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Hunter JD, Hetherington K, Courtney E, Christensen Y, Fuentes-Bolanos N, Bhatia K, Peate M. Parents' and patients' perspectives, experiences, and preferences for germline genetic or genomic testing of children with cancer: A systematic review. Genet Med 2024; 26:101197. [PMID: 38943478 DOI: 10.1016/j.gim.2024.101197] [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] [Received: 04/25/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/01/2024] Open
Abstract
PURPOSE Germline testing in pediatric cancer presents opportunities and challenges. Understanding family perspectives, experiences, and preferences will optimize integration into routine care. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 4 databases for studies exploring perspectives, experiences, and preferences of parents/caregivers and/or patients regarding germline testing of children with cancer. Qualitative and quantitative data were extracted, organized, and summarized by research question and themes. RESULTS We identified 2286 unique articles, of which 24 were included. Interest in and uptake of testing was high. Families were motivated by altruism and a desire for inheritance/causation information. Testing barriers included psychological concerns, timing of the testing approach if offered at diagnosis or in a high-risk cancer setting and privacy/discrimination. Testing experiences highlighted challenges yet also positive impacts, with results providing psychological relief and informing proactive decision making. Timing preferences varied; however, allowing time to adjust to a new diagnosis was a common theme. Most wanted to receive as many germline sequencing-related results as possible. CONCLUSION Findings underscore the importance of integrating germline analyses into pediatric cancer care with flexibility and support for families facing challenges. Where possible, consent should be provided at a time that suits each family's situation with access to information aligning with their needs and preferences. PROSPERO CRD42023444890.
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Affiliation(s)
- Jacqueline D Hunter
- School of Clinical Medicine, Randwick Clinical Campus, Discipline of Pediatrics and Child Health, UNSW Sydney, Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; Department of Obstetrics, Gynecology and Newborn Health, Royal Women's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
| | - Kate Hetherington
- School of Clinical Medicine, Randwick Clinical Campus, Discipline of Pediatrics and Child Health, UNSW Sydney, Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Eliza Courtney
- School of Clinical Medicine, Randwick Clinical Campus, Discipline of Pediatrics and Child Health, UNSW Sydney, Sydney, Australia; Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Yasmin Christensen
- School of Clinical Medicine, Randwick Clinical Campus, Discipline of Pediatrics and Child Health, UNSW Sydney, Sydney, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Noemi Fuentes-Bolanos
- School of Clinical Medicine, Randwick Clinical Campus, Discipline of Pediatrics and Child Health, UNSW Sydney, Sydney, Australia; Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | | | - Michelle Peate
- Department of Obstetrics, Gynecology and Newborn Health, Royal Women's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Takenouchi N, Matsuoka M. The Experience of Adolescents and Young Adults in Their Cancer Journeys in Japan: I Try to Move Forward With Feeling That I Would Be Okay With "My Cancer". J Adolesc Young Adult Oncol 2024. [PMID: 39008423 DOI: 10.1089/jayao.2024.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
Purpose: A cancer diagnosis can greatly affect adolescents and young adults (AYAs), especially those in their late teens and early twenties, who might have their special needs. This study aimed to understand the experiences of the AYAs who were diagnosed between 15 and 24 years of age in Japan, thinking about the care guide supporting them, from the time of their cancer diagnosis through the rest of their lives. Methods: Data were collected using semi-structured interviews, which were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts was used to categorize these into themes for comprehensive interpretation. Results: Twenty AYAs participated; they were diagnosed between the ages 15 and 23 and were 19-29 years old at the time of the interview. In total, 14 core categories were identified, consisting of three themes (1) There is a feeling of distance between the cancer and me, (2) I face "my cancer" in my way, and (3) I feel that I would be okay with "my cancer." Conclusions: AYAs had their way of dealing with cancer while experiencing a distant feeling between themselves and the presence of the disease during their cancer journey. Although the process was not simple, they tried to live their lives in their own way, believing that they would be okay. Nurses must respect and understand that AYAs have a process of facing their own cancer with time and watch over AYAs' experiences to appropriately support them to successfully proceed further.
