1
|
Santoyo-Olsson J, Stewart AL, Nápoles AM. Financial strain, neighborhood cohesion, and health-related quality of life among rural and urban Spanish-speaking Latina breast cancer survivors. J Cancer Surviv 2024; 18:1275-1284. [PMID: 36991270 PMCID: PMC11324799 DOI: 10.1007/s11764-023-01369-2] [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: 02/23/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Among Latina breast cancer survivors, explore associations between rural/urban residence and health-related quality of life (HRQL), and whether associations are moderated by financial strain and low neighborhood cohesion. METHODS We combined baseline data from two randomized controlled trials of a stress management intervention conducted among 151 urban and 153 rural dwelling Latinas with nonmetastatic breast cancer. Generalized linear models estimated associations between rural/urban status and HRQL (overall, emotional, social-family, physical, and functional well-being), and we examined moderation effects of financial strain and low neighborhood cohesion, controlling for age, marital status, and breast cancer characteristics. RESULTS Rural women reported better emotional (β = 1.85; 95% CI = 0.37, 3.33), functional (β = 2.23; 95% CI = 0.69, 3.77), and overall (β = 5.68; 95% CI = 1.12, 10.25) well-being than urban women, regardless of degree of financial strain or neighborhood cohesion; moderation effects were not statistically significant. Financial strain was inversely associated with emotional (β = -2.34; 95% CI = 3.63, -1.05), physical (β = -2.56; 95% CI = -4.12, -1.01), functional (β = -1.61; 95% CI = -2.96, -0.26), and overall (β = -6.67; 95% CI = -10.96, -2.98) well-being. Low neighborhood cohesion was inversely associated with emotional (β = -1.27; 95% CI = -2.50, -0.04), social-family (β = -1.72; 95% CI = -3.02, -0.42), functional (β = -1.63; 95% CI = -2.92, -0.34), and overall (β = -5.95; 95% CI = 9.76, -2.14) well-being. CONCLUSIONS Rural Latina breast cancer survivors reported better emotional, functional and overall well-being than their urban counterparts. Greater financial strain and less neighborhood cohesion were associated with worse HRQL on most domains regardless of rural/urban context. IMPLICATIONS FOR CANCER SURVIVORS Interventions that focus on increasing perceived neighborhood cohesion and reducing or better managing financial strain, could help improve Latina cancer survivors' well-being.
Collapse
Affiliation(s)
- Jasmine Santoyo-Olsson
- University of California San Francisco, Division of Internal Medicine, 490 Illinois Street, 9th floor, Box 0856, San Francisco, CA, 94158, USA.
- University of California Berkeley, School of Public Health, 2121 Berkeley Way, Room 5302, Berkeley, CA, 94720, USA.
| | - Anita L Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, 490 Illinois Street, 12th floor, Box 0646, San Francisco, CA, 94158, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA
| |
Collapse
|
2
|
Aizpurua-Perez I, Arregi A, Gonzalez D, Urruticoechea A, Labaka A, Minguez-Alcaide X, Ugartemendia G, Pascual-Sagastizabal E, Echeverria R, Perez-Tejada J. A randomized controlled trial of the effectiveness of a one-to-one peer support intervention on resilience, social support, and salivary cortisol in recently diagnosed women with breast cancer. Eur J Oncol Nurs 2024; 71:102616. [PMID: 38885598 DOI: 10.1016/j.ejon.2024.102616] [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: 10/29/2023] [Revised: 05/11/2024] [Accepted: 05/18/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Peer support has been suggested as a way to help women diagnosed with breast cancer to better cope with their situation, but studies on its effectiveness have conflicting results. This randomized controlled trial aimed to study the effectiveness of a one-to-one peer support intervention on psychological resilience, social support, and salivary cortisol among breast cancer patients. METHODS The sample consisted of 121 newly diagnosed women at Onkologikoa Hospital. Patients who were prescribed chemotherapy were randomly assigned to Intervention Group 1 (IG1) or Control Group 1 (CG1). Similarly, those prescribed adjuvant radiotherapy were assigned to IG2 or CG2. Women in IG1 received 8 biweekly social support sessions from volunteer survivors who had successfully overcome breast cancer, while IG2 received 6 biweekly sessions. CG1 and CG2 only received standard care. Resilience, social support, and salivary cortisol were assessed at baseline (T1) and at the end of the intervention (T2). RESULTS We found a non-significant, yet a small to moderate size increase in resilience from T1 to T2 in IG1 (p = 0.246; dDc = 0.47). Upon regression analysis, we observed that this increase was determined by changes in cortisol (β = -0.658, p = 00.010), affective support (β = -0.997, p = 00.014), and emotional support (β = 0.935, p = 00.008). We also found a significant decrease in resilience levels in CG2 from T1 to T2 (p = 0.003; dDc = 0.88). CONCLUSION The present study suggests that peer support can exert a protective psychological influence on women diagnosed with breast cancer, and further indicates an exciting avenue for future intervention development in the breast cancer care continuum. TRIAL REGISTRATION ClinicalTrials.gov NCT05077371.
Collapse
Affiliation(s)
- Ibane Aizpurua-Perez
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
| | - Amaia Arregi
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
| | | | | | - Ainitze Labaka
- Department of Nursing II, University of the Basque Country, San Sebastian, Spain.
| | - Xavier Minguez-Alcaide
- Department of Social Psychology, University of the Basque Country, San Sebastian, Spain.
| | | | - Eider Pascual-Sagastizabal
- Department of Basic Psychological Processes and Their Development, University of the Basque Country, San Sebastian, Spain.
| | | | | |
Collapse
|
3
|
Grant SJ, Yanguela J, Odebunmi O, Grimshaw AA, Giri S, Wheeler SB. Systematic Review of Interventions Addressing Racial and Ethnic Disparities in Cancer Care and Health Outcomes. J Clin Oncol 2024; 42:1563-1574. [PMID: 38382005 PMCID: PMC11095878 DOI: 10.1200/jco.23.01290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 02/23/2024] Open
Abstract
PURPOSE Cancer health disparities result from complex interactions among socioeconomic, behavioral, and biological factors, disproportionately affecting marginalized racial and ethnic groups. The objective of this review is to synthesize existing evidence on interventions addressing racial or ethnic disparities in cancer-related health care access and clinical outcomes. METHODS A comprehensive search of Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science Core Collection was conducted from database inception to February 23, 2023. Controlled vocabulary and keywords helped to identify studies on cancer-related disparities and interventions in adults age 18 years or older. Two reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. RESULTS Of 7,526 screened studies, 34 met the inclusion criteria involving 24,134 participants. Most studies focused on breast cancer (n = 17) and Hispanic/Latino populations (n = 10) and enrolled participants primarily from community-based sites (n = 19). Twenty-one studies examined patient-centered outcomes, such as health-related quality of life and psychological well-being, while 15 studies assessed process-of-care outcomes, such as timeliness of care. Most studies followed a community-based participatory research framework. Five patient-centered outcome studies reported a positive intervention effect, often combining cancer education with psychological well-being interventions. Among the 15 process-of-care outcome studies, nine reported positive effects, with the majority (n = 8) being navigation-based interventions. CONCLUSION This systematic review emphasizes the vital role of community partnerships in addressing racial and ethnic disparities in oncology care and highlights the need for standardized approaches in intervention research because of the heterogeneity of studied interventions. Furthermore, the prevailing emphasis on breast cancer and Hispanic populations indicates the need for future investigations into other priority demographic groups.
Collapse
Affiliation(s)
- Shakira J. Grant
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Juan Yanguela
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Olufeyisayo Odebunmi
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT
| | - Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
4
|
Greene Barker T, O'Higgins A, Fonagy P, Gardner F. A systematic review and meta-analysis of the effectiveness of co-designed, in-person, mental health interventions for reducing anxiety and depression symptoms. J Affect Disord 2024; 350:955-973. [PMID: 38199405 DOI: 10.1016/j.jad.2023.12.080] [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: 07/21/2023] [Revised: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Co-design is recommended in mental health fields and has been associated with improved intervention efficacy. Despite its growing popularity, syntheses of evidence on the effectiveness of co-designed interventions are scarce, and little is known about their impact on anxiety and depression. METHODS The purpose of this systematic review and meta-analysis was to consolidate evidence on the effectiveness of in-person, co-designed mental health interventions for reducing anxiety and depression symptoms. An exhaustive search was conducted across six electronic databases (PubMed, PsycINFO, Embase, CINAHL, CENTRAL, and ProQuest) and grey literature. Criteria for inclusion comprised studies utilizing randomized or quasi-randomized methods, implementing non-digital/in-person, co-designed interventions for mental health enhancement, and assessing anxiety and/or depression. Intervention impacts were evaluated using random-effects meta-analyses. RESULTS The review identified 20 studies, with only three using the term 'co-design'. Other terminologies included 'co-developed' (n = 2), 'co-produced' (n = 2), and 'CBPR' (n = 11). Seventeen studies exhibited moderate risk of bias, while three demonstrated high risk. Meta-analyses demonstrated a moderate non-significant effect size of 0.5 (95 % CI: -0.8, 1.08; p = 0.08) on depression outcomes, and a small non-significant effect size of 0.12 (95 % CI: -0.1, 0.33; p = 0.23) on anxiety outcomes. LIMITATIONS The majority of studies lacked sufficient statistical power to detect between-group differences. Following GRADE criteria, confidence in estimates was low. CONCLUSIONS Notwithstanding widespread enthusiasm for co-design, the current evidence base is inadequate to confirm the impact of in-person, co-designed mental health interventions on anxiety and depression. More full-scale evaluation trials of higher quality are urgently needed, along with uniform terminology and measurement.
Collapse
Affiliation(s)
- Tamsin Greene Barker
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Research Department of Clinical, Educational and Health Psychology, University College London, UK.
| | - Aoife O'Higgins
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Foundations What Works Centre for Children & Families, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK
| |
Collapse
|
5
|
Santoyo-Olsson J, Stewart AL, Ortiz C, Palomino H, Torres-Nguyen A, Coleman L, Alhomsi A, Quintero S, Bonilla J, Santana-Ufret V, Nápoles AM. Evaluating the implementation of Nuevo Amanecer-II in rural community settings using mixed methods and equity frameworks. Arch Public Health 2023; 81:194. [PMID: 37946287 PMCID: PMC10633986 DOI: 10.1186/s13690-023-01207-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The 10-week Nuevo Amanecer-II intervention, tested through a randomized controlled trial, reduced anxiety and improved stress management skills among Spanish-speaking Latina breast cancer survivors. This paper describes the implementation and equity evaluation outcomes of the Nuevo Amanecer-II intervention delivered in three California rural communities. METHODS Using implementation and equity frameworks, concurrent convergent mixed methods were applied to evaluate implementation (feasibility, fidelity, acceptability, adoption, appropriateness, and sustainability) and equity (shared power and capacity building) outcomes. Quantitative data were collected using tracking forms, fidelity rating forms, and program evaluation surveys; qualitative data were collected using semi-structured in-depth interviews. Respondents included community-based organization (CBO) administrators, recruiters, compañeras (interventionists), and program participants. RESULTS Of 76 women randomized to the intervention, 65 (86%) completed at least 7 of 10 sessions. Participants' knowledge (85% correct of 7 questions) and skills mastery were high (85% able to correctly perform 14 skills). Mean fidelity ratings across compañeras ranged from 3.8 (modeled skills) to 5.0 (used supportive/caring communication); 1-5 scale. The program was rated as very good/excellent by 90% of participants. Participants and compañeras suggested including family members; compañeras suggested expanding content on managing thoughts and mood and healthy living and having access to participant's survivorship care plan to tailor breast cancer information. CBOs adopted the program because it aligned with their priority populations and mission. Building on CBOs' knowledge, resources, and infrastructure, implementation success was due to shared power, learning, responsibility, and co-ownership, resulting in a co-created tailored program for community and organizational contexts. Building intervention capacity prior to implementation, providing funding, and ongoing technical support to CBOs were vital for fidelity and enhancement of recruiter and compañera professional skills. Two of three CBOs created plans for program sustainability beyond the clinical trial; all administrators discussed the need for new funding sources to sustain the program as delivered. CONCLUSIONS Building on community assets and using equitable participatory research processes were central to the successful implementation of a peer-delivered psychosocial intervention in three rural communities among Spanish-speaking Latinas with breast cancer.
