Browsing by Subject "Symptom management"

Now showing 1 - 6 of 6
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    Acceptance and commitment therapy for fatigue interference in advanced gastrointestinal cancer and caregiver burden: protocol of a pilot randomized controlled trial
    (BMC, 2021-04-20) Mosher, Catherine E.; Secinti, Ekin; Kroenke, Kurt; Helft, Paul R.; Turk, Anita A.; Loehrer, Patrick J., Sr.; Sehdev, Amikar; Al-Hader, Ahmad A.; Champion, Victoria L.; Johns, Shelley A.; Psychology, School of Science
    Background: Fatigue interference with activities, mood, and cognition is one of the most prevalent and bothersome concerns of advanced gastrointestinal (GI) cancer patients. As fatigue interferes with patient functioning, family caregivers often report feeling burdened by increasing responsibilities. Evidence-based interventions jointly addressing cancer patient fatigue interference and caregiver burden are lacking. In pilot studies, acceptance and commitment therapy (ACT) has shown promise for addressing symptom-related suffering in cancer patients. The current pilot trial seeks to test a novel, dyadic ACT intervention for both advanced GI cancer patients with moderate-to-severe fatigue interference and their family caregivers with significant caregiving burden or distress. Methods: A minimum of 40 patient-caregiver dyads will be randomly assigned to either the ACT intervention or an education/support control condition. Dyads in both conditions attend six weekly 50-min telephone sessions. Outcomes are assessed at baseline as well as 2 weeks and 3 months post-intervention. We will evaluate the feasibility, acceptability, and preliminary efficacy of ACT for improving patient fatigue interference and caregiver burden. Secondary outcomes include patient sleep interference and patient and caregiver engagement in daily activities, psychological flexibility, and quality of life. We will also explore the effects of ACT on patient and caregiver physical and mental health service use. Discussion: Findings will inform a large-scale trial of intervention efficacy. Results will also lay the groundwork for further novel applications of ACT to symptom interference with functioning and caregiver burden in advanced cancer.
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    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.
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    Feasibility and Usability of EnergyPoints: A Mobile Health App to Guide Acupressure Use for Cancer Symptom Management
    (Sage, 2024) Beck, Susan L.; Smith, Ryan; Mindes, Janet; Beck, Karl; Kim, JungYoon Leah; Weitzman, Matthew; Stone, Jennifer A. M.; Veleber, Susan; Dudley, William N.; Medicine, School of Medicine
    Objective: To examine the feasibility and usability of EnergyPoints™, an innovative mobile health app that teaches and guides people with cancer to implement daily acupressure to self-manage their fatigue and sleep disturbances. Methods and intervention: The study used an integrated agile, human-centered approach. Adults (age 18 years and over) with cancer experiencing at least moderate fatigue, and living in the Greater New York City community, were recruited from social media, patient advocacy groups, and referrals. Twenty participants (in 3 sprints of 3, 5, and 12) were video-recorded thinking aloud while using the app for the first time. They then used the app at home to self-administer acupressure (twice daily for 1 week) while continuously wearing a fitness tracker. Each participant completed an exit interview and modified Computer System Usability Questionnaire post-participation. Results: Participants were ages 40 to 76 years and 65% female; 65% were non-Hispanic white. Mean pass rates per ritual exceeded 80%. Users completed (totally or partially) greater than 90% of stimulating acupressure and 70% of relaxing acupressure rituals. Sprint 3 SPs totally completed at least 1 ritual 87% of the time. The majority agreed or strongly agreed the app was easy to use (90%), easy to learn (85%), easy to understand (75%), and effective in helping perform self-acupressure (85%). In an analysis of ease of completing 5 key tasks, all successfully completed the tasks; 3 users required some assistance. Of 654 usability statements, those coded as personal experience/context (197), content related to acupressure learning (105), and content related to the onboarding/profile (71) were most frequent. The design team integrated recommendations into the app before the next sprint. Conclusions: Findings supported feasibility and usability, as well as acceptability, and led to significant alterations and improvements. EnergyPoints™ offers an opportunity to mainstream acupressure and help cancer survivors self-manage their symptoms.