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Affiliation(s)
- Naoko Takenouchi
- University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
- School of Medicine, Faculty of Health Sciences, Kyoto University, Kyoto, Japan
| | - Mari Matsuoka
- School of Nursing, Child Health Nursing, Faculty of Medicine, Mie University Graduate School of Medicine, Mie, Japan
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Pettitt NJ, Petrella AR, Neilson S, Topping A, Taylor RM. Psychosocial and Support Needs of the Main Caregiver for Adolescents and Young Adults Undergoing Treatment for Cancer. Cancer Nurs 2024:00002820-990000000-00247. [PMID: 38656263 DOI: 10.1097/ncc.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Family relationships and social networks are critically important to adolescents and young adults (AYAs) with cancer, impacting their experience and well-being throughout the cancer trajectory. A cancer diagnosis impacts the development of independence and an adult identity, which can present challenges to psychosocial well-being needs and relationships between caregivers and AYAs. OBJECTIVE The aim of this study was to explore the psychosocial and support needs of the main caregivers of AYAs. METHODS This is a secondary analysis of the BRIGHTLIGHT caregiver survey, exploring items pertaining to support offered/engaged with, appraisal of helpfulness, and caregivers' emotional and psychological distress experience. Descriptive statistics, a correlational analysis, and a 1-way analysis of variance were conducted. RESULTS There were 518 caregiver responses (62%). Over half received information about their caregiving needs, with the majority finding this very/fairly helpful. Most (80%) of those who had not received the information would have valued it. High levels of negative emotional and psychological well-being were reported, with 91% feeling depressed or anxious since the AYAs' diagnosis and 41% always/often experiencing these feelings. Total distress was associated with being younger, a parent, female, and unemployed, and earning a below-average income. CONCLUSIONS The needs of caregivers are broad and multidimensional; however, some characteristics were associated with higher distress. When caregiver-specific information was provided by healthcare professionals, it was well received. IMPLICATIONS FOR PRACTICE Healthcare professionals should consider caregivers' needs individually and provide/signpost to support. Caregivers need to be involved in designing and implementing future research, given the heterogeneity of needs identified.
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Affiliation(s)
- Nicola J Pettitt
- Author Affiliations: Corporate Nursing, University Hospitals Birmingham NHS Foundation Trust (Mrs Pettitt and Dr Topping); Institute of Clinical Sciences, University of Birmingham (Drs Neilson and Topping); Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust (Dr Petrella); Centre for Nurse, Midwife and Allied Health Profession led Research (CNMAR), University College London Hospitals NHS Foundation Trust (Dr Taylor); and Department of Targeted Intervention, University College London (Dr Taylor), United Kingdom
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Critoph DJ, Taylor RM, Spathis A, Duschinsky R, Hatcher H, Clyne E, Kuhn I, Smith LAM. Triadic communication with teenagers and young adults with cancer: a systematic literature review - 'make me feel like I'm not the third person'. BMJ Open 2024; 14:e080024. [PMID: 38367963 PMCID: PMC10875529 DOI: 10.1136/bmjopen-2023-080024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVES Clinical communication needs of teenagers and young adults with cancer (TYACs) are increasingly recognised to differ significantly from younger children and older adults. We sought to understand who is present with TYACs, TYACs' experiences of triadic communication and its impact. We generated three research questions to focus this review: (1) Who is present with TYACs in healthcare consultations/communication?, (2) What are TYACs' experiences of communication with the supporter present? and (3) What is the impact of a TYAC's supporter being present in the communication? DESIGN Systematic review with narrative synthesis. DATA SOURCES The search was conducted across six databases: Medline, CINAHL, Embase, PsycINFO, Web of Science and AMED for all publications up to December 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Included papers were empirical research published after 2005; participants had malignant disease, diagnosed aged 13-24 years (for over 50% of participants); the research addressed any area of clinical communication. DATA EXTRACTION AND SYNTHESIS Three independent reviewers undertook full-text screening. A review-specific data extraction form was used to record participant characteristics and methods from each included paper and results relevant to the three review questions. RESULTS A total of 8480 studies were identified in the search, of which 36 fulfilled the inclusion criteria. We found that mothers were the most common supporter present in clinical communication encounters. TYACs' experiences of triadic communication are paradoxical in nature-the supporter can help or hinder the involvement of the young person in care-related communication. Overall, young people are not included in clinical communication and decisions at their preferred level. CONCLUSION Triadic communication in TYACs' care is common, complex and dynamic. Due to the degree of challenge and nuances raised, healthcare professionals need further training on effective triadic communication. PROSPERO REGISTRATION NUMBER CRD42022374528.
