Controlling fear: Jordanian women's perceptions of the diagnosis and surgical treatment of early-stage breast cancer

Breast cancer epidemiology among surgically treated patients in Jordan: A retrospective study

Background: Multiple risk factors contribute to the development of breast cancer, including age, positive family history, early menarche, late menopause and the strongest factor being female gender. In this study, we aimed to investigate the proportion of breast cancer patients with certain risk factors, the prevalence of each cancer type, in addition to the surgical procedures performed.

Methods: The medical records of patients diagnosed with breast cancer from January 2010 to November 2015 were evaluated retrospectively regarding demographics, breast cancer risk factors, comorbidities, diagnostic methods, tumor location, cancer type and stage, pathological findings, tumor markers, harvested lymph nodes and the types of surgical procedures. The collected data were statistically analyzed as number, mean, and frequency as percentages. Cases with deficient medical records were excluded from the analysis of certain parameters.

Results: The sample consisted of 120 patients, 118 (98.3%) of whom were women. The mean age was 56.5±12.0 years. The most common diagnostic method at presentation was self-exam in 93.3% of patients. Invasive ductal carcinoma was the most common type of tumor (80.0%). The pathological stages could be determined for only 106 patients, and 26 patients (24.5%) were at stage 1 disease, 45 patients (42.5%) were at stage 2 whereas 34 patients (32.1%) were at stage 3. According to the results of pathological examinations, 72.6% (85 patients) of the cases were estrogen receptor positive, 61.2% (71 patients) were progesterone receptor positive while 24.8% (27 patients) were HER positive. Modified radical mastectomy (MRM) was performed in 52 (43.3%) patients and wide local excision (WLE) was preferred in 46 (38.3%) cases.

Conclusion: Advanced age, positive family history, and prolonged estrogen exposure were remarkable in the majority of patients. Moreover, the most common type of breast cancer was invasive ductal carcinoma, and around half of the patients presented at stage 2 disease. Modified radical mastectomy and WLE were the most commonly performed surgical procedures.

Experiences of accessing and using breast cancer services in Vietnam: a descriptive qualitative study

OBJECTIVES

To understand, describe and analyse the experiences of women with breast cancer in Vietnam when accessing and using breast cancer services.

DESIGN

Descriptive qualitative study. Women were interviewed about their experiences from the first time they became aware of symptoms or changes to their body through treatment and post-treatment. This study is the first descriptive study on breast cancer in Vietnam from the perspective of women with a breast cancer diagnosis.

PARTICIPANTS

Women (n=13) who had completed or were still receiving treatment for breast cancer, purposively recruited from the north and south of Vietnam.

RESULTS

An analysis of the experiences of women with breast cancer in Vietnam revealed a lack of awareness and knowledge about breast cancer and symptoms. Family and social support were described as key factors influencing whether a woman accesses and uses breast cancer services. Cost of treatment and out-of-pocket expenditures limited access to services and resulted in significant financial challenges for women and their families.

CONCLUSIONS

Vietnam has made huge strides in improving cancer care, and is tackling a complex and expanding public health challenge, however, there are a number of areas requiring strengthening and future research. While Vietnam has successfully expanded social health insurance coverage, changes that increase the percentage of costs covered for specific treatments, such as chemotherapy or radiotherapy, could benefit women and their families.

Experiences of breast cancer in Arab countries. A thematic synthesis

BACKGROUND

Breast cancer is the most common cancer in women globally. Its negative effects on a woman's quality of life are related to the individual and socio-cultural factors. This review aimed to identify and synthesise the reported experiences and quality of life of women with breast cancer in Arab countries.

METHODS

PubMed, Embase, Web of Science, SCOPUS, PsychInfo, CINAHL, Allied and Complementary Medicine Database, and Index Medicus for the Eastern Mediterranean Region were searched for articles published from start to March 2019 using PRISMA guidelines. These searches were complimented by citation tracking and  hand searching of relevant journals. A thematic synthesis was carried out on the 'findings/results' sections from the identified papers.

