Search PubMed⌕ Search

Biomedical subjects

K H Dow

Publications and source records attributed to K H Dow.

26 records · Page 2Linked to original sources
PubMedDate not supplied

Quality of life, survivorship, and psychosocial adjustment of young women with breast cancer after breast-conserving surgery and radiation therapy.

PURPOSE/OBJECTIVES: To examine changes in quality of life (QOL), psychosocial adjustment, and survivorship issues over time of women younger than 45 years who underwent breast-conserving surgery and radiation therapy (RT) for breast cancer. DESIGN: Repeated measures, longitudinal design. METHODS: Data were collected at four time points: start of RT, midpoint of RT, end of RT, and six months after RT. Three instruments were used to collect data: Quality-of-Life Index, Psychosocial Adjustment to Illness Scale, and the newly developed Adaptation to Survivorship Experience. Subjects also participated in an indepth interview at the start of RT. SETTING: A large radiation oncology department located in an urban teaching hospital in the Northeast United States. SAMPLE: 23 women with newly diagnosed stage I or II breast cancer who were starting RT following breast-conserving surgery, with a mean age of 37.8 years (range = 25-45 years). MAIN RESEARCH VARIABLES: QOL, psychosocial adjustment, and adaptation to survivorship experience. FINDINGS: Although subjects adjusted their lives to accommodate RT, QOL declined from the start of RT to midpoint, with gradual improvement reported six months later. Social and sexual adjustment declined from start of RT to six months later. Negative perceptions of the survivorship experience and worry about cancer increased from the start of RT to six months later. CONCLUSIONS: Young women with breast cancer experience changes in QOL, psychosocial adjustment, and adaptation to survivorship issues during RT. Changes may not reflect what is observed in clinical practice. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be aware of changes in QOL, psychosocial adjustment, and survivorship to better understand and support young women during RT.

Adaptation, Psychological↗
PubMedDate not supplied

Decreasing documentation time using a patient self-assessment tool.

A 1986 audit of 150 randomly selected radiation therapy patient records revealed 147 records containing completed nursing assessment and weekly progress notes. Documentation of care provided was comprehensive, but concern was expressed over the length of time it required--an average of 40 minutes for the patient interview and an additional 20 minutes for documentation. Two strategies were proposed to reduce the amount of time spent in documentation without jeopardizing the detail of information contained in the initial nursing assessment: to pilot a patient self-assessment tool based on our original functional health pattern nursing assessment and to develop a standard flow sheet that contained both frequently used nursing diagnoses and potential interventions. Selected patients completed self-assessment records and discussed them with their primary nurses on the first day of treatment. Based on the pilot data, the forms were modified and revised. In 1987, 50 revised patient self-assessment records were reviewed revealing that both subjective and objective information had improved. Documentation time was reduced and information was more comprehensive.

Health Status↗
PubMedDate not supplied

Having children after breast cancer.

Having children after breast cancer is an important clinical issue. Evidence from clinical studies on pregnancy subsequent to breast cancer has not shown a survival disadvantage. Clinical experience suggests that desire for children, support from family, and quality of life issues are also important factors in decisions about pregnancy. This qualitative study was done (1) to identify reasons why young women decide to become pregnant after breast cancer; (2) to describe concerns about subsequent pregnancy; (3) to describe helpful behaviors in decision making; and (4) to explore the meaning of having children after breast cancer. Twenty-three women were identified who had early-stage breast cancer and became pregnant after breast-conserving surgery and radiation therapy. Sixteen women participated in a semi-structured interview. Qualitative data were analyzed for content. Results indicate that pregnancy subsequent to breast cancer is a powerful stimulus for young women to "get well" again. Reasons for subsequent pregnancy were related to the women's developmental age. Young women expressed concerns about the potential for future disease recurrence, about breast self-examination and mammography during pregnancy, and about surviving to see their children grow up. Perceived helpful behaviors included developing a realistic perspective, living with uncertainty, love and support of spouse, and delineating differences between personal and medical decision making.

