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Publications in this journal

• Old roots and new growth.

  Authors: Anne Katz

  Oncology nursing forum. 39(3):235.

  Spring is in the air as I write this, my first editorial for the Oncology Nursing Forum. I have been thinking about this column a lot over the past months; during the application and interviewSpring is in the air as I write this, my first editorial for the Oncology Nursing Forum. I have been thinking about this column a lot over the past months; during the application and interview process I dreamed that this day would happen and, over the past few weeks as I dipped my toes into the reality of being the editor of this esteemed journal, I thought about what I would write. A new person in an established role is an opportunity for change, and hopefully growth, too. But the buds of spring cannot develop without the support and sustenance of the roots, and I want to begin this editorial by thanking Susan Moore, RN, MSN, ANP, AOCN®, for her leadership and grace during the past two years of her acting editorship. Over the past few months, she has been the warm voice at the other end of the telephone, often very early in the morning, when I needed guidance or practical assistance. As someone who loves words, I find myself searching for the right words to express my gratitude to her, and I am left with just two-thank you!

• People & events.

  Authors: Linda K Morse

  Oncology nursing forum. 39(3):243-4.

  Oncology Nursing Society (ONS) member Suzanne Mahon, RN, DNSc, AOCN®, APNG, a clinical professor in the Department of Internal Medicine and the School of Nursing at St. Louis University in Missouri,Oncology Nursing Society (ONS) member Suzanne Mahon, RN, DNSc, AOCN®, APNG, a clinical professor in the Department of Internal Medicine and the School of Nursing at St. Louis University in Missouri, received the International Society of Nurses in Genetics (ISONG) Founders' Education Award. The purpose of the award is to honor an ISONG member who demonstrates excellence in nursing or patient education in genomics. Criteria include outstanding accomplishments related to the education of nurses, patients, or other health professionals; creation and dissemination of media or curricula; teaching genomics; and the dissemination of genomics education innovations and research through publication in peer-reviewed nursing and healthcare literature or presentation to professional and lay audiences.

• Management of dyspnea in a patient with lung cancer.

  Authors: Alison K Bonk

  Oncology nursing forum. 39(3):257-60.

  Nine months prior, S.P., a 64-year-old woman, was diagnosed with stage IV non-small cell lung cancer with distant metastases to the bone. Her large tumor burden had compressed both her trachea andNine months prior, S.P., a 64-year-old woman, was diagnosed with stage IV non-small cell lung cancer with distant metastases to the bone. Her large tumor burden had compressed both her trachea and esophagus several months earlier, leading to gastrostomy-tube placement for nutrition and tracheostomy for airway management. Palliative radiation was used to shrink the tumor size and allow for removal of the tracheostomy tube, leaving an open area covered with gauze in the middle of her neck-a reminder of her previous struggles with breathing. Unfortunately, the cancer progressed and S.P. was admitted to the hospital for evaluation and management of dysphagia.

• Fatigue in breast cancer survivors: the impact of a mind-body medicine intervention.

  Authors: Susan E Appling, Susan Scarvalone, Ryan Macdonald, Maureen McBeth, Kathy J Helzlsouer

  Oncology nursing forum. 39(3):278-86.

  Purpose/Objectives: To evaluate a mind-body medicine (MBM) program for its impact on persistent fatigue following breast cancer treatment.Design: Quasiexperimental.Setting: An urban communityPurpose/Objectives: To evaluate a mind-body medicine (MBM) program for its impact on persistent fatigue following breast cancer treatment.Design: Quasiexperimental.Setting: An urban community hospital and a health department in a semirural county, both in Maryland.Sample: 68 breast cancer survivors who were at least six months postadjuvant chemotherapy and/or radiation therapy and had a baseline fatigue score of 50 or lower per the vitality subscale of the SF-36® Health Survey.Methods: A 10-week group-based MBM program for breast cancer survivors with persistent fatigue was evaluated using a pretest/post-test study design.Main Research Variables: Sustained change in fatigue severity as measured by the Piper Fatigue Scale (PFS), SF-36 vitality subscale, and 10 cm visual analog scale (VAS).Findings: Participants were 2.6 years post-treatment, with a mean age of 56.8 years. Overall, fatigue scores improved by 40%. The mean PFS improved from a score of 6 (SD = 1.6) at baseline to 4.2 (SD = 2) at the end of the program (p < 0.001), with additional improvement at two months and sustained at six months (X = 3.6, SD = 2, p < 0.001). Results from the SF-36 and VAS also showed significant improvement in fatigue (p < 0.001).Conclusions: The findings support the use of a holistic MBM intervention to reduce persistent fatigue in breast cancer survivors. Results should be confirmed with a randomized clinical trial.Implications for Nursing: Nurses and other healthcare team members can effectively impact persistent fatigue in breast cancer survivors through the use of a multipronged MBM program.

