Search

Background: Hospitalized advanced cancer patients and their families are inadequately informed about their cancer diagnosis and prognosis, which limits educated and reasonable decision-making for their care and end-of-life planning. Objectives: The primary objective of this evidence-based project was to enhance serious illness conversations (SICs) with advanced cancer patients by providing advanced practice providers (APP) training and to increase the frequency of SIC documentation in the electronic medical record (EMR). Methods: SIC training included a 45-minute Zoom video recording and 30-minute discussion groups. Advanced practice providers’ beliefs and self-efficacy were measured pre- and post-training via a survey. Prior training was queried in the pre-survey. Data from APP discussion groups were summarized and themes identified. Serious illness conversation documentation frequency was measured. Pre- and post-survey differences were assessed using Wilcoxon rank sum tests. Findings: 19 inpatient medical oncology nurse practitioners and 6 physician assistants participated. Many reported little formal training yet are engaging in SICs regularly. Scores on both the belief and self-efficacy survey sections were high prior to training and did not significantly change following training. Despite the high pre-survey scores, many of the APPs verbalized the need for more training to improve their confidence and to learn SIC communication skills. Training significantly improved the APP’s ability to manage their own emotions and be present. This indicates a trend toward improved APP comfort with SICs. Accessible documentation in the EMR increased with training.

The knowledge of Geriatric Oncology requires some information on her history.Thanks to the effort of investigators throughout the world, embattled but undeterred by the objection of a cautious establishment, geriatric oncology has provided a blueprint for the treatment of the most common form of cancer: cancer in the older person. The history of Geriatric Oncology may be divided in three periods: Prehistory,Past and Contemporay history.

Background Cognitive interviewing is a qualitative methodology for generating valid, reliable patient-centered outcome measures. There are challenges inherent in research on sensitive topics that require thoughtful approach by the scientist for data collection methods, analysis, and interpretation. Objective The purpose of this article is to provide principles of cognitive interviewing for sensitive health topics. Methods We review the challenges inherent in cognitive interviewing for sensitive topics scale development. We illustrate adaptations to general cognitive interviewing for sensitive topics through the presentation and analysis of a research exemplar. Results Researchers must consider threats to quality of sensitive topic data collection and potential harms to participants and researchers. We provide specific examples of how these risks were mitigated in a sensitive topic scale development study. Discussion Unique challenges of cognitive interviewing for sensitive health topics can be addressed with a well-planned data collection strategy, anticipating participant safety concerns, and consideration to researcher well-being.

Individuals who provide care to older adult women with breast cancer can experience distressing caregiver strain.The purpose of this study was to determine whether functional status and depression in older adult women with breast cancer relates to strain in their caregivers. Relationships among caregiver characteristics and strain were also evaluated.This multivariate, cross-sectional study used activities of daily living, instrumental activities of daily living, Timed Up and Go Test, Geriatric Depression Scale, and Modified Caregiver Strain Index (MCSI). Statistical analyses included Wilcoxon rank-sum tests and Spearman rank correlations. Logistic regression was used to predict MCSI scores.Patient Timed Up and Go Test and Geriatric Depression Scale scores had the greatest impact on MCSI, with lower function and greater depression associated with increased caregiver strain. Advanced disease was associated with increased caregiver strain. When cancer stage is controlled for, caregiver employment is associated with increased strain.

BACKGROUND Nursing student fatigue and recovery time are important considerations. PURPOSE This descriptive research compared chronic/acute fatigue and recovery time between one 12-hour shift or two 6-hour faculty-supervised clinical shifts per week. METHODS The Occupational Fatigue and Exhaustion Recovery (OFER) scale was completed by undergraduate students in pediatric and obstetrical courses. RESULTS The student (N = 106) mean score on OFER was 37.57 for chronic fatigue, 56.57 for acute fatigue, and intershift recovery was 56.57. No differences in chronic fatigue (P = .40), acute fatigue (P = .14), or intershift recovery (P = .35) were found between groups. Nursing students (79%) preferred 12-hour clinical shifts as compared to 21% who chose two 6-hour clinical. CONCLUSIONS No differences in chronic/acute fatigue or intershift recovery between a 12-hour clinical shift or two 6-hour clinical shifts were found. Nursing students preferred the one 12-hour clinical shift.

The Centers for Disease Control and Prevention (CDC) recommend screening men who have sex with men who are living with HIV for sexually transmitted infections at appropriate extragenital contact sites for bacterial sexually transmitted infections. In an effort to increase provider adherence to CDC recommended guidelines at a Ryan White Clinic, microlearning educational sessions were used. A quality improvement project was designed to determine the rate of provider adherence to CDC guidelines pre/post microlearning sessions. Student t-test was used to compare the number of patients who received urine and extragenital screening to those who received urine-only screening, to before and after the microlearning sessions. The rate of extragenital screening significantly increased after the microlearning sessions (4/460 vs. 70/507, p.0001). The rate of urine screening remained unchanged (p = 1). Although extragenital screening significantly increased, it remained low. A decision tree in the electronic medical record to prompt providers to screen was developed.

