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Jensen-Battaglia M, LoCastro M, Oh H, Sanapala C, Flannery M, Mendler JH, Liesveld J, Huselton E, Loh KP. Patient-oncologist discussion of treatment decisions: Exploring the role of a patient-centered communication tool for older adults with acute myeloid leukemia and their caregivers. J Geriatr Oncol 2024; 15:101716. [PMID: 38336521 DOI: 10.1016/j.jgo.2024.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Marielle Jensen-Battaglia
- James P. Wilmot Cancer Institute and Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Marissa LoCastro
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Haejung Oh
- The Catholic University of Korea, School of Medicine, Seoul, South Korea
| | | | - Marie Flannery
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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Hewison A, Roman E, Smith A, McCaughan D, Sheridan R, Patmore R, Atkin K, Howell D. Chronic myeloid leukaemia: A qualitative interview study exploring disease impact from patient and practitioner perspectives. Eur J Oncol Nurs 2023; 67:102421. [PMID: 37804754 DOI: 10.1016/j.ejon.2023.102421] [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: 08/02/2023] [Accepted: 09/10/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Improvements in chronic myeloid leukaemia treatment mean it is now relevant to examine the experiences of living with this cancer over a lifetime. This qualitative study aimed to investigate the impact of chronic myeloid leukaemia, from patient and healthcare practitioner perspectives. METHODS The research was set within the UK's Haematological Malignancy Research Network; a population-based cohort of patients newly diagnosed with blood cancer, treated at one of fourteen hospitals. Purposive sampling led to interviews with seventeen patients and thirteen health care practitioners. Data were analysed using thematic analysis. RESULTS Two analytical themes, "Significant impact of disease and treatment" and "Mediators of the impact of disease and treatment", and six sub-themes, were derived from patient interviews and supported with data from practitioners. Chronic myeloid leukaemia was described by patients as having significant widespread impact, which could be mediated by their knowledge, social support, and the quality of healthcare systems. Practitioners reflected patient accounts, but could underestimate the impact of this cancer. They generally viewed chronic myeloid leukaemia as less complex, severe and impactful than acute blood cancers; a message that reassured patients at diagnosis, but could later unintentionally contribute to difficulties discussing side effects and struggles to cope. CONCLUSION Chronic myeloid leukaemia may significantly impact individuals, particularly as it is experienced over the lifetime. Greater understanding and discussion of the breadth and extent to which patients are affected, including potential mediators, could enhance clinical care.
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Affiliation(s)
- Ann Hewison
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD, United Kingdom.
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD, United Kingdom.
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD, United Kingdom.
| | - Dorothy McCaughan
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD, United Kingdom.
| | - Rebecca Sheridan
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD, United Kingdom.
| | - Russell Patmore
- Queens Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, HU16 5JQ, United Kingdom.
| | - Karl Atkin
- Department of Sociology, University of York, York, YO10 5DD, United Kingdom.
| | - Debra Howell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD, United Kingdom.
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3
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Shawahna R, Amer R, Salameh H, Shawahna AR, Aljondy M, Zain-Aldain M. Predictors of health-related quality of life of the patients treated for MM: the first study in the Palestinian healthcare system. Ann Hematol 2023; 102:3543-3554. [PMID: 37801084 DOI: 10.1007/s00277-023-05482-1] [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: 07/03/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
Little studies were conducted to assess the health -related quality of life (HR-QoL) of patients with multiple myeloma (MM) in developing and resource-limited countries. This study assessed the HR-QoL of patients with MM who received treatment in the Palestinian healthcare system as an example of healthcare systems in developing and resource-limited countries. Predictors of deteriorated HR-QoL of the affected patients were also identified. In this cross-sectional study, the tool was a questionnaire that collected the demographic and disease variables of the patients. The questionnaire also contained the EORTC QLQ-MY24 items. The questionnaire was piloted to ensure readability, clarity, and comprehensibility. Additionally, the test-retest reliability and internal consistency were also assessed. In this study, 45.5% of patients with MM who were treated in the Palestinian healthcare system returned usable questionnaires. The mean age of the patients was 60.7 ± 7.5 years and the mean time elapsed since diagnosis was 2.6 ± 1.7 years. Of the patients, 54.3%, 47.8%, 46.7%, 66.3%, 46.7%, and 46.7% reported frequent bone pain, pain that increased with activity, back pain, feeling ill, lost hair, and feeling restless or agitated, respectively. Higher disease symptom scores were predicted by low self-rated satisfaction with the ability to do daily life activities and low self-rated satisfaction with overall health. The side effects of treatment scores were predicted by longer time elapsed since diagnosis and low self-rated satisfaction with overall health. Future perspective scores were predicted by low self-rated satisfaction with overall health. On the other hand, social support scores were predicted by having a university education and not receiving radiotherapy. Patients with MM who were treated in the Palestinian healthcare system reported a heavy burden of disease symptoms, treatment adverse effects, and dissatisfaction with the information they received about their disease. The findings reported in this study are informative to hemato-oncologists and other healthcare providers who care for patients with MM in Palestine and other developing and resource-limited countries. Policymakers might use the findings reported in this study to design interventions to improve the HR-QoL of the patients.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Riad Amer
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
- Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Husam Salameh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine.
- Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Abdul-Rahman Shawahna
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Mohmmad Aljondy
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
| | - Mohmmad Zain-Aldain
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
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4
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Bashir Q, Braunstein M, Buck T, Chmielewski C, Hartmann B, Janakiram M, McMahon MA, Romundstad L, Steele L, Usmani SZ, Zwibel K, Kharfan-Dabaja MA. Overcoming Barriers to Autologous Stem Cell Transplantation in Multiple Myeloma: Recommendations from a Multidisciplinary Roundtable Discussion. Transplant Cell Ther 2023; 29:666-673. [PMID: 37661071 DOI: 10.1016/j.jtct.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
Autologous stem cell transplantation (ASCT) is a standard of care treatment for patients with multiple myeloma (MM). However, only 20% to 30% of patients with MM for whom the procedure is indicated undergo ASCT. Barriers to ASCT may be informational, financial, logistic, or cultural and may affect patients and treating oncologists. Available and accessible accurate ASCT-related information is essential to overcome these barriers. Such resources can be created by blood and marrow transplantation societies and patient advocacy groups, ideally in collaboration with MM specialists at transplant centers. An umbrella office at the society level is also recommended to connect oncologists, advocacy groups, and transplantation specialists; provide informational resources to patients; and conduct research into region- and population-specific barriers to ASCT.
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Affiliation(s)
- Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Marc Braunstein
- NYU Long Island School of Medicine, NYU Perlmutter Cancer Center, Mineola, New York
| | - Tondre Buck
- Gibbs Cancer Center & Research Institute, Medical Group of the Carolinas, Spartanburg, South Carolina
| | | | | | | | - Marisa A McMahon
- Perlmutter Cancer Center, NYU Langone Health, New York, New York
| | | | - Lynn Steele
- The Leukemia & Lymphoma Society, Rye Brook, New York
| | | | | | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, Florida
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5
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Kim J, Fairman NP, Dove MS, Hoch JS, Keegan TH. Cancer survivors with sub-optimal patient-centered communication before and during the early COVID-19 pandemic. PATIENT EDUCATION AND COUNSELING 2023; 115:107876. [PMID: 37406471 PMCID: PMC10299944 DOI: 10.1016/j.pec.2023.107876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Patient-Centered Communication (PCC) is an essential element of patient-centered cancer care. Thus, this study aimed to examine the prevalence of and factors associated with optimal PCC among cancer survivors during COVID-19, which has been less studied. METHODS We used national survey (Health Information National Trends Survey) among cancer survivors (n = 2579) to calculate the prevalence (%) of optimal PCC in all 6 PCC domains and overall (mean) by time (before COVID-19, 2017-19 vs. COVID-19, 2020). Multivariable logistic regressions were performed to explore the associations of sociodemographic (age, birth gender, race/ethnicity, income, education, usual source of care), and health status (general health, depression/anxiety symptoms, time since diagnosis, cancer type) factors with optimal PCC. RESULTS The prevalence of optimal PCC decreased during COVID-19 overall, with the greatest decrease in managing uncertainty (7.3%). Those with no usual source of care (odd ratios, ORs =1.53-2.29), poor general health (ORs=1.40-1.66), depression/anxiety symptoms (ORs=1.73-2.17) were less likely to have optimal PCC in most domains and overall PCC. CONCLUSIONS We observed that the decreased prevalence of optimal PCC, and identified those with suboptimal PCC during COVID-19. PRACTICE IMPLICATIONS More efforts to raise awareness and improve PCC are suggested, including education and guidelines, given the decreased prevalence during this public health emergency.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA; Stanford Center for Digital Health, Stanford Medicine, Stanford, CA, USA.
