Care Of Myself Research Articles

Understanding health needs of professional truck drivers to inform health services: a pre-implementation qualitative study in a Canadian Province

ObjectivesLong-haul truck drivers experience multiple challenges, including increased health risks. A large percentage of professional truck drivers (PTDs) suffer from numerous chronic physical health conditions such as obesity, hypertension, diabetes, heart disease, sleep disorders, etc.) as well as poor mental health and social challenges. Furthermore, this population experiences numerous barriers related to accessing health care services including primary care and resources to improve their health. PTDs living in rural and remote areas are at higher risk. The objective of this study is to understand the views of PTDs and the trucking industry on health and personalized healthcare interventions and services.MethodsIn-depth semi-structured interviews were conducted with twenty-six individuals with contextual knowledge and experience in the trucking ecosystem, to better understand the needs, expectations, and preferences of PTDs based in New Brunswick (Canada), related to their health (physical, mental, and social). Analysis of the audiotape recording was conducted using thematic content analysis.ResultsThree major themes emerged from the qualitative analysis describing PTDs’ health needs, existing health and preventive services, as well as recommendations for personalized healthcare interventions and services to be implemented: (1) “My life as a trucker!” Understanding needs and challenges, (2) “Taking care of myself, do you think it is easy while you’re on the road?” Describing drivers and motivators for better health, and (3) “Can you hear what we need?” Translating needs into recommendations for tailored health services and preventative services.ConclusionA highly demanding work environment and lack of timely access to integrated primary care negatively affect PTDs’ health. Results of this study shed light on how to tailor primary care to improve its responsiveness and adequacy to PTDs’ needs and realities. PTDs-sensitive integrated services, including multicomponent interventions (health education, coaching for lifestyle changes, and social support), are still lacking within the New Brunswick health system.

Identification of complex co-occurring symptom burden in persons with cancer through multisite implementation of health-related social needs assessment in community oncology settings.

306 Background: Health related social needs (HRSN) impact cancer outcomes and patient experience, but their integration into routine cancer care is highly variable. To expand the implementation-centered evidence base for effective HRSN assessments, we studied a scalable HRSN screening tool to identify distress and complex symptom burden in patients with cancer. Methods: We prospectively tracked HRSN screenings (using the National Comprehensive Cancer Network [NCCN] Distress Thermometer [DT]) of patients at varying points during their cancer care between 07/2023-12/2023 at seven multi-site community oncology practices within the US Oncology Network. DT responses were used to evaluate the positive finding rate, types of distress reported, and correlations between distress areas and concerns reported. Results: Overall, 219,720 unique patients with cancer received 269,666 HRSN screenings using the NCCN DT; 27% had a distress score ≥1 and 38.5% reported a concern (of whom, 58.2% reported >1). Co-occurring concerns that were most correlated (Pearson correlation coefficient) were emotional & practical concerns in 49% of screenings, physical & practical 44%, emotional & social 37% and social & practical concerns 36%. Emotional symptoms most frequently reported together were sadness/depression + worry/anxiety 47%, loss of interest + sadness/depression 44%, and loneliness & sadness/depression 38.5%. Regarding complex symptom burden, the physical and psychosocial symptoms that were most correlated were fatigue & sleep 43%, pain & fatigue 40%, pain & sleep 38%, anxiety/worry & fatigue 37%, anxiety/worry & sleep 36%. Fatigue and pain, the two most frequently reported concerns were strongly correlated with emotional and practical concerns like sleep, worry or anxiety, memory or concentration, loss or change of physical abilities, sadness or depression, loss of interest or enjoyment, changes in eating, ability to take care of self, feelings of worthlessness or being a burden, etc. Concerns with the strongest correlations are reported in the table. Conclusions: Distress and its components impact multiple cancer outcomes making their rapid identification and consequent action key to high-quality cancer care. The findings highlight the NCCN DT as a scalable approach to integrate HRSN screening and to identify complex symptom burden in the real-world practice. Co-occurring physical and psychosocial concerns. Concern 1 Concern 2 Correlation r Sadness or depression Worry or anxiety 47.3% 0.5 Loss of interest or enjoyment Sadness or depression 44.3% 0.4 Fatigue Sleep 42.5% 0.4 Pain Fatigue 40.0% 0.4 Loneliness Sadness or depression 38.5% 0.4 Pain Sleep 37.8% 0.4 Worry or anxiety Fatigue 36.7% 0.4 Worry or anxiety Sleep 36.1% 0.4 Taking care of myself Taking care of others 35.9% 0.4

