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Full-Text Articles in Medicine and Health Sciences
Translating Capable To Micapable In A State Waiver Program: Community Aging In Place For Better Elderly Living, Sandra Spoelstra
Translating Capable To Micapable In A State Waiver Program: Community Aging In Place For Better Elderly Living, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Poster Presentation
Recruitment & Enrollment Of Older Adults Into Mobile Phone Text Message Clinical Trials, Sandra Spoelstra
Recruitment & Enrollment Of Older Adults Into Mobile Phone Text Message Clinical Trials, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Poster Presentation
Feasibility Of A Text Messaging Intervention To Promote Symptom Management And Medication Adherence For Patients Prescribed Oral Anti-Cancer Agents, Sandra Spoelstra
Feasibility Of A Text Messaging Intervention To Promote Symptom Management And Medication Adherence For Patients Prescribed Oral Anti-Cancer Agents, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: When taking oral anti-cancer agents (OAs), patients need to manage symptoms so that they do not become so severe that it leads to reducing or stopping the medication, rendering the cancer treatment ineffective.
Problem & Purpose: Cancer rates are increasing, as is the number of cancer patients treated with OAs. Therapeutic effect of the cancer treatment may depend on medication adherence. The purpose of this paper is to report on proof-of-concept and preliminary efficacy of a mHealth intervention using text messages to improve symptom management and medication adherence among cancer patients prescribed OAs.
Framework: Principles of Self-Efficacy …
Proof-Of-Concept And Preliminary Efficacy Of A Sms Text Messaging Intervention To Promote Symptom Management And Medication Adherence For Patients Prescribed Oral Anti-Cancer Agents: A Randomized Controlled Trial, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: Cancer rates are increasing, as is the number of cancer patients treated with oral anti-cancer agents (OAs). Therapeutic effects may depend on medication adherence. The purpose of this study was to determine proof-of-concept of SMS text messaging intervention among cancer patients prescribed OAs and examined preliminary efficacy of SMS for symptom management and OA adherence.
Conceptual Framework: Self-Efficacy Theory directed heightening self-efficacy to promote adherence and symptom management.
Method:Patients (N=80) enrolled inalongitudinal randomized controlled trial at two community cancer centers and a large specialty pharmacy. Data on adherence and symptoms were collected weekly …
Assessment And Measurement Of Medication Adherence: Ons Pep Oral Anti-Cancer Agents, Sandra Spoelstra
Assessment And Measurement Of Medication Adherence: Ons Pep Oral Anti-Cancer Agents, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: Oral anti-cancer agent (OA) adherence is often sub-optimal and may influence cancer treatment success. Clinicians are challenged to find ways to assess and measure adherence to OAs.
Problem & Purpose: When assessing and measuring OA adherence, it is essential to evaluate the timing, dosage, frequency, and duration of the regimen. The purpose of this paper is to report on the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative to examine tools to assess and measure medication adherence.
Framework: Not applicable.
Methods: A review of the literature on tools using MEDLINE, the National Library of …
Ons Pep Putting Evidence Into Practice: Evidence-Based Interventions For Oral Anti-Cancer Agents, Sandra Spoelstra
Ons Pep Putting Evidence Into Practice: Evidence-Based Interventions For Oral Anti-Cancer Agents, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: Adherence to oral anti-cancer agents is a significant clinical problem among patients who are very sick with a life threatening disease and may have a substantial impact on treatment success or failure.
Problem & Purpose: The limited evidence available suggests that adherence to oral anti-cancer agents is a significant clinical problem and may have a substantial impact on treatment success or failure. The purpose of this paper is to report on the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for patients prescribed …
Feasibility Of A Text Messaging Intervention To Promote Symptom Management And Medication Adherence For Patients Prescribed Oral Anti-Cancer Agents, Sandra Spoelstra
Feasibility Of A Text Messaging Intervention To Promote Symptom Management And Medication Adherence For Patients Prescribed Oral Anti-Cancer Agents, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: When taking oral anti-cancer agents (OAs), patients need to manage symptoms so that they do not become so severe that it leads to reducing or stopping the medication, rendering the cancer treatment ineffective.
Problem & Purpose: Cancer rates are increasing, as is the number of cancer patients treated with OAs. Therapeutic effect of the cancer treatment may depend on medication adherence. The purpose of this paper is to report on proof-of-concept and preliminary efficacy of a mHealth intervention using text messages to improve symptom management and medication adherence among cancer patients prescribed OAs.
