Background: Adequate provider-patient communication is viewed as an important aspect of good quality (cancer) care, supports patients’ stress control, and can positively influence health outcomes. Objective: The objective of this study was to describe nurse-patient communication in 2 consecutive follow-up consultations after head and neck cancer, with or without a partner present. Methods: This was a descriptive observational study of 17 video-recorded, coded, and analyzed consultations of 10 head and neck cancer patients and 6 partners. Results: Nurses adequately responded to about 25% of patients’ and partners’ emotional cues. In almost 75%, nurses responded to cues using distancing behaviors. The majority of informational questions of both patients and partners were adequately answered. Comparison of consecutive visits showed small differences for patients’ and partners’ cue-emission and for nurses’ responsive behaviors between visits 1 and 2. Conclusion: Nurses adequately responded to informational questions from patients and partners. However, they seemed to be less observant of and able to address emotional cues. Communication on nurse-patient-partner interaction deserves further research in a much larger sample and over a longer time period. Implication for Practice: Nurses’ awareness of the importance of adequate cue responding is vital, as is the choice to “unlearn” the predominant distancing behaviors. The needs and the role of the patients’ partner in consultations and managing consultations require further attention in training and professional practice.

The objective of this review was to determine whether communication training for healthcare professionals (HCP), including nurses and medical doctors, in cancer care improves patient outcomes. Eligible studies with a focus on patient outcomes and a controlled or single group pretest-posttest design were identified according to Cochrane Collaboration Guidelines. Seven studies, encompassing 10 papers and involving five randomised controlled trials, were included. Studies involved 411 HCP, including a total of 1677 encounters with adult cancer patients. Forty-nine papers were excluded, primarily because no patient outcomes were reported. Regarding patient satisfaction outcomes, estimated effects in favour of communication training ranged from 0.07 (95% CI: -0.30 to 0.44) for satisfaction with information and support to 0.70 (95% CI: 0.16 to 1.24) for satisfaction with assessment of concerns. No evidence was found for the effectiveness of communication training on patient distress outcomes. We concluded that the current review reveals inconclusive evidence to prove the effectiveness of communication training on patient satisfaction and patient distress. More high-quality studies are needed.

Objective: The aim is to investigate the relationship between nurses' cue-responding behaviour and patient satisfaction.Methods: One hundred patient-nurse conversations about present concerns were videotaped and patients' expression of emotional cues and nurses' cue responses were coded using the Medical Interview Aural Rating Scale. Nurses (N = 34) and patients (N = 100) were recruited from seven oncology inpatient clinics from a University Medical Centre.Results: A mixed-model analysis was conducted to examine whether cue responding was related with patient satisfaction with the conversation, after adjusting for confounding variables and correlation due to repeated measure of each nurse. Nurses' cue responding was independently related to patient satisfaction. Controlling for the level of cue responding, palliatively treated patients were more satisfied with the communication than curatively treated patients.Conclusions: This study provides evidence that nurses' cue-responding behaviour is appreciated by the patients. Future studies might focus on the effect of improved cue-responding skill on more distall outcome measures, such as identification of concerns, mood and coping behaviour. Copyright (C) 2009 John Wiley & Sons, Ltd.

AIMThis paper is a report of a study to describe nurse-patient interactions, i.e. nurses' cue-responding behaviour in encounters with actors playing the role of patients.BACKGROUNDPatients with cancer seldom express their concerns directly but express cues instead. Few studies empirically investigated nurses' cue-responding behaviour and the subsequent influence of disclosure of cues and concerns.METHODSIn this descriptive observational study, conducted from April to June 2004, five oncology nurses interviewed an actor playing the role of a patient with cancer. Each nurse performed seven different interviews (n = 35); these were videotaped and subsequently rated for cue-responding using the Medical Interview Aural Rating Scale. Mixed model analysis was used to investigate the relation between cues and cue-responding.FINDINGSHalf of the patients' cues were responded to with distancing behaviours. The other half of the cues were either explored (33%) or acknowledged (17%). In 16% of these responses, nurses used open directive questions. One out of four open directive questions were used as a distancing response, suggesting that open directive questions are not used to explore or acknowledge cues of patients. Cue-responding influenced subsequent expression of concerns and emotions, i.e. disclosure of a concern is two times higher after exploration or acknowledging of a preceding cue than after a distancing response.CONCLUSIONCue-responding is a valuable concept which can contribute to our understanding of optimal ways of communicating. Cue-responding behaviour facilitates the disclosure of worries and concerns of patients. Further research is needed to assess the clinical relevancy of cue-responding.

