Evaluating the self-assessed support needs of women with breast cancer

Development and Validation of a Dual-Language (English and Malay) Needs Assessment Tool for Breast Cancer (NeAT-BC)

Background: Needs assessment tools may be used to guide the optimisation of cancer survivorship services. We sought to develop and validate a dual-language needs assessment tool for women with breast cancer. Methods: The study comprised two phases; (I) co-design, and (II) psychometric testing. In Phase I, items were generated based on focus group discussions with patients and a literature review. These items were then translated into the Malay language. Content and face validation were undertaken with an expert panel. In phase II, 315 Malaysian women living with breast cancer were recruited. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to determine construct validity and reliability. Criterion validity was assessed using the EORTC QLQ-C30 questionnaire. Results: We co-designed and validated a 48-item dual-language needs assessment tool for breast cancer (NeAT-BC). Five underlying constructs were revealed in the EFA: (1) emotional support, (2) social and intimate relationships, (3) hospital appointments, (4) personal care and health, and (5) information and services. The NeAT-BC demonstrated good reliability across all constructs (Cronbach’s alpha: 0.90 to 0.96). CFA also demonstrated acceptable convergent and divergent validity, composite reliability ≥ 0.87, and Heterotrait−Monotrait index < 0.85 for all constructs. Criterion validity was established given the significant negative correlation between overall needs and quality of life (r = −0.14; p = 0.02). The NeAT-BC took approximately 25 min to be completed and could be interviewer-administered or self-administered. Conclusion: The utilization of the NeAT-BC is expected to guide establishment of evidence-based cancer survivorship services in Malaysia, with wider potentials for adoption in other multi-ethnic and/or low-and-middle income settings.

Effect of patient decision aids on decisional conflict and regret associated with breast cancer surgery: a randomized controlled trial

BACKGROUND

Patients with breast cancer encounter difficulties in making surgical treatment decisions. Shared decision-making (SDM) with patient decision aids (PDAs) can minimize patients' decisional conflicts. However, the effect of PDAs in Asia remains inconclusive. This study investigated the effect of SDM assisted by PDAs on the decisional conflict of patients with breast cancer.

METHODS

In this two-group, outcome assessor-blind, randomized controlled trial, 151 patients diagnosed as having breast cancer were assigned to the PDA (SDM with PDA) group or the standard (SDM without PDA) group. Demographic and clinical variables were analyzed to identify variables affecting the treatment choice. The patients' decision-making difficulties were evaluated using the four-item SURE scale during preoperative hospitalization, and decisional conflicts were examined using the five-item Decision Regret scale and Hospital Anxiety and Depression Scale (HADS) 1 month after surgery.

RESULTS

The choice of breast conservation therapy and mastectomy did not significantly differ between the PDA and standard groups. The PDA group had a higher level of depression after making decisions (P = 0.029) than did the standard group. No significant difference in the total scores of the SURE scale and Decision Regret scale were noted between the groups.

CONCLUSION

PDAs did not assist the patients with breast cancer in making breast surgery-related decisions. Clinicians should focus on SDM grounded in evidence-based medicine with care and help patients consider their individual preferences.

TRIAL REGISTRATION

ClinicalTrial.gov, NCT03105076; April 7, 2017 ( http://www.

CLINICALTRIALS

gov ).

[Brief Scale to assess Social Support in Chronic Diseases (SUCE-4)]

AIM OF THE STUDY

Social support is an important resource for coping with serious chronic diseases such as cancer. The available questionnaires for the measurement of social support are usually extensive. So far, available short versions do not completely aim at situation-specific requirements of the social environment of chronically ill patients. Therefore, a short form of a measure of perceived social support was developed consisting of only 4 items: the SUCE-4.

METHODS

A sample of cancer patients (N=424) was examined at 2 time points. The factor structure was evaluated using exploratory and confirmatory factor analysis (CFA) and reliability and validity were examined.

RESULTS

The expected factor structure was confirmed (for CFA: RMSEA=0.028). The short questionnaire revealed a good internal consistency (Cronbach's α>0.86). In terms of the first indications of validity, significant and expected correlations with psychological quality of life, self-efficacy expectations, depression and anxiety were found at both time points.

CONCLUSION

The SUCE-4 is an economical, reliable and valid instrument for the assessment of perceived social support in the context of severe chronic diseases such as cancer.

Unmet needs and related factors of Korean breast cancer survivors: a multicenter, cross-sectional study

BACKGROUND

Identification of specific needs in patients with cancer is very important for the provision of patient-centered medical service. The aim of this study was to investigate the unmet needs and related factors of Korean breast cancer survivors.

METHODS

A multicenter, cross-sectional, interview survey was performed among 332 Korean breast cancer survivors. The Comprehensive Needs Assessment Tool for cancer patients was administered to survivors who gave written informed consent to participate. Data were analyzed using t-test, ANOVA and multiple regression analysis.

