Androgen Deprivation and Sleep Disturbance: A Mixed Methods Pilot Study of Remote Assessment and Intervention

BACKGROUND

Men receiving androgen deprivation therapy (ADT) for prostate cancer (PC) are at risk for cardiovascular comorbidities and cognitive changes. Interventional research involves in-person assessment of physical fitness/activity and cognitive function, which has been negatively affected by the COVID-19 pandemic. Androgen deprivation therapy-related hot flashes and nocturia increase risk for insomnia. Insomnia is associated with fatigue and may exacerbate ADT-related cognitive changes.

OBJECTIVES

The purpose of this mixed-methods pilot was to (1) determine feasibility/acceptability of remotely assessing physical fitness/activity, cognitive function, and sleep; (2) deliver telehealth cognitive behavioral training for insomnia (teleCBT-I) to improve sleep; and (3) garner qualitative feedback to refine remote procedures and teleCBT-I content.

METHODS

Fifteen men with PC receiving ADT completed a 4-week teleCBT-I intervention. Videoconferencing was used to complete study assessments and deliver the weekly teleCBT-I intervention.

RESULTS

Self-report of sleep quality improved ( P < .001) as did hot flash frequency ( P = .04) and bother ( P = .025). Minimal clinically important differences were detected for changes in insomnia severity and sleep quality. All sleep logs indicated improvement in sleep efficiency. Remote assessment of fitness/cognitive function was demonstrated for 100% of participants. Sufficient actigraph wear time allowed physical activity/sleep assessment for 80%. Sleep actigraphy did not demonstrate significant changes.

CONCLUSIONS

Remote monitoring and teleCBT-I are feasible/acceptable to men with PC on ADT. Further research to confirm teleCBT-I efficacy is warranted in this population.

IMPLICATIONS FOR PRACTICE

Preliminary efficacy for teleCBT-I interventions was demonstrated. Remote assessments of physical fitness/activity, sleep, and cognitive function may enhance clinical trial access for rural or economically disadvantaged PC survivors.

EMBRACING GENDER DIVERSITY: REIMAGINING HEALTH AND HEALTH EQUITY FOR TRANSGENDER OLDER ADULTS

This presentation will share results of in-depth focus groups exploring eight transgender older adults’ (TOAs) experiences of health and healthcare and related themes, explain weathering and factors contributing to health and healthcare disparities, and apply the Sexual and Gender Minority Health Disparities Research Framework to explore strategies to address individual, interpersonal, community, and societal factors to foster health and health equity. TOAs represent an underserved population at elevated risk for lower socioeconomic status, higher rates of disability and chronic illness, and poorer overall physical and mental health compared to their non-transgender LGBQ and cisgender peers. Due to their unique life experiences including difficult decisions about “coming out” and transitioning, lack of acceptance of being transgender, and physiological impacts of hormonal and surgical treatments, transgender individuals experience long-term chronic stress and accumulate health-related risks as they age, contributing to significant health disparities. Higher levels of illness, disability, and premature death among historically disadvantaged groups can be explained by weathering, the accumulated impact of social disadvantages and socio-political inequalities over the life course producing premature biological aging. A 2019 systematic review of LGBTQ aging literature found that only 10% of studies included trans-identified participants and few addressed the needs of transgender older adults. Understanding the lived experiences of TOAs including healthcare access and receipt, and psychological, social, and financial experiences across the life course, is crucial to understanding current disparities in health and healthcare, developing strategies to improve care and reduce inequities, and fostering health and health equity of transgender older adults.

An Exploratory Study of Cognitive Function and Central Adiposity in Men Receiving Androgen Deprivation Therapy for Prostate Cancer

OBJECTIVES

To prospectively assess cognitive function, anthropomorphic measures, and bone mineral density in men receiving androgen deprivation therapy (ADT) for prostate cancer; explore relationships between cognitive function and central adiposity; and gather preliminary data from a personalized education, exercise, and nutrition intervention.

SAMPLE & SETTING

33 participants consented from a randomized controlled intervention trial.

METHODS & VARIABLES

Neurocognitive performance and self-report of cognitive function were assessed at baseline and 6 and 12 months. Dual-energy x-ray absorptiometry (DEXA) scans were obtained at baseline and 6 months.

