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Palmer JA, Mccullough M, Wormwood J, Soylemez Wiener R, Mesfin N, Still M, Xu CS, Linsky AM. Addressing clinician moral distress: Implications from a mixed methods evaluation during Covid-19. PLoS One 2023; 18:e0291542. [PMID: 37713379 PMCID: PMC10503769 DOI: 10.1371/journal.pone.0291542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
Clinician moral distress has been documented over the past several decades as occurring within numerous healthcare disciplines, often in relation to clinicians' involvement in patients' end-of-life decision-making. The resulting harms impact clinician well-being, patient well-being, and healthcare system functioning. Given Covid-19's catastrophic death toll and associated demands on end-of-life decision-making processes, the pandemic represents a particularly important context within which to understand clinician moral distress. Thus, we conducted a convergent mixed methods study to examine its prevalence, associations with clinicians' demographic and professional characteristics, and contributing circumstances among Veterans Health Administration (VA) clinicians. The study, conducted in April 2021, consisted of a cross-sectional on-line survey of VA clinicians at 20 VA Medical Centers with professional jurisdiction to place life-sustaining treatment orders working who were from a number of select specialties. The survey collected quantitative data on respondents' demographics, clinical practice characteristics, attitudes and behaviors related to goals of care conversations, intensity of moral distress during "peak-Covid," and qualitative data via an open-ended item asking for respondents to describe contributing circumstances if they had indicated any moral distress. To understand factors associated with heightened moral distress, we analyzed quantitative data using bivariate and multivariable regression analyses and qualitative data using a hybrid deductive/inductive thematic approach. Mixed methods analysis followed, whereby we compared the quantitative and qualitative datasets and integrated findings at the analytic level. Out of 3,396 eligible VA clinicians, 323 responded to the survey (9.5% adjusted response rate). Most respondents (81%) reported at least some moral distress during peak-Covid. In a multivariable logistic regression, female gender (OR 3.35; 95% CI 1.53-7.37) was associated with greater odds of moral distress, and practicing in geriatrics/palliative care (OR 0.40; 95% CI 0.18-0.87) and internal medicine/family medicine/primary care (OR 0.46; 95% CI 0.22-0.98) were associated with reduced odds of moral distress compared to medical subspecialties. From the 191 respondents who completed the open-ended item, five qualitative themes emerged as moral distress contributors: 1) patient visitation restrictions, 2) anticipatory actions, 3) clinical uncertainty related to Covid, 4) resource shortages, and 5) personal risk of contracting Covid. Mixed methods analysis found that quantitative results were consistent with these last two qualitative themes. In sum, clinician moral distress was prevalent early in the pandemic. This moral distress was associated with individual-, system-, and situation-level contributors. These identified contributors represent leverage points for future intervention to mitigate clinician moral distress and its negative outcomes during future healthcare crises and even during everyday clinical care.
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Affiliation(s)
- Jennifer A. Palmer
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Megan Mccullough
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Medical Center, Bedford, Massachusetts, United States of America
- University of Massachusetts, Lowell, Massachusetts, United States of America
| | - Jolie Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Medical Center, Bedford, Massachusetts, United States of America
- University of New Hampshire, Durham, New Hampshire, United States of America
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Nathan Mesfin
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Michael Still
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Chris S. Xu
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Amy M. Linsky
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, United States of America
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Mesfin N, Wormwood J, Wiener RS, Still M, Xu CS, Palmer J, Linsky AM. Impact of the COVID-19 Pandemic on Providing Recommendations During Goals-of-Care Conversations: A Multisite Survey. J Palliat Med 2023; 26:951-959. [PMID: 36944150 PMCID: PMC10398728 DOI: 10.1089/jpm.2022.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 03/23/2023] Open
Abstract
Background: Goals-of-care conversations (GoCCs) are essential for individualized end-of-life care. Shared decision-making (SDM) that elicits patients' goals and values to collaboratively make life sustaining treatment (LST) decisions is best practice. However, it is unknown how the COVID-19 pandemic onset and associated changes to care delivery, stress on providers, and clinical uncertainty affected SDM and recommendation-making during GoCCs. Aim: To assess providers' attitudes and behaviors related to GoCCs during the COVID-19 pandemic and identify factors associated with provision of LST recommendations. Design: Survey of United States Veterans Health Administration (VA) health care providers. Setting/Participants: Health care providers from 20 VA facilities with high COVID-19 caseloads early in the pandemic who had authority to place LST orders and practiced in select specialties (n = 3398). Results: We had 323 respondents (9.5% adjusted response rate). Most were age ≥50 years (51%), female (63%), non-Hispanic white (64%), and had ≥1 GoCC per week during peak-COVID-19 (78%). Compared with pre-COVID-19, providers believed it was less appropriate and felt less comfortable giving an LST recommendation during peak-COVID-19 (p < 0.001). One-third (32%) reported either "never" or "rarely" giving an LST recommendation during GoCCs at peak-COVID-19. In adjusted regression models, being a physician and discussing patients' goals and values were positively associated with giving an LST recommendation (B = 0.380, p = 0.031 and B = 0.400, p < 0.001, respectively) at peak-COVID-19. Conclusion: Providers who discuss patients' preferences and values are more likely to report giving a recommendation; both behaviors are markers of SDM during GoCCs. Our findings suggest potential areas for training in conducting patient-centered GoCCs.
