Assessing the Impact Timing of Chemotherapy Education has on a Patient\u27s Ability to Self-Manage Common Side Effects

Purpose A new diagnosis of cancer will often cause an individual to feel overwhelmed, confused and anxious (Kessels, 2003). Many patients often experience anxiety not only related to their cancer diagnosis but also in regards to the plausible side effects of chemotherapy (Greene, Nail, Fieler, Dudgeon, & Jones, 1994; Williams & Schreier, 2004). The purpose of this paper is to evaluate the association between timing of education provided to newly diagnosed patients undergoing chemotherapy for breast cancer and number of self-manageable triage calls to the oncologist’s office Methods A retrospective study design was conducted on newly diagnosed breast cancer patients from January 1, 2016 to December 31, 2016, undergoing chemotherapy in two NCI clinics. The inclusion criteria consisted of medical records of males and females 18 years of age and older with a new breast cancer diagnosis, completed at least two cycles of chemotherapy, English as the primary language spoken and written, received standard of care only (no research trial) and received education at the initial visit or within 2 weeks of the initial physician visit. A total of 59 records were included in the study. Thirty patients were educated on the same day (Group A) as their initial visits with the oncologist and 29 were educated within two weeks of their initial visit (Group B). Results The first objective determined if the nature of the call for Group A involved symptom management in the form of diarrhea \u3c 24 hours, fever \u3c 100.4 degrees Fahrenheit or nausea/vomiting \u3c 24 hours, within the first two cycles of chemotherapy. The number of triage calls that met the criteria was 30% for Group A and 21% for Group B. The second objective compared the number of triage phone calls for Group A and Group B to determine if there was a variation contributable to timing of education. A chi-square test showed that there was no statistical significance between the two groups. Conclusion In conclusion, the results of this study did not show a substantial difference in the outcome based on when the patients and caregivers were educated. Additional research needs to be done to focus on other types of cancer and other factors that could influence patient self-management of common side effects of chemotherap

Implementing & Evaluating a Nurse-Led Educational Intervention for Bone Marrow Transplant Patients in the Acute Care Setting

Objective: The Bone Marrow Transplant (BMT) Basics Class is a nurse-led educational program dedicated to preparing patients and their caregivers of the treatment outline and self-care behaviors associated with receiving a BMT. The purpose of this project is to evaluate the effectiveness of this intervention in order to support the needs of the BMT patient and promote patient-centered care. Study Design: Retrospective review to evaluate a quality improvement project. Participants & Methods: As of July 2016, the BMT Basics Class became a standard of care at an NCI-designated academic cancer center in the southeastern United States. Between July 20, 2016 and November 30, 2016, 33 patients who received a BMT attended the class with their caregiver, making them eligible project participants. A retrospective evaluation of CLABSI rates, 30-day readmission rates, length of stay, and patient satisfaction scores was conducted pre- (July 2015 to November 2015) and post- (July 2016 to November 2016) intervention to determine if there were any improvements in quality indicators for the patients who attended the class compared to patients who received a transplant before the class was created. Results: There were no significant statistical differences between the pre- and post-implementation groups for length of stay or patient experience scores. 30-day readmission rate was lower among the post-implementation group (7.69% vs. 2.56%) with fewer patients readmitted for infection. However, there was an increase in CLABSI rate in the post-implementation group. Conclusion: Educational interventions, such as the BMT Basics Class, could provide a patient-centered approach to improving quality of care, when implemented in addition to current evidence-based practice