• African americans with a family history of colorectal cancer: barriers and facilitators to screening.

  Authors: Kathleen A Griffith, Susan R Passmore, Domanic Smith, Jennifer Wenzel

  Oncology nursing forum. 39(3):299-306.

  Purpose/Objectives: To explore barriers and facilitators of screening for colorectal cancer (CRC), as well as suggestions for improving screening among African Americans with first-degree relativesPurpose/Objectives: To explore barriers and facilitators of screening for colorectal cancer (CRC), as well as suggestions for improving screening among African Americans with first-degree relatives with CRC.Research Approach: A qualitative, descriptive approach involving focus groups.Setting: A community healthcare clinic in Baltimore, MD.Participants: 14 African American men and women aged 40 or older with at least one first-degree family member affected by CRC.Methodologic Approach: In-depth focus groups were conducted until thematic saturation was achieved. Thematic analysis and data reduction were conducted using ATLAS.ti, version 5.0.Main Research Variables: CRC screening barriers and facilitators.Findings: The participants were mostly male, insured, and had a parent with CRC. Commonly reported barriers to CRC screening included fear of serious illness, mistrust of the medical establishment, potential screening discomfort, lack of information on CRC risk factors, lack of healthcare access, absence of symptoms, no knowledge of CRC screening benefits, community reticence about cancer, and CRC myths. Facilitating factors for CRC screening included a belief of personal risk for CRC, physician recommendations, and acknowledgment of age as a risk factor. Suggestions to increase screening rates included distribution of culturally appropriate and community-based efforts (e.g., mobile units, church-based interventions). Participants also suggested ways to increase motivation and provide social support for screening patients.Conclusions: Additional research is needed to identify and test effective screening approaches for this underserved group at increased risk for CRC. Study results suggest that cancer risk and screening education, coupled with screening opportunities in the community, may yield increased screening rates.Interpretation: Lack of knowledge about CRC and CRC screening exists in the study population. Promoting screening across generations, developing and disseminating culturally appropriate educational materials within the community, and encouraging older individuals to screen to take care of their family may be appropriate interventions.

• Oncology update.

  Authors: Diane M Otte

  Oncology nursing forum. 39(3):317-8.

  The U.S. Food and Drug Administration (FDA) has approved oral vismodegib (Erivedge™) for the treatment of adult patients with locally advanced basal cell carcinoma who are not candidates for surgeryThe U.S. Food and Drug Administration (FDA) has approved oral vismodegib (Erivedge™) for the treatment of adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation and for those with metastatic disease. The drug initially was tested at Scottsdale Healthcare in Arizona.

• Identifying family members who are likely to perceive benefits from providing care to a person with a primary malignant brain tumor.

  Authors: Alyssa Newberry, Jean Kuo, Heidi Donovan, Barbara Given, Charles W Given, Richard Schulz, Paula Sherwood

  Oncology nursing forum. 39(3):E226-32.

  Purpose/Objectives: To identify changes in positive aspects of care (PAC) from the time of diagnosis to four months following the diagnosis in family caregivers of care recipients with primaryPurpose/Objectives: To identify changes in positive aspects of care (PAC) from the time of diagnosis to four months following the diagnosis in family caregivers of care recipients with primary malignant brain tumors.Design: Longitudinal.Setting: Dyads were recruited from neurosurgery clinics in Pittsburgh, PA, at the time of care recipients' diagnosis with a primary malignant brain tumor. A second data collection took place four months following the diagnosis.Sample: 89 caregiver and care recipient dyads.Methods: Paired t tests were used to examine change in PAC, univariate analyses were used to determine predictors of PAC at four months, Mann-Whitney U tests and t tests were used to examine associations between categorical predictor variables and PAC at four months, and univariate linear regressions were used to examine associations between continuous predictors and PAC at four months.Main Research Variables: The impact of sociodemographic factors, caregiver-perceived social support, mastery, neuroticism, and marital satisfaction on PAC.Findings: Caregivers' PAC scores during the first four months following diagnosis appeared to remain stable over time. Significant differences were found between the care recipient reasoning domain group at diagnosis and PAC score. Care recipients who scored below average were associated with caregivers with higher PAC scores. Caregiver PAC at four months following diagnosis was significantly predicted by care recipient reasoning and caregiver social support.Conclusions: PAC scores appear to remain stable over time, although levels of PAC may be related to care recipients' level of functioning. Future research should focus on the development of interventions for caregivers who report low levels of PAC at the time of diagnosis in an attempt to help these individuals identify PAC in their caregiving situation.Implications for Nursing: Findings have clinical and research implications. Clinicians may be able to better identify caregivers who are at risk for negative outcomes by understanding the risks faced by caregivers of patients with milder symptoms in addition to those caring for more profoundly affected care recipients.

