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Brown SL, Hope-Stone L, van der Voort N, Hussain R, Heimann H, Coventry WL, Cherry MG. Associations between empirically proportionate and disproportionate fears of cancer recurrence and anxiety and depression in uveal melanoma survivors: Five-year prospective study. Br J Health Psychol 2024; 29:662-675. [PMID: 38462481 DOI: 10.1111/bjhp.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) may develop into elevated anxiety or depression symptoms, but few risk factors for this development are known. Objective recurrence risk estimation is possible in some cancers. Using theories of risk communication and phobias, we examined whether the proportionality of FCR to known objective recurrence risk influences the development of anxiety and depression symptoms. METHOD Uveal melanoma (UM) patients can opt for reliable prognostic testing. Patients experience either a 'good' or 'poor' prognostic outcome, whereby 10-year mortality due to metastatic disease is, respectively, low or high. In a five-year prospective study of a consecutive sample of 589 UM survivors, we used random intercept cross lagged panel analyses to examine whether proportionality differentially influences whether FCR progresses to anxiety and depression. RESULTS Positive cross paths predicting anxiety from FCR were stronger in the poor prognosis group than the good prognosis and not tested groups. Prognostic group differences were not evident for depression. CONCLUSIONS FCR was more likely to progress to elevated anxiety symptoms when proportionate to the known objective recurrence risk. Objective evidence may play a prominent role in the development and structure of fear because it assumes a high epistemic weight that activates a wide range of emotional and cognitive responses. Interventions that assist survivors to tolerate FCR in the presence of higher recurrence risks may be important in reducing anxiety symptoms.
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Affiliation(s)
| | - Laura Hope-Stone
- University of Liverpool, Liverpool, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nicola van der Voort
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rumana Hussain
- University of Liverpool, Liverpool, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Heinrich Heimann
- University of Liverpool, Liverpool, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Wehbe A, Gonte MR, O'Neill SC, Amit‐Yousif A, Purrington K, Manning M, Simon MS. Predictors of nonadherence to breast cancer screening guidelines in a United States urban comprehensive cancer center. Cancer Med 2023; 12:15482-15491. [PMID: 37329206 PMCID: PMC10417068 DOI: 10.1002/cam4.6182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/08/2023] [Accepted: 05/20/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND This study aimed to identify predictors of nonadherence to breast cancer screening guidelines in an urban screening clinic among high- and average-risk women in the United States. METHODS We reviewed records of 6090 women who received ≥2 screening mammograms over 2 years at the Karmanos Cancer Institute to examine how breast cancer risk and breast density were associated with guideline-concordant screening. Incongruent screening was defined as receiving supplemental imaging between screening mammograms for average-risk women, and as not receiving recommended supplemental imaging for high-risk women. We used t-tests and chi-square tests to examine bivariate associations with guideline-congruent screening, and probit regression to regress guideline-congruence unto breast cancer risk, breast density, and their interaction, controlling for age and race. RESULTS Incongruent screening was more likely among high- versus average-risk women (97.7% vs. 0.9%, p < 0.01). Among average-risk women, incongruent screening was more likely among those with dense versus nondense breasts (2.0% vs. 0.1%, p < 0.01). Among high-risk women, incongruent screening was more likely among those with nondense versus dense breasts (99.5% vs. 95.2%, p < 0.01). The significant main effects of density and high-risk on increased incongruent screening were qualified by a density by high-risk interaction, showing a weaker association between risk and incongruent screening among women with dense breasts (simple slope = 3.71, p < 0.01) versus nondense breasts (simple slope = 5.79, p < 0.01). Age and race were not associated with incongruent screening. CONCLUSIONS Lack of adherence to evidence-based screening guidelines has led to underutilization of supplementary imaging for high-risk women and potential overutilization for women with dense breasts without other risk factors.