RESULTS

No between-group differences in cognitive function were demonstrated. Increased visceral adiposity was not associated with decrements in visuospatial abilities. Significant increases in fat mass without increases in body mass index or waist-hip ratio provided further evidence for DEXA as the preferred central adiposity measure.

IMPLICATIONS FOR NURSING

Well-powered prospective research is needed to fully characterize the effects of ADT on cognitive function and the potential benefits of exercise and nutrition-based interventions.

Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American academy of nursing

BACKGROUND

The 2019-2020 American Academy of Nursing (Academy, 2019) policy priorities document states that "they have a clear and distinct focus on social determinants of health and uses this lens to advance policies and solutions within each of the three overarching priorities" PURPOSE: This consensus paper seeks to establish conceptual clarity and consensus for what social determinants of health mean for nursing, with emphasis on examples of health policies that advance planetary health equity and improve planetary health-related quality of life.

METHODS

Volunteers from five Expert Panels of the Academy met via videoconference to determine roles and refine the focus of the paper. After the initial discussion, the first draft of the conceptual framework was written by the first three authors of the paper and, after discussion via videoconference with all the co-authors, successive drafts were developed and circulated for feedback. Consensus was reached when all authors indicated acceptance of what became the final version of the conceptual framework.

DISCUSSION

A conceptual framework was developed that describes how the social determinants of health can be addressed through nursing roles and actions at the individual, family, and population levels with a particular focus on the role of health policy. The paper provides a specific health policy example for each of the six key areas of the social determinants of health to illustrate how nurses can act to improve population health.

CONCLUSION

Nursing actions can support timely health policy changes that focus on upstream factors in the six key areas of the social determinants of health and thus improve population health. The urgent need to eliminate systematic and structural racism must be central to such policy change if equity in planetary health-related quality of life is to be attained.

Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association

Cardiovascular disease and cancer are the leading causes of death in the United States, and hormone-dependent cancers (breast and prostate cancer) are the most common noncutaneous malignancies in women and men, respectively. The hormonal (endocrine-related) therapies that serve as a backbone for treatment of both cancers improve survival but also increase cardiovascular morbidity and mortality among survivors. This consensus statement describes the risks associated with specific hormonal therapies used to treat breast and prostate cancer and provides an evidence-based approach to prevent and detect adverse cardiovascular outcomes. Areas of uncertainty are highlighted, including the cardiovascular effects of different durations of hormonal therapy, the cardiovascular risks associated with combinations of newer generations of more intensive hormonal treatments, and the specific cardiovascular risks that affect individuals of various races/ethnicities. Finally, there is an emphasis on the use of a multidisciplinary approach to the implementation of lifestyle and pharmacological strategies for management and risk reduction both during and after active treatment.

The Histone Demethylase KDM3A, Increased in Human Pancreatic Tumors, Regulates Expression of DCLK1 and Promotes Tumorigenesis in Mice

BACKGROUND & AIMS

The histone lysine demethylase 3A (KDM3A) demethylates H3K9me1 and H3K9Me2 to increase gene transcription and is upregulated in tumors, including pancreatic tumors. We investigated its activities in pancreatic cancer cell lines and its regulation of the gene encoding doublecortin calmodulin-like kinase 1 (DCLK1), a marker of cancer stem cells.

METHODS

We knocked down KDM3A in MiaPaCa-2 and S2-007 pancreatic cancer cell lines and overexpressed KDM3A in HPNE cells (human noncancerous pancreatic ductal cell line); we evaluated cell migration, invasion, and spheroid formation under hypoxic and normoxic conditions. Nude mice were given orthotopic injections of S2-007 cells, with or without (control) knockdown of KDM3A, and HPNE cells, with or without (control) overexpression of KDM3A; tumor growth was assessed. We analyzed pancreatic tumor tissues from mice and pancreatic cancer cell lines by immunohistochemistry and immunoblotting. We performed RNA-sequencing analysis of MiaPaCa-2 and S2-007 cells with knockdown of KDM3A and evaluated localization of DCLK1 and KDM3A by immunofluorescence. We analyzed the cancer genome atlas for levels of KDM3A and DCLK1 messenger RNA in human pancreatic ductal adenocarcinoma (PDAC) tissues and association with patient survival time.

