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Browsing by Author "Tang, Chia-Chun"
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Item The experience and communication of symptoms in advanced pancreatic cancer patients and their families(2017-06-13) Tang, Chia-Chun; Von Ah, Diane; Burke Draucker, Claire; Hickman, Susan E.; Shields, Cleveland G.Symptom management is the main focus of care for patients living with advanced pancreatic cancer (APC). However, evidence shows that symptom management is far from satisfactory for this population. Poorly managed symptoms have had a profound negative impact on APC patients’ and caregivers’ life. While communicating symptoms with healthcare providers is the first step to achieve effective symptom management, some studies have revealed the poor quality of symptom discussions among cancer patients, their caregivers, and healthcare providers. The purpose of this dissertation was to advance the sciences of nursing, symptom management, and patient/caregiver and provider communication in patients with APC. Chapter two, three, and four represented three sub-studies which addressed three specific aims: (1) synthesizing the current evidence regarding the symptom experience of patients with APC, (2) examining recorded healthcare encounters between patients with APC, their caregivers, and healthcare providers to better understand the symptom experiences of patients with APC as told to their healthcare providers, and (3) developing a typology describing patterns and essential elements of real discussions between APC patients/ caregivers and healthcare providers in regards to symptoms. Specifically, chapter two was an integrative review which synthesized sixteen quantitative studies (n=1630 pancreatic cancer patients) and found that pain, fatigue, and appetite loss were primary and intense symptoms experienced by patients with APC. Chapter three was a qualitative descriptive study which used content analysis to examine 37 transcripts of APC patient/caregiver-provider health encounters originally collected for a larger communication study. This study identified ten major symptom groups often described as intense, distressing, and negatively impacting their quality of life. For chapter four, thematic analysis was used to examine 37 transcripts of APC/giver and provider interactions to develop a typology to describe patterns of interactions in regards to symptoms and symptom management. Eight common patient/caregiver-provider interaction patterns regarding symptoms and symptom management were identified. These typologies can be used to enhance patient/caregiver and provider communication programs to promote patient-centered care and improve symptom management in patients with APC. Findings overall will contribute to effective symptom management as it will deepen our understanding of symptom experience and communication processes.Item Factors Predicting Emotional Cue-Responding Behaviors of Nurses in Taiwan: An Observational Study(Wiley, 2017) Lin, Mei-Feng; Lee, An-Yu; Chou, Cheng-Chen; Liu, Tien-Yu; Tang, Chia-Chun; School of NursingObjective Responding to emotional cues is an essential element of therapeutic communication. The purpose of this study is to examine nurses' competence of responding to emotional cues (CRE) and related factors while interacting with standardized patients with cancer. Methods This is an exploratory and predictive correlational study. A convenience sample of registered nurses who have passed the probationary period in southern Taiwan was recruited to participate in 15-minute videotaped interviews with standardized patients. The Medical Interview Aural Rating Scale was used to describe standardized patients' emotional cues and to measure nurses' CRE. The State-Trait Anxiety Inventory was used to evaluate nurses' anxiety level before the conversation. We used descriptive statistics to describe the data and stepwise regression to examine the predictors of nurses' CRE. Results A total of 110 nurses participated in the study. Regardless of the emotional cue level, participants predominately responded to cues with inappropriate distancing strategies. Prior formal communication training, practice unit, length of nursing practice, and educational level together explain 36.3% variances of the nurses' CRE. Conclusions This study is the first to explore factors related to Taiwanese nurses' CRE. Compared to nurses in other countries, Taiwanese nurses tended to respond to patients' emotional cues with more inappropriate strategies. We also identified significant predictors of CRE that show the importance of communication training. Future research and education programs are needed to enhance nurses' CRE and to advocate for emotion-focused communication.Item “I couldn't even talk to the patient”: Barriers to communicating with cancer patients as perceived by nursing students(Wiley, 2017-07) Lin, M.-F.; Hsu, W.-S.; Huang, M.-C.; Su, Y.