| | - Nathan P Fairman
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Melanie S Dove
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Jeffrey S Hoch
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Theresa H Keegan
- Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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6
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McCaughan D, Roman E, Sheridan R, Hewison A, Smith AG, Patmore R, Howell DA. Patient perspectives of 'Watch and Wait' for chronic haematological cancers: Findings from a qualitative study. Eur J Oncol Nurs 2023; 65:102349. [PMID: 37331194 DOI: 10.1016/j.ejon.2023.102349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/02/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE Chronic blood cancers are incurable, and characterised by unpredictable, remitting-relapsing pathways. Management often involves periods of observation prior to treatment (if required), and post-treatment, in an approach known as 'Watch and Wait'. This study aimed to explore patient experiences of 'Watch and Wait'. METHODS In-depth interviews with 35 patients (10 accompanied by relatives) with chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma or myeloma. Data were analysed using descriptive qualitative techniques. RESULTS Patient views of Watch and Wait ranged along a continuum, from immediate acceptance, to concern about treatment deferral. Significant ongoing anxiety and distress were described by some, due to the uncertain pathways associated with Watch and Wait. Infrequent contact with clinical staff was said to exacerbate this, as there was limited opportunity to ask questions and seek reassurance. Patients indicated that the impact of their malignancy could be underestimated by clinicians; possibly due to them comparing chronic and acute subtypes. Most patients lacked knowledge of blood cancers. Support from clinicians was considered greater among treated patients, possibly due to increased contact, and many drew on relatives for aid. Most patients were satisfied with their time-allocation with haematology staff, although experiences could be improved by greater access to clinical nurse specialists, counselling services, and community-based facilities. CONCLUSION Experiences varied. Anxiety about unpredictable futures could be more distressing than any physical symptoms and have a greater impact on quality of life. Ongoing assessment could facilitate identification of difficulties, and is particularly important among individuals without supportive networks.
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Affiliation(s)
- Dorothy McCaughan
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Eve Roman
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Rebecca Sheridan
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Ann Hewison
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Alexandra G Smith
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Russell Patmore
- Queens Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, UK.
| | - Debra A Howell
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
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7
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Ying Q, Lou J, Zheng D. Ginsenoside Rh4 inhibits the malignant progression of multiple myeloma and induces ferroptosis by regulating SIRT2. Clin Exp Pharmacol Physiol 2023. [PMID: 37452691 DOI: 10.1111/1440-1681.13805] [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: 02/05/2023] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023]
Abstract
Multiple myeloma (MM) has a high mortality rate, and the exploration of therapeutic drugs for MM with low side effects is a hot topic at the moment. Ginsenoside Rh4 has been shown to inhibit tumour growth in many cancers. However, the role of ginsenoside Rh4 in MM and its reaction mechanism have not been reported so far. After the treatment with different concentrations of ginsenoside Rh4, the proliferation of NCI-H929 cells was detected by Cell Counting Kit-8 and 5-ethynyl-2'-deoxyuridine staining. The cell apoptosis and cycle arrest were detected by flow cytometry and western blot. The thiobarbituric acid-reactive substances (TBARS) production was assessed with TBARS assay, whereas Fe2+ fluorescence assay was used for the measurement of Fe2+ level. The production of reactive oxygen species was evaluated with dichloro-dihydro-fluorescein diacetate staining, and western blot was applied for the estimation of ferroptosis-related proteins. The potential targets of ginsenoside Rh4 were predicted by molecular docking technology and verified by western blot. The transfection efficacy of overexpression-SIRT2 was examined with quantitative reverse transcription polymerase chain reaction and western blot. To figure out the detailed reaction mechanism between ginsenoside Rh4 and SIRT2 in MM, rescue experiments were conducted. We found that ginsenoside Rh4 inhibited cell proliferation, induced cell apoptosis, promoted cycle arrest and facilitated ferroptosis in MM. Moreover, ginsenoside Rh4 inhibited SIRT2 expression in MM cells. The overexpression of SIRT2 reversed the effects of ginsenoside Rh4 on cell proliferation, cell apoptosis, cycle arrest and ferroptosis in MM. Overall, ginsenoside Rh4 inhibited the malignant progression of MM and induced ferroptosis by regulating SIRT2.
