Podium Abstracts

Podium Abstract
STRESS, TYPE AND SOURCE OF AND SATISFACTION WITH SOCIAL SUPPORT IN WOMEN WITH BREAST CANCER: EFFECTS ON FATIGUE, DEPRESSION, AND IMMUNE RESPONSE AND CHANGES OVER TIME. Diane Von Ah PhD, RN, University of Louisville, Louisville KY US

The diagnosis and treatment for breast cancer causes intense psychological stress. Perceived stress, in turn, may have a deleterious effect on fatigue, depression, and natural killer cell activity (NKCA). Social support, on the other hand, has been shown to have a direct and positive effect on health. However, little is known regarding the impact of stress, type and source of and satisfaction with social support on fatigue, depression, and immune response during the diagnosis and treatment of women with breast cancer.

The purposes of this study were to examine: (1) the level of perceived stress, and type and source of and satisfaction with social support and their impact on fatigue, depression, and NKCA and (2) changes over time in all variables.

The study was derived from Lazarus and Folkman’s cognitive appraisal theory. A convenience sample of 57 women with newly diagnosed breast cancer completed five questionnaires including: Impact of Event Scale, Norbeck Social Support Scale, Social Support Questionnaire-6, Piper Fatigue Scale-Revised, and the Depression subscale of the Profile of Mood States and provided a blood sample to determine NKCA. Questionnaires were collected: prior to adjuvant therapy (T1); 3 months later during adjuvant therapy (T2); and 6 months after baseline at the completion of adjuvant therapy (T3) and participants gave a blood sample at T1.

Data were analyzed using hierarchical multiple regression controlling for age, stage of disease, and type of treatment, and repeated measures ANOVA.

Stress had a deleterious effect on NKCA and resulted in higher levels of depression at T1, T2 and T3 and higher levels of fatigue at T2 and T3. On the other hand, high aid (tangible) support resulted in decreased fatigue at T1 and high satisfaction with social support led to decreased depression at T3. However, increases in total network support actually resulted in higher levels of fatigue at T1; indicating that not all support is beneficial. For changes over time, perceived stress, emotional, aid, and total network social support, fatigue, and depression decreased significantly over time, while satisfaction with social support remained stable. Findings from this study suggest that stress has a significant impact on health and that nurses must incorporate measures to assess and alleviate stress in their practice to improve outcomes for women with breast cancer. Funding Sources: Support for this study was from the Susan G. Komen Breast Cancer Foundation, Birmingham Affiliate, Birmingham, Alabama

Podium Abstract
COMPARING MARITAL CHARACTERISTICS AND MARITAL SATISFACTION IN COUPLES WITH BREAST CANCER. Kathryn H. Anderson Ph.D., RN, LMFT, Florida International University, North Miami FL US; Cherie Christopherson B.S.N., RN, Flagstaff Medical Center, Flagstaff AZ US; Dianna Moll BSN, RN, St. Marys Medical Center, Madison WI US; Frances Marcus Lewis Ph.D., RN, University of Washington, Seattle WA US

Breast cancer (BrCA) is the most common malignancy among women in the United States. Identifying marital characteristics that influence whether couples move closer or become more distant or avoidant is important to determine.

Couple interaction characteristics have not been clearly identified that determine how couples relate with each other during the illness and thus, influence marital satisfaction. The purpose of this study was to determine whether identification by couple interaction characteristics predicts marital satisfaction ten months later in the illness course.

John Gottman’s (1999; 2003) Sound Marital House Theory has 4 major components: (1) creating positive affect in non-conflict contexts, (2) creating positive sentiment override, (3) regulating conflict, and (4) creating shared symbolic meaning with specific descriptive identifiable behaviors.

The study design is a secondary analysis of couple interview data from the Family Home Visitation Study [FHVS] (Lewis, 1992-1996). The sample of 10 couples who both scored below the mean on marital satisfaction measures and 10 couples who both scored above the mean on marital satisfaction measure at T1 were randomly selected. Spanier’s (1976) Dyadic Adjustment Scale (DAS) was used in the original study to measure marital satisfaction. Validity and reliability is well established for this tool.

The four constructs of Gottman Sound Marital House Theory were applied in the analysis of the couple interaction. Based on couple characteristics, couple description profiles were created and classified into high or low marital relationship based on the SMHT schema. The couple marital category was then compared to the couple’s scores on marital satisfaction (Spanier, 1976), measured at T4 in the original FHV study.

Using the 4 levels of the Sound Marital House, the researchers assigned the couples to two groups, one with more positive couple characteristics and the other with more negativity. Using the characteristic descriptors, each couple was placed into a group hypothesized to represent high or low marital satisfaction. Marital characteristics of each group will be discussed and how the characteristics matched the marital satisfaction scores with implications for care of couples with breast cancer. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Aventis Pharmaceuticals

Podium Abstract
THE MEASUREMENT OF MODESTY AMONG JEWISH AMERICAN WOMEN. Caryn Scheinberg Andrews CRNP, PhD, Northwest Hospital Center, Randallstown MD US

Cultural-modesty was found to influence breast and cervical cancer screening among Chinese, Hispanic, and Muslim cultures. It was hypothesized that highly observant Jewish women who practice strict practices of modesty may underutilize preventive health care services. However, the construct of modesty was not well-defined in the literature, and a measure was not found. "Your Views of Modesty" was developed to explore those relationships

This research study aimed to develop and test an instrument to measure the general construct of modesty. The measure of modesty was tested in the context of breast cancer screening.

An expansion of Champion’s Behavioral Model for Mammography Utilization was used.

Design: A cross-sectional mailed survey design was used. Procedure: Hadassah, a Jewish women’s organization, mailed out 2000 study packets to women on their mailing list. Sample: Adult Jewish women, over the age of 18 were mailed surveys. Three hundred and seven Jewish women returned surveys (15% response rate). Ages 26-95 years (mean 67 years), 89% Ashkenazi Jewish, Sephardic 3%, 3% other/both. Religious group denomination: 5% no religion; 21% Reform; 54% Conservative; and 17% Orthodox.

Analysis: Internal consistency reliability was estimated using Cronbach’s alpha and item-total correlations. Validity estimation included convergent, discriminant, and construct validity using hypothesis testing. Bivariate correlations and ANOVA related scores of "Your Views of Modesty", religiosity, with religious group denomination. Descriptive statistics provided measures of central tendency and dispersion of the total scores of the modesty and religiosity scales (summed scores).

Findings: Reliability for "Your Views of Modesty" was Cronbach’s alpha of .92. Item-total correlations ranged from .34 -.74 indicating high reliability. Modesty was correlated with religiosity (r=.26, p <.01). Total modesty scores and self ranked modesty were moderately related (r= .67, p<.01). Implications: Many qualitative studies identified modesty as a barrier to health care. Future research, testing the construct of modesty using "Your Views of Modesty" with Muslim, Chinese, and Hispanic women who have cultural rules about modesty will provide knowledge of modesty and health care utilization. In clinical practice, the understanding of cultural modesty is paramount for providing culturally tailored care. Funding Sources: University of Maryland Womens Health Research Group

Podium Abstract
IMPLEMENTION RESEARCH - THE EXAMPLE OF MUCOSITIS. Sanchia Aranda, Peter MacCallum Cancer Centre, Melbourne AU; Patsy Yates PhD, Queensland University of Technology, Brisbane AU; White Kate PhD, Edith Cowan University, Perth AU; Saward Diane Grad Dip, Peter MacCallum Cancer Centre, Melbourne AU

Implementation of best evidence into practice is a priority research area. Barriers to research implementation are well described but few studies examine approaches to practice change.

Mucositis is a common problem for people receiving cancer treatment. Evidence shows that good oral hygiene reduces the incidence and severity of mucositis. In practice oral hygiene receives little attention and practices, such as reducing toothbrushing, militate against it. Oral care solutions are overused with no evidence they prevent mucositis. A previous educational approach to implementing good oral hygiene did not achieve sustained change. This project draws on Roger's theory of innovation diffusion, utilising facilitation by peers.

Three cancer units, inpatient haematology, day chemotherapy and outpatient radiotherapy, were the intervention targets. Clinical nurses were educated about mucositis prevention, oral assessment and practice change methods focusing on the role of faciliation. The nurses were time-released from practice to implement the oral care protocols, oral assessment tool and patient information brochure.

The project aimed to improve oral assessment frequency, patient access to oral care information and to reduce the unnecessary use of oral solutions in mucositis prevention. We also aimed to reduce the prevalence of severe mucositis. The results showed improvement in patient receipt of oral care information (p, 0.01), reduction in the use of oral solutions and improved documentation. The proportion of patients with an oral score of >10 using the oral assessment guide was reduced (p=0.01). Changes were sustained at three months after removal of the facilitators, with some decline in use of the oral assessment tool and patient information brochure.

Peer facilitation may help introduction of practice change. Facilitators can make a routine topic interesting and raise interest and support for change amongst peers and interdisciplinary teams. Resistance may relate to perceptions that change indicates current practice is poor. Lessons include the need for rapid return of change data and for greater involvement of nurse managers. Future research will focus on strategies to reduce the decline in change over time. The use of peer facilitators is likely to be useful in a range of clinical settings for practice change but requires further research. Funding Sources: National Institute of Clinical Studies - Targets Project Grant

Podium Abstract
PEAK EXERCISE RESPONSE TO CLINICAL EXERCISE TESTING USING THE BRUCE PROTOCOL IN PATIENTS WITH CANCER WITH KNOWN CARDIOVASCULAR, PULMONARY, OR METABOLIC DISEASE. Sonya Arzola BS, Brooke Army Medical Center/Geneva Foundation, Fort Sam Houston TX US; Stacey Young-McCaughan RN, PhD, AOCN, US Army Medical Command, San Antonio TX US; Kenneth Leclerc MD, Brooke Army Medical Center, San Antonio TX US; Marilyn Nowlin RN, BS, BSN, Brooke Army Medical Center/Geneva Foundation, San Antonio TX US

To describe how a group of patients with cancer who had completed treatment with known cardiovascular, pulmonary, or metabolic disease responded to peak exercise using the Bruce protocol.

The American College of Sports Medicine (ACSM) recommends that individuals with known cardiovascular, pulmonary, or metabolic disease receive a clinical exercise test prior to starting a moderate intensity exercise program. To our knowledge a description of peak exercise response to the Bruce protocol in patients with cancer with known cardiovascular, pulmonary, or metabolic disease six months post surgery, radiation, or chemotherapy treatment has not been reported.

All subjects were cleared to participate in the clinical exercise test by their designated primary care provider, the study oncologist, and the study cardiologist. ACSM guidelines for clinical exercise testing were followed. The speed, grade, and duration of the clinical exercise test were dictated by the Bruce protocol. The McConnell formula was selected to predict maximal oxygen consumption, which was then converted into metabolic equivalent (METS). Of the 62 patients consented to participate in the study, approximately half (n = 33) had known cardiovascular, pulmonary, or metabolic disease. Of the 33 patients with known disease, 39% (n=13) were post treatment. Subjects had seven different types of cancer at all stages of disease. At baseline testing peak oxygen consumption, mean METS was 6.6 (SD = 1.43), heart rate 145.9 bpm (SD = 23.31), systolic blood pressure 175 mm Hg (SD = 19.2), diastolic blood pressure 78.1 mm Hg (SD = 10.37), and perceived exertion 15.3 (SD = 2.02). Each of these measures was similar to what would be expected in a similar population of patients with known cardiovascular, pulmonary, or metabolic disease.

In this sample of patients with cancer with known disease six months post treatment, peak exercise response to the Bruce protocol was similar to that of non-cancer populations with known disease.

In a growing number studies that have investigated exercise rehabilitation in patients with cancer, dramatic improvements in physiological and psychological functioning have been documented. How clinical and research exercise testing should be safely conducted in this patient population is currently being defined and refined. This work suggests that standard ACSM precautions for exercise testing and training are appropriate for patients who have undergone treatment for cancer. Funding Sources: Department of Defense Uniformed Services University of the Health Sciences TriService Nursing Research Program, N98-051

Podium Abstract
PALLIATIVE CARE PROGRAM EFFECTIVENESS RESEARCH: DEVELOPING RIGOR IN SAMPLING DESIGN, CONDUCT, AND REPORTING. Marie Bakitas MS, ARNP, AOCN, Dartmouth-Hitchcock Medical Center, Lebanon NH US; Kathleen Lyons ScD, OTR, Dartmouth College, Lebanon NH US; Jane Dixon PhD, RN, Yale University, New Haven CT US

As a newer model of care, few palliative care programs have undergone rigorous testing for clinical efficacy or effectiveness. Among the methodological difficulties of palliative care research, issues of sampling are prominent. The purpose of this presentation is to analyze the unique sampling issues of palliative care program effectiveness research including: identification of the target population, operationalizing the target population through the development of eligibility criteria, and clear reporting of the elements of the sample in the research report. Comprehensive review of sampling issues and approaches to these challenges has received only scarce attention in the literature.

Sampling issues are not unique to palliative care, however palliative care does have unique sampling issues. These require a rigorous approach and attention not only during study design, but also throughout data collection, data analysis, and interpretation and dissemination of study results. For example, palliative care RCTs and evaluation research have identified challenges with recruitment of appropriate types and numbers of patients; at times preventing study completion. In studies with adequate enrollment, highly selective or overly broad eligibility criteria have limited program generalizability.

During design researchers must assure that appropriate types and numbers of patients are available and that eligibility criteria will represent the target population. During the study, monitoring recruitment and adherence to sample selection procedures ensures adequate accrual and detection of sample selection biases. During data analysis, identified sample imbalances may be managed via statistical means. Upon study completion, the sampling strategy and participants should be described in sufficient detail to allow the reader to evaluate the extent to which established quality criteria have been met.

The steps of rigorous sampling design will be illustrated in the design and conduct of an RCT testing the integration of a palliative care program in a cancer center. Following these approaches can minimize threats to study internal and external validity, which can reduce study relevance. As the number of palliative care programs of various models increases, it is necessary that rigorous methods are applied to identify cost-effective and of high quality care models. Careful attention to sampling issues is critical to building this evidence base. Funding Sources: NIH/NCI- 1 R01 HS013336-01

Podium Abstract
SYMPTOM CLUSTERS IN CANCER PATIENTS UNDERGOING THERAPY. Andrea Barsevick DNSc, AOCN, Fox Chase Cancer Center, Philadelphia PA US; William Dudley PhD, University of Utah, Salt Lake City UT US; Susan Beck PhD, APRN, University of Utah, Salt Lake City UT US; Kyra Whitmer PhD, RN, University of Cincinnati, Cincinnati OH US

Although individuals undergoing cancer therapy are likely to experience multiple concurrent symptoms, most research has examined individual symptoms. The clustering and pattern of cancer symptoms in patient groups is not well understood. Likewise, little is known about the antecedents and consequences of symptom clusters.

This presentation reports a secondary data analysis describing groups of cancer patients with unique patterns of clustered symptoms including fatigue, sleep disturbance, and depressive symptoms. Clinical and demographic antecedents as well as clinical outcomes associated with the symptom cluster groups are examined.

The updated Theory of Unpleasant Symptoms (Lenz et al., ANR, 1997) provides the conceptual basis for the analysis.

Data were derived from a randomized clinical trial of energy conservation to manage fatigue during cancer therapy (Barsevick et al., Cancer, 2004). The sample consisted of 278 individuals treated for a variety of cancers with chemotherapy, radiotherapy, or combination therapy. Data collected 48 hours after the second chemotherapy or at the end of radiotherapy were used in the analysis. The Profile of Mood States Depression Scale, General Fatigue Scale, Pittsburgh Sleep Quality Index, and Functional Performance Inventory were the valid and reliable measures used.

Hierarchical cluster analysis identified three homogeneous groups based on the presence and severity of the three symptoms. Parametric and non-parametric statistical procedures were used to examine the relationships with antecedents and consequences.

Three symptom cluster groups demonstrated significant differences in all symptoms (all p<.001). Group #1 (N=154) had the lowest symptom levels. Group #2 (N=89) had lower fatigue and depression but moderate sleep disturbance. Group #3 (N=35) demonstrated the highest symptom levels. Two antecedents were associated with symptom cluster group membership: group #2 had a higher percentage of married individuals; group #3 had a higher percentage who received combination therapy. Group #3 had the worst consequence in overall functioning.

The findings demonstrate that different cancer patient groups can be distinguished by the presence and severity of three common symptoms. Differences in outcome for symptom cluster groups were also evident. It is possible to use clinical and demographic antecedents to identify those at risk for high symptom levels. Funding Sources: NINR Grant 04573

Podium Abstract
SYMPTOM EXPERIENCE OF RURAL AND URBAN OLDER ADULT CANCER SURVIVORS. Susan Beck PhD FAAN AOCN, University of Utah , Salt Lake City UT US; William N. Dudley PhD, University of Utah, Salt Lake City UT US; Karen Lindau MS, University of Utah, Salt Lake City UT US

There is a ten-fold increase in cancer incident rates for those over 65, a population that is growing exponentially in the U.S. The Institute of Medicine has recommended research to establish baseline data regarding the cancer experience in medically underserved populations including the elderly and those living in rural communities. Such underserved populations may have insufficient access to information, resources, and social support following cancer treatment.

The aims of this study are: 1) to document the symptom experience and quality of life in older adult cancer survivors during the period of early survivorship and 2) to compare urban and rural survivors. The study was guided by the Theory of Unpleasant Symptoms which includes three major concepts: the symptoms, influencing factors, and situational factors.

This descriptive, comparative, repeated measures study compares elderly cancer survivors in rural and urban settings following completion of cancer treatment. At one, three, and fifteen months post-treatment, each participant was mailed a questionnaire addressing their symptom experience using psychometrically sound tools (i.e., Brief Pain Inventory, General Fatigue Scale, Pittsburgh Sleep Quality Index, Geriatric Depression Scale and the SF-12).

Measures of central tendency and repeated measures ANOVA were used. Twenty-four females and 31 males ranging in age from 65-81 (mean age = 71.56) participated. Twenty-five percent (25%) were age 75 or older. A 1-year follow-up was completed on 33 (60%) of the participants. Survivors continue to experience a significant number (Mean=3.9) of symptoms for up to 15 months post-treatment. Fatigue, insomnia, and pain persisted with a moderate severity level on average at each time point; there was no significant improvement over time (p>.10). The majority of participants were not depressed and scored highly on the SF-12 Mental Health Status. Physical functioning was less than the national norm for elderly individuals or those with a chronic disease but did significantly improve over time (p=.011). Those in rural areas reported less physical functioning at each time point (p=.08).

This study provides a foundation regarding the needs of older adult survivors and informs future studies to test interventions to improve the care of this underserved population. Funding Sources: National Cancer Institute Supplement to 3P30CA42014-15 (S. Prescott PI)

Podium Abstract
PATTERNS AND RELATIONSHIPS AMONG SYMPTOMS AND FATIGUE DURING AND FOLLOWING ADJUVANT CHEMOTHERAPY FOR BREAST CANCER. Ann Berger PhD, RN. AOCN, University of Nebraska Medical Center College of Nursing, Omaha NE US; Suzanne Bakken MSN, RN, Avera Hematology and Transplant, Sioux Falls SD US

Recent research findings identify the significant role symptoms play in influencing fatigue during and following adjuvant chemotherapy for breast cancer. It is essential that we know about relationships among physical and psychological symptoms and fatigue before designing fatigue intervention studies.

This study’s purpose was to examine the patterns and relationships among physical (nausea, appetite, pain, concentration, bowels, appearance, sleep) and psychological (depression, anxiety) symptoms and fatigue during four treatments and 30, 60, 90 days after the last treatment and 1 year after the first treatment of adjuvant chemotherapy for breast cancer. Theoretical framework was Piper’s Integrated Fatigue Model. This work is part of a prospective, repeated measures, quasi-experimental feasibility study that examines the outcomes of an intervention to improve sleep and fatigue.

Sample: 25 Caucasian, English-speaking women, post-surgery, who completed doxorubicin/cyclophosphamide chemotherapy for stage I or II breast cancer, mean age = 54.3, most married and employed full or part time. Reliable and valid instruments included Piper Fatigue Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale.

Descriptive, correlations, and regression analyses were performed. All symptoms fluctuated during and following chemotherapy for breast cancer. After fatigue, sleep disturbance was the most frequent, intense, and distressing symptom. Mean total fatigue scores (PFS) also fluctuated over time (2.9–5.9, SD= 1.5-2.8). Significant correlations were found between fatigue (PFS) and the combined score of the remaining seven physical symptoms (SES) (r= 0.46- 0.60, p < .02-.001) and between fatigue (PFS) and/or anxiety and depression (HADS) (0.46-0.79, p< .004- 0.001).

Fatigue was most frequently correlated with the individual physical symptoms of sleep disturbance, pain and nausea and the psychological symptoms of depression and anxiety. Regression analyses identified specific clusters of symptoms associated with fatigue at all times except 1 year after the first treatment (R2=.33- .48; F= 4.82- 9.80, p=.02-.001).

Symptoms, including fatigue, sleep disturbances, pain and depression, are experienced both individually and in clusters at all measurement points during and following chemotherapy. Nurses must vigilantly assess symptoms in order to identify symptom clusters that influence fatigue during and following chemotherapy. Interventions are needed to prevent chronic symptom distress after chemotherapy ends. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Ortho Biotech Products, L.P.

Podium Abstract
THE DIAGNOSIS OF BREAST CANCER: TRANSITION FROM HEALTH TO ILLNESS. Marcia Boehmke DNS, ANPc, RN, University at Buffalo, Buffalo NY US; Suzanne Dickerson Assistant Professor, University at Buffalo, Buffalo NY US

Implications: Nurses need to be aware of the intense emotions of women newly diagnosed with breast cancer. While assisting women to manage symptoms and symptom distress experienced during treatment, nurses need to be mindful of a woman’s view/perception of breast cancer that affect their experiences and response to symptoms encountered.

Purpose: To understand the lived-experience and symptom distress encountered by women with breast cancer during adjuvant treatment through interpretation of narrative stories. Questions: (1.) What were the common experiences and shared meanings of women with breast cancer during adjuvant treatment? (2.) What were the women’s perceptions of distress related to diagnosis and symptoms experienced?

Hermeneutic phenomenology was the interpretive approach used to understand women’s experiences through analysis of narrative texts. Methods: Hermeneutic phenomenological approach, emphasizing the complexity of the human experience and lived-experience was used for this study. Women who met inclusion criteria were interviewed and asked to tell their story about being diagnosed with breast cancer and their symptom experience.

Interviews were audio-taped and transcribed providing data for interpretive analysis that consisted of thematic analysis of the taped narratives and teamwork with a senior nurse scientist.

Findings: Four themes emerged: (1.) A woman’s view of the diagnosis of breast cancer affected her experience and response to symptoms/symptom distress; (2.) Symptoms of severe bone, neuropathy, taste changes and diminished attention span were most distressing, affecting functioning; (3.) Experiencing a precipitous transition from "a state of health to illness overnight based on the results of a mammogram"; (4.) Erasing former personhood by experiencing a body altering (physical and emotional) life changing illness.

Conclusions: Women newly diagnosed with breast cancer experience a life transition and encounter symptoms that affect their attitude toward their body, their functioning and ultimately their quality of life. As more women become breast cancer survivors, this transition needs further exploration so that breast cancer survivors can go on to live the lives they have been given back.

Podium Abstract
CAREGIVER DISTRESS: A ROLE FOR SCREENING. Tami Borneman RN, MSN, CNS, Georgetown University Medical Center, Washington DC US; Jane Ingham MBBS, FRACP, Georgetown University Medical Center, Washington DC US

Caregivers (CGs) of advanced cancer patients often report emotional distress and unmet needs, yet no standard exists for identifying distress in the clinic setting. CG distress is often under-recognized by health care providers and risks impacting both CG well-being and patient care. Thus, the role of screening for CG distress is relevant and important.

Explore instruments that assess CG health and distress outcomes. Specifically explored were ranges of scores on several standard mental health instruments for CG’s, and an evaluation of the validity of the "Distress Thermometer" - a self-administered screening tool for detection of distress.

A longitudinal study, using a conceptual model of the caregiving experience to evaluate relationships between CG unmet needs, burden, perceptions of CG distress and health outcomes.

Patient-CG dyads in an outpatient cancer setting completed self report questionnaires including mental and physical health and distress measures: the Center for Epidemiologic Studies-Depression Scale (CES-D), the SF-12 Health Survey-Mental (MCS 12) and Physical Components Summary Scale (PCS 12), and the use of a Distress Thermometer.

45 CGs provided data. Mean age 55.6 (+9.8), 21.3% were male. CES-D Mean 14.4 SD +10.1, Range 0-35.0, (Cut-off for depression 16); MCS(SF-12) Mean: 43.7 SD +10.9 Range 20.6-59.8; Distress Thermometer Mean 4.97 (+2.5) Range 0-10 (0=No Distress 10=Extreme Distress). Mean CG distress correlated with the CES-D scores and the MCS(SF-12) but not with physical function. In the GLM the only significant association was between SF-12 MCS and CG distress. Conclusions were 1) CG distress is prevalent 2) CG distress thermometer may be worthy of further study as a screening measure for psychological distress in CGs. Nurses are in a prime position to help screen for CG distress thus facilitating interventions that would address or minimize their distress. Funding Sources: Supported in part by NINR Grant 1R21NR05225-02

Podium Abstract
THE EFFECTS OF PROVIDING INFORMATION ABOUT MAMMOGRAPHIC BREAST DENSITY IN A MAMMOGRAPHY SCREENING PROGRAM: A CONTROLLED TRIAL. Joan Bottorff RN, PhD, SON, University of British Columbia, Vancouver BC CA; Pamela Ratner RN, PhD, University of British Columbia, Vancouver BC CA; Joy Johnson RN, PhD, University of British Columbia, Vancouver BC CA; Jane Buxton MBBS, MHSc, FRCPC, University of British Columbia, Vancouver BC CA; T. Gregory Hislop MD, BC Cancer Agency, Vancouver BC CA; Weihong Chen RN, MN, PhD Student, University of British Columbia, Vancouver BC CA; Cornelia Zeisser BSc, MEd Student, University of British Columbia, Vancouver BC CA

The density of a woman's breast has emerged as a moderate risk factor for breast cancer. Given this, there is a cogent argument that women should be informed about their mammographic breast density (MBD). Such an argument, however, must be weighed against any evidence that sharing such information leads to harm by causing excessive anxiety.

It is not routine practice in most screening programs to share MBD information with women or their physicians. The purpose of this study was to determine the consequences of providing MBD information to women with breast density greater than 50% of the breast volume with the results of their screening mammogram.

