African American Couples Merging Strengths to Successfully Cope With Breast Cancer

Barriers to and facilitators of online health information-seeking behaviours among cancer patients: A systematic review

Objective: Disparities in cancer care contribute to higher rates of cancer mortality. Online health information would be a resource for cancer patients to obtain knowledge and make health decisions. However, factors that hinder or facilitate online searching behaviours among patients remain unexplored. The current systematic review aims to identify and synthesise evidence of cancer patients' barriers to and facilitators of online health information-seeking behaviours. Methods: Electronic databases (PubMed, EMBASE, Scopus) were systematically searched, and a total of 123 full-text studies were reviewed of which 24 met the inclusion criteria. Results: Thematic analysis was performed to identify barriers and facilitators of online health information-seeking behaviours. Seven key themes were identified: (1) socio-demographic characteristics (age, gender, education, income, ethnicity and language), (2) psychosocial aspects (psychological wellbeing, need for a face to face contact, motivation, support), (3) accessibility (Internet access, residence), (4) quality and quantity of information (amount, reliability), (5) cancer stage and symptoms (time since diagnosis, experiencing symptoms), (6) aspects related to healthcare professionals (relationship with the patients and opinions on online health information) and (7) digital literacy (computer skills and literacy). Conclusions: Findings underscore the significance of recognising the multifaceted nature of barriers and facilitators affecting cancer patients' online health information-seeking behaviours. A strong link between these factors and cancer patients' ability to make informed decisions and cope effectively with their diagnosis emerged. Consequently, addressing these barriers and leveraging the identified facilitators could lead to improvements in patient-centred care, ultimately contributing to better healthcare services and informed decision-making for cancer patients. Future research should prioritise exploring strategies for enhancing cancer care accessibility across all stakeholders involved.

Registration

CRD42023408091.

"We're in this together": Perceived effects of breast cancer on African American survivors' marital relationships

Objective

We examined married African American breast cancer survivors' perceptions of how cancer affected their marriage, social support from their spouses, and spouses' physical and mental health.

Method

We conducted a thematic analysis of semi-structured interviews with 15 married African American breast cancer survivors who had participated in a larger randomized controlled trial. Interviews were professionally transcribed and then independently coded by two coders.

Results

Themes emerged related to the challenges of maintaining mutually supportive relationships. There was variability in the perceived effects of cancer on relationships, as well as uncertainty about cancer's effects on their husbands' emotional and physical health and the adequacy of emotional and tangible support from their husbands. Participants described husbands' key role in promoting wives' positive body image, as well as the challenges of negotiating sexual activity. Participants were receptive to help from medical professionals in dealing with relationship issues.

Conclusions

Findings show variability in couples' responses to cancer, with some patients and couples adapting well and others needing additional support. During treatment and at follow-up, oncology social workers can assess patients' and family members' social support needs, provide mental health services, and provide patient navigation to help patients and caregivers access health care and community resources.

Relationship Dynamics among Couples Dealing with Breast Cancer: A Systematic Review

Most studies have been concerned with the experiences and needs of women with breast cancer and spouses/partners separately. In this review, the relationship dynamics that characterize the couple’s experience of breast cancer treatment were investigated. Findings will inform both researchers and professionals in the area of oncology. A systematic literature search was performed in CINAHL, PsychINFO, MEDLINE, Scopus and Web of Science. A checklist for qualitative and observational studies was used to evaluate the methodological quality of the studies. Seventeen studies were included, and the synthesis of the literature revealed five domains that characterized the dyadic process: dyadic coping strategies, psychosocial support, communication, the couple’s sexual life and spirituality. The included studies provide the basis for knowledge and awareness about the experience of couples with cancer, the specific dimensions enacted during the breast cancer treatment path and the type of responses that are associated with a positive couple’s adjustment to the disease.

The desire to survive: the adaptation process of adult cancer patients undergoing radiotherapy

AIM

Radiotherapy is one of the primary treatment strategies for cancer. However, patients not only deal with the side-effects of radiotherapy, but they must also endure the psychological distress caused by cancer. This study explores how cancer patients adapt to the treatment process when receiving radiotherapy.

METHODS

This study used a grounded theory approach, and eight in-depth interviews were conducted with newly diagnosed cancer patients who received radiotherapy as a primary treatment.

