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Pel-Littel RE, Buurman BM, Minkman MM, Scholte Op Reimer WJM, Twisk JWR, van Weert JCM. The influence of health literacy, anxiety and education on shared decision making and decisional conflict in older adults, and the mediating role of patient participation: A video observational study. PATIENT EDUCATION AND COUNSELING 2024; 124:108274. [PMID: 38547640 DOI: 10.1016/j.pec.2024.108274] [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: 03/24/2023] [Revised: 02/23/2024] [Accepted: 03/21/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To explore the relationship between personal characteristics of older adults with multiple chronic conditions (MCCs) and perceived shared decision making (SDM) resp. decisional conflict. METHODS In a video-observational study (N = 213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data. RESULTS The mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β.01, p < .001) was significantly associated with participation in the SDM process. Education (β = -2.43, p = .05) and anxiety (β = -.26, p = .058) had a marginally significant direct effect on the patients' perceived level of SDM. Education (β = 12.12, p = .002), health literacy (β = -.70, p = .005) and anxiety (β = 1.19, p = .004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM. CONCLUSION Health literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict. PRACTICE IMPLICATIONS Tailoring SDM communication to health literacy levels is important for high quality SDM.
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Affiliation(s)
- Ruth E Pel-Littel
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Mirella M Minkman
- Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands; TIAS School for Business and Society, Tilburg University, Tilburg, the Netherlands
| | | | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
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Jiang S, Wu Z, Zhang X, Ji Y, Xu J, Liu P, Liu Y, Zheng J, Zhao L, Chen J. How does patient-centered communication influence patient trust?: The roles of patient participation and patient preference. PATIENT EDUCATION AND COUNSELING 2024; 122:108161. [PMID: 38308973 DOI: 10.1016/j.pec.2024.108161] [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: 09/08/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE The aim of this study was to examine the effects of patient-centered communication, patient participation, and patient preference on patient trust in the context of China. METHODS A cross-sectional survey was conducted involving 217 cancer patients in China. Mediation and moderation analyses were performed to examine the relationships among the study variables. RESULTS First, patient-centered communication increased patient participation in decision-making, which, in turn, enhanced patient trust. Second, patient-centered communication did not have a direct effect on patient trust. Third, patient preference for a passive role in decision-making weakened the relationship between patient participation and patient trust. CONCLUSION The results underscore the significant effect of facilitating patient participation in linking patient-centered communication to patient trust. However, medical communication should also respond to patients' preferred roles in the decision-making process. PRACTICE IMPLICATIONS Doctors should provide patients with opportunities to ask questions and express their concerns. In addition, they should evaluate patients' preferred degree of involvement before inviting them to contribute so as to respect their preferences and values.
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Affiliation(s)
- Shaohai Jiang
- Department of Communications and New Media, National University of Singapore, Singapore 999002, Singapore
| | - Zhengyu Wu
- School of Public Affairs, Xiamen University, Xiamen 361000, China
| | - Xiaoyu Zhang
- China Agricultural Film and Television Center, Beijing 100020, China
| | - Ying Ji
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | | | - Peng Liu
- Beijing Hospital, Beijing 100020, China
| | - Yan Liu
- Cancer Hospital Chinese Academy of Medical Science, Beijing 100020, China
| | - Jie Zheng
- Department of neurosurgery, Huashan Hospital, Fudan University, Shanghai 200000, China
| | - Liang Zhao
- Cancer Hospital Chinese Academy of Medical Science, Beijing 100020, China
| | - Jingxi Chen
- College of Arts and Media, Tongji University, Weixin Building, No.4800 Cao'an Road, Jiading District, Shanghai 201801, China.
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Kleven AG, Miaskowski C, Torstveit AH, Ritchie CS, Engh ME, Andersen E, Utne I. Quality of life of older gynecologic oncology patients at the initiation of chemotherapy. Nurs Open 2023; 10:6749-6757. [PMID: 37337353 PMCID: PMC10495706 DOI: 10.1002/nop2.1921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
AIM To evaluate older gynecologic oncology patients' quality of life (QOL) at the initiation of chemotherapy and compare their QOL scores with a female age-matched general population (GP) sample. DESIGN Cross-sectional. METHODS Older (n = 122) gynecologic oncology patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) that evaluates global health and five functional scales (range from 0 to 100). Differences in QOL scores between our sample and the GP were evaluated using one-sample t-tests and effect sizes were calculated using Cohen's d. RESULTS Patients' mean age was 70.7 years (±6.6). Mean scores for the function scales ranged from 58.5 (±31.1) for role function to 86.1 (±17.0) for cognitive function. Compared to the GP, our sample reported significantly lower scores for global health status, social, role and physical functioning, and a significantly higher score for cognitive functioning. No differences were found in emotional functioning scores. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Anne Grethe Kleven
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | | | - Ann Helen Torstveit
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | - Christine Seel Ritchie
- Division of Palliative Care and Geriatric MedicineMassachusetts General Hospital Mongan Institute Center for Aging and Serious IllnessBostonMassachusettsUSA
| | - Marie Ellström Engh
- Division Akershus University Hospital, Faculty of MedicineUniversity of OsloOsloNorway
- Department of Obstetrics and GynecologyAkershus University HospitalLørenskogNorway
| | - Elin Andersen
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet ‐ Oslo Metropolitan UniversityOsloNorway
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Hermus M, van der Wilk BJ, Chang R, Dekker JWT, Coene PLO, Nieuwenhuijzen GAP, Rosman C, Heisterkamp J, Hartgrink HH, Timmermans L, Wijnhoven BPL, van der Zijden CJ, van Lanschot JJB, Busschbach J, Lagarde SM, Kranenburg LW. Esophageal cancer patients' need for information and support in making a treatment decision between standard surgery and active surveillance. Cancer Med 2023; 12:17266-17272. [PMID: 37392175 PMCID: PMC10501224 DOI: 10.1002/cam4.6308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND This study explores patients' need for information and support in deciding on esophageal cancer treatment, when experimental active surveillance and standard surgery are both feasible. METHODS This psychological companion study was conducted alongside the Dutch SANO-trial (Surgery As Needed for Oesophageal cancer). In-depth interviews and questionnaires were used to collect data from patients who declined participation in the trial because they had a strong preference for either active surveillance (n = 20) or standard surgery (n = 20). Data were analyzed using both qualitative and quantitative techniques. RESULTS Patients prefer to receive information directly from their doctors and predominantly rely on this information to make a treatment decision. Other information resources are largely used to confirm their treatment decision. Patients highly value support from their loved ones and appreciate emphatic doctors to actively involve them in the decision-making process. Overall, patients' needs for information and support during decision-making were met. CONCLUSIONS The importance of shared decision-making and the role doctors have in this process is underlined. The role of doctors is essential at the initial phase of decision-making: Once patients seem to have formed their treatment preference for either active surveillance or surgery, the influence of external resources (including doctors) may be limited.
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Affiliation(s)
- Merel Hermus
- Department of Psychiatry, Section of Medical Psychology and PsychotherapyErasmus University Medical CenterRotterdamThe Netherlands
| | - Berend J. van der Wilk
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Rebecca Chang
- Department of Psychiatry, Section of Medical Psychology and PsychotherapyErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | | | - Camiel Rosman
- Department of SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Joos Heisterkamp
- Department of SurgeryElisabeth Tweesteden HospitalTilburgThe Netherlands
| | - Henk H. Hartgrink
- Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Liesbeth Timmermans
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
| | - Bas P. L. Wijnhoven
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Charlène J. van der Zijden
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Jan J. B. van Lanschot
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Jan Busschbach
- Department of Psychiatry, Section of Medical Psychology and PsychotherapyErasmus University Medical CenterRotterdamThe Netherlands
| | - Sjoerd M. Lagarde
- Department of SurgeryErasmus Cancer Institute, Erasmus University Medical CenterRotterdamThe Netherlands
| | - Leonieke W. Kranenburg
- Department of Psychiatry, Section of Medical Psychology and PsychotherapyErasmus University Medical CenterRotterdamThe Netherlands
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Piątek S, Szymusik I, Bidziński M. Reproductive Results in Cancer Survivors after Fertility Sparing Management: The Need for the Standardization of Definitions. Cancers (Basel) 2023; 15:3569. [PMID: 37509232 PMCID: PMC10377228 DOI: 10.3390/cancers15143569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
In fertility-sparing management (FSM), two different issues can be distinguished: the risk of recurrence/death and the chance of childbearing. Survival is the principal outcome in oncology, and definitions of overall survival and progression-free survival are therefore well defined and widely accepted. The introduction of FSM to clinical practice was determined by the desire of young cancer patients to still have children. Initially, in small groups of patients, any pregnancy and/or childbirth were considered successes. Nowadays, FSM occupies an important place in cancer treatment, with thousands of young women treated successfully. However, in contrast to survival, no definition has been established for evaluating the reproductive outcomes of FSM. This review article evaluates the current pregnancy and birth rates of cancer patients. Differences between fertility-sparing and conservative treatment are analyzed, and improper and confusing interchangeable applications of these terms are pointed out. Additionally, various reasons for choosing FSM as a treatment method-which are not directly related to fertility preservation (treatment mismatch)-are presented. Uniform definitions of reproduction after FSM should be established to enable the comparison of results and facilitate the counseling of patients regarding the chances of reproduction.
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Affiliation(s)
- Szymon Piątek
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Street, 02-781 Warsaw, Poland
- Kazimierz Pulaski University of Technology and Humanities in Radom, 26-600 Radom, Poland
| | - Iwona Szymusik
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, 80 Ceglowska Street, 00-001 Warsaw, Poland
| | - Mariusz Bidziński
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Street, 02-781 Warsaw, Poland
- Kazimierz Pulaski University of Technology and Humanities in Radom, 26-600 Radom, Poland
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Shamieh O, Alarjeh G, Qadire MA, Alrjoub W, Abu-Nasser M, Abu Farsakh F, AlHawamdeh A, Al-Omari M, Amin Z, Ayaad O, Al-Tabba A, Hui D, Bruera E, Yennurajalingam S. Decision-Making Preferences among Advanced Cancer Patients in a Palliative Setting in Jordan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085550. [PMID: 37107832 PMCID: PMC10138437 DOI: 10.3390/ijerph20085550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Understanding patients' decision-making preferences is crucial for enhancing patients' outcomes. The current study aims to identify Jordanian advanced cancer patients' preferred decision-making and to explore the associated variables of the passive decision-making preference. We used a cross-sectional survey design. Patients with advanced cancer referred to the palliative care clinic at a tertiary cancer center were recruited. We measured patients' decision-making preferences using the Control Preference Scale. Patients' satisfaction with decision-making was assessed with the Satisfaction with Decision Scale. Cohen's kappa statistic was used to assess the agreement between decision-control preferences and actual decision-making, and the bivariate analysis with 95% CI and the univariate and multivariate logistic regression were used to examine the association and predictors of the demographical and clinical characteristics of the participants and the participants' decision-control preferences, respectively. A total of 200 patients completed the survey. The patients' median age was 49.8 years, and 115 (57.5%) were female. Of them, 81 (40.5%) preferred passive decision control, and 70 (35%) and 49 (24.5%) preferred shared and active decision control, respectively. Less educated participants, females, and Muslim patients were found to have a statistically significant association with passive decision-control preferences. Univariate logistic regression analysis showed that, being a male (p = 0.003), highly educated (p = 0.018), and a Christian (p = 0.006) were statistically significant correlates of active decision-control preferences. Meanwhile, the multivariate logistic regression analysis showed that being a male or a Christian were the only statistically significant predictors of active participants' decision-control preferences. Around 168 (84%) of participants were satisfied with the way decisions were made, 164 (82%) of patients were satisfied with the actual decisions made, and 143 (71.5%) were satisfied with the shared information. The agreement level between decision-making preferences and actual decision practices was significant (ⱪ coefficient = 0.69; 95% CI = 0.59 to 0.79). The study's results demonstrate that a passive decision-control preference was prominent among patients with advanced cancer in Jordan. Further studies are needed to evaluate decision-control preference for additional variables, such as patients' psychosocial and spiritual factors, communication, and information sharing preferences, throughout the cancer trajectory so as to inform policies and improve practice.
