Nurses\u27 Perceptions of Diagnosis and Prognosis-Related Communication: An Integrative Review

Background: Disclosure of diagnostic and prognostic information has become the standard in the United States and increasingly around the world. Disclosure is generally identified as the responsibility of the physician. However, nurses are active participants in the process both intentionally and inadvertently. If not included in initial discussions regarding diagnosis and prognosis, the nurse may find it challenging to openly support the patient and family. Objective: The aim of this study is to synthesize published literature regarding nurses’ perceptions and experiences with diagnosis and prognosis-related communication. Methods: The Whittemore and Knafl method guided the integrative review process. Electronic databases including Cumulative Index to Nursing and Allied Health Literature, Health Sciences in ProQuest, PubMed, and Web of Science were used to review the literature from 2000 to 2015. Constant comparison methods were used to analyze the data and develop themes. Results: Thirty articles met all of the inclusion criteria and were included in this review. Several themes emerged from the data, including the nurse’s role in the process of diagnosis and prognosis-related communication, barriers and difficulties related to communication, and positive and negative outcomes. Conclusions: Nurses play an integral role in the process of diagnostic and prognostic disclosure. Further exploration of both physician and patient perceptions of the nurse’s role are needed. Interprofessional training regarding diagnosis and prognosis-related communication is essential to promote collaboration and better empower nurses in this process. Implications for Practice: Nurses should aim to purposefully partner with physician colleagues to plan and participate in diagnostic and prognostic discussions. Nurses should identify opportunities to improve their knowledge, understanding, and comfort with challenging conversations

Pediatric Oncology Nurses\u27 Experiences with Prognosis-Related Communication

Health care providers (HCPs) in pediatric oncology are faced with the challenge of communicating the devastating news of a cancer diagnosis and prognosis. This type of communication can be referred to as prognosis-related communication (PRC). While the initial conversation with the patient and family regarding prognosis is generally considered the responsibility of the physician, patients and family members will subsequently turn to nurses for clarification of the information presented. If nurses are excluded from initial conversations, they may feel as though they are “working in the dark,” trying to answer questions while not contradicting what the physician said. This strained communication limits the nurse’s ability to fully advocate and care for patients. Little has been reported regarding pediatric oncology nurses’ experiences with PRC. A cross-sectional survey design framed by the Quality Care Model© was used to examine 1) nurses’ experiences with PRC with parents of children with cancer; 2) factors associated with experiences; and 3) associations with interprofessional collaboration, quality of care, and moral distress. Three hundred and sixteen members of the Association of Pediatric Hematology/Oncology Nurses completed an online survey containing measures of study variables. Correlation and regression were used to explore relationships among variables. Findings demonstrated that nurses strongly agreed that prognostic disclosure is critical for decision making, but are challenged in determining their role. Nurses who had more years of experience, more training in PRC, worked outpatient or inpatient/outpatient, and indicated higher levels of collaboration reported more positive experiences with PRC. A significant correlation was identified between experiences with PRC and collaboration, and both were significantly associated with measures of quality of care and moral distress. Implications for nursing practice, education and research are identified. Nurses should work to be active participants in PRC. When nurses sense that prognostic discussions have not occurred or if clarity is needed, nurses should feel confident in approaching physician colleagues to ensure parent understanding and satisfaction around communication. Future research and education should aim to develop interprofessional training to enhance communication and collaboration among nurses and physicians to ensure the highest quality of communication and care to patients and families

Pediatric Oncology Nurses’ Perceptions of Prognosis-Related Communication

Background Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described. Purpose Provide an exploration of pediatric oncology nurses’ experiences with prognosis-related communication (PRC). Method Mixed-methods, multiphase design. This paper highlights the qualitative portion of the study. Findings Three themes were identified: Importance of collaboration, impact of PRC, and delivery of prognostic information. Discussion Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family, and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations

The Nurse’s Role in Prognosis-Related Communication in Pediatric Oncology Nursing Practice