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Affiliation(s)
- Qiuhua Ying
- Department of Hematology, Ningbo Municipal Hospital of Traditional Chinese Medicine (TCM), Affiliated Hospital of Zhejiang Chinese Medicine University, Zhejiang, China
| | - Jinjie Lou
- Department of Hematology, Ningbo Municipal Hospital of Traditional Chinese Medicine (TCM), Affiliated Hospital of Zhejiang Chinese Medicine University, Zhejiang, China
| | - Daibo Zheng
- Department of Hematology, Ningbo Municipal Hospital of Traditional Chinese Medicine (TCM), Affiliated Hospital of Zhejiang Chinese Medicine University, Zhejiang, China
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8
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Bylund CL, Eggly S, LeBlanc TW, Kurtin S, Gandee M, Medhekar R, Fu A, Khurana M, Delaney K, Divita A, McNamara M, Baile WF. Survey of patients and physicians on shared decision-making in treatment selection in relapsed/refractory multiple myeloma. Transl Behav Med 2023; 13:255-267. [PMID: 36688466 DOI: 10.1093/tbm/ibac099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Shared decision-making (SDM) is a key component of patient-centered healthcare. SDM is particularly pertinent in the relapsed and/or refractory multiple myeloma (RRMM) setting, in which numerous treatment options can present challenges for identifying optimal care. However, few studies have assessed the extent and relevance of SDM and patient-centered communication (PCC) in RRMM. To describe treatment decision-making patterns between physicians and patients in the RRMM setting, we conducted online surveys of patients and physicians in the USA to compare their perspectives on the process of treatment decision-making. We analyzed the surveys descriptively. Two hundred hematologists/oncologists and 200 patients with RRMM receiving second-line (n = 89), third-line (n = 65), and fourth-line (n = 46) therapy participated. Top treatment goals for physicians and patients included extending overall survival (among 76% and 83% of physicians and patients, respectively) and progression-free survival (among 54% and 77% of physicians and patients, respectively), regardless of the number of prior relapses. Thirty percent of physicians believed patients preferred a shared approach to treatment decision-making, while 40% of patients reported most often preferring a shared role in treatment decision-making. One-fourth of patients most often preferred physicians to make the final treatment decision after seriously considering their opinion. Thirty-two percent of physicians and 16% of patients recalled ≥3 treatment options presented at first relapse. Efficacy was a primary treatment goal for patients and physicians. Discrepancies in their perceptions during RRMM treatment decision-making exist, indicating that communication tools are needed to facilitate SDM and PCC.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Susan Eggly
- Wayne State University Department of Oncology/Karmanos Cancer Institute, Detroit, MI, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Kurtin
- University of Arizona and Arizona Cancer Center, Tucson, AZ, USA
| | | | - Rohan Medhekar
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Alan Fu
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Monica Khurana
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | | | | | - Walter F Baile
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Yilmaz S, Sanapala C, Schiaffino MK, Schumacher JR, Wallington SF, McKoy JM, Canin B, Tang W, Tucker-Seeley RD, Simmons J, Gilmore N. Social Justice and Equity: Why Older Adults With Cancer Belong-A Life Course Perspective. Am Soc Clin Oncol Educ Book 2022; 42:1-13. [PMID: 35649203 PMCID: PMC11070065 DOI: 10.1200/edbk_349825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The population of older adults with cancer in the United States is rapidly increasing, which will have a substantial impact on the oncology and public health workforces across the cancer continuum, from prevention to end of life. Unfortunately, inequities in existing social structures that cause increased psychosocial stressors have led to disparities in the incidence of cancer and the morbidity and mortality of cancer for individuals from marginalized backgrounds. It is imperative that older adults, especially those from historically marginalized backgrounds, be adequately represented in all stages of cancer research to address health inequities. Continued efforts and progress toward achieving social justice and health equity require a deeper commitment to and better understanding of the impact of social determinants of health within the cancer domain. Undoubtedly, a more holistic and integrated view that extends beyond the biologic and genetic factors of health must be adopted for health entities to recognize the critical role of environmental, behavioral, and social determinants in cancer health disparities. Against this backdrop, this paper uses a life course approach to present a multifactorial framework for understanding and addressing cancer disparities in an effort to advance social justice and health equity for racially and ethnically diverse older adults.
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Affiliation(s)
- Sule Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Chandrika Sanapala
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Jessica R Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Sherrie F Wallington
- The George Washington School of Nursing & Milken Institute School of Public Health, Washington, DC
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | | | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
- ZERO-The End of Prostate Cancer, Alexandria, VA
| | - John Simmons
- Cancer and Aging Research Group, City of Hope, CA
- Ethnic Health Institute, Center for Community Engagement, Samuel Merritt University, Oakland, CA
| | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY
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10
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McCaughan D, Roman E, Smith A, Patmore R, Howell D. Treatment decision making (TDM): a qualitative study exploring the perspectives of patients with chronic haematological cancers. BMJ Open 2022; 12:e050816. [PMID: 35351694 PMCID: PMC8966575 DOI: 10.1136/bmjopen-2021-050816] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/25/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Haematological malignancies are the fifth most common cancer in the UK, with chronic subtypes comprising around a third of all new diagnoses. These complex diseases have some similarities with other cancers, but often require different management. Surgical resection is not possible, and while some are curable with intensive chemotherapy, most indolent subtypes are managed with non-aggressive intermittent or continuous treatment, often over many years. Little is known about the views of patients with chronic haematological cancers regarding treatment decision making (TDM), a deficit our study aimed to address. SETTING AND DESIGN Set within the Haematological Malignancy Research Network (HMRN: www.hmrn.org), an ongoing population-based cohort that provides infrastructure to support evidence-based research, HMRN data were augmented by qualitative information from in-depth interviews. Data were analysed for thematic content, combining inductive and deductive approaches. Interpretation involved seeking meaning, salience and connections within data. PARTICIPANTS Thirty-five patients with four chronic subtypes: chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma, and myeloma. Ten relatives were present and contributed to varying extents. RESULTS Five themes were discerned: (1) Preference for clinician recommendations; (2) Factors implicated in patient involvement in TDM; (3) Perceptions of proactive/non-proactive approaches to TDM; (4) Experiences of TDM at various points in the disease trajectory; (5) Support from others. Our principal finding relates to a strong preference among interviewees for treatment recommendations from haematologists, based on trust in their expertise and perceptions of empathetic patient-clinician relationships. CONCLUSION Interviewees wanted to be involved in TDM to varying extents, contingent on complex, inter-related factors, that are dynamic and subject to change according to differing clinical and personal contexts. Patients may benefit from clinicians assessing their shifting preferences for involvement on multiple occasions. Strong preferences for acceptance of recommendations was associated with cancer complexity, trust in clinician expertise and positive perceptions of patient-clinician relationships.
