The role of inner strength in quality of life (QOL) and self-management, primary variables in the Theory of Inner Strength, were examined with demographic and clinical characteristics in 107 women with cancer. The strongest predictors of QOL were depressive symptoms, inner strength, and time since diagnosis, respectively, accounting for 82% of the variance in QOL. When depressive symptoms were excluded due to multicollinearity, 64% of variance in QOL was explained by inner strength, time since diagnosis, and comorbidities, with inner strength the strongest predictor. The strongest predictors of self-management were depressive symptoms and inner strength, accounting for 17% of the variance. Results contribute to theory development and suggest the value of supporting inner strength to enhance QOL in cancer survivors.

The phenomenon of inner strength has been investigated since 1990. Foundations for inner strength have been developed using inductive designs that have led to a middle-range theory of inner strength and a conceptual model. Two instruments have been developed to measure and test inner strength and have been predominantly used in samples of women and the elderly. This paper will trace the development of inner strength knowledge from two distinct paradigms in North America and Northern Europe. Empirical testing is described. Gaps in the current state of knowledge of inner strength are identified as well as implications for future research.

Introduction Latina breast cancer survivors in the United States face disproportionate risk for poorer quality of life and physical health, as well as greater emotional distress. Method A cross-sectional survey was conducted to describe the physical, emotional, and general health status of 135 Latina breast cancer survivors served by a community-based program. Results Of the 135 surveys sent, 48 survivors responded. Of those who responded, time since diagnosis ranged from 0 to 24 years (M = 4.37; SD = 5.54); and 45.9% of the women rated physical health as poor or fair. Fatigue prevalence was high, with 60.5% reporting fatigue as moderate or severe. Nearly 80% reported having pain (score >0); 38.3% reported pain was moderate or severe. The women reported mild levels of anxiety and depression but high levels of stress (M = 4.14; SD = 3.02). Conclusions Latina breast cancer survivors could benefit from interventions focused on commonly shared problems while tailoring specific interventions for subsets with more severe symptoms.

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Objective: Underutilization of palliative care (PC) among racial/ethnic minorities re­mains consistent despite projected demand. The purpose of this study was to examine knowledge of palliative care and advanced care planning (ACP) and potential variations among subgroups of Asian Americans.Design: A survey was conducted to collect information about awareness, knowledge, and perspective of PC and ACP in the southwestern region of the United States, from October 2018 to February 2019. A total of 212 surveys were collected from the general public at such places as health fairs, New Year celebration events, church, and community centers; 154 surveys were included in the descriptive and multivariate data analysis.Results: About 46.1% and 40.3% partici­pants reported having heard of palliative care and advanced care planning, respec­tively. The average score of the Knowledge of Care Options Instrument (KOCO) was 6.03 out of 11 and the average score of the Palliative Care Knowledge Scale (PaCKS) was 4.38 out of 13. Among those who have heard of PC, both Chinese (odds ratio (OR) .19 [CI, .05, .73]) and Vietnamese (.22 [.06, .84]) were less likely to have heard of pal­liative care compared with Filipinos (1.00). Among those who have ever heard of advanced care planning, age (.60 [.43, .84]) was negatively and education level (1.91 [1.18, 3.08]) was positively associated with awareness about advanced care planning. The majority of survey participants preferred family members to serve as their power attorneys.Conclusion: The low levels of palliative care and advanced care planning awareness and knowledge in the diverse Asian groups liv­ing in the United States raise concerns and shed light on the critical need for cultur­ally appropriate education programs. Ethn Dis. 2020;30(3):459-468; doi:10.18865/ed.30.3.459

Background: Significant pharmacotherapy disparities exist among children from ethnic minorities with ADHD. Objective: The purpose of this review is to synthesize existing evidence on African American caregiver medication decision making (MDM) for children with ADHD. Method: Databases queried for this review included the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychINFO, PubMed, and Education Resources Information Center (ERIC). Information regarding the unique culturally specific barriers and supports to MDM were examined through the relevant literature search. Results: Fourteen articles were included in this review (seven observational studies, four qualitative studies, three mixed methods studies). Three main themes were identified which include (a) fundamental perspectives of ADHD, and cultural norms for child behavior; (b) the impact of fundamental perspectives on MDM in ADHD; and (c) ADHD diagnosis and treatment as forms of social control. Conclusion: Evidence-based recommendations for clinicians are provided, along with direction for future research.

Background Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. Objective We examined caregiver and nurse communication behaviors associated with caregiver activation during advanced cancer patients’ home hospice visits using a prospective observational design. Methods We adapted Street’s Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. Results Caregiver communication that reflected activation included: demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses’ responded by: providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. Conclusions Few studies have investigated nurse/caregiver communication in home hospice and to our knowledge no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. Implications for Practice Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice thus resulting in enhanced outcomes for advanced cancer patients.

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