RESULTS

The core category that emerged from this study was "the desire to survive". The categories and subcategories that emerged from the data include facing unknown situations (e.g. searching for relevant information and decision-making considerations, and listening to healthcare professionals' suggestions), experiencing the pain of treatment (e.g. tolerating side-effects, tolerating inconvenience during the treatment, accepting support during the treatment, and adjusting lifestyles), and chances to extend life (e.g. accepting fate, determination to undergo the treatment, and adjusting negative emotions).

CONCLUSION

The study results provide a better understanding of the experiences of cancer patients undergoing radiotherapy. Healthcare professionals should provide effective medical management for side-effects and psychological support to cancer patients during the journey of radiotherapy.

"We both just trusted and leaned on the Lord": a qualitative study of religiousness and spirituality among African American breast cancer survivors and their caregivers

PURPOSE

Most breast cancer (BC) survivorship research focuses on the general population of survivors. Scant research investigates the potentially unique experiences of minorities, especially during and after the difficult transition from primary treatment to post-treatment. This qualitative study explored African American BC survivors' and caregivers' quality-of-life in the post-treatment period with a focus on social and spiritual well-being.

METHODS

Participants included a convenience sample of African American women with stage I-III BC (N = 23) who completed treatment 6-24 months before enrollment. Primary caregivers (N = 22) included friends, spouses and other family members (21 complete dyads). Participants completed separate semi-structured telephone interviews. Template analysis was used to evaluate themes related to religiousness and spirituality, both across and within dyads.

RESULTS

After treatment, religiousness and spirituality played a major role in both survivors' and caregivers' lives by: (1) providing global guidance, (2) guiding illness management efforts and (3) facilitating recovery. Participants described a spiritual connectedness with God and others in their social networks. Dyad members shared the goal of keeping a positive attitude and described positive growth from cancer. Few future concerns were expressed due to the belief that survivors were healed and "done" with cancer. Beyond practical and emotional support, provision of spiritual assistance was common.

CONCLUSIONS

Results highlight the principal, positive role of religiousness and spirituality for African American BC survivors and caregivers after treatment. Findings emphasize the need to assess the importance of religious and spiritual beliefs and practices, and if appropriate, to provide resources that promote spiritual well-being.

A systematic review of barriers to early presentation and diagnosis with breast cancer among black women

OBJECTIVE

To explore barriers to early presentation and diagnosis with breast cancer among black women.

DESIGN

Systematic review.

METHODS

We searched multiple bibliographic databases (January 1991-February 2013) for primary research, published in English, conducted in developed countries and investigating barriers to early presentation and diagnosis with symptomatic breast cancer among black women (≥18 years). Studies were excluded if they did not report separate findings by ethnic group or gender, only reported differences in time to presentation/diagnosis, or reported on interventions and barriers to cancer screening. We followed Cochrane and PRISMA guidance to identify relevant research. Findings were integrated through thematic synthesis. Designs of quantitative studies made meta-analysis impossible.

RESULTS

We identified 18 studies (6183 participants). Delay was multifactorial, individual and complex. Factors contributing to delay included: poor symptom and risk factor knowledge; fear of detecting breast abnormality; fear of cancer treatments; fear of partner abandonment; embarrassment disclosing symptoms to healthcare professionals; taboo and stigmatism. Presentation appears quicker following disclosure. Influence of fatalism and religiosity on delay is unclear from evidence in these studies. We compared older studies (≥10 years) with newer ones (<10 years) to determine changes over time. In older studies, delaying factors included: inaccessibility of healthcare services; competing priorities and concerns about partner abandonment. Partner abandonment was studied in older studies but not in newer ones. Comparisons of healthy women and cancer populations revealed differences between how people perceive they would behave, and actually behave, on finding breast abnormality.

CONCLUSIONS

Strategies to improve early presentation and diagnosis with breast cancer among black women need to address symptom recognition and interpretation of risk, as well as fears of the consequences of cancer. The review is limited by the paucity of studies conducted outside the USA and limited detail reported by published studies preventing comparison between ethnic groups.