Collapse
Affiliation(s)
- Jasmine Santoyo-Olsson
- Division of Internal Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, San Francisco, CA, USA
| | - Carmen Ortiz
- Circulo de Vida Cancer Support and Resource Center, San Francisco, CA, USA
| | - Helen Palomino
- Cancer Resource Center of the Desert, El Centro, CA, USA
| | | | - LaVerne Coleman
- WomenCARE/Entre Nosotras, Family Service Agency of the Central Coast, Watsonville, CA, USA
| | - Alia Alhomsi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie Quintero
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jackie Bonilla
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Veronica Santana-Ufret
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
6
|
Gonzalo-Encabo P, Sami N, Wilson RL, Kang DW, Ficarra S, Dieli-Conwright CM. Exercise as Medicine in Cardio-Oncology: Reducing Health Disparities in Hispanic and Latina Breast Cancer Survivors. Curr Oncol Rep 2023; 25:1237-1245. [PMID: 37715884 PMCID: PMC10640421 DOI: 10.1007/s11912-023-01446-w] [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] [Accepted: 08/01/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE OF REVIEW This review aims to access the current state of the evidence in exercise as medicine for cardio-oncology in Hispanic and Latina breast cancer survivors and to provide our preliminary data on the effects of supervised aerobic and resistance training on cardiovascular disease (CVD) risk in this population. RECENT FINDINGS Breast cancer survivors have a higher risk of CVD; particularly Hispanic and Latina breast cancer survivors have a higher burden than their White counterparts. Exercise has been shown to reduce CVD risk in breast cancer survivors; however, evidence in Hispanic and Latina breast cancer survivors is scarce. Our review highlights a clear need for exercise oncology clinical trials in Hispanic and Latina breast cancer survivors targeting CVD risk factors. Moreover, our exploratory results highlight that 16 weeks of aerobic and resistance training may reduce the 10-year risk of developing CVD by 15% in Hispanic and Latina breast cancer survivors.
Collapse
Affiliation(s)
- Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Ciencias Biomédicas, Área de Educación Física y Deportiva, Madrid, Spain
| | - Nathalie Sami
- Department of Internal Medicine, Los Angeles County-University of Southern California Medical Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Salvatore Ficarra
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144, Palermo, Italy
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
7
|
Kasherman L, Yoon WH, Tan SYC, Malalasekera A, Shaw J, Vardy J. Cancer survivorship programs for patients from culturally and linguistically diverse (CALD) backgrounds: a scoping review. J Cancer Surviv 2023:10.1007/s11764-023-01442-w. [PMID: 37572196 DOI: 10.1007/s11764-023-01442-w] [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: 06/24/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE People of Culturally and Linguistically Diverse (CALD) backgrounds face disparities in cancer care. This scoping review aims to identify the breadth of international literature focused on cancer survivorship programs/interventions specific to CALD populations, and barriers and facilitators to program participation. METHODS Scoping review included studies focused on interventions for CALD cancer survivors after curative-intent treatment. Electronic databases: Medline, Embase, CINAHL, PsycInfo and Scopus were searched, for original research articles from database inception to April 2022. RESULTS 710 references were screened with 26 included: 14 randomized (54%), 6 mixed-method (23%), 4 non-randomized experimental (15%), 2 qualitative studies (8%). Most were United States-based (85%), in breast cancer survivors (88%; Table 1), of Hispanic/Latinx (54%) and Chinese (27%) backgrounds. Patient-reported outcome measures were frequently incorporated as primary endpoints (65%), or secondary endpoints (15%). 81% used multi-modal interventions with most encompassing domains of managing psychosocial (85%) or physical (77%) effects from cancer, and most were developed through community-based participatory methods (46%) or informed by earlier work by the same research groups (35%). Interventions were usually delivered by bilingual staff (88%). 17 studies (77%) met their primary endpoints, such as meeting feasibility targets or improvements in quality of life or psychological outcomes. Barriers and facilitators included cultural sensitivity, health literacy, socioeconomic status, acculturation, and access. CONCLUSIONS Positive outcomes were associated with cancer survivorship programs/interventions for CALD populations. As we identified only 26 studies over the last 14 years in this field, gaps surrounding provision of cancer survivorship care in CALD populations remain. IMPLICATIONS FOR CANCER SURVIVORS Ensuring culturally sensitive and specific delivery of cancer survivorship programs and interventions is paramount in providing optimal care for survivors from CALD backgrounds.
Collapse
Affiliation(s)
- Lawrence Kasherman
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2138, Australia
- Department of Medical Oncology, Illawarra Cancer Care Centre, Wollongong, NSW, Australia
- Sydney Cancer Survivorship Centre, Department of Medical Oncology, Concord Hospital, Concord, NSW, Australia
| | - Won-Hee Yoon
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sim Yee Cindy Tan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2138, Australia
- Sydney Cancer Survivorship Centre, Department of Medical Oncology, Concord Hospital, Concord, NSW, Australia
| | - Ashanya Malalasekera
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2138, Australia
- Sydney Cancer Survivorship Centre, Department of Medical Oncology, Concord Hospital, Concord, NSW, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Janette Vardy
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2138, Australia.
- Sydney Cancer Survivorship Centre, Department of Medical Oncology, Concord Hospital, Concord, NSW, Australia.
| |
Collapse
|
8
|
Nápoles AM, Stewart AL, Strassle PD, Alhomsi A, Quintero S, Ponce S, Wilkerson M, Bonilla J. Depression Symptoms, Perceived Stress, and Loneliness During the COVID-19 Pandemic Among Diverse US Racial-Ethnic Groups. Health Equity 2023; 7:364-376. [PMID: 37351533 PMCID: PMC10282966 DOI: 10.1089/heq.2022.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction Studies have reported increases in psychological distress during the COVID-19 pandemic. This study aimed to estimate associations between race-ethnicity and psychological distress during the COVID-19 pandemic among nationally representative samples of all major racial-ethnic groups in the United States. Methods We conducted a nationally representative cross-sectional survey between December 2020 and February 2021 of Asian, black/African American, Latino (English and Spanish speaking), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, white, and multiracial adults (n=5500). Distress measures included: anxiety-depression (Patient Health Questionnaire-4 [PHQ-4]), stress (modified Perceived Stress Scale), and loneliness-isolation (frequency felt lonely and isolated). Multinomial logistic regression models estimated associations between race-ethnicity and psychological distress, adjusting for demographic and health characteristics. Results Overall, 23.7% reported moderate/severe anxiety-depression symptoms, 34.3% reported moderate/severe stress, and 21.3% reported feeling lonely-isolated fairly/very often. Compared with white adults and adjusting for covariates, the prevalence of moderate/severe anxiety-depression was significantly lower among Asian (adjusted odds ratio [aOR]=0.44, 95% confidence interval [CI]=0.34-0.58), black (aOR=0.49, 95% CI=0.38-0.63), English-speaking Latino (aOR=0.62, 95% CI=0.45-0.85), Spanish-speaking Latino (aOR=0.31, 95% CI=0.22-0.44), and Native Hawaiian/Pacific Islander (aOR=0.66, 95% CI=0.49-0.90) adults. Similar trends were seen for moderate/severe stress and feeling lonely-isolated fairly/very often. Worse distress profiles of American Indian/Alaska Native and multiracial adults were attenuated after adjustment. Conclusions Minoritized groups tended to have less distress than white adults. Collective experiences of cumulative disadvantage could engender shared resiliency/normalization among these groups.
Collapse
Affiliation(s)
- Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Anita L. Stewart
- Center for Aging in Diverse Communities, Institute for Health and Aging, University of California San Francisco, San Francisco, California, USA
| | - Paula D. Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Alia Alhomsi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie Quintero
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Miciah Wilkerson
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Jackie Bonilla
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
9
|
Lui F, Lewicka M, Bao GC, Moyer A, Boyce L, Leng J. A systematic review and meta-analysis of psychosocial interventions for immigrant and limited English proficient cancer patients. Psychooncology 2023; 32:516-557. [PMID: 36792931 PMCID: PMC10410571 DOI: 10.1002/pon.6110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Immigrants, particularly those who are less acculturated and limited English proficient (LEP), often lack access to culturally and linguistically appropriate psychosocial care in cancer survivorship. We sought to determine what psychosocial interventions are available for immigrant and/or LEP cancer patients and to assess treatment and patient factors that may correlate with better psychosocial outcomes for this population. METHODS We conducted a systematic review and meta-analysis of studies published through August 2022 of interventions conducted with immigrant and/or LEP cancer patients aimed at improving psychosocial outcomes (i.e., quality of life, depression, cancer-related distress, and anxiety). Using Covidence, a software program for systematic review management, four independent raters screened 16,123 records with a systematic process for reconciling disagreement, yielding 48 articles (45 studies) for systematic review and 21 studies for meta-analysis. RESULTS Most studies were conducted with Spanish-speaking patients with breast cancer. Study participants (N = 5400) were primarily middle-aged (mean = 53 years old), female (90.0%), and Hispanic (67.0%). The weighted average effect size (g) across studies was 0.14 (95% CI 0.03-0.26) for quality of life (18 studies), 0.04 (95% CI -0.08 to 0.17) for depression (8 studies), 0.14 (95% CI -0.03 to 0.31) for cancer-related distress (6 studies), and 0.03 (95% CI -0.11 to 0.16) for anxiety (5 studies). CONCLUSION The interventions under review had small but beneficial effects on psychosocial outcomes for immigrant and LEP cancer patients. Notably, effect sizes were smaller than those found in previous meta-analyses of psychosocial interventions conducted in majority U.S.-born, non-Hispanic White, English-speaking cancer patient samples. More research is needed to identify key components and adaptations of interventions that benefit immigrant and LEP cancer patients to strengthen their effects for this growing yet underserved population.
Collapse
Affiliation(s)
- Florence Lui
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center; Department of Psychiatry, Weill Cornell Medical College
| | - Malwina Lewicka
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - George C. Bao
- Department of Medicine, Weill Cornell Medical College
| | - Anne Moyer
- Department of Psychology, Stony Brook University
| | - Lindsay Boyce
- Medical Library, Memorial Sloan Kettering Cancer Center
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center; Department of Healthcare Policy and Research, Weill Cornell Medical College
| |
Collapse
|
10
|
Tan Y, Qin M, Liao B, Wang L, Chang G, Wei F, Cai S. Effectiveness of Peer Support on Quality of Life and Anxiety in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Breast Care (Basel) 2023; 18:49-59. [PMID: 36876170 PMCID: PMC9982338 DOI: 10.1159/000527849] [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: 07/13/2022] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Breast cancer patients report high levels of psychosocial maladjustment after hospital discharge. Peer support may play an important role in improving anxiety and quality of life in breast cancer patients. This study aimed to assess the effect of peer support on quality of life and anxiety in breast cancer patients. Method A systematic review and meta-analysis of randomized controlled studies were conducted, using data sourced from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, SinoMed, China Science and Technology Periodical Database, China National Knowledge Infrastructure, and Wanfang Data for randomized controlled trials (RCTs) from inception to October 15, 2021. The RCTs reporting the effect of peer support intervention on quality of life and anxiety in breast cancer patients were included. The quality of evidence was assessed using the Cochrane risk of bias tool, that is, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for the pooled effect size. Results A total of 14 studies were included in the systematic review and 11 in the meta-analysis. The pooled results revealed that peer support significantly improved quality of life (SMD = 0.69, 95% CI = 0.28-1.11) and anxiety (SMD = -0.45, 95% CI = -0.88 to -0.02) in breast cancer patients. The quality of evidence was low as all studies showed the risk of bias and inconsistency. Conclusion Peer support intervention has the potential to effectively improve psychosocial adaptations in breast cancer patients. Future studies with a robust design and larger sample size are needed to investigate the potential factors associated with the beneficial effects of peer support.
Collapse
Affiliation(s)
- Yingyao Tan
- School of Nursing, Guangdong Pharmaceutical University, Guangdong, China
- Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Meijiao Qin
- School of Nursing, Guangdong Pharmaceutical University, Guangdong, China
| | - Bing Liao
- School of Nursing, Guangdong Pharmaceutical University, Guangdong, China
| | - Lixia Wang
- School of Nursing, Guangdong Pharmaceutical University, Guangdong, China
| | - Guangting Chang
- School of Nursing, Guangdong Pharmaceutical University, Guangdong, China
| | - Fengxiang Wei
- School of Nursing, Guangdong Pharmaceutical University, Guangdong, China
- Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Shu Cai
- School of Nursing, Guangdong Pharmaceutical University, Guangdong, China
| |
Collapse
|
11
|
Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
Collapse
Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| |
Collapse
|
12
|
Mo Q, Tan C, Wang X, Soondrum T, Zhang J. Optimism and symptoms of anxiety and depression among Chinese women with breast cancer: the serial mediating effect of perceived social support and benefit finding. BMC Psychiatry 2022; 22:635. [PMID: 36199048 PMCID: PMC9533572 DOI: 10.1186/s12888-022-04261-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This research examines the direct and indirect relationships between optimism, perceived social support (PSS), benefit finding (BF), and anxiety and depressive symptoms among Chinese women with breast cancer (BC). METHODS We recruited 512 patients, aged averagely 47.46(SD = 8.51) years from two hospitals located in Hunan province, China. The variables were assessed using the Optimism-Pessimism Scale (OPS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Benefit Finding Scale (BFS), and the Hospital Anxiety and Depression Scale (HADS). Path analyses were conducted by Amos version 24.0 for Windows to test the hypothesized serial mediation model. RESULTS Path analyses suggest a significant negative association between optimism and symptoms of anxiety and depression. The relationship was mediated by BF (β = -0.085, SE = 0.015, 95% CI [-0.126, -0.055]), and by BF together with PSS (β = -0.027, SE = 0.007, 95% CI [-0.047, -0.017]). The difference comparison between the two indirect effects was significant (β = 0.057, SE = 0.015, 95% CI [0.034,0.101]). CONCLUSIONS Our findings suggest that PSS, and BF are important mediators through which optimism may buffer symptoms of anxiety and depression among Chinese BC patients. Clinicians and healthcare practitioners should be aware of the importance of patients' emotional health and endeavor to offer emotional support, facilitate their capacity to improve their quality of life.
