Purpose Older breast cancer survivors (BCS) may be at greater risk for cognitive dysfunction and ... more Purpose Older breast cancer survivors (BCS) may be at greater risk for cognitive dysfunction and other comorbidities; both of which may be associated with physical and emotional well-being. This study will seek to understand these relationships by examining the association between objective and subjective cognitive dysfunction and physical functioning and quality of life (QoL) and moderated by comorbidities in older BCS. Methods A secondary data analysis was conducted on data from 335 BCS (stages I–IIIA) who were ≥ 60 years of age, received chemotherapy, and were 3–8 years post-diagnosis. BCS completed a one-time questionnaire and neuropsychological tests of learning, delayed recall, attention, working memory, and verbal fluency. Descriptive statistics and separate linear regression analyses testing the relationship of each cognitive assessment on physical functioning and QoL controlling for comorbidities were conducted. Results BCS were on average 69.79 (SD = 3.34) years old and 5....
Objective: To evaluate the relationship between diurnal salivary cortisol patterns and distress f... more Objective: To evaluate the relationship between diurnal salivary cortisol patterns and distress from heart palpitations in midlife women. Methods: We analyzed baseline data from 293 women who were eligible for a 3×2 factorial trial of exercise or yoga vs. routine activity, and omega-3 fish oil vs. placebo for vasomotor symptoms. Women self-collected salivary cortisol using swabs at four time points over two consecutive days and reported distress from heart racing or pounding during the past two weeks using a single item. Sample description and covariate data included demographics, clinical data, vasomotor symptom frequency from daily diaries, medication use, and validated questionnaires on depression, stress, and insomnia (Patient Health Questionnaire-8, Perceived Stress Scale, and Insomnia Severity index). Data were analyzed using descriptive statistics, chi-square and t-tests, and repeated measure linear regression models. Results: Participants were on average 54.6 (SD=3.6) years old, most were white (67%),, most were postmenopausal (84%), and 26% reported distress related to palpitations. In adjusted models, the morning (wake plus 30-minute) geometric mean daily salivary cortisol concentrations were significantly more blunted in those with distress from palpitations compared to those without distress (p≤0.03). When all covariates were controlled, distress from palpitations was the sole significant predictor of wake plus 30-minute cortisol (−0.25 [−0.45 to −0.04], p=0.02). Conclusions: Palpitations among midlife women may be associated with blunted morning cortisol, and this relationship is not explained by demographics, clinical variables, vasomotor symptoms, medications, depression, stress, or insomnia.
Purpose/Aims The aim of this study was to describe how persons given a diagnosis of a brain tumor... more Purpose/Aims The aim of this study was to describe how persons given a diagnosis of a brain tumor who have had a craniotomy describe the quality of their pain after surgery. Design A qualitative descriptive design was used. Methods Qualitative descriptive methods as described by Sandelowski guided this study. Semistructured interviews were conducted with patients hospitalized on a neurological step-down unit in an urban teaching hospital in the Midwestern United States. Interviews focused on the quality of participants' pain after surgery. Narratives were analyzed using standard content analysis. Results Twenty-seven participants were interviewed. Most were White and female. Most underwent a craniotomy using an anterior approach with sedation. Participants described the quality of their pain with 6 different types of descriptors: pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. Conclusions Participants' desc...
The authors would like to acknowledge support from grant #64194 Robert Wood Johnson Foundation, N... more The authors would like to acknowledge support from grant #64194 Robert Wood Johnson Foundation, Nurse Faculty Scholar (PI: D. Von Ah), Walther Cancer Institute #0155.01, (PI: D. Von Ah), American Cancer Society Doctoral Scholarship in Cancer Nursing, & National Institute of Nursing Research #2T32 NR007066. • A secondary data analysis was completed from a cross-sectional, descriptive study. • Multiple regression was used to assess the impact of sleep disturbance on attentional fatigue controlling for the covariates of age, level of education, and time since treatment. • Measures: • The Pittsburgh Sleep Quality Index (PSQI): 9-item sub-scale measuring sleep disturbance, where higher scores indicate worse sleep disturbance. • The Attentional Function Index (AFI): A 13item scale measuring attentional fatigue, where higher scores indicate better functioning. • 68 BCS from a Midwestern cancer center, ranging from 29 to 68 years of age (M=52.1 [SD, 8.6]), and on average 4.97 (SD, 3.36) yea...
