Cancer Caregivers’ Prognostic and End-of-Life Communication Needs and Experiences and their Impact

ContextFamily caregivers of patients with advanced cancer are integrally involved in communications regarding prognosis and end-of-life (EOL) planning and care. Yet little research has examined caregivers’ communication experiences or the impact of these experiences on patients and caregivers at EOL.ObjectivesInvestigate cancer caregivers’ communication experiences and potential impact on patient and caregiver outcomes.MethodsSemistructured interviews with bereaved family cancer caregivers (N=19) about their communication needs and experiences as their loved one approached EOL and died. Audiotaped interviews were transcribed and thematically analyzed for communication-related themes.ResultsCaregivers described fulfilling many important communication roles including information gathering and sharing, advocating, and facilitating—often coordinating communication with multiple partners (e.g., patient, family, oncology team, hospital team). Caregivers reported that, among the many topics they communicated about, prognosis and EOL were the most consequential and challenging. These challenges arose for several reasons including caregivers’ and patients' discordant communication needs, limited opportunity for caregivers to satisfy their personal communication needs, uncertainty regarding their communication needs and responsibilities, and feeling unacknowledged by the care team. These challenges negatively impacted caregivers’ abilities to satisfy their patient-related communication responsibilities, which shaped many outcomes including end-of-life decisions, care satisfaction, and bereavement.ConclusionCaregivers often facilitate essential communication for patients with advanced cancers yet face challenges successfully fulfilling their own and patients’ communication needs, particularly surrounding prognostic and end-of-life conversations. Future research and interventions should explore strategies to help caregivers navigate uncertainty, create space to ask sensitive questions, and facilitate patient-caregiver discussions about differing informational needs.     

Association between patients’ recommendation of their GP and their evaluation of the GP

Objective – To study general practitioners’ (GPs’) inclination to be the advocate of their patients or representatives of the society. The GPs’ opinions were compared with those of psychiatrists.

Design – A postal questionnaire with two case histories. Loyalty towards the social insurance or towards a patient in distress, and loyalty towards a patient seeking asylum or towards society were posited. The degree of distress and urgency of the patients’ situation varied.

Subjects and setting – A random sample of Swedish GPs (n=167) and psychiatrists (n=112).

Results – All doctors significantly changed their minds when asked to fake a psychiatric diagnosis compared with a somatic diagnosis. Compared with psychiatrists, general practitioners tend to be more pragmatic (p=0.016) and in addition female doctors in some cases in both groups seem to be more pragmatic (p=0.023). Good clinical practice seems to be of importance in both groups. If the patient's life is threatened doctors are, however, prepared to overrule their own professional interests. The interests of society seem not to have any strong support in either of the two groups or the two cases.

Conclusions – GPs as well as psychiatrists find it less improper to fake a psychiatric diagnosis than to fake a somatic. GP tends to be more pragmatic than psychiatrists and female doctors tend to be more pragmatic than male in both groups.     

Children’s perceptions of their cerebral palsy and their impact on life satisfaction

Purpose: To assess an individual child’s cognitive and emotional perceptions of their cerebral palsy (CP) and how these are associated with their reported life satisfaction and their functional walking ability.Method: Convenience sample of 48 children with cerebral palsy, GMFCS (Gross Motor Function Classification System) I-IV, mean age of 12.2 ± 2.5 years was recruited from tertiary level out-patient clinics. All children completed the Brief Illness Perception Questionnaire-Cerebral Palsy version (BIPQ–CP), Students’ Life Satisfaction Scale (SLSS) and 1- and 6-min walk tests.Results: Children with CP reported levels of global life satisfaction (mean score 31.4/42) equivalent to previous studies of typically developing children. Higher total SLSS scores were associated with lower concern about CP (rho = ?0.61, p < 0.001), lower emotional impact (rho = ?0.58, p < 0.001), fewer perceived consequences (rho = ?0.53, p < 0.001) and perceptions of higher levels of personal control (rho = 0.40, p = 0.01). Multiple regression models using BIPQ-CP constructs found that a combination of lower level of concern and fewer perceived consequences predicted 46% of the variance in SLSS score (p < 0.001). GMFCS levels, walk distance and age were not significant predictors of life satisfaction. Conclusions: Life satisfaction in this group of children was strongly associated with a child’s perceptions of their CP but was not associated with functional walking ability. Although the cross-sectional nature of the study precludes assumptions of causality, understanding children’s cognitive and emotional beliefs about their cerebral palsy would seem to be an important adjunct to clinical management.

Implications for Rehabilitation

• Children with cerebral palsy as young as eight years can self-report cognitive and emotional beliefs about their condition.

