Journal of The American College of Surgeons, Dec 1, 2006
The Quality Initiative in Rectal Cancer (QIRC) Strategy randomized 16 hospitals across Ontario to... more The Quality Initiative in Rectal Cancer (QIRC) Strategy randomized 16 hospitals across Ontario to the QIRC strategy versus minimal intervention. The strategy included a workshop, recruitment of a local opinion leader (OL), operative demonstrations, postoperative checklists, audit, and feedback. Surgeons at each intervention hospital used a standardized approach to select a local OL from their ranks. We assessed the experiences of OL and non-OL surgeons in the QIRC strategy. Semi-structured qualitative telephone interviews were completed with 8 OLs and 8 non-OL surgeons. Interviews were guided by Grounded Theory. Initial interviews were assessed to ensure that domains of interest were fully explored. Two investigators (FW, MF) independently reviewed all final transcripts and identified themes. Consensus among all investigators was achieved for final themes. All approached surgeons participated in interviews. Seven themes were identified: surgical OLs with subspecialist expertise were supported; surgical OL requires technical expertise; limited role for local OL on changing physician practice in rectal cancer operations; limited effect of identifying local OL on local interactions; operative demonstrations supported; characteristics of operative demonstrator were important; and perceived positive effect of the QIRC strategy on practice. The experience of local OLs in this trial appears to be mixed. Although some of the themes support the concept of a local OL, other themes suggest the local OL had a limited role and effect. The overall QIRC strategy, and in particular the operative demonstration, was viewed positively and was perceived to have a positive longterm effect on participants' practice.
Patients with cancer undergoing treatment with chemotherapy or radiation therapy may experience a... more Patients with cancer undergoing treatment with chemotherapy or radiation therapy may experience a range of treatment-related side effects. One of the most common and most distressing side effects is treatment-induced emesis. The severity of the symptom is great enough to cause some patients to refuse treatments, delay appointments or discontinue therapy entirely. Experiencing treatment-induced nausea and vomiting can create a spectrum of issues for patients and their families and seriously influence their quality of life. Managing nausea and vomiting induced by cancer therapy is of critical importance. A team approach, inclusive of the patient, can be most effective. Nurses play a pivotal role in assessing patterns of nausea and vomiting and the usefulness of anti-emetic therapy, evaluating and updating treatment/care plans and helping the patient and family to cope with the disease and its treatment.
BACKGROUND/MATERIALS AND METHODS: A battery of instruments intended to predict the likelihood of ... more BACKGROUND/MATERIALS AND METHODS: A battery of instruments intended to predict the likelihood of future psychosocial distress in patients with cancer was developed and tested. The battery consists of newly-developed items for constructs relating to social support and to past coping experiences. Embedded within the past coping items are items on future illness-dependent expectations. The battery also incorporates previously developed instruments for recent stressful life events (Sarason) and the presence of anxiety or depression (SCL-90-R). The reliability of the entire instrument was determined in 2 similar groups of patients with cancer. Results: The illness-dependent expectations items were stable and internally consistent. The past coping and social support items possessed stability, but did not possess sufficient internal consistency for either to be used as a scale. The recent stressful life event scores were not stable in either patient group over the two week retest interval. For the SCL-90-R, internal consistencies and stability coefficients are acceptable for all symptom dimensions with the exception of the stability coefficient for hostility.
Building upon the findings of a recent qualitative investigation of women&amp... more Building upon the findings of a recent qualitative investigation of women's experiences with rehabilitative vaginal dilator use, the primary goal of this article is to outline a set of preliminary clinical care recommendations that health care professionals may draw upon in addressing women's unique experiences with vaginal dilator use including their multifaceted struggles with the procedure, possibly enhancing adherence to this practice. Ten women participated in in-depth interviews regarding their experiences with using the dilator as prescribed by their health care providers. Following the analysis of these interviews, members of the interdisciplinary research team met to review and discuss the development of clinical care recommendations stemming from these findings. Eight care recommendations aimed at addressing the concerns expressed by the women interviewed and at improving women's overall experiences with rehabilitative dilator use emerged: (1) introduce the dilator in a light and straightforward manner; (2) enhance dilator accessibility; (3) introduce the vaginal dilator early on in treatment; (4) emphasize health maintenance over intercourse as a benefit of dilator use; (5) explore and acknowledge women's values and views of sexuality; (6) increase awareness and sensitivity to emotional reactions; (7) enhance psychoeducational resources for supporting vaginal dilator use; and (8) ensure consistent institutional practice when introducing the dilator. The clinical care recommendations proposed here reflect the various challenges women may encounter when using the vaginal dilator--which vary from practical to, for some, profoundly emotional--and are designed to better position health care providers to help women navigate these challenges.
One of the important aspects of stakeholder engagement in cancer care and system planning is hear... more One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.
One of the important aspects of stakeholder engagement in cancer care and system planning is hear... more One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.
One of the important aspects of stakeholder engagement in cancer care and system planning is hear... more One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.