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Affiliation(s)
- Nathan Mesfin
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jolie Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
- University of New Hampshire, Durham, New Hampshire, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael Still
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Chris S. Xu
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer Palmer
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Amy M. Linsky
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Seitzman RL, Pushkin J, Berg WA. Effect of an Educational Intervention on Women's Health Care Provider Knowledge Gaps About Breast Cancer Risk Model Use and High-risk Screening Recommendations. JOURNAL OF BREAST IMAGING 2023; 5:30-39. [PMID: 38416962 DOI: 10.1093/jbi/wbac072] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To assess effectiveness of a web-based educational intervention on women's health care provider knowledge of breast cancer risk models and high-risk screening recommendations. METHODS A web-based pre- and post-test study including 177 U.S.-based women's health care providers was conducted in 2019. Knowledge gaps were defined as fewer than 75% of respondents answering correctly. Pre- and post-test knowledge differences (McNemar test) and associations of baseline characteristics with pre-test knowledge gaps (logistic regression) were evaluated. RESULTS Respondents included 131/177 (74.0%) physicians; 127/177 (71.8%) practiced obstetrics/gynecology. Pre-test, 118/177 (66.7%) knew the Gail model predicts lifetime invasive breast cancer risk; this knowledge gap persisted post-test [(121/177, 68.4%); P = 0.77]. Just 39.0% (69/177) knew the Gail model identifies women eligible for risk-reducing medications; this knowledge gap resolved. Only 48.6% (86/177) knew the Gail model should not be used to identify women meeting high-risk MRI screening guidelines; this deficiency decreased to 66.1% (117/177) post-test (P = 0.001). Pre-test, 47.5% (84/177) knew the Tyrer-Cuzick model is used to identify women meeting high-risk screening MRI criteria, 42.9% (76/177) to predict BRCA1/2 pathogenic mutation risk, and 26.0% (46/177) to predict lifetime invasive breast cancer risk. These knowledge gaps persisted but improved. For a high-risk 30-year-old, 67.8% (120/177) and 54.2% (96/177) pre-test knew screening MRI and mammography/tomosynthesis are recommended, respectively; 19.2% (34/177) knew both are recommended; and 53% (94/177) knew US is not recommended. These knowledge gaps resolved or reduced. CONCLUSION Web-based education can reduce important provider knowledge gaps about breast cancer risk models and high-risk screening recommendations.
