1
|
Zhou B, Gek Mui L, Li J, Hu J. The impact of mindfulness-based interventions on the experiences of cancer patients: A qualitative meta-synthesis. PATIENT EDUCATION AND COUNSELING 2024; 127:108353. [PMID: 38964172 DOI: 10.1016/j.pec.2024.108353] [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: 01/25/2024] [Revised: 06/03/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE This study analyzed qualitative research to explore cancer patients' perspectives on MBIs, including benefits, challenges, and recommendations. METHODS This systematic review focused on synthesizing qualitative data and was registered with PROSPERO under the protocol registration number xxx. Searched 7 databases for qualitative studies on MBIs & cancer patients (17 studies, 365 patients). Analyzed data using themes & assessed confidence in findings. RESULTS Thematic analysis using NVivo software revealed four significant themes: (1) benefits and positive outcomes (e.g., symptom improvement, team support, positive experiences), (2) challenges and difficulties (e.g., practice challenges, negative experiences), (3) the journey of change and acceptance (e.g., shifts in perception, personal growth, and acceptance), and (4) adaptations and recommendations (e.g., program modification and flexibility). CONCLUSION Mindfulness-based interventions have the potential to offer cancer patients positive emotional experiences, increased team support, and opportunities for personal growth, self-discovery, and acceptance. This, in turn, can help them manage the psychological distress associated with cancer. Customizing programs to align with individual patients' needs and preferences can enhance engagement and effectiveness. PRACTICE IMPLICATIONS Integrating MBIs into Patient Education and Counseling, tailored to individual needs and with ongoing support, can enhance cancer care. Group interventions foster peer support and effectiveness. Training providers and ensuring accessibility are crucial. Research and customization to patients' journeys optimize outcomes and satisfaction. A patient-centered approach is essential for positive experiences and improved clinical outcomes.
Collapse
Affiliation(s)
- Bo Zhou
- Faculty of Medicine, Bioscience and Nursing, MAHSA University, Malaysia; Huangshan Vocational College of Health, School of Nursing, China.
| | - Lim Gek Mui
- Faculty of Medicine, Bioscience and Nursing, MAHSA University, Malaysia
| | - Jinnan Li
- Huangshan Vocational College of Health, School of Nursing, China
| | - Jiahui Hu
- Huangshan Vocational College of Health, School of Nursing, China
| |
Collapse
|
2
|
Robertson MC, Cox-Martin E, Basen-Engquist K, Lyons EJ. Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e51057. [PMID: 38335025 PMCID: PMC10891490 DOI: 10.2196/51057] [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: 07/20/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. OBJECTIVE The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. METHODS Of the intervention's 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants' written responses. They assessed each comment's depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants' (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. RESULTS Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=-1.04, SE 0.50, 95% CI -0.06 to -2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04). CONCLUSIONS We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy.
Collapse
Affiliation(s)
- Michael C Robertson
- Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | | | - Karen Basen-Engquist
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| |
Collapse
|
3
|
Lu Y, Liu C, Sun M, He X, Wang W, Lu Q. Experiences of breast cancer survivors with exercise rehabilitation: qualitative systematic review and meta-synthesis. Support Care Cancer 2023; 31:565. [PMID: 37682356 DOI: 10.1007/s00520-023-08029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE This study aimed to synthesize and evaluate the available qualitative literature on posttreatment participation in exercise rehabilitation among breast cancer survivors. METHODS This systematic review followed the Joanna Briggs Institute (JBI) meta-aggregation approach guided by ENTREQ, graded according to the ConQual approach, and evaluated using the JBI Qualitative Assessment and Review Instrument (JBI-QARI). We searched qualitative or mixed methods studies related to the experiences of exercise rehabilitation among breast cancer survivors conducted until April 13, 2023, in nine English and Chinese databases. The selected studies were reviewed independently, and the data were collaboratively synthesized into core themes. RESULTS A total of 24 studies were included, and 88 findings resulted in five synthesis findings: (a) benefits of participating in exercise rehabilitation, (b) facilitators of participation in exercise rehabilitation, (c) obstacle factors for participating in exercise rehabilitation, (d) evaluation of the exercise program, and (e) recommendations. CONCLUSION Breast cancer survivors need exercise to recover physically and mentally and to transition from cancer treatment to a normal life. The factors affecting exercise participation in breast cancer survivors are complex. Breast cancer survivors require timely and continuous effective exercise intervention forms, including online, offline, instrumental, and emotional support from others, especially healthcare providers and family members. Moreover, multidisciplinary collaboration is required to develop more effective and convenient exercise interventions.
