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Xiao L, Peng M, Liu Y, Zhang L. Information, deliberation, and decisional control preferences for participation in medical decision-making and its influencing factors among Chinese cancer patients. Health Expect 2021; 24:1725-1736. [PMID: 34309132 PMCID: PMC8483183 DOI: 10.1111/hex.13312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/29/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patient‐centred care should strive to respond to the individual patient's needs and preferences when possible. Yet, preferences of cancer patients for participation in different stages of the medical decision‐making process to increase matching of preferred and actual participation of the patients in decision‐making are not well known. Objective This study aimed to determine the level of information, deliberation and decisional control preferences in decision‐making practices among Chinese cancer patients and to explore their association with the sociodemographic and clinical variables of the patients. Methods A cross‐sectional study was conducted involving a convenience sample of 328 cancer patients from three public hospitals in Guangzhou, China. The Patient Expectation for Participation in Medical Decision‐making Scale (PEPMDS) was used to evaluate information, deliberation and decisional control preferences of the patients. Binary logistic regressions were conducted to determine the association between sociodemographic variables, clinical variables and preferences of the patients. Results Most patients reported a high preference for information (73.2%) and deliberation (73.8%), while a small number (37.2%) reported a high preference for decisional control. Younger patients and patients with higher levels of education were significantly more likely to have a high preference for information, deliberation and decisional control. Patients with low annual family incomes were significantly more likely to have a low preference for decisional control. Conclusion Preferences of patients for involvement in different stages of decision‐making practices could vary. The level of preferences appears to be related to the patient's age, education level, and financial status. Practice Implications Healthcare providers should tailor the participatory approaches of patients considering individual preferences for information, deliberation and decisional control during medical decision‐making. Patient Contribution Patients participated in the survey and filled in the questionnaires.
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Affiliation(s)
- Lin Xiao
- Evidence-based Nursing and Midwifery Practice Center, School of Nursing, Southern Medical University, Guangzhou, China
| | - Meifang Peng
- Department of Medical Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yawei Liu
- Evidence-based Nursing and Midwifery Practice Center, School of Nursing, Southern Medical University, Guangzhou, China
| | - Lili Zhang
- Evidence-based Nursing and Midwifery Practice Center, School of Nursing, Southern Medical University, Guangzhou, China
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The Integration of Emotional, Physiologic, and Communication Responses to Medical Oncology Surveillance Appointments During Breast Cancer Survivorship. Cancer Nurs 2017; 40:124-134. [PMID: 27088607 DOI: 10.1097/ncc.0000000000000375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer survivors regularly interact with providers during routine surveillance medical oncology visits, discussing uncertainty and anxiety about potential cancer recurrence for many years after treatment. Physiologic alteration can also occur as a stress response, triggered by an upcoming surveillance visit. Survivor-provider communication can theoretically allay emotional distress. OBJECTIVE The aim of this study was to evaluate associations between emotional (uncertainty, anxiety, concerns about recurrence) and physiologic responses (cytokine levels, lymphocyte counts), and survivor-provider communication (women's plans for their visit, negotiation of decision-making roles). METHODS Twenty-seven community-dwelling breast cancer survivors participated. Blood specimens, and self-reported data focusing on the previous month, were collected immediately before and the morning after a regularly scheduled medical oncology visit. RESULTS Global concerns about cancer recurrence and acute anxiety and uncertainty were associated with changes in immune status before and after the visit. Postvisit natural killer cells increased in 70% of women, and uncertainty/anxiety decreased. Thirty-three percent of women reported a previous minor illness. Most women had a visit plan; 66% successfully negotiated decision-making roles with providers. CONCLUSIONS Triggered by an upcoming medical oncology visit, women experience uncertainty, anxiety, and altered immunity, potentially placing them at risk of disease exacerbations. IMPLICATIONS FOR PRACTICE Not all women respond similarly to a routine surveillance visit; thus, providers must determine who may be at increased risk of emotional distress and physiologic alteration. Survivor-provider communication facilitates immediate resolution of concerns. Explanations of symptom meaning reduce anxiety and uncertainty and by extension may help resolve immune alteration. Between visits, this could be done by nurse-operated telephone-based "help lines."
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Ramfelt E, Lützén K. Patients with Cancer: their approaches to participation in treatment plan decisions. Nurs Ethics 2016; 12:143-55. [PMID: 15791784 DOI: 10.1191/0969733005ne771oa] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this study was to explore experiences of participation in treatment planning decisions from the perspective of patients recently treated for colorectal cancer. Ten patients were purposively selected and interviewed. Constant comparative analysis, the core concept of grounded theory, was used. The dimensions were developed and organized into the main theme of ‘compliant participation in serious decisions’, which was composed of the two variations: complying with participation; and complying without participation. Complying with participation was characterized by feelings of self-confidence and self-competence and by open dialogue between the participants, significant others and the physician. Complying without participation was characterized by participants’ feelings of uncertainty and distress, and of being rushed into submitting to decisions without having time to reflect on the information provided or the opportunity to influence the treatment and care process. To participate (or choosing not to participate) builds on open and affirming dialogue, information and knowledge about the illness. Patient participation in treatment and care decision making is interpreted as a health promoting way of coping with illness.
