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This study examined the impact of disclosing subclassifications of genetic variants of uncertain significance (VUS) on behavioral intentions. We studied return of VUS results to 79 individuals with a cardiomyopathy‐associated VUS, subclassified into VUS‐high or VUS‐low. Primary outcomes were perceived risk (absolute and comparative), perceived severity, perceived value of information, self‐efficacy, decision regret, and behavioral intentions to share results and change behaviors. There was no significant difference between the 2 subclasses in overall behavioral intentions (t = 0.023, P = .982) and each of the individual items on the behavioral intentions scale; absolute (t = −1.138, P = .259) or comparative (t = −0.463, P = .645) risk perceptions; perceived value of information (t = 0.582, P = .563) and self‐efficacy (t = −0.733, P = .466). Decision regret was significantly different (t = 2.148, P = .035), with VUS‐low (mean = 17.24, SD = 16.08) reporting greater regret. Combining the subclasses, perceived value of information was the strongest predictor of behavioral intentions (β = 0.524, P < .001). Participants generally understood the meaning of a genetic VUS result classification and reported satisfaction with result disclosure. No differences in behavioral intentions were found, but differences in decision regret suggest participants distinguish subclasses of VUS results. The perceived value of VUS may motivate recipients to pursue health‐related behaviors. [ABSTRACT FROM AUTHOR]

Health disparities, particularly in African-Americans, have been identified in a variety of settings. A secondary qualitative analysis of focus group data sought to describe African-American's perceptions of health disparities. Using an interpretive descriptive approach, three main levels of interaction within the health-care setting were identified that contained barriers to receiving the best possible care. The issue of finances was the major barrier that involved the insurance company, while racism, attitude, setting, and waiting were the major obstacles involved in the interaction in the health-care facility. The barriers present during the interaction with a personal provider were racism, a language barrier, and being rushed. Additionally, five ideals for patient-provider interaction were identified, as well as three approaches that the participants used to address the barriers within the health-care setting. A broad framework was developed incorporating these major themes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Unexplained chest pain is a frequent and increasingly common complaint among patients admitted to Emergency Departments. Previous studies have defined unexplained chest pain as non-cardiac or non-coronary artery disease, i.e. patients with other organic causes explaining the chest pain could be included. To increase the knowledge of unexplained chest pain, this study only includes patients without any known explanation for their chest pain. AIM: To analyze gender differences regarding pain characteristics, psychosocial factors and health-related quality of life among patients diagnosed unexplained chest pain. METHODS AND RESULTS: The results are based on 179 patients (101 men, 78 women) between 16 and 69 years old (mean age 45.3) consecutively admitted to Emergency Department. Pain characteristics were assessed by Pain-O-Meter. Social relationships, depression, anxiety, and health-related quality of life were measured by a self-administered questionnaire. There were no gender differences regarding chest pain intensity; however women described their pain as burning (p<0.01) and frightening (p<0.03) more often than men. Men reported less depression (p<0.01) and less trait anxiety (p=0.01) than women. Chest pain intensity did not significantly impact health-related quality of life except physical functioning in men (p=0.05). CONCLUSION: Gender differences were few. Chest pain intensity did not significantly impact health-related quality of life. [ABSTRACT FROM AUTHOR]

