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Maheu C, Lebel S, Bernstein LJ, Courbasson C, Singh M, Ferguson SE, Harris C, Jolicoeur L, Baku L, Muraca L, Ramanakumar AV, Lamonde F, Lefebvre M, Tomei C, Mutsaers B, Secord S, Power J, Drummond N, Hébert M, Wani RJ. Fear of cancer recurrence therapy (FORT): A randomized controlled trial. Health Psychol 2023; 42:182-194. [PMID: 36862474 DOI: 10.1037/hea0001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Most fear of cancer recurrence (FCR) interventions have small effects, and few target FCR. This randomized controlled trial (RCT) with breast and gynecological cancer survivors evaluated the efficacy of a cognitive-existential fear of recurrence therapy (FORT) compared to an attention placebo control group (living well with cancer [LWWC]) on FCR. METHOD One hundred and sixty-four women with clinical levels of FCR and cancer distress were randomly assigned to 6-weekly, 120 min FORT (n = 80) or LWWC (n = 84) group sessions. They completed questionnaires at baseline (T1), posttreatment (T2; primary endpoint), 3 (T3), and 6 months (T4) posttreatment. Generalized linear models were used to compare group differences in the fear of cancer recurrence inventory (FCRI) total score and secondary outcomes. RESULTS FORT participants experienced greater reductions from T1 to T2 on FCRI total with a between-group difference of -9.48 points (p = .0393), resulting in a medium effect of -0.530, with a maintained effect at T3 (p = .0330) but not at T4. For the secondary outcomes, improvements were in favor of FORT, including FCRI triggers (p = .0208), FCRI coping (p = .0351), cognitive avoidance (p = .0155), need for reassurance from physicians (p = .0117), and quality of life (mental health; p = .0147). CONCLUSIONS This RCT demonstrated that FORT, compared to an attention placebo control group, resulted in a greater reduction in FCR posttreatment and at 3 months posttreatment in women with breast and gynecological cancer, indicating its potential as a new treatment strategy. We recommend a booster session to sustain gains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Lori J Bernstein
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, University Health Network
| | | | | | - Sarah E Ferguson
- Obstetrics and Gynecology, Princess Margaret Cancer Centre, University Health Network
| | | | | | | | - Linda Muraca
- Auxiliary Breast Health Program, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital
| | | | - Frederic Lamonde
- Division of Cancer Epidemiology, McGill University Health Center
| | | | | | | | - Scott Secord
- Ontario Association of Social Worker and Social Service Work and Second Consulting Services Toronto
| | - Joanne Power
- Department of Nursing, McGill University Health Centre
| | | | - Maude Hébert
- Nursing Department, Université du Québec à Trois-Rivières
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Lewis T, Care R, Kuta V, Secord S, Trites J, Corsten M, Rigby M, Taylor SM. The pericranial flap for inner lining of full-thickness nasal defects: a retrospective cohort study. J Laryngol Otol 2022; 137:532-536. [PMID: 35382912 DOI: 10.1017/s0022215122000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Effective nasal reconstruction requires skin and soft tissue cover, cartilage or bone structure, and mucosal lining. Ideal lining is thin, pliable and vascularised, making reconstruction challenging. This paper presents the first case series with long-term outcomes of pericranial flaps used as inner lining for nasal reconstruction. METHODS Patients undergoing paramedial forehead flaps from 2007 to 2019 were identified using second-stage nasal reconstruction billing codes. Patients with pericranial flaps for lining, for whom there were data on resulting outcomes and complications, were identified. RESULTS Sixty-six patients underwent second-stage nasal reconstruction. Eighteen patients had paramedian forehead and pericranial flaps for inner lining reconstruction. The flap lining had no immediate post-operative complications. Three patients suffered partial to major reconstructive failure post radiotherapy. Other complications included nasal stenosis and orocutaneous fistula. CONCLUSION Combined with paramedian forehead flaps, the pericranial flap is reliable as inner lining for nasal reconstruction. It is easily accessible and useful in resections with limited mucosal options.