• The reported degree of concern about cerebral palsy is the strongest predictor of the child’s reported level of life satisfaction.

• Those children with cerebral palsy who do report high levels of concern about their condition also report that they have feelings of reduced personal control and are more affected emotionally, suggesting possible targets for intervention.

     

What helps middle-aged widows with their psychological and social adaptation several years after their loss?

This study examines the factors contributing to middle-aged widows' adaptation to their husbands' death due to physical illness, 1 to 5 years after the initial loss. Ninety-three widows and 93 married women, who served as controls, filled out questionnaires assessing their experience of stress and strain, their Sense of Coherence level, the social support they received, as well as measures of psychological and social adaptation. Results show that several years after their husbands' death, many widows still perceive life events and hassles as significantly more intense experiences than do their married counterparts. Moreover, they report a significantly lower Sense of Coherence, diminished social support and a lower level of mental health, as compared with married women. Multiple regression revealed that Sense of Coherence was the most significant contributor to adaptation variables, especially to mental health. Social support contributed significantly to the 2 social adaptation subscales. The discussion emphasizes the importance of Sense of Coherence to adaptation.     

Radioimmunological analysis of pressure regulating substances and their relationship with primary and renal hypertension

Effect of Renin-angiotension-aldosterone system(RAS) in onset of hypertension has been clear,but the relationship between 7 kinds of pressure regulating substances and primary and renal hypertension(HP) need a further study.OBJECTIVE:To explore the effects and significance of RAS,endothelin(ET),Nitric oxide(NO),neuropeptide Y(NPY),ralcitonin gene-related peptides(CGRP) in primary and renal hypertension.     

Iranian nurses´ perceptions of their professional growth and development

Change in today's healthcare settings is inevitable. Professional growth and development are essential in order to remain a viable member of the healthcare team. Although the importance of professional growth and development is emphasized in the literature, the associated outcomes of professional development have not been fully described. In this article the authors present a qualitative study in which 21 Iranian nurses, whose years of nursing experienced ranged from 3 to 28 years, shared the perceptions of their professional development and growth. In reporting the study findings the authors discuss how these nurses described their skill and psychosocial development within the themes of developing judgment, improving communication, instilling confidence, seeing the whole patient, and strengthening commitment to nursing.     

Radioimmunological analysis of pressure regulating substances and their relationship with primary and renal hypertension

BACKGROUND:Effectofrenin-angiotension-aldosteronesystem(RAS)inonsetofhypertensionhasbeenclear,buttherelationshipbetween7kindsofpressureregulatingsubstancesandprimaryandrenalhypertension(HP)needafurtherstudy.OBJECTIVE:ToexploretheeffectsandsignificanceofRAS,endothelin(ET),Nitricoxide(NO),neuropeptideY(NPY),calcitoningene-relatedpeptides(CGRP)inprimaryandrenalhy-pertension.UNIT:DepartmentofClinicalLaboratory,WeihaiweiPeople'sHospitalSUBJECTS:(1)Healthygroup:16malesand9fema…     

How Do People with Intellectual Disabilities and Diabetes Experience and Perceive their Illness?

Introduction Diabetes is a significant health problem amongst people with intellectual disabilities, yet there is a lack of qualitative literature looking specifically at their experiences and perceptions of living with this chronic illness. Method Using Interpretative Phenomenological Analysis, this study explored the experiences and perceptions of four people with intellectual disabilities and diabetes. Results Results showed that participants demonstrated some knowledge of the language surrounding diabetes, but considerable confusion and uncertainty about their illness. The impact of diabetes was described in terms of physical, emotional and social consequences, and participants spoke of diabetes in the context of co‐existing health problems. Conclusions People with intellectual disabilities and diabetes face many challenges when perceiving and coping with their illness. Gaining insight into these challenges could help health professionals work together more effectively and provide appropriate support to people with intellectual disabilities and diabetes.     

Men and family planning: what is their future role?

PURPOSE: To describe men's desired involvement in family planning and to determine the services desired by potential male clients. DATA SOURCES: Using a self-administered questionnaire, this study surveyed male partners of family planing clients and men attending sexually transmitted disease (STD) clinics at an urban health department. Perceived health concerns, contraceptive attitudes and practices, and desired involvement in family planning currently and in the future were targeted. CONCLUSIONS: Respondents reported desiring involvement in family planning decisions, although reported behaviors often conflicted with this desire. Routine physical examinations and receipt of health information were perceived to be important, while "male only" clinics were not. Respondents were willing to attend partners' family planning appointments if asked and were willing to help pay for the chosen contraceptive. Provision of vasectomy services was perceived as important. Prevention of cancer, STDs, and impotence were the three highest health concerns reported. IMPLICATIONS FOR PRACTICE: Men want to be partners in family planning and will access services if available. Current political and social policies are demanding more personal responsibility for the outcome of unintended pregnancies. In response to political and social demands, Title X family planning clinics are refocusing services to include men.     

