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Ludwigson A, Huynh V, Vemuru S, Romandetti K, Fisher C, Coons HL, Pettigrew J, Hampanda K, Kaoutzanis C, Ahrendt G, Afghahi A, Stewart C, Tevis S. Characterizing informational needs and information seeking behavior of patients with breast cancer. Am J Surg 2024; 227:100-105. [PMID: 37863795 PMCID: PMC11376347 DOI: 10.1016/j.amjsurg.2023.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Appropriate information may facilitate adjustment to cancer diagnoses. Our study aims to characterize informational satisfaction in breast cancer patients and assess resources used by patients to gain information. METHODS Newly diagnosed Stage 0-III breast cancer patients seen at an academic medical center between May and September 2020 received questionnaires assessing information satisfaction. Patients indicated resources used to obtain information along with satisfaction with information received in various topics. A subset of questionnaire respondents completed semi-structured interviews. RESULTS Fifty-two (35 %) patients completed the questionnaire. Patients received information from physicians (96 %), the internet (81 %), nurses (79 %), and fellow breast cancer patients (54 %). Interview participants preferred receiving information from providers when making medical decisions but found patient forums and social media to be important adjuncts for receiving information. CONCLUSION Patients are satisfied with information received about diagnosis and treatment, but finances, sexual health, and fertility are less frequently discussed.
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Affiliation(s)
- Abigail Ludwigson
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, USA.
| | - Victoria Huynh
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sudheer Vemuru
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karina Romandetti
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christine Fisher
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Helen L Coons
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica Pettigrew
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anosheh Afghahi
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Camille Stewart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Tevis
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Keim-Malpass J, Vavolizza RD, Cohn WF, Kennedy EM, Showalter SL. Cancer Screening and Treatment Delays During the COVID-19 Pandemic and the Role of Health Literacy in Care Re-engagement: Findings from an NCI-Designated Comprehensive Cancer Center sample. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1405-1412. [PMID: 37202597 PMCID: PMC10195653 DOI: 10.1007/s13187-023-02312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The purpose of this analysis is to (1) report the frequency of self-reported delays in cancer treatment and preventative screening services at an academic, NCI-designated center during the COVID-19 pandemic and (2) investigate cancer-related care and screening delays among those with adequate and limited health literacy. A cross-sectional survey was administered from an NCI-designated Cancer Center with a rural catchment area during November 2020 through March 2021. A total of 1,533 participants completed the survey, and nearly 19 percent of participants were categorized as having limited health literacy. Twenty percent of those with a cancer diagnosis reported a delay in cancer-related care; and 23-30% of the sample reported a delay in cancer screening. In general, the proportions of delays among those with adequate and limited health literacy were similar with the exception of colorectal cancer screening. There was also a notable difference in the ability to re-engage in cervical cancer screening among those with adequate and limited health literacy. Thus, there is a role for those engaged in cancer-related education and outreach to offer additional navigation resources for those at risk to cancer-related care and screening disruptions. Future study is warranted to investigate the role of health literacy on cancer care engagement.
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Affiliation(s)
- Jessica Keim-Malpass
- Department of Pediatrics, Division of Hematology-Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Rick D Vavolizza
- Department of Surgery, Division of Surgical Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Erin M Kennedy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Shayna L Showalter
- Department of Surgery, Division of Surgical Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA
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Odai-Afotey A, Lederman RI, Ko NY, Gagnon H, Fikre T, Gundersen DA, Revette AC, Hershman DL, Crew KD, Keating NL, Freedman RA. Breast cancer treatment receipt and the role of financial stress, health literacy, and numeracy among diverse breast cancer survivors. Breast Cancer Res Treat 2023; 200:127-137. [PMID: 37178432 PMCID: PMC10182756 DOI: 10.1007/s10549-023-06960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Disparities in breast cancer treatment for low-income and minority women are well documented. We examined economic hardship, health literacy, and numeracy and whether these factors were associated with differences in receipt of recommended treatment among breast cancer survivors. METHODS During 2018-2020, we surveyed adult women diagnosed with stage I-III breast cancer between 2013 and 2017 and received care at three centers in Boston and New York. We inquired about treatment receipt and treatment decision-making. We used Chi-squared and Fisher's exact tests to examine associations between financial strain, health literacy, numeracy (using validated measures), and treatment receipt by race and ethnicity. RESULTS The 296 participants studied were 60.1% Non-Hispanic (NH) White, 25.0% NH Black, and 14.9% Hispanic; NH Black and Hispanic women had lower health literacy and numeracy and reported more financial concerns. Overall, 21 (7.1%) women declined at least one component of recommended therapy, without differences by race and ethnicity. Those not initiating recommended treatment(s) reported more worry about paying large medical bills (52.4% vs. 27.1%), worse household finances since diagnosis (42.9% vs. 22.2%), and more uninsurance before diagnosis (9.5% vs. 1.5%); all P < .05. No differences in treatment receipt by health literacy or numeracy were observed. CONCLUSION In this diverse population of breast cancer survivors, rates of treatment initiation were high. Worry about paying medical bills and financial strain were frequent, especially among non-White participants. Although we observed associations of financial strain with treatment initiation, because few women declined treatments, understanding the scope of impact is limited. Our results highlight the importance of assessments of resource needs and allocation of support for breast cancer survivors. Novelty of this work includes the granular measures of financial strain and inclusion of health literacy and numeracy.
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Affiliation(s)
- Ashley Odai-Afotey
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
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Fahmer N, Faller H, Engehausen D, Hass HG, Reuss-Borst M, Duelli K, Wöckel A, Heuschmann PU, Meng K. Patients' challenges, competencies, and perceived support in dealing with information needs - A qualitative analysis in patients with breast and gynecological cancer. PATIENT EDUCATION AND COUNSELING 2022; 105:2382-2390. [PMID: 34930628 DOI: 10.1016/j.pec.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to investigate challenges, competencies, and support in breast and gynecological cancer patients when dealing with information needs and how health literacy as an interplay of these factors might be improved. METHODS Semi-structured interviews were conducted with patients in acute care (n = 19), undergoing rehabilitation (n = 20) or attending self-help groups (n = 16). Interviews were analyzed using content analysis. RESULTS Challenges: gain information according to own needs, internet as information source, information evaluation and decisions, doctor-patient communication, situationally limited information processing, difficult access to information. Competencies: self-regulation of information needs, media and social competencies, communication skills in the doctor-patient conversation, internet competencies, self-directed decisions according to own needs, interest/self-efficacy, previous knowledge, trust in the doctor. SUPPORT by professionals (e.g., patient-centered communication), relatives (e.g., support during consultations), peers (e.g., exchange), facilities (e.g., clinics). CONCLUSIONS Our findings provide insight into challenges and competencies relevant to patients' health literacy and the influence of support. The individuality of the interplay highlights the relevance of an active patient role and patient-centered care. PRACTICE IMPLICATIONS Patients' health literacy should be improved in (psycho)oncological work by both reducing challenges (e.g., by communication skills training, involving relatives) and promoting competencies (e.g., by needs- and competence-oriented information offers).
