Information, support, and communication needs of women with a family history of breast cancer

The roles of experiences and risk perception in the practice of preventative behaviors of COVID-19

Understanding the variables contributing to the practice of COVID-19 preventative behaviors is important in order to provide the best education to the community. Here, we aim to determine what factors affect an individual's compliance to suggested COVID-19 preventable behaviors. We also aim to determine what contributes to an individual's willingness to get the COVID-19 vaccine. This study surveyed residents of South Carolina, USA to analyze factors relating to preventative behavior. Survey respondents were asked a series of questions using Qualtrics survey platform. The questions included demographics, experiences with COVID-19, knowledge about the disease, and the practice of preventive behaviors. Results of this study demonstrate that demographic differences (e.g. being older, female, and more educated) and psychological differences (e.g. more COVID-19 personal experiences, perceived susceptibility and severity) are all shown to be significantly correlated with COVID-19 preventative behaviors and vaccine willingness. The factors that influence an individual's preventative behaviors and vaccine willingness are important to understand so that public health officials can best tailor and target their educational efforts.

Risk perception and screening behavior of Filipino women at risk for breast cancer: implications for cancer genetic counseling

The burden and experiences that come with a breast cancer diagnosis in a family impact how women perceive personal cancer risk and pursue preventive strategies and/or early detection screening. Hence, this study sought to understand how Filipino women incorporate their experiences living with a sister diagnosed with early-onset breast cancer to their personal perceived risk and screening behavior. Guided by phenomenological approach of inquiry, a face-to-face, semi-structured interview was conducted with 12 purposively sampled women with a female sibling diagnosed with breast cancer before age 50. Transcripts were analyzed using thematic analysis. Results revealed that the respondents tend to compare themselves with their sister when constructing views of personal cancer vulnerability. The subjective risk is also shaped by their beliefs regarding cancer causation such as personalistic causes, personal theory of inheritance, and locus of control. Their sisters' cancer diagnoses serve as a motivation for them to perform breast self-examination. However, clinical breast examination and screening mammography are underutilized due to perceived barriers such as difficulty allotting time to medical consultation, fear, and lack of finances. Overall, cancer risk perception and screening behavior are important factors that must be addressed during cancer genetic counseling consultations. Better understanding of these factors will aid in the formulation of an effective management plan for at-risk women.

Examining the information and support needs of first-degree relatives of breast cancer patients

Women with a family history of breast cancer, specifically among first-degree relatives (FDRs) such as daughter, mother and sister, face a two-fold higher risk of getting breast cancer than women with no family history. Current literature highlighted that these FDRs’ needs for factual information and emotional support were poorly met. Owing to a lack of local research, this cross-sectional survey study aimed to identify the information and support needs of FDRs of breast cancer women, their risk perception and self-care practices. Forty-one FDRs of breast cancer patients were recruited via convenience sampling. They completed a questionnaire comprising primarily the Information and Support Needs Questionnaire (ISNQ). In general they perceived information needs to be more important than support needs. The most important need identified was “information about breast cancer treatment.” Overall, only a few participants perceived that their needs were “met fully” both for information ( n = 2, 4.9%) and support needs ( n = 3, 7.3%). Breast screening examination (BSE) adherence was low; only eight FDRs (19.5%) performed monthly BSE. They expressed the need to receive guidance from health care professionals on the proper techniques of BSE. In conclusion, the findings underscored the need for effective avenues to empower FDRs with information and support so they can better support themselves and their loved ones. This is essential to help them cope with the cancer diagnosis of their loved ones, while simultaneously engaging in early screening and health-promoting measures toward betterment of their own quality of life and health outcomes.

Understanding family health information seeking: a test of the theory of motivated information management

Although a family health history can be used to assess disease risk and increase health prevention behaviors, research suggests that few people have collected family health information. Guided by the Theory of Motivated Information Management, this study seeks to understand the barriers to and facilitators of interpersonal information seeking about family health history. Individuals who were engaged to be married (N = 306) were surveyed online and in person to understand how factors such as uncertainty, expectations for an information search, efficacy, and anxiety influence decisions and strategies for obtaining family health histories. The results supported the Theory of Motivated Information Management by demonstrating that individuals who experienced uncertainty discrepancies regarding family heath history had greater intention to seek information from family members when anxiety was low, outcome expectancy was high, and communication efficacy was positive. Although raising uncertainty about family health history may be an effective tool for health communicators to increase communication among family members, low-anxiety situations may be optimal for information seeking. Health communication messages must also build confidence in people's ability to communicate with family to obtain the needed health information.

