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Fefferman ML, Stump TK, Thompson D, Simovic S, Medenwald RJ, Yao K. Patient-reported observations on medical procedure timeliness (PROMPT) in breast cancer: a qualitative study. Breast Cancer Res Treat 2024:10.1007/s10549-024-07406-7. [PMID: 38965153 DOI: 10.1007/s10549-024-07406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Timeliness of care is an important healthcare outcome measure. The objective of this study was to explore patient perspectives on the timeliness of breast cancer diagnosis and treatment at accredited breast cancer centers. METHODS In this qualitative study, 1 hour virtual interviews were conducted with participants 18-75 years old who were diagnosed and treated for stage 0-III breast cancer at a National Accreditation Program for Breast Centers facility from 2018 to 2022. Thematic analysis was used to identify key themes of participant experiences. RESULTS Twenty-eight participants were interviewed. Two thematic domains were identified: etiologies of expedited or delayed care and the impact of delayed or expedited care on patients. Within these domains, multiple themes emerged. For etiologies of expedited or delayed care, participants discussed (1) the effect of scheduling appointments, (2) the COVID-19 pandemic, (3) dissatisfaction with the timeline for various parts of the diagnostic workup, and (4) delays related to patient factors, including socioeconomic status. For the impact of expedited or delayed care, patients discussed (1) the emotional and mental impact of waiting, (2) the importance of communication and clear expectations, and (3) the impact of electronic health portals. Patients desired each care interval (e.g., the time from mammogram to breast biopsy) to be approximately 7 days, with longer intervals sometimes preferred prior to surgery. CONCLUSION These patient interviews identify areas of delay and provide patient-centered, actionable items to improve the timeliness of breast cancer care.
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Affiliation(s)
- Marie L Fefferman
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Tammy K Stump
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Danielle Thompson
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Sandra Simovic
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Riley J Medenwald
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Katharine Yao
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA.
- Department of Surgery, The University of Chicago, Chicago, IL, USA.
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Kang N, Yu ES. Is digital intervention for fear of cancer recurrence beneficial to cancer patients?: A systematic review and meta-analysis. Psychooncology 2023; 32:1348-1358. [PMID: 37571918 DOI: 10.1002/pon.6199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE This study aimed to compare the effectiveness of digital and face-to-face interventions in reducing fear of cancer recurrence (FCR) among individuals with cancer. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for evaluating the efficacy of psychological interventions for FCR published between July 2018 and December 2021. We searched for research papers using PubMed, Embase, and Cochrane and assessed their quality using the Revised Cochrane risk-of-bias tool for randomized trials. RESULTS Of the 2113 identified studies, we analyzed 17 samples (N = 1482) from 14 studies, of which 13 were RCTs. The overall sample showed a moderate effect size (Hedges' g = 0.607; 0.356 to 0.858; p < 0.001; I2 = 81.29%) in FCR reduction. The overall effect size was 0.621 (95% CI, 0.276 to 0.966; p < 0.001; I2 = 81.78%) for face-to-face interventions and 0.517 (95% CI, 0.093 to 0.941; p = 0.017; I2 = 83.19%) for digital interventions. The difference between the two effect sizes was not statistically significant. CONCLUSION Our meta-analysis suggests that digital interventions are moderately effective in reducing FCR, similar to face-to-face interventions. However, given the high degree of heterogeneity, this conclusion should be interpreted with caution. Further studies are required to identify the most effective digital interventions and the populations that may benefit from them.
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Affiliation(s)
- Namgu Kang
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Eun-Seung Yu
- Department of Counseling Psychology, The Cyber University of Korea, Seoul, Republic of Korea
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3
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Bergerot CD, Philip EJ, Bergerot PG, Siddiq N, Tinianov S, Lustberg M. Fear of Cancer Recurrence or Progression: What Is It and What Can We Do About It? Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35561298 DOI: 10.1200/edbk_100031] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with cancer face a trajectory marked by emotional and physical distress that can be associated with both diagnosis and treatment. Fear of cancer recurrence or progression has been considered one of the most common unmet needs reported by patients diagnosed with both localized and metastatic disease. Fear of cancer recurrence or progression has been defined as the "fear, worry, or concern relating to the possibility that cancer will come back or progress." Often overlooked by health care teams, fear of cancer recurrence or progression has been associated with impaired quality of life and psychosocial adjustment, elevated emotional distress, and a range of physical symptoms. Several interventions for fear of cancer recurrence or progression are currently under investigation. Early recognition, support, and validation of feelings associated with fear of cancer recurrence or progression, and appropriate referrals to psychosocial oncology, can be beneficial for many patients. Assessing patients early in their cancer trajectory, and at important milestones, including a change in therapies, at the end of active treatment, and during follow-up visits, can help identify individuals at risk and help individuals engage in supportive programs.
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Affiliation(s)
| | - Errol J Philip
- University of California San Francisco, San Francisco, CA
| | - Paulo Gustavo Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasília, DF, Brazil
| | - Namrah Siddiq
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
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Park SY, Lim JW. Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature. BMC Cancer 2022; 22:217. [PMID: 35227244 PMCID: PMC8883021 DOI: 10.1186/s12885-021-08909-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) has been addressed as a cause of emotional distress among breast cancer survivors (BCSs). This study aimed to systematically review the evidence on randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) designed to reduce FCR among BCSs. METHODS A systematic review of published original research articles meeting the inclusion criteria was conducted. Five electronic databases, including the Cochrane Library, CINAHL, PubMed, PsycINFO, and Web of Science, were independently searched to identify relevant articles. The Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist was used to evaluate the quality of the eligible studies. RESULTS Through a database search and a manual review process, seventeen quantitative studies with an RCT study design were included in the current systematic review. The interventions varied greatly in length and intensity, but the study designs and methodologies were similar. RCTs with face-to-face interventions of at least 1 month seemed to be more effective in reducing FCR outcomes and complying with than the CONSORT 2010 criteria than those with a brief online or telephone format of interventions; nevertheless, most RCT interventions appeared to be effective. CONCLUSIONS These findings highlight the importance of conducting well-designed CBT interventions to reduce FCR in BCSs with diverse populations at multiple sites, thereby improving the quality of research in this area.
