A feasibility study to evaluate breast cancer patients' knowledge of their diagnosis and treatment

Do members of cancer peer support groups know more about cancer than non-members? Results from a cross-sectional study in Germany

PURPOSE

This study aims to assess whether cancer-specific knowledge (CSK) is associated with membership in a cancer peer support group (PSG) and other factors.

METHODS

A cross-sectional study investigated the CSK of 1121 cancer patients of various entities across Germany. CSK was measured with the BCKS-14, a 14-item knowledge instrument which was previously participatory developed with patient representatives and oncologists. Associations between CSK and PSG membership, sociodemographic factors, internet use, and preferences in medical decision-making were analysed with t-tests and multiple linear regressions.

RESULTS

The t-test showed a statistically significant difference in CSK between members and non-members of PSGs. Knowledge for PSG members was on average 0.97 points higher (p < 0.001) and varied between 2 and 14 points compared to 0-14 points for non-members. Regression analysis revealed age, gender, time since diagnosis, education, internet use, and PSG activity to be statistically significant predictors. Younger (β =  - 0.15; p < 0.001), female (β = 0.10; p = 0.001), higher educated patients (β = 0.27; p < 0.001) with and a diagnosis longer ago (β = 0.10; p = 0.002) who use the internet frequently for information seeking (β = 0.20; p ≤ 0.001) and members of cancer PSGs (β = 0.18; p ≤ 0.001) showed a higher CSK.

CONCLUSION

Overall, CSK of the participants shows a high degree of variance. CSK should be promoted for all patients and especially for older, newly diagnosed patients with low educational levels and PSGs introduced early on as they contribute to improving CSK among other benefits.

Identifying and describing cancer survivors: Implications for cancer survivorship research and clinical care

BACKGROUND

Gathering information directly from cancer survivors has advanced our understanding of the cancer survivorship experience. However, it is unknown whether surveys can distinguish important subgroups of cancer survivors. This study aimed to describe the current landscape of survey questions used to identify and describe cancer survivors in national cross-sectional studies.

METHODS

Using publicly available databases, the authors identified national cross-sectional surveys used in the United States within the past 15 years that included a question on self-reported history of cancer. After abstracting questions and response items used to identify cancer survivors, they conducted a descriptive analysis.

RESULTS

The authors identified 14 national cross-sectional surveys, with half administered to the general population and the other half administered to cancer survivors. The most common question used to identify cancer survivors was "Have you ever been told by a doctor or other health professional that you had cancer?" Most surveys had questions asking participants to identify a single cancer type (n = 11), multiple prior cancer diagnoses or types (n = 11), and the time from diagnosis (n = 12). Treatment questions varied from active treatment status to specific treatments received. Questions addressing cancer stage (n = 2), subtypes (n = 1), metastatic status (n = 3), and recurrence (n = 4) were less frequently included.

CONCLUSIONS

There is no standard method for assessing self-reported cancer history, and this limits the ability to distinguish among potentially important subgroups of survivors. Future cross-sectional surveys that capture nuanced data elements, such as cancer types, stages/subtypes, metastatic/recurrent status, and treatments received, can help to fill important gaps in cancer survivorship research and clinical care.

The REDCap consortium: Building an international community of software platform partners

The Research Electronic Data Capture (REDCap) data management platform was developed in 2004 to address an institutional need at Vanderbilt University, then shared with a limited number of adopting sites beginning in 2006. Given bi-directional benefit in early sharing experiments, we created a broader consortium sharing and support model for any academic, non-profit, or government partner wishing to adopt the software. Our sharing framework and consortium-based support model have evolved over time along with the size of the consortium (currently more than 3200 REDCap partners across 128 countries). While the "REDCap Consortium" model represents only one example of how to build and disseminate a software platform, lessons learned from our approach may assist other research institutions seeking to build and disseminate innovative technologies.

The REDCap consortium: Building an international community of software platform partners

The Research Electronic Data Capture (REDCap) data management platform was developed in 2004 to address an institutional need at Vanderbilt University, then shared with a limited number of adopting sites beginning in 2006. Given bi-directional benefit in early sharing experiments, we created a broader consortium sharing and support model for any academic, non-profit, or government partner wishing to adopt the software. Our sharing framework and consortium-based support model have evolved over time along with the size of the consortium (currently more than 3200 REDCap partners across 128 countries). While the "REDCap Consortium" model represents only one example of how to build and disseminate a software platform, lessons learned from our approach may assist other research institutions seeking to build and disseminate innovative technologies.

Assessing Knowledge Regarding Managing Congestive Health Failure Symptoms: Differences in Patient and Professional Scores

Objective:

To assess whether patients with congestive heart failure (CHF) and health coaches agree about patient knowledge of health-enhancing practices related to CHF after ongoing telehealth coaching.