RESULTS

The level of unmet needs was highest in the domain 'Information and education' (mean ± SD; 1.70 ± 1.14) and the item with the highest level of unmet needs was 'Needed help in coping with fear of recurrence' (2.04 ± 1.09). Unmet needs were correlated with age, stage, multiplicity, HER2, treatment state, marital status, employment, psychosocial status, and problems in EQ-5D dimensions. In multiple regression analysis, the 50-59 age group showed a higher level of recognition for physical symptom needs and the unemployed group expressed greater needs for information and education. Survivors with multiplicity had greater needs in the domains of healthcare staff and physical symptom. The stress group showed high levels of needs in all domains except religious support. The group with thoughts of suicide showed higher levels of unmet needs for physical symptom.

CONCLUSION

Most prevalent unmet needs in Korean breast cancer survivors were found in the 'information and education' domain. The 50-59 age group, unemployment, multiplicity, stress and suicidal thoughts were associated with higher levels of unmet needs among Korean breast cancer survivors. Our findings revealed more vulnerable breast cancer survivors with unmet needs and physicians should take a precision approach to satisfy unmet needs of these survivors.

Increasing our understanding of dying of breast cancer: Comorbidities and care

Background: Screening and treatment for breast cancer have improved. However, attention to palliative support and non-cancer co-morbidities has been limited. This study identified types of care for and co-morbidities of persons dying of breast cancer compared to persons dying from all cancers and from non-cancer causes. Methods: Linked administrative data from population-based registries were used to examine 121,458 deaths in Nova Scotia from 1995 to 2009. Results: Breast cancer decedents' mean age was similar to that of all cancer decedents (72.0 versus 72.1 years), but their age spread was greater (20-59 years: 23.1% versus 16.7%; 90+ years: 11.2% versus 6.5%). Among women dying of breast cancer, 15.6% were enrolled in the diabetes registry and 15.1% in the cardiovascular registry, indicating that they had these non-cancer conditions prior to their death. Compared to all cancer decedents, breast cancer decedents were twice as likely to have dementia as a cause of death, and were less likely to die in hospital but more likely to die in a nursing home. Breast cancer decedents had place of death rates more similar to non-cancer than cancer decedents. Conclusions: Rates of dementia and diabetes among the breast cancer decedents were particularly note-worthy in this novel study given that these comorbidities have not received much attention in the breast cancer research literature. Further collaboration with non-cancer disease programs is advised. The extent of adequate comprehensive palliative support for the 20% of the breast cancer decedents who are nursing home residents requires investigation.

Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review

OBJECTIVES

Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women.

METHODS

Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis.

RESULTS

Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences.

CONCLUSION

Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients.

Evaluating psychosocial support needs of female cancer patients in the State of Qatar

Patient perceived perceptions of psychosocial support are increasingly important to understanding appropriate holistic patient-centred care. Information is scarce regarding the attitudes of female cancer patients in Arab and Muslim populations. This study was undertaken in the State of Qatar among female cancer patients. The aim of this study was to investigate what extent women undergoing cancer treatment in the State of Qatar view the importance of psychosocial support? Another aim of this study was to determine which demographic indicators, if any, may predict for certain preferences in support. The authors hypothesized that a majority of female cancer patients will perceive psychosocial support as an important aspect. This study used English and Arabic questionnaires to glean data from female cancer patients attending clinics at the National Centre for Cancer Care and Research in Doha, Qatar. For the purpose of this study, psychosocial support was defined under four categories: 1) family support, 2) religious/spiritual support, 3) support groups 4) physician referred support. Results showed that 88% of female respondents rated psychosocial support categories as important. There was no significance between patient demographics and specific preferences for the support categories in the study. This study may provide some areas for future research that may shape guidelines for improving holistic patient care and in assisting the Supreme Health Council in meeting its targets for the Qatar National Cancer strategy, which states that cancer treatment should be patient-centred focusing on both medical and psychosocial needs of patients.

Psychometric properties of the Persian version of the self- assessed support needs questionnaire for breast cancer cases

BACKGROUND

It has been found that support given to women with breast cancer has a positive effect upon their reactions to the illness and may even prolong their survival. Perceived support needs assessment in breast cancer women could be considered as a necessary part of nursing function.

AIM

The purpose of this study was to translate and culturally adapt the self-assessed support needs (SASN) questionnaire into Persian language and to investigate its psychometric properties.

MATERIALS AND METHODS

After forward-backward translation of the questionnaire and making appropriate changes, we selected 160 women with breast cancer as our study sample. The psychometric properties of the SASN, including its internal consistency, test retest reliability, and construct validity were evaluated through the known-groups technique.

RESULTS

The calculated Kaiser Meyer Olkin was 0.756, indicating that the sample was sufficiently large to perform a satisfactory factor analysis. The six factors all together explained 50.7% of the variance; the first factor (diagnosing) explaining the biggest part of variance (10.9). Internal consistency reliability was 0.83 for the whole scale and the stability of test was 0.78. For the first factor, Cronbach's alpha was 0.90 and factor loadings of scale's items were found to deal with diagnosis subscale. The domains described patients' diagnosis, treatment, support, femininity and body image, family and friends and information.

