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Background: Although resourcefulness has been successfully taught during formal training programs, it can also be acquired informally through life experiences. Family caregivers have many opportunities for learning to be resourceful on their own and those who participate in research may acquire knowledge or skills that increase their resourcefulness. The effects of such differential experiences on the resourcefulness of family caregivers have not been examined over time., Objective: This study compared changes in resourcefulness over time in caregivers who received no intervention, an educational program, biofeedback, or Resourcefulness Training © ., Methods: This longitudinal analysis of data from a randomized controlled trial involved 219 caregivers of persons with bipolar disorder who completed the Resourcefulness Scale © before no intervention, an educational program, biofeedback, or Resourcefulness Training, and at 6 and 12 months afterward. Differences across the groups were examined using RMANOVA. Patterns of mean scores including differences and linear trends in resourcefulness for the four groups were examined., Results: Overall, caregivers increased linearly in resourcefulness over time [ F (1,215) = 4.836, P  = .015]. Although each group showed improvement in resourcefulness, caregivers who received Resourcefulness Training showed the greatest improvement from baseline (estimated mean = 88.244, SE = 2.734) at both 6 months (estimated mean = 92.610, SE = 2.813, P  = .026) and 12 months post-intervention (estimated mean = 95.049, SE = 2.752, P  = .003)., Conclusions: Consistent with resourcefulness theory, the findings showed caregivers of persons with bipolar disorder became more resourceful over time with or without formal training. However, those who received Resourcefulness Training demonstrated resourcefulness skills sooner and to a greater extent, thereby providing the rationale for formal Resourcefulness Training programs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To evaluate the impact that a pharmacist-managed oral anticancer clinic has on patient adherence to oral anticancer therapy in regard to medication adherence and adherence to lab monitoring., Methods: A retrospective chart review was completed for patients prescribed abiraterone, enzalutamide, or ibrutinib within the study time period. The primary outcome was assessing medication adherence by comparing the medication possession ratio (MPR) before (Phase 1) and after (Phase 2) initiation of the pharmacist-led oral anticancer therapy clinic. The secondary outcome was assessing lab monitoring adherence by patients and providers in Phase 1 and Phase 2. This will be done by assessing whether labs were ordered at the appropriate time frame by oncology providers, as well as whether or not the patient came and got these labs drawn. This study will also examine outcomes related to the pharmacist-led oral anticancer therapy clinic (phase 2) for descriptive purposes., Results: A total of 189 charts were analyzed with 134 excluded and 55 included (25 patients in phase 1 and 30 patients in phase 2). Independent sample t -test analyses revealed a statistically significant increase ( t (30.57) = -1.99; p  = 0.027) in the MPR ratio between phase 1 (mean = 0.98, SD = 0.13) compared to phase 2 (mean = 1.04, SD = 0.08). For patient adherence to lab monitoring, there was a statistically significant improvement between phase 1 and phase 2 for patients on abiraterone (21.9% vs 67%; t (25) = -5.73; p  < 0.001) and enzalutamide (35.7% vs. 90.5%; t (8) = -3.26; p  = 0.006). However, for patients on ibrutinib, there was a slight decline in lab monitoring adherence between phase 1 and phase 2 but this effect was not statistically significant (56.2% vs. 51%; t (17) = 0.58; p  = 0.283). Similar results were shown for provider adherence to lab monitoring. Descriptive outcomes showed that the pharmacist had, on average, 6.7 encounters per patient with the majority being phone and face-to-face appointments., Conclusions: Data from this study demonstrated that a pharmacist-led oral anticancer clinic can improve MPR ratios and patient adherence to oral anticancer medication regimens. In addition, patient and provider lab monitoring adherence was improved for abiraterone and enzalutamide. Improvement in patient and provider lab monitoring adherence for ibrutinib was not shown, possibly due to the impact of the COVID-19 pandemic, relatively small sample size, and retrospective nature of this study. The results of this study support that overall, a pharmacist-led oral anticancer clinic can significantly improve patient outcomes, which aligns with previous smaller studies that have shown similar benefits., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies.A causal model was developed and tested using structural equation modeling that examined depression scores of 503 older (age 50-85), male Veterans with moderate to severe symptomatic OA of the knee\hip.The results of the structural equation modeling produced a final model of depressive symptomatology that fit the data well (Chi square = 12.23, DF = 11, p = .346; TLI = .99; CFI = 1.00; RMSEA = .02).The findings indicate the central role that OA severity (pain, stiffness, and functional difficulties) plays in the mental health of older Veterans in terms of the level of reported depressive symptoms.