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Affiliation(s)
- Ethel Ramfelt
- Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
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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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Ghane A, Huynh HP, Andrews SE, Legg AM, Tabuenca A, Sweeny K. The relative importance of patients’ decisional control preferences and experiences. Psychol Health 2014; 29:1105-18. [DOI: 10.1080/08870446.2014.911873] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brom L, Hopmans W, Pasman HRW, Timmermans DRM, Widdershoven GAM, Onwuteaka-Philipsen BD. Congruence between patients' preferred and perceived participation in medical decision-making: a review of the literature. BMC Med Inform Decis Mak 2014; 14:25. [PMID: 24708833 PMCID: PMC3992143 DOI: 10.1186/1472-6947-14-25] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 03/27/2014] [Indexed: 11/30/2022] Open
Abstract
Background Patients are increasingly expected and asked to be involved in health care decisions. In this decision-making process, preferences for participation are important. In this systematic review we aim to provide an overview the literature related to the congruence between patients’ preferences and their perceived participation in medical decision-making. We also explore the direction of mismatched and outline factors associated with congruence. Methods A systematic review was performed on patient participation in medical decision-making. Medline, PsycINFO, CINAHL, EMBASE and the Cochrane Library databases up to September 2012, were searched and all studies were rigorously critically appraised. In total 44 papers were included, they sampled contained 52 different patient samples. Results Mean of congruence between preference for and perceived participation in decision-making was 60% (49 and 70 representing 25th and 75th percentiles). If no congruence was found, of 36 patient samples most patients preferred more involvement and of 9 patient samples most patients preferred less involvement. Factors associated with preferences the most investigated were age and educational level. Younger patients preferred more often an active or shared role as did higher educated patients. Conclusion This review suggests that a similar approach to all patients is not likely to meet patients’ wishes, since preferences for participation vary among patients. Health care professionals should be sensitive to patients individual preferences and communicate about patients’ participation wishes on a regular basis during their illness trajectory.
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Affiliation(s)
- Linda Brom
- Department of Public and Occupational Health, EMGO Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 Amsterdam, BT, The Netherlands.
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Byrne CM, Tan KK, Young JM, Selby W, Solomon MJ. Patient and clinician preferences for surgical and medical treatment options in ulcerative colitis. Colorectal Dis 2014; 16:285-92. [PMID: 24373392 DOI: 10.1111/codi.12538] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/06/2013] [Indexed: 12/13/2022]
Abstract
AIM When treating patients with refractory ulcerative colitis (UC), the choice between escalating medical management or surgery can be difficult. The aim of this study was to quantify the preferences of patients and clinicians for the treatment options in UC. METHOD Ulcerative colitis outpatients were interviewed to measure their preferences for five scenarios examining the management of acute and chronic UC, using a prospective measure of preference method that generates two utility scores: willingness and amount of expected life to trade or gamble. A self-administered questionnaire was mailed to Australian and New Zealand colorectal surgeons and gastroenterologists. RESULTS Fifty-five patients (26 medical and 29 surgical), 91 surgeons and 78 gastroenterologists were surveyed. In the acute setting, 89% of patients, 69% of gastroenterologists and 55% of surgeons were willing to trade part of their life expectancy to avoid a permanent stoma, while for chronic disease 71% of patients were prepared to trade to avoid an operation with a permanent stoma compared with 55% for an operation with a pouch (P = 0.01). Both patients and gastroenterologists were more prepared to gamble or trade to avoid any surgery than were colorectal surgeons. All groups were aligned in their decision to undergo yearly colonoscopy surveillance rather than to undergo definitive surgery that would result in a stoma. CONCLUSION Patient preferences for the treatment of UC were more aligned to those of gastroenterologists than those of colorectal surgeons. Despite postoperative studies revealing an equal quality of life for pouch and stoma patients, this study confirmed that a pouch is the preferred surgical option.
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Affiliation(s)
- C M Byrne
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and University of Sydney, Sydney, Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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Relationships between life attitude profile and symptoms experienced with treatment decision evaluation in patients with cancer. Holist Nurs Pract 2013; 27:98-105. [PMID: 23399709 DOI: 10.1097/hnp.0b013e318280f7d6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite many researches that have examined life attitude profile, treatment decision evaluation, and symptoms experienced in cancer populations, the relationships between life attitude profile and symptoms experienced with treatment decision evaluation are still not well understood. A thorough understanding of these relationships is critical for health care professionals to provide appropriate management to patients. The aim of this study was to determine relationships among life attitude profile, the treatment decision evaluation, and symptoms experienced in Turkish patients with cancer. A convenience sample of 199 patients with cancer at a Turkish university hospital completed a structured questionnaire including demographic characteristics and the Life Attitude Profile-Revised Scale for patients with cancer in 2007. The researchers visited the oncology clinic 5 work days every week and conducted interviews with the patients. The life attitude profile was not correlated with the treatment decision evaluation and symptoms experienced (r = 0.082, r = -026). The treatment decision evaluation showed that the patients were uncertain about their satisfaction with the treatment decision. Significant correlations were found between the treatment decision evaluation and symptoms experienced (r = 0.206; P <.01). Holistic nursing interventions can be implemented as they promote healing of the whole person processes as facilitating self-awareness, living meaningfully, and promotion connection with others and with nature and a higher power.
