The Relationship between Teachers and Pupils with Down Syndrome: A Qualitative Study in Primary Schools

Down syndrome (DS), due the presence of an intellectual disability and a precarious health condition, involves important challenges for developing skills at school. The study explores the relational dynamics between teachers and students with DS and how the latter influence the processes of socialization and learning at school. The study involved 15 (n = 15) special education teachers (M _age = 40.4; SD = 9.3) from primary schools in Italy who were or had previously been in charge of a pupil with DS. The teachers were interviewed through a semi-structured interview, built ad hoc. The data were analyzed through the grounded theory method supported by ATLAS.ti software. Data analysis produced 20 (n = 20) categories grouped into 6 (n = 6) macro-categories: (1) psychophysical characteristics; (2) learnings; (3) relational aspects; (4) collaborations; (5) extracurricular activities; and (6) teacher training. The research shows that students with DS have good relationships with their peers; however, there are still some important critical issues, including poor training of teachers on certain topics and on the application of collaborative and relationship support strategies, the limited collaboration between support teachers and curricular teachers, and the absence of support from ad hoc professional figures.

Abstract P4-19-04: Psychosocial distress monitoring in a multidisciplinary, inner city breast center

Objective: Beginning in 2015, all Commission on Cancer–accredited cancer programs must have developed and implemented a process to screen for psychosocial distress and provide appropriate psychosocial care. At our institution that serves uninsured and underrepresented minority populations, we integrated a distress tool on a continuum, rather than as a onetime event. We reviewed the initial screening tools from our breast center to determine how psychosocial distress differs throughout treatment in order to identify pivotal times during course of treatment and to prioritize intervention strategy.

Methods: NCCN distress thermometer was administered to each patient with review of stressors to complete at 4 different intervals after diagnosis with breast cancer. Newly diagnosed breast cancer patients were asked to complete distress screening at various phases of their cancer care: shortly after diagnosis at surgery office visit, after surgery at first chemotherapy cycle, third medical oncology office visit, and last chemotherapy cycle. The tools were administered by patient navigators and referred to social work with a distress score of 5/10 or higher. Tools were then scanned into the medical record and collected by the social worker. We reviewed the collected distress tools and compared the data based on the where the patient was in course of treatment. Identifying stressors were grouped into 4 categories: practical, family, emotional, and physical.

Results: in April 2015, the implementation and preparation of distress screening was begun. Between August 2015 and April 2016, 94 distress tools were completed by patients in our breast center. 42.5 % patients had a distress score of 5 or above at their initial screen at surgical consultation, 31.8 % at their first cycle of chemotherapy, 53.3% at third medical oncology office visit and 50 % at completion of chemotherapy, triggering a social work intervention. The most common stressors were emotional, worry and fear, (44%) at initial assessment and physical, fatigue and tingling in hands and feet, (100%) at last chemotherapy cycle, with family stressors 33.3 ?%, and practical matters 28%. The least common stressor was treatment decision or need for treatment change. Mean stress levels were 8/10 for surgical patients and 6/10 for patients seeing medical oncology. Although 4 screens were performed, the spectrum of stressors did not change significantly over continuum of care other than all patients reporting fatigue with a score of 5 or higher at completion of chemotherapy. All patients had psychosocial barriers to care that caused stress regardless of phase of cancer care.

Conclusion: Patients are at their peak stress levels at the time of diagnosis in consultation with the surgeon. As they move along their treatment plan, stress levels decrease, but the stressors seem to remain the same, except for physical stress being highest at end of chemotherapy. We recommend timing of the administration of the distress tools be based on capturing peak stress (at time of diagnosis) and then again at completion of chemotherapy to monitor for stress reduction. Addressing psychosocial barriers seems to be paramount in lowering distress scores in our underrepresented, minority breast cancer population.

Citation Format: Castaldi M, Elrafei T, Soliman C. Psychosocial distress monitoring in a multidisciplinary, inner city breast center [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-04.

Abstract P1-09-11: Can patient navigation help overcome barriers to breast cancer treatment in patients with health care disparities?

Background: Patient navigation has been demonstrated to aid in adherence to breast cancer screening initiatives. Fewer studies have documented benefit for patients undergoing treatment, and especially among those with barriers to care. Cancer health disparities affecting low-income and minority patients are well documented. Causes of poor outcomes include treatment delays coupled with social and financial barriers. This report examines the impact of patient navigation on adherence to prescribed cancer treatment, including in patients receiving treatment in adjuvant and metastatic breast cancer settings.

Methods: This Patient Navigation project (supported by an Avon Foundation grant) was initiated at our public safety net hospital to test whether there was sufficient benefit to warrant a larger randomized trial. Health care coverage included 58% Medicaid, 7% uninsured or undocumented. This study was conducted over a 4 month period with new medical oncology practice patients. Those deemed to be at high risk for non-adherence received navigated care. Navigator duties included care coordination, appointment reminders, patient education materials, translation services, and transportation arrangement. Data collected prospectively included patient characteristics, cancer type, time from referral to first RT, and compliance with visits; this was compared with usual care controls during the 4 month period.

Results: Patient Navigation Program patient characteristics: N = 52 patients (42% breast cancer, 12% prostate cancer, 10% lung cancer and 36% with other cancers). Mean age = 55; 48% Black, 38% Hispanic, 8% Asian, 6% White. The table below gives the results of percentage of adherence to visits (and time to first RT) for all patients in the study receiving navigated care, for just the patients with breast cancer receiving navigated care, and for the usual care control (no navigated care).

Table 1. NAVIGATED CARE: ALL PATIENTS (N = 52)NAVIGATED CARE: BREAST CANCER (n = 22)USUAL CARE GROUPPhysician Visits (Medical Oncology)(141 Visits) 90% (95% CI: 84%-95%)(56 Visits) 91% (95% CI: 80%-97%)(2021 Visits) 79% (95% CI: 77%-81%)Chemotherapy Treatment(107 Treatments) 95% (95% CI: 89%-99%)(30 Treatments) 97% (95% CI: 83%-99%)(1656 Treatments) 86% (95% CI: 84%-88%)Time to first RT32 Days (n = 25)35 Days (n = 8)30 Days

Conclusions: This Patient Navigation Program is associated with observed improvements in adherence to chemotherapy and in follow up physician visits. No impact on time to first RT was shown. These results document that a Patient Navigation Program can help overcome barriers to good cancer care.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-11.