Journal of The American College of Surgeons, Dec 1, 2006
The Quality Initiative in Rectal Cancer (QIRC) Strategy randomized 16 hospitals across Ontario to... more The Quality Initiative in Rectal Cancer (QIRC) Strategy randomized 16 hospitals across Ontario to the QIRC strategy versus minimal intervention. The strategy included a workshop, recruitment of a local opinion leader (OL), operative demonstrations, postoperative checklists, audit, and feedback. Surgeons at each intervention hospital used a standardized approach to select a local OL from their ranks. We assessed the experiences of OL and non-OL surgeons in the QIRC strategy. Semi-structured qualitative telephone interviews were completed with 8 OLs and 8 non-OL surgeons. Interviews were guided by Grounded Theory. Initial interviews were assessed to ensure that domains of interest were fully explored. Two investigators (FW, MF) independently reviewed all final transcripts and identified themes. Consensus among all investigators was achieved for final themes. All approached surgeons participated in interviews. Seven themes were identified: surgical OLs with subspecialist expertise were supported; surgical OL requires technical expertise; limited role for local OL on changing physician practice in rectal cancer operations; limited effect of identifying local OL on local interactions; operative demonstrations supported; characteristics of operative demonstrator were important; and perceived positive effect of the QIRC strategy on practice. The experience of local OLs in this trial appears to be mixed. Although some of the themes support the concept of a local OL, other themes suggest the local OL had a limited role and effect. The overall QIRC strategy, and in particular the operative demonstration, was viewed positively and was perceived to have a positive longterm effect on participants' practice.
Patients with cancer undergoing treatment with chemotherapy or radiation therapy may experience a... more Patients with cancer undergoing treatment with chemotherapy or radiation therapy may experience a range of treatment-related side effects. One of the most common and most distressing side effects is treatment-induced emesis. The severity of the symptom is great enough to cause some patients to refuse treatments, delay appointments or discontinue therapy entirely. Experiencing treatment-induced nausea and vomiting can create a spectrum of issues for patients and their families and seriously influence their quality of life. Managing nausea and vomiting induced by cancer therapy is of critical importance. A team approach, inclusive of the patient, can be most effective. Nurses play a pivotal role in assessing patterns of nausea and vomiting and the usefulness of anti-emetic therapy, evaluating and updating treatment/care plans and helping the patient and family to cope with the disease and its treatment.
BACKGROUND/MATERIALS AND METHODS: A battery of instruments intended to predict the likelihood of ... more BACKGROUND/MATERIALS AND METHODS: A battery of instruments intended to predict the likelihood of future psychosocial distress in patients with cancer was developed and tested. The battery consists of newly-developed items for constructs relating to social support and to past coping experiences. Embedded within the past coping items are items on future illness-dependent expectations. The battery also incorporates previously developed instruments for recent stressful life events (Sarason) and the presence of anxiety or depression (SCL-90-R). The reliability of the entire instrument was determined in 2 similar groups of patients with cancer. Results: The illness-dependent expectations items were stable and internally consistent. The past coping and social support items possessed stability, but did not possess sufficient internal consistency for either to be used as a scale. The recent stressful life event scores were not stable in either patient group over the two week retest interval. For the SCL-90-R, internal consistencies and stability coefficients are acceptable for all symptom dimensions with the exception of the stability coefficient for hostility.
Building upon the findings of a recent qualitative investigation of women&amp... more Building upon the findings of a recent qualitative investigation of women's experiences with rehabilitative vaginal dilator use, the primary goal of this article is to outline a set of preliminary clinical care recommendations that health care professionals may draw upon in addressing women's unique experiences with vaginal dilator use including their multifaceted struggles with the procedure, possibly enhancing adherence to this practice. Ten women participated in in-depth interviews regarding their experiences with using the dilator as prescribed by their health care providers. Following the analysis of these interviews, members of the interdisciplinary research team met to review and discuss the development of clinical care recommendations stemming from these findings. Eight care recommendations aimed at addressing the concerns expressed by the women interviewed and at improving women's overall experiences with rehabilitative dilator use emerged: (1) introduce the dilator in a light and straightforward manner; (2) enhance dilator accessibility; (3) introduce the vaginal dilator early on in treatment; (4) emphasize health maintenance over intercourse as a benefit of dilator use; (5) explore and acknowledge women's values and views of sexuality; (6) increase awareness and sensitivity to emotional reactions; (7) enhance psychoeducational resources for supporting vaginal dilator use; and (8) ensure consistent institutional practice when introducing the dilator. The clinical care recommendations proposed here reflect the various challenges women may encounter when using the vaginal dilator--which vary from practical to, for some, profoundly emotional--and are designed to better position health care providers to help women navigate these challenges.
One of the important aspects of stakeholder engagement in cancer care and system planning is hear... more One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.
One of the important aspects of stakeholder engagement in cancer care and system planning is hear... more One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.
One of the important aspects of stakeholder engagement in cancer care and system planning is hear... more One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.
Uploads