Doctor of Philosophy

dissertationRecruitment strategies often fail to examine practices and assumptions in terms of how race and racism shape African American perceptions of participation in cancer research, despite studies linking low participation with poor health outcomes. This study critically explored relationships between actual and potential African American research subjects and the research community to determine how history, discourse, and perceptions related to race, identity, and power constructed the role of research subject as a social identity, and how these relationships may contribute to sustaining inequitable relationships in cancer research. Data were collected during three focus group sessions with 1) individuals who were never recruited to participate in a cancer clinical trial (n=7), 2) individuals who participated in a cancer clinical trial (n=6); and 3) individuals who were approached to participate in a cancer clinical trial and have declined participation (n=3), using African American moderators. Sessions were audiotaped and transcribed verbatim. Analysis integrated a postcolonial perspective with sociolinguistic methods, comparing responses within and across the three groups. A detailed discussion explains how historical, discursive, and sociolinguistic approaches were synthesized into a method for analyzing how history and discourse co-construct "research subject." Focus group talk was analyzed in terms of how African Americans construct their relationship to medical science and how talk of significance, relationship, and identity shape ideas about cancer research and participation for the subjects in positive and negative ways. Positive concepts included historical roots, family, knowledge, accountability, and community. Negative concepts conveyed concerns of distrust, discrimination, limited resources, and lack of information about research studies. Data were also analyzed for relationships among fear, fatalism, and research subject identity, and how these concepts may influence research participation. Four key patterns emerged within the broader discourse of research: fears of the unknown, conspiracy, distrust, and discrimination. Study findings highlight how language mediates and constructs our understanding of cultural and historical practices surrounding cancer research and study recruitment. Recognizing the complex factors that construct relationships between minority subjects and cancer research may give us a better appreciation of individual agency, power, identity, and how the dynamics of individual, community, and organizations influence equitable healthcare

Stress among new oncology nurses

© 2015 by the Oncology Nursing Society. New oncology nurses face multiple stressors related to the predicted nursing shortage, demanding work responsibilities, and growing complexity of cancer care. The confluence of these stressors often causes new nurses to leave their profession. The loss of new nurses leads to staffing, economic, and safety concerns, which have a significant impact on the quality of oncology nursing care. At a Glance • Oncology nurses are valuable resources in the healthcare system. • A promising source of support identified by new oncology nurses is the use of a nurse educator coach to guide them on how to integrate self-care strategies into daily practice. • The findings from the current study can be used to develop innovative interventions to achieve optimal job satisfaction, retention rates, and professional experience for new oncology nurses

Enhancing behavioral change among lung cancer survivors participating in a lifestyle risk reduction intervention: a qualitative study

PURPOSE: Early detection and improved treatment have increased lung cancer survival. Lung cancer survivors have more symptom distress and lower function compared with other cancer survivors; however, few interventions are available to improve health-related quality of life (HR-QOL). Lifestyle risk reduction interventions have improved HR-QOL in other cancer survivors. The purpose of this study was to explore lung cancer survivor perspectives on making behavioral changes in the context of a lifestyle risk reduction intervention. METHODS: Twenty-two lung cancer survivors participated in interviews after completing the Healthy Directions (HD) intervention. Interviews were audiotaped, transcribed, and analyzed using inductive content analysis. Demographic and clinical characteristics were gathered through a survey and analyzed using descriptive statistics. RESULTS: Five main themes were identified: (1) the diagnosis was a motivator for behavior change, (2) participants had to deal with disease consequences, (3) the coach provided guidance, (4) strategies for change were initiated, and (5) social support sustained behavioral changes. Other important subthemes were the coach helped interpret symptoms, which supported self-efficacy and goal setting, and survivors employed self-monitoring behaviors. Several participants found the recommended goals for physical activity were difficult and were discouraged if unable to attain the goal. Findings underscore the need for individualized prescriptions of physical activity, especially for sedentary survivors. CONCLUSIONS: Lung cancer survivors described the benefits of coaching to enhance their engagement in behavioral change. Additional research is needed to validate the benefit of the HD intervention to improve HR-QOL among this vulnerable and understudied group of cancer survivors

