1
|
Zhao H, Geng WJ, Wu RH, Li ZZ. Exploring Female Relatives of Patients with Hemophilia' Awareness, Attitudes, and Understanding Towards Genetic Testing. J Multidiscip Healthc 2024; 17:711-721. [PMID: 38380070 PMCID: PMC10878314 DOI: 10.2147/jmdh.s430984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose A better understanding of the factors that influence engagement is needed to provide a reference for conducting genetic testing in female relatives of patients with hemophilia (PWH). We therefore determined the perceptions and understanding of genetic testing among female relatives of PWH in China. Methods We carried out a qualitative study using in-depth, semi-structured interviews with 11 female relatives of PWH in Shanxi Province, China. The resulting data were analyzed using thematic analyses. Results This study extracted four topics: uncertainty about carrier genetic status; limited understanding of genetic testing; coexistence of positive and negative coping; and multi-aspect demands. Conclusion Healthcare professionals should provide personalized and multidimensional health education and comprehensive decision-making support to female relatives of PWH, to enhance their motivation and willingness to undergo genetic testing. It is also important to actively improve relevant policies, strengthen the genetic testing service system, and promote the popularization of genetic testing in female relatives of PWH.
Collapse
Affiliation(s)
- Hua Zhao
- College of Nursing, Shanxi University of Chinese Medicine, Jinzhong, Shanxi, People’s Republic of China
| | - Wen-Jing Geng
- Nursing Department, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, People’s Republic of China
| | - Rui-Hong Wu
- Department of Hematology, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Zhen-Zhen Li
- Department of Hematology, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| |
Collapse
|
2
|
Fang SY, Chen TC. Validation of the modified Chinese Information and Support Needs Questionnaire (ISNQ-C) for daughters of mothers with breast cancer. Palliat Support Care 2024; 22:110-118. [PMID: 36217687 DOI: 10.1017/s1478951522001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adult daughters concerned about getting breast cancer throughout their lives and required support because their mothers had breast cancer. OBJECTIVES This article aims to examine the revised Information and Support Needs Questionnaire (ISNQ) and validate it in a Taiwanese community population comprising daughters of mothers with breast cancer. METHODS Using convenience sampling, daughters of mothers with breast cancer were recruited and were separated into 2 samples (Sample 1, n = 102, and Sample 2, n = 118). First, we translated and modified the ISNQ to ensure cultural adaptation and formed ISNQ Chinese version (ISNQ-C). Second, we conducted an exploratory factor analysis using both samples to explore the ISNQ-C factor structure. Finally, we tested the criterion validity and known-group validity of the ISNQ-C using Sample 2. RESULTS Thirty-two items addressing 5 factors were identified for the ISNQ-C. Each factor had good internal consistency. The criterion validity was supported by significant correlations between the ISNQ-C scores and scores on the impacts of an event, anxiety, and depression. Known-group comparisons revealed that the group with deceased mothers reported significantly more unmet needs related to "releasing my anxiety" compared to the group where the mother was stable and undergoing regular follow-ups. SIGNIFICANCE OF RESULTS The ISNQ-C demonstrated good reliability and validity in terms of assessing needs among daughters of mothers with breast cancer in Taiwan. Using this assessment tool before genetic counseling to target the individual needs of this population at risk for breast cancer would be helpful to provide personalized care.
Collapse
Affiliation(s)
- Su-Ying Fang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nuring, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ting-Chun Chen
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| |
Collapse
|
3
|
Communication between mothers with breast cancer and minor children: a qualitative systematic review and meta-synthesis. Support Care Cancer 2023; 31:169. [PMID: 36786856 DOI: 10.1007/s00520-023-07630-9] [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: 05/18/2022] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Both women with breast cancer and their minor children were affected by a breast cancer diagnosis. The purpose of this review was to synthesize the evidence from qualitative studies on illness-related communication between mothers with breast cancer and their minor children from mothers' perspectives. METHODS A thorough systematic review and meta-synthesis of qualitative studies was conducted. English articles published prior to 6 November 2021 were searched from five databases, including PubMed/ MEDLINE, EMBASE, Web of Science, CINAHL, and PsycINFO. After screening the titles, abstracts, and full texts, seven articles were finally included in the quality appraisal and meta-aggregation. RESULTS Four synthesized findings were derived from seven articles, including disclosure dilemma, factors impacting disclosure, methods of communication, and information needs. CONCLUSIONS This systematic review offered insight into the communication between mothers with breast cancer and their minor children. Various factors influenced the decision-making process on illness-related disclosure, as well as the methods and contents of the communication. Future studies should be undertaken to explore the common model shared by mothers and children who have had comparable experiences, as well as to completely analyze the differences between different cultures in this topic.
