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Lopez-Olivo MA, Maki KG, Choi NJ, Hoffman RM, Shih YCT, Lowenstein LM, Hicklen RS, Volk RJ. Patient Adherence to Screening for Lung Cancer in the US: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2025102. [PMID: 33196807 PMCID: PMC7670313 DOI: 10.1001/jamanetworkopen.2020.25102] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022] Open
Abstract
Importance To be effective in reducing deaths from lung cancer among high-risk current and former smokers, screening with low-dose computed tomography must be performed periodically. Objective To examine lung cancer screening (LCS) adherence rates reported in the US, patient characteristics associated with adherence, and diagnostic testing rates after screening. Data Sources Five electronic databases (MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched for articles published in the English language from January 1, 2011, through February 28, 2020. Study Selection Two reviewers independently selected prospective and retrospective cohort studies from 95 potentially relevant studies reporting patient LCS adherence. Data Extraction and Synthesis Quality appraisal and data extraction were performed independently by 2 reviewers using the Newcastle-Ottawa Scale for quality assessment. A random-effects model meta-analysis was conducted when at least 2 studies reported on the same outcome. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline. Main Outcomes and Measures The primary outcome was LCS adherence after a baseline screening. Secondary measures were the patient characteristics associated with adherence and the rate of diagnostic testing after screening. Results Fifteen studies with a total of 16 863 individuals were included in this systematic review and meta-analysis. The pooled LCS adherence rate across all follow-up periods (range, 12-36 months) was 55% (95% CI, 44%-66%). Regarding patient characteristics associated with adherence rates, current smokers were less likely to adhere to LCS than former smokers (odds ratio [OR], 0.70; 95% CI, 0.62-0.80); White patients were more likely to adhere to LCS than patients of races other than White (OR, 2.0; 95% CI, 1.6-2.6); people 65 to 73 years of age were more likely to adhere to LCS than people 50 to 64 years of age (OR, 1.4; 95% CI, 1.0-1.9); and completion of 4 or more years of college was also associated with increased adherence compared with people not completing college (OR, 1.5; 95% CI, 1.1-2.1). Evidence was insufficient to evaluate diagnostic testing rates after abnormal screening scan results. The main source of variation was attributable to the eligibility criteria for screening used across studies. Conclusions and Relevance In this study, the pooled LCS adherence rate after a baseline screening was far lower than those observed in large randomized clinical trials of screening. Interventions to promote adherence to screening should prioritize current smokers and smokers from minority populations.
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Affiliation(s)
- Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Kristin G. Maki
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Noah J. Choi
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Richard M. Hoffman
- Department of Internal Medicine, The Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Lisa M. Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Rachel S. Hicklen
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
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Grimm LJ, Shelby RA, Knippa EE, Langman EL, Miller LS, Whiteside BA, Soo MS. Frequency of Breast Cancer Thoughts and Lifetime Risk Estimates: A Multi-Institutional Survey of Women Undergoing Screening Mammography. J Am Coll Radiol 2019; 16:1393-1400. [DOI: 10.1016/j.jacr.2018.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
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Waters EA, Ackerman N, Wheeler CS. Cognitive and Affective Responses to Mass-media Based Genetic Risk Information in a Socio-demographically Diverse Sample of Smokers. JOURNAL OF HEALTH COMMUNICATION 2019; 24:700-710. [PMID: 31525122 PMCID: PMC6900866 DOI: 10.1080/10810730.2019.1664676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Many individuals receive information about genomics from the mass media. When media reports are about conditions that are considered behavioral, such as smoking, they may negatively affect some health-promoting cognitions. We examined how informing adult smokers about the genetic basis for nicotine addiction influenced smoking-related health cognitions and affect and whether responses varied by socio-demographics or genetics beliefs. We recruited 392 smokers (Mage = 44.5, 52.8% African American, 51.3% no college experience, 66.2% women) from public locations in a mid-sized Midwestern city. They were randomly assigned to read a news article describing either a pharmacy's decision to stop selling tobacco (n = 78) or the discovery of a gene associated with increased risk of nicotine addiction and lung cancer (n = 314). Participants also completed a survey assessing socio-demographics, health cognitions (quit intentions, self-efficacy, response efficacy, perceived risk), affect (worry, anticipated regret), genetic determinism, and other genetics beliefs. ANOVAs revealed no statistically significant main effects of genetic information on any health cognitions or affects. Linear regressions revealed that socio-demographics and genetics beliefs moderated very few effects. This suggests that concerns that mass media-based dissemination of genetic discoveries may have detrimental effects on smoking-related cognitions and affects are likely unwarranted.
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Affiliation(s)
- Erika A Waters
- Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Nicole Ackerman
- Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Courtney S Wheeler
- Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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Whitney CA, Dorfman CS, Shelby RA, Keefe FJ, Gandhi V, Somers TJ. Reminders of cancer risk and pain catastrophizing: relationships with cancer worry and perceived risk in women with a first-degree relative with breast cancer. Fam Cancer 2019; 18:9-18. [PMID: 29679190 DOI: 10.1007/s10689-018-0082-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
First-degree relatives of women with breast cancer may experience increased worry or perceived risk when faced with reminders of their own cancer risk. Worry and risk reminders may include physical symptoms (e.g., persistent breast pain) and caregiving experiences. Women who engage in pain catastrophizing may be particularly likely to experience increased distress when risk reminders are present. We examined the degree to which persistent breast pain and experience as a cancer caregiver were related to cancer worry and perceived risk in first-degree relatives of women with breast cancer (N = 85) and how catastrophic thoughts about breast pain could impact these relationships. There was a significant interaction between persistent breast pain and pain catastrophizing in predicting cancer worry (p = .03); among women who engaged in pain catastrophizing, cancer worry remained high even in the absence of breast pain. Pain catastrophizing also moderated the relationships between caregiving involvement and cancer worry (p = .003) and perceived risk (p = .03). As the degree of caregiving responsibility increased, cancer worry and perceived risk increased for women who engaged in pain catastrophizing; levels of cancer worry and perceived risk remained low and stable for women who did not engage in pain catastrophizing regardless of caregiving experience. The results suggest that first-degree relatives of breast cancer survivors who engage in pain catastrophizing may experience greater cancer worry and perceived risk and may benefit from interventions aimed at reducing catastrophic thoughts about pain.
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Affiliation(s)
- Colette A Whitney
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Vicky Gandhi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA.
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Wong EC, Kaplan CP, Dreher N, Hwang J, Van't Veer L, Melisko ME. Integration of Health Questionnaire Systems to Facilitate Supportive Care Services for Patients at an Academic Breast Care Center. JCO Clin Cancer Inform 2019; 2:1-13. [PMID: 30652601 DOI: 10.1200/cci.18.00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study evaluated the use of an electronic Health Questionnaire System (HQS) within the University of California San Francisco Breast Care Center as a screening and triage tool to proactively recognize patients' supportive care needs during new patient consultations and identify demographic characteristics associated with referrals to three supportive care services. PATIENTS AND METHODS A total of 428 patients with and without breast cancer between the ages of 18 and 84 years completed HQS intake forms before appointments at the University of California San Francisco Breast Care Center between November 2014 and May 2015 and agreed to participate in this study. Patient HQS responses triggered referrals to supportive care services, and a review of electronic health records was conducted to determine the outcomes of these referrals. RESULTS A total of 242 patients (56.5%) met criteria for at least one supportive care referral. Women with invasive breast cancer or ductal carcinoma in situ met criteria for supportive services more frequently than women without breast cancer diagnoses (76.9% v 23.8%; P < .001) and were most likely to receive referrals for genetic counseling (67.0%), psychological services (32.2%), and social services (12.1%). Multivariable logistic regression analysis showed that being married was associated with fewer referrals to social work (OR, 0.42; 95% CI, 0.21 to 0.81) and that those between 45 and 54 years of age were less likely to receive referrals to genetic counseling than those ≥ 55 years of age (OR, 0.41; 95% CI, 0.23 to 0.73). Among all referrals (n = 369), 26.8% resulted in completed appointments. CONCLUSION Using an automated intake form is an efficient way to identify and triage individuals in need of supportive care services and can provide insight into the populations with supportive care needs for targeted outreach.
