Browsing by Author "Wang, Hsiao-Lan"
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Item Cancer-Related Pain and Disability: A Longitudinal Study(2011-12) Wang, Hsiao-Lan; Kroenke, Kurt; Wu, Jingwei; Tu, Wanzhu; Theobald, Dale; Rawl, Susan M.Context Although the cross-sectional association between cancer-related pain and disability is well established, their longitudinal relationship has been less studied. Objectives Data from the Indiana Cancer Pain and Depression (INCPAD) trial were analyzed to determine whether baseline cancer-related pain and changes in pain over time predict disability over 12 months. Methods A total of 274 cancer survivors with cancer-related pain were accrued in the INCPAD trial. Data were collected at baseline, one, three, six, and 12 months by interviewers blinded to treatment arm. Disability outcomes included a continuous measure (Sheehan Disability Scale [SDS] score) and a categorical measure (≥14 days in the past four weeks with a ≥50% reduction in usual activities). Predictor variables, operationalized by the Brief Pain Inventory, included baseline pain severity and changes in pain severity scores between each time point. Multivariable analyses were conducted adjusting for treatment group, baseline disability, and selected covariates including depression. Results Baseline pain severity did not predict disability outcomes at 12 months. However, improvement in pain severity predicted less disability over 12 months both in terms of SDS scores (b = −0.17, t = −5.33, P < 0.001) and ≥14 disability days in the past month (odds ratio = 0.85; 95% confidence interval, 0.79–0.93; P < 0.001). Conclusion Disability over 12 months in patients with cancer-related pain is predicted by changes in pain severity over time. Results suggest that effective pain management may reduce subsequent disability among cancer survivors.Item Computer-tailored intervention increases colorectal cancer screening among low-income African Americans in primary care: Results of a randomized trial(Elsevier, 2021) Rawl, Susan M.; Christy, Shannon M.; Perkins, Susan M.; Tong, Yan; Krier, Connie; Wang, Hsiao-Lan; Huang, Amelia M.; Laury, Esther; Rhyant, Broderick; Lloyd, Frank; Willis, Deanna R.; Imperiale, Thomas F.; Myers, Laura J.; Springston, Jeffrey; Sugg Skinner, Celette; Champion, Victoria L.; School of NursingIntroduction: Although African Americans have the highest colorectal cancer (CRC) incidence and mortality rates of any racial group, their screening rates remain low. Study design/purpose: This randomized controlled trial compared efficacy of two clinic-based interventions for increasing CRC screening among African American primary care patients. Methods: African American patients from 11 clinics who were not current with CRC screening were randomized to receive a computer-tailored intervention (n = 335) or a non-tailored brochure (n = 358) designed to promote adherence to CRC screening. Interventions were delivered in clinic immediately prior to a provider visit. Univariate and multivariable logistic regression models analyzed predictors of screening test completion. Moderators and mediators were determined using multivariable linear and logistic regression analyses. Results: Significant effects of the computer-tailored intervention were observed for completion of a stool blood test (SBT) and completion of any CRC screening test (SBT or colonoscopy). The colonoscopy screening rate was higher among those receiving the computer-tailored intervention group compared to the nontailored brochure but the difference was not significant. Predictors of SBT completion were: receipt of the computer-tailored intervention; being seen at a Veterans Affairs Medical Center clinic; baseline stage of adoption; and reason for visit. Mediators of intervention effects were changes in perceived SBT barriers, changes in perceived colonoscopy benefits, changes in CRC knowledge, and patient-provider discussion. Moderators of intervention effects were age, employment, and family/friend recommendation of screening. Conclusion: This one-time computer-tailored intervention significantly improved CRC screening rates among low-income African American patients. This finding was largely driven by increasing SBT but the impact of the intervention on colonoscopy screening was strong. Implementation of a CRC screening quality improvement program in the VA site that included provision of stool blood test kits and follow-up likely contributed to the strong intervention effect observed at that site.Item Interventions to Promote Colorectal Cancer Screening in Primary Care: Results of a Randomized Trial(Office of the Vice Chancellor for Research, 2013-04-05) Rawl, Susan M.; Christy, Shannon M.; Perkins, Susan; Tong, Yan; Krier, Connie; Wang, Hsiao-Lan; Champion, Victoria L.; Myers, Laura Jones; Imperiale, Thomas; Willis, Deanna; Rhyant, Broderick; Springston, Jeffrey; Skinner, Celette SuggAims: The purpose of this randomized trial was to compare rates of self-reported colorectal cancer (CRC) screening and forward movement in stage of adoption at 6 months post-intervention. African American primary care patients (n=595) who were eligible for CRC screening were randomly assigned to receive a computer-delivered tailored CRC screening intervention (n=286) or a non-tailored screening brochure (n=309) prior to their scheduled visit with