Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xi, 170 p.; also includes graphics (some col.) Includes bibliographical references (p. 158-170).

Excerpt: THE STUDY CONDUCTED by McDougall, Becker, Acee, Vaughan, and Delville (2011) concluded that patients with cancer receiving memory training posttreatment had an inherent benefit in performance on cognitive tests and that this finding provides an evidence-based intervention for providers to use when treating postchemotherapy patients exhibiting symptoms of cognitive deficit. However, the findings in this study do not support this conclusion for two reasons.

The present thesis consists of three thematic parts in relation to breast cancer: (a) practice of breast self - examination (BSE), (b) screening mammography attendance and (c) adjustment to breast cancer surgery / mastectomy. The aims of the respective studies are (a) to examine attitudes, beliefs and practices regarding BSE in younger (30 years old or under) and older women (over 30 years old), (b) to explore attitudes and beliefs regarding mammography and identify factors associated with screening mammography attendance and (c) to explore factors associated with adjustment to breast cancer surgery. The above aims are explored in two different cultural contexts, by comparing samples from Scotland and Greece. Samples consisted (a) of 205 younger and 258 older women, university staff and students in Scotland and 85 younger women, university students in Greece, (b) 283 women who attended and 72 women who did not attend the National Breast Screening in Scotland, and 72 women undergoing mammography in Greece and (c) 19 women in Scotland and 27 women in Greece, who have undergone surgery for breast cancer. All participants were assessed on a variety of measures. These included demographics, health history, health beliefs and health - related personality variables. Results indicated that: 1. BSE was predicted by different variables across age and cultural groups. 2. In particular, practice of BSE in younger women was predicted by knowledge about breast cancer, perceived barriers, health motivation and cues for action, whereas practice in older women was predicted by knowledge about BSE, perceived barriers and cues for action. 3. BSE rates in both countries were higher than previously reported but did not differ between women in Scotland and Greece. However, the two groups differed in knowledge and attitudes, regarding BSE, and in personality. Women in Scotland appeared more knowledgeable regarding BSE, felt less susceptible to breast cancer and were less active in coping with health issues than women in Greece. Women in Greece valued their health more and scored higher in chance health locus of control beliefs than women in Scotland. 4. The best predictor of breast screening mammography attendance in Scotland was knowledge about mammography. Attenders appeared to have more knowledge about breast cancer and about mammography and to focus more on emotional coping, in order to deal with health stresses. 5. The two cultural groups differed in health-related decision making and health - related coping styles. Attenders in Scotland were more knowledgeable about risk factors related to breast cancer and about mammograms and perceived significantly more pain/discomfort associated with the procedure, than attenders in Greece. Attenders in Greece resorted more to acceptance and denial and were more likely to seek emotional support, in order to cope with health stressors than attenders in Scotland. 6. Health beliefs of breast cancer patients, in relation to their condition, and their style of coping with threatening information, concerning their breast problem, are highlighted as important factors to their adjustment in both cultures. However, adjustment to breast cancer surgery appears culture-specific, as different factors seem to determine it in different cultural contexts. 7. Patients in Scotland and Greece did not differ in their overall adjustment. However, Greek patients were significantly less well adjusted sexually postoperatively than patients in Scotland. Findings are discussed in relation to theoretical and practical implications.