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Affiliation(s)
| | | | - Wendie A Berg
- DenseBreast-info, Inc, Deer Park, NY, USA
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA, USA
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Chen B, Luo T, Cai Q, Pan F, Liang D, Hu Y. Effect of Psychological Intervention-Assisted Comfort Nursing Based on PERMA Model on Stress and Psychological Changes of Patients after Breast Cancer Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1853754. [PMID: 35712008 PMCID: PMC9197632 DOI: 10.1155/2022/1853754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/23/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022]
Abstract
Objective To investigate the emotional response, stress and psychological changes of patients with breast cancer after surgery for psychological intervention-assisted comfort nursing based on the PERMA model. Methods A total of 100 postoperative breast cancer patients admitted to our hospital from March 2019 to June 2021 were selected as prospective research objects. According to a random number table, they were divided into a control group and an observation group with 50 cases each. Among them, the control group implemented routine nursing care, and the observation group implemented psychological intervention-assisted comfort care based on the PERMA model on the basis of the control group. The differences in compliance behavior, self-care ability, emotional response, stress response changes, and pain scores of the two groups of breast cancer patients before and after nursing were compared. Results After nursing, the mental behavior scores, exercise scores, medication scores, and balanced diet scores of the two groups of breast cancer patients after surgery were significantly improved. The observation group's compliance behavior scores were significantly higher than those of the control group. In the two groups of breast cancer patients, postoperative anxiety, depression, fatigue, and anger of the patients were significantly improved, and the emotional response score of the observation group was significantly lower than that of the control group. The self-care skill score, self-responsibility score, health knowledge score, and self-concept score of the observation group were excellent compared with those of the control group; the difference was significant by the above statistics (P < 0.05). The HR and MAP of the control group during the operation were higher than those 1 day before the start of the operation and decreased at the end of the operation, but still higher than the level 1 day before the start of the operation; the change trend of the observation group was the same as that of the control group, but there were differences between the time points. There was no significant significance (P > 0.05). The HR and MAP of the observation group during the operation were lower than those of the control group, and the MAP at the end of the operation was lower than that of the control group. This difference was statistically significant (P < 0.05). In the control group, the values increased at the time point during the operation and decreased at the end of the operation, but still higher than the level 1 day before the operation. The difference was statistically significant (P < 0.05). The change trend of the observation group was the same as that of the control group; and the values during and at the end of the operation were all lower than those of the control group. This difference was statistically significant (P < 0.05). The pain scores of the two groups of patients at different time points were significantly improved, and the observation group was significantly less than the control group. This difference was statistically significant (P < 0.05). Conclusion Psychological intervention-assisted comfort nursing can effectively enhance the compliance behavior of patients after breast cancer surgery, improve the emotional response, stress response, and pain of patients, and have certain reference value for the nursing of patients after breast cancer surgery.
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Affiliation(s)
- Bin Chen
- Huzhou Traditional Chinese Medicine Hospital, The Operating Room of Huzhou City Hospital in Wuxing District, China
| | - Ting Luo
- Operating Room, Wuhan No. 3 Hospital, China
| | - Qiong Cai
- Huzhou Traditional Chinese Medicine Hospital, The Operating Room of Huzhou City Hospital in Wuxing District, China
| | - Feng Pan
- The Center Hospital of Wuhan, China
| | - DongQin Liang
- Department of Neurosurgery, People's Hospital of Dongxihu District, Wuhan, Hubei 430040, China
| | - YuJie Hu
- Department of Hospital Infection-Control Department, People's Hospital of Dongxihu District, Wuhan, Hubei 430040, China
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Bellhouse S, Hawkes RE, Howell SJ, Gorman L, French DP. Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours. Cancers (Basel) 2021; 13:4150. [PMID: 34439302 PMCID: PMC8394615 DOI: 10.3390/cancers13164150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/20/2022] Open
Abstract
Implementing risk-stratified breast cancer screening is being considered internationally. It has been suggested that primary care will need to take a role in delivering this service, including risk assessment and provision of primary prevention advice. This systematic review aimed to assess the acceptability of these tasks to primary care providers. Five databases were searched up to July-August 2020, yielding 29 eligible studies, of which 27 were narratively synthesised. The review was pre-registered (PROSPERO: CRD42020197676). Primary care providers report frequently collecting breast cancer family history information, but rarely using quantitative tools integrating additional risk factors. Primary care providers reported high levels of discomfort and low confidence with respect to risk-reducing medications although very few reported doubts about the evidence base underpinning their use. Insufficient education/training and perceived discomfort conducting both tasks were notable barriers. Primary care providers are more likely to accept an increased role in breast cancer risk assessment than advising on risk-reducing medications. To realise the benefits of risk-based screening and prevention at a population level, primary care will need to proactively assess breast cancer risk and advise on risk-reducing medications. To facilitate this, adaptations to infrastructure such as integrated tools are necessary in addition to provision of education.
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Affiliation(s)
- Sarah Bellhouse
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (R.E.H.); (D.P.F.)
| | - Rhiannon E. Hawkes
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (R.E.H.); (D.P.F.)
| | - Sacha J. Howell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK;
| | - Louise Gorman
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK;
| | - David P. French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (R.E.H.); (D.P.F.)
