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Housten AJ, Malinowski C, Paredes E, Harris CL, McNeill LH, Chavez-MacGregor M. Movement Through Chemotherapy Delay to Initiation Among Breast Cancer Patients: A Qualitative Analysis. Patient Prefer Adherence 2022; 16:749-759. [PMID: 35345541 PMCID: PMC8957340 DOI: 10.2147/ppa.s350412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose (Neo) adjuvant chemotherapy decreases the risk of recurrence and improves overall survival among breast cancer patients; however, delays in chemotherapy initiation are associated with adverse health outcomes. The causes of delay are complex and include interrelated social, economic, cultural, environmental, and health system factors. Project Start was a qualitative study designed to assess and identify the multilevel factors contributing to the barriers and facilitators of initiating chemotherapy. Patients and Methods Women diagnosed with primary invasive breast cancer who experienced ≥60 day delay in (neo) adjuvant chemotherapy initiation were included. Participants completed semi-structured interviews exploring barriers and facilitators to starting chemotherapy. Interviews were transcribed and coded to identify themes using the Sort and Sift, Think and Shift analytic approach. This analysis included thorough examination of the data by advancing through iterative analytic phases to identify core topics within and across transcripts. Results We enrolled (N=22) participants with median age at diagnosis 53.5 years (range 27-70) who identified as Latina (n=8), Black (n=5), and non-Latina White (n=9). Participants described a common chemotherapy initiation process reflecting their unique needs as they transitioned through four stages: 1) receiving diagnosis and treatment recommendations; 2) processing treatment options; 3) "Flipping the Switch"; and 4) activating treatment and engaging in care. Limited explicit insight into their chemotherapy delay was expressed. Engagement across the self-, family-, community-, and medical-realms revealed interlinked and pivotal sources of support that helped participants navigate toward initiating chemotherapy. Specifically, the overarching themes included logistical, emotional, financial, and social sources of support and the relationship of these sources of support to participants' perceived self-efficacy to move toward initiating treatment. Conclusion Activating women to be engaged in the treatment process across multiple levels appeared to facilitate initiating chemotherapy. Multilevel interventions that engage the patient, family, community, and medical team may support the initiation of timely chemotherapy.
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Affiliation(s)
- Ashley J Housten
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA
| | - Catalina Malinowski
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edna Paredes
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cassandra L Harris
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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2
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Boaz H, Shuli BG. Involvement levels of breast cancer patients-Seeking trusted hospital and physician. J Health Psychol 2021; 27:2603-2612. [PMID: 34875916 DOI: 10.1177/13591053211062350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The active involvement levels of breast cancer patients (BCP) in treatment decisions range from 10% to 81%. We investigated the involvement levels of 179 Israeli breast cancer survivors, aged 30 to 81, in the choice of hospital, surgeon, surgical procedure, chemotherapy, and radiotherapy. High involvement was documented in location decisions (operating hospital 77%, chemotherapy facility 82%) as opposed to low involvement in treatment decisions (chemotherapy 30%-38%, radiotherapy 25%, surgical procedure 31%). Involvement was influenced by hospital and surgeon reputation, education level, and income. BCPs actively choose their treating facility and staff, and then follow their doctor's recommendations.
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Affiliation(s)
- Hovav Boaz
- The Max Stern Yezreel Valley College, Israel.,University of Haifa School of Public Health, Israel
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Ferrer RA, Ellis EM, Orehek E, Klein WMP. Fear increases likelihood of seeking decisional support from others when making decisions involving ambiguity. JOURNAL OF BEHAVIORAL DECISION MAKING 2021. [DOI: 10.1002/bdm.2266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca A. Ferrer
- Basic Biobehavioral and Psychological Sciences Branch National Cancer Institute Rockville Maryland USA
| | - Erin M. Ellis
- Basic Biobehavioral and Psychological Sciences Branch National Cancer Institute Rockville Maryland USA
| | - Edward Orehek
- Department of Psychology San Diego State University San Diego California USA
| | - William M. P. Klein
- Behavioral Research Program, National Cancer Institute Rockville Maryland USA
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Parisek M, Loss J, Holler E, Barata A, Weber D, Edinger M, Wolff D, Schoemans H, Herrmann A. "This Graft-vs.-Host Disease Determines My Life. That's It."-A Qualitative Analysis of the Experiences and Needs of Allogenic Hematopoietic Stem Cells Transplantation Survivors in Germany. Front Public Health 2021; 9:687675. [PMID: 34277549 PMCID: PMC8280766 DOI: 10.3389/fpubh.2021.687675] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Allogeneic hematopoietic stem cell transplantation (alloHSCT) is the only curative treatment modality for many patients affected by hematologic malignancies. However, it can cause debilitating long-term effects. Understanding the impact of alloHSCT on all aspects of the patients' life is required for optimal survivorship management. Aim: To explore in-depth HSCT-survivors' experiences and needs post-transplant. Partners were included to provide further information on survivors' needs and how care could be improved in this area. Methods: We conducted semi-structured face-to-face and phone interviews with alloHSCT-survivors and their partners referred to a survivorship clinic in Germany. Theoretical sampling was used to recruit participants. Data were analyzed using framework analysis. Results: Thirty-two survivors (consent rate: 100%, response rate: 100%) and eighteen partners (consent rate: 84%, response rate: 72%) participated. Survivors were aged between 25 and 68 years (Median: 48, IQR: 25.3) and partners were aged between 26 and 64 years (Median: 54, IQR: 16, SD: 12.8). The themes emerging from the data involved survivors' needs included (i) the diversity of long-term treatment side-effects; and (ii) time post discharge as a dynamic process with individual peaks of burden. Survivors and their partners also suggested strategies for mitigating these unmet needs, i.e., (iii) transparent communication and patient empowerment; and (iv) improvement in continuity of care system and help with claiming social benefits as cornerstones of optimal survivorship care. Conclusion: To our knowledge, this is one of the first qualitative studies focused on the views of German alloHSCT-survivors on the long-term effects of alloHSCT and the first study integrating the view of their partners. Healthcare providers could better support survivors with managing their symptoms and adhering to their prescribed care by ensuring comprehensive, transparent communication that helps increase survivors' understanding and involvement in their care. Further efforts should be made to provide patient-centered, continuous survivorship care that involves additional support with navigating the healthcare and social service system. Intervention studies are required to test the effectiveness of the suggested strategies.