I'm a Jesus girl: coping stories of Black American women diagnosed with breast cancer

Breast cancer continues to be the most diagnosed cancer for all women, excluding non-melanoma skin cancer, in the United States. Incidence rates are 1 in 8 for an American woman being diagnosed. Moreover, statistics indicate that every 13 min an American woman dies from complications related to breast cancer. Despite all the gains made in the area of cancer research, Black American women continue to have a 67% higher mortality rate than their White counterparts. There is no preparation for a diagnosis of breast cancer. Upon hearing the words: you have breast cancer, a woman's life is forever altered. The woman's initial reactions of denial and/or anger yield to strategic responses. These responses may strengthen the woman's resiliency both during and following treatments. Research indicates that Black Americans, specifically Black American women, exhibit greater religiosity/spirituality than do other racial/ethnic groups. In addition, the use of religiosity/spirituality by Black Americans increases during a crisis. This qualitative study examines how religiosity/spirituality was utilized as a coping mechanism by a group of Black American women following their diagnoses of breast cancer.

Coping strategies of African American head and neck cancer survivors

A cross-sectional study was conducted with 50 African American head and neck cancer survivors. Common coping strategies were identified and examined in relation with quality of life and relationship well-being. Coping through support from God, seeking emotional support from family and friends, and helping others were the most commonly used strategies. Having emotional support, being strong and self-reliant, and engaging in distracting activities with family and friends had strongest associations with quality of life. Coping through emotional support, help from God, assistance from one's church family to maintain religious practices, helping others, and engaging in distracting activities with others was more strongly associated with relationship well-being. Future intervention studies should consider these strategies and their possible impact on the physical, psychological, and relationship well-being of this population.

The role of spirituality in the breast cancer experiences of African American women

Breast cancer is the most commonly diagnosed cancer type among African American women. African American women often use spirituality to overcome the physical, psychological, and emotional burdens that accompany a breast cancer diagnosis. Spirituality has been used over the years by African American women to bring hope when dealing with hardships. This integrative review seeks to explore the importance of spirituality to African American women throughout the breast cancer experience. Thirteen qualitative and quantitative studies that discussed how spirituality was used to cope with breast cancer from initial diagnosis to survivorship were reviewed. Spirituality was found to be the main coping mechanism used during all phases of the cancer experience. To provide holistic nursing care, nurses must understand that spirituality is an important coping strategy used by most African American women with breast cancer. The implications for nursing that were identified include the incorporation of spiritual interventions and the utilization of culturally appropriate assessment tools.

Coping profiles common to older African American cancer survivors: relationships with quality of life

CONTEXT

Cancer survivors use distinct sets of coping behaviors that vary in their associations with psychological health and quality of life. However, existing research has largely focused on Caucasian and middle-class subjects.

OBJECTIVES

This study explores whether clusters with differing coping profiles could be identified among older African American cancer survivors and whether these profiles varied on cultural factors and physical, psychological, and relationship well-being.

METHODS

Four hundred forty-nine older African American cancer survivors recruited from outpatient oncology clinics completed a questionnaire booklet containing the Ways of Helping Questionnaire (WHQ), the Brief Index of Race-Related Stress, the Religious Involvement Scale, Mutuality Scale, and the Short Form-12 Health Survey Questionnaire. A k-means cluster analysis was conducted using the WHQ.

RESULTS

Four distinct coping profiles were identified and labeled as high coping, low encouraging healthy behaviors, low coping, and strong/distracting behaviors. Coping profiles were associated with participant's gender, age, and living-alone status. Controlling for these demographic differences, the coping profiles were associated with religiosity; experiences with racism; and physical, psychological, and relationship well-being.

CONCLUSIONS

The findings from this study lend support for examining coping profiles and health outcomes among African American cancer survivors. This research also suggests that these profiles vary on cultural factors. This information should prove useful to researchers as they develop culturally appropriate interventions for this underserved population.

Perceptions of support among older African American cancer survivors

PURPOSE/OBJECTIVES

To explore the perceived social support needs among older adult African American cancer survivors.

RESEARCH APPROACH

Qualitative design using grounded theory techniques.

SETTING

Outpatient oncology clinics in the southeastern United States.

PARTICIPANTS

Focus groups with 22 older adult African American cancer survivors.

METHODOLOGIC APPROACH

Purposeful sampling technique was used to identify focus group participants. In-depth interviews were conducted and participants were interviewed until informational redundancy was achieved.

MAIN RESEARCH VARIABLES

Social support needs of older adult African American patients with cancer.