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Affiliation(s)
- Emily C Wong
- All authors: University of California San Francisco, San Francisco, California
| | - Celia P Kaplan
- All authors: University of California San Francisco, San Francisco, California
| | - Nickolas Dreher
- All authors: University of California San Francisco, San Francisco, California
| | - Jimmy Hwang
- All authors: University of California San Francisco, San Francisco, California
| | - Laura Van't Veer
- All authors: University of California San Francisco, San Francisco, California
| | - Michelle E Melisko
- All authors: University of California San Francisco, San Francisco, California
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Andersen MR, Karlan BY, Drescher CW, Paley P, Hawley S, Palomares M, Daly MB, Urban N. False-positive screening events and worry influence decisions about surgery among high-risk women. Health Psychol 2019; 38:43-52. [PMID: 30431292 PMCID: PMC6738558 DOI: 10.1037/hea0000647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Studies of cancer screening have found that false positive screening events (FPSE) can affect worry about cancer risk and screening program use, we sought to further explore this. METHOD In a study of 1,100 women at high risk for ovarian cancer who participated in a previously published randomized controlled trial (RCT), we sought to explore whether worry might also influence the use of risk-reducing surgical procedures by women. Participants included 234 women with BRCA1/2 mutations and 866 women with high-risk pedigrees. We followed the women for up to 6 years. RESULTS Worry predicted risk reducing prophylactic bilateral salpingo-oophorectomy (pBSO) for both mutation carriers (HR = 1.74; p = .02), and women with high-risk pedigree (HR = 3.41; p < .001). FPSE also predicted subsequent pBSO among women with a high-risk pedigree (HR 2.31; p < .01). While screening may reduce worry among those who never receive a positive result, FPSE increase worry at least temporarily. Worry about ovarian cancer risk predicted use of preventative pBSO among high-risk women including those with BRCA1/2 mutations enrolled in an ovarian cancer-screening program. FPSE also predicted risk-reducing ovarian surgery among high-risk women without a known mutation at the time of screening program enrollment. CONCLUSIONS Physicians who offer screening should know that false positive results may increase use of pBSO, how this should effect clinical practice is unclear. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Paula NCNMD, Martins JAM, Amaral LM, Rhana P, Tavares EC, Leite WS, Tavares GR, Rodrigues ALP. Breast cancer: Is grief a risk factor? ACTA ACUST UNITED AC 2018; 64:595-600. [PMID: 30365661 DOI: 10.1590/1806-9282.64.07.595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/06/2017] [Indexed: 11/21/2022]
Abstract
Cancer is characterized by the disordered growth of cells that have high capacity of invasion to the tissues and organs. One of the types of tumour that has national incidence and high mortality is breast cancer. Studies show that in addition to hereditary factors, lifestyle and environmental factors, there are factors related to emotional distress (mourning), which interfere with the development of breast cancer. Thus, it is necessary to investigate if the experience of mourning can trigger the appearance of the tumour. For this, an integrative review was performed to verify the existence of the relationship between mourning and development of breast cancer, which presented contradictory results. Methodological errors and lack of access to important information, such as alcohol and tobacco use, were pointed out as the main causes of the contradiction found. A possible mechanism involving cortisol release has been proposed, but more research is needed to make it clear whether the association between mourning and breast cancer really exists, and by what path.
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Affiliation(s)
| | | | - Lorena Maciel Amaral
- School of Human, Social and Health Sciences, Fumec University, Belo Horizonte, MG, Brasil
| | - Paula Rhana
- Biochemistry and Immunology Department, Biological Sciences Institute, Federal University of Minas Gerais, Belo Horizonte, MG, Brasil
| | - Eduardo Carlos Tavares
- School of Human, Social and Health Sciences, Fumec University, Belo Horizonte, MG, Brasil
| | - Wilson Soares Leite
- School of Human, Social and Health Sciences, Fumec University, Belo Horizonte, MG, Brasil
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Kaufman AR, Dwyer LA, Land SR, Klein WMP, Park ER. Smoking-related health beliefs and smoking behavior in the National Lung Screening Trial. Addict Behav 2018; 84:27-32. [PMID: 29605757 PMCID: PMC6101245 DOI: 10.1016/j.addbeh.2018.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/20/2022]
Abstract
Understanding the association between smoking-related health beliefs and smoking cessation in the context of lung screening is important for effective cessation treatment. The purpose of the current study is to explore how current smokers' self-reported smoking-related health cognitions (e.g., self-efficacy) and emotions (e.g., worry) are related to cessation. This study utilized longitudinal data from current smokers (age 55-74) in a sub-study of the National Lung Screening Trial (NLST; 2002-2006; N = 2738). Logistic regression analyses examined associations of cessation at last assessment with smoking-related health cognitions and emotions, demographics, and two-way interactions among smoking-related health cognition and emotion variables, gender, and age. Over 37% (n = 1028) of smokers had quit at their last assessment of smoking status. Simple logistic regressions showed the likelihood of quitting was greater among participants reporting higher perceived severity of smoking-related diseases (OR = 1.17, p = .04), greater self-efficacy for quitting (OR = 1.32, p < .001), and fewer perceived barriers to quitting (OR = 0.82, p = .01). Likelihood of quitting was lower among non-Hispanic Black participants (versus non-Hispanic White participants) (OR = 0.68, p = .04) and higher among older participants (OR = 1.03, p = .002). Multiple logistic regression showed that participants reporting greater self-efficacy for quitting (B = 0.09, p = .05), fewer perceived barriers to quitting (B = -0.22, p = .01), and who were older (B = 0.03, p < .01) were more likely to quit smoking. These results suggest that, among heavy smokers undergoing lung screening, smoking-related health cognitions and emotions are associated with smoking cessation. These health beliefs must be considered an integral component of cessation in screening settings.
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Affiliation(s)
- Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States.
| | - Laura A Dwyer
- Cape Fox Facilities Services, 7050 Infantry Ridge Road, Manassas, VA 20109, United States
| | - Stephanie R Land
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - William M P Klein
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - Elyse R Park
- MGH/Harvard Medical School, 100 Cambridge Street, 16th Floor, Boston, MA 02114, United States
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Arnold M, Quante AS. Personalized Mammography Screening and Screening Adherence-A Simulation and Economic Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:799-808. [PMID: 30005752 DOI: 10.1016/j.jval.2017.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/23/2017] [Accepted: 12/13/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Personalized breast cancer screening has so far been economically evaluated under the assumption of full screening adherence. This is the first study to evaluate the effects of nonadherence on the evaluation and selection of personalized screening strategies. METHODS Different adherence scenarios were established on the basis of findings from the literature. A Markov microsimulation model was adapted to evaluate the effects of these adherence scenarios on three different personalized strategies. RESULTS First, three adherence scenarios describing the relationship between risk and adherence were identified: 1) a positive association between risk and screening adherence, 2) a negative association, or 3) a curvilinear relationship. Second, these three adherence scenarios were evaluated in three personalized strategies. Our results show that it is more the absolute adherence rate than the nature of the risk-adherence relationship that is important to determine which strategy is the most cost-effective. Furthermore, probabilistic sensitivity analyses showed that there are risk-stratified screening strategies that are more cost-effective than routine screening if the willingness-to-pay threshold for screening is below US $60,000. CONCLUSIONS Our results show that "nonadherence" affects the relative performance of screening strategies. Thus, it is necessary to include the true adherence level to evaluate personalized screening strategies and to select the best strategy.
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Affiliation(s)
- Matthias Arnold
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany; Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
| | - Anne S Quante
- Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, Germany; Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Department of Gynecology and Obstetrics, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
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Kudach C, Dunwoody C, Wesmiller S. The Relationship of Age and Postoperative Pain in Women after Surgery for Breast Cancer. Pain Manag Nurs 2018; 19:348-353. [PMID: 29503215 DOI: 10.1016/j.pmn.2017.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 12/19/2017] [Accepted: 12/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the past, elderly women with breast cancer were not offered surgery because of beliefs that they would experience serious complications from comorbidities and increased chronological age. Today the decision to offer surgery is based on a woman's fitness rather than her age. OBJECTIVE The purpose of this study is to compare the experience of postoperative nausea and vomiting (PONV), anxiety, and reported pain levels in women who represent four different age groups after breast cancer surgery. This study employed a prospective comparative design. A large women's hospital which houses a Comprehensive Breast Care Program. Women diagnosed with early stage breast cancer and scheduled for surgical resection. METHODS Postoperative pain was measured in the postanesthesia care unit using an 11-point verbal pain scale, PONV was measured categorically, and if present, severity of nausea was assessed. Anxiety was measured preoperatively by the short-form Profile of Mood States. FINDINGS A total of 97 women aged 37-78 participated in this study. Overall, 35% of all women experienced PONV; only two women (18%) in the highest age range (70-79) experienced PONV, yet they reported significantly more pain than women in the other age groups. Understanding the difference in postoperative symptoms experienced by older woman after surgery for breast cancer will support the development of age-specific strategies.
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Affiliation(s)
| | - Colleen Dunwoody
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Susan Wesmiller
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA.
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Dunn CE, Edwards A, Carter B, Field JK, Brain K, Lifford KJ. The role of screening expectations in modifying short-term psychological responses to low-dose computed tomography lung cancer screening among high-risk individuals. PATIENT EDUCATION AND COUNSELING 2017; 100:1572-1579. [PMID: 28274672 DOI: 10.1016/j.pec.2017.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study aimed to examine the relationship between pre-screening expectations and psychological responses to low-dose computerised tomography (LDCT) screening among high-risk individuals in the United Kingdom Lung Cancer Screening (UKLS) pilot trial. METHODS Prior to screening, high-risk individuals randomised into the intervention arm of the UKLS were asked about their expected screening test result. Their actual LDCT scan result was compared with their baseline screening expectation to determine the level of congruence. Levels of concern about and perceived accuracy of the result were assessed in a questionnaire two weeks following receipt of their test result. RESULTS The sample included 1589 participants. Regardless of their expected results, patients who required follow-up investigations after their initial LDCT scan were the most concerned about their result (p<0.001). Participants who expected to require follow-up, but did not need it, perceived the test to be least accurate (p=0.006). CONCLUSIONS Lung cancer screening participants who require follow-up or who have unexpected negative results can be identified for supportive interventions. PRACTICAL IMPLICATIONS These findings can be used to ensure that any future LDCT lung cancer screening programme is tailored to identify and support those high-risk individuals who may benefit from additional help.
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Affiliation(s)
- Charlotte E Dunn
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Ben Carter
- Division of Population Medicine, Cardiff University, Cardiff, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London,UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Kate J Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK.