Determination of information and support needs of first degree relatives of women with breast cancer

BACKGROUND

Breast cancer is the most frequent type of cancer among women in the world and the most common cause of deaths from cancer in females. In Turkey, breast cancer comes first in the list of the most frequent ten cancer types seen in women. As the incidence rate of breast cancer is high, many women having breast cancer in the family experience the breast cancer at secondhand. This study was carried out in an attempt to determine the information and support needs of women whose first-degree relatives have breast cancer and to what extent these needs are met.

METHODS

The research sample consisted of 156 women. Questionnaire Form and Information and Support Needs Questionnaires were used as the data collection tools.

RESULTS

Information need score averages (x?:3.72±0.19) of women included in the research sampling were found to be higher than their score averages of support needs (x?:3.24±0.41).

CONCLUSION

Information needs which were indicated by women as very important were related to treatment, symptoms of breast cancer and breast self examination (BSE), while support needs which were indicated by women as very important were learning how to perform BSE, women's anxiety for themselves and their relatives regarding breast cancer and having their breasts examined by a health professional. It is recommended that nurses and other medical staff should give information to women whose first-degree relatives have breast cancer about the disease, its etiology, scanning, diagnosis, treatment options and protection as well as prevention.

A UK collaborative 1-day pilot information and support forum facilitated by a national breast cancer charity and NHS cancer genetic counsellors, for women at high risk, BRCA 1/2 gene carriers and hereditary breast cancer

Since the identification of the breast cancer susceptibility genes BRCA 1/2, genetic assessments of individuals and their families has greatly increased. The assessment of an individual as being at high risk, a gene carrier or an inheritor of cancer changes that individual's life. There is then a great need for ongoing information and support, not only from healthcare professionals but from peers - other women in the same situation. Breast Cancer Care is aware of this need; for a number of years, we have been providing published information, online-based information and support and telephone support to women who are BRCA 1/2 gene carriers and women with hereditary breast cancer. As part of our continuing commitment to improve on and develop other information and support services to this target group, we collaborated with a number of Genetic Counsellors from London, Oxford, Cambridge and Southampton to develop and pilot a 1-day support forum. This article discusses the factors that led to the pilot information and support forum, its development and how it was evaluated, and suggests a potential way forward.

Covering women's greatest health fear: breast cancer information in consumer magazines

Women identify consumer magazines as a key source of information on many health topics, including breast cancer, which continues to rank as women's greatest personal health fear. This study examined the comprehensiveness and accuracy of breast cancer information provided in 555 articles published in 17 consumer magazines from 2002 through 2007. Accuracy of information was determined for 33 key breast cancer facts identified by an expert panel as important information for women to know. The results show that only 7 of 33 key facts were mentioned in at least 5% of the articles. These facts all dealt with breast cancer risk factors, screening, and detection; none of the key facts related to treatment or outcomes appeared in at least 5% of the articles. Other topics (not key facts) mentioned centered around controllable risk factors, support for breast cancer patients, and chemotherapy treatment. The majority of mentions of key facts were coded as fully accurate, although as much as 44% of mentions of some topics (the link between hormone replacement therapy and breast cancer) were coded as inaccurate or only partially accurate. The magazines were most likely to emphasize family history of breast cancer or genetic characteristics as risk factors for breast cancers; family history was twice as likely to be discussed as increasing age, which is in fact the most important risk factor for breast cancer other than being female. Magazine coverage may contribute to women's inaccurate perceptions of their breast cancer risk.

The primary care physician role in cancer genetics: a qualitative study of patient experience

BACKGROUND

Increased availability of genetic testing is changing the primary care role in cancer genetics. The perspective of primary care physicians (PCPs) regarding their role in support of genetic testing has been explored, but little is known about the expectations of patients or the PCP role once genetic test results are received.

METHODS

Two sets of open-ended semi-structured interviews were completed with patients (N=25) in a cancer genetic programme in Ontario, Canada, within 4 months of receiving genetic test results and 1 year later; written reports of test results were collected.

RESULTS

Patients expected PCPs to play a role in referral for genetic testing; they hoped that PCPs would have sufficient knowledge to appreciate familial risk and supportive attitudes towards genetic testing. Patients had more difficulty in identifying a PCP role following receipt of genetic test results; cancer patients in particular emphasized this as a role for cancer specialists. Still, some patients anticipated an ongoing PCP role comprising risk-appropriate surveillance or reassurance, especially as specialist care diminished. These expectations were complicated by occasional confusion regarding the ongoing care appropriate to genetic test results.