Collapse
Affiliation(s)
- Qingqian Mo
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013 People’s Republic of China
| | - Chen Tan
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013 People’s Republic of China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410000 People’s Republic of China
| | - Tamini Soondrum
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410000 People’s Republic of China
| | - Jinqiang Zhang
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013 People’s Republic of China
| |
Collapse
|
13
|
Santoyo-Olsson J, Stewart AL, Ortiz C, Nápoles AM. An Ecologic Model for Identifying Coping Resources to Manage Psychological Distress Among Spanish-Speaking Latina Women Newly Diagnosed With Breast Cancer. Oncol Nurs Forum 2022; 49:395-408. [PMID: 36067240 PMCID: PMC10826794 DOI: 10.1188/22.onf.395-408] [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: 12/29/2022]
Abstract
OBJECTIVES To examine associations of coping resources for psychological distress among newly diagnosed Spanish-speaking Latina women with breast cancer (LWBC). SAMPLE & SETTING Analyses used baseline data from a randomized controlled trial of a stress management intervention among 151 LWBC. METHODS & VARIABLES Dependent variables were health distress and anxiety. Coping resources at the intrapersonal, interpersonal, and organizational/community levels were included. RESULTS At the intrapersonal level, self-efficacy for coping with breast cancer treatment was associated inversely with health distress and anxiety, and coping confidence with general problems was associated inversely with health distress. At the interpersonal level, having a sense of neighborhood cohesion was associated inversely with health distress. No organizational/community level resources were associated with health distress or anxiety. IMPLICATIONS FOR NURSING Interventions that enhance self-efficacy in coping and foster skills to identify sources of neighborhood support may decrease psychological distress for Spanish-speaking LWBC.
Collapse
Affiliation(s)
- Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco (UCSF), 490 Illinois Street Floor 9-Box 0856, San Francisco, CA 94143, USA
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA 94720, USA
| | - Anita L. Stewart
- Institute for Health and Aging, UCSF, 490 Illinois Street Floor 12-Box 0646, San Francisco, CA 94143, USA
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, 2601 Mission Street, Suite 702, San Francisco, CA 94110 USA
| | - Anna Maria Nápoles
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, USA
| |
Collapse
|
14
|
Julian McFarlane S, Occa A, Peng W, Awonuga O, Morgan SE. Community-Based Participatory Research (CBPR) to Enhance Participation of Racial/Ethnic Minorities in Clinical Trials: A 10-Year Systematic Review. HEALTH COMMUNICATION 2022; 37:1075-1092. [PMID: 34420460 DOI: 10.1080/10410236.2021.1943978] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There has not been a significant improvement in the rate of clinical trial accrual in more than 20 years. Worse, the challenge of inadequate representation among racial and ethnic minorities also persists, deepening disparities in health. Community-Based Participatory Research (CBPR) is a participatory communication method that centers on effective dialogue between researchers and community stakeholders with the goal of creating an equitable partnership for health and social change. The objective of the current study was to provide an update since a systematic review in 2012, on the current status of the empirical research, with a particular focus on the elements of CBPR methods used to improve the rate of accrual of members of racial and ethnic minority communities for clinical trials. Our systematic review found a large increase in the number of CBPR related studies and studies related to racial and ethnic representation in research. More than 85% of studies employing CBPR methods saw statistically positive outcomes. Specifically, the elements of CBPR that are associated with these positive outcomes include community partner participation in (1) a study advisory committee, (2) data collection, (3) the development of interventions, and (4) participant recruitment. However, the results of our study indicate that researchers need to be more transparent about the extent of community participation as well as more thoroughly and accurately describe the nature of the partnership with members of minority communities in order to build upon the scientific literature on community-engaged methods.
Collapse
Affiliation(s)
| | - Aurora Occa
- Department of Communication, University of Kentucky
| | - Wei Peng
- Murrow College of Communication, Washington State University
| | | | | |
Collapse
|
15
|
Zhang S, Li J, Hu X. Peer support interventions on quality of life, depression, anxiety, and self-efficacy among patients with cancer: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:3213-3224. [PMID: 35858869 DOI: 10.1016/j.pec.2022.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Peer support is a common form of social support that is provided by individuals with the same disease, which is cost-effective and has enhanced health outcomes for patients. This study aimed to determine the effectiveness of peer support interventions on quality of life (QOL), depression, anxiety, and self-efficacy among patients with cancer. METHODS A systematic search of seven databases were conducted from inception to January 2021. Studies were screened and assessed by two independent reviewers. Data synthesis was conducted using RevMan 5.3 software, and the standardized mean difference was used to calculate pooled effect sizes. RESULTS Seventeen studies were included in current review. The meta-analysis indicated significant beneficial effects of peer support on QOL (SMD = 0.48, 95% CI 0.21-0.75; p < 0.001), depression (SMD = -0.23, 95% CI -0.39 to -0.07; p = 0.005), anxiety (SMD = -0.24, 95% CI -0.45 to 0.03; p = 0.03), and self-efficacy (SMD = 0.22, 95% CI 0.03-0.42; p = 0.03) relative to controls. The subgroup analysis for QOL revealed that peer support delivered in the mixed mode contributed more than peer support delivered in the single mode (e.g., face-to-face or telephone). CONCLUSION Peer support has significant effects on improving QOL and self-efficacy as well as alleviating depression and anxiety among patients with cancer. Additional randomized controlled trials with rigorous design and larger sample sizes are warranted in the future. PRACTICE IMPLICATIONS Peer support programs might benefit patients with cancer and could be used as a complementary approach to traditional healthcare services during cancer rehabilitation.
Collapse
Affiliation(s)
- Shufang Zhang
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, PR China.
| | - Juejin Li
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, PR China.
| | - Xiaolin Hu
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, PR China.
| |
Collapse
|
16
|
Gonzalo-Encabo P, Wilson RL, Kang DW, Norris MK, Uno H, Christopher CN, Chow C, Sami N, Fox FS, Ligibel JA, Dieli-Conwright CM. Reducing Metabolic Dysregulation in Obese Latina and/or Hispanic Breast Cancer Survivors Using Physical Activity (ROSA) Trial: A Study Protocol. Front Oncol 2022; 12:864844. [PMID: 35619910 PMCID: PMC9128380 DOI: 10.3389/fonc.2022.864844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Latina and Hispanic breast cancer survivors (LHBCS) are at increased risk for long-term complications and poorer metabolic health, including metabolic dysregulation (MetD) before and following breast cancer diagnosis. MetD can increase risk of cancer recurrence, death, and comorbid conditions by increasing inflammation and cancer cell proliferation. While exercise improves physical fitness and metabolic outcomes in breast cancer survivors, there is a lack of studies including underrepresented and disadvantaged minority groups such as LHBCS. Methods Our 12-month randomized (exercise or attention control) controlled trial (the ROSA trial) aims to utilize a progressive combined aerobic and resistance exercise program to improve MetD, insulin resistance, and visceral adiposity among obese LHBCS. We aim to recruit 160 women with Stage I-III breast cancer who are sedentary, centrally obese, and have completed treatment (e.g., surgery, radiation, chemotherapy) prior to enrollment. Participants randomized to the exercise group receive 16-weeks of virtually supervised aerobic and resistance training, followed by 16-weeks of unsupervised home-based aerobic and resistance exercise, and 16-weeks of follow-up. The attention control group receive a 12-month home-based stretching program. Primary and secondary outcomes are measured every 4-weeks during study visits. Discussion The ROSA trial is the first exercise oncology trial targeting high-risk sedentary, obese LHBCS to improve MetD-related outcomes. Results of this trial will help illuminate how exercise impacts health-related outcomes, survivorship, and recurrence, and inform future exercise oncology guidelines to reduce health disparities among minority cancer survivors.
Collapse
Affiliation(s)
- Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Rebekah L Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Mary K Norris
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Hajime Uno
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Cami N Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christina Chow
- UCSF School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Nathalie Sami
- Department of Internal Medicine, Los Angeles County-University of Southern California (LAC+USC) Medical Center, Keck School of Medicine, Los Angeles, CA, United States
| | - Frank S Fox
- Gerson Lehrman Group, New York, NY, United States
| | - Jennifer A Ligibel
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Breast Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
17
|
Bonilla J, Alhomsi A, Santoyo-Olsson J, Stewart AL, Ortiz C, Samayoa C, Torres-Nguyen A, Palomino H, Coleman LV, Urias A, Gonzalez N, Cervantes SA, Duron Y, Nápoles AM. Sharing research results with Latina breast cancer survivors who participated in a community-engaged behavioral RCT study: a descriptive cross-sectional survey study. Trials 2022; 23:25. [PMID: 34998436 PMCID: PMC8742155 DOI: 10.1186/s13063-021-05945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND An often heard and justifiable concern of ethnic minorities is related to researchers' lack of attention to sharing the results of a study with participants after the study has concluded. Few studies have examined the effects of returning overall study results on participants' attitudes, especially among populations underrepresented in research. Among Latina research participants, providing a summary of study results could enhance participation in research. We assess Latina breast cancer survivors' reactions to receiving study results and their attitudes about participating in future studies. METHODS For this cross-sectional survey study, all women who had participated in two behavioral randomized controlled trials (RCTs) were mailed a letter summarizing the study results (using written and graphic formats) and a questionnaire assessing problems and understanding the results, importance of sharing results, willingness to participate in future studies, and format preferences for receiving the results. A postage-paid envelope for returning the completed questionnaire was included. Logistic regression examined the associations of age, education, and rural/urban residence on format preferences and willingness to participate. The survey sample consisted of 304 low-income, predominantly Spanish-speaking Latina breast cancer survivors (151 from urban and 153 from rural communities) who had participated in two RCTs testing a stress management program designed for Latina breast cancer survivors. RESULTS Ninety-two women returned the questionnaires (30.3%). Most of the women (91.1%) indicated that they had no trouble understanding the results of the study, and 97% agreed that it is very/extremely important for researchers to share the study result with the participants. The majority (60.2%) reported that receiving the results increased their willingness to participate in future studies. About half (51.7%) did not have a format preference, 37.4% preferred written summaries, and 10.9% preferred graphs. CONCLUSIONS This study is an important first step to understanding the impact of returning study results among a population that is underrepresented in research. Returning the results of studies and understanding the impact of doing so is consistent with maintaining community involvement in all phases of research. The findings suggest that sharing aggregate research results in simple language yields few problems in participants' understanding of the results and is viewed as important by participants. TRIAL REGISTRATION ClinicalTrials.gov NCT02931552 Date registered: October 13, 2016 and NCT01383174 Date registered: June 28, 2011.
Collapse
Affiliation(s)
- Jackie Bonilla
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA
| | - Alia Alhomsi
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco (UCSF), 3333 California St., Suite 335, San Francisco, CA, 94143-0856, USA
| | - Anita L Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, 490 Illinois Street, 12232, San Francisco, CA, 94158, USA
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, 2601 Mission Street, Suite 702, San Francisco, CA, 94110, USA
| | - Cathy Samayoa
- Health Equity Research Lab, Department of Biology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Alma Torres-Nguyen
- Kaweah Delta Health Care District, 400 W. Mineral King, Visalia, CA, 93291, USA
| | - Helen Palomino
- Cancer Resource Center of the Desert, 444 So. 8th St, Suite B-3, El Centro, CA, 92243, USA
| | - La Verne Coleman
- WomenCARE/Entre Nosotras, Family Service Agency of the Central Coast, 2901 Park Avenue, Suite A1, Soquel, CA, 95073, USA
| | - Aday Urias
- Cancer Resource Center of the Desert, 444 So. 8th St, Suite B-3, El Centro, CA, 92243, USA
| | - Nayeli Gonzalez
- Cancer Resource Center of the Desert, 444 So. 8th St, Suite B-3, El Centro, CA, 92243, USA
| | | | - Ysabel Duron
- Latino Cancer Institute, 123 East San Carlos Street, #413, San Jose, CA, 95112, USA
| | - Anna María Nápoles
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA.
| |
Collapse
|
18
|
Anderson EA, Armer JM. Factors Impacting Management of Breast Cancer-Related Lymphedema (BCRL) in Hispanic/Latina Breast Cancer Survivors: A Literature Review. HISPANIC HEALTH CARE INTERNATIONAL 2021; 19:190-202. [PMID: 33550878 PMCID: PMC8353654 DOI: 10.1177/1540415321990621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Breast cancer-related lymphedema (BCRL) is a treatment sequela with negative physical and psychological implications. BCRL is a lifetime concern for survivors and is currently incurable. With the increase in the Latino population in the United States, it is critical for the cancer care community to address factors that increase BCRL risk and negatively impact long-term quality of life. This literature review undertook to identify successful intervention strategies for BCRL among Latina survivors. METHODS Multiple databases were searched for published articles from 2006 to 2020. PRISMA guidelines were utilized. Data were extracted related to physical activity, diet, and psychosocial stress concerns of Latinas at risk for or living with BCRL. RESULTS Eleven interventions combined education and skill-building techniques to address physical activity, diet, and stress management for BCRL. Family involvement, peer-mentoring, culturally tailored education, and self-care skill development were identified as important for Latina survivors. CONCLUSION Latina survivors may benefit from culturally tailored BCRL education programs and self-management interventions. Health care professionals and researchers should consider cultural influences when developing clinical intervention strategies to enhance outcomes for Latinas at risk for living with BCRL. In addition, including family members and/or peers in such strategies may be helpful to Latina survivors.
