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Background: The symptom burden associated with cancer and its treatment can negatively affect patients' quality of life and survival. Symptom-focused collaborative care model (CCM) interventions can improve outcomes, but only if patients engage with them. We assessed the receptivity of severely symptomatic oncology patients to a remote nurse-led CCM intervention.Methods: In a pragmatic, cluster-randomized, stepped-wedge trial conducted as part of the National Cancer Institute IMPACT Consortium (E2C2, NCT03892967), patients receiving cancer care were asked to rate their sleep disturbance, pain, anxiety, emotional distress, fatigue, and limitations in physical function. Patients reporting at least 1 severe symptom (≥7/10) were offered phone consultation with a nurse symptom care manager (RN SCM). Initially, patients had to "opt-in" to receive a call, but the protocol was later modified so they had to "opt-out" if they did not want a call. We assessed the impact of opt-in vs opt-out framing and patient characteristics on receptiveness to RN SCM calls. All statistical tests were 2-sided.Results: Of the 1204 symptom assessments (from 864 patients) on which at least 1 severe symptom was documented, 469 (39.0%) indicated receptivity to an RN SCM phone call. The opt-out period (odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.12 to 2.32, P = .01), receiving care at a tertiary care center (OR = 3.59, 95% CI = 2.18 to 5.91, P < .001), and having severe pain (OR = 1.80, 95% CI = 1.24 to 2.62, P = .002) were associated with statistically significantly greater willingness to receive a call.Conclusions: Many severely symptomatic patients were not receptive to an RN SCM phone call. Better understanding of reasons for refusal and strategies for improving patient receptivity are needed. [ABSTRACT FROM AUTHOR]

Little is known about the experience of family caregivers when their care partner dies and their dyadic relationship comes to an end. This study qualitatively examined and characterized the loss of the dyadic experience for the caregiver after the death of their care partner. Data was accrued as part of a randomized clinical trial in 29 older hospice caregivers. Iterative thematic analysis focused on dyadic processes before, during and post death. Using two relational parameters from Relational Turbulence Theory resulted in a preliminary characterization of a new concept—dyadic dissolution as a cognitive and affective process whereby a remaining member of a dyad experiences relational uncertainty and partner interference while adapting (or not) to the death of their care partner. Findings suggest that asking several open-ended questions about the dyadic relationship will enable assessment for any continuing impact of relational uncertainty and partner interference on bereaved caregivers. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The purpose of this paper is to describe a model to guide nursing science in a clinical practice‐based setting. Exemplars are provided to highlight the application of this nursing research model, which can be applied to other clinical settings that aim to fill evidence gaps in the literature. Background: Nurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to multiple disparities. The generation and application of this knowledge are essential to inform and guide professional nursing practice. While a number of evidence‐based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice‐based settings. Design: Model development and description. Methods: Mayo Clinic is a large, comprehensive healthcare system with a mission to address unmet patient needs through practice, research and education. PhD‐prepared nurse scientists engage in practice‐based research as an integral component of Mayo Clinic's mission. A practice‐based nursing research model was developed with the intent to advance nursing research in a clinical setting. Results: The components of the Mayo Clinic Nursing Research model include symptom science, self‐management science and caregiving science. The generation of nursing science is focused on addressing needs of patients with complex health conditions, inclusive of caregivers. Conclusions: While clinical settings provide rich opportunities for the conduct of research, priorities need to be established in which to focus scientific endeavours. The Mayo Clinic Nursing Research model may be applicable to nurses around the globe who are engaged in the generation of knowledge to guide practice. Relevance to Clinical Practice: The Mayo Clinic Nursing Research model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions, advance the generation of new nursing knowledge and ultimately improve the health and well‐being of patients and caregivers. [ABSTRACT FROM AUTHOR]

Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe differences in fatigue severity in a sample of adult Puerto Rican patients during and postcancer treatments. Background: Hispanics, including Puerto Ricans, are an understudied population who are under‐represented in clinical trials, especially in symptom research. Although symptom management is a clinical priority in oncology care, treatment‐related differences in Puerto Rican cancer patients’ report of fatigue severity have not been well described. Design/Methods: A cross‐sectional survey was conducted from data of self‐report of 138 Puerto Rican patients during and postcancer treatments at two ambulatory facilities located in San Juan, Puerto Rico. Fatigue severity was assessed using the Fatigue subscale from the Functional Assessment of Cancer Therapy‐Fatigue quality of life questionnaire Spanish version. Differences in fatigue severity across type of treatment (radiation therapy, chemotherapy, combined radiation chemotherapy and post‐treatment) were evaluated using nonparametric (Kruskal–Wallis and Mann–Whitney test) statistical tests. Results: The majority of the participants had prostate (33%) and breast (32%) cancers and were receiving radiation therapy (43%) or chemotherapy (28%). The Kruskal–Wallis test showed that there was a statistically significant difference in fatigue scores between the different four treatment conditions, χ2(3) = 39.1, p = .001 with patients on combined radiation chemotherapy or chemotherapy alone experiencing more severe fatigue. Conclusions: Findings from the current study suggest that type of treatment is a key component of the symptom burden of fatigue among the Puerto Rican oncology population. Specially, patients receiving combined therapy or chemotherapy alone were at increased risk for experiencing severe fatigue, compared to radiation therapy and post‐treatment patients. Relevance to clinical practice: With the worldwide increase in migration of Puerto Rican families, nurses need to recognise that type of treatment is a key component of the symptom burden of fatigue among the Puerto Rican population. The results of this study will improve understanding of treatment‐related fatigue to identify therapeutic targets and improve quality of life of patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate differences in the severity of global, cancer-specific, and cumulative life stress, resilience, and common neuropsychological symptoms among four subgroups of patients with distinct chemotherapy-induced nausea (CIN) profiles. SAMPLE & SETTING: Adult patients with cancer (N = 1,343) receiving chemotherapy. METHODS & VARIABLES: Patients completed stress, resilience, and neuropsychological symptom severity measures. The Memorial Symptom Assessment Scale was used to assess CIN occurrence six times over two cycles of chemotherapy. Parametric and nonparametric statistics were used to evaluate differences among subgroups of patients with distinct CIN profiles. RESULTS: The high class had significantly higher levels of global, cancer-specific, and cumulative life stress; significantly higher levels of depression, anxiety, sleep disturbance, morning and evening fatigue, and pain; and lower levels of morning and evening energy and cognitive dysfunction. IMPLICATIONS FOR NURSING: Clinicians need to evaluate CIN occurrence across each cycle of chemotherapy and assess patients for various types of stress and common neuropsychological symptoms. [ABSTRACT FROM AUTHOR]

Cancer diagnosis and treatment are universally distressing events that may cause or exacerbate symptoms of post-traumatic stress. Accelerated Resolution Therapy (ART) is a mind-body therapy that has demonstrated success is treating trauma resulting from combat experiences, sexual assault, and complicated grief. ART has not yet been tested in the setting of cancer distress with symptoms of post-traumatic stress. The purpose of this qualitative study was to explore contextual elements of the cancer experience that were consistently distressing and/or psychologically traumatic, as well as perceptions of ART for the treatment of cancer distress. Semi-structured interviews were conducted by phone four weeks following ART, audio-recorded, and transcribed verbatim. Purposive sampling techniques were used, and participants were recruited from a National Cancer Institute (NCI)-designated comprehensive care center. Eligibility included: ≥18 years old, English speaking, recent or current cancer treatment, a mean score of at least 1.1 on the Cancer and Treatment Distress (CTxD) scale, a minimum score of 3 on the Primary Care-Post Traumatic Stress Disorder (PC-PTSD) scale. Interviews were conducted until data saturation was met. A thematic analysis was conducted using NVIVO 11.0 software. The majority of participants (n=13) were female (84.6%), Caucasian (76.9%), and non-Hispanic (76.9%). The mean age was 55.2 years. The majority had either a stage III (23.8%) or IV (46.2%) solid tumor and had received previous chemotherapy (84.6%). Participants described a variety of traumatic events earlier in life that influenced their cancer experience. For others, the cancer diagnosis was the underlying source of distress. Participants described various ways in which ART helped them process their emotions and restored a sense of calm, inner peace, and better insight and control over their reactions to stressful events. All participants endorsed early incorporation of ART or coping strategies into cancer treatment. Interventions such as ART that can address previous trauma and current distress are needed to address the psychosocial needs of oncology patients. ART may be particularly helpful when individuals enter cancer treatment with unresolved past trauma. Recognition and treatment of emotional distress by members of the oncology team was viewed very positively by participants. [ABSTRACT FROM AUTHOR]