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Affiliation(s)
| | - Eve Roman
- Health Sciences, University of York, York, UK
| | | | - Russell Patmore
- Queens Centre for Oncology, Castle Hill Hospital, Cottingham, UK
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11
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Incurable but treatable: Understanding, uncertainty and impact in chronic blood cancers-A qualitative study from the UK's Haematological Malignancy Research Network. PLoS One 2022; 17:e0263672. [PMID: 35143569 PMCID: PMC8830712 DOI: 10.1371/journal.pone.0263672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Most blood cancers are incurable and typically follow unpredictable remitting-relapsing pathways associated with varying need for treatment, which may be distressing for patients. Our objective was to conduct a qualitative study to explore understanding among patients with such malignancies, including the explanations given by HCPs and the impact of uncertain trajectories, to generate evidence that could guide improvements in clinical practice. Methods The study is set within a population-based patient cohort (the Haematological Malignancy Research Network), in which care is delivered across 14 hospitals according to national guidelines. In-depth interviews were conducted with 35 patients with chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma or myeloma; and 10 accompanying relatives. Purposive sampling ensured selection of information-rich participants and the data were interrogated using reflective thematic analysis. Results Rich data were collected and four themes (11 sub-themes) were identified: 1) Knowledge and understanding of chronic haematological malignancies; 2) Incurable but treatable; 3) Uncertainty about the future; and 4) Treatable (but still incurable): Impact on patients. Patients had rarely heard of blood cancer and many expressed difficulty understanding how an incurable malignancy that could not be removed, was treatable, often for long periods. While some were reassured that their cancer did not pose an immediate survival threat, others were particularly traumatised by the uncertain future it entailed, suffering ongoing emotional distress as a result, which could be more burdensome than any physical symptoms. Nonetheless, most interviewees understood that uncertain pathways were caused by the unpredictability of their disease trajectory, and not information being withheld. Conclusions Many participants lacked knowledge about chronic haematological malignancies. HCPs acted to reassure patients about their diagnosis, and while this was appropriate and effective for some, it was less so for others, as the cancer-impact involved struggling to cope with ongoing uncertainty, distress and a shortened life-span.
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12
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Artioli G, Ghirotto L, Alquati S, Tanzi S. Behavioral Patterns in Breaking Bad News Communication: An Ethnographic Study with Hematologists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2585. [PMID: 35270277 PMCID: PMC8910064 DOI: 10.3390/ijerph19052585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 01/02/2023]
Abstract
Hematologists adequately disclosing bad news is a critical point precluding patient-centered communication. Specific courses on communication for hematologists seem to be rare, as well as research exploring their communicative skills and patterns. We aim at describing the hematologists' behavior during difficult conversations to account for behavioral patterns in communication and provide new insights regarding teaching skills to communicate bad news. We employed a focused visual ethnography to answer the following research: "what are hematologists' behavioral patterns in communicating bad news to patients and families?" The collected data included (1) video recordings, (2) observational field notes, (3) interviews with hematologists. The analysis highlighted four patterns: (1) a technical-defensive pattern, (2) an authoritative pattern, (3) a relational-recursive pattern, and (4) a compassionate sharing pattern. Hematologists seem to have difficulty expressing compassionate caring and empathetic comprehension. Communication skills remain a challenge for hematologists. The study of behavioral patterns can lead to increasingly targeted training interventions for this specific learner population.
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Affiliation(s)
- Giovanna Artioli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.A.); (S.T.)
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Sara Alquati
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.A.); (S.T.)
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (S.A.); (S.T.)