Objectives To evaluate self-reported and performance-based functional status (FS) in older women with breast cancer according to stage and time of visit during treatment. Sample & setting 72 women with breast cancer aged 78 years or older and receiving any type of treatment at a midwestern outpatient clinic. Methods & variables FS was evaluated using grip strength, the Index of Activities of Daily Living (ADLs), the instrumental ADLs (IADLs) scale, and the Timed Up and Go Test (TUGT). Mixed models were fit for grip strength and the TUGT, and generalized estimating equations were used to fit binary logistic regressions for the Index of ADLs and the IADLs scale. Continuous FS outcomes were evaluated using means and standard deviations. Results Cancer stage and time of visit did not affect self-reported or performance-based FS scores. Most participants were considered independent on the Index of ADLs, the IADLs scale, and the TUGT, which did not change significantly between visits. Self-reported measures revealed less impairment. Implications for nursing Monitoring FS using self-reported and performance-based measures can ensure that older patients receive timely support.

To offer a “toolbox” for geriatric nurses consisting of a general understanding of geriatric oncology, use of a comprehensive geriatric assessment (CGA), role in the multidisciplinary team (MDT), and additional roles as leader, clinician, educator, advocate, and exemplar. Geriatric oncology incorporates the use of the Ambulatory Geriatric Oncology Program (AGOC), CGA, and an MDT to determine functional status, comorbid conditions, social support, and emotional concerns in addition to diagnosing and treating cancer. Nurses have a role in all elements of geriatric oncology. Nursing skills required in geriatric oncology should be cultivated to be able to advocate, lead, educate, and provide clinical care to older people. Resources are available to meet educational needs to continue to develop tools necessary for the geriatric oncology toolbox.

Despite efforts to implement learner competencies in gerontological nursing, a significant knowledge-attitude disassociation remains, with few students interested in pursuing careers in the care of older adults. One reason may be the lack of well-qualified faculty who can design engaging learning experiences with older adults and serve as positive role models for aging care. In response, the National Hartford Center of Gerontological Nursing Excellence commissioned the development of core competencies and a recognition program for educators in gerontological nursing. The goal of these competencies is to promote quality instruction in the care of older adults by describing a set of preferred skills characterizing faculty teaching gerontological content to nursing and interprofessional learners. These educator-focused competencies can guide individual career development for new and current educators who specialize in teaching about the care of older adults. They provide direction for selecting well-prepared individuals for gerontological nursing teaching positions and evaluating educator role performance. This paper describes the development of seven core competencies for nurse educators who teach in academic and professional development programs, as well as criteria for their recognition. An iterative development process was used to define the core competencies, along with descriptions and exemplars of each domain.

Cognitive interviewing is a qualitative methodology for generating valid, reliable patient-centered outcome measures. There are challenges inherent in research on sensitive topics that require thoughtful approach by the scientist for data collection methods, analysis, and interpretation.The purpose of this article is to provide principles of cognitive interviewing for sensitive health topics.We review the challenges inherent in cognitive interviewing for sensitive topics scale development. We illustrate adaptations to general cognitive interviewing for sensitive topics through the presentation and analysis of a research exemplar.Researchers must consider threats to quality of sensitive topic data collection and potential harms to participants and researchers. We provide specific examples of how these risks were mitigated in a sensitive topic scale development study.Unique challenges of cognitive interviewing for sensitive health topics can be addressed with a well-planned data collection strategy, anticipating participant safety concerns, and consideration to researcher well-being.

Background Sexual wellbeing is a critical yet often overlooked aspect of overall wellbeing for women across cancer diagnoses. Objective We identified profiles of women cancer survivors by sexual and psychosocial outcomes and compared groups for differences in relevant outcomes and individual characteristics. Methods Partnered women treated for cancer (n = 226; M age = 51.1 (12.6); 54% breast cancer; 86% White) completed a cross-sectional survey assessing sexual and psychosocial wellbeing. K-means cluster analysis modeled subgroups (clusters) with similar response patterns on measures of sexual wellbeing (sexual function, distress, sexual communication, and self-efficacy for communication), psychosocial wellbeing (quality of life (QOL), anxiety and depressive symptoms), and time since treatment. ANOVAs with Tukey post-hoc analyses and chi-square analyses tested cluster mean differences. Results Three distinct clusters of women differed by levels of adjustment in sexual and psychosocial wellbeing: higher-adjustment (32.7%), intermediate (37.6%), and lower-adjustment (29.6%). Significant differences among the clusters were found for all outcomes, with largest effect sizes for sexual distress (η2p = 0.66), sexual communication (η2p = 0.51), sexual satisfaction (η2p = 0.44), and anxiety and self-efficacy for communication (η2p = 0.32). The intermediate adjustment group was characterized by lower adjustment on measures of sexual and relationship function, and better adjustment on measures of QOL and mood. Conclusions Findings suggest that for women cancer survivors, measures of sexual and psychosocial wellbeing can model distinct profiles to inform targeted interventions to meet women’s needs. Evidence-based targeted interventions could lead to better sexual function, and ultimately to better QOL and overall wellbeing. Implications for practice A stepped intervention approach to sexual health care for women with cancer, where content and format depend on degree of sexual and psychosocial adjustment after cancer, may be most appropriate. Interdisciplinary teams may address sexual, emotional, and relationship functioning.

