Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (10 results)

  • Article
  • Peer Reviewed
UCLA Previously Published Works (2001)
    Cover page: Mastery of Postprostatectomy Incontinence and Impotence: His Work, Her Work, Our WorkCreative Commons 'BY-NC-ND' version 4.0 license
    • Thesis
    • Peer Reviewed
    UCLA Electronic Theses and Dissertations (2017)

    Aim: To understand the barriers Latino Adolescents have to self-manage their diabetes. Type 2 diabetes mellitus (T2DM) is a growing problem among Latino adolescents. An even bigger problem is the lack of adherence to self-management of the disease within this population, but little is known about what adolescents perceive as barriers to diabetes self-management.

    Methods: This study utilized grounded theory in a qualitative design to explore and understand the barriers to effective diabetes self-management care from the perspective of Latino adolescents with T2DM. Focus groups were conducted with 12 participants to identify the important topics for the individual interviews. Other 15 adolescents participated in the in depth individual interviews. All focus groups and individual interviews were video-taped and coding was done directly from the videos. All participants were recruited from Children’s Hospital Los Angeles.

    Results: Participants were 44.4% female, mean age was 16.3 years (SD 2.1), and 92.6% had a BMI >85% for age. They had T2DM for a mean of 3.86 years (SD 2.1), and they had poor metabolic control with a mean HbA1c of 9.1% (SD2.2%). Qualitative data revealed that the intrapersonal barriers and facilitators were the most important factors that influenced the participants in making decisions about their diabetes self-management. The core category was identified as “Acceptance of diabetes”. This study revealed that when Latino adolescents accepted that they have diabetes, and that it is not going away, they were able to embrace it and were able to overcome all the negative influences and perform diabetes self-management tasks. In order to achieve acceptance participants need to have a combination of a positive outlook in life, high self-esteem, be independent and resilient, and need to have some social support.

    Conclusions: This study has generated new knowledge that may have very important implications in the treatment of Latino adolescents with T2DM. Medical providers working with this population need to understand their barriers to treatment and need to implement changes in practice to help these youths acquire the necessary skills and qualities to achieve Acceptance of their diabetes.

      Cover page: Understanding Barriers to Self-Management Among Latino Adolescents with Type 2 DM
      • Thesis
      • Peer Reviewed
      UCLA Electronic Theses and Dissertations (2016)

      Caregiving is a highly individualized experience. While numerous papers have been published on caregiver burden in the context of a variety of diagnoses and conditions, this paper presents the unique features of caregiving in cancer patients with brain metastases. Improved long-term survival of patients, concerns about disease recurrence or progression, the mileposts of the cancer experience (initial diagnosis, treatment, survivorship, recurrence, progression, and end of life), and the increasing complexity of cancer treatments add to the demands placed upon the caregiver of patients with brain metastases.

      The aim of this dissertation was to explore the antecedents and outcomes of caregiver burden within the context of brain metastases using the Comprehensive Health Seeking and Coping Paradigm as a framework to describe the highly interactive relationship among the variables. The first paper derived from this dissertation is a literature review that describes the challenges of caring for a patient with brain metastases and highlights the implications for healthcare professionals. The second paper presents the analysis of the relationships between caregiver burden and the affective disorders anxiety and depression. It describes the higher risk of screening positive for anxiety and depression for caregivers who report increased schedule burden. The third paper examines the impact of the patient’s cognitive impairment on caregiver resilience and caregiver coping strategies. This paper reports the significant correlation found between the coping strategy acceptance and the two dimensions of the patient’s cognitive/behavioral status, i.e., patient’s memory problems and disruptive behavior.

      Caregivers of patients with brain metastases are the hidden morbidity of cancer. While the healthcare industry has consistently recognized the contributions of caregivers, we have fallen behind in identifying and managing their needs. Healthcare providers need to continue to be perceptive of caregiver burden and be ready to administer the appropriate interventions that must be as unique and individualized as their experiences.