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13
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Whitney RL, White AEC, Rosenberg AS, Kravitz RL, Kim KK. Trust and shared decision-making among individuals with multiple myeloma: A qualitative study. Cancer Med 2021; 10:8040-8057. [PMID: 34608770 PMCID: PMC8607252 DOI: 10.1002/cam4.4322] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/02/2021] [Accepted: 09/18/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is an incurable cancer with complex treatment options. Trusting patient-clinician relationships are essential to promote effective shared decision-making that aligns best clinical practices with patient values and preferences. This study sought to shed light on the development of trust between MM patients and clinicians. METHODS Nineteen individual semi-structured interviews were conducted with MM patients within 2 years of initial diagnosis or relapse for this qualitative study. Interviews were recorded and transcripts were coded thematically. RESULTS We identified three main themes: (1) externally validated trust describes patients' predisposition to trust or distrust clinicians based on factors outside of patient-clinician interactions; (2) internally validated trust describes how patients develop trust based on interactions with specific clinicians. Internally validated trust is driven primarily by clinician communication practices that demonstrate competence, responsiveness, listening, honesty, and empathy; and (3) trust in relation to shared decision-making describes how patients relate the feeling of trust, or lack thereof, to the process of shared decision-making. CONCLUSION Many factors contribute to the development of trust between MM patients and clinicians. While some are outside of clinicians' control, others derive from clinician behaviors and interpersonal communication skills. These findings suggest the possibility that trust can be enhanced through communication training or shared decision-making tools that emphasize relational communication. Given the important role trust plays in shared decision-making, clinicians working with MM patients should prioritize establishing positive, trusting relationships.
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Affiliation(s)
- Robin L Whitney
- The Valley Foundation School of Nursing, San Jose State University, San Jose, California, USA
| | | | - Aaron S Rosenberg
- UC Davis Comprehensive Cancer Center, Sacramento, California, USA.,Department of Internal Medicine, University of California, Davis, Davis, California, USA
| | - Richard L Kravitz
- Department of Internal Medicine, University of California, Davis, Davis, California, USA.,Center for Health Policy and Research, University of California, Davis, Davis, California, USA
| | - Katherine K Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, California, USA
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14
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The work of managing multiple myeloma and its implications for treatment-related decision making: a qualitative study of patient and caregiver experiences. BMC Cancer 2021; 21:793. [PMID: 34238260 PMCID: PMC8268411 DOI: 10.1186/s12885-021-08527-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
Background The evolving nature of multiple myeloma (MM) therapies, including the introduction of novel oral agents, has produced a shift in the delivery of care from hospital to home. Within this context, patients and their caregivers are becoming increasingly engaged in the work of illness management, however the exact nature of this work as well as the ways in which this work informs treatment preferences and decisions within this population has not been explored. This qualitative study sought to develop an in-depth understanding of patient and caregiver experiences with different MM treatments, the work necessitated by MM and treatment management, and the processes of patient/caregiver treatment-related decision making. Methods Qualitative interviews were conducted with 16 MM patients and 8 caregivers. Interviews were coded for emergent themes and patterns and a constant comparative approach was used to identify important similarities and differences within and between interviews. Results Patient and caregiver participants described four types of work, including the work of accruing and personalizing medical knowledge, illness-related work in the hospital, illness-related work in the home, and psychosocial and relational management. They illuminated the physical, psychological, social and relational toll of this work and traced a pathway through which work informed their treatment-related decisions, sometimes in ways that conflicted with their preferences for treatment. Conclusions The work involved in managing MM, its treatment, and side-effects can inform the treatment decisions that patients and caregivers make. We must continue to find meaningful ways for patients and caregivers to discuss goals of care and treatment throughout the cancer trajectory, as well as support health care providers in the delivery of person-centred cancer care. With an increasing emphasis on the importance of shared decision making in MM, an improved understanding of the factors that frame patient’s and caregiver’s treatment decisions will be paramount to ensuring meaningful and high-quality patient-centered care.
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15
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Quinn B, Ludwig H, Bailey A, Khela K, Marongiu A, Carlson KB, Rider A, Seesaghur A. Physical, emotional and social pain communication by patients diagnosed and living with multiple myeloma. Pain Manag 2021; 12:59-74. [PMID: 34139887 DOI: 10.2217/pmt-2021-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: To describe physical, social and emotional aspects of pain self-reported by patients with multiple myeloma (MM), and patient-physician communication of physical pain. Materials & methods: We analyzed self-reported data from 330 adults receiving anti-MM therapy in Germany and Italy on health-related quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Core-30 Questionnaire version 3, -MY20) and bone pain symptoms. Results: Patients experienced clinically important physical (69%), emotional (58%) and social (22%) pain. Less than three-quarters of physicians' records matched patients' perception of bone pain (71.5%), with bone pain not recorded in 19.7% of patients experiencing it. Nearly half of physicians underestimated bone pain severity. Conclusion: Patients with MM experience physical, social and emotional pain. Discordance regarding bone pain symptoms and severity was observed, suggesting the need for improved communication.