“Give me the reigns of taking care of myself with a home”: Healing environments in an Indigenous-led alcohol harm reduction program

BackgroundDistinct from western Managed Alcohol Programs (MAPs), Indigenous-led alcohol harm reduction programs can be defined by both ‘culture as healing’ and decolonized harm reduction philosophies. We sought to explore experiences of Indigenous ‘family members’ (participants) in an Indigenous-led alcohol harm reduction program and culturally supportive housing to identify appropriate supports according to family member perspectives, and to inform delivery of the program.MethodsSituated within an Indigenous-western research partnership, we completed semi-structured interviews with seven family members of an Indigenous-led alcohol harm reduction and culturally supportive housing program. Community-guided protocols informed relational knowledge gathering practices including semi-structured in-depth interviews, qualitative thematic analysis, collaborative interpretation of findings, and development of knowledge products.ResultsFamily members highlighted the importance of tailored Indigenous-led alcohol harm reduction in shifting their relationships to alcohol from survival to having choice and control of their drinking (It’s a choice I’m making right now). The provision of varied and incremental culture-based opportunities (Multiple pathways for connecting to culture) facilitated engagement with culture as healing. Policies that honour respect and autonomy were identified as supportive to healing and harm reduction, countering family members’ experiences in western spaces (Give me the reigns of taking care of myself with a home).ConclusionsAn Indigenous-led alcohol harm reduction program within a model of culture as healing facilitated shifts in relationships to alcohol, providing a space where family members could explore long term goals of healing and connection to culture. Family members’ experiences and recommendations offer key considerations for the design of Indigenous-led harm reduction and culture as healing models. Recommendations emphasize the provision of tailored alcohol harm reduction plans in parallel to multiple and accessible opportunities for connection to culture as healing in order to meet diverse participant goals and relationships to alcohol and culture.

"I Take Care of Myself" Program for Self-Care in Schoolchildren of an Educational Institution in Huánuco - Peru

Objective. To determine the effectiveness of the "I take care of myself" program for self-care in schoolchildren. Methods. Quasi-experimental study with a single pre-post test group, with the participation of 120 sixth grade students of the primary level of the Educational Institution of San Pedro - Huánuco, Peru 2022, in which the "I take care of myself" Program was applied. The data collection instrument was the self-care practices scale. In the hypothesis test, the Wilcoxon statistical test was used. Results. It was found that the average score obtained in self-care before the application of the "I take care of myself" program was 3.7, and after this it was 4.0, finding significant differences in the pretest and posttest with p≤0.000. Likewise, there were significant differences in the dimensions of self-care such as practices related to universal self-care requirements, practices related to development self-care requirements, and practices related to self-care requirements in case of health deviation, all with p≤0.05. Conclusions. There are significant differences in self-care after applying the "I take care of myself" program in schoolchildren of the Educational Institution of San Pedro - Huánuco.

“I Am Overworked and I’m Not Taking Care of Myself”: The Experiences of Black Men in Doctoral Programs Navigating Racial Battle Fatigue

ABSTRACT Historically, Black men encountered challenges related to race and racism throughout their educational journeys. Perhaps more pronounced at the doctoral level, Black men often experience racial microaggressions and feelings of isolation. This qualitative study utilized racial battle fatigue to explore the experiences of 20 Black men in social science doctoral programs. Utilizing Critical Race Theory and counter-storytelling, participants shared the effects of racial microaggressions and race related stress on their daily interactions and experiences. The study concludes by presenting implications, offering recommendations for future research, and suggesting strategies to better support Black men who facing and navigating racial battle fatigue in doctoral education.

Utility and Implementation of the Distress Thermometer for Cancer Patients: A Cross-Sectional Study From Saudi Arabia.