Risk communication theory includes domains of risk perception, cognitive processing, decision making under uncertainty, and health behavior. A randomized experiment was conducted and included 618 women who attended one of five screening mammography centers (68% participation rate). The intervention consisted of reporting the presence of MBD in screening mammogram results letters along with a pamphlet that included a description of MBD and other risk factors for breast cancer, factors that influence MBD, and the importance of regular screening. Comparisons between the study groups at 4 weeks and 6 months post-mammogram were made by assessing breast screening practices and psychological outcomes including preoccupation with breast cancer, breast cancer worry, and psychological distress.

The study groups were compared on baseline demographic characteristics and personal background to determine equivalency. Dependent variables were examined for group differences via Chi-square analysis and Student’s t-tests.

Comparison of study groups by breast cancer screening participation revealed a significant difference at 4 weeks for likelihood of having a clinical breast examination (CBE). More women in the intervention group reported being "very likely" to have an annual CBE than women in the control group. No statistically significant differences on the other variables measuring breast cancer screening participation at either 4-week or 6-month follow-ups were found. In addition, there were no statistically significant group differences in women’s psychological responses at either the 4-week or 6-month follow-up. Providing MBD information in mammography screening results letters appears to be a cost-effective strategy for sharing risk information that may become increasingly useful in prevention decisions. Funding Sources: Susan G. Komen Breast Cancer Foundation

Podium Abstract
INCREASING TESTICULAR SELF-EXAMINATION IN ACTIVE DUTY SOLDIERS: AN INTERVENTION STUDY. Carlton Brown RN, MSN, AOCN, Walter Reed Army Medical Center, Washington DC US

Testicular cancer(TC)is the most common malignancy in men 18-35. Approximately 80% of military men are at risk for TC. There was an increase in TC of 78% in military men between 1988-1996. Sixty-six percent of America’s military do not perform monthly TSE; only half have ever received any education about TC or TSE.

The purpose of this study was to determine which educational information program, (printed materials and shower card reminder only method vs. a peer education video and shower card reminder)is the most effective in increasing the proportion of soldiers who practice testicular self-examination.

The Health Belief Model was used as a framework focusing specifically of perceived benefits, barriers, seriousness, and susceptibility. Protocol was modified to a "post-test only". Blesch's Men's Health Belief Survey was used to collect data and Cronbach's Alpha for the four subscales include: barriers (0.78), benefits (0.85), susceptibility (0.64), and seriousness (0.34). Item analysis was also completed on Blesch tool. Descriptive statistics were used to examine the sample and the group demographics. Nonparametric analyses were conducted to examine group differences in categorical dependent variables.

The majority of the participants had heard of TC (89.1%) and TSE (79.6%). Only 1/4 of the sample reported practicing TSE every month. More than half of the sample had never been examined for TC by a health care provider. No statistically significant differences were found between groups in performing TSE correctly (every month). However, no participant in Group B (Video Group) reported NEVER performing TSE. No statistically significant group differences were found on knowledge, benefits, susceptibility, or seriousness. There was a significant difference between Groups B (Video) and C (Control) in their beliefs regarding barriers to the performance of TSE (p=.047). This study has several implications for nursing and other health care professionals. First, soldiers need educational interventions for TC and TSE. Second, providers must make testicular exam a part of routine physical exams. Third, there is a need for further study of the effectiveness of these health promotion methods. Funding Sources: Triservice Nursing Research Grant

Podium Abstract
GENE EXPRESSION CHANGES IN AGED VASCULAR ENDOTHELIAL CELLS. Rosaria K. Cabrera BS, Honors Student, Physiological Sciences, Tucson AZ US; Carrie J. Merkle PhD, RN, FAAN, The University of Arizona College of Nursing, Tucson AZ US; David W. Montgomery PhD, Southern Arizona VA Health Care System, Tucson AZ US

Death from breast cancer is due to metastatic disease. The mechanisms of metastasis are largely unknown, though the endothelium is involved.

Our goal was to determine if there are age-related changes in gene expression in human microvascular endothelial cells (HMVECs) that might facilitate breast cancer metastasis. The aims were to: Aim 1: Age HMVECs in-vitro to form groups identified by population doubling (PD) number, Aim 2: Identify morphological differences in HMVEC age groups, Aim 3: Identify age-related changes in expression of angiogenesis, extracellular matrix/adhesion molecule, and stress/toxicity pathway genes.

Our previous work has shown that breast cancer cell addition to in-vitro aged, but not young, bovine pulmonary artery endothelial cells causes persistent gaps to form between neighboring endothelial cells and facilitates breast cancer cell transmigration of endothelial cells. These observations warrant additional study because: 1. endothelial transmigration occurs in metastasis, and 2. breast cancer metastasis causes death.

Aim 1: HMVECs from the lung of a three year-old female were obtained at PD 20 and serially aged. Aim 2: HMVECs of specific PDs were examined by microscopy. Cell size and density were determined. VE-cadherin, an endothelial adhesion protein, was quantified. Aim 3: RNA from HMVECs at PD 24, 31 and 40 was isolated. Using SuperArray GEArrayTM Q series kits, cDNA probes were formed and added to membranes containing genes for angiogenesis, extracellular matrix/adhesion molecules, and stress/toxicity pathways. Images were captured digitally and analyzed.

Aim 2: Data were analyzed by ANOVA. Aim 3: Data were analyzed by the manufacturer’s protocol and definitions for gene expression, gene expression increases and gene expression decreases.

Aim 1: HMVECs were successfully aged to PD 43. Aim 2: As HMVECs age (increase in PD), cell area increases and cell density decreases. Higher PD HMVECs have less VE-cadherin. Aim 3: Expression of over seventy genes was identified. Expression decreased in two genes (caveolin and a catenin-related protein) and increased in seven genes (specific integrins, plasminogen activator inhibitor and a laminin). These changes may facilitate metastasis, a hypothesis being tested in rodents. Since vascular aging increases with high blood pressure, high lipids, and stress hormones, it is possible that interventions to reduce cardiovascular disease may prevent metastasis. Funding Sources: The University of Arizona Honors College and NIH P20-NR07794

Podium Abstract
EXPANDING THE STAGES OF CHANGE TRANSTHEORETICAL MODEL THROUGH QUALITATIVE INQUIRY: MAMMOGRAPHY SCREENING AND AMERICAN INDIAN WOMEN. Mary Canales Ph.D. RN, The University of Vermont, Burlington VT US; William Rakowski Ph.D., Brown University, Providence RI US

The presentation will focus on the process for translating qualitative data gathered from interviews with American Indian women (AIW) in Vermont, into statements used to empirically test how to integrate AIW themes into an existing model of behavior change – the stages of change, Transtheoretical Model (TTM). The TTM proposes a sequence of stages along a continuum of behavior change, from precontemplation (not intending to adopt), to contemplation (considering adoption), to action (initial adoption), to maintenance (sustained performance). Relapse (inconsistent use) is also possible. Although TTM-based mammography research has been conducted since the early 1990s, AIW have not been a focus to date.

Analysis from a qualitative study with AIW in Vermont suggested that traditionality influenced women’s screening decisions. Is traditionality a separate dimension or can it be incorporated into existing TTM constructs? New items reflecting traditionality were developed for each of the TTM’s major constructs (pros, cons, and processes of change), based on the qualitative analysis and a literature review. A separate traditionality scale was also developed, based on qualitative data and existing measures of ethnic identity, and tailored for AIW living off-reservation. The Vermont Breast Cancer Surveillance System, a statewide database of women who have had a mammogram in the state, was used to invite participants and compare self-report data from the survey with mammography registry data. This type of validation has not been reported with previous TTM research and provides another avenue for assessing the accuracy of self-report data.

This method for instrument development provides an example of how culturally relevant data and existing theoretical constructs can be combined to create an instrument that is specific for diverse populations. Through this tandem approach, existing theories can be usefully adapted for populations whose special features were not major considerations when the theories were originally developed.

Designing tailored mammography interventions so they are relevant for AIW requires understanding of their perspectives as well as having a strong theoretical foundation. The qualitative-quantitative approach for survey design presented holds much promise for developing future nursing interventions for AIW and other populations whose screening rates are currently below national objectives.

Podium Abstract
TAILORED VS TARGETED INTERVENTIONS TO INCREASE MAMMOGRAPHY ADHERENCE IN LOW-INCOME AFRICAN AMERICAN WOMEN. Victoria Champion DNS, RN, Indiana University School of Nursing, Indianapolis IN US; Jeff Springston PhD, University of Georgia, Athens GA US; Terry Zollinger PhD, Indiana University School of Medicine, Indianapolis IN US; Robert Saywell, Jr. PhD, Indiana University School of Nursing, Indianapolis IN US; Katherine Russell DNS, RN, Indiana University School of Nursing, Indianapolis IN US; Patrick Monahan PhD, Indiana University School of Medicine, Indianapolis IN US; Quiangian Zhoa PhD, Indiana University School of Medicine, Indianapolis IN US

Breast cancer continues to be a major cause of mortality for African American women, ranking as the second leading cause of cancer death within this population. Low-income African American women are at relatively high risk for breast cancer mortality due in part to their limited mammography use.

The purpose of this randomized prospective study was to compare a tailored interactive computer intervention with a targeted video; both developed to increase mammography screening among low-income African American women who were non adherent to mammography at baseline. Both intervention groups were compared to a usual care group. Both targeted and tailored interventions used a combination of the Transtheoretical Model (TTM) and Health Belief Model (HBM) to develop intervention content.

A total of 299 African American women who were 45 to 75 and had not had a mammogram in the last 15 months were consented and randomly assigned to one of three groups: 1) Usual Care, 2) Targeted Video, and 3) Tailored Interactive Computer. Mean age was 50. 63 and the average educational level attained was 12.34 years of formal school. A total of 33 % were currently partnered and 67% did not live with a partner. Data were collected in person at baseline and at 3 months post intervention by telephone. Instruments measured theoretical beliefs of perceived risk, perceived benefits and barriers to mammography screening, self efficacy for mammography, and demographic variables. Validity and reliability had been established in prior work. Mammography status was measured by self-report and women were classified in Pre Contemplation (not thinking about having a mammogram), Contemplation (thinking about having a mammogram) or Action (had a mammogram after the intervention.

Results indicated that stage of mammography adoption did differ by intervention group (p <.04). For participants in the usual care group 32% were in Action at 3 months, versus 25% in the video group and 40% in the interactive computer group. Results indicate that a tailored interactive intervention resulted in the highest level of adherence post intervention.

Results can guide nurses to deliver interventions that will increase mammography screening in low-income African American women. Funding Sources: National Cancer Institute

Podium Abstract
CANCER-RELATED SYMPTOM PROFILES BETWEEN DEPRESSED AND NON-DEPRESSED PATIENTS WITH CANCER. Mei-Ling Chen RN, PhD, School of Nursing, Chang Gung University, Tao-Yuan TW

Cancer patients often experience multiple symptoms caused by the disease or cancer treatment. Depression is common but easily overlooked problem in cancer patients. Uncontrolled cancer-related symptoms is identified as a high risk factor of depression.

(1) To compare the symptom profiles, including number of symptoms, symptom severity and symptom interference on daily function, between depressed and non-depressed cancer patients; (2) to identify symptoms that can be used to discriminate cancer patients¡¦ depression status.

Other than pain and fatigue, whether depressed cancer patients have different symptom experience from non-depressed cancer patients has not been systematically investigated.

A convenience sample of 117 patients with various cancer diagnoses was selected from a medical center located in northern Taiwan. Depression was measured by Hospital Anxiety and Depression Scale-Depression Subscale (HADS-D). A cutoff of 8 was applied to classify patients into depressed and non-depressed groups. M.D. Anderson Symptom Inventory (MDASI) was used to measure symptom severity (13 items) and interference (6 items). Both HADS-D and MDASI have valid and reliable Taiwan version.

Independent t test and discriminant analysis were used to analyze the data.

Around 80% patients experienced 5 or more symptoms simultaneously. The mean number of symptoms experienced was 10.22 for depressed patients (n = 73) and 7.76 for non-depressed patients (n = 44) (p = .001). Among 13 symptoms in MDASI, depressed patients reported significantly higher mean severity scores than did non-depressed patients on 12 symptoms (p < .05), including pain, fatigue, nausea, distressed, problem with remembering things, lack of appetite, drowsy, dry mouth, sad, vomiting, and numbness. Among 6 interference items, depressed patients also reported significantly higher symptom interference scores on emotion, work, relations with other people, and enjoyment of life. Stepwise discriminant analysis showed that two symptoms, sad and drowsy, were the significant predictors of patients¡¦ status of depression with a correct prediction rate of 72.6%. Compared to non-depressed cancer patients, depressed patients had an inferior symptom profile in terms of number of symptom, symptom severity and symptom interference. Screening the occurrence and severity of sad and distress may be used to identify potentially depressed cancer patients. Funding Sources: Chang Gung University (Grant Number: CMRP1238)

Podium Abstract
PARENTAL STRESS, COPING STRATEGIES, AND PSYCHOLOGICAL RESPONSE IN PARENTS OF CHILDREN WITH CANCER: A LONGITUDINAL STUDY. Yi-Chen, Chang-Gung University, Taiwan, Tao Yuen TW

Parenting children living with cancer is a complicated psychological and behavioral process. However, major advances in cancer treatment have dramatically improved survival rates for cancer patients, therefore, assessing psychological and behavioral process with time for mothers become a more concern issue. In Taiwan, there was few study investigate regarding the difference of parental stress, coping strategies, and psychological distress experienced by mothers of children with cancer with time.

The longitudinal study was aimed to investigate the parental stress, coping strategies, and psychological response experienced by mothers of children with newly diagnosed cancer (baseline), and six months after initial assessment (6-month follow up).

Stress and coping, suggested by Lazarus and Folkman was used to guide this study.

Longitudinal study design was used to collect data. The data included 35 mothers who served as subjects for this study and selected from a larger data set of surveys from parents whose children were receiving treatment or follow-up care for cancer. After informed consent was obtained, a questionnaire packet was distributed to each subject. On average, the initial assessment of the mothers took place 1.92 months after the child¡¦s date of diagnosis. Subsequent assessment took place 6 months after the initial assessment. The measures used in this study include parental stress index /short form (PSI/SF), parental strategies inventory (PSCI), and Symptom checklist-35-revised (SCL-35R).

Paired-t tests were used to compare the differences of parental stress, coping strategies, and psychological distress experienced by mothers of children with cancer after child’s diagnosis within baseline, and 6-month follow up.

These results demonstrated that mothers on baseline reported significantly high scores of parental distress and total parental distress than 6 months follow -up. At baseline, mother reported statistically more decision making strategy and less physical support strategy than 6 month follow-up. Mothers with children of newly diagnosed reported statistically higher depression and anxiety level than 6 month follow-up. However, there was no statistically significant difference in somatic complaint between baseline- and 6 month follow up assessment. In order to improve quality of care, the findings suggest that nurses health care professionals need to provide a thorough psychiatric consultation at the time of diagnosis for mothers of children who have cancer. Funding Sources: The research was supported by a grant to Dr. Yeh from National Science Council, Taiwan (Grant number. 92-2314-B-182-092)

Podium Abstract
CANCER SYMPTOM MANAGEMENT RESEARCH IN DISADVANTAGED MINORITY PATIENTS: CHALLENGES AND OPPORTUNITIES. Fang-Yu Chou RN, PhD, School of Nursing/UCSF, San Francisco CA US

This paper addresses the challenges and opportunities in the cancer-related symptom management nursing research among disadvantaged minority oncology patients. An on-going study in cancer symptom management of Chinese immigrants is used to guide the discussion of recruitment issues in disadvantaged bilingual cancer patients.

Patients with low English proficiency are not recruited in most health care research due to language difficulties and socio-cultural barriers. As for Chinese Americans and recent immigrants, the majority of them who are not yet proficient in English often do not participate in research and surveys (Ren & Chang, 1998). Up to date, very few studies have investigated the cancer-related symptom experience and self-care among Chinese Americans and immigrants.

An on-going pilot study is conducted at a county medical center in San Francisco Bay Area to recruit Chinese-speaking immigrant cancer patients receiving Chemotherapy for exploring their symptom prevalence, self-care strategies, and quality of life. Most of the participants were not fluent in English and with low-income status. Translated standardized questionnaires and bilingual recruiters were used. There are about 30% refusal rate to participate in the study among eligible Chinese patients. Reasons patients refused to participate included such as "do not want to be bothered and/or talk about cancer"; "too busy";" family rejection"; "concern of privacy issue".

Reasons patients refused to participate in research studies were reported similarly in a study of Chinese family caregiver of dementia (Hinton, et al., 2000). Cancer can carries a social stigma among Chinese and research participation can be viewed as an intrusive event to reexperience distress related to cancer diagnosis. Strategies such as providing clear communication on the purpose of the research in participants’ preferred language, emphasizing on the importance and benefit of the study to the society and themselves, and ensuring their privacy during the study could be helpful to recruit disadvantaged Chinese patients with active cancer treatments. Well-trained bilingual recruiters and data collectors are necessary.

As the cancer populations become more diverse in ethnic and socioeconomic status (Aziz & Rowland, 2002), especially at most urban areas, research studies within and across cultural subgroups are important to expand our knowledge of effective recruitment and retention in research studies, culturally-sensitive cancer care, and issues of potential health disparities. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Ortho Biotech Products, L.P.

Podium Abstract
THE MEANING OF MOTHERHOOD IN ADOLESCENTS WHOSE MOTHERS HAVE BREAST CANCER. Donna (Danuta) Clemmens Ph.D., R.N., New York University Division of Nursing, New York NY US

The potential burden of living with mothers’ breast cancer presents adolescents with potentially devastating life experiences.

While research provides an initial picture of adolescent depression and worries, few studies include the adolescents' descriptions of their experience. An interpretive phenomenological philosophy and method guided the data collection and analysis.

In-depth, semi-structured interviews were conducted with the participants regarding their experiences as both adolescents and children. Data collection continued until thematic redundancy was determined both in interview transcripts and through other data sources. Study rigor was established by considering the credibility, auditability, and fittingness of the data through consultations with both methodological and content experts in the field.

Major themes emerged from the findings highlighting the uniqueness and significance of "MOM" having breast cancer.

A "Life Unraveled" uncovered stressful feelings in the adolescents especially during initial diagnosis and maternal treatments for cancer, because it was Mom that was ill. Many of the adolescents "Learned To Be with Mom" in a different way when Mom was increasingly fatigued. "Turning to Self" included being strong for Mom, and coping by emersion in music, homework and activities. "Needing to Normalize" was a call by adolescents to be able to be adolescent children again with Mom there as Mom and not just as a patient. Finally, "Talking Out Openly" highlighted the need by adolescents to be included in all family discussions about Mom's cancer in an open, honest manner.

These research findings were used to develop an RO3 submission, developing a supportive care program for adolescent children whose mothers have breast cancer. Implications for practice and education include a call to help adolescents and mothers reframe their relationship around the cancer to foster both a growth in their relationship, and, for the adolescents, to promote their psychosocial development. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Genentech, Inc.

Podium Abstract
INTERVENTIONS FOR PARTNERS OF BREAST CANCER PATIENTS. Barbara Cochrane PhD, RN, Fred Hutchinson Cancer Research Center, Seattle WA US; Frances Marcus Lewis PhD, RN, FAAN, Family and Child Nursing, University of Washington, Seattle WA US

To determine appropriate directions for future research with partners of breast cancer patients by critically evaluating published intervention studies to date.

Extensive previous research has documented the psychosocial distress of partners of breast cancer patients, its effect on the diagnosed patient, and the need for interventions to address these issues. However, there are few, if any, evidence-based services available for partners, with intervention research lagging far behind descriptive work. Interventions are needed that are based on empirical evidence, have high potential for improving psychosocial outcomes, and are feasible in today’s health care environment. An integrative review of the research literature in this area was undertaken, beginning with a comprehensive search of bibliographic databases covering 1966-2004. Thousands of titles were retrieved and full-text articles on interventions obtained. Only 12 intervention studies were identified that included partner outcomes. These reports were examined in depth to understand, value, and gain insights about current knowledge. Defining characteristics of each study were analyzed critically to determine methods to incorporate—-or avoid—-in future intervention work.

Only four studies offered evidence of intervention efficacy. Two of these reported outcomes, specifically, in partners of breast cancer patients. None of the studies fully incorporated appropriate methods for testing intervention efficacy: randomized, controlled clinical trial designs; established theoretical and empirical foundations; adequate statistical power; clear descriptions of the target population and study sample; quality assurance monitoring; and outcome measures sensitive to partner concerns. Multi-site studies are needed to ensure adequate samples sizes. Recruitment efforts that target the diagnosed wife and her partner directly can maximize case-finding and minimize bias. Standardized intervention protocols should address documented partner concerns. Interventions delivered to individuals, not just groups or couples, are needed. Finally, both process and relevant outcomes should be measured using reliable and valid instruments. Few evidence-based programs or services focus on the partners’ experience with breast cancer. Oncology nursing research is needed that builds on the lessons learned from previous research to appropriately address the needs of this important, but underserved population. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Aventis Pharmaceuticals

Podium Abstract
PATTERNS OF SMOKING IN WOMEN WITH LUNG CANCER. Mary Cooley PhD, RN, Dana-Farber Cancer Institute, Boston MA US; Linda Sarna DNSc, RN, FAAN, University of California, Los Angeles, Los Angeles CA US; Leda Danao PhD, BSN, University of California, Los Angeles, Los Angeles CA US; Jean Brown PhD, RN, FAAN, University at Buffalo, The State University of New York, Buffalo NY US; Cynthia Chernecky PhD, RN, Medical College of Georgia, Augusta GA US; Geraldine Padilla PhD, University of California, San Francisco, San Francisco CA US

Smoking cessation after a cancer diagnosis is associated with decreased secondary malignancies, decreased treatment complications, and increased survival. Few studies describe tobacco use, readiness to quit, and cessation strategies in women after a diagnosis of lung cancer. The purposes of this longitudinal study were to determine patterns of smoking at entry to the study, 3 and 6 months later, identify readiness to quit and cessation strategies at entry to the study, and examine factors associated with continued smoking over time.

The Transtheoretical Model was used to guide this study Data were collected from 230 women with non-small cell lung cancer at entry to the study, 3 and 6 months later. Complete data was available for 161 women. The mean age of the sample was 65 years, 84% were Caucasian, 11% were African American, and 81% had early stage disease. The mean time since diagnosis was 2 years. Data were collected through reliable and valid standardized questionnaires and interviews, medical record review, and anthropometrics. Current smoking was determined through self-report and biochemical verification with urinary cotinine

Descriptive statistics, chi-square and t-tests were used for analyses.

Eighty-seven percent of women reported ever smoking, 37% reported smoking at the time of diagnosis, and 14% continued smoking at entry to the study, 13% at 3 months, and 11% at 6 months. Most smokers (60%) planned a quit attempt within the next month. Approximately one-third of smokers received assistance with cessation after their diagnosis. Nicotine replacement or buproprion was identified as the most common cessation strategies. Significant factors associated with continued smoking at all three data points included being unmarried, younger, and exposed to secondhand smoke. These findings suggest that the diagnosis of cancer is a strong motivator for behavioral change and that some patients need additional support in order to quit smoking. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Bristol Meyers Squibb Foundation; and National Cancer Institute 1 K07 CA92696-02

Podium Abstract
THURSTONE SCALING AS A MEASUREMENT MODEL IN CANCER NURSING RESEARCH. Lesley Degner R.N., B.N., M.A., Ph.D., Faculty of Nursing, Winnipeg MB CA; Carol Tishelman R.N., B.N., Ph.D., Karolinska Institute, Stockholm SE; Ruth Bond M.A., Manitoba Centre for Health Policy, Winnipeg MB CA

The purpose of this paper is to describe a novel approach to measuring constructs of relevance in cancer nursing. Most often Likert type scaling approaches have been used in the past, but Thurstone scaling provides a different method for eliciting patient responses based on a paired comparison technique. Patients consider pairs of stimuli that are arranged in every possible subset of two using the Ross matrix of optimal ordering to maximize the distance between items to avoid selection bias. This allows patients to judge each pair of stimuli on the attribute of interest. To date, we have used this scaling approach to elicit priorities among a set of 9 information needs in both women with breast cancer, and men with prostate cancer, in Canada, England and Sweden. We have also used this approach to elicit the salience of different dimensions of symptom distress (rather than current intensity) to patients with lung cancer in both Canada and Sweden.

The use of Thurstone scaling allows for production of "ladders" of information needs or of salience of different symptoms that are readily understandable to clinicians. The development of the programming to permit analysis of this data is now in the public domain on the website of the Manitoba Centre of Health Policy. Detailed information on data entry and analysis approaches are described, permitting investigators previously unfamiliar with Thurstone scaling to apply this scaling method in their research.

The development of a touch screen approach to measuring information needs using Thurstone scaling by Davison and colleagues in Vancouver further extends the potential usefulness of this scaling approach.

Calculation of coefficient of concordance among groups completing the Thurstone scales permit us to make recommendations as to whether a group or individual approach is most suited to the area of intervention under study. If patients and partners do the task independently, the results also permit analysis of the degree of concordance between the two groups.

Thurstone scaling has considerable potential for measuring a range of variables in the field of cancer nursing, and for providing an innovative way of displaying results that are more intuitively meaningful to both patients and clinicians.

Podium Abstract
COMPARING NURSES AND PATIENTS VIEW OF INTERNET USE FOR CANCER CARE. Suzanne Dickerson DNS RN, University at Buffalo, State University of New York, Buffalo NY US; Marcia Boehmke DNS, RN, ANP-C, University at Buffalo, The State University of New York, School of Nursing, Buffalo NY US; Jean Brown PhD, RN, FAAN, University at Buffalo, The State University of New York, School of Nursing, Buffalo NY US

While there are a multitude of cancer-related web sites available, little research has been done to compare nurses’ and patients’ views of Internet use for cancer care.

The purpose of this study was to gain an understanding of the similarities and differences of oncology nurses’ and patients’ view of Internet use for cancer care through phenomenological interpretation of their narrative stories.

In the interpretive phenomenological approach underlying a Heideggerian hermeneutical study, the researchers discovers the common meanings the practical knowledge of Internet use for cancer care through interpretation of narrative stories.

Design: Hermeneutic phenomenology was the interpretive approach used to gain understanding of human experience through analysis of narrative text. Population, Sample, Setting: 20 nurses and 20 patients comprised the informants. The nurses were recruited from local and national ONS meetings. Patients were recruited by the oncology nurses and had a variety of cancer diagnoses.