Framework: Principles of Self-Efficacy …
Acceptability And Preliminary Efficacy Of A Sms Text Message Intervention In Older Cancer Patients, Sandra Spoelstra
Acceptability And Preliminary Efficacy Of A Sms Text Message Intervention In Older Cancer Patients, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Symposium Presentation
The Symptom Experience While Taking Oral Anti-Cancer Medication (Chemotherapy Or Targeted Agents), Sandra Spoelstra
The Symptom Experience While Taking Oral Anti-Cancer Medication (Chemotherapy Or Targeted Agents), Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Background: Over 50-oral agents are on the market, and within three years, 25% of treatment will be in pill form, shifting the responsibility for symptom management to the patients. Symptoms need to be managed so they do not become so severe that it leads to reducing or stopping the medication, potentially rendering the cancer treatment ineffective. A gap in the literature exists, with no studies reporting the symptom experience of patients taking oral agents. Prior to developing interventions for patients at home setting on oral agents, we need to determine if symptoms are similar to those treated with IV chemotherapy. …
Symptom Attribution Of Older Cancer Patients With Comorbid Conditions During Chemotherapy Treatment, Sandra Spoelstra
Symptom Attribution Of Older Cancer Patients With Comorbid Conditions During Chemotherapy Treatment, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Background:Over 60% of those who are diagnosed with cancer are older adults, and 75% have comorbid conditions. 15% of cancer treatment is now in pill form; and it is expected to grow to 25% within 3-years. Having comorbid conditions in addition to cancer may exacerbate symptom severity. As a consequence of these symptoms, some patients adjust, interrupt, or stop dosages of the oral agent, which may affect cancer treatment.
Purpose: This study describes the attribution of symptoms (fatigue, pain, numbness/tingling, sleep disturbance, diarrhea, distress, swelling in hands/feet, lack of appetite, constipation, shortness of breath, redness/swelling/pain in hands or …
Acceptability And Preliminary Efficacy Of A Sms Text Message Intervention In Older Cancer Patients, Sandra Spoelstra
Acceptability And Preliminary Efficacy Of A Sms Text Message Intervention In Older Cancer Patients, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
With 68% of adults owning cell phones, text messaging (herein, SMS) may be a means to prompt self-management. A 10-week trial of a 4-week SMS intervention enrolled 80 patients from 2 cancer centers and a specialty pharmacy. Regarding acceptability, 56.3% (80/142) of eligible consented. Mean age of consented was 58.5 (range 39-82); eligible not consented 57.24 (range 32-92); and ineligible 63.6 (range 26-82). Of 142 approached, consent rate according to age was: 60% (27 of 45) for those 65+; 53% (35 of 66) for those 50-64; and 58.1% (18 of 31) for those <50. Females represented 59% (n=47) of consented, …
Translating Evidence-Based Care In A State Waiver Program To Reduce Transitions, Sandra Spoelstra
Translating Evidence-Based Care In A State Waiver Program To Reduce Transitions, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Disability reflects a gap between an individual’s abilities and the environment in which they function, and is the primary modifiable factor in preventing institutionalization. We report on a pilot study testing dissemination and implementation of a proven intervention, intervening directly on pain, medication management, strength and balance, depression and the home environment, in the State of Michigan waiver program to reduce re-institutionalization. We are enrolling 20 clients who were hospitalized or nursing home within the past 14-days, and providing the intervention plus usual waiver services. We will compare those 20 to a match (age, race, gender) cohort from 2012 who …
Feasibility Of Text Messaging To Improve Oral Anti-Cancer Adherence In Older Cancer Patients, Sandra Spoelstra
Feasibility Of Text Messaging To Improve Oral Anti-Cancer Adherence In Older Cancer Patients, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
BACKGROUND
More than 50 oral chemotherapy agents in pill form are on the market, with projections that in 3 years, 25% of cancer treatment will be in pill form. For oral agents to achieve a therapeutically effective level for cancer treatment, patients must strictly adhere to the regimen. However, adherence is often less than 80%, which may be inadequate for treating the cancer. There are more than 285 million wireless subscribers in the US with an estimated 67.5% of adults owning cell phones and 98% of those phones having text messaging capability. A recent review of 12 trials on interventions …
Motivational Interviewing & Cognitive Behavioral Therapy To Promote Adherence In Cancer Patients Taking Oral Agent Medications: An Integrative Review, Sandra Spoelstra
Motivational Interviewing & Cognitive Behavioral Therapy To Promote Adherence In Cancer Patients Taking Oral Agent Medications: An Integrative Review, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: Patients with cancer miss as much as one-third of the prescribed doses of oral anti-cancer agents required for treatment of their disease.
