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Pain, a common debilitating symptom among kidney transplant recipients (KTRs), is among the most common and undertreated symptoms after kidney transplantation.Characterize associations between gut microbiome features and pain interference before and after kidney transplantation.Longitudinal, repeated measures study of 19 living-donor kidney transplant recipients, collecting fecal specimens and pain interference data pretransplant and 3 months posttransplant.Participants were recruited at the Kidney Transplant Clinic at the University of Illinois HospitalHealth Sciences System.19 living fonor kidney transplant recipients. (need to remove this from ``design''.We assessed fecal microbial community structure with shotgun metagenomic sequencing; we used pain interference scores derived from the Patient-Reported Outcomes Measurement Information System-57.We measured a reduction in the Shannon diversity index in both groups after transplantation but observed no significant differences between groups at either time point. We did observe significant differences in fecal microbial Bray-Curtis similarity index among those reporting pain interference pretransplant versus no pain interference at 3-months posttransplant (R = .306, p = .022), and between pain interference groups posttransplant (R = .249, p = .041). Pairwise models showed significant differences between groups posttransplant in relative abundances of several taxa, including a 5-fold reduction in Akkermansia among those with pain interference and a higher relative abundance of taxa associated with chronic inflammation in those with pain interference posttransplant. Functional gene analysis identified two features that were significantly enriched in those with pain interference, including a peptide transport system gene.Gut microbiota community structure differs between groups with and without pain interference at 3 months after kidney transplantation. Several taxa involved in intestinal barrier integrity and chronic inflammation were associated with posttransplant pain.

The treadmill, lift, and carry (TLC) battery is a composite functional performance test created to measure the effectiveness of a functional restoration (FR) program in a military population.To determine the validity, reliability, and minimal clinically important differences (MCIDs) of the individual tests and the composite TLC battery.We assessed the validity by mean differences, effect sizes, and standardized response means pre- and post-FR; and by correlations between the TLC battery and other established measures. We assessed reliability by correlating pre- and post-FR scores. We used principal component analysis (PCA) to create a composite measure. We determined MCIDs via distribution methods and receiver operator curve analysis.There were significant (p .001) mean changes and large effect sizes (0.6-0.8) pre- to post-FR. Pre- and posttest Spearman's correlations ranged from 0.5 to 0.6. Spearman's correlations between TLC battery scores and other measures were small (± 0.3-0.4) and significant (p .001). PCA supported use of a single-component composite. MCIDs were treadmill time: 3 minutes; metabolic equivalent of task: 1.5 units; floor-to-waist lift: 15 lbs; waist-to-shoulder lift: 10 lbs; 40-foot carry: 10 lbs; and composite score: 6 units.This secondary data analysis provides preliminary support for the validity and reliability of the TLC battery for use in military populations.

This study examined relationships between duration of stay and self-rated health among international students in South Korea and compared participants' health-related characteristics according to duration of stay. The study recruited a convenience sample of 165 international students enrolled in undergraduate or graduate programs. For this cross-sectional, descriptive study, participants were recruited at one South Korean university. Data were subjected to ordinal logistic regression analyses. After controlling for covariates, a stay of 6 months or less was a significant predictor of better self-rated health. Compared to those in their first semester, international students staying more than 6 months more frequently experienced short sleep duration, physical health symptoms, healthcare utilization, unmet healthcare needs, and perceived discrimination. Study findings indicate that international students' health tends to deteriorate after their first semester. To promote the health and academic success of international students, universities should provide timely health promotion programs.

OBJECTIVES. To identify the prevalence of screening criteria for acute and post-traumatic stress disorders, and stress symptoms among family members of children in the pediatric intensive care unit (PICU) for more than 8 days and examine risk factors for stress symptoms. DESIGN. Secondary analysis of data from the Family Communication Study, a randomized trial of a palliative care intervention conducted between 2010 and 2014. The sample included 377 family members of 220 children. Outcomes were symptom scores and diagnostic screening criteria for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD). Predictors included demographic and admission related characteristics, and hypothesized risk factors for developing stress-related mental health disorders. SETTING. An urban pediatric hospital in Seattle, WA. MEASUREMENTS AND MAIN RESULTS. The mean score for acute stress symptoms during the ICU stay was 40.3 (sd = 13.8) and 59 family members in total met diagnostic screening criteria for ASD during hospitalization (15.6%). At 3-month follow-up, the mean score for posttraumatic stress symptoms was 30.8 (sd = 12.9) and 52 family members met diagnostic criteria for PTSD (13.8%). Factors associated with meeting ASD screening criteria were unplanned admission and poorer family relationships. Factors associated with PTSD symptoms and diagnosis were longer length of stay, meeting ASD criteria during admission, child’s death, and less perceived social support. CONCLUSIONS. Meeting screening criteria for PTSD was associated with demographic, length of stay and family relationships among family members of seriously ill children. PTSD outcomes were higher among family members whose child died. This study helps identify risk factors that can be used to target needed psychosocial screening, monitoring and support during and following a prolonged PICU admission, as well as family-centered interventions and supportive bereavement intervention for the family members of a deceased child.