FINDINGS

Social support was influenced by (a) symptoms and treatment side effects, (b) perceptions of stigma and fears expressed by family and friends, (c) cultural beliefs about cancer, and (d) desires to lessen any burden or disruption to the lives of family and friends. Survivors navigated within and outside of their networks to get their social support needs met. In some instances, survivors socially withdrew from traditional sources of support for fear of being ostracized. Survivors also described feeling hurt, alone, and socially isolated when completely abandoned by friends.

CONCLUSIONS

The support from family, friends, and fellow church members is important to positive outcomes among older African American cancer survivors. However, misconceptions, fears, and negative cultural beliefs persist within the African American community and negatively influence the social support available to this population.

INTERPRETATION

Early identification of the factors that influence social support can facilitate strategies to improve outcomes and decrease health disparities among this population.

Coping with a diagnosis of breast cancer-literature review and implications for developing countries

Breast cancer is the most common cancer affecting women worldwide. Women are at an increased risk of developing both physical and psychological morbidity after diagnosis; however, many use different strategies to cope with the disease. The aim of this article is to review the available literature on the impact of breast cancer diagnoses and the strategies used by women to cope with this disease. The implications of these emerging findings are extrapolated within the context of health services provided in developing countries. Electronic databases were used to search the relevant literature. The findings showed that women who were diagnosed with breast cancer are at risk of developing several psychological morbidities such as depression, anxiety, fatigue, negative thoughts, suicidal thoughts, fear of dying, sense of aloneness, sexual and body images problems, as well as an overall decrease in the quality of life. Several strategies are used by women with breast cancer to cope with the disease, including positive cognitive restructuring, wishful thinking, emotional expression, disease acceptance, increased religious practice, family and social support, and yoga and exercise. Breast cancer diagnoses have been associated with several devastating psychological consequences; however, many women have used different coping strategies to adjust their lives accordingly. Healthcare professionals in developing countries, who work with women with breast cancer, should be aware of the different coping mechanisms that women use when diagnosed with cancer. Integrating a coping strategy into the treatment regimen would constitute an important milestone in the palliative care of patients with breast cancer.

Development of the Ways Of Helping Questionnaire: a measure of preferred coping strategies for older African American cancer survivors

Although researchers have identified beneficial coping strategies for cancer patients, existing coping measures do not capture the preferred coping strategies of older African American cancer survivors. A new measure, the Ways of Helping Questionnaire (WHQ), was evaluated with 385 African American cancer survivors. Validity evidence from factor analysis resulted in 10 WHQ subscales (Others There for Me, Physical and Treatment Care Needs, Help from God, Church Family Support, Helping Others, Being Strong for Others, Encouraging My Healthy Behaviors, Others Distract Me, Learning about Cancer, and Distracting Myself). Reliability evidence was generally strong. Evidence regarding hypothesized relationships with measures of well-being and another coping measure was mixed. The WHQ's content coverage makes it especially relevant for older African American cancer survivors.

Underrepresentation of African Americans in online cancer support groups

The Internet is increasingly important for many cancer survivors because it provides access to the latest information on cancer treatments and also allows them to receive support by participating in online cancer support groups. Unfortunately, little is known about why African-American cancer survivors are underrepresented in online cancer support groups. This article reviews the relevant literature and discusses three possible explanations for why African Americans are underrepresented in online cancer support groups: the digital divide/digital inequality, preferences for face-to-face support or culture-specific online support, and trust concerns. We conclude that a health inequity exists with regard to the utilization of information that can be obtained from online cancer support groups. However, with regard to the potential benefits of the psychosocial and emotional support aspect of online cancer support groups, a health inequity may not exist, as African Americans have other preferred avenues for obtaining needed support, and there is no evidence that this is detrimental to their health.

"I know he controls cancer": the meanings of religion among Black Caribbean and White British patients with advanced cancer

