Role of Continuing Supportive Cares in Increasing Social Support and Reducing Perceived Uncertainty Among Women With Newly Diagnosed Breast Cancer in Taiwan

Examining the role of pre-visit anxiety on patient uncertainty and breast cancer patient-provider communication

OBJECTIVE

Effective communication between cancer patients and providers is critical for addressing psychological distress, reducing uncertainty, and promoting patient well-being. This is particularly relevant during medical appointments that may elicit uncertainty, such as surgical consultations for newly diagnosed women with breast cancer. This study aimed to evaluate how pre-appointment anxiety and illness uncertainty affect patient-provider communication in breast cancer surgical consultations and subsequent post-appointment well-being. Breast cancer patient anxiety has been studied as an outcome of provider communication, though less is known about the extent to which preexisting anxiety or uncertainty act as antecedents to effective patient-provider communication.

METHODS

This study analyzed videorecorded breast cancer surgical consultations (N = 51) and corresponding patient surveys to understand how pre-appointment anxiety influences pre-appointment patient uncertainty, patient-provider communication during the appointment, and subsequent post-appointment uncertainty.

RESULTS

The proposed model achieved good fit to the data such that more pre-appointment anxiety was associated with more pre-appointment uncertainty, more pre-appointment anxiety was associated with more empathic opportunities per minute, and more empathic opportunities were associated with less post-appointment uncertainty.

CONCLUSIONS

Results indicate breast cancer patients with anxiety pre-appointment are at-risk for more illness uncertainty and are more likely to explicitly provide empathic opportunities. This supports the need for added attention to empathic opportunities to not only address patients emotionally but to also assess whether a patient may be at higher risk of having preexisting anxiety.

The Relationship Between Illness Uncertainty and Social Support Among Cancer Patients: A Meta-analysis

BACKGROUND

As a common psychological problem in cancer patients, illness uncertainty has attracted wide attention from scholars. Some studies have pointed out that the level of social support may affect illness uncertainty in patients with cancer, but the results of these studies remain controversial.

OBJECTIVE

The aim of this study was to evaluate the correlation between illness uncertainty and social support in patients with cancer using meta-analysis.

METHODS

PubMed, Web of Science, EMBASE, EBSCO, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Citation Database were searched for articles published up to 2022. The screening of the literature, data extraction, and quality assessment of the included studies were performed independently by 2 researchers. Stata 17.0 software was used to analyze the overall and moderation effects.

RESULTS

Notably, 41 studies involving 5403 patients were included. The results showed that the illness uncertainty of adults with cancer was moderately negatively correlated with social support (r = -0.33). Country, publication year, cancer type, and instrument used to measure social support moderated the association between illness uncertainty and social support.

CONCLUSION

Improving the level of social support can reduce illness uncertainty experienced by adults with cancer to a certain extent.

IMPLICATIONS FOR PRACTICE

This review provides a clear direction for implementing precise interventions to reduce illness uncertainty among adults with cancer. Furthermore, patients with cancer with high morbidity and mortality rates deserve greater attention from healthcare personnel and family caregivers.

Facilitating psychological adjustment for breast cancer patients through empathic communication and uncertainty reduction

OBJECTIVES

This study examined the degree to which breast cancer patients' psychological well-being is facilitated through empathic provider communication. We explored symptom/prognostic uncertainty reduction as a mechanism through which provider communication influences patient psychological adjustment. Additionally, we tested if treatment status moderates this relationship.

METHODS

Informed by uncertainty in illness theory, current (n = 121) and former (n = 187) breast cancer patients completed questionnaires about perceptions of their oncologists' empathy and their symptom burden, uncertainty, and adjustment to their diagnosis. Structural equation modeling (SEM) was conducted to test hypothesized relationships between perceived provider empathic communication, uncertainty, symptom burden, and psychological adjustment.

RESULTS

SEM supported the following: (1) higher symptom burden was associated with increased uncertainty and reduced psychological adjustment, (2) lower uncertainty was associated with increased adjustment, and (3) increased empathic communication was associated with lower symptom burden and uncertainty for all patients (χ2(139) = 307.33, p < .001; RMSEA = .063 (CI .053, .072); CFI = .966; SRMR = .057). Treatment status moderated these relationships (Δχ2 = 264.07, Δdf = 138, p < .001) such that the strength of the relationship between uncertainty and psychological adjustment was stronger for former patients than for current patients.

CONCLUSIONS

Results of this study reinforce the importance of perceptions of provider empathic communication as well as the potential benefits of eliciting and addressing patient uncertainty about treatment and prognosis throughout the cancer care continuum.