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Ekdahl AW, Hellström I, Andersson L, Friedrichsen M. Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study. BMJ Open 2012; 2:e001063. [PMID: 22654092 PMCID: PMC3367145 DOI: 10.1136/bmjopen-2012-001063] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/27/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore physicians' thoughts and considerations of participation in medical decision making by hospitalised elderly patients. DESIGN A qualitative study using focus group interviews with physicians interpreted with grounded theory and completed with a questionnaire. SETTING AND PARTICIPANTS The setting was three different hospitals in two counties in Sweden. Five focus groups were conducted with physicians (n=30) in medical departments, with experience of care of elderly patients. RESULTS Physicians expressed frustration at not being able to give good care to elderly patients with multimorbidity, including letting them participate in medical decision making. Two main categories were found: 'being challenged' by this patient group and 'being a small part of the healthcare production machine'. Both categories were explained by the core category 'lacking in time'. The reasons for the feeling of 'being challenged' were explained by the subcategories 'having a feeling of incompetence', 'having to take relatives into consideration' and 'having to take cognitive decline into account'. The reasons for the feeling of 'being a small part of the healthcare production machine' were explained by the subcategories 'at the mercy of routines' and 'inadequate remuneration system', both of which do not favour elderly patients with multimorbidity. CONCLUSIONS Physicians find that elderly patients with multimorbidity lead to frustration by giving them a feeling of professional inadequacy, as they are unable to prioritise this common and rapidly growing patient group and enable them to participate in medical decision making. The reason for this feeling is explained by lack of time, competence, holistic view, appropriate routines and proper remuneration systems for treating these patients.
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Affiliation(s)
- Anne Wissendorff Ekdahl
- Department of Geriatric Medicine, Vrinnevi Hospital, Norrköping, Sweden
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
| | - Ingrid Hellström
- Department of Geriatric Medicine, Vrinnevi Hospital, Norrköping, Sweden
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
| | - Lars Andersson
- National Institute for the Study of Ageing and Later Life (NISAL), Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Maria Friedrichsen
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
- Palliative Education and Research Center, Vrinnevi Hospital, Norrköping, Sweden
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van Mossel C, Leitz L, Scott S, Daudt H, Dennis D, Watson H, Alford M, Mitchell A, Payeur N, Cosby C, Levi-Milne R, Purkis ME. Information needs across the colorectal cancer care continuum: scoping the literature. Eur J Cancer Care (Engl) 2012; 21:296-320. [PMID: 22416737 DOI: 10.1111/j.1365-2354.2012.01340.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Because cancer care requires a multifaceted approach, providing useful and timely information to people with colorectal cancer may be fragmented and inconsistent. Our interest was in examining what has and has not captured the attention of researchers speaking to the information needs of people with colorectal cancer. We followed Arksey and O'Malley's framework for the methodology of scoping review. Focusing solely on colorectal cancer, we analysed 239 articles to get a picture of which information needs and sources of information, as well as the timing of providing information, were attended to. Treatment-related information received the most mentions (26%). Healthcare professionals (49%) were mentioned as the most likely source of information. Among articles focused on one stage of the care continuum, post-treatment (survivorship) received the most attention (16%). Only 27% of the articles consulted people with colorectal cancer and few attended to diet/nutrition and bowel management. This study examined the numerical representation of issues to which researchers attend, not the quality of the mentions. We ponder, however, on the relationship between the in/frequency of mentions and the actual information needs of people with colorectal cancer as well as the availability, sources and timing of information.
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Affiliation(s)
- C van Mossel
- University of Victoria, Oxford Street, Victoria, BC, Canada.
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Clayton MF, Latimer S, Dunn TW, Haas L. Assessing patient-centered communication in a family practice setting: how do we measure it, and whose opinion matters? PATIENT EDUCATION AND COUNSELING 2011; 84:294-302. [PMID: 21733653 DOI: 10.1016/j.pec.2011.05.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 05/18/2011] [Accepted: 05/25/2011] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This study evaluated variables thought to influence patient's perceptions of patient-centeredness. We also compared results from two coding schemes that purport to evaluate patient-centeredness, the Measure of Patient-Centered Communication (MPCC) and the 4 Habits Coding Scheme (4HCS). METHODS 174 videotaped family practice office visits, and patient self-report measures were analyzed. RESULTS Patient factors contributing to positive perceptions of patient-centeredness were successful negotiation of decision-making roles and lower post-visit uncertainty. MPCC coding found visits were on average 59% patient-centered (range 12-85%). 4HCS coding showed an average of 83 points (maximum possible 115). However, patients felt their visits were highly patient-centered (mean 3.7, range 1.9-4; maximum possible 4). There was a weak correlation between coding schemes, but no association between coding results and patient variables (number of pre-visit concerns, attainment of desired decision-making role, post-visit uncertainty, patients' perception of patient-centeredness). CONCLUSIONS Coder inter-rater reliability was lower than expected; convergent and divergent validity were not supported. The 4HCS and MPCC operationalize patient-centeredness differently, illustrating a lack of conceptual clarity. PRACTICE IMPLICATIONS The patient's perspective is important. Family practice providers can facilitate a more positive patient perception of patient-centeredness by addressing patient concerns to help reduce patient uncertainty, and by negotiating decision-making roles.
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Heiwe S, Kajermo KN, Tyni-Lenné R, Guidetti S, Samuelsson M, Andersson IL, Wengström Y. Evidence-based practice: attitudes, knowledge and behaviour among allied health care professionals. Int J Qual Health Care 2011; 23:198-209. [PMID: 21242158 DOI: 10.1093/intqhc/mzq083] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Susanne Heiwe
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Pardon K, Deschepper R, Vander Stichele R, Bernheim J, Mortier F, Schallier D, Germonpré P, Galdermans D, Van Kerckhoven W, Deliens L. Are patients' preferences for information and participation in medical decision-making being met? Interview study with lung cancer patients. Palliat Med 2011; 25:62-70. [PMID: 20621948 DOI: 10.1177/0269216310373169] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined the degree to which newly diagnosed patients with advanced lung cancer wanted to be informed and involved in medical decision-making, and whether the patients felt their preferences were met. Patients from 13 hospitals in Flanders were interviewed with a standard questionnaire. A total of 128 patients (68%) participated. Of the patients who wanted to be informed about life expectancy, half (53%) reported they were informed, and of those who wanted to be informed about palliative care and end-of-life decisions, 25% and 31% said they were informed, respectively. With regard to participation in medical decision-making (in general, about treatment, transfer or end-of-life), patients who preferred the doctor to make decisions or those who preferred to make the decision themselves often achieved this (in their perception), while patients who wanted an in-between position with some involvement, often did not. To conclude, preferences of patients with lung cancer for information concerning delicate topics and for shared decision-making with the physician were not well met.