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Affiliation(s)
- T Lewis
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - R Care
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - V Kuta
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - S Secord
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - J Trites
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - M Corsten
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - M Rigby
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - S M Taylor
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Canada
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Esplen MJ, Hunter J, Maheu C, Rosberger Z, Wong J, McGillicuddy P, Secord S, Blacker S, Green E, Toner B, Li J, Dobson K. de Souza interprofessional practice cancer competency framework. Support Care Cancer 2019; 28:797-808. [PMID: 31152301 DOI: 10.1007/s00520-019-04823-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/17/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE As the demand in cancer care continues to increase, health systems require a workforce of highly educated specialists and generalists to provide continuity of care across settings. OBJECTIVES Led by de Souza Institute in Canada, an interdisciplinary working group was formed to develop a competency framework with relevance across regulated health professionals involved in cancer care. METHODS The working group was presented with results from a scoping review of national and international guidelines, standards, and competencies in oncology, as well as data from needs assessments on continuing education opportunities and oncology topics most relevant to clinicians. Fifty-one professionals from, e.g., family medicine, pharmacy, social work, psychology, occupational therapy, and nursing participated in seven focus groups. An additional 32 nurses participated in a nursing-specific needs assessment survey. Using modified Delphi technique, working group members conducted three iterative rounds to review data and built consensus on competency items in relation to three levels of expertise, from early learner/novice practitioner, advancing practitioner, to expert practitioner. RESULTS A final consensus was reached for the selection of competencies that reflect optimal cancer care mapped into three levels of expertise, as well as knowledge, skills, and attitudes expected of each level. Examples for the competency for early learner/novice practitioner include the following: Have awareness of common ethical issues in cancer care (knowledge); demonstrate ability to discuss, educate, and counsel patients and their support persons(s) regarding preferences (skills); and appreciate the impact of culture, the sensitivity, and diversity of attitudes in relation to cancer (attitude). Expert practitioner examples include: recognition of need for, and ability to advocate for challenges involving equity and access in order to improve health outcomes (skill) and awareness of workplace complexities, such as provider roles, team functioning, and organizational environments affecting patient-practitioner relationships (attitude). CONCLUSION The de Souza Interprofessional practice cancer competency framework provides a set of shared competencies and a novice to expert pathway for clinicians across disciplines and supports a more standardized learning and comprehensive approach in organizing professional development towards a coordinated, high quality, and person-centered care.
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Affiliation(s)
- Mary Jane Esplen
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Princess Margaret Cancer Centre, Toronto, Canada. .,de Souza Institute, University Health Network, Toronto, Canada.
| | - Jonathan Hunter
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Sinai Health System, Toronto, Canada
| | - Christine Maheu
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Montréal, Canada.,Departments of Psychology, Oncology & Psychiatry, McGill University, Montréal, Canada
| | - Jiahui Wong
- Department of Psychiatry, Faculty of Medicine, University of Toronto, de Souza Institute, University Health Network, Toronto, Canada
| | - Patti McGillicuddy
- School of Social Work, University of Toronto, Centre for IPE, Toronto, Canada
| | - Scott Secord
- Community Addiction and Mental Health Services of Haldimand and Norfolk (CAMHS), Toronto, Ontario, Canada
| | - Susan Blacker
- Cancer and Palliative Program Planning and Performance, Sinai Health System, Toronto, Canada
| | - Esther Green
- Nursing and Psychosocial Oncology Cancer Care Ontario, Toronto, Canada
| | - Brenda Toner
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jane Li
- de Souza Institute, University Health Network, Toronto, Canada
