Promoting Healing and Resilience in People with Cancer: A Nursing Perspective

Preface
	The Gap Between Research Findings and Clinical Practice
	The Clinical Need for a Conceptual Model of Practice
	Why This Book
	What the Handbook Offers
	How to Use the Handbook
	What Distinguishes This Book from Others
	Reclaiming Nursing’s Legacy
Acknowledgments
Contents
Part I: The Stress, Healing, and Resilience Nursing Model of Whole Person Care
	Introduction
	1: Theoretical Underpinnings
		1.1	 Theoretical Underpinnings
		References
	2: The Stress, Healing, and Resilience Nursing Model of Whole Person Care
		2.1	 Introduction
		2.2	 Objectives
		2.3	 Core Values and Assumptions of Practice
		2.4	 Goals of the Practice Model
		2.5	 The Whole Person and the Environment (See Part II, Chap. 3; Part IV Chaps. 8 and 11)
		2.6	 Psychological Stress (See Part II Chaps. 3, 4 and 5)
		2.7	 Health as an Essential Property of the Whole Being
			Health-Related Outcomes
			Key Internal Processes of Health
				Processes of Development
				Processes of Resilience (See Part II)
				Processes of Innate and Self-Induced Healing (Review Part IV)
		2.8	 Personal Strengths and Social Resources (Supportive Relationships) (See Part IV, Chaps. 8–11)
			Social Resources (Supportive Relationships) (Review Part IV Chaps. 8 and 11)
		2.9	 Healthy Lifestyle Behaviors
		2.10	 Epigenetics
		2.11	 Homeostasis
		2.12	 Energy and Metabolic Processes
		2.13	 Sense of Coherence (See Fig. 2.1)
		2.14	 Nursing Approaches (See Parts IV and V)
			Quality of the Nurse–Patient Relationship (Part IV Chaps. 8 and 19)
			Timing of Interventions
			Format
		References
Part II: Resilience
	Introduction
	3: Psychological Stress
		3.1	 Introduction
		3.2	 Definitions
			Properties of Psychological Stress
			Benefits or Harmful Effects (Review Parts II and III)
		3.3	 Acute Stressor Effects (Review Part II Chaps. 4 and 5)
		3.4	 Prolonged Psychological Stress (Review Part III, Chaps. 6 and 7)
			Early Childhood Adversity (ECA)
				Summary
		3.5	 Need for Measurable Terminology for “Stress”
		3.6	 Cumulative Measures of Stress (Table 3.2)
		3.7	 Nursing Implications
		References
	4: Biological Processes of Resilience
		4.1	 Introduction
		4.2	 Objectives
		4.3	 Definitions
			Resilience
				Allostasis
				Flexibility
			Stressors (Review Part II Chap. 3)
				Good Stress and Resilience
				Tolerable Stress and Resilience
		4.4	 Key Neural Structures and Mediators
			Brain Plasticity
			The Stress-Related Systems and Mediators (Review Also Part III Chap. 6)
			Negative Glucocorticoid Feedback System
		4.5	 The Biphasic Process of Biological Resilience
			The First Phase: The Process of Stress-Induced Neural and Physiological Adjustments
			The Second Phase, Healing, and Restoration
		4.6	 Other Processes That Influence Biological Resilience
			Age
			Sex Differences (Review McEwen [3, 4])
			Epigenetics
			Circadian Rhythm
			Energy
		4.7	 Nursing Implications
		References
	5: Psychosocial Processes of Resilience
		5.1	 Introduction
		5.2	 Objectives
		5.3	 Definition: Psychological Resilience
		5.4	 Theoretical Tenets and Model of Psychological Resilience: The Emotion-Regulating Stress-Coping Adaptation System of Psychological Resilience
			Antecedent Factors
			Cognitive and Emotional Schemas or Representations
			Cognitive and Behavioral Coping Strategies
				Hope
			Personal Resources, Social Resources, and Risk Factors
				Personal Resources (PR)
				Social Resources
				Risk Factors
			Health-Related Outcomes
		5.5	 Research Findings among the Key Variables of the Stress Adaptation Coping System of Resilience (Review Part IV Chap. 9)
			A Meta-Analyses Based on the CSM
			The Stress-Coping Adaptive Process of Resilience (e.g., [6, 13, 14, 16])
