Women’s decision satisfaction and psychological distress following early breast cancer treatment: a treatment decision support role for nurses (original) (raw)
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European Journal of Oncology Nursing, 2016
Women with breast cancer often experience distress. This cohort study investigated the prevalence of distress, predictors of distress, and changes in distress during surgical continuity of care for breast cancer (from diagnosis to commencement of adjuvant treatment). Methods: The participants were 1079 women with breast cancer who were recruited between April 2013 and May 2014 from 11 breast surgery departments in Denmark. Distress was evaluated using the Distress Thermometer (DT) and predictors of distress were assessed with a self-administered questionnaire at the time of diagnosis (T1), at discharge (T2), and by the start of adjuvant treatment or follow-up (T3). Repeated measures ANOVA, simple and multiple linear regression, and mixed effects regression models were used to identify predictors and estimate changes in distress. Results: At T1, 249 (24.3%) women reported no or minimal distress, 298 (29.1%) moderate distress, and 407 (39.8%) severe distress. The mean distress was 5.5 points on the DT, which decreased by 0.70 (95% confidence interval (CI) À0.80, À0.54) points from T1 to T3. Predictors of distress were time since diagnosis, age, prior or concurrent intake of antidepressants or sedative medicine, prior emotional status, children living at home, feelings regarding femininity and attractiveness, and hospital. Conclusions: More than two-thirds of women with breast cancer experienced moderate or severe distress. Mean distress decreased slightly during surgical continuity of care. However, for some women, distress remained unchanged or even worsened. These findings highlight the need to identify the individual women with distress and offer them adequate support and care.
British Medical Journal, 1990
Objectives-To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon's opinion or the patient's choice. To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery was associated with their participation in a randomised clinical trial.
Multidisciplinary interview to assess distress in patients waiting for breast cancer treatments
Translational Cancer Research, 2018
Background: Screening for distress is considered a fundamental goal in cancer care. The literature underlines the need to improve the distress assessment instruments. Our proposal is to identify the main themes/narratives freely emerging during a first interview, 3-5 days after the diagnosis of breast cancer. In our hypothesis, these themes simultaneously represent the patient's main concerns and the initial coping. Our goal is to differentiate different types of distress, through building a list of the most frequent thematic nuclei and, subsequently, differentiating two classes of distress which require different interventions in order to be reduced. Methods: One thousand five hundred new-diagnosed breast cancer patients have been undergone to the Multidisciplinary Interview few days after the diagnosis. Any criterion about the type of breast cancer has been applied. For each interview, the main narrative nuclei were classified and analysed and their frequency was calculated in the whole group. Subsequently, we subdivided the narrative nuclei into two subgroups based on the type of distress hypothesized: the distress depending on factors related to therapeutic decisions (type A) from those depending on processes of adaptation and coping (type B). Results: Few days after diagnosis, it is possible to distinguish two different types of distress: indeed, the most frequent distress themes patients talk about are distributed among issues that affect the impact of the disease in personal life (family, marriage, infertility, work) or more directly related to external organizational factors (diagnostic completions, the waiting for therapies) that it can be defined as type B to issues related to decision-making processes about therapeutic strategies to be adopted, type A. Conclusions: The results show how much distress can be attributed to time-dependent factors (start the therapies or coping processes) but also to variables related to the ability to feel active in decision-making processes, particularly with regard to requests for over-and under-medical treatments. On these latter factors, you can reduce distress through timely communication to the entire team about the interview results and through the involvement of the multidisciplinary team.
Health Services Research, 2005
Objective. To better understand medical decision making in the context of ''preference sensitive care,'' we investigated factors associated with breast cancer patients' satisfaction with the type of surgery received and with the decision process. Data Sources/Data Collection. For a population-based sample of recently diagnosed breast cancer patients in the Detroit and Los Angeles metropolitan areas (N 5 1,633), demographic and clinical data were obtained from the Surveillance, Epidemiology, and End Results tumor registry, and self-reported psychosocial and satisfaction data were obtained through a mailed survey (78.4 percent response rate). Study Design. Cross-sectional design in which multivariable logistic regression was used to identify sociodemographic and clinical factors associated with three satisfaction measures: low satisfaction with surgery type, low satisfaction with the decision process, and decision regret. Principal Findings. Overall, there were high levels of satisfaction with both surgery and the decision process, and low rates of decision regret. Ethnic minority women and those with low incomes were more likely to have low satisfaction or decision regret. In addition, the match between patient preferences regarding decision involvement and their actual level of involvement was a strong indicator of satisfaction and decision regret/ambivalence. While having less involvement than preferred was a significant indicator of low satisfaction and regret, having more involvement than preferred was also a risk factor. Women who received mastectomy without reconstruction were more likely to report low satisfaction with surgery (odds ratio [OR] 5 1.54, po.05), low satisfaction with the process (OR 5 1.37, po.05), and decision regret (OR 5 1.55, po.05) compared with those receiving breast conserving surgery (BCS). An additional finding was that as patients' level of involvement in the decision process increased, the rate of mastectomy also increased ( po.001). Conclusions. A significant proportion of breast cancer patients experience a decision process that matches their preferences for participation, and report satisfaction with both the process and the outcome. However, women who report more involvement in the decision process are significantly less likely to receive a lumpectomy. Thus, increasing patient involvement in the decision process will not necessarily increase use of BCS or lead to greater satisfaction. The most salient aspect for satisfaction with the decision
Women with breast cancer: self-reported distress in early survivorship
Oncology nursing forum, 2015
To identify and compare levels of distress and sources of problems among patients with breast cancer in early survivorship. Descriptive, cross-sectional. A National Cancer Institute-designated comprehensive cancer center. 100 breast cancer survivors were selected to represent four time points in the cancer trajectory. Distress was self-reported using the Distress Thermometer and its 38-item problem list. Analysis of variance and chi-square analyses were performed as appropriate. Distress scores, problem reports, and time groups. Participants scored in range of the cutoff of more than 4 (range = 4.1-5.1) from treatment through three months post-treatment. At six months post-treatment, distress levels were significantly lower. Significant differences were found between groups on the total problem list score (p = 0.007) and emotional (p = 0.01) and physical subscale scores (p = 0.003). Comparison of groups at different points in the cancer trajectory found similar elevated levels from ...
