Cancer fatalism and breast cancer screening in African American women.

Despite significant advances in science, medicine, and technology African American women are more likely to die from breast cancer than Caucasian women. There is a growing body of literature that describes strategies to improve breast cancer screening among African American women. However, data suggest that African American women, compared to Caucasian women, are less likely to participate in regular breast cancer screening. The belief that a diagnosis of cancer will result in death has been identified as a potential barrier to cancer screening in African American population groups. However, research examining the degree to which perceptions of fatalism influence breast cancer screening in culturally and ethnically diverse population groups is scant. This repot describes the outcomes of a study undertaken to examine relationships between perceptions of cancer fatalism and breast cancer screening in African American women. Findings support the postulation that fatalism negatively influences health promoting practices such as breast cancer screening. However, contrary to prior research findings age was observed to be inversely associated with cancer fatalism.     

Developing and testing lay literature about breast cancer screening for African American women

Written materials about breast cancer screening for African American women with low literacy skills are needed. Available materials were not at or below third-grade reading levels, were not culturally sensitive, and were not accurate in illustrating correct breast self-examination (BSE) techniques. Focus groups representing the target population helped the authors design a pamphlet describing how to perform BSE and a motivational picture book to help women overcome barriers to screening. The authors chose a food theme for the cover of the pamphlet written at a third-grade level and suggested a photographic version. In the motivational book, two women address barriers to screening and replace myths and fears with facts and actions. Data from 162 women showed that they learned from both the photographic and illustrated versions. Women in the photographic group found significantly more lumps in the silicone models, so the authors chose that version to use in final testing. Finally, nurses pretested a group of patients before they reviewed the materials and post-tested another group after they reviewed them. The group who had reviewed the materials had greater knowledge of and intent to follow the guidelines and received higher scores on BSE techniques.     

Religion and spirituality: influence on health/risk behavior and cancer screening behavior of African Americans.

In spite of the diversity in the principles, expression and practice, it is believed that significant improvements can occur in the health status of African Americans if health education and outreach efforts are presented and promoted through religious, spiritual and faith-based venues. Several reports published in the peer-reviewed literature address issues related to religion, spirituality and cancer control among African Americans. This growing body of literature describes outcomes of several cancer prevention and control programs designed for and conducted within the African American faith community. However, few efforts have been undertaken to examine the influence of religion and spirituality on health/risk behavior and cancer screening practices of African Americans within the faith community. This report presents the outcomes of an exploratory study undertaken to examine the influence of religion and spirituality on the health/risk behavior and cancer screening practices of African American congregants. Data suggest a need for tailored and targeted health education, outreach and programming among the targeted group of congregants focused specifically on tobacco control, diet and nutrition, exercise and physical activity, weight management, and cancer screening. The same appears to be the case relative to the need for education, outreach and programming focused on communication with primary care providers.     

The quality of life of African American women with breast cancer

The objectives of this study were to describe the quality of life of African American women with breast cancer and test a model of factors that may affect their quality of life. A stress-coping framework that included person (demographics, current concerns, and optimism), social resources (family functioning), and illness-related factors (symptom distress, medical characteristics), as well as appraisal of illness and quality of life, was used to guide this exploratory, cross-sectional study. Participants included 98 African American women who were approximately 4 years postdiagnosis. The women reported a fairly high quality of life, were generally optimistic, and had effective family functioning. Although symptom distress was generally low, a sizable number of women reported problems with energy loss, sleep disturbances, and pain. The model explained 75% of the variance in quality of life, with appraisal, family functioning, symptom distress, and recurrence status each explaining a significant amount of the variance. Current concerns had an indirect effect on quality of life that was mediated by appraisal. These findings underscore the importance of helping women foster a positive appraisal of their illness, manage current concerns, maintain family functioning, and reduce symptom distress, because each of these factors indirectly or directly affects their quality of life.     

Prostate cancer screening in African American and Caribbean males: detriment in delay.