CONCLUSIONS

The reliability and validity of the adapted version of the SASN was shown to be satisfactory. Thus, it can be used to investigate self-assessed support needs of Iranian women suffering from breast cancer since the SASN is a multi-domain scale.

Facilitating social support: member-leader communication in a breast cancer support group

BACKGROUND

Early detection and treatment have resulted in more women surviving breast cancer; increased survivorship has also increased the need for breast cancer support groups (BCSG). The ostensible goal of such groups is to provide support for the physical and emotional stressors that cancer survivors face, as well as provide information on coping and treatment options.

OBJECTIVE

Although scholars have examined the effects of support groups on their group members, the examination of group facilitator messages has been largely neglected. The goal of this study was to extend theory on group leader behavior, specifically investigating how member-leader messages create social support in support groups.

METHODS

The transcribed conversations of weekly meetings of a BCSG were examined using Interaction Process Analysis to discover how the member-leader facilitated the group's enactment and management of social support.

RESULTS

Across the meetings, task talk dominated (primarily statements of orientation or information). Furthermore, analysis of interaction sequences between the support group facilitator and other members revealed 2 broad categories of task-oriented facilitation techniques (changing the focus, clarification) and 1 category of socioemotional facilitation techniques (showing support).

CONCLUSIONS

Support group facilitators need the ability to facilitate both task and relational aspects of social support.

IMPLICATIONS FOR PRACTICE

Facilitator behaviors were highlighted as being instrumental to the creation of social support. The results from this study indicate that the ability to change the focus of interaction, to provide and require clarification on complex issues, and to show support through relational messages is needed in facilitator training.

Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review

OBJECTIVE

The assessment of supportive care needs is a crucial step in the development of appropriate interventions that may improve the quality of life of cancer patients. This review describes and analyzes the prevalence and predictors of the unmet supportive care needs of breast cancer (BC) patients and survivors and suggests paths for further research.

METHOD

Multiple databases were searched, considering only quantitative studies using validated needs assessment instruments and focusing uniquely on women diagnosed with BC.

RESULTS

Out of 761 hits, 23 studies answered to all eligibility criteria. Nineteen were cross-sectional, and the remaining four were longitudinal. Most included patients at different moments along the BC trajectory, from diagnosis to decades into survivorship, with the major proportion of patients under treatment. Only five concentrated on the posttreatment phase into extended survivorship. The concerns of women diagnosed with BC clustered around psychological and information needs, with the top concern being 'fear of the cancer returning'. Predictors of higher levels of needs included advanced disease stage, greater symptom burden, shorter time since diagnosis, higher levels of distress, and younger age. Prevalence differed between cultures with Asian women reporting greater information needs and lower psychological needs compared with Western women.

CONCLUSIONS

Revealing which needs BC patients consider most urgent and the factors related to greater needs will permit the development of improved and targeted supportive care. Future research should comprise longitudinal designs concentrating on women at specific moments along the BC trajectory for a dynamic understanding of these needs.

Assessing the social impact of cancer: a review of available tools

OBJECTIVES

Taking care of oncological patients holistically--from a biological, social, and psychological point of view--also involves evaluating the social aspects of the disease. In the present study, we provide further insights on how investigations regarding the social impact of an oncological disease are conducted with specifically designed tools on patients who have personally been affected. The objective is then to understand how the social dimension is theorized and, therefore, which practical aspects of subjective experience are employed to assess the social impact.

METHOD

We performed a systematic review of the literature identified by MedLine and PsycINFO databases.

RESULTS

Of the 469 articles obtained from the search, 27 deal with 14 different measurement instruments of the social impact of the oncological experience. Of the identified tools, 71% were specifically designed for the oncological setting and were heterogeneous both in the investigated domains as well as social referrals; 64% of these had a multidimensional structure. Internal consistency was reported for all instruments, while temporal stability only for 36% of the tools. Construct validity and concurrent validity were reported for 79% of the instruments, criterion and predictive validity for one instrument only, external validity for 18% of the tools, and cross-cultural validity for one instrument only. The content was directly available for most instruments.

CONCLUSIONS

The great interest in this subject as borne out by the amount of studies published in international psycho-oncological literature confirms the importance of having a valid and reliable instrument specifically dedicated to measuring the social impact of the oncological experience. At the same time, further investigation is required to investigate the psychometric properties of the existing tools.

Development and initial validation of the Three-Levels-of-Needs Questionnaire for self-assessment of palliative needs in patients with cancer

CONTEXT

To improve palliative care, it is important that questionnaires accurately assess the needs of the patients. No questionnaire existed that combined three different and important approaches to needs assessment. We developed such a questionnaire, called the Three-Levels-of-Needs Questionnaire (3LNQ), based on literature searches. The 3LNQ measures 12 important needs with three different approaches when used as a supplement to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): problem intensity, problem burden, and felt need.

OBJECTIVES

To investigate the initial validity of the 3LNQ.

METHODS

We used a relatively new method that investigates whether the questionnaire has the same meaning for the patients as for the researchers. To do this, 74 patients with advanced cancer filled out the questionnaire and participated in an open-ended interview. The patients' responses to the questionnaire before the interview were compared against the researchers' responses based on the interviews. Items showing substantial agreement were accepted as valid without further analysis. For the remaining items, reasons for disagreements were analyzed qualitatively.