Purpose Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality ... more Purpose Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue). Methods Four hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates. Results BCS reported significantly more memo...
Purpose: Family may play an important role in Hematopoietic stem cell transplantation (HSCT) reco... more Purpose: Family may play an important role in Hematopoietic stem cell transplantation (HSCT) recovery; however, little is known about the effect of family functioning on an individual's health. The purpose of this study was to examine the effect of family cohesion (family functioning) on the trajectory of HSCT recipients' symptom distress (symptom frequency and symptom bother) before, during, and after HSCT. Methods: Secondary analysis was conducted using data collected from178 individuals who underwent HSCT. Longitudinal parallel-process (LPP) modeling was used to examine how family cohesion and HSCT associated symptoms (symptom frequency and symptom bother) change over time; and how these longitudinal changes relate to each other. Results: The trajectory of family cohesion predicted the trajectories of HSCT associated symptom frequency and bother. HSCT recipients who experienced higher family cohesion at baseline (T1) showed lower symptom frequency (p<.01) as well as symptom bother (p<.01) at T1. This trajectory analysis also showed that HSCT recipients who had improved family cohesion over time reported decrease in symptom frequency (p<.01) as well as bother (p<.01) over time. Conclusion: Findings indicate that higher family cohesion predicts decrease in symptom distress over the HSCT trajectory. Interventions aimed at enhancing family cohesion have the potential to lower HSCT recipients' symptom distress. Further research is needed to understand the critical role of family cohesion and family functioning and their relationship with HSCT symptom distress prevention, early detection, and risk strati cation.
Cognitive symptoms in breast cancer survivors (BCSs) are common and have a disruptive impact on d... more Cognitive symptoms in breast cancer survivors (BCSs) are common and have a disruptive impact on daily life. Breast cancer survivors frequently engage in self-management strategies to lessen the impact of these cognitive symptoms. There is little information from the perspective of BCS as to their preference of interventions. The purpose of this study was to explore how BCSs cope and self-manage the symptoms associated with cognitive changes, their preferences for the type of intervention(s), and perceived facilitators and barriers to interventions. Methods: A qualitative descriptive study using content analysis was conducted. Semistructured telephone interviews were conducted with 13 BCSs. Results: Breast cancer survivors articulated that validation and selfmanagement strategies were used to relieve cognitive symptoms. Nonpharmacologic, evidence-based interventions that use a combined onlinein-person approach and include follow-up with healthcare providers are preferred by BCSs. Ease of use, accessibility, and convenience were identified by BCSs as most important to facilitate participation. Cost, time intensiveness, and distance to travel hampered participation. Conclusions: Patient-centered interventions tailored to meet the needs of BCSs should be considered when implementing programs or interventions to maximize their utilization and benefit. The process of implementation should be dynamic and include an ongoing collaboration between BCSs and clinical nurse specialists.
The purpose of this study was to examine the incidence of attentional fatigue and the relationshi... more The purpose of this study was to examine the incidence of attentional fatigue and the relationship between sleep disturbance and attentional fatigue in working long-term breast cancer survivors (BCS). Methods: A descriptive, correlation design was used. The data for this study were drawn from a larger descriptive study designed to understand the impact of cognitive dysfunction on work-related outcomes. Breast cancer survivors completed questionnaires regarding sleep disturbance, attentional fatigue, and demographic and medical characteristics. Sleep disturbance, a subscale of the Pittsburgh Sleep Quality Index, is measured by asking 9 questions about sleep disturbances. Attentional fatigue was measured by the Attentional Function Index. Descriptive statistics and multiple regression were performed to assess the impact of sleep disturbance on attentional fatigue, controlling for covariates. Results: Sixty-eight female BCS, ranging from 29 to 68 years old (mean [SD], 52.1 [8.6] years old) and, on average, 4.97 (SD, 3.36) years posttreatment, participated. Thirty-four percent of BCS had poor to moderate attention function. Sleep disturbance significantly predicted attentional fatigue (P G .05), explaining 16% of the variance, F 4,57 = 2.68, P G .04, R 2 = 0.16. Conclusions: Clinicians can assess and intervene to decrease sleep disturbance, which may also improve attentional fatigue in BCS. However, sleep disturbance is only 1 contributing factor. Further investigation into factors contributing to attentional fatigue in BCS is warranted.