Background Cultivating healthy lifestyle beliefs (HLBs) can result in positive health outcomes for students during their nursing program. Purpose The purpose of the study was to determine the effectiveness of short wellness interventions (microlearning) in nursing courses on reducing stress and anxiety and enhancing HLB. Methods Microlearning wellness interventions were offered to graduate and undergraduate nursing students in this cluster randomized intervention study. The Perceived Stress Scale 4, Generalized Anxiety Disorder 7, and Healthy Lifestyle Beliefs Scales were administered. Student perceptions were evaluated using a short answer narrative. Results The intervention group reported higher HLB (P = .15), lower anxiety (P = .06), and lower stress (P = .06) compared with the control group after adjusting for baseline differences. Student comments were favorable and included enjoying the activities, weight loss success, and mindfulness strategies. Conclusions Incorporating wellness interventions into nursing curricula demonstrates a positive trend toward reducing anxiety and stress and improving HLB.

Background The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. Objectives This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. Methods NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. Findings Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.

Cancer is a common comorbidity often associated with aging. Older patients can have specific needs such as caregiver concerns, transportation challenges, limited social support, and other problems ...

Objectives To determine the relationship among gait, grip strength, cognition, depression, pain, and fatigue, and to identify which variables are most predictive of poor sleep. Sample & setting 60 women with breast cancer aged 69 years or older who were receiving treatment in the Senior Adult Oncology Program at the James Cancer Hospital at the Ohio State University. Methods & variables The variables were gait and grip strength (functional domains), cognition, depression, pain, and fatigue. Patients were tested using the Timed Up and Go Test (TUG), Jamar Hydraulic Hand Dynamometer, Mini-Cog, Numeric Pain Rating Scale, Brief Fatigue Inventory, Geriatric Depression Scale, and Pittsburgh Sleep Quality Index. Pearson correlation coefficients and logistic regression models were used. Results The mean age of the sample was 78 years. Pain and fatigue, depression and pain, and depression and fatigue each were positively related, and grip strength and TUG scores were negatively related. Fatigue was the strongest predictor of poor sleep. Implications for nursing These findings are important to the comprehensive care of older women diagnosed with breast cancer. Understanding symptoms associated with poor sleep helps nurses develop comprehensive care plans for older adults with breast cancer.

The purpose of this study was to examine the perception of adult day services (ADS) staff and hospital discharge planners regarding the feasibility of ADS to provide post-acute care (PAC) for persons with dementia. We conducted key informant interviews with emergency department (ED) and inpatient hospital discharge planners ( n = 9), and two focus groups with ADS staff ( n = 15) representing five ADS programs. Four thematic categories were identified from the discharge planners, including concerns for patients, factors influencing discharge, experience with ADS, and conditions for ADS referrals. Four categories identified from ADS staff interviews include public lack of knowledge of ADS, communication challenges, ADS to prevent hospitalization and ED visits, and barriers to providing PAC. Lack of knowledge about ADS, the role of family in PAC decisions, and the lack of reimbursement for PAC in ADS were identified as the most significant drivers in the ability of ADS to provide PAC.

Background: Evidence-based practice in geriatric oncology is growing, and national initiatives have focused on expanding cancer care and research to improve health outcomes of older adults. However, there are still gaps between knowledge and practice for older adults with cancer. Methods: The Cancer and Aging Resiliency (CARE) clinic is a multidisciplinary approach for implementing geriatric-driven health care for older adults with cancer. The CARE clinic was developed as a direct response to recommendations targeting key multifactorial geriatric health conditions (e.g. falls, nutritional deficits, sensory loss, cognitive impairment, frailty, multiple chronic conditions, and functional status). We review the influence of these factors across the cancer care trajectory, including at screening, diagnosis, and treatment and discuss ways in which these conditions may be targeted to improve cancer care in older adults. Results: The CARE clinic was implemented at The Ohio State University Comprehensive Cancer Center (OSUCCC) and targets modifiable risk factors affecting outcomes in older adults with cancer: weight loss, polypharmacy, physical impairments, social support, and mood symptoms. The multidisciplinary team at the CARE clinic discusses and delivers a comprehensive set of recommendations, all in one clinic visit, to minimize burden on the patient and the caregiver. The CARE clinic is part of a set of initiatives that feature education of future leaders in geriatric oncology, survivorship care for an aging population, and outcomes research. Conclusions: Older adults with cancer have a unique set of needs that need to be taken into account throughout their cancer care. The CARE clinic model is an important example of an approach that may combat these difficulties and lead to better outcomes among older adults with cancer.

