Fall 2004
Vol.2 | No. 2

  Rehab Referral Crucial to Cardiac Patients
  Toward Meeting the Spiritual Needs of the Terminally Ill
  An Extra Push for Colorectal Screening
  Walking Away Fatigue During Chemotherapy

Rehab Referral Crucial to Cardiac Patients

Illustration by Timothy Cook

Disparities in the rates of referral and subsequent enrollment in outpatient cardiac rehabilitation can be linked to income and race, according to a new study directed by Jerilyn Allen, ScD, RN, FAAN, associate dean for research.

The research, published in the July issue of The Journal of General Internal Medicine, found that only 19 percent of a group of 250 female heart disease patients said they received a referral to cardiac rehab upon discharge from the hospital. Referral rates for African-American women were half those of whites (12 percent vs. 24 percent), and women making less than $20,000 per year were 66 percent less likely to receive a referral than those with higher incomes.

“What wasn’t surprising, but appalling, was that the majority of women hadn’t even heard about cardiac rehabilitation,” Allen says. “They should not have left the hospital without at least hearing about rehab and how it could benefit them.”

Cardiac rehab programs, initially used by men recuperating from heart episodes, have been shown to reduce mortality, improve quality of life, and decrease the number of hospital re-admissions and overall medical costs among recovering heart disease patients, Allen says.

“Historically, the strongest predictor for a patient enrolling in cardiac rehab programs has been a referral from the primary health provider,” she says. “Automatic referral systems should be considered to increase utilization among women and reduce disparities in referrals.”

Allen’s team surveyed 253 women (108 African American and 145 white) who had been admitted to one of three Baltimore area hospitals for either a heart attack, coronary bypass surgery, or any other procedure for heart disease. Fifty-one percent reported no knowledge of cardiac rehabilitation, and nearly two-thirds said they didn’t know if their health insurance covered the service.

Only 15 percent of all women enrolled in rehab programs, with fewer African-American women reporting enrollment compared to whites (9 percent vs. 19 percent). However, among those who received information or a referral to a rehab program, 80 percent enrolled.

Among the most common reasons cited by patients for not entering rehabilitation programs was the lack of referral or follow-up after hospital discharge.

Other reasons included feeling too sick, believing that they did not need rehabilitation or could exercise on their own, or being too busy to attend.

Transportation and cost were not cited as barriers to enrollment.
The work was supported by the Centers for Disease Control and Prevention. Next up for the study team: determining if establishing an automatic referral system to cardiac rehab programs increases the number of women enrollees.

— Karen I. Blum

Toward Meeting the Spiritual Needs
of the Terminally Ill

Meeting the spiritual needs of terminally ill patients can take on special significance for nurses since patients often may experience an intensification or awakening in their spiritual awareness as they search for life’s meaning.

“In many hospitals, newly admitted patients are simply asked whether they are affiliated with a specific religious denomination, but this provides little insight into potential spiritual needs that may require attention,” says Joan E. Kub, PhD, RN, an assistant professor of nursing who is pursuing a master’s degree in theology.

Questions that inquire about patients’ religious practices and the importance of religion in their lives may be more useful in allowing nurses to help patients stay connected to their affiliation, Kub says.

As part of a longitudinal study on the decision preferences of terminally ill patients, Kub; colleague Marie T. Nolan, DNSc, RN, director of Hopkins’ DNSc program; and others looked at religious practices and the importance of religion among 114 patients recently diagnosed with a life-threatening illness.

Survey results, published in a recent issue of Applied Nursing Research, demonstrated that 68 percent of participants viewed religion as very important and 45 percent attended services once a week or more. Even two subjects who had no religious affiliation and a large number of participants who seldom attended services still identified religion as at least somewhat important in their lives.

If attendance at religious services has been important to a patient but is now difficult, Kub says, a nurse could notify the hospital’s pastoral care team or identify other resources in the community to help the person remain an active participant in his or her faith. Care providers also could encourage the patient and family to communicate special needs with their own religious leaders, invite clergy to visit the patient at home, or ask volunteers to provide transportation to religious services.

Identifying spiritual resources for patients who are unaffiliated or do not identify religion as important is equally significant, Kub says, as terminally ill patients may be in a spiritual crisis, feeling abandoned by God.

Previous studies have shown that religious involvement and spirituality have been associated with better health outcomes, greater longevity, improved coping skills, and greater quality of life even among the terminally ill, she says.

— KIB

An Extra Push for Colorectal Screening
Relatives of colorectal cancer patients often know that they should schedule a colonoscopy to get screened themselves, though Kristin Zawacki observed that they may require a little extra push.

Zawacki, who earned her doctorate in nursing last spring, divided 86 relatives of colorectal cancer patients into four groups. Study participants received either a booklet promoting screening for colorectal cancer, a telephone call with information about screening, both, or neither.

Two weeks later, those in the intervention groups had significantly higher knowledge about screening. Participants who received the booklets and who needed a colonoscopy within the next year were more likely to say that they intended to go through with it. Beliefs that colonoscopy could prevent or help cure colorectal cancer increased among all participants.

“Interventions aimed at increasing screening through other mechanisms, such as provider recommendation, should also be considered,” Zawacki says.
Her work received a dissertation award from the School of Nursing.

— KIB

Walking Away Fatigue During Chemotherapy
A home-based walking program may help breast cancer patients combat the overwhelming fatigue commonly experienced during chemotherapy and radiation therapy, according to research directed by Victoria Mock, DNSc, FAAN, director of the Center for Nursing Research.

Mock and colleagues studied 119 breast cancer patients being treated at four hospitals on the East Coast. Women were randomly assigned to either usual care or to a home exercise program, in which they were given individual walking prescriptions.

Results showed that the majority of patients adhered to their exercise program and had significantly less fatigue and better physical function than those who didn’t exercise.

“Exercise makes patients physically stronger and emotionally better able to cope with cancer. It also gives them an important feeling of control,” Mock says.

The program was particularly beneficial to one patient, whose family was too distressed to discuss her breast cancer diagnosis with her. “Walking alone enabled her to deal with her feelings,” Mock says.

—KIB

top