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Affiliation(s)
- Deborah J Critoph
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Rachel M Taylor
- CNMAR, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anna Spathis
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Robbie Duschinsky
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Helen Hatcher
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Luke A M Smith
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Mogensen N, Kreicbergs U, Albertsen BK, Lähteenmäki P, Heyman M, Harila A. Parental experiences of the informed consent process in randomized clinical trials-A Nordic study. Pediatr Blood Cancer 2023; 70:e30684. [PMID: 37728014 DOI: 10.1002/pbc.30684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Randomized clinical trials (RCTs) are an essential part of improving acute lymphoblastic leukemia (ALL) treatment. This population-based questionnaire study investigated parents' experiences of the informed consent process in the RCTs within the Nordic NOPHO (Nordic Society of Paediatric Haematology and Oncology) ALL2008 trial. PROCEDURE Parents in Sweden, Denmark, and Finland whose child was alive and in first remission after end of therapy and who were asked to participate in any RCT in the ALL2008 protocol, were asked to complete 15 questions/items regarding their experience of the RCT consent process. RESULTS A total of 483 parents of 279 children met the inclusion criteria and answered the study questionnaire. Most (91%) agreed/strongly agreed to having received sufficient information to make a well-informed decision, felt confidence in the study design (86%), and thought that the process was satisfactory (86%). Those who did not consent reported a generally more negative experience of the process. More than a third of all parents and over half of parents who had refused participation felt that it was burdensome to decide. Most parents (66%) in general, and one-third of those with children 8 years or older, reported that their child was not involved in the process. CONCLUSIONS Parents were in general satisfied with the informed consent process, although many parents, particularly those who refused participation, reported it as burdensome to make the decision concerning RCT. Fewer than expected of the school-aged children were involved in the decision process, which calls for attention on how children are included in the consent procedure in clinical trials.
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Affiliation(s)
- Nina Mogensen
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Birgitte Klug Albertsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Aarhus, Aarhus, Denmark
| | - Päivi Lähteenmäki
- Pediatric and Adolescent Hematology/Oncology, Turku University Hospital, Fican-West and Turku University, Turku, Finland
- Swedish Childhood Cancer Registry, Karolinska Institutet, Stockholm, Sweden
| | - Mats Heyman
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institute, Stockholm, Sweden
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Arja Harila
- Department of Women's and Children's Health, Uppsala University and Pediatric Oncology, Uppsala University Hospital, Uppsala, Sweden
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Mobley EM, Thomas SM, Brailsford J, Ochoa CY, Miller K, Applebaum A, Milam J, Freyer DR. Clinical Trial Participation: A Qualitative Study of Adolescents and Younger Adults Recently Diagnosed with Cancer. J Adolesc Young Adult Oncol 2023; 12:303-313. [PMID: 35900287 PMCID: PMC10282798 DOI: 10.1089/jayao.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Although participation of adolescents and young adults (AYAs) in cancer clinical trials (CCTs, i.e., cancer-directed treatment studies) is low, their decision-making perspectives are not well understood, especially following recent diagnosis. Methods: Semistructured interviews with younger AYAs (15-21 years old) eligible for a CCT were to be held within 60 days of beginning treatment at Children's Hospital Los Angeles, an academic pediatric hospital. Using grounded theory methods, key themes regarding CCT participation, barriers, and facilitators were identified from interview transcripts. Thematic saturation was confirmed. Results: Of nine participants, three were <18 years old, four Hispanic, six male, six diagnosed with leukemia, eight enrolled in a CCT, and eight also enrolled in ancillary studies. Four overarching themes emerged: (1) Initial Consent encompassed the first discussion of CCT with patients reflecting positive and negative effects of timing, decisional role, and the emotional impact following cancer diagnosis; (2) Informing Participation involved decision-making processes, specific knowledge, comprehension, and external influences; (3) Participant Relationships emphasized the importance of communication and relationships with providers and parents; and (4) Patient Determinants centered on motives from different perspectives, pre-conceived attitudes, and understanding of CCTs. Conclusion: Recommendations for improving CCT participation among younger AYAs include separating the diagnosis/treatment and CCT discussions, assigning AYAs a meaningful decisional role, having ongoing provider conversations, designing trials to minimize burden, and developing age-appropriate decision aids.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Stefanie M. Thomas