CONCLUSIONS

The potential PCP role in cancer genetics is quite broad. Patients expect PCPs to play a role in risk identification and genetics referral. In addition, some patients anticipated an ongoing role for their PCPs after receiving genetic test results. Sustained efforts will be needed to support PCPs in this expansive role if best use is to be made of investments in cancer genetic services.

Psychosocial impact of the lack of information given at referral about familial risk for cancer

We aimed to identify patient' information and communication needs irrespective of their risk level, when they are referred for genetic risk assessment and genetic counselling for a predisposition to cancer. Semi-structured telephone interviews were conducted with a purposive sample of individuals referred to a clinical genetics unit for a risk assessment of their genetic predisposition to either breast, ovarian or colorectal cancer and stratified by their level of risk. Triangulation was achieved by focus groups conducted with specialist genetic health professionals. Twenty-three participants were interviewed pre- and post-genetic counselling or risk assessment. A further 11 completed a single interview, five pre-assessment and six post-assessment. Three focus groups were conducted with the genetic health professionals. The results showed that many participants were unaware they had been referred for genetic counselling and as a consequence they felt this caused difficulties in coping with the genetic risk information received. Health professionals corroborated these findings of people's lack of awareness about their referral. This work raises important questions about the psychosocial consequences of inadequate information provision at the point of referral by clinicians in primary and hospital-based healthcare that are responsible for referring the majority of people to clinical genetics units.

Information needs of the informal carers of women treated for breast cancer

Although the vital role of informal carers has been acknowledged in government policy documents in the UK, the information needs of informal carers are not well documented. There is also uncertainty about where carers get their information from and whether they are satisfied with the information they receive. This study aimed to examine the information needs and sources of information for informal carers in the acute cancer setting; the informal carers of a sample of women treated for breast cancer. Both quantitative and qualitative data were collected from semi-structured interviews with 50 informal carers. Measures of information needs and sources were administered in addition to an in-depth exploration of information needs. The priority information needs of carers related to cure, spread of disease and treatments, a similar profile to that found for women with breast cancer in previous work. The main source of information for carers was the person they were caring for, although written information was also valued. Health professionals need to ensure that patients are well informed so that patients can provide information for carers and also need to take advantage of any opportunities to directly assess the information needs of carers to enable them to be more effective in their caring role.

A path analysis of factors associated with distress among first-degree female relatives of women with breast cancer diagnosis

Patterns and predictors of psychological distress in first-degree female relatives (N = 624) of newly diagnosed breast cancer patients were explored. First-degree female relatives who were high monitors reported greater cancer-specific and general distress than did low monitors. Greater optimism was associated with lower cancer-specific distress. Optimism's effect on general distress was moderated by women's level of monitoring. Greater optimism was associated with lower general distress for both high and low monitors, but the effect was stronger for high monitors than for low monitors. Avoidance and engaged coping were associated with higher distress. A close relationship with the cancer patient was related to higher cancer-specific distress but lower general distress. Further understanding of the process of adjustment in these women awaits longitudinal study.

Women's posttraumatic stress responses to maternal breast cancer

Levels of posttraumatic stress disorder (PTSD) symptoms and their relationships to demographic and psychosocial variables and maternal medical history were examined among 31 women with maternal histories of breast cancer. The results indicate that 19.4% of these women were likely to merit a PTSD diagnosis related to maternal breast cancer, particularly those who reported greater negative affect. In addition, PTSD symptom severity was positively associated with the mother's cancer stage at diagnosis and was inversely associated with participant age. These results suggest that maternal breast cancer is an emotionally traumatic event for many women and point to the potential influence of psychological factors and stressor characteristics on daughters' PTSD responses.