Background Evidence-based practice in geriatric oncology is growing, and national initiatives have focused on expanding cancer care and research to improve health outcomes for older adults. However, there are still gaps between knowledge and practice for older adults with cancer. Main text Here we provide a detailed methodology of geriatric oncology care delivery within a single institution. The Cancer and Aging Resiliency (CARE) clinic is a multidisciplinary approach for implementing geriatric-driven health care for older adults with cancer. The CARE clinic was developed as a direct response to recommendations targeting key multifactorial geriatric health conditions (e.g. falls, nutritional deficits, sensory loss, cognitive impairment, frailty, multiple chronic conditions, and functional status). The multidisciplinary team assesses and delivers a comprehensive set of recommendations, all in one clinic visit, to minimize burden on the patient and the caregiver. The CARE clinic consultative model is a novel approach integrating cancer subspecialties with geriatric oncology healthcare delivery. Conclusions Older adults with cancer have unique needs that are independent of routine oncology care. The CARE clinic model provides specific assessments and interventions to improve health outcomes among older adults with cancer.

OBJECTIVES To illustrate the predictors of strain among caregivers of older adults diagnosed with breast cancer. SAMPLE A SETTING This study involved 39 women diagnosed with breast cancer who were aged 69 years or older, receiving any type of treatment, and seeking an initial assessment in a geriatric oncology program at a large cancer center in the midwestern United States and their caregivers. METHODS A VARIABLES This cross-sectional study evaluated relationships among the variables of caregiver strain, age, employment status, patient characteristics, and patient scores on the comprehensive geriatric assessment. Bivariate statistics and logistic regression models were used. RESULTS Increasing age of the caregiver was associated with less caregiver strain. Caregivers employed part-time experienced greater strain than those employed full-time. IMPLICATIONS FOR NURSING Nurses must assess for strain in caregivers of individuals diagnosed with cancer, particularly if they are younger and employed part-time. Caregivers of depressed patients should be assessed for strain and offered support.

CASE STUDY Michele Green received the results of her breast cancer biopsy last week. Before surgery for infiltrating ductal carcinoma to her left breast, Michele was advised to meet with the members of the Senior Adult Oncology Program (SAOP) at the cancer center. A phone call from a nurse explained that the 2-hour visit with the SAOP would include meetings with many providers, such as a physical therapist, a social worker, a dietitian, a pharmacist, a nurse practitioner, and an oncologist to undergo a comprehensive geriatric assessment. Driving to her appointment, Michele wondered why her visit would take so long and why she had to see so many people. At 81 years old, Michele maintains her physical fitness and has never really been sick. She continues to work each week at the university and engages in an active social life. What could a team possibly find? Walking past the many examination rooms, Michele began to feel despair that she was now a "cancer patient."

Transition of Care Models can reduce the 30-day hospital readmission rate up to 67% by offering coordination and continuity of care. The purpose of this project was to evaluate a Congregation Transition of Care (CTOC) program in faith-based communities with the use of a faith community nurse and volunteer faith-based registered nurses. Descriptive statistics were used to describe findings, revealing a CTOC program can be effective in reducing 30-day readmissions in the faith community.

The comprehensive geriatric assessment (CGA) is a versatile tool for the care of the older person diagnosed with cancer. The purpose of this article is to detail how a CGA can be tailored to Ambulatory Geriatric Oncology Programs (AGOPs) in academic cancer centers and to community oncology practices with varying levels of resources. The Society for International Oncology in Geriatrics (SIOG) recommends CGA as a foundation for treatment planning and decision-making for the older person receiving care for a malignancy. A CGA is often administered by a multidisciplinary team (MDT) composed of professionals who provide geriatric-focused cancer care. CGA can be used as a one-time consult for surgery, chemotherapy, or radiation therapy providers to predict treatment tolerance or as an ongoing part of patient care to manage malignant and non-malignant issues. Administrative support and proactive infrastructure planning to address scheduling, referrals, and provider communication are critical to the effectiveness of the CGA.

Introduction: Implicit bias affects patient–nurse interactions and care management decisions. The purpose of this educational project was to explore faculty perceptions of engaging students in active learning to address implicit bias using videos vignettes. Method: Three videos were created with a corresponding instructor guide. The vignettes depicted insensitive behaviors, best practice clinical interactions, and a reflection about bias in health care. Faculty who implemented the active learning strategy were invited to complete an online, confidential survey regarding their perceptions. Results: Most faculty (83%) agreed that students benefit from discussing implicit bias using an active learning approach. All faculty ( N = 12) believed the videos and instructor guide to be effective tools in creating meaningful discussion. Discussion: Video vignettes illustrating insensitive behaviors and demonstrating best practice enable faculty to actively engage students in addressing the impact of implicit bias. Educational strategies intended to ensure equitable care are indicated to support positive patient outcomes.

The purpose of this study was to conduct a preliminary validation of the psychometric performance of the newly developed Self-Efficacy to Communicate about Sex and Intimacy (SECSI) scale in a sample of women treated for cancer. Partnered women (n = 250) who had received treatment for cancer completed an online survey that included the SECSI scale and measures of health-related quality of life, depression, anxiety, sexual function, sexual distress, self-efficacy for sexual functioning, sexual behaviors, relationship satisfaction, and satisfaction with sexual communication. Sociodemographic and clinical cancer characteristics data were collected. High internal consistency and strong test–retest reliability of the SECSI scale were shown with a Cronbach’s alpha coefficient of 0.94 and test–retest reliability of r = 0.82, respectively. Construct validity of the SECSI scale, including discriminant, convergent, and divergent validity, was supported except regarding hypothesized relationships between SECSI scores and participant age and time since treatment. The SECSI scale is a valid, reliable measure for use with partnered women treated for cancer. Clinicians working with cancer survivors who may be at risk for difficulties communicating about sex and intimacy needs after cancer treatment may use this scale to identify women who would benefit from interventions to increase their confidence to communicate with their partner. The SECSI scale fills an important gap in ability to assess self-efficacy to communicate about sex and intimacy.