Methods: Participants were individually interviewed and asked to tell stories of Internet use. The interviews were audio taped and transcribed providing data for interpretive analysis.

Narratives [Texts] used in this study were interpreted by the seven-stage hermeneutical process (Diekelmann et al., 1989; Diekelmann & Ironside, 1998).

Findings: Similarities included: 1.) Varying Internet uses and computer competencies. 2.) Gaining information regarding cancer care from a variety of web sources. 3.) Redefining patient/provider relationships and 4.) Connecting to peer supports using the Internet. Differences included: 1.) Patients utilize computer savvy support network to gain information for decision making and validating treatment decisions, 2.) Differing views of ability to determine quality and appropriateness of Internet information. 3.) Variety of responses from providers regarding treatment option discussions especially when discussing alternative approaches. 4.) Value of peer interactions and knowledge gained from talking to others with similar diagnoses.

Implications: Computer savvy patients are creating the need for new interaction patterns and relationships with providers. Nurse patient partnerships may then dialogue to determine quality and appropriateness of Internet information. The movement suggests a need for nurse Internet competencies, environmental support, and consideration for patient access (digital divide). Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Bristol-Meyers Oncology

Podium Abstract
EXPERIENCE OF WOMEN TREATED WITH HDR BRACHYTHERAPY USING THE MAMMOSITE CATHETER. Joy Dienger DNSc, RN, University of Cincinnati College of Nursing, Cincinnati OH US; Lynne Brophy MSN, RN, OCN, TriHealth, Bethesda North Hospital, Cincinnati OH US; Patricia Berning RN, OCN, TriHealth, Good Samaritan Hospital, Cincinnati OH US

Breast cancer is the number two killer of women in the United States. Many women diagnosed with the disease are eligible for breast conservation therapy consisting of lumpectomy followed by radiation therapy. A new method for delivering radiation therapy using high dose rate (HDR) brachytherapy and the MammoSite® Catheter is now available. Oncology nurses play a vital role in the care of women undergoing radiation therapy. Accurate information regarding the experience of women undergoing this method of radiation therapy is needed for nurses to effectively provide education, symptom management and emotional support.

Data reporting the experience of women undergoing HDR brachytherapy using the MammoSite® Catheter are limited. This pilot study sought to increase knowledge regarding symptoms experienced, ability to perform ADLs, and satisfaction with treatment outcome.

Forty-percent of women eligible for breast conservation therapy choose mastectomy to avoid the seven week regimen of external beam radiation (ERT) therapy. The treatment duration is especially an issue for women who live far from treatment centers, work full-time, and/or desire quick closure to the treatment stage of their disease. This HDR brachytherapy delivers the radiation dose over five days of outpatient therapy. It should appeal to many women, offer decreased symptom distress and improved quality of life (QOL) while providing treatment efficacy and cosmetic outcome equal to ERT. Using a descriptive retrospective design, 14 women who completed the HDR brachytherapy using the MammoSite® catheter during the first nine months of availability participated in a structured taped telephone interview. The interview questions were based upon information found in the literature and recorded in radiation therapy treatment records.

Data were analyzed for type and frequency of symptom experienced. Symptoms reported included: mild/moderate erythema, dryness, itching, and blistering of the skin; discomfort, bulky, heavy feeling associated with the catheter; and fatigue. Four worked during the treatment period. Most denied limitations to usual personal/household activities and 78.5% rated their cosmetic outcome as good or excellent. All claimed satisfaction with treatment, however lack of sufficient information remains. Data are being used to plan a larger prospective study, to develop patient education materials, and to refine symptom management techniques. Funding Sources: Deans Research Award, University of Cincinnati, College of Nursing

Podium Abstract
AN ANALYTIC STRATEGY FOR MEASURING AND MODELING CANCER SYMPTOMS. Ardith Doorenbos PhD, RN, Michigan State University, East Lansing MI US; Barbara Given PhD, RN, FAAN, Michigan State University, East Lansing MI US;Charles Given PhD, Michigan State University, East Lansing MI US; Natalya Virbitsky PhD(c), University of Michigan, Ann Arbor MI US

Purpose: To propose an analytically based strategy for measuring and modeling cancer symptoms.

Description of the Methodological Issue: Research on cancer symptoms has focused on single symptoms, a summary score of a number of symptoms, and more recently on symptom clusters. However, the research literature does not provide clear direction for determining which approach is preferable, or how to incorporate these symptom measures into the context of multilevel longitudinal studies.

Theoretical Framework: Item response theory guided this methodological enquiry. It postulates that characteristics of symptoms, such as symptom intractability, interact with a person’s characteristics or condition to determine susceptibility to a given symptom.

Methods: The analyses used data amalgamated from three different descriptive cross-sectional studies. This data set consists of 21 symptoms reported across time by 1,389 individuals with cancer.

Analysis: A three level Hierarchical Linear Model (HLM) was used. Level-1 is the item response model which consists of symptom presence. Level-2 is the trajectory of each individual representing change over time of symptoms within person, and the person related variables that change over time such as depression and activities of daily living. Level-3 explains that trajectory via person-specific characteristics, such as age, cancer site, and gender. Implications and Recommendations: The combined item response and hierarchical linear models extends the usual item response model allowing for multiple symptoms to be measured and examined rather than single symptom, or a symptom summary score. Additionally, it provides information on how symptoms group with one another.

Significance: Item response models can be used as a means to organize symptoms as a multivariate dependent variable. Embedding an item response model in a hierarchical linear model allows researchers to treat symptoms as a multivariate outcome at higher levels. This permits examination of symptoms both longitudinally and at the individual level.

Podium Abstract
A DISCURSIVE ANALYSIS OF THE MEANING OF HOPE FOR OLDER PALLIATIVE CANCER PATIENTS. Wendy Duggleby DSN, RN, AOCN, College of Nursing, Saskatoon SK CA; Natasha Murdock BSN, RN, Masters in Nursing Student College of Nursing University of Saskatchewan, Saskatoon SK CA; Karen Wright PhD RN, College of Nursing University of Saskatchewan, Saskatoon SK CA

Health care professionals who define hope as cure often view the hope of terminally ill patients as a form of denial or false reality. These views have been found to decrease palliative patients’ quality of life(Hall, 1990). Therefore, oncology nurses who understand the meaning of hope for older palliative cancer patients can contribute to their quality of life.

A secondary analysis of data from a qualitative study exploring the experience of hope in older palliative cancer patients was conducted to understand the meaning of hope within the culture of the dying cancer patient while accommodating the historical context. The specific aim was to describe the meaning of hope for palliative home care patients with cancer within their social context.

The philosophical frame for this study was Potter and Wetherell's (1987) discourse theory, which explores the meaning of concepts using function, construction and variation. The few reported studies focusing on hope in palliative patients have not explored the meaning of hope within the social context of someone who is dying.

Saturation was reached with 10 palliative patients with advanced cancer (mean age 75 yrs) who were interviewed in their homes using open-ended questions. Six of the participants were able to complete a second interview where they reviewed their transcripts for accuracy and added additional information if they wanted.

Data were analyzed line-by-line examining how hope was used as function; it's construction in dialogue, and how it varied depending upon the social context in which dialogue occurred. As themes emerged memos were kept regarding the social context in which the meaning of hope was described. Throughout the analysis, the research assistant and PI selectively analyzed data separately and then would meet to compare the analysis.

Six themes emerged: hope as trust, duty, belief, control, value and worth, and emotion. Variation was encountered in the different stories that each participant described related to social context and function of the word. The results of this study provide a foundation for future research on hope and hope fostering strategies that can be used by oncology nurses to foster hope in older palliative cancer patients. Funding Sources: The University of Saskatchewan Presidents SSHRC Research Grant

Podium Abstract
A FEASIBILITY STUDY OF ONLINE SELF-REPORTING OF TOXICITIES, PERFORMANCE STATUS, AND QUALITY OF LIFE INFORMATION BY PATIENTS RECIEVING CHEMOTHERAPY. Dorothy Dulko RN, MS, AOCN, Memorial Sloan Kettering Cancer Center, NY NY Ethan Basch MD, Memorial Sloan Kettering Cancer Center, NY NY US; Mary McCabe RN, Memorial Sloan Kettering Cancer Center, NY NY US; Deborah Schrag MD, Memorial Sloan Kettering Cancer Center, NY NY US

Chemotherapy often causes distressing side effects in cancer patients. Monitoring of symptoms and performance status during treatment is a cornerstone of oncology nursing. Patients who suffer from the side effects of chemotherapy frequently have difficulty in adequately monitoring their symptom experience which can result in unmet needs. The use of computer based technology can improve communication of chemotherapy toxicity and result in improved symptom control.

As patients experience side effects of cancer treatment, their need for therapy alteration, supportive care, or informational services often change. There is limited literature on patients' willingness and ability to accurately self-record toxicity related symptoms and performance status during chemotherapy. This feasibility study investigates patient interest and willingness to report symptoms via a computer based program.

A two-page questionnaire using NCI CTCAE v 3.0 toxicity criteria was designed to evaluate the feasibility of a computer based self-reporting system. A convenience sample of 100 patients with cancer of the cervix, ovary, uterus, prostate, and lung were shown a paper version of the CTCAE toxicity criteria converted into patient language for seven symptoms: (1) nausea; (2) vomiting; (3) diarrhea; (4) constipation; (5) fatigue; (6) pain and; (7) dyspnea. ECOG performance status, available internet access, and willingness to use a computer to report symptoms were also evaluated. Thhe survey revealed that 83% of outpatients have access to a computer (95%CI; 72-90%) and 73% use the internet regularly (95%CI; 61-82%). Among those without internet access, 50% live with a regular internet user (95%CI; 39-61%). 100% of patients surveyed stated that they would like to report symptoms perpetually using the internet. The most frequently reported symptom was fatigue with 61% of patients reporting either mild or moderate fatigue. Online self-reporting of symptoms during chemotherapy can empower patients to become active participants in their care experience. Data from our feasibility survey indicates that patients are receptive to reporting symptoms online. Based on the results of this survey, we are testing STAR (Symptom Tracking and Reporting for Patients) a system developed at Memorial Sloan Kettering Cancer Center that allows patients to self record toxicity symptoms, performance status, and global QoL online (www.mskcc.org/STAR).

Podium Abstract
GENDER DIFFERENCES IN THE PSYCHOLOGICAL EFFECT OF A PSYCHOEDUCATIONAL INTERVENTION DESIGNED TO IMPROVE CANCER PAIN MANAGEMENT. Janet Edrington RN, MS, University of California, San Francisco, San Francisco CA US; Christine Miaskowski RN, PhD, University of California, San Francisco, San Francisco CA US; Claudia West RN, MS, University of California, San Francisco, San Francisco CA US; Marylin Dodd RN, PhD, University of California, San Francisco, San Francisco CA US; Steven Paul PhD, University of California, San Francisco, San Francisco CA US

Intervention studies with patients to improve cancer pain management are extremely limited. Even less is known about the effects of psychoeducational interventions on secondary outcomes such as mood and quality of life.

Therefore, as part of a larger study that evaluated the effectiveness of a psychoeducational intervention called the PRO-SELFÓ Pain Control Program, the purposes of this study in a sample of oncology outpatients with pain from bone metastasis (n=174) was to determine if there were changes in the mood states of patients who participated in the intervention compared to those who received standard care and to determine whether or not these changes in mood states were different in men and women.

Orem’s theory of self-care, as well as the concepts of academic detailing and nurse coaching were the theoretical foundations for the study. A total of 174 patients participated in the 6-week intervention study that provided patients with education, skills training, and nurse coaching to improve cancer pain management. Following randomization into either the PRO-SELFÓ (n=93) or standard care (n=81) groups, patients completed the Profile of Mood States (POMS) at the beginning and at the end of the study.

A total mood disturbance (TMD) score was calculated for each patient at each time point.

Patients in the PRO-SELFÓ group reported significant improvements in knowledge about pain management and significant decreases in average and worst pain intensity scores at the end of the study. In addition, significant improvements in mood (as measured by a decrease in TMD score) were found in the PRO-SELFÓ group compared to the standard care group. However, a surprising finding from this study was that while female patients in the PRO-SELFÓ group reported significant improvements in mood, male patients in the PRO-SELFÓ group reported significant decrements in mood (i.e., an increase in TMD score) following the completion of the intervention. No changes in TMD scores were found in either males or females in the standard care group. These findings suggest that men may be at higher risk for mood disturbance following a psychoeducational intervention. Additional research is needed to determine the mechanism underlying this gender difference. Funding Sources: National Cancer Institute

Podium Abstract
UNSCHEDULED DNA SYNTHESIS IN WOMEN AT HIGH RISK VS. NORMAL RISK FOR BREAST CANCER. Julie Eggert PhD, C-GNP, AOCN, Clemson University, Clemson SC US; Cathy Romerez MS, Greenville Technical College, Greenville SC US; Lyndon Larcom PhD, Clemson University, Clemson SC US

Breast Cancer is the most frequently occurring cancer in women. Developing a simple blood test that could identify early DNA changes in a sub-population of white blood cells could yield a variety of implications for earlier detection of this malignancy thereby impacting the medical, psychosocial and economic aspects for high-risk patients and their families. The purpose of this pilot study was to determine 1) if there was a difference in unscheduled DNA synthesis (UDS) in a sub-population of white blood cells common to the stress and chronic inflammation mechanisms of women at high-risk for breast cancer vs those at low-risk and, 2) if the UDS occurred in CD-14 cells.

The physiologic mechanisms of the body's response to stress and chronic inflmmation were used as the theoretical flamework.

The Gail Model was used to assess level of risk for developing breast cancer. Based on the literature a 1.7% Gail Model Risk was used to differentiate high versus low-risk women. Women with and without a family history of breast cancer were included in the sampling. White blood cells were separated from serum. Both control and experimental cell groups were aliquoted. A third sample was obtained for evaluation by cell flow cytometry. Experimental samples were damged with Ultra0Violet light and treated with tritiated-thymidine to mark UDS. Both sample groups were incubated and lysed to obtain double-stranded DNA for identifying UDS. The levels of UDS were counted and compared for differences between the high and low-risk groups. One sample group of cells was labeled with antibody to CD-14 cells and identified using cell flow cytometry.

T-tests were performed to determine the mean UDS difference between high and low-risk groups. Cell flo cytometry results identified CD-14 labeled cells as those with increased levels of UDS.

The mean repair measure (UDS), in counts per minute, (267.2 +/- 216.3) was significantly higher for the high-risk group (p< 0.01) than mean repair counts for the low-risk group (84.8 +/- 56.0). This suggests breast cancer risk affects UDS in CD-14 cells.

Podium Abstract
IDENTIFYING CLASSES OF CAREGIVING ACTIVITIES: HELPING FAMILY CAREGIVERS DO IT ALL BETTER. Deborah Eldredge PhD RN, Oregon Health & Science University, Portland OR US; Lillian Nail PhD, RN, FAAN, Oregon Health & Science University, Portland OR US; Richard Maziarz MD, Oregon Health & Science University, Portland OR US; Patricia Archbold DNSc, RN, FAAN, Oregon Health & Science University, Portland OR US

Responsibility for safely caring for high-risk medically-fragile patients following autologous blood and marrow transplant (ABMT) has been shifted to family caregivers (FCGs) who are expected to provide complex care at home. Caregiving is often embedded in omnibus measures or approached as a global construct. Identifying classes of caregiving activities is essential to understanding the complex relationships among caregiving and outcomes. To this end, three types of caregiving were inductively derived from 100 activities: performing usual care (supervising scheduled medications, keeping house clean, preparing nutritious foods), providing emotional support (talking with BMT recipients when sad, discussing how people respond to recipients’ illness), and making care-based decisions (prn medications, noticing subtle changes, prioritizing care issues).

The purpose of this paper is to describe relationships among preparedness for caregiving, expected difficulty with caregiving, and caregiver role strain (CRS) for these three types of caregiving activities. In addition, we will examine the relative contribution of preparedness, expectations of caregiving, and ABMT recipient function on the three types of CRS.

Family caregiving was viewed from an interactionist perspective, suggesting that characteristics of and interactions among FCGs, recipients, and the health care system influence the nature of caregiving and subsequent responses to caregiving.

This is a descriptive longitudinal study. FCGs (n = 39) completed a self-report caregiving profile questionnaires at hospital discharge (T1) and again two weeks later (T2). FCGs were on average 50 years old, female (74%), Caucasian (84%), and well educated. Newly constructed caregiving subscales were reliable (alpha > .78).

Descriptive statistics, correlation, and simultaneous regression techniques.

At discharge, caregivers were least prepared to make care-based decisions, and expect decision making to be most difficult. However, at T2, FCGs report the highest strain in providing emotional support. Consistent with other studies, disruption in patient function is the strongest predictor of all types of CRS. The pattern for preparedness for caregiving, expected difficulty of caregiving, and CRS is not consistent across these types of caregiving. Discharge teaching may not adequately address FCGs’ experiences in making care-based decisions or providing emotional support. We need innovative ways to increase FCGs’ skills in caring for ABMT recipients. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Genentech, Inc.

Podium Abstract
THE USE OF CLUSTER ANALYSIS TO STUDY CANCER GENETICS COMMUNICATION. Lee Ellington, University of Utah/College of Nursing, Salt Lake City UT US; Stefanie Bjerregaard-Petersen , University of Utah, Salt Lake City UT US; William Dudley PhD, University of Utah, Salt Lake City UT US; Bonnie Baty MS, University of Utah, Salt Lake City UT US; Ken Smith PhD, University of Utah, Salt Lake City UT US; Jeffrey Botkin MD, MPH, University of Utah, Salt Lake City UT US

Genetic testing for cancer-susceptibility gene mutations helps at-risk individuals make informed decisions about their health and the health of their family.

As genetic technology rapidly evolves and as the public increasingly becomes its consumer, we know little about what takes place in genetic counseling sessions---it’s a virtual "black box." The study purpose is to: 1) adapt a medical coding system to genetic communication; 2) identify patterns of communication, and 3) examine predictors of communication. The model of "relationship-centered care" (Tresolini, 1994) provides the study framework. According to this model, the foundation of a therapeutic relationship is the integration and synthesis of both the patient and provider perspective and is reflected in their dialogue.

The 167 participants are members of the BRCA1 K2082. Three genetic counselors (GC) conducted sessions according to a research protocol. Roter's Interactional Analysis System (RIAS) was used to code every utterance of audiotaped pre-test sessions. RIAS categories were combined to create constructs which reflect session content and processes.

Four analytic methods were used: descriptive statistics, Pearson coefficients, hierarchical cluster analysis, and chi-square.

Most participants were married (83.8%), female (56.9%), and the mean age was 47.6 years. 26% were carriers, 59.9% were non-carriers, and 13.8% did not learn results. Coder reliability was calculated (r > .87). GCs were verbally dominant, making 70.3% of the statements, clients made 25.3%, and significant others accounted for 4.4%. Using combined RIAS categories as input variables, cluster analytic methods identified four patterns of communication: GC Driven/Educational (n=45); Interactive with Medical Focus (n=47); Moderately Interactive (n=42); and Client-Centered (n=33). Surprisingly, GC significantly predicted cluster differences (p < .0001); whereas, client characteristics did not (gender, marital status, and cancer history, p’s > .20). Findings indicate that a widely used physician/patient coding system which has been predominantly used in primary care settings can be successfully adapted to cancer genetic counseling encounters. Despite use of research protocols to standardize sessions, communication patterns were driven by GC style and did not vary according to client characteristics. The cluster analytic method shows promise in identifying unique communication patterns and associations with client and provider variables. Funding Sources: R03 HG02359

Podium Abstract
A METHODS DISCUSSION OF AN INNOVATIVE WAY TO STUDY HEALTH RISK. Noreen Facione RN, PhD, Loyola University Chicago, Chicago IL US; Peter Facione PhD, Loyola University Chicago, Chicago IL US

Many of our cancer research studies seek to understand human judgments and health risk decisions as a way of decreasing cancer risk and optimizing cancer care and survival. This paper presents an innovative data analysis methodology to analyze subjects’ accounts of their decision-making and judgment processes, whether the subjects are providers who administer cancer control interventions or people who make cancer prevention or treatment decisions.

This method is a blend of applied logic and cognitive research on human reasoning. The paper discussed the analysis of interview data capturing a cancer risk decision. The data is coded and diagramed in separate argument strands. Strands are evaluated and constructed into the complete argument map. The resulting analysis reports the content of key reasons for the decision being made, the quality of the reasoning process in terms of ‘good thinking,’ describes the subject’s exploration of alternative cancer control options (conclusions about what to do), and describes where the argument engenders the subject’s confidence in a judgment that entails the possible consequence of advanced cancer and death.

Although the method is robust, and could be used to analyze any high stakes decision, this paper demonstrates the method using a case study of a woman who confidently makes a judgment to delay seeking diagnosis of symptoms she describes as 'possibly breast cancer.' Diagrams of analyzed argument strands, the assessed logical strength of the thinking process, an account of the use of heuristic reasoning, and the complete argument map (results of the analysis) explain her confidence in a poorly reasoned argument to delay diagnosis of her symptoms. Watershed moments when the subject appears able to entertain seeking diagnosis are also identified.

This methodology fills a gap for behavioral researchers in cancer control, explaining judgments that motivate cancer related behavior we seek to modify. For the adept clinician, it offers ways to assess participation in management decisions.

Such mappings of high stakes cancer risk and cancer management decisions offer new insights to understand cancer risk behavior, new opportunities to intervene with targeted educational and decision-making interventions, and new hope for impacting stage at diagnosis and long term survival. Funding Sources: California Breast Cancer Research Program was the funding agency for this case study data

Podium Abstract
HEART SUCCESS PROGRAM: IMPROVING OUTCOMES AND QUALITY OF LIFE IN CANCER PATIENTS WITH HEART FAILURE. Anecita Fadol RN, MSN, FNP, University of Texas M.D. Anderson Cancer Center, Houston TX US

The cardiotoxicity of anticancer agents can have potential adverse cardiac effects resulting in heart failure. Caring for patients with cancer and heart failure is challenging for nurses. To meet this challenge, a collaborative, interdisciplinary "Heart Success Program" was established.

This program was designed to provide comprehensive care focused on functional capacity and quality of life, without compromising cancer treatment. Other goals of the program included reducing hospital admissions related to heart failure, decreasing the overall cost of services, and importantly, developing a model of care to meet the needs of this unique patient population. The American Heart Association and the American College of Cardiology recommended guidelines for heart failure management were utilized in the program. Currently, there is no established guideline for management of cancer patients with heart failure.

Comprehensive patient education on heart failure management using the Theory of Planned Behavior is the theoretical basis of this project. Implementation of the program includes the use of a heart failure pathway, heart failure order set, Heart Success Booklet, and a patient diary. Additionally, videotapes for heart failure management, can be viewed on demand.

Outcome indicators, as part of quality improvement were identified prior to starting the project. Positive outcomes would show improved health-related quality of life (SF-12), decreased number of hospital readmissions for heart failure exacerbations, reduce hospital length of stay, optimum pharmacological therapy based on national guidelines, improved activity level at the time of discharge.

Disease management programs have been found to reduce hospitalization and is cost saving. However, the effectiveness of these programs has not been evaluated in cancer patients with heart failure. Baseline information from this project will have significant implications for oncology nursing, as there are no published data regarding the care of this unique patient population. In addition, further research topics related to symptom management of patients with cancer and heart failure will be identified.

Podium Abstract
THE MEANING OF HEALTH-RELATED QUALITY OF LIFE. Carol Ferrans PhD, RN, FAAN, University of Illinois at Chicago, Chicago IL US

Evaluation of outcomes in terms of health-related quality of life (QOL) has become increasingly important in health care. Nevertheless, because the term "quality of life" has been used to mean so many different things, it is difficult to compare findings, draw conclusions, and apply in clinical practice. For example, QOL can refer to health status, physical functioning, symptoms, psychosocial adjustment, well-being, life satisfaction, and happiness. The purpose of this presentation is to provide guidance for coherent use of the construct, based on examination of multidisciplinary literature over the past 30 years.

A number of well-established instruments are available for assessment of QOL in cancer care. The domains of various instruments have been well characterized in the literature, but less attention has been paid to the aspect of QOL they actually measure, such as health status or life satisfaction. This is important, because conclusions about the effectiveness of treatment may differ depending on which one is used to measure outcomes.

What is meant by QOL also differs in scope. The most narrow definitions focus only on the correction of health problems. The most broad encompass positive as well as negative aspects, such as finding meaning in life and peace of mind. The ultimate objective for assessment of QOL is enhanced well-being. To promote this positive objective, the focus of health care needs to move beyond health problems, loss of abilities, or functional deficits. This has been recognized particularly in end-of-life and palliative care, when interventions are aimed at providing comfort and emotional support, to maximize QOL at the end of life. QOL evaluations provide an important tool for understanding individual differences in response to illness. This includes individual changes that occur in the process of adapting to cancer and treatment, including the re-evaluation of one’s life in the context of a life-threatening disease. They provide an understanding of the impact of illness from the viewpoint of the patient, which is more than health status and physical functioning. Funding Sources: National Cancer Institute (NIH) -- Cancer Outcomes Measurement Working Group

Podium Abstract
METHODOLOGIC ISSUES IN EVALUATION OF OUTCOMES IN EDUCATIONAL RESEARCH. Betty Ferrell PhD, FAAN, City of Hope National Medical Center, Duarte CA US; Marcia Grant DNSc, FAAN, City of Hope National Medical Center, Duarte CA US; Rose Virani RN, MHA, OCN, City of Hope National Medical Center, Duarte CA US; Jo Hanson RN, MSN, OCN, City of Hope National Medical Center, Duarte CA US

The translation of educational research, similar to clinical research, to impact the daily practice of oncology care is contingent upon a strong method of evaluation in order to best capture the outcomes of the project. This symposium will summarize methologic issues derived from successful conduct of four NCI funded National Cancer Education Programs. These projects were funded by the R25 mechanism of the NCI and included a project focusing on integrating palliative care into routine home care (HOPE Project), a project to disseminate patient and public education in pain management (CPEPP), the End of Life Nursing Education Consortium (ELNEC) and Disseminating End of Life Care in Cancer Centers (DELEtCC). Each of these projects extended over four to five years and trained hundreds of nurses and other healthcare professionals to improve critical aspects of cancer care. Using a theoretical perspective derived from adult learning theory, institutional change, quality improvement and diffusion of innovation these projects include extensive evaluation.

The methods of evaluation to be discussed include those used pre course, conference evaluation, as well as follow-up longitudinal evaluation. Methods include chart audits, individual assessment of knowledge and beliefs, the effective use of goal based evaluation, interview, and extensive reinforcement strategies. Methods of tracking individual attendees as well as assessment of individual/team/ institutional outcomes will be explored.