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Affiliation(s)
- Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman 11941, Jordan
- Faculty of Medicine, The University of Jordan, Amman 11941, Jordan
- Correspondence: ; Tel.: +962-(6)5-300-460; Fax: +962-(6)5-342-567
| | - Ghadeer Alarjeh
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman 11941, Jordan
| | - Mohammad Al Qadire
- Faculty of Nursing, Al al-Bayt University, Mafraq 25113, Jordan
- College of Nursing, Sultan Qaboos University, Muscat 123, Oman
| | - Waleed Alrjoub
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman 11941, Jordan
| | - Mahmoud Abu-Nasser
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
- Department of Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | - Fadi Abu Farsakh
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | | | - Mohammad Al-Omari
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | - Zaid Amin
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | - Omar Ayaad
- Office of Nursing, King Hussein Cancer Center, Amman 11941, Jordan
| | - Amal Al-Tabba
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | - David Hui
- MD Anderson Cancer Center, Houston, TX 77030, USA
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Büdenbender B, Köther AK, Grüne B, Michel MS, Kriegmair MC, Alpers GW. When attitudes and beliefs get in the way of shared decision-making: A mediation analysis of participation preference. Health Expect 2023; 26:740-751. [PMID: 36639880 PMCID: PMC10010103 DOI: 10.1111/hex.13699] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/26/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Certain sociodemographic characteristics (e.g., older age) have previously been identified as barriers to patients' participation preference in shared decision-making (SDM). We aim to demonstrate that this relationship is mediated by the perceived power imbalance that manifests itself in patients' negative attitudes and beliefs about their role in decision-making. METHODS We recruited a large sample (N = 434) of outpatients with a range of urological diagnoses (42.2% urooncological). Before the medical consultation at a university hospital, patients completed the Patients' Attitudes and Beliefs Scale and the Autonomy Preference Index. We evaluated attitudes as a mediator between sociodemographic factors and participation preference in a path model. RESULTS We replicated associations between relevant sociodemographic factors and participation preference. Importantly, attitudes and beliefs about one's own role as a patient mediated this relationship. The mediation path model explained a substantial proportion of the variance in participation preference (27.8%). Participation preferences and attitudes did not differ for oncological and nononcological patients. CONCLUSION Patients' attitudes and beliefs about their role determine whether they are willing to participate in medical decision-making. Thus, inviting patients to participate in SDM should encompass an assessment of their attitudes and beliefs. Importantly, negative attitudes may be accessible to change. Unlike stable sociodemographic characteristics, such values are promising targets for interventions to foster more active participation in SDM. PATIENT OR PUBLIC CONTRIBUTION This study was part of a larger project on implementing SDM in urological practice. Several stakeholders were involved in the design, planning and conduction of this study, for example, three authors are practising urologists, and three are psychologists with experience in patient care. In addition, the survey was piloted with patients, and their feedback was integrated into the questionnaire. The data presented in this study is based on patients' responses. Results may help to empower our patients.
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Affiliation(s)
- Björn Büdenbender
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Anja K Köther
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Britta Grüne
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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Abdallah M, Kadambi S, Parsi M, Rai M, Mendler JH, Wittink M, Duberstein PR, Tsang M, Klepin HD, Loh KP. Older patients' experiences following initial diagnosis of acute myeloid leukemia: A qualitative study. J Geriatr Oncol 2022; 13:1230-1235. [PMID: 36064536 PMCID: PMC9982634 DOI: 10.1016/j.jgo.2022.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/16/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The onset of symptoms and the diagnosis of acute myeloid leukemia (AML) often occur suddenly and may lead to a range of emotional responses. Understanding patients' experiences and emotional states allows clinicians to tailor care to patients' needs. Previous studies have largely focused on patients' experiences at diagnosis and after remission has been achieved among those who received intensive chemotherapy. In this study, we evaluated experiences of older patients with AML who had received or were receiving treatments of varying intensity, in both outpatient and inpatient settings, and who were at different stages in their treatment course at the time of our interviews. MATERIALS AND METHODS We conducted a single center qualitative study which aimed to understand factors influencing older patients' treatment decision-making and the findings were previously reported. This analysis specifically explored older patients' experiences at various stages after AML diagnosis. We purposively sampled patients based on treatment intensity and stage of treatment (undergoing induction treatment, post-remission treatment, or post-allogeneic hematopoietic stem cell transplant). We recruited fifteen patients aged ≥60 years with AML. The sample size was determined based on reaching data saturation for the primary study aim. For this analysis, data saturation was reached by the fourteenth manuscript. In-depth semi-structured interviews that had been recorded and transcribed were re-analyzed using inductive thematic analysis to explore patients' experiences. Coding was performed using Atlas.ti. We identified themes with the aim of capturing the most commonly shared experiences. RESULTS Mean age of the fifteen patients was 72.1 years; all had received one or more treatments including intensive induction therapy (10/15), lower-intensity treatment (7/15), and/or hematopoietic stem cell transplant (3/15). Patients experienced strong negative emotional responses, including shock, that were barriers to processing information and meaningful communication. Patients also shared their perspectives on communication with healthcare professionals (including thoughts on adequacy of information provided) and coping strategies. DISCUSSION Understanding older patients' experiences, including emotional responses and barriers to communication and decision making, at AML diagnosis and throughout the illness trajectory allows clinicians to address patients' supportive care needs during this difficult period.
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Affiliation(s)
- Maya Abdallah
- Section of Hematology and Medical Oncology, Boston University School of Medicine, Boston, MA, United States of America.
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States of America.
| | - Meghana Parsi
- MD Anderson Cancer Center at Cooper University Hospital, Camden, NJ, United States of America.
| | - Maitreyee Rai
- Division of Hematology and Medical Oncology, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Jason H Mendler
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States of America.
| | - Marsha Wittink
- Departments of Psychiatry and Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America.
| | - Paul R Duberstein
- Rutgers School of Public Health, Piscataway, NJ, United States of America.
| | - Mazie Tsang
- University of California, San Francisco, CA, United States of America.
| | - Heidi D Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC, United States of America.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States of America.
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Meert G, Kenis C, Milisen K, Debruyne PR, De Groof I, Focan C, Cornélis F, Verschaeve V, Bachmann C, Bron D, Den Bulck HV, Schrijvers D, Langenaeken C, Specenier P, Jerusalem G, Praet JP, Lobelle JP, Flamaing J, Wildiers H, Decoster L. Functional status in older patients with cancer and a frailty risk profile: A multicenter observational study. J Geriatr Oncol 2022; 13:1162-1171. [PMID: 36085275 DOI: 10.1016/j.jgo.2022.08.019] [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: 02/02/2022] [Revised: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Functional status (FS) and frailty are significant concerns for older adults, especially those with cancer. Data on FS (Activities of Daily Living [ADL]; Instrumental Activities of Daily Living [IADL]) and its evolution during cancer treatment in older patients and a frailty risk profile are scarce. Therefore, this study examines FS and its evolution in older patients with cancer and a frailty risk profile and investigates characteristics associated with functional decline. MATERIAL AND METHODS This secondary data-analysis, focusing on FS, uses data from a large prospective multicenter observational cohort study. Patients ≥70 years with a solid tumor and a frailty risk profile based on the G8 screening tool (score ≤ 14) were included. A geriatric assessment was performed including evaluation of FS based on ADL and IADL. At approximately three months of follow-up, FS was reassessed. Univariable and multivariable logistic regression analyses were used to identify predictive factors for functional decline in ADL and IADL. RESULTS Data on ADL and IADL were available at baseline and follow-up in 3388 patients. At baseline 1886 (55.7%) patients were dependent for ADL, whereas 2085 (61.5%) patients were dependent at follow-up. Functional decline was observed in 23.6% of patients. For IADL 2218 (65.5%) patients were dependent for IADL, whereas 2591 (76.5%) patients were dependent at follow-up. Functional decline in IADL was observed in 41.0% of patients. In multivariable analysis, disease stage III or IV, comorbidities, falls history in the past twelve months, and FS measured by IADL were predictive factors for functional decline in both ADL and IADL. Other predictive factors for functional decline in ADL were polypharmacy, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score 2-4, and cognitive impairment, and for functional decline in IADL were female sex, fatigue, and risk for depression. DISCUSSION Functional impairments are frequent in older persons with cancer and a frailty risk profile, and several characteristics are identified that are significantly associated with functional decline. Therefore, FS is an essential part of the geriatric assessment which should be standard of care for this patient population. Next step is to proceed with directed interventions with the aim to limit the risk of functional decline as much as possible.
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Affiliation(s)
- Glen Meert
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cindy Kenis
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Philip R Debruyne
- Department of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Inge De Groof
- Department of Geriatric Medicine, St. Augustinus, Wilrijk, Belgium
| | - Christian Focan
- Department of Oncology, Clinique CHC Montlégia, Liège, Belgium
| | - Frank Cornélis
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Vincent Verschaeve
- Department of Medical Oncology, GHDC Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Dominique Bron
- Department of Hematology, ULB Institut Jules Bordet, Brussels, Belgium
| | | | - Dirk Schrijvers
- Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
| | - Christine Langenaeken
- Department Medical Oncology, Iridium Cancer Network Antwerp, AZ Klina, Brasschaat, Belgium
| | - Pol Specenier
- Department of Medical Oncology, University Hospital Antwerp, Antwerp, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, Centre Hospitalier Universitaire Sart Tilman and Liege University, Liege, Belgium
| | - Jean-Philippe Praet
- Department of Geriatric Medicine, CHU St-Pierre, Free Universities Brussels, Brussels, Belgium
| | - Jean-Pierre Lobelle
- Consultant in Statistics, Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven - University of Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - Lore Decoster
- Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
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Dai Minh L, Quang BV, Ngoc Le Mai D, Quyen LL, Gia NH, Hang NT, Giang KB. Health Literacy of Newly-Admitted Cancer Patients in Vietnam: Difficulties Understanding Treatment Options and Processing Health-Related Information. Health Serv Insights 2022; 15:11786329211067325. [PMID: 35035220 PMCID: PMC8753245 DOI: 10.1177/11786329211067325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Having a good understanding of cancer patients' health literacy in the early stage of diagnosis can help to implement strategies to improve the management process and overall health outcomes. The study aims to describe health literacy and its association with socio-demographic characteristics among newly admitted cancer patients. A cross-sectional study was conducted on 262 newly admitted patients of a cancer hospital in Vietnam using the Vietnamese version of the HLS-SF12 questionnaire. Descriptive analytics and regression analysis were used to describe health literacy and examine associated factors. Older age, lower level of education, and living in rural areas were associated with lower health literacy while there was no significant relationship between gender and health literacy among newly admitted cancer patients. Many newly admitted patients, especially the older patients have difficulties understanding the different treatment options (54%) and evaluating the reliability of health information on the internet (43%). During the early stage of treatment, strategies should be implemented with regards to patients' health literacy, to properly educate patients and their caregivers to improve communication, adherence to medication, lifestyle, and overall better quality of life and treatment outcome.
