1
|
Hinz A, Schulte T, Mehnert-Theuerkauf A, Richter D, Sender A, Brock H, Friedrich M, Briest S. Fear of Cancer Progression: A Comparison between the Fear of Progression Questionnaire (FoP-Q-12) and the Concerns about Recurrence Questionnaire (CARQ-4). Healthcare (Basel) 2024; 12:435. [PMID: 38391810 PMCID: PMC10888487 DOI: 10.3390/healthcare12040435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
As cancer patients often suffer from fear of cancer progression (FoP), valid screening for FoP is of high relevance. The aims of this study were to test psychometric properties of two FoP questionnaires, to determine their relationship to other anxiety-related constructs, and to analyze the impact of sociodemographic and clinical factors on the FoP. Our sample consisted of n = 1733 patients with mixed cancer diagnoses. For measuring FoP, the Fear of Progression questionnaire (FoP-Q-12) and the Concerns About Cancer Recurrence Questionnaire (CARQ-4) were used. The mean scores of the FoP-Q-12 and the CARQ-4 were 30.0 ± 10.4 and 16.1 ± 10.8, respectively, indicating relatively high levels of FoP. Both questionnaires showed excellent internal consistency coefficients, α = 0.895 and α = 0.915, respectively. The correlation between the two FoP questionnaires was r = 0.72. Female patients reported more FoP than male patients (d = 0.84 and d = 0.54, respectively). There was a nonlinear age dependency of FoP, with an increase found in the age range from 18 to 50 years and a decrease in the older age range. Radiation, chemotherapy, and antibody therapy, but not surgery, lead to an increase in FoP. Both questionnaires show good psychometric properties and can be recommended for use in an oncological routine. Female patients and patients in the middle-age range deserve special attention from healthcare providers.
Collapse
Affiliation(s)
- Andreas Hinz
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Thomas Schulte
- Rehabilitation Clinic Bad Oexen, 32549 Bad Oeynhausen, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Diana Richter
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Annekathrin Sender
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Hannah Brock
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Susanne Briest
- Department of Gynecology, Comprehensive Cancer Center Central Germany, University Medical Center Leipzig, 04103 Leipzig, Germany
| |
Collapse
|
2
|
Kastrinos A, Bylund C, Bacharz K, Applebaum A, Fisher CL. Understanding the role of parents' information sharing and withholding on emerging and young adults' caregiving and coping during their parents' advanced cancer. J Psychosoc Oncol 2023; 42:412-426. [PMID: 37929571 PMCID: PMC11070447 DOI: 10.1080/07347332.2023.2276940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Emerging and young adult caregivers (EYACs) who provide care to their parents are a hidden, unsupported population of caregivers. Research identifies information sharing or withholding as a key aspect of caregivers' ability to cope and adjust, which may be especially critical when a parent is diagnosed with advanced cancer. The goal of this study was to examine the impact of parent information sharing/withholding on EYACs' caregiving and coping experiences. We conducted in-depth, semi-structured interviews with 33 EYACs between the ages of 18-35 who cared for a parent that died of advanced cancer. Interview transcripts were thematically analyzed. Three factors played a role in how parents' information sharing/withholding affected EYACs' caregiving/coping: 1) topic, 2) timing, and 3) who is included. Findings highlight the adaptive functioning of parents' information sharing and negative outcomes associated with information withholding, illustrating how parents' disclosure decisions function to promote or inhibit EYACs' care involvement and coping.
Collapse
Affiliation(s)
- Amanda Kastrinos
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY
| | - Carma Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Kelsey Bacharz
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Allison Applebaum
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY
| | - Carla L. Fisher
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| |
Collapse
|
3
|
Tan H. The mediating role of anxiety in disease uncertainty and acute stress in acute ischaemic stroke patients in the post-epidemic era. Front Psychiatry 2023; 14:1218390. [PMID: 37915800 PMCID: PMC10616834 DOI: 10.3389/fpsyt.2023.1218390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/01/2023] [Indexed: 11/03/2023] Open
Abstract
Objective To analyse the influencing factors of anxiety, disease uncertainty and acute stress response in patients with acute ischaemic stroke, and to verify the mediating role of anxiety in the post-epidemic era. Methods 240 patients with acute ischaemic stroke were selected from a tertiary hospital in Wuhan City and investigated by questionnaire and convenience sampling methods. Results The total anxiety score, disease uncertainty and acute stress reaction were at moderate levels. Anxiety was positively correlated with illness uncertainty, and anxiety and acute stress response were negatively correlated. Multiple linear regression analysis showed that Sickness uncertainty, acute stress response, age, and work status influenced anxiety. Anxiety mediated the prediction of Sickness uncertainty and acute stress response, with the mediating effect accounting for 35.6% of the total effect. Conclusion Disease uncertainty in patients with acute ischaemic stroke in the post-epidemic era directly affects the acute stress response and indirectly through anxiety.
Collapse
Affiliation(s)
- Hui Tan
- Quzhou TCM Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University/Quzhou Hospital of Traditional Chinese Medicine, Quzhou, China
| |
Collapse
|
4
|
Broadbridge E, Greene K, Venetis MK, Lee LE, Banerjee SC, Saraiya B, Devine KA. Facilitating psychological adjustment for breast cancer patients through empathic communication and uncertainty reduction. PATIENT EDUCATION AND COUNSELING 2023; 114:107791. [PMID: 37244129 PMCID: PMC11046425 DOI: 10.1016/j.pec.2023.107791] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study examined the degree to which breast cancer patients' psychological well-being is facilitated through empathic provider communication. We explored symptom/prognostic uncertainty reduction as a mechanism through which provider communication influences patient psychological adjustment. Additionally, we tested if treatment status moderates this relationship. METHODS Informed by uncertainty in illness theory, current (n = 121) and former (n = 187) breast cancer patients completed questionnaires about perceptions of their oncologists' empathy and their symptom burden, uncertainty, and adjustment to their diagnosis. Structural equation modeling (SEM) was conducted to test hypothesized relationships between perceived provider empathic communication, uncertainty, symptom burden, and psychological adjustment. RESULTS SEM supported the following: (1) higher symptom burden was associated with increased uncertainty and reduced psychological adjustment, (2) lower uncertainty was associated with increased adjustment, and (3) increased empathic communication was associated with lower symptom burden and uncertainty for all patients (χ2(139) = 307.33, p < .001; RMSEA = .063 (CI .053, .072); CFI = .966; SRMR = .057). Treatment status moderated these relationships (Δχ2 = 264.07, Δdf = 138, p < .001) such that the strength of the relationship between uncertainty and psychological adjustment was stronger for former patients than for current patients. CONCLUSIONS Results of this study reinforce the importance of perceptions of provider empathic communication as well as the potential benefits of eliciting and addressing patient uncertainty about treatment and prognosis throughout the cancer care continuum. PRACTICE IMPLICATIONS Patient uncertainty should be a priority for cancer-care providers both throughout and post-treatment for breast cancer patients.
Collapse
Affiliation(s)
| | - Kathryn Greene
- Department of Communication, Rutgers University, New Brunswick, NJ, USA.
| | - Maria K Venetis
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Lauren E Lee
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Smita C Banerjee
- Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Katie A Devine
- Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| |
Collapse
|
5
|
Wolyniec K, Sharp J, Fisher K, Tothill RW, Bowtell D, Mileshkin L, Schofield P. Psychological distress, understanding of cancer and illness uncertainty in patients with Cancer of Unknown Primary. Psychooncology 2022; 31:1869-1876. [PMID: 35765251 PMCID: PMC9796856 DOI: 10.1002/pon.5990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Patients diagnosed with Cancer of Unknown Primary (CUP) experience high levels of psychological distress and report poor understanding of their cancer. We aimed to investigate: (1) if CUP patients with poorer understanding of their cancer diagnosis and testing experience more symptoms of psychological distress than those with better understanding; (2) if the relationship between patients' understanding of their cancer and psychological distress is mediated by illness uncertainty; and (3) explore whether patients' degree of understanding of their cancer can be predicted by clinical and socio-demographic factors. METHODS 209 CUP patients completed a questionnaire measuring anxiety, depression, illness uncertainty, fatigue, pain, sleep and understanding of their cancer. Using an apriori theoretical framework, we employed structural equation modelling to investigate predictors of patient's understanding of their cancer and psychological distress and the relationships between understanding, illness uncertainty and distress. RESULTS The structural equation model displayed good fit indices and supported the hypothesised relationship of patient's understanding of their cancer and the extent of psychological distress, which was mediated via illness uncertainty. Physical symptoms were positively associated with psychological distress and illness uncertainty. Younger age was predictive of lower patient's understanding of their cancer and higher levels of psychological distress. CONCLUSIONS Patients with CUP, particularly those who are younger and experiencing more physical symptoms, report higher levels of psychological distress and may require additional mental health support. Our findings highlight a need to improve CUP patient's understanding about their illness, which could help reduce their illness uncertainty and alleviate psychological distress.