Introduction: Acupuncture has demonstrated effectiveness for symptom management among breast cancer survivors. This meta-analysis aims to evaluate the effect of acupuncture on treatment-related symptoms among breast cancer survivors. Methods: The authors searched PubMed, CINAHL, and EMBASE for relevant randomized clinical trials (RCTs) of acupuncture for managing treatment-related symptoms published in English through June 2021. They appraised the quality of each article using the Cochrane Collaboration Risk of Bias Criteria. The primary outcomes were pain, hot flashes, sleep disturbance, fatigue, depression, lymphedema, and neuropathy as individual symptoms. They also evaluated adverse events reported in acupuncture studies. Results: Of 26 selected trials (2055 patients), 20 (1709 patients) were included in the meta-analysis. Acupuncture was more effective than control groups in improving pain intensity [standardized mean difference (SMD) = −0.60, 95% confidence intervals (CI) −1.06 to −0.15], fatigue [SMD = −0.62, 95% CI −1.03 to −0.20], and hot flash severity [SMD = −0.52, 95% CI −0.82 to −0.22]. The subgroup analysis indicated that acupuncture showed trends but not significant effects on all the treatment-related symptoms compared with the sham acupuncture groups. Compared with waitlist control and usual care groups, the acupuncture groups showed significant reductions in pain intensity, fatigue, depression, hot flash severity, and neuropathy. No serious adverse events were reported related to acupuncture intervention. Mild adverse events (i.e., bruising, pain, swelling, skin infection, hematoma, headache, menstrual bleeding) were reported in 11 studies. Conclusion: This systematic review and meta-analysis suggest that acupuncture significantly reduces multiple treatment-related symptoms compared with the usual care or waitlist control group among breast cancer survivors. The safety of acupuncture was inadequately reported in the included studies. Based on the available data, acupuncture seems to be generally a safe treatment with some mild adverse events. These findings provide evidence-based recommendations for incorporating acupuncture into clinical breast cancer symptom management. Due to the high risk of bias and blinding issues in some RCTs, more rigorous trials are needed to confirm the efficacy of acupuncture in reducing multiple treatment-related symptoms among breast cancer survivors.

Objective Psychosocial factors are known to predict chronic pain, and the use of complementary and integrative health (CIH) therapies to address pain is emerging among the military population. However, conflicting results on pain outcomes warrant additional research. This study aimed to 1) evaluate the benefit of adding a CIH pain management program to standard rehabilitative care (SRC), as compared with SRC alone, as a precursor to an intensive functional restoration (FR) program; 2) identify factors that predict improvement in pain outcomes after treatment; and 3) determine the proportion of participants who experience a clinically meaningful response. Design Pragmatic randomized controlled clinical trial. Participants were randomized to a 3-week course of either SRC alone or SRC+CIH (stage 1), followed by a 3- to 6-week course of FR (stage 2). Subjects Active duty service members with chronic pain. Methods Participants completed either SRC alone or SRC+CIH (stage 1), followed by a course of FR (stage 2). Patient-reported and provider-determined outcomes were collected at baseline, after stage 1, and after stage 2. A covariance pattern model with an unstructured residual covariance matrix was used to compare treatment arms while accounting for dependency due to repeated measurements. Results A total of 210 service members participated. Most were in the Army (82%) and were male (84%). Participants randomized to the SRC+CIH intervention had greater improvement in the pain impact score than did those in the SRC-alone group. Predictors of outcomes were baseline impact score, anger, depression, and educational status. Conclusions This study found that military service members with the highest pain impact benefit the most from interdisciplinary pain care.

Patient reports of moderate to severe pain are common across the spectrum of chronic kidney disease. The synergistic effects of comorbid depression and anxiety can lead to maladaptive coping responses to pain, namely pain catastrophizing and illness-related post-traumatic stress disorder. If underlying depression and anxiety and associated maladaptive coping responses are not treated, patients can experience an increased perception of pain, worsened disability, decreased quality of life, withdrawal from social activities, and increased morbidity and mortality. Meanwhile, interest in nonpharmacologic treatments for pain that targets coping as well as comorbid anxiety and depression has been increasing, particularly given the significant societal damage that has resulted from the opioid epidemic. Evidence-based, nonpharmacologic treatments have shown promise in treating pain in areas outside of nephrology. Currently, little is known about the effects of these treatments among adults with CKD, and particularly end-stage kidney disease, when chronic pain can become debilitating. In this review, we examine patient-centered concepts related to pain that have received little attention in the nephrology literature. We also describe emerging areas of research, including omics technologies for biomarker discovery and advanced symptom clustering methods for symptom phenotyping, which may be useful to future kidney disease research and treatment.