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Affiliation(s)
| | | | | | | | | | | | - Kim Bao Giang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Vietnam
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11
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Chen CH, Wen F, Chou W, Chen J, Chang W, Hsieh C, Tang ST. Factors associated with distinct prognostic-awareness-transition patterns over cancer patients' last 6 months of life. Cancer Med 2021; 10:8029-8039. [PMID: 34590429 PMCID: PMC8607263 DOI: 10.1002/cam4.4321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 01/01/2023] Open
Abstract
Background Cancer patients may develop prognostic awareness (PA) heterogeneously, but predictors of PA‐transition patterns have never been studied. We aimed to identify transition patterns of PA and their associated factors during cancer patients’ last 6 months. Methods For this secondary‐analysis study, PA was assessed among 334 cancer patients when they were first diagnosed as terminally ill and monthly till they died. PA was categorized into four states: (a) unknown and not wanting to know; (b) unknown but wanting to know; (c) inaccurate awareness; and (d) accurate awareness. The first and last PA states estimated by hidden Markov modeling were examined to identify their change patterns. Factors associated with distinct PA‐transition patterns were determined by multinomial logistic regressions focused on modifiable time‐varying variables assessed in the wave before the last PA assessment to ensure a clear time sequence for associating with PA‐transition patterns. Results Four PA‐transition patterns were identified: maintaining accurate PA (56.3%), gaining accurate PA (20.4%), heterogeneous PA (7.8%), and still avoiding PA (15.6%). Reported physician‐prognostic disclosure increased the likelihood of belonging to the maintaining‐accurate‐PA group than to other groups. Greater symptom distress predisposed patients to be in the still‐avoiding‐PA than the heterogeneous PA group. Patients with higher functional dependence and more anxiety/depressive symptoms were more and less likely to be in the heterogeneous PA group and in the still‐avoiding‐PA group, respectively, than in the maintaining‐ and gaining‐accurate PA groups. Conclusions Cancer patients heterogeneously experienced PA‐transition patterns over their last 6 months. Physicians’ prognostic disclosure, and patients’ symptom distress, functional dependence, and anxiety/depressive symptoms, all modifiable by high‐quality end‐of‐life care, were associated with distinct PA‐transition patterns. Patients with cancer may not develop accurate prognostic awareness (PA) at the same rate or to the same degree and factors associated with PA‐transition patterns are unknown. Here, we identified PA‐transition patterns and their associated factors during the last six months of life for patients with advanced cancer and found that they developed PA in different ways. Four PA‐transition patterns were identified: maintaining accurate PA, gaining accurate PA, heterogeneous PA, and still avoiding PA. Prognostic disclosure by physicians, patient symptom distress, functional dependence, and anxiety/depression symptoms are major factors associated with PA‐transition patterns and can be acted on during high‐quality end‐of‐life care.
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Affiliation(s)
- Chen Hsiu Chen
- School of NursingNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
| | - Fur‐Hsing Wen
- Department of International BusinessSoochow UniversityTaipeiTaiwan
| | - Wen‐Chi Chou
- Division of Hematology‐OncologyChang Gung Memorial HospitalTao‐YuanTaiwan
- College of MedicineChang Gung UniversityTao‐YuanTaiwan
| | - Jen‐Shi Chen
- Division of Hematology‐OncologyChang Gung Memorial HospitalTao‐YuanTaiwan
- College of MedicineChang Gung UniversityTao‐YuanTaiwan
| | - Wen‐Cheng Chang
- Division of Hematology‐OncologyChang Gung Memorial HospitalTao‐YuanTaiwan
- College of MedicineChang Gung UniversityTao‐YuanTaiwan
| | - Chia‐Hsun Hsieh
- Division of Hematology‐OncologyChang Gung Memorial HospitalTao‐YuanTaiwan
- College of MedicineChang Gung UniversityTao‐YuanTaiwan
| | - Siew Tzuh Tang
- Division of Hematology‐OncologyChang Gung Memorial HospitalTao‐YuanTaiwan
- Department of NursingChang Gung Memorial Hospital at KaohsiungKaohsiungTaiwan
- School of NursingMedical CollegeChang Gung UniversityTao‐YuanTaiwan
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12
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Giger AKW, Ditzel HM, Jørgensen TL, Ditzel HJ, Mohammadnejad A, Ewertz M, Pfeiffer P, Lund CM, Ryg J. Predictive value of geriatric oncology screening and geriatric assessment of older patients with cancer: A randomized clinical trial protocol (PROGNOSIS-RCT). J Geriatr Oncol 2021; 13:116-123. [PMID: 34362713 DOI: 10.1016/j.jgo.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Comprehensive geriatric assessment (CGA) has been shown to reduce frailty in older patients in general. In older patients with cancer, frailty affects quality of life (QoL), physical function, and survival. However, few studies have examined the effect of CGA as an additional intervention to antineoplastic treatment. This protocol presents a randomized controlled trial, which aims to evaluate the effects of CGA-based interventions in older patients with cancer and Geriatric 8 (G8) identified frailty. MATERIALS AND METHODS This randomized controlled trial will include patients, age 70+ years, with solid malignancies and G8 frailty (G8 ≤ 14). Patients will be separated into two groups, with different primary endpoints, depending on palliative or curative antineoplastic treatment initiation, and subsequently randomized 1:1 to either CGA with corresponding interventions or standard of care, along with standardized antineoplastic treatment. A geriatrician led CGA with corresponding interventions and clinical follow-up will be conducted within one month of antineoplastic treatment initiation. The interdisciplinary CGA will cover multiple geriatric domains and employ a standard set of validated assessment tools. Primary endpoints will be physical decline measured with the 30-s Chair-Stand-Test at three months (palliative setting) and unplanned hospital admissions at six months (curative setting). Additional outcomes include QoL, treatment toxicity and adherence, occurrence of polypharmacy, potential drug interactions, potential inappropriate medications, and survival. The primary outcomes will be analyzed using a mixed model regression analysis (30-s chair stand test) and linear regression models (unplanned hospitalizations), with an intention to treat approach. Power calculations reveal the need to enroll 134 (palliative) and 188 (curative) patients. DISCUSSION The present study will examine whether CGA, as an additional intervention to antineoplastic treatment, can improve endpoints valued by older patients with cancer. Inclusion began November 2020 and is ongoing, with 37 and 29 patients recruited April 15th, 2021. Registration:NCT04686851.
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Affiliation(s)
- Ann-Kristine Weber Giger
- Department of Geriatric Medicine, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark.
| | - Helena Møgelbjerg Ditzel
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Trine Lembrecht Jørgensen
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Henrik Jørn Ditzel
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | | | - Marianne Ewertz
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
| | - Per Pfeiffer
- Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Cecilia Margareta Lund
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark; Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark; CopenAge, Copenhagen Center for Clinical Age research, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
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Navarrete-Reyes AP, Animas-Mijangos K, Gómez-Camacho J, Juárez-Carrillo Y, Torres-Pérez AC, Cataneo-Piña DJ, Negrete-Najar JP, Soto-Perez-de-Celis E. Geriatric principles for patients with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.
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14
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Decisional involvement and information preferences of patients with hematologic malignancies. Blood Adv 2020; 4:5492-5500. [PMID: 33166406 DOI: 10.1182/bloodadvances.2020003044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022] Open
Abstract
Understanding decisional involvement and information preferences in patients with hematologic malignancies may help to optimize physician-patient communication about treatment decisions and align the decision-making processes with patients' preferences. We described and examined factors associated with preferences of patients with hematologic malignancies for decisional involvement, information sources, and presentation of information. In a multicenter observational study, we recruited 216 patients with hematologic malignancies of any stage from September 2003 to June 2007. Patients were asked about their decisional involvement preferences (Control Preferences Scale), information sources (including most useful source of information), and preferences for their oncologists' presentation of treatment success information. We used multivariate logistic regressions to identify factors associated with decisional involvement preferences and usefulness of information sources (physicians vs nonphysicians). Patient-directed, shared, and physician-directed approaches were preferred in 34%, 38%, and 28% of patients, respectively. Physicians and computer/Internet were the most common information sources; 42% perceived physicians as the most useful source. On multivariate analysis, patients with less than a college education (vs postgraduate education) were less likely to perceive their physician as the most useful source (adjusted odds ratio [AOR], 0.46; 95% confidence interval (CI), 0.21-1.00), whereas patients with acute leukemia (vs other blood cancers) were more likely to perceive their physician as the most useful source (AOR, 2.49; 95% CI, 1.07-5.80). In terms of communicating treatment success rates, 70% preferred ≥1 method(s), and 88% preferred presentation in percentages. Our study suggests that decisional involvement and information preferences vary and should be assessed explicitly as part of each decision-making encounter.
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15
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HAPPY - Humanity Assurance Protocol in interventional radiotheraPY (brachytherapy) - an AIRO Interventional Radiotherapy Study Group project. J Contemp Brachytherapy 2019; 11:510-515. [PMID: 31969908 PMCID: PMC6964336 DOI: 10.5114/jcb.2019.91222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Interventional procedures may produce emotional distress, particularly in interventional radiotherapy (IRT, brachytherapy - BT). This work would like to propose a series of recommendations/interventions to guarantee a human approach in order to favor the psychological well-being of the patient during interventional radiotherapy. Material and methods Thirty patients affected by gynecological cancer and treated with endovaginal high-dose-rate IRT (HDR-IRT) were selected from January to March 2019. A specific Multiprofessional Task Group (MTG) was defined in order to analyze the needs of patients. Each component of the task group spoke with the patients to examine their needs and to investigate their fears and perception. The results of the MTG were subjected to evaluation by an Expert Team (ET) of 4 physicians from 4 different institutions for a final evaluation. Both teams discussed the patient's needs to generate a list of necessary interventions to fulfill every single need in order to obtain their inner well-being. Another team (Master Team - MT) performed an independent check. Results All patients suggest that the main issue is the "lack of information and fear of the unknown". The fear of feeling pain was a significant source of concern, sadness, and vulnerability for the majority of the patients (76.6%). All patients do not appreciate the use of the word "bunker" to describe the treatment place. In 33.3% of patients the word "brachytherapy" (often unknown) determines insecurity while the term "interventional radiotherapy" reassures. Ninety percent of patients preferred to perform the external genital depilation at home and 80% of them would like the bladder catheter to be placed immediately before the procedure. MTG and ET defined nine "HAPPY recommendations". The MT approved the protocol without changes. Conclusions The aim of the present paper was to produce a protocol consisting in intervention that could improve the internal serendipity and emotional state of patients who underwent HDR-IRT.
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16
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Oskay-Özcelik G, Alavi S, Richter R, Keller M, Chekerov R, Cecere SC, Cormio G, Joly F, Kurtz JE, du Bois A, Maciejewski M, Jedryka M, Vergote I, Van Nieuwenhuysen E, Casado A, Mendiola C, Achimas-Cadariu P, Vlad C, Reimer D, Zeimet AG, Friedlander M, Sehouli J. Expression III: patients' expectations and preferences regarding physician-patient relationship and clinical management-results of the international NOGGO/ENGOT-ov4-GCIG study in 1830 ovarian cancer patients from European countries. Ann Oncol 2019; 29:910-916. [PMID: 29415128 DOI: 10.1093/annonc/mdy037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Backround The primary aim of this study was to investigate information needs and treatment preferences of patients with ovarian cancer, focusing especially on physician-patient relationship and treatment. Patients and methods A questionnaire was developed based on the experiences of the national German survey 'Expression II', and was provided to patients with ovarian cancer either at initial diagnosis or with recurrent disease via Internet (online-version) or as print-out-version. Results From December 2009 to October 2012, a total of 1830 patients with ovarian cancer from eight European countries (Austria, Belgium, France, Germany, Italy, Poland, Romania, Spain) participated, 902 (49.3%) after initial diagnosis and 731 (39.9%) with recurrent ovarian cancer. The median age was 58 years (range 17-89). Nearly all patients (96.2%) had experienced upfront surgery followed by first-line chemotherapy (91.8%). The majority of patients were satisfied with the completeness and comprehensibility of the explanation about the diagnosis and treatment options. The three most important aspects, identified by patients to improve the treatment for ovarian cancer included: 'the therapy should not induce alopecia' (42%), 'there must be more done to counter fatigue' (34.5%) and 'the therapy should be more effective' (29.7%). Out of 659 (36%) patients, who were offered participation in a clinical trial, 476 (26%) were included. Conclusion This study underlines the high need of patients with ovarian cancer for all details concerning treatment options irrespective of their cultural background, the stage of disease and the patient's age. Increased information requirements regarding potential side effects and treatment alternatives were recorded. Besides the need for more effective therapy, alopecia and fatigue are the most important side effects of concern to patients.