POST DISCHARGE NAUSEA AND VOMITING IN AMBULATORY SURGICAL PATIENTS: INCIDENCE AND MANAGEMENT STRATEGIES

Approximately 65% of all surgeries are conducted in the outpatient surgery setting involving more than 35 million patients. Thirty-five to fifty percent of these outpatients will experience post discharge nausea and vomiting (PDNV), nausea and vomiting that occurs after discharge from the health care facility after surgery. A dearth of literature details the problems associated with nausea and vomiting experienced by patients after discharge home from outpatient surgery. The purposes of this dissertation were to (1) review the current knowledge in the area of post discharge nausea and vomiting; (2) present results of an integrative review of the research literature to determine best evidence for prevention of PDNV in adults or rescue of patients who suffer from post discharge nausea and vomiting (PDNV); (3) present a critical review and analysis of measurement of nausea and vomiting after discharge from outpatient surgery, and (4) present findings of a prospective research study. The purposes of the research study were to: 1) describe the incidence and severity of PDNV over a 7-day period in a sample of adult surgical patients undergoing outpatient surgeries under general anesthesia, 2) describe the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, 3) compare the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and 4) determine outcomes associated with PDNV. This study was part of a multi-site study that had as a primary objective development of a simplified risk model for predicting patients most likely to suffer PDNV. In this research study we described the incidence and severity of PDNV in adult outpatients after ambulatory surgery, described the pharmacologic and nonpharmacologic modalities of care used by patients with PDNV to manage it, compared the incidence and severity of PDNV between those who do and do not use pharmacologic and nonpharmacologic modalities, and determined outcomes associated with PDNV

Promotion of Early Recognition of Depression to Improve Health Related Quality of Life in Pediatric Oncology Patients

Background: Depression and anxiety are serious complications of cancer and deemed a challenging diagnosis due to the symptoms of depression mimicking common side effects of chemotherapy and radiation. Signs/symptoms frequently are underrecognized thus appropriate treatment is delayed, compromising the health-related quality of life (HRQOL) for pediatric oncology patients. Purpose: Analyze existing physician and Advanced Practice Provider (APP) clinical practice regarding depression, via a pre- and post-survey and educational PowerPoint on the use of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) to promote early recognition of depression. Methods: A prospective, single-arm, study was completed in the Kentucky Children’s Hospital DanceBlue Clinic (DBC). Surveys were distributed to physicians and APPs. Pre- and post-surveys via Qualtrics along with an educational PowerPoint was used to analyze clinician knowledge, clinical practice, and barriers. Results: Out of twelve participants, eight completed the pre- and post-survey; four were Physicians and four were APP. Following the educational PowerPoint, a statistically significant increase in perception of the need to screen every patient with a standardized depression screening tool was observed (75%). A majority were willing to make the practice change (75%), and most recommended the CES-DC (87.5%). Conclusion: The results of this study warrant the need for the use of a standardized depression screening tool, with the CES-DC as the preferred tool, in the pediatric oncology population. The future intentions to screen every patient upon clinic visit and hospital admission could not be analyzed

INFLUENCE OF COPING STYLES ON EMOTIONAL STATE, ILLNESS PERCEPTION, AND INFORMATION SOURCES OF MEN WITH PROSTATE CANCER

Prostate cancer (PCa) has been the leading cause of cancer death in men since1930. While studies pertaining to PCa have primarily focused on the disease and the subsequent side effects of treatment, psychological distress in this group has yet to be adequately addressed. The purpose of this dissertation was to: 1) conceptualize health related quality of life (HRQL) and health seeking behavior of men by describing lifestyle, cultural and health risks associated with being male, 2) evaluate the psychometric properties of the SF-12 Health Survey (SF-12) combined with the urinary and sexual portions of the UCLA PCa Index (UCLA-PCI), 3) investigate the psychological impact, coping styles and informational needs of a group of men diagnosed with PCa who have not yet undergone treatment. Men have been observed to underutilize health care services despite the fact that they are in poorer health, have higher mortality rates and lower life expectancies than women. Restricting emotions, being oriented toward success, having limited social networks and taking health risks are often associated with being male. Because incontinence and sexual dysfunction, the two most common side effects of PCa treatments impact men\u27s quality of life, portions of the UCLA-PCI and the SF12 were analyzed. The psychometric analysis of the SF-12/UCLA-PCI and its three subcomponents confirmed the validity of the instrument. The SF-12 component had a Cronbach\u27s alpha of 0.87, while the urinary and sexual subscales had a Cronbach\u27s alpha of .86 and .91 respectively. All three scales were found to have good internal consistency. KEYWORDS: prostate cancer, health related quality of life, coping styles, psychological distress