Background Cancer patients suffer from variable degrees of distress. The distress thermometer (DT) is a valuable tool for screening those patients for distress. Few studies have addressed the utility of DT in screening cancer patients in Saudi Arabia. We aimed to measure the distress level of adult cancer patients utilizing the DT and identify the appropriate measures and interventions required to improve this population's well-being. Methods This cross-sectional study was carried out at the oncology center of King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Enrollment criteria were Saudi adults (≥14 years old), with a diagnosis of cancer, whogave informed consent. They were screened for distress using the DT and its associated problem list (PL). A workflow for a psycho-oncology supportive program was suggested. Results Using DT at a cut-off score of ≥4, 22% of patients had significant distress. The most frequent problems reported were loss/change of physical activity, swelling/edema, change in eating, family health problems, and child care. The multivariable binary regression analysis showed that sadness, depression, worry/anxiety, fear, loss of interest, change in appearance, taking care of myself, swelling/edema, and memory/concentration problems were independent factors for significant distress in our cohort. The suggested workflow could effectively be implemented among cancer patients. Conclusion The current study's findings support previous reports concerning the utility of DT in screening cancer patients for distress. A considerable number of Saudi cancer patients suffered from significant distress, which was significantly related to the emotional, spiritual, social, and religious aspects of their problems. We suggested a workflow by which cancer centers can implement DT screening after developing a plan for timely distress evaluation, with further proper management and referrals accordingly. Additional studies are warranted.

Experiences of young adults affected by cancer within an 8-week yoga intervention delivered by videoconference: a qualitative interview study

Background Yoga may reduce negative cancer- and treatment-related effects and help improve a range of outcomes, including flexibility, mindfulness, and quality of life among adults affected by cancer. Yet there is little evidence for the role of yoga among young adults (18–39 years) affected by cancer. Purpose The purpose of this study was to explore the experiences of young adults affected by cancer in an 8-week yoga intervention delivered by videoconference. Methods Young adults who were diagnosed with cancer between the ages of 18 and 39 years, at any stage of the cancer trajectory, who were living in Canada, and who completed an 8-week yoga intervention were approached to complete a semi-structured interview. A social constructivist paradigm was adopted. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Results Twenty-eight young adults (Mean age = 34.67 ± 5.11 years; n = 25 female) with varied cancer diagnoses participated. Participants’ perspectives were represented across 6 themes: (1) I was juggling a number of challenges and changes throughout the yoga intervention; (2) I noticed some improvements in my mental and physical health; (3) I made time to discover new strategies to take care of myself; (4) I was able to see what my body is capable of; (5) I was held accountable and I appreciated that, and; (6) I was able to be around similar others in a safe (virtual) space. Conclusions Findings suggest that an 8-week yoga intervention may offer some benefits for young adults affected by cancer. Self-care, self-compassion, mindfulness, feelings of physical competence, establishing a routine, and being around similar others were viewed as important components of the intervention and may have contributed to the benefits experienced. Findings underscore the potential utility of yoga as a supportive care intervention for young adults affected by cancer.

Remote Delivery of the Cuidándome Telehealth Intervention for Self-Management of Depression and Anxiety Among Latina Immigrant Women: Randomized Controlled Trial.

Growing evidence suggests that Latina immigrant survivors of adverse childhood experiences (ACEs) are at increased risk for developing and remaining with either depression or anxiety or both symptoms. This study examined the feasibility and acceptability of a telehealth intervention-Cuidándome (quee-DAN-doh-meh, "taking care of myself"). Cuidándome is a 10-week, patient-centered, trauma-informed intervention delivered by a trained facilitator that promotes self-management of depression and anxiety symptoms through improved problem-solving skills and strategies. The aim of this study was to examine the feasibility and acceptability of Cuidándome delivered remotely (via Zoom) with Latina immigrant ACE survivors with either depression or anxiety or both symptoms. We also estimated the effect sizes associated with the intervention on decreasing depression and anxiety symptoms and improving social problem-solving styles. We evaluated Cuidándome using a randomized controlled trial design. Latina immigrants (N=47) who had experienced at least 1 ACE and had at least mild depression or anxiety symptoms were randomized to Cuidándome or a comparison group delivered by trained facilitators. We assessed for changes in depression and anxiety symptoms as well as social problem-solving styles at baseline, post intervention, and 3- and 6-month follow-up. Analyses indicated significant decreases over time within both Cuidándome and comparison groups for depression and anxiety symptoms and maladaptive problem-solving. The intervention effect was largest for anxiety; at 6-month follow-up, Cuidándome participants had significantly lower anxiety scores than the comparison group. In addition, we observed a greater average point reduction in depression symptoms at 6 months among Cuidándome participants (5.7 points) than in the comparison group (3.7 points). A mental health program delivered via Zoom by a trained facilitator was feasible and acceptable to Latina immigrant women and can be beneficial for reducing anxiety and depression symptoms. More research is needed to assess the effectiveness of Cuidándome among a powered sample size of Latina immigrants. ISRCTN Registry ISRCTN16668518; https://www.isrctn.com/ISRCTN16668518.