The experiences of pediatric oncology nurses with prognosis-related communication (PRC) remain largely unknown. The purpose of this article is to report results of focus groups wherein 15 pediatric oncology nurses from three Midwestern pediatric cancer programs provided descriptions of PRC and how they experience PRC within their daily practice. Data from focus groups were analyzed via an interpretive descriptive approach, which resulted in three themes: (1) nurses’ operational definition of PRC, (2) nurses’ roles in PRC, and (3) nurses’ preparation for engagement in PRC. From discussions within the focus groups, nurses recognized that PRC occurs across a continuum. Nurses distinguished that the definition of PRC expands beyond simply reporting life expectancy to describing the consequences of cancer- and treatment-related toxicities and effects. When nurses are not actively invited by their physician partners to participate in PRC, nurses will often develop workarounds to ensure that they understand what was said to patients and families. This allows them to function more effectively as supporters, advocates, and informants. Nurses described little preparation to participate in such challenging conversations. Pediatric oncology nurses need to acknowledge and embrace that they are an integral part of PRC. Interprofessional communication training is necessary to enhance the comfort and confidence of nurses engaging in PRC

Priority Symptoms, Causes, and Self-Management Strategies Reported by AYAs With Cancer

Context Cancer and symptom experiences of adolescents and young adults (AYAs) with cancer can be highly variable, creating challenges for clinicians and researchers who seek to optimize AYAs\u27 health outcomes. Understanding the heuristics AYAs use to designate priority symptoms can provide insight into the meaning they assign to their symptoms and self-management behaviors. Objectives This study described the frequency and characteristics of priority symptoms. It qualitatively explored reasons for a symptom\u27s designation as a priority symptom, perceived causes of priority symptoms, and strategies AYAs use to manage priority symptoms. Methods Participants in this single-group, longitudinal study reported symptoms using a heuristics-based symptom reporting tool, the Computerized Symptom Capture Tool, at two scheduled visits for chemotherapy. AYAs designated priority symptoms and responded to three short answer questions: What makes this a priority symptom?, What do you think causes it?, and What do you do to make it better? Results Eighty-six AYAs, 15–29 years of age (median 19 years), identified 189 priority symptoms. Priority symptoms were of greater severity (t = 3.43; P \u3c 0.01) and distress (t = 4.02; P \u3c 0.01) compared with nonpriority symptoms. Lack of energy, nausea, difficulty sleeping, and pain comprised 39% of priority symptoms. Reasons for priority designation included the impact of the symptom and the attributes of the symptom. Categories of self-management strategies included “Physical Care Strategies,” “Things I take (or not),” and “Psychosocial Care Strategies.” Conclusion Supporting AYAs to identify their priority symptoms may facilitate a more personalized approach to care. Seeking the patient\u27s perspective regarding priority symptoms could enhance patient-clinician collaboration in symptom management

The Benefits and Burdens of Pediatric Palliative Care and End-of-Life Research: A Systematic Review

Objective: The aim of this study is to report the benefits and burdens of palliative research participation on children, siblings, parents, clinicians, and researchers. Background: Pediatric palliative care requires research to mature the science and improve interventions. A tension exists between the desire to enhance palliative and end-of-life care for children and their families and the need to protect these potentially vulnerable populations from untoward burdens. Methods: Systematic review followed PRISMA guidelines with prepared protocol registered as PROSPERO #CRD42018087304. MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and The Cochrane Library were searched (2000–2017). English-language studies depicting the benefits or burdens of palliative care or end-of-life research participation on either pediatric patients and/or their family members, clinicians, or study teams were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: Twenty-four studies met final inclusion criteria. The benefit or burden of palliative care research participation was reported for the child in 6 papers; siblings in 2; parents in 19; clinicians in 3; and researchers in 5 papers. Benefits were more heavily emphasized by patients and family members, whereas burdens were more prominently emphasized by researchers and clinicians. No paper utilized a validated benefit/burden scale. Discussion: The lack of published exploration into the benefits and burdens of those asked to take part in pediatric palliative care research and those conducting the research is striking. There is a need for implementation of a validated benefit/burden instrument or interview measure as part of pediatric palliative and end-of-life research design and reporting

The 16th Data Release of the Sloan Digital Sky Surveys: First Release from the APOGEE-2 Southern Survey and Full Release of eBOSS Spectra