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Bowen DJ, Robbins R, Bush N, Meischke H, Ludwig A, Wooldridge J. Effects of a web-based intervention on women's breast health behaviors. Transl Behav Med 2017; 7:309-319. [PMID: 28097625 PMCID: PMC5526799 DOI: 10.1007/s13142-016-0439-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Helping women make choices to reduce cancer risk and to improve breast health behaviors is important, but the best ways to reach more people with intervention assistance is not known. To test the efficacy of a web-based intervention designed to help women make better breast health choices, we adapted our previously tested, successful breast health intervention package to be delivered on the Internet, and then we tested it in a randomized trial. We recruited women from the general public to be randomized to either an active intervention group or a delayed intervention control group. The intervention consisted of a specialized website providing tailored and personalized risk information to all participants, followed by offers of additional support if needed. Follow-up at one-year post randomization revealed significant improvements in mammography screening in intervention women compared with control women (improvement of 13 percentage points). The intervention effects were more powerful in women who increased breast health knowledge and decreased cancer worry during intervention. These data indicate that increases in mammography can be accomplished in population-based mostly insured samples by implementing this simple, low resource intensive intervention.
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Affiliation(s)
- Deborah J Bowen
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA, 98109-1024, USA.
| | - Robert Robbins
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA, 98109-1024, USA
| | - Nigel Bush
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA, 98109-1024, USA
| | - Hendrika Meischke
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA, 98109-1024, USA
| | - Abi Ludwig
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA, 98109-1024, USA
| | - Jean Wooldridge
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA, 98109-1024, USA
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Ruberg JL, Helm CW, Felleman BI, Helm JE, Studts JL. Is attendance at an ovarian cancer screening clinic a worry-reducing event? Findings from pre- to post-screening. Gynecol Oncol 2016; 144:363-368. [PMID: 27986270 DOI: 10.1016/j.ygyno.2016.11.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Many studies have examined the relationship between worry and cancer screening. Due to methodological inconsistencies, results of these studies have varied and few conclusions can be made when generalizing across studies. The purpose of the current study was to better understand the worry-cancer screening relationship using a prospective research design. METHOD 180 women enrolled in an annual ovarian cancer (OC) screening clinic completed surveys at three time points-pre-screening, day of screening, and post-screening-using three measures of cancer-specific worry. RESULTS OC worry was highest in the weeks prior to screening and mere presentation at a screening clinic was associated with a significant worry decline. Observed elevations in worry following abnormal screening were not universal and varied by the instrument used to measure worry. CONCLUSIONS In contrast to our hypotheses, it appears that mere presentation at a cancer screening clinic may be a worry-reducing event. Receipt of abnormal results was not necessarily associated with increased worry.
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Affiliation(s)
- Joshua L Ruberg
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States; VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, United States; Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - C William Helm
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States
| | - Benjamin I Felleman
- VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, United States
| | - Jane E Helm
- University of Louisville, Louisville, KY 40292, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States
| | - Jamie L Studts
- University of Louisville, Louisville, KY 40292, United States; University of Kentucky College of Medicine, Lexington, KY 40536-0086, United States; James Graham Brown Cancer Center, 529 South Jackson Street, Louisville, KY 40202, United States; Lucille P. Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, United States
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April-Sanders A, Oskar S, Shelton RC, Schmitt KM, Desperito E, Protacio A, Tehranifar P. Predictors of Breast Cancer Worry in a Hispanic and Predominantly Immigrant Mammography Screening Population. Womens Health Issues 2016; 27:237-244. [PMID: 27863982 DOI: 10.1016/j.whi.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/01/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Worry about developing breast cancer (BC) has been associated with participation in screening and genetic testing and with follow-up of abnormal screening results. Little is known about the scope and predictors of BC worry in Hispanic and immigrant populations. METHODS We collected in-person interview data from 250 self-identified Hispanic women recruited from an urban mammography facility (average age 50.4 years; 82% foreign-born). Women reported whether they worried about developing breast cancer rarely/never (low worry), sometimes (moderate worry), or often/all the time (high worry). We examined whether sociocultural and psychological factors (e.g., acculturation, education, perceived risk), and risk factors and objective risk for BC (e.g., family history, Gail model 5-year risk estimates, parity) predicted BC worry using multinomial and logistic regression. RESULTS In multivariable models, women who perceived higher absolute BC risk (odds ratio, 1.66 [95% confidence interval, 1.28-2.14] for a one-unit increase in perceived lifetime risk) and comparative BC risk (e.g., odds ratio, 2.73, 95% confidence interval, 1.23-6.06) were more likely to report high BC worry than moderate or low BC worry. There were no associations between BC worry and indicators of objective risk or acculturation. CONCLUSIONS In Hispanic women undergoing screening mammography, higher perceptions of BC risk, in both absolute and comparative terms, were associated independently with high BC worry, and were stronger predictors of BC worry than indicators of objective BC risk, including family history, mammographic density, and personal BC risk estimates.
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Affiliation(s)
- Ayana April-Sanders
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Sabine Oskar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Division of Academics, School of Nursing, Columbia University, New York, New York; Avon Foundation Breast Imaging Center-New York Presbyterian, New York, New York
| | - Elise Desperito
- Department of Radiology, Columbia University Medical Center-New York Presbyterian, New York, New York
| | - Angeline Protacio
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
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15
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Kaufman AR, Koblitz AR, Persoskie A, Ferrer RA, Klein WMP, Dwyer LA, Park ER. Factor Structure and Stability of Smoking-Related Health Beliefs in the National Lung Screening Trial. Nicotine Tob Res 2016; 18:321-9. [PMID: 25964503 PMCID: PMC4757932 DOI: 10.1093/ntr/ntv091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 04/19/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Absolute and comparative risk perceptions, worry, perceived severity, perceived benefits, and self-efficacy are important theoretical determinants of tobacco use, but no measures have been validated to ensure the discriminant validity as well as test-retest reliability of these measures in the tobacco context. The purpose of the current study is to examine the reliability and factor structure of a measure assessing smoking-related health cognitions and emotions in a national sample of current and former heavy smokers in the National Lung Screening Trial. METHODS A sub-study of the National Lung Screening Trial assessed current and former smokers' (age 55-74; N = 4379) self-reported health cognitions and emotions at trial enrollment and at 12-month follow-up. Items were derived from the Health Belief Model and Self-Regulation Model. RESULTS An exploratory factor analysis of baseline responses revealed a five-factor structure for former smokers (risk perceptions, worry, perceived severity, perceived benefits, and self-efficacy) and a six-factor structure for current smokers, such that absolute risk and comparative risk perceptions emerged as separate factors. A confirmatory factor analysis of 12-month follow-up responses revealed a good fit for the five latent constructs for former smokers and six latent constructs for current smokers. Longitudinal stability of these constructs was also demonstrated. CONCLUSIONS This is the first study to examine tobacco-related health cognition and emotional constructs over time in current and former heavy smokers undergoing lung screening. This study found that the theoretical constructs were stable across time and that the factor structure differed based on smoking status (current vs. former).
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Affiliation(s)
- Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD;
| | - Amber R Koblitz
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Alexander Persoskie
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - William M P Klein
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Laura A Dwyer
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Elyse R Park
- Massachusetts General Hospital Mongan Institute for Health Policy and Cancer Center, Boston, MA
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16
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Andersen MR, Thorpe J, Buist DSM, Beatty JD, Watabayashi K, Hanson N, Resta R, Chubak J, Urban N. Cancer Risk Awareness and Concern among Women with a Family History of Breast or Ovarian Cancer. Behav Med 2016; 42:18-28. [PMID: 25062114 PMCID: PMC4469617 DOI: 10.1080/08964289.2014.947234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Women with a documented deleterious mutation in BRCA1 or BRCA2 are at substantially elevated risk for ovarian cancer. To understand what percentage of women with high-risk family histories know their risk is elevated we surveyed 1,885 women with a high- or moderate-risk family history and no personal history of breast or ovarian cancer, and asked about their perceived risk of breast and ovarian cancer. Among high-risk women, fewer than 20% reported use of genetic counseling, and knowledge of elevated risk of ovarian cancer was low. Prior genetic counseling was associated with greater perceived risk for ovarian cancer. Results suggest that most high-risk women (>75%) do not know their risk for ovarian cancer. Identification of potentially high-risk women for referral to genetic counseling may improve informed ovarian cancer risk management.
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Affiliation(s)
- M. Robyn Andersen
- Public Health Sciences Division: Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Health Services: University of Washington, Seattle, WA,Department of Epidemiology: University of Washington, Seattle WA
| | - Jason Thorpe
- Public Health Sciences Division: Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Diana SM Buist
- Public Health Sciences Division: Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Health Services: University of Washington, Seattle, WA,Department of Epidemiology: University of Washington, Seattle WA,Group Health Research Institute, Seattle WA
| | - J. David Beatty
- Public Health Sciences Division: Fred Hutchinson Cancer Research Center, Seattle, WA,Swedish Hospital, Seattle WA
| | - Kate Watabayashi
- Public Health Sciences Division: Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Jessica Chubak
- Department of Epidemiology: University of Washington, Seattle WA,Group Health Research Institute, Seattle WA
| | - Nicole Urban
- Public Health Sciences Division: Fred Hutchinson Cancer Research Center, Seattle, WA,Department of Health Services: University of Washington, Seattle, WA
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17
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Kim J, Huh BY, Han HR. Correlates of misperception of breast cancer risk among Korean-American Women. Women Health 2015; 56:634-49. [PMID: 26580449 DOI: 10.1080/03630242.2015.1118722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this study, the authors investigate the factors associated with misperception of breast cancer risk, including unrealistic optimism and unrealistic pessimism, among Korean-American women (KAW). Baseline data were collected between March 2010 and October 2011 from 421 KAW aged 40-65 years who participated in a community-based randomized intervention trial designed to promote breast and cervical cancer screening. Multivariate multinomial regression was performed to identify correlates of misperception of breast cancer risk among KAW. A total of 210 KAW (49.9%) had breast cancer risk perception consistent with their objective risk, whereas 50.1% of KAW in the study had some form of misperception of risk. Specifically, 167 participants (39.7%) were unrealistically optimistic about their own breast cancer risk; 44 (10.5%) were unrealistically pessimistic. In multivariate multinomial logistic regression analysis, living with a partner and higher education were significantly associated with higher odds of having unrealistic optimism. High social support is associated with a lower likelihood of having a pessimistic risk perception. Higher worry is associated with a higher likelihood of having unrealistic pessimism. Misperception of breast cancer risk among KAW and related factors must be considered when developing behavioral interventions for this population.