RESULTS

Levels of KDM3A were increased in human pancreatic tumor tissues and cell lines, compared with adjacent nontumor pancreatic tissues, such as islet and acinar cells. Knockdown of KDM3A in S2-007 cells significantly reduced colony formation, invasion, migration, and spheroid formation, compared with control cells, and slowed growth of orthotopic tumors in mice. We identified KDM3A-binding sites in the DCLK1 promoter; S2-007 cells with knockdown of KDM3A had reduced levels of DCLK1. HPNE cells that overexpressed KDM3A formed foci and spheres in culture and formed tumors and metastases in mice, whereas control HPNE cells did not. Hypoxia induced sphere formation and increased levels of KDM3A in S2-007 cells and in HPNE cells that overexpressed DCLK1, but not control HPNE cells. Levels of KDM3A and DCLK1 messenger RNA were higher in human PDAC than nontumor pancreatic tissues and correlated with shorter survival times of patients.

CONCLUSIONS

We found human PDAC samples and pancreatic cancer cell lines to overexpress KDM3A. KDM3A increases expression of DCLK1, and levels of both proteins are increased in human PDAC samples. Knockdown of KDM3A in pancreatic cancer cell lines reduced their invasive and sphere-forming activities in culture and formation of orthotopic tumors in mice. Hypoxia increased expression of KDM3A in pancreatic cancer cells. Strategies to disrupt this pathway might be developed for treatment of pancreatic cancer.

The Hidden Morbidity of Cancer: Burden in Caregivers of Patients with Brain Metastases

Caregiving is a highly individualized experience. Although numerous articles have been published on caregiver burden from a variety of diagnoses and conditions, this article presents the unique features of caregiving in patients with brain metastases. Improved long-term survival, concerns about disease recurrence or progression, the cancer experience (initial diagnosis, treatment, survivorship, recurrence, progression, and end of life), and the increasing complexity of cancer treatments add to the demands placed on the caregivers of patients with brain metastases. Health care professionals must identify caregiver burden and administer the appropriate interventions, which must be as unique and individualized as the caregivers' experiences.

Cognitive dysfunction in patients with brain metastases: influences on caregiver resilience and coping

PURPOSE

Neurologic deficits that may be manifested as cognitive impairment contribute to the challenges faced by caregivers of patients with brain metastases. To better address their needs, we examined how caregivers respond to these challenges and explore the relationship between the patient's cognitive impairment and caregiver resilience and coping.

METHODS

We conducted a descriptive, cross-sectional study using self-reported data from 56 caregivers of patients with brain metastases. Study participants from a comprehensive cancer center were asked to complete a series of instruments that measured their perception of the patient's cognitive dysfunction (revised memory and behavior problems checklist, RMBC), their own personal resilience (Resilience Scale, RS), and their utilization of a broad range of coping responses (COPE inventory and Emotional-Approach Coping scale).

RESULTS

Caregivers reported that memory-related problems occurred more frequently in the patients they cared for compared to depression and disruptive behavior (mean scores 3.52 vs 2.34 vs. 1.32, respectively). Coping strategies most frequently used by caregivers were acceptance (3.28), planning (3.08), and positive reinterpretation and growth (2.95). Most caregivers scored moderate to high on the RS (77%). The coping strategy acceptance correlated significantly with the memory and disruptive behavior subscales of the RMBC.

CONCLUSIONS

Given the protective effect of problem-focused coping and the high rate of caregivers utilizing less effective coping strategies in instances of worsening cognitive dysfunction, healthcare professionals need to systematically assess the coping strategies of caregivers and deliver a more personalized approach to enhance effective coping among caregivers of patients with brain metastases.

Use of Eyeglasses among Children in Elementary School: Perceptions, Behaviors, and Interventions Discussed by Parents, School Nurses, and Teachers during Focus Groups

Purpose.

To investigate the perceptions, behaviors, and recommendations that parents, school nurses, and teachers have regarding children's use of eyeglasses.

Approach.

Focus groups with parents, school nurses, and teachers were conducted.

Setting.

The study took place in one Southern California school district.

Participants.

There were 39 participants, including 24 parents, seven school nurses, and eight teachers.

Method.

An experienced moderator guided the focus group discussions. Transcripts were analyzed using grounded theory techniques.

Results.