The critical need for follow-up and methods to enhance compliance with the evaluation plan will be presented with the strategies the investigators have used to achieve greater then 90% compliance at 1 year follow-up of these educational endeavors. Effective evaluation and an intensive plan of evaluation are essential for nurse researchers to conduct education research.

Having well defined, consistent measures and evaluation enhance the investigators ability to document the effectiveness of education, either professional or patient focused, and to insure dissemination of findings to impact clinical practice. Funding Sources: National Cancer Institute

Podium Abstract
CHANGES IN THE SEVERITY OF FATIGUE AND THE USE OF SELF CARE BEHAVIORS (SCBS) IN MEN WITH PROSTATE CANCER UNDERGOING RADIATION THERAPY (RT). Barbara Fletcher RN, BS, School of Nursing, San Francisco CA US; Michelle Gabriel RN, University of California, San Francisco CA US; Christine Miaskowski RN, PhD, FAAN, University of California, San Francisco CA US;Claudia West RN, MS, University of California, San Francisco CA US; Marylin Dodd RN, PhD, FAAN, University of California, San Francisco CA US; Kathryn Lee RN, PhD, FAAN, University of California, San Francisco CA US; Steven Paul PhD, University of California, San Francisco CA US

While fatigue is known to occur during RT, studies with specific populations are extremely limited. In addition, no studies have evaluated the use of SCBs by patients during RT.

The purposes of this longitudinal study were to evaluate for changes in fatigue severity in men who did and did not report the use of SCBs and to evaluate for changes over time in the frequency and effectiveness of the SCBs used by these men.

The UCSF Symptom Management Model served as the theoretical framework for this study.

Men with prostate cancer were recruited from two RT departments and assessments were done prior to the initiation of RT, as well as at the middle and end of RT. At each assessment, patients completed the Lee Fatigue Scale (LFS) in the mornings and in the evening. Following completion of the LFS, the men were asked to indicate if they felt fatigued in the last week and if so to indicate which SCBs from a list of 27 they had used for fatigue and its effectiveness using a 0 to 10 scale.

Eighty-two men with a mean age of 67.1 years and a Stage T1 or T2 prostate cancer were recruited for this study. A repeated measures ANOVA determined that men who reported using SCBs had significantly higher levels of both morning and evening fatigue than men who did not report the use of SCBs. In fact, the men who reported the use of SCBs for fatigue had twice as much fatigue at all three time points. The majority of the patients used more then one SCB at any given time. The most commonly used SCBs were: read a book, drank caffeinated liquids, took a nap, and went for a walk.

Effectiveness ratings for the SCBs ranged from 3.8 to 6.2. This study is the first to document the use of SCBs for fatigue by men undergoing RT. The patients who initiated SCBs were a distinct group who reported significantly higher levels of fatigue throughout the course of RT and may represent a high risk group that warrants additional investigation. Funding Sources: National Institute of Nursing Research and National Cancer Institute

Podium Abstract
IMPROVING INTERCODER AGREEMENT IN QUALITATIVE ANALYSIS. Marsha Fonteyn RN, PhD, Dana Farber Cancer Institute, Boston MA US;Margaret Vettese PhD, RN, Dana Farber Cancer Institute, Boston MA US; Susan Bauer-Wu DNSc, RN, Dana Farber Cancer Institute, Boston MA US; Diane Lancaster PhD, RN, Brigham and Womens Hospital, Boston MA US

To address the methodological issues of intercoder agreement and the use of a qualitative software program (QSR NVIVO 2) with multiple researchers, a codebook was carefully developed and refined by four nurse scientists, to serve as a guide for analyzing expressive writing (EW) transcripts from women with metastatic breast cancer.

Use of a team-based approach and NVivo software can reduce the labor-intensive task of qualitative data analysis. Development of a codebook for team-based analysis can provide a reliable guide for on-line coding, improve intercoder agreement and reduce coding time.

This secondary data analysis project originated from a larger intervention study that produced 89 EW transcripts about women’s experiences of living with their breast cancer. The codebook structure evolved over a six-month period to include numerous codes, their definitions, the guidelines for when to use or not use a specific code, and examples of illustrative passages from the transcripts. Initially, each team member independently analyzed three randomly chosen transcripts, coding the text by hand and creating tentative definitions for each code. The team then met to reach consensus on the codes and their definitions. Thus, an initial codebook was created to use as a guide for the analysis of additional sets of randomly chosen transcripts. This iterative method was followed until consensus was reached on all codes, their definitions and use. Throughout the coding process, the team met regularly to discuss coding decisions and resolve discrepancies. Memos were created to track this process and other insights that emerged while coding and reflecting on the data.

This methodological approach reduces the amount of coding time required for a large data set and improves intercoder agreement for the ongoing analysis. Once a codebook is developed, a coding process can be mastered and intercoder agreement established. The remaining transcripts can then be divided among team members for coding and entry into a software program, such as NVivo.

The use of a codebook and specialized software provides many advantages for enabling a research team to code a large amount of qualitative data while maintaining intercoder reliability.

Podium Abstract
DIFFERENTIATING SYMPTOM DISTRESS FROM INTENSITY AND FREQUENCY. Teresa Goodell RN, CNS, Oregon Health & Sciences Univ., Portland OR US

The concept of symptom distress is inconsistently defined in the cancer literature. Identifying its meaning to people with cancer and understanding differences among symptom intensity, frequency and distress will clarify the concept and may enhance symptom management efforts.

This dual-methods pilot study aimed to: 1) quantitatively identify differences in symptom intensity, frequency and distress and 2) qualitatively describe the meaning of symptom distress to people with non-small cell lung cancer (NSCLC).

Self-regulation theory guided the conceptualization of symptoms as possessing intensity, frequency and distress dimensions.

Twenty outpatients with NSCLC completed the Memorial Symptom Assessment Scale. Numerical scales from 1-4 evaluate frequency and intensity. Distress is scaled 0-4, offering a zero distress response option on endorsed symptoms. Twelve participants have been interviewed about perceptions of symptom distress. Descriptive qualitative analysis with expert input was used to code interviews and collapse codes into categories.

Aim 1) Mean symptom frequency, intensity and distress scores were calculated and correlations among them computed. ANOVA was used to examine differences among means.

Aim 2) Descriptive qualitative analysis was used to code semi-structured interviews with twelve participants. Codes were collapsed into categories.

Aim 1) Correlations among symptom intensity, frequency and distress were high (all r > .87, p <.001), but repeated measures ANOVA with intensity, frequency and distress as the within-subjects factor showed highly significantly different means (F = 74.6, p<.001). With the distress dimension recoded to synchronize scaling of the three dimensions, paired t-tests revealed that frequency and distress were higher than intensity (p<.01 in both cases). Before recoding, all three symptom dimensions were significantly different. Aim 2) Preliminary analysis has revealed five categories: life disruption, uncertainty, the unexpected, going it alone, and emotional upset. Interviews will continue until saturation is reached; data will be reanalyzed in consultation with a senior qualitative researcher. This study found quantitative differences that distinguished symptom intensity from distress, but not from frequency. Qualitative analysis suggests that participants viewed symptom distress broadly in relation to difficult aspects of the cancer experience. Clinicians and researchers may use these findings to better understand symptom distress when interpreting subjective symptom reports.

Podium Abstract
PILOT STUDY OF A MEASURE OF FUNCTIONAL DEPENDENCE IN OLDER ADULTS RECEIVING CHEMOTHERAPY. Julia Goodwin M.N.Sc., University of Arkansas for Medical Sciences, Little Rock AR US; Elizabeth Ann Coleman, University of Arkansas for Medical Sciences, Little Rock AR US; Marisue Cody, Central Arkansas Veterans Health Services, North Little Rock AR US; Jennifer Shaw, Little Rock AR US; David Lipschitz, Little Rock AR US

The proportion of older adults in the population and the incidence of cancer in older adults are increasing. Older adults with cancer frequently experience functional dependence (FD) resulting from the disease or treatment. Accurate assessment by oncology nurses or other clinicians would allow early intervention for FD.

The study purpose was to develop and evaluate a brief, patient-completed instrument measuring FD in older adults undergoing cancer treatment.

Orem’s Self-Care Deficit Nursing Care Theory includes compensatory nursing systems and helping methods that address functional dependence in basic and instrumental activities of daily living.

A FD assessment tool was developed and evaluated in older adults with various cancers during outpatient chemotherapy visits at two oncology facilities. Older adults with cancer, social workers, and oncology nurses and physicians established content validity through focus groups and individual interviews. FD included performance measured on a 100mm visual analog scale for basic (BADL-eating, toileting, mobility, dressing, bathing) and instrumental (IADL-phone, shopping, meal preparation, chores, transportation, medications, finances) activities.

Reliability was evaluated for all chemotherapy visits, visits 2-5, and visits 2-9. Repeated measures analysis evaluated functional dependence over time and possible associations with age, use of radiation or surgery, hemoglobin, and cancer type.

Twenty-six participants (mean age 71 yrs, SD 5; 54% female; cancer type: breast 35%, lung 27%, gastrointestinal 23%, other 15%) completed the instrument at chemotherapy visits. The number of assessments completed by each participant(mean 5.6) varied with chemotherapy protocol and participant adherence to treatment. The study instrument demonstrated high internal consistency on SFDS scores: BADL (.7655 - .9357), IADL (.8994 - .9045), and summed total (.8588 - .9139). Repeated measures analysis found statistically significant (p <.01) differences in cancer type and hemoglobin level across summed scores for BADL and for IADL. Increased age, breast or lung cancer, and lower hemoglobin were associated with increased FD. This instrument may assist oncology nurses and other clinicians with patient self-assessment of FD during cancer treatment. Correction or support of FD may increase compliance with chemotherapy treatment and improve quality of life. Further evaluation of the instrument is suggested. Funding Sources: Ortho-Biotech, Inc.

Podium Abstract
SURVIVORSHIP RESEARCH: METHODOLOGICAL ISSUES AND STRATEGIES. Marcia Grant RN, DNSc, FAAN, City of Hope National Medical Center, Duarte CA US; Betty Ferrell PhD, FAAN, City of Hope National Medical Center, Duarte CA US; Elizabeth Cooke RN, MN, AOCN, ANP, City of Hope National Medical Center, Duarte CA US; Gloria Juarez RN, PhD, City of Hope National Medical Center, Duarte CA US

About 1,368,030 new cancer cases are expected in 2004, and of those 63% are expected to survive five years or more. The Office of Cancer Survivorship (OCS) at the National Cancer Institute reports that as of January 1997, an estimated 8.9 million cancer survivors were living in the U.S. The need for studies to improve quality of life (QOL) for survivors is increasing in priority as a larger proportion of the population fall into this group. The purpose of this paper is to provide examples of methods used to overcome challenges in studying QOL in different survivor groups.

Issues addressed will include design selection, subject recruitment and follow-up, instrument burden, dosing of intervention, and solving cultural challenges. Examples will include studies of QOL in ovarian cancer survivors using both a qualitative analysis of correspondence through an ovarian cancer newsletter, quantitative analysis of QOL and a nursing intervention trial; approaches to decreasing subject burden in an intervention study of vulnerable bone marrow transplant early survivors; finding sufficient numbers of cancer patients with ostomies to describe QOL over time; and meeting the issues of language, translation and trust when conducting cross cultural issues in breast cancer survivors.

Methods will focus on selecting the appropriate framework; internet support for finding, recruiting, and maintaining contact with widespread populations; selecting instruments to decrease subject burden; and applying translation principles to the development and implementation of instruments for cross cultural study.

Strategies demonstrated here can be applied to other studies of cancer survivors and provide evidence-based recommendations for follow up care for this large component of our population.

As survivors increase, the need for rigorous studies describing and improving quality of life for cancer survivors are essential. Funding Sources: Funded by the NCI and by the ONS Foundation through an unrestricted grant from Genentech, Inc.

Podium Abstract
ATTITUDINAL BARRIERS TO CANCER PAIN MANAGEMENT IN THE ICELANDIC POPULATION. Sigridur Gunnarsdottir RN, MS, University Hospital of Iceland, Reykjavik IS

Attitudes about pain among patients, their family members and the lay-public can be barriers to pain management.

The purpose of this study was to evaluate the prevalence of attitudinal barriers to cancer-pain management among the general population of Iceland and to evaluate relationships between barriers and background variables.

The study is based on Ward and colleagues framework where attitudinal barriers (e.g. fear of addiction) interfere with pain management (under-utilization of analgesics) and consequently quality of life. The present study—the first in a developing program of research—targets the antecedent variables (attitudes).

A random sample of 1286 Icelandic adults was drawn from a national registry holding information about all 278,000 citizens of Iceland. Data collection was conducted with a postal-survey based on The Total Design Method. Barriers were evaluated with the Icelandic Barriers Questionnaire-II (IBQ-II), a reliable and valid measure.

Descriptive statistics and ANCOVA were used for data analyses. Of 1286 invited, 599 (46.6%) completed the survey. The mean (SD) age of respondents and non-respondents was 45.28(17.14) and 44.25(19.44) respectively. Majority of respondents were female (55.8%), while 47.6% of non-respondents were female. The mean (SD) length of education for respondents was 13.81(4.27) years. Half (55.6%) had personal experience with cancer; of those 95.7% had a relative or a close friend so diagnosed and in addition 33 (10%) had been diagnosed with cancer themselves.

The mean (SD) IBQ-II score was 2.16(0.77), on a scale of 0 to 5, with higher scores indicating stronger barriers. Men had higher barriers scores than women, and education was inversely related to barriers. Those who had personal experience with cancer had lower barriers than those who did not, and those identifying themselves as health care professionals had lower IBQ-II scores than those who did not.

Barriers to cancer pain management are prevalent in Iceland. They are also stronger than what has been seen in previous research conducted in other countries. These findings support the need for interventions aimed at such barriers. This data will aid in the design, implementation, and evaluation of educational interventions and quality-improvement-projects, aimed at overcoming barriers to management of cancer-pain. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Janssen Pharmaceutica Products LP. Research grant from Sigma Theta Tau International. Research grant from the Icelandic Cancer Society.

Podium Abstract
THEORETICAL ISSUES IN THE MEASUREMENT OF COPING IN CHILDREN AND ADOLESCENTS DEALING WITH CANCER. Joan Haase RN, PhD, Indiana University School of Nursing, Indianapolis IN US; Frances Lewis PhD, RN, FAAN, University of Washington, Seattle WA US; Eileen Kintner PhD, RN, University of Michigan, Ann Arbor MI US; Carol Decker MSW, PhD C, Indiana University, Indianapolis IN US; Kristin Fletcher MS, University of Washington, Seattle WA US

The purpose of this paper is to report on a triangulation analysis of two scales used with children and adolescents with dealing cancer: KIDCOPE and the Jaloweic Coping Scales.

Psychosocial adjustment of children and adolescents requires the development of a repertoire of coping strategies. Coping is frequently evaluated using scales and subscales that classify coping according to the types of strategies used and their perceived effectiveness. While there is some agreement about which broad classes of coping lead to adjustment, little work has been done to examine the items, scales, and subscales to identify those that are most likely to lead to positive outcomes. Frequently, items that are ambiguously adaptive/positive or maladaptive/avoidant are included in the same subscale, making it difficult to predict how classes of coping strategies influence outcomes.

Samples used to examine the Jaloweic Coping Scale were newly diagnosed adolescents with cancer (n-74) and 70 adolescent survivors (n=70). The sample used to evaluate KIDCOPE was 126 children (8 to 12 years of age) who had mothers with breast cancer. In addition to usual ways of evaluating psychometric properties, such as item-to-total correlations, Cronbach alpha reliabilities and alpha if item deleted, and factor analysis, we report on a qualitative analysis of each item in light of the quantitative findings and we report on examination of factor structures using alternative theoretical perspectives of coping. Alternative factor structures ranging from 2 to 8 conceptual groupings were evaluated for theoretical meaning at the sub-scale and item level. In addition, issues of measurement, including use of an identified stressful situation about which responses are requested, use of two-part use and effectiveness scaling, and issues of analysis when some coping items are not used by any participants are discussed.

The limitations to measuring and classifying coping strategies of children and adolescents need to be addressed to understand the influence of coping on psychosocial outcomes.

A triangulation approach has rarely been used to evaluate the theoretical underpinnings of measures. Theoretical and conceptual clarity may be enhanced and validity of measures when a triangulated approach is used. Funding Sources: Enhancing Connections: Helping the mother with breast cancer parent her child. (Lewis, PI) NIH, NCI, 1 RO1 CA7824-01A10.Resilience and Quality of Life in Adolescents with Cancer (Haase, PI) NIH, NINR1R29 NR03882-01A1

Podium Abstract
THE TIME IS NOW: ECOLOGICAL MOMENTARY ASSESSMENT OF FATIGUE. Eileen Hacker PhD, RN, AOCN, University of Illinois at Chicago, Chicago IL US

The purpose of this methodological issues abstract is to discuss the applicability of ecological momentary assessment (EMA) for capturing real-time, real-world assessments of fatigue in cancer patients receiving intensive therapy.

Ecological momentary assessment refers to a number of methodological data collection techniques that incorporate repeated real-time measurements of phenomena, such as symptoms, behaviors, or physiological processes, as they occur in naturalistic settings. Ecological momentary assessment, derived from the behavioral sciences, is characterized by (1) studying people in their natural environment to enhance ecological validity, (2) conducting assessments of the individual’s immediate or near-immediate state to minimize recall biases, and (3) sampling the phenomena under study throughout the course of the day to ensure an adequate representation of the individual’s experience. Patients may provide this data through computerized processes or through a pen and paper approach. Computerized EMA offers the added advantage of time stamping data entries permitting examination of patient compliance.

Computerized EMA holds substantial promise for assessing fatigue in cancer patients receiving intensive therapy. These patients frequently experience severe and debilitating fatigue and they may not be able to complete lengthy questionnaires or participate in long interviews. In our recent study, we used computerized EMA to study the experience of fatigue as it occurs over a 3 day period prior to and following intensive cancer treatment. The data collection processes were designed to maximize patient compliance and minimize subject burden. In this study, the majority of patients were able to provide real-time fatigue data, even when experiencing multiple side effects of chemotherapy.

Our study findings demonstrate that it is feasible to use computerized ecological momentary assessment to collect self-report fatigue data in acutely ill oncology patients if the subject burden is reasonable. Ecological momentary assessment of fatigue also provides the researchers and patients with the flexibility of completing fatigue assessments when the fatigue actually occurs, eliminating the problem of recall biases and minimizing response shift issues. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Ortho Biotech Products, L.P.; American Cancer Society; and University of Illinois College of Nursing Center for Research on Cardiovascular and Respiratory Health

Podium Abstract
CONCERNS OF YOUNG WOMEN WHO ARE POSITIVE FOR BRCA1 AND/OR BRCA2. Rebekah Hamilton PhD RN, University of Iowa, Iowa City IA US

Young women are offered BRCA1 and BRCA2 testing in both primary care and specialty care settings. Few studies have specifically focused on the experience of predictive genetic testing with this age group.

Developmental theories lend credence to the suggestion that concerns will be different for this population than for older women in a similar situation. The purpose of the study was to examine the experience of predictive genetic testing for hereditary breast and ovarian cancer (HBOC) and to compare experiences of younger women (¡Ü35 years old) to the older study cohort (36-60 years old).

Grounded theory is an exploratory, theory generating method, used in areas in which little is known. Grounded theory is rooted in the philosophy of symbolic interactionism. The qualitative method of grounded theory was used to examine the phenomenon of adults choosing to have predictive genetic testing for HBOC. A sample of 17 women, seven ¡Ü35 years old was recruited through community and internet support group announcements. Semistructured interviews were conducted in-person, by telephone or email according to participant preference. Analysis consisted of line-by-line coding resulting in the development of concepts, categories and relationships which accounted for a pattern of behavior relevant to the experience of predictive genetic testing. Validation was achieved by member checks (3 participants) and feedback from a research group composed of experienced grounded theorists.

Please see above, the theoretical framework and methods are combined in a grounded theory study

The core category developed was ¡°Being changed by predictive genetic testing.¡± Young women¡¯s experiences were different particularly around concerns about: 1) career plans, 2) reproduction, and 3) intimate relationships. Other concerns not specific to young women but also described included: 1) family relationships, 2) fears of personal mortality, 3) life and health insurance and 4) health information needs. A commonly voiced experience specific to the young adult age group was feeling ¡°out-of-place¡± in the oncology clinics and support groups which participants perceived as being focused on concerns of older women.

Further study may clarify the extent and nature of informational, emotional, social and decision support needs that are unique to this young adult population. Funding Sources: Pre-doctoral T32 fellowship (5T32 NR07102-04)

Podium Abstract
AGE DIFFERENCES IN QUALITY OF LIFE, SELF-EFFICACY, CURRENT CONCERNS, SYMPTOM DISTRESS, AND APPRAISAL OF ILLNESS/CAREGIVING IN COUPLES FACING PROSTATE CANCER. Janet Harden PhD, RN, Wayne State University, Detroit MI US; Laurel Northouse PhD, RN, FAAN, University of Michigan, Ann Arbor MI US; Bernadine Cimprich PhD, RN, FAAN, University of Michigan, Ann Arbor MI US; Joanne Pohl PhD, RN, FAAN, University of Michigan, Ann Arbor MI US; Jersey Liang PhD, University of Michigan, Ann Arbor MI US; Trace Kershaw PhD, Yale University, New Haven CT US

Prostate cancer affects men in all adult life stages, yet a life stage perspective has seldom been used to understand the impact of diagnosis and treatment on patients and partners quality of life outcomes.

A diagnosis of prostate cancer requires that couples simultaneously adjust to the changes brought about by cancer as well as other normative changes specific to their age. The purpose of this study was twofold 1) to determine if the quality of life (QOL) of men with prostate cancer and their partners differs according to developmental stage 50-64 (late middle age); 65-74 (young old); and 75 and above (old-old), and 2) to determine if patients and partners self-efficacy, current stressors, symptom distress and appraisal of illness differs according to developmental stage.

McCubbin and McCubbins Family Stress, Adjustment, and Adaptation Framework (1993) guided this study; it focuses on the effect of normative (developmental stage) and non-normative stressors (illness) on the couples ability to adapt. Variables included influencing factors (age, concurrent stressors and self-efficacy) and illness factors, appraisal and quality of life for both the patient and his partner.

A descriptive design was used to compare data obtained from 69 patients and their partners using secondary analysis. Dyads who completed baseline assessments from a large intervention study were stratified by age cohort and randomly selected for the study (n23 dyads per age cohort). Data were obtained using multiple standardized instruments with adequate reliability and validity. ANOVA and MANOVA were used to determine differences among age groups.

Findings indicated that patients in the middle group (65-74) had a better physical and mental QOL and higher self-efficacy than the younger group; they also had less negative appraisal of illness than the other age groups. Partners in the middle group perceived less bother with hormonal symptoms than the other groups. Partners in the youngest age group reported the most disturbances with sexual changes in their husbands. Findings suggest that age does affect a couples response to a prostate cancer illness. Implications suggest that interventions need to be tailored to couples developmental stage. Funding sources: Intervention study funded by grant from NCI (R01 CA090739) to L. Northouse PI

Podium Abstract
OLDER BREAST CANCER SURVIVORS: AN INDIVIDUALIZED INTERVENTION. Susan Heidrich PhD, RN, School of Nursing, Madison WI US; Judith Egan RN, MS, University of Wisconsin-Madison, Madison WI US; Pornpat Hengudomsub RN,MS, University of Wisconsin-Madison, Madison WI US; Roger Brown PhD, University of Wisconsin-Madison, Madison WI US; Sandra Ward Phd, RN, FAAN, University of Wisconsin-Madison, Madison WI US

Breast cancer is an age-related illness. Multiple symptoms--whether due to cancer, its treatment, other chronic conditions, and age-related changes in physical functioning--are the norm in older women with breast cancer. Yet, symptom intervention research has focused on single symptoms and has neglected age-related symptoms and comorbidities common in older breast cancer survivors. We are testing a theory–based intervention that directly addresses the multiple symptom experience of older breast cancer survivors.

The primary aim of this research was to test the feasibility and short-term effects on symptom distress and quality of life of an individualized representational intervention for symptom management (IRIS) in older (>64 years) breast cancer survivors.

The intervention is theoretically based in Donovan & Ward’s representational approach to patient education. IRIS is a counseling interview in which symptom representations are assessed, barriers based on misconceptions addressed, and symptom management strategies developed. Women (N = 41, mean age = 72, age range = 65 - 86), at least one year post diagnosis of breast cancer, were recruited from an oncology clinic and the community. Women reported an average of 3.5 comorbid conditions and 17 symptoms. Women were randomized to the intervention (IRIS, n = 21) or usual care (control, n = 20) groups and measured at baseline, post-test and six and ten weeks post intervention. Outcome variables were symptom distress (number, severity), quality of life (SF-36, depression, anxiety, purpose in life), and symptom management beliefs. All measures demonstrated adequate internal consistency and construct validity in this and previous studies.

Compared to controls, women in the intervention group had significantly more decrease in symptom distress at eight and ten weeks post-intervention, initiated more symptom management strategies, and perceived these strategies as effective. There were no quality of life differences.

Individualized representational interventions show promise in improving self care of symptoms in older breast cancer survivors. A larger, randomized controlled trial is needed to test efficacy and durability of the intervention. If efficacious, a representational approach to patient education could be adapted for use in practice. Funding Sources: NIH/NINR R55 NR07741

Podium Abstract
SUBJECT RECRUITMENT FOR CANCER CONTROL STUDIES IN AN UNFAVORABLE ENVIRONMENT. Sue Heiney, PhD, RN, CS, FAAN, SC Cancer Center, Columbia SC US; Swann Adams PhD, Arnold School of Public Health, University of South Carolina, Columbia SC US; James Hebert Dr.Sc, Arnold School of Public Health, University of South Carolina, Columbia SC US; Joan Cunningham PhD, Arnold School of Public Health, University of South Carolina, Columbia SC US

Using Lewin's model of change, this paper summarizes recruitment lessons learned from 4 studies: a quasi-experimental comparison of breast cancer patients and controls; an exploratory study of breast cancer patient's knowledge and experience with lymphedema, an experimental study of an intervention to improve QOL and an experimental study of an intervention for men with prostate cancer. The recruitment of subjects was an enormous challenge due to unfavorable community and professional environments.

A post hoc examination of recruitment strategies using Lewin's force field analysis was conducted. Driving and restraining forces for recruitment were explicated and evaluated to successful and unworkable strategies. Also, forces that we should have worked to change the direction of were distinguished. Also, each stage of change was evaluated to identify major components of unfreezing, moving and refreezing. Since some of the projects are ongoing, these efforts were directed toward increasing recruitment and planning for future studies.