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Affiliation(s)
- G Oskay-Özcelik
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin; North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - S Alavi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin; North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - R Richter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin
| | - M Keller
- North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - R Chekerov
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin; North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany
| | - S C Cecere
- Division of Medical Oncolog, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - G Cormio
- Department of Biomedical Science and Human Oncolog, Obstetrics and Gynecology Unit, University of Bari, Bari, Italy
| | - F Joly
- Department of Medical Oncolog, Centre Francois Baclesse, Universite Basse Normandie, Caen, France
| | - J E Kurtz
- Oncology and Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg
| | - A du Bois
- Deptartment of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte (KEM), Essen, Germany
| | - M Maciejewski
- Dolnoslaskie Centrum onkologii/Oddzial Ginekologii Onkologicznej, Wroclaw, Poland
| | - M Jedryka
- Department of Oncology and Gynaecological Oncology Clinic, Wroclaw Medical University, Wroclaw, Poland
| | - I Vergote
- Division of Gynaecological Oncol, Leuven Cancer Institute, Department of Gynaecology and Obstetrics, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - E Van Nieuwenhuysen
- Division of Gynaecological Oncol, Leuven Cancer Institute, Department of Gynaecology and Obstetrics, Universitaire Ziekenhuizen Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - A Casado
- Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - C Mendiola
- University Hospital 12 de Octubre, Madrid, Spain
| | - P Achimas-Cadariu
- Department of Surgery, The Oncology Institute Ion Chiricuţă, Cluj-Napoca, Romania; Department of Surgery and Gynecologic Oncology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Vlad
- Department of Surgery, The Oncology Institute Ion Chiricuţă, Cluj-Napoca, Romania; Department of Surgery and Gynecologic Oncology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - D Reimer
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - A G Zeimet
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - J Sehouli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Gynecology, Charité European Competence Center for Ovarian Cancer, Berlin; North-Eastern German Society of Gynecological Oncology (NOGGO), Berlin, Germany.
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17
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Health related quality of life in older patients with solid tumors and prognostic factors for decline. J Geriatr Oncol 2019; 10:895-903. [DOI: 10.1016/j.jgo.2019.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/18/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023]
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18
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Azuero A, Williams CP, Pisu M, Ingram SA, Kenzik KM, Williams GR, Rocque GB. An examination of the relationship between patient satisfaction with healthcare and quality of life in a geriatric population with cancer in the Southeastern United States. J Geriatr Oncol 2019; 10:787-791. [PMID: 30857937 DOI: 10.1016/j.jgo.2019.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/08/2019] [Accepted: 02/20/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Understanding factors that impact patient satisfaction with cancer care within the growing population of older adults living with cancer will contribute to tailoring programs that address patient needs and expectations. Further, patient satisfaction is a determinant of healthcare organizations' institutional performance. The purpose of this study was to investigate the relationship between patient satisfaction with care and health-related quality of life (HRQoL) among Medicare recipients with common cancers types (breast, prostate, or lung cancer). METHODS Cross-sectional analysis of survey data from 637 Medicare beneficiaries (≥65 years) with breast (n = 304), lung (n = 158), or prostate cancer (n = 175) in twelve hospitals in the Southeastern United States. Participants responded eighteen satisfaction questions across five domains. HRQoL was measured with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF-12.v2 instrument. RESULTS SF-12 scores were positively associated with satisfaction domain scores. The magnitude of these associations was small with covariate-adjusted effect sizes r ranging from 0.05 to 0.12. Satisfaction scores were highest within the Quality of Care domain and lowest within the Patient Engagement domain. CONCLUSIONS Patient satisfaction domains had only modest association with HRQoL, indicating that these constructs should not be assumed to correlate. Satisfaction domains, including how patients access care, coordinate care, and engage within the healthcare system, were identified as potential areas for improvement. Patient satisfaction assessment across age groups may inform oncology care providers on ways in which their patients perceive the quality of care received, which ultimately affect healthcare organizations' accreditation, ranking, and reimbursement.
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Affiliation(s)
- Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), United States of America; Comprehensive Cancer Center, UAB, United States of America.
| | | | - Maria Pisu
- Comprehensive Cancer Center, UAB, United States of America; Division of Preventive Medicine, UAB, United States of America
| | - Stacey A Ingram
- Division of Hematology Oncology, UAB, United States of America
| | - Kelly M Kenzik
- Comprehensive Cancer Center, UAB, United States of America; Division of Hematology Oncology, UAB, United States of America; Institute for Cancer Outcomes and Survivorship, UAB, United States of America
| | - Grant R Williams
- Comprehensive Cancer Center, UAB, United States of America; Division of Hematology Oncology, UAB, United States of America; Institute for Cancer Outcomes and Survivorship, UAB, United States of America
| | - Gabrielle B Rocque
- Comprehensive Cancer Center, UAB, United States of America; Division of Hematology Oncology, UAB, United States of America; Institute for Cancer Outcomes and Survivorship, UAB, United States of America; Division of Gerontology, Geriatrics, and Palliative Care, UAB, United States of America
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Decoster L, Schallier D. Treatment of older patients with advanced non-small cell lung cancer: A challenge. J Geriatr Oncol 2019; 10:528-533. [DOI: 10.1016/j.jgo.2018.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/27/2018] [Accepted: 09/19/2018] [Indexed: 01/06/2023]
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20
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van Hoogdalem LE, Siemes C, Lugtenburg PJ, Busschbach JJV, Ismail SY. Patients' decision-making, experiences and preferences regarding pixantrone treatment in relapsed or refractory diffuse large B-cell lymphoma: study protocol for a longitudinal mixed methods study. BMJ Open 2019; 9:e026505. [PMID: 31122976 PMCID: PMC6538055 DOI: 10.1136/bmjopen-2018-026505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION There is a lot of speculation about why and how patients decide to use invasive treatment in an advanced stage of cancer, but the body of research is limited. The present longitudinal qualitative and quantitative study reflects real-life practice of pixantrone use and aims to collect data on patients' considerations for, expectations of and experiences with pixantrone and trajectories in their quality-of-life (QoL) values in a Dutch clinical setting. Hence, two questions emerge. Why do patients choose for this treatment, while the treatment success rate is limited and curation cannot be achieved? And second, once chosen, what conditions would patients like to satisfy and how do they experience the treatment? METHODS AND ANALYSIS This is a non-interventional longitudinal and multicentre study. Patients are eligible if they are >18 years, have never been treated with pixantrone before, have an Eastern Cooperative Oncology Group performance score ≤2, have a relapsed or refractory diffuse large B-cell lymphoma and have been treated with at least two prior regimens. The decision to treat patients with pixantrone has been taken by the treating physician before patients are asked to participate in the study. If patients refuse study participation after being informed by the investigator, reasons for refusal (if given) will be recorded. Participants will receive at least three interviews accompanied by three QOL questionnaires. Based on the required sample size, we aim to include 20 patients over a period of 2 years. ETHICS AND DISSEMINATION The Medical Ethical Committee of Erasmus MC, Rotterdam, The Netherlands, has approved this study. The results will be disseminated in peer-reviewed journals and major international conferences. The study is non-interventional and falls therefore not under Medical Research Involving Human Subjects Act (In Dutch: Wet medisch-wetenschappelijk onderzoek met mensen; WMO). Hence, this study is approved to be carried out in the Erasmus MC. Each other participating centre will receive this approval and will separately undergo the ethical approval to be able to participate. In addition to the ethical approval, the participating centres need to obtain written informed consent of their patients. Given the non-interventional nature of this study, a study registration was considered but deemed unnecessary. The study will be conducted in accordance with the Declaration of Helsinki (Tokyo, Venice, Hong Kong and Somerset West amendments). A sequential identification number will be automatically attributed to each patient that has given consent to participate in the study. This number will identify the patient and must be included on all documents. Only the main researcher can link the code to the patient's identity.
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Affiliation(s)
- Lothar E van Hoogdalem
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Claire Siemes
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jan J V Busschbach
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
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21
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Verkissen MN, Leemans K, Van den Block L, Deliens L, Cohen J. Information provision as evaluated by people with cancer and bereaved relatives: A cross-sectional survey of 34 specialist palliative care teams. PATIENT EDUCATION AND COUNSELING 2019; 102:768-775. [PMID: 30503640 DOI: 10.1016/j.pec.2018.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/22/2018] [Accepted: 11/17/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore how individuals with cancer and bereaved relatives evaluate information provision by specialist palliative care services (PCSs). METHODS A cross-sectional survey was conducted within four multidisciplinary palliative homecare teams (HCTs), 17 hospital-based palliative care units (PCUs) and 13 hospital-based mobile palliative support teams (PSTs) in Belgium. During four measurement periods, structured questionnaires were administered to people being guided by PCSs and relatives of patients who had died while under the care of PCSs. RESULTS In total, 628 patients (80%) and 980 relatives (55%) responded; 73-82% and 75-77% respectively reported having received the right amount of information. Compared with those receiving care within a PCU, those being supported by a PST were more likely to report suboptimal information provision and decision-making. Relatives of those who had died while under the guidance of a PST were also more likely to report suboptimal information provision than their PCU counterparts. CONCLUSION Although information provision to cancer patients and relatives being supported by PCSs is generally evaluated positively, evaluations depend on the type of service. PRACTICE IMPLICATIONS Information provided within PCUs offering highly personalised, continuous care appears to both groups more satisfactory than that provided by palliative care teams mainly supporting care staff.
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Affiliation(s)
- Mariëtte N Verkissen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Kathleen Leemans
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
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22
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Hong SJ, Biesecker B, Ivanovich J, Goodman M, Kaphingst KA. Factors affecting breast cancer patients' need for genetic risk information: From information insufficiency to information need. J Genet Couns 2019; 28:543-557. [PMID: 30675956 DOI: 10.1002/jgc4.1087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/04/2018] [Indexed: 12/28/2022]
Abstract
Information-seeking models typically focus on information-seeking behaviors based on individuals' interest in information, because their current level is perceived to be insufficient. In the context of genetic risk information (GRI), however, information insufficiency is difficult to measure and thus can limit understanding of information behavior in the context of GRI. We propose that an individual's need for information might be a more direct and conceptually clearer alternative to predicting their information-seeking behavior. To test this hypothesis, this study investigates the extent to which previously identified factors affecting interest in GRI are also predictors of need for GRI among women diagnosed with breast cancer at the age of 40 or younger (N = 1,069). As hypothesized, there was a positive association between interest in and need for GRI. Furthermore, hypothesized factors of numeracy, information orientation, and genetic knowledge were significant predictors of increased interest in and need for GRI. In contrast, hypothesized factors of genetic worry and genetic causal belief predicted increased interest in GRI only, while genetic self-efficacy predicted increased need for GRI only. As hypothesized, BRCA status significantly moderated associations between informational norm and both interest in and need for GRI. Collectively, the findings support inclusion of need for GRI in theoretical information-seeking models in the context of genomic risk.