RESULTS

All items on problem intensity, eight of 12 items on problem burden, and three of 12 items on felt need were accepted as valid because of high agreement. Analysis of the qualitative data concerning the remaining items showed that most disagreements did not indicate problems with the patients' self-assessment. Instead, different causes for disagreements were elucidated, but these did not interfere with validity.

CONCLUSION

The 3LNQ appears to measure palliative needs comprehensively, and this initial validation showed satisfactory results. The analysis gave important insights into the patients' perceptions of their own situations, into their expectations of the health care system, and into the complexity of needs assessment.

The breast care nurse: the care specialist in breast centres

BACKGROUND

In Europe, breast cancer is the most common form of cancer in women; 26.5 per cent of all new malignant diseases and 17.5 per cent of all cancer deaths are due to this type of cancer. In Germany, approximately every tenth woman is diagnosed with breast cancer during her lifetime.

OBJECTIVE

In order to increase the quality of life of breast cancer patients, the European Society of Mastology (EUSOMA) requires the availability of, and an integration of qualified and specialized care into the interdisciplinary team. Thus, in Germany, a new type of job profile for 'breast nurse' as a qualified care specialist has to be established and has to be oriented towards the international standards of a breast care nurse (BCN).

METHODS

The Charité's Academy of Health--in cooperation with the Interdisciplinary Breast Centre of the Charité--has offered a career advisory service curriculum for the BCN since 2006 in accordance with the EUSOMA guidelines.

RESULTS

In three courses, 45 BCNs have been trained. In the first refresher seminar in May 2009, the BCNs were given an opportunity to exchange with fellow BCNs their experiences.

CONCLUSION

We were able to set up a new curriculum to train nurses as BCNs as to improve the quality of care for breast cancer patients and to orientate the training towards the international standards of a BCN qualification.

Are patient assistance programmes able to meet the needs of New York City women with breast cancer? Women's perspectives

Women with breast cancer report needs that may interfere with their ability to obtain necessary treatments. High-quality community-based patient assistance programmes exist; however, their ability to identify and meet women's needs is unknown. We surveyed women with breast cancer attending such programmes to assess programmes' ability to identify and meet their needs. We surveyed 117 (42% minority) women utilizing nine programmes in the New York City area about expectations, needs and experiences. Ninety-two (89%) women wanted information, 102 (95%) psychosocial support and 15 (20%) practical assistance. Seventy-three per cent had all or most of their needs identified, and 74% had all or most of their needs met. Seventy per cent stated programmes met needs they were not previously aware they had. Needs identified and met were lower among minority women (57% vs. 84%; P = 0.003), those with lower income (46% vs. 79%; P = 0.02) and those in poor physical health (56% vs. 78%; P = 0.04), independent of the type of need. High-quality community-based patient assistance programmes effectively identify and meet the needs of women with breast cancer but traditionally at-risk women appear less likely to have needs identified and met. Programmes should enhance the systemization and sensitivity of needs assessments to improve women's experience with cancer.

Sexual desire and satisfaction in sexual life affecting factors in breast cancer survivors after mastectomy

The purpose of this study was to examine impact of treatment and personality characteristics, and support need for femininity and body image on sexual desire and sexual satisfaction of women with breast cancer. The sample consisted of 123 married women who previously underwent mastectomy and applied to medical oncology clinics of a university hospital. Sexual desire of the women in this study was low, and they were slightly satisfied with sexual life. Consequently, the women required supporting needs of femininity and body image. The result of this study could be utilized to determine sexual desire and satisfaction related to sexual life of women with breast cancer.

'Quite an awkward situation to be in': perceptions of patients, carers and health and social care professionals of the supportive cancer care in British military personnel stationed in Germany

GOALS OF WORK

This paper reports findings from a study which identified the nature and volume of supportive care received by British military services personnel and their dependents who experience cancer and are based in Germany. The objectives were to (1) identify any gaps in the provision of supportive care, (2) determine the potential for additional supportive care services (local or remote), and (3) identify any educational or development issues for DMWS personnel.

MATERIALS AND METHODS

Interviews and focus groups were conducted with people with cancer (n = 7), informal carers (n = 6), British health care professionals employed by British Forces in Germany (n = 8), German health care professionals (n = 3), senior military personnel (n = 6) and army support personnel (n = 5). Analysis of the data was thematic and focused on accounts of care related to core issue identified in the UK's National Institute of Health and Clinical Excellence (NICE) guidelines (24).

MAIN RESULTS

The paper explores the difficulties which British military personnel experience in their cancer care. The shortfalls in best practice are discussed in the framework of NICE guidelines focusing on communication, information, psychosocial care and coordination of care/inter-agency working. Significant gaps in the supportive care service provision are apparent

CONCLUSIONS

The limited assessment and discussion of patients' supportive care needs suggests key areas for service improvement for providers both within the British Military in Germany, and in the services provided by German organisations. These findings highlight issues that should be considered by those providing supportive care for marginalised patient groups, such as patients and carers from different cultures.

