1
|
Nash AL, Bloom DL, Chapman BM, Wheeler SB, McGuire KP, Lee CN, Weinfurt K, Rosenstein DL, Plichta JK, Vann JCJ, Hwang ES. Contralateral Prophylactic Mastectomy Decision-Making: The Partners' Perspective. Ann Surg Oncol 2023; 30:6268-6274. [PMID: 37573282 DOI: 10.1245/s10434-023-14022-0] [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: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND The rate of contralateral prophylactic mastectomy (CPM) continues to rise despite no improvement in survival, an increased risk of surgical complications, and negative effects on quality of life. This study explored the experiences of the partners of women who undergo CPM. METHODS This study was part of an investigation into the factors motivating women with early-stage unilateral breast cancer and low genetic risk to opt for contralateral prophylactic mastectomy (CPM). Participating women were asked for permission to invite their partners to take part in interviews. In-depth interviews with partners were conducted using a semi-structured topic guide. A thematic analysis of the data was performed RESULTS: Of 35 partners, all men, 15 agreed to be interviewed. Most perceived their role to be strong and logical. Some hoped their wives would choose a bilateral mastectomy. All felt strongly that the final decision was up to their partners. The partners often framed the decision for CPM as one of life or death. Thus, any aesthetic effects were unimportant by comparison. The male partners had difficulty grasping the physical and emotional changes inherent in mastectomy, which made communicating about sexuality and intimacy very challenging for the couples. In the early recovery period, some noted the stress of managing home life. CONCLUSIONS The experiences of the male partners provide insight into how couples navigate complex treatment decision-making, both together and separately. There may be a benefit to including partners in pre- and post-surgical counseling to mitigate miscommunication regarding the expected oncologic and emotional outcomes related to CPM.
Collapse
Affiliation(s)
- Amanda L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Diane L Bloom
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany M Chapman
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Clara N Lee
- Division of Health Services Management and Policy, Department of Plastic and Reconstructive Surgery, OSU Comprehensive Cancer Center, College of Medicine, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Kevin Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie C Jacobson Vann
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
2
|
Maillard J, Beckmann TS, Tramèr MR, Elia N. Reviewing next of kin regrets in surgical decision-making: cross-sectional analysis of systematically searched literature. J Patient Rep Outcomes 2023; 7:5. [PMID: 36695927 PMCID: PMC9877257 DOI: 10.1186/s41687-023-00539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Decision-making concerning relatives undergoing surgery is challenging. It remains unclear to what extent implicated next of kin eventually regret their decisions and how this regret is assessed. Our aim was to systematically review the literature on decisional regret of next of kin and to describe the assessment tools used and the surgical populations studied. METHODS We included interventional or observational, quantitative or qualitative studies reporting the measurement of decisional regret of next of kin concerning relatives undergoing surgery. We searched a variety of databases without restriction on publication year. We assessed the quality of reporting of quantitative studies using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and of qualitative studies using the Critical Appraisal Skills Program Checklist. RESULTS Thirteen cross-sectional, five prospective cohorts and five qualitative studies matched our inclusion criteria. In 18 studies (78%), patients were children, in five (22%), young or middle-aged adults. No study included elderly or frail patients. Thirteen studies (57%) used the original Decision Regret Scale which was validated for patients, but not for next of kin. Only 3 of the 18 (17%) quantitative studies and only one of the 4 (25%) qualitative studies were rated as "good" in the quality assessment. CONCLUSION None of the retrieved studies used validated tools to assess the decisional regret of next of kin and none of them examined this issue in elderly or frail surgical patients.
Collapse
Affiliation(s)
- Julien Maillard
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Tal S. Beckmann
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Martin R. Tramèr
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Nadia Elia
- grid.150338.c0000 0001 0721 9812Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| |
Collapse
|
3
|
Cincidda C, Oliveri S, Sanchini V, Pravettoni G. The role of caregivers in the clinical pathway of patients newly diagnosed with breast and prostate cancer: A study protocol. Front Psychol 2022; 13:962634. [DOI: 10.3389/fpsyg.2022.962634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundCaregivers may play a fundamental role in the clinical pathway of cancer patients. They provide emotional, informational, and functional support as well as practical assistance, and they might help mediate the interaction and communication with the oncologists when care options are discussed, or decisions are made. Little is known about the impact of dyadic dynamics on patient-doctor communication, patient's satisfaction, or adherence to the therapies. This study protocol aims to evaluate the efficacy of a psychological support intervention on patients-caregivers relationship and their alignment in the treatment decision-making (TDM) process and estimate related improvement in patient' compliance/adherence to treatments.MethodsA total of 102 patients-caregivers' dyads will be involved, among breast and prostate cancer patients. The study entails a pre- post- evaluation through psychological questionnaires, with a randomization of participants in two conditions, the experimental one in which subjects participate in a psychological support consultation, and the control one, where dyads do not receive any intervention. A follow up after 6 months from the enrollment is planned.DiscussionA positive impact of the psychological support intervention on patients' anxiety, depression, distress, and perceived social support is expected. Such improvements can directly affect patients' satisfaction and adherence to treatments. Data gathered from this study may inform health care providers, policy makers, and public health managers about the importance of caregiver's involvement in the cancer care pathway, and the best way to manage it. A further impact is to develop a specific intervention protocol to support caregivers' involvement in cancer care pathway, improve patient's wellbeing, the interaction with physicians and the compliance with the cancer treatment.