their primary care provider. Hypotheses were that differences between groups would be observed in proportions of patients who: 1) completed fecal occult blood tests (FOBT) or colonoscopy; and 2) had moved forward in stages of adoption for these tests. Methods: Participants completed baseline and 6-month telephone interviews; interventions were delivered prior to primary care provider visits. Differences between groups were examined using chi-square tests, predictors of screening were determined using logistic regression models. Results: In the computer-tailored group, the FOBT completion rate was 12.6% compared to 7.8% in the brochure group (p=0.05). The colonoscopy completion rate was 17.5% in the computer group vs. 15.2% in the brochure group (p=0.45). Forward stage movement for FOBT was observed in 28.4% of the computer groups vs. 20.8% in the brochure group (p=0.03). Forward stage movement for colonoscopy was 38.5% in the computer group and 36.8% (p=0.68) in each group, respectively. Conclusions: The computer-tailored intervention was more effective than the brochure at increasing FOBT completion and movement toward action. More research is needed to explain why the tailored intervention was not more effective at increasing colonoscopy completion and to identify moderators of intervention efficacy.Item Predictors of Cancer-related Pain Improvement Over Time(2012-07) Wang, Hsiao-Lan; Kroenke, Kurt; Wu, Jingwei; Tu, Wanzhu; Theobald, Dale; Rawl, Susan M.Objective To determine the predictors of pain improvement among patients being treated for cancer-related pain over 12 months. Methods A secondary analysis of the telephone care Indiana Cancer Pain and Depression trial was performed. Patients (n = 274) were interviewed at baseline and after 1, 3, 6, and 12 months. Pain improvement outcomes included both a continuous measure (Brief Pain Inventory score) and a categorical measure (pain improved versus pain not improved). Predictor variables included change in depression, age, sex, race, marital status, socioeconomic disadvantage, medical comorbidity, type of cancer, and phase of cancer. Multivariable repeated measures were conducted, adjusting for intervention group assignment, baseline pain severity, and time in months since baseline assessment. Results Factors significantly predicting both continuous and categorical pain improvement included participating in the intervention group (β = −0.92, p < .001, odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.65–3.89), greater improvement in depression (β = −0.31, p = .003, OR = 1.84, 95% CI = 1.35–2.51), higher socioeconomic status (Socioeconomic Disadvantage index; β = 0.25, p = .034; OR = 0.73, 95% CI = 0.56–0.94), and fewer comorbid conditions (β = 0.20, p = .002; OR = 0.84, 95% CI = 0.73–0.96). Patients with more severe pain at baseline or with recurrent or progressive cancer were less likely to experience continuous or categorical pain improvement, respectively. Conclusions Effective management of depression and comorbid conditions along with improvement of social services could be critical components of a comprehensive pain management. Patients with more severe pain or with recurrent or progressive cancers may require closer monitoring and adequate treatment of pain.Item Predictors of Health-related Quality of Life at One Month after Head and Neck Cancer Surgery(Office of the Vice Chancellor for Research, 2011-04-08) Wang, Hsiao-Lan; Mikesky, Alan; Keck, Juanita F.; Bunnell, Karen; Buelow, Janice; Rawl, Susan M.Significance: Head and neck cancer (HNC) survivors frequently experience treatment-related complications that may cause decrements in health-related quality of life (HRQOL). Before interventions can be designed to enhance HRQOL in the early postoperative period, descriptive research is needed to determine predictors of HRQOL in this understudied population. Problem and Purpose: The proposed study identified predictors of global HRQOL, and physical, functional, emotional, and social well-being at one month after HNC surgery. Variables examined as potential predictors included shoulder pain, shoulder function, and functional impairments (disfigurement, and eating, speech, and breathing impairments). Theoretical Framework: The University of California, San Francisco School of Nursing Symptom Management Model was modified and used to guide the study. Methods and Analysis: In this exploratory, cross-sectional study, we examined a convenience sample of 29 patients who had undergone HNC surgery with curative intent one month previously. Global HRQOL was measured using the Functional Assessment of Chronic Illness Therapy (FACIT) General Scale, including four well-being subscales. Shoulder pain intensity was measured using the Brief Pain Inventory, shoulder pain distress was measured using a 0-10 numerical rating scale, and functional impairment was measured using the FACIT Head and Neck Subscale. Shoulder function was assessed using a goniometer. Pearson correlations were initially applied to determine correlates (p <0.20) that should be entered in subsequent stepwise regression models. Findings and Implications: The only significant predictor of global HRQOL was eating impairment (B = -0.20, p = 0.02). Predictors of physical well-being were shoulder pain distress (B = -0.10, p = 0.02) and eating impairment (B = 0.27, p = 0.03). Predictors