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Purpose By requiring specific measures, cancer endorsements (e.g., accreditations, designations, certifications) promote high-quality cancer care. While 'quality' is the defining feature, less is known about how these endorsements consider equity. Given the inequities in access to high-quality cancer care, we assessed the extent to which equity structures, processes, and outcomes were required for cancer center endorsements. Methods We performed a content analysis of medical oncology, radiation oncology, surgical oncology, and research hospital endorsements from the American Society of Clinical Oncology (ASCO), American Society of Radiation Oncology (ASTRO), American College of Surgeons Commission on Cancer (CoC), and the National Cancer Institute (NCI), respectively. We analyzed requirements for equity-focused content and compared how each endorsing body included equity as a requirement along three axes: structures, processes, and outcomes. Results ASCO guidelines centered on processes assessing financial, health literacy, and psychosocial barriers to care. ASTRO guidelines related to language needs and processes to address financial barriers. CoC equity-related guidelines focused on processes addressing financial and psychosocial concerns of survivors, and hospital-identified barriers to care. NCI guidelines considered equity related to cancer disparities research, inclusion of diverse groups in outreach and clinical trials, and diversification of investigators. None of the guidelines explicitly required measures of equitable care delivery or outcomes beyond clinical trial enrollment. Conclusion Overall, equity requirements were limited. Leveraging the influence and infrastructure of cancer quality endorsements could enhance progress toward achieving cancer care equity. We recommend that endorsing organizations 1) require cancer centers to implement processes for measuring and tracking health equity outcomes and 2) engage diverse community stakeholders to develop strategies for addressing discrimination.

Current knowledge about mechanisms and interventions for pain has largely been derived from samples that are healthier, wealthier, younger, and more likely to be White than the general population. Failure to conduct inclusive pain research not only restricts generalizability and application of findings, but also hampers the discovery of mechanisms and the development of measures and interventions that are valid across population subgroups. Most of all, inclusive practices are critical to ensure that underrepresented groups derive equitable benefit from pain research. Here, we provide guidance for the pain research community on how to adopt inclusive research practices. We define “inclusion” to encompass a range of identities and characteristics, including racialized group/ethnicity, disability status, gender identity, sexual orientation, and age. We first describe principles relevant to promoting inclusion in pain research, including attention to: 1) stakeholder engagement; 2) structural factors underlying inequities; 3) the limitations of “disparity” research; 4) intersectionality; and 5) universal design. Next, we provide checklists with practical strategies for making studies more inclusive at each stage of the research process. We conclude by calling for system-level changes to ensure that the future of pain research is socially just, scientifically productive, and responsive to the needs of all people. Perspective : This paper offers guidance on promoting inclusion of underrepresented groups in pain research. We describe principles relevant to conducting more inclusive research; e.g., attention to stakeholder engagement, structural factors, and universal design. We provide checklists with practical strategies for inclusion at each stage of the research process.

Purpose The Centers for Disease Control and Prevention’s National Comprehensive Cancer Control Program (NCCCP) requires that states develop comprehensive cancer control (CCC) plans and recommends that disparities related to rural residence are addressed in these plans. The objective of this study was to explore rural partner engagement and describe effective strategies for incorporating a rural focus in CCC plans. Methods States were selected for inclusion using stratified sampling based on state rurality and region. State cancer control leaders were interviewed about facilitators and barriers to engaging rural partners and strategies for prioritizing rural populations. Content analysis was conducted to identify themes across states. Results Interviews (n = 30) revealed themes in three domains related to rural inclusion in CCC plans. The first domain (barriers) included (1) designing CCC plans to be broad, (2) defining “rural populations,” and (3) geographic distance. The second domain (successful strategies) included (1) collaborating with rural healthcare systems, (2) recruiting rural constituents, (3) leveraging rural community–academic partnerships, and (4) working jointly with Native nations. The third domain (strategies for future plan development) included (1) building relationships with rural communities, (2) engaging rural constituents in planning, (3) developing a better understanding of rural needs, and (4) considering resources for addressing rural disparities. Conclusion Significant relationship building with rural communities, resource provision, and successful strategies used by others may improve inclusion of rural needs in state comprehensive cancer control plans and ultimately help plan developers directly address rural cancer health disparities.

Patients with advanced cancer are increasingly experiencing financial hardship (FH) and associated negative health outcomes.The aims of this study were to describe FH and explore its relationship to quality of life (QOL) in patients with advanced cancer receiving outpatient palliative care (PC).Validated questionnaires assessed FH, QOL dimensions, symptom burden, and sociodemographic and clinical characteristics. Descriptive statistics characterized the sample and described FH. Pearson correlation and linear regression assessed relationships between FH and QOL.The average participant (n = 78) age was 56.6 (SD, 12.2) years. Most were female (56.4%), White (50%) or Black (46.2%), and had a range of education, partner statuses, and cancer diagnoses. Median time since cancer diagnosis was 35.5 months (interquartile range, 9-57.3 months). Highest mean symptom burden scores were for pain (2.5 [SD, 1.0]) and fatigue (2.0 [SD, 1.1]), on a 0- to 3-point scale (higher score representing worse symptom burden). The median COST (COmphrehensive Score for financial Toxicity) score was 15.0 (interquartile range, 9.0-23.0). Most (70%) had some (n = 43) or extreme (n = 9) difficulty paying for basic needs. Greater than 28% (n = 21) incurred cancer-related debt. Multivariate models indicated that FH negatively affected role limitations due to physical health ( P = .008), pain ( P = .003), and emotional well-being ( P = .017) QOL dimensions.Financial hardship, QOL, and symptom burden scores demonstrate need for continued support for and research among patients with advanced cancer. Data support links between FH and important QOL dimensions. Larger, longitudinal studies are needed to understand how FH affects QOL in patients with advanced cancer.Proactive financial assessment and interventions are needed to support patients with advanced cancer experiencing the cumulative effects of cancer and its treatment.