PRACTICE IMPLICATIONS

Patient uncertainty should be a priority for cancer-care providers both throughout and post-treatment for breast cancer patients.

Systematic review of illness uncertainty management interventions for cancer patients and their family caregivers

PURPOSE

Illness uncertainty pervades individuals' experiences of cancer across the illness trajectory and is associated with poor psychological adjustment. This review systematically examined the characteristics and outcomes of interventions promoting illness uncertainty management among cancer patients and/or their family caregivers.

METHODS

PubMed, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Cochrane Database of Systematic Reviews were systematically searched for relevant literature. We included randomized controlled trials (RCTs) and quasi-experimental studies focusing on interventions for uncertainty management in cancer patients and/or their family caregivers.

RESULTS

Our database searches yielded 26 studies. Twenty interventions were only offered to cancer patients, who were mostly elder, female, and White. All interventions included informational support. Other intervention components included emotional support, appraisal support, and instrumental support. Most interventions were delivered in person and via telephone (n = 8) or exclusively in person (n = 7). Overall, 18 studies identified positive intervention effects on illness uncertainty outcomes.

CONCLUSION

This systematic review foregrounds the promising potential of several interventions-and especially multi-component interventions-to promote uncertainty management among cancer patients and their family caregivers. To further improve these interventions' effectiveness and expand their potential impact, future uncertainty management interventions should be tested among more diverse populations using rigorous methodologies.

Developing a Decision-Aid Website for Breast Cancer Surgery: An Action Research Approach

Background

Patients with early-stage breast cancer have numerous options when choosing the type of breast surgery method to be applied. Each of these options lead to a similar long-term survival rate, but result in significant differences in appearance, function, cost, recurrence rate, and various other relevant considerations. However, the time available for detailed communication with each patient is often limited in clinics, which puts these women under great psychological stress and can hinder their surgery-related decision making.

Objective

The objective of this study was to develop a multipurpose surgery decision-making website providing medical information, psychological support, and decision-related simulation for women during breast cancer surgery-related decision making.

Methods

Using the 4 steps of action research, which involve multigroup teamwork via regular team meetings, the following were performed: (1) Planning: searching, analyzing, and evaluating health websites to consensually decide the major infrastructure; (2) Action: work was performed simultaneously in 4 groups, which consisted of medical information collection and editing, patient interviews and data extraction, webpage content design, and programming to create or host the website; (3) Evaluation: the website was tested by clinical experts and focus groups of former breast cancer patients to assess its effectiveness and pinpoint appropriate improvements; and (4) Reflection: constant dialogue was conducted between the various participants at each step, which was used as the foundation and motivation of next plan-action-evaluation-reflection circle.

Results

Using the action research approach, we completed the development of our website, which includes the following: (1) “Woman’s Voice”—an animated comic depicting the story of a female breast cancer patient with interspersed questions for the users that will help them better empathize with the experience; (2) “Cancer Information Treasure House”—providing breast cancer surgery-related information through text, tables, pictures and a presentation video; (3) “Decision-making Simulator”—helping patients think through and check the pros and cons of the different surgical options via visual-based interactions including “Stairs Climbing” and “Fruit of Hope”; and (4) “Recommended Links”—providing reliable websites for further reference. Additionally, we have further improved the website based on the feedback received from postsurgery breast cancer patients and clinicians. We hope to continue improving to better meet both the patients’ and health providers’ needs and become a practical decision-making aid for patients undergoing breast cancer surgery.

Conclusions

We have created the first breast cancer surgery decision-making assistance tool in Taiwan using a “Web-based” and multifunctional website design. This site aims to provide health care knowledge, psychological healing, and emotional support functions, as well as decision-making capability enhancement simulations. We look forward to assisting breast cancer patients in their decision-making process and expect our website to increase patient’s autonomy and improve their communication with clinicians.

Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An Action Research Approach

Background

Personal narratives have been seen as a useful way of communicating about cancer treatment options and providing recovery information. Many printed versions of such material are available, including comics that explore the individual memories of patients who have gone through cancer treatment. These studies have been used to orientate patients, patients’ relatives, and physicians. However, only a few Web-based comics have been specifically designed for patients with breast cancer and used as aids to decision making.

Objective

We aimed to describe the developmental process of creating an animated comic as a Web-based surgery decision-making tool; the comic was aimed at illustrating the feelings, thoughts, and meanings when a patient suffers from breast cancer. This was done by recounting the symptoms, diagnostic process, treatments, and treatment effects of such women from the diagnosis stage onward.