Collapse
Affiliation(s)
- Yanjuan Lu
- School of Nursing, Hebei University, #342 Yuhua Road, Lianchi District, Baoding, 071000, Hebei Province, China
| | - Chunlei Liu
- School of Nursing, Hebei University, #342 Yuhua Road, Lianchi District, Baoding, 071000, Hebei Province, China.
| | - Mengying Sun
- School of Nursing, Hebei University, #342 Yuhua Road, Lianchi District, Baoding, 071000, Hebei Province, China
| | - Xiaoge He
- School of Nursing, Hebei University, #342 Yuhua Road, Lianchi District, Baoding, 071000, Hebei Province, China
| | - Wei Wang
- School of Nursing, Hebei University, #342 Yuhua Road, Lianchi District, Baoding, 071000, Hebei Province, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, #38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| |
Collapse
|
4
|
Oner Cengiz H, Bayir B, Sayar S, Demirtas M. Effect of mindfulness-based therapy on spiritual well-being in breast cancer patients: a randomized controlled study. Support Care Cancer 2023; 31:438. [PMID: 37395841 DOI: 10.1007/s00520-023-07904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Spiritual well-being is directly related to the quality of life in breast cancer patients. Mindfulness-based therapy interventions can decrease distress levels in women with breast cancer, while improving spiritual well-being. OBJECTIVE To investigate the effect of mindfulness-based therapy on spiritual well-being in breast cancer patients. METHODS This randomized controlled clinical trial was conducted in accordance with the Consolidated Standards of Reporting Trials. A total of 70 participants were enrolled from September, 2021 to July, 2022. Primary outcome included spiritual well-being, and secondary outcome included quality of life. The data were collected using the Patient Sociodemographic and Medical Data Form and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (SpWB) (FACIT-Sp Version 4). In the statistical analysis, the independent sample t test and paired sample t test were used to examine the intervention effect on primary and secondary outcomes, according to numbers, percentage, mean, standard deviation, and conformity to normal distribution. RESULTS The average age of the therapy group was 42.22 ± 6.86, and the control group was 41.64 ± 6.04. The average score of meaning (12.25 ± 3.03), overall score average of the spiritual well-being (31.56 ± 8.90), the emotional well-being (13.46 ± 5.78) and physical well-being (16.71 ± 5.59), and overall average score of the quality of life (66.98 ± 17.72) of the therapy group was statistically significantly higher (p < 0.05). CONCLUSION The mindfulness-based training may enhance the spiritual well-being and quality of life of breast cancer patients. Nurses should be encouraged for mindfulness-based training sessions to make it a widespread practice, and to regularly evaluate the results. TRIAL REGISTRATION NCT05057078 (date: September 27, 2021).
Collapse
Affiliation(s)
- Hatice Oner Cengiz
- Faculty of Nursing, Department of Nursing, Department of Surgical Diseases Nursing, Ankara University, Ankara, Turkey.
| | - Berna Bayir
- KTO Karatay University School of Health Sciences Department of Nursing, Konya, Turkey
| | - Serap Sayar
- KTO Karatay University School of Health Sciences Department of Nursing, Konya, Turkey
| | - Mehmet Demirtas
- Malatya Turgut Ozal Medical Center Radiation Oncology Clinic, Malatya, Turkey
| |
Collapse
|
5
|
Sullivan MB, Hill K, Ballengee LA, Knoblach D, Fowler C, Haun J, Saenger M. Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231209751. [PMID: 37901847 PMCID: PMC10605678 DOI: 10.1177/27536130231209751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/17/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023]
Abstract
Background While there is recognition by the greater medical community and physical therapists to address the biopsychosocial needs of people with chronic, persistent pain, there are challenges in implementation and delivery including wide variability in interventions, lack of clear rationale, and absence of clinical models that are feasible and acceptable on a large scale. Important components for psychologically informed physical therapy (PiPT) for pain care include behavioral approaches (e.g., Acceptance and Commitment Therapy), mindfulness, pain neuroscience education, motivational interviewing (MI), and interoceptive skills-building. The Empower Veterans Program (EVP) Mindful Movement framework blends these components and emphasizes a mindfulness and self-compassion approach with MI and body-based experiential learning. This program was offered in-person at the Atlanta and Maryland VA Health Care Centers with published positive Patient Reported Outcomes (PRO) pre-COVID 19 crisis and shifted to entirely remote delivery in March 2020. Objective This paper offers an evidence-based and theory driven framework to operationalize a remotely delivered group-based psychologically informed mindful movement physical therapy intervention as part of an interdisciplinary pain care program. Methods Since 2021 PRO and demographics are collected using a survey administered through Qualtrics over a 12-month period at baseline, immediately post TelePain EVP, at 6 months, and at 12 months, with findings forthcoming. Discussion/Results Tele-pain EVP offers 6-9 groups a week with 7-9 veterans from Atlanta based team and 3-4 groups a week with 5-9 veterans from Maryland based team. Adaptations for remote delivery optimized mindfulness and active learning strategies including interoceptive skills-building and use of MI to support self-efficacy to trust, restore a sense of safety in the body, and explore adaptations for safe movement. Conclusion TelePain-EVP Mindful Movement provides a framework for other programs to translate for their populations and systems to further develop best practices in PiPT for pain care and integration into interdisciplinary care.
