Randal D. Beaton’s research while affiliated with University of Washington and other places

Background Patients with advanced cancer are prone to experience burdensome physical, psychological, and financial consequences. Healthcare providers may not fully appreciate advanced cancer patients’ medical care autonomy, such as at that emboded by Advance Care Planning (ACP), and by doing so may compromise their quality of end-of-life (EOL). Hence, it is essential for healthcare providers to effectively assess and communicate with patients’ regarding their medical decisions before their patients are incapacitated by their disease progression. The purpose of this investigation was to describe the decisional balance, attitudes, and practice behaviors of ACP and its predictors of ACP-related experiences in Taiwanese patients with advanced cancer. Methods This cross-sectional, descriptive study employed a mixed-methodsquantitative and qualitative design with a sample of 166 patients that were purposely recruited from in-patient oncology units at a regional teaching hospital in southern Taiwan. Study data consisted of patient replies to a 34-item self-report tool, Decisional Balance, Attitudes, Practice Behaviors of ACP (DAP-ACP) and 4 semi-structured questions. Result Findings indicated that, in general, study participants exhibited favorable ACP-decisional balance and positive ACP-attitudes & practice behaviors. The results also indicated that gender, educational level, and cancer diagnosis were associated with significant differences on the “ACP-decisional balance” and “ACP-attitudes” scales. In addition, our findings documented that the participants’ gender and educational level were significant predictors of both ACP-decisional balance and ACP-attitudes. Furthermore the participants’ ACP-practice behaviors were predicted by ACP-decisional balance, but not with their ACP-attitudes. The qualitative analysis of the semi-structured questions identified six themes in responses to current medical decision making (e.g., compliance with physician instructions, family engagement in treatment decision-making); and eight themes pertaining to future ACP-related concerns were identified (e.g., family conflict, effectiveness of time-limited trials). Conclusion To promote patients’ engagement in ACP, the healthcare professional need to assess and advocate patients’ concerns or attitudes regarding ACP in a timely manner. In addition, factors or concerns that might influence patients’ responses to ACP derived from both the quantitative and qualitative findings of this current study need to be considered especially in initiating the dialogue regarding ACP with patients with advanced cancer. Trial registration No. CYCH 2,019,072, Date of registration 5 Dec 2019.

Abstract Background End-stage renal disease (ESRD) is a major chronic illness worldwide, and Taiwan reports one of the highest incidence rates of ESRD with 529 cases per million population (pmp). A number of patients with ESRD patients might require lifelong hemodialysis (HD) or peritoneal dialyses (PD). Due to the progression of dialysis, patients are likely to experience other chronic comorbidities, anxiety and depression, frequent hospitalizations, and higher rates of mortality compared to patients with other types of chronic illnesses. As a result, dialysis patients are prone to experience advance care planning (ACP) needs, such as whether they withdraw from receiving dialysis while approaching their end-of-life (EOL). Yet, existing studies have shown that dialysis patients seldom receive timely consultation regarding ACP and there are limited studies examining ACP amongst Taiwan HD patients. Purpose The purpose of this study was to examine ACP awareness, contemplation, self-efficacy and readiness; and factors influencing ACP readiness. Design This cross-sectional descriptive study with convenience sampling was conducted in the out-patient HD unit at a regional teaching hospital in southern Taiwan. A total of 143 ESRD patients undergoing HD treatments were recruited. A 55-item ACP engagement survey containing the subscales of awareness, contemplation, self-efficacy, and readiness was employed. The data were analyzed with t-tests, one-way ANOVAs, Pearson’s correlations and multiple regressions. Results The results of our investigation revealed that approximately half of the participants (n = 67, 46.9%) were not informed of ACP. Although they reported considering their EOL, medical decisions and desired care, they demonstrated significantly low self-efficacy in discussing ACP (t= -5.272, p