BACKGROUND Evidence suggests that intravaginal practices (IVPs) women use to cleanse their vagina or enhance sexual pleasure may be associated with unhealthy changes in the vaginal microbiome (VM). However, the effects of these practices in postmenopausal women are unknown. OBJECTIVES The objective of this pilot study was to characterize the VM communities of postmenopausal women, identify types and frequency of IVPs, and explore associations between the VM and IVPs in postmenopausal women. METHODS We analyzed the VM data of 21 postmenopausal women in Atlanta, Georgia, from vaginal swabs collected at a routine gynecological visit. 16S rRNA gene sequencing in the V3-V4 region was used to characterize the VM. In addition, we described the IVPs of these women, identified by using our newly developed instrument: the Vaginal Cleansing Practices Questionnaire. The associations between the VM and IVPs were explored by comparing the alpha diversities, beta diversities, and the relative abundances at both the community level and individual genus level. RESULTS The most abundant known bacterial genus found in the VM samples was Lactobacillus (35.7%), followed by Prevotella (21.4%). Eleven women (52%) reported using at least one type of IVP since menopause. The most common type of IVP was soap and water to clean inside the vagina. The use of IVPs was not associated with any alpha diversity metric, including Shannon index, inverse Simpson index, and Chao1 index; beta diversity metric, including Bray-Curtis and Jaccard distances; nor relative abundances at the community and individual genus level. Sociodemographic factors were also not associated with any alpha diversity metric. DISCUSSION Clinicians must assess IVPs and other vaginal and sexual hygiene practices of women of all ages to educate and promote healthy behaviors. More than half of the postmenopausal women in this pilot study use IVPs. Understanding the reasoning behind participants' use of IVPs and their perceptions of the possible effects of these practices will require further research. Although the small sample did not show associations with the VM, more extensive studies are warranted.

Background Despite the human papillomavirus (HPV) vaccine being a safe, effective cancer prevention method, its uptake is subomptimal in the United States (U.S.). Previous research have found a variety of intervention strategies (environmental and behavioral) in increasing its uptake. The purpose of the study is to systematically review the literature for interventions to promote HPV vaccination from 2015 to 2020. Methods We updated a systemative review of interventions to promote HPV vaccine uptake globally. We ran key word searches in six bibliographic databases. Audiences, design, level of intervention, components and outcomes were abstracted from the full-text articles in Excel databases. Results Of the 79 articles, most were conducted in the U.S. (72.2%) and in clinical (40.5%) or school settings (32.9%), and were directed a single level (76.3%). Related to the intervention type, most were informational (n = 25, 31.6%) or patient-targeted decision support (n = 23, 29.1%). About 24% were multi-level interventions, with 16 (88.9%) combining two levels. Twenty-seven (33.8%) reported the use of theory in intervention development. Of those reporting HPV vaccine outcomes, post-intervention vaccine initiation ranged from 5–99.2%, while series completion ranged from 6.8–93.0%. Facilitators to implementation were use of patient navigators and user-friendly resources, while barriers included costs, time to implement and difficulties of integrating interventions into organizational workflow. Conclusions There is a strong need to expand implementation of HPV-vaccine promotion interventions beyond education alone and at a single level of intervention. Development and evaluation of effective strategies and multi-level interventions may increase the uptake of the HPV vaccine among adolescents and young adults.

As obesity prevalence among gynecologic cancer (GC) survivors is expected to increase, the role of obesity in sexual health needs to be understood. This systematic review examined the impact of obesity on patient-reported sexual health outcomes (SHOs) in this population. PubMed, Embase, Web of Science, CINAHL, and PsycINFO were searched for original studies published between 2015 and 2020 following the Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. We performed a narrative synthesis of findings via cancer type, cancer treatment, sexual health measures, and countries. Eleven observational studies were included. Most were conducted in European countries (n = 7), reported on endometrial cancer survivors (n = 7), and defined obesity as body mass index ≥30 kg/m

PURPOSE: This cross-sectional study evaluated congruence in pain assessment among Black cancer patients taking opioids for pain and their family caregivers and the effects of patient-reported depressive symptoms and cognitive complaints on the congruence. METHODS: Patient-reported pain scores (current, average, and worst pain severity and pain interference) and caregiver proxy scores were independently assessed (Brief Pain Inventory). Patient-reported depressive symptoms (Patient Health Questionnaire-8) and cognitive complaints (Cognitive Difficulties Scale) were also assessed. Paired t-test, intraclass correlation coefficient (ICC), and Bland-Altman (BA) plots were used to evaluate group and dyad level congruence in pain assessment. The influence of patient depressive symptoms and cognitive complaints on congruence was examined using bivariate analyses and BA plots. RESULTS: Among 50 dyads, 62% of patients and 56% of caregivers were female. Patients were older than caregivers (57 vs. 50 years, p=.008). Neither statistically significant (t-test) nor clinically relevant mean differences in pain severity and interference were found at a group level. At the dyad level, congruence was poor in pain now (ICC=0.343) and average pain severity (ICC=0.435), but moderate in worst pain severity (ICC=0.694) and pain interference (ICC=0.603). Results indicated better congruence in pain severity between patients with depressive symptoms and their caregivers, compared to patients without depressive symptoms. Patient CDS scores had no significant correlations with score differences between patients and caregivers in any pain variables. CONCLUSION: Congruence varied depending on how the analysis was done. More information is needed to understand pain assessment between patients and caregivers.

Sleep disturbance is prevalent among caregivers of people living with dementia. However, gaps exist about caregivers’ sleep patterns before and during their caregiving trajectory. This exploratory secondary analysis using a qualitative descriptive approach aimed to (1) identify and describe current caregivers’ patterns of change in sleep before and during caregiving, and (2) understand caregivers’ perceptions of their current sleep compared to their pre-caregiving sleep. We conducted semi-structured interviews with 19 caregivers taking part in a larger randomized controlled trial. Participants were female (n = 11), white (n = 13) and on average 63 years of age. Interview questions focused on caregivers’ sleep patterns. The interviews were audio-recorded using a videoconferencing platform and ranged from 20 to 45 minutes. We conducted thematic analysis of the interview transcripts. Three distinct caregiver-sleep profiles emerged from the qualitative data: changed and dissatisfied, changed and satisfied, and unchanged and dissatisfied. Caregivers whose sleep was categorized as changed reported a difference when comparing their current sleep pattern to their pre-caregiving sleep pattern. This was usually a change from good to poor sleep. Caregivers whose sleep was unchanged had poor sleep pre-caregiving and continued to have poor sleep during caregiving. Caregivers also reported being satisfied or dissatisfied with their current sleep pattern, defined in terms of distress and impairment. These three subtypes highlight the heterogeneity of caregivers’ sleep experiences and debut a useful clinical framework with which to identify, categorize, and target caregivers at risk for sleep disturbance, many who may be ready to engage in behaviors to improve their sleep. Knowing caregivers’ sleep profiles will enable health care providers and researchers to determine caregivers’ needs and readiness for interventions then work collaboratively with them to improve their sleep problems.