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Affiliation(s)
- Soo Jung Hong
- Department of Communications and New Media, National University of Singapore, Singapore
| | | | | | | | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Communication, University of Utah, Salt Lake City, Utah
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23
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Lifford KJ, Edwards A, Burton M, Harder H, Armitage F, Morgan JL, Caldon L, Balachandran K, Ring A, Collins K, Reed M, Wyld L, Brain K. Efficient development and usability testing of decision support interventions for older women with breast cancer. Patient Prefer Adherence 2019; 13:131-143. [PMID: 30679905 PMCID: PMC6338238 DOI: 10.2147/ppa.s178347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Around one-third of breast cancers diagnosed every year in the UK are in women aged ≥70 years. However, there are currently no decision support interventions (DESIs) for older women who have a choice between primary endocrine therapy and surgery followed by adjuvant endocrine therapy (surgery+endocrine therapy), or who can choose whether or not to have chemotherapy following surgery. There is also little evidence-based guidance specifically on the management of these older patients. A large UK cohort study is currently underway to address this lack of evidence and to develop two DESIs to facilitate shared decision-making with older women about breast cancer treatments. Here, we present the development and initial testing of these two DESIs. METHODS An initial prototype DESI was developed for the choice of primary endocrine therapy or surgery+endocrine therapy. Semi-structured interviews with healthy volunteers and patients explored DESI acceptability, usability, and utility. A framework approach was used for analysis. A second DESI for the choice of having chemotherapy or not was subsequently developed based on more focused development and testing. RESULTS Participants (n=22, aged 75-94 years, 64% healthy volunteers, 36% patients) found the primary endocrine therapy /surgery+endocrine therapy DESI acceptable, and contributed to improved wording and illustrations to address misunderstandings. The chemotherapy DESI (tested with 14 participants, aged 70-87 years, 57% healthy volunteers, 43% patients) was mostly understandable, however, suggestions for rewording sections were made. Most participants considered the DESIs helpful, but highlighted the importance of complementary discussions with clinicians. CONCLUSION It was possible to use a template DESI to efficiently create a second prototype for a different treatment option (chemotherapy). Both DESIs were acceptable and considered helpful to support/augment consultations. Development of acceptable additional DESIs for similar target populations using simplified methods may be an efficient way to develop future DESIs. Further research is needed to test the effectiveness of the DESIs.
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Affiliation(s)
- Kate J Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK,
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK,
| | - Maria Burton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Helena Harder
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Fiona Armitage
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lisa Caldon
- Department of General Surgery, The Rotherham NHS Foundation Trust, Rotherham, UK
| | | | - Alistair Ring
- Breast Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Karen Collins
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK,
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24
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Ayvaci MUS, Alagoz O, Ahsen ME, Burnside ES. Preference-Sensitive Management of Post-Mammography Decisions in Breast Cancer Diagnosis. PRODUCTION AND OPERATIONS MANAGEMENT 2018; 27:2313-2338. [PMID: 31031555 PMCID: PMC6481963 DOI: 10.1111/poms.12897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Decision models representing the clinical situations where treatment options entail a significant risk of morbidity or mortality should consider the variations in risk preferences of individuals. In this study, we develop a stochastic modeling framework that optimizes risk-sensitive diagnostic decisions after a mammography exam. For a given patient, our objective is to find the utility maximizing diagnostic decisions where we define the utility over quality-adjusted survival duration. We use real data from a private mammography database to numerically solve our model for various utility functions. Our choice of utility functions for the numerical analysis is driven by actual patient behavior encountered in clinical practice. We find that invasive diagnostic procedures such as biopsies are more aggressively used than what the optimal risk-neutral policy would suggest, implying a far-sighted (or equivalently risk-seeking) behavior. When risk preferences are incorporated into the clinical practice, policy makers should bear in mind that a welfare loss in terms of survival duration is inevitable as evidenced by our structural and empirical results.
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Affiliation(s)
- Mehmet Ulvi Saygi Ayvaci
- Information Systems, Naveen Jindal School of Management, University of Texas at Dallas, 800 W Campbell Rd SM33, Richardson, Texas 75080, USA,
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin, Madison, Wisconsin 53705, USA,
| | - Mehmet Eren Ahsen
- Icahn School of Medicine at Mount Sinai, San Francisco, California 94108, USA,
| | - Elizabeth S Burnside
- Department of Radiology, University of Wisconsin, Madison, Wisconsin 53792, USA,
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25
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Poodt IGM, Schipper RJ, Vugts G, Woensdregt K, van der Sangen M, Voogd AC, Nieuwenhuijzen GAP. The rationale for and long-term outcome of incomplete axillary staging in elderly women with primary breast cancer. Eur J Surg Oncol 2018; 44:1714-1719. [PMID: 30082177 DOI: 10.1016/j.ejso.2018.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/26/2018] [Accepted: 07/08/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The proportion of elderly women diagnosed with breast cancer is rising. Standard treatment, including axillary staging, is often not given to these patients. This study aimed to investigate reasons to omit any surgical axillary staging or to refrain from completion axillary lymph node dissection (cALND) after positive-sentinel lymph node biopsy (SLNB); so-called "incomplete staging". Furthermore, the impact of incomplete staging on regional control and survival in patients aged 75 or older was evaluated. METHODS A retrospective cohort study was conducted including all primary breast cancer patients aged 75 or older, diagnosed between 2001 and 2008, and documented by the Netherlands Cancer Registry (NCR). Patients with incomplete staging were compared to patients with complete axillary staging. Survival analyses were used to determine the risk of local, regional and distant recurrence and overall survival. RESULTS In total, 1467 of 2116 (69%) patients were considered eligible, of whom 258 (17.2%) had incomplete axillary staging. For 93 patients, diagnosed in 6 of the 10 hospitals in the NCR-area, examination of clinical records revealed that age, comorbidities and patient preferences were the main reason for omitting complete axillary staging. The 10-year axillary recurrence rate in these 93 patients was 5.2% (95% CI, 0.03-10.1). Of the 77 patients who had died, 64 (83%) died of non-breast-cancer-related causes. No significant difference in overall survival was observed between patients with or without complete axillary staging. CONCLUSION This study demonstrates that the omission of complete axillary staging is common in selected elderly breast cancer patients with ≥2 comorbidities, with no apparent impact on regional control and 10-year overall survival.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
| | | | - Guusje Vugts
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - Karlijn Woensdregt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Adri C Voogd
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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26
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Angarita FA, Elmi M, Zhang Y, Look Hong NJ. Patient-reported factors influencing the treatment decision-making process of older women with non-metastatic breast cancer: a systematic review of qualitative evidence. Breast Cancer Res Treat 2018; 171:545-564. [PMID: 29974359 DOI: 10.1007/s10549-018-4865-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/22/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Older women (≥ 70 years old) with breast cancer undergo different treatments than young women. Studies have examined factors that influence this disparity, but synthesized patient-reported data are lacking in the literature. This study aims to identify, appraise, and synthesize the existing qualitative evidence on patient-reported factors influencing older women's decision to accept or decline breast cancer treatment. METHODS A systematic review was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) principles. Medline, Embase, CINAHL, and PsycINFO were searched for qualitative studies describing patient-reported factors influencing the decision-making process of older women (≥ 70 years old) with non-metastatic invasive breast cancer. Quality was assessed using the Standards for Reporting Qualitative Research (SRQR) criteria. Common ideas were coded, thematically organized, and synthesized within a theoretical framework. RESULTS Of 5998 studies identified, 10 met eligibility criteria. The median SRQR total score was 13.04 (IQR 12.84-13.81). The studies represented a range of cancer treatments; most of the studies focused on surgery and primary endocrine therapy. Our data show that the most common patient-reported factors in the decision-making process included treatment characteristics, personal goals/beliefs, patient characteristics, physician's recommendation, and personal/family experience. These factors led the patient to either accept or decline treatment, and were not consistent across all studies included. Studies used different interview guides, which may have affected these results. CONCLUSIONS This systematic review highlights the complexity of factors that influence an older woman's treatment decision-making process. Acknowledging and addressing these factors may improve discussions about treatment choices between older women and their health care providers, and encourage maximization of a patient-centered approach.
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Affiliation(s)
- Fernando A Angarita
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Maryam Elmi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Yimeng Zhang
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Nicole J Look Hong
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Surgical Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 102, Toronto, ON, M4N 3M5, Canada.
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27
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Adjei Boakye E, Mohammed KA, Geneus CJ, Tobo BB, Wirth LS, Yang L, Osazuwa-Peters N. Correlates of health information seeking between adults diagnosed with and without cancer. PLoS One 2018; 13:e0196446. [PMID: 29746599 PMCID: PMC5945015 DOI: 10.1371/journal.pone.0196446] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/14/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine predictors of information seeking behavior among individuals diagnosed with cancer versus those without. METHODS Cross-sectional data from the Health Information National Trends Survey 4 Cycles 1-3 (October 2011 to November 2013) were analyzed for 10,774 survey respondents aged ≥18 years. Binary logistic regression was used to examine the effect of socio-demographic and behavioral factors on health information seeking. RESULTS Cancer diagnosis did not predict health information seeking. However, respondents diagnosed with cancer were more likely to seek health information from a healthcare practitioner. Compared to males, females were more likely to seek health information irrespective of cancer diagnosis. Regardless of cancer diagnosis, those without a regular healthcare provider were less likely to seek health information. Likelihood of seeking health information declined across education strata, and significantly worsened among respondents without high school diplomas irrespective of cancer diagnosis. CONCLUSIONS Respondents sought health information irrespective of cancer diagnosis. However, the source of health information sought differed by cancer diagnosis. Gender, education, and having a regular healthcare provider were predictors of health information seeking. Future health communication interventions targeting cancer patients and the general public should consider these findings for tailored interventions to achieve optimal results.