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Affiliation(s)
- Natascha Fahmer
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany.
| | - Hermann Faller
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
| | | | - Holger G Hass
- Paracelsus Clinic Scheidegg, 88175 Scheidegg, Germany
| | - Monika Reuss-Borst
- Center for Rehabilitation and Prevention Bad Bocklet, 97708 Bad Bocklet, Germany
| | - Kristin Duelli
- Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Karin Meng
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
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Lindert L, Kühn L, Kuper P, Choi KE(A. Organizational Health Literacy in the Context of Employee Health: An Expert-Panel-Guided Scoping Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4381. [PMID: 35410062 PMCID: PMC8998773 DOI: 10.3390/ijerph19074381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
Health literacy (HL) is an interplay of individual and organizational health literacy (OHL). While individual HL has been intensively studied, the importance of OHL has become a greater focus of research attention. The National Action Plan Health Literacy in Germany emphasizes the promotion of HL in all areas of everyday life, including occupation and the workplace. The proposed scoping review aims at identifying and evaluating definitions, empirical studies and instruments on OHL targeting employee recipients. The search will be conducted in two consecutive steps and guided by expert-panel discussions in accordance to the method of Consensus Development Panels. The search will be conducted in Web of Science, PubMed and Google Scholar according to the methodological framework of Arksey and O'Malley and supplemented by the snowball principle and a hand search. All records will be included that were published until the final search date. To define eligibility criteria, the PCC framework of the Joanna Briggs Institute is used. The scoping review will critically discuss whether a new definition of OHL in the context of employee health is of purpose for future research and practice. Nonetheless, it will provide orientation in the context of employee health, also facing the consequences of SARS-CoV-2.
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Affiliation(s)
- Lara Lindert
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany; (L.K.); (P.K.); (K.-E.C.)
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Perez NP, Ahmad H, Alemayehu H, Newman EA, Reyes-Ferral C. The impact of social determinants of health on the overall wellbeing of children: A review for the pediatric surgeon. J Pediatr Surg 2022; 57:587-597. [PMID: 34893308 DOI: 10.1016/j.jpedsurg.2021.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023]
Abstract
Disparities in health care access, quality, and outcomes for pediatric patients, and their relationship to race and socioeconomic status (SES) have been extensively documented. The underlying causes behind such disparities have been less carefully studied, as clinicians and researchers often fail to look past immutable features such as race, into modifiable factors like social determinants of health (SDOH). A child's environment affects their patterns of social engagement, sense of security, and overall well-being. Resources such as affordable housing, access to education, public safety, and availability of healthy foods and safe play spaces impact and enhance quality of life, and have significant influence on both health and health care outcomes. These upstream indicators are often unrecognized or misidentified as health concerns. Few pediatric surgery publications discuss SDOH and their effects on children. This paper aims to introduce the five domains of SDOH (economic stability, education, social and community context, health and healthcare, and neighborhood and built environment) along with strategies to identify and address needs in these domains from a provider, hospital, and health system's perspective. It is anticipated that this information will serve as a foundation for pediatric surgeons to understand and develop processes that ameliorate disparities related to SDOH and improve surgical outcomes and the well-being of all children.
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Affiliation(s)
- Numa P Perez
- Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St GRB-425, Boston, MA 02114, United States.
| | - Hira Ahmad
- Department of Surgery, Nationwide Children's Hospital, Columbus, The Ohio State University College of Medicine, OH, United States
| | - Hanna Alemayehu
- Department of Surgery, Children's and Women's Hospital, University of South Alabama Health System, Mobile, AL, United States
| | - Erika A Newman
- Department of Surgery, CS Mott Children's Hospital, The University of Michigan, Ann Arbor, MI, United States
| | - Cynthia Reyes-Ferral
- Department of Surgery, St. Joseph's Children's Hospital, Tampa, FL, United States
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Sharifzadeh Y, Slade AN, Weiss E, Sutton AL, Sheppard VB. Attitudes and Perceptions Towards Radiation Therapy in Breast Cancer Patients: The Role of a Multidisciplinary Care Team. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:639-645. [PMID: 31940123 PMCID: PMC7543055 DOI: 10.1007/s13187-019-01677-1] [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
Previous studies have shown that breast cancer patients' beliefs regarding radiation therapy (RT) are influenced by a multitude of factors encompassing demographic, socioeconomic, cultural, and healthcare-related domains. The association between consultation with a multidisciplinary care team and breast cancer patients' attitudes towards RT, however, remains understudied. Using survey and medical record data from 185 women with invasive, non-metastatic breast cancer who received breast conserving surgery, we aimed to characterize the relationship between the number and type of oncological specialties consulted and women's belief in RT's ability to decrease the likelihood of breast cancer recurrence. Using multivariable models, we found that compared to women who discussed RT with only one oncologist (medical, radiation, or surgical), women who discussed RT with all three oncologists were more likely to report increased agreement with RT's ability to reduce cancer recurrence. No single specialty of oncology, including radiation oncology, showed increased associations with women's beliefs regarding RT's efficacy. We conclude that women's beliefs in the ability of radiation therapy to reduce breast cancer recurrence are associated with an increased number of oncologic physicians consulted.
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Affiliation(s)
- Yasamin Sharifzadeh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA
| | - Alexander N Slade
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA.
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA
| | - Arnethea L Sutton
- Department of Health Behavior & Policy, Virginia Commonwealth University, 401 College St, Richmond, VA, 23298, USA
| | - Vanessa B Sheppard
- Department of Health Behavior & Policy, Virginia Commonwealth University, 401 College St, Richmond, VA, 23298, USA
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Abstract
PurposeThis paper aims to identify consumers' health information consultation patterns by analyzing information sources to better understand consumers' health information needs and behavior in the context of multisource health information.Design/methodology/approachHaodaifu Online, an online health consultation (OHC) website in China, was used as a research data source, and 20,000 consultation cases were collected from the website with Python. After screening and cleaning, 1,601 consultation cases were included in this study. A content analysis-based mixed-methods research approach was applied to analyze these cases.FindingsThe results indicate that with the participation of OHC, there are 15 patterns of consumer health information consultation. Besides OHC, health information sources reported by consumers included medical institutions family/friends and the Internet. Consumers consult on a wide range of health issues including surgical conditions obstetrical and gynecological conditions and other 20 subjects. Consumers have multiple information needs when using OHC: getting prescriptions, diagnosing diseases, making appointments, understanding illnesses, confirming diagnoses and reviewing costs. Through further analysis it was found that consumers’ health information consultation patterns were also significantly different in health issues and health information needs.Originality/valueThis study broadens one’s understanding of consumer health information behavior, which contributes to the field of health information behavior, and also provides insight for OHC stakeholders to improve their services.