The autoregressive model is a useful tool to analyze longitudinal data. It is particularly suitable for gerontological research as autoregressive models can be used to establish the causal relationship within a single variable over time as well as the causal ordering between two or more variables (e.g., physical health and psychological well-being) over time through bivariate autoregressive cross-lagged or contemporaneous models. Specifically, bivariate autoregressive models can explore the cross-lagged effects between two variables over time to determine the proper causal ordering between these variables. The advantage of analyzing cross-lagged effects is to test for the strength of prediction between two variables controlling for each variable's previous time score as well as the autoregressive component of the model. Bivariate autoregressive contemporaneous models can also be used to determine causal ordering within the same time point when compared to cross-lagged effects. Since the technique uses structural equation modeling, models are also adjusted for measurement error. This paper will present an introduction to setting up models and a step-by-step approach to analyzing univariate simplex autoregressive models, bivariate autoregressive cross-lagged models, and bivariate autoregressive contemporaneous models.

Although family caregivers who use both the personal and social resourcefulness skills have the best health outcomes, it is unknown whether their tendency toward personal or social resourcefulness varies by their care recipient's condition. This cross-sectional study of existing data from 234 caregivers of persons with various conditions examined five item pairs from the Resourcefulness Scale © with responses capturing personal and social resourcefulness in relation to anxiety, anger, sadness, indecision, and financial distress. Caregivers were categorized by the recipient's condition (amyotrophic lateral sclerosis, cancer, dementia, mental illness, Parkinson's disease, stroke, traumatic brain injury, other, or multiple conditions). Findings showed that across most groups, caregivers used both personal and social resourcefulness when angry, sad, or indecisive and personal resourcefulness when anxious or managing money. Caregivers of persons with cancer, traumatic brain injury, stroke, and mental illness differed. The findings provide a basis for future clinical trials across diverse caregiver groups.

Purpose: Research supports holistic expansion of the construct of resourcefulness by adding spiritual practices to the existing personal and social dimensions. This study describes the development and testing of items to measure spiritual resourcefulness. Methods/Design: Study phases were: (1) focus group development of item stems and responses; (2) expert testing; (3) scale construction; (4) field testing in 234 family caregivers; and (5) psychometric analysis to identify items for inclusion in a final scale. Findings: A focus group developed 40 item stems with potential responses reflecting three conceptual components of spiritual practices (rational, ritualistic, and relational). Content experts selected the best response for each item. A six-point Likert scale consistent with the Resourcefulness Scale © was constructed. Data from field testing were factor analyzed. The best solution revealed two factors containing 12 items. Ritualistic and relational items loaded together (44.7% variance explained). Rational items loaded separately (19.5% variance explained). Higher-order factor analysis indicated the two subscales reflected a single construct (71.93% variance explained; r  = .44, p  < .001). Conclusion: Availability of a psychometrically sound measure of spiritual resourcefulness is critical to expand resourcefulness training interventions to be more holistic. Clinical interventions can be enriched by including strategies to enhance personal, social, and spiritual resourcefulness skills.

Purpose: Proton pump inhibitors (PPIs) are commonly used medications and are historically well tolerated. Recent studies have linked PPI use to the development of chronic kidney disease (CKD) and end-stage renal disease. This study investigated the impact of discontinuing PPIs on renal function in patients with CKD. Methods: We conducted a retrospective chart review of patients with established CKD, defined as 2 eGFR (estimated glomerular filtration rate) measurements of less than 60 mL/min/1.73 m 2 at least 90 days apart, who were on a PPI from January 1, 2014 to December 31, 2014, with a medication possession ratio greater than or equal to 70%. We compared baseline eGFR to a final eGFR after at least 6 months of discontinuation or continuation of a PPI. After power analysis, we targeted an enrollment of 200 patients (100 in each group) to achieve a power of 0.80 and an alpha of 0.05. Summary: A total of 97 patients in the PPI discontinuation group and 100 patients in the PPI continuation group met the study inclusion criteria. Baseline eGFR in the PPI continuation group was 47.9 mL/min/1.73 m 2 and 50.7 mL/min/1.73 m 2 in the discontinuation group. Final eGFR in the PPI continuation group was significantly higher than baseline at 51.1 mL/min/1.73 m 2 (+3.25 ± 12.8, P = .01). Final eGFR in the PPI discontinuation group was 51.8 mL/min/1.73 m 2 (+1.09 ± 12.8, P = .3). The average time between baseline and final eGFRs was 270 days in the PPI continuation group and 301 days in the discontinuation group. There was no statistically significant difference in the change in eGFRs between groups (95% confidence interval [CI] = -5.48-2.03, P = .37). Conclusions: Proton pump inhibitor discontinuation after prolonged continuous use in patients with CKD was not associated with a significant change in renal function after 1 year., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