Collapse
|
4
|
Rising CJ, Wilsnack C, Boyd P, Sleight AG, Hutson SP, Khincha PP, Werner-Lin A. Family communication challenges of adolescents and young adults with Li-Fraumeni syndrome: Implications for psychosocial care. PATIENT EDUCATION AND COUNSELING 2022; 105:3259-3266. [PMID: 35918231 PMCID: PMC9529832 DOI: 10.1016/j.pec.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This qualitative-descriptive study explored adolescent and young adult (AYA) perspectives, experiences, and challenges with openness and closedness in family communication about Li-Fraumeni syndrome (LFS). METHODS We conducted interviews with AYAs (aged 15-39 years) with LFS enrolled in the National Cancer Institute's LFS study (NCT01443468). An interprofessional clinician-researcher team analyzed transcribed data using the constant comparative method and interpretive description. RESULTS AYAs (N = 38; 26 females, 12 males, mean age=29 years) reported navigating openness and closedness about LFS in their families, which varied by LFS topic, relationship, disease trajectory, and developmental phase. AYAs described communication challenges, including broaching difficult topics (e.g., reproductive decision-making, end-of-life), balancing information-sharing with emotionally protecting family and self, and struggling with interactions that cause relational tensions. CONCLUSIONS AYAs reported experiencing LFS family communication challenges that disrupted their psychosocial well-being. LFS-related stressors and life transitions complicated and were complicated by these challenging family interactions. PRACTICE IMPLICATIONS Clinicians may support AYAs with LFS by inquiring about family communication, responding empathically to communication concerns, providing resources to support difficult conversations, and engaging mental health providers as needed. Researchers could partner with AYAs to develop tailored communication skills training and social support tools.
Collapse
Affiliation(s)
- Camella J Rising
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA.
| | - Catherine Wilsnack
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA.
| | - Patrick Boyd
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA.
| | - Alix G Sleight
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, USA.
| | - Sadie P Hutson
- College of Nursing, The University of Tennessee, Knoxville, USA.
| | - Payal P Khincha
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA.
| | - Allison Werner-Lin
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA.
| |
Collapse
|
5
|
Zhu P, Ji Q, Liu X, Xu T, Wu Q, Wang Y, Gao X, Zhou Z. “I’m walking on eggshells”: challenges faced by mothers with breast cancer in interacting with adolescent daughters. BMC Womens Health 2022; 22:385. [PMID: 36127684 PMCID: PMC9490998 DOI: 10.1186/s12905-022-01872-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background With breast cancer becoming the most diagnosed cancer in the world, the number of breast cancer-afflicted mothers with adolescent daughters is also rising. Further, adolescent daughters’ mothers serve as role models for in identity formation processes, especially concerning gender and sexuality. Nevertheless, breast cancer threats mother’s health, including such a key symbol of her womanhood—the breast—which may adversely affect the development of an adolescent daughter’s own sense of personal identity and womanhood. However, few researchers and practitioners have paid attention to mother-daughter interactions in the context of breast cancer. Therefore, this study aimed to uncover the nuances of the interactive challenges with adolescent daughters from breast cancer-afflicted mothers’ perspective. Methods We conducted a qualitative study following the sample saturation principle, collecting data through semi-structured interviews with 21 breast cancer patients who met the inclusion criteria. We utilized thematic analysis and partially integrated the Foucauldian discourse approach to analyze the data. Results Three major themes emerged from the data: (1) mothers are lost in chaos (inability to handle the shock of cancer, feelings of powerlessness about the uncertainty of their life span, and confusion about how to respond to daughter’s curiosity); (2) mothers struggle to maintain balance (torn between protecting daughters and letting them be independent, and making a tough choice between being a mother or a patient); and (3) mothers are immersed in guilt (increasing daughters’ risk of cancer, influencing daughters’ development, and imposing burdens on daughters). Conclusions Our research explored the interactive experience of breast cancer-afflicted mothers and adolescent daughters. The insights uncovered by this study will help mothers enhance interaction with their daughters and assist health practitioners in devising interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01872-1.
