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Aristokleous I, Öberg J, Pantiora E, Sjökvist O, Navia JE, Mani M, Karakatsanis A. Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy: A cross-sectional study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:60-67. [PMID: 36088236 DOI: 10.1016/j.ejso.2022.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/11/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM). METHODS This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews. RESULTS There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs -1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy. CONCLUSIONS These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity.
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Affiliation(s)
- Iliana Aristokleous
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Johanna Öberg
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Eirini Pantiora
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Olivia Sjökvist
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 75237, Uppsala, Sweden
| | - Jaime E Navia
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Maria Mani
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 75237, Uppsala, Sweden
| | - Andreas Karakatsanis
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden.
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Jayaseelan P, Deodhar J, Ashok A, Jiwnani S, Kuriakose J, Poojary S. Palliative care needs assessment in patients with metastatic and locally advanced oesophageal cancer. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2158287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Prarthna Jayaseelan
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, India
| | - Apurva Ashok
- Homi Bhabha National Institute, India
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Sabita Jiwnani
- Homi Bhabha National Institute, India
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jyothsna Kuriakose
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, India
| | - Shamali Poojary
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, India
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Viljoen B, Chambers SK, Dunn J, Ralph N, March S. Deciding to Enrol in a Cancer Trial: A Systematic Review of Qualitative Studies. J Multidiscip Healthc 2020; 13:1257-1281. [PMID: 33149597 PMCID: PMC7603415 DOI: 10.2147/jmdh.s266281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
Background Clinical trials are essential for the advancement of cancer treatments; however, participation by patients is suboptimal. Currently, there is a lack of synthesized qualitative review evidence on the patient experience of trial entry from which to further develop decision support. The aim of this review is to synthesise literature reporting experiences of participants when deciding to enrol in a cancer clinical trial in order to inform practice. Methods A systematic review and meta-synthesis of qualitative studies were conducted to describe the experiences of adult cancer patients who decided to enrol in a clinical trial of an anti-cancer treatment. Results Forty studies met eligibility criteria for inclusion. Three themes were identified representing the overarching domains of experience when deciding to enrol in a cancer trial: 1) need for trial information; (2) trepidation towards participation; and (3) justifying the decision. The process of deciding to enrol in a clinical trial is one marked by uncertainty, emotional distress and driven by the search for a cure. Conclusion Findings from this review show that decision support modelled by shared decision-making and the quality of a shared decision needs to be accompanied by tailored or personalised psychosocial and supportive care. Although the decision process bears similarities to theoretical processes outlined in decision-making frameworks, there are a lack of supportive interventions for cancer patients that are adapted to the clinical trial context. Theory-based interventions are urgently required to support the specific needs of patients deciding whether to participate in cancer trials.
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Affiliation(s)
- Bianca Viljoen
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Suzanne K Chambers
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Jeff Dunn
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Nicholas Ralph
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia.,Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group, Sydney, NSW, Australia
| | - Sonja March
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield, Brisbane, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield, Brisbane, Australia
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Jabbour J, Dhillon HM, Shepherd HL, Sundaresan P, Milross C, Clark JR. The relationship between role preferences in decision-making and level of psychological distress in patients with head and neck cancer. PATIENT EDUCATION AND COUNSELING 2018; 101:1736-1740. [PMID: 29866431 DOI: 10.1016/j.pec.2018.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/20/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Is there a relationship between decision-making preferences and psychological distress? METHODS Patients who had received treatment for head and neck cancer (HNC) at four institutions within NSW, Australia were invited to complete a single questionnaire. RESULTS Five hundred and ninety-seven patients completed the questionnaire. The majority of patients (308, 54%) preferred shared decision making. Significant predictors of a preference towards active decision making were education level (OR 2.1 for tertiary, p < 0.001), primary cancer site (OR 1.9 for thyroid compared to salivary gland, p = 0.024) and gender (OR 1.4 for female, p = 0.028). Mean psychological distress score on Kessler 6 (K6) was 9 (Range: 0-28). Significant predictors of psychological distress were age (p < 0.001), gender (p < 0.001), primary site (p < 0.01), and decision preference (p < 0.01). CONCLUSION HNC patients who are either tertiary educated or female are more likely to prefer active involvement in decision-making. Psychological distress is more likely in patients actively involved in decision making, younger patients, and in females. PRACTICE IMPLICATIONS Patients experienced paternalistic decision-making, but most preferred active or a shared approached. Clinicians need to be aware of potential for psychological distress in active decision-makers and refer patients for psychosocial support.