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Affiliation(s)
- So-Young Park
- Ewha Institute for Age Integration Research, Ewha Womans University, 52 Ewhayeodae-gil, Sedaemun-gu, Seoul, 03760, Republic of Korea
| | - Jung-Won Lim
- College of Social Welfare, Kangnam University, 40 Kangnam-Ro, Giheung-Gu, Yongin-Si, Gyeonggi-Do, 16979, Republic of Korea.
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5
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Pradhan P, Sharpe L, Menzies RE. Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors. Cancer Manag Res 2021; 13:8953-8965. [PMID: 34880676 PMCID: PMC8645945 DOI: 10.2147/cmar.s294114] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background Fear of cancer recurrence or progression (FCR) is common amongst cancer survivors and an important minority develop clinically significant levels of FCR. However, it is unclear how current clinical services might best support the growing numbers of cancer survivors. Purpose The aim of this study is to develop recommendations for future research in the management of FCR and propose a model of care to help manage FCR in the growing population of cancer survivors. Methods This is a narrative review and synthesis of empirical research relevant to managing FCR. We reviewed meta-analyses, systematic reviews and individual studies that had investigated interventions for FCR. Results A recent, well-conducted meta-analysis confirmed a range of moderately effective treatments for FCR. However, many survivors continued to experience clinical levels of FCR after treatment, indicating a clear need to improve the gold standard treatments. Accessibility of interventions is arguably a greater concern. The majority of FCR treatments require face-to-face therapy, with highly skilled psycho-oncologists to produce moderate changes in FCR. With increasing numbers of cancer survivors, we need to consider how to meet the unmet need of cancer survivors in relation to FCR. Although there have been attempts to develop minimal interventions, these are not yet sufficiently well supported to warrant implementation. Attempts to help clinicians to provide information which might prevent the development of clinically significant FCR have shown some early promise, but research is needed to confirm efficacy. Conclusion The next decade of research needs to focus on developing preventative approaches for FCR, and minimal interventions for those with mild-to-moderate symptoms. When evidence-based approaches to prevent FCR or manage moderate levels of FCR are available, stepped care approaches that could meet the needs of survivors could be implemented. However, we also need to improve existing interventions for severe FCR.
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Affiliation(s)
- Poorva Pradhan
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
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Séguin Leclair C, Lebel S, Westmaas JL. Can Physical Activity and Healthy Diet Help Long-Term Cancer Survivors Manage Their Fear of Recurrence? Front Psychol 2021; 12:647432. [PMID: 34177701 PMCID: PMC8219846 DOI: 10.3389/fpsyg.2021.647432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Fear of cancer recurrence (FCR) adversely affects quality of life, but health behaviors such as physical activity (PA) and fruit and vegetable intake (FVI) may help alleviate FCR for some survivors. This cross-sectional study tested the common-sense model (CSM) of FCR by investigating associations between constructs from the CSM (perceived illness consequences, control over health, and timeline), and survivors' health behaviors, health self-efficacy, and FCR. Methods: Using wave 3 data from the American Cancer Society Longitudinal Study of Cancer Survivorship-I, path analyses were conducted among mixed-cancer participants (N = 2,337) who were on average 8.8 mean years post-diagnosis. Results: A final good fitting model [χ 2 (5, N = 2,337) = 38.12, p < 0.001; SRMR = 0.02; CFI = 0.99; RMSEA = 0.05] indicated that perceiving fewer illness consequences, and greater control over one's health, were directly associated with higher PA (β = 0.15 and -0.24, p < 0.01, respectively) and higher health self-efficacy (β = 0.24, -0.38, p < 0.01, respectively). Timeline (i.e., perceiving cancer as chronic) was directly associated with lower health self-efficacy (β = -0.15, p < 0.01) and higher FCR (β = 0.51, p < 0.01). Both greater PA and FVI were directly associated with higher health self-efficacy (β = 0.10 and 0.11, p < 0.01, respectively) which in turn showed a direct association with lower FCR (β = -0.15, p < 0.01). Conclusion: Increasing survivors' sense of control over health, decreasing perceived chronicity of the illness, and mitigating its consequences may increase their health behaviors and health self-efficacy, which in turn could decrease their FCR. Longitudinal and experimental studies are needed to confirm these findings.