				Stress, Coping Strategies, and Health Outcomes
				Coping Clusters Over Time
				Personal Resources
				Mediating and Interactional Coping Effects
				Social Resources (Support) (See Part IV Chap. 11)
				Support and Personal Resources
		5.6	 Nursing Implications
		References
Part III: Poor Resilience
	Introduction
	6: Poor Resilience
		6.1	 Introduction
		6.2	 Objectives
		6.3	 Definitions
			Poor Resilience
			Allostatic Load (AL) [2–5] (See Table 6.1)
			Allostatic Overload (See Part II Chap. 3)
		6.4	 The Four Conditions of Chronic Stress
		6.5	 Pervasive Neurobiological Maladaptive Disruptions (Review [1, 29])
			Brain, Neural Circuitry, and Threat to Brain’s Plasticity
				Prefrontal Cortex (PFC)
				Amygdala
				Hippocampus
		6.6	 Impaired HPA Axis, ANS, and Immune Functioning
			Impaired Negative Feedback Inhibition System and Damaged Glucocorticoid (GR) Receptors
			Impaired PNS Healing Processes
			Dysregulated Immune System
		6.7	 Other Dysregulated Mediators
		6.8	 The Impaired Dopaminergic Reward System
		6.9	 Dysregulated Circadian Rhythm
		6.10	 Chronically Stress-Induced Epigenetic Changes
		6.11	 Systemic Inflammation
		6.12	 Metabolic Oxidative Stress
		6.13	 Weakened Bioelectromagnetic Field
		6.14	 Behavioral Indicators of Poor Resilience [11, 48] (Review Part II Chaps. 3–5)
		6.15	 Nursing Implications
		References
	7: Cancer
		7.1	 Introduction
		7.2	 Objectives
		7.3	 Chronic Illness
		7.4	 Cancer
			Definition
		7.5	 Factors Conducive to the Development of Cancer
			The Microbiome
		7.6	 The Development of Cancer
			Cancer Stem Cells (CSCs)
			The Role of ROS in Tumorigenesis and Cancer Progression (Review [13, 22])
				Cancer and Antioxidant Capabilities
			The Tumor Microenvironment (TME)
				Cancer-Associated Fibroblasts (CAFs) (See Table 7.5 for Definitions)
				Immune Evasion
		7.7	 Progression, Invasion, and Metastases
			Chemoresistance
			Epithelial-to-Mesenchymal Transition (EMT) in Tumor Progression and Recurrence
			Metastases
		7.8	 Nursing Implications
		References
Part IV: Fostering Healing and Resilience
	1.1	 Introduction
	8: The Quality of the Nurse–Patient Relationship
		8.1	 Introduction
		8.2	 Objectives
		8.3	 Why Patients Need a Quality Relationship with the Nurse
		8.4	 Definition
		8.5	 The Quality of the Nurse–Patient Relationship
			Clinical Research
		8.6	 Relational Characteristics of the Nurse–Patient Relationship
			Being Present
			Communication
				Skills of Communication (Table 8.2)
				Facilitating Personal Narratives
				Clinical Research
			Compassion
				Clinical Research
			A Sense of Connectedness with Patients and Family Caregivers
				Being Known
				Momentary Encounters
				Enhancing Support (See Part IV, Chap. 11)
			Evidence-Based Practice (EBP) (Review Part V, Chap. 19)
		References
	9: Promoting Emotion-Regulating Coping Resilience
		9.1	 Introduction
		9.2	 Objectives
		9.3	 Definitions: The Emotion/Self-Regulating Coping System of Psychological Resilience (Review Part II, Chaps. 4 and 5; Appendix in this Chapter and Appendices A and B)
		9.4	 Randomized Controlled Intervention Studies (RCTs): Enhancing Coping Efforts (Appendix in this Chapter, Appendix in Chaps. 10, 11, 13, and 14, and Appendices A–C)
			Cognitive–Behavioral Strategies (CBS) (Review Appendix in this Chapter)
			Self-Management Interventions (SMI) (Appendix A)
		9.5	 Suggested Nursing Approaches
			Nursing Assessment
				Emotional Distress
				Coping Efforts (Review Appendix B)
				Self-Management Interventions
				Other Relevant Contextual Patient and Caregiver Information to Assess
				A Clinical Assessment Strategy: Patient/Caregiver Narratives (Also Review Patient Narratives in Part IV Chap. 10, Section “Cognitive Restructuring and Distorted Beliefs” and Table 10.2)