Why hospice? The case for ESRD patients and their families

This article defines hospice by giving its historical context, its development over time, and its relevancy for the end stage renal disease (ESRD) patient. A literature review and explication of hospice usage statistics show the lack of utilization by the ESRD community. Comparison of hospice and traditional medical care highlights the philosophy of care over cure and hospice standards of practice are given. Medicare rules and two case studies support the appropriateness of hospice for ESRD patients and their families.     

Nursing students’ knowledge and attitude toward diabetic ulcer care and their contributing factors in Indonesia

ObjectiveThe prevalence of diabetic foot ulcer in Indonesia is far greater than the global prevalence. Nursing students are expected to have good knowledge and positive attitudes regarding diabetic ulcer care in order to deliver high-quality wound care during clinical practice. This study aimed to assess nursing students’ knowledge and attitudes toward diabetic ulcer care and to investigate the factors related to them.MethodsA cross-sectional study was conducted on 396 academic and clinical phases in three nursing schools in Indonesia from September 2021 to February 2022. Participants completed a survey including a questionnaire about knowledge and attitudes regarding diabetic ulcer care. The data were analyzed using a Chi-square test and multivariate logistic regression analysis.ResultsThe results show that 43.2% (171/396) of nursing students had inadequate knowledge of diabetic ulcer care. However, 88.9% (352/396) had a favorable attitude toward the topic. Nursing students lacked knowledge about the characteristics of diabetic ulcers, diabetic neuropathy, wound infection, and adjunctive therapy for diabetic ulcers, and many of them believe that diabetic ulcer care is too time-consuming to carry out. Students in the clinical phase of their studies had significantly better knowledge than those in the academic phase (aOR = 9.99, 95% CI 4.96–20.08, P < 0.001). Male nursing students were significantly less likely to have positive attitude toward the topic than female students (aOR = 0.42, 95% CI 0.19–0.96, P = 0.048), and students accustomed to sharing with peers as a source of knowledge had better attitudes than those who were not (aOR = 2.76, 95% CI 1.40–5.41, P = 0.003).ConclusionFindings show that almost half of the nursing students have insufficient knowledge of diabetic ulcer care. Curriculum developers and educators need to improve the curriculum regarding diabetic wound care and provide strategic programs to improve students’ knowledge and attitudes based on the factors discovered in this study.     

Development and psychometric evaluation of Nurses and Midwives’ Perceptions of their Roles in Primary Healthcare

ObjectiveThis study aimed to develop Nurses and Midwives’ Perceptions of their Roles in Primary Healthcare (NMPR-PHC) and evaluate its psychometric properties.MethodsA cross-sectional survey was performed to recruit a convenient sample of 150 registered nurses and midwives from various primary healthcare settings in Jordan. Reliability was evaluated by examining the internal consistency and split-half reliability of the item. A exploratory factor analysis was performed to assess the factor structure of the NMPR-PHC.ResultsThe final version of NMPR-PHC contained 18 items. Exploratory factor analysis revealed six factors (care coordination and interprofessional collaboration, workplace facilitators of the primary healthcare, management of care, research, workplace constraints of primary healthcare, and advanced education) for the questionnaire which explained 66.49% of the total variance. The Cronbach’s α of the total scale was 0.834, the subscales Cronbach’s α were ranging between 0.662 and 0.770, and the split-half reliability of the total scale was 0.734.ConclusionThe overall performance of the questionnaire showed promising sound psychometric properties. The NMPR-PHC can be recommended for use as a tool for the assessment of nurses and midwives’ perceptions of their roles in primary healthcare.     

Fluticasone and beclometasone: what are their effects on children's growth?

Fear of growth retardation may account for the underuse of inhaled corticosteroids in children with asthma, despite compelling evidence of their effectiveness. This fear may be reduced with newer agents with lower oral bioavailability if their theoretical advantage of fewer systemic adverse effects than the standard treatment of inhaled beclometasone is realized in practice. This review aims to determine if one of the newer agents, inhaled fluticasone, has less effect on the growth of pre-pubertal asthmatic children than inhaled beclometasone. The outcome measure was growth velocity. Two double blind, randomized controlled trials were identified. In one of the studies the mean growth velocity in the fluticasone group was 0.7 cm/year greater than in the beclometasone group. In the second, smaller study the mean growth velocity in the fluticasone group was 0.8 cm/year greater. There is therefore some evidence that fluticasone has less (if any) adverse effect on growth.