A qualitative study exploring experiences of female family caregivers of people with dementia in acceptance and commitment therapy

ABSTRACTObjectiveFew studies have explored the experiences of family caregivers of persons living with dementia (PLWD) in acceptance and commitment therapy (ACT). This study aimed for in-depth exploration on experiences of family caregivers of PLWD in ACT.MethodIndividual interviews were conducted with eight family caregivers of PLWD who were women and participated in an eight-week video conferencing ACT program. Data were analysed using interpretative phenomenological analysis.ResultsTwo overarching themes emerged, including improved strategies in responding to emotions and thoughts in challenging caregiving situations and taking better care of myself. Participants perceived that ACT skills training improved their coping strategies and, subsequently, their daily emotions and relationship with their relatives with dementia. Participants also perceived ACT strategies and exercises as helpful and applicable resources for daily use in challenging caregiving situations. In addition, ACT helped participants feel comfortable taking the time to take care of themselves without feeling guilty and acknowledge that they must take care of themselves first to take better care of their relatives with dementia. These changes helped caregivers increase their participation in valued activities.ConclusionsThis study contributes to the literature by exploring experiences of family caregivers of PLWD in ACT, including its perceived benefits on themselves.Trial registration: ClinicalTrials.gov ID: NCT04847986 (https://clinicaltrials.gov/ct2/show/NCT04847986)

Health Outcome Preferences Among Older Adults with Multiple Myeloma Undergoing Systemic Therapy

Introduction: Multiple Myeloma (MM) is the second most common hematologic malignancy in the US; over half of patients are ≥70y at diagnosis. Prior studies have shown that treatment preferences of older adults with cancer vary based on burden/intensity of current treatment and its impact on functional and cognitive well-being in addition to anticipated survival. However, no such studies exist among older adults with MM. We sought to understand health outcome preferences in a cohort of older adults with MM. Methods: Using the Cancer and Aging Resilience Evaluation in Hematologic Malignancies Registry (NCT05556928), a single institution prospective observational study of older adults with hematologic malignancies undergoing systemic therapy, we identified patients diagnosed with multiple myeloma at age ≥50y who had undergone a geriatric assessment (GA) within 30 days of initiating a new line of therapy (1 st to 5 th line).Treatment preference was assessed using a 9-item health outcome preference attitude scale (Case et al Patient Educ Couns 2013), rating self-reported agreement with statements related to health outcomes on a Likert scale. Frailty was assessed using a deficit accumulation method as previously described (Giri S et al J Am Geriatr Soc 2023) We measured the proportion of patients reporting other outcomes being “as important” or “more important” than survival and compared the response between younger (<70y) and older (≥70y) adults. Subsequently, we built proportional odds models to study the factors associated with a greater prioritization of outcomes other than survival. All p values were two sided and the level of significance was chosen at 0.05. Results: Of the 228 patients initiating a new line of therapy between 01/2022 to 4/2023, 104 (47%) underwent treatment preference assessment. The median age at enrollment was 65y with 33% ≥70y; 62% were males, 57% whites; 19% had ISS stage 3 disease; 28% were frail on the CARE frailty index. In the younger (age <70y) vs older (age ≥70y) patients, 32% vs 77% agreed/strongly agreed with: “I would rather live a shorter life than lose my ability to take care of myself”; and 54% vs 79% agreed/strongly agreed with: “It is more important to me to maintain my thinking ability than to live as long as possible”. In multivariable models, age but not frailty, sex, race or disease stage were associated with health outcome prioritization other than survival. Each 1y increase in age was associated with and 8% (Odds Ratio 1.08; 95% CI 1.03-1.13; p value=0.001) and 4% (OR 1.04; 95% CI 1.0-1.09; p value=0.04) increased odds of rating functional independence and cognition respectively as more important than survival. Conclusions: Three out of four older adults (age>70y) with MM rated other outcomes (particularly physical function and cognitive ability) as being more important than survival. Eliciting which outcomes are the most important for older patients can help define treatment goals and improve shared decision-making. Further, interventions focusing on preserving physical and cognitive function need to be tested in this population.

"My life is about to take care of myself": therapeutic itineraries of care for frail older adults.