Drivers included medical oncologists, mammographers and patients from previous studies. Resisters included staff in the mammography clinic, IRB members and urologists. The strength of this approach is that it points to where energy should be directed. Also, it prevents over focusing on either resistors or drivers which tended to recruitment efforts. Resistance often increased, especially in the hospital departments when administrative drivers increased. This approach also identified that more time should have been spent in unfreezing since this environment was unfamiliar with cancer control studies and viewed them from the perspective of drug trials.

Lewin's model was especially useful in that it increased researcher objectivity as to the source of recruitment obstacles. This perspective prevented the problem from being personalized and becoming a hostile situation. If this approach had been used in the first study, subjects would have been accrued much faster. Planning for recruitment using this model would have saved time even though the upfront time seemed wasteful, especially with limited funding periods.

Nurse researchers entering a new environment for recruitment and /or working with a multi-disciplinary team would benefit from using Lewin's force field analysis prior to writing a proposal or implementing a project. While Lewin's model is not new; it's use in recruitment has not been well documented.

Podium Abstract
PUNJABI IMMIGRANT WOMENS EXPERIENCES OF BREAST CANCER. A. Fuchsia Howard RN, MSN(c), Nursing & Health Behaviour Research Unit, Vancouver BC CA; Joan L. Bottorff PhD, RN, University of British Columbia, School of Nursing, Vancouver BC CA; Lynda G. Balneaves PhD, RN, University of British Columbia, School of Nursing, Vancouver BC CA

There is a notable absence of women from specific ethnocultural groups in the published breast cancer research, including South Asians living in Canada. Punjabi immigrants represent the most populace group of South Asians in British Columbia. The breast cancer experiences of Punjabi women need to be understood in order to provide a framework for culturally appropriate cancer care.

The purpose of this investigation was to explore the ways Punjabi immigrant women story their breast cancer experiences to uncover how women make sense of their experiences and how the women’s cultural and social world is reflected in their stories.

Culture was conceptualized as dynamic, socially constructed, and produced within historical, gendered, ‘raced’ and political context, rather than neutral scripts tied to ethnic roots.

A narrative ethnographic approach was used to guide this qualitative study. In-depth, open-ended interviews were conducted in Punjabi and translated into English with twelve Punjabi immigrant women, who had breast cancer within the last eight years and resided in British Columbia.

Interviews were analyzed using a combination of narrative analysis strategies (Mishler, 1986; Riessman, 1993; Frank, 1995; Cortazzi, 2001). Following close reading of the interviews, summaries were prepared to highlight impressions of each woman’s story. Women’s stories were then compared to identify storylines and subjected to analysis focussing on the structure and function of the narrative. Finally, consideration was given to the larger social context in which the stories were told.

Based on this analysis five storylines emerged: (1) recovering from breast cancer and moving on; (2) surviving the ordeal of breast cancer; (3) suffering through breast cancer and struggling to move on; (4) being consumed by the never ending worry of breast cancer; and (5) accepting breast cancer as kismet and learning to be more devout. In these narratives the stigma of cancer limited women’s disclosure of breast cancer to their closely knit families, resulting in women feeling unable to receive additional support.

Findings of this study suggest that existing research literature fails to account for all women’s experiences of breast cancer and culturally appropriate cancer care is needed to work effectively with Punjabi immigrant women. Funding Sources: Canadian Breast Cancer Research Alliance; Nursing and Health Behaviour Research Unit, UBC; NEXUS, UBC

Podium Abstract
HEALTH CARE DEMANDS OF TAIWANESE CANCER PATIENTS. Chao-Pin Hsiao RN, MS,PhD student, College of Nursing, University of Arizona, Tucson AZ US; Yu-Tzu Dai RN, PhD, Professor, College of Nursing, National Taiwan University, Taipei TW Ida. M. (Ki) Moore RN, DNS, Professor, College of Nursing, University of Arizona, Tucson AZ US

To enhance quality of life, health care providers need to understand the health care demands experienced by cancer patients receiving chemotherapy.

The purpose of the study was to investigate health care demands, symptom distress and physical function in cancer patients receiving chemotherapy at the time of discharge and 7 to 10 days after discharge.

Cancer chemotherapy patients not only experience different symptom distress associated with their disease, but they also suffer multidimensional side effects from a variety of chemotherapy treatments. The conceptual framework was presented based on empirical findings associating demographics, symptom distress, physical function, stage of cancer and treatment to health care demands.

It was a longitudinal, descriptive, and correlational study. 123 cancer patients participated in study. The inclusion criteria of this study were: 1). Cancer diagnosis, 2). At least 18 years of age, 3). No evidence of brain damage, fully conscious and able to answer question, 4). Communicate in Mandarin or Taiwanese. Structured questionnaires were given twice in face-to-face interviews at discharge and 7 to 10 days after discharge. The questionnaires included the Karnofsky Performance Status scale (KPS), Symptom Distress Scale (SDS), and Supportive Care Needs Survey (SCNS). They were highly acceptable instructments of the validity and reliability. The Cronbach's alpha co-efficient of SCNS was 0.95. and 0.97 in KPS, as well as 0.91 in SDS.

Descriptive statistics, t-test, one way ANOVA, pearson correlation and regression were used to evaluate the relationship among demographics, symptom distress, physical function, and health care demands.

78.5% of health care demands were found to be unmet in the overall health care of cancer patients receiving chemotherapy. The most frequently unmet health care demands were: information on health care, daily living care, services, psychological support, medical care, and sexuality. They displayed a low level of symptom distress and three most often reported symptoms of distress were fatigue, change in appetite and insomnia.

The findings can serve as a reference for future research, and to provide a comprehensive discharge assessment and individual education plan for cancer patients at the time of discharge. In addition, a follow up evaluation of individual health care demands at 7 to 10 days after discharge can enhance the satisfaction of health care.

Podium Abstract
RELATIONSHIP OF PAIN SEVERITY, DEPRESSION AND OPIOIDS RELATED SIDE EFFECTS TO FATIGUE IN CANCER PAIN POPULATION. Shirley Hwang RN, MS, VA New Jersey Health Care System, East Orange NJ US, Qi Xia MS, VA New Jersey Health Care System, East Orange NJ US, Victor Chang MD, VA New Jersey Health Care System, East Orange NJ US Donald Hoover PhD, VA New Jersey Health Care System, East Orange NJ US, Shanti Srinivas MD, VA New Jersey Health Care System, East Orange NJ US, Basil Kasimis MD, VA New Jersey Health Care System, East Orange NJ US

We identified a potential causal relationship among pain, opioid side effects(SEs) and depression in relation to fatigue.

We previously reported that pain, depression and other symptoms independently predicted fatigue(Hwang,JPSM;2003:604-614). To conceptualize symptom oriented management of fatigue, we investigated causal relationships of pain, depression, SEs and KPS to fatigue in cancer pain patients before and after pain management.

We used path analysis to evaluate a model in which pain, SEs and KPS were hypothesized to predict fatigue directly, and indirectly through depression at different time points.

The longitudinal survey studied 195 cancer pain patients with baseline worst pain > 4/10(median age 68 yrs, range 44-87) who were managed according to AHCPR guidelines. All patients completed the Brief Pain Inventory, Brief Fatigue Inventory, Geriatric Depression Scale and an 18-item SE check list at 4 time points, one week apart. The KPS was assessed weekly.

Changes in pain, fatigue, KPS, depression and SEs over time were estimated by mixed effect models. At each time point, we also performed a path analysis to test our hypothesized causal relationship model. Model adequacy was assessed by goodness-of-fit index (GFI).

There were significant improvements over the three weeks in mean worst pain(8.4 to 5.1,p<0.0001), usual fatigue(5.4 to 4.2,p=0.001), depression(5.5 to 4.1,p<0.03), and KPS(64.8 to 69,p=0.0005), but mean SEs increased from 2.2 to 2.8(p<0.0001). Usual fatigue, worst pain, depression and number of SEs correlated significantly with each other at each time point. At day 1, the path analysis found that number of SEs predicted fatigue both directly (b=0.14) and indirectly, mediated by depression, with total causal effect of 0.21, and that worst pain severity(b=0.19) and depression(b=0.28) predicted fatigue directly(GFI=0.99). At each follow-up time point, GFI for this model ranged from 0.93 to 0.98. These results elucidate persistent relationships between pain, depression, SEs and fatigue before and after pain management. In the absence of any effective pharmacological intervention, this provides a conceptual framework for fatigue management in cancer pain patients. Funding Sources: VA HSR&D-PCC 98068

Podium Abstract
EXERCISE FOR BREAST CANCER SURVIVORS: ITS EFFECT ON WEIGHT AND BODY COMPOSITION. Carolyn Ingram RN, DNS, McMaster University, School of Nursing, Hamilton ON CA

Exercise is a promising intervention for cancer-related symptom management. Knowledge of the effect of exercise on weight and body composition in women receiving adjuvant breast cancer treatment is required so that nurses can tailor appropriate exercise recommendations to the specific needs of these women.

Evidence regarding the effects of exercise on weight and body composition during early breast cancer was evaluated and synthesized in order to make recommendations for future research and practice. Studies of breast cancer and exercise have focused on ameliorating symptoms such as fatigue, negative mood and reduced function. Weight and body composition have seldom been addressed. With newer therapies, the problem of weight gain during adjuvant breast cancer treatment has diminished. However, negative body composition changes, particularly increases in percentage of body fat, are a problem. The effect of exercise on these outcomes requires further examination A systematic review of the literature was conducted. Medline/Premedline, CancerLIT, Cochrane Central Register, CINAHL, Embase, PEDRO, and Sport Discus were searched. Electronic searches were augmented by hand and ancestry searches and key researchers were contacted. Strict criteria were established for retrieval and evaluation of studies. All research designs except case studies were included.

Titles and abstracts of 1315 references were screened, 82 were reviewed, and 13 primary studies met the inclusion criteria. The majority of studies examined aerobic activity. Changes in weight and body composition were rarely considered or were of secondary interest. Where these outcomes were studied, beneficial effects were consistently seen. Body fat percentage was often maintained or reduced, although weight change was rarely seen. Because weight and body composition were of secondary interest, there were problems with measurement rigor. Studies were not long enough to produce durable changes in weight or body composition. Furthermore lymphedema, which can profoundly affect weight and body composition estimates, was studied as a separate entity.

Current evidence does not support knowledgeable and safe recommendations related to exercise for weight and body composition management in women with early breast cancer. Research is needed in which these outcomes are of primary importance. There are also several measurement issues to address in planning future studies. Funding Sources: Department of Defense Breast Cancer Research Program, U.S. Army Medical Research and Materiel Command, Office of the Congressionally Directed Medical Research Programs (CDMRP)

Podium Abstract
DIFFERENCES IN ATTENTIONAL FUNCTION AMONG ADULT CANCER PATIENTS WHO ARE UNDERGOING CANCER TREATMENT. Catherine Jansen RN MS OCN, Kaiser Permanente Medical Center, San Francisco CA US; Christine Miaskowski RN PhD, University of California, San Francisco, San Francisco CA US; Claudia West RN MS, University of California, San Francisco, San Francisco CA US; Marylin Dodd RN PhD, University of California, San Francisco, San Francisco CA US; Kathryn Lee RN PhD, University of California, San Francisco, San Francisco CA US

Impairment in cognitive function is a newly-recognized side effect of cancer treatment. Attention, an important component of cognition, is essential for informed consent, recognition of side effects, and the ability to learn self-care.

Although anxiety, depression, and fatigue are common during cancer treatment, and can negatively impact an individual’s ability to pay attention and concentrate, relatively little is known about attention and its relationship to anxiety, depression, and fatigue during cancer treatment. The purpose of this study was to examine attentional function, anxiety, depression, and fatigue in patients undergoing cancer treatment. The U.C.S.F.’s "Symptom Management Model" provided the framework for this study.

This study descriptive, correlational study enrolled a convenience sample (n = 194) was drawn from six outpatient oncology clinics. Instruments included the Attentional Function Index (AFI), the Speilberger State and Trait Anxiety Questionnaire (STAI), the Center for Epidemiological Studies Depression Scale (CES-D), and the Lee Fatigue Scale (LFS). The AFI is a 16-item numeric rating scale (ranging from 0-10, with descriptive anchors) which measures directed attention. The STAI is a 20-item, 4-point Likert scale (ranging from 0-4) which measures anxiety. The CESD is a 20-item, 4-point Likert scale (ranging from 0-4) which measures depression. The LFS is an 18-item numeric rating scale (ranging from 0-10, with descriptive anchors) which measures fatigue and energy. Each instrument has established reliability and validity.

Descriptive statistics, t-tests, and Pearson Product Moment Correlations were used to analyze the data.

The results of this study revealed significantly poorer attentional function in patients who were receiving chemotherapy compared to other cancer treatments (p = 0.011). Regardless of the type of cancer treatment employed, patients with poorer levels of attentional function reported significantly higher anxiety (r = -0.50, p < 0.01), depression (r = - 0.56 p < 0.01), and fatigue (r = -0.53, p < 0.01) scores. Conclusion: Although anxiety, depression, and fatigue negatively impact attention, chemotherapy has a greater negative impact on attention compared to other types of cancer treatment. These results suggest the need for further research on chemotherapy-induced impairments in attention, as well as other components of cognitive function. Funding Sources: National Cancer Institute; American Cancer Society Doctoral Scholarship DSCN 02-209-01

Podium Abstract
DO HEALTHY WOMEN IN THE COMMUNITY RECOGNIZE HEREDITARY AND SPORADIC BREAST CANCER RISK FACTORS? Maria Katapodi RN, MSN, PhD, University of California San Francisco, San Francisco CA US; Bradley Aouizerat PhD Quantitative Geneticist, University of California San Francisco Departmet of Physiological Nursing, San Francisco CA US

It is not clear whether women can distinguish between familial and sporadic forms of breast cancer, and whether they recognize the different role of aging, paternal family history, and ovarian cancer in predicting each form of the disease.

The study aimed to 1) describe knowledge of hereditary and sporadic breast cancer risk factors among healthy women in the community, and 2) identify predictors of knowledge of breast cancer risk factors The Adoption Precaution Process (Weinstein, 1988) suggests that individualized information about one's personal risk factors facilitates an accurate perception of susceptibility to disease.

This cross-sectional, community-based survey recruited 184 women from diverse racial/cultural backgrounds (43% Caucasian, 26% African-American, 17% Asian, 14% Hispanic) to complete a questionnaire in English. Participants have never been diagnosed with cancer and were between 30 and 85 years old (X=46+-12). Most (49%) were college graduates and had a median annual income $30,000 to $40,000. We assessed knowledge of hereditary and sporadic breast cancer risk factors with the Breast Cancer Risk Factors Knowledge Index (Cronbach á =.80).

Descriptive statistics and hierarchical regression (Alpha set 0.05) Most women recognized the role of heredity as a risk factor , but some did not recognize the impact of paternal family history. Some did not recognize the link between breast and ovarian cancer, risk factors associated with the Gail model, and that getting older increases one’s risk. Education was an important predictor of knowledge of risk factors. Communication regarding risk factors needs to be optimized. Nursing can provide individualized risk assessment and education regarding breast cancer risk factors to women in the community. Funding Sources: Department of Defense, Medical Research, Clinical Nurse Researcher Award No DAMD17-03-1-0356

Podium Abstract
DIFFERENCES IN THE PREVALENCE AND SEVERITY OF SIDE EFFECTS BASED ON TYPE OF ANALGESIC PRESCRIPTION. Esther Kim RN, MS, University of California, San Francisco CA US; Patrice Villars RN, BS, University of California, San Francisco CA US; Christine Miaskowski RN, PhD, FAAN, University of California, San Francisco CA US; Claudia West RN, MS, University of California, San Francisco CA US; Marylin Dodd RN, PhD, FAAN, University of California, San Francisco CA US; Steven Paul PhD, University of California, San Francisco CA US

Side effects of analgesics are a well-documented barrier to effective pain management. However, very little data are available on the prevalence and severity of side effects associated with different types of analgesic prescriptions.

As part of a larger study that evaluated the effectiveness the PRO-SELFÓ Pain Control Program, the purposes of this study in a sample of oncology outpatients with pain from bone metastasis (n=174) were to determine if there were differences in the prevalence and severity of side effects associated with four different types of analgesic prescriptions (i.e., no opioid, only as needed (PRN) opioid, only an around-the-clock (ATC) opioid, or a PRN+ATC opioid).

Orem’s theory of self-care, as well as the concepts of academic detail and nurse coaching were the theoretical foundations for the study. Patients completed a demographic questionnaire and a pain diary with a side effect checklist on which they indicated if they experienced the side effect and rated its severity using a Likert scale (1 = slight to 4 = very severe). Patients in the no opioid group were the youngest and had the best Karnofsky Performance Status score. Differences in prevalence of all of the side effects (i.e., lack of energy, nightmares, nausea, vomiting, constipation, feeling drowsy, lightheadedness, and poor coordination) except difficulty sleeping and indigestion were found among the four groups. The most prevalent side effect in the ATC+PRN group was feeling drowsy (83.3%). The most prevalent side effect in the no opioid group was difficulty sleeping (56.2%). Across the three groups of patients who took an opioid analgesic, the prevalence of constipation ranged from 44% to 63.3%. Significant differences in the severity of side effects were found among the four groups. In addition, significant positive correlations were found between the severity of all of the side effects and the dose of opioid analgesic taken. This study is the first to document the prevalence and severity of analgesic side effects in a large sample of oncology outpatients. Patients who were receiving ATC or ATC+PRN opioid analgesics were at greatest risk for side effects and when they occurred these side effects were more severe. Funding Sources: National Cancer Institute

Podium Abstract
A CONCEPTUAL FRAMEWORK FOR TARGETING RESEARCH DISSEMINATION INTERVENTIONS TO MEET THE NEEDS OF BREAST CANCER NURSES IN THE UNITED KINGDOM. Marilyn Kirshbaum RN, SRN, BSc, MSc, DipAdultOnc, University of Sheffield, Sheffield GB

Nursing care based on research evidence is a clinical and professional imperative that has specific implications for oncology nurses all over the world. In the United Kingdom, it was documented that a problem of dissemination and utilization of research-based knowledge existed within the specialty of breast cancer, thus depriving individuals of receiving optimum care.

Despite increasingly robust research evidence that has demonstrated the numerous benefits of aerobic exercise for individuals affected by breast cancer, commensurate changes to practice were not noted amongst breast care nurses (BCNs). To assist in addressing this deficiency, a 3-stage study was designed to:

• Identify the barriers to research utilization and preferred methods of research dissemination of BCNs

• Develop and evaluate a dissemination intervention for BCNs

Stage 1 consisted of a national survey of 263 BCNs on research utilization and dissemination issues. In Stage 2, The Conceptual Framework for Selecting a Targeted Dissemination Intervention was created to guide the selection and development of an experimental research dissemination intervention. Stage 3 took the form of a randomized control trial, which evaluated the intervention in terms of changing knowledge, reported practice and attitudes.

This presentation will describe the Conceptual Framework and discuss its implications for oncology nursing and research.

The framework represents a step-wise process designed to: describe a target group (e.g. BCNs), integrate theoretically derived characteristics of effective dissemination and behavior change with the needs of a target group and provide a structure to compare different dissemination options. Practical considerations, such as time and resource limitations of nurses and the researcher/manager were included in the decision making process.

Dissemination of research evidence is a complex, multi-faceted and persistent concern in oncology nursing, and requires a multi-level solution. The Conceptual Framework provided a functional structure for gathering and integrating diverse theoretical, empirical and pragmatic components integral to devising and empirically testing innovative strategies of the future. Application of the framework to other groups of nurses is proposed.

Podium Abstract
DEVELOPMENT AND PSYCHOMETRIC TESTING OF THE COPING WITH BREAST CANCER RISK INSTRUMENT. Diane Lancaster R.N., Ph.D., Brigham and Women's Hospital / Center for Excellence in Nursing Practice, Boston MA US

This study was designed to develop and evaluate the psychometric properties of the Coping with Breast Cancer Risk (CBCR) instrument. The CBCR measures primary prevention and early detection coping strategies used by women with family histories of breast cancer.

Women with a positive family history of breast cancer have a higher relative breast cancer risk than those without. Research pertinent to the coping behaviors of this "at risk" population has focused primarily on the early detection measures of breast self-exam, clinical breast exam, and mammography. Other problem or emotion focused coping behaviors related to breast cancer risk have received little attention. While there are instruments that measure general coping behaviors in response to illness threat, there are no known instruments that measure coping behaviors specific to dealing with perceived breast cancer risk.

The CBCR is an 11 item self-report measure whose format was modeled after the Jalowiec Coping Scale. The CBCR is designed to assess the frequency of use and degree of perceived effectiveness of coping behaviors specific to breast cancer risk. Internal consistency reliabilities and content and construct validity of the CBCR were assessed using a sample of 209 women with family histories of breast cancer.

Alpha coefficients for the CBCR's total use and effectiveness scales were .70 and .76 respectively. Principal components exploratory factor analysis with varimax rotation revealed three conceptually relevant subscales: Dietary factors; Chemical agents; and Early detection measures. Overall, the 11 instrument items accounted for 52% of the variance in breast cancer threat coping behaviors.

The CBCR is a succinct measure whose preliminary psychometrics have demonstrated the instrument’s potential for use by researchers and clinicians working with women at increased risk for breast cancer. However, the current study's sample demographics limit the generalizability of these findings. Additional work with more diverse samples is needed to facilitate further psychometric analysis and refinement of this promising instrument. Funding Sources: Michigan Chapter of the American Cancer Society and the Ross Nursing Resource Committee at Boston Medical Center

Podium Abstract
FAMILY INVOLVEMENT IN DECISION-MAKING FOR PRIMARY TREATMENT IN CHINESE AMERICAN WOMEN WITH EARLY-STAGE BREAST CANCER. Shiu-yu Katie Lee RN MSN DNSc, National Taipei College of Nursing, Taipei AL TW; M. Tish Knobf PHD FAAN, Yale University School of Nursing, New Haven CT US

Significance: Breast cancer is the most common cancer among the growing population of Chinese American (ChA) women in the United States. Traditionally, the role of the Chinese family when a member is ill is not limited to physical care, but has significant involvement in healthcare decision-making. Yet, there is a lack of knowledge about how family involve in decision-making for primary treatment in ChA women with breast cancer.

Purpose: To describe family involvement in decision-making for primary treatment in ChA women with early-stage breast cancer.

Theoretical Framework: Ottawa Decisional Support Framework and Kleinman¡¦s family-patient transaction in Chinese culture were used to identify family involvement in treatment decision-making.

Methods: This was part of a larger quantitative descriptive study. Three open-ended questions in Chinese were used to elicit ChA women¡¦s experience of family involvement in treatment decision-making. A convenience sample of 123 ChA women with early-stage breast cancer were recruited in the larger New York area. The subject¡¦s responses were written in Chinese immediately during the interview, and validated by the subject for accuracy.

Content analysis was used to code and categorize the data. The coding and analysis were reviewed by another researcher based on English-translated responses from 20 purposively selected subjects with equivalence from the Chinese responses.

Findings and Implications: ChA women described involvement of their family in treatment decision-making as supportive and caring. Immediate and/or extended family members were involved by learning breast cancer together, managing healthcare issues, managing family life, and by providing companionship and support. Family-involvement was characterized as a strong voice in treatment decision-making, a collaborator, a sounding board, or a facilitator. Barriers to family members being involved were lack of knowledge, English fluency, timing, distance and conflict. Resentment and conflict occurred when a family member’s involvement differed from the woman¡¦s preference for the family member to be involved. Family involvement is integral to ChA women’s decision-making but the women’s preference for family involvement should be respected. Culturally sensitive patient and family consultation strategies are needed to assist an informed treatment decision-making in ChA women with breast cancer. Funding Sources: Funded by the ONS Foundation

Podium Abstract
PREDICTORS OF SPOUSAL DEPRESSED MOOD IN WOMEN WITH BREAST CANCER: Frances Lewis R.N., M.N., Ph.D., University of Washington, Seattle WA US; Kristin Fletcher M.S., University of Washington, Seattle WA US; Barbara Cochrane R.N., PhD, Fred Hutchinson Cancer Research Center, Seattle WA US

Spouses of women with breast cancer have comparable or greater psychosocial morbidity as the patient. Depressed mood, in particular, is known to negatively impact the spouse’s ability to support his wife but no one knows what predicts his depressed mood.

The purpose of this study was to develop and test a multivariate predictive model of spousal depressed mood during the treatment phase of a wife with early stage breast cancer.

Eight factors associated with spousal depressed mood were identified from published literature; most related to a stress framework or a relational model of illness adjustment. Factors were marital adjustment; wife’s depressed mood; concerns for wife’s well being; diminished access to activities of choice; altered sexual activity; job-related tension; alienation from medical team; low confidence to manage or protect the wife from the cancer; interpersonal disconnection from wife; and illness-related uncertainty.

Spouses of women newly diagnosed with early stage breast cancer (n=206) completed valid and reliable questionnaires that measured the eight factors. Depressed mood was measured by the Center for Epidemiological Studies-Depression (CES-D) Scale. Specially trained nurses administered the questionnaires in the spouses' homes.

Analyses proceeded in 3 phases: preparatory, model development, and model testing. In the preparatory phase, the sample was randomly divided into two statistically comparable samples and data inspected for sampling distributions, outliers, collinearity, and covariates. In both the model development and model testing phases, the hypothesized predictors of spousal mood were regressed onto CES-D, after controlling for covariates. Analyses involved two independent samples, 103 spouses each.

Three factors predicted spousal depressed mood in both the model testing and development analyses: marital adjustment; concerns over the wife’s well being; and job-related tension. In addition, altered sexual activity and illness-related uncertainty predicted spousal depressed mood in the model development and testing phases, respectively. Results reveal that spouses suffered from depression related to every component of their interpersonal lives: their marriage and sexual connection to their wife, their job, their future, and their fear of losing their wife to the cancer. Future intervention research is needed to minimize these sources of spousal distress. Funding Sources: National Cancer Institute, NIH

Podium Abstract
REVIEW OF INSTRUMENTS TO MEASURE PHYSICAL SYMPTOMS IN CHILDREN AND ADOLESCENTS WITH CANCER. Lauri Linder MS, APRN, CPON, University of Utah College of Nursing, Salt Lake City UT US

Approximately 9,000 children in the United States are diagnosed with cancer annually. As survival rates have improved, increased attention has been given to physical symptoms associated with the disease and its treatment. Identification and management of physical symptoms is consistent with the American Cancer Society's National Action Plan for Childhood Cancer.