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Affiliation(s)
- Barry Quinn
- School of Nursing & Midwifery, Queen's University Belfast, BT9 7BL, UK
| | - Heinz Ludwig
- Wilhelminenkrebsforschungsinstitut, c/o 1. Medizinische Abteilung, Zentrum für Onkologie, Hämatologie und Palliativmedizin, Klinik Ottakring, 1090, Vienna, Austria
| | - Abigail Bailey
- Adelphi Real World, Adelphi Mill, Bollington, SK10 5JB, UK
| | - Keerun Khela
- Adelphi Real World, Adelphi Mill, Bollington, SK10 5JB, UK
| | - Andrea Marongiu
- Centre for Observational Research, Amgen Ltd, Uxbridge, UB8 1DH, UK
| | | | - Alex Rider
- Adelphi Real World, Adelphi Mill, Bollington, SK10 5JB, UK
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16
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Tucker-Seeley RD, Wallington SF, Canin B, Tang W, McKoy JM. Health Equity for Older Adults With Cancer. J Clin Oncol 2021; 39:2205-2216. [PMID: 34043411 DOI: 10.1200/jco.21.00207] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA.,USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Sherrie F Wallington
- The George Washington University School of Nursing & Milken Institute School of Public Health, Washington, DC
| | - Beverly Canin
- Cancer and Aging Research Group, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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Liptrott SJ, Bee P, Lovell K. Providing Telephone-Based Support for Patients With Haematological Malignancies: A Qualitative Investigation of Expert Nurses. Can J Nurs Res 2021; 54:121-133. [PMID: 33934610 DOI: 10.1177/08445621211013231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Telephone-based interventions are frequently used to address cancer patient's needs, often delivered by nurses; however, little is known about nurses' opinions of such interventions. PURPOSE The objective of this study was to investigate expert nurses' perceptions of hemato-oncology patient's needs, use of telephone interventions providing support and symptom management and intervention acceptability from a service provider perspective. A qualitative study was undertaken with focus group and individual interview. Inductive and deductive data analysis was performed using Framework Analysis and the Theoretical Framework of Acceptability. RESULTS Two themes emerged: (1) perceived needs of haemato-oncology patients across the cancer trajectory - multifactorial influences, dynamic information needs, and continuity of care, (2) acceptability for nurses delivering interventions was determined by identification of need, agreed expectations and organisational support for the intervention. CONCLUSIONS Greater understanding of contextual factors for recipients and individuals delivering healthcare interventions may contribute to identification of potential barriers and facilitators to adoption in clinical practice.
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Affiliation(s)
| | - Penny Bee
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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18
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Roydhouse JK, Gutman R, Wilson IB, Kehl KL, Keating NL. Patient and proxy reports regarding the experience of treatment decision-making in cancer care. Psychooncology 2020; 29:1943-1950. [PMID: 32840909 DOI: 10.1002/pon.5528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Shared decision-making, including the elicitation of patient preferences regarding treatment decisions, is considered part of high-quality cancer care. However, patients may not be able to self-report due to illness, and therefore proxy reports may be used. We sought to determine the difference between proxy and patient reports about patient decisions and preferences among patients who received or were scheduled for chemotherapy using data from a large, population-based survey of patients with incident lung or colorectal cancer. METHODS Of 3573 patients who received or were scheduled for chemotherapy, 3108 self-reported and 465 had proxies reporting on their behalf about preferred and actual decision roles regarding this treatment. Preferred and actual decision roles were assessed using the Control Preferences Scale, and categorized as shared, patient-controlled, or doctor-controlled. Multivariable logistic regression models were used to assess the association between patient and proxy responses and whether preferences were met. The models adjusted for sociodemographic and clinical variables and patient/proxy-reported health status. RESULTS Sixty-three percent of all respondents reported actual roles in decisions that matched their preferred roles (role attainment). Proxies and patients were similarly likely to report role attainment (65% vs 63%). In adjusted analyses, proxies were more likely report role attainment (OR = 1.27, 95%CI = 1.02-1.59), but this difference was smaller if health variables were excluded from the model (OR = 1.14, 95%CI = 0.92-1.41). CONCLUSION Most patients' preferences for treatment participation were met. Surveys from proxies appear to yield small differences on the reports of attainment of preferred treatment decision-making roles in cancer care vs surveys from patients.
