"The Continuous Shadow of My Mother's Breast Cancer": exploring the voice of daughters

Providing Information or Support Based on Cancer Worry Can Decrease Psychological Distress Among Daughters of Women with Breast Cancer

BACKGROUND

Cancer Worry (CW) can shape the responses and behaviors of information or support-seeking of daughters of women with breast cancer.

OBJECTIVE

This study aims to explore the roles of Cancer Worry (CW) as a moderator and mediator in the relationship between information needs, support needs, and psychological distress.

METHODS

A cross-sectional and correlational design was used in conjunction with a convenience sampling strategy. Daughters of mothers with breast cancer were requested to complete the questionnaires Impact of Event Scale Chinese version (IES-C), Cancer Worry Scale for Genetic Counseling (CWS-GC), and Information and Support Needs Questionnaire (ISNQ). Hayes' PROCESS macro using SPSS for Windows were used to examine the mediator and moderator role of CW.

RESULTS

A total of 194 daughters provided data. Cancer worry was significantly correlated with total IES (r = 0.352, P < .01), intrusion-IES (r = 0.353, P < .01), avoidance-IES (r = 0.313, P < .01), unmet support needs (r = 0.226, P < .01), and unmet information needs (r = 0.17, P < .05). Cancer worry mediated the relationship between unmet support needs and total IES (β = 0.089, 95% CI: 0.026, 0.171) and moderated the relationship between unmet information needs and total IES (β = -0.395, P = .018, 95% CI: -0.723, -0.066).

CONCLUSIONS

The role of cancer worry should be paid attention to when clinicians deliver information and provide support as well as tailoring psychological intervention for ameliorating distress in daughters of women with breast cancer.

IMPLICATIONS FOR NURSING

Providing personalized information and support is essential to address the unmet needs of daughters of women with breast cancer. Healthcare professionals providing interventions to reduce distress and improve overall care should consider individual CW.

PLAIN ENGLISH SUMMARY

This research looks at how worrying about cancer affects daughters of women who have breast cancer. It focuses on the degree of cancer worry changes the way they feel when they don't get the information and support. Researchers used surveys to gather data from these daughters, examining how their level of cancer worry influenced their needs for information and support and their psychological distress. They found that greater unmet support needs will intensify worry about cancer and then increase psychological stress. However, too much or too little worry about cancer will also heighten their psychological distress due to limited information. The findings suggest that healthcare providers, including nurses, should consider the level of worry about cancer when offering support and information to these individuals to help reduce their stress.

Validation of the modified Chinese Information and Support Needs Questionnaire (ISNQ-C) for daughters of mothers with breast cancer

BACKGROUND

Adult daughters concerned about getting breast cancer throughout their lives and required support because their mothers had breast cancer.

OBJECTIVES

This article aims to examine the revised Information and Support Needs Questionnaire (ISNQ) and validate it in a Taiwanese community population comprising daughters of mothers with breast cancer.

METHODS

Using convenience sampling, daughters of mothers with breast cancer were recruited and were separated into 2 samples (Sample 1, n = 102, and Sample 2, n = 118). First, we translated and modified the ISNQ to ensure cultural adaptation and formed ISNQ Chinese version (ISNQ-C). Second, we conducted an exploratory factor analysis using both samples to explore the ISNQ-C factor structure. Finally, we tested the criterion validity and known-group validity of the ISNQ-C using Sample 2.

RESULTS

Thirty-two items addressing 5 factors were identified for the ISNQ-C. Each factor had good internal consistency. The criterion validity was supported by significant correlations between the ISNQ-C scores and scores on the impacts of an event, anxiety, and depression. Known-group comparisons revealed that the group with deceased mothers reported significantly more unmet needs related to "releasing my anxiety" compared to the group where the mother was stable and undergoing regular follow-ups.

SIGNIFICANCE OF RESULTS

The ISNQ-C demonstrated good reliability and validity in terms of assessing needs among daughters of mothers with breast cancer in Taiwan. Using this assessment tool before genetic counseling to target the individual needs of this population at risk for breast cancer would be helpful to provide personalized care.

