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Biomedical subjects

B R Ferrell

Publications and source records attributed to B R Ferrell.

At least 19 recordsLinked to original sources
PubMed2001

Improving cancer care at the end of life.

Excellent care for cancer patients and their families should extend throughout the illness, and should include care provided at the end of life. Recent evidence, including a report from the Institute of Medicine, has emphasised that major reform is needed to improve relief of pain, other symptoms, and psychosocial care. This paper reviews the critical necessity for reform in end-of-life care for the field of oncology and the major educational efforts required to ensure that oncology professionals can respond to this need.

Education, Medical↗
PubMed2001

Ethical dilemmas in pain management.

The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that asked respondents to describe clinical situations in which they had encountered ethical dilemmas. A total of 1,105 surveys were analyzed, with physicians (N = 612), nurses (N = 189), and psychologists (N = 166) representing the professions with the greatest response. Management of pain at the end of life, general undertreatment of pain, and undertreatment of pain in the elderly were the most frequently encountered dilemmas. Qualitative data were analyzed to identify ethical issues in the case examples provided by the respondents. Major themes included inappropriate pain management, barriers to care, interactions and conflicts with others, regulatory/legal issues, euthanasia, assisted suicide, and research issues. We conclude that ethical dilemmas are common in pain management practice and that resolution of these dilemmas requires commitment by individual professionals as well as health systems.

Journal Article↗
PubMed2000

Nurses' personal opinions about patients' pain and their effect on recorded assessments and titration of opioid doses.

In many clinical settings, nurses have a vital role in pain assessment and titration of opioid doses. Surveys of nurses have revealed knowledge deficits in these areas that are thought to contribute to under-treatment of pain. The present study surveys nurses' decisions about assessment and treatment of pain in 2 patient situations and confirms that nurses continue to undertreat severe pain. As shown in previous studies, nurses may be more influenced by the patient's behavior than the patient's self-report of pain, especially in relation to decisions about opioid titration. Nurses are less likely to increase a previously safe but ineffective dose of opioid for a smiling patient than a grimacing patient. Survey results reveal a tendency for nurses' personal opinions about the patients' pain, rather than their recorded assessments, to influence choice of opioid dose and to contribute to undertreatment of pain.

Analgesics, Opioid↗
PubMed1999

Analysis of symptom assessment and management content in nursing textbooks.

This article reports on one goal of a project designed to improve end-of-life (EOL) care in nursing education. The goal was to improve the content regarding pain and EOL care included in major textbooks used in nursing education. A descriptive study design was selected using content analysis of 50 texts selected from a potential of over 700 texts. The 50 texts included 45,683 pages. The text review was conducted using an analysis framework encompassing 9 essential areas of EOL care. The study methods included content analysis as well as quantification of the content present in the texts. The 9 areas of the analysis framework were: palliative care defined; quality of life; pain; other symptom assessment/management; communication with dying patients and families; role/needs of family caregivers in EOL care; death; issues of policy, ethics, and law; and bereavement. This article reports on the findings of the analysis related to symptom assessment/management. Nursing texts have limited content on symptom assessment and management. Increased attention to this area, a critical role of nursing, is essential to improved care for patients at EOL.

Journal Article↗
PubMed1999

Family caregiving in cancer pain management.

The experience of cancer pain is known to greatly affect family caregivers as well as patients. There are many demands placed on caregivers of cancer patients with pain at home as a result of the shifting of care from the acute setting to the home. These complex demands significantly affect caregiver quality of life. The purpose of this study was to describe the experience of pain management from the perspective of family caregivers of patients with cancer amidst the current healthcare environment. This quasi-experimental study involved 231 family caregivers of patients with cancer pain receiving home care. Family caregivers were assessed in conjunction with a pain education program that provided patient and. family education regarding pain assessment, drug and nondrug interventions. Assessment measures used were the Quality of Life (QOL)-Family Caregiver Tool, Knowledge and Attitudes about Pain (K&A) Tool, and Caregiver Finances Tool. Study findings reveal disruption to family caregiver quality of life in the areas of physical, psychological, social, and spiritual well-being. There is also a continued need for education regarding cancer pain management. Comparison between patients and family caregivers demonstrates that pain impacts both the patient experiencing it and their caregivers.