Collapse
Affiliation(s)
- Kamil Wolyniec
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia,Department of Psychological SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Jessica Sharp
- Department of Psychological SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Krista Fisher
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Richard W. Tothill
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Department of Clinical PathologyUniversity of Melbourne Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - David Bowtell
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | | | - Penelope Schofield
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia,Department of Psychological SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
| |
Collapse
|
6
|
Chen J, Henry G, Butow P, Juraskova I, Laidsaar-Powell R, Shaw J. Psychometric assessment of the Concerns about Late Effects in Oncology Questionnaire (CLEO) among female breast cancer survivors. PATIENT EDUCATION AND COUNSELING 2022; 105:3298-3305. [PMID: 35989203 DOI: 10.1016/j.pec.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The Concerns about Late Effects in Oncology (CLEO) questionnaire was developed to measure concerns cancer survivors may have about late effects. The current study sought to assess the Concerns about Late Effects in Oncology's (CLEO) psychometric properties - factor structure, construct validity, discriminatory power, and internal consistency. METHODS 147 breast cancer survivors completed a survey. Factor structure was determined by exploratory factor analysis (EFA). Construct validity was assessed against fear of cancer recurrence, anxiety, depression, quality of life, and neuroticism. Discriminatory power was assessed against participants' age and clinical characteristics. RESULTS The EFA confirmed a 4-factor structure; health professionals' support, psychological impacts, adapting, and daily functional impacts. There was only partial support for construct validity and discriminatory power. The CLEO demonstrated excellent internal consistency, with an overall Cronbach's α = 0.87 (health professionals' support: α = 0.89, psychological impacts: α = 0.93, adapting: α = 0.82, and daily functional impacts: α = 0.89). CONCLUSION The findings suggest further development of the CLEO should focus on the psychological and functional impacts of late effects. PRACTICE IMPLICATIONS Use of the CLEO may enhance communication about the impact of late effects, ensuring earlier identification and management of late effects in this population.
Collapse
Affiliation(s)
- Jill Chen
- Faculty of Science, School of Psychology, Griffith Taylor Building, The University of Sydney, NSW 2006, Australia.
| | - Georgina Henry
- Faculty of Science, School of Psychology, Griffith Taylor Building, The University of Sydney, NSW 2006, Australia.
| | - Phyllis Butow
- Faculty of Science, School of Psychology, Griffith Taylor Building, The University of Sydney, NSW 2006, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), Faculty of Science, School of Psychology, Level 6 North, Chris O'Brien Lifehouse, The University of Sydney, NSW 2006, Australia.
| | - Ilona Juraskova
- Faculty of Science, School of Psychology, Griffith Taylor Building, The University of Sydney, NSW 2006, Australia.
| | - Rebekah Laidsaar-Powell
- Faculty of Science, School of Psychology, Griffith Taylor Building, The University of Sydney, NSW 2006, Australia.
| | - Joanne Shaw
- Faculty of Science, School of Psychology, Griffith Taylor Building, The University of Sydney, NSW 2006, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), Faculty of Science, School of Psychology, Level 6 North, Chris O'Brien Lifehouse, The University of Sydney, NSW 2006, Australia.
| |
Collapse
|
7
|
Sawma T, Choueiri P. The influence of family functioning on the severity of fear of cancer recurrence: A cross-sectional study in a sample of breast cancer survivors of Lebanese women. Eur J Oncol Nurs 2022; 60:102169. [DOI: 10.1016/j.ejon.2022.102169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/06/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
|
8
|
Jung A, Crandell JL, Nielsen ME, Smith SK, Bryant AL, Mayer DK. Relationships among uncertainty, post-traumatic stress disorder symptoms, and quality of life in non-muscle-invasive bladder cancer survivors. Support Care Cancer 2022; 30:6175-6185. [PMID: 35437672 DOI: 10.1007/s00520-022-07034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/03/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to examine relationships among uncertainty, PTSD symptoms (PTSS), and quality of life (QOL) in non-muscle-invasive bladder cancer (NMIBC) survivors. METHODS Eligible NMIBC survivors were identified through the North Carolina Central Cancer Registry, and 398 survivors participated in a mailed survey that measured survivor's outcomes (uncertainty, PTSS, and QOL). Structural equation modeling was used to examine the mediating effect of uncertainty and PTSS on the association between personal characteristics and QOL in NMIBC survivors. RESULTS NMIBC survivors experienced cancer-related uncertainty; higher uncertainty was associated with male, lower income, lack of cure, and lower cognition-ability. Uncertainty was significantly and negatively associated with QOL. In addition, PTSS completely mediated the effect of uncertainty on QOL, and higher PTSS had a strong association with poorer QOL. Additionally, comorbidities, cognition-general concerns, uncertainty, and PTSS had strong negative effects on QOL. CONCLUSION This study has identified modifiable psychosocial factors which affect QOL in NMIBC survivors. The study findings can be used in the development of interventions to improve QOL for NMIBC survivors.
Collapse
Affiliation(s)
- Ahrang Jung
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - Jamie L Crandell
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew E Nielsen
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Ashley Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Deborah K Mayer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
9
|
Han PKJ, Scharnetzki E, Anderson E, DiPalazzo J, Strout TD, Gutheil C, Lucas FL, Edelman E, Rueter J. Epistemic Beliefs: Relationship to Future Expectancies and Quality of Life in Cancer Patients. J Pain Symptom Manage 2022; 63:512-521. [PMID: 34952170 PMCID: PMC8930513 DOI: 10.1016/j.jpainsymman.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Expectations about the future (future expectancies) are important determinants of psychological well-being among cancer patients, but the strategies patients use to maintain positive and cope with negative expectancies are incompletely understood. OBJECTIVES To obtain preliminary evidence on the potential role of one strategy for managing future expectancies: the adoption of "epistemic beliefs" in fundamental limits to medical knowledge. METHODS A sample of 1307 primarily advanced-stage cancer patients participating in a genomic tumor testing study in community oncology practices completed measures of epistemic beliefs, positive future expectancies, and mental and physical health-related quality of life (HRQOL). Descriptive and linear regression analyses were conducted to assess the relationships between these factors and test two hypotheses: 1) epistemic beliefs affirming fundamental limits to medical knowledge ("fallibilistic epistemic beliefs") are associated with positive future expectancies and mental HRQOL, and 2) positive future expectancies mediate this association. RESULTS Participants reported relatively high beliefs in limits to medical knowledge (M = 2.94, s.d.=.67) and positive future expectancies (M = 3.01, s.d.=.62) (range 0-4), and relatively low mental and physical HRQOL. Consistent with hypotheses, fallibilistic epistemic beliefs were associated with positive future expectancies (b = 0.11, SE=.03, P< 0.001) and greater mental HRQOL (b = 0.99, SE=.34, P = 0.004); positive expectancies also mediated the association between epistemic beliefs and mental HRQOL (Sobel Z=4.27, P<0.001). CONCLUSIONS Epistemic beliefs in limits to medical knowledge are associated with positive future expectancies and greater mental HRQOL; positive expectancies mediate the association between epistemic beliefs and HRQOL. More research is needed to confirm these relationships and elucidate their causal mechanisms.
Collapse
Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts.
| | - Elizabeth Scharnetzki
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - Eric Anderson
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts
| | - John DiPalazzo
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - Tania D Strout
- Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts; Department of Emergency Medicine, Maine Medical Center (T.D.S.), Portland, Maine
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine
| | - F Lee Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center (P.K.J.H., E.S., E.A., J.D., C.G., F.L.L.), Portland, Maine; Tufts University School of Medicine (P.K.J.H., E.A., T.D.S., F.L.L.), Boston, Massachusetts
| | - Emily Edelman
- The Jackson Laboratory (E.E., J.R.), Bar Harbor, Maine
| | - Jens Rueter
- The Jackson Laboratory (E.E., J.R.), Bar Harbor, Maine
| |
Collapse
|
10
|
Diekmann A, Schellenberger B, Reck S, Heuser C, Geiser F, Wirtz M, Ansmann L, Ernstmann N. Is patient participation in multidisciplinary tumor conferences associated with their fear of progression? Psychooncology 2021; 30:1572-1581. [PMID: 34004041 DOI: 10.1002/pon.5733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE Previous studies found that some breast cancer patients in Germany are invited to participate in a multidisciplinary tumor conference (MTC) during the discussion of their own case. MTCs are regular meetings of a treatment team in which the diagnosis and treatment plan of cancer patients are discussed. Psychological consequences concerning the patients' participation in an MTC have not been examined yet. This study examines the association between patients' participation in MTC and patients' fear of progression (FoP). METHODS This analysis is part of a larger project named "Patient participation in multidisciplinary tumor conferences in Breast Cancer Care" (PINTU) which is a multicenter observational mixed-methods study. The study was conducted in six breast and gynecological cancer centers in North Rhine-Westphalia, Germany. Data were collected from 2018 to 2020 by patient survey at three time points. Patients with (n = 81) and without (n = 120) MTC participation were compared. FoP was measured with a 12-item short form of the FoP Questionnaire (FoP-Q-SF) at all three measurement time points. Data analysis included descriptive statistics, a one-way repeated variance analysis (ANOVA), and a one-way repeated ANCOVA using the propensity score as a covariate. RESULTS Data of n = 201 patients were included in the analysis. In general, FoP scores decreased in both groups from T0 to T2 (F = 36.539, p < 0.001, η2 = 0.155). Non-participating patients did not differ with regard to their FoP from patients who participated in an MTC before and after participation. The results of AN(C)OVA revealed no significant effects concerning the influence of patient participation in an MTC on FoP (F = 0.014, p = 0.907, η2 = <0.001 and (F = 0.013, p = 0.909, η2 = <0.001). CONCLUSION Since the FoP is not influenced by participation, the findings do not support recommendations for or against patient participation in an MTC. Further research should focus on the question of which patient groups might benefit from participation in an MTC with regard to which outcome variables.