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Lebel S, Maheu C, Lefebvre M, Secord S, Courbasson C, Singh M, Jolicoeur L, Benea A, Harris C, Fung MFK, Rosberger Z, Catton P. Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv 2014; 8:485-96. [PMID: 24756313 DOI: 10.1007/s11764-014-0357-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 03/20/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Evidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors. PURPOSE To develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer. METHODS This study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions. RESULTS A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up. CONCLUSION This brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life, and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy. IMPLICATIONS FOR CANCER SURVIVORS FCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important implications for all cancer survivors as it is the first published intervention that provides preliminary evidence of its efficacy in decreasing fear of cancer recurrence.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier, room 4016, Ottawa, Ontario, Canada, K1N6N5,
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Santos Zanchetta M, Maheu C, Galhego-Garcia W, Baku L, Guruge S, Secord S. Explorando Potencialidades para a Criação de Rede de Apoio Social a Mulheres Lusófonas com Câncer de Mama e que Vivem em Toronto, Canadá. Rev Brasileira De Cancerologia 2013. [DOI: 10.32635/2176-9745.rbc.2013v59n3.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introdução: Indicadores gerais de saúde tendem a alterarem-se devido à participação de indivíduos em redes sociais. Objetivo: Conhecer as ideias dos membros de comunidades lusófonas em Toronto, Canadá, sobre a possibilidade da criação de uma rede de apoio social a mulheres com câncer de mama. Método: Estudo etnográfico critico com 19 participantes que opinaram sobre a construção de uma rede de apoio social, pontos positivos e negativos, bem como pessoas a serem convidadas a ajudar. As discussões foram transcritas, analisadas e codificadas com o auxílio do programa de análise qualitativa Atlas ti 6.0. Resultados: Os componentes fundamentais para a construção da rede de apoio social foram a desmistificação do câncer de mama e de sua prevenção, ênfase na educação em saúde, divulgação da necessidade de voluntários e apoio social direto às mulheres com câncer. Os pontos positivos seriam a participação de mulheres mais idosas como líderes, uso do ambiente escolar e das instituições religiosas para a divulgação. Os empecilhos encontrados foram o câncer de mama ser uma doença vivida pelas mulheres, o desconhecimento relativo à cura e à falta de sensibilização. Em relação à participação de lideranças comunitárias, houve sugestão de diplomatas, padres e pastores, diretores de escolas e empresários da área da comunicação. Conclusão: A criação da rede de apoio social deve considerar a sensibilidade cultural e a diversidade interna das comunidades lusófonas. A recomendação é de que líderes sociais e profissionais angolanos sejam convidados para delinear a estrutura da rede de apoio conforme seus traços culturais específicos.
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Lam A, Secord S, Butler K, Hofer SO, Liu E, Metcalfe KA, Zhong T. A breast reconstruction needs assessment: How does self-efficacy affect information access and preferences? Can J Plast Surg 2013; 20:37-42. [PMID: 23598765 DOI: 10.1177/229255031202000101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Breast cancer patients requiring mastectomy do not consistently receive information about post-mastectomy breast reconstruction (PMBR) surgery from the treatment team. Patients have varying levels of self-efficacy, defined as one's confidence in their ability to gather information and make health-related decisions. The present preliminary study was designed to evaluate the relationship between self-efficacy and access to PMBR information. METHODS A qualitative interview study was conducted on a convenience sample of 10 breast cancer patients considering or having already undergone PMBR and six key health care provider informants. The modified six-item Stanford Self-Efficacy Scale for managing chronic disease was administered. RESULTS Patient self-efficacy scores ranged from 5 to 9.3 (out of 10). Two main access to information themes were identified from the patient qualitative data: theme A - difficulty initiating the PMBR discussion; and theme B - perceived lack of access to PMBR information with the sub-themes of timing, modality, quantity and content of resources. All respondents expressed their concern over the absence of a standardized process for initiating the dialogue of PMBR. Patients also reported that credible and easily accessible information was not routinely available and expressed a desire to hear about their PMBR options early in the decision-making process. CONCLUSIONS Health care providers may need to assume more responsibility in standardizing information dissemination on PMBR. This information should be distributed early in the consultation process, the content should be complete, and there may be a role for individualizing the delivery of information based on a patient's level of self-efficacy.