Objective To pilot test a mobile health intervention using a CONnected CUstomized Treatment Platform that integrates a connected electronic adherence monitoring smartbox and an early warning system of non-adherence with bidirectional automated texting feature and provider alerts. Methods In total, 29 adult women with hormone-receptor-positive, human epidermal growth factor receptor 2-negative metastatic breast cancer and a prescription for palbociclib were asked to complete a survey and participate in a CONnected CUstomized Treatment Platform intervention, including use of a smartbox for real-time adherence monitoring, which triggered text message reminders for any missed or extra dose, and referrals to (a) participant's oncology provider after three missed doses or an episode of over-adherence, or (b) a financial navigation program for any cost-related missed dose. Use of smartbox, number of referrals, palbociclib adherence, CONnected CUstomized Treatment Platform usability measured by System Usability Scale, and changes in symptom burden and quality of life were assessed. Results Mean age was 57.6 and 69% were white. The smartbox was used by 72.4% of participants, with palbociclib adherence rate of 95.8%±7.6%. One participant was referred to oncology provider due to missed doses and one was referred to financial navigation. At baseline, 33.3% reported at least one adherence barrier including inconvenience to get prescription filled, forgetfulness, cost, and side effects. There were no changes in self-reported adherence, symptom burden or quality of life over 3 months. CONnected CUstomized Treatment Platform usability score was 61.9 ± 14.2. Conclusion The CONnected CUstomized Treatment Platform interventions is feasible, resulting in a high palbociclib adherence rate without any decline in overtime. Future efforts should focus on improving usability.

PURPOSE: To assess the reasons why patients do not consent to patient-reported outcome (PRO) and electronic PRO data capture components of clinical trials and potential selection bias by having a separate consent. METHODS AND MATERIALS: Selected NRG Oncology trials were included based on disease site and inclusion of PROs and electronic PRO data capture via VisionTree Optimal Care as separate consent questions. Reasons for not participating were assessed. Pretreatment characteristics between patients who did and did not consent were tested using χ(2) and t tests for univariate comparisons and logistic regression for multivariable analyses. RESULTS: Ten trials were selected in head and neck, prostate, gynecologic, breast, lung, and gastrointestinal cancers, with 4 of these trials having electronic PRO data capture. Most patients consented to the PRO component (75.3%) but not electronic PRO data capture (37.8%). More white patients consented to PROs than nonwhite patients across all trials (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.45-0.63; P < .001), and more patients with education after high school consented compared with those with less education (OR, 1.71; 95% CI, 1.46-2.02; P < .001). Patients who are younger (OR, 0.63; 95% CI, 0.47-0.85; P = .002), white (OR, 0.60; 95% CI, 0.44-0.82; P = .001), and a never or former smoker (OR, 0.57; 95% CI, 0.41-0.78; P = .001) are more likely to participate in electronic PRO data capture. CONCLUSIONS: These results suggest that a patient’s race, age, and education can affect whether a patient chooses to consent or is offered to participate in PRO or electronic PRO data capture components. More investigation is needed, but this analysis provides support for making PROs integrated in the trial.

Over a quarter of chemotherapy regimens now include oral agents. Individuals living with cancer are now responsible for administering this lifesaving therapy at home by taking every dose as prescribed. One type of oral chemotherapy, tyrosine kinase inhibitors (TKIs), is the current recommended treatment for chronic myeloid leukemia. This targeted therapy has markedly improved survival but comes with significant side effects and financial costs. In the study described in this protocol, the investigators seek to understand the dynamic nature of TKI adherence experienced by individuals diagnosed with CML. Using a mixed method approach in this prospective observational study, funded by the National Cancer Institute, we seek to describe subjects’ adherence trajectories over one year. We aim to characterize adherence trajectories in individuals taking TKIs using model-based cluster analysis. Next, we will determine how side effects and financial toxicity influence adherence trajectories. Then we will examine the influence of TKI adherence trajectories on disease outcomes. Additionally, we will explore the experience of patients taking TKIs by interviewing a subset of participants in different adherence trajectories. The projected sample includes 120 individuals taking TKIs who we will assess monthly for 12 months, measuring adherence with an objective measure (Medication Event Monitoring System- MEMS(®)). Identifying differential trajectories of adherence for TKIs is important for detecting subgroups at the highest risk of nonadherence and will support designing targeted interventions. Results from this study can potentially translate to other oral agents to improve care across different types of cancer.

Public health concerns regarding opioids and marijuana have implications for their medical use. This study examined use motives and perceived barriers in relation to opioid and marijuana use and interest in use among US adult cancer survivors. Self-administered surveys were distributed using social media to assess use motives and perceived barriers among participants living with cancer. Overall, 40.9% of cancer survivors reported current (past 30-day) use of opioids, 42.5% used marijuana, and 39.7% used both. The most common use motives for either/both drugs were to cope with pain and stress/anxiety (>70%). Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and not wanting to talk about their symptoms. Controlling for sociodemographics, binary logistic regression indicated that current opioid use was associated with reporting greater barriers to use (OR = 1.17, p = .011; Nagelkerke R-square = .934) and that current marijuana use was associated with reporting greater barriers to use (OR = 1.37, p = .003; Nagelkerke R-square = .921). Cancer survivors report various use motives and barriers to use regarding opioids and marijuana. While use motives and barriers for both drugs were similar, these constructs were differentially associated with use and interest in use across drugs. Understanding patients’ perceptions about opioids and marijuana is an essential component to effectively manage symptoms related to a cancer diagnosis and improve quality of life for cancer survivors.

To describe perceptions of financial navigation staff concerning patients' cancer-related financial burden.This qualitative descriptive study used a semi-structured interview guide to examine perceptions of financial navigation staff concerning patients' cancer-related financial burden. Staff who provided financial navigation support services to cancer patients were interviewed from different types of cancer programs across seven states representing rural, micropolitan, and urban settings. Interviews lasted approximately one hour, were audio recorded, and transcribed. Transcripts were double coded for thematic analysis.Thirty-five staff from 29 cancer centers were interviewed. The first theme involved communication issues related to patient and financial navigation staff expectations, timing and the sensitive nature of financial discussions. The second theme involved the multi-faceted impact of financial burden on patients, including stress, difficulty adhering to treatments, and challenges meeting basic, non-medical needs. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: Cancer-related financial burden has a profound impact on cancer survivors' health and non-health outcomes. Discussions regarding cancer-related costs between cancer survivors and healthcare team members could help to normalize conversations and mitigate the multi-faceted determinants and effects of cancer-related financial burden. As treatment may span months and years and unexpected costs arise, having this discussion regularly and systematically is needed.

Background: Black cancer patients experience pain. Barriers to opioid medications for pain may include geographic factors. This study examines neighborhood factors associated with difficulties receiving prescription opioids from pharmacies for black cancer patients. Design: A secondary data analysis of a study on opioid adherence was used to examine neighborhood-level and individual factors related to difficulties filling prescriptions for opioids. Setting/Subjects: Patients being treated for cancer pain with opioids (n = 104) were recruited. All self-identified as black, were 21 years or older, had cancer diagnoses, and had been prescribed extended release opioids. Measurements: A seven-item survey to identify problems filling opioids was completed by 98 participants along with a nine-item scale to assess perceived neighborhood characteristics. Scales of neighborhood amenities and neglect were created from the perceived neighborhood characteristics scale using principal components analysis. The 2009–2013 American Community Survey data were used to estimate the census tract percentage of non-Hispanic black residents, residents ≥25 years of age without a high school degree or equivalent, and households earning below the federal poverty level within the past 12 months. Results: Nearly 51% reported problems getting their opioids filled: 28% had to wait days and 24% had to return to the pharmacy multiple times. The main theme identified in analysis of an open-ended question was pharmacies not stocking medication. Neighborhood locations that rated higher on the amenities scale were protective for pharmacies sufficiently stocking opioids. Conclusions: Additional research on pharmacies sufficiently stocking opioid pain and neighborhood perceptions is warranted.