Collapse
|
6
|
Fisher CL, Kastrinos A, Curley A, Canzona MR, Piemonte N, Wolf B, Pipe T. Helping Diagnosed Mothers and Their Adolescent-Young Adult Daughters Navigate Challenging Breast Cancer Conversations. CANCER CARE RESEARCH ONLINE 2022; 2:e025. [PMID: 38239410 PMCID: PMC10795856 DOI: 10.1097/cr9.0000000000000025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Background Mothers diagnosed with breast cancer describe daughters as a critical source of support. Talking about breast cancer is especially distressing and challenging for mothers and their adolescent-young adult (AYA) daughters. Objective The over-arching study aim was to generate findings to integrate into an intervention to enhance diagnosed mothers' and AYA daughters' communication skills by identifying approaches they find helpful when talking about cancer. Methods We recruited 27 women (12 dyads). Diagnosed mothers and their AYA daughters (aged 18-29) participated in individual, in-depth, semi-structured interviews. Transcripts were thematically analyzed. Mothers'/daughters' perspectives were compared/ triangulated. Results Both mothers and daughters identified 3 approaches that helped them navigate cancer communication: (mothers) initiate conversations, keep communication positive, and limit cancer conversations. Only mothers reported it was helpful to downplay the seriousness of cancer. Only daughters identified it was important for them to reframe their perspective of mothers' disclosures. Conclusions Findings provide clinicians like nurses and families with a "psychosocial map" of communication approaches and associated strategies mothers and AYA daughters can use to talk about breast cancer in ways that promote daughters' comfort and/or alleviate distress. Implications for Practice Findings capture communication skills to focus on when tailoring developmentally focused interventions targeting diagnosed mothers and AYA daughters. Nurses can translate findings into practice to help patients talk to AYA daughters about cancer, thereby promoting a family-centered cancer care approach. What Is Foundational: AYA daughters are especially distressed talking about cancer with their diagnosed mothers. They can both use communication strategies to enhance their communal coping.
Collapse
Affiliation(s)
- Carla L. Fisher
- University of Florida, College of Journalism and Communications & College of Medicine, UF Health Cancer Center, Gainesville, Florida
| | | | - Alana Curley
- University of Florida, College of Journalism and Communications & College of Medicine, UF Health Cancer Center, Gainesville, Florida
| | - Mollie R. Canzona
- Wake Forest University, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicole Piemonte
- Creighton University, School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Bianca Wolf
- University of Puget Sound, Tacoma, Washington
| | - Teri Pipe
- Arizona State University, Phoenix, Arizona
| |
Collapse
|
7
|
Campbell-Salome G, Barbour JB. Managing Uncertainty for and With Family: Communication Strategies and Motivations in Familial Uncertainty Management for Hereditary Cancer. QUALITATIVE HEALTH RESEARCH 2022; 32:1230-1245. [PMID: 35621326 DOI: 10.1177/10497323221090191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The management of uncertainty is integral to health and illness. Individuals manage uncertainty about their health through communication enmeshed in family systems, but existing theorizing focuses on individuals without accounting for family processes. An iterative qualitative analysis of 42 dyadic, family interviews (N = 84) revealed (a) moments in the context of hereditary cancer that involved individual-centered and familial uncertainty appraisal and management, (b) family members' communication strategies to prompt relatives to engage familial uncertainty, and (c) the communicative (re)creation and negotiation of family models for uncertainty management. The findings illuminate tensions that individuals encounter across their lifespan as they appraise and manage uncertainty about hereditary cancer risks. This study extends uncertainty management theory to encompass familial uncertainty management and contributes insights useful for the management of hereditary cancer.
Collapse
Affiliation(s)
- Gemme Campbell-Salome
- Genomic Medicine Institute, Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Joshua B Barbour
- Moody College of Communication, Department of Communication Studies, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
8
|
Stracke C, Lemmen C, Rhiem K, Schmutzler R, Kautz-Freimuth S, Stock S. "You Always Have It in the Back of Your Mind"-Feelings, Coping, and Support Needs of Women with Pathogenic Variants in Moderate-Risk Genes for Hereditary Breast Cancer Attending Genetic Counseling in Germany: A Qualitative Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3525. [PMID: 35329227 PMCID: PMC8951351 DOI: 10.3390/ijerph19063525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
Hereditary breast cancer accounts for approximately 30% of newly diagnosed breast cancer (BC) cases. Pathogenic variants in moderate-risk BC genes (MBCG) differ from those in high-risk genes in terms of associated cancer risks, affected organs, and available preventive options. Little is known about how MBCG pathogenic variant carriers who have attended post-test genetic counseling perceive their situation, how they cope with their situation, and which support needs they might have. Problem-centered, guided, individual interviews were conducted with twelve women carrying pathogenic variants in MBCG. The interview analysis was based on Mayring's qualitative content analysis. The women were between 29 and 59 years old and carried pathogenic variants in the risk genes CHEK2 (n = 8), ATM (n = 1), or PALB2 (n = 3). Women reported a wide range of feelings, both positive (relief, calmness) and negative (overwhelm, fear, grief, guilt). All women applied strategies of emotion-focused coping to deal with this lifelong situation. Appraisal and evaluation of the affected mother's coping might influence the patient's own behavior and coping style. These results could be used during and after post-test genetic counseling to provide more needs-oriented counseling, and to help women in adjusting to and coping with being a pathogenic variant carrier.