Problem & Purpose: This shift in treatment results in care at home, placing responsibility on patients. This review will discuss the foundation for developing a combined motivational interviewing (MI) and brief cognitive behavioral therapy (CBT) intervention and will examine evidence on MI/CBT interventions that improved adherence.
Framework: Not applicable.
Methods: Whittemore and Knafl’s review method was used, identifying studies via a search in CINAHL and PubMed using key words of MI/CBT; and reviewing of references.
Findings: 2822 …
Symptom Severity, Symptom Attribution, And Preference For Assistance While Taking Chemotherapy Or Targeted Agents, Sandra Spoelstra
Symptom Severity, Symptom Attribution, And Preference For Assistance While Taking Chemotherapy Or Targeted Agents, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: When taking oral agents, patients need to manage symptoms so that they do not become so severe that it leads to decreased function and difficulty with activities of daily living, and reducing or stopping the medication, rendering the cancer treatment ineffective.
Problem & Purpose: Over fifty oral anti-cancer agents are currently on the market, and within three years, 25% of treatment will be delivered in pill form, shifting treatment to the responsibility of patients. This study describes symptoms from oral agents, attribution of symptoms, and preference for assistance.
Framework: Not applicable.
Methods: Thirty cancer patients taking …
Text Messaging To Promote Adherence In Cancer Patients Taking Oral Agent Medications: An Integrative Review, Sandra Spoelstra
Text Messaging To Promote Adherence In Cancer Patients Taking Oral Agent Medications: An Integrative Review, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: A review of oral agent studies indicates less than an 80% rate of adherence; and 10% of those newly prescribed oral agents stop taking their medication. Lack of adherence to oral anti-cancer agents is a significant clinical problem that may result in treatment failure, hospitalization, loss of work, and, in some instances, death.
Problem & Purpose: Treatment is primarily the responsibility of patients who are prescribed oral agents. This review will discuss the foundation for developing a text message intervention and will examine evidence on text message interventions that improved adherence.
Framework: Not applicable.
Methods: Whittemore and …
Development Of A Risk Index To Predict Transfers From Home And Community-Based Waiver Programs To Nursing Homes: Can Care Managers Assist Older Adults To Delay Nursing Home Placement?, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Purpose: This research examines the risk of nursing home placement (NHP) among an inception cohort of 6525 older adults entering a statewide home and community-based waiver program between 2002—2007.
Background: With adults aged 65 and older currently comprising 15% of the population and growing exponentially, concern is mounting as to how to care for this group. It will be important to deliver high-quality care tailored to the needs of clients in order to allow these individuals to remain living in the community. Most older adults prefer to remain in their homes but are forced to transfer to NHs because …
A Multi-Disciplinary Collaboration To Promote Adherence In Cancer Patients Taking Oral Agent Medications, Sandra Spoelstra
A Multi-Disciplinary Collaboration To Promote Adherence In Cancer Patients Taking Oral Agent Medications, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Problem and State of the Science: Over 50 oral agents in pill form are currently on the market, with projections that in three years, 25% of cancer treatment will be delivered in pill form with patients assuming responsibility for self-management at home. For oral agents to achieve a therapeutically effective level for cancer treatment, patients must strictly adhere to the regimen. Adherence to oral cancer agents is often less than 80%, which may be inadequate for treating the cancer. Many barriers exist to promoting medication adherence for cancer patients in fast-paced office settings. This include time demands, focusing on physical …
Determining Preferences For Symptom Management Assistance While Taking Oral Anti-Cancer Agent Pills, Sandra Spoelstra
Determining Preferences For Symptom Management Assistance While Taking Oral Anti-Cancer Agent Pills, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Nearly 50 oral anti-cancer agents are on the market, and it’s projected that in 3 years, 25% of chemotherapy will be delivered in pill form. Thus, patients must take responsibility for managing symptoms at home. This was an 8-week exploratory study of cancer patients on oral agents from 3 cancer centers in the Midwest. Baseline interviews collected characteristics, type/stage of cancer, symptoms, and comorbid conditions. Patients were asked preference for information to help manage symptoms. Mean age was 65.2 years, 50% were Female, 87% Caucasian and 13% African American. Preference for obtaining symptom management information included: 37% phone calls, 27% …
