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

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.

The patient's perspective: a qualitative study of acute myeloid leukaemia patients' need for information and their information-seeking behaviour

In recent years there has been an increased focus on cancer patients' information needs. The majority of the studies have led to the conclusion that most patients want as much information as possible about their disease and treatment. These studies have been large survey studies, and most of the patients enrolled in them have been out-patients. Very little is known about the information needs of severely ill cancer patients being treated as in-patients-such as those with acute myeloid leukaemia (AML). As part of a larger study dealing with AML patients' illness narratives, this work describes the information needs from the patients' perspective and their information-seeking behaviour. In-depth ethnographic interviews were conducted with each of 21 patients on two occasions: at the time of diagnosis and again 2-5 months later. Most patients did not recall much information from the time of diagnosis, except the diagnosis itself and the feelings it had aroused in them. All patients had basic medical knowledge about their disease. However, many patients-especially the elderly-expressed no need to receive further medical details about their disease. Avoiding information, in particular about the prognosis, was explained as a strategy to maintain hope. Most patients attached more importance to information about problems affecting their everyday life and how other persons had coped with their illness. They did not seek medical information on their own, although especially younger patients expressed the feeling that they "ought" to do this. There was a discrepancy between their expressed attitudes regarding the need for medical information in general and their actual information-seeking behaviour. Being informed and seeking information are discussed as society's expectations of today's cancer patient.

Patient education for women being fitted for breast prostheses

Women who undergo mastectomy or other types of breast surgery often will be fitted for breast prostheses for therapeutic weight replacement as well as cosmetic purposes. Nurses are instrumental in educating women about issues related to breast surgery and in helping to promote psychosocial adjustment to the diagnosis and subsequent treatment. Nurses often are involved in the referral process for breast prostheses. Prostheses and bras that fit properly can be very important in the recovery process and ultimately improve quality of life for cancer survivors. Unlike in the past, many choices are available today for women who opt to use breast prostheses. Prostheses come in different colors, shapes, and weights, and some adhere to the chest wall. Many options also are available for bras, camisoles, and swimsuits, which are helpful adjuncts to the fit of the prosthesis. The purpose of this article is to describe the fitting process and options currently available for breast prostheses. Nurses can use this information to inform women of available breast prostheses options and help prepare them for a fitting.

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.

Significant others' experience of suffering when living with women with breast cancer

This is an inquiry into how significant others experience being close to a woman suffering from breast cancer. In order to find this out, theme interviews were arranged with 17 women and 16 significant others from four different caring cultures in Sweden and Finland. A phenomenological case study methodology was adopted and in the analysis of the data a scientific teamwork model was employed, based on ideas developed at the Vancouver School of Doing Phenomenology. The findings show that the significant others experience deep often unrelieved suffering. They consider themselves prisoners of a situation of uncertainty and powerlessness when standing by the woman. They are torn between their own suffering and their desire to alleviate the woman's suffering. A vicious circle of mutual protection intensifies the suffering of the significant other, while actively sharing the suffering brings relief. The gravity of the situation creates an ethical urge in the significant other to assume responsibility for life in common with the woman.

Cancer patients' sources of information: use and quality issues

Appropriate information, offered at the right time, has been recognised as a key factor in enabling patients to cope with a diagnosis of cancer. This paper describes the sources of information that are currently being utilised by patients and the perceived quality of these sources. A sample of 430 patients were asked to indicate on a series of Likert scales their views of 19 commonly available sources of information. The most frequently cited sources of information were the hospital consultant, General Practitioner, chemotherapy/radiotherapy staff, ward staff and family/friends. It is of interest that the internet was only used by under 10% of patients. The source that scored the highest in terms of quality of information was the specialist/Macmillan nurses. GPs and written material scored poorly in terms of quality of information. The relationship between information and sources, gender, age and diagnosis was also examined. Age was found to have the greatest influence on the perceived quality of information and the frequency of its use. The paper concludes that there is a need for improvement in the provision of information by the primary health care team. The issue of the quality of written information available for patients requires further investigation to identify the type of written material used. Furthermore, family/friends should be recognised as important sources of information to many patients. Finally, there is a need for more specialist nurses, as they are clearly the preferred source of information for the majority of cancer patients.