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Affiliation(s)
- Koen Pardon
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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McCaughan E, Prue G, Parahoo K. A systematic review of quantitative studies reporting selected patient experienced outcomes, with a specific focus on gender differences in people with colorectal cancer. Eur J Oncol Nurs 2009; 13:376-85. [DOI: 10.1016/j.ejon.2009.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 04/02/2009] [Accepted: 04/03/2009] [Indexed: 11/15/2022]
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Langius-Eklöf A, Samuelsson M. Sense of coherence and psychiatric morbidity in terms of anxiety and depression in patients with major depression before and after electric convulsive treatment. Scand J Caring Sci 2009; 23:375-9. [PMID: 19645810 DOI: 10.1111/j.1471-6712.2008.00658.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The specific aim of this study was to explore if the Sense of Coherence (SOC) Scale reflects and overlaps with standardized psychiatric assessments of depression and anxiety leading to the main hypothesis that the degree of depression decreases while the SOC scores remain stable. Fifteen patients with a diagnosis of major depression according to Axis I in DSM-IV and planned electric convulsive treatment (ECT) participated in the study. The clinician-rated instruments, Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Function (GAF), and the self-assessment instruments such as SOC and the Comprehensive Psychopathological Rating Scale-Self Rating Scale for Affective Syndromes (CPRS-S-A) were used before and after the treatment. The patients showed statistically significant improvements in clinician-rated depression (p < 0.001) and functional status (p < 0.001), and in self-rated anxiety (p = 0.001) and depression (p = 0.003). There was no significant improvement in SOC (p = 0.213). No significant correlations were found between the SOC scores and any of the measures except for GAF after treatment (r = 0.57, p = 0.039); the lower the SOC scores the greater was the functional dysfunction. In conclusion, the SOC Scale seems not to be a measure of psychopathology in terms of depression or anxiety merely.
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Affiliation(s)
- Ann Langius-Eklöf
- School of Health and Medical Sciences, Orebro University, Orebro, Sweden.
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Florin J, Ehrenberg A, Ehnfors M. Clinical decision-making: predictors of patient participation in nursing care. J Clin Nurs 2009; 17:2935-44. [PMID: 19034992 DOI: 10.1111/j.1365-2702.2008.02328.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To investigate predictors of patients' preferences for participation in clinical decision-making in inpatient nursing care. BACKGROUND Patient participation in decision-making in nursing care is regarded as a prerequisite for good clinical practice regarding the person's autonomy and integrity. DESIGN A cross-sectional survey of 428 persons, newly discharged from inpatient care. METHODS The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation. RESULTS Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient's gender (odds ratio = 1.8), education (odds ratio = 2.2), living condition (odds ratio = 1.8) and occupational status (odds ratio = 2.0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision-making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision making in nursing care. CONCLUSIONS Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient. Relevance to clinical practice. The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients'basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision-making.
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Affiliation(s)
- Jan Florin
- Department of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden.
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Fjelland JE, Barron CR, Foxall M. A review of instruments measuring two aspects of meaning: search for meaning and meaning in illness. J Adv Nurs 2008; 62:394-406. [DOI: 10.1111/j.1365-2648.2008.04597.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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O'Donnell M, Hunskaar S. Preferences for involvement in treatment decision-making generally and in hormone replacement and urinary incontinence treatment decision-making specifically. PATIENT EDUCATION AND COUNSELING 2007; 68:243-51. [PMID: 17904327 DOI: 10.1016/j.pec.2007.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 06/15/2007] [Accepted: 06/23/2007] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To explore whether preferences for involvement in treatment decision-making change depending on the context and factors associated with preferences. METHODS A national telephone survey of 1000 randomly selected Norwegian women aged 18 years or over using the Control Preferences Scale (CPS) to assess preferences. RESULTS More women preferred an active role when asked about hormone replacement therapy (HRT) and urinary incontinence (UI) treatment decision-making specifically than when asked a question about preferences for involvement when generally making treatment decisions. Higher education and very good general health were significantly associated with preferring an active role in HRT and UI treatment decision-making. A negative attitude towards HRT was also significantly associated with preferring an active role when considering HRT. Women with higher educational levels were significantly more likely to choose an option from the CPS that indicated a preference for wanting more involvement in HRT decision-making compared to treatment decision-making generally. CONCLUSIONS Women's preferences for involvement in treatment decision-making change depending on the context as do factors associated with role preferences. PRACTICE IMPLICATIONS Health care professionals need to be aware that patients' preferences may change depending on the context of the treatment decision.