RESULTS

Of 5228 records identified, 19 were included in the review which represented 401 women from 11 Arab countries. All used qualitative methods of data collection to produce rich descriptions of experiences. Thematic synthesis of the extracted data identified three major themes, Perceptions and reactions, Coping or enduring and Changing roles.

CONCLUSIONS

This review provides a rich description of the reported quality of life and experiences of women with breast cancer in Arab countries. These are influenced by the women's and society's views of cancer, the women's role in society and family, religious faith and the healthcare context and access to treatment choices and information.

A rating instrument for fear of hospitalisation

AIMS AND OBJECTIVES

To develop and validate a reliable instrument that can measure fear of hospitalisation experienced by outpatients.

BACKGROUND

After having a diagnosis established, some patients experience sense of fear, unpleasantness and embarrassment due to the possibility to be admitted to a hospital. Currently, there is no available instrument for measuring fear of hospitalisation.

DESIGN

Cross-sectional study for assessing reliability and validity of a questionnaire.

METHOD

The questionnaire with 17 items and answers according to the Likert scale was developed during two brainstorming sessions of the research team. Its reliability, validity and temporal stability were tested on the sample of 330 outpatients. The study was multicentric, involving patients from seven cities and three countries.

RESULTS

Fear of hospitalisation scale showed satisfactory reliability, when rated both by the investigators (Cronbach's alpha .799) and by the patients themselves (Cronbach's alpha .760). It is temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains: fear of being injured, trust to medical staff and fear of losing privacy or autonomy.

CONCLUSIONS

This study developed new reliable and valid instrument for measuring fear of hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

Identification of patients with high level of fear of hospitalisation by this instrument should help clinicians to administer measures which may decrease fear and prevent avoidance of healthcare utilisation.

Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature

BACKGROUND

Although there has been growing research on the burden of treatment, the current state of evidence on measuring this concept is unknown. This scoping review aimed to provide an overview of the current state of knowledge as well as clear recommendations for future research, within the context of chronic disease.

METHODS

Four health-based databases, Scopus, CINAHL, Medline, and PsychInfo, were comprehensively searched for peer-reviewed articles published between the periods of 2000-2016. Titles and abstracts were independently read by two authors. All discrepancies between the authors were resolved by a third author. Data was extracted using a standardized proforma and a comparison analysis was used in order to explore the key treatment burden measures and categorize them into three groups.

RESULTS

Database searching identified 1458 potential papers. After removal of duplications, and irrelevant articles by title, 1102 abstracts remained. An additional 22 papers were added via snowball searching. In the end, 101 full papers were included in the review. A large number of the studies involved quantitative measures and conceptualizations of treatment burden (n = 64; 63.4%), and were conducted in North America (n = 49; 48.5%). There was significant variation in how the treatment burden experienced by those with chronic disease was operationalized and measured.

CONCLUSION

Despite significant work, there is still much ground to cover to comprehensively measure treatment burden for chronic disease. Greater qualitative focus, more research with cultural and minority populations, a larger emphasis on longitudinal studies and the consideration of the potential effects of "identity" on treatment burden, should be considered.

Secondary Traumatic Stress and Burnout Among Muslim Nurses Caring for Chronically Ill Children in a Turkish Hospital

PURPOSE

This study investigated secondary traumatic stress and its relationship to burnout among nurses working at a Turkish hospital.

DESIGN

A mixed-methods design included a cross-sectional survey administering the Professional Quality of Life instrument and Maslach Burnout Inventory to 106 nurses. Interviews with a subgroup of eight participants explored nurses' experiences and coping strategies related to caring for chronically ill pediatric patients.

RESULTS

High risk levels of secondary traumatic stress existed among 40.6% participants, and those over the age of 40 years were at greater risk. Two main interview themes emerged that identified (a) consequences and (b) coping strategies while caring for chronically ill children. Nurses experience emotional burdens and may purposefully distance themselves from chronically ill children. Social support from nurse colleagues and spiritual beliefs assist coping.

IMPLICATIONS

Workplaces should acknowledge stressors inherent in chronic pediatric nursing care. Environments that welcome spiritual practices and actively encourage social support could address job hazards.

