Objective Human papillomavirus (HPV) infects millions of men and women annually and is a substantial contributing factor in many cancers including oral, penile, anal, and cervical. Vaccination can reduce risk but adherence nationwide and, particularly in highly religious states, is suboptimal. Religious principles of abstinence before marriage and total fidelity following marriage may create a belief of protection through adherence to religious guidelines. However, while one partner may remain monogamous, one cannot be assured of their partner's behavior both before and after marriage. These misconceptions may create a barrier to religious youth's adherence to vaccine recommendations. Methods We sampled single young adults, age 18 to 25 years, from a Christian university classified as highly religious and a university not categorized as highly religious. Results Highly religious young adults demonstrated low knowledge of HPV and HPV vaccination. High religious beliefs were associated with lower HPV vaccination adherence. Conclusions Understanding the role religious beliefs have on vaccine adherence can help in the creation of campaigns that specifically address these issues. Campaigns to increase vaccination should address misconceptions of religious youth's feelings of imperviousness to sexually transmitted diseases.

Background: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end of life (EOL). Providing high-quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made for the last 17 years. Objective: The aims of this study were to determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether meaningful changes have occurred since data were first gathered in 1998. Methods: A quantitative-qualitative mixed methods design was used. A random, geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Results: Five obstacle items increased in mean score and rank as compared with 1999 data including (1) family not understanding what the phrase “lifesaving measures” really means, (2) providing lifesaving measures at families' requests despite patient's advance directive listing no such care, (3) family not accepting patient's poor prognosis, (4) family members fighting about the use of life support, and (5) not enough time to provide EOL care because the nurse is consumed with lifesaving measures attempting to save the patient's life. Five obstacle items decreased in mean score and rank compared with 1999 data including (1) physicians differing in opinion about care of the patient, (2) family and friends who continually call the nurse rather than calling the designated family member, (3) physicians who are evasive and avoid families, (4) nurses having to deal with angry families, and (5) nurses not knowing their patient's wishes regarding continuing with tests and treatments. Conclusions: Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time. Obstacles related to families may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has not previously experienced a similar situation. On the basis of the current top 5 obstacles, recommendations for possible areas of focus include (1) improved health literacy assessment of families followed by earlier directed, appropriate, and specific EOL information; (2) improved physician/team communication; and (3) ensuring patients' wishes are followed as written. In general, patient- and family-centered care using clear and open EOL communication regarding wishes and desires between patients and families, their physicians, and nurses will help decrease common obstacles, thus improving the quality of EOL care provided to dying patients and families.

In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.