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Biomedical subjects

Susan M Rawl

Publications and source records attributed to Susan M Rawl.

11 recordsLinked to original sources
PubMed2006

The VA Ostomy Health-Related Quality of Life Study: objectives, methods, and patient sample.

OBJECTIVE: To present the design and methods of a multisite study of health-related quality of life (HR-QOL) in veterans living with ostomies. RESEARCH DESIGN AND METHODS: Veterans from Tucson, Indianapolis, and Los Angeles VA Medical Centers were surveyed using the validated City of Hope ostomy-specific tool (mCOH-QOL-Ostomy) and the SF-36V. Cases (ostomates) had a major gastrointestinal procedure that required an intestinal stoma, while controls had similar procedures for which an ostomy was not required. Ostomy subjects were recruited for four focus groups in each of two sites divided by ostomy type (colostomy versus ileostomy) and overall mCOH-QOL-Ostomy HR-QOL score (highest versus lowest quartile). The focus groups further evaluated barriers, concerns, and adaptation methods and skills. MAIN OUTCOME MEASURES: This report presents recruitment results, reliability of survey instruments, and demographic characteristics of the sample. RESULTS: The overall response (i.e., recruitment) rate across all sites was 48% and by site was 53%, 57%, and 37%, respectively (p < 0.001). Internal consistency reliability estimates indicated that both instruments remain reliable in this population (Cronbach's alpha for HR-QOL domains/scales: 0.71-0.96). Cases and controls were similar in demographic characteristics. Proportions of minority subjects matched projections from the site patient populations. Subjects with ostomies had significantly longer time since surgery than controls (p < 0.001). Focus groups were comprised of two to six subjects per group and demonstrated racial diversity at the Los Angeles site. CONCLUSIONS: The unique design of our study of VA patients with ostomies is an illustration of a successful mixed methods approach to HR-QOL research. We collected meaningful quantitative and qualitative data that will be used in the development of new approaches to care that will lead to improved functioning and well-being in persons living with ostomies. Subsequent reports will provide the results of this research project.

Aged↗
PubMed2005

Patients' interest in discussing cancer risk and risk management with primary care physicians.

Little is known about patients' preferences for discussing cancer risks and risk management with primary care physicians. We sought to determine whether patients want to discuss such topics and what factors are associated with this interest. Participants (375 patients ages 40-85, of diverse race and education level) completed a telephone survey prior to scheduled physician visits. Survey included items on perceived health, perceived cancer risk, education level, and whether participants would like to discuss with a physician their breast, ovarian or colon cancer risk, tamoxifen, cancer genetic counseling, and colon cancer screening. Greater proportions were interested in discussing risks for each cancer, compared with those who were not (P < 0.0001). More participants were interested in discussing mammograms (80%) and cancer genetic counseling (60%) than tamoxifen (49%) or colon cancer screening modalities (43-53%). For many topics, poorer perceived health was associated with greater interest in future discussion; higher education level was associated with less interest.

Adult↗
PubMed2005

Secondary prevention of cancer.

OBJECTIVES: To review criteria for mass cancer screening among asymptomatic populations and barriers to secondary prevention of breast, cervical, and colorectal cancers. To describe challenges to implementing theoretically based interventions to increase appropriate cancer screening, follow-up, and surveillance. DATA SOURCES: Published journal articles, text books, and epidemiologic reports. CONCLUSION: Interventions to increase breast, cervical, and colorectal cancer screening participation must be approached from a systems perspective that includes patient, health care provider, and health care system variables. IMPLICATIONS FOR NURSING PRACTICE: Understanding the array of factors that impede progress in the secondary prevention of cancer is necessary to improve care. Nurses have an important role in decreasing morbidity and mortality from breast, cervical, and colorectal cancers.

Clinical Nursing Research↗
PubMed2005

Impact of the Cancer Risk Intake System on patient-clinician discussions of tamoxifen, genetic counseling, and colonoscopy.

The Cancer Risk Intake System (CRIS), a computerized program that "matches" objective cancer risks to appropriate risk management recommendations, was designed to facilitate patient-clinician discussion. We evaluated CRIS in primary care settings via a single-group, self-report, pretest-posttest design. Participants completed baseline telephone surveys, used CRIS during clinic visits, and completed follow-up surveys 1 to 2 months postvisit. Compared with proportions reporting having had discussions at baseline, significantly greater proportions of participants reported having discussed tamoxifen, genetic counseling, and colonoscopy, as appropriate, after using CRIS. Most (79%) reported CRIS had "caused" their discussion. CRIS is an easily used, disseminable program that showed promising results in primary care settings.

Adult↗
PubMed2004

Colorectal cancer in African Americans.

In the United States, African Americans have the highest incidence of colorectal cancer of any racial or ethnic group. Compared with whites, African Americans have a younger mean age at colorectal cancer diagnosis and a greater proportion have proximal cancers. Survival in African Americans with colorectal cancer is lower than in whites. Currently, there are no established biological explanations for these differences in colorectal cancer between African Americans and whites. As leaders in the prevention and early diagnosis of colorectal cancer in the United States, clinical gastroenterologists can play an important role in promoting colorectal cancer awareness and the need for screening in African Americans.

Adult↗
PubMed2002

Colorectal cancer screening: an overview of current trends.

Colorectal cancer can be cured and, in some cases, even prevented if detected early through screening. Studies have demonstrated that regular screening for colorectal cancer with fecal occult blood testing, sigmoidoscopy, or colonoscopy can reduce mortality from this disease. Unfortunately, rates of participation in these screening tests are unacceptably low among the U.S. population. Nurses have a significant role to play in assisting individuals to incorporate regular colorectal cancer screening into their health maintenance routines.