Participants perceive visual impairment as a serious problem in the development of children. The lack of eyeglasses may lead to problems such as tiredness, headaches, inability to focus on school work, and decreased reading speed. Participants experienced disappointment, unhappiness, worry, and concern when they realized they needed eyeglasses at a young age. Negative societal perceptions toward eyeglasses, lack of eye doctors in minority communities, parental perceptions that children do not need eyeglasses, and peer bullying of children wearing eyeglasses are key obstacles to children's use of eyeglasses. Participants suggest school and national campaigns featuring respected public figures who wear eyeglasses to promote positive attitudes toward eyeglasses.

Conclusion.

Parents and teachers who closely follow the academic development of children have observed that visual impairment has negative consequences for the scholastic achievement of children. They recommend interventions to promote the attractiveness of eyeglasses in society. The participants discuss the need for a national preventative message for eye care similar to the message for dental care. The public health message should emphasize the importance of embracing and respecting differences among individuals.

Misconceptions and miscommunication among Spanish-speaking and English-speaking women with pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

Limited data exist on women's experience with pelvic organ prolapse (POP) symptoms. We aimed to describe factors that prevent disease understanding among Spanish-speaking and English-speaking women.

METHODS

Women with POP were recruited from female urology and urogynecology clinics in Los Angeles, California, and Albuquerque, New Mexico. Eight focus groups were conducted, four in Spanish and four in English. Topics addressed patients' emotional responses when noticing their prolapse, how they sought support, what verbal and written information was given, and their overall feelings of the process. Additionally, patients were asked about their experience with their treating physician. All interview transcripts were analyzed using grounded theory qualitative methods.

RESULTS

Qualitative analysis yielded two preliminary themes. First, women had misconceptions about what POP is as well as its causes and treatments. Second, there was a great deal of miscommunication between patient and physician which led to decreased understanding about the diagnosis and treatment options. This included the fact that women were often overwhelmed with information which they did not understand. The concept emerged that there is a strong need for better methods to achieve disease and treatment understanding for women with POP.

CONCLUSIONS

Our findings emphasize that women with POP have considerable misconceptions about their disease. In addition, there is miscommunication during the patient-physician interaction that leads to further confusion among Spanish-speaking and English-speaking women. Spending more time explaining the diagnosis of POP, rather than focusing solely on treatment options, may reduce miscommunication and increase patient understanding.

Cardiovascular risk profile of veteran men beginning androgen deprivation therapy

We sought to describe the cardiovascular profile of veteran men before beginning androgen deprivation therapy (ADT), with the eventual benefit of targeting treatments to manage harmful cardiovascular side effects. We performed a secondary analysis with chi-square and Fisher's exact tests for associations between demographics and cardiovascular comorbidities on 375 veteran men diagnosed with prostate cancer. Those who were overweight and current smokers were more likely to be younger, whereas men with a systolic blood pressure >120 mmHg were more likely to be older (all P < 0.05). Men with total cholesterol 180 mg/dL were more likely to be identified in the Hispanic/other/unknown ethnicity category. Interventions to manage cardiovascular risk should focus on preventive lifestyle changes for younger men, and chronic disease management for older men. Men in the smaller Hispanic/other/unknown category are at risk for marginalization within the Veteran Administration system owing to their low numbers and should be closely monitored for cholesterol levels when receiving ADT.

The association of health literacy, social support, self-efficacy and interpersonal interactions with health care providers in low-income Latina mothers

OBJECTIVE

We explored relationships between maternal health literacy (HL), communicative self-efficacy (SE), social support (SS) and maternal perception of interactions with health care providers (HCPs).

METHODS

Using a cross-sectional, correlational design, we assessed sociodemographic characteristics, maternal HL, social support, communicative self-efficacy, and interpersonal interactions with HCPs among 124 low-income Latina mothers of young children.

RESULTS

Informal SS significantly predicted maternal SE in interactions. SE predicted maternal perception of a HCP's ability to "elicit and respond to her concerns."

DISCUSSION

Interventions to improve maternal self-efficacy in interacting with HCPs among low health literate Latina mothers may positively impact pediatric health outcomes.

Colorectal cancer screening: the role of perceived susceptibility, risk and cultural illness beliefs among American Indians

PURPOSE

Colorectal cancer (CRC) disproportionately affects American Indians and is a leading cause of mortality despite being treatable when detected early.

METHODS

An explanatory model to guide a CRC screening education media campaign was developed from survey and focus group data collected at three American Indian communities (n = 29) in California. Project data was analyzed using Chi Square, Fisher's Exact Test and thematic analysis.

