http://hdl.handle.net/2027.42/60933 Sun, 19 May 2013 03:57:56 GMT 2013-05-19T03:57:56Z http://deepblue.lib.umich.edu:80/bitstream/id/219388/nursing_logo.gif http://hdl.handle.net/2027.42/60933 http://hdl.handle.net/2027.42/97045 Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer Friese, C. R.; Pini, T. M.; Abrahamse, P. H.; Graff, J. J.; Hamilton, A. S.; Jagsi, R.; Janz, N. K.; Hawley, S. T.; Katz, S. J.; Griggs, J. J. Abstract Adjuvant endocrine therapy for breast cancer reduces recurrence and improves survival rates. Many patients never start treatment or discontinue prematurely. A better understanding of factors associated with endocrine therapy initiation and persistence could inform practitioners how to support patients. We analyzed data from a longitudinal study of 2,268 women diagnosed with breast cancer and reported to the Metropolitan Detroit and Los Angeles SEER cancer registries in 2005–2007. Patients were surveyed approximately both 9 months and 4 years after diagnosis. At the 4-year mark, patients were asked if they had initiated endocrine therapy, terminated therapy, or were currently taking therapy (defined as persistence). Multivariable logistic regression models examined factors associated with initiation and persistence. Of the 743 patients eligible for endocrine therapy, 80 (10.8 %) never initiated therapy, 112 (15.1 %) started therapy but discontinued prematurely, and 551 (74.2 %) continued use at the second time point. Compared with whites, Latinas (OR 2.80, 95 % CI 1.08–7.23) and black women (OR 3.63, 95 % CI 1.22–10.78) were more likely to initiate therapy. Other factors associated with initiation included worry about recurrence (OR 3.54, 95 % CI 1.31–9.56) and inadequate information about side effects (OR 0.24, 95 % CI 0.10–0.55). Factors associated with persistence included two or more medications taken weekly (OR 4.19, 95 % CI 2.28–7.68) and increased age (OR 0.98, 95 % CI 0.95–0.99). Enhanced patient education about potential side effects and the effectiveness of adjuvant endocrine therapy in improving outcomes may improve initiation and persistence rates and optimize breast cancer survival. Keywords Breast neoplasms Aromatase inhibitors Selective estrogen receptor modulators Medication taking Health services research Sun, 31 Mar 2013 00:00:00 GMT http://hdl.handle.net/2027.42/97045 2013-03-31T00:00:00Z http://hdl.handle.net/2027.42/96544 Nursing practice environment and outcomes for oncology nursing Shang, J. J.; Friese, C. R.; Wu, E.; Aiken, L. H. BACKGROUND:: It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness. OBJECTIVES:: The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes. METHODS:: A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and χ test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care. RESULTS:: Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position. CONCLUSIONS:: Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes. IMPLICATIONS FOR PRACTICE:: Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses' participation in hospital decision making. Fri, 01 Jun 2012 00:00:00 GMT http://hdl.handle.net/2027.42/96544 2012-06-01T00:00:00Z http://hdl.handle.net/2027.42/96543 Nursing practice environments and job outcomes in ambulatory oncology settings Friese, C. R.; Himes-Ferris, L. OBJECTIVE: The aim of this study was to investigate job satisfaction and intent to stay for ambulatory oncology nurses. BACKGROUND: An oncology provider shortage suggests that retention is a high priority, and factors associated with job outcomes are unknown in this setting. METHOD: Data were derived from a cross-sectional survey completed by 402 oncology nurses employed in ambulatory settings. Logistic regression models estimated the likelihood of job satisfaction or intent to stay for at least 1 year. RESULTS: Most nurses (80.9%) were satisfied and 87.4%indicated their intent to stay. Significant variables for job satisfactionwere university/hospital ownership, staffing and resource adequacy, nurse manager ability and leadership, and workloads. Variables significant for intent to stay were staffing and resource adequacy, participation in practice affairs, and years of experience. CONCLUSIONS: Favorable practice environments are key to effective nurse retention. Staffing, leadership, and resource allocation influence retention in ambulatory settings. Fri, 01 Mar 2013 00:00:00 GMT http://hdl.handle.net/2027.42/96543 2013-03-01T00:00:00Z http://hdl.handle.net/2027.42/96444 Nursing Practice Environment and Outcomes for Oncology Nursing Shang, J.; Friese, C. R.; Wu, E.; Aiken, L. H. BACKGROUND:: It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness. OBJECTIVES:: The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes. METHODS:: A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and χ test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care. RESULTS:: Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position. CONCLUSIONS:: Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes. IMPLICATIONS FOR PRACTICE:: Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses' participation in hospital decision making. Sun, 01 Jan 2012 00:00:00 GMT http://hdl.handle.net/2027.42/96444 2012-01-01T00:00:00Z