The aim of this thesis is to understand the experiences of eight American high school students who have been diagnosed with cancer. By increasing understanding of the challenges that adolescents in cancer survivorship experience, better support can be identified. The experience of cancer survivorship influences the physical, psychological, and social experiences of patients. As the survival rate of childhood cancers continues to increase, death becomes less likely making the need to maintain educational engagement during survivorship increasingly important. The research questions for this study were designed to address two main gaps in the current field of research. The first research question aims to address how the physical and psychological effects of cancer and treatment impact the participants' engagement with school. The second research question aims to understand the role that school plays for adolescents in cancer survivorship, including how participants experienced supplemental education during and after cancer treatment. This study uses a qualitative research methodology to address the research questions utilizing primarily semi-structured interviews and an adjusted version of the Adolescent Coping Scale. When used in combination with the interviews, the scale provides a picture of what the participants experienced and how they have been able to cope with the challenges they have faced. Interpretive phenomenological analysis was used to provide structure to the interview analysis. The results of this study show that fatigue and a compromised immune system have an impact on school attendance more than other physical effects during cancer treatment. As a result, adolescents are most at-risk of experiencing challenges in educational engagement during treatment. The results of this study also show that the feeling of uncertainty throughout cancer survivorship promotes fear and the feeling of a loss of control. Once treatment ends, fear of relapse is common. Physical and psychological effects were felt to improve as time passed. Another key result of this study is that the cancer experience results in a shift in perspective that becomes incorporated into the formation of identity. Participants feel different from peers as a result of the physical and psychological effects of the cancer experience. The results from the Adolescent Coping Scale indicate that school achievement, relapse and the worsening of physical side effects, and being treated different by peers were common concerns for the participants regarding their school, illness, and social concerns, respectively. Lastly, the participants view supplemental education as successful if it meets their personal academic and physical needs, is implemented consistently, and helps them to feel emotionally supported and socially connected. However, more research is needed that focuses on the implementation of policy at the state and district levels to discern whether this is a common challenge unique to this population of students with a physical or medical disability. The sample available for this research topic is not only limited to an extremely small population, but they are also a highly guarded population, making access for recruitment challenging. However, while generalization is difficult with a study of this size, the evidence collected on the participants' experiences during and after treatment provides valuable data on aspects of supplemental education implementation.

Made available in DSpace on 2016-08-03T16:34:46Z (GMT). No. of bitstreams: 1 ELIANA FERRANTE PIRES.pdf: 282230 bytes, checksum: 43e10c15c5ef4c64c0b4720ce5aa2fb6 (MD5) Previous issue date: 2008-08-15 / This search proposes to describe convictions health factors present in patients with cancer, which can interfere with the process of accession to treatment. For both were used testemonials of six patients in the form of directed interviews, involved in a program of service helth at a university of Greater Sao Paulo. The content of the interviews was analyzed according to a model of conviction health, which advocates that the patients will have greater opportunities to adhere to the following five treatments convictions basics health, namely: susceptibility, severity, benefits, barriers, own efficiency. A extension of this model was proposed by another study that adds two more categories to the existing: impact on diagnosis and expectations for the future.(AU) / O objetivo deste artigo é tecer algumas reflexões acerca das convicções de saúde em pacientes com câncer, participantes de um programa de atendimento multidisciplinar realizado numa universidade da Grande São Paulo. Foram utilizados depoimentos de 06 (seis) pacientes, na forma de entrevistas dirigidas e o conteúdo analisado segundo um modelo de convicção de saúde, o qual preconiza que o paciente terá maiores possibilidades de aderir aos tratamentos, seguindo cinco convicções básicas de saúde, a saber: suscetibilidade, severidade, benefícios, barreiras, eficácia própria. Uma ampliação deste modelo foi proposta por outro estudo que acrescenta mais duas categorias às já existentes: impacto ao diagnóstico e expectativas de futuro.(AU)