Purpose Effective symptom discussion is an essential step to enhance symptom management in patien... more Purpose Effective symptom discussion is an essential step to enhance symptom management in patients with advanced pancreatic cancer (APC). However, little is known about how these patients communicate their symptoms during health encounters. The purpose of this study was to develop a typology to describe patterns of interactions between patients with APC, their caregivers, and healthcare providers as regards to symptoms and symptom management. Methods Thematic analysis was used to analyze 37 transcripts of audio-recorded, naturally occurring encounters among APC patients, caregivers, and healthcare providers. Transcripts were drawn from the Values and Options in Cancer Care study, a larger randomized controlled communication and decision-making intervention trial, which recruited advanced cancer patients and caregivers across the USA. All transcripts from APC patients that were pre-intervention were analyzed. Results Eight unique types of interaction patterns among patients, caregivers, and healthcare providers were identified as follows: collaborative interactions, explanatory interactions, agentic interactions, checklist interactions, cross-purpose interactions, empathic interactions, admonishing interactions, and diverging interactions. Conclusions Our findings provide a systematic description of a variety of types of interaction patterns regarding symptom discussion among APC patients, caregivers, and healthcare providers. These typologies can be used to facilitate effective communication and symptom management.
Journal of professional nursing : official journal of the American Association of Colleges of Nursing
From 2008 to 2017, the Robert Wood Johnson Foundation Nurse Faculty Scholars Program inspired, de... more From 2008 to 2017, the Robert Wood Johnson Foundation Nurse Faculty Scholars Program inspired, developed, and supported cohorts of next generation national leaders in academic nursing through career development awards. With support from mentors, scholars in the program created individual development plans focused on scholarship, teaching, service, and leadership. The curriculum of the scholar development program combined goals and objectives related to leadership development, enhancement of nursing education skills, and focused programs of research and scholarship. In addition, program outcomes emphasized engagement in institutional, university, and professional governance systems. This article describes and recounts findings from the program participants regarding accomplishments, productivity, and facilitators contributing to their achievement of program outcomes.
Background: Pancreatic cancer is a devastating disease with limited treatment options. Over 80% o... more Background: Pancreatic cancer is a devastating disease with limited treatment options. Over 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 was 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, though anxiety and depression were noted. Conclusion: Findings suggest that physical and psychological symptoms are prevalent, some with high intensity. Pre-selection 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.
M ore than 40% of the 14.5 million cancer survivors in the United States alone are of working age... more M ore than 40% of the 14.5 million cancer survivors in the United States alone are of working age (American Cancer Society, 2014). However, many of these individuals experience unrelieved symptoms and side effects from cancer and cancer treatments, including cognitive impairment (Jansen, Miaskowski, Dodd, Dowling, & Kramer, 2005a, 2005b). Concerns regarding cognitive function, including problems with attention, memory, processing information, and making decisions, have been reported by cancer survivors (
Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal... more Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: effects on cancer-related cognitive impairment.
Approximately 50 000 people undergo bone marrow transplants (BMTs) each year worldwide. With the ... more 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. The study purpose was to gain a better understanding of the BMT experience across the trajectory from the perspective of the family caregiver. 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. 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," w...
European journal of oncology nursing : the official journal of European Oncology Nursing Society, 2015
Hyperglycemia is a common phenomenon in hospitalized patients and has been associated with poor c... more Hyperglycemia is a common phenomenon in hospitalized patients and has been associated with poor clinical outcomes. Hyperglycemia was defined as a fasting blood glucose ≥126 mg/dL. In cancer patients' hyperglycemia has been associated with impacting diagnostic imaging studies; facilitating the development of and progression of cancers, and influencing response to treatment. Little is known about the impact of hyperglycemia on clinical outcomes such as: neutropenia, infection and hospital length of stay in hospitalized patients with leukemia. The purpose of this study was to examine the impact of hyperglycemia on the following clinical outcomes: neutropenia, infection and hospital length of stay. This retrospective study examined the prevalence and impact of hyperglycemia on clinical outcomes in this vulnerable population. In this sample of 42 hospitalized patients with leukemia, 60% had at least one incidence of hyperglycemia. Patients with hyperglycemia were 1.6 times more likel...
