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Thomas TH, Murray PJ, Rosenzweig M, Taylor S, Brufsky A, Bender C, Larkin M, Schenker Y. "I was never one of those people who just jumped right in for me": patient perspectives on self-advocacy training for women with advanced cancer. Support Care Cancer 2023; 31:96. [PMID: 36598659 PMCID: PMC9811054 DOI: 10.1007/s00520-022-07531-3] [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: 03/24/2022] [Accepted: 11/19/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Patients with advanced cancer experience many complicated situations that can make self-advocacy (defined as the ability speak up for yourself in the face of a challenge) difficult. Few self-advocacy interventions exist, and most are atheoretical with minimal patient engagement. The purpose of this study is to describe participant perspectives of a novel, self-advocacy serious game intervention called Strong Together. METHODS This was a qualitative cross-sectional descriptive study among women receiving cancer care at an academic cancer center within 3 months of an advanced gynecologic or breast cancer diagnosis. Participants randomized to receive the intervention completed one-on-one semi-structured interviews 3-months post Strong Together and had the option to share voice journals about their experiences. Inductive qualitative approaches were used to descriptively analyze transcripts and voice journals. Descriptive content analysis approaches were used to group similar codes together into themes summarizing participants' experiences engaging with the Strong Together intervention. RESULTS Participants (N = 40) reported that the Strong Together intervention was acceptable, noting that it was realistic and reflective of their personal experiences. Overarching themes included seeing myself in most scenarios and wanting more content; giving me the go ahead to expect more; offering ideas for how to stand up for myself; reinforcing what I am already doing; and reminding me of what I have. Participants suggested adding additional content including diverse characters. CONCLUSION This study demonstrated that women with advanced cancer were receptive to a self-advocacy skills-building intervention. Future research should explore the mechanisms linking serious games to learning and health outcomes.
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Affiliation(s)
- Teresa Hagan Thomas
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA ,Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA
| | - Patty Jo Murray
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA
| | - Margaret Rosenzweig
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA ,Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA ,University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA
| | - Sarah Taylor
- University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA ,Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of Pittsburgh, 1218 Scaife Hal, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Adam Brufsky
- University of Pittsburgh Medical Center Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213 USA ,Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, 1218 Scaife Hal, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Catherine Bender
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Suite 440, Pittsburgh, PA 15261 USA
| | - Mikayla Larkin
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA 15219 USA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA ,Division of General Internal Medicine, School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 USA
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Psychosocial protective interventions associated with a better quality of life and psychological wellbeing for African American/Black female breast cancer survivors: an integrative review. Support Care Cancer 2022; 30:1093-1114. [PMID: 34417643 PMCID: PMC8787847 DOI: 10.1007/s00520-021-06425-0] [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: 03/16/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE This integrative review provides an overview of current psychosocial interventions and qualitative studies exploring African American Breast Cancer Survivors (AABCS)' psychosocial wellbeing. METHODS We conducted a search of five databases: PubMed, Academic Search Ultimate, CINAHL, PsycINFO, and Web of Science. Peer-reviewed articles written in English and published from 2011 to May 26, 2021 were included. We critically appraised intervention studies and qualitative studies using established frameworks. RESULTS Of the 633 unique studies identified, seven interventions and twenty-one qualitative studies were included. Analysis of the interventions revealed the importance of alleviating structural barriers and facilitating peer support for AABCS. Analysis of the qualitative studies revealed seven themes: (1) spirituality/religion, (2) social support, (3) cultural perceptions of BC, (4) lack of representation, (5) negative impacts of treatment, (6) healthcare system experience, and (7) barriers to psychosocial care. CONCLUSIONS This review highlights the dearth of psychosocial interventions created specifically for AABCS. The qualitative literature in this review elucidates the unique psychosocial challenges that AABCS experience, providing rich data to inform the creation of future culturally competent interventions in this population. IMPLICATIONS FOR CANCER SURVIVORS This review found spirituality and social support to be protective factors for AABCS' psychosocial wellbeing. Further research using rigorous methodologies is needed to further evaluate how to most effectively alleviate structural barriers that AABCS face in obtaining long-term support.
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Palmer Kelly E, Meara A, Hyer M, Payne N, Pawlik TM. Understanding the Type of Support Offered Within the Caregiver, Family, and Spiritual/Religious Contexts of Cancer Patients. J Pain Symptom Manage 2019; 58:56-64. [PMID: 30878299 DOI: 10.1016/j.jpainsymman.2019.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT/OBJECTIVES We sought to characterize patterns of social support types (i.e., emotional, informational, appraisal, and instrumental) within the caregiver/spouse, family, and spiritual/religious contexts for patients diagnosed with cancer. METHODS Focus groups were conducted with mixed groups of patients with cancer and caregiver/family members at a Midwestern comprehensive cancer center. Participants completed brief demographic questionnaires. Focus groups were moderated using semistructured interviews. The 90-minute discussions were audio-recorded, transcribed, and uploaded into NVivo for analysis using a deductive approach based on four social support types and the constant comparative method. RESULTS Four focus groups were conducted (n = 25). The average age was 58.4 years (SD = 15.1, range 26.0-76.0). Patient participants reported different malignancy types, including breast, gynecologic, skin, oral, and Non-Hodgkin's lymphoma. Participants acknowledged changes within their social network across the cancer journey. Overall, the caregiver/spouse fulfilled all types of social support. Spirituality/religion was often discussed as a form of appraisal social support. Fellow survivors were sources of informational support. Across groups, nondirective/emotional support was most frequently mentioned. CONCLUSION Cancer is a unique experience, and understanding the importance of social support, including types of social support needed from different contexts to best meet the needs of the patient, may promote optimal, patient-centered care across the cancer trajectory.