The existence of racial and ethnic disparities in healthcare in the United States is well recognized. However, often overlooked in the planning and design of initiatives to address those disparities are the patient perspectives regarding the issues of racial and ethnic disparities that directly affect them. The objective of this study was to identify the patient priorities and to provide recommendations for action to improve minority health-care quality. A secondary objective was the qualitative analysis of the Institute of Medicine (IOM) focus group data. Six focus groups were conducted with nine participants in each. These included an African-American focus group in Washington, D.C., an African-American focus group in Los Angeles, an Asian focus group in Los Angeles, an Hispanic focus group in Washington, D.C., an Hispanic focus group in Los Angeles, and a Native American focus group in Albuquerque, NM. The barriers and priorities for action included difficulty in making informed choices when identifying and selecting providers, poor service delivery from medical office staff, the inefficiency of medical visits, provider communication and cultural competence barriers, and stressful treatment settings. Patient recommendations targeted provision of tools to empower patients throughout the process of care, provider and staff training in communication and cultural competence, alternate models of service delivery, and accessible mechanisms for evaluation and oversight. This study concluded that patient-identified priorities and recommendations warranted modification of current explanatory models for minority health-care quality and the provision of greater clarity regarding directions for policy and behavioral initiatives and criteria for performance evaluation be advanced. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Fatigue is a common symptom in patients with chronic heart failure (CHF) and has a major impact on their daily life activities. The purpose of this study was to examine the prevalence and severity of fatigue, conceptualized as a multiple dimensional symptom, and to determine the influence of sense of coherence and uncertainty on the fatigue experience in patients with CHF. METHODS: Ninety-three consecutive patients, hospitalized with a diagnosis of CHF, completed the Multidimensional Fatigue Inventory Scale (MFI-20), Cardiovascular Population Scale (CPS), and Sense of Coherence Scale (SOC) and were classified according to the New York Heart Association (NYHA) functional classification criteria. Associations between selected variables were explored with multiple regression analysis. RESULTS: The patients reported high prevalence and severity in the physical dimensions of fatigue. Uncertainty was associated positively with tiredness and reduced functional status. High age predicted reduced motivation and the ability to concentrate were affected by low SOC. CONCLUSION: Fatigue is a prevalent and distressing experience in patients with CHF, where a variety of factors influence different dimensions of the fatigue experience. Recognising this, symptom management must be directed towards comprehensive assessment and a broad approach in interventions aimed at alleviating fatigue. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little scientific attention has been paid to providing a comprehensive multidimensional description of chest pain in patients with unexplained chest pain. AIMS: The aims of the present study were: (1) to describe the symptom chest pain, including the dimensions of intensity, quality, duration and location in patients with unexplained chest pain (UCP); and (2) to identify similarities and differences in how patients with UCP and patients with ischemic heart disease (IHD) describe chest pain. METHOD: A descriptive, correlational and comparative design. Totally 208 consecutive UCP patients and 40 IHD patients below 70 years of age participated. Pain was assessed using the instrument Pain-O-Meter. RESULTS: The occurrence of chest pain was 79% (n=165) in UCP patients versus 60% (n=22) in the IHD patients (p=0.001). Patients with UCP reported greater pain intensity and used more sensory and affective words than IHD patients (p<0.01). Relationships between pain location and amount of body surface involved in the pain and pain intensity in both groups were found (p<0.001). CONCLUSIONS: Our results showed some defining characteristics of the UCP group, but the many similarities between the two groups in their experience of chest pain made it impossible to clearly differentiate the groups' pain profiles. [ABSTRACT FROM AUTHOR]

There is a dearth of knowledge about the quality of life of African American women during the breast cancer treatment phase. This pilot study explored spiritual wellbeing, religious coping, and the quality of life of African American women during the breast cancer treatment phase. The sample included a total of 11 African American women from the mid-Atlantic and southeastern United States. The Roy Adaptation Model (Roy & Andrews, 1999) served as a guide for this study. This pilot study used a descriptive cross-sectional design. Data were analyzed utilizing descriptive statistics and the Spearman rho correlational analysis. African American women used more positive religious coping than negative religious coping. Significant relationships were found between spiritual well-being and the QOL domains of physical, emotional, and functional well-being. These findings suggest that nurses should incorporate spiritual and religious support in the care of African American women during the breast cancer treatment phase. [ABSTRACT FROM AUTHOR]

BackgroundPatients with unexplained chest pain have seldom organic pathology. Although both physical and psychological factors have been studied and suggested as causes of chest pain.AimThe aim was to describe the experience of unexplained chest pain and its influence on daily life situation in men and women.MethodsNine women and eleven men with unexplained chest pain, aged 31-62 years were interviewed. A qualitative descriptive design was used. The interviews were analyzed by content analysis focusing on experience by gender.ResultsThe results embraced two domains descriptions and consequences of chest pain and daily life situation. Words like pressure, cramp, strong, or burning were used in the descriptions of the chest pain experienced with more similarities than variations between men and women. Physical, psychological and social consequences due to chest pain influenced daily life. The men specifically reported having a 'fast tempo' in their lives, with stress at work being seen as a feature experienced by both men and women.ConclusionsThis study shows that men and women had more similarities than variations in descriptions of chest pain. Their unexplained chest pain influenced their functions in daily life that led to, especially for the men, few contacts outside the family and therefore a weak social network. [ABSTRACT FROM AUTHOR]

AIM: The aim was to describe patients' experience of unexplained chest pain, and how the pain affected their everyday life. BACKGROUND: Chest pain is one of the most common reasons for patients to consult the emergency department. Often no clear ischaemic heart disease or any other somatic explanation is found. Exploring the pain experience and how the pain affects everyday life may provide insights into the patients' perspective, fill the gaps in our knowledge about this condition and give needed direction for nursing practice. METHOD: The study sample (n = 19) included 11 men and eight women admitted to the emergency department. An open-ended unstructured interview was conducted with each patient and the data were analysed using content analysis. RESULTS: The categories concerning pain include the informants' descriptions of several aspects of pain. These aspects are described in four categories and four subcategories: (i) pain location, (ii) pain duration with the subcategories 'periodic pain' and 'continuous pain', (iii) pain intensity, (iv) quality of pain with the subcategories 'sensory aspects' and 'affective aspects' . The content of pain experience in everyday life was divided into four subthemes and was further abstracted into a theme. Four subthemes, each comprising several meaning units, were created and labelled: (i) fear and anxiety, (ii) feeling of uncertainty, (iii) feeling of stress, and (iv) loss of strength. In these descriptions, it was obvious that chest pain considerably disturbed and affected the informants' lives and an overall theme 'intrusion into the everyday life world' emerged. CONCLUSION: The results of this study show that unexplained chest pain intrudes into everyday life in a destructive manner that cannot be ignored. RELEVANCE TO CLINICAL PRACTICE: Patients are not receiving optimal care to relieve their pain and there is therefore a need for specialized nurses who can give adequate help and support. [ABSTRACT FROM AUTHOR]