Too much, too soon? Patients and health professionals' views concerning the impact of genetic testing at the time of breast cancer diagnosis in women under the age of 40

Recent research suggests that women who develop breast cancer between the ages of 30-34 may have specific tumour characteristics: Those with high grade, oestrogen receptor negative, human epidermal growth factor receptor 2 (HER-2) negative tumours have between a 10% and 27% chance of being a BRCA1 gene carrier. Carriers of BRCA1 and BRCA2 mutations have an increased risk of contralateral breast cancer and cancer of the ovary. Furthermore, recent research indicates that prophylactic mastectomy and/or oophorectomy offer a significant risk reduction in the development of breast/ovarian cancer. In the near future, women in the UK may be offered the choice of a genetic test close to the time of diagnosis. This timing not only provides additional dimensions to treatment decisions, but has psycho-social and familial implications as well. This exploratory study investigates, first, whether or not women diagnosed with breast cancer under the age of 40 would want to be offered information about genetic testing close to the time of their diagnosis. Then secondly, it explores whether the health care professionals treating them support this idea. Third, it highlights the reasons for the women and the health professionals perspectives and concerns. We held focus groups of 13 women who had their only, or first, breast cancer under the age of 40 and who were subsequently identified as BRCA1 or BRCA2 mutation carriers, asking them how they felt about this timing. We also interviewed 17 health care professionals involved in various aspect of breast cancer care and cancer genetics. The majority of former breast cancer women and professionals believed that there was already emotional overload in coping with the cancer diagnosis and decisions regarding existing cancer treatment options and that offering genetic testing would add too much additional stress. Some members of both groups, however, thought that offering genetic testing around the time of breast cancer diagnosis would be more important if the results could alter treatment decisions.

Patients' interest in discussing cancer risk and risk management with primary care physicians

Little is known about patients' preferences for discussing cancer risks and risk management with primary care physicians. We sought to determine whether patients want to discuss such topics and what factors are associated with this interest. Participants (375 patients ages 40-85, of diverse race and education level) completed a telephone survey prior to scheduled physician visits. Survey included items on perceived health, perceived cancer risk, education level, and whether participants would like to discuss with a physician their breast, ovarian or colon cancer risk, tamoxifen, cancer genetic counseling, and colon cancer screening. Greater proportions were interested in discussing risks for each cancer, compared with those who were not (P < 0.0001). More participants were interested in discussing mammograms (80%) and cancer genetic counseling (60%) than tamoxifen (49%) or colon cancer screening modalities (43-53%). For many topics, poorer perceived health was associated with greater interest in future discussion; higher education level was associated with less interest.

Effects of individual and family functioning on interest in genetic testing

OBJECTIVE

The present study reports on the important issue of how family communication and support regarding breast cancer risk affects interest in genetic testing and mental health.

METHODS

Participants (n = 221) were women aged 18-74 who had at least one relative of Ashkenazi Jewish descent, no personal history of breast or ovarian cancer, and lived within 60 miles of Seattle, Wash.

RESULTS

Communication about breast cancer risk was reported with very low frequency across all types of relatives. Women talked with their mothers and sisters more often than their fathers, brothers, or children. The only significant predictor of interest in genetic testing was the individual level variable of seeking social support.

CONCLUSION

Social support needs might be a part of the genetic testing process.

The Effect of Experiential Knowledge on Construction of Risk Perception in Hereditary Breast/Ovarian Cancer

The purpose of this study was to explore the connection between experiential knowledge of hereditary breast/ovarian cancer and understandings of personal cancer risk. Using a qualitative research design, the investigator conducted in-depth interviews with 53 individuals (45 female, 8 male) from families at high-risk for hereditary breast/ovarian cancer. Study results showed that two forms of experiential knowledge, empathetic and embodied knowledge, were integral to participants' constructions of their cancer risk. They also illustrated that knowledge derived from experience often took precedence over objective clinical estimates of risk. The paper discusses the clinical implications of these findings and suggests that counseling strategies, which expand upon patient's lived experience and knowledge of the disease, may enhance communication of genetic risk. Assessment of experiential knowledge promises to suggest new ways to frame genetic information that will enable people to better understand their objective risk or to modify exaggerated and/or inaccurate risk perceptions.

Sociodemographic determinants of cancer treatment health literacy

BACKGROUND

Ethnic and racial disparities in cancer outcomes are often attributed to sociodemographic factors, including income, education, insurance status, and access to quality cancer care. Less attention has been directed toward other possible contributors, such as misconceptions about cancer and its treatment.

METHODS

Nine hundred fifty-seven U.S. adults who reported that they had never been diagnosed with cancer were identified and surveyed using a random digit dialing telephone survey. Sociodemographic associations with endorsement of five misconceptions about cancer treatment were evaluated by weighted logistic regression.