Oral therapies have become a common treatment choice for several lymphoid cancers. While therapeutic efficacy and patient preference for this therapy type have been reported, there is a lack of knowledge about its effectiveness for lymphoma in clinical practice, particularly in regard to the effects of medication nonadherence. While studies of oral medications in other diseases have shown that adherence is a major factor in outcomes and costs, there is scant research investigating adherence specifically in lymphoma patients, who face unique challenges in their diseases and treatments. To address the limited data available, we constructed a conceptual model and highlighted key opportunities for future research to better elucidate oral therapy adherence in lymphoma. This research will hopefully improve understanding and efficacy of oral treatment for lymphoma patients, while also informing other cancers utilizing oral therapies currently and in the future.

Background: As the prevalence of obesity in women increases in the US, a better understanding of the effect of obesity on women with gynecologic cancer (GynCa) is imperative. However, whether obesity impacts sexual functioning (SF) in GynCa patients has been understudied. Limited studies have used body mass index (BMI) as the only obesity indicator, which may result in a misunderstanding of the effect of obesity on SF in GynCa patients with different body compositions. This study aimed to explore the role of obesity via two different measures in determining SF in GynCa patients pre-and post-radiotherapy (RT). Methods: In this secondary analysis, obesity was measured pre-RT by both BMI and body fat percentage (BFP). BFP was calculated by using the Clinica Universidad de Navarra-Body Adiposity Estimator. SF, physical and emotional well-being were assessed pre-RT by the Female Sexual Function Index and the Functional Assessment of Cancer Therapy-General. At 6 months post-RT, SF was reassessed. Generalized linear models (GLM) and generalized linear mixed models (GLMM) with a log-link were implemented to identify the effect of obesity (using BMI and BFP) on SF pre-and post-RT. Regression-based mediation analysis was used to identify mediating effects of physical and emotional well-being between obesity and SF. Results: Among 54 (24 cervical and 30 endometrial) patients, 48% were Black, 52% were married or in a domestic partnership, and 59% were treated with surgery and/or chemotherapy pre-RT (i.e. prior treatment). Less patients were classified as being obese when obesity was measured by BMI (48%) compared to BFP (61%). Patients with endometrial cancer and prior treatment history were more likely to be obese and reported better SF. Unadjusted GLM showed that patients with obesity had better SF than those without obesity pre-RT regardless of obesity measures (BMI p = .018; BFP p = .016). However, we found no association between obesity (both BMI-and BFP-based obesity) and SF pre-RT after adjusting for cancer type and prior treatment history. GLMM showed that BFP-based obesity had a negative effect on the improvement in SF from pre-RT to post-RT (p = .013) after adjusting for cancer type and prior treatment history. Patients without BFP-based obesity showed a significant improvement post-RT (p = .019), but those with obesity (per BFP) showed no changes in SF post-RT (p = .949) compared to pre-RT. BMI-based obesity did not affect the changes in SF post-RT. We found no mediation effects of physical and emotional well-being between obesity and SF. Conclusions: Obesity may play a negative role in SF improvement in GynCa patients post-RT. More rigorous research and clinical attention to obesity measurement are necessary to determine the association between obesity and SF in GynCa patients and thus lead to the discovery of new interventions for this long-neglected topic of SF in GynCa patients, particularly for those who are obese. Citation Format: Haerim Lee, Deborah W. Bruner, Yi-Juan Hu, Jinbing Bai, Tony Y. Eng, Joseph W. Shelton, Pretesh R. Patel, Namita Khanna, Isabelle Scott, Katherine A. Yeager. Impact of obesity on sexual functioning in women with gynecologic cancer pre-and post-radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5940.

Objectives: To explore pharmacists’ perspectives on practice, availability, and barriers related to opioids. Methods: This cross-sectional study evaluated pharmacists’ perspectives on practice, availability, and barriers related to opioids. Electronic surveys were distributed to pharmacists practicing in Georgia via Survey Monkey. The χ2 or Fisher Exact test was used to test differences in practice, availability, and barriers with respect to type of pharmacy and location of pharmacy. Results: Most participating pharmacists practiced in an independent (47%) or community chain pharmacies (37%). The majority checked the Prescription Drug-Monitoring Program (PDMP) on a regular basis (73%), and about a third reported contacting the prescriber prior to dispensing. The most common barrier included concerns about diversion (82%) and illicit use (90%). About two-thirds reported experiencing a shortage of opioids. Significant differences ( P < .05) were found between types of pharmacy in dispensing practices, availability, and barriers. No significant differences were found with respect to pharmacy location. Conclusion: Findings suggest that pharmacists are facing challenges in availability of opioids and are employing stewardship approaches to optimize dispensing practices. This research provides insight regarding broken links in the “pain relief chain” and identifies opportunities to improve the accessibility of opioids when medically indicated. Pharmacists can play an important role in addressing the opioid crisis as well as providing quality care to patients with cancer seeking pain relief.

OBJECTIVES: To identify research priorities addressing COVID-19 that build on the 2019-2022 Oncology Nursing Society (ONS) Research Agenda, in alignment with ONS's mission to promote excellence in oncology nursing and quality cancer care. METHODS A VARIABLES: Priority areas were identified using a multistep approach combining rapid review of the literature; consultation with experts/stakeholders; and review of priorities from other funding agencies, public health, and cancer-focused organizations. RESULTS: The rapid research response team identified five priority areas for research related to COVID-19. IMPLICATIONS FOR NURSING: Oncology nurses are well positioned to address the research priorities and cross-cutting themes identified through this review. The use of innovative methodologic approaches and attention to disparities are necessary to advance cancer care related to COVID-19.