The present study sought to understand how frail older adults perceive their therapeutic care itineraries. This qualitative research was based on Critical Medical Anthropology. Data were collected through interviews in the homes of 22 older adults, whose average age was 79. The emic analysis was guided by the model of Signs, Meanings, and Actions. All interviewees expressed access to professional care in their trajectories, which are understood as insufficient, unprepared, prejudiced, uncomfortable, contradictory, (un)accessible, realization, respectful, and excessive. Therapeutic itineraries were also revealed in the psychosocial and cultural spheres. Several day-to-day actions were evaluated and interpreted in the record of self-care and justified by this end: the time they wake up, sleep, what they eat, and how they behave. They face the lack of care policies in their trajectories, labeling their bodies as undesirable due to physical, symbolic, communicational, attitudinal, systematic, cultural, and political barriers. Thus, they bring to light therapeutic pluralism, challenges, confrontations, insistence, and resistance in maintaining care when experiencing old age with frailties.

An internet‐based support program for family caregivers of community‐dwelling people with dementia: A pre‐post pilot study

AbstractBackgroundCaregivers of people with dementia faces difficulties while constantly caring for their loved ones. Providing support programs should consider for promoting their experience of caregiving, quality of care, and will lead to delay institutionalization of dementia people. Implementing onsite support programs meets obstacles during the Covid‐19 pandemic, internet‐based interventions could be considered as a potential alternative.MethodsThis is a pre‐post pilot intervention study for primary family caregivers of community‐dwelling people with dementia. The 8‐week intervention program was delivered to the participants using ZOOM meetings software. This program consisted of 8 modules (one for each week): 1) reflecting on my caregiving journey, 2) understanding about dementia as a caregiver, 3) taking care of myself, 4) managing stress, 5) communicating with others, 6) learning how to take care of dementia people, 7) pleasant daily life, and 8) planning my caregiving journey. To assess the effects of the program, five caregiver’s outcomes were measured: Positive Aspects of Caregiving, (PAC), Caregiving Self‐Efficacy Scale (CgSES), Perceived Stress Scale (PSS), Health Risk Behaviors (HRB), and satisfaction.Results20 caregivers participated and 18 fully completed the pilot program. The participants have the mean age is 70.6, and 3.5 years playing the role of a family caregiver. The study findings found that the program significantly improved the PAC (P = .001), PSS (P = .027), and three sub‐domains of HRB: physical health (P < .000), mental health (P = .048), and leisure activities (P = .023). Whereas, though scores of the CgSES, and three remaining sub‐domains of HRB: care difficulty, building relationships, and getting help from others were better at the posttest compared with the pretest, these changes were not statistically significant. The participants scored 4.72 (maximum is 5) for their satisfaction with the program.ConclusionThis intervention program successfully improved quality of life and experience of the family caregivers related to their caregiving. Such online programs are a feasible solution in delivering supports to a huge subject anywhere while still mandated social distancing in this unpredictable Covid‐19 pandemic. Therefore, expanding this pilot should be considered.

Taking care of myself in a different and broken world: self-care practices of adolescents on dialysis

ABSTRACT Purpose Being on dialysis is a traumatic situation particularly during adolescence. Therefore, adolescents must have self-care support according to their special needs. The goal of this study was to describe the adolescents´ self-care practices when they are on dialysis. This paper reports only the adolescents´ selfcare practices based on the health care team guidelines but adjusted to their beliefs and habits. Methods The methodology of the study was interpretive phenomenology. In-depth interviews were conducted with 15 adolescents; Smith´s IPA procedure was used for data analysis. Results Being on dialysis meant to the adolescents living in a different and broken world. Self-care practices included: 1) coexisting with the dialysis slavery or being attached to a machine day or night, 2) struggling with the maddening thirst experience, 3) Deciding what, when and how much food to eat, 4) taking care of an alien that helps to survive, 5) taking the medicines when feeling in need of them. Conclusion The adolescents tried to care for themselves adjusting their care activities to the health team´s recommendations. However, they also adjusted those practices to their beliefs and habits, which allows them to live with dialysis in a less traumatic way.

Patient-Defined Goals and Preferences Among Adults With Advanced Neuroendocrine Tumors.

