Barriers to care for breast cancer: A qualitative study in Ireland

Financial Aid in Children, Adolescents and Young Adult's Cancer Care: A Scoping Review

Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers.

Experiences, difficulties and coping methods of female nurses caring for breast cancer surgery patients: A qualitative study

AIM

The present study aims to qualitatively explore the experiences, problems, and coping methods of nurses caring for mastectomy patients.

METHODS

The study employs an exploratory-descriptive design with the participation of 14 nurses serving in a surgical oncology clinic. We gathered the data through semi-structured, face-to-face interviews and analyzed the transcriptions of audio recordings using the thematic analysis method. We then extracted relevant codes and subthemes to achieve the main themes. The main themes are presented in three relevant contexts.

RESULTS

Participating nurses' experiences are addressed through the themes of 'emotional difficulties,' 'physical difficulties,' and 'positive awareness.' In addition, their coping methods are considered within the themes of 'coping methods' and 'motivation.' The final context is identified as needs, where the themes of 'organizational needs' and 'psychosocial needs' are explored. Our findings highlighted that although participating nurses usually confront physical and emotional challenges, they exert much effort to develop both positive awareness and engage in behavioral changes. Interestingly, we observed that participants remain ineffective in dealing with and have difficulties employing relevant solutions for professional issues.

CONCLUSION

Overall, even though participating nurses need to deal with the burden of physical and emotional challenges when caring for patients, their coping strategies with these difficulties often remain insufficient. Thus, our humble recommendation may lie in satisfying the organizational and psychosocial needs of surgical nurses to promote their coping skills when fulfilling their demanding tasks with mastectomy patients.

Under-served groups remain underserved as eligibility criteria routinely exclude them from breast cancer trials

OBJECTIVES

Under-served groups are populations unrepresented or disengaged from medical research or services despite a disproportionately high healthcare burden. Under-served groups may be directly (age, pregnancy as examples) or indirectly excluded (provision of written information in one language only as example) from trial enrolment by strict eligibility exclusions. The purpose of our study was to assess eligibility criteria in published phase III breast cancer clinical trials to determine whether they excluded under-served groups either directly, or indirectly.

STUDY DESIGN AND SETTING

Medline was searched for phase III randomised controlled trials evaluating interventional drugs for breast cancer in high-impact journals published between January 1^st, 2010 and December 31st, 2020. 5133 eligible trials were returned and 40 selected, by simple randomization, for inclusion.

RESULTS

All 40 trials had multiple exclusions that affected recruitment of under-served groups. Clinical or scientific rationale for the recorded inclusion and exclusion criteria was under-reported in 39 of 40 trials.

CONCLUSIONS

Clinical trial eligibility criteria exclude under-served groups from breast cancer trials. Trialists should provide a justification for each eligibility criterion and funders, reviewers, ethics committees, and others should demand one. Without this under-served groups will remain just that: under-served.

The lived experience during the peri-diagnostic period of breast cancer: A scoping review

OBJECTIVES

The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer.

METHODS

Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches.

RESULTS

A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period.

CONCLUSIONS

The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity.

PRACTICE IMPLICATIONS

Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.