Purpose Many colorectal cancer (CRC) patients report having Oxaliplatin-induced peripheral neuropathy (OXAIPN), compromising their overall quality of life (QoL). Yet, the existing studies on examining the effects of elastic-band resistance exercise yielded inconsistent results and there was a scare study with CRC population employing a longitudinal research design. The purpose of this non-randomized preliminary study was to examine the effects of an educational program providing skills and knowledge about OXAIPN along with home-based lower extremity elastic-band exercise training in a sample (n = 42) of Taiwanese patients with CRC. Method A quasi-experimental study with one-group, pretest-posttest repeated measures and longitudinal design was employed. The 4.5-month interventional protocol included 8 sessions of face-to-face education from the 3rd to the 7th cycles of chemotherapy. Physical exams, muscle strength and endurance, and self-reports regarding adverse impacts of OXAIPN and QoL were obtained at three time points throughout chemotherapy course. Results The most consistently significant increase was the participants' muscle strength and endurance measured with one-repetition maximum and 6-min walk distance, respectively (both P < .001). The participants’ OXAIPN-related QoL showed significant improvements at some time points of the chemotherapy cycles, but not others. Conclusion Study findings indicated that an educational program combined with knowledge about OXAIPN symptom management and skills with lower extremity resistance training had potential benefits over time on muscle strength and endurance and autonomic dimension of CIPN-related QoL. These preliminarily results may assist healthcare providers to incorporate self-management strategies such as lower extremity exercise for patients with OXAIPN to partially mitigate its negative effects.

Background: Despite the documented and well known patient benefits of ACP, the completion of ACP, only a minority of patients, during the advanced or EOL stage of their illnesses, receive such care. The misconceptions about ACP for healthcare providers, such as nurses, might become potential barriers to the effective implication of ACP. Also, from the transcultural perspective, it is evident essential to explore Taiwanese nurses' attitudes, knowledge, and actions of ACP. The purposes of this study were to explore the implication of ACP or hospice care for nurses caring for non-cancer chronic illness patients at a regional teaching hospital in Taiwan; and, to identify predictors of those nurses' knowledge, attitudes, and actions toward ACP. Methods: This cross-sectional study with a purposive sample of 218 nurses was conducted at a teaching hospital in southern Taiwan. Structured questionnaires were employed and data were analyzed with descriptive statistics, t-test, one-way ANOVAs, Pearson's correlation and multiple regressions. Results: 16.1% of Taiwanese physicians actively initiated ACP issues or conversations with patients or their family members. Nurses' attitudes toward ACP were fairly positive but their knowledge about ACP was insufficient and actions of ACP were not positively executed. The predictors of ACP-Knowledge (ACP-K) included position title, education hours and lacking of educational training. The predictors of ACP-Attitude (ACP-A) included ACP-K and "fear of patient or family member not accepting", whereas ACP-A, position title, "patients do not feel necessary" and "not sure physician's concern" were the predictors of ACP-Act. Conclusion: Continuous education and training for nurses regarding ACP needs to be improved by taking those predictors found in this current study into account, and more studies on the nurse's role in ACP also should be further examined. Trial registration: KAFGH 106-012. Date of registration 1 May 2017.

The purpose of this study was to evaluate the longitudinal incidence, severity, pattern of changes or predictors of oxaliplatin‐induced peripheral neuropathy (OXAIPN) in Taiwanese patients with colorectal cancer. A longitudinal repeated measures study design was employed, and 77 participants were recruited from the colorectal and oncology departments of two teaching medical centres in Taiwan. Physical examinations were performed, and self‐reports regarding adverse impacts of OXAIPN and quality of life were obtained at five time points throughout 12 cycles of chemotherapy (C/T). The incidence of OXAIPN increased with C/T cycles (31.1%–81.9%), and the upper limb numbness and cold sensitivity were most significant acute OXAIPN symptoms (29.9%–73.6%). Findings also documented significant increases in overall severity, symptom distress, interference and physical results associated with OXAIPN over the course of C/T. Predictors of OXAIPN severity varied by treatment cycle, including younger patient, higher cumulative dose of oxaliplatin, greater body surface area, receipt of chemotherapy in winter and the occurrence of OXAIPN during prior C/T cycles. The results from this study might help healthcare providers to recognise the symptom characteristics, degree of influences, trends and high‐risk group of OXAIPN, facilitating early evaluation and potential interventions to mitigate or prevent negative effects of OXAIPN on patients.