Objective: Interest in fatigue research has grown since the finding that fatigue is, besides pain, the symptom most frequently reported by patients with rheumatoid arthritis (RA). The aim of this study was to explore the experience of fatigue from the patients' perspective.Methods: Twenty-nine patients with RA filled-out written questionnaires on fatigue severity, disability, quality of life and sleep disturbance, and disease activity was calculated using the Disease Activity Score (DAS28). All patients were individually interviewed and asked about fatigue. Qualitative analyses were completed using software program "The Observer". Basic codes, a code plan and coding rules were developed by two researchers through a consensus-based review process. Frequencies of the central codes were calculated by the program SPSS.Results: RA fatigue is verbalised as a physical everyday experience with a variety in duration and intensity. Its sudden onset and exhausting nature is experienced as frustrating and causing anger. Patients mentioned having RA as the main cause of their fatigue. The consequences of fatigue are overwhelming and influence patients' everyday tasks, attitudes and leisure time. Patients described how they have to find their own management strategies by trial and error and described pacing and rest, relaxation and planning activities as the most appropriate interventions. Downward comparison and acceptance as part of the disease are also reported as successful coping strategies for fatigue. Most patients did not discuss fatigue with clinicians explicitly, accepting that they were told that fatigue is part of the disease and believing that they have to manage it alone.Conclusion: The results show that RA fatigue is experienced as being different from "normal" fatigue. Patients do not expect much support from health care professionals, assuming that they have to manage fatigue alone as it is part of the disease. These results will help professionals caring for RA patients to communicate about fatigue, to explore the nature of fatigue individually and to develop tailored interventions. (C) 2007 Elsevier Ltd. All rights reserved.

Daily chlorhexidine mouthwash is often recommended for preventing chemotherapy-induced oral mucositis. Povidone-iodine, NaCl 0.9%, water salt soda solution and chamomile mouthwash are also recommended. However, the effectiveness of these mouthwashes is unclear. Therefore, we performed a systematic review to assess the effectiveness of mouthwashes in preventing and ameliorating chemotherapy-induced oral mucositis. Based on study quality, three out of five randomized controlled trials were included in a meta-analysis. The results failed to detect any beneficial effects of chlorhexidine as compared with sterile water, or NaCl 0.9%. Patients complained about negative side-effects of chlorhexidine, including teeth discoloration and alteration of taste in two of the five studies on chlorhexidine. The severity of oral mucositis was shown to be reduced by 30% using a povidone-iodine mouthwash as compared with sterile water in a single randomized controlled trial. These results do not support the use of chlorhexidine mouthwash to prevent oral mucositis.

Advanced cancer is associated with emotional distress, especially depression and feelings of sadness. To date, it is unclear which is the most effective way to address these problems. This review focuses on the effects of psychosocial interventions on the quality of life (QoL) of patients with advanced cancer. It was hypothesised that patients will benefit from psychosocial interventions by improving QoL, especially in the domain of emotional functioning. The review was conducted using systematic review methodology involving a systematic search of the literature published between 1990 and 2002, quality assessment of included studies, systematic data extraction and narrative data synthesis. In all, 10 randomised controlled studies involving 13 trials were included. Overall interventions and outcome measures across studies were heterogeneous. Outcome measures, pertaining to the QoL dimension of emotional functioning, were most frequently measured. A total of 12 trials evaluating behaviour therapy found positive effects on one or more indicators of QoL, for example, depression. The results of the review support recommendation of behaviour therapy in the care of patients with advanced cancer.