• Chemotherapy-related cognitive change: a principle-based concept analysis.

  Authors: Mary Louise Kanaskie

  Oncology nursing forum. 39(3):E241-8.

  Purpose/Objectives: To present the results of a principle-based concept analysis of cognitive change in patients with cancer following chemotherapy treatment.Data Sources: 86 English-languagePurpose/Objectives: To present the results of a principle-based concept analysis of cognitive change in patients with cancer following chemotherapy treatment.Data Sources: 86 English-language articles retrieved through OVID, PubMed, CINAHL®, and Web of Knowledge searches through June 2010. No time limits were imposed.Data Synthesis: Analysis was based on the philosophical principles: epistemologic, pragmatic, linguistic, and logical. Conceptual components were identified and a theoretical definition of chemotherapy-related cognitive change emerged; the term was not clearly defined or well differentiated in the scientific literature. Implicit meanings are found in patients' subjective accounts, descriptions of the cognitive domains studied, and the choice of neuropsychological assessment instruments. Antecedents relative to chemotherapy-related cognitive change include disease and treatment factors. Moderators may include anxiety, depression, and fatigue. Consequences or outcomes of the experience of chemotherapy-related cognitive change include adjustment to illness, impact on quality of life, and potential for emotional distress.Conclusions: The principle-based concept analysis generated conceptual insights about chemotherapy-related cognitive change that are based on sound scientific evidence. The product of this method of analysis is a theoretical definition that reflects the state of the science.Implications for Nursing: When the impact of cognitive change following chemotherapy is better understood, meaningful and timely interventions can be developed to improve quality of life for cancer survivors.

• Reclaiming Life on One's Own Terms: A Grounded Theory Study of the Process of Breast Cancer Survivorship.

  Authors: Deborah Witt Sherman, Mary Rosedale, Judith Haber

  Oncology nursing forum. 39(3):E258-68.

  Purpose/Objectives: To develop a substantive theory of the process of breast cancer survivorship.Research Approach: Grounded theory.Setting: A LISTSERV announcement posted on the SHARE Web site andPurpose/Objectives: To develop a substantive theory of the process of breast cancer survivorship.Research Approach: Grounded theory.Setting: A LISTSERV announcement posted on the SHARE Web site and purposeful recruitment of women known to be diagnosed and treated for breast cancer.Participants: 15 women diagnosed with early-stage breast cancer.Methodologic Approach: Constant comparative analysis.Main Research Variables: Breast cancer survivorship.Findings: The core variable identified was Reclaiming Life on One's Own Terms. The perceptions and experiences of the participants revealed overall that the diagnosis of breast cancer was a turning point in life and the stimulus for change. That was followed by the recognition of breast cancer as now being a part of life, leading to the necessity of learning to live with breast cancer, and finally, creating a new life after breast cancer. Participants revealed that breast cancer survivorship is a process marked and shaped by time, the perception of support, and coming to terms with the trauma of a cancer diagnosis and the aftermath of treatment. The process of survivorship continues by assuming an active role in self-healing, gaining a new perspective and reconciling paradoxes, creating a new mindset and moving to a new normal, developing a new way of being in the world on one's own terms, and experiencing growth through adversity beyond survivorship.Conclusions: The process of survivorship for women with breast cancer is an evolutionary journey with short- and long-term challenges.Interpretation: This study shows the development of an empirically testable theory of survivorship that describes and predicts women's experiences following breast cancer treatment from the initial phase of recovery and beyond. The theory also informs interventions that not only reduce negative outcomes, but promote ongoing healing, adjustment, and resilience over time.