Objectives: In this study, we examined use of and interest in using opioids and marijuana, particularly in relation to use motives and perceived barriers to use, among people living with HIV (PLWH). Methods: We analyzed online survey data from 304 PLWH in the United States recruited via social media in Summer 2018. Results: In this sample (Mage = 30.86, 40.5% male, 64.5% white), 16.1% reported current (past 30-day) use of opioids, 18.1% marijuana, and 15.8% both. Participants reported more use motives and fewer barriers to using marijuana versus opioids (p's < .001). The most frequently endorsed motive for using either/both drugs were to cope with pain and stress/anxiety. Highest-rated barriers to using either/both drugs were missing symptoms of worsening illness and addiction concerns. Regression analyses indicated that current opioid use correlated with reporting greater opioid use motives; among past-month opioid nonusers, greater interest in using opioids correlated with greater opioid use motives. Current marijuana use correlated with reporting greater marijuana use motives and greater barriers; among past-month marijuana nonusers, greater interest in using marijuana correlated with greater marijuana use motives and fewer barriers. Conclusions: Use motives and barriers differentially correlated with use and interest in use across drugs, thereby indicating different intervention approaches to address appropriate use.

The purpose of this project was to develop and test the feasibility and preliminary efficacy of a video about cancer clinical trials (CCTs) developed for breast cancer patients. We developed 2 brief 7-min videos that focused on breast cancer patients describing their experiences participating in CCTs, supplemented with doctors and research staff explaining key research concepts. One video was culturally tailored to Black patients and the other to White patients. To assess feasibility study, participants and their care providers completed a survey to evaluate their satisfaction with the video. Eligibility criteria for the study included ≥ 21 years of age, English-speaking, no prior experience participating in a CCT, and being potentially eligible for breast CCT enrollment. Preliminary efficacy was evaluated with a pretest-posttest design using a single item asking about intent to enroll in a clinical trial. The mean age of the patient sample (n = 50) was 53.0 years, and 50.0% were Black. Participants reported that the video was in the right length, useful, and easy to understand. Providers’ evaluation (n = 5) revealed that viewing the video helped prepare patients for further CCT discussion. Preliminary efficacy showed no statistically significant difference in participant interest in CCT enrollment pre- and post-video. Changes in patients’ intent in enrollment were associated with age and education. Culturally adapted video interventions can be helpful in supporting both patients and providers throughout the CCT education process but additional work is needed to improve enrollment into clinical trials.

Communicating is essential. The communication chain within units and facilities must be kept strong. Good communication will help staff take responsibility for one another; knowing your work family is looking out for you can offer strength. Respecting each other encourages speaking up to create a platform for shared decision-making and problem-solving. Such shared responsibility will yield the best solutions because the whole is stronger together than individuals alone. Speaking up also is a way to offer immediate feedback if mistakes are observed so that errors are corrected. And when, not if, mistakes are made, staff need to be able to communicate these without fear of retribution.

Introduction Cancer clinical trials (CCT) provide much of the evidence for clinical guidelines and standards of care. But low levels of CCT participation are well documented, especially for minorities. Methods and materials We conducted an online survey of 556 recruitment practices across the NRG Oncology network. Survey aims were 1) to learn how sites recruit minority/underserved populations; 2) to better understand the catchment areas of the NRG institutions; and 3) to aid in planning education programs for accrual of minority/underserved populations. Results The survey response rate was 34.9%. The most effective methods reported for recruiting minority/underserved participants were patient navigators (44.4%) and translators (38.9%). All institutions reported using a mechanism for eligibility screening and 71% of institutions reported using a screening/enrollment tracking system. CCT training was required at 78.1% and cultural competency training was required at 47.5% of responding institutions. Only 19.9% of sites used community partners to assist with minority recruitment and just 37.1% of respondents reported a defined catchment area. Sites reported very little race and ethnicity data. Conclusion This NRG Oncology online survey provides useful data for improvements in trial enrollment and training to recruit minority/underserved populations to CCT. Areas for further investigation include web-based methods for recruitment and tracking, cultural competency training, definition of catchment areas, use of patient navigators, and community partnerships. The survey results will guide recruitment training programs.

Cancer is associated with disease-related and treatment-related symptoms. Little is known about the symptom experience of black individuals with advanced cancer especially those with limited financial resources. Therefore, the purpose of this study was to explore the symptom experience of black adults with advanced cancer living in poverty. This qualitative descriptive study focused on the perspectives of the participants experiencing at least two symptoms related to cancer. A purposive sample of 27 individuals receiving care at a public hospital in a southeastern city participated in the study. Semi-structured audiotaped interviews were conducted by two research interviewers. Content analysis was used to develop themes to describe the symptom experience. Two main themes emerged in terms of the participants’ symptom experiences: (1) “living in pain,” which included the overwhelming experience of pain, both physical and emotional, and (2) “symptoms associated with functioning in everyday life.” Participants frequently used the context of activities in their daily lives to explain symptoms, including the effect of symptoms on the activities of eating, moving and doing, and communicating. People with advanced cancer work to negotiate a high frequency of multiple distressful symptoms of severe-to-moderate severity. Information gained from this study can help guide research in symptom science and provide direction for clinicians working with this minority group.

Background: Prostate cancer is the most common cancer among men. Monitoring of patient-reported outcomes (PROs) can enhance provider-patient communication, promote better decision-making, and improve survival. Geospatial factors, namely rurality and neighborhood socioeconomic deprivation, could influence the experience across cancer treatment, thus impacting PROs and survival. This study examined associations of rurality, neighborhood socioeconomic deprivation (Area Deprivation Index [ADI]) with cancer treatment-related PROs and survival in men with prostate cancer. Methods: Data from men with prostate cancer in the trial NRG Oncology/RTOG 0415 were analyzed. In this trial, 1092 men were randomized to receive conventional radiotherapy (RT) or hypofractionated RT. Patients had Gleason scores of 2-6 and prostate-specific antigen of Results: We analyzed 751 patients with complete data. Patients from the ADI 25% most deprived neighborhoods (vs. the other 75% of neighborhoods) were more likely to be non-white, unmarried and from rural areas. At baseline, patients from the most deprived areas had worse EPIC bowel score (P=0.011), worse sexual score (P=0.042) and worse hormonal score (P=0.015); patients from the most deprived areas had worse self-care (P=0.04) and more pain (P=0.047). Patients from rural areas had worse EPIC urinary score (P=0.03) and sexual score (P=0.003). Longitudinal analyses showed that ADI 25% most deprived areas (β=4.05, P=0.001) and rural areas (β=-5.70, P=0.003) were associated with worse EQ-5D VAS score. Compared to the 75% less deprived neighborhoods and urban, the ADI 25% most deprived neighborhoods and rural areas respectively had 47% (HR=1.466, P=0.033) and 93% (HR=1.925, P=0.026) relative increase in risk of recurrence or death (DFS). No differences were seen in OS. Conclusions: Patients with prostate cancer from the most deprived neighborhoods and rural areas had low QOL at baseline, poor general health and DFS. Interventions should target populations from socioeconomic deprived neighborhoods and rural areas to improve patient access to supportive care services and DFS. Citation Format: Jinbing Bai, Stephanie L. Pugh, Ronald Eldridge, Katherine Yeager, Qi Zhang, W Robert Lee, Amit B. Shah, Ian S. Dayes, David P. D'Souza, Jeff M. Michalski, Jason A. Efstathiou, John M. Longo, Thomas M. Pisansky, Jordan M. Maier, Sergio L. Faria, Anand B. Desai, Samantha A. Seaward, Howard M. Sandler, Mary E. Cooley, Deborah W. Bruner. Rurality and neighborhood socioeconomic deprivation associated with patient-reported outcomes andsurvivalin men with prostate cancer in NRG RTOG 0415 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2528.