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Jones T, Guzman A, Silverman T, Freeman K, Kukafka R, Crew K. Perceptions of Racially and Ethnically Diverse Women at High Risk of Breast Cancer Regarding the Use of a Web-Based Decision Aid for Chemoprevention: Qualitative Study Nested Within a Randomized Controlled Trial. J Med Internet Res 2021; 23:e23839. [PMID: 34100769 PMCID: PMC8262666 DOI: 10.2196/23839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/12/2020] [Accepted: 04/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background Chemopreventive agents such as selective estrogen receptor modulators and aromatase inhibitors have proven efficacy in reducing breast cancer risk by 41% to 79% in high-risk women. Women at high risk of developing breast cancer face the complex decision of whether to take selective estrogen receptor modulators or aromatase inhibitors for breast cancer chemoprevention. RealRisks is a patient-centered, web-based decision aid (DA) designed to promote the understanding of breast cancer risk and to engage diverse women in planning a preference-sensitive course of decision making about taking chemoprevention. Objective This study aims to understand the perceptions of women at high risk of developing breast cancer regarding their experience with using RealRisks—a DA designed to promote the uptake of breast cancer chemoprevention—and to understand their information needs. Methods We completed enrollment to a randomized controlled trial among 300 racially and ethnically diverse women at high risk of breast cancer who were assigned to standard educational materials alone or such materials in combination with RealRisks. We conducted semistructured interviews with a subset of 21 high-risk women enrolled in the intervention arm of the randomized controlled trial who initially accessed the tool (on average, 1 year earlier) to understand how they interacted with the tool. All interviews were audio recorded, transcribed verbatim, and compared with digital audio recordings to ensure the accuracy of the content. We used content analysis to generate themes. Results The mean age of the 21 participants was 58.5 (SD 10.1) years. The participants were 5% (1/21) Asian, 24% (5/21) Black or African American, and 71% (15/21) White; 10% (2/21) of participants were Hispanic or Latina. All participants reported using RealRisks after being granted access to the DA. In total, 4 overarching themes emerged from the qualitative analyses: the acceptability of the intervention, specifically endorsed elements of the DA, recommendations for improvements, and information needs. All women found RealRisks to be acceptable and considered it to be helpful (21/21, 100%). Most women (13/21, 62%) reported that RealRisks was easy to navigate, user-friendly, and easily accessible on the web. The majority of women (18/21, 86%) felt that RealRisks improved their knowledge about breast cancer risk and chemoprevention options and that RealRisks informed their (17/21, 81%) decision about whether or not to take chemoprevention. Some women (9/21, 43%) shared recommendations for improvements, as they wanted more tailoring based on user characteristics, felt that the DA was targeting a narrow population of Hispanic or Latina by using graphic novel–style narratives, wanted more understandable terminology, and felt that the tool placed a strong emphasis on chemoprevention drugs. Conclusions This qualitative study demonstrated the acceptability of the RealRisks web-based DA among a diverse group of high-risk women, who provided some recommendations for improvement.
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Affiliation(s)
- Tarsha Jones
- Florida Atlantic University, Boca Raton, FL, United States
| | | | | | | | - Rita Kukafka
- Columbia University, New York, NY, United States
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Park YHA, Keller A, Hsu TCM, Bidassie B, Venne V, Hawley D, Hoffman-Högg L, Heron B, Colonna S, Aggarwal A. Screening High-Risk Women Veterans for Breast Cancer. Fed Pract 2021; 38:S35-S41. [PMID: 34177240 PMCID: PMC8223736 DOI: 10.12788/fp.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Within the US Department of Veterans Affairs (VA), breast cancer prevalence has more than tripled from 1995 to 2012. Women veterans may be at an increased breast cancer risk based on service-related exposures and posttraumatic stress disorder (PTSD). METHODS Women veterans aged ≥ 35 years with no personal history of breast cancer were enrolled at 2 urban VA medical centers. We surveyed women veterans for 5-year and lifetime risks of invasive breast cancer using the Gail Breast Cancer Risk Assessment Tool (BCRAT). Data regarding demographics, PTSD status, eligibility for chemoprevention, and genetic counseling were also collected. Descriptive statistics were used to determine results. RESULTS A total of 99 women veterans participated, of which 60% were Black. In total, 35% were high risk with a 5-year BCRAT > 1.66%. Breast biopsies had been performed in 22% of our entire population; 57% had a family history positive for breast cancer. Comparatively, in our high-risk Black population, 33% had breast biopsies and 94% had a family history. High-risk patients were referred for chemoprevention; 5 accepted and 13 were referred for genetic counseling. PTSD was present in 31% of the high-risk subgroup. CONCLUSIONS A high percentage of Black patients participated in this pilot study, which also showed an above average rate of PTSD among women veterans who are at high risk for developing breast cancer. Historically, breast cancer rates among Black women are lower than those found in the general population. High participation among Black women veterans in this pilot study uncovered the potential for further study of this population, which is otherwise underrepresented in research. Limitations included a small sample size, exclusively urban population, and self-selection for screening. Future directions include the evaluation of genetic and molecular mutations in high risk Black women veterans, possibly even a role for PTSD epigenetic changes.