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Affiliation(s)
- Mira Parisek
- Faculty of Medicine, University of Regensburg, Regensburg, Germany
| | - Julika Loss
- Department for Health Behaviour, Robert Koch Institute, Berlin, Germany
| | - Ernst Holler
- Department of Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Anna Barata
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain.,Department of Health Outcomes and Behavior, Tampa, FL, United States
| | - Daniela Weber
- Department of Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Edinger
- Department of Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Wolff
- Department of Hematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Helene Schoemans
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anne Herrmann
- Department for Epidemiology and Preventive Medicine, Division of Medical Sociology, University of Regensburg, Regensburg, Germany.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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5
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Herrmann A, Holler E, Edinger M, Eickmann S, Wolff D. A qualitative study on patients' and their support persons' preferences for receiving one longer consultation or two shorter consultations when being informed about allogeneic hematopoietic stem cell transplantation. BMC Health Serv Res 2021; 21:623. [PMID: 34187476 PMCID: PMC8241532 DOI: 10.1186/s12913-021-06632-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Allogeneic hematopoietic stem cell transplantation (alloHSCT) is the only potentially curative treatment option for many patients with hematological disorders but it includes a significant risk of mortality and long-term morbidity. Many patients and their support persons feel overwhelmed when being informed about alloHSCT and may benefit from improvements in consultation style and timing. Aims To explore, qualitatively, in a sample of hematological cancer patients and their support persons, their preferences for receiving one longer consultation or two shorter consultations when being informed about alloHSCT. Participants’ perceptions of when and how different consultation styles should be offered were also examined. Methods Semi-structured face-to-face and phone interviews were conducted. A purposeful sampling frame was used. Data were analysed using framework analysis. Results Twenty patients and 13 support persons were recruited (consent rate: 96%, response rate: 91%). Most patients (60%) and support persons (62%) preferred two shorter consultations over one longer consultation. This helped them digest and recall the information provided, remember questions they had, involve significant others and search for additional information. Patients would have liked to be offered paper and pen to take notes, take a break after 30 min and have their understanding checked at the end of the first consultation, e.g. using question prompt lists. Some patients and support persons preferred both consultations to happen on the same day to reduce waiting times as well as travel times and costs. Others preferred having a few days in-between both consultations to better help them prepare the second consultation. Participants reported varying preferences for different consultation styles depending on personal and disease-related characteristics, such as age, health literacy level and previous treatment. Conclusion To our knowledge, this is the first qualitative study to explore patients’ and their support persons’ preferences for having one longer consultation or two shorter consultations when being informed about alloHSCT. Receiving two shorter consultations may help patients process and recall the information provided and more actively involve their support persons. Clinicians should consider offering patients and their support persons to take a break after 30 min, provide paper and pen as well as question prompt lists.
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Affiliation(s)
- Anne Herrmann
- Department of Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Regensburg, Germany. .,School of Medicine and Public Health/University of Newcastle and Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Ernst Holler
- Department of Haematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Edinger
- Department of Haematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Sascha Eickmann
- Department of Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Daniel Wolff
- Department of Haematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany
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6
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Xia Y, Shi LSB, Chang JH, Miao HZ, Wang D. Impact of the COVID-19 pandemic on intention to use traditional Chinese medicine: A cross-sectional study based on the theory of planned behavior. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 19:219-225. [PMID: 33547011 PMCID: PMC7826027 DOI: 10.1016/j.joim.2021.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/11/2020] [Indexed: 12/11/2022]
Abstract
Objective Coronavirus disease 2019 (COVID-19) has become an increasingly severe public health emergency. Although traditional Chinese medicine (TCM) has helped to combat COVID-19, public perception of TCM remains controversial. We used the theory of planned behavior (TPB) to identify factors that affect the intention to use TCM. Methods A cross-sectional web-based survey of 10,824 individuals from the general public was conducted between March 16 and April 2, 2020. The participants were recruited using a snowball sampling method. Data were collected using a self-administered questionnaire, based on the TPB. The questionnaire consisted of demographic characteristics and TPB structures. Structural equation modeling was used to identify predictors of intention. Results The results indicated the model explained 77.5% and 71.9% of intention and attitude variance. Intention to use TCM had the strongest relationship with attitude (P < 0.001), followed by past behavior (P < 0.001), subjective norms (P < 0.001) and perceived behavioral control (P < 0.001). Attitudes toward TCM were significantly affected by perceived behavioral control (P < 0.001), subjective norms (P < 0.001) and cognition of TCM (P < 0.001). Conclusion Attitude is a key factor in determining the intention to use TCM, followed by past behaviors, subjective norms and perceived behavioral control. Our results offer important implications for health policy makers to promote the use of TCM.
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Affiliation(s)
- Yi Xia
- School of Public Health, Southern Medical University, Guangzhou 510515, Guangdong Province, China; School of Health Management, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Lu-Shao-Bo Shi
- School of Health Management, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Jing-Hui Chang
- School of Health Management, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Hua-Zhang Miao
- School of Health Management, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
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7
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Aarts JWM, Burg LC, Kasius JC, Groenewoud H, Kraayenbrink AA, Stalmeier P, Zusterzeel PLM. Patients' and gynecologists' views on sentinel lymph node mapping in low- and intermediate-risk endometrial cancer: a Dutch vignette study. Int J Gynecol Cancer 2020; 30:813-818. [PMID: 32385051 DOI: 10.1136/ijgc-2019-001138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/16/2020] [Accepted: 03/29/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Sentinel lymph node (SLN) mapping in endometrial cancer is gaining ground. However, patient views on this new technique are unknown. The aim of this study was to determine factors important to patients and gynecologists when considering SLN mapping in low- and intermediate-risk endometrial cancer. METHODS We performed a vignette study. Patients who underwent a total hysterectomy for low- or intermediate-risk endometrial cancer between 2012 and 2015 were invited. Dutch gynecologists specializing in gynecologic oncology were also invited. We based the selection for attributes in the vignettes on literature and interviews: risk of complications of SLN mapping; chance of finding a metastasis; survival gain; risk of complications after radiotherapy; operation time; and hospital of surgery (travel time). We developed a questionnaire with 18 hypothetical scenarios. Each attribute level varied and for each scenario, participants were asked how strongly they would prefer SLN on a scale from 1 to 7. The strength of preference for each scenario was analyzed using linear mixed effects models. RESULTS A total of 38% of patients (41/108) and 33% of gynecologists (42/126) participated in the study. Overall, they had a preference for SLN. The mean preference for patients was 4.29 (95% CI 3.72 to 4.85) and 4.39 (95% CI 3.99 to 4.78) for gynecologists. Patients' preferences increased from 3.4 in the case of no survival gain to 4.9 in the case of 3-year survival gain (P<0.05) and it decreased when travel time increased to >60 min (-0.4, P=0.024), or with an increased risk of complications after adjuvant radiotherapy (-0.6, P=0.002). For gynecologists all attributes except travel time were important. CONCLUSIONS Overall, patients and gynecologists were in favor of SLN mapping in low- and intermediate-risk endometrial cancer. Most important to patients were survival gain, travel time, and complication risk after adjuvant radiotherapy. These preferences should be taken into account when counseling about SLN mapping.
