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8. Time burden and logistical intensity of early-phase clinical trials (EP-CTs).

Author

Durbin, Sienna, primary, Lundquist, Debra, additional, Jimenez, Rachel, additional, Healy, Megan, additional, Johnson, Andrew, additional, Bame, Viola, additional, Martin, Tristan, additional, Capasso, Virginia, additional, McIntyre, Casandra, additional, Cashavelly, Barbara J., additional, Juric, Dejan, additional, and Nipp, Ryan David, additional

Published
2021
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14. Randomized trial of a hospice video educational tool for patients with advanced cancer and their caregivers

Author

El‐Jawahri, Areej, primary, Traeger, Lara, additional, Greer, Joseph A., additional, Vanbenschoten, Olivia, additional, Markovitz, Netana, additional, Cashavelly, Barbara, additional, Tata, Lee Ann, additional, Nipp, Ryan D., additional, Reynolds, Kerry L., additional, Goyal, Lipika, additional, Bhatt, Sunil, additional, Fishman, Sarah, additional, Horick, Nora, additional, Li, Zhigang, additional, Volandes, Angelo, additional, and Temel, Jennifer S., additional

Published
2020
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18. The Relationship between Physical and Psychological Symptoms and Healthcare Utilization in Hospitalized Patients with Advanced Cancer

Author

Nipp, Ryan D., El-Jawahri, Areej, Moran, Samantha M., D’Arpino, Sara M., Johnson, P. Connor, Lage, Daniel E., Wong, Risa L., Pirl, William F., Traeger, Lara, Lennes, Inga T., Cashavelly, Barbara J., Jackson, Vicki A., Greer, Joseph A., Ryan, David P., Hochberg, Ephraim P., and Temel, Jennifer S.

Subjects
Hospitalization, Male, Psychometrics, Neoplasms, Palliative Care, Humans, Female, Length of Stay, Middle Aged, Patient Acceptance of Health Care, Prognosis, Severity of Illness Index, Article
Abstract

Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care utilization.We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type.We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over one-half reported moderate/severe fatigue, poor well being, drowsiness, pain, and lack of appetite. PHQ-4 scores indicated that 28.8% and 28.0% of patients had depression and anxiety symptoms, respectively. The mean hospital LOS was 6.3 days, and the 90-day readmission rate was 43.1%. Physical symptoms (ESAS: unstandardized coefficient [B], 0.06; P.001), psychological distress (PHQ-4 total: B, 0.11; P = .040), and depression symptoms (PHQ-4 depression: B, 0.22; P = .017) were associated with longer hospital LOS. Physical (ESAS: hazard ratio, 1.01; P.001), and anxiety symptoms (PHQ-4 anxiety: hazard ratio, 1.06; P = .045) were associated with a higher likelihood for readmission.Hospitalized patients with advanced cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve health care delivery and utilization. Cancer 2017;123:4720-4727. © 2017 American Cancer Society.

Published
2017

19. Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer

Author

Wong, Risa L., primary, El‐Jawahri, Areej, additional, D'Arpino, Sara M., additional, Fuh, Charn‐Xin, additional, Johnson, P. Connor, additional, Lage, Daniel E., additional, Irwin, Kelly E., additional, Pirl, William F., additional, Traeger, Lara, additional, Cashavelly, Barbara J., additional, Jackson, Vicki A., additional, Greer, Joseph A., additional, Ryan, David P., additional, Hochberg, Ephraim P., additional, Temel, Jennifer S., additional, and Nipp, Ryan D., additional

Published
2018
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20. Symptoms of posttraumatic stress disorder among hospitalized patients with cancer

Author

Nipp, Ryan D., primary, El‐Jawahri, Areej, additional, D'Arpino, Sara M., additional, Chan, Andy, additional, Fuh, Charn‐Xin, additional, Johnson, P. Connor, additional, Lage, Daniel E., additional, Wong, Risa L., additional, Pirl, William F., additional, Traeger, Lara, additional, Cashavelly, Barbara J., additional, Jackson, Vicki A., additional, Ryan, David P., additional, Hochberg, Ephraim P., additional, Temel, Jennifer S., additional, and Greer, Joseph A., additional

Published
2018
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21. Symptom burden in hospitalized patients with curable and incurable cancers.