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Jennifer Brailsford
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Carol Y. Ochoa
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kimberly Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anise Applebaum
- College of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California Irvine, Irvine, California, USA
| | - David R. Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Birkeland S, Bismark M, Barry MJ, Möller S. 'My doctor should decide' - Predictors for healthcare users' stated preferences regarding medical decision-making. PATIENT EDUCATION AND COUNSELING 2023; 114:107825. [PMID: 37269622 DOI: 10.1016/j.pec.2023.107825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To investigate predictors for healthcare users' declared decision control preferences and test their association with satisfaction in vignettes detailing various decision-making. METHODS Cross-sectional vignette survey within a representative general male population aged 45-70 years (response rate 30%). Survey vignettes illustrated different levels of patient involvement. Participants rated their satisfaction with healthcare illustrated and separately rated their 'control preferences'. Comparisons were conducted with linear regression. RESULTS Preferring the doctor to predominantly or exclusively decide (1588/6755 respondents) was associated with older age, being single, lower education, having chronic illness, and living in low-income and less populated areas, with fewer non-western immigrants. Following adjustment, lower education and chronic illness remained statistically significant. Personalities with less openness had preference for least control. When presented with specific clinical scenarios, respondents preferring active or passive roles were equally satisfied with scenarios demonstrating shared decision-making. DISCUSSION Some groups of healthcare users were more likely to say that they preferred their doctor to decide. However, findings suggest that control preference statements, prior to facing a decision, should be interpreted with caution. PRACTICAL VALUE Study findings highlight that patients vary regarding their expressed wish for control in medical decision-making but they seem equally satisfied with shared decision-making scenarios.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000 Odense, Denmark.
| | - Marie Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, USA
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000 Odense, Denmark
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Teela L, Verhagen LE, van Oers HA, Kramer EEW, Daams JG, Gruppen MP, Santana MJ, Grootenhuis MA, Haverman L. Pediatric patient engagement in clinical care, research and intervention development: a scoping review. J Patient Rep Outcomes 2023; 7:32. [PMID: 36988738 DOI: 10.1186/s41687-023-00566-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/21/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In the last decades, pediatric patient engagement has received growing attention and its importance is increasingly acknowledged. Pediatric patient engagement in health care can be defined as the involvement of children and adolescents in the decision-making of daily clinical care, research and intervention development. Although more attention is paid to pediatric patient engagement, a comprehensive overview of the activities that have been done regarding pediatric patient engagement and the changes over time is lacking. Therefore, the aim of this study is to provide an overview of the literature about pediatric patient engagement. METHODS The methodological framework of Arksey & O'Malley was used to conduct this scoping review. The bibliographic databases Medline, Embase, and PsycINFO were searched for eligible articles. All retrieved articles were screened by at least two researchers in two steps. Articles were included if they focused on pediatric patient engagement, were carried out in the context of clinical care in pediatrics, and were published as full text original article in English or Dutch. Data (year of publication, country in which the study was conducted, disease group of the participants, setting of pediatric patient engagement, used methods, and age of participants) were extracted, synthesized, and tabulated. RESULTS A total of 288 articles out of the 10,714 initial hits met the inclusion criteria. Over the years, there has been an increase in the number of studies that engage pediatric patients. Pediatric patients, especially patients with multiple conditions or oncology patients, were most involved in studies in the United States, United Kingdom, and Canada. Pediatric patients were most often asked to express their views on questions from daily clinical care and the individual interview was the most used method. In general, the extent to which pediatric patients are engaged in health care increases with age. DISCUSSION This scoping review shows that there is an increasing interest in pediatric patient engagement. However, lack of uniformity about the definition of pediatric patient engagement and clear information for clinicians hinders engagement. This overview can inform clinicians and researchers about the different ways in which pediatric patient engagement can be shaped and can guide them to engage pediatric patients meaningfully in their projects.