RESULTS

The most prevalent misconception, "Treating cancer with surgery can cause it to spread throughout the body," was endorsed as true by 41% of the respondents. The second most prevalent misconception, "The medical industry is withholding a cure for cancer from the public in order to increase profits, " was identified as true by 27%. The statement, "Pain medications are ineffective against cancer pain, " was accurately rejected by 68% of the respondents, and 89% of the respondents correctly disagreed with the statement, "All you need to beat cancer is a positive attitude, not treatment. " Eighty-seven percent of the respondents were able to identify the statement, "Cancer is something that cannot be effectively treated," as false. Respondents who were older, nonwhite, Southern, or indicated being less informed about cancer endorsed the most misconceptions.

CONCLUSIONS

The prevalence of at least three of the five cancer misconceptions was unacceptably high, and varied by several sociodemographic factors. These beliefs may increase the risk for cancer morbidity and mortality because of poor adherence to treatment regimens.

What are the information needs of Chinese breast cancer patients receiving chemotherapy?

Cancer patients demand information, not only to assist them to understand the disease and its treatment, but also to allow them to interpret the aversive events and action taken, so that the threat inherent from the diagnosis becomes lessened. With the goal of studying the information needs of women with breast cancer who were receiving chemotherapy, 51 patients were invited to complete a self-administered questionnaire at the beginning and again at half way through their chemotherapy treatment. The results showed that for these patients the cancer and its spread, the side effects of chemotherapy and the management of the side effects were the priority information needs in the early stages and following chemotherapy. Among 52 questions, only six items were revealed to have significant difference when compared with the Time 1 and Time 2 measures. The results reflect that over time information needs for this group of patients was relatively stable. Marital status and subscale of disease was found significant difference at the first and second time points. The findings indicate that there is a need for the provision of a family-centered education program that addresses patient's information needs, cultural sensitivity, the use of building up and ongoing.

Knowledge about breast cancer risk factors and hereditary breast cancer among early-onset breast cancer survivors

Little is known about knowledge levels regarding hereditary breast cancer among breast cancer survivors. This study explored, among women with early-onset breast cancer (<50 years): 1) knowledge regarding breast cancer risk factors and hereditary breast cancer; and 2) differences in knowledge based on risk for hereditary disease. Participants recruited from 34 Virginia hospitals responded to two questionnaires. The Family History Questionnaire assessed risk for hereditary breast cancer. The Knowledge, Attitudes, and Beliefs Questionnaire evaluated knowledge of general breast cancer risk factors and hereditary breast cancer. Of 314 respondents, 273 (87%) returned both questionnaires. A total of 137 (52%) participants met the study's criteria for hereditary breast cancer risk. Most participants knew common breast cancer-associated risk factors, including family history of breast cancer. Only 35% recognized family history of non-breast malignancies as a risk factor for breast cancer. Most participants recognized that prophylactic mastectomy does not eliminate breast cancer risk (63%), that not all women carrying a mutation develop disease (73%), and that men can develop breast cancer (96%). The majority selected 'I don't know' for knowledge of several characteristics of hereditary breast cancer, including: early-onset disease (54%); multifocal or bilateral disease (62%); risk transmission through fathers (58%); association with other cancer types (61%); and male breast cancer (70%). Knowledge regarding hereditary breast cancer did not vary between women with suspected hereditary disease and those with presumed sporadic disease. These data highlight the need for information regarding hereditary breast cancer for early-onset breast cancer survivors.

Positive attitude in cancer: patients' perspectives

PURPOSE/OBJECTIVES

To describe what being positive means for patients undergoing treatment for cancer.

RESEARCH APPROACH

Qualitative, descriptive approach.

SETTING

Specialist cancer clinic in a large metropolitan hospital in Sydney, Australia.

PARTICIPANTS

11 patients with cancer currently being treated at a cancer clinic for a variety of cancers.

METHODOLOGIC APPROACH

Semistructured interviews that were audiotaped, transcribed, and thematically analyzed for content related to being positive.

MAIN RESEARCH VARIABLES

Patients' definitions of positive and negative attitude, their perceptions of the importance of attitude during their cancer journey, and any factors that influenced their perceived attitude.

FINDINGS

For patients, positive attitude was defined as optimism for the day and getting though everyday events of the journey by taking control rather than focusing on the future. Factors that affected patients' positive attitude were their relationships with their specialists, people around them being positive and supportive, and having a pleasant environment at home and at the treatment center. Patients found expectations of them to be positive as being detrimental.

CONCLUSIONS

Patients with cancer must be positive for the present rather than the future.

INTERPRETATION

Nurses need to inspire and support patients' positivity while undergoing treatment for cancer. Nurses should not force their own value system on them nor treat them differently if they do not conform to societal expectations to be positive and optimistic for the future.