Collapse
Affiliation(s)
| | - Jane M. Armer
- S312 Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| |
Collapse
|
19
|
Lambert S, Schaffler JL, Ould Brahim L, Belzile E, Laizner AM, Folch N, Rosenberg E, Maheu C, Ciofani L, Dubois S, Gélinas-Phaneuf E, Drouin S, Leung K, Tremblay S, Clayberg K, Ciampi A. The effect of culturally-adapted health education interventions among culturally and linguistically diverse (CALD) patients with a chronic illness: A meta-analysis and descriptive systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1608-1635. [PMID: 33573916 DOI: 10.1016/j.pec.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To review the effectiveness of health education interventions adapted for culturally and linguistically diverse (CALD) populations with a chronic illness. METHODS A systematic review and meta-analysis were conducted. Eligible studies were identified across six databases. Data were extracted and intervention effect was summarized using standardized mean difference. If there were insufficient data for meta-analysis, a descriptive summary was included. Modifying effects of intervention format, length, intensity, provider, self-management skills taught, and behavioral change techniques (BCTs) utilized were examined. RESULTS 58 studies were reviewed and data were extracted for 36 outcomes. Most interventions used multiple modes of delivery and were facilitated by bilingual health care professionals (HCPs). On average, interventions included 5.19 self-management skills and 4.82 BCTs. Interventions were effective in reducing BMI, cholesterol, triglycerides, blood glucose, HbA1C, and depression, and in increasing knowledge. Effectiveness was influenced partly by provider, with HCPs favored over lay providers or paraprofessionals in increasing knowledge; however, the opposite was noted for HbA1c. CONCLUSIONS Health education interventions are effective among CALD populations, particularly at improving objective, distal outcomes (e.g., anthropometric measures). These interventions may be equally effective in improving proximal patient-reported outcomes (PROs); however, diversity in PROs limited analyses. PRACTICE IMPLICATIONS Core outcome sets (COS) are needed to further investigate and compare health education intervention effectiveness on PROs.
Collapse
Affiliation(s)
- Sylvie Lambert
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada.
| | | | - Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
| | | | | | - Nathalie Folch
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Christine Maheu
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Luisa Ciofani
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Sylvie Dubois
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | | | - Susan Drouin
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Katerina Leung
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Sarah Tremblay
- Ingram School of Nursing, McGill University, Montréal, Canada
| | | | - Antonio Ciampi
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
| |
Collapse
|
20
|
Halvorsrud K, Kucharska J, Adlington K, Rüdell K, Brown Hajdukova E, Nazroo J, Haarmans M, Rhodes J, Bhui K. Identifying evidence of effectiveness in the co-creation of research: a systematic review and meta-analysis of the international healthcare literature. J Public Health (Oxf) 2021; 43:197-208. [PMID: 31608396 PMCID: PMC8042368 DOI: 10.1093/pubmed/fdz126] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 09/03/2019] [Accepted: 09/17/2019] [Indexed: 12/15/2022] Open
Abstract
Background To investigate and address the evidence gap on the effectiveness of co-creation/production in international health research. Methods An initial systematic search of previous reviews published by 22 July 2017 in Medline, Embase, PsycINFO, Scopus and Web of Science. We extracted reported aims, elements and outcomes of co-creation/production from 50 reviews; however, reviews rarely tested effectiveness against intended outcomes. We therefore checked the reference lists in 13 included systematic reviews that cited quantitative studies involving the public/patients in the design and/or implementation of research projects to conduct meta-analyses on their effectiveness using standardized mean difference (SMD). Results Twenty-six primary studies were included, showing moderate positive effects for community functions (SMD = 0.56, 95%CI = 0.29–0.84, n = 11) and small positive effects for physical health (SMD = 0.25, 95%CI = 0.07–0.42, n = 9), health-promoting behaviour (SMD = 0.14, 95%CI = 0.03–0.26, n = 11), self-efficacy (SMD = 0.34, 95%CI = 0.01–0.67, n = 3) and health service access/receipt (SMD = 0.36, 95%CI = 0.21–0.52, n = 12). Non-academic stakeholders that co-created more than one research stage showed significantly favourable mental health outcomes. However, co-creation was rarely extended to later stages (evaluation/dissemination), with few studies specifically with ethnic minority groups. Conclusions The co-creation of research may improve several health-related outcomes and public health more broadly, but research is lacking on its longer term effects.
Collapse
Affiliation(s)
- Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Justyna Kucharska
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.,Westminster University, 115 New Cavendich Street, London, W1W 6UW, UK
| | - Katherine Adlington
- East London NHS Foundation Trust, City and Hackney Centre for Mental Health, Homerton Row, London, E9 6SR, UK
| | - Katja Rüdell
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Eva Brown Hajdukova
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - James Nazroo
- Sociology, School of Social Sciences, University of Manchester, Humanities, Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - Maria Haarmans
- Sociology, School of Social Sciences, University of Manchester, Humanities, Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - James Rhodes
- Sociology, School of Social Sciences, University of Manchester, Humanities, Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| |
Collapse
|
21
|
Chacón L, Santoyo-Olsson J, Samayoa C, Alhomsi A, Stewart AL, Ortiz C, Escalera C, Nápoles AM. Self-Efficacy for Coping with Breast Cancer Treatment Among Spanish-Speaking Latinas. Health Equity 2021; 5:245-252. [PMID: 33937611 PMCID: PMC8082036 DOI: 10.1089/heq.2020.0152] [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] [Accepted: 03/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Cancer-related self-efficacy, a multidimensional construct, is the confidence that one can overcome challenges associated with cancer and its treatment; higher levels have been associated with better psychosocial outcomes of breast cancer survivors. Little is known about factors that influence it among Latina breast cancer survivors. Purpose: Assess associations of several aspects of health care processes and of spirituality with self-efficacy for coping with breast cancer treatment among primarily Spanish-speaking Latina breast cancer survivors. Methods: We analyzed baseline data from a randomized controlled trial of a cognitive-behavioral stress management intervention that enrolled 151 Spanish-speaking Latinas within 1 year of breast cancer diagnosis. Multivariate linear regression models examined associations of health care processes (quality of breast cancer care and information, participating in medical care, difficulty engaging with doctors) and spirituality (meaning/peace, faith, acceptance) with self-efficacy for coping with breast cancer treatment. Results: Mean age was 51 (standard deviation [SD]=11), 66% completed high school or less, and most reported financial hardship in the past year (78%). Average time since diagnosis was 3.8 months (SD=2.7). In bivariate analyses, all six determinants were significantly associated with self-efficacy for coping with breast cancer treatment; participating in medical care (B=0.56, p<0.001) and having a sense of meaning/peace (B=0.76; p<0.001) were independently associated, controlling for sociodemographic and treatment characteristics. Discussion: Interventions that promote participation in treatment decisions and sense of meaning and peace could improve confidence in coping with breast cancer treatment, and potentially quality of life, among Latinas living with breast cancer (Trial Registration Number: NCT01383174 [ClinicalTrials.gov]).
Collapse
Affiliation(s)
- Liliana Chacón
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Cathy Samayoa
- Department of Biology, SF BUILD Health Equity Lab, San Francisco State University, San Francisco, California, USA
| | - Alia Alhomsi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Anita L. Stewart
- Department of Medicine, Center for Aging in Diverse Communities, Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, San Francisco, California, USA
| | - Cristian Escalera
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
22
|
Apatu E, Stallings-Smith S, Alvarez E, Anderson L, Spaulding A. Does community engaged Carnegie status matter for county health rankings in the United States? J Public Health (Oxf) 2021; 43:164-171. [PMID: 31211380 DOI: 10.1093/pubmed/fdz066] [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: 12/05/2018] [Revised: 04/23/2019] [Accepted: 05/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Community engagement is commonly used to address social inequities. The Carnegie Foundation offers an optional designation for which U.S. colleges and universities may apply to facilitate better educational outcomes through the institutionalization of community engagement. This study is the first to examine the relationship between Carnegie community engaged status and community health outcomes. METHODS Ordinal logistic regression was conducted to investigate the association between the presence of a community engaged institution and county health outcomes, including health behaviors, clinical care relating to access and quality, social and economic factors, and physical environment from the 2016 Robert Wood Johnson County Health Rankings and 2015 New England Resource Center for Higher Education Community engaged list. We examined 820 U.S. counties containing a university or college, 240 of which had a community engaged designation. RESULTS Findings indicated that the presence of a community-engaged institution was positively associated with Clinical Care (OR = 1.99; 95% CI: 1.09, 3.64). Other county health factors were not similarly associated. CONCLUSIONS Our findings suggest that community engagement status may be most relevant for achieving better access and quality of clinical care. More research is needed to explore this association in the U.S. and internationally.
Collapse
Affiliation(s)
- Emma Apatu
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, USA
| | - Sericea Stallings-Smith
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Elizabeth Alvarez
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, USA
| | - Laura Anderson
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, USA
| | - Aaron Spaulding
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern, Center for the Science of Health Care Delivery, 4500 San Pablo Rd., Jacksonville, FL, USA
| |
Collapse
|
23
|
Bonilla J, Escalera C, Santoyo-Olsson J, Samayoa C, Ortiz C, Stewart AL, Nápoles AM. The importance of patient engagement to quality of breast cancer care and health-related quality of life: a cross-sectional study among Latina breast cancer survivors in rural and urban communities. BMC WOMENS HEALTH 2021; 21:59. [PMID: 33563263 PMCID: PMC7871405 DOI: 10.1186/s12905-021-01200-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022]
Abstract
Background Compared to their white counterparts, Latina breast cancer survivors experience poorer quality of care and worse health-related quality of life. Limited English proficiency (LEP) and patient engagement in cancer care could help explain these disparities. We assessed associations between LEP status and difficulty engaging with physicians, with self-reported quality of breast cancer care and health-related quality of life (physical and emotional well-being) among rural and urban Latina breast cancer survivors. Methods Analyses used cross-sectional baseline survey data from two studies that tested a stress management program among rural and urban Latina breast cancer survivors in California. Medical information was collected through medical records review. Linear regression models examined bivariate and multivariable associations of LEP status (yes or no), difficulty engaging with doctors (asking questions and participating in treatment decisions) (1–4; higher score = greater difficulty), and rural versus urban site, with three outcomes: (1) quality of breast cancer care and information; (2) physical well-being; and (3) and emotional well-being, controlling for demographic and medical factors. Results The total sample included 304 women (151 from urban and 153 from rural sites). Mean age was 52.7 years (SD 10.9). Most were limited English proficient (84.5%) and had less than a high school education (67.8%). Difficulty engaging with doctors was inversely associated with patient ratings of quality of breast cancer care and information (B = − 0.190, p = 0.014), emotional well-being (B = − 1.866, p < 0.001), and physical well-being (B = − 1.272, p = 0.002), controlling for demographic and treatment factors. LEP (vs. not; B = 1.987, p = 0.040) was independently associated with physical well-being only. Rural/urban status was not related independently to any outcome. Conclusions Rural and urban Latina breast cancer survivors who report greater difficulty engaging with physicians experienced worse quality of breast cancer care and health-related quality of life. Promoting greater engagement of Latina breast cancer survivors in cancer care and providing medical interpreters when needed could improve patient outcomes among this vulnerable group. Trial registration: http://www.ClinicalTrials.gov identifier NCT02931552 and NCT01383174.