Objective Approximately 24–68% of breast cancer survivors report co-occurring psychoneurological symptoms of pain, fatigue, sleep disturbance, depression, and anxiety during and after cancer treatment. This study aimed to assess the feasibility and acceptability of acupuncture for the treatment of multiple psychoneurological symptoms among breast cancer survivors and explore metabolomic changes before and after acupuncture. Methods We conducted a single-arm, prospective pilot study of breast cancer survivors with at least two moderate to severe psychoneurological symptoms (>3 on a 0–10 scale). Acupuncture was administered twice weekly for 5 weeks, for 30 minutes per session. Along with Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires, a fasting serum comprehensive hydrophilic metabolites panel was analyzed at baseline and after acupuncture. Results Eight participants (mean age 52.5 ± 10.9 years; 62.5% Black) were enrolled. Feasibility was supported, with 67% recruitment, 87.5% retention, and 98% acceptability. Post intervention, PROMIS T-scores were reduced for all psychoneurological symptoms. Significant differences in serum metabolites before and after acupuncture were F-1,6/2,6-DP, glutathione disulfide, phosphorylcholine, 6-methylnicotinamide, glutathione, and putrescine (variable importance of projection values larger than 1.5 and p values Conclusions Acupuncture to reduce multiple psychoneurological symptoms among breast cancer survivors was feasible and acceptable. Study findings also shed light on the metabolic pathways involved in the acupuncture response and will be tested in future studies.

The COVID-19 pandemic has created disruptions and ethical tensions in palliative care research; however, ethical principles must continue to be applied for evaluating the safety of conducting research with seriously ill patient participants and nurse participants in an acute care setting. This randomized controlled trial is conducted in the acute care hospital and tests the effects of a narrative intervention versus usual care on the primary outcome of patients' perception of quality of communication with their nurses and the secondary outcome of biopsychosocial well-being. In accordance with local and institutional COVID-19 guidance, research activities were temporarily suspended in March 2020, and when allowed to resume, some aspects of the protocol were adapted to maximize safety for all stakeholders: patients/families, nurses, and the research team. This article (a) considers case perspectives of all stakeholders involved in a randomized controlled trial conducted in the acute care hospital setting during the COVID-19 pandemic, (b) describes the ethical dilemma and ethical principles in the context of the case, (c) discusses lessons learned while resuming clinical research activities, and (d) provides an ethical framework for the decision-making processes around vulnerability and safety in conducting research during a pandemic with persons living with serious illness.

Objective Chronic pain complaints are the second most common reason for outpatient primary care visits, yet a comprehensive assessment of the processes and experiences of providers during a chronic pain visit is still lacking. This qualitative descriptive study aimed to conceptualize the processes and experiences that military primary care providers go through while they assess and manage chronic pain. Setting Single U.S. Army medical center. Methods Semistructured interviews with 12 military primary care providers. Interviews were audio-recorded, transcribed, and coded with the use of qualitative software. Transcripts were analyzed with thematic analysis to identify emergent themes. Results Three broad themes with associated subthemes captured the processes and the providers’ experiences: 1) comprehending the pain story—asking the right questions about pain impact, navigating through the complexities of the pain story, and conveying understanding of the pain story back to the patient; 2) optimizing the pain story—perceiving provider–patient disconnect on pain management goals, resetting realistic goals, creating an optimal individualized treatment plan, and evaluating treatment effectiveness; and 3) empathetic and therapeutic engagement with patients—trusting patients and fostering the patient–provider relationship. A thematic map illustrates these provider experiences. Conclusions During chronic pain visits, the provider–patient disconnect on the goals of chronic pain treatment presents a considerable challenge. Further in-depth studies on addressing provider–patient disconnect are warranted to identify solutions, which would help providers communicate realistic chronic pain management expectations to patients. The themes and subthemes described in this study could serve as a guide for directing strategies to improve chronic pain visits in primary care.

Objective This study aimed to determine whether Japanese cancer patients share test results of germline pathogenic variants of hereditary cancer with their relatives. Methods This single-center cross-sectional study enrolled 21 Japanese patients who received results of germline pathogenic variants of hereditary cancer at least 6 months prior. Results All patients shared their test results with at least one relative, with the following sharing rates: 85.7% for first-degree relatives, 10% for second-degree relatives and 8.3% for third-degree relatives. Patients most commonly shared the information with their children aged >18 years (86.7%), followed by their siblings (73.6%), spouses (64.7%) and parents (54.5%). Three categories were extracted from qualitative analysis: ‘characteristics of my cancer’, ‘knowledge and caution about inheritability’ and ‘utilization of medical care.’ Conclusions The rate of test result sharing with first-degree relatives was comparable with those in Europe and the USA. Patients with germline pathogenic variants also tended to share their test results more with their children and siblings than with their parents. Informing their relatives of the results was suggestive of the motivation to influence their relatives’ health outcome and contribute to the well-being of their children and siblings., Japanese patients with germline pathogenic variants of hereditary cancers disclosed their test results to at least one relative, mostly first-degree relatives, including the patients’ adult children, siblings, spouses and parents.