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Affiliation(s)
- Jiyun Kim
- a School of Nursing , Gachon University , Incheon , Korea
| | - Bo Yun Huh
- b School of Nursing , Johns Hopkins University , Baltimore , Maryland , USA
| | - Hae-Ra Han
- b School of Nursing , Johns Hopkins University , Baltimore , Maryland , USA
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18
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Does a High-Risk Recommendation in Mammography Reports Increase Attendance at a Breast Cancer Risk Assessment Clinic? J Am Coll Radiol 2015; 12:923-9. [DOI: 10.1016/j.jacr.2015.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/23/2015] [Accepted: 04/25/2015] [Indexed: 12/13/2022]
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19
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Rosenberg SM, Moskowitz CS, Ford JS, Henderson TO, Frazier AL, Diller LR, Hudson MM, Stanton AL, Chou JF, Smith S, Leisenring WM, Mertens AC, Cox CL, Nathan PC, Krull KR, Robison LL, Oeffinger KC. Health care utilization, lifestyle, and emotional factors and mammography practices in the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2015; 24:1699-706. [PMID: 26304504 DOI: 10.1158/1055-9965.epi-14-1377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 08/02/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Women with a history of chest radiotherapy have an increased risk of breast cancer; however, many do not undergo annual recommended screening mammography. We sought to characterize the relationship between mammography and potentially modifiable factors, with the goal of identifying targets for intervention to improve utilization. METHODS Of 625 female participants sampled from the Childhood Cancer Survivor Study, who were treated with chest radiotherapy, 551 responded to a survey about breast cancer screening practices. We used multivariate Poisson regression to assess several lifestyle and emotional factors, health care practices, and perceived breast cancer risk, in relation to reporting a screening mammogram within the last two years. RESULTS Women who had a Papanicolaou test [prevalence ratio (PR): 1.77; 95% confidence interval (CI) 1.26-2.49], and who perceived their breast cancer risk as higher than the average woman were more likely to have had a mammogram (PR, 1.26; 95% CI, 1.09-1.46). We detected an attenuated effect of echocardiogram screening [PR, 0.70; 95% CI (0.52-0.95)] on having a mammogram among older women compared with younger women. Smoking, obesity, physical activity, coping, and symptoms of depression and somatization were not associated with mammographic screening. CONCLUSION Our findings suggest that compliance with routine and risk-based screening can be an important indicator of mammography in childhood cancer survivors. In addition, there is a need to ensure women understand their increased breast cancer risk, as a means to encouraging them to follow breast surveillance guidelines. IMPACT Screening encounters could be used to promote mammography compliance in this population.
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Affiliation(s)
- Shoshana M Rosenberg
- Harvard School of Public Health, Boston, Massachusetts. Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Joanne F Chou
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Ann C Mertens
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Cheryl L Cox
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Hospital for Sick Children, University of Toronto, Canada
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, Tennessee
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20
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McBride CM, Abrams LR, Koehly LM. Using a Historical Lens to Envision the Next Generation of Genomic Translation Research. Public Health Genomics 2015; 18:272-82. [PMID: 26226840 DOI: 10.1159/000435832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past 20 years have witnessed successive and exponential advances in genomic discovery and technology, with a broad scientific imperative pushing for continual advancements. The most consistent critique of these advances is that they have vastly outpaced translation of new knowledge into improvements in public health and medicine. METHODS We employ a historical and epistemological analysis to characterize how prevailing scientific meta-narratives have shaped the pace and priorities of research applying genomics to health promotion. We use four 'pivotal events' - the genetic characterization of Down syndrome, the launch of the Human Genome Research Project, the discovery of BRCA1, and the emergence of direct-to- consumer genetic testing - to illustrate how these scientific meta-narratives have inhibited genomic translation research. RESULTS The notion that discovery should precede translation research has over-focused translation research on the latest genetic testing platform. The idea that genetic-related research has an exceptional potential for public harm has encouraged research on worst case scenarios. The perceived competition between genetics and social determinants of health has discouraged a unified research agenda to move genomic translation forward. CONCLUSION We make a case for creating new scientific meta-narratives in which discovery and translation research agendas are envisioned as an interdependent enterprise.
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21
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Matthews AK, Brandenburg DL, Cummings S, Olopade OI. Incorporating a Psychological Counselor in a Cancer Risk Assessment Program: Necessity, Acceptability, and Potential Roles. J Genet Couns 2015; 11:51-64. [PMID: 26141561 DOI: 10.1023/a:1013820515603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Evidence suggests that cancer risk assessment may be associated with increased psychological distress. This exploratory study assessed the necessity and acceptability of incorporating psychological counseling into routine clinic procedures at a cancer risk program. Following a visit to a university-based cancer risk clinic, patients (N = 102) completed an anonymous self-report instrument. Participants reported experiencing current stress and anxiety (41%), depression (29%), and suicidal ideation (2%). Patients with a history of cancer were more likely to be experiencing current emotional difficulties. Sixty-nine percent of the participants found the visit with the psychological counselor to be helpful, while 41% of the participants reported interest in follow-up psychological services. Interest in receiving future psychological services was positively correlated with levels of anxiety, depression, and cancer worry. This pilot study demonstrates the acceptability and potential role for psychological counselors in increasing adjustment in high-risk patients undergoing genetic counseling for inherited cancers.
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22
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Peipins LA, McCarty F, Hawkins NA, Rodriguez JL, Scholl LE, Leadbetter S. Cognitive and affective influences on perceived risk of ovarian cancer. Psychooncology 2015; 24:279-86. [PMID: 24916837 PMCID: PMC4522899 DOI: 10.1002/pon.3593] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/07/2014] [Accepted: 05/16/2014] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Studies suggest that both affective and cognitive processes are involved in the perception of vulnerability to cancer and that affect has an early influence in this assessment of risk. We constructed a path model based on a conceptual framework of heuristic reasoning (affect, resemblance, and availability) coupled with cognitive processes involved in developing personal models of cancer causation. METHODS From an eligible cohort of 16 700 women in a managed care organization, we randomly selected 2524 women at high, elevated, and average risk of ovarian cancer and administered a questionnaire to test our model (response rate 76.3%). Path analysis delineated the relationships between personal and cognitive characteristics (number of relatives with cancer, age, ideas about cancer causation, perceived resemblance to an affected friend or relative, and ovarian cancer knowledge) and emotional constructs (closeness to an affected relative or friend, time spent processing the cancer experience, and cancer worry) on perceived risk of ovarian cancer. RESULTS Our final model fit the data well (root mean square error of approximation (RMSEA) = 0.028, comparative fit index (CFI) = 0.99, normed fit index (NFI) = 0.98). This final model (1) demonstrated the nature and direction of relationships between cognitive characteristics and perceived risk; (2) showed that time spent processing the cancer experience was associated with cancer worry; and (3) showed that cancer worry moderately influenced perceived risk. DISCUSSION Our results highlight the important role that family cancer experience has on cancer worry and shows how cancer experience translates into personal risk perceptions. This understanding informs the discordance between medical or objective risk assessment and personal risk assessment. Published in 2014. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Lucy A. Peipins
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, CDC, Atlanta, GA, USA
| | - Frances McCarty
- National Center for Health Statistics, CDC, Hyattsville, MD, USA
| | - Nikki A. Hawkins
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, CDC, Atlanta, GA, USA
| | - Juan L. Rodriguez
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, CDC, Atlanta, GA, USA
| | | | - Steven Leadbetter
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, CDC, Atlanta, GA, USA
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Wesmiller SW, Bender CM, Sereika SM, Ahrendt G, Bonaventura M, Bovbjerg DH, Conley Y. Association between serotonin transport polymorphisms and postdischarge nausea and vomiting in women following breast cancer surgery. Oncol Nurs Forum 2014; 41:195-202. [PMID: 24578078 DOI: 10.1188/14.onf.195-202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE/OBJECTIVES To examine the association of the serotonin transport gene and postdischarge nausea and vomiting (PDNV) in women following breast cancer surgery. DESIGN A cross-sectional study. SETTING A comprehensive cancer center in Pittsburgh, PA. SAMPLE 80 post-menopausal women treated surgically for early-stage breast cancer. METHODS Data were collected using standardized instruments after surgery but before the initiation of chemotherapy. Blood or saliva were used for DNA extraction and analyzed following standardized protocols. Data were analyzed using descriptive statistics and logistic regression. MAIN RESEARCH VARIABLES Serotonin transport gene (SLC6A4), nausea, vomiting, pain, and anxiety. FINDINGS Women who inherited the LA/LA genotypes were at greater risk for nausea and vomiting when compared to women who carried any other combination of genotypes. Twenty-one percent of women reported nausea and vomiting an average of one month following surgery and prior to initiation of adjuvant therapy. Those women who experienced PDNV reported significantly higher anxiety and pain scores. CONCLUSIONS Findings of this study suggest that variability in the genotypes of the serotonin transport gene may help to explain the variability in PDNV in women following breast cancer surgery and why 20%-30% of patients do not respond to antiemetic medications. IMPLICATIONS FOR NURSING Nurses need to be aware that women who do not experience postoperative nausea and vomiting following surgery for breast cancer continue to be at risk for PDNV long after they have been discharged from the hospital, and this frequently is accompanied by pain and anxiety.