Collapse
Affiliation(s)
- Jackie Bonilla
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, MD, 20892, Bethesda, USA
| | - Cristian Escalera
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, MD, 20892, Bethesda, USA
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 3333 California St., Suite 335, San Francisco, CA, 94143-0856, USA
| | - Cathy Samayoa
- Health Equity Research Lab, Department of Biology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, 2601 Mission St, Suite 702, San Francisco, CA, 94110, USA
| | - Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, 3333 California St., Suite 340, San Francisco, CA, 94118, USA
| | - Anna María Nápoles
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, MD, 20892, Bethesda, USA.
| |
Collapse
|
24
|
Buki LP, Schwartz JR, McInerney EEW. Creating community: Expanding access to psychosocial programs for Latina breast cancer survivors. Psychooncology 2021. [PMID: 33555106 DOI: 10.1002/pon.5646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/29/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Breast cancer survivors often derive benefits from psychosocial interventions, but less is known about Latina women's experiences. Given the disproportionately high disease burden faced by Latina survivors, it is critical to examine ways to enhance access for this population. Thus, the present study aimed to (a) examine women's perceptions of factors associated with effective delivery of a psychosocial program designed for Spanish speaking women with limited access to care, and (b) identify the mechanisms by which the program enhanced women's psychological well-being. METHODS In a qualitative study, in-depth interviews were conducted with 15 immigrant Latina breast cancer survivors who previously received psychosocial services at a community-based organization. Grounded theory was used to analyze the data. RESULTS Through open, axial, and selective coding, we arrived at the core category achieving a sense of community. The psychosocial program promoted access and enhanced women's psychological well-being by creating a sense of community among participants. This was facilitated by three primary aspects of service provision: access factors, a holistic approach to health, and therapeutic factors imparted through a biweekly support group. CONCLUSIONS Psychosocial services promoted a sense of community among Latina breast cancer survivors while reflecting their cultural values and unique psychosocial needs. Findings may guide the development of interventions to increase access to care, enhance health outcomes, and create and maintain a sense of community among medically underserved populations.
Collapse
Affiliation(s)
- Lydia P Buki
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
| | - Jessica R Schwartz
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
| | - Elizabeth E W McInerney
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
| |
Collapse
|
25
|
Lakatos K, Uy-Smith E. Landscape analysis for a community-designed intervention to enhance early childhood development in San Francisco. Prev Med Rep 2020; 19:101101. [PMID: 32637299 PMCID: PMC7330604 DOI: 10.1016/j.pmedr.2020.101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/05/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022] Open
Abstract
To determine the appropriate components for a community-based intervention for early childhood development, a broad series of stakeholder interviews was completed in a three-month period (January-March 2019) and a systematic review of their responses was performed. Additionally, 11 citywide assessment reports for child equity were reviewed and added to the information matrix. We performed this population-based assessment in San Francisco, a dense urban environment with roughly 43,000 children under the age of 5. The city has high rates of income inequity, with roughly half of the children considered to be living in low-income or poverty conditions. Interviews were conducted with 34 stakeholders representing various sectors, including community organizations, government, healthcare, and academia. Nine main concerns surrounding low-income families and children (LIFC) living in San Francisco were extracted from stakeholder interviews. The concerns were divided into subcategories based on a socioecological health model. City-funded, community-based, family resource centers were an identified space for performing an early childhood health intervention supporting LIFC. Furthermore, any proposed intervention to support LIFC must be implemented with a culturally tailored focus, as a one-size-fits-all, clinic-based model is not desired. Community-engaged and culturally specific activities are requested and required for effectively promoting early childhood development in an urban environment. In this article we propose that additional work towards implementing community-based interventions with support from the clinic are needed.
Collapse
Affiliation(s)
- Kyle Lakatos
- Department of Family and Community Medicine, University of California, San Francisco, Family Health Center, Zuckerberg San Francisco General, 995 Potrero Ave. Bldg. 80, Ward 83., San Francisco, CA 94110, United States
| | - Elizabeth Uy-Smith
- Department of Family and Community Medicine, University of California, San Francisco, Family Health Center, Zuckerberg San Francisco General, 995 Potrero Ave. Bldg. 80, Ward 83., San Francisco, CA 94110, United States
| |
Collapse
|
26
|
Nápoles AM, Santoyo-Olsson J, Stewart AL, Ortiz C, Samayoa C, Torres-Nguyen A, Palomino H, Coleman L, Urias A, Gonzalez N, Cervantes SA, Totten VY. Nuevo Amanecer-II: Results of a randomized controlled trial of a community-based participatory, peer-delivered stress management intervention for rural Latina breast cancer survivors. Psychooncology 2020; 29:1802-1814. [PMID: 32672864 PMCID: PMC7754127 DOI: 10.1002/pon.5481] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 12/23/2022]
Abstract
Objective We report results of a community‐based multisite, randomized controlled trial of Nuevo Amanecer (NA‐II), a 10‐week stress management program for rural, low literacy Latina breast cancer survivors. Methods Trained peers delivered NA‐II to Spanish‐speaking Latinas with non‐metastatic breast cancer in three rural communities. Women were randomized to receive the program immediately or wait 6 months. Assessments were conducted at baseline, 3 months, and 6 months. Primary outcomes were breast cancer‐specific quality of life domains; secondary outcomes included general distress symptoms and stress management skills. Intention‐to‐treat analyses using repeated‐measures linear regression models estimated changes in slope between groups. Results Of 153 participants (76 randomized to intervention, 77 to control group), 92% were retained at 6 months. Mean age was 54.8 years (SD = 10.5); 80% had less than high school education. There were no statistically significant treatment × time effects on quality of life. Compared to women in the control group, intervention group women reported greater improvements in anxiety at 6 months (−0.20 vs −0.02, P = .049; range 0‐4) as well as three stress management skills: relaxation at 3 months (+0.98 vs −0.07, P < .0001; range 0‐4) and 6 months (+0.82 vs +0.04, P < .001), awareness of tension at 3 months (+0.31 vs −0.19, P < .01; range 0‐4) and 6 months (+0.29 vs −0.11, P < .05), and coping confidence at 3 months (+0.12 vs −0.23, P < .01; range 0‐4). Conclusions Stress management programs delivered by trained peers in rural community settings can reduce anxiety and improve stress management skills among Latina breast cancer survivors.
Collapse
Affiliation(s)
- Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Anita L Stewart
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, California, USA.,Institute for Health & Aging, University of California San Francisco, San Francisco, California, USA
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, San Francisco, California, USA
| | - Cathy Samayoa
- Health Equity Research Lab, Department of Biology, San Francisco State University, San Francisco, California, USA
| | | | - Helen Palomino
- Cancer Resource Center of the Desert, El Centro, California, USA
| | - LaVerne Coleman
- WomenCARE/Entre Nosotras, Family Service Agency of the Central Coast, Park, California, USA
| | - Aday Urias
- Cancer Resource Center of the Desert, El Centro, California, USA
| | - Nayeli Gonzalez
- Cancer Resource Center of the Desert, El Centro, California, USA
| | | | | |
Collapse
|
27
|
Buffart LM, Schreurs MAC, Abrahams HJG, Kalter J, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Armes J, Arving C, Braamse AM, Brandberg Y, Dekker J, Ferguson RJ, Gielissen MF, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Knoop H, Verdonck-de Leeuw IM. Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses. Clin Psychol Rev 2020; 80:101882. [PMID: 32640368 DOI: 10.1016/j.cpr.2020.101882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. METHODS Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. RESULTS CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). CONCLUSIONS CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.
Collapse
Affiliation(s)
- L M Buffart
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - M A C Schreurs
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - H J G Abrahams
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - J Kalter
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, Florida, USA.
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - J Armes
- School of Health Science, University of Surrey, Surrey, UK.
| | - C Arving
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - A M Braamse
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
| | | | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - M M Goedendorp
- Department of Health Science, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA.
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK.
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada.
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Brug
- National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
| | - H Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - I M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, the Netherlands.
| |
Collapse
|
28
|
Santoyo-Olsson J, Stewart AL, Samayoa C, Palomino H, Urias A, Gonzalez N, Torres-Nguyen A, Coleman L, Escalera C, Totten VY, Ortiz C, Nápoles AM. Translating a stress management intervention for rural Latina breast cancer survivors: The Nuevo Amanecer-II. PLoS One 2019; 14:e0224068. [PMID: 31618266 PMCID: PMC6795501 DOI: 10.1371/journal.pone.0224068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022] Open
Abstract
Objectives Adapt a cognitive-behavioral stress management program (Nuevo Amanecer or NA) to be generalizable to rural, low literacy Spanish-speaking Latinas with breast cancer survivors at all phases of survivorship. Methods Apply the Transcreation Framework, a community-engaged translational model, to develop the adapted program (Nuevo Amanecer or NA-II), design a randomized controlled trial for community settings, identify recruiters and interventionists, and recruit participants into the trial. Results Adaptations included expanding the program from eight to ten weeks, simplifying materials, and increasing skills practice. We added stress management videos, healthy lifestyles information, and survivorship information. Interventionists were trained Latina breast cancer survivors. All core components of NA were retained in NA-II including managing the impact of cancer, information on breast cancer and its treatment, finding cancer information, getting support, managing thoughts, stress management techniques, and setting goals. Participants receive a program manual. Each session includes a review of that week’s content using the manual, practicing a stress-management skill, setting a specific goal, and reviewing videos. Spanish-speaking Latinas with non-metastatic breast cancer were recruited by community recruiters. Of 231 women approached, 24% refused, 10% were ineligible, and 153 (66%) were randomized to the intervention or a wait-list control group. The sample was vulnerable: 69% had < high school education, more than half had only Medicaid or no insurance, 91% was foreign born, and 48% reported financial hardship in the past year. Conclusions Applying the Transcreation Framework to engage stakeholders in designing community-based RCTs enhanced congruence with community contexts and recruitment of this vulnerable population.
Collapse
Affiliation(s)
- Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Anita L. Stewart
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, California, United States of America
- Institute for Health and Aging, University of California San Francisco, San Francisco, California, United States of America
| | - Cathy Samayoa
- Health Equity Research Lab, Department of Biology, San Francisco State University, San Francisco, California, United States of America
| | - Helen Palomino
- Cancer Resource Center of the Desert, El Centro, California, United States of America
| | - Aday Urias
- Cancer Resource Center of the Desert, El Centro, California, United States of America
| | - Nayeli Gonzalez
- Cancer Resource Center of the Desert, El Centro, California, United States of America
| | - Alma Torres-Nguyen
- Kaweah Delta Health Care District, Visalia, California, United States of America
| | - LaVerne Coleman
- WomenCARE/Entre Nosotras, Family Service Agency of the Central Coast, Soquel, California, United States of America
| | - Cristian Escalera
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Vicken Y. Totten
- Kaweah Delta Health Care District, Visalia, California, United States of America
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, San Francisco, California, United States of America
| | - Anna Maria Nápoles
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America
| |
Collapse
|
29
|
Escalera C, Santoyo‐Olsson J, Stewart AL, Ortiz C, Nápoles AM. Social support as a moderator in the relationship between intrusive thoughts and anxiety among Spanish-speaking Latinas with breast cancer. Psychooncology 2019; 28:1819-1828. [PMID: 31216604 PMCID: PMC6771841 DOI: 10.1002/pon.5154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Intrusive thoughts, defined as unwanted and recurrent thoughts about a stressful experience, are associated with psychological distress in women with breast cancer. This study assessed moderating effects of various social support dimensions on associations between intrusive thoughts and psychological distress among Latina breast cancer survivors. METHODS We used baseline data from a randomized controlled trial of a stress management intervention delivered to 151 Spanish-speaking Latinas with nonmetastatic breast cancer within 1 year of diagnosis. Intrusive thoughts, four dimensions of social support (emotional/informational, tangible, affectionate, and positive social interaction), and symptoms of anxiety and depression were assessed through in-person interviews. Information on age, time since diagnosis, breast cancer variables, history of depression, and marital status served as covariates. Generalized linear models were used to investigate bivariate and multivariate associations and to explore moderation effects of the four dimensions of social support. RESULTS In bivariate models, intrusive thoughts were associated positively with depression (β = .024, .001) and anxiety (β = .047, P < .001) symptoms. Adjusting for other factors, intrusive thoughts remained associated with depression symptoms (β = .022, .008), regardless of level of social support (for all support dimensions). For anxiety, there were significant interactions of tangible (β = -.013, .034) and affectionate (β = -.022, .005) support with intrusive thoughts. Intrusive thoughts were associated more strongly with anxiety symptoms among women reporting less tangible and affectionate support than those with higher levels of these types of support. CONCLUSIONS Tangible and affectionate support have protective effects on anxiety symptoms among Spanish-speaking Latina breast cancer survivors experiencing intrusive thoughts, but not depression symptoms.
Collapse
Affiliation(s)
- Cristian Escalera
- National Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMaryland
| | - Jasmine Santoyo‐Olsson
- Division of General Internal Medicine, Department of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
| | - Anita L. Stewart
- Center for Aging in Diverse CommunitiesUniversity of California San FranciscoSan FranciscoCalifornia
- Institute for Health and AgingUniversity of California San FranciscoSan FranciscoCalifornia
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource CenterSan FranciscoCalifornia
| | - Anna Maria Nápoles
- National Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMaryland
| |
Collapse
|
30
|
Lee MK, Suh SR. Effects of Peer-Led Interventions for Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2019; 45:217-236. [PMID: 29466347 DOI: 10.1188/18.onf.217-236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION To evaluate the effects of peer-led supportive interventions for patients with cancer.