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Affiliation(s)
| | - Lara C Burg
- Obstetrics and Gynecology, Radboudumc, Nijmegen, The Netherlands
| | - Jenneke C Kasius
- Department of Gynaecology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - Hans Groenewoud
- Health Evidence, Radboudumc University Medical Center, Nijmegen, The Netherlands
| | | | - Peep Stalmeier
- Health Evidence, Radboudumc University Medical Center, Nijmegen, The Netherlands
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8
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Patients' treatment preferences for potentially resectable tumors of the head of the pancreas. HPB (Oxford) 2020; 22:265-274. [PMID: 31501009 DOI: 10.1016/j.hpb.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/15/2019] [Accepted: 06/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The primary aim of this study was to assess if patients with potentially resectable ductal adenocarcinoma (PDAC) of the head of the pancreas would choose a Whipple procedure versus palliative chemotherapy. METHODS A cohort of adults with radiological resectable PDAC was enrolled at a tertiary Canadian teaching hospital. Participants were informed about treatment options, expected outcomes, and adverse events using data from the most recent scientific literature. Probability trade-off (PTO) was used to elicit treatment preferences. RESULTS Surgery was preferred by all participants except one (96.7% vs. 3.3%; P = 0.0001). For 90% of participants preferring surgery, the main reason was the hope of being cured (P = 0.001). If the risk of perioperative mortality was higher than 57%, the risk of perioperative morbidity higher than 85% and the survival benefit was less than 4 months, half of the participants preferred palliative chemotherapy. The likelihood of needing blood transfusions, the length of hospital stay, and long-term consequences such as diabetes or pancreatic exocrine insufficiency were negligible concerns to participants. CONCLUSIONS Informed patients with early-stage PDAC prefer resection over palliative chemotherapy. The dominating factor influencing their decision is the hope of a cure that overshadow the risks of complications, mortality and recurrent disease.
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9
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Moth EB, Kiely BE, Martin A, Naganathan V, Della-Fiorentina S, Honeyball F, Zielinski R, Steer C, Mandaliya H, Ragunathan A, Blinman P. Older adults' preferred and perceived roles in decision-making about palliative chemotherapy, decision priorities and information preferences. J Geriatr Oncol 2019; 11:626-632. [PMID: 31439474 DOI: 10.1016/j.jgo.2019.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
AIM Patients with cancer have varied preferences for involvement in decision-making. We sought older adults' preferred and perceived roles in decision-making about palliative chemotherapy; priorities; and information received and desired. METHODS Patients ≥65y who had made a decision about palliative chemotherapy with an oncologist completed a written questionnaire. Preferred and perceived decision-making roles were assessed by the Control Preferences Scale. Wilcoxon rank-sum tests evaluated associations with preferred role. Factors important in decision-making were rated and ranked, and receipt of, and desire for information was described. RESULTS Characteristics of the 179 respondents: median age 74y, male (64%), having chemotherapy (83%), vulnerable (Vulnerable Elders Survey-13 score ≥ 3) (52%). Preferred decision-making roles (n = 173) were active in 39%, collaborative in 27%, and passive in 35%. Perceived decision-making roles (n = 172) were active in 42%, collaborative in 22%, and passive in 36% and matched the preferred role for 63% of patients. Associated with preference for an active role: being single/widowed (p = .004, OR = 1.49), having declined chemotherapy (p = .02, OR = 2.00). Ranked most important (n = 159) were "doing everything possible" (30%), "my doctor's recommendation" (26%), "my quality of life" (20%), and "living longer" (15%). A minority expected chemotherapy to cure their cancer (14%). Most had discussed expectations of cure (70%), side effects (88%) and benefits (82%) of chemotherapy. Fewer had received quantitative prognostic information (49%) than desired this information (67%). CONCLUSION Older adults exhibited a range of preferences for involvement in decision-making about palliative chemotherapy. Oncologists should seek patients' decision-making preferences, priorities, and information needs when discussing palliative chemotherapy.