Context With concerns about opioid prescribing practices prominent in the professional and lay literature, there is less focus on patients' self-management of opioids for cancer pain and potential safety risks. Objectives To investigate reports of opioid self-management practices and concerns among patients undergoing active cancer treatments—a group excluded from the scope of most policy initiatives on prescription opioids. Methods This sequential multimethod study used freelisting (n = 65) and open-ended semistructured interviews with a racially diverse subgroup (n = 32). Adult ambulatory patients with solid malignancies or multiple myeloma and pain (≥4 on a scale of 0–10) were recruited from an urban National Cancer Institute–designated cancer center in Philadelphia. Freelists were analyzed using consensus analysis and semistructured interview data were analyzed using thematic analysis. Results In freelisting, “pain relief” emerged as the primary term in relation to taking pain medications preceding “addiction” concerns. In interviews, patients described several heuristics and some potentially unsafe practices to minimize opioid use to a self-defined “normal.” These included reducing opioid dose by cutting pills; self-tapering off opioids; using extended-release/long-acting opioids on an as-needed basis; mixing over-the-counter, nonopioid analgesics; and using illicit drugs to avoid “harder medicines” (opioids). Many patients preferred nonopioid treatments for pain but invariably faced access barriers. Some described assuming stewardship of their prescribed opioids and felt that oncology clinicians are quick to prescribe opioids without providing workable alternatives. Conclusions Risks related to self-management of opioids among cancer outpatients, including potential overdose risks, need urgent attention. Interventions are needed for improving clinician-patient communication, patient education, safety, and access to effective nonopioid alternatives.

Background African Americans endure disproportionately high advanced cancer rates and also are disproportionately represented in the lower socioeconomic strata. These individuals work to manage symptoms in order to function and have a satisfactory quality of life. Objective The purpose of this study was to discover what low-income African American adults with advanced cancer do on a day-to-day basis to relieve and manage symptoms. This study viewed the individuals as experts and asked them not what they are told to do, but rather what they actually do. Methods A purposive sample of 27 individuals participated in semistructured interviews conducted by 2 research interviewers. This qualitative descriptive approach used content analysis to develop themes to describe symptom self-management. Results Participants described 2 approaches: making continual adjustments and finding stability through spirituality. In seeking comfort from the distress of their symptoms, they were constantly altering their activities and fine-tuning strategies. They adjusted medical regimens and changed the speed and selection of daily activities, including comfort measures and diet modifications. In contrast, their spirituality was a consistent presence in their lives that provided balance to their unstable symptom experience. Conclusions This study illustrates that people with advanced cancer actively engage in multiple complex self-management strategies in response to symptoms. Implications for practice As providers assess how individuals manage their symptoms, they must find ways to support those efforts. Providers then will recognize the challenges faced by advanced cancer patients in obtaining the best quality of life while managing multiple symptoms, activities, and family responsibilities.

Despite initiatives to increase the enrollment of racial and ethnic minorities into cancer clinical trials in the National Cancer Institute National Cancer Clinical Trials Network (NCCTN), participation by Latino and African American populations remain low. The primary aims of this pilot study are (1) to develop a Cultural Competency and Recruitment Training Program (CCRTP) for physician investigators and clinical research associates (CRAs), (2) to determine if the CCRTP increases cultural competency scores among physician investigators and CRAs, and (3) to determine the impact of the CCRTP on minority patient recruitment into NRG Oncology Radiation Therapy Oncology Group (RTOG) clinical trials. Sixty-seven CRAs and physicians participated in an in-person or online 4-h CRRTP training. Five knowledge and attitude items showed significant improvements from pre- to post-training. A comparison between enrolling sites that did and did not participate in the CCRTP demonstrated a pre to 1-year post-incremental increase in minority accrual to clinical trials of 1.2 % among participating sites. While not statistically significant, this increase translated into an additional 300 minority patients accrued to NCCTN clinical trials in the year following the training from those sites who participated in the training.

Cancer pain relief is often inadequate because of poor adherence to pain medication, especially for black patients.The purpose of this study is to describe factors related to adherence to around-the-clock opioids among 110 black patients being treated for cancer pain.Sociodemographic, clinical, symptoms, and social support data were collected at baseline; pain and adherence data were collected at 30 days. Associations between these variables and opioid adherence measured by Medication Event Monitoring System were estimated using multiple regression.Mean age was 56 (±10.1), the majority were women (63%) and college educated (56%). Mean pain severity at baseline equaled 4.6 (±2.3). Mean dose adherence was 60% (±28.5), while mean schedule adherence was 33.0% (±31.0). In adjusted analysis, 26% of the variance in dose adherence was explained by recent chemotherapy, changes in pain, concerns about nausea, and doctors' focus on cure versus pain control (P0.001); 27% of the variance in schedule adherence was explained by recent chemotherapy, changes in pain, symptom burden, and concerns about doctors focus on cure versus pain control (P0.001).Findings confirm pain medication adherence is poor and pain was not well relieved. Multiple factors influence adherence to around-the-clock opioids. Clinicians need to partner with patients by providing a personalized pain treatment plan including an in-depth assessment of treatment choices and adherence.

The objective of this study was to examine the associations between spirituality and overall quality of life (QOL) and individual QOL domains in black patients with cancer pain.A secondary data analysis of a parent study exploring pain medication adherence in black patients receiving around-the-clock opioids with cancer pain was performed. All the participating patients completed Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (spirituality), Brief Pain Inventory (pain severity and interference), Edmonton Symptom Assessment Scale (symptoms), and Functional Assessment of Cancer Therapy-General (QOL). Pearson correlation and multiple linear regression analyses were conducted to examine the associations between spirituality and overall QOL and QOL domains and to identify the predictors of overall QOL and QOL domains.Black patients treated for cancer pain (n = 102) completed the study. Pearson correlation showed significant positive associations between spirituality and overall QOL (P 0.001) and individual QOL domains (physical, social, emotional, and functional). Higher spirituality was associated with lower pain severity (P = 0.01), pain interference (P = 0.001), and total symptoms score (P 0.001). In multiple regression analysis, the best model for the overall QOL explained 67% of the variance (P 0.001) and included total symptoms score, pain interference, spirituality, and age. Spirituality significantly predicted QOL domains of social (P 0.0001), emotional (P = 0.002), and functional well-being (P = 0.001) rather than physical well-being.Spirituality is associated with decreased pain and lower symptom burden and may serve as a protective factor against diminished overall QOL, specifically social, emotional, and functional domains in black patients with cancer pain. There is a need to develop spirituality-based interventions along with symptom management interventions to improve QOL for this population.