			Nursing Interventions: Promoting Emotion-Regulating Coping Efforts (Review Part IV Chap. 10; Appendix in this Chapter and Appendix B)
			The Nurse’s Essential “Resilient-Promoting Toolbox”
				Reframing [6]
				Cognitive Restructuring and Distorted Beliefs [6, 67]
					Cognitive Restructuring Steps Typically Involve [6, 67]
						Identifying Distorted Beliefs
						Help the Person Distinguish between a Belief and a Fact
						Link Thoughts to Emotions (and to Behaviors)
					Another Use of Cognitive Restructuring (for Illustrative Purposes)
						Explore the Patient’s Assumptions and Beliefs about the World and Self
						Explore the Emotional and Behavioral Costs Versus Benefits of Holding onto a Distorted Belief (Review Chap. 12)
					Based on This Clinic Anecdote, the Nurse May Consider Many Clinical Strategies
					Summary of Coping-Promoting Strategies
				Break Down Generalizations into Smaller Manageable Components (Fig. 9.2) [6]
				Use Metaphors and Literary or Music-Related References
				Encourage Positive Affirmations [6, 67]
				Commendations [6, 67]
				Protecting Patient Hope (See Part II, Chap. 5; Part V Chap. 18)
				Promote a Sense of Personal Control
				Acceptance
				Facilitating Self-Management Strategies [1, 14]
		9.6	 Final Thoughts
		Appendix: Psychosocial Interventions—Cognitive–Behavioral Therapy/Cognitive–Behavioral Stress Management Interventions/Self-Efficacy
		References
	10: Fostering Meaning Making
		10.1	 Introduction
		10.2	 Objectives
		10.3	 Definitions
		10.4	 Emotional and Existential Distress (See Part II Chap. 3)
			Emotional Distress
			Existential Distress
		10.5	 Conceptual Underpinnings
			Global Meaning-Orienting System
			Situational Meaning
			Search for Meaning: Adjusted Global and Situational Meanings
				Cognitive Processing: Assimilation and Accommodation
				The Search for Meaning Can Fail
			Found Meaning or Meaning Made
				Meaning-Made and Physiological Outcomes
				Meaning-Made and Posttraumatic Growth
			Moderators and Mediators of Meaning
				Coping-Related Mediators
				Cognitive Processing, Personal Resources (Optimism and Faith), Social Support, and Meaning-Focused Coping Strategies
		10.6	 Meaning-Making Clinical Interventions (Review Appendix in this Chapter and Appendix B)
			The Life Review (See Appendix B)
			Meaning-Made Interventions (Appendix B)
		10.7	 Nursing Approaches
			Nursing Assessment
			Nursing Interventions: Global Assumptions, Situational Meanings, and Meaning Making
			Meaning-Making Strategies
				Encourage Cognitive Shift toward Neutral or Positive Reappraisals (Review Part IV Chap. 9)
				Encourage the Meaning-Making Narrative
			Facilitating Deliberate Rumination [100] (Chap. 9)
			A Word About Causal Attributions
			A Matter of Personal Choice
		10.8	 Final Thoughts
		Appendix: Psychosocial Interventions—Meaning-Related Studies
		References
	11: Strengthening Supportive Relationships
		11.1	 Introduction
		11.2	 Objectives
		11.3	 Definitions (Review Appendix in this Chapter and Appendix B)
			Family Support
			Partner and Spousal Support
		11.4	 Models of Support and Clinical Findings
			Stress-Buffering Model
			Main Effects Model
			Mediating Effects
		11.5	 Support and Personal Resources
			Support and Attachment
			Support and Self-Efficacy (See Part II, Chap. 5)
			Support and Optimism
			Support and Resilience
			Support and Coping Behaviors
			Not All Support Is Supportive
			When Patients Lack Support
			Support and Neurobiological Effects (Part III Chap. 7)
		11.6	 The Importance of a Patient- Family Caregiver Dyad as the Focus of a Supportive Intervention
