Relationships Between Three Beliefs as Barriers to Symptom Management and Quality of Life in Older Breast Cancer Survivors (original) (raw)
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Cancer Nursing, 2009
Negative attitudes about aging of both older adults and health care providers can be barriers to self care in old age. The aims of this study were 1) to examine the extent to which older breast cancer survivors experience barriers to symptom management, and 2) to explore whether barriers influence quality of life. Three possible barriers to symptom management were examined: negative beliefs about managing symptoms, perceived negative attitudes of health care providers, and difficulties in communicating about symptoms. This study was a secondary analysis of pooled baseline data from 61 older (age > 64) women who participated in two pilot studies that tested a symptom management intervention for older breast cancer survivors. The most frequent barrier reported was difficulties in communicating about symptoms with health care providers. Each of the barriers affected psychosocial, but not physical, quality of life. Barriers to symptom management may lead to poorer self care of symptoms that can result in lower levels of psychosocial quality of life. Health care providers need to encourage older cancer survivors to report symptoms and worries related to their cancer diagnosis and should be cautious in expressing attitudes that could reinforce older adults' negative perceptions about aging.
Symptoms, Symptom Beliefs, and Quality of Life of Older Breast Cancer Survivors: A Comparative Study
Oncology Nursing Forum, 2006
To compare symptoms, symptom beliefs, and quality of life (QOL) of older breast cancer survivors to those of older women without breast cancer. Design: Descriptive, correlational study. Setting: Urban and rural communities in the Midwest United States. Sample: 18 breast cancer survivors and 24 women without breast cancer, older than age 64 (-X age = 76 years). Methods: In-home interviews using structured instruments. Main Research Variables: Symptom distress (number of and distress from symptoms), symptom beliefs, chronic health problems, and QOL. Findings: No group differences existed in demographic characteristics, symptom number, symptom bother, chronic health conditions, or QOL. Women in both groups most often attributed the cause of their symptoms to aging, chronic illness, or unknown, but rarely to breast cancer. Attributing symptoms to chronic illness or breast cancer was signifi cantly related to more pain, depression, role impairment, and poorer mental health. Not knowing the cause of symptoms was signifi cantly related to poorer social functioning, mental health, and purpose in life; less energy; and higher levels of depression and anxiety. Conclusions: The symptom experience and QOL of older breast cancer survivors are similar to those of older women with other chronic health problems. Beliefs about symptoms infl uence QOL in older women. Implications for Nursing: A broader assessment of symptoms is needed to assist older breast cancer survivors with symptom management. Symptom interventions in older women should address patients' beliefs about symptoms if QOL is to be enhanced.
Research in Nursing & Health, 2006
Among older, long-term breast cancer survivors, symptoms from previous treatment can generate uncertainty about whether they represent co-morbid conditions, recurrence, or normal aging. This uncertainty can result in emotional distress and thoughts of recurrence. Communication with health care providers may help women reduce uncertainty and improve both emotional and cognitive well-being. To assess the influence of symptoms, uncertainty, and communication with providers on well-being, data from 203 Caucasian and African American survivors, 5-9 years post treatment, were tested using structural equation modeling. Symptoms, age, and uncertainty had the strongest influence on well-being, regardless of race. There was an unexpected positive association between patient-provider communication and thoughts of recurrence. Descriptive analysis revealed that 52% of women were unable to achieve their desired decision-making role with health care providers.
Older Breast Cancer Survivors' Symptom Beliefs
Oncology Nursing Forum, 2009
Purpose-The purpose of this investigation was to use Leventhal's Common Sense Model (CSM) to describe older breast cancer survivors' symptom representations, symptom management strategies, and perceived barriers to symptom management. Design-A secondary analysis was conducted using data from three pilot studies testing a theory-based intervention to improve symptom management in older breast cancer survivors. Setting-Advanced practice nurses conducted open-ended interviews among older breast survivors either in the women's home or via telephone. Sample-The women were recruited from the community, an oncology clinic, and a state tumor registry. The women (n = 61, mean age = 69.5) were an average of 4.7 years post-breast cancer diagnosis and reported an average of 17 symptoms. Methods-Content analysis was conducted of field notes taken during baseline interviews. Two coders independently coded responses. Inter-rater reliability was 82.3%. Main Research Variables-Symptom representations, symptom management strategies, and perceived barriers to symptom management. Findings-Women described their symptoms as chronic, with multiple causes (but rarely due to aging), with numerous negative consequences, and not curable or controllable. Women described an average of six symptom management strategies, most typically self-care. The most frequent barrier to symptom management was problems communicating with health care providers. Conclusions-The CSM is a useful framework for understanding the symptom beliefs of older breast cancer survivors.