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Affiliation(s)
- Joe Jabbour
- St Vincent's Hospital, Sydney, NSW, Australia; Central Clinical School, University of Sydney, NSW, Australia.
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia; Centre for Medical Psychology & Evidence-Based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Heather L Shepherd
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia; Centre for Medical Psychology & Evidence-Based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Puma Sundaresan
- Central Clinical School, University of Sydney, NSW, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Chris Milross
- Central Clinical School, University of Sydney, NSW, Australia; Department of Radiation Oncology and Medical Services, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jonathan R Clark
- Central Clinical School, University of Sydney, NSW, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; South West Clinical School, University of New South Wales, NSW, Australia
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Robinson JD, Venetis M, Street RL, Kearney T. Breast cancer patients' information seeking during surgical consultations: A qualitative, videotape-based analysis of patients' questions. J Surg Oncol 2016; 114:922-929. [PMID: 27734517 DOI: 10.1002/jso.24470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/19/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite data on breast cancer patients' information needs and their association with patient outcomes, there are currently no data on what U.S. patients actually ask surgeons during primary consultations. METHODS Working from transcripts of videotaped, treatment decision making consultations between breast cancer patients and surgeons, we identify all questions (by patients and companions) and then use grounded theory techniques to determine the most recurrent question-asking themes. RESULTS Sample includes 132 recently diagnosed (M = 8.9 days), late-middle-aged (M = 61.2 years), female patients with predominantly early stage (0-1; 78%), first-time breast cancer (92.4%) consulting with one of nine surgeons in community based offices. Transcripts contained 2,781 questions (1,929 by patients, 852 by companions; Cohen's Kappa = 0.90), which generated 15 patient question asking themes that were represented (i.e., asked about) at least once in >20% of all consultations. CONCLUSION Question asking themes are a concrete index of what patients want to know more about prior to treatment. Identified themes specify, modify, and extend prior findings based on self-report data. Findings potentially increase surgeons' levels of patient centered care by improving surgeons' abilities to satisfactorily address patients' information needs, which has the potential to improve both patient outcomes and clinical practice guidelines. J. Surg. Oncol. 2016;114:922-929. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jeffrey D Robinson
- Department of Communication, Portland State University, Portland, Oregon.,Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Maria Venetis
- Purdue University, Brian Lamb School of Communication, West Lafayette, Indiana
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, Texas.,Department of Medicine, Baylor College of Medicine, College Station, Texas
| | - Thomas Kearney
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
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Turkman YE, Kennedy HP, Harris LN, Knobf MT. "An addendum to breast cancer": the triple negative experience. Support Care Cancer 2016; 24:3715-21. [PMID: 27037812 DOI: 10.1007/s00520-016-3184-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/21/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The triple negative breast cancer (TNBC) subtype, known to be aggressive with high recurrence and mortality rates, disproportionately affects African-Americans, young women, and BRCA1 carriers. TNBC does not respond to hormonal or biologic agents, limiting treatment options. The unique characteristics of the disease and the populations disproportionately affected indicate a need to examine the responses of this group. No known studies describe the psychosocial experiences of women with TNBC. The purpose of this study is to begin to fill that gap and to explore participants' psychosocial needs. METHOD An interpretive descriptive qualitative approach was used with in-depth interviews. A purposive sample of adult women with TNBC was recruited. Dominant themes were extracted through iterative and constant comparative analysis. RESULTS Of the 22 participants, nearly half were women of color, and the majority was under the age of 60 years and within 5 years of diagnosis. The central theme was a perception of TNBC as "an addendum" to breast cancer. There were four subthemes: TNBC is Different: "Bottom line, it's not good"; Feeling Insecure: "Flying without a net"; Decision-Making and Understanding: "A steep learning curve"; and Looking Back: "Coulda, shoulda, woulda." Participants expressed a need for support in managing intense uncertainty with a TNBC diagnosis and in decision-making. CONCLUSIONS Women with all subtypes of breast cancer have typically been studied together. This is the first study on the psychosocial needs specifically of women with TNBC. The findings suggest that women with TNBC may have unique experiences and unmet psychosocial needs.
