Recipients of ONS Foundation Funding

Dr. Eun-Ok Im was greatly affected by an early experience in oncology in her native Korea. She was caring for a terminally ill cancer patient, a man, who complained of great pain. He asked to be moved to a single room, and his wife pleaded with the staff to accommodate his request. After being moved to the single room, the patient committed suicide. She learned two lessons from this experience -first, in the Korean culture men do not tend to complain, so the nurse must pay attention to a man's complaints, specifically. And second, it seemed so very sad to her that this man was forced to end his life to have freedom from pain. She resolved to do a better job of symptom management.

Dr. Im completed her bachelor's degree in nursing and her master's in public health in Korea. After coming to the United States, she completed her MSN and her PhD in nursing at the University of California, San Francisco, and postdoctoral study at University of California at San Francisco in Women's Health and Theory Development. From her early experience as a staff nurse in Korea, she was interested in how cancer patients change as they go through their cancer experience, and she became interested in pain specifically. She notes that in Korea it was not uncommon to use placebos in the treatment of pain, and she questioned that practice.

She became interested in the pain experience during her postdoctoral study working on an interdisciplinary project with a Korean professor aimed at systematic management of cancer pain. At the same time, she was working on another project with her mentor, Dr. Afaf Meleis, on gender and ethnic differences in anginal pain. Gender issues particularly intrigued her. Applying a feminist perspective which she had used in her dissertation work, she began to examine gender and ethnic issues in regard to pain.

Her ONS Foundation funding began with small grant funding for three projects, one of which she was Principal Investigator, that related to a systematic approach to cancer pain using a decision support validating an adaptive fuzzy computer software. At the same time, she was co-investigator on two studies involving breast cancer patients examining their beliefs and screening practices. Subsequently she received the ONS Foundation/Genentech, Inc. Outcomes Research grant to develop a decision support computer program for cancer pain. Dr. Im states that, "Without the research grants from the ONS Foundation, I could not have developed my career as a researcher." She goes on to describe how her research trajectory was built, one study at a time through which she gained research skills and knowledge in oncology nursing. Her work began with smaller studies focused on developing the computer program based on data from international and U.S. nurses which has been refined through larger funding from the ONS Foundation. She is currently conducting a 5-year RO1 study funded by NINR as the PI (2003-2008), which is based on her earlier study on cancer pain management supported by the ONS Foundation. This RO1 study is also aimed at development of a decision support system for cancer pain management based on actual data from cancer patients. She has another RO1 application in development that will further build on her previous work.

She identifies recruitment as the most challenging experience in research. She mentions that in a current Internet study, she has had a difficult time recruiting the African American subjects needed despite trying many of the methods suggested in the literature. "That is one reason why it is important to choose a research topic that you feel passionate about because research has good points, but also downsides (like the recruitment issues), and you need passion to keep you committed to the task, to complete the study and disseminate the results." She urges new researchers not to be disappointed with negative funding decisions. She encourages thinking about the fact that those efforts will never be a loss, but rather serve as the concrete ground for the next project.

Besides being passionate about one's research topic, Dr. Im has this advice for new researchers - try not to become involved with too many projects, especially when they are on very diverse topics, as this can keep you from focusing on the topic you are really passionate about.

Her long term goal is to help nurses provide appropriate and adequate care for all cancer patients in pain and to develop an ultimate decision support system for cancer pain management that includes diverse sub-systems for each different type of cancer that will consider gender and ethnic differences. This will assist the nurse at the bedside through the use of a hand held decision support system to deliver individualized pain management to oncology patients.

Dr. Weber is an innovative nurse scientist, who is committed to improving the quality of life of long-term cancer survivors, particularly prostate cancer patients. A relative newcomer to oncology, his five years in the field have seen the completion of his ONS Foundation funded study, "Dyadic Bonding in Prostate Cancer" that examined the effect of a program of dyadic support for men surviving prostate cancer. He then received further funding from the National Cancer Institute to expand and test the intervention.