Author

Newcomb, Richard, primary, Nipp, Ryan David, additional, Chan, Andrew T., additional, Hochberg, Ephraim P., additional, Jackson, Vicki A., additional, Cashavelly, Barbara J., additional, Wong, Risa Liang, additional, Greer, Joseph, additional, Ryan, David P., additional, Temel, Jennifer S., additional, and El-Jawahri, Areej, additional

Published
2018
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22. Randomized trial of a symptom monitoring intervention for hospitalized patients with cancer.

Author

Fuh, Charn-Xin, primary, Ruddy, Margaret, additional, Temel, Brandon, additional, D'arpino, Sara, additional, Cashavelly, Barbara J., additional, Hochberg, Ephraim P., additional, Jackson, Vicki, additional, Greer, Joseph, additional, Ryan, David P., additional, El-Jawahri, Areej, additional, Temel, Jennifer S., additional, and Nipp, Ryan David, additional

Published
2018
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23. Predictors of Posthospital Transitions of Care in Patients With Advanced Cancer

Author

Lage, Daniel E., primary, Nipp, Ryan D., additional, D'Arpino, Sara M., additional, Moran, Samantha M., additional, Johnson, P. Connor, additional, Wong, Risa L., additional, Pirl, William F., additional, Hochberg, Ephraim P., additional, Traeger, Lara N., additional, Jackson, Vicki A., additional, Cashavelly, Barbara J., additional, Martinson, Holly S., additional, Greer, Joseph A., additional, Ryan, David P., additional, Temel, Jennifer S., additional, and El-Jawahri, Areej, additional

Published
2018
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25. Post-discharge transitions of care for hospitalized patients with advanced cancer.

Author

Lage, Daniel E, primary, Nipp, Ryan David, additional, D'Arpino, Sara, additional, Moran, Samantha M.C., additional, Hochberg, Ephraim P., additional, Traeger, Lara, additional, Jackson, Vicki A., additional, Cashavelly, Barbara J., additional, Martinson, Holly S, additional, Ryan, David P., additional, Greer, Joseph A., additional, Temel, Jennifer S., additional, and El-Jawahri, Areej, additional

Published
2017
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26. Potentially avoidable hospitalizations in patients with advanced cancer.

Author

Johnson, Connor, primary, Xiao, Yian, additional, El-Jawahri, Areej, additional, Wong, Risa, additional, D'Arpino, Sara, additional, Moran, Samantha M.C., additional, Lage, Daniel E, additional, Temel, Brandon, additional, Ruddy, Margaret, additional, Pirl, William F., additional, Traeger, Lara, additional, Lennes, Inga Tolin, additional, Cashavelly, Barbara J., additional, Martinson, Holly S, additional, Jackson, Vicki, additional, Greer, Joseph A., additional, Ryan, David P., additional, Hochberg, Ephraim P., additional, Temel, Jennifer S., additional, and Nipp, Ryan David, additional

Published
2017
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27. Symptom burden and hospital length of stay among patients with curable cancer.

Author

D'Arpino, Sara, primary, El-Jawahri, Areej, additional, Moran, Samantha M.C., additional, Johnson, Connor, additional, Lage, Daniel, additional, Wong, Risa, additional, Xiao, Yian, additional, Ruddy, Margaret, additional, Temel, Brandon, additional, Pirl, William F., additional, Traeger, Lara, additional, Lennes, Inga Tolin, additional, Cashavelly, Barbara J., additional, Martinson, Holly S, additional, Jackson, Vicki A., additional, Greer, Joseph A., additional, Ryan, David P., additional, Hochberg, Ephraim P., additional, Temel, Jennifer S., additional, and Nipp, Ryan David, additional

Published
2017
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28. The importance of recognizing and addressing depression in patients with advanced cancer.