• Factors influencing oncology nurses' use of hazardous drug safe-handling precautions.

  Authors: Martha Polovich, Patricia C Clark

  Oncology nursing forum. 39(3):E299-309.

  Purpose/Objectives: To examine relationships among factors affecting nurses' use of hazardous drug (HD) safe-handling precautions, identify factors that promote or interfere with HD precaution use,Purpose/Objectives: To examine relationships among factors affecting nurses' use of hazardous drug (HD) safe-handling precautions, identify factors that promote or interfere with HD precaution use, and determine managers' perspectives on the use of HD safe-handling precautions.Design: Cross-sectional, mixed methods; mailed survey to nurses who handle chemotherapy and telephone interviews with managers.Setting: Mailed invitation to oncology centers across the United States.Sample: 165 nurses who reported handling chemotherapy and 20 managers of nurses handling chemotherapy.Methods: Instruments measured the use of HD precautions and individual and organizational factors believed to influence precaution use. Data analysis included descriptive statistics and hierarchical regression. Manager interview data were analyzed using content analysis.Main Research Variables: Chemotherapy exposure knowledge, self-efficacy, perceived barriers, perceived risk, interpersonal influences, and workplace safety climate.Findings: Nurses were well educated, experienced, and certified in oncology nursing. The majority worked in outpatient settings and administered chemotherapy to an average of 6.8 patients per day. Exposure knowledge, self-efficacy for using personal protective equipment, and perceived risk of harm from HD exposure were high; total precaution use was low. Nurse characteristics did not predict HD precaution use. Fewer barriers, better workplace safety climate, and fewer patients per day were independent predictors of higher HD precaution use. HD handling policies were present, but many did not reflect current recommendations. Few managers formally monitored nurses' HD precaution use.Conclusions: Circumstances in the workplace interfere with nurses' use of HD precautions.Implications for Nursing: Interventions should include fostering a positive workplace safety climate, reducing barriers, and providing appropriate nurse-patient ratios.

• Malglycemia and cancer: introduction to a conceptual model.

  Authors: Marilyn J Hammer, Joachim G Voss

  Oncology nursing forum. 39(3):E275-87.

  Purpose/Objectives: To introduce a conceptual model detailing the physiologic contributions of malglycemia to cancer formation and increased morbidity and mortality.Data Sources: A literature searchPurpose/Objectives: To introduce a conceptual model detailing the physiologic contributions of malglycemia to cancer formation and increased morbidity and mortality.Data Sources: A literature search was conducted using the PubMed, CINAHL®, and Cochrane databases, as well as Surveillance, Epidemiology and End Results (SEER) cancer statistics.Data Synthesis: Multiple complex factors are associated with malignancy formation, proliferation, and outcomes for each individual. The authors present a model, termed the Malglycemia Orbit Model, that is analogous to an atom, centered on a core of individual factors, and surrounded by "orbits" containing cancer and related factors. Highlighted in this model is the role of malglycemia.Conclusions: Cancer formation and sequelae involve numerous multifaceted factors. One factor not well described or understood within the context of malignancies is glycemic status, most notably how malglycemia impacts cancer formation and risks for adverse outcomes. The atomic-structured malglycemia model describes this process.Implications for Nursing: Among the many uncontrollable factors that contribute to cancer formation and adverse outcomes, malglycemia is one that is modifiable. Nurses are in a prime position to conduct research to enhance understanding and ultimately improve protocols for better glycemic control and, in effect, better outcomes for individuals with cancer.

• Definition of Sexual Minority Raises Concerns for Reader (and Author Response).

  Authors: Sharon M Mills-Wisneski, Ulrike Boehmer

  Oncology nursing forum. 39(3):241.

  While I did enjoy the article by White and Boehmer (2012) in the March issue, I did have a hard time accepting the author's definition of sexual minority women. When I first saw the title, IWhile I did enjoy the article by White and Boehmer (2012) in the March issue, I did have a hard time accepting the author's definition of sexual minority women. When I first saw the title, I immediately thought of minority women, thinking race or ethnicity. I just don't think that this title is appropriate. I have discussed this with some of my colleagues and I guess we are having a problem with the term (I don't want to use the word label).

• Evidence-based practice for obtaining blood specimens from a central venous access device.

  Authors: Sarah J Mendez

  Oncology nursing forum. 39(3):247-51.