Patient preferences (quantity vs quality of life; present vs future health) have not been investigated in patients with neuroendocrine tumors (NETs). The goal of this cross-sectional study was to evaluate patient values toward treatment goals and competing health outcomes among adults with NETs. Patients with well-differentiated, grade 1 or 2, advanced NETs starting a new systemic therapy completed 4 tools: (1) Health Outcomes Tool, which ranks the importance of 4 outcomes (survival, function/independence, freedom from pain, freedom from symptoms); (2) Attitude Scale, which identifies the extent to which patients agree with statements related to health outcomes; (3) Now versus Later Tool, which ranks the relative importance of quality of life (QoL) now versus 1 and 5 years from now; and (4) Prognosis and Treatment Perceptions Questionnaire, which identifies the amount of information the patient prefers to receive about their disease and treatment, the patient's treatment goal, the patient's perception of the physician's treatment goal, and self-reported health status. We recruited 60 patients with NETs (50.0% aged ≥65 years; 96.7% with stage IV disease). Primary tumor locations included the gastrointestinal tract (41.7%), pancreas (30.0%), and lung (21.7%). A plurality of patients reported maintaining independence as their most important health outcome (46.7%), followed by survival (30.0%), freedom from pain (11.7%), and freedom from symptoms (11.7%). A total of 67% of patients agreed with the statement, "I would rather live a shorter life than lose my ability to take care of myself"; 85.0% agreed with the statement, "It is more important to me to maintain my thinking ability than to live as long as possible." When asked to choose between current QoL versus QoL 1 year or 5 years in the future as more important, 48.3% and 40.0% of patients valued their QoL 1 year and 5 years in the future, respectively, more than their current QoL. Only 51.7% of patients believed their physician's treatment goals aligned with their own. Adult patients with NETs strongly value independence over survival. More communication between patients with NETs and their physicians is needed to ensure that patient preferences are incorporated into treatment plans.

Sacrifices

Sacrifices Efrat Lelkes I've always been goal-oriented. Since I was a teenager, I've known what my life would look five, ten years ahead of time. I went straight through—straight to college from high school, to medical school, through residency, fellowship, and to a junior faculty position in academia. I never stopped to ask if this was the right path for me, nor did I ask what I was missing throughout this path. For me, the honor of being in academia meant that I kept going without questioning. I theoretically knew that sacrifices were intrinsic to becoming a physician, especially a physician-scientist. But to be an academician, I believed, was what I was supposed to be, and thus I knew that I would sacrifice sleep, money, and a "normal life" for a long time. I just didn't realize that I would sacrifice myself. In my mid-thirties, I began to recognize that the life I had forged as a physician-scientist was destroying me. I hated being in the lab. I missed my patients. I spent my time away from work living a very unhealthy life. And so, abruptly, I left the lab and my career as a scientist, and I transitioned to being a full-time pediatric critical care physician. I did so with the belief that I was a failure. I did so without considering the need to care for myself and to truly ask what I needed. I just believed I needed to serve others. The pressure I put on myself was immense. I started to mistrust myself as a clinician. I started to make mistakes. I deeply despised myself. And then I broke. With severe depression and anxiety, post-traumatic stress disorder, and a need to run away, I left home for a year under the guise of further training in palliative medicine. It was the year that saved my life, and it was the year that I began to appreciate how much I had given up for this career. It was when I learned that academia was not life, and it was then that I learned what I truly wanted. I wanted a family. I had wasted so much time pretending that I didn't. No glory had been afforded—especially for young women in this world—to needing a companion. I was supposedly superhuman; I didn't need anyone else—whenever anyone asked what was wrong, I would defiantly aver that I was fine—and to suggest otherwise meant that I was a burden and useless. But, by my late thirties, after my year away, after starting to heal, I was learning otherwise. I wanted to belong and to connect. I wanted a partner. Just as much, I wanted to become a mom. So I entered the world of fertility, deciding to become a single mom by choice. My reproductive endocrinologist was remarkable, my friends and my family were supportive, and I felt courageous, proud, and ready. [End Page E16] And, just as I started this process alone, I fell in love for the first time. I met a man the same month I started to try to get pregnant through Intrauterine Insemination (IUI). The first cycle did not work. I was sad, and he supported me. The second cycle did not work, and I was relieved. He was as well. We were becoming part of each other's lives, and we were excited about the future. I chose to put motherhood aside to focus on us, in theory. But, in truth, it was hard not to think about it daily. I knew that I was getting to the end of my reproductive years. Though I wanted a fairy tale, and I wanted us to be together, the aching to be a mom would not subside. I tried to quash it, but it would bubble up, and it would explode. I should have listened to him when he told me he was not ready. We perhaps should have made different decisions about our relationship. But we were deeply in love, we believed in us, so we forged ahead. After an eternity of pressure by me—and pressure fueled by...