Collapse
Affiliation(s)
- Annika Diekmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Sebastian Reck
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Franziska Geiser
- Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, University Hospital Bonn, Bonn, Germany
| | - Markus Wirtz
- Department of Research Methods, University of Education, Freiburg, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| |
Collapse
|
11
|
Zhong L, Donovan EE, Vangelisti AL. Examining the Effectiveness of Genetic Counselors' Communication of Variant of Uncertain Significance Results of Breast Cancer Genes. HEALTH COMMUNICATION 2021; 36:606-615. [PMID: 32122169 DOI: 10.1080/10410236.2020.1733224] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Receiving a variant of uncertain significance (VUS) result is quite common for individuals who undergo genetic testing. Because VUS results are often unexpected and necessarily complex, they are challenging for genetic counselors to deliver. The current research sought to examine how three specific message features (risk estimate formats, establishment of a future plan, and linguistic agency), and message receivers' intolerance of uncertainty, influenced the effectiveness of genetic counselors' communication of a VUS result. A series of MANCOVAs and multiple regressions suggested that these message features affected message receivers' perception of a genetic counselor's credibility and receivers' uncertainty appraisal and information-seeking intentions. Specifically, establishing a future plan and assigning agency to a VUS result enhanced perceived counselor credibility. When results were presented in a numeric format, assigning agency to counselors resulted in heightened danger appraisal and greater information-seeking intentions. Individuals' intolerance of uncertainty moderated the association between risk formats and uncertainty appraisal. These results have both theoretical and practical implications for communication of uncertainty in the context of genetic counseling.
Collapse
Affiliation(s)
- Lingzi Zhong
- Department of Communication Studies, Moody College of Communication, University of Texas at Austin
| | - Erin E Donovan
- Department of Communication Studies, Moody College of Communication, University of Texas at Austin
| | - Anita L Vangelisti
- Department of Communication Studies, Moody College of Communication, University of Texas at Austin
| |
Collapse
|
12
|
Ellis S, Brown RF, Thorsteinsson EB, Pakenham KI, Perrott C. Quality of life and fear of cancer recurrence in patients and survivors of non-Hodgkin lymphoma. PSYCHOL HEALTH MED 2021; 27:1649-1660. [PMID: 33928815 DOI: 10.1080/13548506.2021.1913756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is a common haematological cancer that is comprised of approximately 30 subtypes, of which Waldenström Macroglobulinemia (WM) is a rare incurable form. It is typically managed using a watch-and-wait strategy that can contribute to illness uncertainty which may result in fear of cancer recurrence (FCR) and poor health-related quality of life (QOL). However, few studies have examined the correlates of FCR and QOL in NHL patients, including WM patients. One-hundred males and 92 females with a mean age of 62.7 years who were an average of 6.8 years from diagnosis completed the online questionnaire which asked about demographics, medical history, QOL, FCR, stress, anxiety and depression. Few NHL patients reported significant stress or affective distress, most had moderate-high QOL and 41% experienced recent FCR, relative to published cut-off scores. Poorer QOL was related to depression symptoms, FCR, higher illness burden (i.e. comorbidity) and fewer personal resources (i.e. unemployed), whereas FCR was related to shorter time since diagnosis and more depressive symptoms. Results suggest that FCR and depressive symptoms may adversely impact QOL, whereas a recent cancer diagnosis and depression-related pessimism may contribute to FCR.
Collapse
Affiliation(s)
- Susan Ellis
- University of Queensland, Brisbane, Australia
| | - Rhonda F Brown
- Research School of Psychology, The Australian National University, Canberra, Australia
| | | | | | - Colin Perrott
- School of Psychology, University of New England, Armidale, Australia
| |
Collapse
|
13
|
Verduzco-Aguirre HC, Babu D, Mohile SG, Bautista J, Xu H, Culakova E, Canin B, Zhang Y, Wells M, Epstein RM, Duberstein P, McHugh C, Dale W, Conlin A, Bearden J, Berenberg J, Tejani M, Loh KP. Associations of Uncertainty With Psychological Health and Quality of Life in Older Adults With Advanced Cancer. J Pain Symptom Manage 2021; 61:369-376.e1. [PMID: 32822750 PMCID: PMC7854861 DOI: 10.1016/j.jpainsymman.2020.08.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Older adults with advanced cancer face uncertainty related to their disease and treatment. OBJECTIVES To evaluate the associations of uncertainty with psychological health and quality of life (QoL) in older adults with advanced cancer. METHODS Secondary cross-sectional analysis of baseline data from a national clustered geriatric assessment trial. Patients 70 years and older with advanced cancer considering a new line of chemotherapy were recruited. We measured uncertainty using the modified nine-item Mishel Uncertainty in Illness Scale. Dependent variables included anxiety (Generalized Anxiety Disorder-7), depression (Generalized Depression Scale-15), distress (distress thermometer), QoL (Functional Assessment of Cancer Therapy-General), and emotional well-being (Functional Assessment of Cancer Therapy-General subscale). We used multivariate linear regression analyses to evaluate the association of uncertainty with each dependent variable. We conducted a partial least squares analysis with a variable importance in projection (VIP) plot to assess the contribution of individual variables to the model. Variables with a VIP <0.8 were considered less influential. RESULTS We included 527 patients (median age 76 years; range 70-96). In multivariate analyses, higher levels of uncertainty were significantly associated with greater anxiety (β = 0.11; SE = 0.04), depression (β = 0.09; SE = 0.02), distress (β = 0.12; SE = 0.02), as well as lower QoL (β = -1.08; SE = 0.11) and emotional well-being (β = -0.29; SE = 0.03); the effect sizes were considered small. Uncertainty items related to disease and treatment were most strongly associated with psychological health and QoL scores (all VIP >0.8). CONCLUSION Uncertainty among older patients with advanced cancer is associated with worse psychological health and QoL. Tailored uncertainty management strategies are warranted.
Collapse
Affiliation(s)
- Haydee C Verduzco-Aguirre
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Dilip Babu
- Kaiser Permanente, Portland, Oregon, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Javier Bautista
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Huiwen Xu
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Eva Culakova
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Beverly Canin
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Yingzi Zhang
- University of Rochester School of Nursing, Rochester, New York, USA
| | - Megan Wells
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Ronald M Epstein
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Colin McHugh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Alison Conlin
- Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program (NCORP), Seattle, Washington, USA
| | - James Bearden
- Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, North Carolina, USA
| | - Jeffrey Berenberg
- Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, Hawaii, USA
| | | | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA.
| |
Collapse
|
14
|
Abstract
As more patients with breast cancer survive treatment, the importance of their long-term quality of life is increasing. One important concern for many survivors is fear of recurrence. To better understand worry about recurrence, we conducted a population-based statistical analysis. The National Health Interview Survey (NHIS) is the largest annual source of health information for the U.S. population. We obtained data from the 2010 survey, which asked breast cancer survivors about their fear of recurrence and quality of life. Data were analyzed using SUDAAN software. The 2010 NHIS sample represented 2,668,697 breast cancer survivors. On univariate analysis, worry about recurrence was correlated with current age ( P = 0.03) and radiation therapy ( P = 0.04). Worry was strongly associated with perceived risk of recurrence ( P < 0.01) and decreased overall quality of life ( P < 0.01) as well as lower self-reported physical ( P < 0.01) and mental ( P < 0.01) health and poor satisfaction with social activities and relationships ( P < 0.01). On multivariate analysis, worry was not independently associated with decreased quality of life ( P = 0.09). However, those who “always worried” about recurrence had a lower quality of life (odds ratio, 0.06; 95% confidence interval, 0.01 to 0.45). Worry about recurrence among breast cancer survivors is associated with age and radiation therapy and is correlated with self-reported physical health, mental health, social relationships, and overall quality of life. It is a significant predictor of decreased quality of life in those who worry the most. Screening for worry about recurrence is an important measure for the improvement of quality of life among breast cancer survivors.