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    Referral process to further evaluate poor sleep in breast cancer survivors
    (Wiley, 2022-04) Otte, Julie L.; Chernyak, Yelena; Johns, Shelley A.; Jackson, Lea'; Ludwig, Kandice K.; Dodson, Jill; Manchanda, Shalini; Bufink, Elizabeth; Draucker, Claire; School of Nursing
    Objective: Breast cancer survivors (BCS) are twice as likely to report symptoms of poor sleep as those without cancer. However, sleep disorders are under-assessed and under-treated among BCS. The purpose of this study was to determine the portion of BCS who completed referral visits to a sleep specialist and identify the acceptability, facilitators, and barriers to the screening and referral process. Methods: BCS, who reported having sleep problems, completed questionnaires to screen for symptoms suggestive of sleep disorders. Those with symptoms suggestive of sleep apnea, movement disorders, narcolepsy, insomnia syndrome, or circadian disorders, they were referred to a sleep medicine physician or behavioral sleep medicine psychologist. Two months after the referral, participants were interviewed about their perceptions of the acceptability, barriers, and facilitators to sleep screenings and referrals. Results: Of 34 BCS assessed for eligibility, 29 were eligible and had sleep problems. Only eight of 29 participants (27.6%) completed the sleep referral process. Most thought the screening and referral process was acceptable. However, BCS identified barriers to completing the referral visit, including time, not seeing the need for treatment, insurance/sick leave concerns, and distance/transportation. Conclusion: Adequate evaluation and treatment of sleep disorders in BCS are rare. Creative solutions to address barriers to timely sleep referrals are needed to reduce long-term negative consequences of inadequate sleep.
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    Taxanie-induced musculoskeletal pain in women with ovarian cancer
    (2017-04-18) Davis, Lorie Lynn; Carpenter, Janet S.; Otte, Julie L.; Kroenke, Kurt; He, Chuyan; Smith, Sophia
    Taxane-induced musculoskeletal pain (TIMP) is musculoskeletal pain that includes myalgia (i.e., diffuse muscle pain, usually accompanied by malaise) and/or arthralgia (i.e., joint pain) that occurs following treatment with taxane-based chemotherapy. TIMP is a symptom that is clinically reported as negatively affecting most cancer survivors receiving taxane-based chemotherapy; however, TIMP is not comprehensively understood. The purpose of this dissertation was to conduct a cross sectional, descriptive, correlational pilot study to describe TIMP in women with ovarian cancer who were being or had been treated with paclitaxel-containing regimens. Specific aims were to: (1) describe the TIMP symptom experience (intensity, distress, duration, location, quality, temporal pattern, aggravating and alleviating factors, and pain management); (2) describe the associations between TIMP (intensity, distress) and co occurring symptoms (pain [general], peripheral neuropathy, impaired sleep, fatigue, emotional distress, and/or hot flashes); and (3) identify associations between TIMP (intensity, distress) and patient-reported outcomes (interference with daily activities, physical functioning, and health-related quality of life). Primary data collection was performed on a convenience sample of 15 women with ovarian cancer. Participants were recruited from an outpatient cancer clinic, local cancer support communities, and a national cancer survivors’ research registry. Descriptive statistics and Spearman’s correlations were used. Findings showed TIMP is moderate to severe in intensity on average, constant, affecting a large area of the body, and aggravated by everyday walking. Greater TIMP intensity or distress was associated with greater intensity and interference of most co-occurring symptoms and was associated with greater interference with daily activities, worse physical functioning, and worse health-related quality of life. Nurses are encouraged to comprehensively assess TIMP using structured, validated tools for pain to better intervene on aggravating and alleviating factors and pain management regimens. Prospective, longitudinal studies with larger sample sizes are needed to further understand TIMP and its impact on cancer survivors.
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    Telehospice for Cancer Patients Discharged from a Tertiary Care Hospital in Western Kenya
    (Elsevier, 2023) Cornetta, Kenneth; Nyariki, Sarah; Manji, Imran; Kiplimo, Ivan; Korir, Millicent; Muinga, Esther; Busakhala, Naftali; Elias, Hussein; Medical and Molecular Genetics, School of Medicine
    Context: Worldwide, most patients lack access to hospice services. Objectives: Assess the feasibility of telephone monitoring (Telehospice) in providing symptom management for patients discharged from a tertiary care hospital in Western Kenya. Methods: Inclusion criteria included adults with cancer no longer eligible for chemo-radiation and receiving opioid therapy. Thirty patients were enrolled in a weekly monitoring program assessing physical symptoms and patient and caregiver distress. The participants also had access to a 24-hour hotline. Symptom assessment included 18 questions with 8 from the African Palliative Outcome Scale. Participants were followed for eight weeks or until death or admission to an inpatient hospital or hospice. Results: The primary objective was participation in weekly calls, and we obtained 100% participation. A secondary objective was the use of "comfort kits" which contained 30 doses of six medications. Most patients utilized one or more of the provided medications, with high usage of bisacodyl, paracetamol, and omeprazole. While 12% of weekly calls and 24% of hotline calls led to medication changes, participants continued to express worry and there was only a modest decrease in pain scores despite having morphine available throughout the follow-up period. Family confidence in providing care and access to information remained high. At the end of the eight-weeks of observation, eight participants were alive, 10 died at home, and 12 were admitted to an in-patient facility. Conclusion: Patient and family participation in Telehospice is feasible and may provide an interim solution to managing end-of-life patients who lack access to home hospice.