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Affiliation(s)
- Erin B Moth
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Belinda E Kiely
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia; Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia; National Health and Medical Research Council, University of Sydney, Sydney, NSW, Australia
| | - Andrew Martin
- National Health and Medical Research Council, University of Sydney, Sydney, NSW, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Education and Research on Ageing, Concord Repatriation General Hospital, University of Sydney, Sydney, NSW, Australia; Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Stephen Della-Fiorentina
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia; Southern Highlands Cancer Centre, Bowral, NSW, Australia
| | - Florian Honeyball
- Alan Coates Cancer Centre, Dubbo Base Hospital, Dubbo, NSW, Australia
| | - Rob Zielinski
- Central West Cancer Care Centre, Orange Base Hospital, Orange, NSW, Australia
| | - Christopher Steer
- Border Medical Oncology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
| | - Hiren Mandaliya
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Abiramy Ragunathan
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Prunella Blinman
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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10
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Wallner LP, Li Y, McLeod MC, Gargaro J, Kurian AW, Jagsi R, Radhakrishnan A, Hamilton AS, Ward KC, Hawley ST, Katz SJ. Primary care provider-reported involvement in breast cancer treatment decisions. Cancer 2019; 125:1815-1822. [PMID: 30707773 PMCID: PMC6509002 DOI: 10.1002/cncr.31998] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/14/2018] [Accepted: 12/24/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Treatment decisions for patients with early-stage breast cancer often involve discussions with multiple oncology providers. However, the extent to which primary care providers (PCPs) are involved in initial treatment decisions remains unknown. METHODS A stratified random sample of PCPs identified by newly diagnosed patients with early-stage breast cancer from the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries were surveyed (n = 517; a 61% response rate). PCPs were asked how frequently they discussed surgery, radiation, and chemotherapy options with patients; how comfortable they were with these discussions; whether they had the necessary knowledge to participate in decision making; and what their confidence was in their ability to help (on 5-item Likert-type scales). Multivariate logistic regression was used to identify PCP-reported attitudes associated with more PCP participation in each treatment decision. RESULTS In this sample, 34% of PCPs reported that they discussed surgery, 23% discussed radiation, and 22% discussed chemotherapy options with their patients. Of those who reported more involvement in surgical decisions, 22% reported that they were not comfortable having a discussion, and 17% did not feel that they had the necessary knowledge to participate in treatment decision making. PCPs who positively appraised their ability to participate were more likely to participate in all 3 decisions (odds ratio [OR] for surgery, 6.01; 95% confidence interval [CI], 4.16-8.68; OR for radiation, 8.37; 95% CI, 5.16-13.58; OR for chemotherapy, 6.56; 95% CI, 4.23-10.17). CONCLUSIONS A third of PCPs reported participating in breast cancer treatment decisions, yet gaps in their knowledge about decision making and in their confidence in their ability to help exist. Efforts to increase PCPs' knowledge about breast cancer treatment options may be warranted.
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Affiliation(s)
- Lauren P. Wallner
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, United States
- University of Michigan, Department of Epidemiology
| | - Yun Li
- University of Michigan, Department of Biostatistics
| | | | - Joan Gargaro
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, United States
| | - Allison W. Kurian
- Stanford University, Departments of Medicine and Health Research & Policy
| | - Reshma Jagsi
- University of Michigan, Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine
| | - Archana Radhakrishnan
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, United States
| | - Ann S. Hamilton
- University of Southern California Keck School of Medicine, Department of Preventive Medicine
| | - Kevin C. Ward
- Emory University Rollins School of Public Health, Department of Epidemiology
| | - Sarah T. Hawley
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, United States
- University of Michigan School of Public Health, Department of Health Management and Policy
- University of Michigan School of Public Health, Department of Health Behavior and Education
| | - Steven J. Katz
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, United States
- University of Michigan School of Public Health, Department of Health Management and Policy
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You HM, Park EY. Relationships between Attitude Towards Treatment, Distress, and Decision Conflict among Cancer Patients Receiving Chemotherapy. ASIAN ONCOLOGY NURSING 2019. [DOI: 10.5388/aon.2019.19.4.242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hyun Mi You
- Department of Nursing, National Health Insurance Service Ilsan Hospital, Gyeonggi, Korea
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12
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Sergesketter AR, Thomas SM, Lane WO, Shammas RL, Greenup RA, Hollenbeck ST. The Influence of Marital Status on Contemporary Patterns of Postmastectomy Breast Reconstruction. J Plast Reconstr Aesthet Surg 2018; 72:795-804. [PMID: 30595415 DOI: 10.1016/j.bjps.2018.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/10/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Marital status is known to influence quality of life, survival, and treatment decision-making after breast cancer diagnosis. We aimed to determine whether relationship status impacts contemporary patterns of immediate breast reconstruction. METHODS Surveillance, Epidemiology, and End Results (SEER)-18 was used to identify females undergoing mastectomy for stage 0-III breast cancer from 1998 to 2014. Multivariate logistic regression was used to estimate the association of relationship status with the likelihood of postmastectomy reconstruction. Patients were grouped by diagnosis year to assess change in the reconstructed population with time. Among younger patients ≤45 years, a generalized logistic model was used to predict reconstruction subtype. RESULTS Among 346,418 patients, reconstruction after mastectomy was more likely to occur in women with relationship support in the form of a marriage or partner [odds ratio (OR) 1.31; 95% confidence interval (CI), 1.28-1.34; p<0.001]. Women who were separated (OR 0.76), single (OR 0.73), or widowed (OR 0.56) were significantly less likely than married women to undergo reconstruction (all p<0.001). During the 17-year study period, change in reconstruction rates with time varied by relationship status (interaction p=0.02), with reconstruction rates among divorced patients increasing more slowly than those among married and partnered women. Among younger women, subtype patterns varied by relationship status (p=0.004), with divorced women less likely to receive autologous over implant reconstruction (OR 0.87; p = 0.03). CONCLUSION Relationship status may influence decision-making regarding pursuit and type of postmastectomy reconstruction. Consideration of support networks of patients with breast cancer could facilitate tailored preoperative counseling by reconstructive surgeons.
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Affiliation(s)
- Amanda R Sergesketter
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, NC
| | - Samantha M Thomas
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Whitney O Lane
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ronnie L Shammas
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, NC
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Scott T Hollenbeck
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, NC.
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Herrmann A, Sanson-Fisher R, Hall A, Wall L, Zdenkowski N, Waller A. Support persons' preferences for the type of consultation and the format of information provided when making a cancer treatment decision. BMC Res Notes 2018; 11:456. [PMID: 29996909 PMCID: PMC6042433 DOI: 10.1186/s13104-018-3552-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/28/2018] [Indexed: 12/30/2022] Open
Abstract
Objective Cancer patients and their support persons commonly feel overwhelmed when being confronted with their diagnosis and treatment options. We used a DCE to examine patients’ and support persons’ preferences for: (i) attending one 40 min consultation or two 20 min consultations when making a cancer treatment decision; and for (ii) receiving additional information in written form only or in both written and online forms. Here we focus on support persons’ preferences and whether they differ from patients’ preferences. Results 159 adult medical oncology patients and 64 of their support persons took part in this study. Participants were presented with a set of hypothetical scenarios and asked to indicate their most and least preferred scenario. 92% of support persons (n = 59) completed the DCE. Most preferred to receive two consultations along with written and online information (n = 30, 51%). This was the only scenario that was chosen by statistically significantly more support persons (p =0.037). The proportions of patients and support persons choosing each scenario did not differ significantly from each other (p >0.05). Our findings suggest that when making cancer treatment decisions, clinicians should consider offering patients and support persons written and online information, combined with two shorter consultations.