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Affiliation(s)
| | - Catherine M Bender
- School of Nursing and the Department of Clinical Translational Science, University of Pittsburgh in Pennsylvania
| | - Susan M Sereika
- Department of Clinical Translational Science, and the Graduate School of Public Health, University of Pittsburgh in Pennsylvania
| | | | | | - Dana H Bovbjerg
- Pittsburgh Cancer Institute, University of Pittsburgh in Pennsylvania
| | - Yvette Conley
- Department of Human Genetics, University of Pittsburgh in Pennsylvania
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McClish D, Carcaise-Edinboro P, Esinhart H, Wilson DB, Bean MK. Differences in response to a dietary intervention between the general population and first-degree relatives of colorectal cancer patients. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:376-83. [PMID: 24746549 PMCID: PMC4165655 DOI: 10.1016/j.jneb.2014.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 02/17/2014] [Accepted: 02/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine whether response to a dietary intervention is greater among people with family history of colorectal cancer (CRC) compared with a general population. DESIGN Cohort study examining participants from 2 related studies. SETTING Rural Virginia. PARTICIPANTS Seventy people with first-degree relatives with CRC and 113 participants from the intervention arm of a trial in the general population. INTERVENTION Both studies implemented a low-intensity intervention delivered via telephone and mail, including low-literacy self-help booklets and personalized dietary feedback. MAIN OUTCOME MEASURES Fat, fiber, and fruit and vegetable behavior. ANALYSIS Propensity score matching controlled for confounders. Mixed-model ANOVAs compared samples; mediation by perceived cancer risk was assessed. RESULTS Participants in both groups significantly improved fat, fiber, and fruit and vegetable behavior at 1-month follow-up; there was significantly greater improvement in the general population sample. Cancer risk perception did not mediate the relationship between study sample and dietary change. CONCLUSIONS AND IMPLICATIONS Contrary to expectations, first-degree relatives of CRC patients did not respond better to a dietary intervention than the general population, nor was risk perception related to dietary change. Given the role of diet in CRC risk, additional research should investigate targeted strategies to improve dietary intakes of people at higher cancer risk.
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Affiliation(s)
- Donna McClish
- Department of Biostatistics and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA.
| | | | | | - Diane Baer Wilson
- Department of Internal Medicine and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA
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Risk perception and self-management in urban, diverse adults with type 2 diabetes: the improving diabetes outcomes study. Int J Behav Med 2014; 21:88-98. [PMID: 23385488 DOI: 10.1007/s12529-013-9291-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE AND BACKGROUND The relationship between risk perceptions and diabetes self-care remains ambiguous. This study aimed to assess baseline, 1-year follow-up, and change score relationships among perceived risk, diabetes self-care, and glycemic control for adult individuals participating in a behavioral intervention that improved glycemic control relative to the active control. METHOD One-year randomized trial compared a behavioral telephonic intervention with a print only intervention. Participants (N = 526) are members of a union/employer sponsored health benefit plan, with HbA(1c) ≥ 7.5 %, prescribed at least one oral diabetes medication. Participants rated perceived risk of diabetes and its complications and diabetes self-care at baseline and 1 year. Data were collected in a large urban area in the USA. RESULTS There were no relationships between risk perceptions and glycemic control during the study. Baseline perceived risk predicted follow-up self-care. Additionally, participants assigned to the intervention group showed significant changes in dietary and exercise adherence at high levels of risk knowledge and low levels of optimistic bias. CONCLUSION Perceived risk relates to dietary, exercise, and medication adherence in diabetes. The perceived risk construct might foster a more coherent conceptualization of the relationship between one's diabetes, possible complications, and diabetes self-care behaviors.
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Kok R, Kirsten DK, Botha KF. Exploring Mindfulness in Self-Injuring Adolescents in a Psychiatric Setting. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2011.10820447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Mamdouh HM, El-Mansy H, Kharboush IF, Ismail HM, Tawfik MM, El-Baky MA, El Sharkawy OG. Barriers to breast cancer screening among a sample of Egyptian females. J Family Community Med 2014; 21:119-24. [PMID: 24987281 PMCID: PMC4073560 DOI: 10.4103/2230-8229.134771] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is usually diagnosed in late stages in countries with limited resources. Early detection of BC is likely to improve the outcome of the disease for women in these areas. OBJECTIVE The aim of this study was to understand the possible personal, economic, and systems barriers to BC screening in a sample of Egyptian women. MATERIALS AND METHODS A cross-sectional study was conducted in family health centers representing the seven districts of Alexandria governorate, Egypt. A total of 612 women were randomly selected from the chosen centers. RESULTS IN THIS SAMPLE OF EGYPTIAN WOMEN, THE MOST FREQUENTLY IDENTIFIED POTENTIAL BARRIERS TO BC SCREENING WERE THE FOLLOWING: 81.8% would not seek care until they were ill, 77% were unwilling to have a mammogram until it was recommended by the doctor, 71.4% blamed the, lack of privacy, 69.2% thought that medical checkups were not worthwhile, and 64.6% blamed the cost of services. The study further revealed that women of lower education, women in the lower income category, women who did not do paid work, those who had poor knowledge of the risks of BC, and women with no family history of BC were more likely to perceive different screening barriers compared with their counterparts. CONCLUSION Many potential personal, economic, and health system barriers were identified. Addressing these barriers by increasing the awareness of BC and dealing with the misconceptions that the women have can help the policy makers to design more culturally relevant strategies to motivate women to utilize screening services.
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Affiliation(s)
- Heba M. Mamdouh
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Hazzem El-Mansy
- Medical Research Institute, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
| | - Ibrahim F. Kharboush
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Hanaa M. Ismail
- Department of Family Health, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
- Department of Nutrition, High Institute of Public Health, University of Alexandria, Alexandria, Egypt
| | - May M. Tawfik
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Mohamed Abdel El-Baky
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
| | - Omnia G. El Sharkawy
- Department of Research, Alexandria Regional Center for Women's Health and Development, Alexandria, Egypt
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Park ER, Streck JM, Gareen IF, Ostroff JS, Hyland KA, Rigotti NA, Pajolek H, Nichter M. A qualitative study of lung cancer risk perceptions and smoking beliefs among national lung screening trial participants. Nicotine Tob Res 2014; 16:166-73. [PMID: 23999653 PMCID: PMC3934998 DOI: 10.1093/ntr/ntt133] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/22/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The National Comprehensive Cancer Network and the American Cancer Society recently released lung screening guidelines that include smoking cessation counseling for smokers undergoing screening. Previous work indicates that smoking behaviors and risk perceptions of the National Lung Screening Trial (NLST) participants were relatively unchanged. We explored American College of Radiology Imaging Network (ACRIN)/NLST former and current smokers' risk perceptions specifically to (a) determine whether lung screening is a cue for behavior change, (b) elucidate risk perceptions for lung cancer and smoking-related diseases, and (c) explore postscreening behavioral intentions and changes. METHODS A random sample of 35 participants from 4 ACRIN sites were qualitatively interviewed 1-2 years postscreen. We used a structured interview guide based on Health Belief Model and Self-Regulation Model constructs. Content analyses were conducted with NVivo 8. RESULTS Most participants endorsed high-risk perceptions for lung cancer and smoking-related diseases, but heightened concern about these risks did not appear to motivate participants to seek screening. Risk perceptions were mostly attributed to participants' heavy smoking histories; former smokers expressed greatly reduced risk. Lung cancer and smoking-related diseases were perceived as very severe although participants endorsed low worry. Current smokers had low confidence in their ability to quit, and none reported quitting following their initial screen. CONCLUSIONS Lung screening did not appear to be a behavior change cue to action, and high-risk perceptions did not translate into quitting behaviors. Cognitive and emotional dissonance and avoidance strategies may deter engagement in smoking behavior change. Smoking cessation and prevention interventions during lung screening should explore risk perceptions, emotions, and quit confidence.
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Affiliation(s)
- Elyse R. Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Joanna M. Streck
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Ilana F. Gareen
- Center for Statistical Sciences and the Department of Epidemiology, Brown University School of Medicine, Providence, RI
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kelly A. Hyland
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Hannah Pajolek
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tuscon, AZ
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Biopsychological stress factors in BRCA mutation carriers. PSYCHOSOMATICS 2013; 53:582-90. [PMID: 23157996 DOI: 10.1016/j.psym.2012.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/13/2012] [Accepted: 06/18/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Cancer risk-related stressors are prominent among BRCA mutation carriers. Loss of one's mother to a BRCA-associated cancer is an additional stressor, which may be related to an enhanced inflammatory response. This study examined the effect of mother's vital status on psychological factors and stress-associated biomarkers among BRCA mutation carriers. The role of bereavement on biopsychological variables was also examined. METHODS BRCA-carriers with known maternal transmission enrolled in the Gilda Radner Hereditary Cancer Program were invited to participate. Focus group composition was predetermined based on participants' personal cancer history and mother's vital status. Prior to the focus group, participants completed a Quality of Life (QOL) survey and collected a first morning saliva sample. Inflammatory biomarkers were analyzed from proximal archived serum. One day post focus group, a process survey, and morning saliva were collected. RESULTS QOL was significantly lower for those whose mothers are deceased (n = 17) compared to those whose mothers are alive (n = 15) (P = 0.003) after adjusting for age, personal cancer history and prophylactic surgery. Similarly, those whose mothers are deceased reported significantly more perceived stress (P = 0.015), more intrusive thoughts related to cancer risk (P = 0.049), and more anxiety (P = 0.003). Higher bereavement scores were significantly associated with QOL and psychological measures. Biomarker correlates were consistent with and significantly correlated to the patient-reported psychological outcomes for those whose mothers were deceased. CONCLUSIONS BRCA mutation carriers with a known maternal transmission whose mother is deceased report higher perceived stress and anxiety, lower QOL, and a stress-associated biomarker profile that is potentially globally immune suppressive.