. LITERATURE SEARCH Six electronic databases (EMBASE, MEDLINE®, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL®) were searched for articles published from 1997 to May 2017.
. DATA EVALUATION A total of 159 studies were identified. Eighteen (16 randomized, controlled trials [RCTs] and 2 non-RCTs) were eligible for systematic review and 16 for meta-analysis. The Cochrane risk of bias tool and Comprehensive Meta-Analysis software were used for analysis.
. SYNTHESIS The authors synthesized the results of the effect size of each trial according to cancer symptoms, coping, emotional health, quality of life, self-efficacy, sexuality, social support, and health-related behaviors.
. IMPLICATIONS FOR RESEARCH The findings from this study suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of peer-led supportive interventions within cancer care models.
Collapse
|
31
|
Sternberg RM, Nápoles AM, Gregorich S, Stewart AL. Mentes Positivas en Acción: Feasibility Study of a Promotor-Delivered Cognitive Behavioral Stress Management Program for Low-Income Spanish-Speaking Latinas. Health Equity 2019; 3:155-161. [PMID: 31289774 PMCID: PMC6608695 DOI: 10.1089/heq.2019.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Low-income Latino immigrants lack access to mental health providers. We explored the feasibility of training promotores to deliver a stress management program in community settings. Methods: We trained promotores to deliver an 8-week intervention program comprising evidence-based cognitive-behavioral stress management techniques. Trained promotores then delivered the program to Spanish-speaking Latino immigrants. Results: Promotores (n=10) improved their knowledge significantly after the training (p<0.001) and delivered the program demonstrating excellent fidelity. Participants who received the program (n=50) had significantly improved scores on immigration stress, perceived stress, and depressive symptoms (p<0.001). Conclusion: It is feasible to train Latino promotores to deliver an effective stress management program to low-income Latino immigrants in their communities. Results contribute to a growing literature on the value of such interventions in community settings. If it is found to be effective in future studies, the program could help fill a large need in the Latino community.
Collapse
Affiliation(s)
- Rosa María Sternberg
- Center for Aging in Diverse Communities, University of California San Francisco (UCSF), San Francisco, California.,School of Nursing, University of California San Francisco (UCSF), San Francisco, California
| | - Anna María Nápoles
- Center for Aging in Diverse Communities, University of California San Francisco (UCSF), San Francisco, California.,Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Steven Gregorich
- Center for Aging in Diverse Communities, University of California San Francisco (UCSF), San Francisco, California
| | - Anita L Stewart
- Center for Aging in Diverse Communities, University of California San Francisco (UCSF), San Francisco, California
| |
Collapse
|
32
|
Non-pharmacological therapies for depressive symptoms in breast cancer patients: Systematic review and meta-analysis of randomized clinical trials. Breast 2019; 44:135-143. [DOI: 10.1016/j.breast.2019.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 02/02/2023] Open
|
33
|
Ruiz-Pérez I, Rodríguez-Gómez M, Pastor-Moreno G, Escribá-Agüir V, Petrova D. Effectiveness of interventions to improve cancer treatment and follow-up care in socially disadvantaged groups. Psychooncology 2019; 28:665-674. [PMID: 30695816 DOI: 10.1002/pon.5011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify and characterize the interventions that aimed to improve cancer treatment and follow-up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi-experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co-operation and Development (OECD) member countries and published until 2016. RESULTS Thirty-one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3). CONCLUSIONS The impact of interventions designed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial. Multicomponent-intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.
Collapse
Affiliation(s)
- Isabel Ruiz-Pérez
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.,Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| | | | - Guadalupe Pastor-Moreno
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain
| | - Vicenta Escribá-Agüir
- Department of Nursing, University of Valencia, Valencia, Spain.,Fundación para el fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Dafina Petrova
- Andalusian School of Public Health, Granada, Spain.,Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.,Instituto de Investigación Biosanitaria (ibs. GRANADA), Granada, Spain
| |
Collapse
|
34
|
Meneses K, Gisiger-Camata S, Benz R, Raju D, Bail JR, Benitez TJ, Pekmezi D, McNees P. Telehealth intervention for Latina breast cancer survivors: A pilot. ACTA ACUST UNITED AC 2019; 14:1745506518778721. [PMID: 29807495 PMCID: PMC5977430 DOI: 10.1177/1745506518778721] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aim: This study was a pilot test of the Latina Breast Cancer Survivorship Intervention, a survivorship self-management intervention delivered via telephone. Materials and methods: This study used a wait-list control design with random assignment to either (1) support and early education or (2) support and delayed education. Latina breast cancer survivors were recruited through the Florida Cancer Data System Registry. Latinas with stage I–III breast cancer who completed primary cancer treatment 3 years prior to study enrollment were eligible. The Latina Breast Cancer Survivorship Intervention consisted of three education sessions delivered weekly via telephone and six telephone support calls, both delivered by a native Spanish speaker. Primary outcome variables included physical well-being, emotional well-being, fatigue, pain, and depressive symptoms. Data collection occurred at baseline, 3 months, and 6 months. Results: In total, 40 Latina breast cancer survivors who were middle-aged to older, married, with health insurance, and Spanish as preferred language enrolled in the Latina Breast Cancer Survivorship Intervention. Data were analyzed using mean change scores. Overall, physical and emotional well-being remained similar over time with well-being scores poorer compared with the general population. Pain levels improved over 6 months and showed a high effect size. Fatigue scores improved at 3 months and showed a moderate effect size. Depressive symptoms remained elevated but were not clinically significant. Conclusion: Telephone-based Latina Breast Cancer Survivorship Intervention reached Latina breast cancer survivors for survivorship education and support. Self-management of pain and fatigue showed improvement over time.
Collapse
Affiliation(s)
- Karen Meneses
- Office of Research and Scholarship, School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Silvia Gisiger-Camata
- Office of Research and Scholarship, School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
- Silvia Gisiger-Camata, Office of Research and Scholarship, School of Nursing, The University of Alabama at Birmingham, MT 415A, Birmingham, AL 35294, USA.
| | - Rachel Benz
- Office of Research and Scholarship, School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dheeraj Raju
- Office of Research and Scholarship, School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer R Bail
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanya J Benitez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patrick McNees
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
35
|
Peer support interventions for breast cancer patients: a systematic review. Breast Cancer Res Treat 2019; 174:325-341. [PMID: 30600413 DOI: 10.1007/s10549-018-5033-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/27/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Due to the clear efficacy of peer support as a means of improving emotional well-being and healthy behaviors in a highly cost-effective manner, this program is widely used. Controversy remains, however, with regard to its efficacy in breast cancer patients. Given the heterogeneity of peer support interventions, this review aimed to categorize, assess, and synthesize the existing evidence from randomized controlled trials (RCTs) to clarify the effects of different types of peer support on breast cancer patients. METHODS We searched Pubmed, EMBase, CENTRAL, CINAHL, PsychINFO, Chinese National Knowledge Infrastructure (CNKI) and Wanfang Data for English and Chinese language RCTs. The Cochrane Collaboration 'risk of bias' tool for systematic reviews was used to assess the methodological quality of each RCT. RESULTS Of the 1494 studies screened, 15 studies met eligibility criteria for inclusion, comprising 1695 breast cancer patients. Overall, there were more positive effects than invalid or negative effects across peer interventions, with notable exceptions: unmoderated and unstructured group peer support interventions as well as Internet-based models without peer training had no effect or adverse effects on proximal and distal outcomes. However, adding other peer roles to the peer support structure or using one-on-one models could significantly improve the patients' negative emotions. Peer education showed promising effects on stress management, quality of life, and healthy behaviors. CONCLUSIONS This systematic review found that different types of peer support have different effects on outcomes for breast cancer patients. Web-based group peer support without peer training must be avoided or used with caution in the future. Peer education is recommended for breast cancer patient support models, given its excellent results and cost-effectiveness.
Collapse
|
36
|
Hurtado-de-Mendoza A, Serrano A, Zhu Q, Graves K, Fernández N, Fernández A, Rodriguez-de-Liebana P, Massarelli V, Campos C, González F, Gómez Trillos S, Sheppard VB. Engaging Latina breast cancer survivors in research: building a social network research registry. Transl Behav Med 2018; 8:565-574. [PMID: 30016517 DOI: 10.1093/tbm/ibx053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Disparities persist in breast cancer outcomes between Latina survivors and non-Hispanic Whites. Identifying methods to ensure that Latinas participate in and benefit from translational behavioral medicine research is important to reduce disparities. We developed a "Social Network Research Registry" to enhance Latina survivors' engagement in research and explored the social networks and research/cancer organization participation in this population. We initially recruited 30 Latina breast cancer survivors ("seeds") from community organizations and identified other survivors through snowball sampling. Guided by Social Network Analysis, we assessed the structural (e.g., size) and functional (e.g., social support) characteristics of the network, willingness to join the registry, prior research participation, involvement in cancer organizations, and interest in different types of research and roles in research. The resulting network size was 98, including 53 women who enrolled in the study and 45 who were listed in the network but did not enroll. All enrolled participants (N = 53) agreed to be part of the registry. We identified 15 participants who occupied strategic positions as hubs and/or bridges. Women who were currently involved in cancer organizations were more likely to have participated in research (70.3% vs. 18.8%); χ2 (1, 53) = 11.97, p = .001. Most were interested in surveys/interviews (98%), behavioral interventions (96%), and becoming health promoters (79%). The Social Network Research Registry is an acceptable and feasible strategy to engage underrepresented Latina survivors in research. Social network analysis can be useful to identify members who occupy key positions to enhance recruitment and translational efforts.
Collapse
Affiliation(s)
| | | | - Qi Zhu
- Georgetown University Medical Center, Washington, DC, USA
| | - Kristi Graves
- Georgetown University Medical Center, Washington, DC, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Toija AS, Kettunen TH, Leidenius MHK, Vainiola THK, Roine RPA. Effectiveness of peer support on health-related quality of life in recently diagnosed breast cancer patients: a randomized controlled trial. Support Care Cancer 2018; 27:123-130. [PMID: 30338354 PMCID: PMC6280804 DOI: 10.1007/s00520-018-4499-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
Abstract
Purpose Breast cancer is the most common cancer of Finnish women. Peer support could be a way to help breast cancer patients to deal with the disease but studies on its effectiveness have produced conflicting results. The aim of this randomized controlled trial was to study the effectiveness of peer support on health-related quality of life (HRQoL) of breast cancer patients. Methods Patients with recently diagnosed breast cancer at the Helsinki University Hospital were randomly allocated to intervention (n = 130) or control (n = 130) groups. The intervention group patients received peer support via telephone one to five times according to their preference. The control group received usual care only. HRQoL was assessed with generic (15D) and disease-specific (EORTC QLQ-30 and its breast cancer specific module BR23) instruments at baseline and at 3-, 6-, and 12-month follow-up points. Results The mean (SD) age of the patients was 60.0 (10.5) years and their baseline mean 15D score 0.922 (0.066). At baseline, the intervention and control groups did not differ from each other. During follow-up, the 15D score deteriorated statistically significantly (p < 0.001) and clinically importantly in both groups but slightly less in the intervention group although the difference was not significant. Regarding individual 15D dimensions, the EORTC-QLQ30, or its breast-specific module, peer support did not show any consistent advantage compared to usual care. Conclusion Peer support had no clear effect on the HRQoL of breast cancer patients.
Collapse
Affiliation(s)
- Anu Susanna Toija
- University of Jyväskylä, PL 35 (L), 40014, Jyväskylä, Finland. .,EJY, Kauppamiehentie 6, 02100, Espoo, Finland.
| | - Tarja Helena Kettunen
- University of Jyväskylä, PL 35 (L), 40014, Jyväskylä, Finland.,Central Finland Health Care District, Unit of Primary Health Care, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | | | | | - Risto Paavo Antero Roine
- University of Helsinki and Helsinki University Hospital, PL 100, 00029 HUS, Helsinki, Finland.,University of Eastern Finland, PL 1627, 70211, Kuopio, Finland
| |
Collapse
|
38
|
Nápoles AM, Stewart AL. Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities. BMC Health Serv Res 2018; 18:710. [PMID: 30208873 PMCID: PMC6134771 DOI: 10.1186/s12913-018-3521-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background Methods for translating evidence-based behavioral interventions into real-world settings seldom account for the special issues in reaching health disparity populations. Main text The objective of this article is to describe an innovative “transcreational” framework for designing and delivering interventions in communities to reduce health disparities. We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. The Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities comprises seven steps: 1) identify community infrastructure and engage partners; 2) specify theory; 3) identify multiple inputs for new program; 4) design intervention prototype; 5) design study, methods, and measures for community setting; 6) build community capacity for delivery; and 7) deliver transcreated intervention and evaluate implementation processes. Communities are engaged from the start and interventions are delivered by community-based interventionists and tested in community settings. The framework applies rigorous scientific methods for evaluating program effectiveness and implementation processes. It incorporates training and ongoing technical assistance to assure treatment fidelity and build community capacity. Conclusions This framework expands the types of scientific evidence used and balances fidelity to evidence and fit to the community setting. It can guide researchers and communities in developing and testing behavioral interventions to reduce health disparities that are likely to be sustained because infrastructure development is embedded in the research.