Supportive care of rural women with breast cancer in Tasmania, Australia: changing needs over time

Providing for patients' psychosocial needs is a potential means of minimising cancer morbidity. Needs assessments can guide responsive patient-centred care. A longitudinal survey of women with early breast cancer consulting a breast nurse in a primarily rural state of Australia was undertaken to measure unmet supportive care needs, identify changes in unmet needs across time and compare results with previous studies. Needs assessments were completed with the Supportive Care Needs Survey (SCNS) at 1 month (n = 74) and 3 months (n = 83) post-diagnosis. Access to services was also examined. High levels of psychological and health system and information needs were identified at 1 month post-diagnosis, but these decreased significantly at 3 months post-diagnosis. Sexuality domain needs increased significantly during the same time. Compared to a previous SCNS study of rural women with breast cancer, unmet supportive care needs in this study were significantly lower than previously reported, although assistance with energy levels (i.e. fatigue) continues to be an unmet need for women with breast cancer. Results suggest there have been positive cultural changes within healthcare systems, specifically in better informing patients and providing support. Although services appear to be more responsive to breast cancer patients, significant unmet needs still exist.

Providing supportive care to cancer patients: a study on inter-organizational relationships

Background

Supportive cancer care (SCC) has historically been provided by organizations that work independently and possess limited inter-organizational coordination. Despite the recognition that SCC services must be better coordinated, little research has been done to examine inter-organizational relationships that would enable this goal.

Objective

The purpose of this study was to describe relationships among programs that support those affected by cancer. Through this description the study objective was to identify the optimal approach to coordinating SCC in the community.

Methods

Senior administrators in programs that provided care to persons and their families living with or affected by cancer participated in a personal interview. Setting: South-central Ontario, Canada. Study population: administrators from 43 (97%) eligible programs consented to participate in the study.

Results

Network analysis revealed a diffuse system where centralization was greater in operational than administrative activities. A greater number of provider cliques were present at the operational level than the administrative level. Respondents identified several priorities to improve the coordination of cancer care in the community including: improving standards of care; establishing a regional coordinating body; increasing resources; and improving communication between programs.

Conclusion

Our results point to the importance of developing a better understanding on the types of relationships that exist among service programs if effective integrated models of care are to be developed.

Developing an outcome measurement for meaning-making intervention with Chinese cancer patients

Psychosocial programs designed for cancer patients often facilitate the search for meaning as one of the therapeutic components. This study aimed to develop a self-report instrument, namely Chinese Cancer Coherence Scale (CCCS), which measures the patients' meaning-making process with reference to the concept of coherence. A panel of eight veteran social workers and psychologists generated statements pertaining to the cancer experience. Results from a two-phase study involving 390 breast cancer patients revealed a two-factor structure of the CCCS, namely incoherent-embittered and coherent-enlightened. The use of the CCCS by practitioners and researchers is recommended in order to understand how Chinese cancer patients make sense of their cancer experience.

Psychometric evaluation of Self-Assessed Support Needs of women with breast cancer Scale

AIMS

The issue of self-assessed support needs of women with breast cancer has not been studied enough although it is an important subject for women's health in Turkey. Most of the studies concerning breast cancer patients are about quality of life and life satisfaction. This study aimed to adapt an English version of the Self-Assessed Support Needs of women with breast cancer Scale for Turkish women with breast cancer and to evaluate its psychometric properties.

DESIGN

A descriptive study.

METHODS

The sample consisted of 143 women with breast cancer who attended the outpatient and inpatient oncology clinics. Data were collected by a structured questionnaire including demographic characteristics and the Self-Assessed Support Needs of women with breast cancer Scale. Item analysis, principal components analysis, internal consistency reliability and Cronbach's alpha were used to measure the psychometric properties of the 54-item scale.

RESULTS

In the assessment of construct validity, the principal components method of factor analysis was performed. Seven factors were identified with eigenvalues >1 explained 52.1% of the total variance (diagnosis, treatment, support, femininity and body image, family and friends, information and after care). Internal reliability coefficients of these seven factor-based scales were found to be substantial, ranging from 0.71 to 0.84.

CONCLUSION

The present study provides evidence of the Self-Assessed Support Needs of women with breast cancer Scale's validity, reliability and acceptability. This scale should be further evaluated; with a large enough sample size, in different regions in Turkey and diverse populations of world.

RELEVANCE TO CLINICAL PRACTICE

The scale has potential applications. It can be used both as a research or a regular screening tool with clinical settings. The use of the scale in clinics will enable identification of self-management activities in patients with breast cancer. Assessment of the self-assessed support needs of women with breast cancer should be an essential part of nursing practice.

Choices in cancer treatment: a qualitative study of the older women's (>70 years) perspective

PURPOSE

Primary endocrine therapy (PET) is the treatment of primary, operable breast cancer with drugs, such as tamoxifen, rather than surgery. It is in widespread use in the UK with 40% of women over 70 years old being treated in this way. PET is associated with inferior rates of local control compared with the standard surgical therapies, but there is no difference in overall survival. There has been no published research regarding the attitudes of older women concerning these two alternative approaches to treatment; what may influence their treatment choice or their experience of either treatment modality. This study aimed to address these questions.