Journal of Clinical Oncology, 2002
To identify factors associated with patientphysician communication and to examine the impact of communication on patients' perception of having a treatment choice, actual treatment received, and satisfaction with care among older breast cancer patients. Materials and Methods: Data were collected from 613 pairs of surgeons and their older (> 67 years) patients diagnosed with localized breast cancer. Measures of patients' self-reported communication included physician-and patient-initiated communication and the number of treatment options discussed. Logistic regression analyses were conducted to examine the relationships between communication and outcomes. Results: Patients who reported that their surgeons mentioned more treatment options were 2.21 times (95% confidence interval [CI], 1.62 to 3.01) more likely to report being given a treatment choice, and 1.33 times (95% CI, 1.02 to 1.73) more likely to get breastconserving surgery with radiation than other types of treatment. Surgeons who were trained in surgical oncology , or who treated a high volume of breast cancer patients (> 75% of practice), were more likely to initiate communication with patients (odds ratio [OR] ؍ 1.62; 95% CI, 1.02 to 2.56; and OR ؍ 1.68; 95% CI, 1.01 to 2.76, respectively). A high degree of physician-initiated communication, in turn, was associated with patients' perception of having a treatment choice (OR ؍ 2.46; 95% CI, 1.29 to 4.70), and satisfaction with breast cancer care (OR ؍ 2.13; 95% CI, 1.17 to 3.85) in the 3 to 6 months after surgery. Conclusion: Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care. Technical information and caring components of communication impacted outcomes differently. Thus, the quality of cancer care for older breast cancer patients may be improved through interventions that improve communication within the physician-patient dyad.
Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study
Cancer, 2019
BackgroundLittle is known about longitudinal symptom burden, its consequences for well‐being, and whether lifestyle moderates the burden in older survivors.MethodsThe authors report on 36‐month data from survivors aged ≥60 years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self‐reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]‐Fatigue scale), cognitive (on the FACT‐Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State‐Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well‐being was measured using the FACT‐General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatme...
Psycho-oncology, 2015
Information is a care priority in most breast cancer survivors (BCS). We assessed whether BCS information needs at 8 months after hospital cancer treatment could be related to their age, education level, perceived medical communication competence, satisfaction with care, attachment style, and self-esteem. Of 426 BCS approached during the last week of treatment (T1), 85% completed the Medical Communication Competence Scale, European Organisation for Research and Treatment of Cancer Satisfaction with Care Questionnaire, Rosenberg's Self-Esteem Scale and Experiences in Close Relationships Scale. The Hospital Anxiety and Depression Scale and the Supportive Care Needs Survey were completed at T1 and again 8 months later (T2) with a 66% (n = 283) response rate. Baseline respondents' median (range) age was 56 years (23-86 years). Information needs decreased over time, although some persisted. Multivariate regression analyses evidenced overall higher information needs at T2 in young...
Communication with Breast Cancer Survivors
Health Communication, 2008
Breast cancer survivors must manage chronic side effects of original treatment. To manage these symptoms, communication must include both biomedical and contextual lifestyle factors. Sixty breast cancer survivors and 6 providers were recruited to test a conceptual model developed from uncertainty in illness theory and the dimensions of a patient-centered relationship. Visits were audio-taped, then coded using the Measure of Patient-Centered Communication . Consultations were found to be 52% patient-centered. Chi-square Automatic Interaction Detection (CHAID) analysis showed that survivor self-reported fatigue level and conversation about symptoms were associated with survivor uncertainty, mood state, and survivor perception of patient-centered communication. Survivors may want to discuss persistent symptom concerns with providers, due to concerns about recurrence, and discuss lifestyle contextual concerns with others.
An Intervention to Improve Communication Between Breast Cancer Survivors and Their Physicians
Journal of Psychosocial Oncology, 2010
Breast cancer survivors often use clues to convey their concerns to their oncologists. The authors conducted a randomized trial of a communication coaching intervention in which 22 female breast cancer survivors were randomized to the coaching and 22 to treatment as usual. They hypothesized that the intervention would increase breast cancer self-efficacy, improve mood, and reduce fears of recurrence. Through a series of ANCOVAs they found that the intervention led to increases in self-efficacy. Changes in self-efficacy predicted changes in anxiety, depression, and womanhood fears. This coaching intervention shows promise but requires additional studies to establish is efficacy and effectiveness.