Collapse
Affiliation(s)
- Apoorva Tewari
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Anees B. Chagpar
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
15
|
Kelada L, Wakefield CE, Heathcote LC, Jaaniste T, Signorelli C, Fardell JE, Donoghoe M, McCarthy MC, Gabriel M, Cohn RJ. Perceived cancer-related pain and fatigue, information needs, and fear of cancer recurrence among adult survivors of childhood cancer. PATIENT EDUCATION AND COUNSELING 2019; 102:2270-2278. [PMID: 31257099 DOI: 10.1016/j.pec.2019.06.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Pain and fatigue are under-researched late effects of childhood cancer and its treatment, and may be interpreted by survivors as indicating cancer recurrence. Moreover, unmet information needs for managing pain and fatigue may be related to fear of cancer recurrence. We investigated the complex relationships between perceived cancer-related pain and fatigue, unmet information needs for managing pain and fatigue, and fear of cancer recurrence. METHODS We surveyed 404 adult survivors of any form of childhood cancer (M = 16.82 years since treatment completion). RESULTS Many survivors reported perceived cancer-related pain (28.7%) and fatigue (40.3%), and anticipated future pain (19.3%) and fatigue (26.2%). These symptomologies were all related to unmet information needs for managing pain (18.8%) and fatigue (32.2%; all p's<.001). Survivors reporting unmet information needs for managing pain (B = .48, 95% CI = 0.19-0.76, p = .001) and fatigue (B = .32, 95% CI = 0.06-0.52, p = .015) reported higher fear of cancer recurrence than survivors reporting no information needs. CONCLUSION Survivors often have unmet information needs for managing pain and fatigue, and these unmet needs are related to fear of cancer recurrence. PRACTICE IMPLICATIONS Long-term follow-up clinics should assess pain and fatigue. Information provision about pain and fatigue may be an important tool to help manage fear of cancer recurrence.
Collapse
Affiliation(s)
- L Kelada
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia.
| | - C E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - L C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Palo Alto, USA
| | - T Jaaniste
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Department of Pain & Palliative Care, Sydney Children's Hospital, High Street, Randwick, Australia
| | - C Signorelli
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - J E Fardell
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - M Donoghoe
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, Australia
| | - M C McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - M Gabriel
- Cancer Centre for Children, The Children's Hospital, Westmead, Australia
| | - R J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| |
Collapse
|
16
|
Abstract
Transition to cancer survivorship is frequent lexicon denoting the posttreatment phase of cancer treatment. The concept of being in transition to survivorship is not well defined. To critically analyze this concept, data sources (n = 63) (from 1985 to 2016) from nursing, sociology, medicine, and psychology were evaluated employing Rodgers evolutionary method. Transition to cancer survivorship is a turning point with a variable time period one passes through after treatment. It is an individualized experience with degrees of liminality, changes, and challenging consequences. Understanding this concept helps identify patient needs for targeted nursing interventions that can bridge safe passage to cancer survivorship.
Collapse
|
17
|
Gunter MD, Duke G. Social Support to Reduce Uncertainty in Childhood Cancer in South Texas: A Case Study. J Pediatr Oncol Nurs 2019; 36:207-218. [PMID: 30929543 DOI: 10.1177/1043454219835450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine if supportive measures are found to be most helpful and feasible for families of children with cancer by obtaining in-depth perspectives of uncertainty and adaptation. HYPOTHESES Traditional methods of psychosocial support do not meet the needs of parents and families dealing with cancer. Participants prefer more informal meetings and gatherings that are more social in nature. METHOD A descriptive single embedded case study was used to study uncertainty and social support for families with children treated at a pediatric hematology/oncology department in south Texas. The sample included members of the health care team in a pediatric cancer/bone marrow transplant unit and parents of children diagnosed with cancer. Data were gathered through audio-recorded interviews. DATA ANALYSIS Data were transcribed and analyzed through thematic content and pattern matching using computer software. RESULTS Four themes were identified: meaning of uncertainty in parents and members of the health care team, facilitators of parental adaptation, education and psychosocial support, and patient/family obstacles hindering successful adaptation. These demonstrated aspects of care interventions, clarifying what uncertainty means and how it affects the ability of parents to adapt to life with pediatric cancer, perceptions regarding the helpfulness of education and support interventions or lack thereof, and what internal and external obstacles hinder the family's adaptation. IMPLICATIONS FOR PRACTICE Improving patient education through individualization and delivery time frame as well as providing opportunities for informal sharing and community building are key to reducing uncertainty and improving family adaptation to life with childhood cancer.
Collapse
|
18
|
The Effect of Uncertainty Management Program on Quality of Life Among Vietnamese Women at 3 Weeks Postmastectomy. Cancer Nurs 2018; 42:261-270. [PMID: 29746263 DOI: 10.1097/ncc.0000000000000597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In Vietnam, breast cancer is a top contributor to cancer-related deaths in women. Evidence shows that, after mastectomy, women in Vietnam have a lower quality of life than women in other countries. In addition, high uncertainty is a predictor of low quality of life postmastectomy. Therefore, if nurses can manage uncertainty, the quality of life postmastectomy can improve. OBJECTIVE This study examined the effect of the Uncertainty Management Program (UMP) on quality of life at 3 weeks postmastectomy in Vietnamese women. METHODS This research was a quasi-experimental study using a "posttest only with control group" design. There were 115 subjects assigned to either the experimental group (n = 57), who participated in the UMP and routine care, or the control group (n = 58), who received only routine care. Participants were assessed 2 times postmastectomy using the modified Quality of Life Index Scale-Vietnamese version. RESULTS The experimental group exhibited low uncertainty before discharge and significantly higher quality of life than the control group at 1 and 3 weeks postmastectomy, respectively (P < .05). Women's physical well-being, psychological well-being, body image concerns, and social concerns were significantly increased with UMP. CONCLUSION The UMP was considered as a promising program that might benefit the QoL of women with breast cancer 3 weeks postmastectomy. IMPLICATIONS FOR PRACTICE The UMP appears feasible to apply for women with breast cancer to improve their QoL postmastectomy in various settings. Nurses can flexibility instruct women in their holistic care attention both in the hospital and at home.
Collapse
|
19
|
Ruban PU, Wulff CN, Sperling CD, Sandager M, Jensen AB. Patient evaluation of breast cancer follow-up: A Danish survey. PATIENT EDUCATION AND COUNSELING 2018; 101:99-104. [PMID: 28734558 DOI: 10.1016/j.pec.2017.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 06/17/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of this study was to determine how age influences the degree to which patients with breast cancer feel comfortable with standard follow-up and to assess their satisfaction with the contact to health professionals. METHODS Data was from a Danish population-based questionnaire survey from 2012 including adult cancer patients. 1120 patients with breast cancer returned the questionnaire (response rate: 73%). Age groups were decided before conducting analyses. RESULTS Overall, patients with breast cancer evaluated the follow-up programme positively. However, in five of six items of interest, patients aged 40-49 and 50-59 years differed statistically significantly from patients ≥70 years, by being less comfortable with the follow-up, less satisfied with the health care professionals' ability to listen, and less satisfied with the health care professionals' answers. Satisfaction with the length of consultations, and the number of involved health care professionals were also lower in these age groups compared to patients ≥70 years. CONCLUSION Overall, satisfaction with follow-up was high, but considerable age-related variations were found. PRACTICE IMPLICATIONS The findings suggest a potential for improving the services provided for patients aged 40-59 years with breast cancer.
Collapse
Affiliation(s)
| | | | | | - Mette Sandager
- Documentation and Quality, Danish Cancer Society, Copenhagen, Denmark
| | | |
Collapse
|
20
|
The Integration of Emotional, Physiologic, and Communication Responses to Medical Oncology Surveillance Appointments During Breast Cancer Survivorship. Cancer Nurs 2017; 40:124-134. [PMID: 27088607 DOI: 10.1097/ncc.0000000000000375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer survivors regularly interact with providers during routine surveillance medical oncology visits, discussing uncertainty and anxiety about potential cancer recurrence for many years after treatment. Physiologic alteration can also occur as a stress response, triggered by an upcoming surveillance visit. Survivor-provider communication can theoretically allay emotional distress. OBJECTIVE The aim of this study was to evaluate associations between emotional (uncertainty, anxiety, concerns about recurrence) and physiologic responses (cytokine levels, lymphocyte counts), and survivor-provider communication (women's plans for their visit, negotiation of decision-making roles). METHODS Twenty-seven community-dwelling breast cancer survivors participated. Blood specimens, and self-reported data focusing on the previous month, were collected immediately before and the morning after a regularly scheduled medical oncology visit. RESULTS Global concerns about cancer recurrence and acute anxiety and uncertainty were associated with changes in immune status before and after the visit. Postvisit natural killer cells increased in 70% of women, and uncertainty/anxiety decreased. Thirty-three percent of women reported a previous minor illness. Most women had a visit plan; 66% successfully negotiated decision-making roles with providers. CONCLUSIONS Triggered by an upcoming medical oncology visit, women experience uncertainty, anxiety, and altered immunity, potentially placing them at risk of disease exacerbations. IMPLICATIONS FOR PRACTICE Not all women respond similarly to a routine surveillance visit; thus, providers must determine who may be at increased risk of emotional distress and physiologic alteration. Survivor-provider communication facilitates immediate resolution of concerns. Explanations of symptom meaning reduce anxiety and uncertainty and by extension may help resolve immune alteration. Between visits, this could be done by nurse-operated telephone-based "help lines."