Medication beliefs are a critical factor of medication taking behavior and have been linked to patient outcomes including symptoms, side effects, and adherence. This work is timely given the increased use of oral oncolytic agents (OAAs) among patients with metastatic breast cancer (MBC), who must self-manage care in the home environment. Currently, medication beliefs have been studied among early-stage cancers and those on hormone treatment. There is gap in the literature examining medication beliefs among those with advanced disease who have experienced other failed cancer treatments. This study aimed to examine the medication beliefs of OAAs among women undergoing treatment for MBC to identify opportunities for patient care improvement. This qualitative study used semi-structured interviews that were audio re-corded and transcribed verbatim. A thematic analysis was conducted using Atlas.ti 8.0 software. Inter-rater reliability was set at a threshold of 0.80. Using purposive sampling techniques, participants were recruited from a National Cancer Institute (NCI)-designated comprehensive care center. Eligibility included: >18 years old, English speaking, confirmed MBC diagnosis, and able and willing to complete interviews via telephone or Zoom. Interviews were conducted until saturation was met. Participants (n=16) were largely Caucasian (86.7%), non-Hispanic (93.3%). Mean age was 55.6 years. Patients held dialectical medication beliefs. Positive medication beliefs included the convenience of receiving cancer treatment at home, wide availability, and scientific advances of new OAAs, relief of cancer-related symptoms, and delayed disease progression. Negative medication beliefs included concern regarding OAA cost, side effects, and long- term medication efficacy. Overall, participants were willing to accept the negative consequences of OAAs in exchange for prolonged survival. However, patients also expressed not knowing when to end treatment and transition to end of life care. Examining and addressing medication beliefs are important to determine areas that oncology nurses may intervene across the OAA treatment trajectory. Evaluating medication beliefs may help initiate conversations regarding uncontrolled symptoms, quality of life, or serve to address ethical issues regarding continuing or ending treatment among patients with advanced disease who experience severe symptoms, side effects, and toxicities. Nurses are positioned to advocate for health policies that improve the quality of care of individuals with cancer, which should include early consultations with palliative care services. [ABSTRACT FROM AUTHOR]

The objective of this manuscript is to present the protocol of a study aiming to test the effects of Accelerated Resolution Therapy® (ART) on pre-loss grief and prolonged grief among older adult family caregivers. This study also aims to better understand predictors of response to ART®, and cognitive processes that occur among grieving individuals following ART®., Design: The study is a double-blinded, randomized clinical trial., Setting: This study takes place at both inpatient and outpatient palliative care and hospice programs at two Mayo Clinic sites., Participants: Participants include older adult ( ≥ 60 years) immediate family members who are primary caregivers of someone with an advanced illness and life expectancy of less than 12 months., Intervention: Participants are randomized to either the ART® intervention group or the attention control group. In the ART® intervention, caregivers engage in imaginal exposure, lateral eye movements, and imagery rescripting via 4 sessions lasting 1-1.5 hours each. The attention control group receives a standard social work intervention, including education, resources, and active listening, which is matched for time and attention. Both interventions will longitudinally follow caregivers from active caregiving into bereavement., Outcomes Measured: The primary outcomes of pre-loss grief and prolonged grief will be measured with the Pre-Loss Grief 12 item (PG-12-R) before the care recipient's death, and with the Prolonged Grief-13 (PG-13-R) afterwards., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patients have been known to use cannabinoids for treating established chemotherapy-induced peripheral neuropathy (CIPN) based on anecdotal information and retrospective reports suggesting that such might be beneficial. In response, a double-blinded, placebo-controlled, randomized, pilot clinical trial was developed to evaluate whether resultant data would support a phase III trial for testing whether a cannabidiol (CBD) cream might improve CIPN. Methods: Forty patients with established CIPN were randomized, in a double-blinded manner, to topical CBD or a placebo cream. The study product was applied for 2 weeks, followed by a crossover for 2 weeks. Neuropathy was evaluated using the European Organization of Research and Treatment of Cancer (EORTC)-CIPN20, the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool, and the Global Impression of Change instruments. Side effects were recorded by symptom diaries. Results: The EORTC-CIPN20 scores were similar in the patients receiving CBD versus the placebo. Likewise, the toxicity scores were similar in patients who received the CBD versus the placebo. Conclusions: This pilot trial did not support that the studied CBD isolate cream improved painful established CIPN. It was well tolerated overall. Clinical Trial Registration Number: NCT05388058.

