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

Mapping Information Needs of Patients With Sexually Transmitted Infections Using Web-Based Data Sources: Grounded Theory Investigation

Background

According to the World health organization (WHO), more than 1 million sexually transmitted infections (STIs) are acquired each day across the world. The incidence rates of STIs in the United States are at a record high for the fourth consecutive year. Owing to the stigma associated with the incidence of STI, there is a general reluctance to seek information in person. Instead, web-based information sources remain the primary avenues of information-seeking. However, these sources are designed without a comprehensive understanding of the information needs of individuals who have contracted STIs.

Objective

This study aimed to investigate the information needs of individuals who have or suspect they have contracted an STI. A better understanding of their information needs can drive the design of more effective digital interventions.

Methods

This is a qualitative and analytical study of 549 transcripts (consisting of queries posted over the last 10 years) from web-based forums of the American Sexual Health Association (ASHA), which allows patients, volunteers, and health care providers connect anonymously. The analysis follows a grounded theory (GT) approach with multiple coding stages to uncover categories and themes.

Results

Three categories of information needs emerged. The first two, clinical and logistical, are similar to other contexts. However, our analysis shows that there is a significant need for the last category—psychosocial information. Approximately 59% of instances are linked to concerns such as confusion, discretion, remorse, and others. These needs vary across the stages of a patient’s journey from symptom manifestation to treatment maintenance.

Conclusions

Responding to the needs of individuals who have or suspect they have contracted an STI requires compassionate and personalized responses (beyond factual clinical and logistical information). Web-based forums provide anonymity but do not adequately incorporate mechanisms, practices, or incentives to respond to diverse psychosocial concerns. Innovative approaches to add such support can make the digital interventions more effective for this group of individuals.

Does Context Matter? Examining PRISM as a Guiding Framework for Context-Specific Health Risk Information Seeking Among Young Adults

Research indicates that when people seek health information, they typically look for information about a specific symptom, preventive measure, disease, or treatment. It is unclear, however, whether general or disease-specific theoretical models best predict how people search for health information. We surveyed undergraduates (N = 963) at a large public southeastern university to examine health information seeking in two incongruent health contexts (sexual health and cancer) to test whether a general model would hold for specific topics that differed in their immediate personal relevance for the target population. We found that the planned risk information seeking model was statistically a good fit for the data. Yet multiple predicted paths were not supported in either data set. Certain variables, such as attitudes, norms, and affect, appear to be strong predictors of intentions to seek information across health contexts. Implications for theory building, research methodology, and applied work in health-related risk information seeking are discussed.

Monitoring style of coping with cancer related threats: a review of the literature

Building on the Cognitive-Social Health Information-Processing model, this paper provides a theoretically guided review of monitoring (i.e., attend to and amplify) cancer-related threats. Specifically, the goals of the review are to examine whether individuals high on monitoring are characterized by specific cognitive, affective, and behavioral responses to cancer-related health threats than individuals low on monitoring and the implications of these cognitive-affective responses for patient-centered outcomes, including patient-physician communication, decision-making and the development of interventions to promote adherence and adjustment. A total of 74 reports were found, based on 63 studies, 13 of which were intervention studies. The results suggest that although individuals high on monitoring are more knowledgeable about health threats, they are less satisfied with the information provided. Further, they tend to be characterized by greater perceived risk, more negative beliefs, and greater value of health-related information and experience more negative affective outcomes. Finally, individuals high on monitoring tend to be more demanding of the health providers in terms of desire for more information and emotional support, are more assertive during decision-making discussions, and subsequently experience more decisional regret. Psychoeducational interventions improve outcomes when the level and type of information provided is consistent with the individual's monitoring style and the demands of the specific health threat. Implications for patient-centered outcomes, in terms of tailoring of interventions, patient-provider communication, and decision-making, are discussed.

Measuring reliability and validity of a newly developed stress instrument: Newly Diagnosed Breast Cancer Stress Scale

AIMS AND OBJECTIVES

To assess the reliability and validity of a developed instrument entitled Newly Diagnosed Breast Cancer Stress Scale.

BACKGROUND

Distress, clinical anxiety and depression are evident in patients with cancer, leading to poor psychosocial and quality-of-life outcomes.

DESIGN

Instrument development study with norm-referenced measurements.

METHODS

Content validity was determined by expert review. Cronbach's α was used to assess internal consistency reliability and product-moment correlations were conducted. Exploratory factor analysis measured validity of items using varimax rotation method. Criterion-related validity testing used the Perceived Stress Scale and the convergent validity test of construct validity used the Hospital Anxiety and Depression Scale. A total of 125 women pathologically diagnosed with breast cancer were interviewed on the day prior to initial breast surgery.

RESULTS

After testing, the Newly Diagnosed Breast Cancer Stress Scale consisted of four main factors with 17 items with acceptable reliability and good validity, and its length and time to complete the questionnaire were appropriate. Internal consistency reliability of the scale was shown by Cronbach's α = 0·84, the criterion validity of Perceived Stress Scale-10 was r = 0·46 (p < 0·001), the convergent validity of Hospital Anxiety and Depression Scale-14 was r = 0·57 (p < 0·001) for anxiety and r = 0·35 (p < 0·001) for depression.