Measuring symptoms in children poses challenges because of variation in cognitive abilities within and across developmental stages. In contrast to adults, few studies have addressed physical symptoms in children with cancer. This review of the literature was conducted to evaluate existing measures of physical symptoms in children and adolescents with cancer.

Objectives were: 1) identify instruments developed for measuring physical symptoms in children with cancer, 2) describe the reliability and validity of these tools, and 3) assess developmental appropriateness of the tools.

The review was based on a search of the electronic databases Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsychLit from January 1988 through October 2003. Inclusion criteria were: articles published in peer-reviewed journals in English, those including a tool developed for use in children and adolescents with cancer, and tools in which physical symptoms comprised a portion of the total measure. Dissertations, unpublished papers, abstracts and qualitative studies were excluded.

A coding sheet was developed to assess study purpose, sample size and characteristics, conceptualization and measurement of the symptom, respondent, and respondent burden. Reported measures of reliability and validity also were identified.

Nineteen studies met criteria for review and 17 instruments were identified. Five studies reported measures of single symptoms, and 9 studies reported measures of multiple symptoms. Five studies reported symptoms as a component of quality-of-life measures. Symptom measures included child self-report, parent proxy-report, staff-report, and direct observation of symptoms. Most instruments reported acceptable internal consistency reliability. Validity most often was evaluated through correlation of findings with tools measuring similar constructs; most instruments demonstrated acceptable validity. Study limitations included small sample sizes and cross-sectional samples. Application of tools most often was limited to one study. Areas for future research include application of these measures in specific populations, intervention-based studies, and outcome-focused studies.

Podium Abstract
PRETREATMENT PREDICTORS OF POST PROSTATE CANCER TREATMENT FATIGUE. Sally Maliski PhD, RN, UCLA Department of Urology, Los Angesles CA US; Lorna Kwan MPH, UCLA, Los Angeles CA US; Christopher Saigal MD, MPH, UCLA Department of Urology, Los Angeles CA US; James Orecklin MD, UCLA, Los Angeles CA US Mark S. Litwin MD, MPH, UCLA Department of Urology, Los Angeles CA US

Oncology nurses must assess and manage cancer-related fatigue. Our results suggest that nurses can identify and intervene with men at risk for fatigue prior to cancer treatment.

We proposed to investigate fatigue among men with prostate cancer by treatment, demographics, and pretreatment general and disease-specific health-related quality of life (HRQOL), and to describe baseline characteristics of men fatigued after treatment.

Cancer-related fatigue, a debilitating tiredness or loss of energy, is subjective and multifactorial. With prostate cancer, fatigue is negatively associated with HRQOL. While HRQOL related to prostate cancer is extensively studied, little exists on pretreatment HRQOL and post-treatment fatigue, even though baseline factors are acknowledged as important to outcomes. Secondary analysis used data collected from 1 private and 2 public facilities. HRQOL questionnaires were completed at biopsy, and 6-12 months post-biopsy. Sociodemographics, comorbidities, PSA, biopsy results, Gleason sum, and treatment were obtained. UCLA Prostate Cancer Index (PCI), a validated instrument, measured prostate-specific HRQOL. The validated RAND 36-Item Health Survey (SF-36) measured HRQOL. The SF-36 energy subscale measured fatigue.

From 999 records, 149 with a positive biopsy and HRQOL scores at both time points were analyzed. Follow-up fatigue scores 10 points (1/2 SD) below baseline were categorized "declined" and fatigue scores of 50 or below as "fatigued". Demographic, treatment, SF-36 and PCI differences between "not declined" and "declined" were analyzed univariately. Variables significant at p=0.2 entered into logistic regression. This was repeated for the second outcome, "fatigued".

Those "fatigued" entered treatment significantly lower in all HRQOL and PCI domains and were more likely to be treated at a public facility, African American, Latino or Asian, unmarried, not employed, and have comorbidities. Those "declined" were more likely to be treated at a public facility, have lower baseline fatigue scores, and PSA over 10. Controlling for treatment, lower baseline role-emotional scores predicted both being "fatigued" and "declined". Other baseline predictors of being "fatigued" were radiation, treatment in a public facility, abnormal DRE, and PSA above 10. This highlights the importance of pretreatment factors in identifying men at risk for fatigue suggesting that interventions can be initiated before treatment.

Podium Abstract
COMPARING INFORMATION NEEDS OF WIVES OF MEN WITH PROSTATE CANCER: RADICAL PROSTATECTOMY AND BRACHYTHERAPY. Tina Mason ARNP, MSN, AOCN, H. Lee Moffitt Cancer Center & Research Institute, Tampa FL US

Cancer patient’s families consistently report difficulty obtaining information, a need frequently overlooked by healthcare providers. Hospital stays and clinic appointments have been shortened with the evolution of managed care. Thus, time and opportunities to evaluate and address learning needs are diminished.

Nurses play a key role in patient/family education. Accurately addressing information needs is essential to providing excellent care. The purpose of this abstract is summarize a study aimed to identify and measure perceived information needs of wives of men diagnosed with prostate cancer treated with radical prostatectomy or brachytherapy.

Family Systems Theory espouses that dynamics of family development impacts clinical decision-making and illness adjustment. Each individual’s response can affect other members. Understanding information needs can assist nurses in diagnosing and teaching.

A convenient sample of sixty-five wives was obtained for radical prostatectomy group and sixty-six wives for brachytherapy group. Consent and demographic data were collected. The 30-item Family Inventory of Needs-Wives instrument was utilized. Subjects ranked needs on Likert- type scale (1= not important to 5= extremely important) and noted degree of each need being met. Radical prostatectomy: Mean age of wives = 55.6 years. All needs were rated as important (range 3.26 to 4.97). "Being assured of best possible care given," "Know what treatment is received," "Feel health professionals care," "Explanations in understandable terms," and "Know what exactly is being done" were never rated as unmet. Age influenced unmet needs (p=0.0019). Brachytherapy: Mean age of wives = 60.8 years. All needs were rated important (range 2.85 to 4.95). Only "Be assured that best possible care is being given" was never ranked as unmet. Education and age did not influence unmet needs (p=0.18 and 0.47 respectively).

Of top 4 unmet needs, similar rankings found in both groups, respectively: "Be told about people who could help with problems" (40.8%; 35.7%), ‘Know what to expect of husband’s energies" (34.9%; 33.9%), and "Know how to touch husband’ (30.0%; 32.3%).

With less opportunity to educate, nurses are challenged to appropriately tailor family education. Therefore, an adequate description of information needs is required. Data will be used to prioritize care and develop/revise educational materials.

Podium Abstract
RELATIONSHIP OF DEPRESSIVE SYMPTOMS TO PHYSICAL FUNCTION IN SURVIVORS OF CERVICAL CANCER. Ruth McCorkle PhD, RN, FAAN, Yale University School of Nursing, New Haven CT US; Howard Greenwald PhD, University of Southern California, Los Angeles CA US; Mary Lavery MSN, RN, Yale University School of Nursing, New Haven CT US; Elise Lev PhD, RN, Rutgers University, Newark NJ US; Donna Clemmens PhD, RN, New York University, New York NY US

Cervical cancer is highly curable, yet it is still quite prevalent. It is the fourth most common cancer in women worldwide, with some 10,520 new cases diagnosed in the United States each year. When diagnosed and treated early, cervical cancer is associated with minimal disruption to womens’ lives and with excellent chances of long-term survival. Past research has focused on short-term survival, but little is known about the effects of living with the long-term consequences of cervical cancer and its treatment.

The purpose of the study was to describe the persistence of disease and treatment sequelae related to quality of life outcomes, including physical, psychological, social, and spiritual dimensions.

This study was designed as a population-based survey of women diagnosed with cervical cancer in the State of Connecticut using Padilla and Grant’s Quality of Life framework.

The study required that the Connecticut Tumor Registry (CTR) identify women who were diagnosed with cervical cancer as their primary disease between 1975 and 1995, had survived up to the present time, could be contacted via letter or telephone, and were able and willing to complete a telephone interview. The physician of record was contacted to provide clearance to contact their patient(s). The primary data collection instrument was a survey questionnaire and included the Medical Outcomes Study (MOS-36) and the Center for Epidemiologic Studies Depressive Scale (CES-D).

Descriptive and correlational analyses were conducted. The CTR contained 793 women diagnosed with cervical cancer and 208 women consented and completed the telephone survey. The sample ranged in ages from 29 to 90 years, 90% had completed high school, 65% were married, and 65% perceived their health status as excellent or very good. Depressive symptom scores were dichotomized as low or high based on the clinical cutpoint of 16. Overall, 97 women (47%) reported higher depressive symptoms, and younger women were more likely to be depressed (p = .01). Depressive symptoms were highly correlated with declines in physical function (p = .34). Results indicate that more attention to the psychological needs of long-term survivors of cervical cancer may be indicated. Funding Sources: National Cancer Institute, SEER Special Studies

Podium Abstract
QUALITY OF LIFE IN ADULTS WITH HODGKINS DISEASE: STATE OF THE SCIENCE. Kathleen McDermott BSN, RN, O CN, Dana-Farber Cancer Institute, Boston MA US; Kristin Roper MS, RN, Dana-Farber Cancer Institute, Boston MA US; Mary E. Cooley PhD, RN, CS, Dana-Farber Cancer Institute, Boston MA US; Kecia Boyd RN, BSN, OCN, Dana-Farber Cancer Institute, Boston MA US; Christine Coakley RN, MPH, OCN, Dana-Farber Cancer Institute, Boston MA US; Jacqueline Fawcett PhD, RN, FAAN, University of Massachusetts-Boston, Boston MA US

Hodgkin’s Disease (HD) affects both younger and older adults and has the potential to disrupt developmental tasks. Because long-term survival is excellent, an understanding of issues related to quality of life (QOL) is a critical first step in designing intervention studies. The purpose of this abstract is to present a review of studies examining QOL in adults with HD.

Ganong’s guidelines for conducting integrative reviews were used to guide this review.

Computer searches were performed from January 1984 through April 2004. Key words used to access the articles were "HD and Survivor", "HD and Survivorship", "HD and QOL" and "HD and Health Related Quality of Life". The published reports of empirical studies that explicitly included HD, survivor, and QOL were included in the review. Studies examining symptoms and psychosocial adaptation were also included. The final review encompassed 30 studies.

Content analysis was performed to identify common themes among the studies.

Studies were conducted in the United States and Europe. The mean age of subjects in these studies was 40 years (range: 17-85) with a gender split of 50-60% males and 40-50% females. Eighty-three percent of patients in this review were evaluated from 1 year to 35 years post-treatment. Remaining patients were studied during the first year after diagnosis. One article identified a theoretical framework to guide the study. A variety of instruments were used to measure varying aspects of QOL without consistency and standardization.

Fourteen descriptive studies were identified. Most descriptive studies focused on the negative impact of physical symptoms on psychosocial and functional ability. Fifteen comparative studies examined differences between adults with HD and other samples. Many comparative studies identified the negative impact fatigue had on QOL. Functional and psychological factors that were commonly affected included increased depression and diminished work and leisure activities. One study involved the test of an intervention; results indicated that aerobic activity has a positive impact on chronic fatigue.

Oncology nurses play a key role in promoting QOL among adults with cancer. This integrative literature review can be used to inform and help guide future studies of the QOL of HD survivors. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from the Oncology Nursing Certification Corporation

Podium Abstract
PHYSICAL AND PSYCHOSOCIAL ISSUES IN ELDERLY CAREGIVERS DURING THE FIRST MONTH AFTER THEIR DYING RELATIVES ARE ADMITTED TO A HOME HOSPICE PROGRAM. Deborah McGuire PhD, RN, University of Maryland Baltimore, Baltimore MD US; Joseph B. Straton MD, MSCE, University of Pennsylvania School of Medicine, Philadelphia PA US;Frances K Barg PhD, University of Pennsylvania School of Medicine, Philadelphia MD US

Caring for a dying relative in home hospice poses multiple challenges for caregivers, particularly if they are elderly and frail.

Extant research addresses caregiver burden, but more knowledge is needed about specific physical and psychosocial issues to initiate targeted interventions. The purpose of this study was to describe the physician and psychosocial issues reported by elderly caregivers in the first month after their dying relatives are admitted to home hospice.

A quality of life conceptual framework guided this study.

The study was a secondary analysis of data collected within an intervention study to improve caregivers' general physical and emotional status. The sample was 48 elderly (>65) caregivers whose dying relatives were admitted to the setting of a university-affiliated hospice's home care program in the northeastern US. Instruments included the reliable and valid Center for Epidemiologic Studies-Depression scale (CES-D), Caregiver Quality of Life Index (CQLI), and Medical Outcomes Study Short Form-12 (SF12); and a Participant Profile Form (PPF) for demographic and health related data. Measurement points were at admission (all instruments), and 2 and 4 weeks later (CQLI, SF12, & PPF).

Preliminary analyses are presented below, and ongoing analyses are examining correlates of physical and psychosocial issues.

Just over half (51%) of the caregivers were >75 years old, 70% were female, 35% were African American, 78% were spouses of patients, and 51% were caregivers for >6 months. At admission, 54% exhibited clinical depression (>16 on CES-D); reported low quality of life on CQLI emotional, social, financial, and physical domains; and had impaired physical and mental health, and social functioning (SF12). At all points, a majority reported numerous conditions that interfered with caregiving, including impaired sleep and appetite, fatigue, musculoskeletal problems, cardiovascular problems, and medication side effects. These findings reveal that elderly caregivers have multiple physical and psychosocial issues during the first month after admission and would likely benefit from targeted interventions. Funding Sources: The Pew Charitable Trusts.

Podium Abstract
USING THE COPE INTERVENTION TO IMPROVE PATIENT SYMPTOM DISTRESS AND QUALITY OF LIFE: A CLINICAL TRIAL. Susan McMillan PhD, ARNP, FAAN, University of South Florida College of Nursing, Tampa, FL US; Brent Small PhD, University of South Florida College of Arts and Sciences, Tampa FL US; Michael Weitzner MD, University of South Florida College of Medicine, Tampa FL US; William Haley PhD, University of South Florida School of Aging Studies, Tampa FL US; Ronald Schonwetter MD, University of South Florida College of Medicine, Tampa FL US

Hospice family caregivers must be prepared to accurately report the patient's condition and to provide the needed care. Without this preparation, the patient may have uncontrolled symptoms and patient quality of life may suffer.

To test an intervention for hospice family caregivers that was designed to help them master the skills needed to better assess and manage symptoms experienced by cancer patients, thus decreasing symptom distress and enhancing patient quality of life.

The stress-process model was used for the larger clinical trial with patient symptoms as the caregiver stressors. This paper presents only patient data.

A three group comparative design with repeated measures was used. The study was conducted in large hospice that provides primarily homecare. 328 patients with advanced cancer were randomly divided into three groups, a control group receiving standard care (Group I), a group receiving standard care plus support visits (Group II), and a group receiving standard care plus the experimental intervention (Group III). Group III received training in COPE (Creativity, Optimism, Planning, Expert Information) to assist with symptom management. Group II received Supportive Visits on the same schedule as Group III to control for the effects of researcher time and attention. The interventions were offered in three visits. Instruments included the Pain Numeric Rating Scale (NRS), Dyspnea NRS, Constipation Assessment Scale (assessing the three most common symptoms experienced by this group), Memorial Symptom Assessment Scale (symptom distress), and the Hospice Quality of Life Index. All measures had been validated with hospice patients with cancer and had shown strong evidence of reliability. Data were collected on admission to hospice, at day 16, and at day 30.

Data were analyzed using repeated measures ANOVA.

Results: Although the three target symptoms showed no significant improvement, the experimental group experienced significantly less symptom distress (p <.001). Quality of life remained stable. Conclusions/Implications: The COPE intervention is easily taught and is effective in improving the distress from multiple symptoms experienced by patients with cancer. This intervention is immediately translatable to the bedside with some minimal training for hospice nurses. However, further research is warranted to identify other possible outcomes. Funding Sources: National Cancer Institute

Podium Abstract
FACTORS ASSOCIATED WITH FEAR OF RECURRENCE IN CANCER SURVIVORS AND THEIR FAMILY CAREGIVERS. Suzanne Mellon PhD, RN, University of Detroit Mercy, Detroit MI US; Laurel Northouse PhD, RN, FAAN, University of Michigan, Ann Arbor MI US; Trace Kershaw PhD, Yale University, New Haven CT US; Laurie Freeman-Gibb RN, MSN, Karmanos Cancer Institute, Detroit MI US

Although fear of cancer recurrence is one of the greatest concerns among survivors and their families, few studies have examined fear of recurrence or factors associated with it. This information is essential in order to help survivors and caregivers find ways to manage this pervasive fear and maintain their quality of life.

The purpose of this study was to determine the relationship between personal, social, and illness-related factors, appraisal, and fear of recurrence in survivors and their family caregivers. Personal factors included demographics such as age, gender, education, income, and other concurrent family stressors. Social factors included family hardiness and social support. Illness-related factors included time since diagnosis, type of cancer, and other health problems. Appraisal addressed the family’s meaning of the illness.

A stress-coping framework, adapted from McCubbin and McCubbin's model, guided the study.

Secondary analysis of data obtained in a large population-based exploratory study of survivors and their family caregivers was used to meet study aims. Cancer survivors, stratified by race (Caucasian and African American) and cancer site (breast, colon, uterine, and prostate) were randomly selected from the NCI SEER Cancer Registry in southeastern Michigan. The resulting sample consisted of 123 survivor and family caregiver dyads; 62 dyads were Caucasian and 61 dyads were African-American. Standardized instruments with adequate reliability and validity were used to measure study variables: Family Pressures Index, Family Hardiness Index, Social Support Index, Constructed Meaning Scale, and Fear of Recurrence Questionnaire. ANOVA and multiple regression were used to analyze the data.

Study variables accounted for 41.8% of the variance in survivors’ and 26.6% of the variance in caregivers’ fear of recurrence. Survivors who were younger, had more family stress, less meaning associated with the illness, and fewer other health problems reported more fear. Caregivers who were Caucasian, had more family stress, less meaning, and fewer other health problems also had more fear. Implications suggest a profile of factors that puts participants at risk of having more fear of recurrence during survivorship. These factors need to be addressed in programs of care.

Podium Abstract
SYMPTOM CLUSTERS IN ONCOLOGY OUTPATIENTS EFFECT PATIENT OUTCOMES. Christine Miaskowski RN, PhD, FAAN, School of Nursing, San Francisco CA US; Marylin Dodd RN, PhD, FAAN, University of California, San Francisco CA US; Kathryn Lee RN, PhD, FAAN, University of California, San Francisco CA US; Claudia West RN, MS, University of California, San Francisco CA US; Bruce Cooper PhD, University of California, San Francisco CA US; Steven Paul PhD, University of California, San Francisco CA US; Brad Aouizerat PhD, University of California, San Francisco CA US

Recent evidence suggests that multiple symptoms can have a negative effect on patient outcomes. However, no studies of oncology outpatients have attempted to cluster patients based on reports of symptom intensity and to evaluate for differences in patient outcomes based on cluster group membership.

The purposes of this study, with a sample of oncology outpatients who were receiving active treatment for their cancer (n=191) were to determine cluster membership based on self-reports of pain, fatigue, sleep disturbance, and depression and to evaluate for differences in functional status and quality of life among the different cluster groups.

The UCSF Symptom Management Model served as the theoretical framework for this study as well as the conceptualization of symptom clusters reported by Dodd, Miaskowski, and Paul, 2001.

A cross-sectional sample of oncology patients was recruited from four outpatient settings. Patients completed the Lee Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological Studies Depression Scale, Karnofsky Performance Status Score (KPS) and Multidimensional Quality of Life Scale-Cancer. If patients were experiencing pain, they rated their worst pain using a 0 to 10 numeric rating scale for pain intensity.

Standardized scores for each of the symptoms were derived and were used as the dependent variables in the weighted average linkage hierarchical cluster analysis.

The analysis revealed a four cluster solution (i.e., LOW on all symptoms (n=46), no pain and moderate levels of fatigue, sleep disturbance, and depression (n=68), high pain and moderate levels of fatigue, sleep disturbance, and depression (n=54), and HIGH on all symptoms (n=23)). Patients who were clustered in the LOW on all symptoms group had the best outcomes (i.e., highest KPS score and highest quality of life score). Patients who were clustered in the HIGH on all symptoms group had the worst outcomes. This study is the first to use cluster analysis to determine groupings of oncology outpatients based on self-reports of symptom intensity and to evaluate for differences in patient outcomes based on these cluster groupings. These data suggest that patients with high levels of symptoms experience poorer outcomes and may warrant different types of nursing interventions. Funding Sources: National Institute of Nursing Research and National Cancer Institute

Podium Abstract
MATH INTERVENTION FOR CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA. Ida Moore RN, DNS, FAAN, College of Nursing, The University of Arizona, Tucson AZ US; Marilyn Hockenberry RN, PhD, FAAN, Baylor College of Medicine, Houston TX US; Kris Kaemingk PhD, The University of Arizona, Tucson AZ US; Petra Miketova PhD, The University of Arizona, Tucson AZ US

The study documents a mechanisms of chemotherapy-induced central nervous system (CNS) injury, and provide evidence for efficacy of a Math Intervention.

The purpose was to test a math intervention for children diagnosed with acute lymphoblastic leukemia (ALL) who receive intrathecal chemotherapy and systemic intermediate dose methotrexate. The specific aims were to: 1. Determine if a Math Intervention prevents declines in math achievment scores in children with ALL; 2. Determine if a Math Intervention improves math abilities in children with documented declines in math abilities following CNS treatment, and 3. Investigate oxidative injury during CNS treatment. The conceptual model examined CNS treatment on CNS treatment effects on cell injury, effects of cell injury on cognitive and academic outcomes, and effect of a Math Intervention on academic math abilities.

A prospective repeated measures design was used. Subjects were randomized to standard care or Math Intervention. 65 children with ALL and 15 healthy sibilings were studied. Standardized measures of cognitive and academic abilities were administered at baseline (after completion of induction therapy; and 1, 2, and 3 year after ALL diagnosis. Cerebral spinal fluid (CSF) was collected at diagnosis and subsequently in conjunction with therapeutic lumbar punctures.Phospholipids were extracted from CSF (Floch et al), separated by normal phase HPLC with diode array detection. Oxidation was measured in the major membrane phospholipid, phosphatidycholine (PC). Unoxidized PC was detected at 206 nm, and oxidized PC was detected at 234 nm. The ratio of oxidized PC to un-oxidized PC was calculated.

Data were evaluated using descriptive statistics, t-tests, and repeated measures analysis of variance.

Math Intervention had a significant effect on math achievement scores of children who completed ALL treatment (F= 14.3; p < 0.01). Math intervention had a significant increase in math achievement scores in children receiving CNS treatment (p < 0.05). There were no significant differences in the oxidized PC ratio in diagnostic CSF samples among ALL risk groups. The oxidized PC index was significantly increased in CSF obtained during ALL treatment. Significant effects for risk group, treatment phase, and risk group by treatment phase interaction were found (p < 0.01). Funding Sources: NR04905, HD37816; P20 NR007794; ONS Foundation through an unrestricted grant from Ortho Biotech Products, L.P.

Podium Abstract
CURRICULUM SURVEY OF CANCER-RELATED CONTENT IN SIX SCHOOLS OF NURSING. Mary Mundt PhD, RN, University of Louisville, Louisville KY US; April Conner MSSW, University of Louisville, School of Nursing, Louisville KY US; Carla Hermann PhD, RN, University of Louisville, School of Nursing, Louisville KY US

The incidence and prevalence of cancer and the increase in cancer survivors means that nurses will encounter persons with cancer-related health concerns in all areas of practice. Nursing curricula should include cancer-related content to assure broad based knowledge in cancer nursing. The Center for Cancer Nursing Education and Research (CCNER) at the University of Louisville is implementing a community-wide intervention to improve cancer nursing education in six schools of nursing.

The purpose of the study was to document all cancer-related content in nursing curricula in the participating schools of nursing. The aim was to develop a baseline for future curriculum enhancements.

The framework of the study was educational communication as a statement of value and emphasis as represented in written curriculum materials. Course syllabi constitute a fundamental form of academic communication. The unit of analysis was each nursing course as documented in the course syllabi.

Each school identified a primary faculty member as liaison to the study. The group defined cancer-related content and developed a data collection instrument. Data collection occurred in two phases. In Phase I course syllabi were reviewed by the faculty contact. Cancer-related content was documented along with descriptive variables about time allocated and learning variables. In Phase II the course coordinator validated Phase I data and added content that was not observable in the syllabus. This method assured accuracy and full documentation of cancer content.

Each school submitted Phase I and Phase II data to the CCNER where it was coded according to the ONS Standards of Care and Professional Performance, adding additional codes as they emerged.

A total of 138 courses were analyzed and 49% were found to have cancer-related content. The findings indicate the most frequent cancer-related topics were in the category of "Background Knowledge" (69%), with 31% of the content topics related to the ONS standards. Coverage of cancer-related content in nursing curricula was sporadic and there was no identifiable organizing framework. Recommendations are made for including cancer- related content in the nursing curriculum as a means of communicating the importance and significance of this common health problem. Funding Sources: Dept. of Health and Human Services, Health Resources and Services Administration

Podium Abstract
CHALLENGES OF RECRUITMENT TO A RANDOMIZED CLINICAL TRIAL FOR OSTEOPOROSIS PREVENTION. Carol D. Ott RN, OCN, PhD, University of Nebraska Medical Center College of Nursing, Kearney NE US; Janice J. Twiss APRN, PhD, University of Nebraska Medical Center College of Nursing, Omaha NE US; Nancy L. Waltman APRN, PhD, University of Nebraska Medical Center College of Nursing, Lincoln NE US; Gloria J. Gross RN, PhD, University of Nebraska Medical Center College of Nursing, Scottsbluff NE US; Ada M. Lindsey RN, PhD, FAAN, Professor Emeritus, Retired, AL US

The purpose of this presentation is to describe recruitment planning and monitoring for a federally funded home-based clinical trial with a longitudinal design with four recruitment catchment areas that include 100 mile radius around each site across a 500 mile wide state.

Recruitment is a challenging issue for a statewide randomized intervention trial for osteoporosis prevention with an accrual goal of 240 healthy postmenopausal women with a history of breast cancer. This recruitment goal was distributed to target 60% from two metropolitan sites and 40% from two rural sites with monthly monitoring of contacts and enrollment from each site for each recruitment method At the 66% time point into the 18 month recruitment phase, only 39% of the overall accrual goal had been attained. Re-evaluation of effective strategies and exploration of new ones were necessary.

