Purpose/Objectives To determine facilitators and barriers to managing patient loss from the combined perspectives of oncology nurses and to extract essential components of a supportive intervention. Research Approach Qualitative, descriptive. Setting The comprehensive National Cancer Institute–designated cancer center of a mid-Atlantic university teaching hospital. Participants 34 nurses from inpatient and outpatient adult and pediatric oncology units. Methodologic Approach Focus groups were held with oncology staff nurses to identify challenges regarding work-related bereavement, current support for managing grief and loss, and how to support interpersonal functioning and resiliency. Main Research Variables Work-related bereavement, bereavement support, and interventions and management strategies for bereavement and loss. Findings Two primary themes emerged: dimensions of work-related loss and working through bereavement. Participants also provided many concrete suggestions for the creation of a supportive self-care environment. Conclusions Support issues were numerous, multilevel, and varied. However, addressing those concerns can improve job satisfaction and decrease compassion fatigue. The findings lay the foundation for appropriate interventions to assist nurses in managing those situations. Interpretation Administrators, managers, and individuals interested in furthering the multifaceted goals of oncology care, including nurses themselves, are challenged to create and maintain mutually supportive environments for providing optimal care to patients and families.

Cancer survivors in the United States often encounter significant challenges in obtaining and paying for medical care. Multiple research studies have examined these issues in Medicare and Medicaid populations and the underinsured, but very little is known about insurance-related challenges encountered by cancer survivors enrolled in private insurance programs such as managed care. This secondary analysis of data explored the insurance-related and financial challenges reported by women enrolled in a managed care organization during cancer treatment and early follow-up. The researchers reviewed semistructured interviews with 14 women with breast cancer near the time of diagnosis, midway through treatment, and after treatment completion. Most women reported considerable stress related to performance of insurance-related tasks during or immediately after treatment, which resulted in negative emotional and psychological experiences. This article presents recommendations for how oncology nurses can intervene to assess and address these challenges and their effects. Future research should examine best practices related to nursing management of insurance-related and financial challenges during cancer.

Older African Americans face substantial barriers to state-of-the-art cancer care. Implementing culturally appropriate support throughout cancer therapy is critical to improving cancer outcomes and quality of life for this vulnerable population. The purpose of this study was to obtain experiential data regarding cancer diagnosis and treatment, and analyze survivors’ recommendations regarding treatment-related needs, psychosocial support, and strategies and resources. Four main issues emerged from the study: (a) the need for more health-related and cancer-specific education, (b) the importance of faith and spirituality, (c) the availability of support, and (d) participants’ difficulty identifying and articulating financial needs. Few participants reported requesting or receiving assistance (financial or otherwise) outside of the family during their cancer experience. However, treatment-related medication costs posed a significant hardship for many.

Purpose/Objectives Although frameworks for understanding survivorship continue to evolve, most are abstract and do not address the complex context of survivors’ transition following treatment completion. The purpose of this theory adaptation was to examine and refine the Illness Trajectory Theory, which describes the work of managing chronic illness, to address transitional cancer survivorship. Data Sources CINAHL, PubMed, and relevant Institute of Medicine reports were searched for survivors’ experiences during the year following treatment. Data Synthesis Using an abstraction tool, sixty-eight articles were selected from the initial search (N>700). Abstracted data were placed into a priori categories refined according to recommended procedures for theory derivation, followed by expert review. Conclusions Derivation resulted in a framework describing “the work of transitional cancer survivorship” (TCS work). TCS work is defined as survivor tasks, performed alone or with others, to carry out a plan of action for managing one or more aspects of life following primary cancer treatment. Theoretically, survivors engage in 3 reciprocally-interactive lines of work: (1) illness-related; (2) biographical; and (3) everyday life work. Adaptation resulted in refinement of these domains and the addition of survivorship care planning under “illness-related work”. Implications for Nursing Understanding this process of work may allow survivors/co-survivors to better prepare for the post-treatment period. This adaptation provides a framework for future testing and development. Validity and utility of this framework within specific survivor populations should also be explored.

Synopsis Aging with independence benefits individuals, family and society. To achieve independence, older adults must be able to function in their homes. This function is determined both by their abilities and by the environment in which they maneuver. In this article, we describe a promising program that intervenes with both older adults and their home environments to improve function. This program, called CAPABLE, is funded through the Affordable Care Act and can be scaled up nationally if determined to be a success in improving health and decreasing health care costs.