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Affiliation(s)
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - J Lee Westmaas
- Behavioral Research Center, American Cancer Society, Atlanta, GA, United States
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Improving symptom-related communication skills among cancer patients in an oncology ward: a best practice implementation project. JBI Evid Implement 2021; 20:87-100. [PMID: 33703851 DOI: 10.1097/xeb.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS As a symptom is a subjective perception of patients, good symptom management requires the patients to actively talk to clinicians about their symptom experience and to effectively express concerns about treatment. It has been found that the patients displayed poor communication behaviors and lacked communication knowledge and skills in the oncology ward of a tertiary hospital in PR China, indicating the need for improvement. This project aimed to promote the cancer patients' symptom-related communication with clinicians in this hospital setting. METHOD A baseline audit against six evidence-based audit criteria derived from best practice recommendations was conducted, utilizing the JBI Practical Application of Clinical Evidence System tool. Identification of facilitators and barriers to best practice was then carried out and strategies were implemented to overcome identified barriers. A postimplementation audit was undertaken to assess any improvement in practice. RESULTS The baseline audit showed that the nurses' compliance with best practice recommendations was unsatisfactory, with five out of six criteria recording 0% compliance. Strategies including nurse education, patient symptom assessment, patient education and use of communication tools were implemented. The postimplementation audit showed significantly improved compliance in the nurses' practice with all best practice recommendations, with all audit criteria achieving at least 69% compliance. CONCLUSION The project achieved improved practice in patient communication promotion across all six audit criteria. However, further effort is needed to strengthen and maintain best practice. Patient symptom-related communication behavior should be measured in the future.
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8
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Reb AM, Borneman T, Economou D, Cangin MA, Cope DG, Ma H, Ruel N, Sharpe L, Patel SK, Cristea M, Koczywas M, Ferrell B. A nurse-led intervention for fear of cancer progression in advanced cancer: A pilot feasibility study. Eur J Oncol Nurs 2020; 49:101855. [PMID: 33120211 PMCID: PMC8493814 DOI: 10.1016/j.ejon.2020.101855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the feasibility, acceptability, and preliminary effects of a nurse-led intervention for managing fear of cancer progression in advanced cancer patients. METHODS A single group mixed methods study was conducted in patients with stage III or IV gynecologic or lung cancer (n = 31) with dysfunctional levels of fear of progression or distress. The intervention consisted of seven videoconferencing sessions with skills practice. Feasibility measures included enrollment rate, attendance, attrition, and home practice adherence. Acceptability was based on exit interview responses. Content analysis was used to analyze the qualitative data. Participants completed quantitative questionnaires assessing fear of progression and secondary outcomes at baseline, eight, and 12 weeks. Linear mixed model analysis was used to assess changes in outcome measures. RESULTS The average enrollment rate was seven participants/month over 4.5 months. Participants attended a mean of 5.3 of seven sessions. Attrition rate was 30%. The analysis showed improvements over time in fear of progression and exploratory outcomes. Participants reported feeling calmer and more focused. The skills practice helped to manage anxiety and fears. Themes included: Struggling with fears, Refocusing the fears, and Realizing/reaffirming what is important in life. The most beneficial components included the values clarification exercise, detached mindfulness and worry postponement practices. CONCLUSION The intervention was acceptable; most feasibility criteria were met. Preliminary data suggest that the intervention reduced fear of progression and improved secondary outcomes. The intervention required a significant time commitment by participants, which may have contributed to increased attrition. To decrease burden, we will shorten the intervention.
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Affiliation(s)
- Anne M Reb
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA.
| | - Tami Borneman
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
| | - Denice Economou
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
| | - Marissa A Cangin
- City of Hope, Department of Supportive Care Medicine, Duarte, CA, USA
| | - Diane G Cope
- Florida Cancer Specialists & Research Institute, Fort Myers, FL, USA
| | - Huiyan Ma
- City of Hope, Division of Biomarkers of Early Detection and Prevention, Department of Population Sciences, Duarte, CA, USA
| | - Nora Ruel
- City of Hope, Department of Computational and Quantitative Medicine, Duarte, CA, USA
| | - Louise Sharpe
- University of Sydney, School of Psychology, Sydney, Australia
| | - Sunita K Patel
- City of Hope, Divisions of Outcomes and Psychology, Departments of Population Sciences and Supportive Medicine, Duarte, CA, USA
| | - Mihaela Cristea
- City of Hope National Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA, USA
| | - Marianna Koczywas
- City of Hope National Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA, USA
| | - Betty Ferrell
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
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9
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Wu QL, Street RL. The Communicative Ecology of Chinese Patients' Experiences with Health Care. JOURNAL OF HEALTH COMMUNICATION 2020; 25:463-473. [PMID: 32716729 DOI: 10.1080/10810730.2020.1789245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patient satisfaction and trust are important intermediate outcomes along pathways linking clinician-patient communication to improve well-being, but they are difficult to achieve in Chinese health care. Problematic physician-patient interactions, questionable health-care organizational practices, and media coverage of medical scandals may have contributed to this problem. Nevertheless, there isscant literature documenting reasons underlying dissatisfaction with Chinese health care. Using Street's ecological model of communication in medical encounters as a conceptual framework, this study explores how media and organizational factors affect Chinese patients' satisfaction and trust both directly and as mediated by the quality of patients' past communication experiences with clinicians. A survey was conducted among 257 Ob-gyn patients in a top-tier hospital in Sichuan, China. The results show that several organizational and media factors, along with patients' experiences with physician communication, predict patient satisfaction and trust. Perceptions of physician communication mediated some of the relationships between organizational and media factors with outcomes. Theoretical and practical implications are discussed, particularly with respect to improving health-care services in China.
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Affiliation(s)
- Qiwei L Wu
- Department of Communication, Texas A&M University , College Station, Texas, USA
| | - Richard L Street
- Department of Communication, Texas A&M University , College Station, Texas, USA
- Department of Medicine, Baylor College of Medicine , Houston, Texas, USA
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10
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Tauber NM, O'Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, Maheu C, Ozakinci G, Prins J, Sharpe L, Smith AB, Thewes B, Simard S, Zachariae R. Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis. J Clin Oncol 2019; 37:2899-2915. [PMID: 31532725 PMCID: PMC6823887 DOI: 10.1200/jco.19.00572] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis. METHODS We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514). RESULTS A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges’s g) were found both at postintervention (g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up (g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs (g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = −.01; 95% CI, −.01 to −.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR. CONCLUSION Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition—for example, worry, rumination, and attentional bias—rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients’ FCR presentation.