Cancer-and cancer treatment-related cognitive impairment is a common, bothersome, and potentially... more Cancer-and cancer treatment-related cognitive impairment is a common, bothersome, and potentially debilitating symptom incurred by cancer survivors. Cognitive impairment has a significant impact on patients' day-today functioning and quality of life, but it remains under-recognized and undertreated. This article, which is an update from the initial Oncology Nursing Society Putting Evidence Into Practice for cancer-and cancer treatment-related cognitive impairment, provides a comprehensive critical review and summary of the evidence regarding interventions addressing cognitive impairment for cancer survivors. This article examines the effectiveness of interventions focused on cancer-and cancer treatment-related cognitive impairment, makes recommendations for practice, and identifies gaps in knowledge and areas for further research.
The purpose of this cross-sectional study was to examine the impact of personality factors (neuro... more The purpose of this cross-sectional study was to examine the impact of personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness), cognitive factors (sense of coherence and self-efficacy), coping resources (family and friend social support) and demographic factors (gender and ethnicity) on cigarette smoking behaviors (initiation, frequency, and amount of cigarette smoking) among college students. A total of 161 U.S. college students, aged 18-26, who enrolled in an introductory psychology course completed self-report questionnaires. The majority of the students had tried smoking (55%); among those who had tried, 42% were current smokers. The majority (77%) who had smoked a whole cigarette did so at age 16 years or younger. Students who reported lower levels of conscientiousness and self-efficacy had a greater likelihood to had tried cigarette smoking. Also, students who had lower levels of self-efficacy reported smoking more frequently and greater quantities of cigarettes than students with higher levels of selfefficacy. Self-efficacy was the most significant predictor of smoking behaviors. Health promotion programs focused on self-efficacy may be an effective tool for reducing the initiation, frequency, and amount of cigarette smoking among college students.
Purpose Older breast cancer survivors (BCS) may be at greater risk for cognitive dysfunction and ... more Purpose Older breast cancer survivors (BCS) may be at greater risk for cognitive dysfunction and other comorbidities; both of which may be associated with physical and emotional well-being. This study will seek to understand these relationships by examining the association between objective and subjective cognitive dysfunction and physical functioning and quality of life (QoL) and moderated by comorbidities in older BCS. Methods A secondary data analysis was conducted on data from 335 BCS (stages I–IIIA) who were ≥ 60 years of age, received chemotherapy, and were 3–8 years post-diagnosis. BCS completed a one-time questionnaire and neuropsychological tests of learning, delayed recall, attention, working memory, and verbal fluency. Descriptive statistics and separate linear regression analyses testing the relationship of each cognitive assessment on physical functioning and QoL controlling for comorbidities were conducted. Results BCS were on average 69.79 (SD = 3.34) years old and 5....
Objective: To evaluate the relationship between diurnal salivary cortisol patterns and distress f... more Objective: To evaluate the relationship between diurnal salivary cortisol patterns and distress from heart palpitations in midlife women. Methods: We analyzed baseline data from 293 women who were eligible for a 3×2 factorial trial of exercise or yoga vs. routine activity, and omega-3 fish oil vs. placebo for vasomotor symptoms. Women self-collected salivary cortisol using swabs at four time points over two consecutive days and reported distress from heart racing or pounding during the past two weeks using a single item. Sample description and covariate data included demographics, clinical data, vasomotor symptom frequency from daily diaries, medication use, and validated questionnaires on depression, stress, and insomnia (Patient Health Questionnaire-8, Perceived Stress Scale, and Insomnia Severity index). Data were analyzed using descriptive statistics, chi-square and t-tests, and repeated measure linear regression models. Results: Participants were on average 54.6 (SD=3.6) years old, most were white (67%),, most were postmenopausal (84%), and 26% reported distress related to palpitations. In adjusted models, the morning (wake plus 30-minute) geometric mean daily salivary cortisol concentrations were significantly more blunted in those with distress from palpitations compared to those without distress (p≤0.03). When all covariates were controlled, distress from palpitations was the sole significant predictor of wake plus 30-minute cortisol (−0.25 [−0.45 to −0.04], p=0.02). Conclusions: Palpitations among midlife women may be associated with blunted morning cortisol, and this relationship is not explained by demographics, clinical variables, vasomotor symptoms, medications, depression, stress, or insomnia.