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Affiliation(s)
- Eric Adjei Boakye
- Saint Louis University Center for Health Outcomes Research (SLUCOR), Saint Louis University, Saint Louis, Missouri, United States of America
| | - Kahee A. Mohammed
- Saint Louis University Center for Health Outcomes Research (SLUCOR), Saint Louis University, Saint Louis, Missouri, United States of America
| | - Christian J. Geneus
- Department of Environmental and Occupational Health, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Betelihem B. Tobo
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Lorinette S. Wirth
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Lei Yang
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
- Saint Louis University Cancer Center, Saint Louis, Missouri, United States of America
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, United States of America
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28
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Pisu M, Azuero A, Halilova KI, Williams CP, Kenzik KM, Kvale EA, Williams GR, Meneses K, Sullivan M, Yagnik SK, Goertz HP, Rocque GB. Most impactful factors on the health-related quality of life of a geriatric population with cancer. Cancer 2018; 124:596-605. [PMID: 29250775 DOI: 10.1002/cncr.31048] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND As the population of older adults with cancer continues to grow, the most important factors contributing to their health-related quality of life (HRQOL) remain unclear. METHODS A total of 1457 older adults (aged ≥65 years) with cancer participated in a telephone survey. Outcomes were measured using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Survey (SF-12) from the Medical Outcomes Study (version 2). Statistical techniques used to identify factors in 4 domains (physical, psychological, social, and spiritual) most strongly associated with HRQOL included linear models, recursive partitioning, and random forests. Models were developed in a training data set (920 respondents) and performance was assessed in a validation data set (537 respondents). RESULTS Respondents were a median of 19 months from diagnosis, and 28.1% were receiving active treatment. The most relevant factors found to be associated with PCS were symptom severity, comorbidity scores, leisure-time physical activity, and having physical support needs. The most relevant factors for MCS were having emotional support needs, symptom severity score, and the number of financial hardship events. Results were consistent across modeling techniques. Symptoms found to be strongly associated with PCS included fatigue (adjusted proportion of summary score's variance [R2 ] = 0.34), pain (adjusted R2 = 0.32), disturbed sleep (adjusted R2 = 0.16), and drowsiness (adjusted R2 = 0.16). Symptoms found to be strongly associated with MCS included fatigue (adjusted R2 = 0.23), problems remembering things (adjusted R2 = 0.17), disturbed sleep (adjusted R2 = 0.16), and lack of appetite (adjusted R2 = 0.16). CONCLUSIONS The findings of the current study support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity, and addressing financial challenges. A long-term comprehensive approach is needed to ensure the well-being of older adults with cancer. Cancer 2018;124:596-605. © 2017 American Cancer Society.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karina I Halilova
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Courtney P Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly M Kenzik
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth A Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Grant R Williams
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Meneses
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Sullivan
- Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama
| | | | | | - Gabrielle B Rocque
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Hoerger M, Perry LM, Gramling R, Epstein RM, Duberstein PR. Does educating patients about the Early Palliative Care Study increase preferences for outpatient palliative cancer care? Findings from Project EMPOWER. Health Psychol 2017; 36:538-548. [PMID: 28277698 PMCID: PMC5444973 DOI: 10.1037/hea0000489] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Randomized controlled trials, especially the Early Palliative Care Study (Temel et al., 2010), have shown that early outpatient palliative cancer care can improve quality of life for patients with advanced cancer or serious symptoms. However, fear and misconceptions drive avoidance of palliative care. Drawing from an empowerment perspective, we examined whether educating patients about evidence from the Early Palliative Care Study would increase preferences for palliative care. METHOD A sample of 598 patients with prostate, breast, lung, colon/rectal, skin, and other cancer diagnoses completed an Internet-mediated experiment using a between-group prepost design. Intervention participants received a summary of the Early Palliative Care Study; controls received no intervention. Participants completed baseline and posttest assessments of preferences of palliative care. Analyses controlled for age, gender, education, cancer type, presence of metastases, time since diagnosis, and baseline preferences. RESULTS As hypothesized, the intervention had a favorable impact on participants' preferences for outpatient palliative cancer care relative to controls (d = 1.01, p < .001), while controlling for covariates. Intervention participants came to view palliative care as more efficacious (d = 0.79, p < .001) and less scary (d = 0.60, p < .001) and exhibited stronger behavioral intentions to utilize outpatient palliative care if referred (d = 0.60, p < .001). Findings were comparable in patients with metastatic disease, those with less education, and those experiencing financial strain. CONCLUSIONS Educating patients about the Early Palliative Care Study increases preferences for early outpatient palliative care. This research has implications for future studies aimed at improving quality of life in cancer by increasing palliative care utilization. (PsycINFO Database Record
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30
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Burton M, Kilner K, Wyld L, Lifford KJ, Gordon F, Allison A, Reed M, Collins KA. Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer. Psychooncology 2017; 26:2094-2100. [PMID: 28332254 DOI: 10.1002/pon.4429] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/15/2017] [Accepted: 03/19/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision-making (DM) style. METHODS This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences. RESULTS Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology-based sources of information. There was equal preference for a patient- or doctor-centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0-100). CONCLUSIONS Women strongly preferred face to face information. Written formats were also helpful but not computer-based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret.
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Affiliation(s)
- Maria Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Karen Kilner
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Lynda Wyld
- Academic Unit of Surgical Oncology, University of Sheffield, Medical School, Sheffield, UK
| | - Kate Joanna Lifford
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Frances Gordon
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - Annabel Allison
- Biostatistics Unit, MRC, Cambridge Institute of Public Health, Cambridge, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - Karen Anna Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
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Nomura S, Tsubokura M, Ozaki A, Murakami M, Hodgson S, Blangiardo M, Nishikawa Y, Morita T, Oikawa T. Towards a Long-Term Strategy for Voluntary-Based Internal Radiation Contamination Monitoring: A Population-Level Analysis of Monitoring Prevalence and Factors Associated with Monitoring Participation Behavior in Fukushima, Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040397. [PMID: 28397769 PMCID: PMC5409598 DOI: 10.3390/ijerph14040397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 11/22/2022]
Abstract
Following Japan’s 2011 Fukushima nuclear incident, we assessed voluntary-based monitoring behavior in Minamisoma City—located 10–40 km from the Fukushima nuclear plant—to inform future monitoring strategies. The monitoring in Minamisoma included occasional free of charge internal-radiation-exposure measurements. Out of around 70,000 individuals residing in the city before the incident, a total of 45,788 residents (female: 52.1%) aged ≥21 were evaluated. The monitoring prevalence in 2011–2012 was only 30.2%, and this decreased to 17.9% in 2013–2014. Regression analyses were performed to estimate factors associated with the monitoring prevalence and participation behavior. The results show that, in comparison with the age cohort of 21–30 years, the cohort of 71–80 and ≥81 years demonstrated significantly lower monitoring prevalence; female residents had higher monitoring prevalence than male residents; those who were living in evacuation zones at the time of the incident had higher monitoring prevalence than those who lived outside any of the evacuation zones; for those living outside Fukushima and neighboring Prefectures post-incident monitoring prevalence decreased significantly in 2013–2014. Our findings inform the discussion on the concepts of radiation risk perception and accessibility to monitoring and societal decision-making regarding the maintenance of the monitoring program with low monitoring prevalence. We also stress the possibility that the monitoring can work both to check that internal contamination levels are within acceptable limits, and as a risk communication tool, alleviating individuals’ concern and anxiety over radiation contamination.
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Affiliation(s)
- Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Masaharu Tsubokura
- Department of Radiation Protection, Minamisoma Municipal General Hospital, 2-54-6 Takami-cho, Haramachi-ku, Minamisoma, Fukushima 975-0033, Japan.
| | - Akihiko Ozaki
- Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takami-cho, Haramachi-ku, Minamisoma, Fukushima 975-0033, Japan.
| | - Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima 960-1295.
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan.
| | - Susan Hodgson
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
| | - Marta Blangiardo
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
| | - Yoshitaka Nishikawa
- Department of Health Informatics, School of Public Health, Kyoto University, Yoshida-Konoe, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Tomohiro Morita
- Department of Radiation Protection, Soma Central Hospital, 3-5-18 Okinouchi, Soma, Fukushima 976-0016, Japan.
| | - Tomoyoshi Oikawa
- Department of Radiation Protection, Minamisoma Municipal General Hospital, 2-54-6 Takami-cho, Haramachi-ku, Minamisoma, Fukushima 975-0033, Japan.
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Sak G, Rothenfluh F, Schulz PJ. Assessing the predictive power of psychological empowerment and health literacy for older patients' participation in health care: a cross-sectional population-based study. BMC Geriatr 2017; 17:59. [PMID: 28219334 PMCID: PMC5319152 DOI: 10.1186/s12877-017-0448-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has confirmed a positive link between patient involvement in decision-making and improvements in health outcomes. The objective of this study was to examine the roles of psychological empowerment and health literacy on the elderly's willingness to engage in treatment decisions. METHODS A self-administered questionnaire was completed by a randomly selected sample of Swiss adults aged 65-80 years old (N = 826). Multivariate logistic regression was applied to determine the contribution of health literacy, psychological empowerment, and trust in physician on participants' preference to be active, collaborative or passive in decision-making. RESULTS Most of the survey respondents preferred some participation in dealing with health related decisions (collaborative: 51%, and active: 35.6%). More than two-thirds of the sample was satisfied with their current involvement in medical decision-making (72.7%). Roughly one-fifth (18.8%) wished to attain a more active engagement than currently experienced, and the remainder of the sample preferred the opposite (8.5%). Due to higher reported levels of psychological empowerment and health literacy, Swiss-German seniors significantly preferred and assumed higher participation in medical decisions than Swiss-Italians. Psychological empowerment correlated with older adults' preferred and perceived involvement in medical decision-making. However, health literacy only predicted actual involvement in the last treatment decision that had to be made, differentiating only the active from the passive involvement group. Additionally, this research showed that health literacy mediated the relationship between psychological empowerment and the actual involvement in the last treatment decision that had to be made by the participant. Trust in physician and age appeared to be barriers to involvement, whereas education served as a facilitator. CONCLUSIONS As older adults' health literacy plays a role in individuals' willingness to attain an active role in health care decision-making, public health efforts should aim at developing programs and appropriate information that facilitate this process, especially for individuals with moderate or lower levels of health literacy. The current investigation showed that adequate health literacy levels are essential (but not sufficient) in order to reach higher rates of participation in the healthcare context. This research complements past evidence by adding knowledge on the psychosocial antecedents, and their combined effects on patients' involvement in healthcare.
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Affiliation(s)
- Gabriele Sak
- Institute of Communication and Health (ICH), Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland
| | - Fabia Rothenfluh
- Institute of Communication and Health (ICH), Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland
| | - Peter J. Schulz
- Institute of Communication and Health (ICH), Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland
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Koo NY, Lee JH. Factors Influencing Conflicts of Chemotherapy Decision Making among Pre-Operative Cancer Patients. ASIAN ONCOLOGY NURSING 2017. [DOI: 10.5388/aon.2017.17.2.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nam Yee Koo
- Department of Nursing, Kosin University Gospel Hospital, Busan, Korea
| | - Ji Hyun Lee
- College of Nursing, Kosin University, Busan, Korea
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Hoerger M, Chapman BP, Mohile SG, Duberstein PR. Development and psychometric evaluation of the Decisional Engagement Scale (DES-10): A patient-reported psychosocial survey for quality cancer care. Psychol Assess 2016; 28:1087-100. [PMID: 27537003 PMCID: PMC4991547 DOI: 10.1037/pas0000294] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In light of recent health care reforms, we have provided an illustrative example of new opportunities available for psychologists to develop patient-reported measures related to health care quality. Patient engagement in health care decision making has been increasingly acknowledged as a vital component of quality cancer care. We developed the 10-item Decisional Engagement Scale (DES-10), a patient-reported measure of engagement in decision making in cancer care that assesses patients' awareness of their diagnosis, sense of empowerment and involvement, and level of information seeking and planning. The National Institutes of Health's ResearchMatch recruitment tool was used to facilitate Internet-mediated data collection from 376 patients with cancer. DES-10 scores demonstrated good internal consistency reliability (α = .80), and the hypothesized unidimensional factor structure fit the data well. The reliability and factor structure were supported across subgroups based on demographic, socioeconomic, and health characteristics. Higher DES-10 scores were associated with better health-related quality of life (r = .31). In concurrent validity analyses controlling for age, socioeconomic status, and health-related quality of life, higher DES-10 scores were associated with higher scores on quality-of-care indices, including greater awareness of one's treatments, greater preferences for shared decision making, and clearer preferences about end-of-life care. A mini-measure, the DES-3, also performed well psychometrically. In conclusion, DES-10 and DES-3 scores showed evidence of reliability and validity, and these brief patient-reported measures can be used by researchers, clinicians, nonprofits, hospitals, insurers, and policymakers interested in evaluating and improving the quality of cancer care. (PsycINFO Database Record
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Chernyak N, Stephan A, Bächle C, Genz J, Jülich F, Icks A. Assessment of information needs in diabetes: Development and evaluation of a questionnaire. Prim Care Diabetes 2016; 10:287-292. [PMID: 26777538 DOI: 10.1016/j.pcd.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 09/22/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
AIM To develop a questionnaire suitable for assessing the information needs of individuals with diabetes mellitus types 1 and 2 in diverse healthcare settings (e.g. primary care or long-term care) and at different time points during the course of the disease. METHODS The initial questionnaire was developed on the basis of literature search and analysis, reviewed by clinical experts, and evaluated in two focus groups. The revised version was pilot-tested on 39 individuals with diabetes type 2, type 1 and gestational diabetes. RESULTS The final questionnaire reveals the most important information needs in diabetes. A choice task, a rating task and open-ended questions are combined. First, participants have to choose three topics that interest them out of a list with 12 general topics and specify in their own words their particular information needs for the chosen topics. They are then asked how informed they feel with regard to all topics (4-point Likert-scale), and whether information is currently desired (yes/no). The questionnaire ends with an open-ended question asking for additional topics of interest. CONCLUSIONS Careful selection of topics and inclusion of open-ended questions seem to be essential prerequisites for the unbiased assessment of information needs. The questionnaire can be applied in surveys in order to examine patterns of information needs across various groups and changes during the course of the disease. Such knowledge would contribute to more patient-guided information, counselling and support.