Background Geriatric oncology incorporates comprehensive geriatric assessment (CGA) and traditional oncology care. Objectives The aims are to identify limitations reflected by mean scores on the CGA instruments and describe the CGA recommendations documented in the medical record. Methods CGA was administered and consisted of the Timed Up and Go Test, the Activities of Daily Living Scale, the Instrumental Activities of Daily Living Scale, grip strength, falls, pain, the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Geriatric Depression Scale, the Mini-Cog, and the Mini Nutritional Assessment. CGA recommendations were obtained from the medical record. Descriptive statistics were used to analyze the data. Findings Most recommendations were for general cancer treatment, followed by fall referral/education.

Functional status assessment is a useful and essential component of the complete history and physical exam of the older patient diagnosed with cancer. Functional status is the ability to conduct activities that are necessary for independence and more executive activities, such as money management, cooking, and transportation. Assessment of functional status creates a portal into interpreting the health of in older persons. Understanding limitations and physical abilities can help in developing cancer treatment strategies, patient/family teaching needs, and in-home services that enhance patient/family care. This article will review the benefits of functional assessment, instruments that can be used during an ambulatory care visit, and interventions that can address potential limitations.

A diagnosis of cancer is a stressful, difficult, and life-altering event. Breaking bad news is distressing to patients and families and is often uncomfortable for the nurse delivering it. Evidence-based communication models have been developed and adapted for use in clinical practice to assist nurses with breaking bad news. .The purpose of this article is to provide an overview on breaking bad news and to review the utility of the SPIKES and PEWTER evidence-based communication models for oncology nurses. .Perceptions of breaking bad news from the nurse and patient perspectives, as well as barriers and consequences to effective communication, will be presented. Clinical examples of possible situations of breaking bad news will demonstrate how to use the SPIKES and PEWTER models of communication when disclosing bad news to patients and their families. .By using the evidence-based communication strategies depicted in this article, oncology nurses can support the delivery of bad news and maintain communication with their patients and their patients' families in an effective and productive manner.

Objectives To discuss the evolution and effectiveness of the comprehensive geriatric assessment (CGA), the need for interprofessional collaboration, and the role of oncology nurses in the assessment and care coordination of the older patient with cancer. Data Sources Historical and recent publications. Conclusion Oncology nurses collect and synthesize geriatric data and can be a central resource to the multidisciplinary team. Implications for Nursing Practice Oncology nurses can incorporate CGA and results into their practice to enhance the care of the older person.

Older women diagnosed with breast cancer may also have preexisting cognitive deficits. .The aim of the current study is to describe errors on the clock-drawing test (CDT), which is used to screen for preexisting cognitive deficits in older women diagnosed with breast cancer. .This descriptive study included a convenience sample of women aged 69 years or older with a diagnosis of breast cancer. The CDT was used to screen for cognitive deficits, such as size of the clock, graphic difficulties, stimulus-bound response, conceptual deficit, spatial and/or planning deficit, and perseveration. Data were analyzed by the Rouleau qualitative error analysis. .Many older adult patients exhibit some abnormality on the CDT. Most abnormalities were spatial/planning difficulties. Cognitive screening should be included in the comprehensive assessment of older adults diagnosed with breast cancer to screen for preexisting cognitive limitations.

Purpose/objectives To evaluate mind-body movement exercise (MBME) classes (yoga, tai chi, and Qigong) for cancer survivors. . Design A single-group, repeated-measures design. . Setting The Ohio State University Wexner Medical Center-Arthur G. James Cancer Hospital in Columbus. . Sample 33 adult cancer survivors, with any cancer diagnosis, participating in MBME classes. . Methods The researchers sought to examine feasibility of multiple data collection time points and data collection measures; acceptability; and changes to physical, emotional, and biometric measures over time, as a result of participation in MBME classes. . Main research variables Quality of life, sleep, depressive symptomatology, fatigue, stress, upper body strength, gait and balance, body mass index, heart rate, and blood pressure. . Findings The current study was feasible because survivors were willing to participate and completed most of the questionnaires. Participants found these classes to be beneficial not only for exercise, but also for social support and social connectedness. Poor sleep quality was consistently reported by participants. MBME classes should be recommended to survivors and are beneficial for oncology practices to offer. . Conclusions Conducting MBME research with cancer survivors is feasible, and participants find the MBME acceptable and a way of addressing health and managing cancer-related symptoms. . Implications for nursing Nurses should help patients and caregivers identify locations and times when MBME class participation is possible, assess MBME class participation during each clinic visit to promote continued involvement and to understand if positive effects are occurring, and continue to provide support for MBME classes throughout the survivorship experience.