Exercise counseling and programming preferences of cancer survivors

PURPOSE

Exercise has emerged as an important quality-of-life intervention for cancer survivors, but exercise motivation is a challenge. The purpose of this study was to provide a comprehensive assessment of the exercise preferences of cancer survivors.

DESCRIPTION OF STUDY

A mailed, self-administered survey was completed by 307 survivors of prostate, breast, colorectal, or lung cancer. The survey contained questions on demographic and medical variables, past exercise, and various exercise counseling and programming preferences.

RESULTS

For exercise counseling, 84% of participants said they preferred or maybe preferred to receive exercise counseling at some point during their cancer experience. Moreover, 85% preferred to receive exercise counseling face to face, and 77% preferred to receive it from an exercise specialist affiliated with a cancer center. For exercise programming, 98% preferred recreational exercises, 8!% preferred walking, 57% preferred unsupervised exercise (57%), and 56% preferred moderate-intensity exercise. In addition, 48% preferred to exercise in the morning, 44% preferred to exercise alone, 40% preferred to exercise at home, and 32% preferred to start their exercise program before treatment. Chi-square analyses revealed that a small number of exercise preferences were moderated by demographic, medical, and exercise variables.

CLINICAL IMPLICATIONS

The results of this study indicate that cancer survivors have unique and varied exercise counseling and programming preferences. Fifty-six percent of cancer survivors preferred to exercise at moderate intensity rather than at high intensity. Moderate-intensity exercise has been shown previously to be relatively safe even for cancer survivors who are advanced in age. The key to success for inactive cancer survivors may be to provide reassurance that exercise is a safe and beneficial modality for cancer survivors and to prescribe an exercise program that builds their confidence by slowly increasing the level of exercise intensity.

Information needs and awareness of diagnosis in patients with cancer receiving chemotherapy: a report from Greece

This study assessed the information needs of Greek cancer patients and examined whether awareness of diagnosis had any impact on patients. One hundred patients were interviewed about overall and specific information needs, satisfaction, emotional distress, and quality of life. Patients exhibited a great desire for information overall. The need to have more information was high especially regarding the aftermath of chemotherapy, prognosis, how chemotherapy worked, and diagnosis. Patients were more satisfied with care but less satisfied with the information received. Only 37% knew they had cancer, especially the younger, the better educated, and those with breast cancer. Awareness was not related to satisfaction, emotional distress, or quality of life. Our findings suggest that Greek cancer patients need more factual information about their condition and management. Greek oncologists may feel freer to inform their patients about the diagnosis and other issues following their judgement, rather than employing the policy of concealing the truth.

Information needs and the related characteristics of Japanese family caregivers of newly diagnosed patients with cancer

In Japan, family caregivers of newly diagnosed patients with cancer usually receive information on the patient from healthcare professionals before patients are told the truth. Efforts to provide suitable information to these caregivers may be crucial to improving the quality of life in patients as well as in family caregivers. A descriptive correlational study explored and assessed the informational needs of family caregivers of newly diagnosed patients with cancer. Data were obtained by a semistructured interview with a questionnaire administered to 66 caregivers. Information needs were assessed on disease, treatment, prognosis, and patient and family care. In addition, the demographic and situational characteristics related to individual information needs were investigated by logistic regression analyses. More than 70% of caregivers wanted the disease-related information and about one third of those wanted the care-related information for the patient and family. The disease-related information needs had significant correlations only with the demographic variables. The care-related information needs were correlated both with the demographic variables and with the situational variables such as the presence of pain in the patient and the presence of other family caregivers. Our results may help healthcare professionals to plan the appropriate provision of information to newly diagnosed patients with cancer and their family caregivers.