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Affiliation(s)
- Nina M Tauber
- Aarhus University, Aarhus, Denmark.,International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada
| | | | - Andreas Dinkel
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Technical University of Munich, Munich, Germany
| | - Jacqueline Galica
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Gerry Humphris
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of St Andrews, St Andrews, United Kingdom
| | - Sophie Lebel
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Maheu
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,McGill University, Montréal, Québec, Canada
| | - Gozde Ozakinci
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of St Andrews, St Andrews, United Kingdom
| | - Judith Prins
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Louise Sharpe
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Sydney, Sydney, NSW, Australia
| | - Allan Ben Smith
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Ingham Institute for Applied Medical Research and University of New South Wales, Sydney, NSW, Australia
| | - Belinda Thewes
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Sydney, Sydney, NSW, Australia
| | - Sébastien Simard
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Robert Zachariae
- Aarhus University, Aarhus, Denmark.,International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Aarhus University Hospital, Aarhus, Denmark
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11
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Systematic review of interventions by non-mental health specialists for managing fear of cancer recurrence in adult cancer survivors. Support Care Cancer 2019; 27:4055-4067. [DOI: 10.1007/s00520-019-04979-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
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Wittenberg E, Reb A, Kanter E. Communicating with Patients and Families Around Difficult Topics in Cancer Care Using the COMFORT Communication Curriculum. Semin Oncol Nurs 2018; 34:264-273. [PMID: 30100368 DOI: 10.1016/j.soncn.2018.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To examine nurse communication in cancer care and offer communication strategies for quality palliative care nursing. DATA SOURCES Communication strategies offered are based on the COMFORT Communication curriculum, an evidence-based communication training program. CONCLUSION Whole-patient assessment, a major component of palliative care, involves communication that includes eliciting the patient's story, addressing health literacy needs, being mindful of burnout, and relating to the patient and family. IMPLICATIONS FOR NURSING PRACTICE Quality communication skills are essential to oncology nursing, especially given their vital role in cancer care.
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Economou D, Reb A. Communication Concerns When Transitioning to Cancer Survivorship Care. Semin Oncol Nurs 2017; 33:526-535. [DOI: 10.1016/j.soncn.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cheng KKF, Lim YTE, Koh ZM, Tam WWS. Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database Syst Rev 2017; 8:CD011152. [PMID: 28836379 PMCID: PMC6483678 DOI: 10.1002/14651858.cd011152.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both. OBJECTIVES To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors. SEARCH METHODS In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of the review. MAIN RESULTS We included 22 RCTs and four quasi-RCTs on 2272 participants. We categorised the intervention components into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Most of the studies used usual care (routine medical follow-up services) as the comparator. A few studies used a lower level or different type of intervention (e.g. stress management or exercise) or attention control as the comparator.We used the Functional Assessment of Cancer Therapy-Breast (FACT B), European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC C30), Quality of Life (QoL) Breast Cancer, and SF36 questionnaires to assess quality of life. HBMS programmes may increase breast cancer-specific quality of life and global quality of life immediately after the intervention, as measured by FACT-B and EORTC C30 (FACT-B: mean difference (MD) 4.55, 95% confidence interval (CI) 2.33 to 6.78, 7 studies, 764 participants; EORTC: MD 4.38, 95% CI 0.11 to 8.64, 6 studies; 299 participants; moderate-quality evidence). There was no evidence of a difference in quality of life as measured by QoL-Breast Cancer or SF-36 (QoL-Breast Cancer: MD 0.42, 95% CI -0.02 to 0.85, 2 studies, 111 participants, very low-quality evidence; physical composite score SF36: MD 0.55, 95% CI -3.52 to 4.63, 2 studies, 308 participants, low-quality evidence).We observed a similar pattern at one to three months after the intervention: FACT-B (MD 6.10, 95% CI 2.48 to 9.72, 2 studies, 426 participants), EORTC-C30 (MD 6.32, 95% CI 0.61 to 12.04, 2 studies; 172 participants) and QoL-Breast Cancer (MD 0.45, 95% CI -0.19 to 1.09, 1 study, 61 participants). At four to six months and 12 months, there was no evidence of a difference in quality of life between groups (four to six months: EORTC - MD 0.08, 95% CI -7.28 to 7.44, 2 studies; 117 participants; SF-36 - MD -1.05, 95% CI -5.60 to 3.51, 2 studies, 308 participants; 12 months: EORTC - MD 2.04, 95% CI -9.91 to 13.99, 1 study; 57 participants).Functional status was incorporated into the quality of life subscale findings. HBMS programmes may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) -1.01, 95% CI -1.94 to -0.08, 5 studies, 253 participants, low-quality evidence) compared to control immediately after the intervention but the effect did not persist at four to six months. There was no evidence of improvements in depression immediately after HBMS (MD of HADS -1.36, 95% CI -2.94 to 0.22, 4 studies, 213 participants, low-quality evidence) or at follow-up. HBMS programmes may also decrease fatigue (MD -1.11, 95% CI -1.78 to -0.45, 3 studies, 127 participants; low-quality evidence) and insomnia (MD -1.81, 95% CI -3.34 to -0.27, 3 studies, 185 participants, low-quality evidence).None of the included studies reported service needs and utilisation and cost of care, and therefore the effect of HBMS programmes on healthcare utilisation and cost is unknown. Due to the variations in assessment methods of adherence among the eight studies, we could not combine the results for meta-analysis. We synthesised the results narratively, with the reported adherence rates of 58% to 100%. AUTHORS' CONCLUSIONS The results of this systematic review and meta-analysis revealed that HBMS programmes in breast cancer survivors appear to have a short-term beneficial effect of improving breast cancer-specific quality of life and global quality of life as measured by FACT-B and EORTC-C30, respectively. In addition, HBMS programmes are associated with a reduction in anxiety, fatigue and insomnia immediately after the intervention. We assessed the quality of evidence across studies as moderate for some outcomes, meaning that we are fairly confident about the results, while we assessed other outcomes as being low-quality, meaning that we are uncertain about the result.
