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Recent clinical practice guidelines suggest that hospice can be a valuable alternative for patients with advanced heart failure (HF). Unfortunately, there are very few evidence-based nursing interventions to guide symptom management for HF patients in hospice and their caregivers. Nevertheless, conducting clinical research in hospice populations remains fraught with methodological and ethical challenges. Our research team was not naive to the fact that hospice research is difficult. We believed that we had prepared well for a number of contingencies before the beginning of our clinical trial testing the feasibility of delivering a psychosocial intervention to caregivers of patients with HF. Despite the team expertise and well-defined recruitment strategies, the recruitment, both accrual and attrition, remained daunting in this population. The purpose of this article was to report the challenges of recruiting hospice patients with HF and caregivers for our randomized clinical trial, those we anticipated and those we did not. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To determine the severity and trajectory of constipation among patients with cancer from opioids and/or vinca alkaloids.Design: Exploratory, descriptive.Setting: Moffitt Cancer Center, a National Cancer Institute-designated comprehensive cancer center in Tampa, FL.Sample: 400 patients at risk for developing medication-induced constipation from opioids, vinca alkaloids, or both.Methods: Patients' baseline data included the Constipation Assessment Scale (CAS), the constipation item from the Memorial Symptom Assessment Scale (MSAS) for intensity and distress, and the laxative interview. Following the interview, the medical chart was reviewed for clinical and demographic data. Patients were asked about constipation (CAS) and laxatives consumed (laxative interview) during eight weekly telephone calls.Main Research Variables: Constipation presence, intensity, and distress.Findings: At baseline, 63% of patients reported some level of constipation. During the eight weeks, constipation fluctuated with scores ranging from 0-16, with the opioid-only group showing a small but statistically significant decrease in intensity. Constipation intensity and distress on the MSAS were significantly correlated (r = 0.76; p = 0.000).Conclusions: The majority of the sample reported constipation that ranged from mild to severe, persisted over time, and caused symptom distress. Therefore, healthcare providers in the cancer center likely were neither adequately managing the medication-induced constipation nor apparently teaching patients to manage it themselves.Implications for Nursing: National Comprehensive Cancer Network guidelines support the importance of managing medication-induced constipation. However, guidelines are not being followed in many cases; therefore, more focus is needed on constipation in clinical and educational settings as well as more research.Knowledge Translation: Patients receiving opioids and vinca alkaloids are at risk of constipation. Currently, medication-induced constipation is poorly managed. Managing constipation may lessen symptom distress, thereby improving quality of life in these patients. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To test the validity and reliability of the Spiritual Needs Inventory (SNI) in measuring the spiritual needs of informal caregivers of patients with cancer in hospice home care.Design: A subanalysis of a longitudinal, randomized hospice clinical trial.Setting: Two hospices in the southwestern United States.Sample: 410 informal caregivers of patients with cancer in hospice home care.Methods: To test the hypotheses, Pearson and Spearman correlations, principal factor analysis with oblique rotation, and coefficient alpha were conducted.Main Research Variables: Spiritual needs, depression, social support.Findings: The SNI showed a small but significant positive correlation with the social support (p = 0.003). A three-factor solution of the SNI accounted for about 55% of the variability. The first factor captured a traditional religious measure, with the original patient-reported subscales of inspiration, spiritual activities, and religion collapsing into this one factor. The second and third factors were similar to the original patient study. Cronbach alpha for the total scale was 0.88. The factor alphas ranged from 0.68-0.89.Conclusions: The current study provides early evidence for the validity and reliability of the SNI in informal caregivers of patients with cancer in hospice home care. Additional testing in other populations is recommended.Implications for Nursing: Use of the SNI with hospice caregivers could aid nurses in the identification of spiritual needs, enabling the development of plans of individualized, high-quality care. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To describe depressive symptoms, grief, and complicated grief for bereaved family caregivers of patients who died from cancer-related causes and to explore relationships among these variables.Design: A nonexperimental, secondary analysis of cross-sectional descriptive data from a longitudinal intervention study evaluating the effect of providing feedback from standardized assessment tools.Setting: Two large, private, not-for-profit hospices in Florida.Sample: Convenience sample of 280 family caregivers, bereaved three months.Methods: Secondary analysis of self-report, survey data three months following death.Main Research Variables: Depressive symptoms, grief, and complicated grief.Findings: Three months after the loss of a loved one, 34% of the caregivers had clinically meaningful scores for depressive symptoms. A significant number of bereaved caregivers were experiencing grief and depression.Conclusions: Bereaved caregivers were experiencing significant levels of depressive symptoms and complicated grief. Caregivers with higher levels of grief had more depressive symptoms.Implications for Nursing: Tools are available to identify bereaved caregivers most in need of intervention. [ABSTRACT FROM AUTHOR]