Collapse
Affiliation(s)
- Claudia Stracke
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Clarissa Lemmen
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Rita Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| |
Collapse
|
9
|
Beach WA. Enacting Woundedness and Compassionate Care for Recurrent Metastatic Breast Cancer. QUALITATIVE HEALTH RESEARCH 2022; 32:210-224. [PMID: 34894862 DOI: 10.1177/10497323211050907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This analysis integrates Arthur Frank's timeless revelations about woundedness within the communication context of an oncology interview. A Patient whose life is threatened by recurrent metastatic breast cancer claims personal knowledge and visibly demonstrates impacts from illness experiences. Conversation Analysis (CA) was conducted on a video recorded and transcribed case study involving a Patient, her husband, and co-present oncologists. By focusing on narratives as talk-in-interaction, grounded exemplars are provided of primary interactional achievements: How woundedness gets displayed and responded to with empathy and compassionate witnessing; Patient's flooding out with emotion and potential embarrassment; attempting to regain control and resume talking about her condition; and the serial organization of crying and laughter when managing noticeably delicate moments. In this interview, woundedness is not discounted or dismissed but recognized as legitimate suffering meriting shared commiseration. Understanding how to enact humane and communicatively competent skills during emotionally uncertain moments can enhance medical education.
Collapse
Affiliation(s)
- Wayne A Beach
- School of Communication, 7117San Diego State University, San Diego, CA, USA
| |
Collapse
|
10
|
Stracke C, Lemmen C, Rhiem K, Schmutzler R, Kautz-Freimuth S, Stock S. Medical knowledge and information needs among women with pathogenic variants in moderate-risk genes for hereditary breast cancer attending genetic counseling at an academic hospital in Germany-A qualitative approach. J Genet Couns 2021; 31:698-712. [PMID: 34837291 DOI: 10.1002/jgc4.1536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/20/2022]
Abstract
With 69,000 newly diagnosed cases every year, breast cancer (BC) is the most frequent cancer disease among women in Germany. Familial clustering is seen in about 30% of newly diagnosed cases. Besides the high-risk genes BRCA1/2, there are also moderate-risk BC genes (MBCG) that are associated with a 20%-50% risk of BC, such as CHEK2, ATM, and PALB2. In Germany, carriers of pathogenic variants in MBCG receive specific information on their test results, individual risks, and preventive options during genetic counseling for the disclosure of the results in a specialized center. Little is known about the medical knowledge that women have after attending counseling. This study aims to identify the medical knowledge, further information needs, and the possible impact of a lack of information on dealing with everyday life for women with pathogenic variants in MBCG who have attended genetic counseling at an academic hospital in Germany. Problem-centered, guided, individual interviews were conducted with twelve women carrying pathogenic variants in MBCG. The interview guide was developed based on the methods of the problem-centered interview according to Witzel. The interview analysis was based on Mayring's qualitative content analysis. The women were between 29 and 59 years old and carried pathogenic variants in the risk genes CHEK2 (n = 8), ATM (n = 1), or PALB2 (n = 3). Several medical uncertainties and information needs emerged from the data, concerning (a) medical terms, (b) risk perception, (c) BC therapy for hereditary BC, (d) lifestyle advice and risk factors, and (e) family planning and risk-reducing mastectomy. Women with pathogenic variants in MBCG might develop their own conceptions regarding the onset of disease and inheritance. In order to meet the need for information and address the uncertainties that may still exist after genetic counseling, structured, evidence-based and comprehensible written information in German should be developed for this group.