Barriers to information access, perceived health competence, and psychosocial health outcomes: test of a mediation model in a breast cancer sample

This study examined the relationship between breast cancer patients' experience of barriers to accessing health information and their psychosocial health outcomes and explored the extent to which this relationship was mediated by patient perceptions of competence in dealing with health-related issues. Study sample consisted of 225 women surveyed within 6 months of diagnosis. Regression analyses suggested that patients who reported greater difficulty in accessing needed information experienced lower emotional (P=0.05), functional (P<0.05), and social/family (P<0.05) well-being as well as lower perceptions of health competence (P<0.001). Also, patient perceptions of health competence mediated the relationship between barriers to accessing information and patient outcomes (emotional well-being, P<0.05; functional well-being. P<0.01; social/family well-being, P=0.01). Breast cancer patients often report dissatisfaction with the extent to which their information needs are addressed by their health care providers. Our findings underscore the need for designing and implementing interventions that would aid providers in better meeting the information needs of their patients.

Measurement of outpatients' views of service quality in a Finnish university hospital

AIMS OF THE STUDY

To describe the development of service quality in the surgical and medical outpatient departments of a university hospital.

RATIONALE

Measurement and documentation of service quality and the use of these data as a basis for improvement are prerequisites for service improvement.

METHODS

A survey conducted over a 3-week period using a 12-item questionnaire measuring service quality on a rating scale from 4 to 10 (extremely poor - excellent quality). Nineteen outpatient departments participated at a Finnish university hospital, 7679 voluntary patients visiting the outpatient departments between 1997 and 1999 completed the questionnaires.

RESULTS

The questionnaire, which has not been described in use previously, proved to be a good tool enabling systematic access to patient feedback on service quality in outpatient departments. The instrument allowed the detection of strengths of the service provided by a large organization and long-term trends from patients' perspective. Patient evaluations were mainly good and the results improved year by year, although the instrument was built on questions concerning issues that were rated poorest by patients. The poorest ratings were related to access to information and adherence to appointment times.

CONCLUSIONS

The service quality instrument offers a means to generate information to be used for service quality improvement in outpatient departments.

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.

Evaluating the self-assessed support needs of women with breast cancer

AIMS OF THE STUDY

The first aim of the study was to identify the self-assessed support needs of women with breast cancer at various points of illness and, secondly, to establish if these needs formed clusters which could provide the basis for developing a standardized scale of needs for use by breast care teams in the evaluation of care.

BACKGROUND

It has been found that support given to women with breast cancer has a positive effect upon their reactions to the illness and may even prolong their survival. Given that breast cancer affects a large number of women it is obviously important that those affected receive, in addition to the best available medical treatment, the type of support that best meets their needs. This study aimed to provide information on the impact of breast cancer and the need for various types of support by examining women's own assessment of their needs at different stages of their illness.

DESIGN AND METHODS

A purposive sample of 12 women with a diagnosis of breast cancer was selected in one health authority in England, United Kingdom (UK). Women selected represented a wide age range (between 26 and 58), were married or in long-term cohabiting relationships and were at different points on the illness trajectory. Women were invited to take part in a semi-structured interview about their experiences of breast cancer. The data from these interviews were analysed using the software package Qualitative Solutions and Research, Nonnumerical Data Indexing, Searching and Theorizing (QSR*NUDIST). Following this content analysis, a questionnaire was formulated which divided statements into seven categories: diagnosis, treatment, support, femininity and body image, family and friends, information and after care, to be rated on a Likert scale ranging from "of no importance" to "extremely important". Questionnaire data were analysed by means of a one-way analysis of variance (for three independent variables) or t-test for two independent variables. Results. The questionnaire was sent to 971 women and achieved a response rate of 50.4%. The mean score for statements of need reached the level of point 4 on the Likert scale (important) with three exceptions: having professional help with family problems and domestic upheaval, coping with feelings of anger and dealing with the question "why me?"

CONCLUSION

With the above three exceptions, women experienced a high level of need associated with a diagnosis of breast cancer. Studies of this kind should enable resources to be targeted to areas of highest need.

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.

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.