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Affiliation(s)
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Nicolette Payne
- The Ohio State University College of Medicine, Columbus, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA.
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Nolan TS, Ivankova N, Carson TL, Spaulding A, Davies S, Enah C, Meneses K. Perceptions of a Breast Cancer Survivorship Intervention: Pearls of Wisdom from Young African American Women. J Adolesc Young Adult Oncol 2018; 8:165-171. [PMID: 30407099 DOI: 10.1089/jayao.2018.0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE African American (AA) women ages 20-44 develop breast cancer at higher rates compared with Caucasian women. These young survivors (<45 years) also have disparate quality of life (QOL). Little is known about survivorship information needs of young AA survivors. The purpose of this study was to explore young AA survivors' perceptions of an existing QOL intervention for breast cancer survivors, identifying information needs to address using a targeted intervention. METHODS Two semistructured interviews were conducted with each of 15 young AA survivors who had completed breast cancer treatment. This article focuses on the second interview in which young AA survivors reviewed intervention materials and described their perceptions of the intervention. Content analysis was used to identify themes, which were validated by participants. RESULTS Participants (n: 15; mean age at study entry: 35 years) reported that the existing evidence-based intervention discussed relevant but general survivorship information. They suggested adapting the information for young AA survivors: addition of content geared toward finances, how to better communicate to manage dating and relationships, how to engage in healthful activities, and how to find local resources for any stage of survivorship. Furthermore, they suggested multiple modes of information delivery and inclusion of diverse imagery. CONCLUSION Engaging young AA survivors yielded pearls of wisdom, highlighting the general nature of an existing intervention and suggesting adaptations to meet young AA survivors' information needs. Applying such pearls can be a powerful method to target survivorship interventions for this disparate group of cancer survivors.
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Affiliation(s)
- Timiya S Nolan
- 1 College of Nursing, The Ohio State University , Columbus, Ohio
| | - Nataliya Ivankova
- 2 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
| | - Tiffany L Carson
- 3 School of Medicine, and University of Alabama at Birmingham , Birmingham, Alabama
| | - Amelia Spaulding
- 1 College of Nursing, The Ohio State University , Columbus, Ohio
| | - Susan Davies
- 4 School of Public Health, University of Alabama at Birmingham , Birmingham, Alabama
| | - Comfort Enah
- 2 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
| | - Karen Meneses
- 2 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama
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An Integrative Review of Psychosocial Concerns Among Young African American Breast Cancer Survivors. Cancer Nurs 2018; 41:139-155. [DOI: 10.1097/ncc.0000000000000477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Pettiford J, Felts S, Wischkaemper E, Miller D, Crawford S, Layeequr Rahman R. A Bio-Psychosocial Intervention Program for Improving Quality of Life in Breast Cancer Survivors - Final Outcome of a Prospective Randomized Trial. Breast J 2017; 23:537-544. [PMID: 28233921 DOI: 10.1111/tbj.12786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Given the 3.1 million breast cancer survivors in America, quality of life (QoL) is a vital issue. Bio-psychosocial milieu of survivorship is increasingly important. This study assesses the impact of Bio-psychosocial Intervention (BPSI) on the QoL of breast cancer survivors utilizing Functional Assessment of Cancer Therapy - Breast (FACT-B) instrument. A prospective randomized trial was designed; intervention arm included a 4-hour BPSI coping skills class; control arm received standard of cancer and follow-up care (SOC). Women diagnosed within 2 years of study initiation were eligible. Sample size was based on 8-point difference in FACT-B score, 90% power, 5% type I error, and 20% attrition. FACT-B questionnaire was administered to all patients at baseline and at 6-month intervals. SAS 9.3 software was used to analyze data using Chi-square test for categorical and Wilcoxon rank sum for ordinal data; linear mixed modeling was used for longitudinal analysis. One-hundred and three of 120 (86%) patients were available for analysis. Forty-seven patients were in BSPI arm, and 56 received SOC. For BPSI arm versus SOC arm, the median (interquartile) age (60 [52.68] versus 58 [52.68] years, p = 0.9135), cancer-stage (0:1:2:3 = 11%:41%:35%:13% versus 18%:46%:22%:15%, p = 0.4645), and biology (ER+:triple negative:HER2+ = 74%:9%:16% versus 72%:7%:20%, p = 0.8454), respectively, was similar. Median (25th to 75th centile) FACT-B scores in BPSI versus SOC arms at baseline were 109 (95.121) versus 112 (95, 122) (p = 0.6125); mean (SE) change since baseline at 6, 12, 18, and 24 months was: 7.42 (2.22) versus 7.04 (1.97) (p = 0.8862); 17.0 (2.64) versus -6.09 (2.37) (p < 0.0001); 16.03 (2.53) versus 3.58 (2.29) (p = 0.0004), and 15.48 (1.89) versus 16.4 (1.71) (p = 0.7966), respectively. The inter-group differences remained after adjusting for confounding variables at baseline. The p-value for interaction among groups over 2 years remained <0.0001 except for breast cancer specific concerns. BPSI coping skills class significantly improved the QoL of breast cancer survivors by 1 year post-intervention time point; this difference narrowed at 18 months and disappeared at 24 months.
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Affiliation(s)
- Janine Pettiford
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Sharon Felts
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Edna Wischkaemper
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Debbie Miller
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Sybil Crawford
- University of Massachusetts Medical School, Worcester, Massachusetts
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