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Affiliation(s)
- Karis Kin Fong Cheng
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Yee Ting Ethel Lim
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Zhi Min Koh
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Wilson Wai San Tam
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
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Abstract
BACKGROUND Body image is a complex issue with the potential to impact many aspects of cancer survivorship, particularly for the younger breast cancer survivor. OBJECTIVE The purpose of this review is to synthesize the current state of the science for body image in younger women with breast cancer. METHODS Combinations of the terms "body image," "sexuality intervention," "women," "younger women," and "breast cancer" were searched in the PubMed, PsycINFO, CINAHL, Web of Knowledge, and Science Direct databases through January 2014. Inclusion criteria for this review were (1) original research, (2) published in English from the year 2000 forward, (3) measuring body image as an outcome variable, and (4) results included reporting of age-related outcomes. RESULTS Thirty-six articles met the inclusion criteria. The majority of studies were cross-sectional, with extensive variation in body image assessment tools. Age and treatment type had a significant impact on body image, and poorer body image was related to physical and psychological distress, sex and intimacy, and the partnered relationship among younger women. Only 1 intervention study found a significant improvement in body image after intervention. CONCLUSIONS Findings suggest body image is a complex posttreatment concern for breast cancer survivors, particularly younger women. The findings of this review are limited by the high level of variation in the methods for assessing body image. IMPLICATIONS FOR PRACTICE Further research of interventions to address body image concerns following treatment for breast cancer is warranted. Improvement of body image may improve the quality of life of younger breast cancer survivors.
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Gemmiti M, Hamed S, Wildhaber J, Pharisa C, Klumb PL. Pediatric Consultations: Negative-Word Use and Parent Satisfaction. J Pediatr Psychol 2017; 42:1165-1174. [DOI: 10.1093/jpepsy/jsx061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 02/19/2017] [Indexed: 12/30/2022] Open
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Dawson G, Madsen L, Dains J. Interventions to Manage Uncertainty and Fear of Recurrence in Female Breast Cancer Survivors: A Review of the Literature. Clin J Oncol Nurs 2016; 20:E155-E161. [DOI: 10.1188/16.cjon.e155-e161] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Maheu C, Lebel S, Courbasson C, Lefebvre M, Singh M, Bernstein LJ, Muraca L, Benea A, Jolicoeur L, Harris C, Ramanakumar AV, Ferguson S, Sidani S. Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer. BMC Cancer 2016; 16:291. [PMID: 27112319 PMCID: PMC4845394 DOI: 10.1186/s12885-016-2326-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/20/2016] [Indexed: 01/31/2023] Open
Abstract
Background Clinically significant levels of fear of cancer recurrence (FCR) affect up to 49 % of cancer survivors and are more prevalent among women. FCR is associated with psychological distress, lower quality of life, and increased use of medical resources. Despite its prevalence, FCR is poorly addressed in clinical care. To address this problem, we first developed, and pilot tested a 6-week, 2 h, Cognitive-existential group intervention therapy that targeted FCR in survivors of breast or gynecological cancer. Following the positive outcome of the pilot, we are now testing this approach in a randomized clinical trial (RCT). Goal and hypotheses: This multicenter, prospective RCT aims to test the efficacy of the intervention. The study hypotheses are that, compared to a control group, cancer survivors participating in the intervention (1) will have less FCR, (2) will show more favorable outcomes on the following measures: cancer-specific distress, quality of life, illness uncertainty, intolerance of uncertainty, perceived risk of cancer recurrence, and coping skills. We further postulate that the between-group differences will persist three and 6 months post-intervention. Methods Sixteen groups of seven to nine women are being allocated to the intervention or the control group. The control group receives a 6-week, 2 h, structurally equivalent support group. We are recruiting 144 cancer survivors from four hospital sites in three Canadian cities. The sample size was based on the moderate pre/post-test changes found in our pilot study and adjusted to the drop-out rates. Measurements: The primary outcome, FCR, is measured by the Fear of Cancer Recurrence Inventory. Secondary outcomes measured include cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, coping, and quality of life. We use reliable and recognized valid scales. Participants are to complete the questionnaire package at four times: before the first group session (baseline), immediately after the sixth session, and 3 and 6 months post-intervention. Analysis: In the descriptive analysis, comparison of group equivalent baseline variables, identification of confounding/intermediate variables and univariate analysis are planned. Each participant’s trajectory is calculated using Generalized Estimating Equation models to determine the time and group effects, after considering the correlation structures of the groups. An intent-to-treat analysis approach may be adopted. Discussion Our Fear of Recurrence Therapy (FORT) intervention has direct implications for clinical service development to improve the quality of life for patients with breast (BC) and gynecological cancer (GC). Based on our pilot data, we are confident that the FORT intervention can guide the development of effective psychosocial cancer survivorship interventions to reduce FCR and improve psychological functioning among women with BC or GC. Trial registration Dr. Christine Maheu registered the trial with ISRCTN registry (Registration number: ISRCTN83539618, date assigned 03/09/2014).
