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PTSS and Cancer Survivors

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My ultimate project after these papers will be a poster…
1. The central focus of my project is to research and share/present my findings about Post Traumatic Stress Syndrome in Breast Cancer Survivors. This topic is interesting to me because I have often jokingly swore I have it, and was surprised to find that there is actually research out there about it! My topic will include the studies and outcomes that have been previously completed on this topic.

2. My target audience will be breast cancer survivors, nurses, and practitioners.

3. I plan to implement my project in the breast care setting. I believe it is important for all involved to be as educated as possible about the patients they are working with as well as the patients that are actually going through this diagnosis. I will create a poster about this topic and reveal assessment signs and or symptoms as well as inform patients of available help for anyone experiencing these signs and or symptoms. If applicable, I plan to present my poster during the research portion of our nurse’s week activities. I would also like to display it at our (Hershey Medical Center’s) breast center clinic.

4. Some inter-collaboration strategies I will be needing include contacting our research and nursing education committees for their input and direction of how to make a submission, as well as inquiring through management of the breast cancer center about displaying my poster there.

This is the critique I did on one of the articles if you would incorporate?
Prevalence and Predictors of Post-Traumatic Stress Symptoms
in Adolescent and Young Adult Cancer Survivors: A One Year Follow Up Study

Studies suggest adolescent and young adult cancer survivors experience symptoms of post-traumatic stress (Kwak, Zebrack, Meeske, Embry, Aguilar, Block, Hayes-Lattin, Li, Butler, & Cole, 2013). 1The purpose of this study was to examine the prevalence and predictors of post-traumatic stress symptoms (PTSS) among adolescent and young adult cancer survivors. This literature discussed indications and how Findings showed that PTSS they are recognized as a convincing suggestion of anguish in cancer survivors. 2 No conceptual framework was identified. 4The study was conducted in Oregon, California and Texas. 5Intuitional review board approval was obtained from the coordinating centers, and consent was obtained from each participant recruited for the study.
There were not many published studies that included this group of patients and the associated psychosocial issues they encountered with a cancer diagnosis, such as disturbing memories of their experience, nightmares, and insomnia (Kwak et al., 2012). 1This study’s objective was to detect the occurrence of PTSS six and twelve-months post diagnosis, the hazard of post-traumatic stress disorder (PTSD), and to evaluate whether the incidence of PTSS changed over the first year of diagnosis. It also inspected health status and demographic variables correlated to fluctuations in PTSS.
6The current survey-based study was part of a longitudinal study that was conducted over 2 years. As a portion of a longitudinal study to detect 6 Vvariations in psychological adaptation, quality of life, and health service utilization were examined over time., The current study this study used baseline data collected within the first four months of diagnosis and at one-year post diagnosis. The baseline data included individually reported socio-demographic variables such as marital and relationship status, race, gender, employment, and education status. 7Participants were eligible for this study if were they were diagnosed with cancer had to have a cancer diagnosis between the ages of 14 and 39 years-old, it had to be their first cancer diagnosis and treatment, and they were able had to have the ability to read and understand English or Spanish 7Participants (N=286) were identified by research assistants, and recruited from five tertiary medical centers. 7At six and twelve-month post-diagnosis, 151 (N=151) patients (of the original sample) aged 15–39 years submitted completed both the six-month and 12-month post-diagnosis 8mailed surveys. Age at diagnosis was considered and Respondents were placed into three groupings, based on age at diagnosis, to estimate developmental life stages in accordance to theoretical models of human development (Arnett, 2000). Patients revealed their employment and school situation at both baseline and post diagnosis, as well as at each consequent time point of data gathering.
Additionally, research provision was provided by Hope Lab Foundation, Redwood City, California. After the researchers obtained Institutional Review Board authorization from each participating and the organizing medical center, participants were recruited from five tertiary care medical centers in Los Angeles, Portland, and San Antonio between the dates of March, 2008 and April, 2010. Research staff in clinics recognized 286 appropriate patients and pursued physician agreement for enrollment. Fifty-eight patients were released because either the physicians refused contact with the patients who they believed were too sick to be included, or patients declined to partake. Of the 228 patients engaged and agreed to partake, 12 did not return a completed survey after providing consent, and one passed away. The sample size was 215 or n=215. Conditions for patients to participate in this study were they had to have a cancer diagnosis between the age of 14 and 39 years-old, it had to be their first cancer diagnosis and treatment, and had to have the ability to read and understand English or Spanish. Patient agreement and parental authorization were obtained for those patients under the age of 18 years. Subjects of this study did receive cash incentives for finishing the questionnaires.