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Affiliation(s)
- Anne Herrmann
- Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Callaghan, Australia. .,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia. .,Health Behaviour Research Group, University of Newcastle, University Drive, W4, HMRI Building, Callaghan, NSW, 2308, Australia.
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Alix Hall
- Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Laura Wall
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - Nicholas Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Department of Medical Oncology, Calvary Mater Newcastle, Waratah, Australia
| | - Amy Waller
- Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Hamilton JG, Shuk E, Garzon MG, Rodríguez VM, Westerman J, Hay JL, Offit K, Robson ME. Decision-Making Preferences About Secondary Germline Findings That Arise From Tumor Genomic Profiling Among Patients With Advanced Cancers. JCO Precis Oncol 2017; 1. [PMID: 31938761 DOI: 10.1200/po.17.00182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose In patients with advanced cancers, tumor genomic profiling (TGP) can reveal secondary germline findings (SGFs) regarding inherited disease risks. This study examines the process by which patients with advanced cancers would make the decision about whether or not to learn these SGFs, and their preferences regarding specific challenging decision scenarios including whether patients should be required to receive SGFs and whether SGFs should be returned to family after a patient's death. Patients and Methods We conducted qualitative semi-structured interviews with 40 patients with advanced breast, bladder, colorectal, or lung cancer who had TGP. Data were collected regarding participants' perspectives about the hypothetical decision to learn their SGFs including their anticipated approach to the decision-making process, as well as their preferences about challenging decision scenarios. Data were evaluated using thematic content analysis. Results We identified themes regarding participants' preferred degree of decisional autonomy, perceived vital role of doctors, information needs, and anticipated process of deliberation. Although participants reported that this decision was ultimately their own, many wanted input from family and trusted others. Oncologists were expected to provide decision guidance and key clarifying information. Most participants stated that patients should be able to make a choice about receiving actionable SGFs, and a majority stated that SGFs should be available to family after a patient's death. Conclusion These results provide insight into SGFs decision-making processes of patients with advanced cancers, which can allow clinicians to provide patients optimal decision support in this context. Patients with advanced cancers have specific information needs and decision-making preferences that educational and communication interventions should address to ensure that patients make informed choices about learning SGFs.
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Affiliation(s)
- Jada G Hamilton
- Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Psychiatry, Weill Cornell Medical College, Cornell University, New York, NY.,Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elyse Shuk
- Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Margaux Genoff Garzon
- Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vivian M Rodríguez
- Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joy Westerman
- Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer L Hay
- Behavioral Sciences Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Psychiatry, Weill Cornell Medical College, Cornell University, New York, NY
| | - Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
| | - Mark E Robson
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY
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Wallner LP, Li Y, McLeod MC, Hamilton AS, Ward KC, Veenstra CM, An LC, Janz NK, Katz SJ, Hawley ST. Decision-support networks of women newly diagnosed with breast cancer. Cancer 2017; 123:3895-3903. [PMID: 28640360 PMCID: PMC5626589 DOI: 10.1002/cncr.30848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known about the size and characteristics of the decision-support networks of women newly diagnosed with breast cancer and whether their involvement improves breast cancer treatment decisions. METHODS A population-based sample of patients newly diagnosed with breast cancer in 2014 and 2015, as reported to the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries, were surveyed approximately 7 months after diagnosis (N = 2502; response rate, 68%). Network size was estimated by asking women to list up to 3 of the most important decision-support persons (DSPs) who helped them with locoregional therapy decisions. Decision deliberation was measured using 4 items assessing the degree to which patients thought through the decision, with higher scores reflecting more deliberative breast cancer treatment decisions. The size of the network (range, 0-3 or more) was compared across patient-level characteristics, and adjusted mean deliberation scores were estimated across levels of network size using multivariable linear regression. RESULTS Of the 2502 women included in this analysis, 51% reported having 3 or more DSPs, 20% reported 2, 18% reported 1, and 11% reported not having any DSPs. Married/partnered women, those younger than 45 years, and black women all were more likely to report larger network sizes (all P < .001). Larger support networks were associated with more deliberative surgical treatment decisions (P < .001). CONCLUSIONS Most women engaged multiple DSPs in their treatment decision making, and involving more DSPs was associated with more deliberative treatment decisions. Future initiatives to improve treatment decision making among women with breast cancer should acknowledge and engage informal DSPs. Cancer 2017;123:3895-903. © 2017 American Cancer Society.
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Affiliation(s)
- Lauren P. Wallner
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Epidemiology
| | - Yun Li
- University of Michigan, Department of Biostatistics
| | | | - Ann S. Hamilton
- University of Southern California Keck School of Medicine, Department of Preventive Medicine
| | | | - Christine M. Veenstra
- University of Michigan, Department of Internal Medicine, Division of Hematology and Oncology
| | | | - Nancy K. Janz
- University of Michigan, Department of Health Behavior and Health Education
| | - Steven J. Katz
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Health Management and Policy
| | - Sarah T. Hawley
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Health Behavior and Health Education
- University of Michigan, Department of Health Management and Policy
- Ann Arbor VA Center for Clinical Management Research
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Hamilton JG, Lillie SE, Alden DL, Scherer L, Oser M, Rini C, Tanaka M, Baleix J, Brewster M, Craddock Lee S, Goldstein MK, Jacobson RM, Myers RE, Zikmund-Fisher BJ, Waters EA. What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders. J Behav Med 2017; 40:52-68. [PMID: 27566316 PMCID: PMC5296255 DOI: 10.1007/s10865-016-9785-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/10/2016] [Indexed: 12/12/2022]
Abstract
Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.
