Cancer Treatment, Symptom Monitoring, and Self-care in Adults

A descriptive study was conducted on self-reported symptoms and self-care by 37 adults receiving chemotherapy primarily for leukemia, lymphomas, or breast cancer or radiation therapy for head and neck or lung cancers. The Therapy-Related Symptom Checklist and demographic and interview forms on self-care for identified symptoms were used. Severe symptoms on the Therapy-Related Symptom Checklist subscales fatigue, eating, nausea, pain, numbness in fingers/toes, hair loss, and constipation were reported by patients on chemotherapy. Those on radiation therapy reported severe symptoms on the eating, fatigue, skin changes, oropharynx, and constipation subscales.Self-care strategies were in the following categories, using complementary medicine as framework: diet/nutrition/lifestyle change (eg, use of nutritional supplements; modifications of food and of eating habits; naps, sleep, and rest); mind/body control (eg, relaxation methods, prayer, music, attending granddaughter's sports events); biologic treatments (vitamins); herbal treatments (green mint tea); and ethnomedicine (lime juice and garlic). The first category was predominantly used by patients in both treatment types. Medications were prescribed also to help control symptoms (eg, pain and nausea). Symptom monitoring and self-care for symptoms identified may be facilitated by the Therapy-Related Symptom Checklist; based on reported symptom severity, care providers may prioritize interventions. A larger study needs to be done on (a) the use of the Therapy-Related Symptom Checklist as a clinical tool to assess symptoms that oncology patients experience during therapy; (b) whether care providers, based on patient-reported symptom severity, can prioritize interventions--and how this influences the efficiency of care; (c) the self-care strategies used by patients on chemotherapy or radiation therapy or both; and (d) how useful these strategies are in alleviating symptoms.

Validity of the revised Impact on Family (IOF) scale

OBJECTIVE

To assess psychometric properties of the revised 15-item Impact on Family (IOF) Scale.

STUDY DESIGN

A secondary analysis of items using data collected from 252 parents during an earlier randomized clinical trial.

RESULTS

Exploratory factor analysis and confirmatory factor analysis identified a single factor with factor loadings similar to that of IOF developers. The one factor accounts for 45.7% of the sample variance. An Item Response Theory analysis found that 11 of the 15 items had alpha values greater than 1.00, with good to excellent item characteristic and item information curves. The test information and measurement error curves for the entire IOF were excellent. Construct validity of the IOF also was supported. Parent IOF scores correlated in the expected directions with maternal mood (r = -0.50), sibling behavior problems (r = -0.35), and severity of illness (r = 0.31) and were associated with family socioeconomic status (t = -4.5, all P < .001).

CONCLUSIONS

This study provides independent support for validity and reliability of the revised IOF scale. This scale is a promising, easy-to-use instrument for the measurement of impact of illness and disability on families of children with chronic illness or disability.

Thai mothers and children and the home observation for measurement of the environment (home inventory): pilot study

The HOME Inventory is a measure of home stimulation available to children. The purposes of the study were to: (a) examine the psychometric properties of a Thai-translated HOME (Infant/Toddler), (b) compare Thai mean HOME scores with three groups (Hmong, Eskimo, HOME normative sample in the state of Washington) reported in the literature. A convenience sample from Mahasarakham public health centers in northeastern Thailand was assessed using 36 dyads of mothers and toddlers, 13-35 months. The internal consistency was 0.81 for the total scale; F-tests of the HOME total scale and subscale means showed significant differences between Thai and three other groups. Scheffe tests which showed Thai means on three subscales (Maternal Involvement, Responsivity, Restriction) were not significantly different from the Washington sample, but were significantly lower on three subscales (Play, Organization, Stimulation). Further study is needed on the use of home assessment instruments by nurses and others working in multicultural settings.

Fatigue in mothers of infants discharged to the home on apnea monitors

A comparative study was done to determine differences in caregiver fatigue between two groups of mothers of preterm infants at baseline, in the hospital (Time 1), 1 week postdischarge (Time 2), and 1 month postdischarge (Time 3). Group 1 infants were discharged home on apnea monitors (AM) (n = 28), and Group 2 infants were not on apnea monitors (nonAM)(n = 46). Measured by the Multidimensional Assessment of Fatigue (MAF) scale, mean fatigue scores from Time 1 to Time 3 markedly increased for the monitor group and decreased for the nonmonitor group. The scores were significantly different between the two groups at Times 2 and 3 but not at baseline. Two-way analysis of variance (ANOVA) with repeated measures showed group by time interaction effects on fatigue. Monitoring and alleviation of fatigue in home caregivers of preterm infants on apnea monitors are necessary.