BACKGROUND In the health care setting, electronic health records (EHRs) are one of the primary modes of communication about patients, but most of this information is clinician centered. There is a need to consider the patient as a person and integrate their perspectives into their health record. Incorporating a patient’s narrative into the EHR provides an opportunity to communicate patients’ cultural values and beliefs to the health care team and has the potential to improve patient-clinician communication. This paper describes the protocol to evaluate the integration of an adapted person-centered narrative intervention (PCNI). This adaptation builds on our previous research centered on the implementation of PCNIs. The adaptation for this study includes an all-electronic delivery of a PCNI in an outpatient clinical setting. OBJECTIVE This research protocol aims to evaluate the feasibility, usability, and effects of the all-electronic delivery of a PCNI in an outpatient setting on patient-reported outcomes. The first objective of this study is to identify the barriers and facilitators of an internet-based–delivered PCNI from the perspectives of persons living with serious illness and their clinicians. The second objective is to conduct acceptability, usability, and intervention fidelity testing to determine the essential requirements for the EHR integration of an internet-based–delivered PCNI. The third objective is to test the feasibility of the PCNI in an outpatient clinic setting. METHODS Using a mixed method design, this single-arm intervention feasibility study was delivered over approximately 3 to 4 weeks. Patient participant recruitment was conducted via screening outpatient palliative care clinic schedules weekly for upcoming new palliative care patient visits and then emailing potential patient participants to notify them about the study. The PCNI was delivered via email and Zoom app. Patient-reported outcome measures were completed by patient participants at baseline, 24 to 48 hours after PCNI, and after the initial palliative care clinic visit, approximately 1 month after baseline. Inclusion criteria included having the capacity to give consent and having an upcoming initial outpatient palliative care clinic visit. RESULTS The recruitment of participants began in April 2021. A total of 189 potential patient participants were approached via email, and 20 patient participants were enrolled, with data having been collected from May 2021 to September 2022. A total of 7 clinician participants were enrolled, with a total of 3 clinician exit interviews and 1 focus group (n=5), which was conducted in October 2022. Data analysis is expected to be completed by the end of June 2023. CONCLUSIONS The findings from this study, combined with those from other PCNI studies conducted in acute care settings, have the potential to influence clinical practices and policies and provide innovative avenues to integrate more person-centered care delivery. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/41787

Objective: Chronic pain is a common symptom experienced among patients with sickle cell disease (SCD). Our aims were to assess the feasibility and acceptability of performing acupuncture for the treatment of chronic pain in adults with SCD. Methods: This was a single-arm, prospective pilot study of six adults with SCD. Participants reported ⩾ 3 months of chronic pain and were > 18 years of age. Per protocol, acupuncture was to be administered twice per week for 5 weeks, for 30 min per session. All treatments were performed in the acupuncture treatment laboratory at the University of Illinois Chicago College of Nursing. Pain intensity, pain interference, and other symptoms were measured at baseline and after the intervention. Participants completed a semi-structured interview and a protocol acceptability questionnaire after the acupuncture intervention. Results: Six participants (mean age 52.5 years, six Black) were enrolled. Although the study was suspended due to COVID-19 and not all participants completed the 10-session protocol, completion rates were high with no missed appointments. One participant did not complete the study due to hospitalization unrelated to acupuncture. No adverse events were reported. At completion of the intervention at 4–5 weeks post-baseline, all participants had reduced pain intensity and pain interference. The mean acceptability score on the protocol acceptability questionnaire was 82%. Conclusion: It was feasible and acceptable to implement acupuncture in adults with SCD. This study can be used to guide a larger randomized controlled trial to evaluate the effect of acupuncture on reducing chronic pain in adults with SCD. Trial registration number: NCT04156399 (ClinicalTrials.gov)

Asian American women, both immigrant and US-born, are known to have low mammography screening rates. To reduce health disparities and address community health needs, we undertook a systematic review to identify factors that affect mammography uptake among Asian American women following a mammography screening intervention. Following the PRISMA guidelines, we searched four databases and selected 12 studies that met our inclusion criteria. We identified 22 relevant factors and developed a new conceptual model that comprehensively captures these sociodemographic; cultural; knowledge, attitude, and perception; health history; health care accessibility and availability; and intervention factors, including components and mode of intervention. This conceptual model can be used to guide development of interventions that effectively promote mammography screening. Future research should focus on the effect of acculturation on screening behaviors and the importance of culturally tailored intervention and information-sharing elements to improving mammography screening among Asian Americans.

Objective This study examined the relationships between symptom domains relevant to post-traumatic stress disorder (PTSD) diagnosis, PTSD screening, and chronic pain-related symptoms (pain intensity, pain interference, physical function, fatigue, depression, anxiety, anger, satisfaction with social roles) experienced by active duty military service members with chronic pain. Design ross-sectional study. Setting This study was conducted at the Interdisciplinary Pain Management Center (IPMC) at Madigan Army Medical Center between 2014 and 2018. Subjects Active duty service members receiving care at IPMC (n = 2745) were included in this study. Methods Independent sample t test was conducted to compare pain intensity and pain-related measures of physical, emotional, and social functioning among patients with and without a PTSD diagnosis or PTSD positive screen (≥3 symptoms). Relative weight analysis was used to identify the relative importance of each PTSD symptom cluster (e.g., intrusion, avoidance, hyperarousal, emotional numbness) to pain and related domains. Results Approximately 27.9% of the patients had a positive screen for PTSD, and 30.5% of the patients had a PTSD diagnosis. Patients with PTSD diagnosis and positive screening had higher pain interference and lower physical function and social satisfaction scores (P Conclusion To improve treatment effectiveness and overall functioning for active duty military patients, integrated treatment and therapies targeted to reducing chronic pain and PTSD symptoms (focus on emotional numbness and avoidance) are recommended.