Bakgrund: Syftet med palliativ vård i livets slut är att lindra symtom och främja livskvalitet. Flera studier har visat brist på kunskap, färdighet och erfarenhet hos sjuksköterskor inom vård i livets slut. Därför ville författarna sammanställa patienters upplevelser av livets slutskede, för att ge en överblick i vad sjuksköterskan kan göra för att främja dessa patienters livskvalitet. Syfte: Syftet med litteraturstudien var att beskriva hur patienter med cancersjukdom som vårdas palliativt upplever livskvalitet ilivets slut. Metod: Detta är en beskrivande litteraturstudie där elva vetenskapliga artiklar inkluderades, samtliga artiklar söktes på databasen Medline via PubMed. Därefter gjordes en tematisk analys. Resultat: Två teman identifierades med tillhörande subteman: (1) Faktorer som har en negativ inverkan på livskvaliteten och (2) Faktorersom har en positiv inverkan på livskvaliteten. Livskvaliteten påverkades av fysiska symtom och psykologiska besvär. Tidig tillämpning av palliativ vård hade en positiv inverkan på livskvaliteten och religion och tro ansågs värdefullt. Slutsats: Denna studie upplyser hur olika omkringliggande faktorer såsom fysiska, psykologiska och andliga kan påverka individens livskvalitet under det palliativa vårdskedet. Eftersom sjuksköterskor har en viktig roll i den palliativa vården bör de vara medvetna om de olika faktorerna för att kunna hantera dem själva eller med hjälp av andra yrkeskategorier inom vården för att kunna hjälpa patienten att uppnå bästa möjliga livskvalitet. / Background: The purpose of palliative care in the end of life is to relieve symptoms and promote quality of life. However, several studies have shown a lack of knowledge, skills, and experience among nurses in end-of-life care. Therefore, the authors wanted to compile patients with cancer experiences of the end of life, to give an overview of what the nurse can do to promote these patients’ quality of life. Purpose: The purpose of this literature review was to describe the experience of quality of life in patients with cancer undergoing palliative care. Method: This is a descriptive literature review of eleven scientific articles, all data were searched in the Medline database via PubMed. A thematic analysis was made. Result: Two themes were identified with associated subthemes: (1) Factors that have a negative impact on the quality of life, and (2) Factorsthat have a positive impact on the quality of life. The quality of life was affected by both physical and psychological symptoms. An early integration of palliative care had a positive impact on the quality of life, and religion and faith were considered valuable. Conclusion: This study illuminates how different surrounding factors such as physical, psychological, and spiritual factors can affect an individual's quality of life during the palliative care phase. As nurses have an important role in palliative care, they should be aware of the various factors to be able to handle them by themselves or with the help of other professional categories to help the patient achieve the best possible quality of life.

Despite a rise in breast cancer incidence, mortality rates have fallen. This improvement in mortality is due to the success of anti-cancer treatments such as chemotherapy and radiotherapy. Such treatments, however, are known to be associated with a range of symptoms. A number of studies exploring patients’ chemotherapy-related symptom experiences have shown that patients consistently rate nausea and fatigue highly, not only in relation to severity, but also in relation to the associated distress they experience. The subjective and non-observable nature of both nausea and fatigue complicates their assessment. While a range of assessment tools exists to evaluate patients’ experiences of these two symptoms, there is currently no gold standard assessment tool for assessing either symptom. Moreover, while a range of pharmacological and non-pharmacological interventions have been developed for both symptoms, further evaluation is often needed to provide the level of evidence required to recommend their implementation in real life clinical environments. The SNA↔P (structured nursing assessment into practice) study arose in response to this clinical situation. The SNA↔P study was a longitudinal study that evaluated the impact of a complex evidence-based intervention, incorporating structured multidimensional symptom assessment and multiple symptom management techniques, on patients’ experiences of nausea and fatigue during a course of chemotherapy for breast cancer. Using complementary quantitative and qualitative research methods not only allowed in-depth understanding of patients’ experiences and patterns of nausea and fatigue during a course of chemotherapy, but also facilitated a rounded evaluation of the intervention, incorporating both statistical elements and those of personal significance. The use of these methods showed that the implementation of the SNA↔P intervention in routine clinical practice has significant potential for improving patients’ symptom experiences during a course of chemotherapy. In so doing, it also highlighted a number of areas in which clinical practice can be influenced, and research conducted, to further improve patients’ symptom experiences.