Journal Article↗
PubMed1999

The meaning of quality of life in cancer survivorship.

PURPOSE/OBJECTIVES: To describe the meaning of quality of life (QOL) in long-term cancer survivors, to validate inductively derived QOL themes, and to identify and cluster over-arching themes across long-term cancer survivors. DESIGN: Qualitative study that was part of a larger, cross-sectional survey. SETTING/SAMPLE: 687 (57% response) cancer survivors at an average of 6.7 years after diagnosis. In the sample, 81% were female (with a mean age of 49.6 years), 72% were college educated, 63% were married, and 49% worked full time. METHODS: Mailed survey of three open-ended questions and standard QOL tools. A QOL conceptual model was used to frame the research study, describe the QOL responses of the participants, and explore the meaning of cancer survivorship. Content analysis was used to answer the research questions. Data collection and analysis occurred sequentially. MAIN RESEARCH CONCEPTS: Meaning, QOL cancer survivorship. FINDINGS: 25 of 30 inductively derived QOL themes were validated in this study of long-term cancer survivors; 107 additional QOL themes were identified and clustered into 11 over-arching themes across the entire data set. Over-arching themes included struggle between independence-dependence, balance, wholeness, life purpose, reclaiming life, multiple losses, having control, altered meaning of health, and surviving cancer from a family perspective. IMPLICATIONS FOR NURSING PRACTICE: The meaning of QOL in long-term cancer survivors is multifaceted and complex. CONCLUSIONS: Nurses can use this broader conception of QOL in breast cancer survivors to help patients prepare for and cope with adjustments.

Adaptation, Psychological↗
PubMed1999

Patient and family caregiver perspectives.

The introduction of any new analgesic agent or delivery system is often focused on efficacy of the agent or on considerations of use by health care professionals. Introduction of novel pain technologies should also consider the ultimate recipients of the treatments, i.e., patients and family caregivers at home. This article reviews four frequently ignored issues in the integration of new pain treatments. These are 1) recognizing that pain is managed by patients and family caregivers at home; 2) acknowledging patient and family caregivers' knowledge and beliefs about pain; 3) recognizing cost considerations; and 4) identifying common ethical dilemmas in managing pain at home. Attention to these considerations will ensure optimum pain relief and support of patients and their family caregivers.

Analgesics↗
PubMed1998

Improving end-of-life care education in home care.

A training program for home care professionals, HOPE (Home care Outreach for Palliative care Education), was designed to improve the knowledge and skills of those providing care to patients and family caregivers at home. This article presents an overview of the pilot HOPE training program and a case study to illustrate the complex end-of-life (EOL) care needs in nonhospice home care settings. HOPE was designed as five training modules based on a needs assessment survey completed by 134 home care agencies. The training modules were composed of (a) General Overview of End of Life Care; (b) Pain Management; (c) Symptom Management; (d) Communication with Patients and Families; and (e) the Death Event. The program was implemented for clinical staff (N = 52), predominantly nurses, in two home care agencies and evaluated with pre- and postcourse surveys. Pre- and postcourse evaluations demonstrated an increase in the overall rating of EOL care from a mean rating of 5.97 to 7.42 for self-assessment and from 6.59 to 7.94 for agency assessment (on a scale of 0 = not at all effective to 10 = very effective). Future palliative care education should also include evaluation of the impact of such programs on patient care. We concluded that increasing palliative care knowledge of home care professionals is necessary to improve patient care at the EOL.

Journal Article↗
PubMed1998

Quality of life in breast cancer. Part II: Psychological and spiritual well-being.