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Chang ME, Baker SJ, Dos Santos Marques IC, Liwo AN, Chung SK, Richman JS, Knight SJ, Fouad MN, Gakumo CA, Davis TC, Chu DI. Health Literacy in Surgery. Health Lit Res Pract 2020; 4:e46-e65. [PMID: 32053207 PMCID: PMC7015264 DOI: 10.3928/24748307-20191121-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/22/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy. Key Results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%–50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2). Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45–e65.] Plain Language Summary: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniel I. Chu
- Address correspondence to Daniel I. Chu, MD, Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, KB 428, 1720 2nd Avenue S., Birmingham, AL 35294-0016;
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10
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Nakata H, Halbach S, Geiser F, Stock S, Kowalski C, Enders A, Pfaff H, Ernstmann N. Health literacy, mental disorders and fear of progression and their association with a need for psycho-oncological care over the course of a breast cancer treatment. PSYCHOL HEALTH MED 2020; 26:818-831. [PMID: 32484756 DOI: 10.1080/13548506.2020.1772987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This studyinvestigates the need for psycho-oncological care over the course of a breast cancer treatment and possible associated factors to develop such a need. The PIAT-Study was a longitudinal postal survey study conducted in Germany (2013 to 2014) with breast cancer patients (BCPs). Patients received a questionnaire at three-time points (T1: few days after surgery, T2: after 10 weeks; T3: after 40 weeks). This study considers information about patients' needs for psycho-oncological care, their breast cancer disease, social support, anxiety, health literacy (HL) and sociodemographic information. Data were analysed with descriptive statistics and logistic regression modelling to estimate the association between a need for psycho-oncological treatment and patient characteristics. N = 927 breast cancer patients reported their psycho-oncological need. 35.2% of patients report at least at one measuring point to be in need for psycho-oncological care. In a multiple logistic regression, noticeable determinants for developing such a need are an inadequateHL(OR = 1.97), fear of progression (FoP) (OR = 2.08) and psychological comorbidities (OR = 8.15) as well as certain age groups. BCPs with a low HL, suffering from a dysfunctional level of FoP or mental disorders are more likely to develop a need for psycho-oncological care.
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Affiliation(s)
- Hannah Nakata
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Franziska Geiser
- Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | | | - Anna Enders
- Department for Health Promotion for Vulnerable Groups, The Federal Centre for Health Education (BZgA), Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany.,Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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11
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Portelli Tremont JN, Downs-Canner S, Maduekwe U. Delving deeper into disparity: The impact of health literacy on the surgical care of breast cancer patients. Am J Surg 2020; 220:806-810. [PMID: 32444064 DOI: 10.1016/j.amjsurg.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast surgical oncology is a unique field that involves complex cancer management and longstanding patient interactions with the healthcare system, making it potentially challenging for patients with low health literacy. The purpose of this review is to summarize the current knowledge regarding health literacy in breast cancer and identify future directions for research and potential intervention in breast surgical oncology. DATA SOURCES A search of relevant literature querying PubMed and Science Direct was performed and included the following keywords: health literacy, breast cancer, breast surgical oncology, surgery, outcomes, prevention, screening, healthcare utilization, chronic disease. CONCLUSIONS Limited health literacy may detrimentally affect understanding and outcomes in breast surgical oncology. Identifying ways providers can improve patient understanding and utilization of health information is important, and surgeons may have a pivotal role. Further studies addressing health literacy in breast surgical oncology is needed in order to better optimize care of patients.
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Affiliation(s)
- Jaclyn N Portelli Tremont
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
| | - Stephanie Downs-Canner
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
| | - Ugwuji Maduekwe
- University of North Carolina at Chapel Hill, Department of Surgery, Division of Surgical Oncology, 170Manning Drive, CB #7213, 1150 Physicians Office Bldg., Chapel Hill, NC, 27599-7213, USA.
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Gunn CM, Paasche-Orlow MK, Bak S, Wang N, Pamphile J, Nelson K, Morton S, Battaglia TA. Health Literacy, Language, and Cancer-Related Needs in the First 6 Months After a Breast Cancer Diagnosis. JCO Oncol Pract 2020; 16:e741-e750. [PMID: 32216715 DOI: 10.1200/jop.19.00526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Low health literacy (HL) and language negatively affect cancer screening and prevention behaviors; less is known about how they affect the patient's experience during cancer treatment. This study explores associations among HL, spoken language, and dimensions of cancer-related needs within 6 months of receiving a breast cancer diagnosis. METHODS Women speaking English, Spanish, or Haitian Creole, enrolled in a patient navigation study at diagnosis, completed a survey in their primary spoken language at baseline and 6 months to characterize their cancer-related needs. HL was measured using the Brief Health Literacy Screening Tool. Outcomes included the Cancer Needs Distress Inventory (CaNDI; n = 38 items) and the Communication and Attitudinal Self-Efficacy scale (CASE-Cancer) for cancer (n = 12 items). Linear regressions measured the impact of HL and language on total CaNDI and CASE-Cancer scale for cancer scores and subscales, adjusted for demographics. RESULTS At baseline, 262 women participated and 228 (87%) followed up at 6 months. Of these, 38% had adequate HL, 33% had marginal HL, and 29% had inadequate HL. Women with inadequate or marginal HL had higher median baseline CaNDI scores (P = .02) and lower self-efficacy scores (P = .008), relative to those with adequate HL. Haitian-Creole speakers had significantly lower CANDI scores at baseline (P = .03). Adjusting for demographics, differences in CaNDI scores at baseline remained significant for those with lower HL and Haitian-Creole speakers. At 6 months, differences in self-efficacy persisted for Haitian-Creole speakers. CONCLUSION Findings suggest that interventions oriented to mitigating HL and language barriers might reduce distress at the time of diagnosis and improve self-efficacy over the course of treatment.
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Affiliation(s)
- Christine M Gunn
- Evans Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, MA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Michael K Paasche-Orlow
- Evans Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Sharon Bak
- Evans Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, MA
| | - Na Wang
- Biostatistics and Epidemiology Data Analytic Center, Boston University, Boston, MA
| | - Jennifer Pamphile
- Evans Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, MA
| | - Kerrie Nelson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | | | - Tracy A Battaglia
- Evans Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, MA
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Sheridan A, Kemple M, Hyde A, Fox P, Furlong E, Coughlan B, Bell M, Naughton C, Carberry S, Drennan J. Non-use of cancer information services among people experiencing cancer in Ireland. Eur J Oncol Nurs 2020; 44:101700. [PMID: 32007695 DOI: 10.1016/j.ejon.2019.101700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to explore the reasons for non-use of a national cancer society's cancer information services among people experiencing cancer. METHOD This study used a qualitative design. Semi-structured interviews were conducted with a total of 17 participants who had not previously utilised the Cancer Society's information services. Data were analysed using Thematic Analysis. RESULTS The key themes to emerge from the date were 'living in the here and now' and 'awareness of the Cancer Society'. For most participants, not utilising cancer information services was a means of coping with the initial diagnosis and the impact of treatment. Those who progressed to being ready to seek information identified the multi-disciplinary team as the primary source of trusted information, with particular mention of cancer nurse specialists. For participants with children, their role as a parent was central in how they managed their diagnosis. The majority of participants lacked awareness of the range of services provided by the Cancer Society. CONCLUSIONS Reasons for non-use of cancer information services were identified as: readiness to seek information and a lack of knowledge of the Cancer Societies' services. Cancer information services need to continue make a concerted effort to enhance visibility and awareness of its services to optimise patient engagement.