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Affiliation(s)
- Lorynn Teela
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Digital health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands
| | - Lieke E Verhagen
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hedy A van Oers
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental health and Digital health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands
| | - Esmée E W Kramer
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Joost G Daams
- Amsterdam UMC location University of Amsterdam, Research Support, Medical Library, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mariken P Gruppen
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of General Pediatrics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Lotte Haverman
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health, Mental health and Digital health, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Child development, Amsterdam, The Netherlands.
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Morand M, Roth M, Peterson SK, Bednar EM, Ramdaney A, Livingston JA, Yarbrough A, Corredor J. Factors impacting adolescent and young adult cancer patients' decision to pursue genetic counseling and testing. Support Care Cancer 2022; 30:5481-5489. [PMID: 35306607 PMCID: PMC9703615 DOI: 10.1007/s00520-022-06974-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Adolescent and young adult (AYA) cancer patients face challenges when navigating cancer treatment and survivorship. Many are at risk for cancer predisposition syndromes; however, factors influencing pursuit of genetic counseling and testing have not been reported. We describe AYA cancer patients' decision-making process, including motivational factors and barriers, as it relates to utilization of genetic services. METHODS Thirty AYAs diagnosed with cancer previously referred for cancer predisposition genetic counseling completed semi-structured interviews via audio-only Zoom calls. Thematic analysis was used to perform qualitative analysis and identify major themes. RESULTS The sample comprised 21 AYAs who had genetic counseling and nine who did not. Motivational factors identified included learning genetic counseling is an available service, concern about the impact of a hereditary syndrome on family members and family planning, learning about the need for cancer screening or prevention, affordability of genetic testing, and easing worry about additional cancer risks. For those who did not pursue genetic counseling, barriers included scheduling or other priorities, worry, and cost. However, the majority expressed they would reconsider genetic counseling in the future. CONCLUSION AYA cancer patients have similar motivational factors to pursue genetic counseling compared to other patients; however, their younger age of diagnosis may alter how these factors affect decision-making. While there are barriers limiting access to genetic services, they did not decrease interest in future genetic counseling for most patients. Genetic counseling and testing should be discussed with patients who previously declined genetic services.
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Affiliation(s)
- Megan Morand
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
- Department of Pediatrics, The University of Texas Medical Branch, Galveston, TX, USA
| | - Michael Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erica M Bednar
- Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
- Cancer Prevention and Moon Shots Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aarti Ramdaney
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Andrew Livingston
- Department of Pediatrics, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Angela Yarbrough
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jessica Corredor
- Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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Christy SM, Livingstone AS, Byrne MM. Feasibility, acceptability, and effectiveness of a decision aid versus an informational website to promote clinical trial decision-making among cancer patients: A pilot randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2022; 105:1082-1088. [PMID: 34511283 DOI: 10.1016/j.pec.2021.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess intervention feasibility and acceptability, and compare the effectiveness of the CHOICES Decision Aid (DA) versus the National Cancer Institute (NCI) Cancer Clinical Trials (CCT) website to improve knowledge about CCTs and preparedness to make an informed decision. METHODS Oncology patients (n = 101) with a scheduled clinic visit were enrolled and randomized. Decision-making variables were collected at two timepoints. Post-intervention scores were examined via paired t-tests and multivariate regression analyses. Predictors of the magnitudes of the change in scores were examined in multivariable regression analyses. RESULTS The interventions were feasible to implement and acceptable to participants. Both interventions increased objective and subjective knowledge, improved clarity of opinions, and reduced decisional conflict (p-values < 0.01). Improvements in the belief that one could find out about CCTs were observed in the CHOICES DA arm (p < 0.001). Multivariable analyses controlling for educational attainment showed no significant differences in the magnitude of change in outcome variables between intervention arms, but did find that improvements in some variables in the NCI arm - but not CHOICES DA arm - were associated with previous educational attainment. CONCLUSIONS Interventions were feasible to implement and acceptable. Improvements in knowledge and decision-making outcomes were observed in both arms, supporting the view that interventions to improve CCT decision making are effective and feasible. Our results suggest that the CHOICES DA may be more effective than an informational website in improving decision-making outcomes regardless of participants' educational attainment. PRACTICE IMPLICATIONS CCT resources should support informed decision-making among all cancer survivors, regardless of educational attainment.
