Faculty Bibliography

PURPOSE/OBJECTIVES: To examine trends in fertility preservation attitudes and behaviors of pediatric oncology nurses and evaluate their awareness of fertility preservation guidelines published in June 2006 by the American Society of Clinical Oncology (ASCO). DESIGN: Cross-sectional surveys conducted in 2005 and 2006. SETTING: Annual meetings of the Florida Association of Pediatric Tumor Programs. SAMPLE: 115 pediatric oncology nurses in 2005 and 95 nurses in 2006. METHODS: A 45-item survey was distributed to conference attendees. MAIN RESEARCH VARIABLES: Knowledge, current fertility preservation practices, and awareness of fertility preservation guidelines. FINDINGS: Nurses' attitudes about fertility preservation discussions with patients did not change during the survey period; however, the number of nurses believing that one of their duties was to discuss fertility preservation with patients decreased from 91% in 2005 to 81% in 2006. Nurses' likelihood to discuss fertility preservation with patients with specific characteristics significantly changed over time. Fertility preservation discussions were just as likely for single patients as they were for those married or recently engaged, although nurses were more likely to discuss fertility preservation with patients who had at least one child or who had a poor prognosis. Nurses' awareness of ASCO guidelines was less than 5%. CONCLUSIONS: A majority of nurses perceive that fertility preservation options should be offered to patients. However, practice and patient family barriers exist that may impede discussion. Attitudes and behaviors will be monitored with the 2006 ASCO guidelines. IMPLICATIONS FOR NURSING: Nurses play a key role in survivorship discussions for pediatric patients with cancer and their families. Increased knowledge of fertility preservation guidelines may help promote the fertility preservation concept and lead to improved dissemination and implementation of training programs that focus on current ASCO fertility preservation guidelines and address the psychosocial needs of children aged 12-16 years.

Missed appointments are a significant problem in a healthcare system. They can cause problems for both the practice and the patient. To help a large OB/GYN clinic in South Florida discern typical reasons for missed appointments, a concurrent triangulation design was used in which patient responses on a quantitative mail survey of reasons for missed appointments were compared with those obtained through in-depth interviews. Initial quantitative results indicated appointments were missed due to forgetting, lack of transportation, and lack of childcare. Interview results revealed women had more complicated and emotional reasons behind missed appointments, such as embarrassment, than those identified in the quantitative survey. Interview data revealed that cognitive barriers may be the more likely reason behind missed appointments than structural barriers such as transportation and lack of childcare.

Infertility is a common result of cancer treatment; however, opportunities exist for patients to preserve fertility prior to treatment. Recent evidence suggests that healthcare providers, including nurses, do not consistently discuss fertility preservation (FP) with patients. This qualitative, cross-sectional pilot study used a focus group and in-depth interviews to explore knowledge, attitudes, and practice behaviors related to nurses' discussion of FP with patients with cancer. Results indicate that only half of the nurses discuss FP methods with patients, even though most believe that having discussions with patients about fertility is part of their role. Factors associated with the discussion of FP among nurses included (a) knowledge (FP procedures, fertility institutes and clinics, resources for patients, and practice guidelines), (b) attitudes (difficulty finding facilities, time constraints, role, comfort level, ethical issues, financial considerations, and patient characteristics), and (c) behaviors (patient initiation, physician behaviors, patient characteristics, and timing). Discussion should be stimulated among nurses about the role of nurses in the FP discussion, and educational interventions and practice guidelines should be developed that are aimed at oncology nurses to help facilitate discussions with patients.

In 2002, the Thoracic Oncology Advocacy Program at H. Lee Moffitt Cancer Center and Research Institute was created with a mission to contribute to the prevention and cure of lung cancer by embracing the patient perspective. In an effort to increase awareness of clinical trials (CTs) and to humanize the CT process, members of the advocacy programme were involved in the creation of the Faces of Lung Cancer project. Twelve lung cancer patients who participated in a CT, four caregivers of patients who had been on a trial and four thoracic health care professionals were interviewed and photographed by a professional photographer with prior experience in photo-documentary work. Preliminary results indicate just the process of participating in the Faces of Lung Cancer project and creating the photo essay has had a positive impact on the lives of cancer patients and their caregivers. Formal evaluation of the Faces of Lung Cancer project is underway; however, preliminary results indicate that the project is viewed as successful in terms of conveying a message of hope and increasing awareness. By including visual displays, in conjunction with patient interviews, the photo essay is able to generate and blend powerful information and images that provide a richer, more complete portrayal of the context of a patient's experience.