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Affiliation(s)
- Máire O'Donnell
- Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Byrne CM, Solomon MJ, Young JM, Selby W, Harrison JD. Patient preferences between surgical and medical treatment in Crohn's disease. Dis Colon Rectum 2007; 50:586-97. [PMID: 17380368 DOI: 10.1007/s10350-006-0847-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Crohn's disease poses difficult choices in which the most appropriate treatment option is not always obvious. When this state of uncertainty exists, patients' preferences should have an increasingly important part of clinical decision making. The purpose of this study was to compare patients' preferences for surgical intervention in Crohn's disease with the preferences of surgeons and gastroenterologists. METHODS Outpatients with Crohn's disease were interviewed to quantify their preferences for six scenarios by using the prospective preference measure. An identical questionnaire was mailed to all Australian and New Zealand colorectal surgeons and a random sample of 300 Australian gastroenterologists. RESULTS Forty-one of 123 patients with Crohn's disease (33 percent), 92 of 127 colorectal surgeons (72 percent), and 74 of 272 gastroenterologists (27 percent) participated. There were significant differences between patients and gastroenterologists for three of six scenarios and between surgeons and gastroenterologists in four of six scenarios. Seventy-six percent of gastroenterologists were willing to gamble to avoid an ileocolic resection compared with 37 percent of surgeons (chi-squared = 25.44; P < 0.0001) and 39 percent of patients (chi-squared = 15.44; P < 0.001). CONCLUSIONS Patients and clinicians were able to trade and gamble life expectancy as a measure of preference for varying hypothetical surgical treatments, even though these treatment options impacted on quality of life rather than survival. Patients' preferences did not align with clinicians. For most scenarios, colorectal surgeons' preferences were significantly different to those of gastroenterologists.
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Affiliation(s)
- Christopher M Byrne
- Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service & University of Sydney, P.O. Box M157, Missenden Road, NSW, 2050, Sydney, Australia
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O' Donnell M, Monz B, Hunskaar S. General preferences for involvement in treatment decision making among European women with urinary incontinence. Soc Sci Med 2007; 64:1914-24. [PMID: 17360093 DOI: 10.1016/j.socscimed.2007.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Indexed: 11/24/2022]
Abstract
Current health care policies advocate patient participation in treatment decision making. Little evidence on possible differences between European women's preferences for involvement in this process exists. In this study we explore preferences for involvement in treatment decision making in 15 European countries in a sample of 9434 women seeking treatment for urinary incontinence in an outpatient setting. Their generally preferred role in treatment decisions was assessed using the Control Preferences Scale. Results show variations within and between countries in preferences for involvement in treatment decision making. The 'collaborative role' was the most preferred role in Austria, Belgium, Denmark, France, Germany, Ireland, Sweden, Switzerland, the Netherlands and the UK. In Greece, Portugal and Spain the 'passive role' was most preferred. Over a third of women in Denmark, Finland and Norway preferred an 'active role'. Multinominal regression analyses found that, after adjusting for case mix and factors previously associated with role preferences, country membership was strongly associated with role preferences, with women living in Southern European countries preferring a more passive role. Such clear differences are of interest in the current health care environment where active patient participation is being encouraged. Greater efforts need to be made to establish whether patient preferences are genuine or merely a learned response influenced by cultural attitudes and traditions so that a balance can be struck between assisting women to play a more active role in the treatment decision-making process without disregarding some women's genuine preferences to play a more passive role.
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Affiliation(s)
- Máire O' Donnell
- Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen, Kalfarveien 31, Bergen 5018, Norway.
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21
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Frick E, Fegg MJ, Tyroller M, Fischer N, Bumeder I. Patients? health beliefs and coping prior to autologous peripheral stem cell transplantation. Eur J Cancer Care (Engl) 2007; 16:156-63. [PMID: 17371425 DOI: 10.1111/j.1365-2354.2006.00725.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to determine the associations between health locus of control (LoC), causal attributions and coping in tumour patients prior to autologous peripheral blood stem cell transplantation. Patients completed the Questionnaire of Health Related Control Expectancies, the Questionnaire of Personal Illness Causes (QPIC), and the Freiburg Questionnaire of Coping with Illness. A total of 126 patients (45% women; 54% suffering from a multiple myeloma, 29% from non-Hodgkin lymphomas, and 17% from other malignancies) participated in the study. Cluster analysis yielded four LoC clusters: 'fatalistic external', 'powerful others', 'yeah-sayer' and 'double external'. Self-blaming QPIC items were positively correlated with depressive coping, and 'fate or destiny' attributions with religious coping (P<0.001). The highest scores were found for 'active coping' in the LoC clusters 'powerful others' and 'yeah-sayer'. External LoC and an active coping style prevail before undergoing autologous peripheral blood stem cell transplantation, whereas the depressive coping is less frequent, associated with self-blaming causal attributions. Health beliefs include causal and control attributions, which can improve or impair the patient's adjustment. A mixture between internal and external attributions seems to be most adaptive.
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Affiliation(s)
- E Frick
- Department of Psychotherapy and Psychosomatics, Psychiatric Clinic, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Florin J, Ehrenberg A, Ehnfors M. Patient participation in clinical decision-making in nursing: a comparative study of nurses' and patients' perceptions. J Clin Nurs 2006; 15:1498-508. [PMID: 17118072 DOI: 10.1111/j.1365-2702.2005.01464.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM AND OBJECTIVES The aim of this study was to compare the degree of concordance between patients and Registered Nurses' perceptions of the patients' preferences for participation in clinical decision-making in nursing care. A further aim was to compare patients' experienced participation with their preferred participatory role. BACKGROUND Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients' preferences. METHODS A comparative design was adopted with a convenient sample of 80 nurse-patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient. RESULTS A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision-making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles. CONCLUSIONS Registered Nurses are not always aware of their patients' perspective and tend to overestimate patients' willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision-making in nursing care according to their own perceptions and not even to the patients' more moderate preferences of participation. RELEVANCE TO CLINICAL PRACTICE A thorough assessment of the individual's preferences for participation in decision-making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.