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Affiliation(s)
- A Sheridan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland.
| | - M Kemple
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - A Hyde
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - P Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - E Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - B Coughlan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - M Bell
- Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland
| | - C Naughton
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - S Carberry
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - J Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Nowak M, Lee S, Karbach U, Pfaff H, Groß SE. Short length of stay and the discharge process: Preparing breast cancer patients appropriately. PATIENT EDUCATION AND COUNSELING 2019; 102:2318-2324. [PMID: 31427170 DOI: 10.1016/j.pec.2019.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/16/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Breast cancer is the most common cancer among women worldwide, increasing the relevance of an efficient and successful care process. As length of stay (LOS) in the hospital decreases, patients' satisfaction with the LOS varies. We hypothesize that successful discharge planning can improve this evaluation. METHODS Data of 4,390 female breast cancer patients from a cross-sectional survey was analyzed. The data was collected in 2017 in 86 German hospitals. Logistic regressions were used to test hypotheses. RESULTS The majority of included patients rated their LOS as appropriate. However, patients who felt better prepared for discharge were less likely to rate their stay as too short. A longer stay in the hospital further decreased this likelihood. The effect of LOS was moderated by patient experiences with preparation for discharge. CONCLUSION As hospital LOS decreases, one challenge in allowing patients to feel sufficiently informed and ready to go home is the reduced time for face-to-face consultations. Our results indicate, however, that a strong and thorough discharge planning makes the actual number of days for LOS irrelevant for patient's rating of LOS. PRACTICE IMPLICATIONS The study results underscore the importance of ensuring the quality and thoroughness of the discharge process.
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Affiliation(s)
- Marina Nowak
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany.
| | - Susan Lee
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences of the Technical University Dortmund, Dortmund, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany
| | - Sophie E Groß
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany; LVR-Institute of Health Care Research, LVR Clinic Cologne, Cologne, Germany
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15
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Zhou K, Huo L, He X, Li M, An J, Wang W, Li J, Li X. The Needs Self-Rating Questionnaire for Breast Cancer (NSQ-BC): Development of a tool for the needs assessment of women with breast cancer in mainland China. J Eval Clin Pract 2019; 25:889-895. [PMID: 30773748 DOI: 10.1111/jep.13113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 01/03/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES A needs assessment tool considering the cultural background of mainland China has not been reported. This study developed a Needs Self-rating Questionnaire for Breast Cancer (NSQ-BC) based on Maslow's hierarchy of needs for mainland Chinese patients. METHODS The Delphi technique and pilot cross-sectional surveys (two rounds) were performed for item selection. In the Delphi technique, items were selected according to the experts' perspective on the item's significance (ie, 1-5 Likert-scale ratings of importance; mean > 4.0 and coefficients of variation <0.25). In the pilot cross-sectional surveys, items were selected according to internal consistency reliability (Cronbach's α ≥ 0.70), discriminant validity (stronger correlations of the item with the hypothesized subscale than for other subscales), and convergent validity (hypothesized item-subscale correlations ≥0.40). All decisions were made based on the results of statistical analyses, recommendations of the experts, and in-depth discussion among research team members. RESULTS Following the two evaluation rounds, the revised NSQ-BC comprised 26 items across five subscales of needs: physical, psychological, respect/self-esteem, information, and rehabilitation. Item ratings from the expert panellists met the aforementioned criteria (ie, Kendall's W = 0.329, P < 0.001). Except for the "respect/self-esteem needs" subscale, Cronbach's α for all subscales exceeded 0.70. All items had acceptable discriminant and convergent validity. Additionally, two new items-good environment/facilities and economic support-were added to the NSQ-BC, as recommended by the experts. CONCLUSIONS The NSQ-BC was developed fully via the comprehensive use of Delphi technique and pilot cross-sectional surveys. It provides evidence of a proper instrument for needs assessment and evaluation among women with breast cancer in mainland China.
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Affiliation(s)
- Kaina Zhou
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Lanting Huo
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xiaole He
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Minjie Li
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jinghua An
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Wen Wang
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jin Li
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Differences in perception of breast cancer treatment between patients, physicians, and nurses and unmet information needs in Japan. Support Care Cancer 2019; 28:2331-2338. [PMID: 31482403 PMCID: PMC7083820 DOI: 10.1007/s00520-019-05029-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/06/2019] [Indexed: 01/21/2023]
Abstract
Purpose Discrepancies exist between healthcare provider and patient perceptions surrounding breast cancer treatment. Significant treatment changes in the last 10 years have made re-evaluation of these perceptions necessary. Methods Physicians and nurses involved in breast cancer treatment, and patients who had received breast cancer chemotherapy (past 5 years), were questioned using an Internet survey. Participants ranked physical concerns (treatment side effects), psychological concerns, priorities for treatment selection, and side effects to be avoided during treatment. Patients were asked about desired treatment information/information sources. Rankings were calculated using the mean value of scores. Spearman’s rank correlation was used to determine the concordance of rankings among groups. Results Survey respondents included 207 patients, 185 physicians, and 150 nurses. Patients and nurses similarly ranked distressing physical concerns; physician rankings differed. Quality of life (QoL) and treatment response ranked high with physicians and patients when considering future treatment; nurses prioritized QoL. All three groups generally agreed on ranking of psychological concerns experienced during chemotherapy, explanation of treatment options, and how treatment decisions were made, although more patients thought treatment decisions should be made independently. Healthcare providers reported providing explanations of treatment side effects and information on physical/psychological support options while patients felt both were lacking. Concordance was calculated as 0.47 (patient–physician), 0.83 (patient–nurse), and 0.76 (physician–nurse). Patients desired additional information, preferring healthcare providers as the source. Conclusions Specific areas for improvement in breast cancer patient care were identified; programs should be implemented to address unmet needs and improve treatment in these areas. Electronic supplementary material The online version of this article (10.1007/s00520-019-05029-z) contains supplementary material, which is available to authorized users.
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Garcia-Codina O, Juvinyà-Canal D, Amil-Bujan P, Bertran-Noguer C, González-Mestre MA, Masachs-Fatjo E, Santaeugènia SJ, Magrinyà-Rull P, Saltó-Cerezuela E. Determinants of health literacy in the general population: results of the Catalan health survey. BMC Public Health 2019; 19:1122. [PMID: 31420029 PMCID: PMC6698033 DOI: 10.1186/s12889-019-7381-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Health Literacy (HL) is the knowledge and competence to access, understand, appraise, and apply health information for health judgment. We analyze for the first time HL level of Catalonia’s population. Our objective was to assess HL of population in our area and to identify social determinants of HL in order to improve the strategies of the Healthcare Plan, aimed at establishing a person-centered system and reducing social inequalities in health. Methods This was a cross-sectional study based on the Health Survey for Catalonia (ESCA, Enquesta de Salut de Catalunya), which included the 16 items of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The statements in the questionnaire cover three different health literacy domains: Health Care, Disease Prevention, and Health Promotion. HL was categorized in three levels: Sufficient, Problematic and Inadequate. Chi-square tests were performed to compare the percentages of subjects with adequate or inadequate HL across sociodemographic and health-related variables. Variables showing significant differences were included in a stepwise logistic regression to predict inadequate HL level. Results The questionnaire was administered to 2433 subjects aged between 15 and 98 years old (mean of 45.9 years, SD 18.0). Overall, 2059 subjects (84.6%) showed sufficient HL, 250 (10.3%) inadequate HL, and 124 (5.1%) problematic HL, with no significant differences between men and women (p = 0.070). A logistic regression analysis showed that low health literacy is associated with a lower level of education (OR 2.08, CI 95% 1.32–3.28, p = 0.002), low socioeconomic status (OR 2.11, CI 95% 1.42–3.15, p < 0.001) and a physical limitation to perform everyday activities (OR 2.50, CI 95% 1.34–4.66, p = 0.004). We also found a more modest association with low physical activity, having a self-perceived chronic disorder and performing preventive activities. Conclusions Catalonia has a high percentage of subjects with sufficient HL. Education level, socioeconomic status and physical limitations were the factors with the strongest contribution to inadequate or problematic health literacy. Although these results are likely to be country-specific, the factors identified will allow policymakers of areas with similar socioeconomic profiles to identify groups with high risk of problematic or inadequate HL, which is essential for a successful patient-centered model of care.