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Affiliation(s)
- Alexandra Wehbe
- Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of OncologyBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Wayne State University School of MedicineDetroitMichiganUSA
| | - Madeleine R. Gonte
- Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Wayne State University School of MedicineDetroitMichiganUSA
| | - Suzanne C. O'Neill
- Department of Oncology, Lombardi Cancer CenterGeorgetown UniversityWashingtonDCUSA
| | - Alit Amit‐Yousif
- Center for Breast HealthOakland Macomb Obstetrics and GynecologyRochester HillsMichiganUSA
| | - Kristen Purrington
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
| | - Mark Manning
- Department of PsychologyOakland UniversityRochesterMichiganUSA
- Center for Molecular Medicine and GeneticsWayne State University School of MedicineDetroitMichiganUSA
| | - Michael S. Simon
- Department of OncologyBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
- Population Studies and Disparities Research ProgramBarbara Ann Karmanos Cancer InstituteDetroitMichiganUSA
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Woof VG, Howell A, McWilliams L, Gareth Evans D, French DP. How do women who are informed that they are at increased risk of breast cancer appraise their risk? A systematic review of qualitative research. Br J Cancer 2022; 127:1916-1924. [PMID: 36002751 PMCID: PMC9681857 DOI: 10.1038/s41416-022-01944-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/09/2022] Open
Abstract
This review aimed to synthesise qualitative research on how women notified that they are at increased risk of breast cancer view their risk. Five electronic databases were systematically reviewed for qualitative research investigating how women who have received an increased breast cancer risk estimate appraise their risk status. Fourteen records reporting 12 studies were included and critically appraised. Data were thematically synthesised. Four analytical themes were generated. Women appraise their risk of breast cancer through comparison with their risk of other familial diseases. Clinically derived risk estimates were understood in relation to pre-conceived risk appraisals, with incongruences met with surprise. Family history is relied upon strongly, with women exploring similarities and differences in attributes between themselves and affected relatives to gauge the likelihood of diagnosis. Women at increased risk reported living under a cloud of inevitability or uncertainty regarding diagnosis, resulting in concerns about risk management. Women hold stable appraisals of their breast cancer risk which appear to be mainly formed through their experiences of breast cancer in the family. Healthcare professionals should explore women's personal risk appraisals prior to providing clinically derived risk estimates in order to address misconceptions, reduce concerns about inevitability and increase perceived control over risk reduction.
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Affiliation(s)
- Victoria G. Woof
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Anthony Howell
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK ,grid.498924.a0000 0004 0430 9101The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9QZ UK
| | - Lorna McWilliams
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - D. Gareth Evans
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK ,grid.498924.a0000 0004 0430 9101The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9QZ UK
| | - David P. French
- grid.5379.80000000121662407University of Manchester, Oxford Road, Manchester, M13 9PL UK
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Brown SL, Fisher PL, Morgan A, Davies C, Olabi Y, Hope-Stone L, Heimann H, Hussain R, Cherry MG. 'I Don't Like Uncertainty, I Like to Know': How and why uveal melanoma patients consent to life expectancy prognostication. Health Expect 2022; 25:1498-1507. [PMID: 35474381 PMCID: PMC9327814 DOI: 10.1111/hex.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Technological advances have led to cancer prognostication that is increasingly accurate but often unalterable. However, a reliable prognosis of limited life expectancy can cause psychological distress. People should carefully consider offers of prognostication, but little is known about how and why they decide on prognostication. Using uveal melanoma (UM) patients, we aimed to identify (i) how and why do people with UM decide to accept prognostication and (ii) alignment and divergence of their decision-making from conceptualizations of a 'well-considered' decision. METHODS UM provides a paradigm to elucidate clinical and ethical perspectives on prognostication, because prognostication is reliable but prognoses are largely nonameliorable. We used qualitative methods to examine how and why 20 UM people with UM chose prognostication. We compared findings to a template of 'well-considered' decision-making, where 'well-considered' decisions involve consideration of all likely outcomes. RESULTS Participants wanted prognostication to reduce future worry about uncertain life expectancy. They spontaneously spoke of hoping for a good prognosis when making their decisions, but largely did not consider the 50% possibility of a poor prognosis. When pressed, they argued that a poor outcome at least brings certainty. CONCLUSIONS While respecting decisions as valid expressions of participants' wishes, we are concerned that they did not explicitly consider the realistic possibility of a poor outcome and how this would affect them. Thus, it is difficult to see their decisions as 'well-considered'. We propose that nondirective preference exploration techniques could help people to consider the possibility of a poor outcome. PATIENT OR PUBLIC CONTRIBUTION This paper is a direct response to a patient-identified and defined problem that arose in therapeutic and conversational discourse. The research was informed by the responses of patient participants, as we used the material from interviews to dynamically shape the interview guide. Thus, participants' ideas drove the analysis and shaped the interviews to come.
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Affiliation(s)
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Andrew Morgan
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Cari Davies
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Yasmin Olabi
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Laura Hope-Stone
- School of Psychology, University of Plymouth, Plymouth, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Heinrich Heimann
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rumana Hussain
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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5
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Brown SL, Beesley H, Holcombe C, Saini P, Salmon P. Warranting the decision-maker, not the decision: How healthcare practitioners evaluate the legitimacy of patients' unprompted requests for risk-reducing mastectomy. PATIENT EDUCATION AND COUNSELING 2019; 102:1446-1451. [PMID: 30922623 DOI: 10.1016/j.pec.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/12/2019] [Accepted: 03/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Shared decision-making exists to reconcile healthcare practitioners' responsibilities to respect patients' autonomy whilst ensuring well-made decisions. Patients sometimes make unprompted requests for procedures that carry medical and other risks, such as risk-reducing mastectomy (RRM). Faced with pre-formed decisions into which they have had little input, it is unclear how practitioners can reconcile respecting autonomy with ensuring well-made decisions. METHODS Qualitative study of linked patient-practitioner interviews in a breast unit in North-West England. We examined how 10 practitioners addressed 19 patients' unprompted requests for RRM. RESULTS Practitioners empathised with patients' distress about cancer risk, regarded RRM as legitimate to help, but were wary of choices made 'emotionally'. Practitioners did not seek to establish whether choices were well-made but, instead, 'warranted' patients by satisfying themselves that patients were 'sensible' and 'informed' decision-makers, and thus their decisions could be trusted. Practitioners provided information, and tested patients' resolve by delaying decisions and presenting 'what if' scenarios depicting failure or harm from RRM. CONCLUSION Patients who present emotionally and with resolution can receive RRM without evidence of a well-made decision. PRACTICE IMPLICATIONS Argumentation theory proposes an ethically robust and clinically practicable approach, whereby practitioners elicit, examine and, where appropriate, challenge arguments underpinning patients' decisions.