Collapse
|
21
|
Patients With Hepatocellular Carcinoma Near the End of Life: A Longitudinal Qualitative Study of Their Illness Experiences. Cancer Nurs 2017; 38:E19-27. [PMID: 25122134 DOI: 10.1097/ncc.0000000000000188] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the United States, the incidence of hepatocellular carcinoma (HCC) is rising. For those diagnosed with terminal HCC, there is no curative treatment and duration of survival is typically 1 to 2 years. Research on illness and treatment experiences toward the end of life for patients with terminal HCC is limited. OBJECTIVE The aim of this study was to explore the illness experiences of patients with terminal HCC as they approached the end of life. METHODS This study used a prospective, longitudinal descriptive design. Interview data were collected from 14 patients once a month for up to 6 months, for a total of 45 interviews. Data were analyzed using conventional content analysis. RESULTS Three major themes (illness perceptions, decision to start treatment, and navigating treatment over time) and 10 subthemes were identified that were reflected across time in all patient experiences. Patients faced challenges with symptom experiences, treatment decisions, and unmet information needs affecting their quality of life. CONCLUSIONS Gaining knowledge about the challenges facing patients with HCC is crucial for designing interventions that optimize their quality of life. IMPLICATIONS FOR PRACTICE Healthcare professionals may improve the quality of life of patients with terminal HCC by eliciting patients' perceptions of their illness and treatment decisions, symptom experiences, and information needs as the disease progresses and providing symptom management and offering information tailored to their needs. Care for patients with HCC who are approaching the end of life should be multidisciplinary and include timely referral to palliative care.
Collapse
|
22
|
Shay LA, Carpentier MY, Vernon SW. Prevalence and correlates of fear of recurrence among adolescent and young adult versus older adult post-treatment cancer survivors. Support Care Cancer 2016; 24:4689-96. [PMID: 27387913 DOI: 10.1007/s00520-016-3317-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We sought to (1) assess prevalence of fear of recurrence among cancer survivors diagnosed as adolescent and young adults (AYA; 15-39 years) versus those diagnosed at a later age (40+ years) and (2) identify factors associated with fear of recurrence in each group. METHODS We used logistic regression to determine the correlates of fear of recurrence by age group at diagnosis among survivors responding to the 2010 LIVESTRONG survey. RESULTS Prevalence of fear of recurrence was significantly higher among AYA survivors (85.2 %) than those diagnosed at an older age (79.7 %). Among AYA respondents, being employed and less than 5 years off treatment were positively associated with fear of recurrence while those with thyroid cancer and those who participated in a clinical trial were less likely to experience fear of recurrence. Among older adults, receipt of surgery was associated with fear of recurrence whereas having insurance coverage through Medicare or Medicaid and positive patient-provider communication were negatively associated with fear of recurrence. CONCLUSIONS For both AYA and older adult survivors, changeable factors such as having a more positive cancer care experience may impact fear of recurrence. Our findings highlight the need to identify and understand aspects of the communication process that can be targeted in future interventions with survivors and healthcare providers to ensure that fear of recurrence is being appropriately managed. Factors associated with fear of recurrence differ for AYA and older adult survivors; thus, interventions would likely benefit from tailoring based on age at diagnosis.
Collapse
Affiliation(s)
- L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA.
| | - Melissa Y Carpentier
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - Sally W Vernon
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA
| |
Collapse
|
23
|
Halbach SM, Enders A, Kowalski C, Pförtner TK, Pfaff H, Wesselmann S, Ernstmann N. Health literacy and fear of cancer progression in elderly women newly diagnosed with breast cancer--A longitudinal analysis. PATIENT EDUCATION AND COUNSELING 2016; 99:855-862. [PMID: 26742608 DOI: 10.1016/j.pec.2015.12.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study aims to investigate the distribution of health literacy levels and the association of health literacy with fear of cancer progression (FoP) over the course of cancer treatment in a sample of elderly women newly diagnosed with breast cancer. METHODS The analyses are part of a prospective, multicenter cohort-study (PIAT) that took place in Germany between 2013 and 2014. Elderly women (aged 65 years and older) newly diagnosed with breast cancer completed validated measures of health literacy and FoP directly after the breast cancer surgery and 40 weeks later. Multivariate random-effects regression analysis for longitudinal data was applied to estimate the association of health literacy with FoP considering socio-demographic, clinical and psychosocial characteristics of the patients. RESULTS About half of the elderly breast cancer patients in our sample were classified as having limited health literacy (inadequate and problematic levels). Inadequate and problematic health literacy were significantly associated with higher levels of FoP in the elderly breast cancer patients. CONCLUSION Limited health literacy is an independent risk factor for increased FoP. PRACTICE IMPLICATIONS Enhancing health literacy could contribute to reducing patients' cancer-related fears.
Collapse
Affiliation(s)
- Sarah Maria Halbach
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
| | - Anna Enders
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | | | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | | | - Nicole Ernstmann
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| |
Collapse
|
24
|
Uncertainty and Personal Growth Through Positive Coping Strategies Among Chinese Parents of Children With Acute Leukemia. Cancer Nurs 2016; 39:205-12. [DOI: 10.1097/ncc.0000000000000279] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
25
|
Wei D, Liu XY, Chen YY, Zhou X, Hu HP. Effectiveness of Physical, Psychological, Social, and Spiritual Intervention in Breast Cancer Survivors: An Integrative Review. Asia Pac J Oncol Nurs 2016; 3:226-232. [PMID: 27981165 PMCID: PMC5123516 DOI: 10.4103/2347-5625.189813] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Factors affecting the health outcomes of cancer patients have gained extensive research attention considering the increasing number and prolonged longevity of cancer survivors. Breast cancer survivors experience physical, psychological, social, and spiritual challenges. This systematic literature review aims to present and discuss an overview of main issues concerning breast cancer survivors after treatment. Treatment-related symptoms as well as psychosocial and spiritual aspects of breast cancer survivors are evaluated. Moreover, the benefits of intervention for emotional, physical, social, and spiritual needs of the patient during the survivorship are investigated. This review also proposes avenues for future studies in this field and develops a new, integrated, and complete interpretation of findings on the holistic well-being of women with breast cancer. Thus, this study provides clinicians with a more comprehensive source of information compared with individual studies on symptom experiences.
Collapse
Affiliation(s)
- Di Wei
- Nursing Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Xiang-Yu Liu
- Nursing Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Yong-Yi Chen
- Nursing Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Xin Zhou
- Nursing Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Hui-Ping Hu
- Nursing Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| |
Collapse
|
26
|
Magsamen-Conrad K, Checton MG, Venetis MK, Greene K. Communication Efficacy and Couples' Cancer Management: Applying a Dyadic Appraisal Model. COMMUNICATION MONOGRAPHS 2015; 82:179-200. [PMID: 25983382 PMCID: PMC4430110 DOI: 10.1080/03637751.2014.971415] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The purpose of the present study was to apply Berg and Upchurch's (2007) developmental-conceptual model to understand better how couples cope with cancer. Specifically, we hypothesized a dyadic appraisal model in which proximal factors (relational quality), dyadic appraisal (prognosis uncertainty), and dyadic coping (communication efficacy) predicted adjustment (cancer management). The study was cross-sectional and included 83 dyads in which one partner had been diagnosed with and/or treated for cancer. For both patients and partners, multilevel analyses using the actor-partner interdependence model (APIM) indicated that proximal contextual factors predicted dyadic appraisal and dyadic coping. Dyadic appraisal predicted dyadic coping, which then predicted dyadic adjustment. Patients' confidence in their ability to talk about the cancer predicted their own cancer management. Partners' confidence predicted their own and the patient's ability to cope with cancer, which then predicted patients' perceptions of their general health. Implications and future research are discussed.
Collapse
Affiliation(s)
| | - Maria G Checton
- Department of Health Care Management, College of Saint Elizabeth
| | | | | |
Collapse
|
27
|
Sajjadi M, Rassouli M, Bahri N, Mohammadipoor F. The correlation between perceived social support and illness uncertainty in people with human immunodeficiency virus/acquired immune deficiency syndrome in iran. Indian J Palliat Care 2015; 21:231-5. [PMID: 26009679 PMCID: PMC4441187 DOI: 10.4103/0973-1075.156508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Illness uncertainty is a source of a chronic and pervasive psychological stress for people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWH), and largely affects their quality of life and the ability to cope with the disease. Based on the uncertainty in illness theory, the social support is one of the illness uncertainty antecedents, and influences the level of uncertainty perceived by patients. AIM To examine uncertainty in PLWH and its correlation with social support in Iran. MATERIALS AND METHODS This cross-sectional correlational study was conducted with 80 PLWH presenting to AIDS Research Center, Tehran, Iran in 2013. The data collected using illness uncertainty and social support inventories were analyzed through Pearson's correlation coefficient, Spearman's correlation coefficient, and regression analysis. RESULTS The results showed a high level of illness uncertainty in PLWH and a negative significant correlation between perceived social support and illness uncertainty (P = 0.01, r = -0.29). CONCLUSION Uncertainty is a serious aspect of illness experience in Iranian PLWH. Providing adequate, structured information to patients as well as opportunities to discuss their concerns with other PLWH and receive emotional support from their health care providers may be worthwhile.
Collapse
Affiliation(s)
- Moosa Sajjadi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Maryam Rassouli
- Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Bahri
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Fatemeh Mohammadipoor
- Nursing and Midwifery School, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
28
|
Uncertainty, Self-efficacy, and Self-care Behavior in Patients With Breast Cancer Undergoing Chemotherapy in China. Cancer Nurs 2015; 38:E19-26. [DOI: 10.1097/ncc.0000000000000165] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Abstract
Health and illness fluctuate across a person's life span, and various theories have been developed to address the unique perceptions and situations that accompany these fluctuations. An innovative model of health change resulted from a synthesis of the major concepts from 2 such theories: Mishel's uncertainty in illness theory and the Corbin and Strauss chronic illness trajectory framework. The proposed integrated model, the Health Change Trajectory Model, provides original conceptual definitions that operationalize trajectory framework in the context of changes in health. The use of a health trajectory perspective extends applications of the model to a wide range of health changes that result in uncertainty and ambiguity.