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Affiliation(s)
- Yasemin E Turkman
- University of Virginia School of Nursing, 202 Lancaster Way, Charlottesville, VA, 22903, USA.
| | | | - Lyndsay N Harris
- Division of Hematology/Oncology, Department of Medicine, Case Western University Medical School, Cleveland, OH, 44106, USA
| | - M Tish Knobf
- Yale School of Nursing in West Haven, West Haven, CT, USA
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Becerra Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and Predictors of Decision Regret about Health Care Decisions: A Systematic Review. Med Decis Making 2016; 36:777-90. [PMID: 26975351 DOI: 10.1177/0272989x16636113] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/06/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND People often face difficult decisions about their health and may later regret the choice that they made. However, little is known about the extent of decision regret in health care or its predictors. We systematically reviewed evidence about the extent of decision regret and its risk factors among individuals making health decisions. METHODS The data sources were Medline, Embase, and reverse citation searches in Google Scholar and Web of Science. Studies using the Decision Regret Scale (DRS) to measure decision regret among individuals making nonhypothetical health decisions were included. There were no restrictions on study design, setting, or language. We extracted characteristics of included studies, measures of central tendency for DRS scores (0 = no regret, 100 = high regret), and all risk factors from published analyses. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. A narrative synthesis was performed owing to the heterogeneity of studies. RESULTS The initial search yielded 372 unique titles, and 59 studies were included. The overall mean DRS score across studies was 16.5, and the median of the mean scores was 14.3 (standard deviation range = 2.2-34.5) (n = 44 studies). The risk factors most frequently reported to be associated with decision regret in multivariate analyses included higher decisional conflict, lower satisfaction with the decision, adverse physical health outcomes, and greater anxiety levels. CONCLUSIONS The extent of decision regret as assessed with the DRS in nonhypothetical health decisions was often low but reached high levels for some decisions. Several risk factors related to the decision-making process significantly predicted decision regret. Additional research into the psychometrics of the DRS and the relevance of scores for clinicians and patients would increase the validity of decision regret as a patient-reported outcome.
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Affiliation(s)
| | - Matthew Menear
- CHU de Québec Research Centre, Quebec City, Canada (MMBP, MM, FL),Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada (MM, FL)
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada (JB),School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada (JB)
| | - France Légaré
- CHU de Québec Research Centre, Quebec City, Canada (MMBP, MM, FL),Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada (MM, FL)
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Rattani NS, Swift-Scanlan T. Deconstructing breast cancer heterogeneity: clinical implications for women with Basal-like tumors. Oncol Nurs Forum 2015; 41:639-46. [PMID: 25355019 DOI: 10.1188/14.onf.639-646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To compare and contrast the molecular and environmental factors contributing to basal-like breast cancer and highlight the clinical implications for women with this phenotype. DATA SOURCES CINAHL® and PubMed databases, journals, and citation indices were searched using the key word basal-like in combination with breast cancer, epigenetic, treatment, subtype, risk factor, and BRCA1 to synthesize the literature on the multiple underpinnings of basal-like breast cancer. DATA SYNTHESIS Research findings related to the molecular foundation of basal-like breast cancer were integrated with knowledge of nongenetic contributing risk factors. Approved therapies and those under development were summarized with the goal of improving understanding for research and practice. CONCLUSIONS Of the five subtypes of breast cancer, the basal-like subtype has the shortest survival and poorest prognosis. The development of gene expression assays with epigenetic studies has enabled reliable identification of the basal-like subtype and has shed light on novel therapeutic possibilities. Clinical trials for basal-like breast cancer are underway, and the potential for individualized treatments for women with this subtype show promise. IMPLICATIONS FOR NURSING The main difficulties with basal-like breast cancer are its aggressive course, treatment refractory nature, and complex biology, all of which pose real challenges for clinical management and patient education. Oncology nurses play a pivotal role in providing holistic care and patient support. Therefore, nurses must understand the complexity of the clinical presentation and the underlying biology of this cancer subtype.