  As part of a scheduled policy and procedure review, the department of nursing education at a large urban academic medical center conducted a literature review to determine the most up-to-dateAs part of a scheduled policy and procedure review, the department of nursing education at a large urban academic medical center conducted a literature review to determine the most up-to-date evidence for central venous access device (CVAD) blood draws. The literature review revealed that the dead space blood draw was the best practice methodology because the dead space methodology, defined as the point at which blood is in the attached syringe when aspirating without flushing, reduced the potential for infection with minimal blood loss from blood discard.

• Physical activity and the risk of breast cancer recurrence: a literature review.

  Authors: Paul D Loprinzi, Bradley J Cardinal, Kerri Winters-Stone, Ellen Smit, Charles L Loprinzi

  Oncology nursing forum. 39(3):269-74.

  Purpose/Objectives: To examine the association between physical activity and breast cancer mortality and recurrence, and to provide an overview of factors related to physical activity behavior inPurpose/Objectives: To examine the association between physical activity and breast cancer mortality and recurrence, and to provide an overview of factors related to physical activity behavior in women with breast cancer.Data Sources: An extensive review of the epidemiologic literature on the effect of physical activity on breast cancer recurrence and mortality was conducted using PubMed up to December 2010, involving the following key words: physical activity, exercise, breast cancer, breast cancer recurrence, and breast cancer mortality.Data Synthesis: For breast cancer recurrence and breast cancer-related mortality, studies were included if physical activity served as the independent variable and a measure of association was reported. To examine determinants of physical activity, studies were included if a hypothesized factor served as the independent variable and a measure of association was reported.Conclusions: Of the six studies that examined the influence of physical activity on breast cancer mortality, four (67%) reported a protective effect (i.e., inverse association), two examined the influence of physical activity on breast cancer recurrence and reported a nonsignificant risk reduction. Few studies have examined factors that influence physical activity behavior in women with breast cancer, and findings suggest that psychosocial factors play an important role in influencing the activity patterns of breast cancer survivors. Future longitudinal studies are needed to confirm those findings.Implications for Nursing: To prevent breast cancer recurrence and breast cancer-related mortality, nurses should encourage breast cancer survivors to engage in regular exercise.

• Predicting fear of breast cancer recurrence and self-efficacy in survivors by age at diagnosis.

  Authors: Kim Wagler Ziner, George W Sledge, Cynthia J Bell, Shelley Johns, Kathy D Miller, Victoria L Champion

  Oncology nursing forum. 39(3):287-95.

  Purpose/Objectives: To determine the effect that age at diagnosis has on fear of breast cancer recurrence and to identify the predictors of fear of recurrence using self-efficacy as aPurpose/Objectives: To determine the effect that age at diagnosis has on fear of breast cancer recurrence and to identify the predictors of fear of recurrence using self-efficacy as a mediator.Design: Cross-sectional survey.Setting: Two university cancer centers and one cooperative group in the midwestern United States.Sample: 1,128 long-term survivors.Methods: Survivors were eligible if they were aged 18-45 years (younger group) or 55-70 years (older group) at cancer diagnosis, had received chemotherapy, and were three to eight years postdiagnosis. Fear of recurrence was compared between younger and older groups. Multiple regression analyses were used to test variables' prediction of fear of recurrence and breast cancer survivor self-efficacy, as well as breast cancer survivor self-efficacy mediation effects.Main Research Variables: Fear of recurrence, breast cancer survivor self-efficacy, and age at diagnosis.Findings: Survivors diagnosed at a younger age had significantly higher fear of recurrence, as well as health, role, womanhood, death, and parenting worries. Perceived risk of recurrence, trait anxiety, and breast cancer reminders explained significant variance in fear of recurrence and breast cancer survivor self-efficacy. Breast cancer survivor self-efficacy partially mediated the effects of variables on fear of recurrence.Conclusions: The findings suggest that breast cancer survivor self-efficacy may have a protective effect for survivors who are younger at diagnosis and have higher perceived risk of recurrence, higher trait anxiety, and more breast cancer reminders. Oncology nurses already use the skills required to support self-efficacy. Additional research is needed to define and test breast cancer survivor self-efficacy interventions.Implications for Nursing: Oncology nurses are in a key role to assess fear of recurrence and provide self-efficacy interventions to reduce it in breast cancer survivors. Strategies to efficiently address fear of recurrence to reduce psychological distress in survivorship follow-up care are warranted.

• Breast cancer survivors' perception of survivorship.