This paper documents the 16th data release (DR16) from the Sloan Digital Sky Surveys (SDSS), the fourth and penultimate from the fourth phase (SDSS-IV). This is the first release of data from the Southern Hemisphere survey of the Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2); new data from APOGEE-2 North are also included. DR16 is also notable as the final data release for the main cosmological program of the Extended Baryon Oscillation Spectroscopic Survey (eBOSS), and all raw and reduced spectra from that project are released here. DR16 also includes all the data from the Time Domain Spectroscopic Survey and new data from the SPectroscopic IDentification of ERosita Survey programs, both of which were co-observed on eBOSS plates. DR16 has no new data from the Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey (or the MaNGA Stellar Library "MaStar"). We also preview future SDSS-V operations (due to start in 2020), and summarize plans for the final SDSS-IV data release (DR17)

The 16th Data Release of the Sloan Digital Sky Surveys: First Release from the APOGEE-2 Southern Survey and Full Release of eBOSS Spectra

This paper documents the 16th data release (DR16) from the Sloan Digital Sky Surveys (SDSS), the fourth and penultimate from the fourth phase (SDSS-IV). This is the first release of data from the Southern Hemisphere survey of the Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2); new data from APOGEE-2 North are also included. DR16 is also notable as the final data release for the main cosmological program of the Extended Baryon Oscillation Spectroscopic Survey (eBOSS), and all raw and reduced spectra from that project are released here. DR16 also includes all the data from the Time Domain Spectroscopic Survey and new data from the SPectroscopic IDentification of ERosita Survey programs, both of which were co-observed on eBOSS plates. DR16 has no new data from the Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey (or the MaNGA Stellar Library "MaStar"). We also preview future SDSS-V operations (due to start in 2020), and summarize plans for the final SDSS-IV data release (DR17)

The Fifteenth Data Release of the Sloan Digital Sky Surveys: First Release of MaNGA-derived Quantities, Data Visualization Tools, and Stellar Library

Twenty years have passed since first light for the Sloan Digital Sky Survey (SDSS). Here, we release data taken by the fourth phase of SDSS (SDSS-IV) across its first three years of operation (2014 July–2017 July). This is the third data release for SDSS-IV, and the 15th from SDSS (Data Release Fifteen; DR15). New data come from MaNGA—we release 4824 data cubes, as well as the first stellar spectra in the MaNGA Stellar Library (MaStar), the first set of survey-supported analysis products (e.g., stellar and gas kinematics, emission-line and other maps) from the MaNGA Data Analysis Pipeline, and a new data visualization and access tool we call "Marvin." The next data release, DR16, will include new data from both APOGEE-2 and eBOSS; those surveys release no new data here, but we document updates and corrections to their data processing pipelines. The release is cumulative; it also includes the most recent reductions and calibrations of all data taken by SDSS since first light. In this paper, we describe the location and format of the data and tools and cite technical references describing how it was obtained and processed. The SDSS website (www.sdss.org) has also been updated, providing links to data downloads, tutorials, and examples of data use. Although SDSS-IV will continue to collect astronomical data until 2020, and will be followed by SDSS-V (2020–2025), we end this paper by describing plans to ensure the sustainability of the SDSS data archive for many years beyond the collection of data

The 16th Data Release of the Sloan Digital Sky Surveys : First Release from the APOGEE-2 Southern Survey and Full Release of eBOSS Spectra

This paper documents the 16th data release (DR16) from the Sloan Digital Sky Surveys (SDSS), the fourth and penultimate from the fourth phase (SDSS-IV). This is the first release of data from the Southern Hemisphere survey of the Apache Point Observatory Galactic Evolution Experiment 2 (APOGEE-2); new data from APOGEE-2 North are also included. DR16 is also notable as the final data release for the main cosmological program of the Extended Baryon Oscillation Spectroscopic Survey (eBOSS), and all raw and reduced spectra from that project are released here. DR16 also includes all the data from the Time Domain Spectroscopic Survey and new data from the SPectroscopic IDentification of ERosita Survey programs, both of which were co-observed on eBOSS plates. DR16 has no new data from the Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey (or the MaNGA Stellar Library "MaStar"). We also preview future SDSS-V operations (due to start in 2020), and summarize plans for the final SDSS-IV data release (DR17).Peer reviewe