Adult↗
PubMedDate not supplied

Portraits of cancer survivorship: a glimpse through the lens of survivors' eyes.

Cancer survivorship is a tumultuous experience of balancing the elation of surviving life-threatening illness with the demands of chronic health concerns and altered life meaning. Increased awareness of the needs of cancer survivors is enhanced by large studies of this growing population, but also by appreciation of individual stories of survivorship. "Portraits" of survival, in the form of personal narratives, contribute to our understanding of the experience of cancer. Select portraits from a study exploring quality of life in cancer survivorship are shared to convey themes of rendering an old life, transition to a different life, and living an altered life after cancer diagnosis.

Adaptation, Psychological↗
PubMedDate not supplied

Quality of life and the cancer experience: the state-of-the-knowledge.

PURPOSE/OBJECTIVES: To address the state-of-the-knowledge concerning quality of life (QOL) issues and the cancer experience from theoretical, research, clinical, and educational perspectives. DATA SOURCES: Published books and articles and a panel of experienced QOL experts who convened at the Oncology Nursing Society's State-of-the-knowledge Conference on Quality of Life in February 1995. DATA SYNTHESIS: Despite the evolution and support of QOL in oncology nursing practice, education, and research, there remains gaps in theory, research, and practice related to QOL. This article explores these gaps in knowledge and recommends future directions for QOL theory, research, education, and practice. CONCLUSIONS: Further conceptual work and resolution of QOL methodologic issues to guide clinical practice and education are warranted. The impact of cultural variables and precancer life experiences on patients' perceptions of QOL also must be addressed. NURSING IMPLICATIONS: Oncology nurse clinicians, educators, and researchers must continue to work collaboratively to enhance the knowledge base regarding QOL and to improve the nursing care provided to individuals with cancer.

Adolescent↗
PubMedDate not supplied

Balancing demands of cancer surveillance among survivors of thyroid cancer.

PURPOSE: The purpose of this qualitative study was to explore and describe the demands of long-term cancer surveillance among survivors of thyroid cancer and how these perceived demands influence their quality of life. DESCRIPTION OF STUDY: The sample consisted of 34 participants who had undergone thyroid hormone withdrawal before body scanning for evaluation of cancer recurrence and/or metastatic disease. Participants completed two self-report instruments: 1) a Demographic Data Tool, and 2) three open-ended questions about quality of life during thyroid hormone withdrawal. The participants wrote down their answers to the demographics and open-ended questions. RESULTS: The 34 participants had a mean age of 40 years (range, 22-73 years); 85% were women and 74% were white. All were high school educated, and 32% were college graduates. Sixty-eight percent were married, and 75% were employed either full- or part-time. Participants experienced profound changes in relationship to withdrawal from thyroid hormone medication. These changes in physical well-being coupled with the potential for disease recurrence influenced their psychological and social well-being. Balancing the demands of cancer surveillance (through body scanning and thyroid hormone withdrawal) against day-to-day living had a major influence on perceptions of quality of life. CLINICAL IMPLICATIONS: Study results support other studies and clinical reports that physical symptoms related to thyroid hormone withdrawal were profound, severe, and debilitating. First, participants with thyroid cancer had to learn through their own personal experiences what physical limitations were imposed during the period of surveillance testing. Second, the physical changes and anticipation of body scanning exerted a profound effect on psychological and social well-being. Feelings of loss, anxiety, depression, and loss of concentration were very difficult to endure. Third, given the general characteristics of this population of thyroid cancer survivors who generally are younger and working, the experience of hypothyroidism can have a major impact on work schedules. Individuals who require a large amount of concentrated attention to work tasks may need to modify their work schedules during hypothyroid states. Findings suggest that individuals who are considered "cured" of their disease are a largely forgotten segment of cancer survivors. However, participants in this study continued to inform us of the process of cancer survivorship and the need for exploring quality-of-life concerns, regardless of prognosis.

Adult↗