Reports of information and support needs of daughters and sisters of women with breast cancer

The aim of this study was to describe the information and support needs of women who have primary relatives with breast cancer. The Information and Support Needs Questionnaire (ISNQ) was developed and revised from previous qualitative and pilot studies. The ISNQ addressed concepts of the importance of, and the degree to which, 29 information and support needs related to breast cancer had been met. The study sample consisted of 261 community-residing women who had mothers, sisters, or a mother and sister(s) with breast cancer. Data were collected using a mailed survey. In addition to the ISNQ, additional items addressed family and health history, breast self-care practices, perception of the impact of the relative's breast cancer and other variables. Also included were established and well-validated measures of anxiety and depression. The findings document women's priority information and support needs. The information need most frequently identified as very important was information about personal risk of breast cancer. Other highly rated needs addressed risk factors for breast cancer and early detection measures. Generally, the women perceived that their information and support needs were not well met. These findings illuminate needs of women for more information and support when they have close family relatives with breast cancer and opportunities for primary care providers to assist women in addressing their needs.

Information needs about hereditary breast cancer among women with early-onset breast cancer

To explore hereditary breast cancer (HBC) information needs of early-onset breast cancer survivors, two questionnaires were mailed to women diagnosed at age <50 years. The Family History Questionnaire, sent to women treated at 34 Virginia hospitals, was designed to identify women with suspected HBC versus women with presumed sporadic breast cancer (SBC). Among 314 respondents, 137 reported personal/family histories suggestive of HBC. A total of 287 (87%) participants responded to the subsequent Knowledge, Attitudes, and Beliefs Questionnaire, which assessed HBC knowledge, attitudes, and beliefs, including HBC information needs, sources, and perceived value. Fifty-two percent of women reported seeking any HBC information. Women with presumed SBC were as likely to seek information as those with suspected HBC. Women with daughters were more likely to seek information. Many (71%) women reported finding the information sought, including information about their children's and relatives' risks, DNA testing, treatment differences for HBC, and genetic counseling.

Women's views of consultations about familial risk of breast cancer in primary care

Developments within genetic testing may increase demands on general practitioners to advise about family history of breast cancer (FHBC). This descriptive, qualitative study, investigated women's views of GP consultations about FHBC and their context. Participants were women from the general population who had experienced a primary care consultation in which FHBC was mentioned, as reported by the practitioner. Information about women's views of consultation context was obtained from 72 telephone interviews. More in-depth information about context and women's evaluations of FHBC consultations were obtained from a sub-sample of 20 face to face interviews. FHBC was rarely the main focus of consultations. It featured as a part of an overall discussion of breast symptoms, treatment and cancer risk. Women's understanding of heredity and disease was often idiosyncratic and might differ from biomedical models. A main task for clinicians appeared to be appropriate reassurance. Failure to reassure was linked to a failure to provide explanations at the woman's level of understanding. Clinicians cannot assume that patients share their perceptions of the mechanisms of disease and heredity. Instead they need to ascertain the patient's understanding and provide explanations accordingly. GPs need to have, or access, enough knowledge to inform and reassure.

Information and support needs of women with primary relatives with breast cancer: development of the Information and Support Needs Questionnaire

AIMS OF THE STUDY

The aim was to develop and pilot test a newly developed measure, The Information and Support Needs Questionnaire (ISNQ), for use with women with primary relatives with breast cancer.

BACKGROUND/RATIONALE

Breast cancer is a major risk to the health of women in the United Kingdom (UK). Increasingly, research is documenting women's needs for information and support, particularly at the time of diagnosis. However, to date there is little understanding of the information and support needs of women who have a family history of breast cancer. Contributing to the dearth of understanding of female relatives' needs is the lack of valid and reliable instruments for use in descriptive and intervention research with this population.

DESIGN/METHODS

The ISNQ and survey items documenting family history, sources of information and support for breast cancer risk, breast self-care practices, and other variables were pilot tested for the acceptability of the measures, appropriateness of the data collection methods, initial psychometric properties of the ISNQ, and time and financial costs of administration. Data were collected from 39 women living in the North-west of England who had primary relatives with breast cancer using mailed questionnaires and follow-up telephone interviews.

FINDINGS

The items on the ISNQ were reported to be clear, acceptable to women and to yield relevant data. The psychometric properties of the new measure were satisfactory with a high reliability coefficient alpha. Descriptive findings indicate that women had moderate to high needs for information and support, but reported that these needs were not well met.