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Affiliation(s)
- Jan Florin
- Department of Health and Social Sciences, Dalarna University, Falun, Sweden.
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Fischer M, Visser A, Voerman B, Garssen B, van Andel G, Bensing J. Treatment decision making in prostate cancer: patients' participation in complex decisions. PATIENT EDUCATION AND COUNSELING 2006; 63:308-13. [PMID: 16965887 DOI: 10.1016/j.pec.2006.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Revised: 07/24/2006] [Accepted: 07/28/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE (1) To explore to what degree prostate cancer (PC) patients felt they had participated in treatment decision making (TDM). (2) To determine whether perceived roles during TDM were associated with medical and sociodemographic variables. (3) To examine to what extent satisfaction with TDM was related to perceived role or medical and sociodemographic variables. METHODS Patients (n=126) were recruited in hospitals and from the Dutch PC patient organization. The relationship between patients' role and stage of disease, treatment modality, age, social status and education was determined, as well as patients' satisfaction with TDM. RESULTS Most patients felt they had participated in TDM (autonomous 18%, collaborative 60%). Older patients and those with advanced disease more frequently reported not having been involved in decision making. Satisfaction with TDM was related to age and role in TDM but not to stage of disease or treatment modality. Younger men were least content when they had not been involved in decision making. CONCLUSION Patients' level of participation and satisfaction with TDM appears to be related to medical and sociodemographic variables. PRACTICE IMPLICATIONS Satisfaction with TDM may be related to patients' age and assumed role. It is recommended to take this into account when planning treatment for prostate cancer patients.
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Affiliation(s)
- Maarten Fischer
- Helen Dowling Institute, Center for Psycho-oncology (HDI), Rubenslaan 190, 3582 JJ Utrecht, The Netherlands.
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Kiesler DJ, Auerbach SM. Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions. PATIENT EDUCATION AND COUNSELING 2006; 61:319-41. [PMID: 16368220 DOI: 10.1016/j.pec.2005.08.002] [Citation(s) in RCA: 253] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 08/04/2005] [Accepted: 08/05/2005] [Indexed: 05/03/2023]
Abstract
OBJECTIVE A comprehensive review was conducted of the theoretical and empirical work that addresses the preference-match strategy in physician-patient communication. METHODS Searches were conducted on Medline, PsychINFO, InFoTrac One File Plus, Sociological Abstracts, and Dissertation Abstracts through 2004. The following keywords were used: patient preferred and received information; patient preferred and actualized treatment decision-making; patient-physician beliefs in shared decision-making; patient-physician match, fit, or concordance; reciprocal relationship or mutuality; doctor-patient affiliation, control, relationship; match/fit between patient and physician in affiliation, control, or relationship. RESULTS Findings revealed varying degrees of support for the positive effects of matching patients' preferred levels of information, decisional control, and consultative interpersonal behavior. CONCLUSIONS Findings justify not only continued but expanded research efforts in this area that would incorporate recommended changes in research design and implementation. PRACTICE AND RESEARCH IMPLICATIONS: Assessment strategies and match interventions are discussed that, if evidence continues to be supportive, might routinely optimize patient-physician encounters toward more positive outcomes. Methodological guidelines are suggested that can improve future preference-match studies of the patient-physician interaction. Practitioners need to consider adoption of patient-match assessment and intervention strategies in addition to recent exclusive concentrations on patient-centered and shared decision-making approaches.
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Affiliation(s)
- Donald J Kiesler
- Virginia Commonwealth University, Department of Psychology, 808 W. Franklin Street, Box 842018, Richmond, VA 23284, USA
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Lee V, Cohen SR, Edgar L, Laizner AM, Gagnon AJ. Clarifying "meaning" in the context of cancer research: a systematic literature review. Palliat Support Care 2006; 2:291-303. [PMID: 16594414 DOI: 10.1017/s1478951504040386] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This article synthesizes the published literature related to the construct of meaning in the adult cancer population. METHODS The databases CancerLit, CINAHL, Medline, PsychINFO, and the Journal of Psychosocial Oncology and PsychoOncology were searched to identify all studies related to meaning. The methodological aspects of all studies are described and the conceptual aspects are summarized only from those studies that met criteria for methodological rigor and validity of findings. The definitions for global meaning, appraised meaning, search for meaning, and meaning as outcome as proposed by Park and Folkman were used to interpret the findings. RESULTS Of 44 studies identified, 26 met the criteria for methodological rigor. There is strong empirical and qualitative evidence of a relationship between meaning as an outcome of and psychosocial adjustment to cancer. SIGNIFICANCE OF RESULTS The qualitative findings are considered useful for the development of psychosocial interventions aimed at helping cancer patients cope with and even derive positive benefit from their experience. However, variations in the conceptual and operational definitions, frequent reliance on homogeneous and convenience sampling, and the lack of experimental designs are considered to be methodological limitations that need to be addressed to advance the study of meaning in the context of cancer.
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Affiliation(s)
- Virginia Lee
- School of Nursing, McGill University, Montreal, Quebec H3G 1A4, Canada.