RESULTS

Low perceived susceptibility due to low harm value, cultural illness beliefs, and competing priorities likely lead to poor CRC screening behavior, placing American Indians at high risk for CRC mortality.

Health literacy and interpersonal interactions as predictors of maternal perception of ambulatory care for low-income, Latino children

OBJECTIVE

This study explores whether maternal HL (MHL) and maternal perception of health care provider (HCP) interpersonal interactions predict maternal perception of quality of pediatric ambulatory care received.

METHODS

This cross-sectional study included 124 low-income Latina mothers of children 3 months to 4 years. Maternal HL, perception of maternal-HCP interpersonal interactions, and perception of pediatric ambulatory care were measured using well-validated surveys.

RESULTS

In adjusted hierarchical regression models, HCP fail to speak clearly (β=-.225, 95% CI -13.998, -1.960, p=.01) and explain results (β=.344, 95% CI 3.480, 13.010, p=.001) predicted perception of quality of developmental guidance received. Explaining results (β=.422, 95% CI 5.700, 14.089, p=<.001), working out treatment together (β=.441, 95% CI 6.657, 13.624, p<.001) and MHL (β=-.301, 95% CI -7.161, -2.263, p<.001) predicted perception of family centeredness of care.

CONCLUSIONS

Speaking with clarity, explaining results fully and working with the mother to determine a child's plan of care is most predictive of whether she feels her child is receiving high quality pediatric ambulatory care services.

PRACTICE IMPLICATIONS

Interventions that target mother and provider interaction may improve perception of care.

Decreasing Uncorrected Refractive Error in the Classroom Through a Multifactorial Pilot Intervention

The study assessed the effectiveness of a pilot intervention to promote the use of eyeglasses in one school in California. The intervention used a one-group pretest, posttest design. Between January and June 2011, during the intervention, all first- and second-grade children received eye evaluations and the children with refractive error received two pairs of attractive eyeglasses. Parents received eye care education. Teachers monitored the use of eyeglasses in the classroom. Prior to the intervention in January 2011, 1 of the 15 children with refractive error (6.7%) wore eyeglasses in the classroom and the remaining 14 (93.3%) lacked eyeglasses altogether; 6 months following the end of the intervention in December 2011, 11 of the 15 children (73.3%) wore eyeglasses in the classroom and the remaining 4 (26.7%) did not ( p = .002). The multifactorial intervention increased the use of eyeglasses in the classroom even months after the end of the summer vacation.

Male Veterans Coping With the Pendulum Swing of Rheumatiod Arthritis Pain: A Qualitative Study

This study describes the physical, psychological and social context of rheumatoid arthritis (RA) pain from the male veterans. A qualitative, descriptive design was employed using a purposive sampling to ensure representation of male veterans. Interviews were conducted with 12 male veterans of the VA Greater Los Angeles Healthcare System. Socio-demographic characteristics, clinical profiles and descriptors of rheumatoid pain experienced by male veterans' since their diagnoses were gathered. Interviews were audio recorded and transcribed verbatim. Grounded Theory analysis techniques were used to identify concepts related to living with RA Pain. Six concepts related to RA pain adaptation emerged. Three concepts were associated with movement (keep moving, consequences of not moving, staying physically active) and three were related to emotion (thinking positive thoughts, doing jobs, focusing on male identity). The "keep moving" concept explained coping with chronic RA pain through three activity types: physical, cognitive and socio-economic activities. These activities fluctuated in intensity depending upon the disease stage and RA symptoms. The forward and backward pendulum swing described the unpredictable course and pain coping strategy of the veterans. Further studies are recommended to determine the transferability of our findings to other populations and to confirm the impact of continuous motion as an effective pain management strategy for RA.

