Effect of Perceived Barriers to Symptom Management on Quality of Life in Older Breast Cancer Survivors (original) (raw)
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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.
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.
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...
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.
Symptom Clusters and Quality of Life in Older Adult Breast Cancer Survivors
Oncology Nursing Forum, 2011
Objective-To identify symptom clusters in older breast cancer survivors and examine whether symptom clusters are related to demographic, health, and quality of life variables. Design-Symptom bother measures were analyzed using factor analysis to identify possible symptom clusters and the resulting clusters were then correlated with quality of life measures. Setting-The randomized clinical trail from which the data used for these analyses were drawn took place over the phone between the participant and a trained research nurse. Sample-Data from 192 older breast cancer survivors (mean age = 70) who had participated in a randomized clinical trial testing a symptom management intervention were used for this study. Methods-This was a secondary data analysis of the baseline measures of demographics, health history, symptom bother, and physical, mental, and existential dimensions of quality of life. Exploratory and confirmatory factor analyses were conducted as well as MIMIC modeling and partial correlation analyses to assess the relationships amongst clusters and demographic, health history, and quality of life measures. Main research variables-The main research variables were self-reported symptom bother, demographics such as age and education level, health history and quality of life. Findings-Seven clinically distinct symptom clusters tapping 36 different symptoms in older breast cancer survivors were found, and these symptom clusters were significantly related to multiple dimensions of quality of life. Conclusions-Older breast cancer survivors experience multiple, concurrent symptoms that appear to cluster. Identifying symptom clusters helps to elucidate possible inter-symptom relationships, which may lead to the design of more effective symptom management interventions for older breast cancer survivors. Implications for Nursing-Older breast cancer survivors should be assessed for a wide variety of symptoms if clinicians hope to identify and understand inter-symptom relationships. Such an assessment would enable more comprehensive symptom management.
British Journal of General Practice, 2022
Background The cancer burden falls predominantly on older (≥65 years) adults. Prompt presentation to primary care with cancer symptoms could result in earlier diagnosis. However, patient symptom appraisal and help-seeking decisions involving cancer symptoms are complex and may be further complicated in older adults. Aim To explore the effect of older age on patients’ appraisal of possible cancer symptoms and their decision to seek help for these symptoms. Design and setting Mixed-methods systematic review. Method MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science Core Collection, ASSIA, the ISRCTN registry, and the National Institute for Health and Care Excellence were searched for studies on symptom appraisal and help-seeking decisions for cancer symptoms by adults aged ≥65 years. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-Analysis guidelines. Results Eighty studies were included with a total of 32 995 participants. Studies suggested a possible association between increasing age and prolonged symptom appraisal interval. Reduced knowledge of cancer symptoms and differences in symptom interpretation may contribute to this prolonged interval. In contrast, in the current study a possible association was found between increasing age and prompt help-seeking. Themes affecting help-seeking in older adults included the influence of family and carers, competing priorities, fear, embarrassment, fatalism, comorbidities, a desire to avoid doctors, a perceived need to not waste doctors’ time, and patient self-management of symptoms Conclusion This review suggests that increasing age is associated with delayed cancer symptom appraisal. When symptoms are recognised as potentially serious, increasing age was associated with prompt help-seeking although other factors could prolong this. Policymakers, charities, and GPs should aim to ensure older adults are able to recognise potential symptoms of cancer and seek help promptly.