Purpose There is limited evidence on the effect of chemotherapy-associated taste alteration. This study aimed to evaluate taste alteration characteristics in patients receiving taxane-based chemotherapy and investigate the association of taste alterations with appetite, weight, quality of life (QOL), and adverse events. Methods This cross-sectional study evaluated 100 patients receiving paclitaxel, docetaxel, or nab-paclitaxel as monotherapy or combination therapy. Taste alterations were evaluated using taste recognition thresholds and severity and symptom scales. Taste recognition thresholds, symptoms, appetite, weight, and adverse events were compared between patients with and without taste alterations, and logistic regression analysis was performed to identify risk factors. Results Of the 100 patients, 59% reported taste alterations. We found significantly elevated taste recognition thresholds (hypogeusia) for sweet, sour, and bitter tastes in the taste alteration group receiving nab-paclitaxel (p = 0.022, 0.020, and 0.039, respectively). The taste alteration group reported general taste alterations, decline in basic taste, and decreased appetite. Neither weight nor QOL was associated with taste alterations. Docetaxel therapy, previous chemotherapy, dry mouth, and peripheral neuropathy were significantly associated with taste alterations. Conclusions Almost 60% of patients receiving taxane-based regimens, especially docetaxel, reported taste alterations. Taste alteration affected the patient’s appetite but did not affect the weight or QOL. Docetaxel therapy, previous chemotherapy, dry mouth, and peripheral neuropathy were independent risk factors for taste alterations.

Among breast cancer survivors, pain, fatigue, depression, anxiety, and sleep disturbance are common psychoneurological symptoms that cluster together. Inflammation-induced activation of the tryptophan-kynurenine metabolomic pathway may play an important role in these symptoms.This study investigated the relationship between the metabolites involved in the tryptophan-kynurenine pathway and psychoneurological symptoms among breast cancer survivors.Cross-sectional study.Participants were recruited at the oncology clinic at the University of Illinois HospitalHealth Sciences System.79 breast cancer survivors after major cancer treatment.We assessed psychoneurological symptoms with the PROMIS-29 and collected metabolites from fasting blood among breast cancer survivors after major cancer treatment, then analyzed four major metabolites involved in the tryptophankynurenine pathway (tryptophan, kynurenine, kynurenic acid, and quinolinic acid). Latent profile analysis identified subgroups based on the five psychoneurological symptoms. Mann-Whitney U tests and multivariable logistic regression compared targeted metabolites between subgroups.We identified two distinct symptom subgroups (low, 81%; high, 19%). Compared with participants in the low symptom subgroup, patients in the high symptom subgroup had higher BMI (p = .024) and were currently using antidepressants (p = .008). Using multivariable analysis, lower tryptophan levels (p = .019) and higher kynurenine/tryptophan ratio (p = .028) were associated with increased risk of being in the high symptom subgroup after adjusting for BMI and antidepressant status.The tryptophan-kynurenine pathway and impaired tryptophan availability may contribute to the development of psychoneurological symptoms.

Purpose: Disparities in breast cancer mortality between Black and white women have been well documented. Few studies, however, have examined the interaction of race and clinical characteristics among young breast cancer survivors. This study aimed to enhance the understanding of racial disparities in survival probabilities specific to the young breast cancer population.Methods: We extracted Surveillance, Epidemiology and End Results (SEER) Research Data for 2000 to 2017 for breast cancer, females, and age 20 to 44 years. We applied Kaplan-Meier curves, Cox proportional hazard regression, and marginal effects analysis after Cox regression. Results: We analyzed data from 93,491 young breast cancer cases. Notably, compared to non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB) showed significantly higher predicted hazard ratio (HR) values regardless of cancer subtype or stage. NHB with triple-negative subtype had an HR of 11.238 (p=.026) compared to NHW counterparts; NHB with Her2-/HR+ subtype had an HR of 16.599 (pConclusions: Our findings revealed that young NHB breast cancer survivors had significantly lower cancer-specific survival probabilities than NHW survivors, even given the same tumor biology and stage, with the lowest survival probabilities among NHB with Her2-/HR+ subtype and higher cancer stage. These findings document significant disparities in survival among young breast cancer survivors and point to avenues for clinical interventions to improve outcomes for all young survivors.