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MESH Headings
- Choice Behavior
- Comprehension
- Consumer Health Information
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes Mellitus, Type 2/therapy
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/physiopathology
- Diabetes, Gestational/therapy
- Female
- Focus Groups
- Health Knowledge, Attitudes, Practice
- Health Services Needs and Demand
- Humans
- Male
- Needs Assessment
- Patient Education as Topic
- Pilot Projects
- Pregnancy
- Qualitative Research
- Review Literature as Topic
- Surveys and Questionnaires
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Affiliation(s)
- N Chernyak
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany.
| | - A Stephan
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany.
| | - C Bächle
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - J Genz
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - F Jülich
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - A Icks
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany; German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Düsseldorf, Germany.
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Krok-Schoen JL, Palmer-Wackerly AL, Dailey PM, Wojno JC, Krieger JL. Age Differences in Cancer Treatment Decision Making and Social Support. J Aging Health 2016; 29:187-205. [PMID: 26850474 DOI: 10.1177/0898264316628488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine the decision-making (DM) styles of younger (18-39 years), middle-aged (40-59 years), and older (≥60 years) cancer survivors, the type and role of social support, and patient satisfaction with cancer treatment DM. METHOD Adult cancer survivors ( N = 604) were surveyed using Qualtrics online software. RESULTS Older adults reported significantly lower influence of support on DM than younger adults. The most common DM style for the age groups was collaborative DM with their doctors. Younger age was a significant predictor of independent ( p < .05), collaborative with family ( p < .001), delegated to doctor ( p < .01), delegated to family ( p < .001), and demanding ( p < .001) DM styles. DISCUSSION Despite having lower received social support in cancer treatment DM, older adults were more satisfied with their DM than younger and middle-aged adults. Health care workers should be aware of different DM styles and influence of social networks to help facilitate optimal patient DM and satisfaction.
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Whittle AK, Kalsi T, Babic-Illman G, Wang Y, Fields P, Ross PJ, Maisey NR, Hughes S, Kwan W, Harari D. A comprehensive geriatric assessment screening questionnaire (CGA-GOLD) for older people undergoing treatment for cancer. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27132979 DOI: 10.1111/ecc.12509] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 12/12/2022]
Abstract
Oncology services do not routinely assess broader needs of older people with cancer. This study evaluates a comprehensive geriatric assessment and comorbidity screening questionnaire (CGA-GOLD) covering evidence-based domains and quality of life (EORTC-QLQ-C30). Patients aged 65+ attending oncology services were recruited into (1) Observational cohort (completed CGA-GOLD, received standard oncology care), (2) Intervention cohort (responses categorised 'low-risk', 'high-risk', 'possible need' by geriatricians). N = 417 observational patients (1002 invited by post, 418 consented, age 73.9 ± 5.4) completed CGA-GOLD in 11.7 ± 7.9 min, 86.3% required no assistance, 3.1% overall missing responses. Multiple problems reported: hypertension (18.1%), diabetes (16.9%), dyspnoea on flat surfaces (27.6%), polypharmacy (46%), difficulty walking (14.9%), fatigue (40.5%), living alone (30.9%), social isolation (11.2%), recent functional dependence (27.8%), urinary incontinence (21.4%), falls (13.3%). 237/239 intervention patients completed CGA-GOLD and consecutive subsets examined. The doctor and nurse specialist independently identified same need level in 87.3% (high inter-rater reliability kappa = 0.80), taking 1-2 min per questionnaire. Need level remained unchanged following hospital notes review against responses in 90% (75/83). 'Possible need' patients were telephoned with change in 29% (16/55) to low-risk and none to high-risk, confirming high need was not being missed. CGA-GOLD screening questionnaire was acceptable to older patients, feasibly administered in NHS cancer services, described comorbidities, CGA and QOL needs, and reliably identified higher risk patients requiring further input for optimal cancer treatment.
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Affiliation(s)
- A K Whittle
- Department of Ageing & Health, Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - T Kalsi
- Department of Ageing & Health, Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.,Division of Health and Social Care Research, King's College London, London, UK
| | - G Babic-Illman
- Department of Ageing & Health, Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Y Wang
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - P Fields
- Department of Haematology, Guys & St Thomas' NHS Trust, Guys Hospital, London, UK
| | - P J Ross
- Department of Medical Oncology, Guys & St Thomas' NHS Trust, Guys Hospital, London, UK
| | - N R Maisey
- Department of Medical Oncology, Guys & St Thomas' NHS Trust, Guys Hospital, London, UK
| | - S Hughes
- Department of Clinical Oncology, Guys & St Thomas' NHS Trust, London, UK
| | - W Kwan
- Bexley Clinical Commissioning Group/Macmillan GP, Crook Log General Practice Surgery, Bexleyheath, Kent, UK
| | - D Harari
- Department of Ageing & Health, Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.,Division of Health and Social Care Research, King's College London, London, UK
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van Weert JCM, van Munster BC, Sanders R, Spijker R, Hooft L, Jansen J. Decision aids to help older people make health decisions: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2016; 16:45. [PMID: 27098100 PMCID: PMC4839148 DOI: 10.1186/s12911-016-0281-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 04/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision aids have been overall successful in improving the quality of health decision making. However, it is unclear whether the impact of the results of using decision aids also apply to older people (aged 65+). We sought to systematically review randomized controlled trials (RCTs) and clinical controlled trials (CCTs) evaluating the efficacy of decision aids as compared to usual care or alternative intervention(s) for older adults facing treatment, screening or care decisions. METHODS A systematic search of (1) a Cochrane review of decision aids and (2) MEDLINE, Embase, PsycINFO, Cochrane library central registry of studies and Cinahl. We included published RCTs/CCTs of interventions designed to improve shared decision making (SDM) by older adults (aged 65+) and RCTs/CCTs that analysed the effect of the intervention in a subgroup with a mean age of 65+. Based on the International Patient Decision aid Standards (IPDAS), the primary outcomes were attributes of the decision and the decision process. Other behavioral, health, and health system effects were considered as secondary outcomes. If data could be pooled, a meta-analysis was conducted. Data for which meta-analysis was not possible were synthesized qualitatively. RESULTS The search strategy yielded 11,034 references. After abstract and full text screening, 22 papers were included. Decision aids performed better than control resp. usual care interventions by increasing knowledge and accurate risk perception in older people (decision attributes). With regard to decision process attributes, decision aids resulted in lower decisional conflict and more patient participation. CONCLUSIONS This review shows promising results on the effectiveness of decision aids for older adults. Decision aids improve older adults' knowledge, increase their risk perception, decrease decisional conflict and seem to enhance participation in SDM. It must however be noted that the body of literature on the effectiveness of decision aids for older adults is still in its infancy. Only one decision aid was specifically developed for older adults, and the mean age in most studies was between 65 and 70, indicating that the oldest-old were not included. Future research should expand on the design, application and evaluation of decision aids for older, more vulnerable adults.
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Affiliation(s)
- Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, Department of Communication Science, University of Amsterdam, P.O. Box 15791, 1001 NG, Amsterdam, The Netherlands.
| | - Barbara C van Munster
- University Medical Center Groningen (UMCG), Department of Medicine, Groningen, The Netherlands.,Gelre Hospitals, Department of Geriatrics, Apeldoorn, The Netherlands
| | - Remco Sanders
- Amsterdam School of Communication Research/ASCoR, Department of Communication Science, University of Amsterdam, P.O. Box 15791, 1001 NG, Amsterdam, The Netherlands
| | - René Spijker
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Medical Library, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jesse Jansen
- Sydney School of Public Health, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, Australia
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Kim S, Real K. A profile of inactive information seekers on influenza prevention: a survey of health care workers in Central Kentucky. Health Info Libr J 2016; 33:222-38. [PMID: 26725746 DOI: 10.1111/hir.12132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/17/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study developed a profile of inactive information seekers by characterising how they are different from active seekers, identifying possible determinants of inactive seekers and understanding characteristics of frequently asked influenza-related questions. METHODS A survey and follow-up interviews were conducted between December 2010 and January 2011. A total of 307 health care workers in three hospitals in Central Kentucky (USA) are included. RESULTS Four study groups were formed based on their information-seeking and vaccination uptake status: (1) Inactive Seekers with Vaccination (N = 141); (2) Inactive Seekers without Vaccination (N = 49); (3) Active Seekers with Vaccination (N = 107); and (4) Active Seekers without Vaccination (N = 10). Inactive Seekers without Vaccination are found to be least responsive to health outcomes. Inactive Seeker groups do not prefer to use sources such as Internet or family/friends. In predicting inactive seekers, Information Needs and Knowledge Perception made significant contributions to prediction. The most frequently asked questions included information about survival duration of influenza virus (N = 25) followed by the incubation period for influenza (N = 24). CONCLUSION Profiling inactive seekers can serve as a way to better design customised influenza information sources and services for health care workers, thus giving hospitals through medical libraries additional tools to reduce the spread of influenza.
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Affiliation(s)
- Sujin Kim
- Division of Biomedical Informatics, School of Library and Information Science, University of Kentucky, Lexington, KY, USA
| | - Kevin Real
- Department of Communication, University of Kentucky, Lexington, KY, USA
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Gironés R. Desire for Information in the Elderly: Interactions with Patients, Family, and Physicians. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:766-773. [PMID: 25428838 DOI: 10.1007/s13187-014-0760-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lung cancer chemotherapy decisions in patients≥70 years old are complex. To assess the modes of communication with older lung cancer patients, we prospectively collected data. We assessed patients' level of knowledge about diagnosis and prognosis. Eighty-three patients diagnosed with lung cancer from January 2006 to February 2008 were recruited from a single center. Logistic regression and multiple imputation methods were used to assess associations between patient information and independent variables. Families received the diagnosis of lung cancer (92.8%). Family was more protective when the patients were elderly (p 0.036), depressed (p 0.054), had dementia (p 0.03), had poor performance status (p 0.03), or complied with frailty criteria (p 0.014). Physicians who gave cancer diagnoses were not oncologists and they usually gave cancer diagnosis preferably to family members. Only 27.7% of patients were informed that they had tumors. A 73.5% of patients actively solicited information; however, elderly and frail patients tended to do so less. A large proportion of elderly lung cancer patients do not receive adequate information about their disease prior to contact with oncologists. However, they do actively ask for information and speak about cancer with oncologists.
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Affiliation(s)
- Regina Gironés
- Oncologist, Physician, Medical Oncology Unit, Hospital Lluís Alcanyís, Crta Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain.