of functional well-being were speech impairment (B = -0.43, p < 0.01) and disfigurement (B = - 0.20, p = 0.02). No significant predictors were found for emotional and social well-being. The findings suggested that patients’ physical and functional well-being can be influenced by eating impairment, shoulder pain distress, speech impairment, or disfigurement at one month after HNC surgery. Nurses need to monitor nutrition intake, provide proper pain management, and collaborate with speech and physical therapists to promote early rehabilitation. A longitudinal study with a larger sample size is warranted to describe needs for multidisciplinary care to improve HQOL after HNC surgery.Item Predictors of stage of adoption for colorectal cancer screening among African American primary care patients(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2014-07) Wang, Hsiao-Lan; Christy, Shannon M.; Skinner, Celette S.; Champion, Victoria L.; Springston, Jeffrey K.; Perkins, Susan M.; Tong, Yan; Krier, Connie; Gebregziabher, Netsanet; Rawl, Susan M.; Department of Psychology, School of ScienceBACKGROUND: Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. OBJECTIVE: Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. METHODS: Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. RESULTS: Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. CONCLUSIONS: Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. IMPLICATIONS FOR PRACTICE: Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.Item Shoulder Pain after Neck Dissection among Head and Neck Cancer Patients(2009-11-04T18:53:26Z) Wang, Hsiao-Lan; Keck, Juanita F.; Rawl, Susan M.; Buelow, Janice M.; Mikesky, Alan E.Shoulder pain was constantly reported as a problematic symptom causing dysfunction and quality of life interference after neck dissection in head and neck cancer patients. Due to a lack of conceptual framework and inconsistency of instrument selection, a comparison among previous studies was almost impossible, making it difficult to understand the phenomenon. The current study applied the University of California, San Francisco School of Nursing Symptom Management Model. The purposes of the study were to (a) describe the symptom experience of shoulder pain at 1 month after neck dissection, (b) describe the relationships among symptom experience of shoulder pain, functional status, and quality of life, and (c) identify the contextual variables, concurrent symptoms, and/or adherence predicting symptom experience of shoulder pain, functional status, and/or quality of life. This was a descriptive study with a convenience sample of head and neck cancer patients. The data were collected via a medical record review, a self-administered survey, and a physical examination. The data from 29 patients were entered for descriptive statistics, Pearson correlations, and multiple regressions. At 1 month after surgery, 62% of patients reported they had shoulder pain at some point within a week. Their shoulder pain was from mild to moderate. Fifty-nine percent complained that shoulder pain bothered them about the moderated level. In the final model, symptom experience, shoulder pain, was significantly correlated with one outcome, active shoulder abduction, but not the other, total quality of life, generic quality of life, and head and neck quality of life. Active shoulder abduction was significantly correlated with three quality of life measures. Adding significant predictors of symptom experience and outcomes into the final model, there is a potential that the model would be useful to guide treatment strategies. Treatment for myofascial pain of the levator scapulae could relieve shoulder pain after neck dissection and improve head and neck quality of life. Those with level V dissection were high risk populations of developing shoulder pain. Risk factors of quality of life, which were depression, loss of sensation, and radiation would describe how an intervention could change or unchange the patient’s life.Item Shoulder Pain, Functional Status, and Health-Related Quality of Life after Head and Neck Cancer Surgery(2013-12) Wang, Hsiao-Lan; Keck, Juanita F.; Weaver, Michael T.; Mikesky, Alan; Bunnell, Karen; Buelow, Janice M; Rawl, Susan M.Head and neck cancer (HNC) patients experience treatment-related complications that may interfere with health-related quality of life (HRQOL). The purpose of this study was to describe the symptom experience (shoulder pain) and functional status factors that are related to global and domain-specific HRQOL at one month after HNC surgery. In this exploratory study, we examined 29 patients. The outcome variables included global HRQOL as well as physical, functional, emotional, and social well-being. Symptom experience and functional status factors were the independent variables. In the symptom experience variables, shoulder pain distress was negatively associated with physical well-being (R2 = 0.24). Among the functional status variables, eating impairment was negatively related to global HRQOL (R2 = 0.18) and physical well-being (R2 = 0.21). Speaking impairment and impaired body image explained a large amount of the variance in functional well-being (R2 = 0.45). This study provided initial results regarding symptom experience and functional status factors related to poor HRQOL in the early postoperative period for HNC patients.