"It [Diabetes] is From God and I Need to Take Care of Myself": Type 1 Diabetes Self-Management Among Adolescents and Their Parents in Jordan.

Type 1 diabetes is the most common endocrine condition among adolescents. Diabetes self-management can be challenging during adolescence. The objective of this study is to understand how adolescents and their parents manage type 1 diabetes in Jordan. Constructivist grounded theory methodology principles were used to achieve the study aim. A total of 48 participants were recruited using purposive and theoretical sampling techniques, including adolescents and their parents. Data were collected (October 2016 - April 2017) using 38 semi-structured, audio-recorded interviews (one-to-one or joint interviews based on participants' preferences). Data were collected and analyzed concurrently using different levels of coding, constant comparative analysis, and memo writing. This study was approved by relevant ethics committees from the University of Manchester and Jordan University Hospital. The theme of living with diabetes is presented and discussed in this article. Culture emerged as the central theme; two aspects of culture are presented in this article: collectivism and cultural beliefs. This study identified that diabetes self-management could be influenced by the culture in which Jordanian adolescents live in as well as being shaped by their religious beliefs. These findings are potentially transferable to other Arab and non-Arab countries that share similar cultural aspects and religious beliefs.

“Khi mô về?” (When will you go home?) Evocative Autoethnography on Death, Impermanence, and Time-Space Extension

This article is motivated by my personal wish to pay tribute to my beloved grandfather, who passed away during the COVID-19 pandemic while I was stranded in Australia. Relying on an evocative autoethnography of a grandson, a father, a PhD candidate and graduate, and a researcher, and in reference to the concepts of place-making theories such as time-space expansion, I tried to embrace my experience of grief and loss as well as to make sense of my feelings of distance, impermanence, and death during this chaotic period. The story I will tell below chronicles my emotional and spiritual journey from the moment I first learned of my grandfather’s illness (early 2020) until the time after his passing (October 2021). I have found out that during this process of attempting to converse with, heal, and take care of myself, I have transcended the physical-social aspects of place and touched on spiritual space.

Patient-defined goals and preferences among adults with advanced neuroendocrine tumors.

509 Background: Patient values toward treatment goals and competing health outcomes among adults with neuroendocrine tumors (NETs) are not well understood. The goal of this study was to identify NET patient values towards treatment goals and health outcomes. Methods: Patients with well-differentiated, grade 1/2, advanced NETs starting a new systemic therapy were recruited at a National Cancer Institute-designated cancer center. Patients completed four tools: 1) Health Outcomes Tool: ranks importance of four outcomes (survival, function, freedom from pain, freedom from symptoms); 2) Attitude Scale: identifies the extent to which patients agree with statements related to health outcomes; 3) Now versus Later Tool: ranks relative importance of quality of life (QOL) now, one year from now, and five years from now; and 4) Prognosis and Treatment Perceptions Questionnaire: identifies the amount of information patients prefer to receive about their disease and treatment, patient’s goal of treatment, physician’s goal of treatment (patient’s perception), and self-reported health status. Results: Sixty patients (50.0% ≥65 years) completed the questionnaires. Ninety-seven percent had stage IV disease. Primary tumor locations included gastrointestinal tract (41.7%), pancreas (30.0%), and lung (21.7%). Sixty percent of patients had received at least one prior systemic therapy. Only 30.0% of patients chose survival as their most important treatment outcome on the Health Outcomes Tool. The remaining 70.0% chose maintaining independence (46.7%), freedom from pain (11.7%), and freedom from symptoms (11.7%) as their most important health outcome. Similarly, on the Attitude Scale, 66.7% of patients agreed with: “I would rather live a shorter life than lose my ability to take care of myself”; 85.0% agreed with: “It is more important to me to maintain my thinking ability than to live as long as possible.” Ninety-three percent of patients agreed with: “I am willing to have side effects right now if it means I could have a better quality of life in the future.” Moreover, on the Now versus Later Tool, 48.3% of patients considered QOL one year in the future more important than their current QOL; 40.0% considered QOL five years in the future more important than their current QOL. On the Prognosis and Treatment Perceptions Questionnaire, only 30.0% of patients chose “To extend my life as long as possible” as their primary treatment goal, but 40.0% believed survival was their oncologist’s primary treatment goal. Furthermore, only 51.7% of patients believed they had the same treatment goal as their oncologist. Across all questionnaires, there were no significant differences between the responses of younger and older patients. Conclusions: NET patients value independence more than survival. More communication between NET patients and physicians is needed to ensure patient preferences and values are incorporated into treatment plans.