Male Veterans Coping with the Pendulum Swing of Rheumatoid Arthritis Pain

This study describes the physical, psychological and social context of rheumatoid arthritis (RA) pain from the male veterans. A qualitative, descriptive design was employed using a purposive sampling to ensure representation of male veterans. Interviews were conducted with 12 male veterans of the VA Greater Los Angeles Healthcare System. Socio-demographic characteristics, clinical profiles and descriptors of rheumatoid pain experienced by male veterans’ since their diagnoses were gathered. Interviews were audio recorded and transcribed verbatim. Grounded Theory analysis techniques were used to identify concepts related to living with RA Pain. Six concepts related to RA pain adaptation emerged. Three concepts were associated with movement (keep moving, consequences of not moving, staying physically active) and three were related to emotion (thinking positive thoughts, doing jobs, focusing on male identity). The “keep moving” concept explained coping with chronic RA pain through three activity types: physical, cognitive and socio-economic activities. These activities fluctuated in intensity depending upon the disease stage and RA symptoms. The forward and backward pendulum swing described the unpredictable course and pain coping strategy of the veterans. Further studies are recommended to determine the transferability of our findings to other populations and to confirm the impact of continuous motion as an effective pain management strategy for RA.

Spirituality and end-of-life care in disadvantaged men dying of prostate cancer

Purpose

Despite the positive influence of spiritual coping on the acceptance of a cancer diagnosis, higher spirituality is associated with receipt of more high intensity care at the end of life. The purpose of our study was to assess the association between spirituality and type of end-of-life care received by disadvantaged men with prostate cancer.

Methods

We studied low-income, uninsured men in IMPACT, a state-funded public assistance program, who had died since its inception in 2001. Of the 60 men who died, we included the 35 who completed a spirituality questionnaire at program enrollment. We abstracted sociodemographic and clinical information as well as treatment within IMPACT, including zolendroic acid, chemotherapy, hospice use, and palliative radiation therapy. We measured spirituality with the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being questionnaire (FACIT-Sp) and compared end-of-life care received between subjects with low and high FACIT-Sp scores using chi-squared analyses.

Results

A higher proportion of men with high (33%) versus low (13%) spirituality scores enrolled in hospice, although our analysis was not adequately powered to demonstrate statistical significance. Likewise, we saw a trend toward increased receipt of palliative radiation among those with higher spirituality (37% vs. 25%, P = 0.69). The differences in end-of-life care received among those with low and high spirituality varied little by the FACIT-Sp peace and faith subscales.

Conclusions

End-of-life care was similar between men with lower and higher spirituality. Men with higher spirituality trended toward greater hospice use, suggesting that they redirected the focus of their care from curative to palliative goals.

Em busca de conhecimento de enfermagem sobre o homem com câncer: uma experiência internacional

Trata-se de um relato de experiência de visita técnico-científica e intercâmbio cultural na Escola de Enfermagem Universidade da Califórnia de Los Angeles, no período de janeiro a junho de 2008, durante o desenvolvimento do curso de mestrado na Escola de Enfermagem Anna Nery da Universidade Federal do Rio de Janeiro. O propósito é apresentar as atividades desenvolvidas em disciplinas e grupo de pesquisa. A experiência contribuiu para o aprofundamento de aspectos teóricos relacionados à temática do homem portador de câncer e às possibilidades de intervenção de enfermagem. Sugere-se que estratégias institucionais sejam implementadas pelos programas de pós-graduação, com o apoio dos órgãos de fomento para viabilizar experiências de intercâmbio internacional durante o curso de mestrado, pois favorecem grande avanço pessoal e profissional, além de estreitar laços de cooperação com pesquisadores e instituições do exterior para o desenvolvimento de pesquisas no seguimento da formação profissional.

Prostate cancer knowledge among low income minority men

PURPOSE

We identified sociodemographic characteristics that predict poor disease understanding in low income, uninsured men with prostate cancer.

MATERIALS AND METHODS

A total of 399 low income, uninsured men with prostate cancer participating in the Men's Health Survey done by researchers at University of California-Los Angeles Jonsson Comprehensive Cancer Center completed questionnaires assessing their knowledge of prostate cancer. Logistic regression was used to identify sociodemographic factors, eg age, education level, language preference, ethnicity and relationship status, associated with poor prostate cancer knowledge.

RESULTS

Most subjects were Latino (54% or 213 of 399), spoke English (53% or 213 of 399) and had a high school education or less (86% or 344 of 399). In the multivariate model increasing age (p<0.014) and less than a high school education (p<0.012) were associated with lower knowledge of disease, while Latino ethnicity and relationship status were not.

CONCLUSIONS

Among low income men with prostate cancer increasing age and less formal education were associated with lower knowledge of disease. Further study is needed to determine the roles of language preference and ethnicity in the understanding of the disease in patients with prostate cancer.