CONCLUSIONS

The results of this pilot are guiding the development of a larger study in which the information and support needs of women with a family history of breast cancer are explored.

The use of between-methods triangulation in cancer nursing research: a case study examining information sources for partners of women with breast cancer

This article describes between-methods triangulation-the combination of research strategies using different methods--and illustrates its use in cancer nursing research by outlining a case study, which identified the information sources for partners of women with breast cancer. By combining both qualitative and quantitative data, the study was found to possess good convergent validity. Between-methods triangulation also provided a more complete picture of the topic of inquiry than that supplied by either method alone. It is a useful strategy for identifying the information sources for partners of women with breast cancer and its use is encouraged in cancer nursing research.

Breast cancer risk perception: what do we know and understand?

Women's perceptions of breast cancer risk are largely inaccurate and are often associated with high levels of anxiety about cancer. There are interesting cultural differences that are not well researched. Genetic risk counselling significantly improves accuracy of women's perceptions of risk, but not necessarily to the correct level. Reasons for this are unclear, but may relate to personal beliefs about susceptibility and to problems or variations in risk communication. Research into the impact of demographic and psychological factors on risk perception has been inconclusive. An understanding of the process of developing a perception of risk would help to inform risk counselling strategies. This is important, because knowledge of risk is needed both for appropriate health care decision making and to reassure women who are not at increased risk.

The psychometric properties of the Miller Behavioural Style Scale with adult daughters of women with early breast cancer: a literature review and empirical study

Several researchers have suggested that the information-seeking behaviours of patients need to be taken into consideration when assessing their information needs. This study reviews published evidence of the psychometric properties of the Miller Behavioural Style Scale, a tool commonly used to identify the information-seeking behaviours of individuals under threat, and examines its reliability and validity with adult daughters of women with early breast cancer. Ninety-seven adult daughters completed the MBSS and a 30-item, self-administered questionnaire, a tool designed to explore the information needs of adult daughters of women with breast cancer. The internal consistency of the monitoring and blunting sub-scales of the MBSS was alpha = 0.65 and 0.41 respectively. The blunting sub-scale fell substantially below acceptable limits and was discarded from subsequent analyses. The monitoring sub-scale possessed good test-retest reliability (n = 17) with a 5-week time interval (r= 0.71, P < 0.005), as measured using a Pearson's correlation coefficient. Furthermore, the majority (73.4%) of monitoring items possessed moderate or substantial test-retest reliability, as indicated by kappa coefficients. Finally, the monitoring sub-scale possessed good construct validity, both discriminant and convergent validity, as measured by the univariate associations between monitoring behaviour and selected items from the information questionnaire and a demographic questionnaire. In conclusion, adequate support exists for the psychometric properties of the monitoring sub-scale of the MBSS and its use with adult daughters of women with early breast cancer in future research. These findings have a number of implications for nursing research and these are discussed in this paper.

The information needs and source preferences of women with breast cancer and their family members: a review of the literature published between 1988 and 1998

A comprehensive and critical literature review was conducted to examine the information needs and source preferences of women with breast cancer and their family members. Relevant papers published between 1988 and 1998 were reviewed and despite their having several methodological weaknesses, a number of conclusions can still be drawn. First, women with breast cancer have distinct needs for information throughout their breast cancer journeys, indicating that information needs change with time since diagnosis and with treatment-related events. Second, family members of women with breast cancer also have substantial needs for information. Third, women with breast cancer and their family members often prefer verbal forms of information from health care professionals (HCPs), particularly around the time of diagnosis. Women with breast cancer, however, are often dissatisfied with the information they receive from HCPs. Further, the family members of women with breast cancer often perceive their information needs to be ignored by HCPs. Finally, few studies have focused specifically on the information needs and source preferences of family members of women with breast cancer. These findings have a number of implications for nursing, both for clinical practice and nursing research, and these are discussed in the review.

Assessment of the need for palliative care as perceived by individual cancer patients and their families: a review of instruments for improving patient participation in palliative care

BACKGROUND

Palliative care should fit the needs of individual cancer patients and their families. Instruments can help to improve needs assessment. This review evaluates questionnaires for the systematic assessment of needs experienced by individual cancer patients for help, care, or support, as well as the needs of their family members.

METHODS

The MEDLINE and PsycLIT data bases were searched systematically. Questionnaires were evaluated by reviewing their contents and estimating their validity, reliability, and feasibility for use in caregiving practice.