Mindfulness, resilience, and resourcefulness are theoretically distinct but related constructs critical for improving psychosocial well-being outcomes for informal caregivers and others. Our aims were to evaluate the theoretical and operational distinctions among these constructs. Measures of mindfulness (Decentering Scale), resilience (Connor-Davidson Scale) and resourcefulness (Resourcefulness Scale) were collected from a national sample of 348 grandmother caregivers. We conducted exploratory factor analysis and examined correlation patterns. Inter-correlations ranged from r= .26 (resourcefulness and resilience) to r= .73 (resilience and mindfulness). Factor analyses and scree plots indicated unidimensional factors for resilience and for mindfulness, and two factors for resourcefulness (personal and social). When items from all measures were analyzed together, the four factors remained. Distinct relationships were found between mindfulness, resilience, and resourcefulness with relevant external variables. Our results support the conceptual distinctions among the constructs, providing support for interventions targeting these constructs to improve psychosocial outcomes in caregivers.

Objective: This article examines the relative importance of cancer-related and noncancer illness factors as they predict the health quality of life among older adult, long-term cancer survivors. Specifically, it examines the effects that continuing cancer symptoms and comorbidities have on functional difficulties and how they in turn affect perceptions of disability and self-rated health., Method: Data from an National Cancer Institute (NCI)-funded, tumor registry-based 10-year study of 321 older adult (age 60+), long-term (5+years post diagnosis) survivors of breast colorectal and prostate cancer are examined using regression analyses., Results: The analyses documented the independent effects of both cancer-related and age-related health factors as they contribute to explaining functional difficulties, perceptions of disability and self-rated health. Gender and racial differences in health quality of life were also identified., Discussion: The findings suggest that geriatricians, geriatric nurses, and clinical gerontologists who work with cancer survivorsneed to be aware of the ways in which both cancer and noncancer illness factors work together in producing threats to health quality of life through the extent and nature of functional impairments.

A recent increase in children living with grandparents places more children at increased risk for emotional, psychological, or behavioral problems. This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to examine how children's living situation, parental monitoring, child's resourcefulness, and perceived support affect depressive symptoms and perceived family functioning. Of participants, 36% ( n = 56) lived with their parents only, 44% ( n = 69) lived with a grandmother as their primary caregiver, and 20% ( n = 31) lived in a multigenerational household. Results indicate parental monitoring and support affected perceptions of family functioning. Subjective support and resourcefulness affected depressive symptoms. No effects were found from living situation and demographic factors. Resourcefulness had the strongest effect on depressive symptoms, with a 3-point decrease in symptoms for each incremental increase in resourcefulness. This study provides insight into factors influencing children's depressive symptoms and perceived family functioning, and provides direction for the development of future interventions.

Background: Advance directives (ADs) have traditionally been viewed as clear instructions for implementing patient wishes at times of compromised decision-making capacity (DMC). However, whether individuals prefer ADs to be strictly followed or to serve as general guidelines has not been studied. The Veterans Administration's Advance Directive Durable Power of Attorney for Health Care and Living Will (VA AD) provides patients the opportunity to indicate specific treatment preferences and to indicate how strictly the directive is to be followed., Objective: To describe preferences for life-sustaining treatments (LSTs) in various illness conditions as well as instructions for the use of VA ADs., Design/setting: A descriptive study was performed collecting data from all ADs entered into the medical record at 1 VA Medical Center between January and June 2014., Measurements: Responses to VA AD with emphasis on health care agents (HCAs) and LW responses., Results: Veterans were more likely to reject LST when death was imminent (74.6%), when in a coma (71.1%), if they had brain damage (70.6%), or were ventilator dependent (70.4%). A majority (67.4%) of veterans preferred the document to be followed generally rather than strictly. Veterans were more likely to want VA ADs to serve as a general guide when a spouse was named HCA., Conclusion: Most of the sampled veterans rejected LST except under conditions of permanent disability. A majority intend VA ADs to serve as general guidelines rather than strict, binding instructions. These findings have significant implications for surrogate decision making and the use of ADs more generally.