Collapse
Affiliation(s)
- Claudia Stracke
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Clarissa Lemmen
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Kerstin Rhiem
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Rita Schmutzler
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Sibylle Kautz-Freimuth
- Faculty of Medicine and University Hospital Cologne, Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| |
Collapse
|
11
|
Wright KB, Cai X, Fisher C, Rising CJ, Burke-Garcia A, Afanaseva D. A Content Analysis of Social Support Messages about Environmental Breast Cancer Risk within Blogs for Mothers. HEALTH COMMUNICATION 2021; 36:1796-1804. [PMID: 32744079 PMCID: PMC7855537 DOI: 10.1080/10410236.2020.1800241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bloggers can help stimulate online conversations among their readers about a variety of health topics, including breast cancer. However, in previous studies, researchers have not specifically examined supportive messages within an online blogger community that stem from an intervention where bloggers were provided with evidence-based information about breast cancer risk that they could tailor and disseminate to their readers. In the current study, we content analyzed 282 supportive messages within online conversations from participants in blogger communities over a 2-month period immediately following an intervention where the authors provided 74 bloggers who write about motherhood issues with an infographic based on evidence-based information from the Breast Cancer and the Environment Research Program (BCERP) about environmental breast cancer risk/prevention. Bloggers who shared information about their personal breast cancer risk generated a significantly higher number of blog reader comments than bloggers who did not share information about their personal breast cancer risk. Bloggers who cited breast cancer statistics in posts were more likely to draw esteem and emotional support from their readers. Bloggers' repetition of information from blog intervention messages was more likely to elicit esteem, informational, and emotional support from readers. Disclosure of a personal breast cancer diagnosis was associated with mixed types of social support messages. The theoretical and practical implications are discussed along with key limitations of the study and future directions for research in this area.
Collapse
Affiliation(s)
- Kevin B Wright
- Department of Communication, George Mason University, Fairfax, VA, USA
| | - Xiaomei Cai
- Department of Communication, George Mason University, Fairfax, VA, USA
| | - Carla Fisher
- UF Health Cancer Center, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Camella J Rising
- Department of Communication, George Mason University, Fairfax, VA, USA
| | | | | |
Collapse
|
12
|
O'Neill SC, Hamilton JG, Conley CC, Peshkin BN, Sacca R, McDonnell GA, Isaacs C, Robson ME, Tercyak KP. Improving our model of cascade testing for hereditary cancer risk by leveraging patient peer support: a concept report. Hered Cancer Clin Pract 2021; 19:40. [PMID: 34565430 PMCID: PMC8474818 DOI: 10.1186/s13053-021-00198-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023] Open
Abstract
Consensus and evidence suggest that cascade testing is critical to achieve the promise of cancer genetic testing. However, barriers to cascade testing include effective family communication of genetic risk information and family members' ability to cope with genetic risk. These barriers are further complicated by the developmental needs of unaffected family members during critical windows for family communication and adaptation. Peer support could address these barriers. We provide two illustrative examples of ongoing BRCA1/2-related clinical trials that apply a peer support model to improve family communication and functioning. Peer support can augment currently available genetic services to facilitate adjustment to and effective use of cancer genetic risk information. Importantly, this scalable approach can address the presence of cancer risk within families across multiple developmental stages. This applies a family-centered perspective that accommodates all potentially at-risk relatives. This peer support model can be further applied to emerging topics in clinical genetics to expand reach and impact.
Collapse
Affiliation(s)
- Suzanne C O'Neill
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA.
| | | | - Claire C Conley
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Beth N Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Rosalba Sacca
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kenneth P Tercyak
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C, USA
| |
Collapse
|
13
|
Fisher CL, Wright KB, Rising CJ, Mullis MD, Afanaseva D, Burke-Garcia A, Cai X. Culturally Appropriate Breast Cancer and Environmental Risk Messages: Targeting Racially and Ethnically Diverse Mothers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:284-293. [PMID: 31820415 DOI: 10.1007/s13187-019-01626-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The National Institute of Environmental Health Sciences (NIEHS)-funded Breast Cancer and Environment Research Program (BCERP) provides evidence-informed educational materials targeting mothers with daughters to help them engage in lifestyle changes to reduce their environmental risk of breast cancer. Building on a partnership we developed to disseminate these materials via social media, we teamed with mommy bloggers and readers to evaluate the cultural appropriateness of the information using evidence-based practices for message design. We sought to (1) identify cross-culture factors that speak to a broad group of mothers and culture-specific factors to integrate when targeting specific cultures and (2) capture cultural challenges mothers encounter when they share the information with family to understand the social context in which they receive, interpret, and act on risk-reducing messages. We conducted 50 interviews with racially and ethnically diverse bloggers/readers and thematically analyzed transcripts, comparing findings across cultures. Across cultures, mothers identified five key factors for ensuring cultural appropriateness, but with notable cultural differences: (1) incorporate diverse images, (2) provide more information specific to environmental and cultural risk, (3) heighten the message of "it's a family affair", (4) make behavioral changes feasible, and (5) use less text, more visuals. Across cultures, women experienced intergenerational communication challenges with family, which were tied to (1) lack of openness, (2) relational norms, and (3) generational resistance. Findings provide message design considerations for targeting mothers broadly or based on race/ethnicity and support the notion that the larger family system should be considered when disseminating cancer risk education.