Author

Wong, Risa, primary, El-Jawahri, Areej, additional, Irwin, Kelly, additional, D'Arpino, Sara, additional, Moran, Samantha M.C., additional, Johnson, Connor, additional, Lage, Daniel, additional, Ruddy, Margaret, additional, Temel, Brandon, additional, Traeger, Lara, additional, Lennes, Inga Tolin, additional, Cashavelly, Barbara J., additional, Martinson, Holly S, additional, Jackson, Vicki, additional, Greer, Joseph A., additional, Ryan, David P., additional, Hochberg, Ephraim P., additional, Pirl, William F., additional, Temel, Jennifer S., additional, and Nipp, Ryan David, additional

Published
2017
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29. Code status transitions from full code to do-not-resuscitate (DNR) among hospitalized patients with advanced cancer.

Author

Lau-Min, Kelsey S., primary, Nipp, Ryan David, additional, D'Arpino, Sara, additional, Moran, Samantha M.C., additional, Hochberg, Ephraim, additional, Traeger, Lara N., additional, Jackson, Vicki, additional, Cashavelly, Barbara J., additional, Martinson, Holly S, additional, Ryan, David P., additional, Greer, Joseph, additional, Temel, Jennifer, additional, and El-Jawahri, Areej, additional

Published
2017
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30. Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer.

Author

Wong, Risa L., El‐Jawahri, Areej, D'Arpino, Sara M., Fuh, Charn‐Xin, Johnson, P. Connor, Lage, Daniel E., Irwin, Kelly E., Pirl, William F., Traeger, Lara, Cashavelly, Barbara J., Jackson, Vicki A., Greer, Joseph A., Ryan, David P., Hochberg, Ephraim P., Temel, Jennifer S., and Nipp, Ryan D.

Subjects
ANTIDEPRESSANTS, CANCER patient psychology, MENTAL depression, LENGTH of stay in hospitals, HOSPITAL admission & discharge, LONGITUDINAL method, PATIENTS, REGRESSION analysis, TUMOR classification, MEDICAL records
Abstract

Background: Among patients with cancer, depressive symptoms are associated with worse clinical outcomes, including greater health care utilization. As use of antidepressant medications can improve depressive symptoms, we sought to examine relationships among depressive symptoms, antidepressant medications, and hospital length of stay (LOS) in patients with advanced cancer. Materials and Methods: From September 2014 to May 2016, we prospectively enrolled patients with advanced cancer who had an unplanned hospitalization. We performed chart review to obtain information regarding documented depressive symptoms in the 3 months prior to admission and use of antidepressant medications at the time of admission. We compared differences in hospital LOS by presence or absence of depressive symptoms and used adjusted linear regression to examine if antidepressant medications moderated these outcomes. Results: Of 1,036 patients, 126 (12.2%) had depressive symptoms documented prior to admission, and 288 (27.8%) were taking antidepressant medications at the time of admission. Patients with depressive symptoms experienced longer hospital LOS (7.25 vs. 6.13 days; p =.036). Use of antidepressant medications moderated this relationship; among patients not on antidepressant medications, depressive symptoms were associated with longer hospital LOS (7.88 vs. 6.11 days; p =.025), but among those on antidepressant medications, depressive symptoms were not associated with hospital LOS (6.57 vs. 6.17 days; p =.578). Conclusion: Documented depressive symptoms prior to hospital admission were associated with longer hospital LOS. This effect was restricted to patients not on antidepressant medications. Future studies are needed to investigate if use of antidepressant medications decreases LOS for patients hospitalized with advanced cancer and the mechanisms by which this may occur. Implications for Practice: This study investigated the prevalence of documented depressive symptoms in patients with advanced cancer in the 3 months prior to an unplanned hospitalization and the prevalence of use of antidepressant medications at time of hospital admission. The relationship of these variables with hospital length of stay was also examined, and it was found that documented depressive symptoms were associated with prolonged hospital length of stay. Interestingly, antidepressant medications moderated the relationship between depressive symptoms and hospital length of stay. These findings support the need to recognize and address depressive symptoms among patients with advanced cancer, with potential implications for optimizing health care utilization. Patients with cancer often experience depression, which can influence treatment outcomes and quality of life. This article evaluates associations among depressive symptoms, use of antidepressants, and hospital length of stay in patients with advanced cancer. [ABSTRACT FROM AUTHOR]

Published
2019
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31. Symptom burden to predict health care utilization in hospitalized patients with incurable cancer.

