<p> Declared a disease by the AMA in 2013, obesity claims the lives of over 2.8 million people annually in the U.S. Mounting evidence indicates weight bias is encountered in the interactions with health care professionals; resulting in a decreased health-related quality of life and shorter survival rates. Knowingly or unknowingly, healthcare providers communicate forms of weight bias when they associate negative traits and assumptions with obesity to their patients. Using a descriptive phenomenology methodology, the purpose of this research study is to explore and describe the phenomenon of weight bias as experienced by overweight and obese cancer survivors in their interactions with oncology nurses and physicians. </p><p> The study findings report heavy underlying implications related to the psychosocial and cultural aspects related to the overweight and obese cancer survivor population that oncology nurses and doctors are not addressing in their clinical practice. There are strong implications related to the coexisting factors including large body size and increased risks of many types of cancer, yet often nurses and doctors fail to contemplate what constitutes health outcomes for overweight and obese cancer survivors. Findings from this study explicate and illuminate disparities within the oncological healthcare settings. Evidence from this study found oncologists simply do not &ldquo;want to get involved&rdquo; in the weight-related implications of cancer. One participant called it a disservice and others simply described it as ignoring the <i>elephant in the room</i>. Additionally, the study findings discovered emerging themes denoting the <i>participants&rsquo; positive experiences</i> with their cancer care. </p><p> The current study advanced the understanding of how overweight and obese cancer survivors experience oncology health care. Given the prevalence of obesity in the U. S. and permeation of weight bias throughout the healthcare industry, meaningful remedies are needed to protect patients against weight bias. Findings may be used to further the state-of-the-knowledge by informing oncology healthcare nurses and physicians of tactics to change current practice to include culturally sensitive, holistic, and respectful delivery of care for the overweight and obese cancer survivor.</p>

Chinese people traditionally hesitate to talk about illness and death as these topics are considered bad luck. Studies indicate that Chinese cancer patients seldom have the opportunity to share their deep feelings, although many experience “fear of death.” Clarifying one's meaning in life can facilitate overcoming this fear. This qualitative study therefore explored how U.S. resident Chinese immigrants with metastatic cancer search for meaning at the end of their lives. Data were gathered by a topical life history method, using life-story, in-depth interviews. Results show that participants appreciated having opportunities to share their experiences. They described how the interviews gave them a deeper understanding of themselves; by recalling their life events they realized how meaningful their lives were. Narrative analysis of 12 participant interviews revealed six themes: suffering and impending death; compassion and love; joy and value; hope and faith; readjustment and transcendence; and empowerment and peaceful dying. Participants simultaneously faced physical, psychological, spiritual and moral suffering, including physical discomfort, shock and denial, fear, psychological conflict, loss, loneliness, hopelessness, powerlessness, worry, uncertainty, and guilt. Despite this suffering, participants experienced compassion and love from religious practices and the caring and support of family and others. They experienced joy and value by feeling satisfied with their quality of life, having good relationships with family and friends, practicing religion, appreciating the present moment, and keeping everyday life normal. Participants built hope and faith by continuing to live, believing in a possible cure, having religious beliefs and getting encouragement from family and others. They readjusted and transcended suffering by accepting the unexpected in life, looking for positive impacts of having cancer, and developing a positive attitude toward living with cancer. They felt empowered and prepared to die peacefully by maintaining good symptom control, remaining independent, and finding peace of mind. Significantly, 8 of the 12 participants took both western and eastern medicines for cancer control. Besides hoping for a cure, participants believed that eastern medicines could promote physical comfort and help them die peacefully. This study's results have both theoretical and practical value for a fuller understanding of Chinese immigrants with cancer. One implication for oncology nurses is involving family members and religious beliefs in the care of Chinese clients with metastatic cancer.