8In addition to medical chart reviews to distinguish and cluster subjects with curable forms of cancer, from those with more uncertain prognosis, the use of the Surveillance Epidemiology and End Results Codes, and a symptom checklist, the data collection procedure to assess for PTSS was completed through the application of multiple tools. The Post-traumatic Stress Diagnostic Scale was utilized by replacing the word “traumatic” with “cancer” for relevance purposes. Severity scores for re-experiencing, avoidance, and arousal were also calculated by summing subscale items. The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders was utilized to determine PTSS scores that proposed the possibility of PTSD. In addition, the Brief Symptoms Inventory-18 and the Medical Outcomes Study 36-Item Short Form Health Survey were used to reach their conclusions. These scores were transformed to age and gender formulated paired T-scores on the basis of adult non-patient community norms. 9 Changes in PTSS over time (6-months and 12-months) were analyzed by a pair T-test and tThe Wilcoxon signed-rank test. and Cronbach’s alpha measurement was utilized to estimate the reliability and outcomes of their findings. Also, calculated analyses of variances (ANOVA) and numerous multivariate linear regression analyses and correlations, such as Pearson’s correlation coefficient examined variables that were predictors of change. , were completed to examine the projecting effects of socio-demographic and clinical features on variations in PTSS over time.
The researchers found the Findings revealed that 39% of the participants showed moderate to severe levels of PTSS at 6 months, and 44% of the participants showed moderate to several PTSS at 12 months. 10Rresults of this study also showed re-experiencing (p < .08) and avoidance (p < .28) revealed small declines between the subject’s six month and twelve-month follow-up with a p value of 0.08 and 0.28. Arousal increased slightly over time (p < .3) having a p value of 0.30. Additionally, tThe results suggest the predictors of changes in PTSS over 1 year were seen in subjects who were not employed or in school prior to diagnosis revealed growths in PTSS between 6-month and 12-month follow-up irrespective of their present employment or school status. Those subjects who were employed or in school prior to diagnosis, then discontinued their work or school, described almost no changes in PTSS scores. In addition, Lastly, results showed that subjects who continued to be employed or in school post-diagnosis described slight reductions in PTSS results. “Diagnosis and treatment of cancer constitute stressful and life-threatening events” (Kwak, 2012, p. ?) was supported and, though there was some fluctuation in p values, there was not enough statistical evidence to reject the hypothesis of this study.
1Overall, the findings of this study by Kwak et al (2012) seem reliable and have the possibility to make of making a substantial impact on evidence-based nursing practice in the care of adolescent and young adult cancer patients. 2Based on the Hopkins Scale, the strength and quality of the evidence is III llB (Newhouse, 2005). 3The review of literature supported the need for the study. This article was clear, concise, and well-written. I believe the results of this study supported the significance of this study. The technique as to how the sample size outcome was well defined and adequate, though the population of the locations the subjects were from was not noted. 4Although recruitment strategies were clearly described, the study used convenience sampling, as research assistants identified participants from the tertiary care centers who fit the study’s criteria, rather than using randomized selection. This study’s strong points included its Despite convenience sampling, the sample was adequate, reasonably sized and culturally diverse, and representative of the overall population of adolescent and young-adult cancer survivors. assorted multi-institutional sample d they were selected for this study near the time of their initial diagnoses. In addition, there was a high participation rate of 75% and the study had equal gender distribution. The researchers did not mention power analysis as a way of having determined sample size. It seemed as though the questionnaires were reliable and valid. 5Reliability scores (Cronbach’s alpha) were reported for both the PDS questionnaire and the SF-36 questionnaire, strengthening the internal validity of the study. 6Computerized analysis of data minimized the risk for bias. The data was analyzed without noticed bias, though the hypothesis statement “Diagnosis and treatment of cancer constitute stressful and life-threatening events” (Kwak, 2013) posed an opinionated outcome prior to actually reading the results. In addition, this study is somewhat restricted by the design of the study, because including a control group may have been supportive in approximating a more precise system to evaluate to what degree PTSS is increased by cancer.
In conclusion, I believe without reluctance, the findings can be applied to my clinical practice setting, and without hesitation, and most, health care worker’s practice. For instance, early identification of cancer patients who impose an increased risk of developing PTTS and PTSD may enable us to direct them to the appropriate resources needed to avoid and cope with these symptoms, hopefully increasing quality of care, positive outcomes, and decreasing costs. In addition, I believe raising awareness about the prevalence and predictors of PTSS in adolescent and young adult cancer survivors will ultimately assist in relieving patients of the traumatic experiences they are introduced to with a cancer diagnosis. “Post-traumatic stress symptoms were observed as early as six months following diagnosis and remained stable at 12-month follow-up” (Kwak, 2012). The growth of primary contributions for decreasing anguish among adolescent and young adult patients in treatment would be ideal.

Arnett, Jeffrey Jensen (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469-480.
Kwak, M., Zebrack, B. J., Meeske, K. A., Embry, L., Aguilar, C., Block, R., Cole, S. (2013). Prevalence and predictors of post-traumatic stress symptoms in adolescent and young adult cancer survivors: A 1-year follow-up study. Psycho-Oncology, 22, 1798-1806. DOI: 10.1002/pon.3217
Newhouse, R, Dearholt, S., Pugh, L.C. & White, K. (2005). The Johns Hopkins nursing evidence-based practice rating scale. Baltimore, MD: The Johns Hopkins University School of Nursing

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