Collapse
Affiliation(s)
- Carla L Fisher
- College of Journalism and Communications, University of Florida, UF Health Cancer Center, PO Box 118400, Gainesville, FL, 32611-8400, USA.
| | - Kevin B Wright
- Department of Communication, George Mason University, 4400 University Dr, MSN3D6, Fairfax, VA, 22030, USA
| | - Camella J Rising
- Department of Communication, George Mason University, 4400 University Dr, MSN3D6, Fairfax, VA, 22030, USA
| | - Michaela Devyn Mullis
- College of Journalism and Communications, University of Florida, PO Box 118400, Gainesville, FL, 32611-8400, USA
| | | | - Amelia Burke-Garcia
- NORC at the University of Chicago, 4350 East-West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Xiaomei Cai
- Department of Communication, George Mason University, 4400 University Dr, MSN3D6, Fairfax, VA, 22030, USA
| |
Collapse
|
14
|
Fisher CL, Wright KB, Rising CJ, Cai X, Mullis MD, Burke-Garcia A, Afanaseva D. Helping Mothers and Daughters Talk about Environmental Breast Cancer Risk and Risk-Reducing Lifestyle Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134757. [PMID: 32630657 PMCID: PMC7370108 DOI: 10.3390/ijerph17134757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 01/30/2023]
Abstract
Background: Mothers and daughters struggle to talk about breast cancer risk. Even less attention is paid to environmental determinants of cancer. Third-party online approaches can be helpful navigating these conversations. The aim of this study was to obtain feedback from mothers exposed to a social media intervention (“mommy bloggers”) and identify their preferences for message-design approaches that could help them talk to their daughter(s) about environmental breast cancer risk. Methods: We conducted semi-structured interviews with 50 mothers. A thematic analysis was conducted using the constant comparative method. Results: Mothers identified four approaches to message design that could help facilitate mother–daughter communication about environmental breast cancer risk. These included two action-oriented approaches that centered on getting the conversation started and keeping the conversation going and two approaches based on lifespan factors to promote daughters’ engagement by using age-appropriate language and visuals and focusing on developmentally specific lifestyle behaviors. Mothers also provided recommended strategies within each approach. Conclusions: Mothers identified various approaches interventionists can utilize to overcome barriers to talking to daughters about environmental breast cancer risk. To promote mother–daughter communication, the messages should be action-oriented to facilitate interaction, but also developed with lifespan and developmental considerations in mind to engage daughters.
Collapse
Affiliation(s)
- Carla L. Fisher
- UF Health Cancer Center, College of Journalism and Communications, University of Florida, P.O. Box 118400, Gainesville, FL 32611-8400, USA;
- Correspondence: ; Tel.: +1-352-294-1019
| | - Kevin B. Wright
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Camella J. Rising
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Xiaomei Cai
- Department of Communication, George Mason University, 4400 University, Dr, MSN3D6, Fairfax, VA 22030, USA; (K.B.W.); (C.J.R.); (X.C.)