Women with metastatic breast cancer experience diminished quality of life (QOL) as a consequence of disease, treatment or psychosocial issues. The role of the nurse includes providing interventions to promote QOL. QOL is a multidimensional concept, including affective and cognitive aspects, that has the potential to improve through use of effective psychosocial and behavioral interventions. Expressive writing (EW) is a psycho-behavioral intervention developed by Pennebaker to promote disclosure: narrative formation resulting in catharsis, reframing and integration. EW has been related to positive health outcomes in healthy and ill samples. Gaps in the literature were identified in exploring both use of EW and cognitive processes of disclosure in cancer patients. The purpose of this secondary analysis was to explore the relationship between patterns of language used in EW texts and QOL in women with metastatic breast cancer. Usage patterns of affect, causal and insight words in EW texts from a sample (n = 68) who completed baseline and three month QOL assessments were identified through use of the Linguistic Inquiry and Word Count (LIWC). Relationships between these patterns of language and QOL were explored. QOL was measured using the Functional Assessment of Cancer Therapy - Breast (FACT-B), assessing overall QOL status and subscales: physical well-being, social/family well-being, emotional well-being and functional well-being. The correlation between word pattern use and QOL was investigated using general linear regression. No relationship was observed between positive affect language and QOL. A statistically significant relationship was demonstrated between positive affect language use and emotional well-being subscale scores (β = 1.87, p = 0.02). No relationships were observed with QOL scores and progressive use of causal or insight language. Ten complete EW texts were manually scored to validate LIWC data. Evaluation of text containing grammatical errors, idiomatic language, or complex expression of ideas was inadequate with LIWC. A significant difference between LIWC and manual word counts for negative language was identified. Although no significant difference was noted in word counts for causal or insight language, differences in contextual meaning were noted. Further research including the use of qualitative methods to examine content and contextual use of language is warranted.

<p> Breast cancer is the second leading cause of cancer death and the leading cause of premature death of women in the United States (US). It was estimated that 231,840 women were expected to develop breast cancer in the US in 2015 and approximately 40,290 women were estimated to die of the disease. Even though most breast cancers are sporadic, 5-10% of women are at an increased risk for developing breast cancer due to a hereditary risk. Too few healthcare providers are identifying women with family histories suggestive of hereditary cancer syndromes. An efficient way to identify high risk women in the primary care setting is through an easy to understand, self-administered family history risk assessment tool. The Pedigree Assessment Tool (PAT) family history questionnaire was offered to women age 18 and over at a primary care clinic in northern Louisiana. A PAT score of 8 or above prompted a cancer family history discussion by the physician or nurse practitioner and was followed by a genetic counseling referral. A total of 428 women completed the risk assessment tool during a 4 month period, 32 were high risk as evidenced by scoring 8 or higher on the PAT. Fourteen women were referred for genetic counseling. Twelve declined testing due to lack of insurance coverage, previous completion of genetic testing or felt the information would not improve their health. Six of the thirteen women completed genetic counseling and genetic testing. Lack of insurance coverage was identified as a major barrier to genetic counseling referrals. Utilization of the PAT identifies high risk women who would benefit from a genetic counseling referral. Genetic testing provides information that allows the patient and primary care provider to make informed decisions regarding surveillance protocols or prophylactic surgeries to diagnose cancer at an early stage or prevent cancer from developing.</p>