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Affiliation(s)
- Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah E Lillie
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Dana L Alden
- Shidler College of Business, University of Hawaii, Honolulu, HI, USA
| | - Laura Scherer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Megan Oser
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine Rini
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Miho Tanaka
- Health Services Research and Development Service, Department of Veterans Affairs, Washington, DC, USA
| | - John Baleix
- Hawaii Medical Service Association, BCBS of Hawaii, Honolulu, HI, USA
| | | | - Simon Craddock Lee
- Department of Clinical Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary K Goldstein
- Geriatric Research Education and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ronald E Myers
- Department of Medical Oncology, Sidney Kimmel Medical Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erika A Waters
- Division of Public Health Sciences, Department of Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
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Koo NY, Lee JH. Factors Influencing Conflicts of Chemotherapy Decision Making among Pre-Operative Cancer Patients. ASIAN ONCOLOGY NURSING 2017. [DOI: 10.5388/aon.2017.17.2.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nam Yee Koo
- Department of Nursing, Kosin University Gospel Hospital, Busan, Korea
| | - Ji Hyun Lee
- College of Nursing, Kosin University, Busan, Korea
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Kwait RM, Pesek S, Onstad M, Edmonson D, Clark MA, Raker C, Stuckey A, Gass J. Influential Forces in Breast Cancer Surgical Decision Making and the Impact on Body Image and Sexual Function. Ann Surg Oncol 2016; 23:3403-11. [DOI: 10.1245/s10434-016-5365-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 01/12/2023]
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Tőkés T, Torgyík L, Szentmártoni G, Somlai K, Tóth A, Kulka J, Dank M. Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future? PATIENT EDUCATION AND COUNSELING 2015; 98:695-703. [PMID: 25749023 DOI: 10.1016/j.pec.2015.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/05/2015] [Accepted: 02/15/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated. METHODS We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC. RESULTS A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery. CONCLUSION Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival. PRACTICE IMPLICATIONS Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice.
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Affiliation(s)
- Tímea Tőkés
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary.
| | - László Torgyík
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Gyöngyvér Szentmártoni
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Krisztián Somlai
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary; St. Margaret Hospital, Surgical Division, Budapest, Hungary
| | - Andrea Tóth
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Janina Kulka
- Semmelweis University, 2nd Department of Pathology, Budapest, Hungary
| | - Magdolna Dank
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
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20
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Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians. Br J Cancer 2014; 111:674-9. [PMID: 24921911 PMCID: PMC4134490 DOI: 10.1038/bjc.2014.322] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/28/2014] [Accepted: 05/12/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Vaginal brachytherapy (VBT) in high-intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making. METHODS Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making. RESULTS Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, P<0.001), for irradiated than for non-irradiated patients (median=0 vs 6.5%, P<0.001), and for radiation oncologists than for gynaecologists (median=4 vs 13%, P<0.001). Substantial variation existed within the groups of patients and clinicians. Participants preferred the patient and clinician to share in the decision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making. CONCLUSIONS We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.
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Molinari M, De Coutere S, Krahn M, Helton S, Urbach DR. Patients' preferences and trade-offs for the treatment of early stage hepatocellular carcinoma. J Surg Res 2014; 189:57-67. [PMID: 24650457 DOI: 10.1016/j.jss.2014.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/27/2014] [Accepted: 02/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radio frequency ablation (RFA) and hepatic resection (HR) provide similar survival for early stage hepatocellular carcinoma (ES-HCC). Although RFA has a higher recurrence rate, HR is associated with an increased risk of complications and death. When multiple treatments are available, patients should be enabled to direct their preferred therapy. Yet there is lack of knowledge on patients' preferences for the treatment of ES-HCC. The objective of this study was to assess treatment preferences between HR and RFA for ES-HCC. METHODS A cohort of 75 cirrhotic adults was educated about the natural history of HCC, treatment options, and the risks and the benefits of HR and RFA. Probability trade-off interviews were used to elicit participants' preferences between the two treatments and strength of their decisions. RESULTS RFA was preferred by 70% of participants (P = 0.001) who identified the risk of perioperative morbidity and mortality of HR as the main reasons for their decision. Participants changed their minds if HR could provide better 5 (≥15%) and 3-y disease-free survival (≥10%) when compared with RFA. Their preference also changed when RFA had a median ≥8% risk for complications, ≥5% for mortality, ≥8% for nonradical therapy, and ≥5% for tumor seeding. CONCLUSIONS Informed cirrhotic patients prefer RFA for the treatment of ES-HCC. Participants who preferred RFA were more concerned about the risks of perioperative morbidity and mortality of HR than long-term cancer outcomes. Patients' values and attitudes toward risks and benefits for the treatment of ES-HCC should be explicitly elicited and included in multidisciplinary treatment decisions.
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Affiliation(s)
- Michele Molinari
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Sarah De Coutere
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray Krahn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott Helton
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - David R Urbach
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Lillie SE, Janz NK, Friese CR, Graff JJ, Schwartz K, Hamilton AS, Gay BB, Katz SJ, Hawley ST. Racial and ethnic variation in partner perspectives about the breast cancer treatment decision-making experience. Oncol Nurs Forum 2014; 41:13-20. [PMID: 24368235 PMCID: PMC5058443 DOI: 10.1188/14.onf.13-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To characterize the perspectives of partners (husbands or significant others) of patients with breast cancer in the treatment decision-making process and to evaluate racial and ethnic differences in decision outcomes. DESIGN A cross-sectional survey. SETTING Los Angeles, CA, and Detroit, MI. SAMPLE 517 partners of a population-based sample of patients with breast cancer four years post-treatment. METHODS A self-administered mailed questionnaire. Chi-square tests and logistic regression were used to assess associations between race and ethnicity and decision outcomes. MAIN RESEARCH VARIABLES Decision regret and three elements of the decision process: information received, actual involvement, and desired involvement. FINDINGS Most partners reported receiving sufficient information (77%), being involved in treatment decisions (74%), and having sufficient involvement (73%). Less-acculturated Hispanic partners were more likely than their Caucasian counterparts to report high decision regret (45% versus 14%, p<0.001). Factors significantly associated (p<0.05) with high decision regret were insufficient receipt of treatment information, low involvement in decision making, and a desire for more involvement. CONCLUSIONS Partners were generally positive regarding their perspectives about participating in the breast cancer treatment decision-making process. However, less acculturated Hispanic partners were most vulnerable to decision regret. In addition, high decision regret was associated with modifiable elements of the decision-making process. IMPLICATIONS FOR NURSING Attention should be paid to ensuring racial and ethnic minority partners are sufficiently involved in breast cancer treatment decisions and receive decision support.