        Cover page: The Hidden Morbidity of Cancer: An Exploratory Study of Burden in Caregivers of Cancer Patients with Brain Metastases
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2014)

        Purpose/objectives

        To investigate how familial communication about prostate cancer (PCa) risk and screening affects sons of men with PCa.

        Research approach

        Qualitative grounded theory.

        Setting

        Southern California.

        Participants

        17 Latino sons of PCa survivors.

        Methodologic approach

        The team conducted semistructured interviews and follow-up interviews. Therefore, the sample includes 25 transcripts. Data were analyzed with a mix of a priori topical codes and grounded theory techniques.

        Findings

        Sons were in need of information about familial risk and screening options. They became sensitized to PCa, desired information, and held protective intentions. Hopeful intentions came up against cultural taboos around sex, reproductive health, and intimacy that limited discussions between fathers and sons. Fathers were a valued source of information but play various roles, which affect sons' screening intentions. Open communication between father and son promoted awareness of screening and familial risk.

        Conclusions

        Uncertainty about familial risk and screening options, especially early detection strategies, was exacerbated by cultural taboos around PCa. Fathers could have been primary and credible advocates for shared decision making, but sons had difficulty learning from their fathers' experience.

        Interpretation

        FINDINGS from the study can help inform community-based interventions with Latino families, help to culturally tailor health messaging, and sensitize clinicians to a group that needs concerted counseling about PCa risk and screening.
          Cover page: Latino men and familial risk communication about prostate cancer.
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2012)
          Utilizing qualitative methods, this study describes the perceptions of and reliance on spirituality among indigent Latino men with prostate cancer. Sixty men were interviewed in Spanish. Transcripts were transcribed verbatim, translated, and analyzed using grounded theory techniques. Common across all men was a process involving the formation of an alliance of support that included God, doctors, and self. From this alliance, men drew strength to manage their disease, maintained hope for the future, and found new existential meaning. By recognizing the potential value of this alliance, health care professionals may tap into a beneficial empowering resource for some Latino men.
            Cover page: Alliance of Support for Low-Income Latino Men with Prostate Cancer: God, Doctor, and Self
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2012)
            To characterize patients' willingness to donate a biospecimen for future research as part of a breast cancer-related biobank involving a general screening population. We performed a prospective cross-sectional study of 4,217 women aged 21-89 years presenting to our facilities for screening mammogram between December 2010 and October 2011. This HIPAA-compliant study was approved by our institutional review board. We collected data on patients' interest in and actual donation of a biospecimen, motivators and barriers to donating, demographic information, and personal breast cancer risk factors. A multivariate logistic regression analysis was performed to identify patient-level characteristics associated with an increased likelihood to donate. Mean patient age was 57.8 years (SD 11.1 years). While 66.0 % (2,785/4,217) of patients were willing to donate blood or saliva during their visit, only 56.4 % (2,378/4,217) actually donated. Women with a college education (OR = 1.27, p = 0.003), older age (OR = 1.02, p < 0.001), previous breast biopsy (OR = 1.23, p = 0.012), family history of breast cancer (OR = 1.23, p = 0.004), or a comorbidity (OR = 1.22, p = 0.014) were more likely to donate. Asian-American women were significantly less likely to donate (OR = 0.74, p = 0.005). The major reason for donating was to help all future patients (42.3 %) and the major reason for declining donation was privacy concerns (22.3 %). A large proportion of women participating in a breast cancer screening registry are willing to donate blood or saliva to a biobank. Among minority participants, Asian-American women are less likely to donate and further qualitative research is required to identify novel active recruitment strategies to insure their involvement.
              Cover page: Patients’ willingness to participate in a breast cancer biobank at screening mammogram
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2018)

              Aims and objectives

              To describe the spirituality and religiosity of 30 non-directed (altruistic) living kidney donors in the USA and explore how they may have affected their motivations to donate and donation process experiences.