Background: Individuals with cancer experience stress throughout the cancer trajectory. Allostatic load (AL), a cumulative multi-system measure, may have a greater value in stress assessment and the associated biological burden than individual biomarkers. A better understanding of the use of AL and its operationalization in cancer could aid in early detection and prevention or alleviation of AL in this population. Purpose: To consolidate findings on the operationalization, antecedents, and outcomes of AL in cancer. Methods: Seven databases (CINAHL, Ovid MEDLINE, Web of Science, APA PsycInfo, Scopus, Embase, and Cochrane CENTRAL) were searched for articles published through April 2020. The NIH tools were used to assess study quality. Results: Twelve studies met inclusion criteria for this review. Although variability existed in the estimation of AL, biomarkers of cardiovascular, metabolic, and immune systems were mostly used. Associations of AL with cancer-specific variables were examined mostly utilizing population-databases. Significant associations of AL with variables such as cancer-related stress, positive cancer history, post traumatic growth, resilience, tumor pathology, and cancer-specific mortality were found. Mini meta-analysis found that a one-unit increase in AL was associated with a 9% increased risk of cancer-specific mortality. Conclusion: This review reveals heterogeneity in operationalization of AL in cancer research and lack of clarity regarding causal direction between AL and cancer. Nevertheless, AL holds a significant promise in cancer research and practice. AL could be included as a screening tool for high-risk individuals or a health outcome in cancer. Optimal standardized approaches to measure AL would improve its clinical utility.

OBJECTIVES: To examine skeletal muscle mass change in a racially diverse sample of patients undergoing cancer treatment, determine significant predictors of muscle mass loss, and explore the interaction of race and cancer site. SAMPLE & SETTING: A retrospective analysis was conducted for 212 patients seeking treatment at a university hospital clinic. METHODS & VARIABLES: Skeletal muscle mass index (SMI) was determined by computed tomography at the time of cancer diagnosis and with cancer treatment. RESULTS: One hundred thirty-four patients (63%) had SMI loss with cancer treatment. Race and cancer site were found to be significant predictors of SMI loss. Compared to other racial groups, non-Hispanic Black (NHB) patients had the greatest SMI loss (p < 0.001) with cancer treatment. NHB patients with rectal cancer experienced the greatest SMI loss compared to patients of other races and cancer types. IMPLICATIONS FOR NURSING: To improve survivorship care for patients with cancer, it is essential to develop strategies for assessing and managing skeletal muscle mass loss throughout treatment, particularly for NHB patients with rectal cancer.

The co-occurrence of multiple psychoneurological symptoms, including pain, sleep disturbance, fatigue, depression, anxiety, and cognitive disturbance among adult cancer survivors led us to question which common biological mechanisms are shared among these conditions. Variances in tryptophan (Trp) levels and downstream metabolites of the kynurenine (Kyn) metabolic pathway are known to affect immune response and psychoneurological symptoms. The objective of this systematic review was to help us (a) better understand the role of the Kyn pathway in psychoneurological symptoms among adult cancer survivors and (b) identify common significant biomarkers across psychoneurological symptoms as a guide for future research. Some evidence has shown that decreased Trp levels and increased Kyn, Trp/Kyn ratio, and kynurenic acid/Trp ratio in parallel with immune activation are correlated with some psychoneurological symptoms among people undergoing cancer treatment, although discrepancies exist between studies. Kyn pathway activation could also be associated with psychoneurological symptoms among adult cancer survivors, but further research is needed to confirm its exact etiological role with respect to psychoneurological symptoms.

Background: Incorporating patient narratives into the electronic health record (EHR) is an opportunity to integrate patients' values and beliefs into their care and improve patient-clinician communication. Objective: The study's aims were to (1) identify barriers and facilitators influencing the implementation of a cocreated patient narrative intervention and (2) assess the acceptability/usability of the patient's narrative from the perspective of key stakeholders-the patient and acute care bedside nurse. Design: We used an implementation design using mixed methods. Setting/Subjects: Twenty patients and 18 nurses were enrolled from five units in an acute care hospital. Results: For patients, the narrative intervention provided an avenue to discuss and share how illness has impacted their life in psychological, social, and spiritual belief domains. For nurses, the ability to read the patient's narrative provided benefits that fostered improved communication and more connection with their patients. Despite successfully meeting recruitment targets, time was the largest barrier for patient and nurse participants. Overall, the nurse participants gave high ratings on most of the items on the System Usability Scale with one exception-EHR integration. The lack of EHR integration on the System Usability Survey corresponds with the nurses' stated desire for a prominent location of patient narratives in the EHR. Conclusions: The patient narrative intervention was acceptable and usable for hospitalized patients and nurse participants. Our study demonstrates that a cocreated patient narrative intervention provides avenues for patients and nurses to connect despite being in hectic acute care settings. Trial Registration: ClinicalTrials.gov NCT03391115.

Few studies of death preparation in South Korea are available. This article describes South Koreans’ experiences of death and a funeral in a hospital setting to improve health care providers’ ability to care for dying patients and their family. Using Colaizzi’s phenomenological method, we conducted semistructured interviews with 40 South Koreans who had lost a family member in a hospital setting. Participants’ statements were classified into 12 themes, 5 theme clusters, and 3 categories: (a) vagueness of funeral culture, (b) distortion of meaning in funeral culture, and (c) the need to prepare for death and process grief. Our findings are relevant to hospital-based health care providers who care for dying patients and their family. Targeted educational information could help health care providers better serve patients and family. Policy changes could improve quality of care by allowing health care providers to transition with the family from hospital units to a hospital-based funeral setting.