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Affiliation(s)
- Yeun-Hee Anna Park
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Alison Keller
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Ta-Chueh Melody Hsu
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Balmatee Bidassie
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Vickie Venne
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Douglas Hawley
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Lori Hoffman-Högg
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Bernadette Heron
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Sarah Colonna
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
| | - Anita Aggarwal
- is Chief of Hematology/Oncology; is a Research Coordinator; and is a Research Nurse Practitioner, all at James J. Peters Veterans Affairs Medical Center, Bronx, New York. is an Industrial Engineer VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC) at Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. was a Senior Genetic Counselor for the US Department of Veterans Affairs (VA) Genomic Medicine Services, and is a Hematologist/Oncologist; both at George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah. is a Hematologist/Oncologist at Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio. is a ONS Clinical Nurse Advisor for the Oncology Field Advisory Committee and VHA National Program Manager for Prevention Policy at Veterans Health Administration (VHA) National Center for Health Promotion and Disease Prevention, Durham, North Carolina and VHA Office of Nursing Services, Washington, DC. is a Program Manager at Veterans Health Administration, Pharmacy Benefits Management Services in Hines, Illinois. is a Hematologist/Oncologist Washington Veterans Affairs Medical Center, Washington, DC
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Padamsee TJ, Hils M, Muraveva A. Understanding low chemoprevention uptake by women at high risk of breast cancer: findings from a qualitative inductive study of women's risk-reduction experiences. BMC Womens Health 2021; 21:157. [PMID: 33863327 PMCID: PMC8052843 DOI: 10.1186/s12905-021-01279-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chemoprevention is one of several methods that have been developed to help high-risk women reduce their risk of breast cancer. Reasons for the low uptake of chemoprevention are poorly understood. This paper seeks a deeper understanding of this phenomenon by drawing on women's own narratives about their awareness of chemoprevention and their risk-related experiences. METHODS This research is based on a parent project that included fifty in-depth, semi-structured interviews with a purposive sample of African American and White women at elevated risk of breast cancer. This specific study draws on the forty-seven interviews conducted with women at high or severe risk of breast cancer, all of whom are eligible to use chemoprevention for breast cancer risk-reduction. Interviews were analyzed using grounded theory methods. RESULTS Forty-five percent of participants, and only 21% of African American participants, were aware of chemoprevention options. Women who had seen specialists were more likely to be aware, particularly if they had ongoing specialist access. Aware and unaware women relied on different types of sources for prevention-related information. Those whose main source of information was a healthcare provider were more likely to know about chemoprevention. Aware women used more nuanced information gathering strategies and worried more about cancer. Women simultaneously considered all risk-reduction options they knew about. Those who knew about chemoprevention but were reluctant to use it felt this way for multiple reasons, having to do with potential side effects, perceived extreme-ness of the intervention, similarity to chemotherapy, unknown information about chemoprevention, and reluctance to take medications in general. CONCLUSIONS Lack of chemoprevention awareness is a critical gap in women's ability to make health-protective choices. Future research in this field must consider complexities in both women's perspectives on chemoprevention and the reasons they are reluctant to use it.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Megan Hils
- Lutheran Social Services of Central Ohio, Worthington, OH USA
| | - Anna Muraveva
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH USA
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