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Affiliation(s)
- Andrea Lam
- Faculty of Medicine, University of Toronto
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7
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Jones JM, Lewis FM, Griffith K, Cheng T, Secord S, Walton T, Bernstein LJ, Maheu C, Catton P. Helping Her Heal-Group: a pilot study to evaluate a group delivered educational intervention for male spouses of women with breast cancer. Psychooncology 2013; 22:2102-9. [PMID: 23505095 DOI: 10.1002/pon.3263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/21/2013] [Accepted: 01/25/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Distress in husbands of women with early-stage breast cancer may be equivalent to or even higher than their wives. Husbands often struggle to help and support their wives cope with the illness and its treatment. In response, we developed a five-session group educational counselling intervention (Helping Her Heal-Group (HHH-G)) for husbands of women with early-stage breast cancer. The primary aim of the current pilot study was to determine the acceptability and feasibility of HHH-G and to obtain a preliminary estimate of its impact on participating men's skills, self-confidence and self care. Secondary aims were to assess the impact of the intervention on both the participating spouses' and wives' ratings of marital quality and depressed mood. METHODS The study employed a one-arm, pre-post-intervention design whereby participating men (n=54) and their wives (n=54) independently completed measures at baseline (T0), immediately following the last session (T1) and 3 months after the last session (T2). RESULTS Overall, there was very high study retention (87%). On the basis of the questionnaire data, we found significant improvements in spouses' self-efficacy (p<0.001) and self-reported skills including wife support (p=0.003) and self-care (p<0.001). In addition, there was a significant improvement in wives' mood scores (p=0.003). Post-intervention interviews support acceptability and impact of the HHH-G intervention, and provide support for the group format of the program. CONCLUSIONS The feasibility and acceptability of HHH-G was supported, and treatment outcomes suggest the potential benefits of the intervention. Phase III evaluation of HHH-G program is warranted.
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Affiliation(s)
- Jennifer M Jones
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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8
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Wiljer D, Urowitz S, Jones J, Kornblum A, Secord S, Catton P. Exploring the use of the survivorship consult in providing survivorship care. Support Care Cancer 2013; 21:2117-24. [PMID: 23455454 DOI: 10.1007/s00520-013-1760-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Advances in breast cancer treatment have increased survival and contributed to longer periods of survivorship as reported by the Committee CCSsS (Canadian Cancer Statistics) (2011) and Hewitt et al. (2005), increasing the relevance of survivorship care. Survivorship care includes encouraging survivors to acquire the knowledge, skills and confidence to manage their life, as well as engaging survivors through post-diagnosis disease self-management and self-care strategies. The Survivorship Consult (SC) was designed to help survivors reflect on their needs, establish goals and create an action plan. METHODS Twenty-six breast cancer survivors who participated in the SC at Princess Margaret Cancer Centre took part in semi-structured interviews to assess the survivor experience and effectiveness of the SC. Data from these interviews were coded, and themes were identified using a modified grounded theory approach. RESULTS Themes that emerged regarding the experience and effectiveness of the SC included (1) the supportive experience of collaborative dialogue with supportive care clinicians (i.e. nurses, social workers, occupational therapists, etc.), (2) the development of personalized goals that motivated individuals to implement recommendations, (3) an enhanced understanding of their health condition, team and options, (4) an improved ability to identify needs and (5) an increased sense of confidence to manage issues related to care. CONCLUSIONS The assessment of the SC improved the experience of breast cancer patients by providing a supportive environment where they could feel cared about, by increasing understanding of their condition and its treatment, by improving communication with the care team and by motivating patients to manage care issues. Further research is needed on survivors who conduct the SC before the treatment phase of their cancer trajectory.
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Affiliation(s)
- David Wiljer
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S2S1, Canada.
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Lam A, Secord S, Butler K. A breast reconstruction needs assessment: How does self-efficacy affect information access and preferences? Plast Surg (Oakv) 2012. [DOI: 10.4172/plastic-surgery.1000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wiljer D, Urowitz S, Frasca E, Nyhof-Young J, Secord S, Walton T, Catton P. The role of a clinician-led reflective interview on improving self-efficacy in breast cancer survivors: a pilot study. J Cancer Educ 2010; 25:457-463. [PMID: 20383675 DOI: 10.1007/s13187-010-0103-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/22/2010] [Indexed: 05/29/2023]
Abstract
Breast cancer survivors experience a wide range of survivorship issues that are not always adequately addressed. This study is an assessment of the Survivorship Consult (SC), a one-to-one clinician-led reflective interview used to capture a comprehensive summary of the survivor experience, to determine its impact on self-efficacy and the perceived likelihood that it initiates behavior change. Using a pre-test/post-test design, data were collected from participants (N = 40) using validated instruments and opened-ended questions to evaluate the SC. Participants found the SC to be a useful tool for planning and goal setting and improved self-efficacy as measured by the Cancer Behavior Inventory with an increase of 2.0 (p = 0.03). The SC demonstrates promise in improving the ability and confidence of breast cancer survivors to manage their care, but further research is required to understand the optimal implementation of this intervention and its impact on the delivery of survivorship services.