The COVID-19 pandemic revealed a need for people and communities for death preparation. Few studies have examined community-level interventions for death preparation and education. This scoping review scrutinized the relevant literature following PRISMA 2018 guidelines. Six databases were searched for articles published between 2010 and 2020. We found that cultural, socioeconomic, and individual values affected death preparation and that online courses and life-death education were effective preparation methods. Additional research is needed to identify the population-specific effectiveness of interventions. To fully investigate death preparation and education at the community level, theory-based studies employing quantitative and qualitative methods are also needed.

Background In the health care setting, electronic health records (EHRs) are one of the primary modes of communication about patients, but most of this information is clinician centered. There is a need to consider the patient as a person and integrate their perspectives into their health record. Incorporating a patient’s narrative into the EHR provides an opportunity to communicate patients’ cultural values and beliefs to the health care team and has the potential to improve patient-clinician communication. This paper describes the protocol to evaluate the integration of an adapted person-centered narrative intervention (PCNI). This adaptation builds on our previous research centered on the implementation of PCNIs. The adaptation for this study includes an all-electronic delivery of a PCNI in an outpatient clinical setting. Objective This research protocol aims to evaluate the feasibility, usability, and effects of the all-electronic delivery of a PCNI in an outpatient setting on patient-reported outcomes. The first objective of this study is to identify the barriers and facilitators of an internet-based–delivered PCNI from the perspectives of persons living with serious illness and their clinicians. The second objective is to conduct acceptability, usability, and intervention fidelity testing to determine the essential requirements for the EHR integration of an internet-based–delivered PCNI. The third objective is to test the feasibility of the PCNI in an outpatient clinic setting. Methods Using a mixed method design, this single-arm intervention feasibility study was delivered over approximately 3 to 4 weeks. Patient participant recruitment was conducted via screening outpatient palliative care clinic schedules weekly for upcoming new palliative care patient visits and then emailing potential patient participants to notify them about the study. The PCNI was delivered via email and Zoom app. Patient-reported outcome measures were completed by patient participants at baseline, 24 to 48 hours after PCNI, and after the initial palliative care clinic visit, approximately 1 month after baseline. Inclusion criteria included having the capacity to give consent and having an upcoming initial outpatient palliative care clinic visit. Results The recruitment of participants began in April 2021. A total of 189 potential patient participants were approached via email, and 20 patient participants were enrolled, with data having been collected from May 2021 to September 2022. A total of 7 clinician participants were enrolled, with a total of 3 clinician exit interviews and 1 focus group (n=5), which was conducted in October 2022. Data analysis is expected to be completed by the end of June 2023. Conclusions The findings from this study, combined with those from other PCNI studies conducted in acute care settings, have the potential to influence clinical practices and policies and provide innovative avenues to integrate more person-centered care delivery. International Registered Report Identifier (IRRID) DERR1-10.2196/41787

Objective The two approaches to symptom-cluster research include grouping symptoms and grouping patients. The objective of this systematic review was to examine the conceptual approaches and methodologies used in symptom-cluster research in patients with head and neck cancer. Data sources Articles were retrieved from electronic databases (CINAHL, MEDLINE via Ovid, APA PsycINFO, Scopus, Embase, and Cochrane Central Register of Controlled Trials-CENTRAL), five grey literature portals, and Google Scholar. Seventeen studies met the eligibility criteria. Eight studies grouped symptoms to identify symptom clusters, of which two used qualitative methods. The number of symptom clusters ranged from two to five, and the number of symptoms in a cluster ranged from 2 to 11. Nine studies grouped patients based on their experiences with multiple symptoms. Cluster analysis and factor analysis were most commonly used. Despite variable names and composition of symptom clusters, synthesis revealed three prominent symptom clusters: general, head and neck cancer-specific, and gastrointestinal. Being female and quality of life were significantly associated with high symptom group or cluster severity. Biological mechanisms were sparsely examined. Conclusion Symptom cluster research in head and neck cancer is emerging. Consensus on nomenclature of a symptom cluster will facilitate deduction of core clinically relevant symptom clusters in head and neck cancer. Further research is required on understanding patients’ subjective experiences, identifying predictors and outcomes, and underlying mechanisms for symptom clusters. Implications for Nursing Practice Identification of clinically relevant symptom clusters would enable targeted symptom assessment and management strategies, thus improving treatment efficiencies and patient outcomes.