-H.; Crawford, P.; Tang, Chia-Chun; School of NursingCommunication is closely related to safe practice and patient outcomes. Given that most clinicians fall into routines when communicating with patients, it is important to address communication issues early. This study explores Taiwanese nursing students’ experiences of communication with patients with cancer and their families. Senior nursing students who had cared for cancer patients were recruited to participate in focus group interviews. These semi-structured interviews were recorded and transcribed for content analysis. Among the 45 participants, about 36% of them never received any communication training. Up to 76% of the participants stated that their communication with cancer patients was difficult and caused them emotional stress. Subsequent data analysis revealed four themes: disengagement, reluctance, regression and transition. Students’ negative communication experiences were related to the patients’ terminally ill situation; the students’ lack of training, low self-efficacy and power status, poor emotional regulation, and cultural considerations. The findings of this study provide a deeper understanding of nursing students’ communication experiences in oncology settings within the cultural context. Early and appropriate communication training is necessary to help students regulate their emotions and establish effective communication skills. Further studies are needed to examine the relationship among students’ emotional labour, communication skills and outcomes.Item Improving Patient-Health Care Provider End-of-Life Communication Using Improvisational Theater Techniques: Outcome of a Workshop(Office of the Vice Chancellor for Research, 2015-04-17) Tang, Chia-Chun; Wocial, LuciaBackground Communication plays a significant role in health care. While evidence showed the strong relationship between good communication and better patient outcomes including emotional health, symptom resolution, function, physiologic measures, pain control and adherence, miscommunication can results in medical errors, extra financial cost and negative attitude of health care providers. Health communication can be particular challenging in palliative care given the fact that palliative care is often link to poor prognosis, end of life and increased emotionally laden. Although more and more studies and programs were developed to teach health care providers communication skills, few of them provided interdisciplinary education despite the increasing emphasis of teamwork in health care. This project focuses on improving health care providers’ communication ability by using an innovative teaching method and emphasizing on teamwork through a 2-phase workshop. Method In the first phase, medical teams that have a goal to improve palliative and end of life care were recruited to a two part immersion workshop. Teams consisted of nurses, physicians and a chaplain, social worker or equivalent. During phase one of the workshop, these teams were exposed to a nationally-recognized lecturer and engaged in learning medical improv techniques. After 6 months, the teams were invited to complete a 2 day long update workshop including additional training using Vital Talk techniques and principles from Team STEPPs. Outcomes such as communication behavior, confidence and workshop evaluation were measured pre and post workshop. Results 14 participants included nurses, physicians, social workers and patient navigators completed the 2-phase workshop and outcome evaluation. The results showed that participants’ communication skills and confidence both improved. The self-identified weakest behavior and confidence improved the most compared to other types of behavior and confidence. In addition, this improvement is cross professions. In general, participants thought that the workshop was very valuable. Conclusion Both the workshop content and instructors received extremely positive feedback regarding interactive presentation, involvement, quality of scientific content and content appropriateness for target audience. This innovative workshop offered a promising way to teach health care providers how to communicate with terminal patients and enhance their confidence. More studies are needed to evaluate long-term and clinical outcomes.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.Item The Symptom Experience of Patients With Advanced Pancreatic Cancer: An Integrative Review(Lippincott, Williams, and Wilkins, 2017-01) Tang, Chia-Chun; Von Ah, Diane; Fulton, Janet S.; School of NursingBackground: Pancreatic cancer is a devastating disease with limited treatment options. More than 80% of pancreatic cancers are diagnosed in advanced stages and often have debilitating symptoms, making symptom management paramount, yet the symptom experience of patients with advanced pancreatic cancer (APC) is not well understood. Objective: The purpose of this integrative review is to synthesize the current evidence regarding the symptom experience of patients with APC. Method: An integrative literature review was conducted to identify the patient symptom experience in studies published from 2005 to 2015. Results: Sixteen studies met the inclusion criteria. All studies used a quantitative approach; 44% were quasi-experimental, 31% were descriptive, and 25% were correlational. Physical symptoms, especially pain, were the primary focus in most studies. Fatigue, loss of appetite, and impaired sense of well-being were prevalent and reported by patients to be of high intensity. Few studies examined psychological symptoms in patients with APC, although anxiety and depression were noted. Conclusion: Findings suggest that physical and psychological symptoms are prevalent, some with high intensity. Preselection of symptom inventories limits our ability to fully understand the symptom experience of patients with APC. Future qualitative work is needed to provide a more in-depth understanding of symptoms, especially symptom quality and distress level, from patients' perspectives. More studies are needed to explore psychological symptoms and the interaction of physical and psychological symptoms. Implications for Practice: Findings help healthcare givers to better understand the symptom experience of their APC patients.