		11.7	 Controlled Trials: Supportive Expressive Intervention Studies (Review Appendix in this Chapter and Appendix B)
			SEGT and Survivability
		11.8	 Nursing Approaches
			Nursing Assessment of Patients and Family Caregivers
				Social Resources
				Support Functions
				The Quality of the Patient-Family Caregiver Relationship
				Quality of Communication (Review Part IV Chap. 8)
			Nursing Interventions (Review Appendix in this Chapter and Appendix B)
				Encourage Open Communication and Emotional Expression [97, 110, 98]
				Strengthen the Patient’s and Family Caregiver’s Sense of Connectedness with One Another (as well as More Broadly with Their Family/Significant Others)
				Heighten Awareness of the Unspoken Meanings Conveyed by Patient-Caregiver’s Respective Behaviors
				Closing the Gap
				Supportive Needs of Family Caregivers (Review Appendix B)
				Obtaining Needed Support from the Nurse and Physician
		11.9	 Final Thoughts
		Appendix: Psychosocial Support-Related Interventions
		References
	12: Psychological Healing and Leveraging the Placebo Effect
		12.1	 Introduction
		12.2	 Objectives
		12.3	 Definitions
		12.4	 How Cognitive Expectations Are Formed (See “Mechanisms” of Action in Sect. 12.6)
			Positive and Negative Expectations: Side Effects
				Cognitive Expectations Affect the Pharmacodynamics Associated with Drug Efficacy
			Cognitive Expectations: Drug Conditioning
		12.5	 Unconscious Conditioning Associated with Treatment-Induced Immunosuppression
		12.6	 Mechanisms of Action: Psychosocial-Neurobiological Systems of Healing
			Learning and Conditioning
			The Brain’s Reward System
				Dopamine Release
				Opioid and Related Pathways
			Neuroimaging and the Stress Response System and Immune Responses
				Genes and the Placebo
			MOA and Nocebo Pathways
		12.7	 Nursing Approaches
			The Quality of the Nurse-Patient Relationship (Review Part IV Chap. 8)
				Shared Beliefs
			Verbal Suggestions and Open/Closed Treatments (Review Sect. 12.4)
			Open/Hidden Clinical Condition
			Promoting Cognitive Expectations: RCTs
			Strategies to Minimize the Nocebo Effect
			Managing Informed Consent
			Modulating Unconscious Conditioning (Review Sect. 12.5)
		12.8	 Final Comments
		References
	13: Mindfulness-Based Practice and Eliciting the Relaxation Response
		13.1	 Introduction
		13.2	 Objectives
		13.3	 Definitions
		13.4	 Mindful Meditation
			Benson’s Relaxation Response (RR) Technique
			Mindfulness-Based Cancer Recovery (MBCR)
		13.5	 Mechanism of Action
		13.6	 Research Findings
			Mindful Techniques on Neural Structural Regions (Review Fox [42])
			Physiological Outcomes
			Immune Functions
			Molecular Changes
			Psychological and Behavioral Outcomes
			Cognitive Functions
		13.7	 MM as a Self-Care Skill for Nurses
		13.8	 Nursing Implications
		13.9	 Final Thoughts
		Appendix: MBSR. Psychosocial and Behavioral Interventions—Mindful Meditation (MM), Relaxation Response Technique (RR), Mindfulness-Based Stress Reduction Intervention (MBSR), and Mindfulness-Based Cancer Recovery (MBCR)
		References
	14: Physical Touch and Healing Touch
		14.1	 Introduction
		14.2	 Objectives
		14.3	Physical Touch
			Definitions
				Physical Touch
					Affective Touch
					The intention of affective touch is to convey caring and an emotional connection with the patient [9, 10]. It refers to a gentle, tactile pleasant touch containing an emotional component within a “cognitive-relational” human context [11–13]. Aff
					Tactile Touch or Effleurage
					Procedural Touch
					Affectionate Touch
		14.4	 Contextual Factors
		14.5	 Attachment and Embodiment Theories (Review [27, 28])
		14.6	 Buffering and Main Effects
		14.7	 Neurobiological Processes of Physical Touch
		14.8	 Experimental Research
			Touch and Healthy Volunteers