| | - Michaela D. Mullis
- UF Health Cancer Center, College of Journalism and Communications, University of Florida, P.O. Box 118400, Gainesville, FL 32611-8400, USA;
| | - Amelia Burke-Garcia
- NORC at the University of Chicago, 4350 East West Highway, Bethesda, MD 20814, USA;
| | - Dasha Afanaseva
- Fors Marsh Group, 901 N. Glebe Road, Arlington, VA 22201, USA;
| |
Collapse
|
15
|
Abstract
Objective: This qualitative study sought to identify and describe patients' variant perceptions of disease severity after receiving a type 2 diabetes (T2DM) or prediabetes (preDM) diagnosis. Design: Researchers interviewed 29 patients from two US medical centers to ascertain perceptions of severity. We used the constant comparative method from a grounded theory approach to identify themes from patients' perspectives that inform their disease severity. This approach was used to help translate research to practice and ultimately identify intervention strategies informed by authentic experiences of preDM and T2DM patients. Results: Perceptions of disease severity fell into two groups: high and low severity. Patients diagnosed with T2DM and preDM emerged in both groups and were comparative in terms of sample size, gender, and ethnic diversity. Several factors contributed to patients' beliefs, including what they were told about the disease, observations from experiences within their own social network, and information from formal diabetes classes and their own research. The two perspectives diverged when patients described how their belief was informed by three thematic properties or personal factors: (i) fears; (ii) clinician communication; and (iii) social comparisons. Conclusions: Beliefs about severity are influenced by patients' fears, interactions with clinicians, and experiences within their social networks. These findings show that when interacting with patients with T2DM or preDM, clinicians should elicit patient perceptions of disease severity so they may then tailor the discussion to address these perceptions and help patients grasp the severity of these conditions.
Collapse
|
16
|
Wright K, Fisher C, Rising C, Burke-Garcia A, Afanaseva D, Cai X. Partnering With Mommy Bloggers to Disseminate Breast Cancer Risk Information: Social Media Intervention. J Med Internet Res 2019; 21:e12441. [PMID: 30843866 PMCID: PMC6427105 DOI: 10.2196/12441] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/11/2018] [Accepted: 12/14/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Women are concerned about reducing their breast cancer risk, particularly if they have daughters. Social media platforms, such as blogs written by mothers, are increasingly being recognized as a channel that women use to make personal and family health-related decisions. Government initiatives (eg, Interagency Breast Cancer and Environmental Research Coordinating Committee) and researchers have called for scientists and the community to partner and disseminate scientifically and community-informed environmental risk information. OBJECTIVE We developed and evaluated a blog intervention to disseminate breast cancer and environmental risk information to mothers. We teamed with mommy bloggers to disseminate a message that we developed and tailored for mothers and daughters based on scientific evidence from the Breast Cancer and the Environment Research Program (BCERP). We posited that the intervention would influence women's exposure to, acceptance of, and beliefs about environmental risks while promoting their intention to adopt risk-reducing behaviors. METHODS Using a quasi-experimental design, we recruited 75 mommy bloggers to disseminate the breast cancer risk message on their respective blogs and examined the impact of the intervention on (1) readers exposed to the intervention (n=445) and (2) readers not exposed to the intervention (comparison group; n=353). RESULTS Following the intervention, blog reader scores indicating exposure to the breast cancer risk and prevention information were greater than scores of blog readers who were not exposed (or did not recall seeing the message; mean 3.92, SD 0.85 and mean 3.45, SD 0.92, respectively; P<.001). Readers who recalled the intervention messages also had higher breast cancer risk and prevention information satisfaction scores compared with readers who did not see (or recall) the messages (mean 3.97, SD 0.75 and mean 3.57, SD 0.94, respectively; P<.001). Blog readers who recalled seeing the intervention messages were significantly more likely to share the breast cancer risk and prevention information they read, with their daughters specifically, than readers who did not recall seeing them (χ21=8.1; P=.004). Those who recalled seeing the intervention messages reported significantly higher breast cancer risk and prevention information influence scores, indicative of behavioral intentions, than participants who did not recall seeing them (mean 11.22, SD 2.93 and mean 10.14, SD 3.24, respectively; P=.003). Most women ranked Facebook as their first choice for receiving breast cancer risk information. CONCLUSIONS Results indicated that blog readers who were exposed to (and specifically recalled) the BCERP-adapted intervention messages from mommy bloggers had higher breast cancer risk and prevention information exposure scores and higher breast cancer risk and prevention information satisfaction and influence scores than those who did not see (or recall) them. Mommy bloggers may be important opinion leaders for some women and key to enhancing the messaging, delivery, and impact of environmental breast cancer risk information on mothers.