Objectives To explore the prevalence, discomfort, and self-relief behaviours of painful diabetic neuropathy (PDN) among rural community residents with type 2 diabetes. Design A community-based, cross-sectional study. Setting This study was part of a longitudinal cohort study of a nurse-led health promotion programme for preventing foot ulceration in Chiayi County, Taiwan. Participants Six hundred and twenty-eight community adults with type 2 diabetes participated in this study. Outcome measures Parameters assessed included peripheral neuropathy, peripheral vasculopathy, glycaemic control and metabolic biomarkers. Statistical analyses included descriptive statistics and a multivariate logistic regression model. Results About 30.6% of participants (192/628) had PDN. Factors associated with PDN included an abnormal ankle brachial index (ABI; OR=3.4; 95% CI 1.9 to 6.2; p<0.001), Michigan neuropathy screening index (OR=1.69; 95% CI 1.0 to 2.6; p=0.021), triglyceride level (OR=1.61; 95% CI 1.0 to 2.4; p=0.036) and being female (OR=1.68; 95% CI 1.1 to 2.4; p=0.022). PDN was characterised by uncomfortable feelings of prickling, stinging or burning pain and inexplicable dullness around the base or dorsal areas of the feet, but received little attention or treatment from primary healthcare providers. Conclusions A high prevalence of PDN was found in rural community residents with type 2 diabetes and the healthcare workers provided little attention to, or treatment of, discomfort. It is important to identify high-risk groups with PDN early in order to prevent foot ulceration and reduce the incidence of amputation of the extremities. It is also urgent to develop appropriate treatment and self-relief behaviours to halt or reverse the progression of PDN for this population living in rural areas.

An investigation was made into the role of blood pH in the regulation of food intake. Rats were each subjected to five treatments: acid injection, base injection, two saline injections, and no-injection control. Eating behavior was monitored directly after these treatments. The negative results indicated that blood pH probably does not serve as a hunger cue.

Despite extensive progress in the scientific understanding and the control of pain, 51–77% of patients with cancer, especially for patients with advanced cancer or approaching end-of-life phase, still experience moderate to severe pain at some time during their illness. This cancer pain can and does erode the quality of life of this patient population. For this and other reasons it is important for health professionals to advocate for appropriate pharmacological and non-pharmacological modalities, such as massage therapy (MT), for pain management in patients with cancer. Evidence from studies reviewed in this chapter documents that patients/subjects in massage groups appeared to have more positive outcomes compared to those in control groups in terms of decreasing pain intensity, nausea or vomiting, fatigue, distressing symptoms, anxiety, depression, and self-reports of relaxation. These and associated effects on measures of physiological arousal (blood pressure) can be documented during massages as well as 5 min, 10–20 min, and 2–3 h following massage, but not beyond 24 h. In contrast, the most notable inconsistent massage effects are more relevant to sleep, quality of life, and stress adaptation indicators (i.e. heart rate, respiratory rate, cortisol, IgA and α-amylase, natural killer cells or lymphocytes). Future studies with well-designed trials and research directed at the mechanism will clarify potential sensitive indications, subgroup effects in terms of types or dose of massage, types or stage of cancer or type of symptom as well as, the mechanism of massage and in which circumstance it does and does not work. Importantly, MT interventions examined in this systematic review appear to be safe for patients with cancer which is also feasible for patients with advanced cancer or bone metastases and MT appears to enhance the quality of life for this population.

This case study describes the process and outcomes of the Northwest Center for Public Health Practice Child and Family Disaster Research Training (UWDRT) Program housed at the University of Washington, which used web-based distance learning technology. The purposes of this program were to provide training and to establish a regional cadre of researchers and clinicians; to increase disaster mental health research capacity and collaboration; and to improve the scientific rigor of research investigations of disaster mental health in children and families. Despite a number of obstacles encountered in development and implementation, outcomes of this program included increased team member awareness and knowledge of child and family disaster mental health issues; improved disaster and public health instruction and training independent of the UWDRT program; informed local and state disaster response preparedness and response; and contributions to the child and family disaster mental health research literature.