Purpose/Aims The aim of this study was to describe how persons given a diagnosis of a brain tumor... more Purpose/Aims The aim of this study was to describe how persons given a diagnosis of a brain tumor who have had a craniotomy describe the quality of their pain after surgery. Design A qualitative descriptive design was used. Methods Qualitative descriptive methods as described by Sandelowski guided this study. Semistructured interviews were conducted with patients hospitalized on a neurological step-down unit in an urban teaching hospital in the Midwestern United States. Interviews focused on the quality of participants' pain after surgery. Narratives were analyzed using standard content analysis. Results Twenty-seven participants were interviewed. Most were White and female. Most underwent a craniotomy using an anterior approach with sedation. Participants described the quality of their pain with 6 different types of descriptors: pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. Conclusions Participants' desc...
The authors would like to acknowledge support from grant #64194 Robert Wood Johnson Foundation, N... more The authors would like to acknowledge support from grant #64194 Robert Wood Johnson Foundation, Nurse Faculty Scholar (PI: D. Von Ah), Walther Cancer Institute #0155.01, (PI: D. Von Ah), American Cancer Society Doctoral Scholarship in Cancer Nursing, & National Institute of Nursing Research #2T32 NR007066. • A secondary data analysis was completed from a cross-sectional, descriptive study. • Multiple regression was used to assess the impact of sleep disturbance on attentional fatigue controlling for the covariates of age, level of education, and time since treatment. • Measures: • The Pittsburgh Sleep Quality Index (PSQI): 9-item sub-scale measuring sleep disturbance, where higher scores indicate worse sleep disturbance. • The Attentional Function Index (AFI): A 13item scale measuring attentional fatigue, where higher scores indicate better functioning. • 68 BCS from a Midwestern cancer center, ranging from 29 to 68 years of age (M=52.1 [SD, 8.6]), and on average 4.97 (SD, 3.36) yea...
Purpose Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality ... more Purpose Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue). Methods Four hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates. Results BCS reported significantly more memo...
Purpose: Family may play an important role in Hematopoietic stem cell transplantation (HSCT) reco... more Purpose: Family may play an important role in Hematopoietic stem cell transplantation (HSCT) recovery; however, little is known about the effect of family functioning on an individual's health. The purpose of this study was to examine the effect of family cohesion (family functioning) on the trajectory of HSCT recipients' symptom distress (symptom frequency and symptom bother) before, during, and after HSCT. Methods: Secondary analysis was conducted using data collected from178 individuals who underwent HSCT. Longitudinal parallel-process (LPP) modeling was used to examine how family cohesion and HSCT associated symptoms (symptom frequency and symptom bother) change over time; and how these longitudinal changes relate to each other. Results: The trajectory of family cohesion predicted the trajectories of HSCT associated symptom frequency and bother. HSCT recipients who experienced higher family cohesion at baseline (T1) showed lower symptom frequency (p<.01) as well as symptom bother (p<.01) at T1. This trajectory analysis also showed that HSCT recipients who had improved family cohesion over time reported decrease in symptom frequency (p<.01) as well as bother (p<.01) over time. Conclusion: Findings indicate that higher family cohesion predicts decrease in symptom distress over the HSCT trajectory. Interventions aimed at enhancing family cohesion have the potential to lower HSCT recipients' symptom distress. Further research is needed to understand the critical role of family cohesion and family functioning and their relationship with HSCT symptom distress prevention, early detection, and risk strati cation.