Collapse
|
30
|
Pedro LW, Schmiege SJ. Rural living as context: a study of disparities in long-term cancer survivors. Oncol Nurs Forum 2014; 41:E211-9. [PMID: 24769604 DOI: 10.1188/14.onf.e211-e219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore the impact of rurality on health-related quality-of-life (HRQOL) disparities in rural long-term cancer survivors. DESIGN Cross-sectional survey. SETTING Rural-Urban Continuum Codes (RUCC) 7, 8, and 9. SAMPLE 91 adults at least five years post-treatment. METHODS Mailed surveys measured HRQOL, self-esteem, and social support. Regression models were estimated to isolate (from self-esteem and social support) the effect of level of rurality on HRQOL. MAIN RESEARCH VARIABLES HRQOL, self-esteem, social support, and rurality. FINDINGS No differences in demographic characteristics existed among RUCCs. Survivors residing in RUCCs 7 or 8 tended to be similar in several dimensions of HRQOL. Survivors living in RUCC 7 reported significantly lower social function and greater financial difficulty and number of symptoms compared to survivors in RUCC 9 (the most remote). Self-esteem and social support strongly correlated with HRQOL. CONCLUSIONS The significant impact of rurality on HRQOL beyond self-esteem and social support suggests its role in explaining cancer survivorship disparities and directing practice. Until additional exploration can identify mechanisms behind rurality's impact, consideration of level of rurality as a potential factor in evaluating survivors' HRQOL outcomes is reasonable. IMPLICATIONS FOR NURSING Survivor context (e.g., level of rurality) influences HRQOL outcomes. Context or culture-relevant risk minimization and HRQOL optimization nursing practices are indicated.
Collapse
Affiliation(s)
- Leli W Pedro
- College of Nursing, University of Colorado in Denver
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, University of Colorado in Denver
| |
Collapse
|
31
|
Cahill JE, Lin L, LoBiondo-Wood G, Armstrong TS, Acquaye AA, Vera-Bolanos E, Gilbert MR, Padhye NS. Personal health records, symptoms, uncertainty, and mood in brain tumor patients. Neurooncol Pract 2014; 1:64-70. [PMID: 26034618 DOI: 10.1093/nop/npu005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The advantages of patient access to the electronic medical record (EMR) through integrated personal health records (PHR) may be substantial, and foremost is the enhanced information flow between patient and practitioner. Because this is an emerging technology, the actualized benefits to complex patient groups remain largely unknown. MD Anderson Cancer Center provides web-based PHR portal access to the EMR including clinic notes, MRI results, and pathology reports. This study sought to evaluate PHR use by glioma patients. METHODS Cross-sectional survey and PHR-derived user data from 186 patients were analyzed using descriptive and inferential statistics. Logistic regression assessed disparities between users and nonusers. Dependence of PHR access on treatment stage was tested through linear regression. Path analysis evaluated PHR access, disease-related uncertainty, symptom experience, and mood. RESULTS Patients averaged 44.2 years (range 19y-80y), 77% had a high-grade tumor, and 60% had accessed PHR at least one time (range 0-126). Strongest predictors of access included education level (college level or higher), low performance status, middle income, and in-state residency. Patients undergoing treatment were more active users. PHR access was associated with lower disease-related uncertainty and lower symptom severity. Mood was not directly related to PHR use but mediated an association between symptom severity and uncertainty. CONCLUSIONS While many reports presume better disease and symptom understanding for patients with EMR access, this study is the first to correlate PHR use to lower patient uncertainty levels. Early examination of PHR provides an important basis for critical evaluation and optimization to better structure this benefit for brain tumor patients.
Collapse
Affiliation(s)
- Jennifer E Cahill
- Department of Family Health , The University of Texas Health Science Center at Houston, School of Nursing , Houston, Texas (J.E.C., L.L., T.S.A.); Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., A.A.A., E.V.B., M.R.G.); Department of Nursing Systems , The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas (G.L.W., N.S.P.)
| | - Lin Lin
- Department of Family Health , The University of Texas Health Science Center at Houston, School of Nursing , Houston, Texas (J.E.C., L.L., T.S.A.); Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., A.A.A., E.V.B., M.R.G.); Department of Nursing Systems , The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas (G.L.W., N.S.P.)
| | - Geri LoBiondo-Wood
- Department of Family Health , The University of Texas Health Science Center at Houston, School of Nursing , Houston, Texas (J.E.C., L.L., T.S.A.); Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., A.A.A., E.V.B., M.R.G.); Department of Nursing Systems , The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas (G.L.W., N.S.P.)
| | - Terri S Armstrong
- Department of Family Health , The University of Texas Health Science Center at Houston, School of Nursing , Houston, Texas (J.E.C., L.L., T.S.A.); Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., A.A.A., E.V.B., M.R.G.); Department of Nursing Systems , The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas (G.L.W., N.S.P.)
| | - Alvina A Acquaye
- Department of Family Health , The University of Texas Health Science Center at Houston, School of Nursing , Houston, Texas (J.E.C., L.L., T.S.A.); Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., A.A.A., E.V.B., M.R.G.); Department of Nursing Systems , The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas (G.L.W., N.S.P.)
| | - Elizabeth Vera-Bolanos
- Department of Family Health , The University of Texas Health Science Center at Houston, School of Nursing , Houston, Texas (J.E.C., L.L., T.S.A.); Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., A.A.A., E.V.B., M.R.G.); Department of Nursing Systems , The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas (G.L.W., N.S.P.)
| | - Mark R Gilbert
- Department of Family Health , The University of Texas Health Science Center at Houston, School of Nursing , Houston, Texas (J.E.C., L.L., T.S.A.); Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., A.A.A., E.V.B., M.R.G.); Department of Nursing Systems , The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas (G.L.W., N.S.P.)
| | - Nikhil S Padhye
- Department of Family Health , The University of Texas Health Science Center at Houston, School of Nursing , Houston, Texas (J.E.C., L.L., T.S.A.); Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center, Houston, Texas (T.S.A., A.A.A., E.V.B., M.R.G.); Department of Nursing Systems , The University of Texas Health Science Center at Houston, School of Nursing, Houston, Texas (G.L.W., N.S.P.)
| |
Collapse
|
32
|
Forsythe LP, Arora NK, Alfano CM, Weaver KE, Hamilton AS, Aziz N, Rowland JH. Role of oncologists and primary care physicians in providing follow-up care to non-Hodgkin lymphoma survivors within 5 years of diagnosis: a population-based study. Support Care Cancer 2014; 22:1509-17. [PMID: 24414999 DOI: 10.1007/s00520-013-2113-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 12/25/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The growing population of non-Hodgkin lymphoma (NHL) survivors living longer with high physical and psychological treatment burden, in combination with the projected shortage of medical professionals, necessitates redesigning cancer follow-up care. This study examined follow-up care patterns, factors associated with follow-up care, and attitudes towards follow-up care among NHL survivors. METHODS We surveyed survivors of aggressive NHL 2 to 5 years post-diagnosis (N = 363) using a population-based sample from the Los Angeles County Surveillance Epidemiology and End Results registry. RESULTS Most survivors (82 %) received cancer-related follow-up care in the past year from an oncologist. History of recurrence, more comorbidities, more symptoms, and a shorter survivor-oncologist relationship were associated with high-frequency care with the oncologist [(≥5 visits in the past year), p < 0.05]. Many survivors followed up by oncologists (71 %) also saw a primary care provider (PCP) and 47 % also saw both a PCP and other specialists. Factors associated with seeing a PCP in addition to an oncologist included more symptoms, more health information needs, no history of recurrence, perceived excellent quality of cancer follow-up care, and fewer visits with the oncologist (p < 0.05). Survivors generally reported high reassurance from, and low negative anticipation towards, follow-up care. CONCLUSIONS The high proportion of NHL survivors receiving care from multiple physicians, and the sizable proportion (∼30 %) who have not recently seen a PCP, suggests that coordinating care across specialties is critical to ensure comprehensive, non-duplicative care. Understanding factors associated with cancer-related follow-up is a first step towards more effective, efficient, patient-centered care.