		14.9	 Clinical Research Findings
			Physical Touch Within the Context of the Nurse-Patient Relationship
			Facilitating Affectionate Touch Within a Close Patient-Family Caregiver Relationship
		14.10	 Nursing Implications
			Nursing Take-aways
		14.11	 Final Comments
		14.12	 Biofield Modalities: Therapeutic Touch (TT), Healing Touch, and Reiki
			Ms X was in the terminal phase of her life, and despite being heavily sedated for pain, she was clearly suffering. Ms X would recoil and cry out each time the nurse gently touched her or tried to reposition her body. Her husband sat helplessly nearby w
				The Electromagnetic Field
				“Subtle” Energy
		14.13	 Conceptual Underpinnings
		14.14	 Research Findings
			Symptom Relief
			Quality of Life (QOL)
			Healthcare Providers and Reiki
			Experimental Animal Research
		14.15	 Clinical Research Caveats
		14.16	 Final Thoughts
		Appendix: Mind-Body (MBSR). Psychosocial Interventions—Multimodal Interventions—Mind-body (MBSR), Energy, and Other CTs
		References
Part V: Nursing Approaches
	Introduction
	15: The Diagnostic Phase
		15.1	 Introduction
		15.2	 Objectives
		15.3	 Definitions: The Diagnostic Prehabilitation Phase
		15.4	 Emotional Distress (Review Part II Chap. 3; Part IV Chaps. 9 and 10)
			Factors Underlying Patient and Caregiver Distress
		15.5	 Physical Functioning, Fitness, and Activity (Review Part V Chap. 16)
		15.6	 Neurophysiological Dysregulation (Review Part III Chaps. 6 and 7)
		15.7	 Clinical Research Findings: Prehabilitation Interventions
			Presurgery
				Multimodal Interventions
				Exercise
				Diet/Nutrition
				Exercise and Nutrition
				Psychosocial Interventions
		15.8	 Nursing Implications
			Nursing Assessment (Review Part IV Chaps. 9–11)
				Emotional Distress (Review Part II Chap. 3)
			Establishing a Nurse-Patient/Caregiver Relationship (Review Part IV Chap. 8)
			Provide Relevant Information
				Philosophy of Care
				Roles and Functions
				Accessing Reliable Health-Related Resources
				Information About the Cancer and Treatment (Review Chap. 12)
			Cognitive Beliefs and Expectations (Review Part IV Chap. 12)
				Enhancing Positive Expectations About Treatment
				Counter Negative Treatment Expectations
				Strategies to Redress Distorted Beliefs (Review Part IV Chap. 9)
			Enhancing Cognitive-Behavioral and Meaning-Making Coping Strategies (Review Part IV Chaps. 9 and 10; Appendix in Chap. 9; Appendix in Chap. 10; Appendix B)
				Problem-Focused Coping Strategies [39, 40]
				Emotion-Focused Strategies (Part IV Chaps. 9–11; Part V Chaps. 16 and 18; Review Appendix B)
				Meaning-Focused Coping Strategies [45] (Review Part IV Chaps. 9 and 10)
				Facilitate Deliberate Rumination (See Part IV Chap. 10)
				Promote Behavioral Coping Strategies (See Part IV Chap. 13)
			Self-Management Interventions (Review Part IV Chap. 9; Appendices A and B)
			Strengthening Supportive Relationships (Review Part III Chap. 6; Part IV Chap. 11; Appendix B)
			Healthy Lifestyle Behaviors with a Focus on Physical Fitness, Physical Activity, Healthy Diet, and Nutrition (Review Appendix C; Part V Chap. 16)
				Physical Exercise (PE) [22]
				Diet (Review Part V Chap. 16)
		15.9	 Managing Consent
		References
	16: Treatment Phase
		16.1	 Introduction
		16.2	 Objectives
		16.3	 Definition
		16.4	 Clinical Issues
			Lifestyle Health-Related Risks
		16.5	 Treatment: Chemotherapy and Radiation-Related Therapy and Surgery (Review Part III Chaps. 6 and 7)
			Perisurgical Phase Review [1]
			Symptoms and Side Effects (Review Part III Chaps. 6 and 7)
			Body Image Impairments
		16.6	 Psychosocial Interventions and Related Research
			Perceived Support (Review Chap. 11)