Collapse
|
4
|
Effects of Family Participatory Nursing on Clinical Outcomes of Premature Infants in NICU and Families’ Psychological Status. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7420909. [PMID: 35854782 PMCID: PMC9277171 DOI: 10.1155/2022/7420909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to explore the effects of family participatory nursing on the clinical outcomes of premature infants in the neonatal intensive care unit (NICU) and their families’ psychological status. Total of 150 premature infants were admitted to the NICU of our hospital from December 2019 to December 2021, and their families were selected by convenience sampling method and divided into control group (n = 78, from December 2019 to December 2020) and observation group (n = 72, from January 2020 to December 2021) according to the admission time. The infants in the control group were given routine nursing, while those in the observation group received family participatory nursing. In the observation group, the length of stay and duration of oxygen therapy were shorter, the weight gain speed was higher, and the incidence rate of nosocomial infection was lower than those in control groups
. The time of reaching full gastrointestinal feeding was earlier, the daily milk intake and exclusive breastfeeding rate were higher, and the feeding intolerance rate was lower in observation group than those in control group
. Observation group exhibited significantly higher body weight, Z-value of body weight, NBNA score at 7 d after hospitalization, 15-month mental development index (MDI), and psychomotor development index (PDI) scores than control group
. In addition, the families’ somatization, depression and anxiety factor scores, and total score of SCL-90 in the observation group were lower than those in the control group, while each dimension score and total score of MPOC-20 were higher than those in control groups
. Family participatory nursing is of great significance in ameliorating the clinical outcomes of premature infants in the NICU, which can shorten the length of stay, improve feeding conditions, facilitate infant growth and development, and enhance their families’ psychological status and nursing satisfaction.
Collapse
|
5
|
Wind A, van der Linden C, Hartman E, Siesling S, van Harten W. Patient involvement in clinical pathway development, implementation and evaluation - A scoping review of international literature. PATIENT EDUCATION AND COUNSELING 2022; 105:1441-1448. [PMID: 34666931 DOI: 10.1016/j.pec.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/10/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Although various pathway design methods recognize patients as stakeholders, an overview of current practice is lacking. This article describes the results of a literature review assessing patient involvement in clinical cancer pathway development, implementation and evaluation. METHODS A scoping review was conducted following PRISMA-ScR. Two databases were searched to identify studies published in English between 2014 and 2021. RESULTS Of 12841articles identified 22 articles met the inclusion criteria and reported on one or more of the three phases: development phase (N = 2), implementation (N = 4), evaluation (N = 11), development/evaluation (N = 3), and implementation/evaluation (N = 2) of clinical pathways. The numbers of involved patients ranged from 10 to 793, and the reported methods varied considerably. CONCLUSION This review presents a synthesis of methods for involving patients in the clinical pathway lifecycle. No relationship was found between methods and the number of involved patients or between pathway complexity and methods. Although patients are seen as valuable stakeholders in the pathway design, to involve them in practice using the best practice can be improved. PRACTICE IMPLICATIONS The lack of a clear justification for the choice of methods and number of involved patients calls for further research and framework development to inform pathway developers.
Collapse
Affiliation(s)
- Anke Wind
- Rijnstate Hospital, Arnhem, the Netherland; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | - Elmar Hartman
- Rijnstate Hospital, Arnhem, the Netherland; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; dept Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Wim van Harten
- Rijnstate Hospital, Arnhem, the Netherland; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands; The Netherlands Cancer Institute, Amsterdam. The Netherlands.
| |
Collapse
|
6
|
Liu J, Hunter S, Zhu J, Lee RLT, Chan SWC. Decision regret regarding treatments among women with early-stage breast cancer: a systematic review protocol. BMJ Open 2022; 12:e058425. [PMID: 35301213 PMCID: PMC8932263 DOI: 10.1136/bmjopen-2021-058425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Women with early-stage breast cancer (EBC) are commonly required to make treatment decisions. Decision regret regarding treatments is an adverse outcome that negatively affects women's psychological well-being and quality of life. A systematic review will be conducted to synthesise evidence about decision regret among women regarding treatments for EBC. The study will focus on levels of decision regret, what is regretted, and the factors associated with decision regret. METHODS AND ANALYSIS A systematic review will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Electronic databases, including CINAHL Complete, Embase, PubMed, Medline and Web of Science, will be searched for relevant articles published from 2000 to 2021. The reference lists of eligible studies will also be manually searched. All types of quantitative, qualitative and mixed-methods studies that report on decision regret regarding treatments among women with EBC will be included. The primary outcome of this review will be women's levels of decision regret regarding breast cancer treatments. The secondary outcomes will include the content of their regrets, and the factors contributing to decision regret. The methodological quality of the studies will be assessed using the Joanna Briggs Institute appraisal tools. Meta-analysis and thematic synthesis approaches will be used to synthesise quantitative and qualitative data, respectively. A convergent parallel approach will be used to integrate quantitative and qualitative findings. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. The findings of this work will be disseminated at international conferences and peer-reviewed journals. The findings of this systematic review will inform the development of decision interventions to improve the decision outcomes of breast cancer treatments. PROSPERO REGISTRATION NUMBER CRD42021260041.