Collapse
Affiliation(s)
- Anna María Nápoles
- National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA.
| | - Anita L Stewart
- University of California San Francisco, 3333 California Street, Suite 350E, San Francisco, CA, 94118, USA
| |
Collapse
|
39
|
Nápoles AM, Santoyo-Olsson J, Stewart AL, Ortiz C, García-Jímenez M. Evaluating the Implementation of a Translational Peer-Delivered Stress Management Program for Spanish-Speaking Latina Breast Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:875-884. [PMID: 28275966 PMCID: PMC5591043 DOI: 10.1007/s13187-017-1202-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Information is needed on implementation processes involved in translating evidence-based interventions (EBIs) into health disparity communities. In an RCT, Nuevo Amanecer, a cognitive-behavioral stress management (CBSM) program delivered by breast cancer survivors (compañeras) in community settings to Spanish-speaking Latina breast cancer survivors, was effective in improving quality of life and decreasing breast cancer concerns and depressive and bodily symptoms. Using mixed methods, we evaluated the processes of implementing Nuevo Amanecer. Program delivery was assessed by direct observation. Treatment receipt was assessed by participants' mastery and homework completion. Perceived benefits, quality, ease of use, usefulness of components, and suggested improvements were evaluated through participant surveys and semi-structured interviews of participants and compañeras. Eighty percent of women completed six or more of eight sessions. Observer ratings of program delivery indicated compañeras demonstrated fidelity 80-90% of the time for three components (e.g., following the manual), but only 10% for two components (e.g., modeling skills). Regarding treatment receipt, most participants completed all homework. Knowledge and skills mastery was high (mostly >85%). In program evaluations, 93% indicated the program helped them cope with breast cancer "quite a bit/extremely." Participants reported improved self-management skills and knowledge. Suggested improvements were to add more sessions to practice cognitive-behavioral coping skills and simplify exercises and homework. We conclude that CBSM programs can be delivered in community settings by trained peers with high fidelity, acceptability, and perceived usefulness. Results provided some areas where the program could be improved. Our rigorous evaluation illustrates methods for evaluating processes of translating EBIs for community implementation. TRIAL REGISTRATION NCT01383174 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Anna María Nápoles
- Department of Medicine, University of California San Francisco (UCSF), 3333 California Street, Suite 335, San Francisco, CA, 94118-1944, USA.
| | - Jasmine Santoyo-Olsson
- Department of Medicine, University of California San Francisco (UCSF), 3333 California Street, Suite 335, San Francisco, CA, 94118-1944, USA
| | - Anita L Stewart
- Institute for Health and Aging, UCSF, San Francisco, CA, USA
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, San Francisco, CA, USA
| | | |
Collapse
|
40
|
Hoogland AI, Lechner SC, Gonzalez BD, Small BJ, Tyson DM, Asvat Y, Barata A, Gomez MF, Rodriguez Y, Jim HSL, Antoni MH, Jacobsen PB, Meade CD. Efficacy of a Spanish-Language Self-Administered Stress Management Training intervention for Latinas undergoing chemotherapy. Psychooncology 2018; 27:1305-1311. [PMID: 29462503 DOI: 10.1002/pon.4673] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cancer patients often report increased stress during chemotherapy. Stress management training has been shown to reduce this adverse outcome, but few interventions exist for Spanish-speaking Hispanic and Latina women (Latinas). METHODS Following community feedback (including focus groups/in-depth interviews), we transcreated the Spanish-Language Self-Administered Stress Management Training (SL-SAT) intervention based on our previously developed and implemented English-based intervention. Latinas about to begin chemotherapy were randomized to SL-SAT (n = 121) or usual care (n = 119). A Spanish-speaking interventionist met with SL-SAT participants who received the SL-SAT toolkit containing instructions in 3 well-established stress management techniques (deep breathing, progressive muscle relaxation and guided imagery, and use of coping self-statements). Usual care participants received an educational booklet about coping with chemotherapy. All patients were instructed by nurses on their chemotherapy medications and given a resource listing of local support groups. Outcomes were obtained at baseline, and 7 and 13 weeks after starting chemotherapy. Primary outcomes included anxiety and depression, cancer-related distress, emotional well-being, and spiritual well-being. Secondary outcomes included functional well-being, social/family well-being, physical well-being, symptom severity, and self-efficacy for managing stress. Data were analyzed by using mixed models. RESULTS In both groups, improvements were observed in emotional well-being (P = .01), and declines were observed in functional well-being (P = .05), and physical well-being (P < .0001). Symptom severity increased across the follow-up period (P < .001). CONCLUSIONS To be effective, stress management interventions for Latinas receiving chemotherapy may necessitate more attention from an interventionist, delivery of the intervention over a longer interval, and/or a group-based format.
Collapse
Affiliation(s)
- Aasha I Hoogland
- Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | | | | | | | | | | | - Anna Barata
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | | |
Collapse
|
41
|
Yanez BR, Buitrago D, Buscemi J, Iacobelli F, Adler RF, Corden ME, Perez-Tamayo A, Guitelman J, Penedo FJ. Study design and protocol for My Guide: An e-health intervention to improve patient-centered outcomes among Hispanic breast cancer survivors. Contemp Clin Trials 2018; 65:61-68. [PMID: 29198729 PMCID: PMC6040887 DOI: 10.1016/j.cct.2017.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
Breast cancer is the most commonly diagnosed non-skin cancer in women and the leading cause of death among Hispanic women living in the United States. Relative to non-Hispanic white women, Hispanic women report poorer health related quality of life (HRQoL) after treatment. Although eHealth interventions delivered via Smartphones are a viable approach to addressing supportive care accessibility issues while also integrating multidisciplinary approaches for improving HRQoL, few eHealth interventions have been developed that specifically target Hispanic breast cancer survivors (BCS). This manuscript describes the methodology of a multi-site, randomized controlled behavioral trial investigating the feasibility and preliminary efficacy of a Smartphone application aimed at improving HRQoL and cancer-specific distress among Hispanic BCS. Participants will be randomized to receive the intervention application, My Guide (psychoeducation & self-management program), or the health education control condition application, My Health (health education), for six weeks. All participants will also receive weekly telecoaching to enhance adherence to both control and intervention conditions. We will measure the study's primary outcomes, general and disease-specific HRQoL and cancer-specific distress, at three time points: prior to, immediately after the intervention, and eight weeks after initial application use. My Guide may have the potential to improve HRQoL, and to address issues of limited access to supportive care among Hispanic women recovering from breast cancer treatment.
Collapse
Affiliation(s)
- Betina R Yanez
- Northwestern University, Department of Medical Social Sciences, 633 N St. Clair St. 19th Floor, Chicago, IL 60611, United States.
| | - Diana Buitrago
- Northwestern University, Department of Medical Social Sciences, 633 N St. Clair St. 19th Floor, Chicago, IL 60611, United States
| | - Joanna Buscemi
- DePaul University, Department of Psychology, 2219 N Kenmore Ave., Chicago, IL 60614, United States; University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Rd., Chicago, IL 60608, United States
| | - Francisco Iacobelli
- Northeastern Illinois University, Department of Computer Science, 5500 N St. Louis Ave., Chicago, IL 60625, United States
| | - Rachel F Adler
- Northeastern Illinois University, Department of Computer Science, 5500 N St. Louis Ave., Chicago, IL 60625, United States
| | - Marya E Corden
- Northwestern University, Department of Medical Social Sciences, 633 N St. Clair St. 19th Floor, Chicago, IL 60611, United States
| | - Alejandra Perez-Tamayo
- University of Illinois at Chicago, Department of Surgery, 1801 W Taylor St., Chicago, IL 60608, United States
| | - Judy Guitelman
- ALAS-WINGS, The Latina Association for Breast Cancer, 3023 N Clark St. Suite 613, Chicago, IL 60657, United States
| | - Frank J Penedo
- Northwestern University, Department of Medical Social Sciences, 633 N St. Clair St. 19th Floor, Chicago, IL 60611, United States
| |
Collapse
|
42
|
Gudenkauf LM, Ehlers SL. Psychosocial interventions in breast cancer survivorship care. Breast 2017; 38:1-6. [PMID: 29169071 DOI: 10.1016/j.breast.2017.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/21/2017] [Accepted: 11/09/2017] [Indexed: 01/03/2023] Open
Abstract
Cancer distress screening and subsequent referral for psychosocial intervention has been mandated for continued cancer center accreditation. Increasing emphasis is being placed on the referral component of this mandate, ensuring that patient distress is not only identified but also effectively treated. Many evidence-based interventions exist for cancer distress. Specific interventions can effectively target biopsychosocial impacts of stress and promote adaptive coping, focusing on problem-solving, social support utilization, assertive communication, sexual health and intimacy, adherence to medical and supportive care recommendations, health behavior change, and emotional processing and expression. In randomized clinical trials, specific interventions have also been associated with biological improvements, including neuroendocrine and immune functioning, decreased rates of breast cancer recurrence, and improved survival rates. As cancer treatments advance and patients live longer, it is pertinent to treat the impacts of breast cancer with evidence-based interventions.
Collapse
Affiliation(s)
- Lisa M Gudenkauf
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, United States
| | - Shawna L Ehlers
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, United States.
| |
Collapse
|
43
|
Behavioral Interventions for Tobacco Use in HIV-Infected Smokers: A Meta-Analysis. J Acquir Immune Defic Syndr 2017; 72:527-33. [PMID: 27028502 DOI: 10.1097/qai.0000000000001007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Smoking is responsible for increased morbidity and mortality in HIV-infected smokers. OBJECTIVE To assess the efficacy of behavioral interventions for smoking cessation among HIV-infected smokers compared with the standard care. DATA SOURCES PubMed, Cochrane, CINHAL, PsychINFO, and Google Scholar were searched for randomized controlled trials published in English. STUDY SELECTION Eligibility criteria were randomized controlled trials with targeted behavioral interventions compared with standard of care (or enhanced standard of care) aimed at promoting abstinence in HIV-infected smokers. A total of 17,384 articles were found and 17,371 were excluded; 13 full text articles were obtained and reviewed, and 8 met the eligibility criteria (Κ = 0.94). DATA EXTRACTION The primary outcome was expired carbon monoxide-verified 7-day point prevalence abstinence rates. Adequate sequence generation and freedom from incomplete or selective outcome reporting was used to assess study quality. RESULTS A total of 1822 subjects from 8 studies yielded a statistically significant effect of behavioral interventions in increasing abstinence in HIV-infected smokers with a moderate effect size (relative risk: 1.51; 95% confidence interval: 1.17 to 1.95). Those studies with interventions of 8 sessions or more had a large effect size for abstinence (relative risk: 2.88; 95% confidence interval: 1.89 to 4.61). When stratified by the number of sessions, there was no heterogeneity. CONCLUSIONS Targeted behavioral smoking cessation interventions are efficacious. Interventions consisting of 8 sessions or more had the greatest treatment efficacy.
Collapse
|
44
|
Physical exercise, vegetable and fruit intake and health-related quality of life in Chinese breast cancer survivors: a cross-sectional study. Qual Life Res 2017; 26:1541-1550. [PMID: 28229328 DOI: 10.1007/s11136-017-1496-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Breast cancer has long-term effects on health-related quality of life (HRQOL) of cancer survivors after treatment. Few research studies have focused on the association between health behaviors and HRQOL of Chinese breast cancer survivors (BCS). The aim of this study was to examine the separate and combined influence of physical exercise, vegetable and fruit intake on health-related quality of life of BCS. METHODS A cross-sectional study was conducted among BCS from April to July 2013, in Shanghai, China. Data were collected using a self-reported questionnaire, which included questions about basic socio-demographic characteristics, health conditions and treatments, health behaviors and HRQOL. HRQOL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30) simplified Chinese V3.0 version and the Functional Assessment of Cancer Therapy-General (FACT-G) simplified Chinese 4th version. Multiple linear regression models were performed to estimate the effects of physical exercise, vegetable and fruit intake as well as the effects of health behavior patterns on HRQOL adjusting for potential confounding variables. RESULTS Exercisers reported significantly higher scores in most HRQOL dimensions than non-exercisers. Participants who ate more than 250 g of vegetables reported significantly higher scores in most HRQOL dimensions than participants who ate equal or less than 250 g of vegetables. Participants who ate fruit every day reported significantly higher scores in all HRQOL dimensions than those who did not eat fruit every day (P Adjusted ≤ 0.032), except symptom subscales. All subscale scores and total scores of HRQOL, except symptom subscales, were positively associated with the number of adopted healthy lifestyle behaviors (P Trend ≤ 0.003). Compared to participants who adopted only one healthy behavior, participants who adopted two or three healthy behaviors both reported significantly higher HRQOL scores. CONCLUSION Physical exercise, enough vegetable and fruit intake are positively associated with HRQOL of BCS. BCS who adopted several healthy behaviors simultaneously had better HRQOL than one healthy behavior alone. Healthy behaviors, including engagement in exercise, proper diet, especially comprehensive lifestyle behavior interventions, should be valued in improving HRQOL of BCS.