Men of the African diaspora are diagnosed with prostate cancer much later than Caucasians and the mortality rate is significantly higher in these groups than among Caucasians. This study investigates health beliefs surrounding prostate health in a sample of African American and Caribbean men and identifies reasons men have for delaying or avoiding prostate screenings. One hundred African American and Caribbean men recruited from three churches, aged 37-89, were surveyed about their health seeking behaviors and knowledge of prostate cancer. Forty-five of these men also attended a seminar on the importance of early detection. Eighty percent of the men revealed they were embarrassed to have digital rectal examinations. Sixty percent feared impotence and incontinence after treatment if diagnosed with cancer. Findings reveal that attention to cultural realities may assist healthcare professionals in planning culturally sensitive educational interventions in the community that may narrow the health disparities gap in this population.     

Symptom distress, spirituality, and quality of life in African American breast cancer survivors

This study examined the relationships among the demographic characteristics, symptom distress, spirituality, and quality of life (QOL) of African American breast cancer survivors. A convenience sample of 30 survivors with a mean age of 56 years and a mean survival of 6 years was recruited from African American breast cancer support groups and churches in the Southeastern United States. Data were collected through face-to-face interviews using a demographic questionnaire, the Quality of Life Index-Cancer Version, the Symptom Distress Scale, and the Spiritual Perspective Scale. Statistically significant relationships were found between symptoms and QOL (r = -0.62, P < .05) and between spirituality and QOL (r = 0.70, P < .05). No statistically significant relationships were found between age at diagnosis, income, or education and QOL. This research suggests that symptoms and spirituality are associated with QOL. Culturally appropriate care should be provided to these women to reduce health disparities and to improve their QOL.     

African American women and breast cancer: notes from a study of narrative

Survival after breast cancer and after all cancers is significantly worse for African American women than for others. Although many reasons have been proposed, no studies have explored the reception of messages about breast cancer by African American survivors of this disease, and how public images and discourses about breast cancer affects both their perceived risk for this disease and their experiences of illness. Narrative accounts of their lived experiences with breast cancer were collected from 23 African American survivors of breast cancer. Three themes have emerged: (a) Breast cancer is perceived to be a white woman's disease; (b) cancer is caused by experiences of repeated traumatic heartbreak; and finally, (c) there is a perceived lack of social support and understanding for the unique life experiences of the African American survivor of breast cancer. Nurses are on the front line of patient care. In the context of the managed care environment, they spend more time with patients than other health care providers and are soundboards for many patient concerns. As such, they can use the information provided in this study to inform high-risk women, current patients, partners, and other individuals in the medical community of how African American women might inaccurately access their personal risks for breast cancer, despite the public emphasis on this disease. Through the use of culturally sensitive pamphlets, nurses and other medical practitioners can also open discussions with underserved and minority patients as a means of realistically addressing some of these women's fears about breast cancer. These fears are barriers to effective cancer prevention because these individuals may consciously or unconsciously link a diagnosis of breast cancer, or even behaviors related to cancer prevention, to a potential death sentence.     

Outcomes of training nurses to conduct breast and cervical cancer screening of Native American women

Native WEB (Women Enjoying the Benefit) is a unique training program for nurses employed by the Indian Health Service (IHS), tribal clinics, and other clinics with large, underserved populations. It teaches nurses breast and cervix cancer screening techniques and trains them to administer and maintain high-quality screening programs that include patient outreach, education, and training. We review American Indian (AI)/Alaska Native (AN) women's need for screening services, identify some of the obstacles to screening, and present our evaluation of the Native WEB's impact on clinics, nurses, and patients. Findings show that Native WEB training is associated with increased screening activity at all three levels.     