Background Fear surrounds Ebola Virus Disease (EVD) because it is highly infectious. Yet members of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) had to overcome that fear when caring for patients with EVD. Purpose The analysis reported here illustrates how the members of EUH's SCDU tacitly enacted high reliability (HR) principles while caring for patients with EVD. Methods A qualitative study was conducted to describe the experience of members of the EUH SCDU who worked with EVD patients in 2014. We completed 17 semi-structured interviews involving registered nurses, physicians, and support personnel (eg, laboratory technicians). Interview recordings were transcribed and analyzed using conventional content analysis. Exploring HR principles was not among the questions guiding this exploration, but the participants repeatedly described concepts related to HR. Results The goal of the SCDU team was to save patients' lives while protecting their own lives. Rigorous training and meeting high standards were required to make the team. The fear surrounding EVD set in motion the enactment of HR principles. HR principles served to alleviate failures or breakdowns in infection prevention and control, thus keeping patients and staff safe. Conclusions These findings illustrate that it is possible to move HR principles from theory to practice in high-risk situations. HR principles were essential to safety and to infection prevention and control.

To assess how accrual to clinical trials is related to US minority population density relative to clinical trial site location and distance traveled to Radiation Therapy Oncology Group (RTOG) clinical trial sites.Data included member site address and ZIP codes, patient accrual, and patient race or ethnicity and ZIP code. Geographic Information System maps were developed for overall, Latino, and African American accrual to trials by population density. The Kruskal-Wallis test was used to assess differences in distance traveled by site, type of trial, and race or ethnicity.From 2006 to 2009, 6168 patients enrolled on RTOG trials. The RTOG US site distribution is generally concordant with overall population density. Sites with highest accrual are located throughout the United States and parts of Canada and do not cluster, nor does highest minority accrual cluster in areas of highest US minority population density. Of the 4913 US patients with complete data, patients traveled a median of 11.6 miles to participate in clinical trials. Whites traveled statistically longer distances (12.9 miles; P.0001) to participate, followed by Latinos (8.22 miles) and African Americans (5.85 miles). Patients were willing to drive longer distances to academic sites than community sites, and there was a trend toward significantly longer median travel for therapeutic versus cancer control or metastatic trials.Location matters, but only to a degree, for minority compared with nonminority participation in clinical trials. Geographic Information System tools help identify gaps in geographic access and travel burden for clinical trials participation. Strategies that emerged using these tools are discussed.

Racial and ethnic diversity has historically been difficult to achieve in National Cancer Institute-sponsored clinical trials, even while as many as 80% of those trials have faced difficulty in meeting overall recruitment targets. In an attempt to address these issues, NRG Oncology recently convened a comprehensive workshop titled "Clinical Trials Enrollment: Challenges and Opportunities." Discussants at the workshop included representatives of the three legacy groups of the NRG (ie, Gynecologic Oncology Group, National Surgical Adjuvant Breast and Bowel Program, and Radiation Therapy Oncology Group), a minority-based community clinical oncology program, a large integrated health care system, the leadership of the National Cancer Institute, and a large patient advocacy group. This article summarizes the concepts discussed at the workshop, which included: needs assessments, infrastructural support, training of investigators and research staff, specific clinical trial recruitment strategies (both system and community based), and development and mentoring of young investigators. Many new, more specific tactics, including use of diverse cancer care settings, direct-to-consumer communication, and the need for centralized information technology such as the use of software to match trials to special populations, are presented. It was concluded that new, innovative trial designs and the realities of limited funding would require the adoption of effective and efficient recruiting strategies, specialized training, and stakeholder engagement. US clinical research programs must generate and embrace new ideas and pilot test novel recruitment strategies if they are to maintain their historic role as world leaders in cancer care innovation and delivery.

Insomnia is prevalent in caregivers of persons living with dementia (PLWD); however, more research is needed to identify which dyadic factors most impact caregiver sleep. This study aimed to identify the factors associated with caregiver insomnia in the baseline component of a randomized clinical trial. A linear regression was conducted with caregiver variables (e.g., depression), and PLWD variables (e.g., disruptive nighttime behaviors) as independent variables in relation to insomnia, as assessed with Insomnia Severity Index (ISI). Caregivers (n=49) were on average 63 years, mostly female (65.3%), White (69.4%), and spouses (65.3%). Mean ISI was 6.8, indicating mild-to-moderately disturbed sleep. Multiple linear regression (F(11,32) = 13.4, p

The Problem Organizations face several challenges that stand poised to place a significant strain on the availability of qualified leaders. Flatter organization structures, the use of more teams, and impending retirements of the Baby Boomer generation mean that the field of human resource development (HRD) must be prepared to help organizations develop the next generation of leaders. Scholars and practitioners must ensure that leader development initiatives will effectively prepare the forthcoming leaders from among young adults. The Solution The focus of this study was to develop an understanding of how leadership experiences shape leader identity development. We offer a model that explains the dynamic, interactive process of leader identity development. Specifically, this model identifies the importance of relationships, leading by example, authenticity, and the motivation to lead for young adults. The Stakeholders HRD scholars and practitioners may use the findings in this study to target developmental initiatives for future leaders.

PurposeThe use of teams in organizations given the current trend toward globalization, population changes, and an aging workforce, especially in high‐income countries, makes the issue of diverse team building critical. The purpose of this paper is to explore the issue of team diversity and team performance through the examination of theory and empirical research. Specifically, the paper seeks to answer the question: “How might individuals with diverse characteristics such as culture, age, work experience, educational background, aptitude and values, become successful team members?”.Design/methodology/approachA review of theories that are pertinent to individual differences and team formation, including social identity theory, mental models, inter contact theory, social comparison theory, and chaos theory, was conducted. Team formation and diversity literature were reviewed to identify ways of developing diverse and effective teams.FindingsIt is a truism that working together in teams is a smart way of achieving organizational performance goals. This paper discusses the theories, research and practices that underlie the development of efficient and effective teams. It demonstrates that recognizing the underlying individual differences, mental models, and assumptions that team members bring to the organization can help build teams that are able to overcome dysfunctional barriers and ensure performance improvement of the individuals, teams and organizations.Research limitations/implicationsThe approach used to review the literature is a limitation of this study as the authors may have missed a discussion surrounding an important concept or theory related to team diversity and performance.Practical implicationsHuman resource development interventions that target team building, team work and team learning include modules that raise awareness of the perspectives of team members' individual differences and appropriateness of actions. Training at the team level should focus on the interaction between factors that shape the identity of individuals. Procedures and work design systems should be redesigned to insure that the development of strong and functional teams is supported from a holistic and organizational perspective.Originality/valueThis paper highlights diversity issues related to individual differences that underlie team formation and suggests strategies needed to develop effective teams.