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Affiliation(s)
- Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, Quebec, J7V 0E2, Canada. .,Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada.
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Christine Courbasson
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | - Monique Lefebvre
- Department of Psychology and Psychosocial Oncology Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, K1H 8L6, Canada
| | - Mina Singh
- School of Nursing, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Lori J Bernstein
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada
| | - Linda Muraca
- Auxiliary Breast Health Program, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada
| | - Aronela Benea
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, M5S 1B2, Canada
| | - Lynne Jolicoeur
- Integrated Cancer Program, The Ottawa Hospital, Ottawa, Ontario, K1H 8L6, Canada
| | - Cheryl Harris
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | | | - Sarah Ferguson
- Obstetrics and Gynecology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, M5B 2K3, Canada
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Hefner J, Csef EJ, Kunzmann V. Fear of Progression in Outpatients With Chronic Myeloid Leukemia on Oral Tyrosine Kinase Inhibitors. Oncol Nurs Forum 2016; 43:190-7. [PMID: 26906130 DOI: 10.1188/16.onf.190-197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess fear of progression (FoP) in outpatients with chronic myeloid leukemia (CML) on oral tyrosine kinase inhibitors (TKIs).
DESIGN Prospective and descriptive.
SETTING A university-based outpatient cancer clinic in Wuerzburg, Germany.
SAMPLE 37 outpatients with CML on oral TKIs.
. METHODS FoP was assessed with a questionnaire. Clinical data were extracted from the medical charts.
. MAIN RESEARCH VARIABLES Frequency and contents of FoP.
FINDINGS Sum scores and levels of FoP in the sample population (N = 37) were as high as in cancer populations with more unfavorable life expectancies. Regarding single items, fear that medication may harm the body was most prevalent, regardless of group affiliation. The actual fear of disease progression was only ranked sixth out of 12 items for the total sample and was ranked second by the second-generation TKI group.
CONCLUSIONS In a sample of outpatients with CML, FoP was frequent and most often generated by fears of treatment side effects.
IMPLICATIONS FOR NURSING Nurses should be vigilant about FoP in this population. Established questionnaires may help to identify and evaluate this frequent source of distress. Specific communication could reveal unmet informational needs and may help to initiate interventions. Additional studies are needed to confirm the numbers in a larger cohort of patients, to examine the prevalence during the course of disease, to search for potential influences on the outcome (i.e., via adherence), and to extract the best interventions.
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Smith PR, Cope D, Sherner TL, Walker DK. Update on research-based interventions for anxiety in patients with cancer. Clin J Oncol Nurs 2015; 18 Suppl:5-16. [PMID: 25427605 DOI: 10.1188/14.cjon.s3.5-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anxiety may begin at the moment a person is diagnosed with cancer and may fluctuate throughout the cancer trajectory as physical illness improves or declines. The purpose of this article is to present current evidence for nurses to implement interventions to reduce anxiety in patients who have cancer. The PubMed and CINAHL® databases were searched to identify relevant citations addressing interventions that treat or prevent anxiety symptoms in patients with cancer. Based on available evidence, the interventions addressed herein are categorized according to the Putting Evidence Into Practice (PEP®) rating schema. Interventions include pharmacologic and nonpharmacologic approaches to care, and meet criteria for three PEP categories: likely to be effective, effectiveness not established (the largest category of results), or effectiveness unlikely.
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Affiliation(s)
- Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
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Palmer NRA, Weaver KE, Hauser SP, Lawrence JA, Talton J, Case LD, Geiger AM. Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer 2015; 23:3201-9. [PMID: 25821145 DOI: 10.1007/s00520-015-2706-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Despite recommendations for breast cancer survivorship care, African American women are less likely to receive appropriate follow-up care, which is concerning due to their higher mortality rates. This study describes differences in barriers to follow-up care between African American and White breast cancer survivors. METHODS We conducted a mailed survey of women treated for non-metastatic breast cancer in 2009-2011, 6-24 months post-treatment (N = 203). Survivors were asked about 14 potential barriers to follow-up care. We used logistic regression to explore associations between barriers and race, adjusting for covariates. RESULTS Our participants included 31 African American and 160 White survivors. At least one barrier to follow-up care was reported by 62 %. Compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03). After adjustment for covariates, African Americans were three times as likely to report at least one barrier to care (odds ratio (OR) = 3.3, 95 % confidence interval (CI) = 1.1-10.1). CONCLUSIONS Barriers to care are common among breast cancer survivors, especially African American women. Financial barriers to care may prevent minority and underserved survivors from accessing follow-up care. Enhancing insurance coverage or addressing out-of-pocket costs may help address financial barriers to follow-up care among breast cancer survivors. Psychosocial care aimed at reducing fear of recurrence may also be important to improve access among African American breast cancer survivors.