PH Professional Network: From Patient to Provider: How My Diagnosis Makes Me a Better Nurse

PH Professional Network: From Patient to Provider: How My Diagnosis Makes Me a Better Nurse

Quality of life for social care centre clients

Introduction:There are approximately 60 million people over 60 years of age in the world. The United Nations predicts that by 2050 the number of people aged 60 years and older could be around 2 billion (Zaļkalns, 2015). In Latvia, every fourth inhabitant is a pensioner. Given Latvia's socio-economic situation, social and health care options for older, lonely people are becoming increasingly less accessible. A large part of the population of Latvia cannot provide themselves with quality of life in old age. If there is no family or, due to various circumstances, relatives cannot take care of the elderly, the only option is social care institutions (Slokenbeka, Zepa, 2013). The quality of life of an elderly person remains an issue when he or she is in a social care centre. Quality of life is a complex, interacting set of objective and subjective indicators in different areas of life. The World Health Organisation defines quality of life as “the perception of an individual's personal life position in the context of the cultural and value system in which the individual lives in relation to the individual's goals, expectations, standards and concerns. It is a broad concept that is influenced in complex ways by a person's physical health, psychological state, personal beliefs, social relationships and key environmental factors” (Scester, 2012).
 The Aim of the study:To analyse the quality of life for social care centre clients.Materials and methods:Quantitative research method was chosen to obtain the results. A questionnaire with 25 questions was developed. The participants of the research were clients of two social care centres (hereafter SAC) (SAC “X”, n = 50; SAC “Y”, n = 50).
 Results:The majority of SAC respondents have lived in the institution for more than four years (SAC “X” = 54%; SAC “Y” = 70%). In both groups, the predominant reason for being in SAC is “I am lonely, I cannot take care of myself” (SAC "X" = 62%; SAC "Y" = 58%). On the questions about the frequency of meals and the quality of food in the SAC, the data show that 78% of clients in SAC “X” and 94% in SAC “Y” are satisfied with the frequency of meals, while on the quality of food the dominant answer is “the food is satisfactory” (SAC “X” = 54%; SAC “Y” = 32%). The questions on living conditions show that SAC clients live both alone and in pairs (mainly spouses). The relationship with the roommate is described by 52% in SAC “X” and 38% in SAC “Y” with the phrase “we get along peacefully, without quarrels”. 26% of respondents in both groups describe their relationship as “very good and friendly”. SAC clients describe their financial situation as “modest”. Emotional support is received from other residents, staff and family members/relatives. Emotional uplift is also provided by various activities in the SAC and by doing things that they enjoy and find interesting, e.g., handicrafts, crossword puzzles. SAC clients note that they try to attend all events organised by the SAC, especially concerts by amateur groups and famous artists. The “feeling of security” in the SAC is prevalent in both groups of respondents (SAC “X” = 56%; SAC “Y” = 70%). Although there is a feeling of security, both groups of respondents report that they “miss the feeling of home” when living in SAC (SAC “X” = 24%; SAC “Y” = 34%).
 Conclusions:Clients in the social care centre are satisfied with the quality of life in the physical and social spheres, but are partially satisfied or dissatisfied with the quality of life in the emotional and area of independence. The participants often feel lonely and sad and experience longing and anticipation. Respondents in both social care centres never or rarely experience feelings such as love, joy and happiness. Respondents indicate a lack of independence, acknowledging that they have limited autonomy and that they cannot be who they are because they have to adapt to the existing regime.
 Bibliography:1. Zaļkalns J. (2015). Novecošana – aktualitātes un problemātika. Retrieved 25 January 2017 from http://www.afonds.lv/editor/uploads/files/prezentacijas/1_Zalkalns_Novecosana_aktualitates_ problematika.ppt2. Slokenbeka A., Zepa D. (2013). Vecums – liktenis, izaicinājums, dāvana. Rīga: RAKUS Atbalsta fonds. 96 lpp3. Šķestere, I. (2012). Pētījums par dzīves kvalitātes izvērtējuma metodēm un instrumentiem. Rīga: ES Eiropas Sociālais fonds. 43 lpp.