Cognitive symptoms in breast cancer survivors (BCSs) are common and have a disruptive impact on d... more Cognitive symptoms in breast cancer survivors (BCSs) are common and have a disruptive impact on daily life. Breast cancer survivors frequently engage in self-management strategies to lessen the impact of these cognitive symptoms. There is little information from the perspective of BCS as to their preference of interventions. The purpose of this study was to explore how BCSs cope and self-manage the symptoms associated with cognitive changes, their preferences for the type of intervention(s), and perceived facilitators and barriers to interventions. Methods: A qualitative descriptive study using content analysis was conducted. Semistructured telephone interviews were conducted with 13 BCSs. Results: Breast cancer survivors articulated that validation and selfmanagement strategies were used to relieve cognitive symptoms. Nonpharmacologic, evidence-based interventions that use a combined onlinein-person approach and include follow-up with healthcare providers are preferred by BCSs. Ease of use, accessibility, and convenience were identified by BCSs as most important to facilitate participation. Cost, time intensiveness, and distance to travel hampered participation. Conclusions: Patient-centered interventions tailored to meet the needs of BCSs should be considered when implementing programs or interventions to maximize their utilization and benefit. The process of implementation should be dynamic and include an ongoing collaboration between BCSs and clinical nurse specialists.
The purpose of this study was to examine the incidence of attentional fatigue and the relationshi... more The purpose of this study was to examine the incidence of attentional fatigue and the relationship between sleep disturbance and attentional fatigue in working long-term breast cancer survivors (BCS). Methods: A descriptive, correlation design was used. The data for this study were drawn from a larger descriptive study designed to understand the impact of cognitive dysfunction on work-related outcomes. Breast cancer survivors completed questionnaires regarding sleep disturbance, attentional fatigue, and demographic and medical characteristics. Sleep disturbance, a subscale of the Pittsburgh Sleep Quality Index, is measured by asking 9 questions about sleep disturbances. Attentional fatigue was measured by the Attentional Function Index. Descriptive statistics and multiple regression were performed to assess the impact of sleep disturbance on attentional fatigue, controlling for covariates. Results: Sixty-eight female BCS, ranging from 29 to 68 years old (mean [SD], 52.1 [8.6] years old) and, on average, 4.97 (SD, 3.36) years posttreatment, participated. Thirty-four percent of BCS had poor to moderate attention function. Sleep disturbance significantly predicted attentional fatigue (P G .05), explaining 16% of the variance, F 4,57 = 2.68, P G .04, R 2 = 0.16. Conclusions: Clinicians can assess and intervene to decrease sleep disturbance, which may also improve attentional fatigue in BCS. However, sleep disturbance is only 1 contributing factor. Further investigation into factors contributing to attentional fatigue in BCS is warranted.
Purpose Effective symptom discussion is an essential step to enhance symptom management in patien... more Purpose Effective symptom discussion is an essential step to enhance symptom management in patients with advanced pancreatic cancer (APC). However, little is known about how these patients communicate their symptoms during health encounters. The purpose of this study was to develop a typology to describe patterns of interactions between patients with APC, their caregivers, and healthcare providers as regards to symptoms and symptom management. Methods Thematic analysis was used to analyze 37 transcripts of audio-recorded, naturally occurring encounters among APC patients, caregivers, and healthcare providers. Transcripts were drawn from the Values and Options in Cancer Care study, a larger randomized controlled communication and decision-making intervention trial, which recruited advanced cancer patients and caregivers across the USA. All transcripts from APC patients that were pre-intervention were analyzed. Results Eight unique types of interaction patterns among patients, caregivers, and healthcare providers were identified as follows: collaborative interactions, explanatory interactions, agentic interactions, checklist interactions, cross-purpose interactions, empathic interactions, admonishing interactions, and diverging interactions. Conclusions Our findings provide a systematic description of a variety of types of interaction patterns regarding symptom discussion among APC patients, caregivers, and healthcare providers. These typologies can be used to facilitate effective communication and symptom management.
Journal of professional nursing : official journal of the American Association of Colleges of Nursing
From 2008 to 2017, the Robert Wood Johnson Foundation Nurse Faculty Scholars Program inspired, de... more From 2008 to 2017, the Robert Wood Johnson Foundation Nurse Faculty Scholars Program inspired, developed, and supported cohorts of next generation national leaders in academic nursing through career development awards. With support from mentors, scholars in the program created individual development plans focused on scholarship, teaching, service, and leadership. The curriculum of the scholar development program combined goals and objectives related to leadership development, enhancement of nursing education skills, and focused programs of research and scholarship. In addition, program outcomes emphasized engagement in institutional, university, and professional governance systems. This article describes and recounts findings from the program participants regarding accomplishments, productivity, and facilitators contributing to their achievement of program outcomes.