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Affiliation(s)
- Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, United Kingdom; School of Psychology, University of Adelaide, Australia.
| | - Helen Beesley
- Department of Psychological Sciences, University of Liverpool, United Kingdom
| | - Christopher Holcombe
- Department of Psychological Sciences, University of Liverpool, United Kingdom; Royal Liverpool and Broadgreen University Hospitals Trust, United Kingdom
| | - Pooja Saini
- School of Natural Sciences and Psychology, Liverpool John Moores University, United Kingdom
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, United Kingdom
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6
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Brown SL, Salmon P. Reconciling the theory and reality of shared decision-making: A "matching" approach to practitioner leadership. Health Expect 2018; 22:275-283. [PMID: 30478979 PMCID: PMC6543140 DOI: 10.1111/hex.12853] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022] Open
Abstract
Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that patients and practitioners negotiate decisions. In practice, patients often do not wish to participate in decisions, or cannot make good decisions. Consequently, practitioners sometimes lead decision making, but doing so risks the paternalism that SDM is intended to avoid. We argue that practitioners should take leadership when patients cannot make good decisions, but practitioners will need to know: (a) when good decisions are not being made; and (b) how to intervene appropriately and proportionately when patients cannot make good decisions. Regarding (a), patients rarely make decisions using formal decision logic, but rely on informal propositions about risks and benefits. As propositions are idiographic and their meanings context‐dependent, normative standards of decision quality cannot be imposed. Practitioners must assess decision quality by making subjective and contextualized judgements as to the “reasonableness” of the underlying propositions. Regarding (b), matched to judgements of reasonableness, we describe levels of leadership distinguished according to how directively practitioners act; ranging from prompting patients to question unreasonable propositions or consider new propositions, to directive leadership whereby practitioners recommend options or deny requested procedures. In the context of ideas of relational autonomy, the objective of practitioner leadership is to protect patients’ autonomy by supporting good decision making, taking leadership in patients’ interests only when patients are unwilling or unable to make good decisions.
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Affiliation(s)
- Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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7
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Heightened perception of breast cancer risk in young women at risk of familial breast cancer. Fam Cancer 2017; 17:15-22. [DOI: 10.1007/s10689-017-0001-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Fielden HG, Brown SL, Saini P, Beesley H, Salmon P. How do women at increased breast cancer risk perceive and decide between risks of cancer and risk-reducing treatments? A synthesis of qualitative research. Psychooncology 2016; 26:1254-1262. [PMID: 27983769 PMCID: PMC5599983 DOI: 10.1002/pon.4349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022]
Abstract
Objective Risk‐reducing procedures can be offered to people at increased cancer risk, but many procedures can have iatrogenic effects. People therefore need to weigh risks associated with both cancer and the risk‐reduction procedure in their decisions. By reviewing relevant literature on breast cancer (BC) risk reduction, we aimed to understand how women at relatively high risk of BC perceive their risk and how their risk perceptions influence their decisions about risk reduction. Methods Synthesis of 15 qualitative studies obtained from systematic searches of SCOPUS, Web of Knowledge, PsychINFO, and Medline electronic databases (inception‐June 2015). Results Women did not think about risk probabilistically. Instead, they allocated themselves to broad risk categories, typically influenced by their own or familial experiences of BC. In deciding about risk‐reduction procedures, some women reported weighing the risks and benefits, but papers did not describe how they did so. For many women, however, an overriding wish to reduce intense worry about BC led them to choose aggressive risk‐reducing procedures without such deliberation. Conclusions Reasoning that categorisation is a fundamental aspect of risk perception, we argue that patients can be encouraged to develop more nuanced and accurate categorisations of their own risk through their interactions with clinicians. Empirically‐based ethical reflection is required to determine whether and when it is appropriate to provide risk‐reduction procedures to alleviate worry.
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Affiliation(s)
- Hannah G Fielden
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Pooja Saini
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,CLAHRC North West, University of Liverpool, Liverpool, UK
| | - Helen Beesley
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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