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Royak-Schaler R, Cheuvront B, Wilson KR, Williams CM. Addressing women's breast cancer risk and perceptions of control in medical settings. J Clin Psychol Med Settings 2013; 3:185-99. [PMID: 24226756 DOI: 10.1007/bf01993905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many women with family histories of breast cancer deal with two distinct but related issues: their objective physical risk and the emotions this risk engenders. Studies indicate that approximately 70% of African American and white women are concerned about their chances of developing breast cancer someday and perceive themselves to be at risk. Health care providers, including psychologists, need to be aware of the special needs and psychosocial concerns of high-risk women with family histories of breast cancer, since perceptions of breast cancer risk influence screening practices. Providers need training in understanding the significance of specific family patterns of breast cancer, screening guidelines appropriate for women at risk, and the benefits and risks of available prevention options, including genetic screening. Delivering accurate information about both established risk factors known to elevate personal risk, such as age and family history, and factors which women associate with breast cancer, such as bumping and bruising a breast, smoking, and oral contraceptive use, is essential for promoting accurate risk perceptions and appropriate screening schedules.
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Affiliation(s)
- R Royak-Schaler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Abstract
Following Weinstein's (1980) pioneering work many studies established that people have an optimistic bias concerning future life events. At first, the bulk of research was conducted using populations in North America and Northern Europe, the optimistic bias was thought of as universal, and little attention was paid to cultural context. However, construing unrealistic optimism as a form of self-enhancement, some researchers noted that it was far less common in East Asian cultures. The current study extends enquiry to a different non-Western culture. Two hundred and eighty seven middle aged and middle income participants (200 in India, 87 in England) rated 11 positive and 11 negative events in terms of the chances of each event occurring in "their own life," and the chances of each event occurring in the lives of "people like them." Comparative optimism was shown for bad events, with Indian participants showing higher levels of optimism than English participants. The position regarding comparative optimism for good events was more complex. In India those of higher socioeconomic status (SES) were optimistic, while those of lower SES were on average pessimistic. Overall, English participants showed neither optimism nor pessimism for good events. The results, whose clinical relevance is discussed, suggest that the expression of unrealistic optimism is shaped by an interplay of culture and socioeconomic circumstance.
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Affiliation(s)
- Mary Sissons Joshi
- Department of Psychology, Social Work and Public Health, Oxford Brookes UniversityOxford, UK
| | - Wakefield Carter
- Department of Psychology, Social Work and Public Health, Oxford Brookes UniversityOxford, UK
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Cameron LD, Diefenbach MA. Responses to Information about Psychosocial Consequences of Genetic Testing for Breast Cancer Susceptibility: Influences of Cancer Worry and Risk Perceptions. J Health Psychol 2012; 6:47-59. [PMID: 22049237 DOI: 10.1177/135910530100600104] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We assessed the impact of information about psychosocial consequences of genetic testing for breast cancer susceptibility on interest in and beliefs about genetic testing, and whether these effects vary by levels of either cancer worry or perceived cancer risk. Women (N = 180) in an experimental study were randomly assigned to read one of four messages consisting of standard information along with information about either psychosocial advantages, potential disadvantages, both advantages and disadvantages, or no additional information. Women receiving only standard information reported higher interest in obtaining genetic testing than did women who received additional information about advantages, disadvantages, or both advantages and disadvantages. Cancer worry (but not perceived risk) predicted greater interest and more favorable beliefs about the benefits of testing. Beliefs that testing causes emotional distress were positively associated with worry and negatively associated with risk perceptions.
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Zhang J, Yang KH, Tian JH, Wang CM. Effects of yoga on psychologic function and quality of life in women with breast cancer: a meta-analysis of randomized controlled trials. J Altern Complement Med 2012; 18:994-1002. [PMID: 22909345 DOI: 10.1089/acm.2011.0514] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The aim of this meta-analysis was to evaluate the effects of yoga on psychologic function and quality of life (QoL) in women with breast cancer. DESIGN A systematic search of PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature Database, and the Chinese Digital Journals Full-text Database was carried out. Randomized control trials (RCTs) examining the effects of yoga, versus a control group receiving no intervention, on psychologic functioning and QoL in women with breast cancer were included. Methodological quality of included RCTs was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1, and data were analyzed using the Cochrane Collaboration's Review Manager 5.1. RESULTS Six (6) studies involving 382 patients were included. The meta-analysis showed that yoga can improve QoL for women with breast cancer. A statistically significant effect favoring yoga for the outcome of QoL was found (standard mean difference=0.27, 95% confidence interval [0.02, 0.52], p=0.03). Although the effects of yoga on psychologic function outcomes--such as anxiety, depression, distress and sleep--were in the expected direction, these effects were not statistically significant (p>0.05). Fatigue showed no significant difference (p>0.05). CONCLUSIONS The present data provided little indication of how effective yoga might be when they were applied by women with breast cancer except for mildly effective in QOL improvement. The findings were based on a small body of evidence in which methodological quality was not high. Further well-designed RCTs with large sample size are needed to clarify the utility of yoga practice for this population.
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Affiliation(s)
- Jun Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
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Breitkopf CR, Sinicrope PS, Rabe KG, Brockman TA, Patten CA, McWilliams RR, Ehlers S, Petersen GM. Factors influencing receptivity to future screening options for pancreatic cancer in those with and without pancreatic cancer family history. Hered Cancer Clin Pract 2012; 10:8. [PMID: 22738386 PMCID: PMC3410777 DOI: 10.1186/1897-4287-10-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 06/27/2012] [Indexed: 02/08/2023] Open
Abstract
Background Pancreatic cancer (PC) is considered the most lethal cancer and approximately 10% of PC is hereditary. The purpose of the study was to assess attitudes of at-risk family members with two or more relatives affected with pancreas cancer (PC) toward PC risk and future screening options. Methods At-risk family members and primary care controls were surveyed regarding perceived PC risk, PC worry/concern, attitude toward cancer screening, screening test accuracy, and intentions regarding PC screening via blood testing or more invasive endoscopic ultrasound (EUS). Results PC family members reported greater perceived risk of PC than controls (54% vs. 6%, respectively, p < 0.0001). PC family members also reported higher levels of PC worry/concern than controls (p < 0.0001), although 19% of PC family members indicated they were “not at all concerned” about getting PC. PC family members indicated greater acceptance of a false-negative result on a PC screening test relative to controls (12% vs. 8%, p = 0.02). Both groups reported high (>89%) receptivity to the potential PC screening options presented, though receptivity was greater among PC family members as compared to controls (p < 0.0001) for EUS. In multivariable analyses, degree of PC concern (p < 0.0001) was associated with intention to screen for PC by blood test and EUS, while perceived PC risk was associated with likelihood of undergoing EUS only (p < 0.0001). Conclusions Receptivity to screening options for PC appears high. Clinicians should address behavioral and genetic risk factors for PC and foster appropriate concern regarding PC risk among at-risk individuals.
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Affiliation(s)
- Carmen Radecki Breitkopf
- Mayo Clinic College of Medicine, Department of Health Sciences Research, Charlton 6, 200 First Street SW, Rochester, MN, 55905, USA.
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Quality of life and functional outcome for individuals who underwent very early colectomy for familial adenomatous polyposis. Dis Colon Rectum 2012; 55:436-43. [PMID: 22426268 DOI: 10.1097/dcr.0b013e318245645a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The major manifestation of familial adenomatous polyposis is colorectal adenomas, which, if untreated, lead to colorectal cancer. The impact of IPAA on quality of life in adolescents with familial adenomatous polyposis is favorable. There is a group of children who develop polyps at a younger age requiring earlier colectomy. Little is known about this very young subgroup in relation to bowel function or quality of life. OBJECTIVE The aim of this study was to investigate the outcome in patients with familial adenomatous polyposis who had colectomy at ≤14 years. DESIGN A cross-sectional quantitative survey was designed to assess outcome. Standardized validated instruments included bowel/psychosocial functioning and quality of life. RESULTS Among 1337 patients with familial adenomatous polyposis from 409 kindreds, 4% (n = 59) of patients underwent colectomy at ≤14 years of age. Response rate was 84% (n = 32). The mean age at colectomy was 12 years (SD 2), with a current mean age of 24 years (SD 8.5). Fifty-seven percent of patients reported continence. Of the 43% reporting daytime or nighttime incontinence, the majority are <18 years (86%). Younger participants (currently less than 18 years of age) report more restrictions. Mental health is significantly lower among participants with incontinence. They report higher depression and anxiety symptoms, higher levels of intrusion and avoidance, and inferior mental health. The percentage of those worrying about risk of cancer is significantly higher in the younger group (71% vs 24%). Most patients (n = 24, 75%) have had surveillance endoscopy within the past 2 years. LIMITATIONS This study is limited by study generalizability, selection bias, and small sample size. CONCLUSIONS Twelve years after colectomy more than half of the patients have favorable bowel function. The rate of incontinence is high, especially among younger patients who have had a shorter time since surgery. Patients with incontinence reported lower psychosocial functioning, are very concerned about their cancer risk, and experience greater distress. This subgroup would benefit from added psychological interventions to enhance coping with familial adenomatous polyposis and surgery.