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26
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Ramfelt E, Lützen K, Nordström G. Treatment decision-making in a group of patients with colo-rectal cancer before surgery and a one-year follow-up. Eur J Cancer Care (Engl) 2006; 14:327-35. [PMID: 16098117 DOI: 10.1111/j.1365-2354.2005.00588.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Encouraging patient participation in medical and nursing care is an active expression of respect for a person's autonomous choice. The aim of the present study was to compare preferences about the degree of participation in treatment decision-making in a group of patients with colo-rectal cancer before and one-year after surgery, and further to compare these preferences to the patients' actual participating role before surgery and their sense of coherence. Fifty-five persons diagnosed as having rectal or colon cancer were studied. The following instruments were used: The Control Preferences Scale (CPS) and the Sense of Coherence Scale (SOC). Results show that 71% and 75%, respectively, chose a collaborative participation role, before surgery and at follow-up. A majority, 64%, maintained their preferred role from before surgery to the one-year follow-up. Agreement between the preferred and the actual participating role was achieved by 31%. There were no statistically significant differences between the preferred role and with respect to the participants' sense of coherence either before surgery or at follow-up. The sense of coherence seemed not to be related to the preferences before surgery or at follow-up preferences. Further research is needed to elaborate the understanding about patients' preferences for participating in treatment and care decisions.
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Affiliation(s)
- E Ramfelt
- Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
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27
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Clayton MF, Mishel MH, Belyea M. Testing a model of symptoms, communication, uncertainty, and well-being, in older breast cancer survivors. Res Nurs Health 2006; 29:18-39. [PMID: 16404732 DOI: 10.1002/nur.20108] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Among older, long-term breast cancer survivors, symptoms from previous treatment can generate uncertainty about whether they represent co-morbid conditions, recurrence, or normal aging. This uncertainty can result in emotional distress and thoughts of recurrence. Communication with health care providers may help women reduce uncertainty and improve both emotional and cognitive well-being. To assess the influence of symptoms, uncertainty, and communication with providers on well-being, data from 203 Caucasian and African American survivors, 5-9 years post treatment, were tested using structural equation modeling. Symptoms, age, and uncertainty had the strongest influence on well-being, regardless of race. There was an unexpected positive association between patient-provider communication and thoughts of recurrence. Descriptive analysis revealed that 52% of women were unable to achieve their desired decision-making role with health care providers.
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Affiliation(s)
- Margaret F Clayton
- College of Nursing, University of Utah, Salt Lake City, Utah 84112-5880, USA
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Reedy J, Haines PS, Steckler A, Campbell MK. Qualitative comparison of dietary choices and dietary supplement use among older adults with and without a history of colorectal cancer. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2005; 37:252-8. [PMID: 16053814 DOI: 10.1016/s1499-4046(06)60280-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To explore colorectal cancer survivors' beliefs about diet, dietary supplements, health, and cancer in relation to beliefs of a similar group without colorectal cancer. DESIGN In-depth, semistructured, open-ended interviews were used to examine perceptions. PARTICIPANTS Twenty-two participants (10 colorectal cancer survivors and 12 from a comparison group) from the North Carolina Strategies for Improving Diet, Exercise, and Screening Study. ANALYSIS Verbatim interview transcripts were coded and analyzed. Comparisons were made between colorectal cancer survivors and the comparison group. RESULTS Three main themes emerged: the influence of significant life events on dietary change, concerns about contaminants in the food supply, and a lack of physician guidance in dietary supplement selection. CONCLUSION AND IMPLICATIONS The experience of colorectal cancer is significant and may lead to dietary change among some survivors, but these findings do not suggest that it is necessarily more influential than other life events. Participants sought to control diet (for coping or survival) and also felt that diet cannot be controlled (due to the contamination of the food supply). Although many lacked guidance from physicians about dietary supplements, they were comfortable making their own decisions to self-treat. Enhanced understanding of the themes that guide selection of diet and dietary supplements can provide a context for dietitians in practice and researchers conducting behavioral interventions.
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Affiliation(s)
- Jill Reedy
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
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Pinquart M, Duberstein PR. Information needs and decision-making processes in older cancer patients. Crit Rev Oncol Hematol 2004; 51:69-80. [PMID: 15207255 DOI: 10.1016/j.critrevonc.2004.04.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The paper provides an overview of age-differences in patients' preferences for participation in cancer treatment decision-making and factors that relate to these age-differences. On average, older cancer patients prefer to receive less information about their illness and treatment and assume a less active role in making treatment decisions. They are also less likely to collect and analyze all relevant information in order to make an optimal decision. Observed age-differences are, in part, explained by age-associated cognitive decline. Age-differences are, on average, small to moderate, and most older patients prefer to be well-informed. Nonetheless, only a minority of them wishes to play an active role in decision-making. Given their lower preference for active participation in decision-making, older adults may show less positive psychological effects of active participation, but this question warrants research. Implications for working with older cancer patients are discussed.
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Affiliation(s)
- Martin Pinquart
- Department of Developmental Psychology, Friedrich Schiller University, Am Steiger 3 Haus 1, D-07743 Jena, Germany.