Methods:

Forty patients with CHF and eligible for both Medicare and Medicaid were recruited from a regional managed care organization for this pilot study. Telecoaching sessions via a health insurance portability and accountability act(HIPAA)-compliant tablet-based platform focused on educational information designed to improve patient self-care. Social workers administered the 13-item Member Confidence Measure at baseline and at 30 and 180 days into the intervention. Patients and social workers provided separate ratings.

Results:

As expected at baseline, patient and coach scores differed, with patients reporting higher perceived knowledge scores (P < .01). Contrary to expectation, patient and coach scores did not converge at 30 and 180 days. Patient scores continued to increase at 30 and 180 days, while coaches’ scores increased at 30 days, but not at 180 days.

Conclusion:

Overall, patients continued to overrate their understanding about CHF. A telecoaching platform provides an opportunity to enhance patient’s knowledge of their chronic disease and for patients to sustain that knowledge over time.

Practice Implications:

Addressing a patient’s misperception of their knowledge to manage a chronic disease is critical for enhancing well-being. Coaches’ scores did increase at 30 days suggesting that telecoaching is effective, but more monitoring may be required to ensure that these gains persist over time.

How Well Informed Do Patients Feel about Their Breast Cancer Surgery Options? Findings from a Nationwide Survey of Women after Lumpectomy and/or Mastectomy

BACKGROUND

Women diagnosed with breast cancer often describe the process of treatment decision making as bewildering and worrisome. Patients who do not feel completely informed about their surgical options might make choices that are suboptimal or regretted later. The Institute of Medicine has called for more research on why breast cancer patients are inadequately informed about treatment options. The aims of the study were to explore how women become informed about their breast cancer surgery treatment options and to identify improvement opportunities.

STUDY DESIGN

A nationwide internet survey was conducted among women who reported being surgically treated by lumpectomy only (n = 215), mastectomy only (n = 140), or by both procedures (n = 132) for breast cancer. To improve generalizability, Census-based enrollment quotas were applied for geographic region, health insurance, and income.

RESULTS

Only 47% (95% CI 41% to 54%) of lumpectomy-only patients, 67% (95% CI 59% to 75%) of mastectomy-only patients, and 28% (95% CI 21% to 35%) of patients having both procedures said they felt "completely informed" about treatment options before their operations. "Making a quick decision" was more important than "thoroughly researching all options" for 35% of lumpectomy-only patients, 31% of mastectomy-only patients, and 22% of patients having both procedures. Nearly all women used some other source of information to research treatment options. Lumpectomy-only and mastectomy-only patients who relied on their surgeon's recommendation without additional research were significantly less likely to report feeling "completely informed" (odds ratio 0.6; 95% CI 0.4 to 0.9; p < 0.02).

CONCLUSIONS

Many women who had surgery for breast cancer did not feel completely informed about their surgical options. This appears to be due, in part, to a false sense of urgency and perhaps insufficient or misdirected information gathering by patients. The responsibility for fully informing patients about their treatment options must be better fulfilled by surgeons.

A feasibility study to assess the validity of administrative data sources and self-reported information of breast cancer survivors

BACKGROUND

Cancer survivorship has increasingly become the focus of research due to progress in early detection and advancements in the therapeutic approach, but high-quality information sources for outcomes, potential confounders and personal characteristics present a challenge. Few studies have collected breast cancer care data from mixed data sources and validated them, and to the best of our knowledge, none so far have been conducted in Israel, where National Health Insurance Law assures universal health care, delivered through four health care funds with computerized administrative, pharmaceutical and medical databases. This validation study is aimed to assess the accuracy and completeness of information on cancer care and health outcomes using several research tools, before embarking on a full-scale study aimed to evaluate the long-term treatment-related health adverse outcomes in a cohort of breast cancer survivors.

METHODS

One hundred twenty randomly sampled female patients diagnosed with primary breast cancer in years 2000-2010 in northern Israel, who are members of the "Leumit" healthcare fund, were included. Data sources included "Leumit" medical records, the National Cancer Registry and a self-report questionnaire. The questionnaire was completed by 99 % of the women contacted. The accuracy of the information regarding cancer care was assessed with the reference standard set as one of the research tools, varying per the characteristic being under investigation. For example: health outcomes and medical history were validated against "Leumit" medical records, while construct validity of the self-reported questionnaire served to assess the prevalence of chronic pain. Agreement, predictive values, correlations, and internal consistency were calculated. Logistic regression models were constructed to assess potential predictors of correct responses.

RESULTS

The overall level of agreement (Kappa) was almost perfect for demographics and outcomes, above 0.8 for treatments and chronic pain, while only fair to moderate for most of the self-reported medical history. Correct responses of medical history were associated with Jewish ethnicity, recency of breast cancer diagnosis, and family history of cardiovascular disease. The internal consistency of the quality-of-life scale was above 0.9.

CONCLUSION

In the absence of a national registry for cancer care, a mixed methodology for data collection is the most complete source.

TRIAL REGISTRATION

Trial registration number Not available. This is an observational study with prospective data collection and no intervention; therefore, trial registration number is not required.