Nurses' experiences, expectations, and preferences for mind-body practices to reduce stress

BACKGROUND: Most research on the impact of mind-body training does not ask about participants\u27 baseline experience, expectations, or preferences for training. To better plan participant-centered mind-body intervention trials for nurses to reduce occupational stress, such descriptive information would be valuable. METHODS: We conducted an anonymous email survey between April and June, 2010 of North American nurses interested in mind-body training to reduce stress. The e-survey included: demographic characteristics, health conditions and stress levels; experiences with mind-body practices; expected health benefits; training preferences; and willingness to participate in future randomized controlled trials. RESULTS: Of the 342 respondents, 96% were women and 92% were Caucasian. Most (73%) reported one or more health conditions, notably anxiety (49%); back pain (41%); GI problems such as irritable bowel syndrome (34%); or depression (33%). Their median occupational stress level was 4 (0 = none; 5 = extreme stress). Nearly all (99%) reported already using one or more mind-body practices to reduce stress: intercessory prayer (86%), breath-focused meditation (49%), healing or therapeutic touch (39%), yoga/tai chi/qi gong (34%), or mindfulness-based meditation (18%). The greatest expected benefits were for greater spiritual well-being (56%); serenity, calm, or inner peace (54%); better mood (51%); more compassion (50%); or better sleep (42%). Most (65%) wanted additional training; convenience (74% essential or very important), was more important than the program\u27s reputation (49%) or scientific evidence about effectiveness (32%) in program selection. Most (65%) were willing to participate in a randomized trial of mind-body training; among these, most were willing to collect salivary cortisol (60%), or serum biomarkers (53%) to assess the impact of training. CONCLUSIONS: Most nurses interested in mind-body training already engage in such practices. They have greater expectations about spiritual and emotional than physical benefits, but are willing to participate in studies and to collect biomarker data. Recruitment may depend more on convenience than a program\u27s scientific basis or reputation. Knowledge of participants\u27 baseline experiences, expectations, and preferences helps inform future training and research on mind-body approaches to reduce stress

The Efficacy of Exercise in Reducing Depressive Symptoms among Cancer Survivors: A Meta-Analysis

INTRODUCTION: The purpose of this meta-analysis was to examine the efficacy of exercise to reduce depressive symptoms among cancer survivors. In addition, we examined the extent to which exercise dose and clinical characteristics of cancer survivors influence the relationship between exercise and reductions in depressive symptoms. METHODS: We conducted a systematic search identifying randomized controlled trials of exercise interventions among adult cancer survivors, examining depressive symptoms as an outcome. We calculated effect sizes for each study and performed weighted multiple regression moderator analysis. RESULTS: We identified 40 exercise interventions including 2,929 cancer survivors. Diverse groups of cancer survivors were examined in seven exercise interventions; breast cancer survivors were examined in 26; prostate cancer, leukemia, and lymphoma were examined in two; and colorectal cancer in one. Cancer survivors who completed an exercise intervention reduced depression more than controls, d(+) = -0.13 (95% CI: -0.26, -0.01). Increases in weekly volume of aerobic exercise reduced depressive symptoms in dose-response fashion (β = -0.24, p = 0.03), a pattern evident only in higher quality trials. Exercise reduced depressive symptoms most when exercise sessions were supervised (β = -0.26, p = 0.01) and when cancer survivors were between 47-62 yr (β = 0.27, p = 0.01). CONCLUSION: Exercise training provides a small overall reduction in depressive symptoms among cancer survivors but one that increased in dose-response fashion with weekly volume of aerobic exercise in high quality trials. Depressive symptoms were reduced to the greatest degree among breast cancer survivors, among cancer survivors aged between 47-62 yr, or when exercise sessions were supervised

Satisfaction with a Quitline-based Smoking Cessation Intervention among Cancer Survivors

Abstract Continued smoking after diagnosis jeopardizes cancer survivors' health and well-being. Quitline-based smoking cessation treatment is convenient, widely available and free, yet the appropriateness of this treatment approach for survivors is not known. We assessed satisfaction among participants in an enhanced quitline intervention as part of a randomized clinical trial assessing feasibility. Methods: We recruited cancer survivors through the NCI Community Clinical Oncology Program (CCOP) network within 6 months of treatment who smoked within the last 7 days and randomized them 2:1 to an enhanced quitline- based intervention (brief in-person motivational interviewing counseling session, quitline telephone counseling, 6 weeks of nicotine replacement patches) or usual care. We collected treatment satisfaction data and self-reported smoking status at 12 weeks and confirmed smoking status for reported non-smokers using a semi-quantitative urinary cotinine assessment. Results: We enrolled 146 survivors (75% female, 79% non-Hispanic white, mean age = 58 years). At entry, survivors reported smoking an average of 15 cigarettes per day; 77% reported smoking within 30 minutes of awakening. Assessments were completed by 63% of the quitline group and 75% of the usual care group at 12 weeks (P &amp;gt; 0.05). 83% of participants in the intervention arm (n = 98) completed at least one quitline call, and 18% completed ≥3 calls. Use of nicotine patches was 61% in the quitline group and 42% in usual care. Quitline participants were generally satisfied with both the in-person counseling (mean satisfaction score = 4.2 (SD = 1.0), on 1–5 scale) and the quitline telephone counseling (mean satisfaction score = 3.4 (SD = 1.3)). 87% would recommend the quitline program to others. Self-reported 7-day point prevalence cessation was 26% in the quitline group and 17% in the usual care arm (P = 0.33). Conclusions: An enhanced quitline smoking cessation intervention appears to be acceptable to cancer survivors and to result in a trend towards slightly higher cessation at 12 weeks. Increased efforts to retain survivors in treatment and encourage the use of nicotine replacement may be necessary to increase the impact of this intervention approach.</jats:p

The 3-phase-model of dyadic adaptation to dementia: why it might sometimes be better to be worse

In the next years and decades, the number of old spousal dyads having to deal with the onset and progression of dementia in one partner will increase significantly. Existing research indicates that caregiving for an ill spouse is related to decreased caregiver well-being and high levels of caregiver stress. In this theoretical paper, we argue that three aspects deserve additional theoretical and empirical attention: (a) Some spousal caregivers seem to exhibit stable pattern of individual well-being, (b) dyads may be able to adapt their ways of supporting each other to maintain a maximum of dyadic autonomy, and (c) the progression of the dementia increasingly compromising the individual autonomy is likely to require different behaviors and skills of the dyad to achieve high levels of dyadic wellbeing. We suggest a 3-phase-model of dyadic adaptation to dementia-related losses of patients’ individual autonomy and discuss adaptive processes in three phases of dementia that may allow stable levels of well-being in caregivers over time. Thereby, our model can integrate existing findings and theories and allows deriving areas of future research