Sickle cell disease (SCD) is a chronic condition that affects thousands of people worldwide. The purpose of this study is to illustrate some of the challenges and perceptions of people diagnosed with SCD. The aims were to describe stressors, problematic symptoms, sources of support, and interactions with healthcare providers. This descriptive study, using mostly open-ended questions and conceptual analysis, included a sample of patients with SCD who were older than 18 years in ambulatory (57%) and inpatient (43%) clinics. Participants completed a 20-minute interview. Pain or SCD crisis were the chief reasons for hospitalization, and a wellness checkup was the chief reason people returned to an ambulatory clinic. Most (74%) were able to perform chores. Family was reported to cause the most stress in the home and also provide the most help. Pain is a pervasive aspect of life, limiting activities of daily living. Negative interactions with healthcare providers are common; therefore, advocacy is necessary for patients with SCD.

Caregiver strain is the emotional and physical demands associated with providing care, particularly when the needs exceed the resources. The purpose of this presentation is to illustrate the predictors of strain among caregivers of older breast cancer patients. Relationships among caregiver strain (Modified Caregiver Strain Index), age, employment status, patient characteristics and scores on the comprehensive geriatric assessment (grip strength, Timed up & Go, Mini Nutritional Assessment, MiniCog, Geriatric Depression Scale, Pittsburgh Sleep Quality Index, and Brief Fatigue Inventory) are described. This cross sectional study included women who were diagnosed with breast cancer, over the age of 69 years, receiving any type of treatment and seeking an initial assessment in a geriatric oncology program.. Dyads (N=39) had a mean patient age of 77 and caregiver age of 64 years. Most patients were diagnosed with infiltrating ductal carcinoma 30 (76.9%), most had lumpectomy 23 (59%), and were stage 1 15 (38.5%). Most patients had one caregiver 22(56.4%) who worked full-time 12(30.8) and rated their health as very good 16 (25.4%). Increasing age of the caregiver was associated with less caregiver strain (r = -0.45, p=.02). Employment status of the caregiver was significantly related to caregiver strain -0.35 (p=.03). Caregivers employed full time 3.5 (p = .08), and part time 5.9 (p=0.3) experienced greater strain (mean±SD: 9.4±8.8) than those employed full-time (4.7±3.4). Patient depression, caregiver employment status and age of the caregiver are related to caregiver strain. Healthcare providers must assess for strain in cancer givers of cancer patients.

Medical Qigong (MQ) is a mind-body exercise that includes movement and meditation and is beneficial in reducing high blood pressure, high cholesterol, anxiety, stress, pain, and incidence of falls. The purpose of the current study was to determine whether patients with cancer and survivors who participated in an MQ class experienced a change in fatigue, depression, and sleep from a preintervention evaluation to a postintervention evaluation. Participants were patients diagnosed with cancer who participated in MQ classes. Some were actively undergoing cancer treatment (e.g., surgery, hormone therapy, radiation therapy, chemotherapy) and some were receiving no treatment. Patients diagnosed with cancer and enrolled in an MQ class were invited to participate. A packet of surveys was completed before the first class and before the final class. Scores showed a reduced depression score after completing the five-week MQ course. Those findings indicate that MQ is helpful in reducing some of the problems associated with cancer and cancer treatment.

About 73% of patients diagnosed with cancer report poor pain management. The purpose of this study was to evaluate pain intensity and the extent to which pain was controlled, and based on the findings, to pose options for improving pain management for hospitalized patients with cancer.

For many patients, a hematopoietic stem cell transplant (HSCT) can be challenging to physical and emotional health. Supportive care needs can be overwhelming for many patients and families. The purpose of this study was to evaluate the effect of quality of life (QOL), spiritual well-being, and supportive care resources post-HSCT. This descriptive, repeated-measures study included people over the age of 18 years undergoing HSCT for any cancer diagnosis. The Functional Assessment in Cancer Therapy--Bone Marrow Transplant scale, the Functional Assessment of Chronic Illness Therapy--Spiritual--12 scale, and a resource questionnaire were administered prior to HSCT and following HSCT at 30, 60, 90, and 180 days. Three groups of HSCT patients were examined: allogeneic, autologous, and overall. Data analysis included descriptive statistics and correlations. In the sample (n = 159), the autologous HSCT group reported the highest QOL scores. Spirituality scores increased for the autologous HSCT group at 90 days, but decreased for the overall and allogeneic groups. The type of supportive care resources most used were information from the physician and nurse, the Leukemia and Lymphoma Society Support as the most used form of support group, and Faith, Prayer and Spiritual Healing. QOL and spiritual well-being scores correlated best at 180 days (6 months) for autologous and allogeneic patients.