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Affiliation(s)
- Oriol Garcia-Codina
- Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Dolors Juvinyà-Canal
- Research Group Health and Health Care, University of Girona, Plaça de Sant Domènec, 3, 17004, Girona, Spain.
| | - Paloma Amil-Bujan
- Chronicity Prevention and Care Programme, Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Carmen Bertran-Noguer
- Research Group Health and Health Care, University of Girona, Plaça de Sant Domènec, 3, 17004, Girona, Spain
| | - María Asunción González-Mestre
- Chronicity Prevention and Care Programme, Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Eulàlia Masachs-Fatjo
- Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Sebastià J Santaeugènia
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Universitat de Vic - University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,Chronic Care Program, Ministry of Health, Generalitat de Catalunya, Catalonia, Spain
| | - Pilar Magrinyà-Rull
- Health Planning General Directorate, Ministry of Health, Government of Catalonia, Barcelona, Spain
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Aunan ST, Wallgren GC, Saetre Hansen B. Breast cancer survivors' experiences of dealing with information during and after adjuvant treatment: A qualitative study. J Clin Nurs 2019; 28:3012-3020. [PMID: 30357944 DOI: 10.1111/jocn.14700] [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] [Received: 11/09/2017] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe breast cancer (BC) survivors' experiences of participating in a 2-day educational programme (Breast Cancer School, BCS) and their critical reflection on information received during and after adjuvant treatment. The following research questions guided the study. How do BC survivors experience their participation in an educational programme? How do BC survivors experience the information trajectory during and after adjuvant treatment? BACKGROUND BC is the most prevalent cancer among women in Norway. BC survivors have a substantial need for information about the disease, treatment and recovery. During the past few years, BC treatment in Norway has changed from inpatient- to outpatient-based treatment. Oncology nurses and oncologists are obliged to provide patients and their families with information, which has necessitated reorganisation of the procedures for providing information. New arenas such as the Breast Cancer School (BCS) offer the opportunity to learn from experts and fellow patients. DESIGN Qualitative, descriptive design. METHODS Focus groups with 20 BC survivors after having participated in the BCS were used to enable critical reflection. The COREQ checklist was followed to ensure rigour in the study. RESULTS Two themes emerged from qualitative analysis: Balancing between the need for and the fear of information and Moving from a safe structure to lonely recovery. We identified differences between BC survivors in diversity, uniqueness and need for information. Continuity and expert knowledge provided by a primary oncology nurse and oncologists were highlighted as important. CONCLUSION The study reveals the need for information tailored to each BC survivor's unique needs. The BC survivors expressed both the need for and the fear of information. BCS takes both a systematic and individual approach to provide expert information, dialog and the opportunity to meet with fellow patients. The transition from the structure of the treatment to lonely recovery after the most intensive treatment was perceived as unsafe and challenging. BC patients' experiences must be continuously valued and used to improve educational programmes, care and treatment. Oncology nurses play an important part in the information chain and continuity. RELEVANCE TO CLINICAL PRACTICE This study highlights the importance of including BC survivors in the design and evaluation of educational programmes. The provision of information and supportive care with continuity between oncology nurses and oncologists through the trajectory of treatment and care is crucial.
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Affiliation(s)
- Siv Tove Aunan
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Gry Ciekals Wallgren
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Britt Saetre Hansen
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, Quality and Safety in Health Care Systems, University of Stavanger, Stavanger, Norway
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de Ligt KM, van Egdom LS, Koppert LB, Siesling S, van Til JA. Opportunities for personalised follow-up care among patients with breast cancer: A scoping review to identify preference-sensitive decisions. Eur J Cancer Care (Engl) 2019; 28:e13092. [PMID: 31074162 PMCID: PMC9285605 DOI: 10.1111/ecc.13092] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/21/2019] [Accepted: 04/20/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Current follow-up arrangements for breast cancer do not optimally meet the needs of individual patients. We therefore reviewed the evidence on preferences and patient involvement in decisions about breast cancer follow-up to explore the potential for personalised care. METHODS Studies published between 2008 and 2017 were extracted from MEDLINE, PsycINFO and EMBASE. We then identified decision categories related to content and form of follow-up. Criteria for preference sensitiveness and patient involvement were compiled and applied to determine the extent to which decisions were sensitive to patient preferences and patients were involved. RESULTS Forty-one studies were included in the full-text analysis. Four decision categories were identified: "surveillance for recurrent/secondary breast cancer; consultations for physical and psychosocial effects; recurrence-risk reduction by anti-hormonal treatment; and improving quality of life after breast cancer." There was little evidence that physicians treated decisions about anti-hormonal treatment, menopausal symptoms, and follow-up consultations as sensitive to patient preferences. Decisions about breast reconstruction were considered as very sensitive to patient preferences, and patients were usually involved. CONCLUSION Patients are currently not involved in all decisions that affect them during follow-up, indicating a need for improvements. Personalised follow-up care could improve resource allocation and the value of care for patients.