Pilot study of the breast cancer experiences of African American women with a family history of breast cancer: implications for nursing practice

Experts in the area of breast cancer detection and control recommend that women at increased risk discuss their risk status and risk management with their health care providers. In spite of the excessive breast cancer burden borne by African American women, little attention has been given to studying breast cancer risk communication and/or breast cancer risk management in this at-risk population group. This report summarizes the outcomes of a study undertaken to explore the degree to which breast cancer, breast cancer risk, and breast cancer risk management were discussed by African American women and their health care providers Targeted for inclusion in the study were African American women who had a first degree relative or multiple second degree relatives that had been diagnosed with pre-menopausal breast cancer. Of particular interest was the extent to which African American women with a family history of breast cancer perceived themselves to be at risk for developing breast cancer and the extent to which they discussed their family history, their breast cancer risk, and, breast cancer risk management with their providers.     

African American women with breast cancer and their spouses' perception of care received from physicians.

Several studies have been conducted which have examined the communication patterns and interpersonal relationships among minority patients and their physicians. These studies suggest that there are differences in the care received from physicians based on the racial and cultural background of the patient. However, little is known about the interpersonal relationships and communication patterns of AA couples coping with a breast cancer diagnosis and their physicians. This report presents the outcomes of a qualitative study undertaken to examine the perceptions of breast cancer care rendered by physicians to African American couples. The AA couples involved in the study reported that the care they received was compassionate, competent, comprehensive and comparable to other women. Each of these qualities was identified by as being essential to quality patient care.     

The health-care practices of Vietnamese-Canadian women: cultural influences on breast and cervical cancer screening.

Breast and cervical cancer are major contributors to morbidity and mortality among Vietnamese-Canadian women. Vietnamese women are at risk due to their low participation rate in screening programs for these cancers. The purpose of this exploratory qualitative study, informed by Kleinman's Exploratory Model of Health and Illness, was to explore the participation of Vietnamese-Canadian women in screening for breast and cervical cancer; the appropriateness of current cancer-prevention services for Vietnamese women; and the influence of social, cultural, political, historical, and economic factors, shaped by race, gender, and class, on the screening practices of Vietnamese-Canadian women. Fifteen Vietnamese-Canadian women and 6 health-care providers were interviewed. Analysis revealed that several factors influenced the women's participation in cancer screening. This paper reports on the process by which cultural knowledge and beliefs contributed to the women's health-care practices. The study revealed that the following cultural factors influenced the women's level of participation in screening programs for breast and cervical cancer: cultural knowledge and values with regard to women's bodies, conceptualization of health and illness, and beliefs and values concerning the patient/health-care provider relationship. The author offers recommendations on the promotion of screening for breast and cervical cancer among Vietnamese-Canadian women.     

Recruitment of African American women to a walking program: eligibility, ineligibility, and attrition during screening

The purposes of this study were to identify strategies successful in the recruitment of African American (AA) women to a home-based walking program and to examine factors that contribute to attrition, eligibility, and ineligibility during the recruitment screening protocol. Of the 696 women who contacted the researchers, 281 (40.4%) women enrolled in the study, 227 (32.6%) were lost to attrition, and 188 (27%) were ineligible. Those not enrolled due to attrition during screening or ineligibility reported more family risk for cardiovascular disease (CVD) and lived in neighborhoods with higher poverty. Although our recruitment strategies may have been successful in attracting low-income AA women, we were not as successful in preventing their attrition during the screening protocol, particularly for those living in poorer neighborhoods.     

What we thought we knew: African American males' perceptions of prostate cancer and screening methods.

This study applied the Health Belief Model in determining African American male's knowledge, attitudes and perceptions of prostate cancer and early detection methods. The ultimate value of the information assessed from this population was used to design specific theory-based, culturally relevant interventions which may decrease mortality in this high-risk population. Two focus groups were conducted with African-American men whose ages ranged from 38-80 years. After consenting to audio-taping, participants completed a survey questionnaire and viewed a culturally appropriate video on prostate cancer. Results indicate that, on average, the men believed in the efficacy of prostate cancer early detection methods. Study participants felt physicians did not adequately screen or suggest that they be screened for prostate cancer. Men between 40 and 50 years of age expressed concern about possible changes in their sex life if diagnosed with prostate cancer. Despite having limited knowledge of prostate cancer they considered a digital rectal examination to be embarrassing and uncomfortable. However, they were not opposed to having the procedure done.     