Infertility is a common result of cancer treatment; however, opportunities exist that allow patients to preserve their fertility prior to treatment. Evidence suggests health care providers, including social workers, do not consistently discuss this topic with patients. This study used a qualitative, cross-sectional design using a focus group and in-depth interviews to explore knowledge, attitudes, barriers, and behaviors related to social workers' discussion of fertility preservation with cancer patients. Factors that influence the discussion of fertility preservation among social workers include: (1) Knowledge (e.g., Fertility Preservation Resources); (2) Attitudes (e.g., Cost, Perceived Role, Comfort Level, Fertility Preservation Discussion Difficulty/Priority); (3) Barriers (e.g., Cost, Urgency to start Treatment/Time, Patient Factors, Physician Attitudes/Beliefs); (4) Behaviors; and (5) Suggestions. Results show social workers are not typically discussing fertility preservation methods with patients; however, they may be in an ideal position to facilitate the conversation between the physician and the patient. There is a strong need to develop educational interventions aimed at oncology social workers, to help facilitate discussions with patients.

OBJECTIVE: To identify the specific barriers and benefits of violent behaviours as noted by middle school youth and to develop a social marketing campaign that attends to the needs and wants of the target audience. STUDY DESIGN: A non-experimental, qualitative study design was used to assess youth perceptions of violence in a large, southeast urban school district. METHODS: Using a social marketing approach, a series of in-depth interviews were conducted with middle school youths, to gain an understanding of perceived barriers and benefits of violent behaviours. Additionally, interviews assessed youth preferences for an effective spokesperson for an anti-violence campaign. Qualitative analysis of coded transcripts revealed key themes that were incorporated into a multi-media initiative. RESULTS: Critical themes of the research highlighted that the majority of violence occurs at school, during school hours and most of the youths believed the use of violence was necessary to defend themselves from other peers or to protect family members. Another key finding pertained to adolescent views on violent people; although the majority of respondents reported engaging in violent acts, they did not view themselves as violent. Results were used to inform the development of a social marketing campaign designed to reduce youth violence among middle school students in a large, urban central Florida school district. CONCLUSION: Findings from the formative research led to the creation and pre-testing of five potential campaign brands. The campaign slogan that tested best with the target audience emphasized the choice youth have to either engage in violent behaviour and suffer the consequences or to 'rise above' physical conflict and reap the benefits.

BACKGROUND: The purpose of the study was to examine lung cancer patients' knowledge, attitudes, and behavior regarding clinical trials and to develop an effective intervention for increasing patient knowledge and awareness of clinical trials for lung cancer patients. METHODS: Qualitative semistructured, in-depth interviews were conducted with (1) new patients who had not yet interacted with their physicians, (2) existing patients who had participated in a clinical trial, and (3) existing patients who had not been offered a trial. Findings from the interviews led to the creation of a letter that was sent to all new patients before their first appointment, explaining that offering a clinical trial at this hospital was the norm, to expect this discussion, and the option of standard treatment was always available. RESULTS: Results showed new patients and established patients had similar perceptions of trials--the fear of being a guinea pig, offering a trial meant no hope, and misconception of purpose. Existing patients who had participated in a trial expressed positive benefits of trial participation, even if their health did not improve. A year after the letter process was initiated, accrual rates increased 18% and approximately 81% of all eligible lung cancer patients were in a trial. CONCLUSIONS: The letter, addressing patient's preexisting fears about being offered a clinical trial, appears to show some initial success in improving clinical trial accrual.

This study explores nurses' attitudes toward the discussion of fertility preservation (FP) with pediatric cancer patients and their families. A cross-sectional survey was administered to attendees of a pediatric oncology conference. Of the 115 nurses who responded and comprised the study sample, most reported discussing risks of infertility or FP

PMID: 17827491

ISSN: 1043-4542

CID: 2588412