METHOD

In-depth qualitative interviews were undertaken to explore the views of a group of 21 purposively selected older women (>70 years old), who had been treated by PET or surgery for breast cancer. The interviews were transcribed verbatim and analysed using Framework Analysis.

RESULTS

Both surgery and PET were well tolerated and had high satisfaction ratings from most women. This was the case even for those who had complications following surgery or needed a change of management in the PET group. Older women expressed no age-specific fears for operative procedures. The women were passive information seekers and relied heavily on 'expert' advice in making their treatment choices. Neither social support or age were factors in their decision-making. Their main concern was to ensure that their quality of life and independence remained unaffected.

CONCLUSION

Older women have no strong preference for either treatment option but are concerned that the treatment is effective and causes minimal disruption to their quality of life and independence. This study suggests that medical consultations may need to be adapted to reflect the passive acceptance of 'expert' advice in the majority of women in this age group.

Healthcare and support needs of women with suspected breast cancer

AIM

This paper is a report of a study to investigate changes in the healthcare and support needs during the diagnostic period, and factors that affect these needs in women with suspected breast cancer.

BACKGROUND

Although the needs of women with breast cancer are well recognized, few studies have examined the needs of women with suspected breast cancer during the diagnostic period.

METHOD

This longitudinal study used an investigator-developed, self-administered questionnaire to collect data from 127 women in Taiwan on three occasions: notification of need for breast biopsy, before biopsy and after diagnosis. The data were collected from November 2004 to April 2005.

FINDINGS

Participants had high need levels before and after diagnosis, with their top needs in the domains of healthcare services for diagnosis, follow-up and consultation, and information about the disease. They needed disease- and treatment-related information more than emotional support. Need levels were higher (P < 0.01) before diagnosis than after, highest before biopsy, and lowest after diagnosis. Furthermore, needs were higher (P < 0.01) before than after diagnosis for diagnostic services, disease information, and involvement of family and friends. Higher needs were found in married women with more education and no history of benign tumours. Need level did not differ statistically significantly by age, religious status, degree of social support, family history and breast symptoms.

CONCLUSION

Need levels of women with suspected breast cancer vary during the diagnostic period, are highest before breast biopsy, and related to personal characteristics and cultural context. Therefore, during this period, nursing staff should provide patients and families with culturally sensitive, individualized, supportive care.

Patient Education About Treatment in Cancer Care

An increasing number of older people are treated for cancer. Several factors, such as comorbidity and sensory deficits, occur more frequently in older patients than in younger patients. In addition, their life circumstances, values, and preferences may differ. These factors ask for tailored nurse-older patient communication. This article reviews recent literature on the specific needs of older patients with cancer in the treatment phase of the disease. No studies addressed treatment-related needs of older patients specifically. Seventeen studies controlled for age showed that many older patients want as much information on disease and treatment as possible, but they are less interested in details than younger patients. Furthermore, older patients reported less need for information on sexual consequences and psychosocial support. The results remain difficult to interpret because of variation in study designs and questionnaires. Moreover, none of the studies controlled for age-related variables. Studies that illuminate the unique needs of older patients with cancer in the treatment phase of the disease are strikingly limited given the demographics of cancer in our society. Research is needed that explicitly investigates these needs and the influence of age-related changes in cognitive, physical, and psychosocial functioning.

Coping with breast cancer: a qualitative analysis of reflective journals

Non-disclosure of emotions has been shown to inhibit individuals' adjustment to illness and formulation of adequate coping mechanisms. The purpose of this qualitative study was to examine responses to the diagnosis and treatment of breast cancer and patterns of coping through an analysis of written reflective journals. Eight women submitted their journals to the researchers for analysis. Issues identified were (1) the assumption of an adaptive position; (2) the need for tangible evidence of love and support with three divergent responses, and (3) the need for something more. Specific patterns were identified within each issue.

Appraising the self-assessed support needs of Turkish women with breast cancer

The purposes of this study were to establish the range of needs of women with breast cancer and to examine how women's needs might form clusters that could provide the basis for developing a standardized scale of needs for use by local breast care nurses in the evaluation of care. The sample consisted of 143 women with breast cancer who were admitted to the outpatient and inpatient oncology clinics in a university hospital in Erzurum, Turkey. The data were collected by questionnaire, and included demographic characteristics and the self-assessed support needs of women with breast cancer. Statistical analyses have shown that the standardized scale of needs has statistically acceptable levels of reliability and validity. The women's support needs mostly clustered in Family and Friends (79%) and After Care (78.3%). The most frequently required support category was Family and Friend; however, the women were in need of support of all categories. In terms of age ranges, there are statistically significant differences in relation to Femininity and Body Image, and Family and Friends of the seven categories. Women experienced a high level of needs associated with a diagnosis of breast cancer. The results in this study should increase awareness among cancer care professionals about a range of psychosocial needs and may help them target particular patient groups for particular support interventions.