GETTING TO THE OTHER SIDE: AN EXPLORATION OF THE HEAD AND NECK CANCER TREATMENT EXPERIENCE

Diagnosis of head and neck squamous cell carcinoma (HNSCC) presents a multifarious problem. Late stage diagnosis, uncertainty regarding appropriate clinical treatment, as well as the high potential for disfigurement and functional loss resulting in diminished quality of life, contributes to anxiety, stress, fear, and uncertainty throughout the cancer treatment experience. This qualitative study sought to explore the cancer treatment experience of adults with newly diagnosed HNSCC, including laryngeal, esophageal, and oral cancers. Study participants were recruited from the University of Kentucky Ear Nose and Throat Clinic in Lexington KY. Participants agreed to be interviewed after receipt of their cancer diagnosis and again after completion of their cancer treatment. Socio-emotional Selectivity Theory, and Leventhal’s Self-Regulation Model provided the theoretical foundation for exploring the ongoing emotional, psychological, and physical aspects of the cancer experience while also recognizing the role of age and time perception. Forty-one patients completed two in depth semi- structured interviews. Transcripts were coded for key themes. Findings indicated that HNSCC in older patients is often preceded by lifelong alcohol, tobacco, and substance use. Despite frequent interaction with health and substance abuse treatment professionals, very few patients had prior knowledge of HNSCC risk or had been screened for these cancers. Experience with addiction treatment programs and perceptions of time seem to influence cancer treatment experience. The following themes were identified: (1) dynamic time perspectives including taking time, making time, junk time and time out; (2) recovery vs. cure from disease; (3) the role of reconciliation, hope, self-inventory, reflection, and spirituality in navigating the cancer experience; (4) the role of healing vs. cure; and (5) patient\u27s moving forward to a life after cancer. Findings from this investigation suggest that patients with a history of lifelong substance use could benefit from earlier detection and improved awareness and knowledge of HNSCC risk. Findings can be applied to improve access to cancer screening through addiction and cessation programs, reduce lags in diagnosis, improve prognosis and contribute to the development of clinical tools. Additionally, the intersection of advancing chronological age, comorbidity, and perception of time warrants further investigation

Social Support in Young Adult Cancer Survivors and Their Close Social Network Members

A cancer diagnosis often causes biographical disruption in the lives of young adult (i.e., 18-39; YA) survivors and their close social network members (i.e., familial, plutonic, or romantic relational partners with whom the survivor has a salient relationship; SNM). In order to integrate their illness into their lives, normatively regain balance and equilibrium, and achieve a “new normal” following a cancer diagnosis, YA survivors and their close SNMs must work to reconstruct their biographies by engaging in tangible interpersonal communication processes often used to initiate and maintain relationships. However, YA cancer survivors report facing social struggles due to the biographical disruption of their illness across the trajectory of diagnosis, treatment, and survivorship. To learn more about their unique social experience of cancer, I conducted private, open-ended narrative interviews with 20 YA survivor-close SNM dyads, 1 YA survivor-SNM close triad, and 10 individual YA survivors (N = 51). I used thematic narrative analysis to determine how and why YA cancer survivors and their close SNMs communicate social support messages with romantic partners, family, friends, peers, and one another. By examining the narratives of YA survivors, their close SNMs, and the dyad itself, this dissertation explores the interpersonal communication processes used to initiate and maintain relationships across the illness trajectory by focusing on the barriers and facilitators these individuals experience in the communication of social support. Through their individual narrative accounts, YA survivors explained why and how they perceived various support attempts from others to be positive or negative, and their close SNMs detailed their attempts to navigate the YA’s larger support network and assume the duties inherent in their newly-adopted “top supporter” role. In addition, reports from YAs and their SNMs revealed that they often engaged in mutual pretense, a unique and often unsustainable form of support that occurred between YA survivors and their close SNMs involving topic avoidance and emotional management. Implications for the advancement of interpersonal communication theory and for practical intervention targeting YA patients and survivors, their close SNMs, and medical practitioners are also discussed

REDEFINING PATERNALISTIC PRACTICES IN WOMEN’S HEALTH: HOW DYSFUNCTIONAL TRUST RELATIONSHIPS IMPACT MEDICAL AUTONOMY OF FEMALE PATIENTS IN THE CONTEMPORARY CLINICAL SETTING