Collapse
Affiliation(s)
- Laura P Forsythe
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, Suite 900, Washington, DC, 20036, USA,
| | | | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Koch L, Bertram H, Eberle A, Holleczek B, Schmid-Höpfner S, Waldmann A, Zeissig SR, Brenner H, Arndt V. Fear of recurrence in long-term breast cancer survivors-still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the cancer survivorship--a multi-regional population-based study. Psychooncology 2013; 23:547-54. [PMID: 24293081 DOI: 10.1002/pon.3452] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Fear of recurrence (FoR) is a widespread problem among breast cancer survivors. So far, little is known about prevalence, determinants, and consequences of FoR specifically in long-term breast cancer survivors, even though it was found to be one of the most important concerns in this group. METHODS Analyses are based on data of several population-based cohorts of long-term breast cancer survivors, recruited by six German cancer registries. Overall, 2671 women were included in the analyses. FoR was assessed using the short form of the Fear of Progression Questionnaire. Potential determinants of moderate/high FoR and the association with depression and quality of life (QoL) were explored via multiple logistic and linear regression. RESULTS Even though the majority of women reported low levels of FoR (82%), a substantial percentage experienced moderate (11%) and high (6%) FoR. Younger age (odds ratio = 3.00, confidence intervals = 1.91-4.73 for women below age 55 years) and considering oneself as a tumor patient (odds ratio = 3.36, confidence intervals = 2.66-4.25) were found to exhibit the strongest associations with moderate/high FoR. Overall, psychosocial and sociodemographic factors played a far bigger role in FoR than clinical factors. Higher FoR was associated with higher depression and lower QoL. CONCLUSION Fear of recurrence (mostly low levels) is highly prevalent among long-term breast cancer survivors and can negatively affect QoL and well-being. Therefore, it should be given appropriate consideration in research and clinical practice. As specifically younger women tended to be impacted by FoR, it is crucial to be particularly attentive to specific needs of younger survivors.
Collapse
Affiliation(s)
- Lena Koch
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Janz NK, Friese CR, Li Y, Graff JJ, Hamilton AS, Hawley ST. Emotional well-being years post-treatment for breast cancer: prospective, multi-ethnic, and population-based analysis. J Cancer Surviv 2013; 8:131-42. [PMID: 24222081 DOI: 10.1007/s11764-013-0309-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 09/11/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE This study investigated factors associated with declines in emotional well-being (EWB) over time in breast cancer survivors. METHODS Women with breast cancer (Stages I-III) residing in Los Angeles, CA, or Detroit, MI, and reported to the Surveillance, Epidemiology, and End Results registries between June 2005 and February 2007 completed surveys at 9 months and 4 years after diagnosis. EWB was measured by the Functional Assessment of Cancer Treatment-Breast. Using a stress coping framework, logistic regression models assessed associations between personal, social, and clinical correlates, appraisal (e.g., worry about recurrence) and coping factors (e.g., emotional support) to EWB declines. RESULTS Among eligible women who completed primary breast cancer treatment, 772 completed both surveys, and 192 (24.9 %) experienced EWB declines over time. Women with past or current depression were more likely to report EWB decline (p < 0.01). Survivors who perceived they did not receive enough information about risk of breast cancer recurrence during primary treatment were more likely to have EWB decline (OR 0.53, 95 % CI 0.32-0.87). Greater perceived likelihood of recurrence (OR 1.95, 95 % CI 1.01-5.29) and increased worry about recurrence (OR 1.38, 95 % CI 1.10-1.72) were associated with EWB decline. Higher spirituality beliefs and practices were associated with EWB decline. CONCLUSIONS A considerable number of breast cancer patients report emotional well-being declines over time. Early identification of women who are vulnerable, such as women with past depression, is crucial to improve quality of care. Women would benefit from education about cancer recurrence and tailored strategies to manage worry about recurrence over time. IMPLICATION FOR CANCER SURVIVORS Understanding actual risk of recurrence and managing worry about recurrence is important for cancer survivors. Emotional concerns are common for individuals with cancer so survivors should feel free to reach out and discuss such concerns with providers well into the survivorship period.
Collapse
Affiliation(s)
- Nancy K Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, 2830-SPH1, Ann Arbor, MI, 48109-2029, USA,
| | | | | | | | | | | |
Collapse
|
36
|
The evolution of fear of cancer recurrence during the cancer care trajectory and its relationship with cancer characteristics. J Psychosom Res 2013; 74:354-60. [PMID: 23497839 DOI: 10.1016/j.jpsychores.2012.12.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/21/2012] [Accepted: 12/25/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This population-based longitudinal study assessed the prevalence, incidence and evolution of fear of cancer recurrence (FCR) and its relationship with some cancer characteristics in a large sample of patients with mixed cancer sites over an 18-month period. METHODS A total of 962 patients scheduled to undergo surgery for cancer completed the severity subscale of the Fear of Cancer Recurrence Inventory at the peri-operative period and 2, 6, 10, 14, and 18 months later. RESULTS Results indicated that FCR levels were highest at baseline, significantly decreased at the 2-month evaluation and then remained stable throughout the remainder of the study. Between 44.0% and 56.1% of the patients reported a clinical level of FCR during the study, with the highest proportion found at baseline. A relationship was obtained between greater FCR and some indices of poorer prognosis (i.e., diagnosis of head and neck cancer, more advanced cancer, cancer recurrence), as well as with the administration of adjuvant treatment, particularly chemotherapy. Patients with clinical FCR at baseline continued to display clinical levels at all subsequent time points. The incidence rate of clinical levels of FCR was 51.7% overall. CONCLUSION FCR is a highly prevalent and persistent condition. More efforts should be devoted to developing effective treatments for patients with clinical levels of FCR. Early interventions appear particularly relevant in order to prevent the problem from becoming chronic, although patients' acceptability and the efficacy of this approach remain to be demonstrated.
Collapse
|
37
|
Lin YH. Comparison of the uncertainty level of radical prostatectomy recipients with or without psychological support. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2012. [DOI: 10.1111/j.1749-771x.2012.01149.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
Cahill J, LoBiondo-Wood G, Bergstrom N, Armstrong T. Brain Tumor Symptoms as Antecedents to Uncertainty: An Integrative Review. J Nurs Scholarsh 2012; 44:145-55. [DOI: 10.1111/j.1547-5069.2012.01445.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
39
|
Ziner KW, Sledge GW, Bell CJ, Johns S, Miller KD, Champion VL. Predicting fear of breast cancer recurrence and self-efficacy in survivors by age at diagnosis. Oncol Nurs Forum 2012; 39:287-95. [PMID: 22543387 PMCID: PMC5018900 DOI: 10.1188/12.onf.287-295] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine the effect that age at diagnosis has on fear of breast cancer recurrence and to identify the predictors of fear of recurrence using self-efficacy as a mediator. DESIGN Cross-sectional survey. SETTING Two university cancer centers and one cooperative group in the midwestern United States. SAMPLE 1,128 long-term survivors. METHODS Survivors were eligible if they were aged 18-45 years (younger group) or 55-70 years (older group) at cancer diagnosis, had received chemotherapy, and were three to eight years postdiagnosis. Fear of recurrence was compared between younger and older groups. Multiple regression analyses were used to test variables' prediction of fear of recurrence and breast cancer survivor self-efficacy, as well as breast cancer survivor self-efficacy mediation effects. MAIN RESEARCH VARIABLES Fear of recurrence, breast cancer survivor self-efficacy, and age at diagnosis. FINDINGS Survivors diagnosed at a younger age had significantly higher fear of recurrence, as well as health, role, womanhood, death, and parenting worries. Perceived risk of recurrence, trait anxiety, and breast cancer reminders explained significant variance in fear of recurrence and breast cancer survivor self-efficacy. Breast cancer survivor self-efficacy partially mediated the effects of variables on fear of recurrence. CONCLUSIONS The findings suggest that breast cancer survivor self-efficacy may have a protective effect for survivors who are younger at diagnosis and have higher perceived risk of recurrence, higher trait anxiety, and more breast cancer reminders. Oncology nurses already use the skills required to support self-efficacy. Additional research is needed to define and test breast cancer survivor self-efficacy interventions. IMPLICATIONS FOR NURSING Oncology nurses are in a key role to assess fear of recurrence and provide self-efficacy interventions to reduce it in breast cancer survivors. Strategies to efficiently address fear of recurrence to reduce psychological distress in survivorship follow-up care are warranted.
Collapse
|
40
|
The influence of symptoms, social support, uncertainty, and coping on health-related quality of life among cholangiocarcinoma patients in northeast Thailand. Cancer Nurs 2012; 34:434-42. [PMID: 21372698 DOI: 10.1097/ncc.0b013e31820d0c3f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is an important outcome for evaluating the effectiveness of cancer care. Cholangiocarcinoma (CCA) is a major public health problem in northeast Thailand. There is little information regarding factors influencing HRQOL in CCA patients. Understanding the factors affecting HRQOL in CCA patients is necessary to develop nursing interventions to improve the HRQOL. OBJECTIVE The purpose of this study was to develop and test a model that explained the influence of symptoms, social support, uncertainty, and coping on the HRQOL in CCA patients. METHODS Using a cross-sectional descriptive design, a convenience sample of 260 CCA patients were consecutively recruited from a regional hospital and a university hospital in northeast Thailand. All participants responded to a set of 6 questionnaires in structured interview format. A linear structural relationship was used to test the hypothesized model. RESULTS Findings revealed the hypothesized model fit the empirical data and explained 69.4% of the variance of HRQOL. Symptoms were the most influential factor affecting HRQOL directly and indirectly through uncertainty. Social support had a direct effect on HRQOL and an indirect effect on HRQOL through uncertainty. Uncertainty had a direct effect on coping and HRQOL. Coping had a nonsignificant direct effect on HRQOL. CONCLUSION Symptoms, social support, and uncertainty were important factors influencing HRQOL in CCA patients. IMPLICATIONS FOR PRACTICE Cholangiocarcinoma is a unique yet understudied condition. Further work in developing CCA-specific HRQOL interventions is warranted.