Collapse
Affiliation(s)
- Marlysa B. Sullivan
- TelePain-EVP National Program Coordinator EVP Mindful Movement, Atlanta VA Health Care System (AVAHCS), Atlanta, GA, USA
| | - Kelsea Hill
- TelePain-EVP Mindful Movement, Veterans Administration Maryland Health Care System (VAMHCS), Baltimore, MD, USA
| | - Lindsay A. Ballengee
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Daniel Knoblach
- Veterans Administration Maryland Health Care System (VAMHCS), Baltimore, MD, USA
| | - Christopher Fowler
- Research and Development Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Jolie Haun
- Research and Development Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michael Saenger
- Creator of Empower Veterans Program and National Director of TelePain-EVP, Atlanta VA Health Care System (AVAHCS), Atlanta, GA, USA
- School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
6
|
Gonçalves L, Moraes MS, Silva DAS. Counseling for Physical Activity in Adults during the COVID-19 Pandemic: A Scope Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148687. [PMID: 35886538 PMCID: PMC9322393 DOI: 10.3390/ijerph19148687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 01/02/2023]
Abstract
Objective: The aim of this scope review was to map the available scientific evidence on physical activity counseling for adults during the COVID-19 pandemic. Methods: The search was performed in PubMed, Web of Science, Scopus, SPORTDiscus, LILACS, SciELO, and CINAHL databases. Studies that described the population of adults over 18 years of age that used physical activity counseling during the COVID-19 pandemic context were selected. Data extracted were author, study location, sample, age group, sex, population characteristics, design, means used for intervention, time of intervention, professionals involved, and intervention or counseling strategy. Results: Physical activity counseling interventions were aimed at participants with insufficient levels of physical activity or with comorbidities; counseling was carried out in the online format; by health professionals, in the highest proportion of coaches, physicians, researchers, and nutritionists; through educational contents regarding the practice of physical activity; and using the transtheoretical model of behavior change as a reference method. Conclusions: The results of this review can provide tools for health professionals to assist in the process of coping with physical inactivity.
Collapse
|
7
|
Robertson MC, Cox-Martin E, Shegog R, Markham CM, Fujimoto K, Durand CP, Brewster A, Lyons EJ, Liao Y, Flores SA, Basen-Engquist KM. The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design. JMIR Cancer 2022; 8:e31815. [PMID: 35486425 PMCID: PMC9107061 DOI: 10.2196/31815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness.
Collapse
Affiliation(s)
- Michael C Robertson
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States.,Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | | | - Ross Shegog
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Christine M Markham
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Kayo Fujimoto
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Casey P Durand
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Abenaa Brewster
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Yue Liao
- College of Nursing and Health Innovation, The University of Texas, Arlington, TX, United States
| | - Sara A Flores
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
8
|
Ee C, Singleton AC, de Manincor M, Elder E, Davis N, Mitchell C, Dune T, MacMillan F, McBride K, Grant S. A Qualitative Study Exploring Feasibility and Acceptability of Acupuncture, Yoga, and Mindfulness Meditation for Managing Weight After Breast Cancer. Integr Cancer Ther 2022; 21:15347354221099540. [PMID: 35652533 PMCID: PMC9168877 DOI: 10.1177/15347354221099540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Weight gain is common after breast cancer. Yoga, mindfulness meditation, and
acupuncture may assist with managing weight. However, evidence on
effectiveness is limited. This study assessed the feasibility and
acceptability of recruiting for and implementing a randomized controlled
trial (RCT) evaluating these interventions as adjuncts to lifestyle
interventions (diet and exercise) for weight management in women with breast
cancer. Methods: Qualitative study involving virtual focus groups or semi-structured
interviews. Participants were recruited via email invitation from a breast
cancer consumer organization and breast cancer center in Australia. Eligible
participants had received treatment for breast cancer, and were fluent in
English. A purposive sample of culturally and linguistically diverse (CALD)
participants was also recruited. Focus groups and interviews were
audio-recorded, transcribed verbatim and analyzed using thematic analysis
with the constant comparison method. Results: Emails were sent to 1415 women of which 37 provided data in 5 focus groups
and 1 semi-structured interview, including 1 focus group (n = 6) with only
women from CALD backgrounds. Yoga and mindfulness meditation were perceived
as feasible and acceptable for weight management, but acupuncture was seen
to be too invasive to be acceptable. A focus on wellness rather than weight
reduction, flexible program delivery, trusted advice, consideration of
participant burden and benefit, and peer-support were key factors perceived
to increase feasibility and acceptability. Conclusions: Yoga and mindfulness meditation are acceptable and useful adjuncts to
lifestyle interventions for weight management after breast cancer. This
research places end-users at the forefront of trial design, and will inform
future trials using these interventions for weight management and improving
health and wellbeing after breast cancer.
Collapse
Affiliation(s)
- Carolyn Ee
- Western Sydney University, Penrith, NSW, Australia
| | - Anna C Singleton
- Engagement and Co-Design Research Hub, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Westmead, NSW, Australia
| | | | | | - Nikki Davis
- Primary Care Collaborative Cancer Clinical Trials Group, Melbourne, VIC, Australia
| | | | - Tinashe Dune
- Western Sydney University, Penrith, NSW, Australia
| | | | - Kate McBride
- Western Sydney University, Penrith, NSW, Australia
| | | |
Collapse
|