Background: Pancreatic cancer is a devastating disease with limited treatment options. Over 80% o... more Background: Pancreatic cancer is a devastating disease with limited treatment options. Over 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 was 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, though anxiety and depression were noted. Conclusion: Findings suggest that physical and psychological symptoms are prevalent, some with high intensity. Pre-selection 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.
M ore than 40% of the 14.5 million cancer survivors in the United States alone are of working age... more M ore than 40% of the 14.5 million cancer survivors in the United States alone are of working age (American Cancer Society, 2014). However, many of these individuals experience unrelieved symptoms and side effects from cancer and cancer treatments, including cognitive impairment (Jansen, Miaskowski, Dodd, Dowling, & Kramer, 2005a, 2005b). Concerns regarding cognitive function, including problems with attention, memory, processing information, and making decisions, have been reported by cancer survivors (
Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal... more Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: effects on cancer-related cognitive impairment.
Approximately 50 000 people undergo bone marrow transplants (BMTs) each year worldwide. With the ... more 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. The study purpose was to gain a better understanding of the BMT experience across the trajectory from the perspective of the family caregiver. 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. 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," w...
European journal of oncology nursing : the official journal of European Oncology Nursing Society, 2015
Hyperglycemia is a common phenomenon in hospitalized patients and has been associated with poor c... more Hyperglycemia is a common phenomenon in hospitalized patients and has been associated with poor clinical outcomes. Hyperglycemia was defined as a fasting blood glucose ≥126 mg/dL. In cancer patients' hyperglycemia has been associated with impacting diagnostic imaging studies; facilitating the development of and progression of cancers, and influencing response to treatment. Little is known about the impact of hyperglycemia on clinical outcomes such as: neutropenia, infection and hospital length of stay in hospitalized patients with leukemia. The purpose of this study was to examine the impact of hyperglycemia on the following clinical outcomes: neutropenia, infection and hospital length of stay. This retrospective study examined the prevalence and impact of hyperglycemia on clinical outcomes in this vulnerable population. In this sample of 42 hospitalized patients with leukemia, 60% had at least one incidence of hyperglycemia. Patients with hyperglycemia were 1.6 times more likel...
Cancer-and cancer treatment-related cognitive impairment is a common, bothersome, and potentially... more Cancer-and cancer treatment-related cognitive impairment is a common, bothersome, and potentially debilitating symptom incurred by cancer survivors. Cognitive impairment has a significant impact on patients' day-today functioning and quality of life, but it remains under-recognized and undertreated. This article, which is an update from the initial Oncology Nursing Society Putting Evidence Into Practice for cancer-and cancer treatment-related cognitive impairment, provides a comprehensive critical review and summary of the evidence regarding interventions addressing cognitive impairment for cancer survivors. This article examines the effectiveness of interventions focused on cancer-and cancer treatment-related cognitive impairment, makes recommendations for practice, and identifies gaps in knowledge and areas for further research.
The purpose of this cross-sectional study was to examine the impact of personality factors (neuro... more The purpose of this cross-sectional study was to examine the impact of personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness), cognitive factors (sense of coherence and self-efficacy), coping resources (family and friend social support) and demographic factors (gender and ethnicity) on cigarette smoking behaviors (initiation, frequency, and amount of cigarette smoking) among college students. A total of 161 U.S. college students, aged 18-26, who enrolled in an introductory psychology course completed self-report questionnaires. The majority of the students had tried smoking (55%); among those who had tried, 42% were current smokers. The majority (77%) who had smoked a whole cigarette did so at age 16 years or younger. Students who reported lower levels of conscientiousness and self-efficacy had a greater likelihood to had tried cigarette smoking. Also, students who had lower levels of self-efficacy reported smoking more frequently and greater quantities of cigarettes than students with higher levels of selfefficacy. Self-efficacy was the most significant predictor of smoking behaviors. Health promotion programs focused on self-efficacy may be an effective tool for reducing the initiation, frequency, and amount of cigarette smoking among college students.
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Papers by Diane Von Ah