Browsing by Author "Nielsen, Adele"
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Item Cancer, Cognitive Impairment, and Work-Related Outcomes: An Integrative Review(ONS, 2016-09) Von Ah, Diane; Storey, Susan; Tallman, Eileen; Nielsen, Adele; Johns, Shelley A.; Pressler, Susan J.; IU School of NursingProblem Identification: Cancer survivors often report concerns regarding their memory, attention, and ability to process information and make decisions. These problems, which have also been demonstrated on objective neuropsychological assessments, may have a significant impact on work-related outcomes. Literature Search: A literature review was conducted using the following electronic databases: Ovid (MEDLINE®), PubMed, CINAHL®, and Web of Science. Search terms included cancer, survivors, cognitive, work, and work ability. Empirical research published in English from January 2002 to August 2015 that focused on cognitive impairment in adult cancer survivors was included in the review. Data Evaluation: Articles were evaluated by two independent researchers. Synthesis: Twenty-six studies met the inclusion criteria. Ten were qualitative, 15 were quantitative, and 1 had a mixed-methods design. Quantitative articles were synthesized using the integrative methodology strategies proposed by Whittemore and Knafl. Synthesis of qualitative articles was conducted using the criteria established by the Swedish Agency for Health Technology Assessment and Assessment of Social Services. Conclusions: To date, research in this context has been limited by cognitive assessments focusing primarily on patient self-assessments of attention, concentration, and memory. Additional research is needed to examine the impact of cognitive performance and to expand work-related outcomes measures to include perceived work ability, productivity, and actual performance. Implications for Nursing: Lack of information regarding cognitive impairment inhibits survivors’ ability to prepare, understand, and accept impending cognitive changes and how they may affect work ability. Oncology nurses can assist cancer survivors by preparing and educating them on how to better manage impairment associated with cancer and its treatment.Item The Caregiver’s Role Across the Bone Marrow Transplantation Trajectory(Wolters, 2015) Von Ah, Diane; Spath, Mary; Nielsen, Adele; Fife, Betsy; School of NursingBackground: Approximately 50 000 people undergo bone marrow transplants (BMTs) each year worldwide. With the move to more outpatient and home care, family caregivers are playing an ever-increasing role. However, there is little information regarding the needs and well-being of caregivers of individuals undergoing BMT. Objective: The study purpose was to gain a better understanding of the BMT experience across the trajectory from the perspective of the family caregiver. Methods: Qualitative interviews were conducted with 15 family caregivers during and 4 months after BMT. Interviews were recorded, transcribed verbatim, and analyzed using a content analysis approach. Results: Uncertainty and need for more information were 2 major underlying themes noted across the early BMT trajectory. Caregivers reported feeling overwhelmed and juggling multiple roles, including (a) ‘‘interpreter,’’ which included obtaining and translating medical information to their partner, family, and social network; (b) ‘‘organizer,’’ which included arranging and coordinating medical appointments (pre- and post-BMT) for the patient, but also juggling the needs of immediate and extended family members; and (c) ‘‘clinician,’’ which included assessing and identifying changes in their significant other, with many reporting that they had to be ‘‘vigilant’’ about or ‘‘on top of’’ any changes. Caregivers also reported the most challenging aspects of their role were to ‘‘be strong for everyone’’ and ‘‘finding balance.’’ Conclusions: Our results underscore the unique needs of family caregivers as a consequence of BMT. Implications for Practice: A greater understanding of the adaptation of caregivers will lead to the development of effective interventions for families going through BMT.Item PAIN AND ANXIETY AND QUALITY OF LIFE IN BREAST CANCER SURVIVORS(Office of the Vice Chancellor for Research, 2015-04-17) Guilkey, Rebecca; Storey, Susan; Tang, Chia-Chun; Nielsen, Adele; Von Ah, DianeBACKGROUND: Pain and anxiety are symptoms that frequently occur as co-related groups termed “clusters.” While it is known that pain may be associated with decreased quality of life (QOL), less is understood about the effects of anxiety on breast cancer survivors (BCS). PURPOSE: The purpose of this study was to: 1) determine levels of pain and anxiety in breast cancer survivors and 2) examine the relationship between anxiety and pain on quality of life in breast cancer survivors (BCS) controlling for age and time post-treatment. THEORETICAL FRAMEWORK: Ferrell’s Quality of Life Model guided this study. METHODS: A cross-sectional, descriptive design was used. BCS enrolled in a longitudinal cognitive behavioral study completed self-report questionnaires including the Medical Outcome Scale-Short Form, Pain Subscale, Spielberger State-Trait Anxiety Instrument (STAI) State Subscale to measure anxiety, and Ferrell’s QOL Instrument which measures Physical, Psychological, Social and Spiritual Well-being (higher scores indicating higher quality of life). Covariates of age and time post-treatment were controlled for. All data were collected at a baseline assessment before randomization in the cognitive intervention study. Data were evaluated using descriptive statistics and general linear regression. RESULTS: 88 female BCS averaging 57 years old (range 40-74; SD=8.54), primarily Caucasian (88.6%), college-educated (88%), approximately 5.3 (SD=4.0) years post-treatment participated. Cancer-related pain (4 lymphedema, 4 neuropathy) was specified by 8 participants. BCS reported low-moderate pain (x= 66.0114; sd = 22.348) and moderate anxiety (x̅=35.0227; sd= 8.7749). Clinically significant levels of anxiety (≥ 39 on the STAI-S where higher scores indicated higher anxiety) were reported in 24% of BCS. Age, anxiety, and pain significantly accounted for 45% of the total variance on QOL in the regression model (R = 0.45, F = 18.61; p = <0.000), controlling for age and time post-treatment. CONCLUSIONS: This study provides support for the fact that both pain and anxiety are negatively associated with QOL. Anxiety is a significant long-term symptom for a sub-set of BCS which negatively impacts all dimensions of BCS quality of life. Findings indicate the need for comprehensive assessment of symptoms of anxiety in long-term BCS and the development of evidenced-based interventions to alleviate anxiety and improve QOL.