Perceived barriers to symptoms management among family caregivers of cancer patients
Indian Journal of Palliative Care, 2018
IntroductIon Family caregivers experience psychosocial distress while caring for cancer patients. Usually, terminally ill patients spend their end stages of life at home being cared for by their families, without formal homecare services. [1] The caregivers experience many barriers to manage the symptoms experienced by their beloved one who is suffering from cancers. Fear of addiction may be the main barrier to cancer pain management. [2] Depression among caregivers is mainly due to the fear of unemployment during caregiving, being the spouse of a patient, burden of caregiving, and disturbance of personal life. [3] Family caregivers (FCGs) experience many difficulties and have increased responsibilities during and after the treatment for cancer. [4] Caregiver's sleep disturbances contribute to depression, anger, and anxiety. [5] The struggle with symptoms and the decreased quality of life (QOL) continue for the cancer survivors and their caregivers throughout their survival. [6] FCGs experience and struggle with many issues in taking care of the cancer patients, especially in symptom management. Increasing the knowledge of caregivers is more important for symptom management among the cancer patients. [7] Objectives of this study The following objectives were: • To identify the perceived barriers to symptom management among the FCGs by using perceived barriers to symptom management tool • To find the association between perceived barriers to symptom management of caregivers' with their Introduction: Caring for patients with advanced disease involves many concerns for caregivers. All aspects of health of the caregiver is compromised in the process of caring for the cancer patients. Usually, most of the terminally ill cancer patients live with their caregivers at home. Objectives: The aims of the present study was to identify the barriers to symptom management among caregivers of cancer patients and to find the association between perceived barriers to symptom management of caregivers' with their demographic variables and their patients' disease-related variables. Materials and Methods: A descriptive study was conducted among 768 family caregivers (FCGs) of cancer patients, and they were selected using convenient sampling technique. Data was collected from caregivers who were caring for their beloved one at least 2-3 h/day and who were above 20 years of age. Data was collected through a structured interview using barriers questionnaire and demographic pro forma after obtaining the consent from the caregivers. Results: The result shows that among 768 FCGs, 216 (28.1%) of them were in the age group between 31 and 40 years and most of them were spouses (45.6%). The perceived barriers of caregivers were less confidence on the management of symptoms. A total of 423 (55.1%) had lack of awareness about pain assessment and management of cancer by 681 (88.6%). Majority, i.e., 654 (85.1%) of them had financial problems in the family. Conclusion: FCGs take the major responsibilities both at the hospital and at home in caring for the cancer patients. Since FCGs had lack of knowledge on caring of cancer patients, there is a need for awareness program on the assessment and management of symptoms among cancer patients.
Perceptions of breast cancer across the lifespan
Journal of Psychosomatic Research, 2003
Objective: The risk of developing breast cancer increases with advancing age. There is evidence to suggest that delayed helpseeking for breast cancer symptoms is associated with poorer survival and that older women are more likely to delay in seeking help for such symptoms. This study examined age differences in beliefs regarding breast cancer and intentions to seek medical care for breast symptoms in a general population sample. Method: A general population sample of 546 women completed a postal questionnaire about beliefs regarding the symptoms, causes and outcomes associated with breast cancer, attitudes towards help-seeking and beliefs about one's ability to seek help. The questionnaire was based on components of the self-regulation model and the theory of planned behaviour. Help-seeking intention was measured by asking participants to rate the likelihood of visiting a general practitioner for a range of breast symptoms. The subscales of each model were entered as predictors of intention to seek help for breast symptoms in a series of hierarchical multiple regression analyses performed for each age group. Results: The inability to correctly identify a range of potential breast cancer symptoms (identity subscale) was a significant predictor of intention delay in seeking help across all age groups. For women aged 35 -54, negative attitudes toward medical help-seeking for breast symptoms (b = 1.82, P < .05) and a negative belief in one's ability to seek help (perceived behavioural control) were additional predictors of intention not to seek help (b = 0.229, P < .001). Holding negative beliefs about the consequences associated with breast cancer (i.e., that the disease could be potentially disabling or disfiguring) was found to be an important additional predictor of potential delay in helpseeking among women aged over 65 years (b = 0.210, P < .05). Conclusion: Correct identification of potential breast cancer symptoms was universally important in predicting intention to seek medical care across age groups. However, additional beliefs differentially influenced help-seeking intention within different age groups. Preliminary findings suggest that interventions to reduce delay behaviour in help-seeking for breast symptoms should inform women of the diversity of breast cancer symptoms, advances in the management of breast cancer and provide advice on how to obtain help for breast cancer symptoms. D