Providing care for an elder with dementia can produce extreme stress that adversely affects caregiver health. Learning to be resourceful, which involves practicing resourcefulness skills using a journal or voice recorder, may reduce caregiver stress. However, before testing the effectiveness of journaling and voice recording as resourcefulness training (RT) practice methods, intervention fidelity should first be established. This pilot trial with 63 women dementia caregivers examined the fidelity of journaling and voice recording and whether allowing a choice between the methods affected RT intervention fidelity. Following RT, Resourcefulness Scale scores were similar for journal and recorder methods but higher for caregivers in the choice versus random condition. Patterns of RT skill use documented in journals or recordings were similar for choice and random conditions and for journal and recorder methods. The results support the implementation fidelity of RT that allows caregivers to choose a method to reinforce their resourcefulness skills., (© The Author(s) 2016.)

The latent growth curve model (LGCM) is a useful tool in analyzing longitudinal data. It is particularly suitable for gerontological research because the LGCM can track the trajectories and changes of phenomena (e.g., physical health and psychological well-being) over time. Specifically, the LGCM compares lines of change across a set of individuals and determines the overall model's line of change. LGCMs can be used to track either linear or curvilinear trajectories. Since the technique uses structural equation modeling, models are also adjusted for measurement error. This article will present a step-by-step approach to setting up, analyzing, and interpreting an LGCM using post-hospitalization recovery in depressive symptomatology as an example. This article will demonstrate how to test linear, quadratic, and freely estimated lines of change using LGCMs with the purpose of finding the line of trajectory for depressive symptoms that best fits the data., (© The Author(s) 2016.)

Few resources are available to help grandmother caregivers to grandchildren manage their complex family situations that may have immediate and long-term consequences for themselves and their families. Resourcefulness training is an intervention designed to help grandmothers improve their ability to deal with these problems. The purpose of this pilot study was to evaluate the necessity, feasibility, acceptability, fidelity, safety, and effectiveness (i.e., effect sizes) of an online, computer-based resourcefulness training intervention that was adapted from a face-to-face intervention. Twelve grandmothers raising or living with grandchildren participated in the pilot intervention that included (a) watching an instructional video on resourcefulness, (b) completing two online questionnaires over a 6-week time period, and (c) writing in an online journal every day for 4 weeks. Data are evaluated within the context of the six parameters important to intervention development. Qualitative and quantitative results provide initial support for all six parameters. Recommendations to improve aspects of the intervention are discussed., (© The Author(s) 2015.)

Over one million American grandmothers raise grandchildren, and many experience stress that adversely affects their mental health. Teaching resourcefulness skills can minimize this stress. However, before testing effectiveness of resourcefulness training (RT), its fidelity must be established. This pilot intervention trial examined the fidelity of two methods of RT: expressive writing (journaling) and verbal disclosure (voice recording) using a quasi-experimental design with random assignment of 80 grandmothers to RT-expressive writing, RT-verbal disclosure, or expressive writing or verbal disclosure alone. Quantitative data (Resourcefulness Scale) and qualitative data (journals, recordings) were collected. Grandmothers with RT showed greater resourcefulness over time than those without RT, with similar effects for RT-expressive writing and RT-verbal disclosure. Evidence for the use of RT skills was found in journals and recordings. The findings provide support for RT intervention fidelity and support moving forward to test RT effectiveness in reducing grandmothers' stress and promoting their mental health.

Recognition of the family as a component of patient-centered critical care has shifted our attention to the assessment of family satisfaction in the intensive care unit (ICU). To date, there are no established measures of satisfaction with ICU care for family members of the chronically critically ill (CCI). This study evaluated psychometric properties of the Critical Care Family Satisfaction Survey (CCFSS) in 326 family members of the CCI using exploratory and confirmatory factor analysis (CFA). From the exploratory factor analysis, two unique structural models emerged, each with alpha coefficients of .72 to .91 and discriminant validity among factors (r < .70). The CFA confirmed the best-fitting structural model was a 14-item, three-factor solution (χ(2) = 354, df = 148, p < .001, Tucker Lewis Index = .88, Comparative Fit Index = .90, root mean square error of approximation = .06). Thus, the modified 14-item version of the CCFSS is reliable and valid in family members of CCI patients.

The purpose of this study was to describe nurses' knowledge, attitudes, and experiences regarding advance directives. A secondary purpose was to examine predictors of advance directive discussions between nurses and patients. Seven-hundred and nineteen respondents, randomly selected from a list of registered nurses in the state of Ohio, completed mailed questionnaires. Descriptive t test, chi-square, and logistic regression statistics were used in the data analyses. The respondents were knowledgeable and possessed positive attitudes about advance directives. Higher self-perceived confidence in advance directive discussion skills and the experience of caring for at least one patient with a current advance directive were found to be significant predictors of advance directive discussions. These findings suggest that experience with advance directives documents is critical for nurses' comfort and that developing interventions to further nurses' confidence in their discussion skills may increase advance directive discussions.