CONCLUSIONS

The Newly Diagnosed Breast Cancer Stress Scale has acceptable reliability and good validity to measure stress in newly diagnosed patients with breast cancer.

RELEVANCE TO CLINICAL PRACTICE

The Newly Diagnosed Breast Cancer Stress Scale can provide healthcare workers with an instrument to better identify stress levels in newly diagnosed breast cancer patients and provide valuable information when defining psychosocial care interventions.

Family members of patients with cancer: what they know, how they know and what they want to know

BACKGROUND

Recent changes in healthcare management generally and in cancer care in particular, indicate a major shift in the clinical management of cancer from hospitals and healthcare professionals (HCPs) to patients and families. In light of these changes national and international policies and reports by the Department of Health and Children (2001, 2006) and the World Health Organisation (2004) have recommended that HCPs support family members (FMs) to care for loved ones. The purpose of this review therefore was to explore the extent to which FMs' needs are realised by HCPs in practice.

OBJECTIVES

To examine recent research (2000-2010) in relation to; the type of information that FMs of patients with cancer generally seek, how they seek this information from HCPs, and, FMs' experiences of communicating with HCPs in this context.

METHODS

A review of the literature was conducted using key databases Medline, Pub med, Psych-Info and CINAHL.

RESULTS

Thirty four papers were included in the review. Overall the studies demonstrated that FMs of patients with cancer have similar information needs and demonstrate similar strategies for seeking information. While many FMs report positive communication experiences with HCPs and have information needs met, the majority of FMs report negative communication encounters with HCPs.

CONCLUSION

HCPs are highly significant in the lives of FMs of patients with cancer. The review concludes with identifying; FMs most wanted information needs, their struggles with accessing HCPs and the type of communication encounters FMs most desire to have with HCPs. Recommendations for education, practice and research are addressed.

PRISM: a planned risk information seeking model

Recent attention on health-related information seeking has focused primarily on information seeking within specific health and health risk contexts. This study attempts to shift some of that focus to individual-level variables that may impact health risk information seeking across contexts. To locate these variables, the researcher posits an integrated model, the Planned Risk Information Seeking Model (PRISM). The model, which treats risk information seeking as a deliberate (planned) behavior, maps variables found in the Theory of Planned Behavior (TPB; Ajzen, 1991) and the Risk Information Seeking and Processing Model (RISP; Griffin, Dunwoody, & Neuwirth, 1999), and posits linkages among those variables. This effort is further informed by Kahlor's (2007) Augmented RISP, the Theory of Motivated Information Management (Afifi & Weiner, 2004), the Comprehensive Model of Information Seeking (Johnson & Meischke, 1993), the Health Information Acquisition Model (Freimuth, Stein, & Kean, 1989), and the Extended Parallel Processing Model (Witte, 1998). The resulting integrated model accounted for 59% of the variance in health risk information-seeking intent and performed better than the TPB or the RISP alone.

Adult daughters' reports of breast cancer risk reduction and early detection advice received from their mothers: an exploratory study

OBJECTIVE

Awareness of cancer family history is dependent upon communication between family members. Communication of this information and related decision-making could be important factors influencing breast cancer risk reduction and early detection behaviors. Using survey data from 2328 women (mean age 62.5 years) from 372 families enrolled in the Minnesota breast cancer family study, we explored adult daughter's reports of breast cancer risk reduction advice received from their mothers.

METHODS AND RESULTS

Approximately 212 (9%) of respondents reported receiving breast cancer risk reduction advice from their mothers and 130 (89%) reported acting upon such advice. Having a mother or first degree relative (FDR) with a history of breast cancer was significantly correlated with following advice to a higher degree as compared with those not having such family history (p=0.003). Most frequently reported types of advice were to have mammograms (36%) and to have clinical breast exams (35%). Using multivariable logistic regression and after accounting for non-independence of the sample, significant independent correlates of receiving advice included younger age, having an affected mother, and having a higher perceived breast cancer risk. Receiving advice was also correlated with engaging in a higher number of health promoting behaviors and ever having received a mammogram.

CONCLUSIONS

Our preliminary findings are consistent with social influence theory and suggest that mother-daughter communication about reducing risk, especially among those having a FDR with breast cancer, could be a potential pathway through which breast cancer family history is associated with the adoption of breast cancer screening and risk reduction behaviors.

Quality of life of family caregivers of cancer survivors: across the trajectory of the illness

BACKGROUND

Cancer affects not only the quality of life (QOL) of individuals with the disease but also that of their family members and close friends. The impact on various aspects of the family caregivers' QOL is significant throughout the trajectory of the illness. The authors reviewed literature on the QOL of family caregivers at the acute and middle- to long-term survivorship phases as well as the bereavement phase.