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Shea-Budgell MA, Kostaras X, Myhill KP, Hagen NA. Information needs and sources of information for patients during cancer follow-up. ACTA ACUST UNITED AC 2014; 21:165-73. [PMID: 25089098 DOI: 10.3747/co.21.1932] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Now more than ever, cancer patients want health information. Little has been published to characterize the information needs and preferred sources of that information for patients who have completed cancer treatment. METHODS We used a nationally validated instrument to prospectively survey patients attending a cancer clinic for a post-treatment follow-up visit. All patients who came to the designated clinics between December 2011 and June 2012 were approached (N = 648), and information was collected only from those who agreed to proceed. RESULTS The 411 patients who completed the instrument included individuals with a wide range of primary malignancies. Their doctor or health professional was overwhelmingly the most trusted source of cancer information, followed by the Internet, family, and friends. The least trusted sources of information included radio, newspaper, and television. Patients most preferred to receive personalized written information from their health care provider. CONCLUSIONS Cancer survivors are keenly interested in receiving information about cancer, despite having undergone or finished active therapy. The data indicate that, for patients, their health care provider is the most trusted source of cancer information. Cancer providers should ask patients about the information they want and should direct them to trusted sources.
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Affiliation(s)
- M A Shea-Budgell
- Guideline Utilization Resource Unit, Cancer-Control Alberta, Calgary, AB
| | - X Kostaras
- Guideline Utilization Resource Unit, Cancer-Control Alberta, Calgary, AB
| | - K P Myhill
- Guideline Utilization Resource Unit, Cancer-Control Alberta, Calgary, AB
| | - N A Hagen
- Department of Oncology, Faculty of Medicine, University of Calgary, and Tom Baker Cancer Centre, Calgary, AB
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Education and psychological support meet the supportive care needs of Taiwanese women three months after surgery for newly diagnosed breast cancer: A non-randomised quasi-experimental study. Int J Nurs Stud 2014; 51:390-9. [DOI: 10.1016/j.ijnurstu.2013.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/13/2013] [Accepted: 07/16/2013] [Indexed: 11/18/2022]
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Taioli E, Joseph GR, Robertson L, Eckstein S, Ragin C. Knowledge and prevention practices before breast cancer diagnosis in a cross-sectional study among survivors: impact on patients' involvement in the decision making process. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:44-49. [PMID: 24022520 PMCID: PMC3952028 DOI: 10.1007/s13187-013-0540-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Disparities exist in breast cancer knowledge and education, which tend to influence symptom interpretation and decision to seek screening/care. The present project describes a cohort of women's experiences, knowledge, and health behavior prior to and after a diagnosis of breast cancer. It also studies how knowledge and demographic factors are associated with level of involvement participants had in the treatment of their breast cancer. Women >18 years who have been diagnosed and treated for breast cancer within 10 years were recruited in Pittsburgh, PA, through the Healthy People Cohort Registry, a database of volunteers from the community, and Brooklyn, NY, through the American Cancer Society breast cancer survivor database. Subsequent to institutional ethics approval, a questionnaire was administered by mail and through an electronic interactive format. The study included 124 breast cancer survivors, one-quarter of whom were of African ancestry. Roughly half of the women indicated that their overall knowledge of breast cancer was limited before diagnosis; no significant association between overall knowledge before diagnosis and stage at diagnosis or an active role of the patient in treatment choices was observed. Two-third of the women reported using personal research on internet, books, and other media to increase knowledge on breast cancer after diagnosis; the improvement of knowledge was associated with an active role in therapy choice. White women's self report of breast cancer knowledge prior to diagnosis was higher than that of women of African origin (p = 0.03); the latter experienced more delays in getting results about the diagnosis (p = 0.002), in starting treatment (p = 0.03), and in having treatment available at local facilities (p = 0.007) than white women. White women were more likely to improve their knowledge through their own research (p = 0.08) and through the contribution of their physician (p = 0.06) than women of African origin.There is still a need for addressing breast cancer knowledge among black women, and improvement in physician emotional support and in their contribution to the patient's knowledge is necessary. These efforts may have a positive impact on breast cancer knowledge among black women in the US.
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Affiliation(s)
| | - Gail R. Joseph
- University of Pittsburgh School of Medicine, Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Linda Robertson
- University of Pittsburgh School of Medicine, Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Stacy Eckstein
- Human Engineering Research Laboratories, University of Pittsburgh School of Health and Rehabilitation Science, Pittsburgh, PA
| | - Camille Ragin
- Fox Chase Cancer Center - Temple University Health, Cancer Prevention and Control Program, Philadelphia, PA
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