The ONS Foundation funding, in addition to an alumni award, the Marie Haug Award from the F. P. Bolton School of Nursing and the Center on Aging and Health at Case Western Reserve University, and a grant from the Midwestern Nursing Research Society, launched his research career by funding his dissertation work. The idea for that first study was generated from a clinical exemplar --prompting the question, "Why do some patients do better than others during their cancer treatment and subsequent survivorship?" Efforts to understand the process of self-efficacy and the effects of support led to the development of an intervention specifically for men with prostate cancer where they were paired with another man who was a trained long-term prostate cancer survivor. His findings included men in the intervention group reported better clinical outcomes as well as improved quality of life, led to larger funding through a R03 award from NCI.

"Logistics" provide the greatest challenge in doing research, Dr. Weber explains. Finding clinical settings for accrual of research participants, gaining access to the potential participants, obtaining clinic staff support for the study and the detail work of implementing the study provide logistical challenges to the nurse scientist. He has found that establishing relationships with staff in the clinical setting are invaluable to getting your research accomplished -taking the time to develop these relationships and getting the staff's investment in the study are important.

If he could begin again, Dr. Weber, now a faculty member at the University of Florida, College of Nursing, would come to cancer research earlier in his career. As a second career person, he came to nursing "later" in his life. His advice to novice nurse researchers is to find a passion for a clinical topic and then find great mentors. He credits his doctoral advisor, other senior nursing researchers and interdisciplinary colleagues for helping him achieve his success thus far -"they demanded excellence but encouraged and mentored."

His hope is that his work regarding supportive interventions for cancer survivors will furnish the evidence-base needed to develop best practices in this area. His work has been important in showing that men not only accepted the intervention and had improved quality of life, but had better functional outcomes as well. The subjects appreciated the one-on-one nature of the dyadic support, and reported that the flexibility of peer support better met their needs versus going to a scheduled support group. Additionally, the trained prostate cancer survivor derived benefit from helping the "new" patient.

Quality of life for cancer survivors is not only an ONS research priority, it is the vision for Dr. Weber as he looks ahead to a productive cancer nursing research career.

Terry Badger, PhD, RN, CS, Professor at the College of Nursing, The University of Arizona

Dr. Badger is passionate about the psychosocial needs of cancer patients and how research can improve the oncology nurse's skill in meeting those needs. An established researcher and Principal Investigator of the recently completed ONS Foundation CLIR Symptom Management Research Grant, "Telephone Intervention: Rural Women with Cancer and Their Partners", Dr. Badger advises oncology nurses starting out on a research career to get on a research team in some capacity - project director, data collector, etc. Then, she urges, "Find your passion!"

She began her funded research career with an interest in depression in chronic illness, and a National Institute of Mental Health grant that involved training in assessment and management of depression. From there, she expanded her interest in depression to older adults and then to various oncology populations. The ONS Foundation funded project tested the effectiveness of a telephone interpersonal counseling intervention in meeting the psychosocial needs of rural breast cancer women and their partners. The intervention group was found to have improved outcomes-both those outcomes related to symptom management, as well as mood and quality of life. Both the woman with breast cancer and her partner benefited from the intervention. In addition, patients and their partners in the intervention group liked the interpersonal intervention because it was focused on their individual needs.

She is currently involved with efforts, funded by NIH, to expand her research on this intervention to a larger sample of women with breast cancer and their partners and men with prostate cancer and their partners. This proposal followed her funding from the ONS Foundation. The Foundation's initial funding provided the pilot data for the NIH funded proposal. Future research efforts will focus on patients with other cancers, i.e., lung cancer. She has built an effective research team that continues to fuel her enthusiasm for research.

Her interdisciplinary research team consists of Co-Investigators, Dr. Chris Segrin from the Department of Communications, Dr. Ana Maria Lopez from the Arizona Cancer Center, and Dr. Paula Meek from The University of New Mexico; Project Director, Dr. Donna McArthur; Interventionist, Elizabeth Bonham, MS, APRN, BC; Data Manager, Dr. Alice Pasvogel; and Data Entry, Amelia Sieger, Nursing Student.