Jordanian Physicians' Attitudes toward Disclosure of Cancer Information and Patient Participation in Treatment Decision-making

OBJECTIVE

This study aims to determine the attitude of Jordanian physicians toward disclosure of cancer information, comfort and use of different decision-making approaches, and treatment decision making.

METHODS

A descriptive, comparative research design was used. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons practicing mainly in oncology was recruited. A modified version of a structured questionnaire was used for data collection. The questionnaire is a valid measure of physicians' views of shared decision making.

RESULTS

Almost 91% of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early-stage cancer diagnosis. Physicians provide abundant information about the extent of the disease, the side effects and benefits of the treatment, and details of the treatment procedures. They also provided less information on the effects of treatment on the sexuality, mood, and family of the patient. Almost 48% of the participating physicians reported using shared decision making as their usual approach for treatment decision making, and 67% reported that they were comfortable with this approach. The main setting of clinical activity was the only factor associated with physicians' usual approach to medical decision making. Moreover, age, years of experience, and main setting of clinical activity were associated with physicians' comfort level with the shared approach.

CONCLUSIONS

Although Jordanian physicians appreciate patient autonomy, self-determination, and right to information, paternalistic decision making and underuse of the shared decision-making approach persist. Strategies that target both healthcare providers and patients must be employed to promote shared decision making in the Jordanian healthcare system.

Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women

To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers' support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system.

Information needs and disclosure preferences among Jordanian women diagnosed with breast cancer

To determine Jordanian women's attitudes toward disclosure of breast cancer information and their information needs. A descriptive comparative research design was used in this study. A convenience sample of 156 Jordanian women who had a confirmed first time diagnosis of breast cancer within 18 months prior to the study and had treatment at three hospitals in Central and Northern Jordan was recruited for the study. A modified version of the Information Needs Questionnaire (INQ) was used for data collection. The vast majority of patients wanted to know whether the diagnosis was breast cancer (92%) and the stage of the disease (78%). Information about spread of the disease and chances of cure was of highest importance for the majority of the patients (88% and 85% respectively). Younger patients and those with higher education were more likely to express a preference for truthful disclosure of breast cancer diagnosis. The majority of Jordanian women wanted information about breast cancer diagnosis, chances of cure, and treatment side effects.

Decision-making preferences of Jordanian women diagnosed with breast cancer

PURPOSE

The purpose of the study was to determine Jordanian women's preferences regarding participation in decision-making related to their breast cancer treatment.

METHODS

A cross-sectional survey design was used in this study. A convenience sample of 156 Jordanian women, who had a confirmed, first-time diagnosis of breast cancer within 18 months prior to the study and had undergone treatment at three hospitals in Central and Northern Jordan, was recruited for the study. A modified version of the Control Preferences Scale was used for data collection.

RESULTS

More than half of the participants (57 %) wanted the physician to make the decision about the appropriate treatment, approximately 33 % wanted to share the decision with the physician, and only 10 % wanted to make their own decisions. Participants aged more than 50 years, those with secondary school education or less, and those who were undergoing treatment at the public or teaching hospital under study were more likely to prefer a passive role in decision-making regarding treatment.

CONCLUSIONS

Although more than half of the participants involved in this study preferred to play a passive role, their preferences in this regard varied. This highlighted the importance of individually assessing patients' preferences regarding participation in the decision-making process and provision of information that is tailored according to each patient's needs.

Experiences of Newly Diagnosed Breast Cancer Patients in Turkey

PURPOSE

The purpose of this qualitative study is to describe the experiences of women in Turkey during the diagnostic phase of breast cancer.

DESIGN

In the research, the phenomenological approach was used. The data were collected through semistructured in-depth interviews. The sample comprised nine breast cancer patients in the diagnostic phase.

RESULTS

The data were categorized into four themes: facing the breast cancer diagnosis, uncertainty, avoidance, and holding on to life. Women experience intense uncertainty about the disease, treatment, and social relationships and thus exhibit avoidance behavior.

IMPLICATIONS

Nurses should be aware of psychosocial difficulties suffered during the diagnostic phase and provide care for patients. It is important that nurses provide information about the diagnostic phase to women with breast cancer and encourage them to ask questions and express their feelings.