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Affiliation(s)
- Kelly M. de Ligt
- Department of ResearchNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of Health Technology and Services Research, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | - Laurentine S.E. van Egdom
- Department of Surgical OncologyErasmus MC Cancer Institute, University Medical Centre RotterdamRotterdamThe Netherlands
| | - Linetta B. Koppert
- Department of Surgical OncologyErasmus MC Cancer Institute, University Medical Centre RotterdamRotterdamThe Netherlands
| | - Sabine Siesling
- Department of ResearchNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of Health Technology and Services Research, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | - Janine A. van Til
- Department of Health Technology and Services Research, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
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Heuser C, Diekmann A, Kowalski C, Enders A, Conrad R, Pfaff H, Ansmann L, Ernstmann N. Health literacy and patient participation in multidisciplinary tumor conferences in breast cancer care: a multilevel modeling approach. BMC Cancer 2019; 19:330. [PMID: 30961598 PMCID: PMC6454712 DOI: 10.1186/s12885-019-5546-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/28/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Decisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes. Furthermore, it has been shown that in some breast cancer centers in Germany, patients participate in MTCs and that participation is associated with sociodemographic and breast cancer center-related factors. Health literacy (HL) has been shown to be predictive for individual health behavior and is an important prerequisite for patient participation in healthcare. However, so far nothing is known about the association between HL and MTC patient participation. To close this gap in research, we analyzed which patient characteristics affect participation in MTCs and whether participation varies between breast cancer centers. METHODS In a prospective, multicenter cohort study, newly diagnosed breast cancer patients were surveyed directly after surgery (T1) as well as 10 weeks (T2) and 40 weeks (T3) after surgery. After descriptive analysis, t-tests were conducted, correlations for independent variables were run, and logistic multilevel regression analysis was applied to estimate the association between patient participation in MTCs at T1 and HL (HLS-EU-Q16 [1]), sociodemographic and disease-related characteristics (n = 863 patients) and the variation between breast cancer centers (n = 43 centers). RESULTS Descriptive results show that 6.8% of breast cancer patients took part in a MTC. The logistic multilevel regression model revealed that patients with an inadequately HL are less likely to participate in MTCs (OR = 0.31, 95%-CI = 0.1-0.9, Pseudo-R2 = 0.06), and participation is dependent on the breast cancer center (ICC = 0.161). CONCLUSIONS These findings are the first to show significant differences in HL and patient participation in MTCs in a large sample of breast cancer patients. In future research on patient participation in MTCs and HL, questions concerning the organization, communication and decision-making in MTCs with and without patient participation have to be addressed, and patient and provider perspectives must be equally considered. TRIAL REGISTRATION Database Health Services Research, VfD_PIAT_12_001630 , registered prospectively on 01.03.2012.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christoph Kowalski
- German Cancer Society e.V. (DKG), Department for Certification, Kuno-Fischer-Straße 8, 14057 Berlin, Germany
| | - Anna Enders
- Department for Research and Quality Management, The Federal Centre for Health Education (BZgA), Maarweg 149-161, 50825 Cologne, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany
| | - Lena Ansmann
- Organizational Health Services Research, Department for Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstraße 140, 26129 Oldenburg, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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Associations between hospital structures, processes and patient experiences of preparation for discharge in breast cancer centers: A multilevel analysis. Health Care Manage Rev 2019; 46:98-110. [PMID: 33630502 DOI: 10.1097/hmr.0000000000000237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Discharge management is a central task in hospital management. Mitchell's quality health outcomes model offers a contextual framework to derive expectations about the relationship between indicators of hospital structures and processes with patient experiences of preparation for discharge. PURPOSE The aim is to analyze the association between hospital structures and processes with patient experiences of preparation for discharge in breast cancer centers. METHODOLOGY The data were collected between February 1 and July 31, 2014-2016, with annual cross-sectional postal surveys on patient experiences of preparation for discharge in breast cancer center hospitals in Germany. These data were combined with secondary data on hospital structures, obtained from structured quality reports 2014 and the accreditation institution certifying breast cancer centers, constituting a hierarchical data structure. A total of 10,750 newly diagnosed breast cancer patients from 67 hospitals were analyzed. Following listwise deletion, 9,762 patients could be included in linear hierarchical regression analyses. RESULTS Patients felt better prepared for discharge in hospitals that communicate the discharge date timely to patients, with good coordinative processes, and which cooperate with two other breast cancer center hospitals. Hospital structures, size, teaching status, and ownership were not associated with the patient experiences of preparation for discharge. CONCLUSION The results suggest that timely and informative communication, well-organized care processes, and the network structure of centers allow for an improvement of preparation for discharge. Current and future approaches for the improvement of hospital discharge should consider the identified hospital resources. PRACTICE IMPLICATIONS Hospital management should increase the focus on structured communication and coordination processes to improve the discharge process. Cooperating networks should be expanded to increase expertise and resources. Results can be generalized to other care domains with caution. Patients' characteristics should further be assessed in order to use resources efficiently.
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Heuser C, Halbach S, Kowalski C, Enders A, Pfaff H, Ernstmann N. Sociodemographic and disease-related determinants of return to work among women with breast cancer: a German longitudinal cohort study. BMC Health Serv Res 2018; 18:1000. [PMID: 30594181 PMCID: PMC6311058 DOI: 10.1186/s12913-018-3768-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/26/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Return to work (RTW) is a key parameter of outcome quality that ensures social participation. Therefore, this study analyses the sociodemographic and disease-related determinants of RTW among newly diagnosed breast cancer patients. METHODS In a prospective, multicentre cohort study, breast cancer patients were surveyed three times: directly after surgery, after 10 weeks, and after 40 weeks. Logistic regression analysis was applied to estimate the association of RTW at 40 weeks following discharge with sociodemographic and disease-related characteristics (n = 577). RESULTS The sociodemographic variables "entrance certificate at a university of applied science" compared to "university entrance certificate" (OR = 3.1, 95%-CI = 1.2-8.1), age group "55-59 years" compared to "18-44 years" (OR = 3.2, 95%-CI = 1.2-8.4) and "having children" (OR = 2.8, 95%-CI = 1.2-6.2) as well as the disease-related variables "rehabilitation" (OR = 0.5, 95%-CI = 0.3-0.9), self-rated health "good" and "excellent" compared to "bad" (OR = 2.7, 95%-CI = 1.4-5.5; OR = 11.6, 95%-CI = 4.2-31.8) and the UICC-classification "stage II" and "stage III/IV" in comparison to "stage 0/I" (OR = 0.5, 95%-CI = 0.3-0.8; OR = 0.2, 95%-CI = 0.1-0.5) significantly affect RTW among breast cancer patients (Nagelkerke's Pseudo-R2 = 0.275). CONCLUSIONS The findings show that significant differences in RTW exist between patient groups and suggest that RTW issues must be addressed more effectively before, during and after treatment. For future research on RTW in Germany, longitudinal studies with a follow-up of several years are necessary. Information and support deficits should be tackled by social services or breast care nurses. TRIAL REGISTRATION Database Health Services Research, VfD_PIAT_12_001630 , registered 01.03.2012.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christoph Kowalski
- German Cancer Society e.V. (DKG), Department for Certification, Kuno-Fischer-Straße 8, 14057 Berlin, Germany
| | - Anna Enders
- The Federal Centre for Health Education (BZgA), Department for Research and Quality Management, Maarweg 149-161, 50825 Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology,Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Eupener Str. 129, 50933 Cologne, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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Hammersen F, Pursche T, Fischer D, Katalinic A, Waldmann A. [Signs of social inequality in information seeking and evaluation of information among young women with breast cancer - results of a cohort study]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2018; 139:10-16. [PMID: 30473447 DOI: 10.1016/j.zefq.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The extent to which cancer patients are well-informed can have manifold effects. The aim of this study was to explore both the sources of information that young breast cancer patients with children use and how they evaluate the information obtained. METHODS Participants were recruited within a rehabilitation program for young mothers with non-metastatic breast cancer (the Groemitz project "gemeinsam gesund werden"). Data on information seeking, the level of information, socio-demographic data and clinical characteristics were collected using a questionnaire. RESULTS The patients (n=827) used several additional sources of information - most frequently the internet (69.5%; n=767). The majority felt well informed about their disease and found the information provided easy to understand. A social gradient was observed in relation to media use, information evaluation and obtaining a second opinion. CONCLUSION To young breast cancer patients, the internet is crucial for obtaining further information. The indication of a social gradient underlines the importance of addressing the information needs of patients with a lower socioeconomic status.
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Affiliation(s)
- Friederike Hammersen
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck,Lübeck, Deutschland.
| | - Telja Pursche
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | | | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck,Lübeck, Deutschland; Institut für Krebsepidemiologie e.V., Universität zu Lübeck, Lübeck, Deutschland
| | - Annika Waldmann
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck,Lübeck, Deutschland; Hamburgisches Krebsregister, Behörde für Gesundheit und Verbraucherschutz, Hamburg, Deutschland
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Horneber M, van Ackeren G, Fischer F, Kappauf H, Birkmann J. Addressing Unmet Information Needs: Results of a Clinician-Led Consultation Service About Complementary and Alternative Medicine for Cancer Patients and Their Relatives. Integr Cancer Ther 2018; 17:1172-1182. [PMID: 30352519 PMCID: PMC6247549 DOI: 10.1177/1534735418808597] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose. To report on a telephone consultation service with
cancer patients and their relatives about complementary and alternative medicine
(CAM) between 1999 and 2011. Methods. We offered a
Germany-wide, free-of-charge telephone consultation service about CAM led by
oncology clinicians from a comprehensive cancer center. The consultations
followed a patient-centered approach with the aim to provide guidance and
evidence-based information. Sociodemographic, disease-related data as well as
information about the consultations’ content were collected in a standardized
manner, and feedback questionnaires were sent out immediately after the
consultations. Results. Overall, 5269 callers from all over
Germany used the service (57% patients, 43% relatives). The “big 4” cancer types
(breast, gastrointestinal, prostate, and lung) accounted for 55% of all calls.