There is evidence that religion and spirituality affect psychosocial adjustment to cancer. However, little is known about the perceptions and meanings of religion and spirituality among Black and minority ethnic groups living with cancer in the UK. We conducted semi-structured interviews with 26 Black Caribbean and 19 White British patients living in South London boroughs with advanced cancer to explore how religion and spirituality influenced their self-reported cancer experience. Twenty-five Black Caribbean patients and 13/19 White British patients volunteered views on the place of religion or God in their life. Spirituality was rarely mentioned. Christianity was the only religion referred to. Strength of religious belief appeared to be more pronounced among Black Caribbean patients. Three main themes emerged from patients' accounts: the ways in which patients believed religion and belief in God helped them comprehend cancer; how they felt their faith and the emotional and practical support provided by church communities assisted them to live with the physical and psychological effects of their illness and its progression; and Black Caribbean patients identified the ways in which the experience of cancer promoted religious identity. We identified that patients from both ethnic groups appeared to derive benefit from their religious faith and belief in God. However, the manner in which these were understood and expressed in relation to their cancer was culturally shaped. We recommend that when health and social care professionals perform an assessment interview with patients from different cultural backgrounds to their own, opportunities are made for them to express information about their illness that may include religious and spiritual beliefs since these may alter perceptions of their illness and symptoms and thereby influence treatment decisions.

Challenges and strategies in recruitment of ethnically diverse populations for cancer nursing research

PURPOSE/OBJECTIVES

To describe common barriers, identify challenges for researchers, and provide strategies for recruitment and retention of ethnic minority groups for cancer nursing research.

DATA SOURCES

Computerized search of databases, published articles, abstracts, master's theses, and doctoral dissertations.

DATA SYNTHESIS

Social, economic, and cultural factors present challenges to recruitment of minorities into research. Knowing the culture of the target population, developing trust, engaging the community, and using tailored materials are strategies for recruitment and retention of minorities.

CONCLUSIONS

Knowledge of potential barriers and challenges to research with diverse populations provides the foundation for the development of strategies for successful recruitment of minorities in cancer nursing research.

IMPLICATIONS FOR NURSING

Increasing ethnic minorities in research will generate knowledge that will contribute to culturally competent cancer care.

Psychosocial Responses in Breast Cancer Survivors

OBJECTIVES

To review the evidence on psychosocial responses in breast cancer survivors (BCS); identify factors that influence those responses; and propose patterns of psychosocial functioning that may provide a framework for assessment and intervention.

DATA SOURCES

Research articles/abstracts; literature reviews.

CONCLUSION

The majority of breast cancer survivors demonstrate a pattern of recovery. Age, information, communication, social and emotional support, family, and degree of symptom distress are known factors influencing QOL outcomes.

IMPLICATIONS FOR NURSING PRACTICE

Assessment of psychosocial functioning is essential to identify needs and risk factors. Interventions should be targeted to meet informational needs, promote effective communication, manage uncertainty, control symptoms, enhance social and emotional support, and address cultural differences.

Family support of immigrant Punjabi women with breast cancer

Women with breast cancer have been found to rely heavily on family members for providing support during their illness experiences. There has been limited research on ethnocultural families' experiences of illness and how these families respond to a diagnosis of breast cancer. This study examined the experiences and responses of family members of immigrant Punjabi women diagnosed with breast cancer. Through interviews with 19 Punjabi women diagnosed with breast cancer and 18 family members, key practical and emotional support strategies were described. Recommendations for culturally appropriate, family-centered models of care are provided that acknowledge breast cancer as a family event.

Low rates of acceptance of BRCA1 and BRCA2 test results among African American women at increased risk for hereditary breast-ovarian cancer

PURPOSE

This study evaluated rates of BRCA1 and BRCA2 (BRCA1/2) test result acceptance among African American women and identified determinants of test result acceptance.

METHODS

Acceptance of BRCA1/2 test results was evaluated among 157 African American women at high and moderate risk for having a BRCA1/2 mutation who were offered genetic testing as part of a clinical genetic counseling research program.

RESULTS

Twenty-two percent of women received BRCA1/2 test results. Test result acceptance differed between women with > or =10% prior probability of having a BRCA1/2 mutation (34%) and those who had a 5% prior probability (8%). Among women with > or =10% prior probability, test result acceptors were most likely to be married (OR = 5.29, 95% CI = 1.82, 15.38, P = 0.002) and be less certain about their risk of developing cancer (OR = 3.18, 95% CI = 1.04, 9.80, P = 0.04).

CONCLUSION

These results demonstrate that acceptance of BRCA1/2 test results may be limited among African American women. Being married and having less certainty about one's cancer risk may motivate acceptance of BRCA1/2 test results among African American women. It may be important to emphasize the possibility that BRCA1/2 test results may not clarify cancer risks during pre-test counseling with African American women to ensure informed decision-making about testing.