  Authors: Patricia I Documet, Jeanette M Trauth, Meghan Key, Jason Flatt, Jan Jernigan

  Oncology nursing forum. 39(3):309-15.

  Purpose/Objectives: To explore (a) how women who were diagnosed with breast cancer (BC) defined themselves as survivors and when this occurred, and (b) the types of benefits they derived from theirPurpose/Objectives: To explore (a) how women who were diagnosed with breast cancer (BC) defined themselves as survivors and when this occurred, and (b) the types of benefits they derived from their experiences.Research Approach: An exploratory, qualitative approach.Participants: 112 women who had BC (response rate = 70%).Setting: Participants were recruited from two cancer survivor organizations in a northeastern U.S. city.Methodologic Approach: Responses to open-ended questions in telephone interviews were examined by age at diagnosis using thematic analysis. Chi squares were used to conduct analyses by age (younger than 51 years; aged 51 years or older).Main Research Variables: Meaning of survivorship, defining moment, benefits derived from surviving from breast cancer.Findings: Participants' perceptions of survivorship included two main components, a defining moment and the meaning attached to being a survivor. Becoming a survivor is an active process, except in the case of those participants who realized they were survivors when informed by a third party. Meanings differed by age at diagnosis. Most participants listed at least one benefit from surviving cancer.Conclusions: The definitions of survivorship and benefits outlined here suggest that many positive aspects of the survivorship experience exist that may inform future interventions' designs.Implications for Practice: Providers should acknowledge the strength survivors show in the process of meaning-making and finding benefits in their adverse experiences. The use of expressive and supportive interventions may hold promise for women facing difficulties in coping with their diagnosis.

• Knowledge central.

  Authors: Patricia Ringos Beach

  Oncology nursing forum. 39(3):319-20.

  "I want to tell the truth about my cancer experience. I want to show the whole picture, even the disgusting parts … I want to state my fears and anxieties, my ups and downs. This is not a tale of"I want to tell the truth about my cancer experience. I want to show the whole picture, even the disgusting parts … I want to state my fears and anxieties, my ups and downs. This is not a tale of heroics. Living with cancer and undergoing the torment of its treatment is a many-layered experience" (p. 63).

• The experience of patients with cancer who develop venous thromboembolism: an exploratory study.

  Authors: Alison Mockler, Brigit O'Brien, Jessica Emed, Gina Ciccotosto

  Oncology nursing forum. 39(3):E233-40.

  Purpose/Objectives: To better understand the experience of venous thromboembolism (VTE) from the points of view of patients with cancer during various stages of the cancer experience.ResearchPurpose/Objectives: To better understand the experience of venous thromboembolism (VTE) from the points of view of patients with cancer during various stages of the cancer experience.Research Approach: Qualitative, descriptive.Setting: Various inpatient and outpatient units of a large urban university-affiliated hospital in Montreal, Quebec, Canada.Participants: Purposive sample of 10 participants who were anticipating, had recently undergone, or were currently undergoing cancer treatment and who had received a VTE diagnosis within the past year.Methodologic Approach: Semistructured interviews were transcribed verbatim. Thematic analysis of data revealed themes contributing to understanding the lived experience of VTE during cancer care.Main Research Variables: The experience of patients with cancer who develop VTE.Findings: Patients' initial reaction to VTE included VTE as a life-threat, past experience with VTE, and VTE as the "cherry on the sundae" in light of other cancer-related health issues. Patients' coping with VTE also included three themes: VTE being overshadowed by unresolved cancer-related concerns, VTE as a setback in cancer care, and attitudes about VTE treatment.Conclusions: This study contributes new insight into the experience of patients with cancer who develop VTE. The most salient finding was that patients having no prior VTE knowledge experienced VTE as more challenging. Future studies comparing experiences with VTE across the various stages of cancer care are needed.Interpretation: Study findings suggest that patient education about VTE would be useful for the initial reaction and subsequent coping phases of VTE, thus representing an important target area for nursing intervention.

• Perspectives on coping among patients with head and neck cancer receiving radiation.

  Authors: Mary Ellen Haisfield-Wolfe, Deborah B McGuire, Sharon Krumm

  Oncology nursing forum. 39(3):E249-57.