Collapse
|
45
|
Nápoles AM, Ortiz C, Santoyo-Olsson J, Stewart AL, Lee HE, Duron Y, Dixit N, Luce J, Flores DJ. Post-Treatment Survivorship Care Needs of Spanish-speaking Latinas with Breast Cancer. JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY 2017; 15:20-27. [PMID: 28944260 DOI: 10.12788/jcso.0325] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND A comprehensive assessment of Spanish-speaking breast cancer survivors' (SSBCS) survivorship needs is lacking. OBJECTIVE Assess SSBCS' post-treatment symptom management, psychosocial, and informational needs. METHODS 118 telephone surveys and 25 in-person semi-structured interviews with SSBCS, and semi-structured interviews with 5 support providers and 4 physicians who serve SSBCS from 5 Northern California counties. RESULTS Surveys identified the most bothersome (bothered by it in the past month "somewhat/quite a bit/a lot") physical symptoms as: joint pain, fatigue, hot flashes, numbness in hands/feet, and vaginal dryness. The most bothersome emotional symptoms were thoughts of recurrence/new cancers, depression/sadness, anxieties, and stress. Seven themes emerged from interviews: 1) unmet physical symptom management needs; 2) social support from family/friends often ends when treatment is completed; 3) challenges resuming roles; 5) sense of abandonment by health care system when treatment ends; 6) need for formal transition from active treatment to follow-up care; 6) fear of recurrence especially when obtaining follow-up care; and 7) desire for information on late effects of initial treatments and side effects of hormonal treatments. Based on survey and interview results, we present a conceptual framework for survivorship care interventions for SSBCS. LIMITATIONS Sample may not represent SSBCS' concerns seen outside of Northern California hospitals. CONCLUSIONS Physical and psychosocial symptoms were common. SSBCS need culturally appropriate survivorship care programs that address symptom management, psychosocial concerns, follow-up care, and healthy lifestyles.
Collapse
Affiliation(s)
- Anna María Nápoles
- Center for Aging in Diverse Communities, University of California San Francisco (UCSF), 3333 California St., Suite 335, San Francisco, California 94143-0856, USA.,Division of General Internal Medicine, Department of Medicine, UCSF, 3333 California St., Suite 335, San Francisco, California 94143-0856, USA
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, 2601 Mission Street, Suite 500, San Francisco, California 94110 USA
| | - Jasmine Santoyo-Olsson
- Center for Aging in Diverse Communities, University of California San Francisco (UCSF), 3333 California St., Suite 335, San Francisco, California 94143-0856, USA.,Division of General Internal Medicine, Department of Medicine, UCSF, 3333 California St., Suite 335, San Francisco, California 94143-0856, USA
| | - Anita L Stewart
- Institute for Health and Aging, UCSF, 3333 California St., Suite 340, San Francisco, California 94143-0856, USA
| | - Howard E Lee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, 875 Blake Wilbur Dr., Stanford, California 94305 USA
| | - Ysabel Duron
- Latinas Contra Cancer, 255 North Market Street, Suite 175, San Jose, California 95110 USA
| | - Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, UCSF/San Francisco General Hospital, 995 Potrero Ave Building 80, Ward 84, San Francisco, California 94110 USA
| | - Judith Luce
- Division of Hematology/Oncology, Department of Medicine, UCSF/San Francisco General Hospital, 995 Potrero Ave Building 80, Ward 84, San Francisco, California 94110 USA
| | - Diana J Flores
- Biology Scholars Program, University of California, Berkeley, 2075 Valley Life Science Building, Berkeley, California 94720-3120 USA
| |
Collapse
|
46
|
Effectiveness of a multimodal standard nursing program on health-related quality of life in Chinese mainland female patients with breast cancer: protocol for a single-blind cluster randomized controlled trial. BMC Cancer 2016; 16:698. [PMID: 27576298 PMCID: PMC5006518 DOI: 10.1186/s12885-016-2726-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background Breast cancer and its treatment-related adverse effects are harmful to physical, psychological, and social functioning, leading to health-related quality of life (HRQoL) impairment in patients. Many programs have been used with this population for HRQoL improvement; however, few studies have considered the physical, psychological, and social health domains comprehensively, and few have constructed multimodal standard nursing interventions based on specific theories. The purpose of this trial is to examine the effect of a health belief model (HBM)-based multimodal standard nursing program (MSNP) on HRQoL in female patients with breast cancer. Methods This is a two-arm single-blind cluster randomized controlled trial (cRCT) in clinical settings. Twelve tertiary hospitals will be randomly selected from the 24 tertiary hospitals in Xi’an, China, and allocated to the intervention arm and control arm using a computer-generated random numbers table. Inpatient female patients with breast cancer from each hospital will receive either MSNP plus routine nursing care immediately after recruitment (intervention arm), or only routine nursing care (control arm). The intervention will be conducted by trained nurses for 12 months. All recruited female patients with breast cancer, participating clinical staff, and trained data collectors from the 12 hospitals will be blind with respect to group allocation. Patients of the control arm will not be offered any information about the MSNP during the study period to prevent bias. The primary outcome is HRQoL measured through the Functional Assessment of Cancer Therapy-Breast version 4.0 at 12 months. Secondary outcomes include pain, fatigue, sleep, breast cancer-related lymphedema, and upper limb function, which are evaluated by a visual analogue scale, the circumference method, and the Constant-Murley Score. Discussion This trial will provide important evidence on the effectiveness of multimodal nursing interventions delivered by nurses in clinical settings. Study findings will inform strategies for scaling up comprehensive standard intervention programs on health management in the population of female patients with breast cancer. Trial registration Chictr.org.cn ChiCTR-IOR-16008253 (April 9, 2016)
Collapse
|
47
|
Yanez B, McGinty HL, Buitrago D, Ramirez AG, Penedo FJ. Cancer Outcomes in Hispanics/Latinos in the United States: An Integrative Review and Conceptual Model of Determinants of Health. ACTA ACUST UNITED AC 2016; 4:114-129. [PMID: 27429867 DOI: 10.1037/lat0000055] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cancer is the leading cause of death among Hispanics. Compared to non-Hispanic Whites, Hispanics are more likely to be diagnosed with advanced stages of disease and experience poor quality of life following a cancer diagnosis. Cancer outcomes are influenced by a confluence of social, cultural, behavioral and biological factors. Yet, much of the behavioral and psychosocial research in oncology has focused on non-Hispanic Whites, thus limiting our understanding of the potential web of factors that can influence cancer-related outcomes among Hispanics. Furthermore, features of Hispanic ethnicity and culture may influence and interact with, social, psychosocial, health care, disease-specific, and medical factors known to influence cancer-related outcomes, yet very few studies have integrated Hispanic cultural processes when addressing cancer-related outcomes for this ethnic group. Guided by the extant literature in oncology, Hispanic culture and health, and previously established models of determinants of minority health, we present a conceptual model that highlights the interplay of social, cultural, psychosocial, disease-specific, health care, and medical factors as determinants of cancer outcomes (morbidity, mortality, quality of life) and review key evidence of how features of Hispanic culture may influence cancer outcomes and contribute to the disparate outcomes observed in Hispanic cancer samples relative to non-Hispanic Whites. Finally, we conclude with a discussion of future research opportunities and existing challenges to researching oncology outcomes among Hispanics.
Collapse
Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Heather L McGinty
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Diana Buitrago
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Amelie G Ramirez
- Institute for Health Promotion, University of Texas Health Science Center
| | - Frank J Penedo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| |
Collapse
|
48
|
Ashing KT, Loscalzo M, Burhansstipanov L, Wang JHY, Napoles A. Attending to Distress as part of quality, comprehensive cancer care: Gaps and Diversity Considerations. ACTA ACUST UNITED AC 2016; 1:257-259. [PMID: 28217748 DOI: 10.1080/23809000.2016.1195689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Matt Loscalzo
- City of Hope National Medical Center, Duarte, CA, United States
| | | | | | - Anna Napoles
- University of California, San Francisco., San Francisco, CA
| |
Collapse
|
49
|
Cyril S, Smith BJ, Possamai-Inesedy A, Renzaho AMN. Exploring the role of community engagement in improving the health of disadvantaged populations: a systematic review. Glob Health Action 2015; 8:29842. [PMID: 26689460 PMCID: PMC4685976 DOI: 10.3402/gha.v8.29842] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/02/2015] [Accepted: 11/20/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although community engagement (CE) is widely used in health promotion, components of CE models associated with improved health are poorly understood. This study aimed to examine the magnitude of the impact of CE on health and health inequalities among disadvantaged populations, which methodological approaches maximise the effectiveness of CE, and components of CE that are acceptable, feasible, and effective when used among disadvantaged populations. DESIGN The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out methodological assessments of the included studies using rating scales. The analysis focussed on model synthesis to identify the key CE components linked to positive study outcomes and comparative analysis between positive study outcomes, processes, and quality indicators of CE. RESULTS Out of 24 studies that met our inclusion criteria, 21 (87.5%) had positively impacted health behaviours, public health planning, health service access, health literacy, and a range of health outcomes. More than half of the studies (58%) were of good quality, whereas 71% and 42% of studies showed good community involvement in research and achieved high levels of CE, respectively. Key CE components that affected health outcomes included real power-sharing, collaborative partnerships, bidirectional learning, incorporating the voice and agency of beneficiary communities in research protocol, and using bicultural health workers for intervention delivery. CONCLUSIONS The findings suggest that CE models can lead to improved health and health behaviours among disadvantaged populations if designed properly and implemented through effective community consultation and participation. We also found several gaps in the current measurement of CE in health intervention studies, which suggests the importance of developing innovative approaches to measure CE impact on health outcomes in a more rigorous way.
Collapse
Affiliation(s)
- Sheila Cyril
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Ben J Smith
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alphia Possamai-Inesedy
- Office of the Pro-Vice Chancellor Arts (Education), Western Sydney University, Bankstown, NSW, Australia
| | - Andre M N Renzaho
- Humanitarian and Development Studies, School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia;
| |
Collapse
|
50
|
Gonzales FA, Hurtado-de-Mendoza A, Santoyo-Olsson J, Nápoles AM. Do coping strategies mediate the effects of emotional support on emotional well-being among Spanish-speaking Latina breast cancer survivors? Psychooncology 2015; 25:1286-1292. [PMID: 26352186 DOI: 10.1002/pon.3953] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/12/2015] [Accepted: 08/05/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to assess the relationship between emotional social support and emotional well-being among Latina immigrants with breast cancer and test whether two culturally relevant coping strategies, fatalism and acceptance, mediate this relationship. METHODS One hundred fifty Spanish-speaking Latinas within 1 year of breast cancer diagnosis participating in a randomized trial of a stress management intervention were assessed in person at baseline and via telephone 6 months later. Survey measures included baseline emotional support, fatalism, and acceptance and emotional well-being 6 months later. Generalized linear models estimated direct effects of emotional support on emotional well-being and indirect effects through fatalism and acceptance. RESULTS Mean age was 50.1 (SD = 10.9) years; most women had low education and acculturation levels. Emotional support was negatively associated with fatalism (r = -0.24, p < 0.01) and positively associated with acceptance (r = 0.30, p < 0.001). Emotional support (r = 0.23, p = 0.005) and acceptance (r = 0.28, p = 0.001) were positively associated with emotional well-being, whereas fatalism (r = -0.36, p < 0.0001) was negatively associated with emotional well-being. In multivariable models, emotional support was associated with emotional well-being (b = 0.88, 95% CI: 0.24, 1.52). This direct effect remained significant when additionally controlling for fatalism (b = 0.66, 95% CI: 0.03, 1.30) and acceptance (b = 0.73, 95% CI: 0.09, 1.37) in separate models. There was a significant indirect effect of emotional support on emotional well-being through fatalism (b = 0.21, 95% CI: 0.04, 0.51) as well as a marginally significant effect through acceptance (b = 0.15, 95% CI: 0.001, 0.43). CONCLUSIONS Emotional support may increase well-being among Spanish-speaking Latina cancer survivors by reducing cancer fatalism.Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Felisa A Gonzales
- Cancer Prevention Fellowship Program, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
| | - Alejandra Hurtado-de-Mendoza
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine and the Center for Aging in Diverse Communities, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anna María Nápoles
- Division of General Internal Medicine and the Center for Aging in Diverse Communities, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|