              Background

              The rise in non-directed donors and their ability to initiate kidney chains offer a novel approach to help alleviate the overextended kidney transplant wait list in the USA. However, little is known about the non-directed donors' motivations, characteristics and experiences.

              Design

              We conducted a qualitative-dominant study and used a grounded theory approach to analyse data.

              Methods

              Thirty participants completed in-depth interviews between April 2013-April 2015. Three analysts independently read and coded interview transcripts. Grounded theory techniques were used to develop descriptive categories and identify topics related to the non-directed donors donation experience.

              Results

              Sixteen of the 30 non-directed donorss discussed the topic of spirituality and religiosity when describing their donation experiences, regardless of whether they were actively practising a religion at the time of donation. Specifically, three themes were identified within spirituality and religiosity: motivation to donate, support in the process, and justification of their donation decisions postdonation.

              Conclusions

              Findings from this study are the first to describe how spirituality and religiosity influenced the experiences of U.S. non-directed donorss and may help improve non-directed donors educational resources for future spiritual or religious non-directed donors, and the overall non-directed donors donation experience in efforts to increase the living donor pool.

              Relevance to clinical practice

              Spirituality and religiosity are often overlooked yet potentially influential factors in Western medicine, as demonstrated through the experiences of Jehovah's Witnesses and their religious restrictions while undergoing surgery and the beliefs of Christian Scientists against taking medications and receiving medical procedures. Understanding needs of non-directed donors specifically with spirituality and religiosity can better position kidney transplant centres and teams to improve predonation screening of non-directed donor candidates and provide support services during the donation process.
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2009)

                Background

                Progress has been made in addressing pain in specific diseases such as cancer, but less attention has focused on understanding pain in nonmalignant states, including heart failure (HF).

                Methods and results

                From March 2006 to June 2007, 672 veterans were surveyed and scores for the Brief Pain Inventory, pain distress, clinically significant pain levels (moderate to severe pain), and pain locations were compared using univariate and multivariate models. Fifteen percent of the final sample had HF (95/634). In our study, the HF patients were older (P < .000), reported lower levels of general health (P = .018), had more co-morbidities (P < .000), were more likely to have a history of cancer (P = .035), and suffered more chest pain and fewer headaches (P = .026, P = .03, respectively) than their non-HF cohorts. When controlling for age, co-morbidity and cancer disorders, HF and non-HF patients did not differ in pain severity, interference, distress or locations. Of the patients currently experiencing pain, 67.3% of HF patients and 68.4% of non-HF patients rated their pain as moderate or severe (pain >or=4 on a 0 to 10 scale).

                Conclusions

                Although HF has not been identified as a painful condition, this study suggests the burden of pain is significant for both HF and non-HF ambulatory care patients.
                  Cover page: A Comparative Study of Pain in Heart Failure and Non-Heart Failure Veterans
                  • Article
                  • Peer Reviewed
                  UC Irvine Previously Published Works (2008)
                    Cover page: Heart Failure, the Hidden Problem of PainCreative Commons 'BY' version 4.0 license
                    • Article
                    • Peer Reviewed
                    UC Irvine Previously Published Works (2009)
                    Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67+/-11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pain>or=4/10). The presence of pain was reported more frequently than dyspnea (67 [71.3%] vs. 58 [61.7%]). Age (P=0.02), psychological (depression: P=0.002; anxiety: P=0.001), social (P<0.001), spiritual (P=0.010), and physical (health status: P=0.001; symptom frequency: P=0.000; functional status: P=0.002) well-being were correlated with pain severity. In the resulting model, 38% of the variance in pain severity was explained (P<0.001); interference with relations (P<0.001) and symptom number (P=0.007) contributed to pain severity. The association of physical, psychological, social, and spiritual domains with pain suggests that multidisciplinary interventions are needed to address the complex nature of pain in HF.
                      Cover page: Heart Failure: The Hidden Problem of PainCreative Commons 'BY' version 4.0 license
                      Top