  Purpose/Objectives: To describe coping among patients with laryngeal and oropharyngeal cancer during definitive radiation with or without chemotherapy.Research Approach: Qualitative content analysisPurpose/Objectives: To describe coping among patients with laryngeal and oropharyngeal cancer during definitive radiation with or without chemotherapy.Research Approach: Qualitative content analysis conducted within a larger study.Setting: Two radiation oncology outpatient clinics in Baltimore, MD.Participants: 21 patients with oropharyngeal or laryngeal cancer.Methodologic Approach: Interviews with open-ended questions were conducted during treatment. Questions covered topics such as coping during treatment, treatment-related issues, and resources.Main Research Variables: Coping, treatment, and coping resources.Findings: Patients' self-assessments suggested they were coping or that coping was rough or upsetting. Issues that required coping varied over four time points. Physical side effects were problematic during and one month after treatment completion. Patients used coping to manage the uncertainties of physical and psychological aspects of their experience. Family and friend support was a common coping strategy used by patients, with the intensity of side effects corresponding with the support provided across time points.Conclusions: Findings confirm previous research, but also provide new information about ways in which patients with head and neck cancer cope with their illness experience. Emergent themes provide insight into patients' feelings, issues, and assistance received with coping.Interpretation: Patients with head and neck cancer need education on the amount and severity of side effects and should be appraised of potential difficulties with scheduling, driving, and other logistic issues. Patients also should be informed of helpful types of support and coping strategies. Additional research is needed to expand the findings related to patients' coping with treatment and to explore the experiences of family and friends who provide social support.

• Hope in patients with cancer transitioning to survivorship: the mid-life directions workshop as a supportive intervention.

  Authors: Clare M Butt

  Oncology nursing forum. 39(3):E269-74.

  Purpose/Objectives: To describe the Mid-Life Directions workshop as an intervention to support hope and quality of life in midlife cancer survivors.Data Sources: Published articles and books.DataPurpose/Objectives: To describe the Mid-Life Directions workshop as an intervention to support hope and quality of life in midlife cancer survivors.Data Sources: Published articles and books.Data Synthesis: The Mid-Life Directions workshop assists survivors to integrate the cancer experience through conscious awareness and choice, and transistion to survivorship with an increased level of adaptation. Quality of life and hope are enhanced through new information and skills allowing participants to direct their lives into a preferred future.Conclusions: The midlife cancer survivor is challenged to face the fear of recurrence, death, and the crisis of meaning in a developmentally appropriate way. The task of midlife is to navigate the tension of generativity versus stagnation for care to emerge as the predominant strength. The Mid-Life Directions workshop provides the cancer survivor the opportunity to reevaluate goals, reprioritize values, and find one's own answers to these challenges to adapt to life as a cancer survivor.Implications for Nursing: This clinically relevant intervention merits formal study. Facilitator preparation, mode of delivery, and other elements for possible research are discussed.

• Exploring the role of community health workers in providing cancer navigation: perceptions of african american older adults.

  Authors: Jennifer Wenzel, Randy Jones, Rachel Klimmek, Sarah Szanton, Sharon Krumm

  Oncology nursing forum. 39(3):E288-98.

  Purpose/Objectives: To obtain experiential data regarding African American older adult survivors' perceptions of and recommendations on the role of community health workers (CHWs) in providing aPurpose/Objectives: To obtain experiential data regarding African American older adult survivors' perceptions of and recommendations on the role of community health workers (CHWs) in providing a cancer navigation intervention.Research Approach: Focus groups.Setting: Rural Virginia and urban Maryland.Participants: 48 African American solid-tumor cancer survivors, aged 65 years or older, with Medicare insurance.Methodologic Approach: Analysis was accomplished through a reflexive process of transcript review, categorization, and interpretation.Findings: Themes and accompanying categories identified were uneasiness surrounding the CHW role (disconnect between identified support needs and CHW role, essential CHW characteristics, and potential application of CHWs), recommendations to adequately address cancer needs (coordinating cancer treatment and unmet needs during cancer), and the importance of individualized interventions. Participants provided specific recommendations regarding the role of the CHW and how to develop supportive interventions.Conclusions: Study participants had surprisingly limited prior exposure to the CHW role. However, they stated that, in certain circumstances, CHWs could effectively assist older adult African Americans undergoing cancer diagnosis or treatment.Interpretation: Study findings can be helpful to researchers and to healthcare providers engaged in assisting older African Americans during cancer diagnosis and treatment. The results lay a foundation for developing culturally appropriate interventions to assist this at-risk population.

• How women with advanced cancer pray: a report from two focus groups.