Shared governance is a model of nursing leadership that drives practice. The purpose of this project was to determine whether nursing education, work experience, certification, employment position, setting (inpatient/ambulatory), participation in shared governance, and age were related and predictive of scores on the Index of Professional Nursing Governance (IPNG). The significance was to provide a basis on which to enhance a nursing shared governance model resulting in enhanced patient care. This prospective, cross-sectional study included nurses in any type of nursing role and with any level of educational preparation. An analysis of variance was employed to identify strength of relationships among the categorical or ordinal variables and regression models for the continuous variables. General linear models were used to identify the variables most predictive of IPNG scores. Of the 98 participants, most (96%) were women, 58% were bachelor's prepared, and 80% were staff nurses. The mean IPNG score was 186.5. No significant relationships were found among demographic measures and IPNG scores. A reported role in shared governance, when combined with work setting (inpatient or ambulatory), was predictive of IPNG scores. Nurses who worked in the inpatient setting reported higher mean IPNG scores.

Objective Fatigue has multiple causes but the pathogenesis is not completely understood. Fatigue is one of the worst threats to the functional independence of older individuals. The aim of this study is to establish an association between fatigue, anemia and functional dependence in older cancer patients receiving chemotherapy. Materials and methods Patients aged 70 years or older with a diagnosis of metastatic malignancy were enrolled. All patients were evaluated at the beginning and after 3 months of treatment. A comprehensive geriatric assessment and Fatigue Symptom Inventory (FSI) were used at the beginning and at the end of the study. Results The final sample involved 129 patients. Almost all fatigue scores had a significant increase from the beginning to the end of treatment. IADLs and PS decreased significantly between the baseline and the final evaluations. The worsening in severity of fatigue, anemia, the increase in interference with daily living as well as the hours of fatigue during the day were associated with disabilities in IADLs. The decline in creatinine value was the only parameter associated with PS. Conclusions Fatigue is almost universal in older cancer patients at the end of chemotherapy treatment and is associated with functional dependence, especially IADLs. We also established an independent correlation of anemia and functional dependence in older individuals.

PURPOSE: While quality of life is the focus of care in hospices, limited research has been conducted on the quality of life of cancer patients in hospice home care. The purpose of this study was to explore the predictors of quality of life of older adults who are receiving hospice care in their homes. METHODS: A secondary analysis of data from a larger study was conducted using linear regression and including the following predictor variables: age, functional status, number of symptoms endorsed, overall symptom distress, pain intensity, and depressive symptoms. The outcome variable was quality of life. RESULTS: The sample consisted of 533 adults with an average age of 78.1 years (SD=7.4). A regression model that included symptom distress, number of symptoms, depression, and functional status accounted for 46% of the variance in quality of life. Pain, age, and caregiver depression did not contribute to predicting quality of life and therefore were not included in the final model. CONCLUSIONS AND IMPLICATIONS: Because both physical symptoms and depression are predictors of quality of life, a continued focus is needed on these factors by those providing care to older adults with cancer near the end of life.

The purpose of this study was to evaluate possible risk factors for falls in a group of patients with chemotherapy-induced peripheral neuropathy (CIPN).This prospective, descriptive study included persons receiving paclitaxel, docetaxel, oxaliplatin, or cispatin who reported at least one symptom of CIPN. Each patient was invited to complete the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) and a demographic data questionnaire. Data were analyzed using descriptive statistics and logistic regression.In this sample (n = 109), fallers (n = 21) had higher doses of chemotherapy(p = 0.045), more neuropathic symptoms (p = 0.016), higher scores on the symptom experience (p = 0.005) and interference items (=0.001) on the CIPNAT, more severe muscle weakness (p0.001) and loss of balance (p0.001), and higher interference with walking(p0.001) and driving (p = 0.022). Patients who received taxanes were more likely to have fallen than patients who received platinum-based chemotherapy (p = 0.022). No significant differences in age or disease stage between fallers and non-fallers were present. Severity of loss of balance and cycle number was independently associated with falling.This study demonstrates that the risk of falls increases with each cycle of chemotherapy and that patients receiving taxanes may be at greater risk of falls than patients receiving neurotoxic platinum-based drugs. Patients who report muscle weakness and loss of balance or say that their symptoms interfere with walking or driving may be at a higher risk of falls.

