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Prostate cancer is the most common cancer among men in the United States and is accompanied by devastating treatment-related sequelae (incontinence, sexual dysfunction) that can negatively affect the quality of life of men and their spouses. To date, few intervention studies have been conducted to help men and spouses manage the effects of illness and maintain their quality of life. The purpose of this study was to determine if a family intervention could improve several proximal outcomes (appraisal of illness or caregiving, hopelessness, uncertainty, self-efficacy, coping, family communication, and symptom bother) and the distal outcome of quality of life in men with prostate cancer and their spouses. This study was guided by a stress-coping framework. A randomized clinical trial was used with a sample of men with prostate cancer and their spouses. Men were in one of three phases of illness: newly diagnosed, post-treatment biochemical recurrence, or advanced. Dyads were referred to the study by clinic staff. Of those referred, 263 dyads completed baseline assessments were randomly assigned to treatment (129 dyads) or control group (134 dyads), and completed a follow-up assessment at 4 months (236 dyads). The intervention was a five session, family program that consisted of three home visits and two follow-up phone calls by masters- prepared nurses. Several instruments with established reliability and validity were administered: Appraisal of Illness/Caregiving Scales, Beck Hopelessness Scale, Mishel Uncertainty Scale, Lewis Self-efficacy Scale, Brief COPE, Lewis MIS scale, Symptoms Scale, and FACT-G. Descriptive statistics and repeated measures ANOVA were used for data analyses. Findings indicated that patients in the intervention group reported significantly less uncertainty (p=.06), better communication (p=.06), and higher quality of life (p=.07) than control patients. Spouses in the intervention group reported significantly less negative appraisal of caregiving (p=.004), less hopelessness (p=.04), less uncertainty (p=.007), more self-efficacy (p=.05), better communication (p=.002), and higher quality of life (p=.003) than control spouses. Findings suggest that the family intervention produced beneficial outcomes for patients and spouses and is relevant for clinical practice. Funding Sources: National Cancer Institute (R01CA90739) [ABSTRACT FROM AUTHOR]

An increasing proportion of newly diagnosed AIDS cases is being reported among African American urban women. Recent research regarding the psychosocial and behavioral impact of a mother''s HIV status on her uninfected children as well as a growing body of clinical evidence suggest that these children are extremely vulnerable and at risk for problems in psychosocial adjustment. The present paper reports the results of research designed to examine the pathways by which a mother''s HIV-positive status affects the psychosocial adjustment of her uninfected school-age child. The principal predictor variables of the model are family sociodemographic characteristics, social support available to mother and child, HIV-related symptom distress in the mother, coping strategies of both mother and child, emotional distress of the mother, and quality of the parent–child relationship. The dependent variable is the psychosocial adjustment of the child. Data were collected on 147 mother–child dyads using standardized questionnaires and personal interviews. Eighty-six percent of the mothers were African American and over 96% were on public assistance. Structural equation modeling was used to test the proposed model of mother–child coping and adjustment. After adding three paths, the model had a good fit to the data (comparative fit index=0.94; root mean square estimate of error=0.06). Five model constructs accounted for 36% of the variance in child adjustment. The constructs in order of importance were maternal HIV-associated stressors, maternal emotional distress, child social support, child coping, and quality of parent–child relationship. [Copyright &y& Elsevier]

Nurses at the Well-Being Institute, a community-based nursing outreach clinic in Detroit, Michigan, located 75 women living with HIV, mental illness, and substance abuse who were lost to follow-up at their HIV medical clinic as part of a nursing research study. Women who had been scheduled for an appointment in the last 4 months but who had missed that appointment were considered "lost to follow-up" in the HIV clinic. The purpose of the research was to study factors related to health care access in women not participating in regular health care for their HIV infection. Women were randomly assigned to two study groups. Women assigned to "care as usual" study group (n = 37) received no additional services beyond study interviews for 1 year. Women assigned to the "nursing intervention" group (n = 38) were provided with nursing services designed to facilitate their return to and continued connection with their HIV clinic. Findings showed that factors related to the women's vulnerability, such as mental illness and drug use, were more related to their use of expensive health care services such as hospital emergency departments or hospital inpatient admissions than was assignment to either the "nursing intervention" or "care as usual" study groups. Two case studies describing the cost of care for 2 of the multiply diagnosed women in the study is presented. The women differed on whether they had stable housing and were accessing care for their mental illness.

Purpose/objectives: To evaluate the FOCUS Program (family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management), a family-based program of care for women with recurrent breast cancer and their family caregivers., Data Sources: Randomized clinical trial., Setting: Midwest region of the United States., Data Synthesis: The family-based program of care consisted of five components: family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management. The program was delivered in three home visits and two follow-up phone calls over a five-month period of time., Conclusions: Patients with recurrent breast cancer and their family members reported high satisfaction with the FOCUS Program. Although the FOCUS Program had a number of strengths, limitations of the program also were identified that need to be addressed in future family-based interventions., Implications for Nursing: A need exists for family-based programs of care that enable both patients and their family members to manage the multiple demands associated with recurrent breast cancer.