In 67% of calls, patients had just received the diagnosis or commenced
anticancer therapy; 69% of patients had advanced or metastatic diseases. More
than half of the callers (55%) had vague concerns like “what else can I
do?” rather than specific questions related to CAM. The
consultations covered a broad spectrum of issues from CAM therapies to cancer
treatment and measures supportive of health, nutrition, and psychosocial
support. Callers highly valued the service. Conclusions.
Consulting about CAM addresses important unmet needs from cancer patients and
their relatives. It provides clinicians with the opportunity to engage in open
and supportive dialogues about evidence-based CAM to help with symptom
management, psychological support, and individual self-care. Consulting about
CAM cannot be separated from consulting about conventional care and should be
provided from the beginning of the cancer journey.
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Affiliation(s)
- Markus Horneber
- 1 Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany
| | - Gerd van Ackeren
- 2 Department of Internal Medicine, Hematology and Oncology, Vivantes Clinic Neukoelln, Berlin, Germany
| | - Felix Fischer
- 3 Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Berlin, Germany
| | - Herbert Kappauf
- 4 Hematology/Medical Oncology, Psychooncology and Palliative Medicine, Starnberg, Germany
| | - Josef Birkmann
- 1 Department of Internal Medicine, Division of Oncology and Hematology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany
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25
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Papadakos JK, Hasan SM, Barnsley J, Berta W, Fazelzad R, Papadakos CJ, Giuliani ME, Howell D. Health literacy and cancer self-management behaviors: A scoping review. Cancer 2018; 124:4202-4210. [DOI: 10.1002/cncr.31733] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/04/2018] [Accepted: 07/30/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Janet K. Papadakos
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Patient Education; Cancer Care Ontario Toronto Ontario Canada
| | - Salwa M. Hasan
- Undergraduate Medical Education, Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Jan Barnsley
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Whitney Berta
- Institute of Health Policy, Management, and Evaluation; University of Toronto; Toronto Ontario Canada
| | - Rouhi Fazelzad
- Library and Information Services; Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Christine J. Papadakos
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Patient Education; Cancer Care Ontario Toronto Ontario Canada
| | - Meredith E. Giuliani
- Cancer Health Literacy Research Centre; Cancer Education, Princess Margaret Cancer Centre Toronto Ontario Canada
- Radiation Medicine Program; Princess Margaret Cancer Centre Toronto Ontario Canada
- Department of Radiation Oncology, Faculty of Medicine; University of Toronto; Toronto Ontario Canada
| | - Doris Howell
- Division of Psychosocial Oncology and Palliative Care; Ontario Cancer Institute; Princess Margaret Cancer Centre Toronto Ontario Canada
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Gehrke A, Lee SS, Hilton K, Ganster B, Trupp R, McCullough C, Mott E, Feuerstein M. Development of the Cancer Survivor Profile-Breast Cancer (CSPro-BC) app: patient and nurse perspectives on a new navigation tool. J Cancer Surviv 2018. [PMID: 29524014 DOI: 10.1007/s11764-017-0668-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Despite advancements in care, cancer survivors continue to report unmet needs following active cancer treatment. The Cancer Survivor Profile-Breast Cancer (CSPro-BC) application (app) was developed to help address these needs, using breast cancer survivors (BCS) as a pilot group. This paper describes the app development, BCS and nurse perceptions of the app, and changes made based on this feedback. METHODS The CSPro-BC app was developed for use on an iPad and includes (1) administration of a 15-20-min survey assessing 18 needs, (2) generation of a profile of needs, relative to a reference group of BCS (median 2 years post-treatment), and (3) provision of problem-specific online resources. Perceptions of the app were evaluated using both quantitative and qualitative approaches. Feedback was elicited from nurse navigators and BCS. BCS were recruited until the point of saturation. RESULTS BCS (N = 11) were middle-aged and a median of 2.4 months post active treatment. Structured questionnaires indicated the following: survey covered meaningful problem areas, profile display was clear, and nurse's involvement was helpful. Follow-up interviews (2 weeks later) revealed that BCS shared their profile with others, but most BCS did not use the resources and those who did thought there were too many. Nurses (N = 3) said the app increased appointment time, but prompted them to discuss areas often not covered in typical BCS follow-up. CONCLUSIONS Feedback by end users directly informed revision of the app. IMPLICATIONS FOR CANCER SURVIVORS The CSPro-BC app has been optimized based on BCS feedback.
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Affiliation(s)
- Amanda Gehrke
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Sukhyung Steve Lee
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Karrie Hilton
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Barbara Ganster
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Rebecca Trupp
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Corinne McCullough
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Elizabeth Mott
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA
| | - Michael Feuerstein
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, 20889, USA.
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
- Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
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27
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Yagil D, Eshed-Lavi N, Carel R, Cohen M. Health care professionals' perspective on return to work in cancer survivors. Psychooncology 2018; 27:1206-1212. [DOI: 10.1002/pon.4649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Dana Yagil
- Faculty of Social Welfare and Health Sciences; University of Haifa; Haifa Israel
| | - Nofar Eshed-Lavi
- Faculty of Social Welfare and Health Sciences; University of Haifa; Haifa Israel
| | - Rafi Carel
- Faculty of Social Welfare and Health Sciences; University of Haifa; Haifa Israel
| | - Miri Cohen
- Faculty of Social Welfare and Health Sciences; University of Haifa; Haifa Israel
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28
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Ernstmann N, Halbach S, Kowalski C, Pfaff H, Ansmann L. Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM). ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 121:58-63. [PMID: 28545615 DOI: 10.1016/j.zefq.2016.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies addressing the organizational contexts of care that may help increase the patients' ability to cope with a disease and to navigate through the health care system are still rare. Especially instruments allowing the assessment of such organizational efforts from the patients' perspective are missing. The aim of our study was to develop a survey instrument assessing organizational health literacy (HL) from the patients' perspective, i. e., health care organizations' responsiveness to patients' individual needs. METHODS A pool of 30 items was developed by a group of experts based on a literature review. The items were developed, tested and prioritized according to their importance in 11 semi-structured interviews and cognitive think-aloud interviews with cancer patients. The resulting 16 items were rated in a standardized postal survey involving a total of N=453 colon and breast cancer patients treated in cancer centers in Germany. An exploratory factor analysis, a confirmatory factor analysis and structural equation modelling were conducted. Item properties were analyzed. RESULTS 83.2 % of the patients were diagnosed with breast cancer, 16.8 % had a diagnosis of colon cancer. The patients' mean age was 61 (26-88), 89.4 % were female. The most common comorbidities were hypertension (34.0 %) and cardiovascular disease (11.0 %). The final prediction model included nine items measuring the degree of health literacy-sensitivity of communication. The model showed an acceptable model fit. The nine items showed corrected item-total correlations between .622 and .762 and item difficulties between 0.77 and 0.87. Cronbach's α was .912. DISCUSSION In a comprehensive development process, the original item pool comprising several aspects of organizational HL was reduced to a one-dimensional scale. The instrument measures an important aspect of organizational HL; i.e., the degree of health literacy-sensitivity of communication (HL-COM). HL-COM was found to impact patient enablement, mediated through the support by physicians. Future research will have to test these associations in the context of other diseases or institutions.