Can Nursing Home Transfer Be Delayed If Home And Community-Based Waiver Personal Care Services Are Increased?, Sandra Spoelstra
Can Nursing Home Transfer Be Delayed If Home And Community-Based Waiver Personal Care Services Are Increased?, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
There is a pressing need to retain the dually eligible elderly in the community.This research compared the use and cost of personal care services (PCS) and nursing home placement (NHP) among 7302 older adults aged 65 and older in a statewide home and community-based waiver program. A model was developed to estimate costs of increased PCS to compare savings associated with remaining the community versus NHP. The second to last and last Minimum Data Set-Home Care assessments and Medicaid claims files were examined. Median hours of PCS and savings based on average cost were calculated. Median hours of PCS were …
Patient Beliefs And Their Influence On Adherence To Oral Anti-Cancer Agents, Sandra Spoelstra
Patient Beliefs And Their Influence On Adherence To Oral Anti-Cancer Agents, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance: To focus clinicians on what to address with patients on oral agents to promote adherence.
Problem & Purpose: With increased use of oral anti-cancer agents, patients are responsible for adhering to complex regimens. The aim of this study was to explore beliefs about oral anti-cancer agents and describe how those beliefs were associated with adherence to the regimens among 119 solid tumor cancer patients taking oral agent regimens.
Framework: The trial assessed beliefs about oral anti-cancer agents and used a cognitive behavioral model to compare the impact of: usual care with strategies to manage symptoms and adherence, …
Do Elderly Cancer Survivors Have More Pain? A Comparison Of Cancer Survivors To Those Without Cancer, Sandra Spoelstra
Do Elderly Cancer Survivors Have More Pain? A Comparison Of Cancer Survivors To Those Without Cancer, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Introduction: Pain can impact the quality of life of cancer survivors. This research determined if a difference in pain existed among elderly cancer survivors compared to a like group of elderly without a cancer diagnosis. A synthesized aging and nursing model was used to guide this study.
Method: A longitudinal, secondary data analysis compared 865 cancer survivors to 8617 elderly without cancer. Data from the Michigan Home and Community Based Services program Minimum Data Set was linked to the Cancer Registry (2002-2007). Those with and without cancer were matched on age, race, and sex. Generalized Estimating Equations modeling were …
Interventions To Improve Adherence And Symptoms For Oral Agents, Sandra Spoelstra
Interventions To Improve Adherence And Symptoms For Oral Agents, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance & Background:
With increased use of oral chemotherapy agents to treat cancer, patients are responsible for adhering to complex dosing regimens and to self-monitor symptoms.
Purpose:
This study determined through a three arm trial of 119 patients with solid tumors from four Cancer Centers, how an Automated Voice Response (AVR) system alone (n=40), or the AVR complemented by nurse strategies to manage symptoms and adherence (n=40), or to manage adherence alone (n=39), reduced symptom severity and non-adherence to oral chemotherapy.
Conceptual Framework:
This trial compared an educational approach to symptom management coupled with reminders to take medications …
The Influence Of Comorbidities On Use Of #11;Symptom Management Strategies, Sandra Spoelstra
The Influence Of Comorbidities On Use Of #11;Symptom Management Strategies, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
This research examines 552 solid tumor cancer patients undergoing chemotherapy, the impact of comorbidities on patient’s use of management strategies for 15 common symptoms during treatment. After adjusting for age and intervention mode, number of comorbidities was significantly related to number of symptoms threshold; ranging from 5.5—7.5 (no comorbidity to 3+). However, numbers of comorbidities had no impact on patients trying proposed strategies. To determine if age adjusted numbers of comorbidities influenced proportion of symptoms, severe, moderate, mild cut-points were applied and responses were defined as moving from severe to moderate/mild, or moderate to mild. Mean response rates among patients …
Falls And Fractures In Community Dwelling Elderly Cancer Survivors, Sandra Spoelstra
Falls And Fractures In Community Dwelling Elderly Cancer Survivors, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Significance & Background:
Cancer survivors are living longer, but continue to encounter physical, psychosocial, and economic impacts of cancer until end of life. Of all types of injuries, falls pose the most serious threat to quality of life in the elderly.