METHODS

By using several databases, the authors searched the literature published in English from 1996 through July 2007. Keywords searched included cancer, carcinoma, family, family member, caregivers, and quality of life. Several criteria were used to guide the literature review: Articles had to be published in refereed journals and had to use rigorous methods, sample, and validated measures.

RESULTS

The findings suggested that the QOL of family caregivers of individuals with cancer varies along the illness trajectory. This highlights were importance of assessing the ongoing adjustment of the caregivers over time. However, there were few theory-driven studies, and significant gaps remain in the current understanding of the effects of family caregiving beyond the time of diagnosis and treatment.

CONCLUSIONS

Accumulating evidence has supported the concept that cancer affects not only the patients/survivors but also their family members. However, theoretically and methodologically rigorous research on various aspects of the family's QOL, including not only the psychological but also the physical, spiritual, and behavioral adjustment to cancer in the family, remains sparse. Family-based interventions across the trajectory of the illness also are needed.

EORTC QLQ-INFO26: a questionnaire to assess information given to cancer patients a preliminary analysis in eight countries

Information disclosure is a key factor in the support for cancer patients. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group has developed a questionnaire to evaluate the level of information received by cancer patients at different stages of their disease and treatment: the EORTC QLQ-INFO26. It can be used in clinical practice and research, including clinical trials. The questionnaire was developed following EORTC Quality of Life Group guidelines. The paper presents the data on 133 patients from eight countries. The resulting EORTC QLQ-INFO26 questionnaire includes four sub-scales on information regarding their cancer, medical tests, treatment and other services and several single items.

Vitality, mental health, and satisfaction with information after breast cancer

OBJECTIVE

The purpose of this study was to investigate the relationship between satisfaction with information about treatment-related and survivorship issues and mental health outcomes, including vitality, in long-term breast cancer survivors.

METHODS

Participants who had finished treatment for breast cancer at least 3 months before enrollment completed a survey instrument designed to evaluate satisfaction with diagnostic and treatment information and satisfaction with survivorship information. Mental health and vitality were measured using the Medical Outcomes Study SF-36, and distress was measured using the impact of events scale. Bivariate analyses and linear regression analyses were performed to investigate the relationships between satisfaction with information, mental health, vitality, and distress controlling for clinical and treatment variables.

RESULTS

The survey was completed by 231 participants (response rate 83%). More respondents were highly satisfied with treatment information (87%) than with survivorship information (30%, p=0.0001). There was a strong positive relationship between satisfaction with information (both treatment and survivorship issues) and vitality, mental health, and a strong negative relationship with distress. In multivariate analyses, satisfaction with treatment information was independently associated with mental health (p<0.01), and satisfaction with survivorship information was independently associated with vitality (p<0.05).

CONCLUSION

Among patients who have completed treatment for breast cancer, satisfaction with diagnosis and treatment information is greater than satisfaction with survivorship issues and satisfaction with information may play an important role in mental health outcomes.

PRACTICE IMPLICATIONS

Given the relationship between satisfaction with information and vitality, interventions to improve informational support regarding survivorship issues are warranted.

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.

Developing a profile of consumer intention to seek out additional information beyond a doctor: the role of communicative and motivation variables

Current reports in the medical literature demonstrate increasing acknowledgment of consumer involvement in autonomous health and medical information search beyond the doctor. Although multiple studies have segmented consumers into different groups based on the different levels of patient autonomy, the literature review revealed the lack of systematic attempts at elucidating the antecedents of autonomous consumer health information search. In this article, I examine the role of health consciousness as a mediator of the relation between communicative (interpersonal, community, print, television, and Internet) factors and health information seeking.

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.

Developing a profile of consumer intention to seek our health information beyond a doctor

The health care consumer of the new millennium is becoming increasingly involved in his/her health choices. The explosion in the number of media outlets offering health-specific information has further propelled the growth in active health orientation. The goal of this research is to understand the profile of the actively oriented health care consumer. It constructs a psychographic plot of additional health information seeking by investigating variables such as health consciousness, environmental consciousness, and consumerism. Based on the study results, strategic recommendations are made for health information targeting and delivery.

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.

Information needs and information-seeking behaviors of men with prostate cancer and their partners: a review of the literature

A critical review of the literature was carried out in the United Kingdom to identify the information needs and information-seeking behaviors of men with prostate cancer and their partners. Relevant papers published between 1990 and 2000 were reviewed and despite having several methodologic limitations, a number of conclusions can still be drawn from this review. First, men with prostate cancer have distinct information needs and information-seeking behaviors throughout their cancer journeys. Although there is considerable variation in the amount and type of information that men require, the majority of men with prostate cancer are satisfied with the information they receive. Second, although partners of men with prostate cancer have needs for information, these needs are often unmet. Partners undergo an information-seeking pattern that is comparable with, if not more active than, patients' information-seeking behaviors. These findings have a number of implications for cancer nursing practice and research, which are discussed in the article.

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.