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Affiliation(s)
- Shannon M Christy
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Alan S Livingstone
- Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Margaret M Byrne
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
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Abstract
Informal caregivers invest a significant amount of time and effort to provide cancer patients with physical, psychological, information, and social support. These challenging tasks can harm their own health and well-being, while a series of social-ecological factors may also influence the outcomes of cancer caregiving. Several instruments have been developed to help clinicians and researchers understand the multi-dimensional needs and concerns of caregivers. A growing body of evidence indicates that supportive interventions including psychoeducation, skills training, and therapeutic counseling can help improve the burden, information needs, coping strategies, physical functioning, psychological well-being, and quality of life of caregivers. However, there is difficulty in translating research evidence into practice. For instance, some supportive interventions tested in clinical trial settings are regarded as inconsistent with the actual needs of caregivers. Other significant considerations are the lack of well-trained interdisciplinary teams for supportive care provision and insufficient funding. Future research should include indicators that can attract decision-makers and funders, such as improving the efficient utilization of health care services and satisfaction of caregivers. It is also important for researchers to work closely with key stakeholders, to facilitate evidence dissemination and implementation, to benefit caregivers and the patient.
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12
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Foster M, Quaye AA, Whitehead L, Hallström IK. Children's voices on their participation and best interests during a hospital stay in Australia. J Pediatr Nurs 2022; 63:64-71. [PMID: 35074701 DOI: 10.1016/j.pedn.2022.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore school-aged children's experiences about their best interests and participation in care during a hospital admission. DESIGN AND METHODS A descriptive qualitative design involving in-depth, iterative inductive review of child responses to generate key words that led to identification of categories and themes. The study was guided by the United Nations Convention on the Rights of the Child's definition of the best interests of the child, Bronfenbrenner's bioecological model and a child centred care approach. RESULTS Nine school-aged children (5-15 years old) from one children's ward in Australia participated. Analysis yielded thirteen categories, six sub-themes, and three themes: 1) Relationships with parents were positive when they met their children's physical and emotional needs and advocated for them; 2) Relationships with staff were positive when staff created opportunities for children to have a say in their healthcare, and checked in on the children and 3) Seeking familiarity away from home was facilitated when the environment children found themselves in provided them their own space and various forms of entertainment. CONCLUSION School-aged children were able to verbalize what their best interests were and how participation in care could be facilitated in the hospital setting. The inter-relationships of the children with their parents, healthcare professionals, and the immediate environment reflected interactions both within, and between systems. RESEARCH AND PRACTICE IMPLICATIONS Children in hospital need to be provided with age-appropriate opportunities to participate in shared decision making to support their best interests. Studies that model and evaluate such opportunities are needed.
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Affiliation(s)
- Mandie Foster
- Auckland University of Technology, School of Clinical Sciences, Auckland, New Zealand; Edith Cowan University, School of Nursing and Midwifery, Perth, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia.
| | - Angela Afua Quaye
- Department of Health Science, Faculty of Medicine, Lund University, Box 188, 221 00 Lund, Sweden.
| | - Lisa Whitehead
- Edith Cowan University, School of Nursing and Midwifery, Perth, Western Australia, Australia; Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
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13
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Katz NT, Le BH, Berger I, Lewin J, Thompson K, Pitt H, Philip J. A Descriptive Cohort Study of Adolescent and Young Adult Decedents Known to an Australian Comprehensive Cancer Center. J Adolesc Young Adult Oncol 2021; 11:535-539. [PMID: 34874784 DOI: 10.1089/jayao.2021.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In Australia, cancer is the second leading cause of death in adolescents and young adults (AYA). In an audit of 76 AYA decedents known to a comprehensive cancer center, most were male (63%), and most had a parent as primary carer (78%). Median age at diagnosis was 21 years (range: 15-27). Median time from diagnosis to first palliative care consultation was 9 months, and from first palliative care review to death, 4 months. Location of death was hospital (41%), home (24%), and palliative care unit (16%). Eleven (65%) of 17 patients who wished to die at home achieved this.
