients with impaired cognitive functioning and the report of care recipient pain by family caregivers are discussed. Specifically, hospice staff must educate family caregivers regarding the potential impact of care recipient cognitive impairment on pain reports in order to facilitate accurate pain assessment and management.

Adult↗
PubMed2002

Revising the blueprint for the Oncology Certified Nurse (OCN) examination: a role delineation study.

PURPOSE/OBJECTIVES: To conduct a role delineation study of basic oncology nursing practice as a basis for revision of the blueprint for the Oncology Certified Nurse (OCN) examination. DESIGN: Three-phase study of oncology nurses' practice. SAMPLE: 735 oncology nurses randomly chosen from all nurses who are OCN certified. METHODS: A pilot survey was mailed to a small group to allow refinement of the survey instrument. The revised survey then was e-mailed to a total sample of 3,000 OCNs. The results and input from experts on the subject matter were used to revise the test blueprint. MAIN RESEARCH VARIABLES: Frequency and importance of 223 oncology nursing activities previously identified by the group of experts in oncology nursing. FINDINGS: The highest ranked items for the combined frequency and importance scales pertained to the subscales Professional Performance, Patient/Family Education, Comfort, Protective Mechanisms, and Coping. The lowest ranked activities pertained to subscales Research, Detection, Sexuality, and Prevention. CONCLUSIONS: The blueprint for the OCN examination reflects entry-level oncology nursing practice and includes eight domains of practice: Quality of Life (36%), Protective Mechanisms (13%), Gastrointestinal and Urinary Function (10%), Cardiopulmonary Function (8%), Oncologic Emergencies (7%), Scientific Basis for Practice (12%), Health Promotion (3%), and Professional Performance (11%). IMPLICATIONS FOR NURSING: Because oncology nursing is changing, reconfirming and updating the blueprint for the certification examination is necessary. Certification examinations beginning in April 2003 will be based on the revised blueprint.

Adaptation, Psychological↗
PubMedDate not supplied

Presence and severity of constipation in hospice patients with advanced cancer.

Although constipation is a problem commonly seen in hospice patients it is not often addressed in the literature as a target symptom needing management. The purpose of this study was to assess the levels of self-reported constipation in a group of patients with advanced cancer at admission to hospice and two weeks and one month after admission. The constipation assessment scale (CAS) measured the presence and intensity of constipation. Comparisons between time points were not possible, but trends seem to indicate that patient symptoms are not being successfully managed.

Aged↗
PubMedDate not supplied

Symptom distress and quality of life in patients with cancer newly admitted to hospice home care.

PURPOSE/OBJECTIVES: To evaluate the relationships between quality of life (QOL) and symptom distress, pain intensity, dyspnea intensity, and constipation intensity in people with advanced cancer who were newly admitted to hospice home care. DESIGN: Descriptive and correlational. SETTING: A large hospice that provides primarily home care. SAMPLE: 178 adult hospice homecare patients with cancer who were accrued to a clinical trial funded by the National Institutes of Health focusing on symptom management and QOL. Patients were excluded if they received a score lower than seven on the Short Portable Mental Status Questionnaire. METHOD: The patients were invited to participate in the clinical trial within 48 hours of admission to hospice home care. Among the questionnaires they completed were a QOL index and a distress scale. Scales measuring present intensity of pain, dyspnea, and constipation also were administered. MAIN RESEARCH VARIABLES: QOL, symptom distress, pain intensity, dyspnea intensity, and constipation intensity. FINDINGS: The most frequently reported symptoms among the sample were lack of energy, pain, dry mouth, and shortness of breath. Lack of energy caused the greatest distress, followed closely by dry mouth and pain. The results of the regression analysis indicated that total distress score, pain intensity, dyspnea intensity, and constipation intensity were related to QOL at the univariate level. When all predictors were considered simultaneously, only the total distress score remained a significant predictor of QOL (p< 0.001), accounting for about 35% of variance. CONCLUSIONS: QOL was affected by symptom distress in people with advanced cancer near the end of life. IMPLICATIONS FOR NURSING: The symptoms most commonly reported and those that cause the greatest patient distress should be addressed first by hospice nurses. Continued effort is needed in the important area of symptom management.

Adult↗
PubMedDate not supplied

Methodologic issues in collecting data from debilitated patients with cancer near the end of life.

PURPOSE/OBJECTIVES: To report the experience of a group of researchers who have had a year of experience in a clinical trial with homecare hospice patients. SAMPLE: 150 hospice patients with cancer and their primary caregivers who were accrued to a National Cancer Institute-funded clinical trial focusing on quality of life. METHODS: The investigative team kept careful records of the numbers of patient/caregiver dyads accrued to the study and the reasons for nonaccrual as well as reasons for attrition. Data were analyzed using descriptive statistics. FINDINGS: During a nine-month period, the hospice admitted 2,517 patients; 75% had cancer and 95% had caregivers, making them eligible for the study. However, after further screening, only 19% were eligible for contact and only 5% finally were accrued to the study. For the 125 patient/caregiver dyads actually accrued to the study, baseline data were obtained on only 50% and evaluable follow-up data on only 50%. CONCLUSIONS: Accruing patients to clinical trials and retaining them when they are critically ill and near death are extraordinarily difficult tasks. The inability to recruit and retain subjects for clinical trials has implications for integrity of data, data analysis, success of the project, and the cost of conducting such projects in the future.

Clinical Trials as Topic↗
PubMedDate not supplied

Validating the brief pain inventory for use with surgical patients with cancer.

PURPOSE/OBJECTIVES: To examine the psychometric characteristics of the Brief Pain Inventory (BPI) for surgical patients with cancer and to compare the validity and reliability results between surgical and medical patients with cancer. DESIGN: Descriptive and correlational. SETTING: Inpatient units in two veterans hospitals. SAMPLE: 388 patients with cancer (medical n = 229, surgical n = 159). METHODS: The BPI was administered to patients once, and a pain visual analog scale (VAS) was administered to patients three times. The VAS was correlated with individual items of the BPI and with the Pain Interference Subscale of the BPI; correlations were conducted separately for medical and surgical patients as a study of validity. Reliability was assessed using Cronbach's alpha for each group. MAIN RESEARCH VARIABLES: Pain at its worst and least, current pain intensity, average pain intensity, and pain relief. FINDINGS: Patients in both groups were predominantly male, older, and Caucasian. Means from both groups were similar for items on the BPI. Correlations between the Pain Interference Subscale and the other items on the BPI were similar for both groups. Correlations between the VAS and the Pain Interference Subscale of the BPI were equally high for the medical (r = 0.71, p less than 0.01) and surgical (r = 0.73, p less than 0.01) oncology groups. Reliability evaluated by the coefficient alpha was very high for the medical (r = 0.95) and surgical (r = 0.97) oncology groups. CONCLUSIONS: The BPI is equally valid and reliable for medical and surgical male, Caucasian patients with cancer. IMPLICATIONS FOR NURSING: Nurses working with patients with cancer can have confidence that the BPI will assist them in assessing and managing pain in both groups.

Adult↗