Collapse
Affiliation(s)
- Kevin Wright
- George Mason University, Fairfax, VA, United States
| | - Carla Fisher
- University of Florida, UF Health Cancer Center, Gainesville, FL, United States
| | | | | | | | - Xiaomei Cai
- George Mason University, Fairfax, VA, United States
| |
Collapse
|
17
|
Young MA, Forrest LE, Rasmussen VM, James P, Mitchell G, Sawyer SD, Reeve K, Hallowell N. Making Sense of SNPs: Women's Understanding and Experiences of Receiving a Personalized Profile of Their Breast Cancer Risks. J Genet Couns 2017; 27:702-708. [PMID: 29168041 DOI: 10.1007/s10897-017-0162-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 10/03/2017] [Indexed: 12/22/2022]
Abstract
Genome wide association studies have identified a number of common genetic variants - single nucleotide polymorphisms (SNPs) - that combine to increase breast cancer risk. SNP profiling may enhance the accuracy of risk assessment and provides a personalized risk estimate. SNP testing for breast cancer risks may supplement other genetic tests in the future, however, before it can be implemented in the clinic we need to know how it will be perceived and received. Semi-structured qualitative interviews were conducted with 39 women who had previously had a breast cancer diagnosis and undergone BRCA1/2 testing, participated in the Variants in Practice (ViP) study and received personalized risk (SNP) profiles. Interviews explored their understanding and experiences of receiving this SNP information. Women reported feeling positive about receiving their personalized risk profile, because it: provided an explanation for their previous diagnosis of cancer, vindicated previous risk management decisions and clarified their own and other family members' risks. A small group was initially shocked to learn of the increased risk of a second primary breast cancer. This study suggests that the provision of personalized risk information about breast cancer generated by SNP profiling is understood and well received. However, a model of genetic counseling that incorporates monogenic and polygenic genetic information will need to be developed prior to clinical implementation.
Collapse
Affiliation(s)
- Mary-Anne Young
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia. .,Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Parkville, Australia.
| | - Laura Elenor Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Parkville, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Paul James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Parkville, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Gillian Mitchell
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Parkville, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Sarah Dilys Sawyer
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Parkville, Australia.,Department of Pathology, The University of Melbourne, Melbourne, VIC, Australia
| | - Katrina Reeve
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
18
|
Dean M, Rauscher EA. “It was an Emotional Baby”: Previvors’ Family Planning Decision-Making Styles about Hereditary Breast and Ovarian Cancer Risk. J Genet Couns 2017; 26:1301-1313. [DOI: 10.1007/s10897-017-0069-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/15/2017] [Indexed: 01/14/2023]
|
19
|
Fisher CL, Roccotagliata T, Rising CJ, Kissane DW, Glogowski EA, Bylund CL. “I Don’t Want to Be an Ostrich”: Managing Mothers’ Uncertainty during BRCA1/2 Genetic Counseling. J Genet Couns 2016; 26:455-468. [DOI: 10.1007/s10897-016-9998-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
|
20
|
Dean M. "It's not if I get cancer, it's when I get cancer": BRCA-positive patients' (un)certain health experiences regarding hereditary breast and ovarian cancer risk. Soc Sci Med 2016; 163:21-7. [PMID: 27376595 DOI: 10.1016/j.socscimed.2016.06.039] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 06/14/2016] [Accepted: 06/22/2016] [Indexed: 12/01/2022]
Abstract
RATIONALE Women with a harmful mutation in the BReast CAncer (BRCA) gene are at significantly increased risk of developing hereditary breast and ovarian cancer (HBOC) during their lifetime, compared to those without. Such patients-with a genetic predisposition to develop cancer but who have not yet been diagnosed with cancer-live in a constant state of uncertainty and wonder not if they might get cancer but when. OBJECTIVE Framed by uncertainty management theory, the purpose of this study was to explore BRCA-positive patients' health experiences after testing positive for the BRCA genetic mutation, specifically identifying their sources of uncertainty. METHODS Thirty-four, qualitative interviews were conducted with female patients. Participants responded to online research postings on the non-profit organization Facing Our Risk of Cancer Empowered's (FORCE) message board and social media pages as well as HBOC-specific Facebook groups. The interview data were coded using the constant comparison method. RESULTS Two major themes representing BRCA-positive patients' sources of uncertainty regarding their genetic predisposition and health experiences emerged from the data. Medical uncertainty included the following three subthemes: the unknown future, medical appointments, and personal cancer scares. Familial uncertainty encompassed the subthemes traumatic family cancer memories and motherhood. CONCLUSIONS Overall, the study supports and extends existing research on uncertainty-revealing uncertainty is inherent in BRCA-positive patients' health experiences-and offers new insight regarding uncertainty management and HBOC risk.
Collapse
Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, 4202 E. Fowler CIS 3057, Tampa, FL 33620, USA.
| |
Collapse
|
21
|
|