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Hilgart JS, Coles B, Iredale R. Cancer genetic risk assessment for individuals at risk of familial breast cancer. Cochrane Database Syst Rev 2012; 2012:CD003721. [PMID: 22336791 PMCID: PMC7154385 DOI: 10.1002/14651858.cd003721.pub3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The recognition of an inherited component to breast cancer has led to an increase in demand for information, reassurance, and genetic testing, which has resulted in the creation of genetic clinics for familial cancer. The first step for patients referred to a cancer genetic clinic is a risk assessment. OBJECTIVES To evaluate the impact of cancer genetic risk-assessment services on patients at risk of familial breast cancer. SEARCH METHODS The specialised register maintained by the Cochrane Breast Cancer Group was searched on 16th February 2005. We also searched MEDLINE, EMBASE, CINAHL, PsycLIT, CENTRAL, DARE, ASSIA, Web of Science, SIGLE and LILACS. The original searches covered the period 1985 to February 2005. We also handsearched relevant journals. For this review update the search was repeated through to April 2011. SELECTION CRITERIA We considered trials looking at interventions for cancer genetic risk-assessment services for familial breast cancer for inclusion. Trials assessed outcomes such as understanding of risk, satisfaction and psychological well-being. We excluded studies if they concerned cancers other than breast cancer or if participants were not at risk of inherited breast cancer. We also excluded trials concerning the provision of general cancer genetic information or education as this review was concerned with the delivery of genetic risk assessment. Participants could be individuals of any age or gender, with or without a known BRCA mutation, but without a previous history of breast cancer or any other serious illness. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Additional information was sought from investigators as necessary. Due to the heterogeneity of both the interventions and outcomes, we reported data descriptively. MAIN RESULTS In this review update, we included five new trials, bringing the total number of included studies to eight. The included trials (pertaining to 10 papers), provided data on 1973 participants and assessed the impact of cancer genetic risk assessment on outcomes including perceived risk of inherited cancer, and psychological distress. This review suggests that cancer genetic risk-assessment services help to reduce distress, improve the accuracy of the perceived risk of breast cancer, and increase knowledge about breast cancer and genetics. The health professional delivering the risk assessment does not appear to have a significant impact on these outcomes. AUTHORS' CONCLUSIONS This review found favourable outcomes for patients after risk assessment for familial breast cancer. However, there were too few papers to make any significant conclusions about how best to deliver cancer genetic risk-assessment services. Further research is needed assessing the best means of delivering cancer risk assessment, by different health professionals, in different ways and in alternative locations.
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Affiliation(s)
- Jennifer S Hilgart
- Institute of Medical Genetics, Cardiff University, Heath Park, Cardiff, Wales, UK, CF14 4XN
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Hartman SJ, Dunsiger SI, Marcus BH. A pilot study of a physical activity intervention targeted towards women at increased risk for breast cancer. Psychooncology 2011; 22:381-7. [PMID: 22135183 DOI: 10.1002/pon.2101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 10/06/2011] [Accepted: 10/19/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective was to pilot test a physical activity intervention targeted towards women with a first-degree relative with breast cancer. METHODS Sedentary women (n = 27) with at least one first-degree relative with breast cancer but no personal breast cancer diagnosis received a print-based physical activity intervention. The intervention was a 12-week theory-based and individually tailored physical activity intervention targeted towards women with a family history of breast cancer. Participants' minutes of physical activity, worry about breast cancer, perceived risk of developing breast cancer, and perceived control over breast cancer risk were assessed at baseline and 12 weeks. RESULTS There was a significant increase in minutes of moderate to vigorous intensity physical activity from baseline to 12 weeks (t = 4.93, p < 0.001), with a mean increase in physical activity of 130.56 min/week (SD = 137.50). At 12 weeks, 41% met the American College of Sports Medicine criteria of engaging in 150 min or more of moderate intensity activity. Regression models indicate that change in perceived risk of breast cancer was significantly associated with change in physical activity (t = -2.36, p = 0.03, r = 0.34), with decreases in perceived risk associated with increases in physical activity over time. CONCLUSIONS Findings suggest that a targeted intervention can increase physical activity and decrease perceived risk of breast cancer.
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Affiliation(s)
- Sheri J Hartman
- Department of Family and Preventive Medicine, University of California, San Diego, CA 92093-0901, USA.
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Schneider TR, Feufel MA, Berkel HJ. Promoting colorectal cancer screening in public health outreach campaigns. HUMAN FACTORS 2011; 53:637-646. [PMID: 22235526 DOI: 10.1177/0018720811427134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Research on public outreach campaigns is presented. BACKGROUND One study examines the effects of instruction design on adherence to cancer self-screening instructions. A second study examines the effect of persuasive announcements on increasing screening campaign participation. METHOD The first study examined adherence to screening (operationalized as returning results for evaluation) given standard instructions, or one of three other versions: persuasive, human factored, or a combination of the two.The second study investigated combining persuasion with a campaign announcement to increase participation (operationalized as picking up a test kit). RESULTS The first study found that among first-time participants, the persuasive and human-factored instructions evoked higher result return rates than did the standard. The second study found that participation was significantly increased by adding persuasion to the campaign announcement. CONCLUSION Enhancing motivation and reducing cognitive barriers increase adherence to test instructions and increase participation. APPLICATION These are simple, cost-effective strategies that increase adherence to cancer screening in public outreach campaigns,which may reduce cancer-specific mortality.
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Affiliation(s)
- Tamera R Schneider
- Psychology Department, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA.
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Roussi P, Sherman KA, Miller SM, Hurley K, Daly MB, Godwin A, Buzaglo JS, Wen KY. Identification of cognitive profiles among women considering BRCA1/2 testing through the utilisation of cluster analytic techniques. Psychol Health 2011; 26:1327-43. [PMID: 21756124 PMCID: PMC3197930 DOI: 10.1080/08870446.2010.521938] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Based on the cognitive-social health information processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counselling, participants (N = 171) completed a study questionnaire concerning their cognitive and affective responses to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in Clusters One, Two and Three had no personal history of cancer, whereas Cluster Four consisted almost entirely of women affected with cancer. Women in Cluster One had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counselling interventions and messages.
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Affiliation(s)
- Pagona Roussi
- Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Spiegel TN, Esplen MJ, Hill KA, Wong J, Causer PA, Warner E. Psychological impact of recall on women with BRCA mutations undergoing MRI surveillance. Breast 2011; 20:424-30. [DOI: 10.1016/j.breast.2011.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 03/03/2011] [Accepted: 04/10/2011] [Indexed: 01/04/2023] Open
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Collins RE, Lopez LM, Marteau TM. Emotional impact of screening: a systematic review and meta-analysis. BMC Public Health 2011; 11:603. [PMID: 21798046 PMCID: PMC3223929 DOI: 10.1186/1471-2458-11-603] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 07/28/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a widely held expectation that screening for disease has adverse emotional impacts. The aim of the current review is to estimate the short (< 4 weeks) and longer term (> 4 weeks) emotional impact of such screening. METHODS Studies selected for inclusion were (a) randomised controlled trials in which (b) participants in one arm underwent screening and received test results, and those in a control arm did not, and (c) emotional outcomes were assessed in both arms. MEDLINE via PubMed (1950 to present), EMBASE (1980 to present), PsycINFO (1985 to present) using OVID SP, and CINAHL (1982 to present) via EBSCO were searched, using strategies developed with keywords and medical subject headings. Data were extracted on emotional outcomes, type of screening test and test results. RESULTS Of the 12 studies that met the inclusion criteria, six involved screening for cancer, two for diabetes, and one each for abdominal aortic aneurysms, peptic ulcer, coronary heart disease and osteoporosis. Five studies reported data on anxiety, five [corrected] on depression, two on general distress and eight on quality of life assessed between one week and 13 years after screening (median = 1.3 years).Meta-analyses revealed no significant impact of screening on longer term anxiety (pooled SMD 0.01, 95% CI -0.10, 0.11), depression (pooled SMD -0.04, 95% CI -.12, 0.20), or quality of life subscales (mental and self-assessed health pooled SMDs, respectively: 0.03; -0.01, (95% CI -.02, 0.04; 0.00, 95% CI -.04, 0.03). CONCLUSION Screening does not appear to have adverse emotional impacts in the longer term (> 4 weeks). Too few studies assessed outcomes before four weeks to comment on the shorter term emotional impact of screening.
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Affiliation(s)
- Ruth E Collins
- Department of Psychology (at Guy's), Kings College London, Health Psychology Section, 5th Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, UK
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Waters EA, Klein WMP, Moser RP, Yu M, Waldron WR, McNeel TS, Freedman AN. Correlates of unrealistic risk beliefs in a nationally representative sample. J Behav Med 2011; 34:225-35. [PMID: 21110077 PMCID: PMC3088765 DOI: 10.1007/s10865-010-9303-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
Abstract
Unrealistically optimistic or pessimistic risk perceptions may be associated with maladaptive health behaviors. This study characterized factors associated with unrealistic optimism (UO) and unrealistic pessimism (UP) about breast cancer. Data from the 2005 National Health Interview Survey were analyzed (N = 14,426 women). After accounting for objective risk status, many (43.8%) women displayed UO, 12.3% displayed UP, 34.5% had accurate risk perceptions (their perceived risk matched their calculated risk), and 9.5% indicated "don't know/no response." Multivariate multinomial logistic regression indicated that UO was associated with higher education and never smoking. UP was associated with lower education, lower income, being non-Hispanic Black, having ≥3 comorbidities, current smoking, and being overweight. UO was more likely to emerge in younger and older than in middle-aged individuals. UO and UP are associated with different demographic, health, and behavioral characteristics. Population segments that are already vulnerable to negative health outcomes displayed more UP than less vulnerable populations.