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Affiliation(s)
- Naomi T Katz
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Center, Palliative Care Service, Alfred Health, Victorian Pediatric Palliative Care Program, Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Brian H Le
- Parkville Integrated Palliative Care Service, Victorian Comprehensive Cancer Center, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Ilana Berger
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer, Melbourne, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer, Department of Medical Oncology, Peter MacCallum Cancer Center, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Kate Thompson
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer, Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Holly Pitt
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Center, Palliative Care Service, St. Vincent's Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia
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14
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Darabos K, Berger AJ, Barakat LP, Schwartz LA. Cancer-Related Decision-Making Among Adolescents, Young Adults, Caregivers, and Oncology Providers. QUALITATIVE HEALTH RESEARCH 2021; 31:2355-2363. [PMID: 34382889 PMCID: PMC9198895 DOI: 10.1177/10497323211037654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Decision-making among adolescents and young adults with cancer (AYA) is often complex, ongoing, and multifaceted, involving caregiver and oncology provider perspectives. Engagement in decision-making against the backdrop of normative developmental processes of acquiring autonomy and gaining independence contributes to the complexity of decision-making. Semi-structured qualitative interviews from 11 AYA and caregiver dyads and eight oncology providers examined decision-making processes with specific attention to the role of shared decision-making, cognitive and emotional processes, and coping with the decision-making experience. Five decision-making patterns were identified, with collaborative decision-making and AYA-driven decisions most commonly described. Utilizing hypothesis coding, AYA and caregivers explained how cognitive (i.e., pros/cons) and emotional (i.e., shock and fear of missing out) processes influenced cancer-related decisions. Coping strategies provided clarity and respite when engaged in decision-making. Our findings illuminate important implications for how to best support decision-making among AYA and caregivers, including the role oncology providers can play during decision-making.
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Affiliation(s)
- Katie Darabos
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Lamia P. Barakat
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A. Schwartz
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
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15
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Birkeland S, Bismark M, Barry MJ, Möller S. Is greater patient involvement associated with higher satisfaction? Experimental evidence from a vignette survey. BMJ Qual Saf 2021; 31:86-93. [PMID: 33888595 DOI: 10.1136/bmjqs-2020-012786] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patient-centredness is an essential quality parameter of modern healthcare. Accordingly, involving patients in decisions about care is required by international laws and an increasing number of medical codes and standards. These directives are based on ethical principles of autonomy. Still, there is limited empirical knowledge about the influence of patient involvement on satisfaction with care. OBJECTIVE In a large national vignette survey, we aimed to empirically test healthcare users' satisfaction with healthcare given different degrees of patient involvement, choices made and outcomes. METHODS A web-based cross-sectional survey distributed to a randomised sample of men in Denmark aged 45-70 years. Case vignettes used prostate-specific antigen (PSA) screening for early detection of prostate cancer as a clinical model. Using a 5-point Likert scale, we measured respondents' satisfaction with care in scenarios which differed in the amount of patient involvement (ranging from no involvement, through involvement with neutral or nudged information, to shared decision-making), the decision made (PSA test or no PSA test) and clinical outcomes (no cancer detected, detection of treatable cancer and detection of non-treatable cancer). RESULTS Participating healthcare users tended to be more satisfied with healthcare in scenarios illustrating greater levels of patient involvement. Participants were positive towards nudging in favour of the intervention but patient involvement through shared decision-making obtained the highest satisfaction ratings (Likert rating 3.81 without any involvement vs 4.07 for shared decision-making, p<0.001). Greater involvement also had an ameliorating effect on satisfaction if a non-treatable cancer was later diagnosed. CONCLUSION Our study provides empirical support for the hypothesis that greater patient involvement in healthcare decision-making improves satisfaction with care irrespective of decisions made and clinical outcomes. Overall satisfaction with the care illustrated was highest when decisions were reached through shared decision-making.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark .,Open Patient data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