The purpose of this descriptive exploratory study by the Dutch Oncology Nursing Society was to describe the problem areas in the care of patients who are receiving chemotherapy as perceived by patients and professional caregivers as well as to explore differences between the perceptions of patients and professional caregivers. Three independent samples of 120 patients who are being treated with chemotherapy, 42 chemotherapy prescribing medical specialists, and 68 oncology nurses who are involved in the daily bedside care of the patients undergoing chemotherapy participated in the study. Patients and professional caregivers completed a 69- and a 58-item self-administered questionnaire, respectively. Results show that patients were satisfied with the medical and nursing care they received. Furthermore, results suggest that professional caregivers perceive the experience of patients with chemotherapy differently than patients, eg, patients perceive chemotherapy as reassuring that something is being done; whereas caregivers think that patients experience chemotherapy as something to fear or be anxious or uncertain about. It further seems that professional caregivers are more prone to act upon the medical-technical aspects of the treatment than to act on psychosocial sequelae of the treatment.

Dermal exposure to anti-neoplastic drugs has been suggested as a potentially important route of exposure of hospital workers. Three small-scale workplace surveys were carried out in several hospitals focusing on contamination by leakage from IV infusion systems; contamination by spilled urine of patients treated with anti-neoplastic drugs and particulate phase anti-neoplastic drugs in the air of outpatient and nursing clinics. A new visual scoring technique using a fluorescent tracer was developed. The method showed a very low limit of detection (0.02 μl of contamination) and a very high inter-observer agreement (ICC=0.99). Evaluation of IV systems and connectors showed distinct differences between the systems. It was estimated that 0.5–250 μg of a drug can become available for contamination during each infusion. Differences in average contamination between nurses were negligible in the experimental set-up. Widespread and frequent contamination due to spillage of contaminated urine was revealed and appeared not to be restricted to the patient's room. Airborne particulate concentrations went undetected for 80% of the measurements. However, in a few cases concentrations up to 2 ng/m3 of cyclophosphamide were measured predominantly in a room of a patient treated with this anti-neoplastic drug. Based on these results and a recently proposed conceptual model for dermal exposure a most likely exposure scenario was postulated both for nurses involved in administering drugs and nurses caring for treated patients. Estimation of all relevant mass transport rates will be a challenge for the near future.

Ruud Uitterhoeve Oncology Clinical Nurse Specialist, University Hospital Nijmegen, PO BOX 9101, 6500 HB Nijmegen,The Netherlands Bet ty Ambaum RV, MSN, Coordinator Research, University Medical Centre Utrecht, The Netherlands Correspondence and offprint requests to: Ruud Uitterhoeve This paper describes the application and testing of the Stetler Model for Research Utilization in an out-patient clinic of a University Hospital in the Netherlands. This work was part of a wider project being undertaken jointly by EONS and EUROQUAN, the aims of which were to develop an educational framework for advanced cancer nursing practice and to formulate standards against which to audit cancer nursing practice (Knowles 1999). This paper outlines how the Stetler Model for Research Utilization was tested using Donabedian's framework of structure, process and outcome. The process involved educating clinical nurses in research methodology, selecting a topic of interest, reviewing the literature and formulating and implementing a plan of change. Evidence-based nursing practice (EBNP) is the new paradigm of nursing. It is no longer acceptable to base nursing practice on tradition. 'Because we have always done it that way' is not sufficient anymore. Nursing practice should be based on the best evidence available. When a research base exists it provides the best evidence and should be used to ensure that assessments will be true measures of clinical phenomena and that interventions will lead to intended outcomes. However, the use of available research findings is not as easy as it first appears. Different studies have shown that numerous barriers to research utilization exist. In a recent study by Rutledge et al (1998) oncology staff nurses (N-1100), randomly selected from the members of the Oncology Nursing Society, rated 28 items to the extent they perceived them as barriers to