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Affiliation(s)
- Jessica K Roydhouse
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ira B Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kenneth L Kehl
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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19
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Doubova SV, Terreros-Muñoz E, Delgado-Lòpez N, Montaño-Figueroa EH, Infante-Castañeda C, Pérez-Cuevas R. Experiences with health care and health-related quality of life of patients with hematologic malignancies in Mexico. BMC Health Serv Res 2020; 20:644. [PMID: 32650770 PMCID: PMC7353677 DOI: 10.1186/s12913-020-05498-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In Mexico, patients with hematologic malignancies (HMs) are characterized by being at high risk and advanced stages at diagnosis and by having a low cure rate; yet information on their experiences with health care and health-related quality of life (HRQL) is scarce. We aimed to evaluate experiences with health care and HRQL of patients with HMs and the association between these patient-reported measures. METHODS We conducted a cross-sectional survey in two public oncology hospitals in Mexico City. The study included outpatient cancer patients aged ≥18 years with a diagnosis of leukemia, lymphoma, or multiple myeloma. We used a patient-centered quality of cancer care questionnaire to assess patient experiences with receiving 1) timely care; 2) clear information; 3) information for treatment decision-making; 4) care to address biopsychosocial needs; and 5) respectful and coordinated care. We applied the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) to measure HRQL. We performed a multiple linear regression to evaluate the association between patient-reported experiences (independent variables) and the QLQ-C30 summary score (dependent variable). RESULTS Of the 515 participating HM patients, 46.6% had lymphoma, 34% leukemia, and 19.4% multiple myeloma; 70.9% were at advanced stages or at high risk. Additionally, 15.1% had anxiety and 12.8% had depression. Over one third (35.9%) reported receiving clear information, 28.5% timely care, 20.6% information for treatment decision-making, 23.7% care that addressed their biopsychosocial needs, and 31% respectful and coordinated care. The mean QLQ-C30 summary score was 71.9 points. Timely care, clear information, and care that addresses biopsychosocial needs were associated with higher HRQL. CONCLUSIONS Health care services for HM patients at public oncology hospitals in Mexico need improvement. Notably, providing timely care, clear information, and care that addresses patients' biopsychosocial needs can increase the likelihood of better HRQL. Health care providers should measure and improve the experiences of HM patients with health care.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, Del. Cuauhtemoc, CP 06720, Mexico City, Mexico.
| | - Eduardo Terreros-Muñoz
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Nancy Delgado-Lòpez
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Efreen Horacio Montaño-Figueroa
- Departamento de Hematología, Hospital General de México "Dr. Eduardo Liceaga". Secretaría de Salud, Ciudad de México, Mexico
| | - Claudia Infante-Castañeda
- Instituto de Investigaciones Sociales, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Interamerican Development Bank, Kingston, Jamaica
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20
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Lehmann V, Labrie NHM, van Weert JCM, van Dulmen S, de Haes HJCJM, Kersten MJ, Pieterse AH, Smets EMA. Tailoring the amount of treatment information to cancer patients' and survivors' preferences: Effects on patient-reported outcomes. PATIENT EDUCATION AND COUNSELING 2020; 103:514-520. [PMID: 31585818 DOI: 10.1016/j.pec.2019.09.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/30/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Tailoring medical information to cancer patients' needs is recommended, but there is little guidance on how to tailor, and limited research exists about its effects. Tailoring to the amount of preferred information may be easily implementable in clinic and is tested here. METHODS A video-vignette experiment was used to systematically vary video patients' information preferences (limited/extensive) and amount of provided information (additional/no additional). N = 253 cancer patients/survivors evaluated these video-recorded consultations, serving as analogue patients (APs), and completed outcome measures. RESULTS Tailoring information to video patients' preferences had no effect on APs' evaluation of the consultation (satisfaction, trust). Yet, there was a main effect of APs' own information preferences: Those preferring extensive information recalled (MΔ = 5.8%) and recognized (MΔ = 3.5%) more information than those preferring limited information. Moreover, information provision mattered among APs who preferred limited information: They recognized even less if provided with extensive information. CONCLUSIONS Tailoring to the amount of video patient's information preferences did not affect APs' evaluation of the consultation (satisfaction, trust), while APs' personal information preferences determined their recall and recognition of medical information. PRACTICE IMPLICATIONS Information preferences should be assessed and tailored to in clinical practice. Overwhelming patients/survivors, who prefer limited information, should be prevented.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hanneke J C J M de Haes
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands.
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Abstract
OBJECTIVE To describe the interdisciplinary management of acute leukemias across the continuum of care. DATA SOURCE Literature review and experiential knowledge. CONCLUSION Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes. IMPLICATIONS FOR NURSING PRACTICE Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.
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Affiliation(s)
- Sandra Kurtin
- The University of Arizona Cancer Center, Tucson, AZ.
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