The culture of pregnancy and infant care in African American women: an ethnographic study.

In Hamilton County, Ohio, the infant mortality rate for African American infants in 2002 was 18.1 per 1,000 live births compared with 14.4 for the United States. It is essential to engage community residents and leaders in identifying the underlying cultural factors contributing to this disparity. The purpose of the study was to explore the cultural contexts of prenatal and infant care practices among African American women of childbearing age living in an urban community located in Hamilton County, Ohio. This was an ethnographic community-based participatory research study. Seven participants were recruited for the study. Family support from mothers and sisters in obtaining needed resources related to pregnancy and child care emerged as the central theme. A strong family-based social network was core to the culture of pregnancy and infant care for these women. Nurses should consider developing family-centered interventions to reduce disparity in infant health.     

The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial

Background

Few studies have investigated breast health programs to promote rates of having a mammography, clinical breast examination and breast self-examination among non-adherent Turkish women.

Objectives

To determine the effectiveness of a breast health promotion program on mammography and clinical breast examination use, breast self-examination frequency and proficiency (breast self-examination skills and lump detection), breast health knowledge and health beliefs about breast cancer screening in a sample of Turkish women.

Design

Experimental (pretest-posttest control group).

Setting

A community-based setting in Istanbul, Turkey.

Participants

190 Non-adherent women (intervention group = 97, control group = 93) aged 41 and older, residing in Istanbul, Turkey.

Methods

The intervention group (n = 97) received a 120-min breast health promotion program based on health belief model including a breast health education, film, breast self-examination instruction, and a booklet, a calendar, a card designed specifically for the study. The control group (n = 93) received general information except breast health. Data were collected before the program, immediately after the program, and at 3- and 6-month post-program. The outcome measures are the mammography, clinical breast examination, and breast self-examination frequency, breast self-examination proficiency, breast health knowledge, and health beliefs (perceived susceptibility to breast cancer, benefits to mammography and breast self-examination, barriers of mammography and breast self-examination, confidence in performing breast self-examination).

Results

The breast health promotion program significantly increased breast self-examination frequency and proficiency and breast health knowledge. No significant differences existed in mammography and clinical breast examination rates between the two groups at 6 months. The program was effective in increasing perceived susceptibility to breast cancer, perceived benefits of mammography and breast self-examination, and confidence of breast self-examination. No significant difference was found between the two groups for perceived barriers to mammography.

Conclusions

The breast health promotion program was effective in increasing breast self-examination frequency and proficiency in a sample of Turkish women. In addition, it appears to be useful in raising the knowledge of breast health, enhancing confidence in performing breast self-examination, and increasing most health belief levels.     

A pilot study to examine patient awareness and provider discussion of the impact of cancer treatment on fertility in a registry-based sample of African American women with breast cancer

Purpose

Fertility is a concern for many cancer patients diagnosed during their reproductive years. Although African American women are more likely to be diagnosed with early breast cancer (i.e., ≤age 40), little is known about patient awareness of or provider discussion related to fertility in this group. We examined African American women's awareness of the possible impact of cancer treatment on fertility.

Methods

In a cross-sectional survey of African American women with early-onset breast cancer, demographic and clinical variables were compared with patient awareness and physician discussion of potential fertility loss.

Results

For women in our sample (N?=?48), 45.8% reported being aware of the potential impact of cancer treatment on fertility, and 56.3% reported that their providers discussed fertility with them. Bivariate analyses demonstrated that awareness was significantly higher in women diagnosed at age ≤45 (p?p?p?p?p?Conclusion Study results suggest potential health disparities in reproductive health among early-onset breast cancer patients and demonstrate missed clinical opportunities to provide information about fertility that may impact long-term quality of life in early-onset African American breast cancer patients.