Oncology Nursing Society Year 2004 Research Priorities Survey

PURPOSE/OBJECTIVES

To determine the Oncology Nursing Society (ONS) research priorities for 2005-2008 for oncology nursing across the entire scope of cancer care, including prevention, detection, treatment, survivorship, and palliative care.

DESIGN

Descriptive, cross-sectional survey.

SAMPLE

Stratified into two groups: random sample of general membership (N = 2,205; responses = 287, or 13%) and all ONS active members in the United States with doctoral degrees (N = 627, responses = 144, or 23%); overall response rate was 15%.

METHODS

The 2000 survey was revised and updated. Postcards were mailed to the original sample (N = 1,605) prior to the launch of the online survey, inviting participation via an online or paper-and-pencil survey. An e-mail announcement of the survey was launched one week later, followed by reminders the following week. Because of low response rates, a second sample (N = 600) was selected and contacted.

MAIN RESEARCH VARIABLES

117 topic questions divided into seven categories. Several items were new or reworded.

FINDINGS

The top 20 research priorities included 12 of the top 20 items found in the 2000 survey; 8 topics were new to the top 20. Priority topics were distributed across six of seven categories. When general membership results were compared to the doctoral sample, 10 topics were among the top 20 for both groups. Nine topics were top priorities in the 2000 (researcher) and 2004 (doctorally prepared) surveys.

CONCLUSIONS

Response rates to the electronic survey were lower than for previous paper-and-pencil surveys, but an adequate response was obtained. Rank order of mean importance ratings was determined by narrow differences in scores. The general membership and doctorally prepared samples showed similarities as well as differences in results.

IMPLICATIONS FOR NURSING

The 2004 survey results will inform the 2005 research agenda and assist the ONS Foundation and other funding organizations in distributing research funds.

Spirituality influences health related quality of life in men with prostate cancer

Spirituality is interdependent with the biological, psychological, and interpersonal aspects of life. Although spirituality has been studied in breast cancer survivors, little work has been done in men with prostate cancer. We sought to determine whether lower spirituality in men with early stage prostate cancer is associated with worse general health-related quality of life (HRQOL), disease-specific HRQOL, or psychosocial health. Two hundred and twenty-two subjects were drawn from a state-funded program providing free prostate cancer treatment to indigent men. Validated instruments captured spirituality, general and disease-specific HRQOL, anxiety, symptom distress, and emotional well-being. We found a consistent relationship between spirituality and the outcomes assessed. Low spirituality was associated with significantly worse physical and mental health, sexual function and more urinary bother after controlling for covariates. All of the psychosocial variables studied reflected worse adjustment in the men with low spirituality. Because the likelihood of prostate cancer survivorship is high, interventions targeting spirituality could impact the physical and psychosocial health of many men.

Health-related quality-of-life in low-income, uninsured men with prostate cancer

The objective was to describe health-related quality-of-life (HRQOL) in low-income men with prostate cancer. Subjects were drawn from a statewide public assistance prostate cancer program. Telephone and mail surveys included the RAND 12-item Health Survey and UCLA Prostate Cancer Index Short Form and were compared with normative age-matched men without cancer from the general population reported on in the literature. Of 286 eligible men, 233 (81%) agreed to participate and completed the necessary items. The sample consisted of 51% Hispanics, 23% non-Hispanic whites, and 17% African Americans. The low-income men had worse scores in every domain of prostate-specific and general HRQOL than had the age-matched general population controls. The degree of disparity indicated substantial clinical differences in almost every domain of physical and emotional functioning between the sample group and the control group. Linear regression modeling determined that among the low-income men, Hispanic race, and income level were predictive of worse physical functioning, whereas only comorbidities predicted mental health. Low-income patients with prostate cancer appear to have quality-of-life profiles that are meaningfully worse than age-matched men from the general population without cancer reported on in the literature.

Partnership status influences quality of life in low-income, uninsured men with prostate cancer

BACKGROUND

Being partnered confers significant benefits in survival for patients with prostate cancer, yet little is known of the impact of relationship status on health-related quality of life (HRQOL). The authors evaluated the influence of partnership on measures of HRQOL.

METHODS

The authors studied 291 patients who were enrolled in a program that provided free treatment to impoverished, uninsured men with prostate cancer. The associations between relationship status and measures of general and disease-specific HRQOL were evaluated. Results from multivariate models determined the independent effect of partnership on HRQOL.