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Affiliation(s)
- Sarah E Lillie
- Minneapolis Veterans Affairs Medical Center in Minnesota
| | - Nancy K Janz
- Department of Health Behavior and Health Education, University of Michigan in Ann Arbor
| | | | - John J Graff
- Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kendra Schwartz
- Department of Family Medicine, Wayne State University, Detroit, MI
| | - Ann S Hamilton
- Department of Preventive Medicine, University of Southern California in Los Angeles
| | | | - Steven J Katz
- Department of Internal Medicine, University of Michigan and Ann Arbor Veterans Affairs Healthcare System
| | - Sarah T Hawley
- Department of Internal Medicine, University of Michigan and Ann Arbor Veterans Affairs Healthcare System
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Laidsaar-Powell RC, Butow PN, Bu S, Charles C, Gafni A, Lam WWT, Jansen J, McCaffery KJ, Shepherd HL, Tattersall MHN, Juraskova I. Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. PATIENT EDUCATION AND COUNSELING 2013; 91:3-13. [PMID: 23332193 DOI: 10.1016/j.pec.2012.11.007] [Citation(s) in RCA: 265] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 10/31/2012] [Accepted: 11/04/2012] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To systematically review quantitative and qualitative studies exploring physician-adult patient-adult companion (triadic) communication and/or decision-making within all medical encounters. METHODS Studies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria. RESULTS Of the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely. CONCLUSION Triadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed. PRACTICE IMPLICATIONS Preliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations.
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Affiliation(s)
- R C Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, Australia.
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Poe JK, Hayslip JW, Studts JL. Decision Making and Distress Among Individuals Diagnosed with Follicular Lymphoma. J Psychosoc Oncol 2012; 30:426-45. [DOI: 10.1080/07347332.2012.684853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Development and Validation of an Instrument for Measuring Attitudes and Beliefs about Complementary and Alternative Medicine (CAM) Use among Cancer Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:798098. [PMID: 22693532 PMCID: PMC3369496 DOI: 10.1155/2012/798098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 03/25/2012] [Accepted: 03/27/2012] [Indexed: 11/17/2022]
Abstract
Despite cancer patients' extensive use of complementary and alternative medicine (CAM), validated instruments to measure attitudes, and beliefs predictive of CAM use are lacking. We aimed at developing and validating an instrument, attitudes and beliefs about CAM (ABCAM). The 15-item instrument was developed using the theory of planned behavior (TPB) as a framework. The literature review, qualitative interviews, expert content review, and cognitive interviews were used to develop the instrument, which was then administered to 317 outpatient oncology patients. The ABCAM was best represented as a 3-factor structure: expected benefits, perceived barriers, and subjective norms related to CAM use by cancer patients. These domains had Eigenvalues of 4.79, 2.37, and 1.43, and together explained over 57.2% of the variance. The 4-item expected benefits, 7-item perceived barriers, and 4-item subjective norms domain scores, each had an acceptable internal consistency (Cronbach's alpha) of 0.91, 0.76, and 0.75, respectively. As expected, CAM users had higher expected benefits, lower perceived barriers, and more positive subjective norms (all P < 0.001) than those who did not use CAM. Our study provides the initial evidence that the ABCAM instrument produced reliable and valid scores that measured attitudes and beliefs related to CAM use among cancer patients.
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Shared decision making in the Netherlands, is the time ripe for nationwide, structural implementation? ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:283-8. [PMID: 21620322 DOI: 10.1016/j.zefq.2011.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
WHAT ABOUT POLICY REGARDING SDM? The Dutch health care system has been reformed in 2006 to make it more patient-oriented and demand-driven. We shortly describe four strategies of this health care reform. Although research projects are now fully spread over the country, a coordinated research agenda on SDM is lacking. WHAT ABOUT TOOLS - DECISION SUPPORT FOR PATIENTS? The Dutch governmental healthcare internet portal for patients hosts 16 patient decision aids. WHAT ABOUT PROFESSIONAL INTEREST AND IMPLEMENTATION? There is quite a strong patient participation movement in the Netherlands, on macro and meso level. Limited effort, related to the local research projects has been put into training professionals in SDM skills. WHAT DOES THE FUTURE LOOK LIKE? We need concerted action on the level of educating health care professionals, empowering patients, making patient decision aids easily accessible, supporting the professionals in this new task, and measuring the process of SDM in performance indicators used in quality assurance. The Dutch Platform for SDM that will be launched in Maastricht in June 2011 is therefore a timely and relevant initiative.
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Droste S, Herrmann-Frank A, Scheibler F, Krones T. Ethical issues in autologous stem cell transplantation (ASCT) in advanced breast cancer: a systematic literature review. BMC Med Ethics 2011; 12:6. [PMID: 21496244 PMCID: PMC3103481 DOI: 10.1186/1472-6939-12-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 04/15/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. METHODS We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included articles, and were assessed and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. RESULTS Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. CONCLUSIONS The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature.