Hope is significant to cancer patients in their struggle to find meaning in life as they adapt to the disease and its treatment. The purpose of this study was to test the effectiveness of a nurse telephone intervention to maintain hope and reduce symptom distress in chemotherapy patients. A conceptual framework, based on the hope models of Herth (1989) and Morse and Doberneck (1995), guided the study. Patient needs and resources were appraised using a Hope Assessment Guide (Penrod & Morse, 1997) that focused on behaviors related to coping with symptom distress, achieving goals, and mobilizing internal and external resources to maintain hope. A two-group randomized experimental design was used to test the effects of a nursing telephone intervention on hope and symptom distress in cancer patients (n = 100) receiving chemotherapy for the first time. Repeated measures of hope and symptom distress were made before the start of chemotherapy (baseline) and four times during the first two cycles of treatment. Mood states were measured at baseline and at expected nadir after the second cycle of chemotherapy. A total of three phone calls were made to each participant: those in the intervention group received a structured call from a nurse and those in the control group received brief reminder calls from a non-nurse. Hope was measured by the Herth Hope Index and Hope Visual Analog Scale, mood states by the brief Profile of Mood States, and symptom distress by the Symptom Distress Scale. Data were analyzed by descriptive statistics, t-test, Cronbach's alpha and analysis of variance. Patients in the telephone intervention group did not experience any statistically significant changes in either levels of hope or symptom distress compared to the control group. In addition, baseline measures of hope, symptom distress and positive mood states were significantly correlated in all subjects in the study. Because of study limitations, this correlation did not hold up over the course of treatment. A significant relationship was found between reduced symptom distress and positive mood states in all subjects of the study over two cycles of chemotherapy. These findings suggest that two measures of quality of life (mood state and symptom distress) were improved. Study results indicate a need to explore both hope-inspiring strategies and the management of symptom distress as mediators for enhancing quality of life in chemotherapy patients. Additional randomized testing in a larger sample of cancer patients is recommended. Further studies should also focus on the potential of meaningful nursing telephone interventions to improve health outcomes during chemotherapy treatment.

<p> The purpose of this descriptive study is to collect the experiences of cervical cancer survivors related to the information they received from their health care providers about how their diagnosis and treatment may impact their sexuality and sexual health. The perspectives of the cervical cancer survivors will be used to modify public domain educational materials used in oncology practices and cancer support organizations to reflect a more patient centered approach to sexual health information. Study outcomes will contribute to existing knowledge through submission to appropriate journals and conferences to improve cancer patient-provider sexual health communication.</p><p>

<p> Patients diagnosed with cancer often require interventions for the accompanying mental health distress of their diagnosis; patients&rsquo; mental distress can lead to hopelessness and noncompliance. Improvements for assessment and interventions are needed. This project provides recommendations for improving oncological nursing knowledge by implementing competencies for nurses through educational modules, focusing on nursing approach, confidence, and interventions necessary for understanding methods of treatment and the measurement of distress in oncology and oncological treatment. Using established standards and competencies will improve knowledge and skill in inpatient settings. Current established nursing standards from the American Nursing Association, Institute Of Medicine/National Comprehensive Cancer Network, C-Change, and Public Mental Health Essentials were explored in order to identify gaps and create a list of recommended competencies for oncology nursing. Six associated adaptable educational modules were developed based on the adult education framework of Knowles, and participant training entailed proper use and comprehension of the Distress Thermometer for measurement of distress. The C-Change observation displayed participant (<i>n</i> = 102) results of approximately 119% improvement, which was observed in knowledge, communication, and confidence. Participants used the resources to reduce distress levels by initiating the selected established interventions for management, all of which was made evident in patient self-reported outcomes, using resources from published, established, standardized competencies. Having such training will allow for improved care for patients with cancer, thus having an influence on positive social change. </p>

Although the survival rate of childhood cancer is high, nearly two thirds of these survivors experience negative long-term secondary side effects from cancer treatments. Infertility is one such side effect that can have a prominent impact on quality of life as the patient ages. It is important for nurses working with pediatric oncology patients to provide the patient and family with education about risk for infertility and fertility preservation (FP) in order to allow families to make decisions about FP before cancer treatment starts. However, pediatric oncology nurses report being uneducated about FP guidelines and are hesitant to broach this subject with families. The purpose of this HIM thesis is to review nurse perceived barriers related to educating patients and their families about the risk for infertility following cancer treatments and FP and to make recommendations for improving communication between nurses and families about FP. A search was performed using CINAHL, PreCINAHL, PsychINFO, PsychARTICLES, and Medline databases and examined peer-reviewed quantitative and qualitative research studies. Key terms used in the database searches were ped' OR child', onco' OR cancer', fert', and nurs'. Findings indicated that there were many barriers for pediatric oncology nurses, which inhibited the discussion of FP with patients and families such as lack of knowledge and resources, provider attitudes toward FP, and patient factors. Based on the findings, the researcher identified several interventions to aid pediatric oncology nurses in overcoming these barriers to FP discussion.