Peripheral neuropathy is a debilitating neurological disorder affecting 13% to 14% of the US population. Estimates for co-occurring mood disorders in individuals with neuropathy range from 30% to 47%, but sparse evidence exists regarding depression treatment for adults with neuropathy. A cognitive-behavioral treatment, Acceptance and commitment therapy, is known to reduce depression in people with chronic pain, but little is known about its effectiveness in adults with neuropathy, particularly when the treatment is provided via videoconference. Acceptability and usability of this therapeutic treatment provided via videoconference was assessed in participants with peripheral neuropathy and symptoms of depression. Participants completed pre- and post-self-report outcome measures: the nine-item depression scale of the Patient Health Questionnaire and the 36-item Short-Form Health Survey. They also completed the Acceptability e-Scale and Post-Study System Usability Questionnaire after treatment. Depression decreased significantly, with scores declining from an average of 9.2 to 5.1 on the Patient Health Questionnaire ( P < .05). The Short-Form Health Survey indicated significant improvement post-treatment on the "Energy/Fatigue" and "Emotional Well Being" subscales. The intervention was rated by participants as acceptable and demonstrated high usability. This initial therapeutic treatment via videoconference offers promise to treat depression in older adults with neuropathy., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Grieving is a normal reaction to loss; however, not everyone is able to recover from grief and adjust to a life after the loss. "Complicated grief" (CG) is a term used to describe intense and prolonged bereavement after the loss of a loved one that interferes with normal activities accompanied by destructive thoughts and behaviors. In practice and research, the concept of CG varies in definition and instruments used to measure. This concept analysis examines relevant research related to CG experienced by caregivers to provide a clear, comprehensive definition. Implications for nursing practice and research are explored.

Chemotherapy-induced neuropathy is a painful and debilitating adverse effect of certain chemotherapy drugs. There have not been any patient-centered, easily accessible Web-based interventions to assist with self-management of chemotherapy-induced neuropathy. The aims of this study were to evaluate usability and acceptability and to estimate an effect size of a Web-based intervention for assessing and managing chemotherapy-induced neuropathy. Participants (N = 14) were instructed to complete the Creativity, Optimism, Planning, and Expert Information for Chemotherapy-Induced Peripheral Neuropathy program and provide verbal responses to the program. Participants completed the Chemotherapy Induced Peripheral Neuropathy Assessment Tool and Post-Study System Usability Questionnaire. Iterative changes were made to the COPE-CIPN. Participants were asked to provide feedback on the revised COPE-CIPN, repeat the Chemotherapy Induced Peripheral Neuropathy Assessment Tool, and evaluate acceptability using the Acceptability e-Scale. The COPE-CIPN demonstrated high usability (mean, 1.98 [SD, 1.12]) and acceptability (mean, 4.40 [SD, 0.52]). Comments indicated that the interface was easy to use, and the information was helpful. While neuropathy symptoms continued to increase in this group of patients receiving neurotoxic chemotherapy, there was a decrease in mean level of interference with activities from 53.71 to 39.29 over 3 to 4 months, which indicated a moderate effect (d = 0.39) size. The COPE-CIPN may be a useful intervention to support self-management of chemotherapy-induced neuropathy.