			Cognitive-Behavioral Interventions (CB) (Review Chaps. 5 and 9; Appendix in Chap. 9)
			MBSR/MBCTs (Review Appendix in Chap. 9; Appendix in Chap. 13)
			Self-Management Interventions (SMI) (Review Appendix A)
			Progressive Relaxation and Imagery
			Massage, Foot Reflexology
			Exercise, Weight, and Nutrition (Review Appendix C)
				Exercise
				Diet and Nutrition
			Therapeutic Healing (Review Part IV Chap. 14; Appendix in Chap. 14)
		16.7	 Family Caregivers
			Cognitive-Behavioral Strategies CBT (Appendix in Chap. 9)
			Mindfulness-Based Interventions (MB) (Review Part IV Chap. 13; Appendix in Chap. 9; Appendix in Chap. 13)
		16.8	 Nursing Approaches
			The Nurse–Patient Relationship (Review Part IV Chap. 8)
			Promoting Self-Management (Problem-Solving) Capabilities (Review Part IV Chap. 9; Appendices A and B)
			Cognitive-Behavioral Coping Approaches (Review Part IV Chaps. 9 and 10; Part IV Chap. 13; Appendix in Chap. 9; Appendix in Chap. 13; Appendix B)
			Enhancing the Quality of Supportive Relationships (Review Part IV Chap. 11; Appendix B)
			Managing Positive/Negative Expectations of Treatment (Please Review Part IV Chap. 12)
			Promoting Immune Functioning (Review Part IV Chaps. 9, 11, 12, and 14)
				Unconscious Conditioning During Chemotherapy (See Part IV Chap. 12)
			Supporting Diet, Relevant Nutrition, and Physical Activity (Review Part V Chap. 15)
				Diet and Nutrition
				Physical Activity (Review Part V Chap. 15)
			Facilitating Wound Healing in the Perioperative Period (Review Sect. “Body Image Impairments”)
			Symptom/Side Effects
				Pain (Review Part IV Chaps. 9, 12, 13, and 14; Part V Chap. 18; Appendix A)
				Peripheral Neuropathy
				Fatigue (Review Appendix C)
				Sleep Disturbances (Review Part IV Chaps. 9 and 14; Appendix in Chap. 9; Appendix in Chap. 14)
				Body Image Impairments
				Lymphedema (LE)
			Family Caregivers (Review Part V Chap. 18)
		References
	17: The Transition to Survivorship
		17.1	 Introduction
		17.2	 Objectives
		17.3	 Definition
		17.4	 Common Patient Concerns
			Feelings of Medical Abandonment (Review Part IV Chaps. 8, and 11)
			An Altered Self-Identity
			Fear of a Cancer Recurrence (FCR)
			Changes in Family Support (Review Part IV Chap. 11)
			Enduring Symptoms and Side Effects of Treatment or Cancer (Review Chaps. 6 and 7)
			Lifestyle Behaviors (Review Part V Chap. 16)
		17.5	 Clinical Research: Psychosocial Interventions
			Cognitive-Behavioral (CB) Strategies (Review Appendix in Part IV Chap. 9 and Appendix B)
			Mind–Body Stress Reduction (MBSR) and Mindfulness-Based Cancer Recovery (MBCR) (Review Appendix in Part IV Chap. 13)
			Massage and Foot Reflexology (Review Part V Chap. 20; Review Appendix in Chap. 14)
			Self-Management Interventions (SMI) (Review Part V, Chap. 16; Appendix A)
			Health-Related Education (Review Appendices A and B)
			Health-Promoting Lifestyle Interventions (Review Appendix C)
				Nutrition and Diet
				Exercise/Physical Activity
		17.6	 Proposed Nursing Approaches (See Part IV, Chaps. 8–14; Part V Chap. 16)
			Maintain a Sense of Connectedness between Nurse and Individual and Family (Part IV, Chap. 8)
			Promote Self-Management Capabilities (Review Content in Part IV Chap. 9; Review Appendix A)
			Fear of a Cancer Recurrence (Part IV, Chap. 10)
			The Quality and Quantity of Informal Support (See Part IV, Chaps. 10 and 11)
			Managing Symptoms and Side Effects of Treatment and the Cancer (See Part V, Chap. 16)
				Specific Side Effects (Review Part III, Chaps. 6 and 7)
			Finding Meaning in the New Normal Life (See Part IV Chap. 10; Part V Chap. 18; Appendix B)
			Promoting a Healthy Lifestyle (Review Part V, Chaps. 15 and 16 Sections on Healthy Lifestyle Behaviors, Physical Activity, Diet) (Tables 17.2, 17.3 and 17.4)