The symptom burden of women with a known risk of breast cancer receiving risk reducing medication

BACKGROUND

For the estimated 10 million women in the United States who meet the high-risk criteria for breast cancer, evidence-based interventions may reduce the risk of breast cancer by 50-65 %. Even with substantial evidence supporting preventive medication for risk reduction, there is significant lack of uptake and adherence. The purpose of this study was to characterize the experience of women at high risk for breast cancer and define the content domain for a patient-reported outcomes (PRO) measure of symptom burden from breast cancer risk and risk reducing medication.

METHODS

Thirty women at high risk for breast cancer and receiving risk reducing medication participated in single qualitative interviews. Content analysis was used to identify the symptom burden. An expert panel review rated the relevance of symptoms identified in the qualitative interviews to establish the items for inclusion in a PRO symptom burden measure.

RESULTS

Participants had a mean age of 54.6 years; 43.3 % self-identified as Hispanic and 20.0 % self-identified as Black. Content analysis found 20 symptoms related to both risk and preventive treatment, with 8 symptoms reported by ≥ 20 % of women. All women described distress related to their risk and preventive care. Treatment-related symptoms varied based on history of risk-reducing surgery and type of endocrine therapy. Women described symptom-related interference with relationships, work, enjoyment of life, and adherence to risk reducing medication.

CONCLUSIONS

Women with a known high risk of breast cancer and receiving preventive care experience a unique symptom burden including multiple symptoms and functional impact related to symptoms.

Breast Cancer Worry in U.S. Female First-degree Relatives: Moderating Role of Daily Spiritual Experiences

Female first degree relatives of breast cancer patients experience worry because of their own increased breast cancer risk. The aim in the present study was to examine the role of daily spiritual experiences as a potential protective factor against breast cancer worry. We hypothesized that daily spiritual experiences would moderate the relationship between relatives' stage of disease and breast cancer worry. Sixty-three mothers, daughters or sisters of breast cancer survivors completed surveys assessing relative's disease characteristics and their own demographics, fear of breast cancer, and daily spiritual experiences. All participants were living in the midwestern United States. Results showed that daily spiritual experiences moderated the relationship between stage of disease and breast cancer worry. Low scores on daily spiritual experiences were associated with more worry when relatives had advanced disease, and high scores on daily spiritual experiences was associated with less worry when relatives had advanced disease. Findings suggest the need to focus on this population when providing support services to families of patients.

Helping Diagnosed Mothers and Their Adolescent-Young Adult Daughters Navigate Challenging Breast Cancer Conversations

Background

Mothers diagnosed with breast cancer describe daughters as a critical source of support. Talking about breast cancer is especially distressing and challenging for mothers and their adolescent-young adult (AYA) daughters.

Objective

The over-arching study aim was to generate findings to integrate into an intervention to enhance diagnosed mothers' and AYA daughters' communication skills by identifying approaches they find helpful when talking about cancer.

Methods

We recruited 27 women (12 dyads). Diagnosed mothers and their AYA daughters (aged 18-29) participated in individual, in-depth, semi-structured interviews. Transcripts were thematically analyzed. Mothers'/daughters' perspectives were compared/ triangulated.

Results

Both mothers and daughters identified 3 approaches that helped them navigate cancer communication: (mothers) initiate conversations, keep communication positive, and limit cancer conversations. Only mothers reported it was helpful to downplay the seriousness of cancer. Only daughters identified it was important for them to reframe their perspective of mothers' disclosures.

Conclusions

Findings provide clinicians like nurses and families with a "psychosocial map" of communication approaches and associated strategies mothers and AYA daughters can use to talk about breast cancer in ways that promote daughters' comfort and/or alleviate distress.

Implications for Practice

Findings capture communication skills to focus on when tailoring developmentally focused interventions targeting diagnosed mothers and AYA daughters. Nurses can translate findings into practice to help patients talk to AYA daughters about cancer, thereby promoting a family-centered cancer care approach. What Is Foundational: AYA daughters are especially distressed talking about cancer with their diagnosed mothers. They can both use communication strategies to enhance their communal coping.