Author

Nipp, Ryan David, primary, El-Jawahri, Areej, additional, Moran, Samantha M.C., additional, D'Arpino, Sara, additional, Johnson, Connor, additional, Lage, Daniel E., additional, Wong, Risa, additional, Xiao, Yian, additional, VanDusen, Harry, additional, Pirl, William F., additional, Traeger, Lara, additional, Lennes, Inga Tolin, additional, Cashavelly, Barbara J., additional, Martinson, Holly S., additional, Jackson, Vicki A., additional, Greer, Joseph A., additional, Ryan, David P., additional, Hochberg, Ephraim P., additional, and Temel, Jennifer S., additional

Published
2016
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32. Relationship between symptom burden and hospital length of stay (LOS) in patients with incurable cancer.

Author

Nipp, Ryan David, primary, El-Jawahri, Areej, additional, Moran, Samantha M.C., additional, D'Arpino, Sara, additional, Johnson, Connor, additional, Lage, Daniel, additional, Wong, Risa, additional, Xiao, Yian, additional, VanDusen, Harry, additional, Pirl, William F., additional, Traeger, Lara, additional, Kumar, Pallavi, additional, Lennes, Inga Tolin, additional, Cashavelly, Barbara J., additional, Martinson, Holly S, additional, Jackson, Vicki A., additional, Greer, Joseph A., additional, Ryan, David P., additional, Hochberg, Ephraim P., additional, and Temel, Jennifer S., additional

Published
2016
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33. Symptom burden in hospitalized patients with advanced cancer.

Author

Moran, Samantha M.C., primary, El-Jawahri, Areej, additional, Pirl, William F., additional, Traeger, Lara, additional, Kumar, Pallavi, additional, Ryan, David P., additional, Lennes, Inga Tolin, additional, Cashavelly, Barbara J., additional, Martinson, Holly S, additional, VanDusen, Harry, additional, Hochberg, Ephraim P., additional, Jackson, Vicki A., additional, Greer, Joseph A., additional, Temel, Jennifer S., additional, and Nipp, Ryan David, additional

Published
2015
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36. Caring for One of Our Own

Author

Schapira, Lidia, primary, Blaszkowsky, Lawrence S., additional, Cashavelly, Barbara J., additional, Kim, Christina Y., additional, Riley, John P., additional, Wold, Mali C., additional, Ryan, David P., additional, and Penson, Richard T., additional

Published
2014
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44. Cervical dysplasia

Author

Cashavelly, Barbara Jean

Abstract

Carcinoma of the cervix is the third most common gynecologic malignancy in women in the United States. Dysplasia and carcinoma in situ are significant factors of the cervical cancer problem. Research shows a significant increase in the diagnosis of cervical dysplasia, especially in younger women. The mounting frequency of this diagnosis is directly related to the increased use of the Papanicolaou smear. Recently, significant attention has been directed toward the viral agents, herpes virus and papillomavirus, as possible etiologic factors in the development of this disease. The epidemiology, histology, detection, diagnosis, and treatment of cervical dysplasia are discussed. The oncology nurse must have a comprehensive understanding about the disease entity and treatment. With this knowledge, the nurse will be able to identify the high-risk patient and provide effective care to the patient.

Published
1987

46. SUPPORT FOR THE ONCOLOGY SUPPORT STAFF: RECOGNIZING DIFFICULTIES THAT FACE NON-LICENSED STAFF IN AN ONCOLOGY SETTING.

Author

Cashavelly, Barbara, Binda, Katie, and Alterman, Elizabeth

Subjects
*JOB satisfaction of nurses, *NURSE stress, *ONCOLOGY, *WORK environment, *PATIENTS
Abstract