RESULTS

Analysis of the 471 articles identified from the searches yielded 9 questionnaires for the assessment of patients' needs and 6 questionnaires for the assessment of family members' needs. Most of these instruments were carefully constructed; their validity and reliability were satisfactory and well documented. However, in most questionnaires the needs for care were confounded by satisfaction with care, and the problems experienced by patients. Only one questionnaire for patients specifically addressed the need for help; none for family members was so specific. Data on the feasibility of questionnaires for use in regular care were scarce. Issues frequently omitted were spiritual issues, the personal needs of family members, and the continuity of care.

CONCLUSIONS

None of the instruments the authors found was complete for all dimensions of palliative care. Most instruments were constructed for research purposes and had not been tested for use in practical care. Further development of practical instruments based on a theoretical concept of needs assessment seems necessary. The feasibility of instruments for use in practical caregiving and their effects on the quality of care needs further research.

Breast cancer patients' experiences of patient-doctor communication: a working relationship

The traumas of diagnosis and treatment for breast cancer are well researched and generally addressed in care. While women with breast cancer continue to identify the need for better communication with physicians, studies to date have not investigated how the process of communication between physicians and women with breast cancer actually unfolds. This phenomenological study therefore explored how women with breast cancer experience patient-physician communication to gain a greater understanding of effective approaches. Interviews of a purposeful sample of 11 women within 6 months of initial diagnosis or recurrence of breast cancer were audiotaped, transcribed verbatim and analyzed using inductive interpretation. Themes and patterns of positive and negative experiences emerged. All experiences began with the woman's feeling of vulnerability. In positive experiences, information sharing and relationship building were inextricably linked components of a working relationship which was at the same time affective, behavioural and instrumental. This experience, in turn, influenced the woman's experience of control and mastery of the illness experience, and their experience of learning to live with breast cancer. Findings illuminate the importance of comprehensively patient-centred, working relationships. Several specific techniques to enhance effective communication are identified.

Meeting the information needs of adult daughters of women with early breast cancer. Patients and health care professionals as information providers

This study explored the information needs of adult daughters whose mothers had early breast cancer and illustrated the information flows between the daughters and two information providers: patients and health care professionals (HCPs). Participants were 97 daughters, who completed a 30-time self-administered questionnaire, a tool designed to identify the information needs of daughters and their communication channels. Daughters also completed the Miller Behavioral Style Scale, a scale used to determine the information-seeking behavior of individuals under threat. Descriptive statistics revealed that the information flows between women with breast cancer and daughters participating in this study were good. Most of the daughters received information from their mothers and asked their mothers questions. Few daughters thought their mothers avoided giving them information. The vast majority of the daughters, however, sought information from sources other than their mothers, indicating that the mothers alone did not satisfy their information needs. More than half of the daughters participating in this study accompanied their mothers to their medical consultations and received information from HCPs. Logistic regression indicated that the communication flows between patients, HCPs, and adult daughters of women with breast cancer depended on a number of factors, in particular, on the amount of communication desired by women with breast cancer.

The information concerns of spouses of women with breast cancer: patients' and spouses' perspectives

A user-centred study employing focus group methodology was conducted in the United Kingdom in order to establish the key information concerns of spouses of women with breast cancer from both patients' and spouses' perspectives. Four unstructured focus group discussions were convened, three with women with breast cancer (n=11, n=7 and n=12) and one with spouses (n=9). The discussions were audio-taped and transcribed in full. All transcripts were analysed manually using theme analysis and considered patterns common to the data. Themes were established and corresponding quotations used to support all themes. Emergent themes were grouped into the following categories: information needs of spouses; sources of information for spouses; and family information. Several important points emerged within each of these categories and these are discussed. Validity was established by participant evaluation of the findings. Findings clearly indicate the key information concerns of spouses from patients' and spouses' perspectives. These findings are of value to health care professionals and have a number of nursing implications. The study also highlights particular areas where further research and development are needed.

Communicating cancer risk information: the challenges of uncertainty

Developments in predictive testing for inherited cancers have focused attention on the accurate and sensitive communication of risk information. Although sharing risk information is often equated with genetic testing, it is important to acknowledge that the need for risk information related to familial cancer is also relevant to those not eligible for, or interested in, testing. Communicating cancer risk information is germane to a number of health professions including physicians, geneticists, genetic counsellors, psychologists, nurses, health educators and social workers. Based on a literature review of 75 research reports, expert opinion papers and clinical protocols, we provide a synthesis of what is known about the communication of cancer risk information and make recommendations for the enhancement of knowledge and practice in the field.