Methods

Using cycles of planning, action, evaluation, and reflection, which involved collaborative work, action research was conducted to develop a Web-based animated comic. The stages of action research consisted of (1) semistructured and in-depth interviews to collect experiences of women with breast cancer; (2) construction of an animated comic by editors, graphics designers, dubbers, and information technology engineers; (3) redrawing of pictures of the comic after gathering feedback from a breast surgeon; and (4) evaluation of the Web-based animated comic using 6 patient focus groups.

Results

The comic was produced and showcased on the website “The Network of Making-decision Aids for Breast Cancer Surgery”; the comic was accompanied by soft music and audio explanations. The comic functions as a personal statement that describes experiencing breast cancer. The animated comic consists of 8 chapters, based on the 8 themes deducted from the findings obtained during the analysis of relevant interviews. The 8 chapters include (1) the appearance of a lump; (2) confirmation by medical diagnosis; (3) the uncertainty of waiting (4) fear of life-threatening disease; (5) choosing life over despair; (6) being brave and deciding to undergo treatment; (7) choosing the type of surgery; and (8) being reborn.

Conclusions

Using action research, this study illustrated that the comic that sheds light on issues of feelings, emotions, and thoughts that are present when a woman is diagnosed with breast cancer and provides a communication medium to explain the steps in the process. Meanwhile, it implies that hope will be able to overcome the challenges that will be faced. Within the Web-based decision aid for patients with breast cancer, the animated comic acts as an information resource and is aimed at patients’ understanding of impacts of emotions arising when suffering from breast cancer. It is potentially applicable as a therapeutic tool that facilitates self-reflection and self-healing among newly diagnosed patients with breast cancer.

Uncertainty in Illness: Theory Review, Application, and Extension

Mishel's uncertainty in illness theory provides a conceptual framework to explain how uncertainty is generated and how it affects psychological adjustment to the cancer experience. Since 1981, when it was created, researchers have used the theory to develop and test uncertainty management interventions in multiple populations of patients with cancer. This article reviews the theory's concepts and propositions, summarizes supporting evidence, and discusses extension of the theory, clinical implications, and future directions for research.

Psychiatric Symptoms and Psychosocial Problems in Patients with Breast Cancer

Cancer is a physical disease and also one of the leading clinical manifestations where psychosocial problems are prevalent. Psychosocial problems that these patients may have in the long run include anxiety, uneasiness, mourning, helplessness, fatigue, impairment of concentration, sleep disorders, mental and cognitive reservation, sexual dysfunction, infertility, psychological distress, and psychiatric disorders. Psychosocial problems have a nature of underpinning the emergence of psychological troubles. The prevalence of psychological disorders in patients with cancer range from 29% to 47%. Psychiatric disorders that are likely to be seen are severe stress disorder, adjustment disorder, depressive disorder, and other neurotic disorders. It is considered by the present author that in the event of breast cancer, potential psychiatric disorders may affect prognosis of the disease, adherance to and success of therapy, social and societal functioning, and survival rate. This paper aims to review the psychiatric symptoms and diseases that may develop in patients with breast cancer, which is one of the most frequent types of a globally common disease; i.e., cancer, as well as the impact of psychiatric symptoms on the treatment of disease.

"The support I need": women's experiences of social support after having received breast cancer diagnosis and awaiting surgery

BACKGROUND

Social support is associated with a better adjustment to breast cancer, whereas inadequate social support increases psychological distress. However, the period between diagnosis and surgery is particularly stressful, and few studies have addressed the significance of social support in this period.

OBJECTIVE

The purpose of this study was to describe women's individual experiences of social support after having received a breast cancer diagnosis and awaiting surgery.

METHODS

A qualitative descriptive design was used. Individual semistructured interviews were conducted the day before surgery with 21 women aged 41 to 73 years with newly diagnosed breast cancer at a Norwegian university hospital.

RESULTS

Methods of qualitative meaning condensation analysis revealed 5 themes: available support, information and advice, care, having confidants, and balancing distance and closeness. Knowing that both family and healthcare professionals were available and caring gave a sense of security. Social support gave strength, although too much could be experienced as difficult and frightening. The women needed a balance between distance from and closeness to their social network. Both professional information and someone professional with whom to talk personally were essential.

CONCLUSIONS

Social support is an important resource for women with breast cancer but can be a double-edged sword as the network's offered support can sometimes be a burden.

IMPLICATIONS FOR PRACTICE

Healthcare professionals could call each patient, encourage the patients to call if they want, and, if preferred, offer face-to-face consultations for women with breast cancer awaiting surgery. This contact should be a supportive, informative, and confidential available resource.