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Affiliation(s)
- Sigrid Droste
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | | | - Fueloep Scheibler
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Tanja Krones
- Institute of Biomedical Ethics, University Hospital, Zurich, Switzerland
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Hawley ST, Griggs JJ, Hamilton AS, Graff JJ, Janz NK, Morrow M, Jagsi R, Salem B, Katz SJ. Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. J Natl Cancer Inst 2009; 101:1337-47. [PMID: 19720966 DOI: 10.1093/jnci/djp271] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have evaluated the association between patient decision involvement and surgery received among racially and ethnically diverse patients or patients' attitudes about surgery and the role of family and friends in surgical treatment choices. METHODS Women diagnosed with nonmetastatic breast cancer from June 2005 through February 2007 and reported to the Los Angeles or Detroit Surveillance, Epidemiology, and End Results registries were mailed a survey after diagnosis (N = 3133). Latina and African American women were oversampled. The response rate was 72.4%. The analytic sample (N = 1651) excluded those with stage IIIA or higher disease, self-reported clinical contraindications to breast-conserving surgery with radiation, and unclear race or ethnicity. The dependent variable was receipt of mastectomy initially. The primary independent variables were patient involvement in decision making, race or ethnicity, attitudes about recurrence, the effects of radiation, the impact of surgery on body image, and the role of others in decision making. Latinas were categorized as low or high acculturated. The association between patient involvement in decision making and the receipt of mastectomy was evaluated using logistic regression while controlling for other independent variables. All statistical tests were two-sided. RESULTS The analytic sample was 23.9% Latina (12.0% low acculturated, 11.9% high acculturated), 27.1% African American, and 48.9% white, and 17.2% received a mastectomy initially. For each racial or ethnic group, more women who reported a patient-based decision received mastectomy than those who reported a shared or surgeon-based decision (P = .022 for low-acculturated Latinas, P < .001 for other groups). Women who reported that concerns about recurrence or radiation effects were very important in their surgery decision were more likely to receive mastectomy than those less concerned (for recurrence concerns, estimated relative risk [RR] = 1.66, 95% confidence interval [CI] = 1.28 to 2.10; for radiation concerns, estimated RR = 2.35, 95% CI = 1.88 to 2.85). Women who reported that body image concerns and their spouse's opinion were very important in their surgery decision less often received mastectomy than those less concerned about body image or who placed less weight on their spouse's opinion (for body image concerns, estimated RR = 0.47, 95% CI = 0.30 to 0.74; for spouse's opinion, estimated RR = 0.53, 95% CI = 0.36 to 0.78). CONCLUSION Greater patient involvement in decision making was associated with receipt of mastectomy for all racial and ethnic groups. Patient attitudes about surgery and the opinions of family and friends contribute to surgical choices made by women with breast cancer.
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Affiliation(s)
- Sarah T Hawley
- Division of General Medicine, Department of Internal Medicine, University of Michigan, 300 N. Ingalls, Ste 7E12, Box 0429, Ann Arbor, MI 48109-0429, USA.
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Rogers SN. Quality of life for head and neck cancer patients – has treatment planning altered? Oral Oncol 2009; 45:435-9. [DOI: 10.1016/j.oraloncology.2008.11.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Masi CM, Gehlert S. Perceptions of breast cancer treatment among African-American women and men: implications for interventions. J Gen Intern Med 2009; 24:408-14. [PMID: 19101776 PMCID: PMC2642574 DOI: 10.1007/s11606-008-0868-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 10/27/2008] [Accepted: 11/18/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND While breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. Current strategies to reduce this disparity focus on logistical and information needs, but contextual factors, such as concerns about racism and treatment side effects, may also represent significant barriers to improved outcomes. OBJECTIVE To characterize perceptions of breast cancer treatment among African-American women and men. DESIGN A qualitative study of African-American adults using focus group interviews. PARTICIPANTS Two hundred eighty women and 165 men who live in one of 15 contiguous neighborhoods on Chicago's South Side. APPROACH Transcripts were systematically analyzed using qualitative techniques to identify emergent themes related to breast cancer treatment. RESULTS The concerns expressed most frequently were mistrust of the medical establishment and federal government, the effect of racism and lack of health insurance on quality of care, the impact of treatment on intimate relationships, and the negative effects of surgery, radiation therapy, and chemotherapy. CONCLUSIONS In addition to providing logistical and information support, strategies to reduce the breast cancer mortality gap should also address contextual factors important to quality of care. Specific interventions are discussed, including strategies to enhance trust, reduce race-related treatment differences, minimize the impact of treatment on intimate relationships, and reduce negative perceptions of breast cancer surgery, radiation therapy, and chemotherapy.
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Affiliation(s)
- Christopher M Masi
- Section of General Internal Medicine, University of Chicago, 5841 S. Maryland Avenue, M/C 2007, Chicago, IL 60637, USA.
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Decision making and quality of life in the treatment of cancer: a review. Support Care Cancer 2008; 17:117-27. [DOI: 10.1007/s00520-008-0505-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
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Wang J, Kuo YF, Freeman J, Markowitz AB, Goodwin JS. Temporal trends and predictors of perioperative chemotherapy use in elderly patients with resected nonsmall cell lung cancer. Cancer 2008; 112:382-90. [PMID: 18041068 DOI: 10.1002/cncr.23181] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The authors assessed patterns of perioperative chemotherapy use in elderly patients with resected stage I, II, or IIIA nonsmall cell lung cancer (NSCLC) from 1992 to 2002. METHODS By using data from the Surveillance, Epidemiology, and End Results Program, 11,807 patients were identified who had resected stage I, II, or IIIA NSCLC between 1992 and 2002 and survived >or=120 days beyond diagnosis. The rate of perioperative chemotherapy use was measured by calendar year, and the association between clinical/demographic characteristics and the receipt of chemotherapy was examined by using logistic regression. RESULTS In total, 957 patients with stage I, II, or IIIA NSCLC (8.1% of the study population) received perioperative chemotherapy. The proportion of patients receiving chemotherapy for stage I NSCLC changed little during the study period. Of 3230 patients with stage II and IIIA NSCLC, 609 patients (18.9%) received chemotherapy, 423 patients (13%) received chemotherapy combined with radiation. 452 patients (15.6%) received adjuvant chemotherapy, and 66 patients (2.3%) received neoadjuvant chemotherapy. The use of chemotherapy increased significantly among patients who were diagnosed after 1994 relative to patients who were diagnosed in 1992 after controlling for sociodemographic and treatment characteristics (P< .001). There was significantly increased use of new-generation chemotherapy agents, such as carboplatin and taxanes (P< .001). The proportion of patients receiving combined-modality therapy also increased significant (P< .001). Younger age, being married, having advanced-stage tumor or adenocarcinoma, having a later diagnosis year, receiving radiation, and seeing an oncologist were predictors for the receipt of chemotherapy (P< .001). CONCLUSIONS A substantial proportion of Medicare beneficiaries with NSCLC received perioperative chemotherapy. Specifically designed prospective trials that focus on older patients are needed.
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Affiliation(s)
- Jue Wang
- Department of Internal Medicine, Section of Oncology-Hematology, University of Nebraska Medical Center, Omaha, Nebraska 68198-7680, USA.
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