| | - Marie Bismark
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael John Barry
- Informed Medical Decisions Program, Division of General Internal Medicine, Department of Medicine, and The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark.,Open Patient data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
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16
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Telles CM. A scoping review of literature: What has been studied about adolescents and young adults (AYAs) with cancer? Cancer Treat Res Commun 2021; 27:100316. [PMID: 33545568 DOI: 10.1016/j.ctarc.2021.100316] [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: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To map, organize and analyze the articles published in the last five years about AYAs with cancer. METHODS CAPES database and Google Scholar were searched to identify relevant studies from 2015 to February 2020. Eligible articles included empirical or theoretical research, quantitative and/or qualitative studies, targeted AYAs with cancer, addressed different topics related to AYAs such as unmet needs, hospital challenges, interventions or tools based on evidence, as well as political and socioeconomic aspects. RESULTS Of the 161 articles analyzed, 74 (46%) discussed the health system, including hospital dynamics, treatment and interventions during treatment; 63 (39.1%) discussed aspects or interventions that influence the quality of life and mental health of AYAs with cancer; 14 (8.7%) discussed issues related to sexual health; and 10 (6.2%) addressed social, economic and demographic problems of AYAs with cancer. Three types of purposes have been identified in the articles: 118 (73.3%) investigated variables in areas related to AYAs with cancer, aiming to increase the understanding of the phenomenon and the needs of AYAs; 18 (11.2%) intervened on the needs of AYAs with cancer through pilot studies or evidence-based interventions; and 22 (13.7%) aimed to evaluate an intervention previously performed or to evaluate an intervention based on evidence. CONCLUSION There is still much to be researched within the last two categories. In the last three years, these categories have been growing gradually and on a small scale.
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Affiliation(s)
- Camila M Telles
- Graduating in Psychology - Senior year, Positivo University - Curitiba, Paraná, Brazil (Student); Teen Cancer America - Los Angeles, California, the United States of America (Intern Pro Cancer).
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17
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Hart RI, Cowie FJ, Jesudason AB, Lawton J. Adolescents and young adults' (AYA) views on their cancer knowledge prior to diagnosis: Findings from a qualitative study involving AYA receiving cancer care. Health Expect 2020; 24:307-316. [PMID: 33275814 PMCID: PMC8077068 DOI: 10.1111/hex.13170] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Cancer is rare amongst adolescents and young adults (AYA). Previous research has reported (healthy) AYA’s knowledge of risk factors and symptoms as limited, with this potentially leading to delays in help‐seeking and diagnosis. Objectives We explored AYA’s views on their cancer knowledge prior to diagnosis and if/how they perceived this as having affected their experiences of diagnosis and care. Methods We interviewed 18 AYA diagnosed with cancer (aged 16‐24 years). Interviews were recorded and transcribed verbatim. We undertook qualitative descriptive analysis, exploring both a priori topics and emergent themes, including cancer knowledge prior to diagnosis. Results Adolescents and young adults characterized their knowledge of cancer and treatment prior to diagnosis and treatment initiation as limited and superficial. AYA perceived gaps in their knowledge as having profound consequences throughout their cancer journey. These included: hindering recognition of symptoms, thereby delaying help‐seeking; impeding understanding of the significance of tests and referrals; amplifying uncertainty on diagnosis; and affording poor preparation for the harsh realities of treatment. Conclusions Adolescents and young adults perceived their limited cancer knowledge prior to diagnosis as affecting experiences of diagnosis and initial/front‐line care. These findings prompt consideration of whether, when and how, AYA’s knowledge of cancer might be improved. Two broad approaches are discussed: universal education on AYA cancer and/or health; and targeted education (enhanced information and counselling) at and after diagnosis. Patient or Public Contribution Our work was informed throughout by discussions with an advisory group, whose membership included AYA treated for cancer.
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Affiliation(s)
- Ruth I Hart
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
| | | | - Angela B Jesudason
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, UK
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