With an increasing number of women surviving breast cancer beyond treatment, the focus of care has shifted from the acute treatment-related side effects to long-term effects associated with changes in quality of life (QOL). Part I of this article described the impact of breast cancer on the domains of physical and social well-being of 21 long-term survivors of breast cancer through qualitative analysis. Part II explores the impact of breast cancer on the domains of psychological and spiritual well-being.

Adaptation, Psychological↗
PubMed1998

Quality of life in breast cancer survivors: implications for developing support services.

PURPOSE/OBJECTIVES: Quality of life (QOL) is becoming more important in regard to breast cancer as treatment advances extend the period of survivorship. The purpose of this article is to share the results of a cancer center's attempt to evaluate the QOL needs of breast cancer survivors in order to provide improved supportive-care services. DESIGN: Descriptive mailed survey. SETTING: A medical center in southern California. SAMPLE: A random sample of breast cancer survivors (N = 298). METHODS: Breast cancer survivors completed a mailed survey that included major outcome variables of QOL and pain. Subjects were stratified by three age groups: younger than 40 years, 40-60 years, and older than 60 years. MAIN RESEARCH VARIABLES: QOL subscales (physical, psychological, social, and spiritual well-being) and overall QOL score and pain as assessed by the Brief Pain Inventory. FINDINGS: Results indicated continued physical demands of breast cancer, including fatigue and pain, as well as psychological burdens related to fear of breast cancer recurrence and anxiety. The social well-being domain indicated some unique aspects of QOL when applied to breast cancer survivorship such as the fear of breast cancer in female relatives. The spiritual well-being domain illustrated the unique QOL aspects of life-threatening illness such as living with uncertainty and maintaining hope. Breast cancer survivors also reported positive aspects and life changes after successfully facing breast cancer. CONCLUSIONS: Breast cancer survivors experience many demands of illness across the physical, psychological, social, and spiritual domains. IMPLICATIONS FOR NURSING PRACTICE: The study's findings can be useful in directing cancer centers' efforts to provide comprehensive care for breast cancer survivors. Nurses play a critical role in leading these efforts for supportive-care services intended to improve the QOL of breast cancer survivors.

Adaptation, Psychological↗
PubMed1997

Quality of life in breast cancer survivors as identified by focus groups.

Currently, over 1,700,000 women are living with breast cancer in the United States. These long-term survivors of breast cancer are challenged to redirect their energy from issues of cancer treatment and early side effects toward quality of life issues related to long-term survivorship, such as menopause, infertility, fear of recurrence, family distress, and uncertainty. In an attempt to obtain patient perspectives on quality of life and health care issues faced by breast cancer survivors, focus group methodology was utilized in the first year of a 2 year study. The sample was stratified to represent three age groups: < 40 years, 40-60 years, and > 60, and was intended to represent different developmental levels believed to have varying experiences with quality of life and potentially divergent needs following breast cancer diagnosis. Results of these focus groups revealed unique quality of life concerns of breast cancer survivors across four domains of physical, psychological, social, and spiritual well being. Each of these domains yields important implications for future research and clinical practice.

Adaptation, Psychological↗
PubMed1997

Cancer pain education for patients.

OBJECTIVES: To review the basic principles of patient education, models of innovative approaches to patient education, and needs for future development in patient education. DATA SOURCES: Review articles, research studies, book chapters, personal communication, and standards pertaining to cancer pain education. CONCLUSIONS: Patient education based on principles of effective teaching and learning is the cornerstone of effective pain management. Improved methods of patient teaching combined with novel approaches to delivering appropriate pain content can lead to enhanced patient compliance with the prescribed pain medication regimen. IMPLICATIONS FOR NURSING PRACTICE: Nurses are essential to improving the care of cancer patients in pain by providing patient education as a care component of professional nursing practice. The challenge remains to overcome significant barriers of limited time and resources to achieve these goals.

Curriculum↗