Prevalence of burnout, job dissatisfaction and stress in the oncology workplace has been widely studied. Understanding the impact of caring for the oncology patient on oncology nurses has been researched since the 1970's. However, the experiences of non-licensed support staff in the oncology setting have rarely been examined. Support staff's contributions to patient care are rarely acknowledged or addressed. Value is placed primarily on the practical aspects of their jobs and not how their experience in the clinical environment impacts their daily working lives. It remains unknown how applicable the experiences of the oncology nurse are to support staff working in the oncology setting. However, given the level of contact the support staff has with patients, it is probable that similarities may exist. In a large academic Cancer Center, non-licensed support staff working in an oncology setting was experiencing job dissatisfaction and burnout. There was high turnover, emotional struggles, and lack of preparation for working with oncology patients. Acknowledging these issues, nursing leadership, administration and social work collaborated to understand and address the needs of the non-licensed support staff. The purpose of this project is to describe the experiences of the nonlicensed support staff working in an ambulatory oncology setting caring for cancer patients. A descriptive qualitative approach was developed utilizing 7 focus groups of non-licensed support staff. The participants included: medical assistants, phlebotomists, phone coordinators, office assistants, and secretaries. The groups were facilitated by an oncology social worker. Discussions included the following areas: positive and difficult aspects of their work, caring for yourself, and suggestions for a supportive work environment. Five themes were identified: relationships with patients, coping with death and dying, value and recognition from patients and professional staff, balancing function with emotion and dealing with difficult patients. The findings provided insight into the practice experiences and the role of the non-licensed support staff caring for cancer patients. Findings are similar to those found in the oncology nursing literature. Findings provide oncology nursing leadership insight into the significance of the role of the oncology non-licensed staff and also have implications for the development of an educational support program. [ABSTRACT FROM AUTHOR]

Published
2006

47. Sexual attitudes of oncology and rehabilitation nurses

Author

Cashavelly, Barbara J.

Subjects
Oncology nurses, Rehabilitation nurses
Abstract

Sexuality is one quality of being human. Sexual health must be addressed as a significant and integral element of total health care. Nurses caring for patients with oncology and neuromuscular related disabilities are presented with situations concerning sexual dysfunctions that require judgement, knowledge and sensitivity. Yet, studies have shown that nurses demonstrate low sexual knowledge levels and conservative sexual attitudes. They often neglect this aspect of patient care. The sexual attitudes of nurses may be a significant obstacle to their effective functioning in the field of sexual counseling. This proposed study will investigate sexual attitudes of oncology nurses and rehabilitation nurses.

Published
1988

48. UNCOVERING PRACTICE DIFFERENCES RELATED TO THE CARE OF INDWELLING AND EXTERNAL TUNNELED CATHETERS ACROSS PRACTICE SETTINGS IN A LARGE ACADEMIC MEDICAL CENTER.

Author

Bartholomay, Marian, Finn, Susan, Rounds, Alicia, Bigelow, Robyn, Barrett, Erika, Coakley, Amanda, Bolton, Rachel, and Cashavelly, Barbara

Subjects
*CATHETERS, *DRUG delivery devices, *ONCOLOGY nursing, *NURSING, *ONCOLOGY
Abstract

Tunneled catheters place the client at risk for complications such as infection, occlusion and extravasations. Inappropriate care of these devices can result in persistent disability or even early death. The overall complication rate involving tunneled catheters is reported between 1.4% and 14.4 % (Dicarlo, et al. 2001). Evidenced-based guidelines identified that education and training of health care providers who insert and maintain these catheters is one of the most important strategies for the prevention of catheter-related infections (Ogrady, et al. 2002). The MGH nursing policy and procedure manual clearly delineates the care for these catheters. Despite this, members of the Cancer Nursing Practice Committee (CNPC) at the Massachusetts General Hospital (MGH), representing oncology nurses in both adult and pediatric ambulatory and inpatient areas, identified that there is variation in the nursing care of these catheters across care units. In an effort to identify care actually being delivered to this population, members of the CNPC have developed an electronic survey to be administered across the oncology nursing clinical areas. The goals are to identify current practice, and develop an educational program that will promote consistency of care across practice settings. The objective of the Survey is to describe actual nursing management of Port-a-Caths and Hickman/Broviac catheters in the different inpatient units and outpatient treatment areas. An ongoing review of the literature will be conducted to evaluate practice at MGH, as compared to evidence-based best practices. The survey data will be used to inform the CNPC current nursing practice and serve as a guide for an education curriculum to assure consistency with evidence-based practice Analysis of the survey as well as example of the education plan will be presented. Engaging the staff nurses in this process and providing the time and leadership support required has proven to be an effective means of engaging the staff nurse in the process of shaping evidence based practice and critical peer review of oncology nursing care. [ABSTRACT FROM AUTHOR]

Published
2006

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