Recruitment strategies were intensified using the more successful methods and abandoning those less successful based on the following distribution: newspaper ads 43%, word of mouth 17%, TV interviews 10%, presentations to support and women’s groups 8%, fliers 7%, radio PSA’s and ads 4%, physician clinics 2%. Additional strategies were developed to address motivators for participation in clinical trials (e.g. staying healthy and trying a novel experience) and deterrents (e.g. fear of the unknown and unclear expectations). Because 86% of women were demonstrating bone loss via free DEXA screening, recruitment information also began emphasizing the prevalence of the problem in this population.

As a result of these modifications and with 3 months remaining in the modified recruitment time line, 90% of the recruitment goal of 240 women are enrolled. Of 669 women screened to date via telephone and lab/DEXA testing, 215 (32%) have met eligibility criteria - 66% metropolitan and 34% rural. Recruitment costs per enrolled participant is $30. Tracking of recruitment efforts in large clinical trials should be ongoing, site specific, and cost effective.

Monthly monitoring of accrual as a result of each recruitment strategy allowed for early identification of areas for change. Changes incorporated early in the recruitment phase addressed unique aspects of rural vs metropolitan areas and is resulting in achievement of accrual goals.

Podium Abstract
SHIFTING PARADIGM: A MODEL FOR COOPERATIVE RESEARCH TRIALS. Judith K. Payne PhD, RN, AOCN, Duke University School of Nursing, Durham NC US

There is increased interest and critical need for the development and implementation of large multi-site clinical trials to reconcile differences in symptom management, selection and testing of interventions, nurse-sensitive outcomes, and related nursing care issues. Cooperative controlled clinical studies need to be undertaken at multiple universities and medical centers on both national and, occasionally, international levels. Increasingly nurse researchers are employing multi-site research initiatives; however, the lack of an infrastructure designed to facilitate large collaborative and cooperative clinical trials has made this difficult and progress slow. The purpose of this paper is to propose a research consortium outlining an infrastructure for nurse researchers to conduct large cooperative clinical trials at multiple universities and medical centers. Through this consortium, select studies would be open for enrollment to participating, vested organizations and researchers in an effort to increase the number of trials open and thereby increasing subject accrual.

The hope for rapidly achieving good data rests in cooperative national studies at multiple universities and medical centers by sharing routine tasks, expertise, and resources. Researchers at different institutions would be able to enroll eligible patients to open studies on a national level. Albeit possible scrutiny, this may be the most viable solution to the current problem presented by small studies using different outcome measures and evaluation, and lack of long-term follow-up for survival data.

Provide timely findings and answers to research questions; generate data to determine evidenced-based practice or best practice guidelines. It is critical that we identify outcome indicators for quality oncology care, and incorporate multiple aspects of patient responses to nursing care interventions. Researchers would benefit from shared resources and a vested commitment to high quality, large clinical trials using consistent measures, designs, and outcomes from which evidenced-based practice can be based. Findings generated from large clinical trials will influence health care policy to a greater extent than small individual studies.

While there has been a paucity of research which addresses the critical need for a multi-site nursing research consortium, this paper will explore research infrastructures and strategies from other disciplines. Literature from medicine, federal regulatory agencies, and other disciplines will be used to construct a similar yet futuristic paradigm of a research consortium useful to nurse researchers.

Podium Abstract
MEASUREMENT OF HOPE IN ADOLESCENTS AND YOUNG ADULTS WITH CANCER (AYA). Celeste Phillips MSN, RN, Indiana University School of Nursing, Indianapolis IN US; Joan Haase PhD, RN, Indiana University School of Nursing, Indianapolis IN US; Patrick Monahan PhD, Indiana University School of Medicine, Indianapolis IN US

Hope is an important influencing factor for successful psychosocial adjustment and hope can potentially enhance resilience and quality of life outcomes in adolescents and young adults with cancer (AYA).

There are few psychometrically sound instruments designed to measure hope in AYA. Because outcomes for AYA are poorer than for older adults, it is important to have a measure of hope that can be used for across-group comparisons. The purpose of this paper is to report the psychometric properties of the Herth Hope Index (HHI) in AYA. The HHI is widely used with adults; we will report on the psychometric properties based on two studies with AYA.

The Adolescent Resilience Model (ARM) guided each of the studies. The HHI was completed by 127 AYA at various stages of treatment and 74 newly diagnosed AYA.

ANOVA comparing three age groups (18) on mean HHI scores was not significant at the .05 level for either study. The t test comparing two time-since-diagnosis groups on mean hope score was also not significant for the two studies. Estimates of internal consistency using the Cronbach coefficient were acceptable in both studies based on the suggested criterion level for coefficient alpha of .70 or above. Construct validity was supported with significant correlations (r =.78, -.93) of the HHI with measures of resilience (self-esteem, self-confidence, and self-transcendence) and quality of life (index of well-being). The hypothesized three factor analysis solution of the HHI using varimax rotation was supported with criterion of Eigenvalues > 1; however a two- factor solution had the clearest loadings set at >.30 and explained a greater amount of variance (40%).

The results of this study indicate that the HHI is a valid and reliable measure of hope in AYA. In order to make the necessary group comparisons to evaluate outcomes, the HHI may be more appropriate than the one measure often used to evaluate hope in adolescents, the Hinds Adolescent Hope Scale. Advantages of each will be discussed. Funding Sources: NIH/NINR R29 NR03882-01A1

Podium Abstract
NUTRITION AND FATIGUE IN MELANOMA PATIENTS DURING AND AFTER BIOCHEMOTHERAPY. Davina Porock PhD RN, School of Nursing, Nottingham, England GB; Brenda Beshears RN MSN, Blessing School of Nursing, Hannibal MO US; Jackie Juenger RN MSN, Boone Hospital, Columbia MO US; Pamela Hinton PhD, University of Missouri, Columbia MO US

Fatigue is a prevalent symptom of cancer and cancer treatment. For patients undergoing biochemotherapy, fatigue can be so severe as to be dose-limiting. Little is known about fatigue related to biochemotherapy compared to other anti-cancer therapies, even less is known about nutrition in this population and how it relates to the perception of fatigue.

The purpose of this study is to describe fatigue and nutritional status and their relationship in patients during and after biochemotherapy treatment for melanoma.

Winningham’s psychobiologic entropy theory guided the larger study on the physiological and psychological characteristics of fatigue in biotherapy from which this presentation is taken.

A mixed method approach was taken for this study combining a descriptive correlational method for the quantitative part and a simple thematic analysis for the qualitative part. All 25 participants completed the quantitative measurements and 10 were interviewed. The participants were patients at a Midwest cancer center for advanced melanoma with biochemotherapy. Fatigue was measured using the 6-item Schwarz Cancer Fatigue Scale. Nutritional intake was recorded by 24-hour diet recall.

Nutritional status was described in terms of participant BMI and nutrient intake: total caloric intake, and carbohydrate, protein, fat and vitamin intake. Fatigue responses were analyzed using descriptive statistics. Fatigue and nutritional status were correlated using non-parametric analysis. A thematic analysis was performed on the taped interviews. Comparison between the qualitative and quantitative analyses was done qualitatively.

The sample was overweight and most had a more than adequate intake of nutrients based on the recommended daily-required intake. There was no significant relationship between nutrient intake and perception of fatigue. Despite the intuitiveness in the current theoretical understanding of nutritional status being related to or even causative for fatigue, when the patient is well nourished and not underweight the impact of nutrition is difficult to establish. The results of the qualitative analysis in terms of the perception of fatigue did not entirely correspond with participants’ responses to the quantitative measures. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Schering Oncology Biotech

Podium Abstract
BREAST BIOPSY AND DISTRESS: TESTING A REIKI INTERVENTION. Pamela Potter APRN, BC, DNSc, Yale University School of Nursing, New Haven CT US

Over one million women annually in the United States undergo breast biopsy.

Women, prior to and after breast biopsy, report distressing psychological symptoms of anxiety and depression. The study’s purpose was to test the distress-reducing effect of a standardized Reiki treatment for women undergoing breast biopsy compared with those who receive conventional care. Specific aims were to: (1) describe the distress associated with breast biopsy; and (2) test the effectiveness of Reiki treatments for alleviating the distress. Women who received Reiki were hypothesized to report a significantly greater decrease in post-biopsy distress than those who received conventional care only.

Crisis Theory accounts for the crisis experience of breast biopsy that may evolve from the potential diagnosis of cancer, which represents a severe, acute existential threat to the person.

Thirty-two women scheduled for breast biopsy were enrolled and randomized to intervention (n = 17) or conventional care control (n = 15). In addition to receiving the conventional care, the intervention group received one Reiki treatment within the week prior to and one within the week after biopsy. Effects were evaluated using self-report questionnaires.

Data were double entered and compared for accuracy. Preliminary data analysis computed summary statistics, box plots, and frequency distributions for all variables. The groups were compared for equivalence on all baseline variables—two groups one-way Analysis of Variance (ANOVA) for continuous or Fisher’s Exact Test for categorical measurement. Residual analyses were performed; data that were not normally distributed were transformed in order to obtain a more robust analysis. Repeated measures ANOVA tested for a significant group-by-time effect.

No difference in distress variables was found between groups at baseline or at study completion. Study participants did not demonstrate a crisis response to breast biopsy. Due to sample selection bias, the study was insufficiently powered to reach informed conclusions about the efficacy of the Reiki intervention. Institutional barriers, internal barriers and barriers to recruiting for a complementary therapy trial impeded recruitment. The results serve as preliminary data for conducting future intervention studies with complementary therapies and this population. Funding Sources: Department of Defense Breast Cancer Research Program institutional grant, American Cancer Society Scholarship, Funded by the ONS Foundation through an unrestricted grant from Ortho Biotech Products, L.P.

Podium Abstract
TESTING USABILITY OF A TAILORED INTERACTIVE HEALTH COMMUNICATION INTERVENTION TO INCREASE COLON CANCER SCREENING AMONG AFRICAN AMERICANS. Susan Rawl PhD, RN, Indiana University School of Nursing, Indianapolis IN US; Victoria Champion RN, DNS, FAAN, Indiana University School of Nursing, Indianapolis IN US; Linda Scott MS, Indiana University School of Nursing, Indianapolis IN US; Tschannette Cotton MSW, Indiana University School of Nursing, Indianapolis IN US; Leslie Weaver MSW, Indiana University School of Nursing, Indianapolis IN US; Amanda Overgaard MPH, Regenstrief Institute, Indiana University School of Medicine, Indianapolis IN US; Adam Buchanan MPH, Duke University Medical Center, Durham NC US; Monahan Patrick PhD, Indiana University School of Medicine, Indianapolis IN US; Celette Sugg Skinner PhD, Duke University Medical Center, Durham NC US

Colorectal cancer (CRC), when discovered early, is highly treatable. CRC screening has been shown to decrease incidence of CRC by 75% to 90% through identification and removal of precancerous polyps. Early diagnosis and treatment of CRC results in a survival rate greater than 90%.

Promotion of screening among African Americans is needed. Both incidence and mortality rates are higher in African Americans than any other racial/ethnic group due, in part, to lower screening rates resulting in advanced stage disease at presentation. Prevention and earlier detection of CRC are needed to further reduce cancer deaths and disparities. The purpose of this study was to develop and test the usability of a tailored interactive health communication program designed to encourage CRC screening among African Americans.

This theory-based interactive health communication intervention delivers messages that are individually tailored to each user’s perceived and objective risk for CRC, benefits and barriers to colorectal screening, self-efficacy, and stage of adoption for specific screening tests. Culturally-relevant constructs that were incorporated into the program include fatalism, religiosity, and time orientation.

Usability testing was conducted with a convenience sample of 14 African Americans. Participants viewed the 25-minute program then immediately completed a self-administered survey to assess usability of the program software and hardware, appropriateness and comprehension of messages, visual appeal and clarity of graphics. User feedback also was collected through debriefing interviews conducted after completion of the survey.

Data were analyzed using descriptive statistics and content analyses of qualitative data.

All participants agreed or strongly agreed they learned a lot about: 1) how colorectal cancer develops, 2) colorectal cancer screening tests they should consider, and 3) their personal risk for developing the disease. All but one participant (93%) reported that the program: 1) made them think about getting a colon screening test; 2) would be useful to family and friends; 3) would be useful to people who do not know a lot about colon cancer; 4) was easy to use; and 5) was interesting. Valuable suggestions for improving the program were provided and will be used to guide revisions for future studies. Implications for researchers who are developing and testing health behavior interventions will be presented. Funding Sources: Conducted in affiliation with the Walther Cancer Institute, Indianapolis, Indiana

Podium Abstract
THE IMPACT OF BREAST CANCER ON THE FAMILY: A PHENOMENOLOGICAL STUDY OF FAMILIES WITH ADOLESCENTS. Gail Rea RN, PhD, University of Missouri - St. Louis, St. Louis MO US

The impact of breast cancer is a major turning point in the woman's life and her family's. Despite the recognition that cancer is a family affair, most studies have focused either on the patient or on family members, and have overlooked the family as a whole.

The purpose of this phenomenological study was to investigate the impact of breast cancer on the lived experience of families with adolescents, as perceived by the patient, spouse, and adolsecent, and the family unit. Family systems, family development, Rolland's illness-model, and Combrinck-Graham's family spiral model were the guiding theories for this study. Five families were interviewed. The women had been diagnosed with non-metastatic breast cancer and had completed their adjunctive therapy.

Interviews with the patients, spouses, and adolescents and the family unit explored the research questions: What is the impact of breast cancer on the individaul lived experience of the patient, spouse, and adolescent? What is the impact of breast cancer on the lived experience of families with adolescents?

Data was analyzed using the phenomenological analysis methods of Giorgi, Schutz, and Patton. Trustworthiness was established by family members and two nurse researchers validating the descriptions of the themes. The data was also compared and triangulated with the literature.

The themes identified from the patient interviews included gathering support, becoming self-focused, decision making, and expanding focus to family. The spouses themes included becoming focused, taking action, being protective, and sharing with others. Themes identified from the adolescent interviews: not knowing, changes of family roles, awareness of behavior, and altering plans. Themes unique to the family interviews included: anxious beginnings, spiritual experience, role of humor, and honor and celebration. Implications for further study during different phases of the illness and recovery. In addition, studied conducted during other phases of family development and those including in-laws and/or grandparents would be valuable. Nurses need to be aware of family life cycles and individual development processess are dynamic and occurring simultaneously when an illness such as breast cancer is introduced into the family. In order to assist families, nurses need to think in a systemic manner about these developmental processes.

Podium Abstract
A QUALITATIVE SYSTEMATIC REVIEW OF DECISIONS ABOUT CANCER GENETIC TESTING (CGT) FOR HEREDITARY BREAST CANCER (HBC): WILL THE REAL UPTAKE RATE PLEASE STAND UP? Mary Ropka Ph.D., RN, FAAN, UVA School of Medicine and School of Nursing, Charlottesville VA US; Elayne Phillips Ph.D., RN, UVA School of Medicine, Charlottesville VA US; Jennifer Wenzel MS, UVA School of Nursing, Charlottesville VA US; John Philbrick M.D., UVA School of Medicine, Charlottesville VA US

Building on recent progress of the Human Genome Project, risk assessment and counseling is increasingly incorporated into cancer nursing practice. Individuals and families dealing with hereditary cancer risk face complex decisions, including whether to obtain CGT.

Synthesis of research regarding CGT decisions is important to guide development, testing, and dissemination of evidence-based decision support interventions. Our review of 40 papers addressing HBC CGT revealed large variability in CGT uptake (20% to 96%). The purpose of this analysis was to explain that variability. Aims included examining role of: methods of measuring uptake; HBC personal history (PH) and family history (FH); and research methodology.

Ottawa Decision Support Framework (knowledge, expectations, values, support, skills) guides assessment of decision making needs and subsequent tailoring of CGT decision support interventions.

Design: Qualitative Systematic Review.

Sample: Using MEDLINE, CINAHL, and PSYCHINFO, we identified 40 primary research reports in English, 1990-2002, meeting these criteria: cancer-related; adults; breast CGT decisions; and peer-reviewed.

Procedure: Data Abstracted: Breast cancer PH and FH; CGT uptake percent, "real" (blood draw, R), or "hypothetical" (intent or interest, H) and how measured; study design; sampling strategy; recruitment, setting.

In 40 studies, 58 rates (40 H-CGT, 18 R-CGT) were reported in 56 patient cohorts.

Mean H-CGT and R-CGT rates were similar (70% vs 73%). FH patients had higher H-CGT rates (74% FH vs. 53% other), while PH patients had higher R-CGT rates (82% PH vs. 50% other).

Other factors contributing to uptake variability were: study design differences (26 correlational, 5 randomized controlled trials, 9 other); patient assembly (30 convenience, 4 consecutive series, 6 other); sampling frame (hospital/clinic/registry 27, community 7, both 5); and methods measuring H-CGT rates (40 different questions).

Our review shows that study methodology, in addition to patient and cancer characteristics, must be evaluated as part of interpreting CGT research. Only then can results be used to guide clinical care and future research. Funding Sources: National Cancer Institute K07 Award

Podium Abstract
TOBACCO REDUCTION WITHIN THE CONTEXT OF ACUTE CARE HOSPITALS. Annette Schultz MN PhD Candidate, RN, University of British Columbia, School of Nursing, Vancouver BC CA

Hospitalization is reported to be a window of opportunity to address tobacco reduction (TR), which would influences rates of cancer morbidity and mortality. Studies reporting on TR during hospitalization have tended to explore patient cessation efforts and/or health professional activities. However, organizational activities could also influence the actualization of this opportunity.

To describe the social context related to TR embedded in the practice world of the nurses working in acute care hospitals.

The larger mixed-methods study investigated the practice, perspectives and work context of nurses working on adult in-patient hospital wards in Western Canada. An ecological framing advocated behavior is a product of individual and contextual factors. The qualitative part of the study was guided by symbolic interactionism, which theorizes people's understanding of the world is partially constructed through social interaction. Thus, exploring structural features like use of space and documents reveals contextual cues that could influence the construction and integration of TR in practice. Data was collected on 16 wards located in two hospitals. Ethnographic data collection occurred during 2 four hour visits per ward and included: ward and hospital observations, document review of available materials, and over 100 conversations with nurses.

Field notes and photographs were analyzed for evidence relevant to the provision of public space for tobacco use. Collected documents were reviewed for presence of tobacco use assessment and reduction.

Document review findings were varied. Admission sheets and patient education material related to cardiovascular, respiratory, and cerebra-vascular diseases demonstrated both a request for tobacco use assessment and varying amounts of information about TR. Otherwise tobacco use status and TR was mostly absent from referral forms, and patient education material. There was an absence of written material to inform nurses or patients about tobacco use and reduction. Finally, while hospital buildings are smoke free in Canada, the provision of smoking spaces in these hospitals has been fraught with difficulties that has created tensions between nurses and patient who use tobacco, and between smokers and non-smokers. These two examples of structural features demonstrate ways organizations might inhibit nurses' integration of TR into practice. Funding Sources: University of British Columbia School of Nursing, Katherine McMillan Directors Discretionary Fund

Podium Abstract
A QUALITATIVE COMPONENT OF A RANDOMIZED CLINICAL TRIAL. Karen Schumacher RN, PhD, University of Nebraska Medical Center College of Nursing, Omaha NE US; Setsuko Koresawa RN, MS, Doctoral Student, University of California San Francisco, San Francisco CA US; Claudia West RN, MS, University of California San Francisco, San Francisco CA US; Marylin Dodd RN, PhD, University of California San Francisco, San Francisco CA US; Steven Paul PhD, University of California San Francisco, San Francisco CA US; Christine Miaskowski RN, PhD, University of California San Francisco, San Francisco CA US

To describe a method of nesting qualitative research within a randomized clinical trial (RCT) using audiotaped intervention sessions as a source of data.

Qualitative research may fruitfully be combined with intervention studies but few examples exist detailing methodological strategies for doing so. Audiotaped intervention sessions in a RCT provide extensive qualitative data on the implementation of the intervention that can be used for knowledge development about the intervention itself. As audiotaping increasingly is used as a strategy for monitoring treatment integrity for psychoeducational interventions, large qualitative databases will become available for substantive data analysis, as well as for quality assurance purposes. This presentation will provide an example of how one research team used those data. In a recently completed RCT of a nursing intervention called the PRO-SELF© Pain Control Program the teaching/coaching sessions with oncology outpatients experiencing pain from bone metastases and their family caregivers were audiotaped originally for quality assurance purposes. However, early reviews of the audiotapes revealed that they were a rich source of data about patients’ and family caregivers’ experiences with pain management. To mine this data source, we applied for and received an administrative supplement to the NCI funded study in order to transcribe the audiotapes and conduct a qualitative study. Our objectives were 1) to better understand the pain management difficulties patients and family caregivers brought to the interventionist’s attention, 2) to better understand patients for whom the intervention did not work, and 3) to describe how patients and family caregivers used specific pain management tools. We will describe the sampling strategies and analytic procedures for each objective and the way in which the qualitative results will be used in future RCTs.

In large programs of research, interventions are developed and refined across multiple studies. Conducting a qualitative analysis of audiotaped intervention sessions in one study provides valuable insights for subsequent research.

The information gained can increase the consistency of intervention implementation in future RCTs, facilitate the translation of research into practice, and contribute to the knowledge base around nursing interventions. Funding Sources: National Cancer Institute, (Administrative Supplement to R01 CA64734)

Podium Abstract
CHALLENGES IN DELIVERING A MANUALIZED INTERVENTION IN THE HOME ENVIRONMENT. Mary Ellen Shands RN, MN, University of Washington School of Nursing, Seattle WA US; Anne Hannahan RN, MA, LP, North Memorial Medical Center, Robbinsdale MN US; Kim Wagler Ziner RN, MSN, Indiana University School of Nursing, Indianapolis IN US; Terri Farmer PhD (C), RN, University of Arizona College of Nursing, Tucson AZ US

The purpose of the presentation is to describe the areas in which interventionists experienced challenges delivering the manualized intervention in the home environment to help mother's with breast cancer support their children.

Psychosocial intervention research with families must address the dynamic processes that arise during interactions between the interventionists and the participants. Manualized interventions using fully scripted text can ensure that intervention content is delivered consistently and appropriately to research participants no matter what the setting or who is delivering the intervention. However, such interventions can be a challenge for professional nurses, because they have only a small amount of discretion in the delivery of the intervention.

Interventionists in six U.S. states have been trained to deliver a five session manualized intervention targeted at assisting mothers with early stage breast cancer to support their school age children. Sessions focused on helping mothers to sharpen their skills in communicating with their children about the breast cancer; draw out the child's feelings and concerns; and decrease the child's stress related to the breast cancer. All sessions were delivered in the mother's home at a time convenient for her. To date, 162 families have been accrued, 82 have been randomized to the intervention arm, and 62 have completed all 5 intervention sessions. Interventionists engaged in this project have discussed the challenges of intervention delivery during trainings and conference calls and have identified specific strategies for addressing these challenges.

Challenges were categorized as: logistical coordination of delivering the intervention in the families' homes; external influences in the home setting; delivering personalized intervention within the boundaries of protocol. Examplars of particular challenges within each area will be presented along with the actions taken to manage the challenges.

Elucidation of the challenges encountered by the interventionists can facilitate the planning of future research and intervention delivery for families living with breast cancer as well as inform oncology nurses who seek to provide evidence based care. Funding Sources: National Cancer Institute, NIH

Podium Abstract
BONE MARROW DONATION: FACTORS INFLUENCING INTENTION IN AFRICAN-AMERICANS. Mary Ellen Smith PhD, RN, CS, Drexel University, Philadelphia PA US

A major obstacle to bone marrow transplantation is donor availability particularly among African Americans.

The purpose of this descriptive study was to identify factors influencing African-Americans’ intentions regarding bone marrow donation. The Theory of Planned Behavior proposes that an individual’s intention to perform a behavior is the central determinant of the behavior. Thus, intention is determined by attitudes, subjective norms, and perceived behavioral control.

An exploratory, non-experimental descriptive design was used to explore African-Americans’ responses concerning their intentions to donate bone marrow, and the factors influencing such intentions.

The 65-item Bone Marrow Donation Intention Tool was designed to identify factors influencing African-Americans’ intentions regarding bone marrow donation. The items from the Bone Marrow Donation Intention Tool were entered into an exploratory factor analysis using principal components extraction.

Seven factors influencing bone marrow donation were identified: Fear or Not Trusting, Helping Others, External Influences, Approval of People, Care that Individual is a Human Being, Value of Knowledge, and Concerned about Resources. Findings revealed that Fear or Not Trusting, External Influences, and Concern about Resources were associated with subject’s intention not to donate bone marrow. Helping Others, Approval of People, and Value of Knowledge were associated with their intention to donate bone marrow.

Demographic variables that significantly correlated with intention to donate were possession of an organ donor card and affiliation with the Methodist Church (0.0010 and 0.0022 respectively). The factor value of knowledge significantly correlated with the intention to donate bone marrow. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Genentech, Inc.

Podium Abstract
THE UNCERTAINTY SCALE FOR KIDS: INSTRUMENT DEVELOPMENT AND PILOT TESTING. Janet Stewart PhD, RN, University of Pittsburgh School of Nursing, Pittsburgh PA US

Uncertainty is one of the primary challenges children with cancer face, but has not been systematically studied to date. Development of a psychometrically sound instrument to measure children’s uncertainty represents the first step in a planned program of research into uncertainty in children with cancer and its consequences for their psychological adjustment.

The purpose of the study was to evaluate the psychometric properties of a child-centered instrument to measure uncertainty in the context of cancer treatment.

The improvement in outcome for most children with cancer, resulting in large part from increasingly intensive treatments, has resulted in unpredictable illness trajectories with an unknown outcome for any individual child, creating a powerful paradox of increased optimism accompanied by enduring uncertainty. Children undergoing cancer treatment describe high levels of uncertainty, particularly during the early phases of diagnosis and treatment, characterized as not understanding, not knowing what will happen when, and not being sure what things mean (Stewart, 2003). Mishel’s (1988) Uncertainty in Illness theory provided the foundation for the conceptualization of uncertainty in children.

The Uncertainty Scale for Kids (USK), consisting of 22 items utilizing a 4-point interval scale, was derived from qualitative interviews with children with cancer, evaluated for content validity by both clinical experts and child informants, and tested in an initial sample of 72 children aged 8 to 17 years (mean 13.0, sd 2.9) undergoing treatment for cancer. Reliability was evaluated with Cronbach's alpha, inter-item correlations, and one-week test-retest. Validity was evaluated by correlating uncertainty with anxiety and with depressive symptoms and by comparing uncertainty scores by intensity of treatment.