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Affiliation(s)
- Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Köln Bonn, Germany.
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | | | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Lena Ansmann
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Hajiebrahimi Z, Mahmoodi G, Abedi G. Care management process of breast cancer in primary health-care system, Golestan Province, Iran, 2013-2014. J Family Med Prim Care 2017; 6:798-802. [PMID: 29564267 PMCID: PMC5848402 DOI: 10.4103/jfmpc.jfmpc_220_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Health-care service processes need to be assessed over time. We aimed to assess the breast cancer care process in primary health system of Golestan Province, North Iran. Materials and Methods: To perform a descriptive cross-sectional study, information on breast cancer care processes in primary health-care system was collected using a “collecting form” from 234 health houses, 29 health posts, 44 urban health centers, and 80 rural health centers in Golestan Province. Registered data in the centers and patients’ journal were used in data collection. Moreover, we collected data on all women who were diagnosed with breast cancer in 2014 to know the characteristics of the patients. Results: Around 50% of health workers at rural or urban area were trained on breast cancer. Moreover, 2% of women from general population in rural area and around 6% of them in urban area have been trained on breast cancer. Mean age of women diagnosed with breast cancer was 48 ± 10 years and 40.2% of them were affected at age between 43 and 52 years. The results showed that 18.9% of women have received their information through self-study before the diagnosis of breast cancer while 53.8% of them received their information from the private clinics after diagnosis of breast cancer. Conclusion: The process of breast cancer care in Golestan Province needs to be improved in the primary health-care level. Both inter- and multi-disciplinary activities are needed.
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Affiliation(s)
| | - Ghahraman Mahmoodi
- Department of Health Services Management, University of Medical Sciences, Sari, Iran
| | - Ghasem Abedi
- Department of Health Services Management, University of Medical Sciences, Sari, Iran
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30
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Halbach SM, Ernstmann N, Kowalski C, Pfaff H, Pförtner TK, Wesselmann S, Enders A. Unmet information needs and limited health literacy in newly diagnosed breast cancer patients over the course of cancer treatment. PATIENT EDUCATION AND COUNSELING 2016; 99:1511-1518. [PMID: 27378079 DOI: 10.1016/j.pec.2016.06.028] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/16/2016] [Accepted: 06/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate unmet information needs in newly diagnosed breast cancer patients over the course of cancer treatment and its association with health literacy. METHODS We present results from a prospective, multicenter cohort study (PIAT). Newly diagnosed breast cancer patients (N=1060) were surveyed directly after breast cancer surgery, 10 and 40 weeks later. Pooled linear regression modeling was employed analyzing changes in unmet information needs over time and its association with health literacy. RESULTS Unmet information needs on side effects and medication and medical examination results and treatment options were high and increased during the first 10 weeks after breast cancer surgery. Considering health promotion and social issues, unmet information needs started high and decreased during post-treatment. Patients with limited health literacy had higher unmet information needs. CONCLUSION Our results indicate a mismatch in information provision and breast cancer patients' information needs. Patients with limited health literacy may be at a distinct disadvantage in having their information needs met over the course of breast cancer treatment. PRACTICE IMPLICATIONS Strategies are needed to reduce unmet information needs in breast cancer patients considering treatment-phase and health literacy and thereby enable them to better cope with their diseases.
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Affiliation(s)
- Sarah Maria Halbach
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany; Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany.
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany
| | | | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | | | - Anna Enders
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Ansmann L, Kowalski C, Pfaff H. Ten Years of Patient Surveys in Accredited Breast Centers in North Rhine-Westphalia. Geburtshilfe Frauenheilkd 2016; 76:37-45. [PMID: 26855439 DOI: 10.1055/s-0041-111572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction: Patient surveys are an established tool for quality control in healthcare organizations. This report looks at the design and development of the annual patient surveys carried out among breast cancer patients treated in the Breast Centers of North Rhine-Westphalia and discusses selected findings from 10 consecutive years. Material and Methods: Since 2006 the Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR) of the University of Cologne has carried out an annual survey of breast cancer patients using the Cologne Patient Questionnaire for Breast Cancer. The patients included in the survey have been diagnosed with primary breast cancer and undergo surgery between February and July in one of the Breast Centers in North Rhine-Westphalia accredited by the medical association of Westphalia-Lippe. The questionnaire and the type of feedback given to the Breast Centers were comprehensively revised in 2014. Selected results collected over the survey period were analyzed descriptively. Results: The survey period of 10 years provides information on the actual medical care delivered in the Breast Centers based on the data obtained in this period from around 40 000 patients. Some areas showed positive developments over time. Conclusion: The approach used to survey patients, the Cologne Patient Questionnaire for Breast Cancer 2.0 and the benchmark-focused feedback provide an impetus for organizational learning in Breast Centers. The concept could also be used in other healthcare organizations to stimulate learning and improve healthcare services.
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Affiliation(s)
- L Ansmann
- Universität zu Köln, IMVR - Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät, Cologne
| | - C Kowalski
- Zertifizierung, Deutsche Krebsgesellschaft e. V., Berlin
| | - H Pfaff
- Universität zu Köln, IMVR - Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen Fakultät und der Medizinischen Fakultät, Cologne
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32
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Yeşilyurt DS, Fındık ÜY. Informational Needs of Postmastectomy Patients. THE JOURNAL OF BREAST HEALTH 2016; 12:155-157. [PMID: 28331754 DOI: 10.5152/tjbh.2016.3062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/12/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to determine informational needs of postmastectomy patients. MATERIALS AND METHODS This descriptive study was conducted in the general surgery clinics of a university health center for medical research and practice with 72 voluntary patients. For data collection, a patient identification form was used, which was prepared by the researchers in accordance with the literature. RESULTS The mean age of the patients was 52.66±13.39 years, 87% were married, 58% had primary school education, 76% had moderate economic status, and 53% had undergone simple mastectomy. It was determined that 83% of the patients wanted to be informed about hospital and home care interventions, 82% about symptoms and prevention of post-surgical problems, 76% regarding breast cancer and treatment options, and in the range of 54-68%, patients wanted information on the effects of surgery on the body, shoulder and arm exercises, breast self-examination, the effects of breast cancer on family and work life, lymphedema and prevention interventions. CONCLUSION We recommend that patients with mastectomy should be informed about topics including care interventions, breast cancer and treatment options, effects of surgery, and reducing these effects.
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Affiliation(s)
- Duygu Soydaş Yeşilyurt
- Division of Nursing, Department of Surgical Nursing, Trakya University School of Health Sciences, Edirne, Turkey
| | - Ümmü Yıldız Fındık
- Division of Nursing, Department of Surgical Nursing, Trakya University School of Health Sciences, Edirne, Turkey
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