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Affiliation(s)
- Erika A Waters
- Department of Surgery (Prevention and Control), Washington University School of Medicine, Campus Box 8100, 660 S. Euclid, St. Louis, MO 63110, USA.
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[Cognitive, emotional and behavioral impact of an uncertain outcome after study of BRCA1/2: review of the literature]. Bull Cancer 2011; 98:184-98. [PMID: 21382771 DOI: 10.1684/bdc.2011.1309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent advances in oncogenetics have enabled the development of tests for predisposition to breast and ovarian cancers. Where no mutation has been identified in the BRCA1 or 2 genes, the proband (first person tested in a family with a genetic risk) can receive an uncertain outcome: negative inconclusive or identification of a variant of unknown clinical significance. From the demonstration of such outcomes, their psychological impact has been studied among women concerned. OBJECTIVE The purpose of this article is to summarize the results of studies about the impact of delivering an uncertain BRCA1/2 genetic result on emotional (general or cancer specific distress), cognitive (perception of risk) and behavioral (decisions of medical care) reactions of consultants. It is also to identify factors particularly associated with personal or familial medical history that may alter this impact. METHODOLOGY A literature review was conducted from a key word search on the databases PsycINFO and PubMed (breast*, BRCA*, genetic*, familial, mutation, heredit*) crossed with terms related to the psychological impact and mutation status. Included papers are quantitative studies focused on the psychological impact of the uncertain genetic test result, compared to the impact resulting from positive or true negative result, or from test refusal. RESULTS The results of the eight selected articles generally suggest a less emotional distress and a lower perceived risk of predisposition or to develop cancer facing uncertain genetic result compared to positive result. Intentions of breast cancer surveillance are optimal, indicating the absence of "false reassurance", while demand for prophylactic surgery appears to be less frequent. Nevertheless risk factors of inappropriate psychological reactions may be highlighted as pretest clinical distress, a personal cancer history or multiple family history of cancer. CONCLUSION Current data suggest psychological reactions adapted to the clinical significance of uncertain genetic test results. These findings are preliminary given the small number of studies and their restriction to populations with similar sociocultural characteristics.
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Rosenzweig M, Brufsky A, Rastogi P, Puhalla S, Simon J, Underwood S. The attitudes, communication, treatment, and support intervention to reduce breast cancer treatment disparity. Oncol Nurs Forum 2011; 38:85-9. [PMID: 21186164 DOI: 10.1188/11.onf.85-89] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES to test the effect of a supportive, one-time psychoeducational intervention on treatment adherence among African American women receiving first adjuvant therapy for breast cancer. DESIGN a pilot, randomized, controlled clinical trial, two-group design, with one-time intervention and four data collection points. SETTING two University of Pittsburgh Cancer Institute clinics. SAMPLE 24 African American women. METHODS the Attitudes, Communication, Treatment, and Support (ACTS) intervention is a 45-minute one-on-one session with an African American woman recommended to have chemotherapy for breast cancer. The interventionist is an African American breast cancer survivor. The intervention consists of a discussion about chemotherapy and the importance of communicating knowledge needs and distress, an explanation of the specific treatment plan according to pathology, and support through the survivor testimonial and video clips from the African American community. MAIN RESEARCH VARIABLES dose of chemotherapy received and dose of chemotherapy prescribed. FINDINGS Twenty patients completed chemotherapy, and four chose not to begin or discontinued recommended chemotherapy. The groups were equal in key sociodemographic variables. Compared to usual care, the ACTS intervention participants demonstrated trends toward initiation of chemotherapy (100% versus 82%), overall adherence to chemotherapy (92% versus 73%), and percentage of total dose of chemotherapy received or prescribed (94% versus 74%). Compared to usual care, the ACTS intervention participants demonstrated more rapid initiation of chemotherapy and better overall adherence to chemotherapy. CONCLUSIONS the pilot ACTS intervention shows promise as a psychoeducational intervention to assist with chemotherapy decision making among African American women. IMPLICATIONS FOR NURSING African American women are at high risk of not receiving the full dose of prescribed chemotherapy for breast cancer for multiple reasons. Nurses must be sensitive to the unique fears and concerns of this population regarding chemotherapy decisions. An intervention addressing these fears and concerns may help to increase adherence.
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Gallagher KM, Updegraff JA, Rothman AJ, Sims L. Perceived susceptibility to breast cancer moderates the effect of gain- and loss-framed messages on use of screening mammography. Health Psychol 2011; 30:145-52. [PMID: 21401248 PMCID: PMC4679369 DOI: 10.1037/a0022264] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the role of three distinct beliefs about risk (risks associated with screening, construal of the function of screening as health-affirming or illness-detecting, and perceived susceptibility to breast cancer) in moderating women's responses to framed messages that promote mammography. DESIGN Three hundred fifty-five women recruited from an inner city hospital, nonadherent to guidelines for receiving annual screening mammograms,were randomly assigned to view a gain- or loss-framed video message about the importance of mammography. MAIN OUTCOME MEASURE Mammography screening was self-reported at a 3-month follow-up. RESULTS Only perceived susceptibility to breast cancer significantly moderated the effect of message framing on screening. Women with average and higher levels of perceived susceptibility for breast cancer were significantly more likely to report screening after viewing a loss-framed message compared to a gain-framed message. No effects of framing on reported screening were observed for women with lower levels of perceived susceptibility. CONCLUSION The study identifies a key role for perceived susceptibility in shaping responses to framed messages that promote cancer screenings.
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Bowen DJ, Robbins R, Bush N, Meischke H, Ludwig A, Wooldridge J. Effects of a Web-based intervention on women's breast health behaviors. Transl Behav Med 2011; 1:155-164. [PMID: 21643515 PMCID: PMC3104848 DOI: 10.1007/s13142-011-0028-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Helping women make choices to reduce cancer risk and to improve breast health behaviors is important, but the best ways to reach more people with intervention assistance is not known. To test the efficacy of a Web-based intervention designed to help women make better breast health choices, we adapted our previously tested, successful breast health intervention package to be delivered on the Internet, and then we tested it in a randomized trial. We recruited women from the general public to be randomized to either an active intervention group or a delayed intervention control group. The intervention consisted of a specialized Web site providing tailored and personalized risk information to all participants, followed by offers of additional support if needed. Follow-up at 1-year post-randomization revealed significant improvements in mammography screening in intervention women compared with control women (improvement of 13 percentage points). The intervention effects were more powerful in women who increased breast health knowledge and decreased cancer worry during intervention. These data indicate that increases in mammography can be accomplished in population-based mostly insured samples by implementing this simple, low resource intensive intervention.
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Affiliation(s)
- Deborah J Bowen
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
- />Department of Community Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 USA
| | - Robert Robbins
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Nigel Bush
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Hendrika Meischke
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Abi Ludwig
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Jean Wooldridge
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
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Versión española de la Cancer Worry Scale (Escala de Preocupación por el Cáncer: adaptación cultural y análisis de la validez y la fiabilidad). Med Clin (Barc) 2011; 136:8-12. [DOI: 10.1016/j.medcli.2010.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/24/2010] [Accepted: 04/27/2010] [Indexed: 11/20/2022]
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Feufel MA, Schneider TR, Berkel HJ. A field test of the effects of instruction design on colorectal cancer self-screening accuracy. HEALTH EDUCATION RESEARCH 2010; 25:709-723. [PMID: 20304976 DOI: 10.1093/her/cyq015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A field experiment tested whether instruction design improves accurate adherence to instructions for medical do-it-yourself tests like the Fecal Occult Blood Test (FOBT). As part of an outreach campaign, 16,073 participants received FOBTs with instructions that were (i) human factored, (ii) motivational, (iii) human factored/motivational combined, or (iv) the standard used in the past. Among all test results returned (N = 2483), only the human factors instructions reduced errors in filling out result cards. However, after post-validating result cards that had errors, the human-factored, motivational and merged instructions reduced errors. The present findings show that medical instructions designed with human factors and persuasion principles increase accurate adherence. These design principles provide simple and cost-effective ways to increase test taking accuracy and FOBT effectiveness. Better screening instructions can improve the chances of detecting colorectal cancer early, which may help to decrease cancer mortality.
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Affiliation(s)
- Markus A Feufel
- Department of Psychology, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
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Ochoa EM, Gómez-Acebo I, Rodríguez-Cundín P, Navarro-Córdoba M, Llorca J, Dierssen-Sotos T. Relationship between family history of breast cancer and health-related behavior. Behav Med 2010; 36:123-9. [PMID: 21186435 DOI: 10.1080/08964289.2010.516783] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article explores the relationship between family history of breast cancer (FHBC) and health-related behavior and medical management, using a cross-sectional analysis of 685 women, based on self-report. The influence of FHBC on lifestyle (alcohol use, physical activity, weight and diet) and medical management decisions (screening for chronic diseases) was assessed using odds ratios (OR) and 95% confidence interval (CI). Adjustment for confounders was performed using unconditional logistic regression. Sixty five women (9.5%) reported relatives with breast cancer. Women with FHBC are more likely to have had a mammography and colonoscopy or sigmoidoscopy. These women have about twice the probability of performing more intense physical exercise, contrasting with high-risk women whose consumption of fibre is lower and sweets is higher. No significant association was found between alcohol consumption or Body Mass Index and family history. Spontaneous behavioral change to a more preventive lifestyle in relatives of cancer patients is very low.
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McCaul KD, Reid PA, Rathge RW, Martinson B. Does Concern About Breast Cancer Inhibit or Promote Breast Cancer Screening? BASIC AND APPLIED SOCIAL PSYCHOLOGY 2010. [DOI: 10.1207/s15324834basp1802_5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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