Colorectal Neoplasms↗
PubMed2002

Population-based cancer screening.

PURPOSE/OBJECTIVES: To provide an overview of current issues surrounding the prevention of and screening for lung, breast, cervical, colorectal, ovarian, prostate, and skin cancer. DATA SOURCES: Original research, review articles, and published guidelines. DATA SYNTHESIS: Although morbidity and mortality rates have decreased for these cancers, prevention and early detection still require increased funding and research. CONCLUSIONS: More behavioral scientists must be trained in prevention and early detection of cancer, and increased research funding is necessary to encourage advances in primary and secondary prevention. IMPLICATIONS FOR NURSING: Oncology nurses should incorporate appropriate prevention and early-detection strategies into practice.

Adult↗
PubMed2002

Intervention to improve psychological functioning for newly diagnosed patients with cancer.

PURPOSE/OBJECTIVES: To test the effects of a computer-based nursing intervention designed to provide patients and family caregivers with concrete, objective information on symptom management; provide education about disease and treatment; coordinate medical resources; and provide emotional support and counseling. DESIGN: Two-site, randomized clinical trial. SETTINGS: A large, urban, midwestern, tertiary-cancer center and a community-based cancer center in a medium-sized midwestern city. SAMPLE: 109 patients newly diagnosed with breast, colon, or lung cancer who were receiving chemotherapy; 54 received standard care, and 55 participated in the intervention group. METHODS: Outcome data were collected via structured telephone interviews at three time points: baseline, midway through the intervention, and one month postintervention. The intervention consisting of nine visits, five in person and four by telephone, was conducted over 18 weeks by advanced practice oncology nurses. MAIN RESEARCH VARIABLES: Psychosocial functioning, anxiety, and depression. FINDINGS: Patients who received the intervention had significantly less depression between baseline and the midway point, as well as less anxiety and greater improvement in the role-emotional and mental health subscales of the Medical Outcomes Study 36 Short Form. CONCLUSIONS: Cancer-care nursing interventions can decrease psychosocial morbidity and improve quality of life for newly diagnosed patients with cancer undergoing treatment. Additional research is needed to understand who benefited most from the intervention. IMPLICATIONS FOR NURSING: This nurse-directed intervention resulted in improved mental health for patients; however, physical subscales were not changed. Further work is needed to determine why depression and mental health were affected yet physical health and symptoms did not differ between groups. Results support the important role of nurses in addressing mental health issues in patients and families experiencing cancer.

Adult↗
PubMed2002

Comparisons of tailored mammography interventions at two months postintervention.

The recent decrease in breast cancer mortality has been linked in part to increased breast cancer screening. Although the percentage of women screened once is rising, rate of continued adherence is poor. The purpose of this article is to assess the effects of tailored mammography interventions implemented prospectively in a factorial design contrasting groups receiving either (a) usual care (no intervention), (b) tailored telephone counseling for mammography, (c) tailored mailed materials promoting mammography, or (d) a combination of tailored mail and telephone counseling. This prospective, randomized study with a 2 x 2 factorial design included women 51 years and older (N = 1,367) who were not adherent with mammography at baseline. The intervention is based on integration of the Transtheoretical and Health Belief Models. Participants were enrolled in one of two health maintenance organizations or seen in a university-related primary care clinic. Baseline data were collected on mammography history and beliefs and knowledge related to mammography. Data were collected via telephone interviews using previously developed scales. The follow-up interviewers were conducted with 976 women. The sample was 41% White, 56% African American, and 3% other. Mean age at baseline was 66.5. Logistic regression indicates that postintervention mammography status in all three intervention groups was significantly better than usual care, with odds ratios ranging from 1.66 (telephone only) to 2.16 (telephone plus mail).

Aged↗
PubMedDate not supplied

Symptom experiences of chronically constipated women with pelvic floor disorders.

PURPOSE: Chronic constipation is a frequent and bothersome problem in women with pelvic floor disorders, and standard treatment protocols are often ineffective. The purposes of this study were to describe the constipation symptom experience, perceived effectiveness of symptom-management strategies, and the lifestyle limitations associated with constipation symptoms among women with pelvic floor disorders. DESIGN: A cross-sectional descriptive design was used. SETTING: Participants were recruited from a tertiary-level outpatient urogynecology center. SAMPLE: Thirty women with pelvic floor disorders completed a self-administered instrument at the time of their clinic appointment. METHODS: The instrument included questions about the distress, frequency, intensity, and occurrence of constipation symptoms. In addition, the effectiveness of symptom-management strategies used to treat constipation and the lifestyle limitations associated with constipation were assessed. FINDINGS: The symptom experience of chronic constipation in these women included multiple distressing and uncomfortable symptoms that resulted in mild lifestyle limitations. Although self-management strategies were perceived to have limited effectiveness, the most effective strategies used by the women to manage constipation included use of laxatives, using their hand in or near the vagina or rectum to expel stool, and using an enema. CONCLUSIONS: More effective interventions are needed to promote satisfactory symptom management of chronic constipation for women with pelvic floor disorders. Further assessment of outcomes, including comfort and depression, may be warranted. IMPLICATIONS FOR PRACTICE: A more thorough assessment of constipation symptoms in this population is recommended. A combination of symptom-management strategies may be needed to relieve the multiple symptoms associated with constipation.

Adult↗