The USK demonstrated adequate internal consistency (alpha = .94, inter-item r’s .30-.70) and stability (test-retest r = .64, p < .01). Scores on the USK were significantly correlated with children’s anxiety (r = .52, p < .001). Children undergoing more intensive treatment demonstrated significantly higher uncertainty scores (t69 = 3.08, p < .01). Therefore the USK appears psychometrically sound and offers promise for moving forward the study of children’s uncertainty and their adjustment to cancer treatment. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Amgen, Inc.

Podium Abstract
IMPLEMENTATION OF AN EVIDENCE BASED ORAL CARE GUIDELINE CHANGES PRACTICE AT A NCI-DESIGNATED CANCER CENTER. Carrie Stricker, University of Pennsylvania Medical Center, Philadelphia PA US; Jacqueline Sullivan PhD, RN, Thomas Jefferson University, Philadelphia PA US AL US

Mucositis is one of the most common and significant side effects of cancer therapy, occuring in 80% of high-risk populations such as head/neck radiotherapy and stem-cell transplant (SCT).

The purpose of this project was to synthesize into a clinical practice guideline (CPG) the contemporary evidence on prevention and management of oral mucositis in cancer patients undergoing chemotherapy, head and neck radiotherapy, and hematopoetic stem cell transplant, and evaluate the impact of this CPG on both nursing and physician practices and patient care outcomes in radiation oncology and inpatient oncology/SCT at a northeastern US NCI-designated comprehensive cancer center.

A multidisciplinary workgroup composed of staff nurses, nurse practitioners, medical oncologists, oral medicine, and an academic nurse researcher was convened to synthesize the contemporary evidence into a CPG and direct the implementation and evaluation of the evidence based CPG. A quasi-experimental pre-test/post-test design was undertaken to measure significant changes in provider and patient- specific outcomes. Provider outcomes included 1) inpatient and radiation oncology staff nurse knowledge of evidence-based oral care practices (n = 35 pretest, n = 29 posttest), measured by an investigator developed, expert content-validated questionnaire, and 2) physician house staff/inpatient nurse practitioner (NP) oral care ordering practices (33 patients pretest, 34 posttest) evaluated by retrospective chart review. Patient outcomes included 1) oral mucositis measured by the Oral Assessment Guide (Eilers, 1988) and 2) oral pain measured by the Brief Pain Inventory (Cleeland et al., 1982). The multidisciplinary implementation of the CPG had a significant effect on staff nurse knowledge and physician/NP oral care orders. While pre-implementation testing described the incidence and timing of oral complications, the effect of the CPG on patient care outcomes was unable to be determined due to the introduction of a clinical trial with potential to increase oral mucositis between pre-test and post-test timepoints.

The multidisciplinary development and implementation of an evidence-based oncology oral care clinical practice guideline significantly changed the mucositis prevention and management practices at a NCI-designated comprehensive cancer center. Not only can these oral care guidelines be applied to other practices to improve oncology care, but this model of evidence-based practice can guide the development, implementation, and evaluation of other guidelines for evidence-based oncology practice.

Podium Abstract
OVARIAN CANCER QUALITY OF LIFE INTERVENTION: A PILOT STUDY. Virginia Sun RN, MSN, City of Hope National Medical Center, Duarte CA US; Betty Ferrell PhD, FAAN, City of Hope National Medical Center, Duarte CA US; Marcia Grant RN, DNSc, FAAN, City of Hope National Medical Center, Duarte CA US; Gloria Juarez PhD, RN, City of Hope National Medical Center, Duarte CA US; Deborah MacDonald RN, MS, APNG, City of Hope National Medical Center, Duarte CA US; Robert Morgan MD, City of Hope National Medical Center, Duarte CA US

Over 200,000 women are currently living with ovarian cancer and a nursing education intervention on survivorship concerns may be beneficial for this population.

The purpose of this pilot study was to test the feasibility of the implementation of the Ovarian Cancer Quality of Life Intervention (OCEI) and gain feedback from pilot subjects regarding intervention design. The OCEI is based on the COPE model, which teaches a problem-solving process to develop an individualized plan of action to cope with patient-identified concerns. These concerns were focused around quality of life issues, specifically those in the physical, psychological, social, and spiritual domains.

The pilot intervention incorporated the use of three scheduled 60-minute education sessions with a research nurse, use of written materials on ovarian cancer, and two data collection time points. Outcome measures were obtained using the Ovarian Cancer QOL Tool and a Patient Follow-Up Inventory to evaluate the intervention.

The impact of the intervention was followed through comparisons of descriptive QOL data at baseline and evaluation. Mean age of subjects (n=14) was 60, and ethnicity included 60% Caucasian, 20% Hispanic, and 20% Asian. Subjects included 80% Stage III and 20% Stage IV disease of which 40% were undergoing treatment for initial diagnosis and 60% were undergoing treatment for recurrent disease. Subjects identified their major concerns as maintaining positive outlook/psychological coping (40%), concern for female relatives (30%), fear of recurrence (10%), anxiety (10%) and side effects (10%). Results indicate that immediate effects in several priority concerns were identified in the physical, psychological, and social QOL domains. Based on this preliminary data analysis, a follow-up procedure by phone and clinic visit was conducted with the first ten study subjects to determine the long-term application and efficacy of the OCEI. The follow-up data suggests that the OCEI may have a long lasting positive effect on the QOL of ovarian cancer patients. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Genentech, Inc.

Podium Abstract
PROSPECTIVE STUDY COMPARING SIDE EFFECTS AND SATISFACTION WITH TREATMENTS FOR PROSTATE CANCER. Karen Swenson RN, MS, AOCN, Park Nicollet Institute, Minneapolis MN US; Carol McPherson MSW, MPH, Park Nicollet Institute, Minneapolis MN US; Janice Kjellberg RN, Park Nicollet Institute, Minneapolis MN US

Prostate cancer is the most common cancer in men, with approximately 230,110 new cases and 29,900 deaths annually in the US. Treatments for prostate cancer can cause side effects including impotence and urinary incontinence that can profoundly affect patients’ quality of life. Oncology nurses can improve patient’s satisfaction with treatment by assisting patients with treatment decision-making and helping them manage treatment-related side effects.

The objective of this study is to compare patient-reported side effects and satisfaction with treatments for early stage prostate cancer at baseline (before definitive treatment), and at 6, 12, and 24 months after treatment.

The study is based on a multidimensional QOL framework. 225 men with early stage prostate cancer were enrolled prospectively after diagnosis and before treatment, and followed for 24 months post-treatment. Patients completed the Prostate Cancer Treatment Outcome Questionnaire (PCTO-Q) at baseline, and at 6, 12, and 24 months post-treatment. The PCTO-Q has established reliability (Chronbach's alpha >.73) and validity.

Descriptive statistics were used to evaluate demographic information and satisfaction. Analysis of Covariance (ANCOVA), using baseline scores as covariates, was used to compare differences in PCTO-Q scores between the three main treatment groups (surgery, brachytherapy, and RT) over the three time periods. Age, baseline scores, and comorbidity were controlled for in the multivariate model.

At 24 months, surgery patients experienced more urinary incontinence (63%) and sexual dysfunction (87%): radiation patients experienced more bowel difficulties (16%). Brachytherapy patients experienced significantly less bowel (11%) and sexual dysfunction (58%) at 24 months than either surgery or radiation therapy patients (p <.05). In the whole cohort at 24 months, 89% of men were partially/totally impotent, 22% experienced urinary incontinence, and 13% experienced bowel dysfunction. Men who had sexual dysfunction at 24 months expressed greater dissatisfaction with their treatment choice (P<.02). This study shows that although side effects diminish, many significant symptoms persist at 24 months after treatments. Treatment satisfaction was significantly reduced among men who experienced long-term side effects. Persistent symptoms, reduced treatment satisfaction and patient anticipation of realistic side effects have importance for nursing practice. Alteration in the content and focus of patient education should be considered. Funding Sources: Nycomed Amersham and Novartis Oncology

Podium Abstract
DETERMINANTS OF DEATH IN AN INPATIENT HOSPICE FOR TERMINALLY ILL CANCER PATIENTS. Siew Tzuh, Stephanie Tang RN, DNSc, National Yang-Ming University, Taipei City United Hospital Taipei TW; Ruth McCorkle Ph.D., F.A.A.N, Yale University School of Nursing, New Haven CT US

Despite the strong emphasis on home-based end-of-life care in the United States and the recognition of dying at home as a gold standard of quality of care, hospice home care is not a panacea and death at home may not be feasible for every terminally ill cancer patient. However, factors predisposing death in an inpatient hospice were under-explored from the existing studies.

To investigate the determinants of death in an inpatient hospice for terminally ill cancer patients. Mor and Hiris’s (1983) framework of determinants of place of death: (a) sociodemographics, (b) support network, (c) clinical condition/ care needs, and (d) health-system factors.

Research Design: Prospective cohort study.

Measurements: Preferred/actual place of death, functional dependency, symptom distress, availability/utilization of health care resources.

Data Analysis: Determinants of death in an inpatient hospice were identified by survival analysis with Cox proportional hazards model.

Results: A total of 180 terminal cancer patients were enrolled (87% response rate). Approximately two-fifths (40.8%) of terminally ill cancer patients in this study died in an inpatient hospice over the two-year study period. Results from Cox proportional hazards model with adjustment for covariates indicated that cancer patients who received hospice care before death (hazard ratio (HR)=7.32, 95% confidence interval (CI): 3.21-16.67), with a preference to die in an inpatient hospice (HR= 4.86, 95% CI: 2.24-10.51), resided in New Haven County (HR=1.70, 95% CI:1.00-2.93), or who experienced higher levels of functional dependency (HR=1.05, 95% CI: 1.02-1.08) were at significantly higher likelihood to die in an inpatient hospice.

Implications: The high prevalence of inpatient hospice death for terminally ill cancer patients in this study was related to the local health care system characteristics, health care needs at the end of life, and personal preference of place of death. Findings from this study make a valuable contribution to our currently limited understanding of how inpatient hospice care influences place of death. Available and ease access to inpatient hospice services facilitate a death in a place that is in accord with some terminally ill cancer patients¡¦ wished¡Xan important component of ¡§good death¡¨ as defined by Institute of Medicine. Funding Sources: ONS Foundation through an unrestricted grant from the Roxanne Laboratories, Inc. and Mary Lewis, Manager Palliative Care Education.

Podium Abstract
IMPROVING CANCER PAIN MANAGEMENT USING AHCPR CANCER PAIN GUIDELINES. Mary Thomas RN, MS, AOCN, Veterans Affairs Palo Alto Health Care System, Palo Alto CA US; Marilyn Douglas RN, DNSc, FAAN, VA Palo Alto Health Care System, Palo Alto CA US; Stephen Rao PhD, University of California San Francisco, San Francisco CA US; Jan Elliott RN, MS, AOCN, VA Palo Alto Health Care System, Palo Alto CA US; Kathleen Fahey RN, MS, AOCN, VA Palo Alto Health Care System, Palo Alto CA US; Christine Miaskowski RN, PhD, FAAN, University of California San Francisco, San Francisco CA US; AL US CA US

Ineffective cancer pain management (PM) remains a significant problem. Patient’s attitudinal barriers (ABs) can be a significant obstacle to effective PM.

The purpose of this study was to test the effectiveness of two interventions (standardized versus individualized education) to ameliorate ABs toward PM on improving pain, functional status and quality of life (QOL). Cancer pain was conceptualized as multidimensional in nature (Ahles); to be effective, PM should also be multidimensional.

A convenience sample of 288 adults with pain related to cancer/treatment participated. After completing baseline questionnaires, subjects were stratified by pain severity and concurrent chemo/radiation therapy, and then randomized into three groups: Control (usual care), Education (AHCPR booklet and PM video), or Coaching (same as education group, plus four structured telephone calls by a PM clinical nurse specialist addressing ABs and PM strategies). The coaching intervention was based on self-regulation theory (Miller & Brown) using motivational interviewing techniques; calls occurred over a six-week time period. Questionnaires were re-administered 12 weeks after randomization. Instruments with established reliability and validity were used to measure the study’s dependent variables: Brief Pain Inventory (pain severity, pain relief, pain-related interference with function); Barriers Questionnaire (ABs); Functional Assessment of Cancer Therapy-General (QOL); and SF-36 (functional status).

Results were analyzed by addressing the effects of time and group on the dependent variables using repeated measures ANOVA.

The sample was predominantly male (88%), veteran (85%), middle aged, and had a variety of cancer types; over 30% were receiving concurrent cancer therapy. Patients in the coaching group demonstrated less pain, improved pain relief and emotional well-being, and less interference with function from pain; however, these results were not statistically significant. Lack of achieving statistical significance may be due to any of the following: a small effect size, loss of many subjects to death or progressive illness while on study, time between assessments, and diminished ability to strictly adhere to the attention control call format when subjects voiced significant problems warranting intervention. Attitudinal barriers are prevalent in cancer patients and this coaching intervention may be an effective strategy in improving PM. However, other methods are needed to test its effectiveness. Funding Sources: Veterans Affairs, Health Services Research and Development Service, NRI 97-026-1

Podium Abstract
REVIEW AND CRITIQUE OF THE STATE OF THE SCIENCE: ADDRESSING CANCER AMONG AND BETWEEN U.S. ETHNIC/RACIAL MINORITY POPULATIONS. Sandra Underwood RN, PhD, FAAN, University of Wisconsin Milwaukee, Milwaukee WI US; Barbara Powe PhD, RN, American Cancer Society, Atlanta GA US; Mary Canales PhD, RN, University of Vermont, Burlington VA US

Advances made in the area of cancer prevention and cancer control over the last two decades have led to declines in cancer incidence and mortality and increases in survival for many cancer patients. However, while the trends relative to cancer incidence, mortality and five-year survival for the Nation as a whole have significantly improved, data reveal that there are significant disparities in the degree to which the burden of cancer that remains is borne by racial/ethnic minority populations.

As a practice-oriented discipline grounded in research, nursing could have a dominant role in efforts aimed toward eliminating the cancer disparities experienced by racial/ethnic minority population groups. Several reports of nursing studies have been published in the peer-reviewed literature that address factors associated with the cancer disparities experienced between and among U.S. racial/ethnic minority groups. However, given that few efforts have been undertaken to comprehensively review and critique this body of research, little is known about the scope, quality and potential impact of this body of nursing science.

This presentation will present the results of the first comprehensive critiques of nursing research undertaken to address cancer related health disparities in ethnic/racial minority populations within the United States.

The dimensions of the cancer care continuum, the dimensions of the continuum of research and the principles of evidence based practice were used as frameworks to guide this review and critique. The review and critique of 56 published nursing research reports addressing cancer in minority populations was conducted in four phases (selection of databases, selection of articles focused on cancer in minority populations, thematic sorting, review and critique) using the methods proposed by Cooper (1982).

The findings revealed that this body of nursing research has contributed much to the identification and understanding of factors associated with the excess cancer morbidity and mortality of minority populations. However, in order for the profession to more fully contribute to the elimination of cancer related health disparities, data suggest the need to expand and strengthen this base of knowledge through the development of research methods and the conduct of intervention trials, population-based studies, and demonstration projects.

Podium Abstract
THE USE OF MUSIC THERAPY IN REDUCING SYMPTOMS OF RADIATION THERAPY. Nancy Wells RN, DNSc, Vanderbilt University Medical Center, Nashville TN US; Michael Clark MME, MT-BC, Tennessee Technical University, Cookeville TN US; Gloria Isaacs-Downton BM, MTBC, Vanderbilt University Medical Center, Nashville TN US; Sheryl Redlin-Frasier RN, ONC, Vanderibilt University Medical Center, Nashville TN US; Carole Eck MBA, RN, Vanderbilt University Medical Center, Nashville TN US

Radiation therapy (RT) is a common treatment for many cancers. For curative RT, patients receive daily treatments for 3 to 7 weeks. These treatments are anxiety-provoking, and typically produce fatigue and pain. Developing effective interventions to relieve these responses may provide better treatment experiences and improve quality of life in patients receiving RT.

The purpose of this study was to examine the effect of music therapy, provided by a board-certified music therapist, on the emotional responses (anxiety, depression, treatment-related distress) and symptom activity (fatigue and pain) of patients undergoing curative RT.

Music therapy may produce beneficial effects on emotions and symptoms through a number of mechanisms. Promotion of relaxation, entrainment, and distraction have been proposed as mechanisms. The literature suggests that music therapy is most effective when it incorporates the patient’s musical preferences and is delivered by a trained music therapist.

A total of 63 patients were included in this randomized clinical trial; 35 received music therapy and 28 received usual care. The intervention consisted of a single 45 minute session with a music therapist to select preferred music, which was then developed into a patient-specific audiotape to be used throughout RT. Outcomes, measured with validated instruments, included anxiety and depression (HAD), treatment-related distress (NRS), fatigue (POMS), and pain (NRS). Measures were obtained at baseline, mid-treatment, and end of treatment for all variables except distress, which was collected weekly.

Data were analyzed using a 2 (group) by 3(time) mixed model repeated measures ANOVA.

The groups were equivalent on demographic and clinical variables. Anxiety and distress were significantly lower for the experimental participants when compared to the controls and declined over time for both groups. No significant differences between groups or over time were found for depression, fatigue, or pain. While these data suggest music therapy may be beneficial in relieving anxiety and distress during RT, a more intensive intervention is recommended to produce effects on symptom activity. Funding Sources: American Music Therapy Association; Sigma Theta Tau Iota Chapter

Podium Abstract
PATTERNS OF CHANGE IN FATIGUE, ENERGY LEVELS, AND SLEEP PARAMETERS IN MEN UNDERGOING RADIATION THERAPY (RT) FOR PROSTATE CANCER. Claudia West RN, MS, School of Nursing, San Francisco CA US; Christine Miaskowski RN, PhD, FAAN, University of California, San Francisco CA US; Kathryn Lee RN, PhD, FAAN, University of California, San Francisco CA US; Marylin Dodd RN, PhD, FAAN, University of California, San Francisco CA; Steven Paul PhD, University of California, San Francisco CA US; William Wara MD, University of California, San Francisco CA US; Patrick Swift MD, University of California, San Francisco CA US

Fatigue is a common symptom reported by patients undergoing RT. Less is known about the pattern of sleep disturbance during RT.

The purpose of this descriptive, longitudinal study was to evaluate for changes in fatigue, energy levels, and sleep parameters in men who underwent RT for prostate cancer.

The UCSF Symptom Management Model served as the theoretical framework for this study.

Patients were recruited from two RT departments prior to the initiation of therapy and assessments were done at baseline, as well as at the middle and the end of RT. At each assessment point, patients completed the Lee Fatigue Scale (LFS) in the mornings and in the evening, as well as the General Sleep Disturbance Scale (GSDS).

A total of 82 men with a mean age of 67.1 years, an average Karnofsky Performance Status Score of 95.6, and a Stage T1 or T2 prostate cancer were recruited for this study. A repeated measures ANOVA was done and determined that both morning and evening fatigue increased over time and were highest at the end of RT.

At all assessments, evening fatigue was significantly higher than morning fatigue. Higher energy levels were reported in the morning compared to the evening. However, energy levels did not change over the three assessments. In contrast, significant differences were found in total GSDS scores from baseline to the middle of and at the end of RT. Men reported significant decrements in the quality of their sleep, significant increases in the quantity of their sleep, a longer sleep onset latency, as well as significant increases in the number of mid-sleep awakenings, the number of early morning awakenings, and an increase in excessive daytime sleepiness. All of these changes in sleep parameters reached a peak at the middle of RT and remained elevated at the end of RT. These findings suggest that the experience of RT for men with prostate cancer produces significant disruptions in sleep that are followed by increases in fatigue. The disruptions in sleep may be attributed to the increased frequency of urination during the course of RT. Funding Sources: National Institute of Nursing Research and National Cancer Institute

Podium Abstract
GENETICS KNOWLEDGE AMONG ONCOLOGY NURSES. M. Linda Workman PhD, RN, FAAN, Case Western Reserve University, Cleveland OH US

Advances in genetics confirm genetic predisposition for diverse health problems. Nurses at every level will be involved with the study or care of individuals/families with genetic disorders, genetic predispositions, or who are undergoing genetic testing. Unfortunately, nursing literature exposes the absence of genetics content in BSN and MSN curricula nation-wide. Nursing programs lack faculty with sufficient expertise to incorporate substantial genetics content into basic and graduate nursing education or to use genetics information in nursing research.

The purpose of this project was to determine level of genetics knowledge among oncology nurses.

This project used an educational framework to assess the extent/depth of genetics knowledge within a nursing specialty. Subjects: Subjects were 812 members of the Oncology Nursing Society who attended a national conference. Most subjects had 10 years or more experience in oncology nursing. All levels of nursing education were represented. Method: A 20 item genetics knowledge survey was developed by genetic and oncology experts. Ten items represented general genetics content and ten items were specific for cancer genetics content. Content validity for the survey items was established during the development process. Items varied in degree of difficulty from 0.87 to 0.09. Guessing was discouraged by the use of "don't know/not sure" as a response choice for all items.

No single item was answered correctly by all participants. Correct responses for the 20 items ranged from 5.3% (42/812) to 87.6% (689/812). The survey's overall degree of difficulty was 45% and the discrimination index was 0.65. Only three items had the correct answer selected by at least 70% of the participants. MSN prepared nurses had slightly higher scores for cancer genetics knowledge. General genetic knowledge scores did not correlate with advanced degrees or years of nursing experience.

Oncology nurses at all levels of education and practice have deficits in basic and cancer genetic knowledge. Such deficits should be corrected to improve practice and use genetic testing or genetic counseling in nursing research.

Podium Abstract
NEW CANCER-RELATED FATIGUE INSTRUMENT: PSYCHOMETRIC TESTING. Horng-Shiuann Wu PhD, RN, Saint Louis University, St. Louis MO US; Maryellen McSweeney PhD, Saint Louis University, St. Louis MO US; Kathleen Wyrwich PhD, Saint Louis University, St. Louis MO US

Cancer-related fatigue (CRF) is a highly prevalent, subjective experience of cancer patients and survivors. Effective assessment of CRF attributes from the patients perspective is essential. Researchers have tackled some of the persistent problems in the measurement of CRF such as including the patients perspective in the development and/or validation of CRF instruments and separating the effects of fatigue from its manifestations. This study determined the psychometric properties of a new CRF instrument, a specific measure of CRF symptoms developed from the patients perspective, for a breast cancer population.

The premise of Pipers Integrated Fatigue Model, that subjective indicators are essential to assessing the fatigue experience, guided the study. Classical Test Theory, including error of measurement and the domain-sampling model, guided the psychometric analyses.

254 breast cancer chemotherapy outpatients, at various stages and on various chemotherapy regimens, of three cancer clinics in a metropolitan area participated in this study. Four instruments were completed in order: the newly developed CRF instrument, Schwartz Cancer Fatigue Scale (SCFS), Geriatric Depression Scale (GDS), and Cancer Related Fatigue Distress Scale (CRFDS). The psychometric properties, including construct and criterion-related validities and internal consistency reliability, were tested (n=82) then the measurement model was cross-validated (n=172) using structural equation modeling. Principal axis factoring gave a one-factor solution accounting for 59% variance. Alpha=0.95 for the 15-item scale. Convergent validity with the SCFS was 0.84; concurrent validity with the GDS was 0.61; and predictive validity with the CRFDS was 0.83. Confirmatory factor analysis (LISREL 8.54) confirmed the one-factor measurement model with nine items remaining. Nonsignificant Satorra-Bentler Scaled chi-square(27)=32.52, p=0.21, standardized RMR=0.032, NNFI=0.97, CFI=0.98, and IFI=0.98 indicated a good model fit with alpha=0.91 for the final 9-item scale.

This newly developed CRF instrument provides quantitative information on fatigue symptom status to monitor the patients condition or treatment progress. The information can improve the communication between clinicians and patients, be incorporated into treatment decisions, and help better manage CRF. Funding Sources: Funded by the ONS Foundation through an unrestricted grant from Ortho Biotech Products, L.P.

Podium Abstract
CONSIDERATIONS IN SCORING ACTIGRAPH RECORDINGS OF SLEEP AND WAKE ACTIVITIES. Stacey Young-McCaughan RN, PhD, AOCN, Colonel, U. S. Army Nurse Corps, US Army Medical Command, Fort Sam Houston TX US; Mary Z. Mays PhD, University of Arizonia, Tuscon AZ US; Sonya M. Arzola BS, Brooke Army Medical Center / Geneva Foundation, Fort Sam Houston TX US; Marilyn U. Nowlin RN, BS, BSN, Brooke Army Medical Center / Geneva Foundation, San Antonio TX US

To discuss considerations scoring actigraph recordings of sleep and wake activities. One instrument used to objectively assess sleep is the actigraph, a wrist-worn microcomputer that measures movement in three dimensions. Computerized actigraph algorithms for characterizing sleep periods and sleep stages correlate highly with electroencephalograph recordings. However, dramatic differences in measures can result depending upon how the actigrams are trimmed and scored.

In a prospective, repeated measures study of 62 patients diagnosed with cancer within the previous two years, activity and rest patterns were assessed using a wrist actigraph. Ages of subjects ranged from 24 to 83 (mean = 59). Half of the participants were male and half were female. Participants had a wide range of cancer diagnoses and all stages of cancer. At the start of the study, the study team agreed upon scoring protocols to capture characteristics of both awake and sleep periods which were strictly adhered to during data analysis. Actigraphs were initiated to collect data in one-minute epochs for 72 hours. Actigrams were trimmed to a single 48-hour record beginning at 9:01 am on Wednesday and ending at 9:00 am on Friday. Each 48-hour record included two "up" (active) periods and two "down" (rest) periods. The actigrams were scored using the Cole-Kripke algorithm. Subjects slept an average of only 6.5 hours per night. However, their sleep was quite fragmented; average sleep episodes lasted less than 50 minutes, and they awakened 14 times per night on average. Thus, subjects spent an average of only 78% of the night asleep.

Actigraph assessed measures of sleep and activity can vary depending upon the scoring protocols that are followed. If there were generally agreed upon scoring protocols, the results of studies and comparisons between studies could more easily be communicated.

Nurse researchers are using wrist-worn actigraphs to assess sleep and wake activities of patients with cancer. Different researchers employ different methods to analyze the actigraph data. Open discussions of the strengths and weaknesses of the different approaches to analysis would advance this field of research. Funding Sources: The Department of Defense Uniformed Services University of the Health Sciences TriService Nursing Research Program, N98-051.