Breast cancer treatment can have a profound influence on a woman's physical, psychological, social, and spiritual well-being. Anxiety, depression, anger, fatigue, and fear of recurrence are common responses to a diagnosis of breast cancer and undergoing breast cancer treatment. Women develop their own coping strategies for the pain and other effects of treatment. However, it is unclear whether there is a relationship between adaptation to pain and psychological distress during breast cancer treatment. Findings from the present study reveal that breast cancer patients who have better pain coping strategies also have lower levels of anxiety, fatigue and depression. These results suggest that pain coping interventions may reduce fatigue and psychological distress among women with breast cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cancer-related fatigue (CRF) is a subjectively experienced symptom that is multidimensional and multifactorial. Patients with cancer have identified fatigue as one of the major troubling symptoms and the primary cause of distress in their lives. AIMS: The major aim of the study was to examine how patients diagnosed with uterine cancer describe their experience of fatigue, psychological distress, coping resources and quality of life. A secondary aim was to describe the relationship between selected variables. METHOD: A descriptive and correlational design was used and the study was conducted at a university hospital in Sweden. The study population consisted of women, diagnosed with uterine cancer, who where scheduled to receive curative external radiation therapy. Sixty women participated in the study and data were collected through self-report instruments. Demographic and clinical data were extracted from patient records. The data were collected during year 2000-2002. The Conceptual Model of Symptom Management was used as a framework to guide the study. FINDINGS: Patients experienced a low grade of fatigue and psychological distress, but their functional status and global quality of life was high. Significant correlations were found between general fatigue and anxiety and also between general fatigue and depression. There was a significant negative correlation between general fatigue and coping resources. Depression explained 44% of the variance in general fatigue. CONCLUSIONS: The findings provide knowledge about predictors of CRF in women with uterine cancer, and can serve as a basis for future longitudinal studies in which different prophylactic strategies against therapy-related fatigue are prospectively studied. [ABSTRACT FROM AUTHOR]

Twenty-four family caregivers of bone marrow transplant (BMT) patients were interviewed to describe the burden of care and health outcomes (anxiety, depression, symptom distress and fatigue). A descriptive correlational research design with repeated measures was used. Data were collected in a conference room in the oncology unit of a midwestern university hospital using a battery of questionnaires. Questionnaires were administered pre-BMT (prior to the patient's hospitalization) and 5 and 20 days post-BMT. Objective burden remained at a similar level throughout the study (mean range 31.4 to 32.9), whereas subjective burden was highest pre-BMT (mean range 25.3-21.7). Significant correlations were found between objective burden and all health outcomes (P<0.01 to P<0.001) on day 5. Symptom distress was significantly correlated to subjective burden pre-BMT and to both types of burden on days 5 and 20. Results of this study suggest that family caregivers of BMT patients may experience more objective burden than subjective burden, and that burden of care may contribute to negative health outcomes, especially on day 5 post-BMT. Interventions designed to reduce sources of caregiver burden and negative health outcomes should be planned according to critical time periods of the BMT patient's hospitalization. [ABSTRACT FROM AUTHOR]

Abstract Background The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the relationships between coping strategies, negative life events, sleep problems, physical activity, stress and chest pain intensity. Method The sample consisted of 179 patients younger than 70 years of age, who were evaluated for chest pain at the emergency department daytime Monday through Friday and judged by a physician to have no organic cause for their chest pain. The study had a cross-sectional design. Results Emotive coping was related to chest pain intensity (r = 0.17, p = 0.02). Women used emotive coping to a greater extent than did men (p = 0.05). In the multivariate analysis was shown that physical activity decreased emotive coping (OR 0.13, p < 0.0001) while sex, age, sleep, mental strain at work and negative life events increased emotive coping. Twenty-seven percent of the patients had sleep problems 8 to14 nights per month or more. Permanent stress at work during the last year was reported by 18% of the patients and stress at home by 7%. Thirty-five percent of the patients were worried often or almost all the time about being rushed at work and 23% were worried about being unable to keep up with their workload. Concerning total life events, 20% reported that a close relative had had a serious illness and 27% had reasons to be worried about a close relative. Conclusion Our results indicated that patients with more intense UCP more often apply emotive coping in dealing with their pain. Given that emotive coping was also found to be related to disturbed sleep, negative life events, mental strain at work and physical activity, it may be of value to help these patients to both verbalise their emotions and to become cognizant of the influence of such factors on their pain experience.