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Affiliation(s)
- David Wiljer
- Knowledge Management and Innovation, Oncology Education and Radiation Medicine Program, Princess Margaret Hospital/University Health Network, Toronto, ON, Canada.
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Nyhof-Young J, Regehr M, Secord S, Jusko Friedman A, Catton P. Competency building for self-management and self-care: evidence informed development of an empowerment course for breast cancer survivors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18626 Purpose: To improve survivorship outcomes by empowering and preparing survivors to self- manage their health. We describe the evidence-informed development of a patient empowerment course “Managing Your Cancer Journey” offered in the Breast Cancer Survivorship Program at Princess Margaret Hospital in Toronto, Canada. Methods: Audio-taped and transcribed focus groups (3; n = 16 patients, August 2004), interviews (n = 8 lymphedema patients, spring 2004, n = 8 patients, spring 2005) were held for patient directed guidance in survivorship course and program development. A comprehensive literature review was conducted to develop a theoretical framework for empowerment. Three main competencies: knowing, navigating and negotiating emerged and were developed into 5 ×1.5 hour classes facilitated by two social workers in collaboration with health professionals and community organizations. Feedback from survivors in a community forum (n = 40) and during piloting with survivors (n = 10) and educators was solicited. Analysis of transcripts and observer/consultant debriefings were analyzed for emergent themes. Results: Respondents recommended program interventions that allowed people to gain mastery or a perceived sense of control over their lives with cancer. Survivors and expert consultants prioritized 3 major domains for the survivorship program: psychosocial support, information provision, and support for dealing with the physical effects of breast cancer. In response, outcome measures for empowerment will include: patient satisfaction, cancer knowledge, self-efficacy in disease management, empowerment, and depression. Conclusions: Ongoing iterative feedback from and piloting with the survivor target audience and embedding the course within the hospital’s strategic plan for patient centred care and competency building are keys to successful course implementation. No significant financial relationships to disclose.
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Affiliation(s)
- J. Nyhof-Young
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada
| | - M. Regehr
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada
| | - S. Secord
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada
| | - A. Jusko Friedman
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada
| | - P. Catton
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada
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Abstract
PURPOSE Reconstruction for incontinent myelomeningocele is assumed to improve health related quality of life (HRQOL) yet there are no published data to support this assumption. MATERIALS AND METHODS A retrospective cohort study was performed of 36 consecutive incontinent meningomyelocele cases undergoing surgery (augmentation, with or without Mitrofanoff, bladder neck reconstruction and cecostomy). Controls were matched 2:1 for age, lesion level, parental marital status, ambulatory status and shunt status. HRQOL was assessed with a previously validated disease specific discriminative instrument that stratifies for ages 12 years or less and 13 years or greater. An additional 5-point Likert questionnaire was used for self-scoring of bladder and bowel continence. RESULTS Responses were 89% and 84% for cases and controls, respectively. The 2-sample t testing for subjects 12 years old or younger revealed no significant difference in mean HRQOL score between those who underwent reconstruction (12, mean 165 +/- 23) and those who did not (9, mean 162 +/- 27, p=0.73). Results in older subjects were similar for cases (20, mean 190 +/- 23) and controls (3, mean 192 +/- 26, p=0.80). This finding occurred despite the fact that 78% of reconstructed cases achieved urinary continence for 3 hours or more with equal or superior self-reported bladder and bowel continence compared to controls. CONCLUSIONS We were unable to demonstrate superior HRQOL in patients over controls. Several possible interpretations exist, such as surgery may have no impact on HRQOL, patients might have scored much lower without surgery, or perhaps only caregiver quality of life improves. The impact of urinary tract reconstruction upon quality of life in the myelomeningocele population warrants further study.
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Affiliation(s)
- A E Macneily
- Division of Urology, University of British Columbia, Vancouver, BC, Canada.
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