With mounting pressure to move toward precision health care and implementation science, nurse researchers are faced with the challenge of producing evidence that their interventions are applicable in real-world clinical settings. Pragmatic clinical trials are critically important to generate evidence that is relevant to clinical practice. Pragmatic designs closely replicate true-to-life settings thereby expediting research translation and improving health outcomes. The Sequential Multiple Assignment Randomized Trial (SMART) is a valuable a pragmatic trial design that is receiving greater attention in nursing. SMART designs can be used to provide relevant clinical evidence by comparative evaluation of two or more alternative interventions. The objectives of this article are to provide: (a) A description of the main considerations and key components of SMART designs, and (b) a summary of three different nursing studies using SMART designs. Information provided by pragmatic nursing trials using SMART designs, which more closely mirror clinical practice, will facilitate evidence-based clinical practice.

Objectives: Family members of children admitted to intensive care units (ICUs) suffer from severe stress, which sometimes results in long-term psychological problems. We aimed to identify associations between demographic and psychosocial variables at early stages of a child’s admission to the ICU and depression and anxiety in family members at approximately 3 months after admission. We also explored predictive models for depression and anxiety at 3 months after admission. Methods: This study is a secondary analysis of data from a previous clinical trial of palliative care for family members in ICUs, in which 380 family members of 220 children reported demographic and psychosocial status at approximately 1 week after ICU admission (baseline), at discharge from the ICUs, and at 3 months after the child’s admission to the ICU. Clinical data were extracted from the children’s medical records. We used linear regression models and stepwise linear regression for the analyses. Results: After controlling for significant confounders of gender (female) and child mortality, worse psychological status at baseline, represented by reported depression, anxiety, and acute stress symptoms, was associated with more severe depression and anxiety at 3 months. Also, a better family relationship at baseline was associated with lower depression and anxiety at 3 months. Conclusion: We suggest a need to screen family members of children admitted to the ICU with validated scales and intervening with those at high risk of depression and anxiety. Clinical Trials: Registry number NCT02144779 on ClinicalTrials.gov . https://clinicaltrials.gov/ct2/show/NCT02144779?term=NCT02144779&rank=1 .

Complementary therapies provide cancer survivors and clinicians with options for managing chronic pain. Recent published clinical guidelines and research findings support the use of relaxation therapy for managing chronic pain in cancer survivors. However, translating research findings into clinical practice remains a challenge. Using theory to guide implementation of a new practice can increase the likelihood of successful adoption. This article uses relaxation therapy for cancer survivors to describe how clinicians could use Rogers’ Diffusion of Innovation Theory and the related Collaborative Research Utilization Model to implement a complementary therapy and ensure that it becomes standard practice.

Objective The University of Washington instituted a policy requiring all credentialed clinicians who prescribe opioids to complete a one-time education activity about safe and responsible opioid prescribing. A scenario-based, interactive online learning module was developed for opioid management of acute pain in hospitalized adults. This study examined the impact of the education module on learners’ knowledge, perceived competence, and use of guideline-adherent practices. Methods Clinicians who completed the education module participated in a voluntary de-identified online survey approximately six months after the learning activity. Survey questions were related to 1) the perception of improved knowledge; 2) impact on learner’s use of three guideline-adherent practices; and 3) perceived competence in managing opioids for acute pain. Descriptive statistics were generated, and multiple linear regression models were used for analysis. Results Clinicians (N = 167) reported improvement in knowledge and perceived competence. Controlling for other aspects of knowledge evaluated, learning to construct a safe opioid taper plan for acute pain, distinguishing between short- and long-acting opioids, and safely initiating opioids for acute pain were significantly associated with increased self-reported likelihood of incorporating the Washington state Prescription Monitoring Program (P = 0.003), using multimodal analgesia (P = 0.022), and reducing the duration of opioids prescribed (P = 0.016). Only improvement in knowledge of how to construct a safe opioid taper plan was significantly associated with increased perceived competence (P = 0.002). Conclusions Our findings suggest that this online education module about safe opioid prescribing for acute pain management was effective at improving knowledge, increasing the likelihood of using guideline-adherent clinical practices, and increasing perceived competence.

Objective: We investigated the incidence of falls and functional impairments in breast cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). Additionally, we examined whether taxane-induced peripheral neuropathy was associated with the patients' falls and functional impairments. Methods: We conducted a cross-sectional study including 88 patients with breast cancer who received taxane-based chemotherapy and were recognized as having peripheral neuropathy symptoms (Common Terminology Criteria for Adverse Events Grade ≥1). Patients completed the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity questionnaire for neuropathy and described falls from the onset of the taxane-based chemotherapy to the time of the survey. Functional impairments were defined using the Activities of Daily Living subsection of the Vulnerable Elder's Scale. Data were analyzed using descriptive statistics and logistic regression. Results: Of the participants, 40.9% experienced falls and 38.4% reported functional impairments. Most falls occurred on flat ground. Bone fracture due to falls was observed in 11.4% of the participants. Logistic regression revealed that CIPN was not significantly associated with the reported incidence of falls. However, it was significantly associated with functional impairments (odds ratio, 6.415; 95% confidence interval: 1.271–32.379; P = 0.024). Conclusions: CIPN was associated with functional impairments, but not with the incidence of falls. Patients should be informed prior to the onset of anticancer therapy that CIPN is a risk factor for functional impairments.