Purpose: The purpose of this study was to examine the impact of a cancer diagnosis on falls and fractures.
Conceptual Framework: An aging and nursing model of care were synthesized.
Methods & Analysis:
This is a longitudinal, retrospective, study comparing 865 with cancer to 8617 without cancer. We analyzed data from the Michigan Home …
Explaining Transfers From Home And Community Based Waiver Program To Nursing Home: Can Patients Stay At Home?, Sandra Spoelstra
Explaining Transfers From Home And Community Based Waiver Program To Nursing Home: Can Patients Stay At Home?, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Purpose Among6,836 medically and economically vulnerable older persons enrolled in a Home and Community Based Waiver (HCBW) program between 2003 and 2007 we compare those who remain at home with those who transfer to a nursing home (NH).
Background NHs is costly, averaging over $70,000 per year. Beyond escalating financial concerns, there are a constellation of potentially negative outcomes associated with NH admission, and most older adults prefer to remain in their homes but are forced to transfer to NHs because community supports are inadequate to meet their needs.
Methods Those who remained at home (4343) and NH …
Falls, Fall Sequale, And Healthcare In Aging Community Dwelling Elderly Cancer Survivors, Sandra Spoelstra
Falls, Fall Sequale, And Healthcare In Aging Community Dwelling Elderly Cancer Survivors, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
The influence of cancer on elderly is examined in a Home and Community Based Waiver program during 2002-2007. A comparison of with cancer (865) to without cancer (8617) on falls, fractures and healthcare use occurred. Data were obtained from Minimum Data Set assessments, vital records, and claims. Mean age was 77.1 years, 67.8% female, 74.0% Caucasian. Cancers was 92.7% > stage 2. Falls were 35.9% (304) with cancer and 25.3% (2,174) with non-cancer, a significant difference (p-value 0.01); hip fractures were 4.6% (38) and 5.3% (449) p-value 0.38; service use: ER 35.4% (295) to 22.2% (1904) and hospitalization 13.1% (109) …
The Influence Of Medications On Falls In Community Dwelling Elderly, Sandra Spoelstra
The Influence Of Medications On Falls In Community Dwelling Elderly, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Problem Statement Medication use can place older adults at risk for falls and increased health care utilization. A need exists to better understand medication use in the community dwelling elderly and how it may contribute to falls and utilization of health care services. This study compares and contrasts those elderly with a significant amount of medications to those without a significant amount of medications to determine if certain types, as well as the number of medications impacts falls. The hypothesis is that there is a relationship between patients with more medications or between certain of these drug classes and falls. …
Frailty And Falls In Commuity Dwelling Elderly Cancer Survivors, Sandra Spoelstra
Frailty And Falls In Commuity Dwelling Elderly Cancer Survivors, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Aim:
Cancer survivors are diagnosed at an older age, with treatment often complicated by comorbidities which may exacerbate functional decline. The purposes of this study were to examine1) the effect of cancer diagnosis on frailty (activities of daily living, cognition, depression, incontinence, weight loss, vision, and hearing) and 2) differences in falls by site, stage, or cancer treatment. The hypothesis is that elderly cancer survivors experience the influence of the disease or treatment of cancer, and have increased frailty and falls. A synthesized aging and nursing model of care is being used.
Method:
This is a longitudinal, retrospective, cohort …
The Influence Of Cancer On Falls In Community Dwelling Elderly, Sandra Spoelstra
The Influence Of Cancer On Falls In Community Dwelling Elderly, Sandra Spoelstra
Sandra L. Spoelstra, PhD, RN, FGSA, FAAN
Cancer survivors are living longer, and encounter physical, psychosocial, and economic impacts until the end of life. However studies examining whether a cancer diagnosis alters the rate of falls in elderly survivors are rare. This retrospective, longitudinal cohort study examined community dwelling elderly in a home based waiver program to identify if individuals with a diagnosis of cancer experience falls at a higher rate than those without cancer. The Minimum Data Set in a State in the Midwest was used to examine cancer, age, gender, race and ethnicity, poor vision, reduced ADLs, reduced IADLS, cognitive skill, incontinence, pain, or depression …