Utilizing Trudy Govier’s (1997) conception of social trust, this dissertation will provide a framework for understanding trust in healthcare relationships and highlight some of the ways that unequal power distribution and dependency, poorly defined roles, and institutions complicate trust between women and their providers. This framework will also explain how distrust, especially prejudicial distrust, leads to paternalistic attitudes on the part of providers. Paternalism limits patient autonomy because medical autonomy is constitutively relational. This means that insofar as distrust causes paternalism, it also damages autonomy. Through negative outcomes, this lack of autonomy can cause patients to distrust healthcare, which can contribute to a spiral of distrust between patients and providers. This dissertation will provide two contexts of how this distrust could play out in the clinical setting. The first conception involves lying as a response to testimonial injustice. When providers give patients a credibility deficit and distrust them to testify about their symptoms, providers may engage in the paternalistic practice of dismissing or minimizing the patient’s testimony in favor of their own assessment of the patient’s lived experience. If this practice is institutionalized, it can lead to a phenomenon known as testimonial silencing, where patients feel hopeless about their ability to convey information and distrust providers to take them seriously. This dissertation suggests that in order to overcome this silencing and reclaim autonomy in the patient-provider relationship, patients may lie to providers, not to deceive them, but in order to convey accurate information in a way that achieves perlocutionary success. The second conception deals with choice limitation in reproductive healthcare. In expanding the scope of reproductive coercion, it becomes evident that certain practices at the systematic or political level and at the clinical level should be defined as reproductive coercion. In order to explicate how reproductive choices, especially women’s choices, are restricted in multiple spheres, I argue that reproductive coercion occurs at three distinct levels of engagement with society: intimate, clinical, and systematic. By focusing on the clinical setting, the dissertation can demonstrate how paternalistic practices in healthcare, brought on by distrust in patients as decision-makers, can coerce women into certain reproductive choices that run counter to their autonomous preferences

“IT’S A VERY TRICKY COMMUNICATION SITUATION : A COMPREHENSIVE INVESTIGATION OF END-OF-LIFE FAMILY CAREGIVER COMMUNICATION BURDEN

Family caregivers encounter immense negative consequences including decreased quality of life and increased rates of morbidity and mortality that stem from physical burdens, emotional distress, depression, social isolation, and loss of financial security. Although communication is an important aspect of caregiving, communication tasks are reportedly difficult for end-of-life family caregivers. The goal of this study was to explore the variety of communication stressors experienced by end-of-life family caregivers to gain insight into the communication tasks caregivers perceive as most difficult and the reasons why. Qualitative data was achieved through in-depth, face-to-face interviews with 40 caregivers currently providing care for a family member diagnosed with Alzheimer’s disease and related dementias (n=20; ADRD) and Glioblastoma (n=20; brain tumor [GBM]). A grounded theory approach was employed to gain insight into end-of-life family caregiver communication experiences. The results revealed that communication is perceived as a burden for end-of-life family caregivers. Not only does communication burden exist, end-of-life family caregivers experience immense tension and stress regarding a variety of relational contexts when communicating with the care recipient, others (family, friends), and clinicians. The results further revealed that communication burden stems from the caregiver’s attempt to negotiate between two opposing extremes: a desire to protect the patient and others versus a need to protect oneself. Thus, internal tension occurs when end-of-life family caregivers contemplate whether and how to engage in difficult conversations, and then again when following through. The presence of these contradictory tensions induced the emergence of barriers and therefore communication burden within various aspects of the end-of-life caregiver experience. Added insight into communication burden was achieved through a supplementary scale development study in a sample of ADRD and oncology end-of-life caregivers (N=263), which revealed communication burden as significantly associated with caregiver burden and quality of life. Implications for the advancement of interpersonal and health communication theory as well as practical tailored interventions targeting end-of-life family caregivers are discussed

Precision Nutrition and Advanced Culinary Medicine

This electronic textbook (eBook) accompanies NS801, Precision Nutrition and Advanced Culinary Medicine, a 1-credit, 8-week online medical elective course for the University of Kentucky College of Medicine Office of Medical Education. The eBook provides module-based background information including text, tables, and figures to support each module of the online course: Introduction Culinary Challenges Preparation Emerging Concepts in Precision Nutrition Cardiovascular Disease & Nutritional Considerations Neurological and Mental Health Disorders & Nutritional Considerations Cancer & Nutritional Considerations Gastrointestinal (GI) Health, Microbiome & Nutritional Considerations Renal Conditions & Nutritional Considerations As an open access textbook supported by the University of Kentucky Libraries Alternative Textbook program, all sources are linked and readily available.https://uknowledge.uky.edu/pharmacol_textbooks/1000/thumbnail.jp