Collapse
|
41
|
Koch L, Jansen L, Brenner H, Arndt V. Fear of recurrence and disease progression in long-term (≥5 years) cancer survivors-a systematic review of quantitative studies. Psychooncology 2012; 22:1-11. [PMID: 22232030 DOI: 10.1002/pon.3022] [Citation(s) in RCA: 318] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 11/28/2011] [Accepted: 11/30/2011] [Indexed: 01/11/2023]
Affiliation(s)
- L. Koch
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg; Germany
| | - L. Jansen
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg; Germany
| | - H. Brenner
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg; Germany
| | - V. Arndt
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg; Germany
| |
Collapse
|
42
|
Abstract
The aim of this study was to explore the phenomenon of feeling unsure as viewed from the humanbecoming school of thought. The Parse research method was used to guide this study and answer the question: What is the structure of the lived experience of feeling unsure? The central finding of the study is: Feeling unsure is wavering irresolutely with discerning ponderings arising in venturing with trepidation, while revering alliances. The findings are discussed in relation to the humanbecoming school of thought and related literature.
Collapse
|
43
|
Kim SH, Lee R, Lee KS. Symptoms and uncertainty in breast cancer survivors in Korea: differences by treatment trajectory. J Clin Nurs 2011; 21:1014-23. [DOI: 10.1111/j.1365-2702.2011.03896.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
44
|
Clayton MF, Latimer S, Dunn TW, Haas L. Assessing patient-centered communication in a family practice setting: how do we measure it, and whose opinion matters? PATIENT EDUCATION AND COUNSELING 2011; 84:294-302. [PMID: 21733653 DOI: 10.1016/j.pec.2011.05.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 05/18/2011] [Accepted: 05/25/2011] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This study evaluated variables thought to influence patient's perceptions of patient-centeredness. We also compared results from two coding schemes that purport to evaluate patient-centeredness, the Measure of Patient-Centered Communication (MPCC) and the 4 Habits Coding Scheme (4HCS). METHODS 174 videotaped family practice office visits, and patient self-report measures were analyzed. RESULTS Patient factors contributing to positive perceptions of patient-centeredness were successful negotiation of decision-making roles and lower post-visit uncertainty. MPCC coding found visits were on average 59% patient-centered (range 12-85%). 4HCS coding showed an average of 83 points (maximum possible 115). However, patients felt their visits were highly patient-centered (mean 3.7, range 1.9-4; maximum possible 4). There was a weak correlation between coding schemes, but no association between coding results and patient variables (number of pre-visit concerns, attainment of desired decision-making role, post-visit uncertainty, patients' perception of patient-centeredness). CONCLUSIONS Coder inter-rater reliability was lower than expected; convergent and divergent validity were not supported. The 4HCS and MPCC operationalize patient-centeredness differently, illustrating a lack of conceptual clarity. PRACTICE IMPLICATIONS The patient's perspective is important. Family practice providers can facilitate a more positive patient perception of patient-centeredness by addressing patient concerns to help reduce patient uncertainty, and by negotiating decision-making roles.
Collapse
|
45
|
Survivors of breast cancer: patient perspectives on survivorship care planning. J Cancer Surviv 2011; 5:337-44. [PMID: 21643836 DOI: 10.1007/s11764-011-0185-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 05/10/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Survivors of breast cancer (SBC) constitute the largest population of cancer survivors. Needs for survivorship care may vary according to life stage and urban/rural place of residence. This study was conducted to better understand patient preferences for survivorship care plans (SCP). METHODS Patients were identified through cancer agency electronic records and invited to participate by mail. Sessions were stratified by age and rural/urban place of residence. Participants were asked about preferences for content and format of SCP. Focus groups were conducted using a semi-structured format with interviews being taped, transcribed, cross-checked for accuracy, and analyzed independently, using constant comparative methods. RESULTS Preferred SCP key elements included treatment summary, information on nutrition/exercise, expected side effects, signs and symptoms of recurrence, recommended follow-up schedule, information sent to primary care physician, and updates on changes. SBC emphasized preference for individualized content depending upon physical and psychosocial effects. No difference was observed between preferred SCP content among patients residing in urban/rural areas. Rural participants preferred electronic formats for ongoing information bulletins and communication with health care providers. DISCUSSION/CONCLUSIONS SBC from all age groups identify common preferences for key SCP elements with individualized content reflecting the wide variation observed among physical and psychosocial effects of breast cancer. Patterns of key psychological, social, and physical effects observed at different life stages may help SCP customization. IMPLICATIONS FOR CANCER SURVIVORS Results provide direction for designing key content and format of SCP and also provide information about elements of care planning that should be customized to individual patient needs.
Collapse
|
46
|
Janz NK, Hawley ST, Mujahid MS, Griggs JJ, Alderman A, Hamilton AS, Graff JJ, Jagsi R, Katz SJ. Correlates of worry about recurrence in a multiethnic population-based sample of women with breast cancer. Cancer 2011; 117:1827-36. [PMID: 21445916 DOI: 10.1002/cncr.25740] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/09/2010] [Accepted: 09/27/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Worry about recurrence (worry) is a persistent concern of breast cancer survivors. Little is known about whether race/ethnicity or healthcare experiences are associated with worry. METHODS Women with nonmetastatic breast cancer diagnosed from June 2005 to February 2007 and reported to Detroit or Los Angeles Surveillance, Epidemiology, and End Results registries were surveyed (mean 9 months postdiagnosis); 2290 responded (73%). Latinas and African Americans were oversampled. A worry scale was constructed as the mean score of 3 items (on 5-point Likert, higher = more worry): worry about cancer returning to the same breast, occurring in the other breast, or spreading to other parts of the body. Race/ethnicity categories were white, African American, and Latina (categorized into low vs high acculturation). The worry scale was regressed on sociodemographics, clinical/treatment, and healthcare experience factors (eg, care coordination collapsed into low, medium, high). RESULTS Low acculturated Latinas reported more worry and African Americans less worry than whites (P < .001). Other factors independently associated with more worry were younger age, being employed, more pain and fatigue, and radiation (Ps < .05). With all factors in the model, less worry was associated (all Ps < .05) with greater ease of understanding information (2.89, 2.99, 2.81 for low, medium, high), better symptom management (3.19, 2.89, 2.87 for low, medium, high), and more coordinated care (3.36, 2.94, 2.82 for low, medium, high). Race/ethnicity remained significant controlling for all factors (P < .001). CONCLUSIONS Less acculturated Latina breast cancer patients are vulnerable to high levels of worry. Interventions that improve information exchange, symptom management, and coordinating care hold promise in reducing worry.
Collapse
Affiliation(s)
- Nancy K Janz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-20296, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Roundtree AK, Giordano SH, Price A, Suarez-Almazor ME. Problems in transition and quality of care: perspectives of breast cancer survivors. Support Care Cancer 2010; 19:1921-9. [PMID: 21140173 DOI: 10.1007/s00520-010-1031-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 10/18/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE We conducted a qualitative study to explore breast cancer survivors' perceptions and attitudes about their current healthcare utilization, screening, and information needs. METHODS We completed eight focus groups of breast cancer survivors. We included women, adult survivors, with an initial diagnosis of breast cancer in the year 2000, treated, and without a recurrence as per medical record. To analyze transcripts, we used grounded theory methods, wherein unexpected themes and direct answers emerged from consensus between co-coders. RESULTS Focus groups included 33 participants, the majority of whom were white (84.8%), college-educated (66.7%), and covered by private medical insurance (75.7%) or Medicare (27.3%). Participants' perceptions and attitudes about care were framed in terms of personal experiences (including facing barriers to screening, feeling in limbo in the healthcare system, having problems with communication with and between physicians, confusion about symptoms, and using self-prescribe remedies), personal attitudes (including strong opinions about what survivorship means, concerns about recurrence, and changes in self-perception and agency), and social influences (including modeling others' behaviors, changes in social life, and listening to family). CONCLUSION Survivorship attitudes, recurrence fears, memories, and self-perceptions were influential personal factors in addition to self-efficacy. Solutions such as providing a cancer treatment summary might resolve many of the problems by consolidating and making readily available the numerous medical history and recommendations that survivors accrue over time, switching from provider to provider. Clinicians must also implement communication changes in their interactions with patients to enhance positive attitudes and behaviors, and leverage social influences.
Collapse
Affiliation(s)
- Aimee Kendall Roundtree
- The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1465, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
48
|
Clayton MF. The impact of Health Communication research on cancer survivorship. HEALTH COMMUNICATION 2010; 25:565-566. [PMID: 20845143 DOI: 10.1080/10410236.2010.496719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
49
|
Zambroski CH, Combs P, Cronin SN, Pfeffer C. Edgar Allan Poe, "The pit and the pendulum," and ventricular assist devices. Crit Care Nurse 2010; 29:29-39; quiz 1 p following 39. [PMID: 19952336 DOI: 10.4037/ccn2009249] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
50
|
Fedele DA, Mullins LL, Eddington AR, Ryan JL, Junghans AN, Hullmann SE. Health-related Quality of Life in College Students with and without Childhood-Onset Asthma. J Asthma 2009. [DOI: 10.1080/02770900903184229] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|