Breast cancer survivors’ supportive care needs 2–10 years after diagnosis

GOALS OF THE WORK

A significant proportion of breast cancer patients experience psychosocial morbidity after treatment, although their longer-term outcomes and supportive care service needs have not been comprehensively documented. The aim of this study was to identify longer-term outcomes and supportive care needs in disease-free breast cancer survivors.

MATERIALS AND METHODS

One hundred seventeen patients who had been diagnosed with breast cancer 2-10 years earlier completed questionnaires to assess psychosocial outcomes including supportive care needs, psychological distress, and quality of life (QoL).

MAIN RESULTS

QoL and depression scores were consistent with community rates although anxiety scores were higher. Approximately two thirds of survivors reported at least one unmet need, most frequently concerning existential survivorship issues, thereby highlighting the unique needs of survivors. Years since diagnosis was not correlated with need levels. Survivors classified as clinically anxious reported over three times as many unmet needs and survivors classified as depressed reported over two and a half times as many unmet needs. Positive outcomes were frequently reported.

CONCLUSIONS

The findings have direct clinical relevance: irrespective of years since diagnosis, comprehensive and extended supportive care services are required to identify breast cancer survivors in need of supportive care interventions and remediate high levels of anxiety.

The experiences of men with breast cancer in the United Kingdom

To investigate the experiences of men with breast cancer across the United Kingdom, a multi-phase study using: (a) focus groups (n = 4) with men and women with breast cancer and with healthcare professionals; (b) questionnaires to men with breast cancer (n = 161); (c) follow-up interviews with these men (n = 30) and (d) reconvening the focus groups (n = 2) for the men and women with breast cancer. The majority of men (84%, n = 135) reported their symptoms early, but were shocked to receive a breast cancer diagnosis. Disclosure of the diagnosis was commonly made to partners (80%, n = 129) and other close family and was influenced by perceptions of embarrassment, stigma and altered body image. Very little information was available to participants; that which was available was often inappropriate as it was intended for women. Over half the sample wanted much more information (56%, n = 90). This study also demonstrated low utilisation of formal support services and initiatives are needed to improve the information and support provided to men with breast cancer after diagnosis and treatment. Increasing the profile of breast cancer in men generally amongst healthcare professionals and the public is also needed.

Informational and emotional needs of long-term survivors of breast cancer

AIMS

This paper presents a review of the informational and emotional needs of long-term breast cancer survivors, with particular attention to the different needs of women according to their age and to critiquing healthcare provision to these women.

BACKGROUND

Women with a history of breast cancer are the largest group of cancer survivors. While they may be disease-free, their cancer diagnosis has ongoing physical and psychosocial implications for their lives and well-being.

METHODS

A literature search for the period 1985 to March 2004 was undertaken using the CINAHL, MEDLINE, CANCERLIT, PubMed and CUIDEN databases and the keywords long-term, breast cancer survivors, needs and social support. Hand-searching was also done, and reference lists of papers were examined for relevant studies.

RESULTS

Survivors of breast cancer continue to experience informational and emotional needs during their long-term survivorship, and variation in the amount and type of support required is age-related. However, women's needs are often unmet by oncology teams and they have to find other sources of support, such as self-help groups. Thus, ongoing care is required after completion of medical treatment, and nurses have a significant contribution to make here.

CONCLUSIONS

Nursing research on long-term breast cancer survivorship is limited. Future studies need to investigate the unmet needs of long-term survivors of breast cancer and, specifically, explore the kind of support women would like to receive from oncology teams, and particularly from breast cancer nurses.

Social Support as a Mediator Between Symptom Distress and Quality of Life in Women With Breast Cancer

OBJECTIVE

To examine relationships between symptom distress and quality of life when religious support and personal support were introduced as mediating variables.

DESIGN

Cross-sectional, correlational.

SETTING

Internet recruitment following university institutional review board approval.

PARTICIPANTS

Mailed questionnaires from 100 women with breast cancer, mean age 46, length of time since surgery 1 to 24 months, predominantly White.

INSTRUMENTS

Symptom Distress Scale, Religious Support Scale, FACT-B, and Facit-Sp-12.

RESULTS

Personal support was positively related to quality of life and partially mediated the effects of symptom distress. Religious support did not mediate symptom distress and was not directly related to quality of life.

CONCLUSIONS

Social support from family members and friends helped to decrease the negative effects of symptoms on quality of life. This study underscores the need to continue to assess for symptom distress and adequacy of personal support throughout the cancer trajectory and to facilitate the garnering of support resources when needed.

Information needs and sources of information among cancer patients: a systematic review of research (1980-2003)

Understanding what cancer patients need to know and from whom they receive information during the course of care is essential to ensuring quality care. We reviewed 112 articles published from 1980 to 2003 and developed a typology summarizing cancer patients' information needs and the sources from which they receive information. The majority of articles focused on information needs and sources during the diagnosis and treatment phase. Thus, the most frequent information need was treatment-related (38.1%). The most frequent information source was health professionals (27.3%). We examined patients' information needs and sources along the continuum of care and found that during diagnosis and treatment, information needs about the stage of disease, treatment options, and side-effects of treatment were prominent; during post-treatment, patients continued to need information about treatment, and information about recovery was also important. Future research should examine cancer patients' information needs and sources throughout their cancer journey.