Interventions to improve continuity of care in the follow-up of patients with cancer

BACKGROUND

Care from the family physician is generally interrupted when patients with cancer come under the care of second-line and third-line healthcare professionals who may also manage the patient's comorbid conditions. This situation may lead to fragmented and uncoordinated care, and results in an increased likelihood of not receiving recommended preventive services or recommended care.

OBJECTIVES

To classify, describe and evaluate the effectiveness of interventions aiming to improve continuity of cancer care on patient, healthcare provider and process outcomes.

SEARCH METHODS

We searched the Cochrane Effective Practice and Organization of Care Group (EPOC) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, and PsycINFO, using a strategy incorporating an EPOC Methodological filter. Reference lists of the included study reports and relevant reviews were also scanned, and ISI Web of Science and Google Scholar were used to identify relevant reports having cited the studies included in this review.

SELECTION CRITERIA

Randomised controlled trials (including cluster trials), controlled clinical trials, controlled before and after studies and interrupted time series evaluating interventions to improve continuity of cancer care were considered for inclusion. We included studies that involved a majority (> 50%) of adults with cancer or healthcare providers of adults with cancer. Primary outcomes considered for inclusion were the processes of healthcare services, objectively measured healthcare professional, informal carer and patient outcomes, and self-reported measures performed with scales deemed valid and reliable. Healthcare professional satisfaction was included as a secondary outcome.

DATA COLLECTION AND ANALYSIS

Two reviewers described the interventions, extracted data and assessed risk of bias. The authors contacted several investigators to obtain missing information. Interventions were regrouped by type of continuity targeted, model of care or interventional strategy and were compared to usual care. Given the expected clinical and methodological diversity, median changes in outcomes (and bootstrap confidence intervals) among groups of studies that shared specific features of interest were chosen to analyse the effectiveness of included interventions.

MAIN RESULTS

Fifty-one studies were included. They used three different models, namely case management, shared care, and interdisciplinary teams. Six additional interventional strategies were used besides these models: (1) patient-held record, (2) telephone follow-up, (3) communication and case discussion between distant healthcare professionals, (4) change in medical record system, (5) care protocols, directives and guidelines, and (6) coordination of assessments and treatment.Based on the median effect size estimates, no significant difference in patient health-related outcomes was found between patients assigned to interventions and those assigned to usual care. A limited number of studies reported psychological health, satisfaction of providers, or process of care measures. However, they could not be regrouped to calculate median effect size estimates because of a high heterogeneity among studies.

AUTHORS' CONCLUSIONS

Results from this Cochrane review do not allow us to conclude on the effectiveness of included interventions to improve continuity of care on patient, healthcare provider or process of care outcomes. Future research should evaluate interventions that target an improvement in continuity as their primary objective and describe these interventions with the categories proposed in this review. Also of importance, continuity measures should be validated with persons with cancer who have been followed in various settings.

Living with breast cancer, a Lebanese experience

AIM

The purpose of this qualitative phenomenological study is to provide in-depth understanding of the experience of Lebanese women living with breast cancer.

BACKGROUND

Breast cancer is the most frequently diagnosed cancer in women worldwide. In Lebanon, a country of 4 million people, breast cancer is as well the most widespread type of cancer among Lebanese women. The meaning of cancer diagnosis, the meaning of childbearing and femininity all have cultural bases in Lebanon. The international literature lacks information on how Lebanese women live with breast cancer when compared with women of other cultures.

METHOD

The study followed purposeful sampling and saturation principles in which 10 participants with a mean age of 51.3 years were chosen based on their actual knowledge of the phenomenon, and their readiness to share that knowledge. Data were collected between December 2007 and May 2008. All interviews were audio-taped and transcribed verbatim. Data were analyzed based on the Utrecht School of Phenomenology.

FINDINGS

Four major core themes describing the participants' lived experience emerged from the interviews: Living with losses; living with guilt feeling; living with fears and uncertainty; Living with the need to know and to share that knowledge.

CONCLUSION

The experience of Lebanese women with breast cancer revealed distinctive themes not reported by other women from other cultures. The results of this study challenge health care providers and educators to be aware of the difficulties that Lebanese women are facing when they are living with breast cancer.

Social support networks and depression of women suffering from early-stage breast cancer: a case control study

The aim of this study was to investigate the areas of depression, anxiety, and social support using the structural model of the social network. By comparing the networks of two samples of breast cancer sufferers and healthy control participants, it was possible to identify differences in their relationships, in the shape of the networks themselves, and in the levels of depression and anxiety. Women with breast cancer described smaller and denser networks, including mainly kins whereas the healthy women included more friends, coworkers, and leisure companions. The levels of anxiety and depression were higher in women with breast cancer. Social network and social support measure correlated differently with depression and anxiety in the two groups.