This report summarizes findings related to the psychometric properties (internal consistency and construct validity) of the Pittsburgh Sleep Quality Index (PSQI) and discusses issues related to its use based on data from two clinical studies with diverse samples of cancer patients. Subjects completed a questionnaire that included the PSQI, the Schwartz Cancer Fatigue Scale, and specific demographic, disease, and treatment variables. There were complete data on 170 (of 214) cases in Study 1 and 249 (of 259) cases in Study 2. The Cronbach's alpha for the Global Sleep Quality scale was 0.81 in Study 1 and 0.77 in Study 2 A comparison of Global Sleep Quality in two contrasting groups with low and high fatigue yielded statistically significant differences in both samples. Psychometric evaluation supports its internal consistency reliability and construct validity. However, the scoring is rather cumbersome and raises questions regarding level of measurement and appropriate analysis techniques.

The PELI captures strongly held personal preferences and shows promise as a practical tool that allows providers to document client preferences and customize care accordingly.

Background: Care in nursing homes (NHs) often overlooks individual values and preferences. Residents' voices are critical to discussions about preferences, yet there remains limited research on conversations about the end of life (EOL) from the perspective of older adults who reside in NHs. Objective: The aim of this study was to describe the communication, content and process, related to EOL conversations among residents, family, and staff. Methods: We used semistructured interviews in this qualitative, descriptive study to describe conversations about EOL preferences. We examined participants' conversation, when it occurred, and what was discussed. We queried about barriers to and facilitators in discussing EOL care in the NH setting. We interviewed residents (n = 16), family (n = 12), and interdisciplinary staff (n = 10) from four NHs. Results: The overarching theme-missed conversations-describes EOL-related communication. Residents, families, and staff rarely talked about EOL care preferences, nor did they pass along information about preferences or initiate conversations about EOL care with each other. Three categories explained missed conversations: inquiry (''No one asked''); assumptions (presence of an advance directive [AD], ''They know me''); and conveying (lack of conveying information or wishes). Existing barriers and lacking facilitators resulted in missed opportunities to hold conversations about EOL preferences. Conclusions: Not all residents wanted to have conversations, but many wanted to be asked about their preferences. Missed conversations may adversely affect the quality of EOL care. Conversations with residents can be initiated by asking residents who they would like involved in the conversation and drawing upon the experience of others.

This study examined the symptom experience, health-related quality of life, and functional performance of elderly cancer survivors at 1 and 3 months after the completion of initial treatment. The study used a descriptive, comparative, repeated-measures design. A mixed-methods approach combined completion of survey instruments with qualitative interviews. Of the 52 participants, 22 resided in rural (n = 12) or semirural (n = 10) areas and 30 lived in urban settings. There were 23 women and 29 men ranging in age from 65 to 81 years (mean age, 71.53 years). Survivors experienced a significant number of symptoms (mean, 4.58), which were, on average, moderate in intensity and did not differ based on urban or rural residence. The Medical Outcomes Study SF-12 Physical Component Summary was less than the national norm for elderly individuals or those with a chronic disease. There was minimal improvement 3 months after treatment. Elderly survivors, regardless of whether they were rural or urban, experienced a significant number of unrelieved symptoms, including fatigue, pain, and difficulty sleeping. Eighty-eight percent had other chronic diseases. Comorbidities were associated with greater symptom intensity and less physical health status. Survivorship care for elderly adults should include a comprehensive geriatric assessment and tailored strategies for symptom management.