Negotiating risk: how women working in massage parlours preserve their sexual and psychological health

The small exploratory study was conducted in a heavily populated urban area in the Midlands region of England. Through semistructured interviews with women working in massage parlours, we investigated the health risks inherent in the work and the strategies adopted by the women to overcome these, as well as examining circumstances where theses strategies could be compromised. The effects of working in the sex industry on women's relationships and lives outside also emerged as the research progressed. We found that, in addition to preserving their sexual health, women's main concern was with the separation of home and work.

Tree-based model for breast cancer prognostication

PURPOSE

To define prognostic groups for recurrence-free survival in breast cancer, assess relative effects of prognostic factors, and examine the influence of treatment variations on recurrence-free survival in patients with similar prognostic-factor profiles.

PATIENTS AND METHODS

We analyzed 1,055 patients diagnosed with stage I-III breast cancer between 1990 and 1996. Variables studied included socioeconomic factors, tumor characteristics, concurrent medical conditions, and treatment. The primary end point was recurrence-free survival (RFS). Multivariable analyses were performed using recursive partitioning and Cox proportional hazards regression.

RESULTS

The most significant difference in prognosis was between patients with fewer than four and those with at least four positive nodes (P <.0001). Four distinct prognostic groups (5-year RFS, 97%, 78%, 58%, and 27%) were developed, defined by the number of positive nodes, tumor size, progesterone receptor (PR) status, differentiation, race, and marital status. Patients with fewer than four positive nodes and tumor < or = 2 cm, PR positive, and well or moderately differentiated had the best prognosis. RFS in this group was unaffected by type of adjuvant therapy (P =.38). Patients with at least four positive nodes and PR-negative tumors had the worst prognosis, and those treated with tamoxifen plus chemotherapy had the best outcome in this group (P =.0001). Among patients in the two intermediate-risk groups, those treated with tamoxifen or a combination of tamoxifen and chemotherapy had the best outcome.

CONCLUSION

Lymph node status, PR status, tumor size, differentiation, race, and marital status are valuable for prognostication in breast cancer. The prognostic groups derived can provide guidance for clinical trial design, patient management, and future treatment policy.

Breast cancer: evaluation of the Common Journey Breast Cancer Support Group

BACKGROUND

Most studies of cancer support groups have focused on the effects of groups established for research purposes, from the exclusive perspective of the group participants.

AIM

This Roy Adaptation Model-based programme evaluation project focused on identifying the experiences of both participants in and facilitators of a community hospital-sponsored breast cancer support group.

DESIGN

Repeated measures survey methodology.

METHODS

Ten women with breast cancer and two Registered Nurse group facilitators participated in the programme evaluation project. Qualitative data were analysed using content analysis. Themes extracted from the data were categorized according to the Roy Adaptation Model modes of adaptation. The group participants completed Initial and End of Year Interview Guides and Group Voices Forms; the group facilitators completed the Facilitators' Voices Form. The Institutional Review Committee of a community hospital approved the programme evaluation project.

RESULTS

The Common Journey Breast Cancer Support Group is a community hospital-sponsored cancer support group established to meet the informational, emotional support, and social support needs of women with breast cancer who reside in a rural state in the New England region of the USA. Responses of participants and facilitators, which reflected all four of the Roy model modes of adaptation, indicated that the combination of information and emotional and social support was effective.

CONCLUSIONS

Nurses and other health professionals who establish community-based cancer support groups should consider formal evaluation of the outcomes, from the perspectives of both participants and facilitators, and should publish the results. The results of this programme evaluation project are limited to one breast cancer support group with a small number of female participants and two facilitators. Results cannot be generalized to support groups for other types of cancer or to cancer support groups for men.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other health professionals should consider establishing and facilitating community hospital-sponsored support groups for women with breast cancer, which have the potential to meet the women's informational, emotional support, and social support needs.

Patients' experiences of their intake of food and fluid following gastrectomy due to tumor

Several studies have documented patients' intake of parenteral and enteral nutrition following gastrointestinal surgery. There is a lack of knowledge, however, regarding patients' experiences of intake of food and fluid following gastrointestinal surgery. The aim of this study was to describe patients' experiences of their appetite, hunger, changes in weight, and intake of food and fluid three months after gastrointestinal surgery due to tumor. Fifteen patients were invited to be interviewed regarding their experiences following gastrointestinal surgery due to tumor. The method used for data analysis was a qualitative content analyses approach. The categorization of data identified three themes: 1) the struggle to eat and drink; 2) bodily estrangement; and 3) nutritional treatment regimens. These three themes consisted of subthemes such as: lack of appetite and hunger; difficulties in eating and drinking; feelings of nausea; and fighting and adaptation. The findings contribute to a deeper understanding of these patients' nutritional regimen and suggest the individual's personal situation and living circumstances should be considered when developing a nutritional plan following gastrointestinal surgery for tumor.