		References
	18: Supportive Care and End of Life
		18.1	 Introduction
		18.2	 Objectives
		18.3	 Definition
		18.4	 Cessation of Treatment
		18.5	 Transition to Supportive Care Services
			Nature of Transition and Lack of Information
			Timing
		18.6	 Patient Concerns, Distress, and Symptom Burden
			Emotional Distress and Existential Suffering (Review Part IV Chap. 10)
			Symptom Burden
		18.7	 Family Caregiver Concerns
		18.8	 Clinical Benefits of Early Integrated Oncology-Supportive Care Services
		18.9	 RCTs: Psychosocial Interventions
			Patient-Focused Studies (Appendix A)
			Focus on Patient and Caregiver Dyads
			Focus on the Family Caregiver
		18.10	 Nursing Approaches (Review Part IV Chaps. 8–14; Also, Part III, Chaps. 6 and 7; Appendix in Chaps. 9, 10, 11, 13, and 14, Appendices A–C)
			Quality of the Nurse–Patient/Family Relationship (Review Part IV Chap. 8; Appendix B)
			Cognitive-Behavioral Emotion-Regulating Coping Strategies (Review Part IV Chaps. 9 and 10; Appendix B)
			More Cognitive Strategies (Review Part IV, Chaps. 8, 9, and 10)
			Strengthening Supportive Relationships (Review Part IV Chap. 11)
			Symptom Management (Review Part V Chap.  16; Part IV Chaps.  9, 12, 13 and 14; Part III Chaps. 6 and 7)
				Pain (e.g., Cognitive-Behavioral Strategies, Mindful Meditation, Relaxation Response Technique, Leveraging Cognitive Expectations, and Acupuncture)
					Pain Assessment
					Nursing Goals
					Nursing Approaches
				Dyspnea Review [148] Mindfulness Techniques, Music Therapy, Breathing Retraining, Relaxation, Acupressure, and Acupuncture
					Nursing Assessment
					Nursing Goals
					Nursing Approaches
				Other Nonpharmacological Interventions for Symptom Management (also Review Chaps. 9, 12, and 14)
			Health Education (Review Part V Chap. 16; Appendix C)
			Self-Management Interventions (Review Part IV Chap. 9; Appendices A and B)
		18.11	 Unique Needs of Caregivers [22, 57] (Review Part IV; Appendix A)
			Bereavement
		References
	19: Is It Feasible
		19.1	 Introduction
		19.2	 Nursing Objectives
		19.3	 Definitions
		19.4	 Barriers to Evidence-Based Nursing Practice
			Peer-Reviewed Research Versus Clinical Nursing Journals
			A Paucity of Patient-Centered Conceptual Practice Models
			Definitions of Evidence-Based Practice
			Work-Related Stress
			The Quality of the Nurse–Patient Relationship
			A Lack of Scientific Knowledge and Psychosocial Skills Among Clinical Nurses
		19.5	 Toward Academic Practice
			The Nursing Leadership
			Implementing the Model
			Team Values
			Critical Analytic Research Skills
			Clinical Skills
				The 1- to 10-min Nursing Interventions (Table 19.3)
				The 30- to 40-min Nursing Interventions
				Regularly Scheduled Nurse-Led Group Workshops (Appendix in Chap. 9; Appendix in Chap. 13; Appendix A)
			Staffing, Schedules, and Assignments
				Nurse Qualifications
				Staff Scheduling
				Carve Out Protected Time for Nurses to Engage in Therapeutic Patient/Caregiver
			A University-Affiliated Clinical Learning Environment
			Nurturing the Nurse’s Wholeness
		References
Closing Remarks
	Epilogue
Clinical Approaches: Appendices
	Appendix A
		Psychosocial Interventions, Self-Management (SMI) Approaches
	Appendix B
		Nursing Strategies (Review chaps. 12, 13 and 14)
			Psychosocial Interventions that facilitate Psychological Adjustment to the Cancer or Treatment-Related Threat
	Appendix C
		Clinical Interventions to Promote Healthy Lifestyle Behaviors
			Cancer Survivors
			During Treatment
			Exercise Before, During, and/or After Treatment
			Prehabilitation
			Prehabilitation with Neoadjuvant Treatment
			During Chemotherapy
			Adjuvant Chemotherapy
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