RESULTS

Partnered patients were more likely than unpartnered patients to be Hispanic (58% vs. 34%) and were more likely to have elected surgical therapy (49% vs. 34%). Multivariate analyses, controlling for age, ethnicity, disease stage, and treatment type, revealed that partnered patients had better mental health (P = 0.009), less urinary bother (P = 0.011), higher spirituality (P = 0.037), and lower symptom distress (P = 0.005) than unpartnered participants.

CONCLUSIONS

Relationship status had a positive effect on the quality of life of low-income, uninsured men with prostate cancer.

Ethnic variation in health-related quality of life among low-income men with prostate cancer

OBJECTIVE

To describe and compare health-related quality of life (HRQOL) among Hispanic, African-American, and Caucasian men with localized prostate cancer.

DESIGN

Observational study of low-income, ethnically diverse men with non-metastatic prostate cancer.

SETTING

Statewide public assistance program in California.

PARTICIPANTS

208 men (51 Caucasian, 115 Hispanic, and 42 African-American men) with non-metastatic disease.

INTERVENTIONS

Radical retropubic prostatectomy, radiation therapy, and hormonal therapy.

MAIN OUTCOME MEASURES

Validated instruments measured general and disease-specific HRQOL, anxiety and fear of recurrence, spirituality, symptom distress, and self-efficacy.

RESULTS

Hispanic men with prostate cancer were less educated, more often in significant relationships, and had more variable incomes compared with men of other ethnic/racial backgrounds. In univariate analyses, Caucasian men reported better physical function but less spirituality, while Hispanic men reported worse sexual function. Multivariate analysis revealed that Hispanic men had significantly worse physical function, bowel function, and bowel bother. African-American men experienced greater anxiety over recurrence. African-American and Hispanic men were more spiritual than Caucasian men.

CONCLUSIONS

Greater attention to demographic variations in HRQOL may allow physicians to improve outcomes across ethnicities in low-income men with prostate cancer by offering more specialized counseling and providing referral to social support systems.

Assessment of content completeness and accuracy of prostate cancer patient education materials

Providing care for men with prostate cancer is particularly challenging because of the controversy surrounding screening and the paucity of randomized control trials comparing treatments. Therefore, a patient's personal preferences, and adequate patient education become central to well-informed medical decision-making. Acknowledging the need for high quality education materials for men with prostate cancer, we developed and pilot tested a measure to assess the completeness and accuracy of available materials. The measure rates materials on their inclusion and accuracy of the primary knowledge base a patient should acquire before deciding on prostate cancer screening or treatment, to prepare for staging, and to manage treatment and disease-related symptoms. We found that many available prostate cancer education materials are factually accurate, but omit information that is important and relevant to patients with prostate cancer.

What makes oncology nursing special? Walking the road together

PURPOSE

To identify the factors that influence oncology nurses' decisions to enter nursing and specialize in oncology and to describe the role dimensions of oncology nursing practice.

DESIGN

Multi-institutional, descriptive, qualitative.

SETTING

Six sites in different regions of the United States; rural and urban cancer and noncancer centers.

SAMPLE

38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degree in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared).

METHODS

Phenomenological; content analysis of interviews.

MAIN RESEARCH VARIABLES

Life events, career decision-making, personal and professional rewards, role dimensions of practice, caring behaviors.

FINDINGS

Nurses said that their decisions to specialize in oncology were based on family experiences with cancer, the challenges of administering sophisticated cancer therapies, and influential role models. They reported that professional rewards are derived from valuing each patients as a 'whole person' and providing family-centered care. Nurses find that personal rewards and career survivorship are embedded in several ongoing discoveries: work offers a unique laboratory for learning about life in general, distancing maneuvers are necessary for self-preservation, and the fuzzy boundary between work and personal life must be constantly renegotiated.

CONCLUSIONS

Oncology nurses find the best in the worst of situations, live fully the cancer experience by embracing their patients' heartaches and triumphs, share a collective sense of pride in their specialty, and report a high level of job satisfaction.

IMPLICATIONS FOR NURSING PRACTICE

Caring for the dying person with cancer is the most difficult aspect of oncology nursing practice and being with--being present in the moment, no matter what the outcome--is the most rewarding and ubiquitous caring behavior of oncology nurses.