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Affiliation(s)
- Nynikka R A Palmer
- Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
| | - Kathryn E Weaver
- Social Science and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sally P Hauser
- General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Julia A Lawrence
- General Surgery, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Jennifer Talton
- Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - L Douglas Case
- Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ann M Geiger
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Rebuilding self-confidence after cancer: a feasibility study of life-coaching. Support Care Cancer 2014; 23:651-9. [PMID: 25160492 DOI: 10.1007/s00520-014-2399-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cancer survivors often experience decreased self-confidence which impacts negatively on their ability to self-manage the practical, social and emotional problems frequently faced as they emerge from end of treatment. This was a feasibility study of a life-coaching intervention, designed to rebuild confidence of survivors and support transition to life after cancer treatment. METHODS A one group pre-test, post-test design was used, recruiting participants from community organisations. Eligibility criteria are as follows: <1 year of completion of primary cancer treatment, aged >18, no metastases, and no mental health problems. Participants received one individualised face-to-face and five telephone coaching sessions over 3 months. Outcome measures are as follows: New General Self-Efficacy Scale, Hope Scale, Personal Well-being Index, Assessment of Survivorship Concerns, Quality of Life in Adult Cancer Survivors, Hospital Anxiety and Depression Scale, Social Difficulties Index, and a goal attainment score. Interviews explored feasibility, acceptability and impact of life-coaching and research design. RESULTS Nine women and two men were recruited, representing varying cancer diagnoses. All outcome measures were sensitive to change and indicated positive trends post-intervention. Participant interviews indicated the intervention was well received and had a positive impact. Lessons were learnt about study design, recruitment and intervention delivery. CONCLUSIONS Life-coaching has a potential to enable cancer survivors to manage the transition to life beyond cancer and effect change on a range of outcomes. The intervention was feasible to deliver and acceptable to survivors at a time when many struggle to make sense of life. It merits further evaluation through a randomised controlled trial.
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Lebel S, Maheu C, Lefebvre M, Secord S, Courbasson C, Singh M, Jolicoeur L, Benea A, Harris C, Fung MFK, Rosberger Z, Catton P. Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv 2014; 8:485-96. [PMID: 24756313 DOI: 10.1007/s11764-014-0357-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 03/20/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Evidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors. PURPOSE To develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer. METHODS This study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions. RESULTS A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up. CONCLUSION This brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life, and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy. IMPLICATIONS FOR CANCER SURVIVORS FCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important implications for all cancer survivors as it is the first published intervention that provides preliminary evidence of its efficacy in decreasing fear of cancer recurrence.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier, room 4016, Ottawa, Ontario, Canada, K1N6N5,
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Buriak SE, Potter J. Impact of an online survivorship primer on clinician knowledge and intended practice changes. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:114-21. [PMID: 24104208 DOI: 10.1007/s13187-013-0556-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The number of adult cancer survivors in the USA is expected to double by the year 2050. A call for increased survivorship care and provider training came from the Institute of Medicine (IOM) in the form of a landmark report in 2006. A shortage of physicians complicates the burden of survivorship care. The purpose of this effort was to design, develop, and evaluate a fully accredited, evidence-based continuing medical education (CME) and continuing education (CE) intervention to address the established knowledge gap for breast cancer, prostate cancer, colorectal cancer, and non-Hodgkin lymphoma survivorship education. Delivered through the Medscape Education (WebMD) platform, the course covered epidemiology, survivor issues, and currently available guidelines using illustrative patient cases. Knowledge gain was evaluated using a pretest-posttest design. Program evaluation was assessed by survey. Additional areas examined included post-intervention inquiry regarding expected changes to clinical practice. The results of this educational intervention demonstrated the effectiveness of internet-based CME/CE for cancer survivorship. Learning gain was significant (p < 0.0005). Effect size (d = 1.71) suggested extremely high practical significance, as the difference between the means was larger than 1 standard deviation. Significant knowledge gains were observed for each survivorship knowledge question across all clinical specialties studied. Nearly 100% of participants agreed that the course contributed to survivorship care and was organized effectively. Participants reported that the course was designed effectively (97.2%), and 68.1% responded in favor of adopting alternative communication strategies with patients and families upon completion of the course.
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Affiliation(s)
- Susan E Buriak
- A.T. Still University, 800 W Jefferson St, Kirksville, MO, 63501, USA,
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Traino HM. Communication self-efficacy, perceived conversational difficulty, and renal patients' discussions about transplantation. PATIENT EDUCATION AND COUNSELING 2014; 94:180-186. [PMID: 24280037 DOI: 10.1016/j.pec.2013.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/12/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Many patients with chronic and end-stage renal disease (ESRD) have reported difficulties initiating and managing discussions about kidney transplantation, particularly live donor transplantation (LDT). Limited communication has demonstrable impact on patients' access to transplantation, the duration of dialysis treatments, and the length of time awaiting a transplantable kidney. This formative study sought to identify the specific communicative and conversational elements impeding ESRD patients' discussions about transplantation to inform the design of an educational program facilitating transplant-related discussions. METHODS From March to July 2012, semi-structured telephone interviews (n=63) were conducted with ESRD patients waitlisted for kidney transplantation at one mid-Atlantic transplant center. RESULTS Although 85.7% (n=54) of patients reported holding discussions about transplantation, qualitative analyses of open-ended responses revealed that the majority (66.7%) had limited conversations. Patients reported difficulties managing a variety of logistical and content-related aspects of LDT discussions. Moderate levels of communication self-efficacy were also found (mean=19.2 out of 28); self-efficacy was highest among respondents having held discussions and was significantly related to perceived magnitude of difficulty handling conversational aspects. CONCLUSION Results support comprehensive communication skills training for ESRD patients awaiting kidney transplantation. PRACTICE IMPLICATIONS Potential topics to be included in such training are discussed.
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Affiliation(s)
- Heather M Traino
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, USA.