An ONS member for approximately six years, Dr. Badger regrets her "late" entry into oncology nursing research, and wishes she had worked with cancer patients earlier. Her vision of the priorities for future research in oncology are further investigation of psychosocial interventions, adding a cost effectiveness component, genetics and of course, a continued focus on symptom management.

Norma Kay Krumwiede, EdD, RN

"Understanding Family Experience of Neutropenia,” led by primary investigator Norma Kay Krumwiede, EdD, RN, studied rural families’ experience of chemotherapy-induced neutropenia (CIN). The qualitative study—accomplished over 18 months from conception to manuscript—identified how families understand and manage the experience of CIN. The study involved semistructured interviews with seven families (21 individuals) that had family members experiencing CIN.

“Neutropenia is a significant event within the whole of the cancer experience for the family,” Krumwiede said. “The depth of meaning expressed by families during a short interview was humbling and overwhelming at times with 432 pages of transcript to read, analyze, and synthesize.”

The study reported that because of patients’ neutropenia, family members had tempered their feelings about hope for patients to be cured. The study found that, during the neutropenic period, family members respond with protective behaviors toward the neutropenic patient. These behaviors led to a reframed sense of family integrity with more intensified connections within the family. The study also identified nurses, physicians, and community members as significant in the family’s construction of the meaning of neutropenia. The neutropenia study findings have contributed to development of the Family Cancer Care Protocol for Neutropenia, which includes assessment and intervention strategies ideally implemented by a family nurse assigned to a patient and family.

Amgen has underwritten this neutropenia study and others through the ONS Foundation Center for Leadership, Information and Research (CLIR). According to Krumwiede, the CLIR grant has allowed the Family Nursing Research Team to clarify its focus, increase the number of team members, and bring in consultants when needed. Because the grant supported an interdisciplinary team, one of the outcomes from the research is validation of the worth of such a team. With external funding, team members could participate fully in the project, dedicating time and attention to the work of the project.

“Computerized Symptom and Quality-of-Life Assessment in Clinical Practice,” led by principle investigator Donna L. Berry, PhD, RN, AOCN^®, involved a multidisciplinary team developing and testing an innovative computerized symptom and quality-of-life (QOL) assessment tool. The University of Washington study, which began with production of a prototype framework for the tool, has led to the development of software with a useful clinical application.

The computerized patient assessment tool generates a graphic summary of symptom distress and/or troublesome QOL issues for use during initial and continuing consultation visits with a radiation oncology physician and nurse. The tool, based on input and testing from more than 100 patients with cancer receiving radiation, is available in a wireless, Web-based format.

“The tool allows nurses to approach their patients as individuals who experience cancer in all aspects of their lives,” said Berry. “Too often we are faced with shrinking resources that remove opportunities for lengthy interpersonal interactions with patients,” she said. “The patient’s symptom and QOL experience, reported in a reliable and efficient method, is the essential basis for clinical assessment, diagnosis, and treatment plan.”

Based on the study, Berry and her colleagues have concluded that a computerized assessment of cancer symptoms and QOL is technically feasible in an ambulatory cancer clinic. They concur that the ability to capture a quick (less than 10 minutes), easily interpreted illustration of a patient’s symptom and QOL experience is a potentially useful adjunct to traditional face-to-face interviewing.

The study findings will be published soon. Berry reports that several sites within the University of Washington network and the Seattle Cancer Care Alliance are preparing to implement computerized assessment as part of routine practice. Data generated from computerized assessment at those sites will continue to build the research’s database.

Berry pointed out that the study, made possible by an unrestricted grant from Ortho Biotech to CLIR, complemented the needs of research and clinical practice. “The support of the ONS Foundation made a difference in our research and in our clinical practice. The symptom research priority matched the clinical priority in our cancer care setting,” Berry said.

Awards, Grants, and Scholarships
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