Introduction This thesis describes a research study designed to examine the consequences of disability arising out of spinal cord compression secondary to cancer, and to examine the rehabilitation services available to patients. Research aims and questions The study was intended to achieve the following: 1. To ascertain what might constitute effective rehabilitation interventions for patients with metastatic spinal cord compression. 2. To identify the conditions in which these intervention might be delivered. 3. To ground proposals in spinal cord compression patients’ experience of disability. The following research questions were posed: 1. What are the consequences of disability for patients with metastatic spinal cord compression? 2. What strategies do patients themselves use to manage disability? 3. What do health care staff, particularly rehabilitation professionals, understand to be the consequences of disability for this patient group, and correspondingly, what are their views on the significance and provision of rehabilitation? 4. To what extent is rehabilitation being provided to these patients, and with what effect? 5. Where rehabilitation is not being provided, why is this the case? Study design The study had two components: • A series of nine in-depth interview-based case studies, which involved talking to patients about their experiences of living with spinal cord compression, as well as gaining the perspectives of family members and the health professionals who provided care and services. • A retrospective audit of the medical records of 73 spinal cord compression patients admitted to a radiotherapy in-patient unit (the Frank Ellis Unit at the Churchill Hospital in Oxford) over a two year period (July 2003 – June 2005), identifying disability-related problems and the measures taken to address them. This was a Phase I modelling study in terms of the Medical Research Council’s framework for evaluating complex interventions, with Pawson and Tilley’s (1997) Context-Mechanism-Outcome configuration adopted as a conceptual basis for data collection. Within-case analysis was informed by George and Bennett’s (2004) account of process tracing, and between-case analysis was modelled on the constant comparative method of Glaser and Strauss (1967) with an analysis of narrative as a variation on that theme. Results Disability is a serious problem for patients with spinal cord compression, but it is one problem among many others, not the least of which are the physical and emotional consequences of life-threatening illness. In response to disability, patients ‘twin-track’ their attitudes to it, acknowledging but also resisting the idea of themselves as disabled, and adopting a series of psychological devices to manage the tension. In effect, patients recognise that something significant has changed and that, as a consequence, new self-management skills must be learned, functional boundaries must be explored, useful information must be sought. At the same time, they display a determination to hold on to an established identity, associated with a sense of normality. This identity embraces the idea of competence and resourcefulness, the events, activities and pleasures that one looks forward to, and the wish to avoid burdening others. It is not a ‘disabled’ identity. To some extent, these two attitudes are in tension, as one acknowledges disability while the other, implicitly or explicitly, resists it. Consequently, patients try to find ways of resolving this tension, by ‘revising downwards’ their expectations, by constantly deferring the anticipated pleasures, and by avoiding situations in which their abilities might be put to the test, or the sense of normality be disconfirmed. Health care professionals are likely to construe the patient’s response as indicative of a certain type of character – ‘realistic’ on one hand, and ‘unrealistic’ on the other. They do not see ‘acknowledging / not acknowledging’ as twin facets of a complex response to circumstances, or as something which every patient engages in to one degree or another. Patients are motivated not to recognise rehabilitation as something they need, a view which is confirmed by the cursory form of rehabilitation experienced in hospital, and by the marginal significance attributed to it by nursing and medical staff. On discharge, hospital staff assume that rehabilitation needs will be identified in the community, although the way in which community rehabilitation services are organised virtually guarantees that this will not happen, unless a specific referral is made (as it is in only 5% of cases). The patient, meanwhile, remains unaware of the potential value of rehabilitation, and has no incentive to request rehabilitation if no-one offers it. They are consequently unprepared for life post-discharge, and assume that they (and their families) must manage on their own. Conclusions Like the patients, health care professionals may have to ‘twin-track’ if they are to provide rehabilitation in a way that is acceptable to patients with metastatic spinal cord compression. Instead of categorising patients as ‘realistic’ or ‘unrealistic’, they should work towards sustaining patients’ ‘positive illusions’, while at the same time taking whatever opportunities arise to enhance the patient’s day-to-day ability to function in a ‘safe’ space. This entails revising some deeply entrenched ideas about working with patients who have a disability: patient-centredness, the importance of goal setting, and the need for adjustment.