  Authors: Amy Rex Smith, Susan Desanto-Madeya, John E Pérez, Elizabeth F Tracey, Susan Decristofaro, Rebecca L Norris, Shruti L Mukkamala

  Oncology nursing forum. 39(3):E310-6.

  Purpose/Objectives: To explore the meaning, function, and focus of prayer for patients with advanced cancer, and to identify the effects of prayer on their coping.Research Approach: Qualitative,Purpose/Objectives: To explore the meaning, function, and focus of prayer for patients with advanced cancer, and to identify the effects of prayer on their coping.Research Approach: Qualitative, descriptive design using focus groups.Setting: Three cancer centers that are part of a university-affiliated comprehensive cancer network in the northeastern United States.Participants: 13 adult, female outpatients receiving active treatment for ovarian or lung cancer.Methodologic Approach: Two semistructured, focus group interviews were conducted. Audiotapes were transcribed verbatim. Data were coded and analyzed using standard content analysis procedures.Main Research Variables: Prayer and coping.Findings: Four themes emerged: finding one's own way, renewed appreciation for life, provision of strength and courage, and gaining a stronger spiritual connection. In addition, praying for others, conversational prayer, petitionary prayer, ritual prayer, and thanksgiving prayer were used most often by participants to cope.Conclusions: The findings support prayer as a positive coping mechanism for women with advanced ovarian or lung cancer.Interpretation: The study provides knowledge about prayer as a source of spiritual and psychological support. Oncology nurses should consider the use of prayer for patients coping with advanced cancer.

• Preserving tradition and embracing change.

  Authors: Susan Moore

  Oncology nursing forum. 39(2):123.

  The cover of this issue doesn't give away the exciting change contained within the pages. If you haven't already looked at the masthead, please flip back a few pages. At the top of the masthead youThe cover of this issue doesn't give away the exciting change contained within the pages. If you haven't already looked at the masthead, please flip back a few pages. At the top of the masthead you will find the name of the new editor of the Oncology Nursing Forum (ONF): Anne Katz, RN, PhD. Anne assumed editorial leadership of this flagship journal effective with this issue, and we are honored to have her at the helm. She is a clinical nurse specialist at the Manitoba Prostate Centre, an adjunct professor in the School of Nursing at the University of Manitoba, and a sexuality counselor for the Department of Psychosocial Oncology, CancerCare, all in Winnipeg, Canada. She has served as the editor for the journal Nursing for Women's Health, the clinical practice journal of the Association of Women's Health, Obstetric, and Neonatal Nursing, and also is a contributing editor for the American Journal of Nursing.

• Lifelong learning for professional oncology nurses.

  Authors: Oncology Nursing Society

  Oncology nursing forum. 39(2):127.

  Nursing, as a profession, is called to lead change and advance health (Institute of Medicine [IOM], 2010). To meet this challenge, nurses must practice a commitment to lifelong learning. LifelongNursing, as a profession, is called to lead change and advance health (Institute of Medicine [IOM], 2010). To meet this challenge, nurses must practice a commitment to lifelong learning. Lifelong learning is the notion that learning occurs along a continuum, from elementary and secondary education to undergraduate and graduate education, lasting through the end of one's career (IOM, 2009). Learning occurs in a variety of methods and across multiple settings including, but not limited to, undergraduate, graduate, and doctoral education, self-study, formal and informal continuing education, and other types of learning.

• Evaluation of outpatient oncology services using lean methodology.

  Authors: Deanna Belter, Jennifer Halsey, Heidi Severtson, Amy Fix, Laura Michelfelder, Karen Michalak, Patty Abella, Angela De Ianni

  Oncology nursing forum. 39(2):136-40.

  The Lean Transformation Process is a methodology created by the Toyota Production System that focuses on the elimination of nonvalue-added operations in the workplace to create flow and quickThe Lean Transformation Process is a methodology created by the Toyota Production System that focuses on the elimination of nonvalue-added operations in the workplace to create flow and quick response to customer demand. The process improvement strategy, when applied to the healthcare setting, can enhance the patient experience by cutting out waste (nonvalue added work) and providing a safer, streamlined visit (Lean Enterprise Institute, 2011). Because providing chemotherapy is a multistep, interdisciplinary process, it is ideal for Lean evaluation. The goal of this application was to improve the overall efficiency of the multidisciplinary chemotherapy process in an oncology infusion center by implementing changes that would decrease patient wait times and improve communication across disciplines.

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