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30
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Berglund B, Mattiasson AC, Nordström G. Acceptance of disability and sense of coherence in individuals with Ehlers-Danlos syndrome. J Clin Nurs 2003; 12:770-7. [PMID: 12919224 DOI: 10.1046/j.1365-2702.2003.00776.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ehlers-Danlos syndrome (EDS) is a relatively rare, inherited connective tissue disorder and skin hyperextensibility, joint hypermobility, chronic joint and limb pain, blood vessel and tissue fragility are frequent symptoms. The aims of this study were to describe the degree to which individuals with EDS accept and cope with perceived limitations related to the syndrome, and to determine the relationships between acceptance of disability (AD), sense of coherence (SOC), functional health status and background data. Four questionnaires were mailed: the AD scale Modified (ADM), the SOC Scale, the Sickness Impact Profile (SIP) and a background form. The respondents with EDS were recruited through the EDS National Association in Sweden and the response rate was 74% (69 females and eight males). The Ethical Committee at Huddinge University Hospital (ref. no. 152/95) approved the study. This study has shown that the level of AD and SOC in individuals with EDS is similar to other patient groups, e.g. individuals with ostomy and with diabetes. Further, the SOC was in concordance with that of the general population. Those working full-time accepted their disability to a greater degree than those on sick leave or disability pension. A multiple regression analysis showed that a greater AD was associated with a higher level of SOC and a better functional health status. The SOC and SIP together accounted for 50% of the variance in the ADM. For health promotion in nursing practice it is important to have insight into the problem areas which may influence the overall life situation for an individual with EDS. A key issue for nurses is to identify individuals with low acceptance of their disease and/or low SOC in order to support these persons' adaptation process. Future research on EDS may be directed towards projects focusing on the development and implementation of models to strengthen the level of AD and SOC in this group.
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Affiliation(s)
- Britta Berglund
- Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
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Sanders T, Skevington S. Do bowel cancer patients participate in treatment decision-making? Findings from a qualitative study. Eur J Cancer Care (Engl) 2003; 12:166-75. [PMID: 12787015 DOI: 10.1046/j.1365-2354.2003.00370.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The views of bowel cancer patients towards treatment decision-making and the extent to which they participate in this process were investigated. A prospective longitudinal qualitative study was conducted based on 55 new consultations between oncologists and bowel cancer patients and interviews with 37 recently diagnosed patients, 28 of whom were re-interviewed after 6 months. The interview and consultation data were transcribed verbatim and coded. Theoretical comparisons were made between the interviews and themes emerging from the consultation narratives. The analysis revealed that most bowel cancer patients preferred a limited role in the treatment decision-making process, preferring to delegate the responsibility to the clinician. However, they did not always consider themselves as 'passive' participants within the consultation and many felt that they had made the final decision to accept or refuse treatment. The consultation data shows that when a treatment recommendation was not forthcoming from the oncologist, patients became more proactive in the consultation, often taking the initiative to participate. It is concluded that patients who indicate a desire to participate in these types of consultations should be encouraged to do so and oncologists should try to identify those patients who could benefit from a greater role in treatment decision-making.
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Affiliation(s)
- T Sanders
- Department of Applied Social Science, The University of Manchester, UK.
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Degner LF, Hack T, O'Neil J, Kristjanson LJ. A new approach to eliciting meaning in the context of breast cancer. Cancer Nurs 2003; 26:169-78. [PMID: 12832949 DOI: 10.1097/00002820-200306000-00001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A semistructured measure was developed from early descriptive work by Lipowski to elicit the meaning of breast cancer using eight preset categories: challenge, enemy, punishment, weakness, relief, strategy, irreparable loss, and value. This measure was applied in two studies: a cross-sectional survey of 1012 Canadian women at various points after diagnosis and a follow-up study 3 years later of 205 women from the previous study who were close to the time of diagnosis at the first testing. The majority of the 1012 women chose "challenge" (57.4%) or "value" (27.6%) to describe the meaning of breast cancer, whereas fewer chose the more negative "enemy" (7.8%) or "irreparable loss" (3.9%). At the 3-year follow-up assessment, 78.9% of the women who had indicated positive meaning by their choices of "challenge" or "value" did so again. Verbal descriptions provided by the women were congruent with those reported in previous qualitative studies of meaning in breast cancer with respect to the two most prevalent categories: challenge and value. At follow-up assessment, women who ascribed a negative meaning of illness with choices such as "enemy," "loss," or "punishment" had significantly higher levels of depression and anxiety and poorer quality of life than women who indicated a more positive meaning. The meaning-of-illness measure provides an approach that can be applied in large surveys to detect women who ascribe less positive meaning to the breast cancer experience, women who may be difficult to identify in the context of small, qualitative studies.
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Affiliation(s)
- Lesley F Degner
- Helen Glass Centre for Nursing, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada.
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Ramfelt E, Severinsson E, Lützén K. Attempting to find meaning in illness to achieve emotional coherence: the experiences of patients with colorectal cancer. Cancer Nurs 2002; 25:141-9. [PMID: 11984102 DOI: 10.1097/00002820-200204000-00011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of the study was to explore the emotional and interactional perspectives of the meaning of illness in patients with colorectal cancer. Fifty-two respondents were included in the study. Data were obtained through an open-ended question at the time of diagnosis as well as 3 and 12 months after diagnosis. The constant comparative method of data analysis, consisting of an interpretation of the data, was used. The overall ascribed meaning was expressed in the main theme, attempting to find meaning in illness to achieve emotional coherence. The main theme consisted of 2 dimensions: unified and dichotomized embodiment. The unified embodiment dimension subthemes include gratefulness, confidence in oneself and others, and looking forward to creating a new future. The dichotomized embodiment dimension subthemes include altered self-value, loss of temporality, and infringement of body integrity. The characteristics of unified embodiment were hope and faith, a strong self-value, and an anticipated future. For dichotomized embodiment, the characteristics were the struggle, loss of temporality, nonmovement, and lack of hope and faith. The study provided a theoretical basis that is relevant for both nursing practice and nursing education.
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Affiliation(s)
- Ethel Ramfelt
- Departments of Nursing, Karolinska Institutet, Stockholm, Sweden.
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