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How breast cancer survivors cope with fear of recurrence: a focus group study. Support Care Cancer 2013; 22:705-12. [PMID: 24193220 DOI: 10.1007/s00520-013-2025-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this qualitative study was to examine the ways in which breast cancer survivors cope with fear of recurrence. METHODS Three focus groups were held with breast cancer survivors. Focus group interviews were recorded, transcribed verbatim, and analyzed using qualitative techniques. Coding was done on two levels: styles and strategies. RESULTS Twenty-seven women participated. The majority of the women (74 %) were a little anxious, and some patients (11 %) were somewhat anxious about the possibility of cancer recurrence. Most women (74 %) indicated to think a few times a month about the possibility of cancer recurrence. Different coping styles were reported, but commonly, women (80 %) reported an emotion-focused coping strategy. About half of the women (49 %) used passive or avoidant coping styles. CONCLUSION The emotion-focused coping strategy was most commonly used. This information can be used to provide tailored psychosocial care.
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Lourens M. An exploration of Xhosa speaking patients' understanding of cancer treatment and its influence on their treatment experience. J Psychosoc Oncol 2013; 31:103-21. [PMID: 23311974 DOI: 10.1080/07347332.2012.741091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cultural beliefs often influence people in seeking appropriate health care. In South Africa, misperceptions and fear about medical interventions contribute to the fact that many indigenous people prefer to make use of traditional healers. This qualitative study explores Xhosa patients' perception of cancer and cancer treatment modalities, and their need for support. Language creates an image of the unknown to which people attach meaning. Oncology social workers play an important role in educating people about cancer and the treatment thereof, as doctors seldom have time to deal with the psychosocial aspects of cancer. Health care providers need to be sensitive to patients' perceptions to render the best possible cancer care.
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Moore PM, Rivera Mercado S, Grez Artigues M, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2013; 2013:CD003751. [PMID: 23543521 PMCID: PMC6457800 DOI: 10.1002/14651858.cd003751.pub3] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction. SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.
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Affiliation(s)
- Philippa M Moore
- Family Medicine, P. Universidad Catolica de Chile, Lira 44, Santiago, Chile.
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Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv 2013; 7:300-22. [DOI: 10.1007/s11764-013-0272-z] [Citation(s) in RCA: 537] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 02/16/2013] [Indexed: 12/31/2022]
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Nielsen BK, Mehlsen M, Jensen AB, Zachariae R. Cancer-related self-efficacy following a consultation with an oncologist. Psychooncology 2013; 22:2095-101. [PMID: 23463726 DOI: 10.1002/pon.3261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 01/21/2013] [Accepted: 01/27/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE When receiving a cancer diagnosis, patients are often faced with psychological distress and loss of control. As a result, their psychological well-being may be influenced by their perceived ability to cope with disease-related and treatment-related challenges. Research indicates that the patient-oncologist relationship may have an impact on patients' self-efficacy. The aim was to examine predictors of self-efficacy following a consultation in an oncology outpatient clinic and the predictors of change. METHODS A total of 226 patients (mean age: 61 years, 40% male) attending an oncology outpatient clinic completed questionnaires before and after a consultation including the Hospital Anxiety and Depression Scale, two domain-specific self-efficacy scales measuring coping self-efficacy and decision self-efficacy, the Physician-Patient Relationship Inventory, and the Information Satisfaction Questionnaire. RESULTS While most patients experienced an increase in self-efficacy following the consultation, some patients experienced lower self-efficacy post-consultation. In the multivariate analysis, depressive symptoms emerged as a relatively strong predictor of both coping self-efficacy and decision self-efficacy, whereas marital status was a significant predictor of coping self-efficacy, and satisfaction with information significantly predicted decision self-efficacy. No significant associations were found between self-efficacy and the patients' ratings of the physician-patient relationship. CONCLUSION Depression seems to be a potential risk factor for lower cancer-related self-efficacy, following an oncologist consultation. By identifying patients who exhibit symptoms of depression, health professionals can increase their attention on empowering these patients. Furthermore, our results suggest that patients' experience of self-efficacy depends on what particular challenges they have to overcome.
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Affiliation(s)
- Berit Kjaerside Nielsen
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
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Henselmans I, de Haes HCJM, Smets EMA. Enhancing patient participation in oncology consultations: a best evidence synthesis of patient-targeted interventions. Psychooncology 2012; 22:961-77. [DOI: 10.1002/pon.3099] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/16/2012] [Accepted: 04/06/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Hanneke C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
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Fischer MJ, Krol-Warmerdam EMM, Ranke GMC, Zegers MHW, Aeijelts Averink R, Scholten AN, Kaptein AA, Nortier HWR. Routine Monitoring of Quality of Life for Patients with Breast Cancer: An Acceptability and Field Test. J Psychosoc Oncol 2012; 30:239-59. [DOI: 10.1080/07347332.2011.644398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bylund CL, Goytia EJ, D'Agostino TA, Bulone L, Horner J, Li Y, Kemeny M, Ostroff JS. Evaluation of a pilot communication skills training intervention for minority cancer patients. J Psychosoc Oncol 2011; 29:347-358. [PMID: 21966720 PMCID: PMC4322131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this study was to pilot test in a minority cancer patient population a communication workshop to improve doctor-patient communication skills. Thirty-two patients participated. Eighteen evaluated a face-to-face workshop, while 14 completed surveys only. Participants in the workshop group completed the Patient Report of Communication Behavior (PRCB) before and after the workshop and a course evaluation. Participants did not differ on baseline PRCB scores. Posttest scores were significantly higher than pretest scores (p < 0.01). All participants agreed or strongly agreed that they would use the communication skills; 93% agreed or strongly agreed that the skills would improve their health care.
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Affiliation(s)
- Carma L Bylund
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, USA.
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