Collapse
Affiliation(s)
- Jing Liu
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sharyn Hunter
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jiemin Zhu
- Department of Nursing, School of Medicine, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Regina Lai-Tong Lee
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Sally Wai-Chi Chan
- President Office, Tung Wah College, Hong Kong, People's Republic of China
| |
Collapse
|
7
|
Chichua M, Brivio E, Mazzoni D, Pravettoni G. Shared decision-making and the lessons learned about decision regret in cancer patients. Support Care Cancer 2022; 30:4587-4590. [PMID: 35031827 PMCID: PMC9046326 DOI: 10.1007/s00520-021-06725-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/27/2021] [Indexed: 12/24/2022]
Abstract
The commentary presents reflections on the literature on post-treatment cancer patient regret. Even though a lot of effort has been made to increase patient satisfaction by engaging them in medical decisions, patient regret remains present in clinical settings. In our commentary, we identify three main aspects of shared decision-making that previously have been shown to predict patient regret. Based on these findings, we provide recommendations for physicians involved in the shared decision-making process. In addition, we make methodological suggestions for future research in the field.
Collapse
Affiliation(s)
- Mariam Chichua
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Unit for Cognitive and Psychological Science, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Eleonora Brivio
- Applied Research Unit for Cognitive and Psychological Science, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Unit for Cognitive and Psychological Science, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| |
Collapse
|
8
|
Yagil D, Goldblatt H, Cohen M. Family members' experiences of the return to work of cancer survivors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:184-192. [PMID: 33852745 DOI: 10.1111/hsc.13388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/14/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
Although family members play an important role in various aspects of coping with cancer and are significantly affected by it, little is known about their perspectives regarding return to work (RTW). This study explored attitudes and experiences of cancer survivors' family members related to cancer survivors' RTW. The present study consists of a qualitative research design, employing in-depth semistructured interviews with first-degree family members (N = 21) of cancer survivors who were approached through online social networks: spouses, children, parents and siblings. Grounded theory techniques were used for data analysis. Four themes emerged from the interviews: (a) the family's cautious voice in return-to-work decision making; (b) work-home imbalance; (c) inhibiting or promoting the effect of work on the recovery process and (d) expectations and appreciation of unconditional workplace support. The findings suggest that psychosocial and health care professionals should help family members play an active role in the decision of RTW. Professionals should also prepare family members for potential costs of RTW for the family and help them develop realistic expectations regarding workplace support of the cancer survivor.
Collapse
Affiliation(s)
- Dana Yagil
- Department of Human Services, University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Human Services, University of Haifa, Haifa, Israel
| | - Miri Cohen
- Department of Human Services, University of Haifa, Haifa, Israel
| |
Collapse
|
9
|
Tyner TE, Freysteinson WM. A concept analysis of decision regret in women with breast cancer. Nurs Forum 2021; 57:112-120. [PMID: 34431105 DOI: 10.1111/nuf.12642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
The aim of this article is to understand the components of decision regret for women making breast cancer treatment decisions. Patient-centered care models encourage women to become more active in the decision-making process, inadvertently exposing them to the risk of experiencing decision regret. Enhancing the understanding of the concept of decision regret can offer insight into ways to mitigate this phenomenon. The Walker and Avant method was used to analyze this concept. Using PubMed, CINAHL, ERIC, Academic Search Complete, PsychINFO, SocINDEX, Joanna Briggs Institute of EBP Database, and an online dictionary, articles from 2011 to 2021 were analyzed to identify concept uses, attributes, antecedents, and consequences. Decision regret in women making breast cancer healthcare decisions is a negative cognitive-emotional response to a treatment decision that involves counterfactual thinking with three targets of regret: outcome regret, chosen option regret, and process regret. Experiencing decision regret can reduce a woman's quality of life, inflict psychological distress, and impact future decision-making. Unfavorable outcomes, decision uncertainty, and breakdowns in the decision-making process can lead to decision regret. Findings provide information on identifying women experiencing decision regret and illustrate opportunities to address causative factors through patient education and support to promote optimal patient outcomes.
Collapse
Affiliation(s)
- Tracy E Tyner
- College of Nursing, Texas Woman's University, Denton, Texas, USA
| | - Wyona M Freysteinson
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| |
Collapse
|