Open communication and proactive planning of care at the end-of-life (EOL) can protect patients from unwanted medical treatments and relieve family members and healthcare providers from making difficult decisions. End-of-life (EOL) communication and planning and associated factors were evaluated in a convenience sample of stage IV breast cancer patients (n = 174). A total of 40.7 per cent of the participants reported not having an advance directive and not verbally sharing their wishes with loved ones. Most (63 per cent) discussed EOL decisions with others, although over half (52 per cent) had not informed their loved ones or doctors about their preferences. Participants were most likely to discuss this issue with family, least likely to discuss it with healthcare professionals or clergy, and more likely to discuss with their lawyers (20.7 per cent) than their physicians (6.9 per cent). Over one-third (36.8 per cent) had not discussed EOL decisions with anyone. Older age, having dependent children...

We analyze here the behavior of the magnitudes of the F 1 and E peaks of the electron density profiles measured by the Radio Science Subsystem of the Mars Global Surveyor spacecraft, as a function of solar zenith angle χ and solar flux. For each of the 658 days of data in the six occultation seasons in the northern hemisphere, we choose one profile to analyze, which is that for which the F 1 peak is the median value. We assume that the variations of the measured peak densities can be represented as A ( cos χ ) a and as B ( F 10.7 ) b , where F 10.7 is the usual solar flux proxy, appropriately shifted to the orbital position of Mars. To minimize the effect of solar activity, we divide the data into 6 F 10.7 bins, fit the data in each bin, and derive the values of the exponent a and the coefficient A F 10.7 for each bin. The median values that we derive for the exponent a is 0.46 for the F 1 peak, and 0.395 for the E peak. To minimize the effect of SZA, we divide the data into eight SZA bins, and derive the exponent b and the coefficient B χ for each SZA bin. We argue that the last three SZA bins should be excluded because the fits were poor, due partly to the small number of data points in each of these bins. If we do so, the median values of b that we derive are 0.27 and 0.40 for the F 1 and E peaks, respectively. Finally we derive a 3-parameter fit to all the data, which expresses the variability of the peak densities as a function of ( cos χ ) a ′ and ( F 10.7 ) b ′ simultaneously. The fitted values of the exponents a ′ and b ′ for the F 1 peak are 0.45 and 0.26, respectively; for the E peak, the values are 0.39 and 0.46, respectively. We compare our results to Chapman theory, and to those of other investigators.

The study was conducted to test the feasibility of a telephone-based self-management program for adults with epilepsy. The program was based on social cognitive theory and principles of motivational interviewing (MI). Twenty-two adults with epilepsy were recruited from hospital-based epilepsy clinics. The mean age of participants was 43 years, and 68% were men. Participants were randomly assigned to the intervention or control group. Those in the intervention group received a five-session intervention with a nurse trained in MI counseling. Following an in-person introductory session, the remaining four sessions were conducted by phone. Ninety-five percent of the 55 planned MI sessions and the 44 planned courtesy calls for those in the control group were completed, demonstrating high acceptance of the program. Participants were very satisfied with the program and noted the benefits of the telephone delivery method. Analysis of outcomes provided support for continued development and testing of the program.

The purposes of the work described in this article were to (1) describe a model of predictive relationships among psychosocial variables and lifestyle management, and (2) test the model among people with epilepsy. The variables selected for the model were based on social cognitive theory and the results of previous studies examining psychosocial predictors of self-management among people with chronic physical health conditions. Variables included in the model were self-efficacy, outcome expectancies, depressive symptoms, and social support. Participants for the study were recruited from epilepsy treatment facilities in Boston, MA, and Atlanta, GA, USA. Half of the participants were female, 81% were white, and their mean age was 43.1 years. As predicted by social cognitive theory, self-efficacy was related to lifestyle management and explained 23% of its variation. Depressive symptoms were related to both self-efficacy and social support. Social support was related to self-efficacy. These findings suggest that lifestyle management is influenced by a number of relationships between psychosocial variables, particularly by self-efficacy.

The purpose of this study was to document seizure events associated with the use of a computer-based assessment and to describe the contextual factors surrounding these seizure episodes. Study participants were adults with epilepsy who were enrolled at research sites in Atlanta and Boston. Subjects were asked to complete a computer-based assessment at 3 time points. Fourteen seizure events were documented; they occurred during 1.6% of all completed assessments (896) and affected 4.4% of the participants (320). The mean age of participants who experienced seizure events was 41.4 years; about 70% were female, and 70% were white. A variety of possible precipitating factors for seizure events included hunger, fatigue, stress, and medication changes. Participants indicated computer use could have triggered their seizures in 2 instances. These findings suggest use of computer-based assessments may pose minimal risks for adults with epilepsy, particularly those without a history of photosensitivity epilepsy.

Background The global Ebola virus disease (EVD) epidemic of 2014/2015 prompted faculty at Emory University to develop an educational program for nursing students to increase EVD knowledge and confidence and decrease concerns about exposure risk. Purpose The purpose of this article is to describe the development, implementation, and evaluation of the EVD Just-in-Time Teaching (JiTT) educational program. Methods Informational sessions, online course links, and a targeted, self-directed slide presentation were developed and implemented for the EVD educational program. Three student surveys administered at different time points were used to evaluate the program and change in students' EVD knowledge, confidence in knowledge, and risk concern. Discussion Implementation of a JiTT educational program effectively achieved our goals to increase EVD knowledge, decrease fear, and enhance student confidence in the ability to discuss EVD risk. These achievements were sustained over time. Conclusion JiTT methodology is an effective strategy for schools of nursing to respond quickly and comprehensively during an unanticipated infectious disease outbreak.

This article describes the initial development and testing of the Antiretroviral Medication Complexity Index (AMCI), an instrument to measure complexity of antiretroviral medications and regimens. Data were derived from a pilot study and the main study of an intervention designed to promote adherence to antiretroviral medications. Interrater reliability coefficients ranged from .74 to 1.0 for project staff and from .33 to 1.0 for nurse clinicians. Test-retest coefficients ranged from .297 to .988 for forms completed by the same interviewer and from .200 to .922 for different interviewers. Strong relationships existed between rankings of the medications by clinical judgment and rankings of the medications using the AMCI, providing support for criterion validity. Complexity as measured by the AMCI was associated with some measures of adherence, providing partial support for construct validity. Results provide evidence for the reliability and validity of the AMCI when used for research purposes.