Background: Adults over age 65 are the fastes- growing segment of the US population. However, clinicians have less evidence of how to treat older adults, because they are underrepresented in clinical trials, and studies designed specifically for older adults are rare. Therefore, clinicians have to extrapolate from trials conducted in younger, healthier populations when developing treatment plans for older adults. Over 40% of new breast cancer diagnoses in the US occur in women aged over 65 years. In general, breast cancer in the older woman has distinct biologic features, including less aggressive characteristics and greater expression of estrogen receptor and progesterone receptor. Increasing age is associated with higher rates of comorbidity and frailty, which has been shown to potentially reduce the survival advantage of more aggressive breast cancer therapies. We are conducting a prospective cohort study of adults > or = 65 years with a new diagnosis of breast cancer (OSU-16153) in order to better understand the complex health issues faced by this population, and to collect data with which to support future studies designed to improve the management of these patients. Specific Aims: 1) To assess overall and progression-free survival of breast cancer patients ages 65 and older seen in the Breast Medical Oncology clinics at the Stefanie Spielman Comprehensive Breast Center at The Ohio State University; 2) to examine the association of demographic, diagnostic, and treatment data with patient outcomes, such as progression-free and overall survival, within this patient population; 3) to evaluate the unique needs of breast cancer patients ages 65 and older by implementing a Comprehensive Geriatric Assessment (CGA) within the Breast Medical Oncology clinics at The Ohio State University. Methods: The study will enroll patients > or = 65 years with a new diagnosis of breast cancer. Participants will complete a brief baseline questionnaire, including items addressing demographics, lifestyle, and health history. Patients will then be asked to complete a Comprehensive Geriatric Assessment (CGA) at the time of enrollment, and approximately every six months while on follow-up. The CGA contains both performance-based assessments of patients’ function, completed by study staff, as well as the patients’ self-reports of symptoms and quality of life. The CGA contains a multifaceted battery of clinical instruments including the PROMIS Global Short Form, Functional Assessment of Cancer Therapy-Breast (FACT-B), Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Scale, The Pittsburgh Sleep Quality Index, Geriatric Depression Scale, The James Supportive Care Screening Tool, Timed Up & Go Test, Grip Strength, Blessed Orientation-Memory-Concentration Test, Mini-Cog Test, Charlson Comorbidity Index, Mini Nutritional Assessment, Katz Index of Independence in Activities of Daily Living, and Instrumental Activities of Daily Living. Participant medical records will be reviewed every three months to assess survival, disease progression, and treatment changes. All questionnaire data will be completed using iPads, and will be directly recorded into the REDCap database. Electronic medical records will be reviewed by research staff, and relevant data will be manually entered into the REDCap database. The aim is to enroll 1,000 participants, and the recruitment period will be five years from study initiation. Participants will be followed for five years from the time of enrollment, resulting in a total study length of ten years. The study opened to accrual on 18 April 2017. To date 3 patients have been enrolled and have completed baseline assessments. Citation Format: Anne M. Noonan, Janine A. Overcash, Anupama Suresh, Laura K. Flora, Julie Stephens, Geetika Bhatt, Raquel Reinbolt, Nicole O. Williams, Robert Wesolowski, Jeffrey B. VanDeusen, Sagar D. Sardesai, Maryam B. Lustberg, Bhuvaneswari Ramaswamy. A prospective geriatric breast cancer cohort study to define unique features and outcomes in older breast cancer patients [abstract]. In: Proceedings of the AACR Special Conference: Advances in Breast Cancer Research; 2017 Oct 7-10; Hollywood, CA. Philadelphia (PA): AACR; Mol Cancer Res 2018;16(8_Suppl):Abstract nr A55.

Purpose/Objectives: To examine themes associated with falls specific to older adult patients diagnosed with cancer.Design: Prospective, exploratory, qualitative study.Setting: A senior adult oncology program at a cancer and research center in the southeastern United States.Sample: Men and women aged 70 years and older with any cancer diagnosis who had experienced a fall within three months.Methods: Patients were telephoned after research consent to participate in an interview about their falls. Frequencies were conducted on the biographic data. Themes were identified and grouped according to topic.Main Research Variables: Eastern Cooperative Oncology Group performance status, cancer site, cancer treatment modality, location of fall, and fear of falls.Findings: Mean age was 76.2 years. Most falls occurred at home (75%). The themes of physical problems, general weakness, and walking were found to be the most common motivations for falls. Themes associated with self-imposed activities as a result of falls included "being more careful" and "using an assistive device."Conclusions: Perceptions of physical problems, general weakness, and difficulty walking should be included in an oncology nursing fall-risk assessment. Exploration of perceptions concerning activities that have potentially caused a past fall and self-imposed activities also should be included.Implications for Nursing: Beyond the boundaries of a fall-risk assessment, conducting a subjective interview to identify the individualities of falls and fall risk is vital to constructing a realistic plan of care. Language: en

To address the emerging concern of oncologists who can expect to see an increasing number of older cancer patients with dementia, this retrospective case-control study compared a sample of older cancer patients with cognitive impairment (N=86) to a non-cognitively impaired control group (N=172) as to patterns of care and survival by age, site and stage. Treatment patterns presented much less differences between both groups than in other series. After adjusting for age, sex, performance status, ADLs/IADLs and comorbidity, results showed significantly greater survival (values p

Purpose/objectives To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide evidence for the validity and reliability of the model for use in practice and research. Design Nonexperimental and cross-sectional using baseline data collected within 24-72 hours of admission to hospice. Setting Two hospices in the southeastern United States. Sample 403 hospice homecare patients; 56% were men and 97% were Caucasian with a mean age of 77.7 years. Methods Confirmatory factor analyses using structural equation modeling with AMOS statistical software. Main research variables Clinical status; physiologic, psychological, and spiritual variables; and quality of life (QOL). Findings A three-factor model with QOL as an outcome variable showed that 67% of the variability in QOL is explained by the patient's symptom and spiritual experiences. Conclusions As symptoms and associated severity and distress increase, the patient's QOL decreases. As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion), QOL also increases. Implications for nursing The model supports caring for the physical and metaphysical dimensions of the patient's life. It also highlights a need for holistic care inclusive of physical, emotional, and spiritual domains.