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Riffin C, Pillemer K, Reid MC, Lӧckenhoff CE. Decision Support Preferences Among Hispanic and Non-Hispanic White Older Adults With Chronic Musculoskeletal Pain. J Gerontol B Psychol Sci Soc Sci 2015; 71:914-25. [PMID: 26307486 DOI: 10.1093/geronb/gbv071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 07/09/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Despite broad recognition that social networks play a key role in the management of chronic musculoskeletal pain (CMP), little is known about when and why older adults with CMP choose to involve others in treatment decisions. This study investigates the types (i.e., informational, emotional, and instrumental) and sources (i.e., formal and informal) of support Hispanic and non-Hispanic White CMP patients desire and receive when making decisions about their pain care. METHOD Semi-structured interviews were conducted with Hispanic and non-Hispanic White older adults with CMP (N = 63) recruited from one medical center and one senior center in New York City. Interviews were transcribed and then analyzed using content analysis. RESULTS CMP patients sought network members who supported their emotional well-being throughout the decision-making process. When considering high-stakes treatment decisions, participants selectively involved individuals who had similar pain conditions or first-hand experience with the procedure. Participants' perceptions of the decision-making process were contingent upon the congruence between the decision they made and the support they received for it. For Spanish-speaking participants, positive perceptions were linked with satisfactory language competence by their providers. On the other hand, lack of language competence among providers hindered Spanish speakers' ability to obtain adequate informational support. DISCUSSION Results reveal the importance of empathic patient-provider exchanges across diverse patient populations and cultural sensitivity for Spanish-speaking patients. Findings suggest that social networks beyond the patient-provider dyad influence patients' decision-making satisfaction.
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Affiliation(s)
- Catherine Riffin
- Department of Human Development, Cornell University, Ithaca, New York.
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
| | - Manny C Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York
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Mislang AR, Biganzoli L. Adjuvant Systemic Therapy in Older Breast Cancer Women: Can We Optimize the Level of Care? Cancers (Basel) 2015; 7:1191-214. [PMID: 26151681 PMCID: PMC4586766 DOI: 10.3390/cancers7030833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/17/2015] [Accepted: 06/26/2015] [Indexed: 01/03/2023] Open
Abstract
Defining optimal adjuvant treatment for older women with breast cancer is challenged by the lack of level-1 clinical evidence and the heterogeneity of the older population. Nevertheless, recommendations based on reviews of available evidence mainly from retrospective subgroup analyses and extrapolation of study results from younger patients, and expert opinions, may be useful to guide treatment decisions in fit patients. But how can we properly define a "fit" older patient? In clinical practice, age by itself and clinical impression generally drive treatment decision, although the appropriateness of this judgment is under-documented. Such an approach risks overtreatment or, more frequently, undertreatment. A geriatric assessment can be valuable in oncology practice to address this issue. In this review article, we will focus only on systemic treatment and will discuss "standard" adjuvant systemic treatment strategies for fit older breast cancer patients and the role of "personalized" systemic therapy in unfit patients. The concepts conveyed in this review cannot be extrapolated to locoregional therapy.
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Affiliation(s)
- Anna Rachelle Mislang
- Sandro Pitigliani Medical Oncology Unit, Nuovo Ospedale Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Nuovo Ospedale Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy.
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Burton M, Collins KA, Lifford KJ, Brain K, Wyld L, Caldon L, Gath J, Revell D, Reed MW. The information and decision support needs of older women (>75 yrs) facing treatment choices for breast cancer: a qualitative study. Psychooncology 2014; 24:878-84. [PMID: 25534045 DOI: 10.1002/pon.3735] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/14/2014] [Accepted: 11/15/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Primary Endocrine Therapy (PET) is a good alternative to surgery for breast cancer in older frailer women. Overall survival rates are equivalent although rates of local control are inferior. There is little research regarding the decision support needs of older patients faced with this choice. This qualitative study aimed to explore these among older breast cancer patients offered a choice of treatment, as the basis to develop an appropriate decision support tool. METHODS Semi-structured interviews were undertaken with older women (>75 years) with breast cancer who had been offered a choice of PET or surgery at diagnosis. Women's involvement in their treatment decision and support for the process were explored and analysed using framework analysis. RESULTS Thirty-three interviews were undertaken (median age 82, range 75-95 years, 22 PET, 11 surgery). Most women, regardless of treatment choice, wanted tailored information about the different treatment options, their impact on independence, the practicalities of treatment and the risk of recurrence and spread. Surgery was the treatment of choice in women wanting optimal disease control; those choosing PET felt that they were 'too old' for surgery and wanted minimal disruption. CONCLUSIONS Older women described making active treatment decisions. However, some knowledge was inaccurate. Women wanted information and decision support from their clinicians along with a specific tailored information booklet to support this process.
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Affiliation(s)
- Maria Burton
- Sheffield Hallam, University Centre for Health and Social Care Research Montgomery House, Sheffield, South Yorkshire, United Kingdom
| | - Karen Anna Collins
- Sheffield Hallam, University Centre for Health and Social Care Research Montgomery House, Sheffield, South Yorkshire, United Kingdom
| | - Kate Joanna Lifford
- Cardiff University, Institute of Primary Care and Public Health, School of Medicine, Cardiff, United Kingdom
| | - Kate Brain
- Cardiff University, Institute of Primary Care and Public Health, School of Medicine, Cardiff, United Kingdom
| | - Lynda Wyld
- University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - L Caldon
- University of Sheffield, Sheffield, United Kingdom
| | - Jacqui Gath
- North Trent Cancer Network Consumer Research Panel, Sheffield, United Kingdom
| | - Deirdre Revell
- North Trent Cancer Network Consumer Research Panel, Sheffield, United Kingdom
| | - Malcolm William Reed
- University of Sheffield, Academic Surgical Oncology Unit, Sheffield, United Kingdom
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Trarieux-Signol S, Moreau S, Gourin MP, Penot A, Edoux de Lafont G, Preux PM, Bordessoule D. Factors associated with the designation of a health care proxy and writing advance directives for patients suffering from haematological malignancies. BMC Palliat Care 2014; 13:57. [PMID: 25859160 PMCID: PMC4391307 DOI: 10.1186/1472-684x-13-57] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Abstract
Background During the last few decades, patients’ rights have been reinforced in many countries by acts of law. Measures now include health care proxies to uphold the doctor-patient relationship and advance directives for end-of-life patients. These could be relevant tools as early as the initial diagnosis of haematological malignancies because of the uncertain disease course. The aim of this research was to assess the factors associated with the designation of a proxy and writing advance directives by patients in a haematology department in France. Methods After a specific programme to encourage discussions about end-of-life preferences, we conducted a mixed-methods study comprising retrospective analysis of a random sample of 200 patients’ medical records, crossed with a qualitative analysis of the content of advance directives. Statistical analysis was performed by the RKward V 0.6.1 software with 0.05 denoting significance. The study was performed and presented in accordance with the STROBE guidelines. A thematic analysis of the advance directives was performed by two researchers. Results A total of 197 medical records were evaluable. The mean age of the patients was 66 years (range: 18–91). Nearly 2/3 of them (64.5%) designated a proxy, 6.1% wrote advance directives, and 8.1% and 4.6% expressed a wish to meet a religious representative or a volunteer, respectively. The 2-year survival rate was 78.4% [95%CI: 68.2-90.2]. Patients who wrote advance directives were statistically older (p <0.00025). Patients who wrote an advance directive were more likely to have expressed a wish to meet a religious representative (p <0.001) or a volunteer (p = 0.003). Marital status was a significant factor in appointing a proxy (p = 0.04). Conclusions To the best of our knowledge, this is the first paper to identify influencing factors for proxies and advance directives in a homogenous population of patients with haematological malignancies. Most patients chose a proxy. However, despite several training programmes for the carers and a care planning programme, few patients wrote advance directives. Our findings suggest that influencing factors are advanced age and a wish to see a religious representative. This study highlights the importance of oral communication about end-of-life issues between carers, patients and their relatives. Electronic supplementary material The online version of this article (doi:10.1186/1472-684X-13-57) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophie Trarieux-Signol
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Stéphane Moreau
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Marie-Pierre Gourin
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Amélie Penot
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Geoffroy Edoux de Lafont
- Centre Hospitalier Universitaire, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Pierre-Marie Preux
- Centre Hospitalier Universitaire, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Dominique Bordessoule
- Centre Hospitalier Universitaire, Service d'hématologie Clinique et de thérapie cellulaire, 2 avenue Martin Luther King, 87042 Limoges, France
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Cherny N. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol 2014; 25 Suppl 3:iii143-52. [DOI: 10.1093/annonc/mdu238] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Burton M, Collins K, Caldon LJM, Wyld L, Reed MWR. Information Needs of Older Women Faced with a Choice of Primary Endocrine Therapy or Surgery for Early-Stage Breast Cancer: A Literature Review. CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-014-0159-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hwang JW, Bang WJ, Oh CY, Yoo C, Cho JS. Factors influencing the acceptance of transrectal ultrasound-guided prostate biopsies. Korean J Urol 2014; 55:460-4. [PMID: 25045444 PMCID: PMC4101115 DOI: 10.4111/kju.2014.55.7.460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/18/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to improve prostate biopsy compliance by analyzing the factors that influence the acceptance of prostate biopsy by patients to whom transrectal ultrasound (TRUS)-guided prostate biopsy is recommended for suspected prostate cancer. Materials and Methods The subjects of this study were 268 patients to whom TRUS-guided prostate biopsy was recommended from January to June 2011 and who completed a questionnaire. Patients who showed a prostate-specific antigen (PSA) increase to more than 4.0 ng/mL or abnormal findings on a digital rectal examination and TRUS were recommended to undergo prostate biopsy. The questionnaire consisted of 9 questions about the subjects' demographic characteristics and 15 questions that assessed their knowledge of prostate disease. Fisher exact probability test was conducted to assess the influence of the demographic characteristics and levels of knowledge of prostate disease on acceptance of prostate biopsy. Results The mean age of the subjects was 66.2 years (range, 43-83 years). Of the cohort, 188 patients (70.7%) agreed to the prostate biopsy and 78 patients (29.3%) refused. In terms of demographic characteristics, the patients' acceptance of prostate biopsy was associated only with education level. Patients with relatively lower education levels had a higher acceptance rate for prostate biopsy (80.0% vs. 65.9%, p=0.018). Other demographic factors, as well as the degree of knowledge of prostate disease, had no significant effect on the acceptance rate. Conclusions The patients' acceptance of prostate biopsy can be influenced by demographic characteristics, especially education level. Therefore, when prostate biopsy is recommended to patients, their demographic characteristics should be taken into consideration.
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Affiliation(s)
- Ji Won Hwang
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Woo Jin Bang
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Changhee Yoo
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
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Rood JAJ, Eeltink CM, van Zuuren FJ, Verdonck-de Leeuw IM, Huijgens PC. Perceived need for information of patients with haematological malignancies: a literature review. J Clin Nurs 2014; 24:353-69. [DOI: 10.1111/jocn.12630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Janneke AJ Rood
- Department of Haematology (pk 2 br 018); VU University Medical Center; Amsterdam The Netherlands
- Department of Internal Medicine; Medical Center; Alkmaar
| | - Corien M Eeltink
- Department of Haematology (pk 2 br 018); VU University Medical Center; Amsterdam The Netherlands
| | - Florence J van Zuuren
- Department of Clinical Psychology; University of Amsterdam; Amsterdam The Netherlands
| | | | - Peter C Huijgens
- Department of Haematology (pk 2 br 018); VU University Medical Center; Amsterdam The Netherlands
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Bergenmar M, Johansson H, Sharp L. Patients' perception of information after completion of adjuvant radiotherapy for breast cancer. Eur J Oncol Nurs 2014; 18:305-9. [DOI: 10.1016/j.ejon.2014.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/20/2014] [Accepted: 02/10/2014] [Indexed: 01/23/2023]
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50
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Majumder K, Brandberg Y, Johansson H, Nilsson S, Bergenmar M. Less Satisfaction With Information in Patients With Prostate Cancer Treated With Surgery and Salvage Radiotherapy Compared With Patients Treated With Curative Radiotherapy Alone, Despite Similar Health-Related Quality of Life. Clin Genitourin Cancer 2014; 12:e71-82. [DOI: 10.1016/j.clgc.2013.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/05/2013] [Accepted: 11/08/2013] [Indexed: 11/29/2022]
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