Indicators of distress in newly diagnosed breast cancer patients
PeerJ, 2015
Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient's knowledge (β = −0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping selfefficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = −0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress. Subjects Oncology, Psychiatry and Psychology WB, Golden-Kreutz DM, Emery CF, Thornton LM, Young DC, Carson 3rd WE. 2008. Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer 113(12):Arora NK, Finney Rutten LJ, Gustafson DH, Moser R, Hawkins RP. 2007. Perceived helpfulness and impact of social support provided by family, friends, and health care providers to women newly diagnosed with breast cancer. Psycho-Oncology 16(5):474-486 DOI 10.1002/pon.1084. Avci IA. 2008. Factors associated with breast self-examination practices and beliefs in female workers at a Muslim community. AS, Moffat Jr FL, Clark KC. 1993. How coping mediates the effects of optimism on distress: a study of women with early stage breast cancer. . Carver CS, Scheier MF. 2000. Scaling back goals and recalibration of the affect system are processes in normal adaptive self-regulation: understanding 'response shift' phenomena. Social Science and Medicine 50(12):1715-1722 DOI 10.1016/S0277-9536(99)00412-8. Casellas-Grau A, Font A, Vives J. 2014. Positive psychology interventions in breast cancer. A systematic review. Psycho-Oncology 23(1):9-19 DOI 10.1002/pon.3353. Chen JY, Diamant AL, Thind A, Maly RC. 2008. Determinants of breast cancer knowledge among newly diagnosed, low-income, medically underserved women with breast cancer. Cancer . Fiszer C, Dolbeault S, Sultan S, Brédart A. 2014. Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psychooncology 23(4):I, Dulay MF, Liscum KR. 2006. Optimism, social support and psychosocial functioning among women with breast cancer. Psycho-Oncology 15(7):595-560 DOI 10.1002/pon.992. Gallagher J, Parle M, Cairns D. 2002. Appraisal and psychological distress six months after diagnosis of breast cancer. . Henselmans I, Fleer J, de Vries J, Baas PC, Sanderman R, Ranchor AV. 2010. The adaptive effect of personal control when facing breast cancer: cognitive and behavioural mediators. Psychology and Health 25(9):HW, Fielding R. 2007. Treatment decision difficulties and post-operative distress predict persistence of psychological morbidity in Chinese women following breast cancer surgery. Psychooncology 16(10):Maunsell E, Brisson J, Deschi'nes L. 1992. Psychological distress after initial treatment of breast cancer assessment of potential risk factors. Cancer 70(1):120-125 . Mehnert A, Koch U. 2008. Psychological co-morbidity and health-related quality of life and its association with awareness, utilization and need for psychosocial support in a cancer register based sample of long-term breast cancer survivors. Journal of Psychosomatic Research (02)00350-1. Ohaeri BM, Ofi AB, Campbell OB. 2012. Relationship of knowledge of psychosocial issues about cancer with psychic distress and adjustment among breast cancer clinic attendees in a Nigerian teaching hospital. Psycho-Oncology 21(4):419-426 DOI 10.1002/pon.1914. Philip EJ, Merluzzi TV, Zhang Z, Heitzmann CA. 2013. Depression and cancer survivorship: importance of coping self-efficacy in post-treatment survivors. Psycho-Oncology 22:987-994 DOI 10.1002/pon.3088. Preacher KJ, Hayes AF. 2008. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40(3):879-891
Difference of patient's perceived need in breast cancer patients after diagnosis
Japanese Journal of Clinical Oncology, 2014
Objective: The purpose of this study was to investigate the difference of patients' perceived needs after cancer diagnosis. Differences in quality of life and psychological distress were also examined. Methods: Ambulatory breast cancer patients who were randomly selected participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey, which covers five domains of need (health system and information, psychological, physical, care and support and sexuality needs), the European Organization for Research and Treatment of Cancer QLQ-C 30 and the Hospital Anxiety and Depression Scale. Results: A total of 408 patients were enrolled and distributed into four groups [Group 1 (N = 115)], within 1 year of diagnosis; Group 2 [N = 105], 1-3 years since diagnosis; Group 3 [N = 94], >3 years since diagnosis; and Group 4 [N = 94], recurrence). Significant differences were observed in total, psychological, physical and daily living, and patient care and support needs, as well as in quality of life, whereas there were no significant differences in health system and information, sexuality needs and psychological distress. In general, Groups 1 and 4 had a higher need level and lower quality of life. Conclusions: Patients' perceived needs and quality of life may vary according to time since cancer diagnosis and the presence of cancer recurrence. The findings suggest that different care for supporting breast cancer survivors after diagnosis should be recommended, and that the time since diagnosis and/or the presence of recurrence may be relevant indicators for providing optimal and individualized care.