Update to 2019-2022 ONS Research Agenda: Rapid Review to Address Structural Racism and Health Inequities

PURPOSE: The Oncology Nursing Society (ONS) formed a team to develop a necessary expansion of the 2019-2022 ONS Research Agenda, with a focus on racism and cancer care disparities. METHODS: A multimethod consensus-building approach was used to develop and refine the research priorities. A panel of oncology nurse scientists and equity scholars with expertise in health disparities conducted a rapid review of the literature, consulted with experts and oncology nurses, and reviewed priorities from funding agencies. RESULTS: Critical gaps in the literature were identified and used to develop priority areas for oncology nursing research, practice, and workforce development. SYNTHESIS: This is the first article in a two-part series that discusses structural racism and health inequities within oncology nursing. In this article, three priority areas for oncology nursing research are presented; in the second article, strategies to improve cancer disparities and equity and diversity in the oncology workforce are described. IMPLICATIONS FOR RESEARCH: Research priorities are presented to inform future research that will provide methods and tools to increase health equity and reduce structural racism in oncology nursing practice, research, education, policy, and advocacy

Update to 2019-2022 ONS Research Agenda: Rapid Review to Promote Equity in Oncology Healthcare Access and Workforce Development

PURPOSE: The Oncology Nursing Society (ONS) tasked a rapid response research team (RRRT) to develop priorities to increase diversity, equity, and inclusivity in oncology clinical care and workforce development. METHODS: An RRRT of experts in health disparities conducted a rapid review of the literature, consulted with oncology nurse leaders and disparities researchers, and reviewed priorities from funding agencies. RESULTS: Significant gaps in the current oncology disparities literature were identified and used to inform priority areas for future research practice and workforce development in oncology nursing. SYNTHESIS: This is the second article in a two-part series that presents findings on structural racism and health inequities in oncology nursing. In the first article, three priority areas for oncology nursing research were presented. In this article, strategies to improve diversity, equity, and inclusivity in clinical practice and the oncology workforce are described. IMPLICATIONS FOR RESEARCH: Recommendations are presented to inform research, clinical, administrative, and academic oncology nursing settings on increasing diversity, equity, and inclusivity and deconstructing structural racism

Feasibility and acceptability of healthy directions a lifestyle intervention for adults with lung cancer

OBJECTIVE: The aims of this feasibility study of an adapted lifestyle intervention for adults with lung cancer were to (1) determine rates of enrollment, attrition, and completion of 5 nurse-patient contacts; (2) examine demographic characteristics of those more likely to enroll into the program; (3) determine acceptability of the intervention; and (4) identify patient preferences for the format of supplemental educational intervention materials. METHODS: This study used a single-arm, pretest and posttest design. Feasibility was defined as \u3e /=20% enrollment and a completion rate of 70% for 5 nurse-patient contact sessions. Acceptability was defined as 80% of patients recommending the program to others. Data was collected through electronic data bases and phone interviews. Descriptive statistics, Fisher\u27s exact test and Wilcoxon rank sum test were used for analyses. RESULTS: Of 147 eligible patients, 42 (28.6%) enrolled and of these, 32 (76.2%) started the intervention and 27 (N = 27/32; 84.4%; 95% CI, 67.2%-94.7%) completed the intervention. Patients who were younger were more likely to enroll in the study (P = .04) whereas there were no significant differences by gender (P = .35). Twenty-three of the 24 (95.8%) participants\u27 contacted posttest recommended the intervention for others. Nearly equal numbers of participants chose the website (n = 16, 50%) vs print (n = 14, 44%). CONCLUSION: The intervention was feasible and acceptable in patients with lung cancer. Recruitment rates were higher and completion rates were similar as compared to previous home-based lifestyle interventions for patients with other types of cancer. Strategies to enhance recruitment of older adults are important for future research